The Clinical journal of pain
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Randomized Controlled Trial
Botulinum Toxin A in Postherpetic Neuralgia: A Parallel, Randomized, Double-Blind, Single-Dose, Placebo-controlled Trial.
Cumulative evidence support a beneficial effect of botulinum toxin A (BTX-A) in postherpetic neuralgia (PHN). We aimed to assess efficacy, safety, and tolerability of BTX-A in the management of PHN, performing a randomized, double-blind, single-dose, placebo-controlled trial. ⋯ Data confirm that BTX-A is effective and well tolerated in the treatment of PHN.
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Catheterization to measure bladder sensitivity is aversive and hinders human participation in visceral sensory research. Therefore, we sought to characterize the reliability of sonographically estimated female bladder sensory thresholds. To demonstrate this technique's usefulness, we examined the effects of self-reported dysmenorrhea on bladder pain thresholds. ⋯ Sonographic estimates of bladder sensory thresholds were reproducible and reliable. In these healthy volunteers, dysmenorrhea was associated with increased bladder pain and urgency during filling but unrelated to capacity. Plausibly, women with dysmenorrhea may exhibit enhanced visceral mechanosensitivity, increasing their risk to develop chronic bladder pain syndromes.
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Case Reports
An Alternative to Traditional Mirror Therapy: Illusory Touch Can Reduce Phantom Pain When Illusory Movement Does Not.
There is evidence that amputation leads to cortical reorganization, and it has been suggested that phantom pain might be related to a consequently emerging incongruence of motor intention, somatosensation and visual feedback. One therapeutic approach that has the potential to temporarily resolve this visuo-proprioceptive dissociation is mirror therapy, during which amputees typically move their intact limb while observing its reflection in a mirror, which in turn evokes the illusory perception of movement of their phantom limb. However, while the action of moving the phantom relieves pain for some patients, it can actually increase cramping sensations in others. In the current study we therefore implemented an alternative version of the mirror therapy involving a visuotactile illusion, to explore whether it might be effective with amputees for whom the action of moving the phantom increases phantom pain. ⋯ Albeit preliminary, our results represent an encouraging finding of possible future clinical relevance, and indicate that the type of multisensory stimulation that most efficiently reduces phantom pain can vary in different sub-populations of amputees.
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Case Reports
Percutaneous Trigeminal Rhizotomy for Facial Pain Secondary to Head and Neck Malignancy.
Nearly 80% of patients with head and neck cancers experience facial pain related to their tumor or treatment. The majority obtain pain relief with appropriate medical treatment. Occasionally some remain refractory to all analgesics or cannot tolerate the accompanying side effects. They may benefit from surgical intervention. ⋯ Percutaneous trigeminal rhizotomy is a surgical option for managing nociceptive pain secondary to a head and neck malignancy. This technique, last reported in the literature almost 30 years ago, must not be forgotten by the next generation of oncologists, pain specialists, and neurosurgeons.
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To investigate the relation between localized pressure pain sensitivity and the amplitude and specificity of semispinalis cervicis muscle activity in patients with chronic neck pain. ⋯ In contrast to asymptomatic individuals, the semispinalis cervicis muscle displays reduced and less-defined EMG activity during a multidirectional isometric contraction in patients with chronic neck pain. The altered behavior of the semispinalis cervicis is weakly associated to pressure pain sensitivity.