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Douleur Neuropathique 4 (DN4) is a screening questionnaire to help identify neuropathic pain (NP) in clinical practice and research. We tested the accuracy of the DN4 questionnaire in stratifying possible NP (pNP) and definite NP (dNP) in patients operated for breast cancer.
Learn More >African Americans experience an increased burden of motor vehicle collision (MVC), post-MVC musculoskeletal pain (MSP) and Vitamin D insufficiency. In this prospective multicenter study, we tested the hypothesis that African Americans (n=133) presenting to the ED after MVC with low peritraumatic Vitamin D levels would have worse chronic MSP outcomes compared to individuals with sufficient Vitamin D. Vitamin D levels were assessed in the early aftermath of MVC via enzyme-linked immunosorbent assay, and pain severity was assessed via the 0-10 numeric rating scale at 6 weeks, 6 months and 1 year. In repeated-measures analysis, African American MVC survivors with vitamin D insufficiency experienced more severe chronic pain (β=1.18, p=0.031). In secondary analyses, we assessed for evidence that the effect of Vitamin D on post-MVC pain outcomes is mediated, at least in part, by the influence of Vitamin D on genetic variants in genes involved in immune system regulation (IL-10 and NLRP3). Genotyping was performed using a genome-wide microarray using collected DNA samples. Secondary analyses suggest that the effect of Vitamin D on post-MVC pain outcomes may be influenced by genetic variation in IL-10 and NLRP3. Further studies are needed to assess the impact of Vitamin D insufficiency on pain outcomes in African Americans experiencing MVC and other common trauma exposures, to assess factors affecting this relationship, and to assess the efficacy of administering Vitamin D in the immediate aftermath of MVC to prevent chronic pain. Such low-cost, non-opioid interventions are urgently needed to address chronic pain development following MVC.
Learn More >Localizing pain is crucial because it allows for detecting which part of the body is being hurt and identifying in its surrounding which stimulus is producing the damage. Nociceptive inputs should therefore be mapped according to somatotopic ("which limb is stimulated?") and spatiotopic representations ("where is the stimulated limb?"). Because the body posture constantly changes, the brain has to realign the different spatial representations, for instance when the arms are crossed with the left hand in the right space and vice versa, to adequately guide actions towards the threatening object. Such ability is thought to be dependent on past sensory experience and contextual factors. We compared performances of early blind and normally sighted participants during temporal order judgement tasks. Two nociceptive stimuli were applied, one on each hand, with the hands either uncrossed or crossed. Participants reported which stimulus they perceived as first presented, according to either its location on the body or the position of the stimulated hand, respectively, prioritizing anatomy or external space as task-relevant reference frame. Relative to the uncrossed posture, sighted participants' performances were decreased when the hands were crossed, whatever the instruction be. Early blind participants' performances were affected by crossing the hands during spatial instruction, but not during anatomical instruction. These results indicate that nociceptive stimuli are automatically coded according to both somatotopic and spatiotopic representations, but the integration of the different spatial reference frames depends on early visual experience and ongoing cognitive goals, illustrating the plasticity and the flexibility of the nociceptive system.
Learn More >Safe opioid prescribing practices are critical to mitigate the risk of prescription opioid overdose in adolescents and young adults. However, studies that examine opioid prescribing patterns associated with prescription opioid overdose have mostly focused on older adults. The generalizability of these studies to adolescents and young adults is unclear.
Learn More >To describe the efficacy of tofacitinib in reducing pain in patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA) or ankylosing spondylitis (AS) in a post-hoc analysis of randomised controlled trials.
Learn More >Many individuals with migraine report symptoms of dry eye (DE). However, it is not known whether DE profiles are similar between individuals with and without migraine. To bridge this gap, we evaluated symptoms and signs of DE, including symptoms suggestive of nerve dysfunction, in a large group of individuals with DE symptoms, and compared profiles between individuals with migraine and those without migraine or headache.
Learn More >Societal costs of low back pain are high, yet few studies have been performed to identify predictive factors of high societal costs among chronic low back pain patients. This study aimed to determine which factors predict high societal costs in patients with chronic low back pain.
Learn More >Dorsal root ganglion (DRG) stimulation has been demonstrated to be effective in treating painful diabetic polyneuropathy in a small case series. However, diabetic polyneuropathy only accounts for 41% of all polyneuropathies and the efficacy of DRG on other types of polyneuropathy is unclear. The objective of this study is to evaluate the efficacy of DRG stimulation in treating painful hereditary and idiopathic axonal polyneuropathy.
Learn More >Both temporomandibular disorders myalgia (TMDM) and fibromyalgia (FM) have been linked to central and peripheral changes in serotonin availability. The precursor of serotonin, tryptophan (TRP), is mainly catabolized via another pathway to produce kynurenine (KYN), but whether changes of this pathway are present in TMDM and FM are still unclear.
Learn More >The objective of the present analysis was to determine whether changes in Brief Pain Inventory (BPI) average pain by patient global impression of improvement (PGI-I) category and the cut-off for clinically important difference (CID) were different between Asian and Caucasian patients with chronic pain due to osteoarthritis. This analysis used data from 3 (Caucasian) and 2 (Asian) randomized, placebo-controlled, 10- to 14-week duloxetine studies for the treatment of patients aged ≥40 years with osteoarthritis pain. The receiver operating characteristic (ROC) analysis was used to characterize the association between changes in BPI average pain and PGI-I levels at study endpoint. The CID was characterized by PGI-I and the cut-off point for CID in BPI average pain was determined by the intersection of a 45̊ tangent line with each ROC curve. Data from 668 Asian and 868 Caucasian patients were available for analysis. Baseline BPI average pain ratings including worst and least pain were comparable between Asians and Caucasians. Ratings for percentage change from baseline to endpoint for BPI average pain in Asian patients and Caucasian patients were similar across the 7 PGI-I categories, regardless of age, gender, study, and treatment. The ROC analysis results of cut-off points in BPI average pain demonstrated the raw change cut-off was -3.0, and percentage change cut-off was -40% for both Asian and Caucasian patients. Overall, the present analysis concludes changes in BPI average pain by PGI-I category and the cut-off for CID were similar for Asian and Caucasian patients with chronic pain due to osteoarthritis.
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