European journal of pain : EJP
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The development and refinement of an acute pain service based on the increased availability of clinical evidence would be expected to improve the quality of postoperative pain control. This report reviews the application of postoperative patient-controlled analgesia (PCA) using intravenous morphine in a single institution between 2002 and 2005. More than 5000 patients were evaluated and the results were compared with a similar study performed 10 years ago. ⋯ We conclude that, in our institution over the last decade, PCA has become more popular for postoperative pain management but with no attendant improvement in pain relief or reduction in side effects. Using PCA alone may result in poorer quality postoperative analgesia. Our findings add to the growing body of evidence that postoperative pain management has not substantially improved despite increased adoption of acute pain services.
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The neurotrophins nerve growth factor (NGF) and brain-derived neurotrophic factor (BDNF) play a pivotal role in the generation and maintenance of hyperalgesia. In the present study we analyzed NGF and BDNF levels in human skin of the upper arm and axilla skin sites by dermal microdialysis and multiplexed assay. Skin sensitization and inflammatory responses were evoked experimentally by repetitive shaving of one axilla provoking local erythema and reduced heat pain thresholds. ⋯ On average, NGF levels were analyzed at 14.6 fg/microg/ml and BDNF values at 202 fg/microg/ml. These data demonstrate enhanced level of neurotrophin release in inflamed human skin in vivo which might well contribute to peripheral sensitization. Analyses of neurotrophic factors by dermal microdialysis are useful endogenous markers to further explore their role in neuronal sensitization processes in human.
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It is well known that patients with orofacial cancer suffer from cancer-induced pain which produces feeding difficulties. To understand the mechanisms of pain associated with orofacial cancer, we have recently created a model for rat orofacial cancer by inoculation with Walker carcinosarcoma 256B-cells into the vibrissal pads. The present study used both behavioral and immunohistochemical techniques to investigate changes in pain-related and ingestive behavior, along with c-Fos expression in the medullary dorsal horn which is a site for processing orofacial pain. ⋯ Although hyposensitivity to mechanical and thermal stimulation was observed in the inoculated region after day 10, hyperalgesia developed on the margin of the tumor, suggesting that the hypersensitive region spread with growth of tumor mass. In the medullary dorsal horn, the levels of c-Fos immunoreactivity of the ipsilateral side increased significantly on days 4, 7 and 10, supporting the behavioral observations. These results indicate that the rat model shows symptoms similar to those in patients with orofacial cancer, for example, induction of feeding disorder and neuropathic pain.
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Electronic diaries are increasingly used to assess daily pain in many different forms and populations. This systematic review aims to survey the characteristics of studies using electronic pain diaries and to examine how these characteristics affect compliance. A literature search of 11 electronic databases was conducted. ⋯ It is important that the various study characteristics are catalogued carefully, especially response and attrition rates, because they can affect compliance. Measures of momentary pain are often developed for the purpose of a certain study; standardisation and validation of these measures is recommended. Finally, authors should mention whether they report on data that has also been used in previous studies.