European journal of pain : EJP
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Clinical Trial Controlled Clinical Trial
Pain thresholds during and after treatment of severe depression with electroconvulsive therapy.
Pain and depression are often associated suggesting that both conditions share a common neurobiological mechanism, which modulate emotional function and processing of noxious information. Pain thresholds are hypothesized to be altered in depressed patients and normalized with the amelioration of depression. The purpose of this study was therefore to determine pain thresholds in patients during and after treatment with electroconvulsive therapy (ECT) of severe depression and in healthy controls. ⋯ While ECT significantly improved Hamilton depression score (from mean 23.9 (SD:5) to mean 12.5 (SD:5.7)) there was no significant change in pain thresholds during and after ECT in the patient group. However, depressed patients had significantly lower pain tolerance in the Cold Pressor Test on both examinations and on pressure pain tolerance on the second examination day than their corresponding control subjects. The differential effect of ECT on depression score and pain processing indicate that mood and noxious processing are not medicated directly by the same systems but that a complex relationship between pain and depression exists.
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The present study attempted to replicate the robustness of a two-factor model of the Tampa Scale for Kinesiophobia (TSK) in chronic low back pain (CLBP) patients and fibromyalgia patients, by means of confirmatory factor analysis. Construct and predictive validity of the TSK subscales were also examined. Results clearly indicated that a two-factor model fitted best in both pain samples. ⋯ Construct validity of the TSK and its subscales was supported by moderate correlation coefficients with self-report measures of pain-related fear, pain catastrophising, and disability, predominantly in patients with CLBP. Predictive validity was supported by moderate correlation coefficients with performance on physical performance tests (i.e., lifting tasks, bicycle task) mainly in CLBP patients. Implications of the results are discussed and directions for future research are provided.
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Several studies have reported lower neck muscle strength in patients with chronic neck pain compared to healthy controls. The aim of the present study was to evaluate the association between the severity of neck pain and disability with neck strength and range of movement in women suffering from chronic neck pain. One hundred and seventy-nine female office workers with chronic neck pain were selected to the study. ⋯ Pain may prevent full effort during strength tests and hence the production of maximal force. Thus in patients with chronic neck pain the results do not always describe true maximal strength, but rather the patients' ability to bear strain, which may be considerably influenced by their painful condition. The results of the present study suggest that rehabilitation in cases of chronic neck pain should aim at raising tolerance to mechanical strain.
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Clinical Trial Controlled Clinical Trial
Cerebral decreases in opioid receptor binding in patients with central neuropathic pain measured by [11C]diprenorphine binding and PET.
Central neuropathic pain (CNP) is pain resulting from damage to the central nervous system. Up till now, it has not been possible to identify a common lesion or pharmacological deficit in these patients. This preliminary study in a group of patients with CNP with predominantly post-stroke pain, demonstrates that there is significantly less opioid receptor binding in a number of cortical and sub-cortical structures that are mostly, but not exclusively, within the medial pain system in patients compared to age-matched pain-free controls. ⋯ This may be a key common factor resulting in undamped nociceptor activity within some of the structures that are predominantly within the medial nociceptive system. If confirmed, these findings may explain why certain patients with CNP require high doses of synthetic opiates to achieve optimum analgesia. The findings also raise the possibility of new pharmacological approaches to treatment.
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There is now strong evidence for sex differences in pain and analgesia. These differences imply that gonadal steroid hormones such as estradiol and testosterone modulate sensitivity to pain and analgesia. ⋯ Evidence is presented to demonstrate that sex differences in pain and analgesia may be both quantitative and qualitative in nature. Current research suggests that sex-specific management of clinical pain will be a reality in the not-so-distant future.