European journal of pain : EJP
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Non-specific low back pain is a relatively common and recurrent condition for which at present there is no effective cure. In current guidelines, the prognosis of acute non-specific back pain is assumed to be favourable, but this assumption is mainly based on return to function. This systematic review investigates the clinical course of pain in patients with non-specific acute low back pain who seek treatment in primary care. DATABASES AND DATA TREATMENT: Included were prospective studies, with follow-up of at least 12 months, that studied the prognosis of patients with low back pain for less than 3 months of duration in primary care settings. Proportions of patients still reporting pain during follow-up were pooled using a random-effects model. Subgroup analyses were used to identify sources of variation between the results of individual studies. ⋯ The findings of this review indicate that the assumption that spontaneous recovery occurs in a large majority of patients is not justified. There should be more focus on intensive follow-up of patients who have not recovered within the first 3 months.
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Controlled Clinical Trial
The effects of transcranial direct current stimulation with visual illusion in neuropathic pain due to spinal cord injury: an evoked potentials and quantitative thermal testing study.
Neuropathic pain (NP) is common in spinal cord injury (SCI) patients. One of its manifestations is a lowering of pain perception threshold in quantitative thermal testing (QTT) in dermatomes rostral to the injury level. Transcranial direct current stimulation (tDCS) combined with visual illusion (VI) improves pain in SCI patients. We studied whether pain relief with tDCS + VI intervention is accompanied by a change in contact heat- evoked potentials (CHEPs) or in QTT. ⋯ Two weeks of tDCS + VI induced significant changes in CHEPs, evoked pain and heat pain threshold in SCI patients with NP. These neurophysiological tests might be objective biomarkers of treatment effects for NP in patients with SCI.
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Comparative Study
Pain tolerance in children and adolescents: sex differences and psychosocial influences on pain threshold and endurance.
Laboratory studies with children and adolescents revealed inconsistent findings regarding sex differences in pain tolerance, although lower pain tolerance is commonly reported for adult women. Besides biological mechanisms, several socio-cognitive variables are discussed which may influence pain tolerance in regard to sex differences. The purpose of the present study was to investigate the pain tolerance of children and adolescents using the cold pressor task (CPT) and to analyse influences of pain-coping and pain-related self-efficacy. ⋯ Our results support the assumption that female and male adolescents develop in different directions regarding their pain tolerance when reaching puberty. This seems mainly attributable to a decrease of pain threshold in girls. In contrast, boys and girls are able to endure pain to an equal extent influenced, however, by self-efficacy and coping variables.
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Clinicians' estimates of patients' pain are frequently used as a basis for delivering care, and the characteristics of the clinician and of the patient influence this estimate. ⋯ Midwives' personal characteristics can bias the estimation of pain in woman in labour and therefore influence treatment.
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The role of extracellular signal-regulated kinases (ERKs) in nociception has been explored in the last years. While in spinal cord their activation is frequently correlated with pain or acute noxious stimuli, supraspinally, this association is not so evident and remains unclear. This study aims to evaluate ERK1/2 activation in the spinal cord and brainstem nuclei upon neuropathy and/or an additional mechanical stimulus. ⋯ ERK1/2 are differentially activated in the spinal cord and in selected brainstem nuclei implicated in nociception, in response to an acute noxious stimulus and/or to a neuropathic pain condition.