European journal of pain : EJP
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Randomized Controlled Trial Clinical Trial
Complete withdrawal is the most feasible treatment for medication-overuse headache: A randomized controlled open-label trial.
Complete stop of acute medication and/or migraine medication for treatment of medication-overuse headache (MOH) has previously been reported more effective in reducing headache days and migraine days per month compared with restricted intake of acute medication. However, it is unknown whether complete stop or restricted intake is the most feasible treatment for patients. ⋯ A complete stop of all analgesics is the most effective treatment for MOH regarding reduction in headache days but has often been regarded as too challenging for patients. However, in this study, complete stop appears to be more feasible compared with restricted intake of analgesics seen from the patients' perspective.
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Randomized Controlled Trial
The effect of total intravenous anaesthesia with propofol on postoperative pain after third molar surgery: a double blind randomized controlled trial.
Total intravenous anaesthesia (TIVA) with propofol may reduce pain after surgery compared with inhalational anaesthetic techniques. Whether propofol provides analgesic benefit may be influenced by the surgical procedure and anaesthetic/analgesic regime. Third molar surgery is a consistent and fairly standard surgical technique that provides a good model for postoperative pain. We investigated whether propofol TIVA or sevoflurane (SEVO) inhalational anaesthesia would produce better quality pain relief after third molar surgery. ⋯ Choice of general anaesthetic technique can affect postoperative analgesia. The results of this study suggest that propofol TIVA improves postoperative pain and patient satisfaction after third molar surgery compared to inhalational anaesthesia.
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Randomized Controlled Trial
Rewarded placebo analgesia: A new mechanism of placebo effects based on operant conditioning.
Placebo analgesia is explained by two learning processes: classical conditioning and observational learning. A third learning process, operant conditioning, has not previously been investigated as a mechanism of placebo effects. We aimed to induce placebo analgesia by operant conditioning. ⋯ According to the current placebo literature, placebo analgesia can be explained by two learning processes: classical conditioning and observational learning. A third learning process, operant conditioning, has not previously been investigated as a mechanism of placebo effects. Our study reveals that patients can learn placebo analgesia as a result of operant conditioning, suggesting that randomized controlled trials could be improved by controlling the reinforcement that might occur spontaneously when patients interact with, for example, medical personnel.
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Randomized Controlled Trial
Ketamine infusion for 96 hr after thoracotomy: Effects on acute and persistent pain.
Why is this significant?
This is the first randomised controlled trial looking at the impact of perioperative ketamine on persistent post-surgical (PPS) pain 1 year after thoracic surgery. Thoracotomy is associated with both severe and a high incidence (up to 50% at 6 months) chronic pain.
Ketamine has important analgesic properties through NMDA blockade, and has been long thought (hoped) that via this it may modify chronic post-surgical pain. Nonetheless, many studies have been unable to show a benefit for ketamine in reducing PPS pain.
What did they show?
Chumbley et al. ran ketamine infusions at 0.1 mg/kg/hour for 96 hours in patients undergoing thoracotomy, starting with a 0.1 mg/kg bolus 10 minutes before surgery. Patients also received either an epidural or paravertebral infusion for post-operative analgesia.
Although there were small differences in acute pain (notably the ketamine group used less PCA morphine) there was no difference in persistent post-surgical pain at 12 months.
Bottom-line
The evidence continues to mount against perioperative ketamine, suggesting it does not reduce persistent post-surgical pain, not-withstanding its acute analgesia benefits. Await results of the ROCKet trial (Reduction Of Chronic Post-surgical Pain with Ketamine) to provide greater clarity...
An afterthought
Notably, the researchers did demonstrate a dramatically lower incidence of PPS pain than for similar studies (27%, 18%, 13% at 3, 6, 12 months) across both the ketamine and placebo group. This suggests that either the study participants were not representative of the typical thoracotomy patient (unlikely), or other care associated with the study had a beneficial effect on reducing PPS – perhaps even via a Hawthorne-like effect.
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Randomized Controlled Trial
Eye-movement behaviours when viewing real-world pain-related images.
Pain-related cues are evolutionarily primed to capture attention, although evidence of attentional biases towards pain-related information is mixed in healthy individuals. The present study explores whether healthy individuals show significantly different eye-movement behaviours when viewing real-world pain-related scenes compared to neutral scenes. The effect of manipulating via written information the threat value of the pain-related scenes on eye-movement behaviours was also assessed. ⋯ Healthy individuals show different eye-movement behaviours when viewing pain-related scenes than neutral scenes, supporting evolutionary accounts of pain. Implications for the onset and/or maintenance of chronic pain need to be explored.