Pain medicine : the official journal of the American Academy of Pain Medicine
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Meta Analysis
Size reduction of the right amygdala in chronic pain patients with emotional stress: A systematic review and meta-analysis.
The structural impact of chronic pain on amygdala in chronic pain (CP) patients remains unclear, although major depression and anxiety are known to be associated with its increase and decrease in size, respectively. This study aimed at examining the relationship between emotional stress and amygdala size in CP patients. The effects of mediating and moderating variables were also examined. ⋯ Besides, pain from a single body region was more likely to impact the amygdala size compared to diffuse pain (P = .02). Regression analysis revealed no significant association between continuous variables (age, gender, pain duration/intensity) and amygdala size. Our findings demonstrated that emotional stress was associated with a reduced right amygdala size in CP patients.
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Review Meta Analysis
Amputation for Complex Regional Pain Syndrome: Meta-Analysis and Validation of a Histopathology Scoring System.
Pathology can provide crucial insights into the etiology of disease. The goal of this review is to evaluate the rigor of histopathology reports of Complex Regional Pain Syndrome (CRPS). ⋯ The Pathology Score is a useful quality assessment tool to evaluate studies. As expected, Anatomic papers scored significantly higher than Non-Anatomic papers. CRPS papers had small sample sizes (median 1) and infrequent reporting of diagnostic criteria, routine stain, any clinical pathologic correlation. These particular elements are crucial for analyzing and reviewing pathologic features. The analysis explains why it is quite difficult to write a meaningful systematic review of CRPS histology at this time.
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Approximately one in four total knee replacement patients develop persistent pain. Identification of those at higher risk could help inform optimal management. ⋯ Rigorously conducted observational studies are required to establish the relative importance of higher levels of peri-operative pain and pain catastrophizing with persistent pain after knee replacement surgery.
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The main aim was to determine the effects of percutaneous electrical nerve stimulation (PENS) and transcutaneous electrical nerve stimulation (TENS) on endogenous pain mechanisms in patients with musculoskeletal pain. ⋯ PENS and TENS have a mild-moderate immediate effect on local mechanical hyperalgesia in patients with musculoskeletal pain. It appears that these effects are not sustained over time. Analyses suggest an effect on central pain mechanisms producing a moderate increase in remote PPT, an increase in conditioned pain modulation, but further studies are needed to draw clearer conclusions.