Articles: hyperalgesia.
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Eur. J. Obstet. Gynecol. Reprod. Biol. · Oct 2015
Multicenter StudyThe pelvic floor muscle hyperalgesia (PFMH) scoring system: a new classification tool to assess women with chronic pelvic pain: multicentre pilot study of validity and reliability.
The contribution of pelvic floor muscle tenderness to chronic pelvic pain (CPP) is well established in the literature. However pelvic floor muscle hyperalgesia (PFMH) is often missed during vaginal examination of women with CPP. To our knowledge criteria for diagnosing PFMH has not been established or validated so far. The aim of this study is to assess the validity and reliability of the PFMH scoring system. ⋯ The PFMH scoring system is a simple, reliable, valid and easy screening tool for in the assessment of women with CPP.
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Randomized Controlled Trial Multicenter Study
Sensory profiles of patients with neuropathic pain based on the neuropathic pain symptoms and signs.
This manuscript aimed to characterize the clinical profile of various neuropathic pain (NeP) disorders and to identify whether patterns of sensory symptoms/signs exist, based on baseline responses on the Neuropathic Pain Symptom Inventory (NPSI) questionnaire and the quantitative sensory testing (QST). These post hoc analyses were based on data from 4 randomized, double-blind, placebo-controlled clinical studies of pregabalin (150-600mg/day) in patients with NeP syndromes: central poststroke pain, posttraumatic peripheral pain, painful HIV neuropathy, and painful diabetic peripheral neuropathy. The NPSI questionnaire includes 10 different pain symptom descriptors. ⋯ Based on QST signs, PCA identified 2 pain dimensions: evoked by cold and evoked by touch. A hierarchical cluster analysis identified 4 clusters with distinct pain characteristics profiles. These "trans-etiological" profiles may reflect distinct pathophysiological mechanisms and therefore, potential differential responses to treatment.
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Randomized Controlled Trial Multicenter Study
The analgesic efficiency of combined pregabalin and ketamine for total hip arthroplasty: a randomised, double-blind, controlled study.
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Multicenter Study
Pain hypersensitivity in juvenile idiopathic arthritis: a quantitative sensory testing study.
Juvenile Idiopathic Arthritis (JIA) is the most common cause of non-infectious joint inflammation in children. Synovial inflammation results in pain, swelling and stiffness. Animal and adult human studies indicate that localized joint-associated inflammation may produce generalized changes in pain sensitivity. The aim was to characterize pain sensitivity in children with JIA to mechanical and thermal stimulus modalities using quantitative sensory testing (QST) at an affected inflamed joint, and compare to children in clinical remission. Generalized hypersensitivity was evaluated by comparing QST measures at the thenar eminence between JIA and healthy control children. ⋯ JIA is associated with increased sensitivity to painful mechanical and thermal stimuli, even in absence of pain reports, or markers of disease activity. Future research investigating mechanisms underlying pain hypersensitivity in JIA is warranted; this will in turn guide pharmacologic and non-pharmacologic interventions to prevent or reverse these processes.
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Randomized Controlled Trial Multicenter Study
Viscerosomatic facilitation in a subset of IBS patients, an effect mediated by N-methyl-D-aspartate receptors.
Irritable bowel syndrome (IBS) is a common gastrointestinal disorder in which the pathophysiological mechanisms of the pain and hypersensitivity are incompletely understood. IBS patients frequently complain of pain in body regions somatotopically distinct from the gut, suggesting involvement of central hyperalgesic mechanisms. We tested the role of tonic peripheral impulse input by using both repetitive thermal stimuli to the leg and repetitive stimuli to the rectum. Changes in thermal/visceral pain sensitivity after nociceptive thermal/visceral repetitive stimulation were determined. A subset of IBS patients showed enhanced rectal/thermal pain sensitivity after repetitive thermal/rectal stimulation, respectively. IBS patients then received 60 mg dextromethorphan and placebo (diphenhydramine) in a randomized, double-blind, crossover trial. The results showed that 1) a subset of IBS patients had increased visceral/cutaneous hypersensitivity following a series of repetitive nociceptive stimuli and that 2) this increased pain sensitivity was blocked by administration of dextromethorphan. This is the first human study indicating that repetitive stimulation enhances a bidirectional mechanism of secondary hyperalgesia due to viscerosomatic facilitation in IBS patients. These unique findings elucidate mechanisms of somatic hypersensitivity in IBS patients and support an etiologic basis for abnormal N-methyl-D-aspartate receptor mechanisms that may be the target of future therapies for IBS. ⋯ Repetitive stimulation enhances a bidirectional mechanism of secondary hyperalgesia due to viscerosomatic convergence in IBS patients. The findings elucidate unique mechanisms of somatic/visceral hypersensitivity in a subset of IBS patients and further support an etiologic basis for abnormal N-methyl-D-aspartate receptor mechanisms that may be future targets of therapies for IBS.