European journal of pain : EJP
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This study investigated the role of anger in attentional bias for linguistic threat-related stimuli in individuals with chronic daily headache (CDH) tension type and healthy controls. Attentional bias was assessed using a visual probe task which presented pain-related (sensory and affective), social threat, anger-related, and neutral words at two exposure duration conditions: 500 ms and 1250 ms. Compared to healthy controls, individuals with CDH showed significantly greater attentional bias towards pain-related words at 1250 ms, indicating a bias in maintained attention to pain cues in this group. ⋯ Across the whole sample, pain bias scores at 1250 ms were significantly associated with anger out, whilst anger bias scores at both 500 ms and 1250 ms correlated significantly with trait anger. The results of the present investigation support the content-specificity hypothesis, according to which attentional bias in patients with chronic pain is shown only towards pain-related cues. Moreover, the current pattern of results highlights the importance of exploring further the role of anger in the aetiology and maintenance of chronic pain in general, and CDH tension type in particular.
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Randomized Controlled Trial
Effects of treatment of peripheral pain generators in fibromyalgia patients.
Fibromyalgia syndrome (FS) frequently co-occurs with regional pain disorders. This study evaluated how these disorders contribute to FS, by assessing effects of local active vs placebo treatment of muscle/joint pain sources on FS symptoms. Female patients with (1) FS+myofascial pain syndromes from trigger points (n=68), or (2) FS+joint pain (n=56) underwent evaluation of myofascial/joint symptoms [number/intensity of pain episodes, pressure pain thresholds at trigger/joint site, paracetamol consumption] and FS symptoms [pain intensity, pressure pain thresholds at tender points, pressure and electrical pain thresholds in skin, subcutis and muscle in a non-painful site]. ⋯ At day 8, all placebo-treated patients requested active local therapy (days 8 and 11) vs only three patients under active treatment. At a 3-week follow-up, FS pain was still lower than basis in patients not undergoing further therapy and had decreased in those undergoing active therapy from day 8 (p<0.0001). Localized muscle/joint pains impact significantly on FS, probably through increased central sensitization by the peripheral input; their systematic identification and treatment are recommended in fibromyalgia.
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Heritable phenotypes resulting from environment-caused changes in a chromosome without alterations in the DNA sequence are increasingly recognized as a basis of personalized therapy. Epigenetic mechanisms include covalent modifications of the DNA (methylation) or of the DNA-packaging histones (e.g., deacetylation or phosphorylation). In addition, regulatory non-coding RNA molecules (micro-RNAs) exert epigenetic actions. ⋯ Finally, epigenetic techniques such as RNA interference have been employed in pain research to proof the contribution of certain proteins to nociception. Thus, the new field of epigenetics becomes increasingly used in research and management of pain and will complement genetics. This article introduces epigenetics to pain and summarizes the current and future utility.
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The etiology of post-stroke shoulder pain (PSSP) is largely unclear and may involve both nociceptive and neuropathic mechanisms. No gold standard is present for PSSP diagnosis. The neuropathic pain diagnostic questionnaire (DN4), was originally developed to identify neuropathic pain in the clinical context. ⋯ Notably, several symptoms and signs suggestive of either neuropathic or nociceptive pain corresponded to the subgroups DN4+ and DN4- respectively. However, since the pathophysiological mechanisms remain unclear and none of the sensory signs could be exclusively related to either DN4+ or DN4-, PSSP prognosis and treatment should not be solely based on the DN4. Nonetheless, a thorough assessment of neuropathic and nociceptive pain complaints and somatosensory functions should be included in the diagnostic work-up of PSSP.
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Randomized Controlled Trial Comparative Study
Pain relief by applying transcutaneous electrical nerve stimulation (TENS) during unsedated colonoscopy: a randomized double-blind placebo-controlled trial.
Transcutaneous electrical nerve stimulation (TENS) is a noninvasive alternative to traditional pain treatments. TENS has been studied in the past as a pain reduction modality in colonoscopy with limited success. Reviews and meta-analysis have shown that the inconclusive results of TENS may be due to the lack of randomized controlled trials and the difficulty in defining precise output parameters. ⋯ On the five-point Likert scale, there was also a significant reduction in pain score in the active TENS group compared to the placebo TENS and control groups (P=0.009). No significant differences were found between the study groups as to the bloating sensation and the duration of the procedure. We conclude that TENS can be used as a pain relief therapy in unsedated screening colonoscopy.