The Clinical journal of pain
-
Randomized Controlled Trial Comparative Study
Preoperative but Not Postoperative Flurbiprofen Axetil Alleviates Remifentanil Induced Hyperalgesia after Laparoscopic Gynecological Surgery: A Prospective, Randomized, Double-blinded, Trial.
Acute remifentanil exposure during intraoperative analgesia might enhance sensitivity to noxious stimuli and nociceptive responses to innocuous irritation. Cyclooxygenase inhibition was demonstrated to attenuate experimental remifentanil-induced hyperalgesia (RIH) in rodents and human volunteers. The study aimed to compare the effects of preoperative and postoperative flurbiprofen axetil (FA) on RIH after surgery. ⋯ Preoperative FA reduces postoperative RIH in patients undergoing laparoscopic gynecologic surgery under sevoflurane-remifentanil anesthesia.
-
In 2009, Gramke and colleagues have described predictive factors to preoperatively detect those at risk for moderate to severe acute postsurgical pain (APSP) after day surgery. The aim of the present study is to externally validate this initial model and to improve and internally validate a modified version of this model. ⋯ The original prediction model of Gramke and colleagues performed insufficiently on our cohort of outpatients with respect to discrimination and calibration. Internal validation of a modified model shows promising results. In this model, preoperative pain, patient derived expected pain, and different types of surgery are the strongest predictors of moderate to severe APSP after day surgery.
-
To determine pressure pain detection threshold (PPDT) related phenotypes of individuals with mechanical neck pain that may be identifiable in clinical practice. ⋯ The results suggest that there are a large proportion of people with neck pain that present with signs indicating dysfunction beyond the local tissues. Ongoing exploration of these presentations may lead to more informed management and improved outcomes.
-
Normal efficiency of exercise-induced hypoalgesia (EIH) has been demonstrated in people with knee osteoarthritis (OA), while recent evidence suggests that EIH may be associated with features of pain sensitization such as abnormal conditioned pain modulation (CPM). The aim of this study was to investigate whether people with knee OA with abnormal CPM have dysfunctional EIH compared with those with normal CPM and pain-free controls. ⋯ Results are suggestive of dysfunctional EIH in response to aerobic and isometric exercise in knee OA patients with abnormal CPM, and normal function of EIH in knee OA patients with an efficient CPM response. Identification of people with knee OA with inefficient endogenous pain modulation may allow for a more individualized and graded approach to exercises in these individuals.
-
Although reducing pain catastrophizing has been shown to contribute to functional improvement in patients receiving interdisciplinary pain care, little is known about how changes in the different dimensions of pain catastrophizing uniquely contribute to improvement in outcome. The study examined the unique relationship between changes in the 3 distinct factors of pain catastrophizing-helplessness, rumination, and magnification-and changes in pain outcomes. ⋯ Results suggest that changes in the 3 dimensions of pain catastrophizing differentially mediate improvement in pain outcome. Treatment approaches that specifically target helplessness and rumination may be particularly useful in improving the outcomes of patients with refractory pain conditions enrolled in interdisciplinary pain rehabilitation program.