European journal of pain : EJP
-
Randomized Controlled Trial
Effects of multifocal transcranial direct current stimulation targeting the motor network during prolonged experimental pain.
Antinociceptive effects of transcranial direct current stimulation (tDCS) over the primary motor cortex (M1) have been extensively studied in the past years. However, M1 does not work in isolation, but it rather interacts within a network, the so-called resting-state motor network. ⋯ These findings highlight that the stimulation of the resting state motor network with multifocal tDCS may represent a potential cortical target to treat chronic pain, particularly in patients exhibiting maladaptive corticomotor excitability and impaired conditioned pain modulation effects.
-
The many risks associated with opioid therapy for chronic non-cancer pain (CNCP) have led to questions about use. This is particularly relevant for risk of increased mortality. However, underlying medical conditions of those using opioids may influence mortality findings due to confounding by indication. Similarly, non-opioid analgesics are also associated with an increased risk of mortality, too. ⋯ An increased all-cause mortality associated with opioid use compared to non-opioid analgesics for CNCP was identified by a systematic review of four propensity score matched cohort studies in real-world settings. The number needed to harm for an additional excess death per 10,000 person-years was 116. Despite extensive propensity score matchings and sensitivity analyses, all studies could not fully exclude confounding by indication. The potential risk of increased all-cause mortality with opioids should be discussed with patients when considering opioid treatment.
-
Randomized Controlled Trial
Efficacy of transforaminal epidural magnesium administration when combined with a local anesthetic and steroid in the management of lower limb radicular pain.
Lower limb radicular pain resulting from a herniated intervertebral disc is a cause of functional disability and could lead to increased consumption of opioids. We evaluated the efficacy of epidural magnesium combined with a local anaesthetic and steroid in the management of this pain. ⋯ Magnesium is efficient when added to local anaesthetics and steroids for management of lower limb radicular pain.
-
The experience of pain is a complex interaction of somatic, behavioural, affective and cognitive components. Negative psychological states (e.g., anxiety, fear and depression) are intertwined with pain and contribute to poorer outcomes for individuals suffering from chronic and acute pain by exacerbating the overall experience of pain and leading to increased dysfunction, disability, and distress. A need exists for efficient assessment of aversive emotional states that are associated with pain. ⋯ The BADP provides an efficient, psychometrically-supported means to assess affective distress (i.e., anxiety, fear, depression, and negative affect) associated with pain.
-
Although there is growing evidence of metformin's pleiotropic effects, including possible effects on pain, there is a lack of studies investigating the association of metformin with the prevalence of musculoskeletal pain among a large cohort with type 2 diabetes cohort. ⋯ People with type 2 diabetes taking metformin are less likely to present with musculoskeletal pain than those not taking metformin. Metformin may have a protective effect for musculoskeletal pain, which appears to be stronger among women than men.