Articles: function.
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The underlying mechanisms of adaptations to pain are unclear. In order to explore whether central or peripheral mechanisms predominate, the effects of two centrally mediated phenomena - spatial summation of pain (SSP) and transcutaneous electrical nerve stimulation (TENS) - were examined. The effect of the degree of painfulness, rather than absolute stimulation intensity, was also examined. ⋯ The mathematical models and the lack of effect of SSP on adaptation suggest that its dominant component is peripheral. Whereas relative painfulness determines whether pain adaptation or intensification occurs (probably a defence mechanism), absolute stimulation intensities influence the magnitude of the effect. Pain intensification is differentially affected by probe size, depending upon the occurrence of initial adaptation.
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Reg Anesth Pain Med · Mar 2015
Review Meta AnalysisObesity and Chronic Pain: Systematic Review of Prevalence and Implications for Pain Practice.
The combination of obesity and pain may worsen a patient's functional status and quality of life more than each condition in isolation. We systematically searched PubMed/MEDLINE and the Cochrane databases for all reports published on obesity and pain. The prevalence of combined obesity and pain was substantial. ⋯ Screening for obesity, pain-related disability, and behavioral disorders as well as monitoring of functional performance should become routine in pain medicine practices. Such an approach requires additional physician and staff training. Further research should focus on better understanding the interplay between these 2 very common conditions and the development of effective treatment strategies.
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Anesthesia and analgesia · Mar 2015
Comparative StudyThree-Dimensional Versus Two-Dimensional Echocardiographic Assessment of Functional Mitral Regurgitation Proximal Isovelocity Surface Area.
The geometric shape of the mitral regurgitation (MR) proximal isovelocity surface area (PISA) is conventionally assumed to be a hemisphere (HS). However, in functional MR, PISA is frequently neither an HS nor a hemiellipse (HE) but is often asymmetric and crescent shaped. We used 3-dimensional transesophageal echocardiographic (3D TEE), full-volume data sets to directly measure the PISA and subsequently compared calculated values of effective regurgitant orifice area (EROA) with conventional 2D TEE techniques. EROA calculations from all PISA measurements were finally compared with the cross-sectional area at the vena contracta, a well-validated reference measure of the functional MR orifice area. ⋯ Quantitative assessment of functional MR severity by 3D TEE may be superior to 2D methods by permitting more direct measures of PISA. Two-dimensional TEE techniques for assessing functional MR severity that rely on an HS- or HE-PISA shape may underestimate the EROA due to geometric assumptions that do not account for asymmetry.