The Clinical journal of pain
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Comparative Study
Effect of high-frequency vibration on experimental pain threshold in young women when applied to areas of different size.
The purpose of this study was to compare the effects of high-frequency vibration when applied to two areas of different size. Subjects were 30 right-handed Caucasian women, aged 19-38 years, with a negative history of upper extremity dysfunction. The experimental cutaneous pain threshold was determined by stimulating the skin over the pisiform bone on the palmar surface of the hand. ⋯ Results of the mixed design analysis of variance performed on the mean pain thresholds indicate that there was no significant main effect for group (size of area vibrated), p greater than 0.05, or interaction effect between group by trial (size of area vibrated and time of pain threshold measurement), p greater than 0.05. There was a significant main effect for trial (time of pain threshold measurement), p less than 0.001. Pain threshold values were greatest for both groups during the period of vibration.
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Work and injury related musculoskeletal pain is often complicated by psychological and medicolegal factors that obscure the validity of the pain presentation. Pressure algometry and stretching during thiopentone sodium (Pentothal) anesthesia was studied in 45 cases of musculoskeletal injury. ⋯ In unilateral pain cases, a right to left pressure threshold difference of 2.0 kg/cm2 predicted 94% of true organic pain cases and 100% of cases at a pressure threshold of 1.5 kg/cm2 if combined with stretching. Results of stretching painful areas correlated highly with pressure threshold assessments.
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Randomized Controlled Trial Clinical Trial
A controlled trial of the treatment of migraine by acupuncture.
A randomised controlled trial comparing true and sham acupuncture was conducted on 30 patients suffering from chronic migraine. Diary measures of headache and medication intake were recorded throughout the study, and measures of headache quality, anxiety, and pain behaviour were taken. ⋯ True acupuncture was significantly more effective than the control procedure in reducing the pain of migraine headache. Posttreatment reductions in pain scores and medication of 43 and 38%, respectively, were recorded in the true acupuncture group and were maintained at 4-month and 1-year follow-up.
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Reflex sympathetic dystrophy (RSD) usually occurs in an individual who has been experiencing significant personal stress, a state associated with increased discharge of norepinephrine (NE) from perivascular postganglionic sympathetic neurons. RSD is often precipitated by this sequence: traumatic arterial spasm, regional ischemia, neurogenic inflammation, and ischemic/edematous damage to membranes of preterminal perivascular nociceptive neurons. In the natural repair of these membranes, it is suggested that adrenoceptors appear and are ordinarily transitory; but in RSD, they are retained by the increased adjacent NE. This process delays further healing, produces pain, and releases inflammatory substances, resulting in interacting pathophysiologic vicious cycles.
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In an effort to identify components of the chronic pain experience, a sample of 444 chronic pain patients who had completed a battery of self-report measures was divided into two groups. The data from each group were analyzed using principal components analysis. Four factors emerged for one group of patients, which accounted for 57.6% of the variance and represented the dimensions of psychological distress, pain-related disability, pain description, and pain history. ⋯ These factors represented psychological distress, disability, pain intensity, pain sensation, and pain history. The similarity of these factors across groups suggests that they represent stable dimensions of the patient's pain experience. Research implications and methodological considerations are discussed.