Articles: chronic-pain.
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Randomized Controlled Trial
METHA-NeP: effectiveness and safety of methadone for neuropathic pain: a controlled randomized trial.
In this randomized, double-blind, parallel placebo-controlled clinical trial, we evaluated the efficacy of methadone as an add-on therapy for people with chronic neuropathic pain (NP). Eighty-six patients were randomly assigned to receive methadone or placebo for 8 weeks. The primary outcome was the proportion of participants achieving at least 30% pain relief from baseline using a 100-mm pain Visual Analogue Scale. ⋯ No serious adverse events or deaths occurred. Discontinuation due to adverse events was reported in 2 participants in the methadone and none in the placebo arm. Methadone use as an add-on to an optimized treatment for NP with first- and/or second-line drugs provided superior analgesia, improved sleep, and enhanced global impression of change, without being associated with significant serious adverse effects that would raise safety concerns.
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Central sensitization (CS) is believed to play a role in many chronic pain conditions. Direct non-invasive recording from single nociceptive neurons is not feasible in humans, complicating CS establishment. This review discusses how secondary hyperalgesia (SHA), considered a manifestation of CS, affects physiological measures in healthy individuals and if these measures could indicate CS. It addresses controversies about heat sensitivity changes, the role of tactile afferents in mechanical hypersensitivity and detecting SHA through electrical stimuli. Additionally, it reviews the potential of neurophysiological measures to indicate CS presence. ⋯ Gathering evidence for CS in humans is a crucial research focus, especially with the increasing interest in concepts such as 'central sensitization-like pain' or 'nociplastic pain'. This review clarifies which readouts, among the different behavioural and neurophysiological proxies tested in experimental settings, can be used to infer the presence of CS in humans.
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Randomized Controlled Trial
Ten Minutes of Core Stabilisation Exercise Result in Local Exercise-Induced Hypoalgesia in Patients With Chronic Unspecific Low Back Pain.
Core stabilisation training is known to be effective in managing pain in patients suffering from chronic low back pain (CLBP). Yet, acute effects of core stabilisation exercise on exercise-induced hypoalgesia (EIH) are largely unknown. This study aimed to examine the EIH effects of an easy-to-perform core stabilisation exercise in CLBP patients and to explore associations between EIH and potential influencing factors (i.e., physical activity, catastrophizing, kinesiophobia, subjective pain state and exercise exertion). ⋯ This study shows for the first time that a brief and easy-to-perform 10-min core stabilisation exercise produces significant local pain relief (EIH) in patients with unspecific CLBP. The effect is localised to the lumbar region, with no observed impact on remote sites. Higher pain catastrophizing seems to be linked to reduced hypoalgesic response. These findings support the use of short core stabilisation exercises as an effective, immediate, non-pharmacological pain management strategy for these patients.
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Extensive audio-motor training and psychological stress can cause professional musicians acute overstrain-injury and chronic pain, resulting in damaged careers and diminished quality of life. It has also been previously shown that musicians might perceive pain differently than non-musicians. Therefore, the aim of our study was to quantify differences between musicians and non-musicians regarding their subjective responses to painful contact heat stimuli and assess how emotional traits might influence these responses. ⋯ The findings of this report justify musicians' repetitive sensorimotor training as an important model for plasticity and contribute to a better understanding of pain perception in musicians.