European journal of pain : EJP
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Randomized Controlled Trial Comparative Study
Postoperative analgesia and early rehabilitation after total knee replacement: a comparison of continuous low-dose intravenous ketamine versus nefopam.
The effects of nefopam and ketamine on pain control and rehabilitation after total knee replacement were compared in a prospective, double blinded study. Seventy-five patients were randomly assigned to receive a 0.2mg kg(-1) bolus of nefopam or ketamine, followed by a 120microg kg(-1) h(-1) continuous infusion until the end of surgery, and 60microg kg(-1) h(-1) until the second postoperative day, or an equal volume of saline considered as placebo. Pain scores measured on a visual analog scale at rest and on mobilization, and patient-controlled intravenous morphine consumption, were assessed during 48h. ⋯ Ketamine improved knee flexion on post operative day 3 (59 degrees [33-63] vs. 50 degrees [47-55] and 50 degrees [44-55] in ketamine, placebo and nefopam groups, respectively, p<0.0002) and decreased the delay to flex the knee at 90 degrees (9.1+/-4.2 vs. 12.3+/-4.0 days, in ketamine and placebo groups, respectively, p=0.01). Ketamine produces opioid-sparing, decreases pain intensity, and improves mobilization after total knee replacement. Nefopam achieves less significant results in that circumstances.
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Chronic hip pain after total hip arthroplasty (THA) is a significant problem, but the aetiology remains unclear. ⋯ We found signs of hypersensitivity on the operated side, which was more prominent in patients with pain. Pain referred from the back or deeper structures in the hip seems to play a role for the pain in subgroups of patients. In addition, chronic hip pain was associated with mental vulnerability.
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Normalization of activities in daily living is an important goal in rehabilitation treatment of chronic lower back pain (CLBP) patients. Clinicians indicate that CLBP patients often show deconditioning but also CLBP patients who seem to be too active are seen. The objective of the present cross-sectional study was to gain more insight into the daily activity pattern of CLBP patients compared to controls, using accelerometry. ⋯ Overall activity levels do not differ significantly between CLBP patients and controls, but the distribution of activities over the day differs significantly.
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Comparative Study
Sex differences in perceptions of pain coping strategy usage.
Sex differences are generally found in the perception and experience of pain, with women reporting more intense and frequent pain than men. One reason why such differences may occur has been linked to socially-acquired gender-role expectations associated with pain. Although there is evidence that men and women report using different pain coping strategies, we do not know the extent to which gender-specific expectations are associated with pain-related coping. ⋯ Furthermore, sex differences were also found in how participants viewed their own coping behaviours in comparison to that of the typical man and typical woman. These results confirm that alongside pain, men and women hold different gender-specific expectations with respect to certain pain coping strategies. Future research is required to examine whether these different coping expectations influence an individuals own choice of strategy, and whether this in turn affects actual pain experiences.
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Dysregulations of the hypothalamus-pituitary-adrenal (HPA) axis, as a physiological substrate of stress, have been observed in patients with different stress-related and chronic pain disorders. In this study, we investigated possible dysregulations of the HPA axis in patients with masticatory muscles pain. In 20 patients with myogenous facial pain and 20 healthy controls, awakening cortisol responses, i.e.cortisol rise in the first hour after awakening, as well as a short circadian free cortisol profile, i.e. four cortisol samples over 12h during the day, were assessed before and after administration of 0.5mg dexamethasone. ⋯ In comparison to controls, chronic myogenous facial pain patients showed enhanced and prolonged suppression of cortisol after the administration of 0.5mg dexamethasone. Unstimulated cortisol response (before dexamethasone-intake) to awakening and cortisol levels during the day did not differ between the groups. Dysregulation in terms of enhanced negative feedback suppression exists in chronic myogenous facial pain. These results are in line with a multifactorial etiology of chronic facial pain, shifting the perspective away from a local towards a more central etiology with dysregulations in the stress and pain modulating system.