European journal of pain : EJP
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The objective was to determine the association between the prevalence of lower back problems (LBP), fear-avoidance beliefs and pain coping strategies using an analytical cross-sectional epidemiological study among a group of 366 workers in a South African stainless steel industry. Outcome (LBP) was defined using a questionnaire and a functional rating index. ⋯ Significant protective associations were found for increased activity levels (OR 0.57; 95% CI 0.42-0.78). These findings have utility in preventative screening procedures to identify workers with such beliefs and coping strategies who are at risk for prolonged work restrictions.
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To describe the use of a generalizable stochastic-simulation model of the treatment of neuropathic pain associated with peripheral neuropathies. ⋯ When combined with data on health-state utilities and treatment costs, this new analytical tool can provide a foundation for formal cost-effectiveness evaluations of interventions for painful peripheral neuropathies.
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Antidepressants are widely used to treat painful chronic rheumatic conditions but, contrary to neuropathic conditions, little is known about their true analgesic properties and value in these situations. Our group, which focuses on pain in rheumatology, aimed to develop recommendations for the use of antidepressants in rheumatology, based on evidence-based review of published data and expert opinion. ⋯ These recommendations for the treatment of painful rheumatological conditions with antidepressants were developed using evidence-based and expert consensus approaches and are the first of their kind in this field. Our review of the literature highlights the need for further, well-designed clinical studies of the use of antidepressants to treat painful rheumatological conditions.
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Randomized Controlled Trial
Adding propacetamol to ketorolac increases the tolerance to painful pressure.
Combining an NSAID and paracetamol (acetaminophen) has in some studies given superior analgesia compared with the single drugs. In other trials no additive effect has been found. We have investigated the effect of this drug combination on the pressure pain tolerance threshold (PPTT), a reproducible correlate to clinical pain. The aim of this double blind, randomised, placebo controlled, crossover study was to evaluate the effect of i.v. propacetamol 2 g (= paracetamol 1 g) and ketorolac 30 mg, individually and in combination, on PPTT in 16 volunteers on four separate days. PPTT was measured 15 min before and at 45, 60, 90 and 150 min after the start of test drug administration. The pressure stimuli were applied on the base of a fingernail, increasing by 30 kPa/s until the pressure pain tolerance threshold was reached. For the total observation period (150 min), only the combination (propacetamol+ketorolac) increased significantly PPTT compared with baseline (P<0.04), while PPTT decreased significantly after placebo (P<0.01). The combination (propacetamol+ketorolac) and ketorolac alone increased PPTT compared with placebo (combination vs. placebo and ketorolac vs. placebo, P<0.001) and with propacetamol (combination vs. propacetamol and ketorolac vs. propacetamol, P<0.001). The combination was significantly better than ketorolac alone (P<0.04). After propacetamol 2 g, PPTT did not change significantly neither compared with placebo or baseline. ⋯ Tolerance to repeated painful pressure (PPTT) decreased after placebo. Ketorolac 30 mg caused an increase in PPTT compared with placebo but not with baseline. Adding propacetamol 2 g to ketorolac 30 mg significantly increased PPTT. These findings support the practice of combining paracetamol with an NSAID for relief of acute pain.
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Plurisegmental endogenous pain inhibitory mechanisms related to diffuse noxious inhibitory controls (DNIC) were demonstrated in animal experiments to act on multireceptive neurons of the entire cord outside the conditioned segment without any side differences. Human experiments have demonstrated altered pain sensitivity to pressure, heat and electrical stimulation during heterotopic noxious conditioning stimulation (HNCS). The purpose of the study was to examine if side and/or time differences in pain thresholds and suprathreshold pain sensitivity for pressure and heat, respectively, could be detected during HNCS. ⋯ On the lastly assessed side only SPP and SHP increased significantly on both sides alike (p<0.02 and p<0.03, respectively), without magnitude differences between sides. During unilateral HNCS of the left arm, a time factor was demonstrated only for alterations in suprathreshold pain sensitivity, without any differences in magnitude between sides. Therefore, the results have implications for future design of HNCS-related experimental and clinical studies.