European journal of pain : EJP
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There is continuing reluctance to prescribe strong opioids for the management of chronic non-cancer pain due to concerns about side-effects, physical tolerance, withdrawal and addiction. Randomized controlled trials have now provided evidence for the efficacy of opioids against both nociceptive and neuropathic pain. However, there is considerable variability in response rates, possibly depending on the type of pain, the type of opioid and its route of administration, the time to follow-up, compliance and the development of tolerance. ⋯ There were no withdrawal effects or addictive behaviour on treatment cessation, regardless of duration of the treatment. In conclusion, strong opioids may provide prolonged effective pain relief in selected patients with nociceptive and neuropathic non-cancer pain. Transdermal fentanyl treatment can often be temporary and can easily be stopped following adequate pain relief without withdrawal effects or any evidence of addictive behaviour.
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Clinical Trial Controlled Clinical Trial
The assessment of radiating low back pain by thermal sensory testing.
Low back pain radiating into the legs is a common pain syndrome. However, neurological examination, imaging and electromyographic studies are of limited value for prognosis or therapy. The origin of the pain remains unknown. ⋯ We propose that these findings indicate selective damage to the Adelta fibres which are involved in transmission of cold sensation and pain, presumably by root compression. We found no evidence of involvement of C fibres, which transmit warm sensation and pain. Thermal testing should be considered among the testing modalities that are capable of demonstrating objective findings in patients with radiating low back pain.
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This synopsis outlines factors that prompted development of national clinical practice guidelines for the management of pain and presents the essential content of major pain control guidelines. Also described is the concurrent growth of the evidence-based pain management movement worldwide in the decade since initial US federal guidelines on acute and cancer pain were developed, and products of this global movement. ⋯ This survey will highlight recent research that evidence-based guidelines alone are insufficient to overcome established attitudes, practices and myths that hinder pain assessment and management. Hypotheses for the inadequacy of scientific evidence per se to overcome clinicians' attitudes and practices will be advanced, along with suggestions as to how those in the 'pain treatment community' may help to tip the balance.
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The present study was undertaken to assess the health-related quality of life (HRQoL) and burden of illness due to pain and its treatment for patients with peripheral neuropathic pain (PNP). It is the first step in finding reliable instruments/targets to evaluate treatment outcome in this patient population. Study population consisted of 126 patients suffering from neuropathic pain due to a peripheral nerve or root lesion, recruited from two multidisciplinary pain clinics. ⋯ Besides pain, patients were most bothered by difficulty in sleeping, lack of energy, drowsiness, difficulty in concentrating and dry mouth. Employment status was reduced owing to pain in 52% of the patients. The intense pain, other troublesome symptoms, limited efficacy and tolerability of available treatments, together with the impaired health and reduced work status, amount to a substantial burden for patients with PNP.
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This study compared the pain sensitivity in healthy women at the abdomen and lower back (presumed referral areas of menstrual pain), thigh and arm (control areas), in the menstrual, ovulatory, luteal and premenstrual phases of confirmed ovulatory cycles, with that of males. The pressure pain threshold (PPT) and pinch pain threshold (PiPT) was determined by an electronic pressure algometer, heat pain threshold (HPT) by a contact thermode and tactile threshold (TT) with von Frey hairs. The abdominal PPT was significantly lower in females in all menstrual phases as compared to the control sites ( p<0.0007). ⋯ During the ovulatory phase, the HPT was significantly reduced at the abdomen and the PPT at the back compared with the menstrual, luteal and premenstrual phases (p<0.0002). There were no within-menstrual phase variations in the PiPT and TT at any site, or for the HPT and PPT at the control areas. The reduced thresholds in menstruating women may be due to the presence of latent uterine algogenic stimuli, and the increased levels of oestrogen and leuteinizing hormone at ovulation may enhance nociception by acting both at the peripheral and central level, resulting in the hypersensitivity changes at the abdomen and lower back areas.