European journal of pain : EJP
-
Randomized Controlled Trial
Effect of morphine in needle procedures in children with cancer.
The aim was to investigate whether children experience less fear, distress, and/or pain when they receive oral morphine vs. placebo before a needle is inserted in a subcutaneously implanted intravenous port when combined with topical anesthesia. ⋯ We could not reject the null hypothesis that there is no difference between the oral morphine and placebo groups assuming an effect size of 15 mm on VAS. Therefore it seems that oral morphine at 0.25 mg/kg does not give any additional reduction of fear, distress or pain compared with placebo when combined with topical anesthesia in pediatric patients undergoing subcutaneous port needle insertion, and would not be expected to be of any advantage for similar procedures such as venipuncture and venous cannulation when topical anesthesia is used.
-
Under-treatment of pain is a worldwide problem. We examine how often pain was addressed and the factors that influence how much time was spent on treating pain. We analyzed 385 videotapes of routine office visits in several primary care practices in the Southwest and Midwest regions of the United States. ⋯ Time constraints and racial concordance significantly influenced the length of discussion. We conclude that despite repeated calls for addressing under-treatment for pain, only a limited amount of time is used to address pain among elderly patients. This phenomenon could contribute to the under-treatment of pain.
-
Comparative Study
Estrogen receptors localization in the spinal trigeminal nucleus: an immunohistochemical study in humans.
There is increasing evidence for estrogenic modulation of neurotransmission within the trigeminal pain pathway. It is also likely that the effects of estrogens may be influenced by the presence and localization of estrogen receptors (ERs) in a given brain area. To date, human data on the localization of ERs in the spinal trigeminal nucleus (STN), a key brain region in craniofacial nociception, are lacking. ⋯ This study is the first to provide evidence in humans that ER immunoreactivity is detectable on neuronal and glial cells of the STN. The two ER subtypes exhibited different expression patterns, with higher expression levels of ERα than ERβ. The presence of ER-containing cells in the STN suggests that estrogens may directly affect trigeminal neuron excitability in humans.
-
Pain is thought to interfere with training-induced plasticity of corticomotor pathways. Although this implies direct interference with plastic processes, it may be explained by compromised performance in the training task during pain. Repeated finger movements can induce plasticity and change the amplitude/direction of acceleration of finger movement evoked by transcranial magnetic stimulation (TMS). ⋯ There was no change in FDI MEPs in any conditions. These data do not support direct effects of nociceptive input (pain) on training-induced plasticity of corticomotor pathways. Remote pain may compromise learning due to distraction from the training task or other complex central pain processes.
-
Herpes zoster results from the reactivation of the varicella-zoster virus, which is often accompanied by a prodrome of dermatomal pain. Little is known about the burden of prodromal pain. ⋯ The burden of prodromal pain is significant and should be considered when evaluating the overall benefit of herpes zoster vaccination.