The Clinical journal of pain
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This study sought to determine what functional and affective outcomes had the most predictive value for overall satisfaction and improvement in patients seeking chiropractic treatment of low back pain. ⋯ Pragmatic rather than affective variables played some part in predicting satisfaction through global improvement in these patients. This should help to inform future interpretation of clinical trials of chiropractic treatments for back pain. However, the nature of the "unknown" components needs further investigation. There are initial indications in the literature that information giving, and the reconfiguration of patients' perceptions of the problem, may contribute to patient satisfaction generally. Further work is needed to confirm this and to establish where such interventions can also contribute to overall improvement.
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Myofascial pain syndrome (MPS) is defined as acute or chronic pain with sensory or motor autonomic symptoms, referred from active myofascial triggering points with associated dysfunction. Previous studies have suggested the usefulness of botulinum toxin A (BTX-A) in the treatment of MPS since it is capable of controlling muscular spasms, as well as other alternative mechanisms of action. ⋯ The results of this study are consistent with other studies showing the efficacy of BTX-A for treating pain in MPS. The evaluation of the psychologic dimension of this disorder and its associated disability can provide valuable information for the adequate management of these patients and for assessing treatment outcome.
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Sex differences in the response threshold to painful stimuli and the higher number of chronic pain syndromes in women than in men have prompted a series of studies on lower animals and humans aimed at clarifying the role of gonadal hormones in pain. ⋯ This article examines the morphologic and functional aspects of gonadal hormone systems and the relations between gonadal hormones and pain circuits, to identify areas deserving of increased attention in elucidating the endocrine mechanisms that contribute to abnormal pain states.
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Analgesic drug development as currently undertaken is limited by a number of factors that contribute to the paucity of new analgesics introduced into clinical practice despite marked advances in delineating of the molecular-genetic mechanisms contributing to acute and chronic pain. The participants in this workshop explored the unmet need in analgesia and recommended strategies for enhancing analgesic drug development in the future. The workshop concluded that translating scientific advances into improved pain relief will require new thinking and a cooperative effort among the pharmaceutical industry, regulatory agencies, funding agencies, the biomedical research community, professional societies and clinicians. The workshop also recommended that a better understanding of the epidemiology of pain could contribute to improvement in clinical trial methodology and outcome measures.
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Randomized Controlled Trial Clinical Trial
The cholecystokinin antagonist proglumide enhances the analgesic effect of dihydrocodeine.
To investigate the potential pro-analgesic effect of the non-specific CCK antagonist proglumide on the analgesia produced by dihydrocodeine. ⋯ The CCK antagonist proglumide enhances the analgesic effect of dihydrocodeine.