European journal of pain : EJP
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Awareness that SCI pain is common emerged during the past decade. However, there are a number of unresolved issues. There is a need for variety of experimental models to reflect diversity of SCI pains. ⋯ More attention should be given to a condition of the spinal cord below and above the SCI lesion. A consensus for what is an optimal SCI functional assessment for patients with sensory complaints and pain should be developed. Further extensive SCI pain research is needed prior to spinal cord regeneration trials in order to be able to cope with a potential for newly developed pains that may appear during incomplete spinal cord regenerative attempts.
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Aim of this study was to analyse the incidence CRPS-I after a fracture of the distal radius and to analyse risk factors. Patients who visited the Emergency Unit of the University Hospital, with a fracture of distal radius were asked to participate. As risk factors for CRPS-I, number of repositions (with or without local anaesthesia), additional cast changes and pain during the cast period, were assessed. ⋯ One female (1%, 95% CI: 0.2 to 6%), age 69 years with the following characteristics developed CRPS-I: one set of local anaesthetics, one repositioning attempt, no additional cast changes, average pain scores, no life events and her total score on the SCL-90 of 117, was slightly above average. Based on the results of this study it is concluded that the incidence of CRPS-I may be low (1%, 95% CI: 0.2 to 6%) after fractures of the distal radius. Further the risk factors described in literature play a minor role in the development of CRPS-I.
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The innervation of the temporomandibular joint (TMJ) has attracted particular interest because of the close association with complex mandibular movement. Although the pathological changes of disk innervation may have a crucial role in the development of TMJ pain, the innervation of the TMJ disk by experimentally induced arthritis has rarely been examined in detail. Arthritic rats were induced by injection with 0.1ml solution of Complete Freund's adjuvant (CFA). ⋯ In addition, the ratio of trkA- and p75-positive small- and medium-sized cells increased in trigeminal ganglia. It is assumed that increasing innervation of the TMJ disk may be important for the pathophysiology of TMJ pain. NGF and its receptors are likely involved in pathological changes of the TMJ disk.
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In subgroups of patients with localised musculoskeletal pain spread of pain and signs of altered somatosensory processing at painful sites, both focal and referred areas have been reported. The purpose of the study was to examine somatosensory processing in patients with mainly unilateral long-term (> or =1 year) trapezius myalgia with ongoing pain for the last 3 months in the trapezius muscle in conjunction with ongoing or recurrent referral of pain to the ipsilateral arm. Ten patients with trapezius myalgia and 10 age- and sex-matched healthy controls participated. ⋯ Compared to controls a bilaterally decreased sensitivity to light touch was found in patients in the area of referred pain (p<0.01). No differences were found in the outcome of thermal testing. These findings suggest altered central processing of somatosensory input from the area of referred pain in patients with trapezius myalgia.
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Comparative Study
Experimental muscle pain provokes long-lasting alterations of thermal sensitivity in the referred pain area.
This study explores thermal sensitivity and thermal nociception for signs of central sensitization in the area of referred muscle pain. Two groups of 24 healthy subjects (ss) each, and with mean ages of, respectively, 27 and 55 years, were first trained in quantitative sensory testing and pain rating. Then, in a second session, referred pain was evoked by injection of 6% hypertonic saline into the infraspinatus muscle. ⋯ The decrease of cold pain threshold or SHT in subgroups of ss may indicate central sensitization. However, the observed changes in this experiment do not provide an unambiguous indicator for central sensitization which seems to be rather individual and might depend on pain intensity and proneness to express central mechanisms of sensitization. Therefore in clinical pain states the individual pattern of sensory abnormalities has to be analysed and interpreted in addition to the pain parameters to assess central involvement.