Modification of Experimental, Lower Limb Ischemic Pain With Transcutaneous Electrical Nerve Stimulation.
Clin J Pain. 2011 Dec 30;
Authors: Seenan C, Roche PA, Tan CW, Mercer T
Abstract
INTRODUCTION:: Transcutaneous electrical nerve stimulation (TENS) has been shown to be effective for the reduction of experimentally induced ischemic pain in the upper limb. No studies have been published on the effects of TENS for lower limb ischemic pain. OBJECTIVES:: To investigate the pain-modifying effect of TENS on experimentally induced ischemic pain in the lower limb. METHODS:: A modified Submaximal Effort Tourniquet Test-induced ischemic pain in the nondominant lower limb of 27 healthy volunteers. Each of the participants completed a baseline modified Submaximal Effort Tourniquet Test (No TENS) and 1 of the experimental conditions: either high-frequency TENS (HF-TENS) or placebo TENS (P-TENS). The outcome measures were the time taken (in seconds) for the participants to report pain threshold and pain tolerance. Pain endurance was calculated as the difference between these points. Pain intensity during ischemia was assessed using a numerical rating scale. The McGill Pain Questionnaire recorded participants’ retrospective description of ‘intolerable’ induced pain. The differences in scores between these measures at the baseline and TENS intervention was calculated and used for the analysis. RESULTS:: Paired Student t-tests found significant increases in time to pain tolerance and pain endurance in both the TENS groups (P<0.001 HF-TENS and P<0.05 for P-TENS, respectively). When compared with baseline, time to pain threshold increased significantly only with HF-TENS (P<0.01). The independent Student t-tests detected greater increases in pain threshold, tolerance, and endurance in the HF-TENS group compared with the P-TENS group (P<0.05, 0.002, and 0.003, respectively). Compared with P-TENS, HF-TENS significantly reduced the pain intensity between the fifth and eigth minutes. Both HF-TENS and P-TENS significantly reduced the mean McGill Pain Questionnaire Pain Rating Index scores, but did not show a between-group difference. CONCLUSIONS:: HF-TENS had stronger modifying effects on several aspects of laboratory-induced ischemic pain than did P-TENS. HF-TENS delayed the onset of pain, reduced pain levels, and delayed the onset of extreme pain over a period of several minutes.
PMID: 22209796 [PubMed - as supplied by publisher]
Painful Diabetic Polyneuropathy: Approach to Diagnosis and Management.
Clin J Pain. 2011 Dec 30;
Authors: Spallone V, Lacerenza M, Rossi A, Sicuteri R, Marchettini P
Abstract
OBJECTIVES:: To provide a current overview of the diagnostic work-up and management of painful diabetic polyneuropathy (PDPN). METHODS:: A review covering the literature from 2004 to 2011, which describes the tools designed to diagnose neuropathic pain and assess its severity, including self-administered questionnaires, validated laboratory tests and simple handheld screening devices, and the evidence-based therapeutic approaches to PDPN. RESULTS:: The clinical aspects, pathogenesis, and comorbidities of PDPN, as well as its impact on health related quality of life (HR-QoL), are the main drivers for the management of patients with suspected PDPN. PDPN treatment consists first of all in improving glycemic control and lifestyle intervention. A number of symptomatic pharmacological agents are available for pain control: tricyclic antidepressants and selective serotonin norepinephrine reuptake inhibitors (venlafaxine and duloxetine), α2-delta ligands (gabapentin and pregabalin), opioid analgesics (tramadol and oxycodone), and agents for topical use, such as lidocaine patch and capsaicin cream. With the exception of transcutaneous electrical nerve stimulation, physical treatment is not supported by adequate evidence. DISCUSSION:: As efficacy and tolerability of current therapy for PDPN are not ideal, the need for a better approach in management further exists. Novel compounds should be developed for the treatment of PDPN.
PMID: 22209797 [PubMed - as supplied by publisher]
A Randomized Controlled Trial of Cognitive-behavioral Therapy for the Treatment of PTSD in the Context of Chronic Whiplash.
Clin J Pain. 2011 Dec 30;
Authors: Dunne RL, Kenardy J, Sterling M
Abstract
OBJECTIVES:: Whiplash-associated disorders (WAD) are common and involve both physical and psychological impairments. Research has shown that persistent posttraumatic stress symptoms are associated with poorer functional recovery and physical therapy outcomes. Trauma-focused cognitive-behavioral therapy (TF-CBT) has shown moderate effectiveness in chronic pain samples. However, to date, there have been no clinical trials within WAD. Thus, this study will report on the effectiveness of TF-CBT in individuals meeting the criteria for current chronic WAD and posttraumatic stress disorder (PTSD). METHOD:: Twenty-six participants were randomly assigned to either TF-CBT or a waitlist control, and treatment effects were evaluated at posttreatment and 6-month follow-up using a structured clinical interview, self-report questionnaires, and measures of physiological arousal and sensory pain thresholds. RESULTS:: Clinically significant reductions in PTSD symptoms were found in the TF-CBT group compared with the waitlist at postassessment, with further gains noted at the follow-up. The treatment of PTSD was also associated with clinically significant improvements in neck disability, physical, emotional, and social functioning and physiological reactivity to trauma cues, whereas limited changes were found in sensory pain thresholds. DISCUSSION:: This study provides support for the effectiveness of TF-CBT to target PTSD symptoms within chronic WAD. The finding that treatment of PTSD resulted in improvements in neck disability and quality of life and changes in cold pain thresholds highlights the complex and interrelating mechanisms that underlie both WAD and PTSD. Clinical implications of the findings and future research directions are discussed.
PMID: 22209798 [PubMed - as supplied by publisher]
Diffuse Noxious Inhibitory Control Function in Women With Provoked Vestibulodynia.
Clin J Pain. 2011 Dec 30;
Authors: Sutton KS, Pukall CF, Chamberlain S
Abstract
OBJECTIVES:: The objective of the study was to assess diffuse noxious inhibitory control (DNIC) function in women with provoked vestibulodynia (PVD) compared with healthy controls through the use of 2 different methodologies. Furthermore, the study aimed to assess whether pain characteristics correlate with DNIC in women with PVD. METHODS:: Twenty-three healthy control women and 23 women diagnosed with PVD by the study gynecologist participated in the study. To assess DNIC, heat pain tolerance, determined through an ascending method of limits and temporal summation of thermal pain were used as test stimuli and a cold water bath was used as the conditioning stimulus. Participants reported on pain characteristics as potential correlates with DNIC function. RESULTS:: No significant group differences were found in the number of DNIC responders per group when using heat pain tolerance or temporal summation procedures to examine DNIC. The magnitude of the DNIC response was examined for the overall groups and for positive DNIC responders only. When all participants were included in the analyses with the heat pain tolerance procedure, women with PVD displayed a higher magnitude of DNIC responding. Correlations between pain variables and DNIC responding and magnitude were nonsignificant. DISCUSSION:: Results support previous findings of intact DNIC function in women with PVD, using both an ascending method of limits and a temporal summation paradigm. Pain-related variables were not correlated with DNIC function in women with PVD, perhaps this unexpected finding is due to the possibility that central processes other than DNIC, such as descending facilitation, provoke or maintain this chronic pain condition.
PMID: 22209799 [PubMed - as supplied by publisher]
Predictive Factors for Postherpetic Neuralgia Using Ordered Logistic Regression Analysis.
Clin J Pain. 2011 Dec 30;
Authors: Kanbayashi Y, Onishi K, Fukazawa K, Okamoto K, Ueno H, Takagi T, Hosokawa T
Abstract
OBJECTIVES:: To identify predictive factors for the occurrence of postherpetic neuralgia (PHN). METHODS:: The participants were 73 herpes zoster patients who had been treated at the pain clinic of our hospital between January 2008 and June 2010. Variables present at the initial visit were extracted from the clinical records for regression analysis of factors related to the occurrence of PHN. The following scores for response were used: 0=no PHN after 3 months; 1=PHN present after 3 months but absent after 6 months; and 2=PHN present after 6 months. Multivariate ordered logistic regression analysis was performed to identify the predictive factors for PHN. RESULTS:: Advanced age [odds ratio (OR)=2.740, confidence interval (CI)=1.110-6.761; P=0.0288] and deep pain (OR=4.244, CI=1.114-16.163; P=0.0341) at the initial visit to our outpatient pain clinic were found to be significant predictive factors for the occurrence of PHN. Diabetes mellitus (OR=3.075) and pain reduced by bathing (OR=3.389) also had high OR, although they were not significant. DISCUSSION:: Our study indicates that advanced age and deep pain at the initial visit are significant predictors for PHN. Our results are considered likely to contribute to the establishment of evidence-based medicine in the optimal treatment of PHN.
PMID: 22209800 [PubMed - as supplied by publisher]
Natural Variation in the μ-opioid Gene OPRM1 Predicts Increased Pain on Third Day After Thoracotomy.
Clin J Pain. 2011 Dec 30;
Authors: Ochroch EA, Vachani A, Gottschalk A, Kanetsky PA
Abstract
OBJECTIVES:: The mechanism whereby acute postsurgical pain can persist and become chronic remains unknown. Thoracotomy is a common procedure with a high incidence of long-term pain for which acute postsurgical pain is an established risk factor. Therefore, the genetic basis of elevations in acute postsurgical pain after thoracotomy was investigated. METHODS:: A cohort of thoracotomy patients participating in an ongoing trial of outcomes after cancer were enrolled. A standard combined general and epidural anesthetic and surgical approach were used. All patients received a standardized postoperative epidural analgesia regimen. Postoperatively, pain scores were determined and blood was collected for genotyping. Our a priori hypothesis was that variability of genes involved in nociception and analgesic therapy would predict pain score ≥3 of 10 on the third postoperative day. RESULTS:: Ninety patients with pain and genotyping data on postoperative day 3 were examined. We found no association between markers in COMT, COX1, COX2, and TRPV1 and postoperative pain. We demonstrated several statistically significant associations with 4 single nucleotide polymorphism markers in OPRM1 (odds ratio, 95% confidence intervals): rs634479 (0.4, 0.17, 0.97), rs499796 (0.35, 0.13, 0.92), rs548646 (0.47, 0.23, 0.97), and rs679987 (0.1, 0.01, 0.84). From these, we inferred 2 haplotype blocks in OPRM1 where both had a frequency of 9% and P=0.03 and 0.04. Previously published functional single nucleotide polymorphisms in OPRM1 and COMT were not associated with increased pain on the third postoperative day. DISCUSSION:: We identified previously unpublished haplotypes of the OPRM1 receptor that predicted increases in self-reported pain on the third postoperative day after thoracotomy. These findings require replication and further refinement before their impact on patient care can be determined.
PMID: 22209801 [PubMed - as supplied by publisher]
Patient Satisfaction After Anterior Cervical Discectomy and Fusion Is Primarily Driven by Relieving Pain.
Clin J Pain. 2011 Dec 6;
Authors: Hessler C, Boysen K, Regelsberger J, Vettorazzi E, Winkler D, Westphal M
Abstract
OBJECTIVES:: A prospective follow-up study of patients with anterior cervical discectomy and fusion (ACDF) for single-level cervical disc disease was conducted to determine the extent of impact of pain, sensory function, motor function, and range of motion (ROM) of the neck on patient satisfaction after ACDF. METHODS:: A total of 67 ACDF patients were monitored by clinical examination (pain, motor function, sensory function, and ROM in the neck) preoperatively and at follow-up (mean, 217 d after surgery; range, 198 to 232 d) and by a satisfactory questionnaire (SQ) at follow-up only. According to the SQs, 4 patient groups were characterized. Inside each patient group for each examination parameter, the percentage of patients who showed improved, unchanged, or worsened clinical results was analyzed. RESULTS:: Patient satisfaction was found to depend primarily on the improvement in pain (P=0.001). The development of motor function (P=0.056), sensory function (P=0.225), and ROM of the neck (P=0.565) did not demonstrate significant correlation with patient satisfaction. The Numerical Rating Scale score decreased from 6.2 before surgery to 2.1 on follow-up, whereas the level of analgesic use (World Health Organization scheme) decreased from 1.9 to 0.3. DISCUSSION:: Improvement in pain seemed to be most important aspect in ACDF patients regarding the subjective SQ. Therefore, we strongly recommend focusing on pain-reducing therapies when choosing treatment for these patients during the postoperative period.
PMID: 22193847 [PubMed - as supplied by publisher]
BACKGROUND:: Recent applications of cognitive-behavior therapy for primary insomnia in the management of pain-related insomnia are based on the implicit assumption that the 2 types of insomnia share the same presentation and maintaining mechanisms. The objectives of this study were to compare the characteristics of patients who have pain-related insomnia with those reporting primary insomnia and to identify psychological factors that predict pain-related insomnia. METHODS:: Chronic pain patients with concomitant insomnia (n=137; Pain-related Insomnia Group) completed a selection of questionnaires that measure sleep patterns, psychological attributes, and cognitive-behavioral processes associated with the persistence of insomnia. Their responses were compared with those of primary insomnia patients (n=33; Primary Insomnia Group), using 3 sets of multivariate analyses of covariance that took account of demographic differences. Hierarchical regression analyses were performed to identify predictors of insomnia severity among the chronic pain patients. RESULTS:: The Pain-related Insomnia Group did not differ from the Primary Insomnia Group in their pattern and severity of sleep disturbance. The 2 groups were largely comparable in terms of their psychological characteristics, except that the Primary Insomnia Group was distinguishable from the Pain-related Insomnia Group by their greater tendency to worry. Patients in the Pain-related Insomnia Group reported levels of sleep-related anxiety and presleep somatic arousal that matched with those reported by patients in the Primary Insomnia Group. However, relative to patients in the Pain-related Insomnia Group, those in the Primary Insomnia Group reported more dysfunctional sleep beliefs and presleep cognitive arousal. In addition to pain intensity, depression, and presleep cognitive arousal were significant predictors of insomnia severity within the Pain-related Insomnia Group. CONCLUSIONS:: There are more similarities than differences between the 2 types of insomnia. Besides pain, mood, and presleep, thought processes also seem to have a role in the manifestation of pain-related insomnia. It is suggested that hybrid treatments that seek to simultaneously address factors across these domains may represent more effective treatments than 1-dimensional interventions.
PMID: 22179550 [PubMed - as supplied by publisher]
The Change in Deep Cervical Flexor Activity After Training Is Associated With the Degree of Pain Reduction in Patients With Chronic Neck Pain.
Clin J Pain. 2011 Dec 7;
Authors: Falla D, O’Leary S, Farina D, Jull G
Abstract
OBJECTIVES:: Altered activation of the deep cervical flexors (longus colli and longus capitis) has been found in individuals with neck pain disorders but the response to training has been variable. Therefore, this study investigated the relationship between change in deep cervical flexor muscle activity and symptoms in response to specific training. METHODS:: Fourteen women with chronic neck pain undertook a 6-week program of specific training that consisted of a craniocervical flexion exercise performed twice per day (10 to 20 min) for the duration of the trial. The exercise targets the deep flexor muscles of the upper cervical region. At baseline and follow-up, measures were taken of neck pain intensity (visual analogue scale, 0 to 10), perceived disability (Neck Disability Index, 0 to 50) and electromyography (EMG) of the deep cervical flexors (by a nasopharyngeal electrode suctioned over the posterior oropharyngeal wall) during performance of craniocervical flexion. RESULTS:: After training, the activation of the deep cervical flexors increased (P<0.0001) with the greatest change occurring in patients with the lowest values of deep cervical flexor EMG amplitude at baseline (R=0.68; P<0.001). There was a significant relationship between initial pain intensity, change in pain level with training, and change in EMG amplitude for the deep cervical flexors during craniocervical flexion (R=0.34; P<0.05). DISCUSSION:: Specific training of the deep cervical flexor muscles in women with chronic neck pain reduces pain and improves the activation of these muscles, especially in those with the least activation of their deep cervical flexors before training. This finding suggests that the selection of exercise based on a precise assessment of the patients’ neuromuscular control and targeted exercise interventions based on this assessment are likely to be the most beneficial to patients with neck pain.
PMID: 22156825 [PubMed - as supplied by publisher]
PubMed requires this notice of disclaimer is present.
