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Chronic central pain

Patricia M Herman, Eric L Hurwitz, Paul G Shekelle, Margaret D Whitley, Ian D Coulter
BACKGROUND: Spinal mobilization and manipulation are 2 therapies found to be generally safe and effective for chronic low back pain (CLBP). However, the question remains whether they are appropriate for all CLBP patients. RESEARCH DESIGN: An expert panel used a well-validated approach, including an evidence synthesis and clinical acumen, to develop and then rate the appropriateness of the use of spinal mobilization and manipulation across an exhaustive list of clinical scenarios which could present for CLBP...
March 12, 2019: Medical Care
Caroline E Phelps, Edita Navratilova, Anthony H Dickenson, Frank Porreca, Kirsty Bannister
Diffuse noxious inhibitory controls (DNIC) is a pain inhibits pain phenomenon demonstrated in humans and animals. DNIC is diminished in many chronic pain states, including neuropathic pain. The efficiency of DNIC has been suggested to prospectively predict both the likelihood of pain chronification and treatment response. Little is known as to why DNIC is dysfunctional in neuropathic pain. Here, we evaluated DNIC in the rat L5/L6 spinal nerve ligation (SNL) model of chronic pain using both behavioral and electrophysiological outcomes...
March 8, 2019: Pain
Sidney M Rubinstein, Annemarie de Zoete, Marienke van Middelkoop, Willem J J Assendelft, Michiel R de Boer, Maurits W van Tulder
OBJECTIVE: To assess the benefits and harms of spinal manipulative therapy (SMT) for the treatment of chronic low back pain. DESIGN: Systematic review and meta-analysis of randomised controlled trials. DATA SOURCES: Medline, PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL, Physiotherapy Evidence Database (PEDro), Index to Chiropractic Literature, and trial registries up to 4 May 2018, including reference lists of eligible trials and related reviews...
March 13, 2019: BMJ: British Medical Journal
Bill McCarberg, John Peppin
OBJECTIVE: This article reviews the structural and functional changes in pain chronification and explores the association between memory and the development of chronic pain. METHODS: PubMed was searched using the terms "chronic pain," "central sensitization," "learning," "memory," "long-term potentiation," "long-term depression," and "pain memory." Relevant findings were synthesized into a narrative of the processes affecting pain chronification...
March 13, 2019: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
Rune Tendal Paulsen, Leah Carreon, Frederik Busch, Alexander Isenberg-Jørgensen
INTRODUCTION: Radio-frequency (RF) denervation of the facet joints is a procedure aimed at the nociceptive median branch nerves of the lumbar dorsal rami. Pain signals from the facet joints are carried through these fibres; by ablating these fibres, central signalling can be prevented. This pilot study investigated the clinical effect and feasibility of the procedure at our institution, the Spine Centre of Southern Denmark. METHODS: Patients with at least 50% pain relief after initial medial branch diagnostic blocks were candidates for RF denervation...
March 2019: Danish Medical Journal
Naveen Raj
Systemic opioids have been the main stay for the management of perioperative pain in children undergoing cardiac surgery with sternotomy. The location, distribution and duration of pain in these children has not been studied as extensively as in adults. Currently there is no consensus to the dose of opioids required to provide optimum analgesia and attenuate the stress response whilst minimising their unwanted side effects. At present there is a tendency to use lower dose aiming for early extubation and minimise opioid related side effects, but this may not obtund the stress response in all children...
March 12, 2019: Paediatric Anaesthesia
Raleigh Ems, Anisha Garg, Thomas A Ostergard, Jonathan P Miller
Hypertension is the single greatest contributor to human disease and mortality affecting over 75 million people in the United States alone. Hypertension is defined according to the American College of Cardiology as systolic blood pressure (SBP) greater than 120 mm Hg and diastolic blood pressure (DBP) above 80 mm Hg measured on two separate occasions. While there are multiple medication classes available for blood pressure control, fewer than 50% of hypertensive patients maintain appropriate control. In fact, 0...
2019: Frontiers in Neuroscience
Chiara Leoni, Elizabeth Katherine Anna Triumbari, Catello Vollono, Roberta Onesimo, Maria Podagrosi, Valentina Giorgio, Eliza Kuczynska, Stefania Veltri, Marco Tartaglia, Giuseppe Zampino
Pain in individuals with RASopathies is a neglected topic in literature. In this article, we assessed prevalence and profile of pain in a sample of 80 individuals affected by RASopathies. The study sample included individuals with Noonan syndrome (N = 42), Costello syndrome (N = 17), and cardio-facio-cutaneous syndrome (N = 21). A set of standardized questionnaires and scales were administered (VAS/numeric scale, r-FLACC, Wang-Baker scale, NPSI, BPI, NCCPC-R) to detect and characterize acute and chronic pain and to study the influence of pain on quality of life (PEDs-QL, SF-36) and sleeping patterns (SDSC); revision of past medical history and multisystemic evaluation was provided...
March 10, 2019: American Journal of Medical Genetics. Part A
David M Klyne, G Lorimer Moseley, Michele Sterling, Mary F Barbe, Paul W Hodges
Central sensitisation is considered to have a pathophysiological role in chronic low back pain (LBP). Whether individuals with increased central sensitisation early in their condition are more likely to develop persistent pain or whether it increases over time is unclear. This study aimed to determine whether sensory profiles during acute LBP differ between individuals who did and did not recover by 6-months and to identify subgroups associated with outcomes. Individuals with acute LBP (<2 weeks of onset, N=99) underwent pain threshold (heat/cold/pressure) and conditioned pain modulation (CPM) testing after completing questionnaires related to pain/disability, sleep, and psychological status...
March 7, 2019: Journal of Pain: Official Journal of the American Pain Society
Elisabeth Ng, Adel Ekladious, Luke P Wheeler
A 62-year-old man presented to the Emergency Department with dyspnoea and central pleuritic chest pain radiating posteriorly to between the scapulae. His medical history included hypertension, osteoporosis and chronic kidney disease secondary to focal segmental glomerulosclerosis with relapsing nephrotic syndrome. Significant examination findings included a loud palpable P2 and a displaced apex beat. An ECG revealed sinus tachycardia with a right-bundle branch block and p-pulmonale. A CT pulmonary angiogram and aortogram demonstrated extensive bilateral pulmonary emboli and a descending thoracic aortic dissection...
March 8, 2019: BMJ Case Reports
Rouvin Kurian, Kazim Raza, Harsha Shanthanna
BACKGROUND AND OBJECTIVE: N-methyl-D-aspartate (NMDA) receptors are involved in pain signalling and neuroplasticity. Memantine has been shown to have analgesic properties in pre-clinical and small clinical studies. We conducted a systematic review and meta-analysis to assess the efficacy of memantine to prevent or reduce chronic pain. DATABASES AND DATA TREATMENT: MEDLINE, EMBASE, and CENTRAL databases were searched for comparative trials using memantine, either against placebo or active medications, for chronic pain in adults...
March 8, 2019: European Journal of Pain: EJP
Brian Anderson, Vitaliy Meyster
Objective: This case report describes the application of graded motor imagery principles to a patient experiencing central sensitization and chronic pain. Clinical Features: A 46-year-old woman presented with pain in all 4 limbs along with global spinal pain and loss of range of motion. These symptoms initiated after a motor vehicle accident 5 years before and were exacerbated by 2 subsequent motor vehicle accidents. Examination indicated global loss of spinal range of motion, severe apprehension toward any movement, decreased grip strength bilaterally, and loss of 2-point discrimination...
December 2018: Journal of Chiropractic Medicine
Kristin Thuve Dahm, Hilde Tinderholt Myrhaug, Hilde Strømme, Brynjar Fure, Kjetil Gundro Brurberg
BACKGROUND: Many home-dwelling elderly use medical compression stockings to prevent venous insufficiency, deep venous thrombosis, painful legs and leg ulcers. Assisting users with applying and removing compression stockings demands resources from the home based health services, but the effects are uncertain. This systematic review aims to summarize the effects of preventive use of medical compression stockings for patients with chronic venous insufficiency and swollen legs. METHODS: We conducted a search in six databases (Epistemonikos, Cochrane Database of Systematic Reviews, MEDLINE, Embase, CENTRAL and CINAHL) in March 2018...
March 7, 2019: BMC Geriatrics
Jia Chen, Dan Chen, Yue Li, Hang Shen, Ji Li, Jia Ming Qian
Wernicke's encephalopathy(WE),characterized by nystagmus and ophthalmoplegia,unsteadiness of stance and gait and mental-status changes,is an acute or subacute metabolic encephalopathy of the central nervous system resulting from Vitamin B1(VitB1)deficiency. A 29-year-old male patient was admitted to our hospital due to abdominal pain and fever. He remained chronically undernourished. He was complicated with WE at the late stage of diagnosis,mainly manifested as the convulsion of limbs,ataxia,and delirium. After treatment with VitB1,these neuropsychiatric symptoms were remarkably resolved...
February 28, 2019: Zhongguo Yi Xue Ke Xue Yuan Xue Bao. Acta Academiae Medicinae Sinicae
J M Witkin, R Cerne, P G Davis, K B Freeman, J M do Carmo, J K Rowlett, K R Methuku, A Okun, S D Gleason, X Li, M J Krambis, M Poe, G Li, J M Schkeryantz, R Jahan, L Yang, W Guo, L K Golani, W H Anderson, J T Catlow, T M Jones, F Porreca, J L Smith, K L Knopp, J M Cook
Clinical evidence indicates that positive allosteric modulators (PAMs) of GABAA receptors have analgesic benefit in addition to efficacy in anxiety disorders. However, the utility of GABAA receptor PAMs as analgesics is compromised by the central nervous system side effects of non-selective potentiators. A selective potentiator of GABAA receptors associated with α2/3 subunits, KRM-II-81(5-(8-ethynyl-6-(pyridin-2-yl)-4H-benzo[f]imidazo[1,5-a][1,4]diazepin-3-yl)oxazole), has demonstrated anxiolytic, anticonvulsant, and antinociceptive effects in rodents with reduced motoric side effects...
February 27, 2019: Pharmacology, Biochemistry, and Behavior
S M Lockwood, A H Dickenson
BACKGROUND: Many Osteoarthritis (OA) patients report with clinical features to their pain that cannot be explained by purely peripheral mechanisms. Yet, the analgesic agents available that tackle centrally driven chronic pain often provide only partial pain relief, or have dose-limiting side effects. We explored a combination therapy of the centrally acting analgesic agents tapentadol and pregabalin, to investigate if they could be used in combination to provide superior analgesia. METHODS: Using electrophysiological single-unit recordings taken from spinal wide dynamic range (WDR) neurons, Diffuse Noxious Inhibitory Controls (DNIC) were assessed as a marker of potential changes in descending controls in a monoiodoacetate (MIA) model of OA...
March 1, 2019: European Journal of Pain: EJP
Toshiyuki Kanemasa, Katsumi Koike, Tohko Arai, Hiroko Ono, Narumi Horita, Hiroki Chiba, Atsushi Nakamura, Yasuhide Morioka, Tsuyoshi Kihara, Minoru Hasegawa
BACKGROUND: Naldemedine (S-297995) is a peripherally acting μ-opioid receptor antagonist developed as a once-daily oral drug for opioid-induced constipation (OIC) in adults with chronic noncancer or cancer pain. This study characterized the pharmacological effects of naldemedine in vitro and in vivo. METHODS: The binding affinity and antagonist activity of naldemedine against recombinant human μ-, δ-, and κ-opioid receptors were assayed in vitro. Pharmacologic effects of naldemedine were investigated using animal models of morphine-induced inhibition of small and large intestinal transit, castor oil-induced diarrhea, antinociception, and morphine withdrawal...
February 28, 2019: Neurogastroenterology and Motility: the Official Journal of the European Gastrointestinal Motility Society
Joanne Guay, Santhanam Suresh, Sandra Kopp
BACKGROUND: The use of ultrasound guidance for regional anaesthesia has become popular over the past two decades. However, it is not recognized by all experts as an essential tool, perhaps because it is unclear whether ultrasound reduces the risk of severe neurological complications, and the cost of an ultrasound machine (USD 22,000) is substantially higher than the cost of other tools. This review was published in 2016 and updated in 2019. OBJECTIVES: To determine whether ultrasound guidance offers any clinical advantage when neuraxial and peripheral nerve blocks are performed in children in terms of decreasing failure rate or the rate of complications...
February 27, 2019: Cochrane Database of Systematic Reviews
Jacob Lloyd, Ashna Maria Pinto, Shoba Nair, Subhash Tarey
Introduction: Stroke is the development of a focal neurological disturbance lasting >24 h, of vascular origin. In India, stroke is one of the leading causes of morbidity and mortality. Most stroke patients, during their duration of treatment and posthospitalization, want relief of suffering, a sense of control and minimized burden on the family. Aim: The aim of this study is to describe treating doctors' perspectives on the palliative needs of stroke patients in India...
January 2019: Indian Journal of Palliative Care
Laura Andrés-Rodríguez, Xavier Borràs, Albert Feliu-Soler, Adrián Pérez-Aranda, Antoni Rozadilla-Sacanell, Jesús Montero-Marin, Michael Maes, Juan V Luciano
Fibromyalgia (FM) is a highly prevalent and disabling syndrome characterized by chronic widespread musculoskeletal pain and a broad range of cognitive and affective symptoms. Up to now, the pathogenesis of FM is unknown although a peripheral and central sensitization involving an imbalance on immune biomarkers appears to have a relevant role in its aetiology. The aim of this study was to extend previous clinical findings of Mindfulness-Based Stress Reduction (MBSR) to both its impact on clinical symptomatology and immune biomarkers (IL-6, CXCL8, IL-10 and hs-CRP), and also to explore the role of biomarkers as predictors of efficacy...
February 25, 2019: Brain, Behavior, and Immunity
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