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The purpose of this review is to summarize recent findings on conditioned pain modulation (CPM) in humans with a focus on methodology, factors modulating CPM, and the potential for CPM as a clinical marker for pain progression.
Learn More >Chronic pain patients are frequent and recurrent users of health services, which may have an impact on levels of health literacy (HL). Therefore, the aim of the present study was to investigate associations between healthcare utilization and varying levels of HL in individuals with and without chronic pain.
Learn More >Despite optimal medical management (OMM), low back pain (LBP) can be disabling, particularly after spinal surgery. Spinal cord stimulation (SCS) is effective in reducing neuropathic leg pain; however, evidence is limited for LBP.This prospective, open-label, parallel-group trial randomized (1:1) failed back surgery syndrome (FBSS) patients with predominant LBP to SCS plus OMM (SCS group) or OMM alone (OMM group) in 28 sites in Europe and the Americas. If trial stimulation was successful, a SCS system was implanted. Outcomes were assessed at baseline (pre-randomization) and 1, 3, 6, and 12 months post-randomization. Patients could change treatment groups at 6 months. The primary outcome was the proportion of patients with ≥50% reduction in LBP (responder) at 6 months. Secondary outcomes included change in pain intensity, functional disability and health-related quality of life (HRQoL). Results are posted at ClinicalTrials.gov registration number NCT01697358.In the intent-to-treat analysis, there were more responders in the SCS group than the OMM group (13.6%,15/110 versus 4.6%, 5/108, difference 9% with 95% CI 0.6-17.5%, P=0.036) at 6 months. The SCS group improved in all secondary outcomes compared to the OMM group. The OMM group only improved in HRQoL. In the SCS group, 17.6% (18/102) experienced SCS-related AEs through 6 months, with 11.8% (12/102) requiring surgical re-intervention.Adding multicolumn SCS to OMM improved pain relief, HRQoL and function in a traditionally difficult to treat population of FBSS patients with predominant LBP. Improvements were sustained at 12 months.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
Learn More >In this report we describe a series of patients with a previously undescribed headache.
Learn More >The phase III research evaluating migraine prophylaxis therapy (PREEMPT) protocol was developed in low-risk migraine patients. We studied longitudinal response to treatment in a sequential retrospective observational cohort to evaluate predictors of effectiveness in patients with multiple overlapping pain syndromes treated in a quaternary pain management clinic.
Learn More >The aim of this study was to explore the effects of mindfulness-based stress reduction (MBSR) on reducing the psychological and physical symptoms in patients with postherpetic neuralgia (PHN). A total of 50 patients with PHN from January 2017 to September 2018 were selected into the intervention group and the control group. Both groups received routine care, whereas the intervention group also was given an 8-week of MBSR. Psychological (depression and anxiety) and physical (pain) symptoms were assessed before and after the intervention. The study demonstrated evidence of MBSR effectiveness in reducing depression (p < 0.01), anxiety (p < 0.01), and pain (p < 0.01) scores after intervention for herpetic patients with neuralgia. MBSR can effectively alleviate depression, anxiety, and pain in patients with PHN. Our results provide clinical effectiveness evidence that MBSR works to improve the psychological and physical symptoms with the greatest improvement occurring during the 8-week program.
Learn More >More than 15,000 children die annually in the United States due to an underlying life-limiting disease and the majority of those children experience distressing symptoms, which are not adequately relieved, such as pain and dyspnea. Multimodal analgesia, that is multiple agents, interventions, rehabilitation, psychological modalities, and integrative (nonpharmacologic) therapies, act synergistically for more effective pediatric pain and symptom control with fewer side effects than a single analgesic or modality. However, opioids, such as morphine, fentanyl, hydromorphone, oxycodone, and methadone (in the United Kingdom: diamorphine) remain the mainstay medication to effectively treat pain and dyspnea in children with serious illness.
Learn More >To examine the longitudinal course of vasomotor symptoms (VMS) in women with a history of migraine, in comparison to women without a history of migraine disease.
Learn More >Non-selective glutamate AMPA receptor antagonists are efficacious in chronic pain, but have significant tolerability issues, likely arising from the ubiquitous expression of AMPA receptors in CNS. Recently, LY3130481 has been shown to selectively block AMPA receptors co-assembled with the auxiliary protein, TARP γ8, which is highly expressed in hippocampus, but also in pain pathways, including anterior cingulate (ACC) and somatosensory (SS) cortices and spinal cord, suggesting that selective blockade γ8/AMPA receptors may suppress nociceptive signaling with fewer CNS side effects. The potency of LY3130481 on recombinant γ8-containing AMPA receptors was modulated by co-expression with other TARPs; γ2 subunits affected activity more than γ3 subunits. Consistent with these findings, LY3130481 had decreasing potency on receptors from rat hippocampal, cortical, spinal cord, and cerebellar neurons that was replicated in tissue from human brain. LY3130481 partially suppressed, whereas the non-selective AMPA antagonist GYKI53784 completely blocked AMPA receptor-dependent EPSPs in ACC and spinal neurons in vitro. Similarly, LY3130481 attenuated short-term synaptic plasticity in spinal sensory neurons in vivo in response stimulation of peripheral afferents. LY3130481 also significantly reduced nocifensive behaviors after intraplantar formalin that was correlated with occupancy of CNS γ8-containing AMPA receptors. In addition, LY3130481 dose-dependently attenuated established gait impairment after joint damage and tactile allodynia after spinal nerve ligation; all in the absence of motor side effects. Collectively, these data demonstrate that LY3130481 can suppress excitatory synaptic transmission and plasticity in pain pathways containing γ8/AMPA receptors and significantly reduce nocifensive behaviors, suggesting a novel, effective and safer therapy for chronic pain conditions.
Learn More >To understand the process of change at an individual level, this study used a single-case experimental design to evaluate how change in potential mediators related to change in disability over time, during an exposure-based behavioural intervention in four people with chronic low back pain and high pain-related fear. A second aim was to evaluate whether the change (sequential or simultaneous) in mediators and disability occurred at the same timepoint for all individuals.
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