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Patient and Disease Characteristics Associates With Sensory Testing Results in Chronic Pancreatitis.
Abdominal pain is the most common symptom in chronic pancreatitis and has extensive impact on patients' lives. Quantitative sensory testing (QST) provides information on sensitivity to pain and mechanisms which can help quantify pain and guide treatment. The aims of this study were (1) to explore sensitivity to pain in patients with chronic pancreatitis using QST, and (2) to associate patient- and disease characteristics with QST results.
Learn More >The objective of this investigation was to examine the distribution of galcanezumab and a control immunoglobulin 4 antibody containing the same constant regions as galcanezumab, into peripheral and central tissues.
Learn More >Excessive prescription of opioids has become a national problem. Providers must attempt to decrease the amount of opioids prescribed while still providing patients with adequate pain relief after surgery.
Learn More >Nocebo hyperalgesia is an increase in pain through the expectation of such an increase as a consequence of a sham treatment. Nocebo hyperalgesia can be induced by observation of a model demonstrating increased pain via verbal pain ratings. The aim of the present study was to investigate whether observing natural pain behavior, such as facial pain expressions, can also induce nocebo responses.
Learn More >Diagnostic uncertainty, the perception of a lack of or incorrect label to explain symptoms, has been reported by parents of youth with chronic pain. This study was the first to examine diagnostic uncertainty in both youth with chronic pain and their parents using qualitative methodology. Individual, face-to-face, semi-structured interviews were conducted with twenty youth with chronic pain recruited from a pediatric chronic pain program. Independent interviews were also conducted with one of their parents. Interviews explored participants' memories and perceptions around diagnosis. In-depth thematic analysis revealed four themes: (1) The Function of a Diagnosis. Parents and youth struggled with the meaning of the diagnosis, needed further explanation for the pain, and perceived the 'right' diagnosis (i.e., one that fit with their beliefs) as justification for the pain. (2) Haunted by Something Missing. Negative test results did not provide relief or counter the belief that something serious could have been missed by clinicians. (3) The Search for an Alternative Diagnosis. A search persisted for the 'right' diagnosis, particularly when a non-pharmacological treatment plan was provided. (4) Mistrust in the Medical System. Clinician communication and perceptions of clinicians' uncertainty impacted parent and youth 'buy in' to the diagnosis. Findings suggest that many youth with chronic pain and their parents experience diagnostic uncertainty, which is integrally tied to their past experiences with the medical system. Greater understanding of diagnostic uncertainty may help tailor how clinicians deliver diagnoses to achieve 'buy in', increase understanding of pain and diagnosis, and improve treatment response. Perspective: A major challenge that youth with chronic pain and their parents face is understanding the cause of the pain. Youth with chronic pain and their parents experience uncertainty about their diagnosis, which may be linked to their 'buy in' and treatment response.
Learn More >To investigate suicidality related to cluster headache and factors associated with increased suicidality in cluster headache patients.
Learn More >A growing body of evidence suggests that chronic pain is associated with perceptual changes, such as impaired tactile acuity and laterality judgements. A recent study on low back pain showed that tactile acuity was reduced immediately after acute pain induction. Biologically, acute pain should lead to enhanced rather than disruptive changes in tactile acuity to meaningfully respond to potentially damaging nociceptive stimuli. In this double-blinded experiment, 30 healthy volunteers attended three experimental sessions (injection, sham-injection and control condition) separated by one week each, to investigate the effect of acute nociception on tactile precision and laterality judgements. In the real injection condition, acute pain was induced by hypertonic saline solution injected into the mid portion of the trapezius muscle. Tactile acuity (two-point discrimination and an estimation task) and laterality judgements were measured before and during pain perception. In the sham condition the injection was mimicked by a sham procedure (without piercing the skin), in the control condition no intervention took place. Results showed that tactile acuity remained intact (P=0.92) indicating that experimentally induced neck pain did not affect tactile precision. The time needed to complete the laterality judgement task improved over-time in all conditions reflecting a learning effect (P=0.05), We conclude that acute neck pain does not result in perceptual distortions, possibly reflecting a higher protection demand for the neck, a body region in close anatomical proximity to neural centers responsible for vital functions. This data -in the context of existing evidence- indicates that tactile acuity may respond differently to noxious stimulation in different anatomical regions. Perspective: In this study, a sensory adaptation to acute neck pain was investigated. It was found that experimental neck pain did not elicit changes in the sensory axis leaving tactile acuity intact in otherwise healthy subjects. These data support site-specific sensory adaptation to pain.
Learn More >Prescription opioid misuse is a public health problem that leads to overdose. Although existing interventions focus on limiting prescribing to patients at high risk, individuals may still access prescription opioids dispensed to family members.
Learn More >Intensive interdisciplinary treatment is emerging as an effective treatment of chronic pain in youth. These programs often include a parental component with the belief that targeting parental distress and responses to a child's pain will improve outcomes. However, few studies have evaluated the impact of a parental intervention in the interdisciplinary treatment of pediatric chronic pain. The present study consists of a nonrandomized pre-post design to evaluate change in psychological and behavioral functioning of parents who participated in intensive parent programming that utilized Cognitive Behavioral Therapy (CBT) and Acceptance and Commitment Therapy (ACT), delivered within the context of an interdisciplinary intensive 3-week pain treatment program for youth with chronic pain.
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