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The Journal of Clinical Investigation Nov 2010To paraphrase Cole Porter's famous 1926 song, "What is this thing called pain? This funny thing called pain, just who can solve its mystery?" Pain, like love, is all... (Review)
Review
To paraphrase Cole Porter's famous 1926 song, "What is this thing called pain? This funny thing called pain, just who can solve its mystery?" Pain, like love, is all consuming: when you have it, not much else matters, and there is nothing you can do about it. Unlike love, however, we are actually beginning to tease apart the mystery of pain. The substantial progress made over the last decade in revealing the genes, molecules, cells, and circuits that determine the sensation of pain offers new opportunities to manage it, as revealed in this Review series by some of the foremost experts in the field.
Topics: Humans; Pain; Syndrome
PubMed: 21041955
DOI: 10.1172/JCI45178 -
Trials Jul 2020Nonspecific chronic neck pain is a fairly common disorder that causes a great impact, and it is greatly influenced by psychosocial factors. Among a number of treatment... (Comparative Study)
Comparative Study Randomized Controlled Trial
BACKGROUND
Nonspecific chronic neck pain is a fairly common disorder that causes a great impact, and it is greatly influenced by psychosocial factors. Among a number of treatment modalities described for its management, the most common approach is based on manual therapy and specific therapeutic exercise, which have shown a moderate effect on subjects with chronic non-specific neck pain. However, the effect times of these treatments have not been accurately detailed. Our study aims to break down and compare the effects of two experimental treatments based on manual therapy and therapeutic exercise.
METHODS
The short-term and mid-term changes produced by different therapies on subjects with non-specific chronic neck pain were studied. The sample was randomized divided into three groups: manual therapy, therapeutic exercise, and placebo. As dependent variables of our research, we studied (a) pain, based on the visual analog scale and the pressure pain threshold, and (b) cervical disability, through the Neck Disability Index (NDI). Outcomes were registered on week 1, week 4, and week 12. The findings were analyzed statistically considering a 5% significance level (P ≤ 0.05).
RESULTS
No statistically significant differences (P 0.05) were obtained between the experimental groups, if they exist against the control group. Nonetheless, we found that manual therapy improved perceived pain before than therapeutic exercise, while therapeutic exercise reduced cervical disability before than manual therapy. Effect size (R) shows medium and large effects for both experimental treatments.
CONCLUSION
There are no differences between groups in short and medium terms. Manual therapy achieves a faster reduction in pain perception than therapeutic exercise. Therapeutic exercise reduces disability faster than manual therapy. Clinical improvement could potentially be influenced by central processes.
TRIAL REGISTRATION
Brazilian Clinical Trial Registry, RBR-2vj7sw. Registered on 28 November 2018.
Topics: Brazil; Chronic Pain; Exercise Therapy; Humans; Musculoskeletal Manipulations; Neck Pain; Treatment Outcome
PubMed: 32723399
DOI: 10.1186/s13063-020-04610-w -
Pain Sep 2018An acute bout of physical activity and exercise can increase pain in individuals with chronic pain, but regular exercise is an effective treatment. This review will... (Review)
Review
An acute bout of physical activity and exercise can increase pain in individuals with chronic pain, but regular exercise is an effective treatment. This review will discuss these two dichotomous findings by summarizing studies in human and animal subjects. We will provide the data that supports the role of physical activity in modulating central nervous system excitability and inhibition, immune system function, and psychological constructs associated with pain. We show evidence that the sedentary condition is associated with greater excitability and less inhibition in both the central nervous system (brainstem inhibitory/facilitatory sites) and the immune system. We further show that exercise and regular physical activity decreases excitability and improves inhibition in both the central nervous system (brainstem inhibitory/facilitatory sites) and the immune system. We will then discuss the clinical implications of these findings, make recommendations for clinical application of exercise, and suggest future research directions.
Topics: Analgesia; Animals; Clinical Trials as Topic; Exercise; Humans; Immune System; Pain
PubMed: 30113953
DOI: 10.1097/j.pain.0000000000001235 -
Journal of Hand Therapy : Official... 2020Clinical commentary. (Review)
Review
STUDY DESIGN
Clinical commentary.
INTRODUCTION/PURPOSE
Pain and movement are universally relevant phenomena that influence human experiences in readily observable ways. Improved understanding of pain-movement relationships can guide medical and rehabilitative approaches to recovery and decrease risk of dysfunctional long-term consequences of otherwise normal neuromuscular responses. Therefore, the overall intent of this article is to elucidate the relationships between pain and movement as they relate to clinical decision making.
CONCLUSIONS
Motor output is highly adaptable, can be influenced by multiple mechanisms at various levels along the nervous system, and may vary between individuals despite similar diagnoses. Therefore, interventions need to be individualized and consider both the types of motor response observed (ie, whether the response is protective or maladaptive), and the patient's acute physical activity tolerance when prescribing exercise/movement.
Topics: Adaptation, Psychological; Avoidance Learning; Exercise Therapy; Humans; Motor Activity; Muscle Strength; Pain
PubMed: 30025839
DOI: 10.1016/j.jht.2018.05.001 -
Pain Apr 2017The experience of pain is characterized by tremendous inter-individual variability. Multiple biological and psychosocial variables contribute to these individual... (Review)
Review
The experience of pain is characterized by tremendous inter-individual variability. Multiple biological and psychosocial variables contribute to these individual differences in pain, including demographic variables, genetic factors, and psychosocial processes. For example, sex, age and ethnic group differences in the prevalence of chronic pain conditions have been widely reported. Moreover, these demographic factors have been associated with responses to experimentally-induced pain. Similarly, both genetic and psychosocial factors contribute to clinical and experimental pain responses. Importantly, these different biopsychosocial influences interact with each other in complex ways to sculpt the experience of pain. Some genetic associations with pain have been found to vary across sex and ethnic group. Moreover, genetic factors also interact with psychosocial factors, including stress and pain catastrophizing, to influence pain. The individual and combined influences of these biological and psychosocial variables results in a unique mosaic of factors that contributes pain in each individual. Understanding these mosaics is critically important in order to provide optimal pain treatment, and future research to further elucidate the nature of these biopsychosocial interactions is needed in order to provide more informed and personalized pain care.
Topics: Age Factors; Female; Humans; Individuality; Male; Pain; Psychology; Sex Characteristics
PubMed: 27902569
DOI: 10.1097/j.pain.0000000000000775 -
Journal of Neural Transmission (Vienna,... Apr 2020Neuropathic pain is a frequent condition caused by a lesion or disease of the central or peripheral somatosensory nervous system. A frequent cause of peripheral... (Review)
Review
Neuropathic pain is a frequent condition caused by a lesion or disease of the central or peripheral somatosensory nervous system. A frequent cause of peripheral neuropathic pain is diabetic neuropathy. Its complex pathophysiology is not yet fully elucidated, which contributes to underassessment and undertreatment. A mechanism-based treatment of painful diabetic neuropathy is challenging but phenotype-based stratification might be a way to develop individualized therapeutic concepts. Our goal is to review current knowledge of the pathophysiology of peripheral neuropathic pain, particularly painful diabetic neuropathy. We discuss state-of-the-art clinical assessment, validity of diagnostic and screening tools, and recommendations for the management of diabetic neuropathic pain including approaches towards personalized pain management. We also propose a research agenda for translational research including patient stratification for clinical trials and improved preclinical models in relation to current knowledge of underlying mechanisms.
Topics: Chronic Pain; Diabetic Neuropathies; Humans; Neuralgia
PubMed: 32036431
DOI: 10.1007/s00702-020-02145-7 -
Journal of Clinical Research in... Feb 2020Most adolescents will experience discomfort during menstruation. Due to normalization of dysmenorrhea, there is delay to diagnosis and treatment. Non-steroidal...
Most adolescents will experience discomfort during menstruation. Due to normalization of dysmenorrhea, there is delay to diagnosis and treatment. Non-steroidal anti-inflammatories are a first line treatment. Adolescents can safely be offered menstrual suppression with combined hormonal contraception, and progestin-only options. When the above are ineffective, gonadotropin releasing hormone agonists with add back treatment can be considered. Transabdominal ultrasound is indicated when first line treatments do not improve symptoms. Endometriosis should be considered in adolescents who experience ongoing pain despite medical treatment. If laparoscopy is performed and endometriosis visualized, it should be treated with either excision or ablation. Women with endometriosis should be counselled on menstrual suppression until fertility is desired. Management of chronic pain requires the involvement of a multi-disciplinary team.
Topics: Adolescent; Chronic Pain; Complementary Therapies; Diagnosis, Differential; Dysmenorrhea; Endometriosis; Female; Humans; Pelvic Pain; Physical Examination
PubMed: 32041388
DOI: 10.4274/jcrpe.galenos.2019.2019.S0217 -
Cleveland Clinic Journal of Medicine Jun 2022Chronic anal pain is difficult to diagnose and treat, especially with no obvious anorectal cause apparent on clinical examination. This review identifies 3 main... (Review)
Review
Chronic anal pain is difficult to diagnose and treat, especially with no obvious anorectal cause apparent on clinical examination. This review identifies 3 main diagnostic categories for chronic anal pain: local causes, functional anorectal pain, and neuropathic pain syndromes. Conditions covered within these categories include proctalgia fugax, levator ani syndrome, pudendal neuralgia, and coccygodynia. The signs, symptoms, relevant diagnostic tests, and main treatments for each condition are reviewed.
Topics: Anus Diseases; Chronic Pain; Humans; Neuralgia; Pain; Pelvic Pain
PubMed: 35649568
DOI: 10.3949/ccjm.89a.21102 -
Transactions of the American Clinical... 2015Chronic musculoskeletal pain is one of the most intractable clinical problems faced by clinicians and can be devastating for patients. Central pain amplification is... (Review)
Review
Chronic musculoskeletal pain is one of the most intractable clinical problems faced by clinicians and can be devastating for patients. Central pain amplification is perceived pain that cannot be fully explained on the basis of somatic or neuropathic processes and is due to physiologic alterations in pain transmission or descending pain modulatory pathways. In any individual, central pain amplification may complicate nociceptive or neuropathic pain. Furthermore, patients with somatic symptom disorders may have alterations in their psychological or behavioral responses to pain that contribute significantly to the clinical presentation. Genetic, physiologic, and psychological factors associated with central pain amplification are beginning to be understood. One important contributor to chronic pain is perceived stress and stress response systems. We and others have shown a complex relationship between the physiologic stress response and chronic pain symptoms. Unfortunately, treatments for chronic pain are woefully inadequate and often worsen clinical outcomes. Developing new treatment strategies for patients with chronic pain is of utmost urgency. This essay provides a framework for thinking about chronic pain and developing new treatment approaches.
Topics: Adaptation, Psychological; Brain; Chronic Pain; Cost of Illness; Humans; Musculoskeletal Pain; Neural Pathways; Pain Management; Pain Perception; Pain Threshold; Prognosis; Risk Factors
PubMed: 26330672
DOI: No ID Found -
Minerva Anestesiologica Feb 2012In recent years, increasing attention has been focused on the treatment of acute and chronic pain with a considerable number of publications about it. Nevertheless all... (Review)
Review
In recent years, increasing attention has been focused on the treatment of acute and chronic pain with a considerable number of publications about it. Nevertheless all the attention focused on it, the evidence of pain treatments is still unfolding, and occasionally conflicting. Hence it is still necessary that we point out our research efforts in trying to obtain a better understand of pathophysiology of pain and of real efficacy and safety of acute and chronic pain treatments. Our goal with this review is to summarize the latest research trends and the most advanced therapeutic standards for pain syndromes described in the literature, the discussion will be divided in four main topics, as these topics were treated during the SIMPAR (Study In Multidisciplinary PAin Research) meeting, held on December 2010 in Pavia: pathophysiology of pain, acute postoperative pain, opioids and pain, and chronic pain (Failed Back Surgery Syndrome). In the chapter of pathophysiology of pain we analyzed how to obtain a more personalized treatment through the study of the genetic and neurophysiological characteristics of patients and how to select the right local anesthetic according to anatomic and metabolizing patterns of patients. In acute postoperative pain we focalized our attention on the evidence supporting the use of continuous peripheral nerve blocks in the treatment of postoperative pain and in the prevention of chronic persistent post-operative pain, with a special attention in preventing side effects of regional anesthesia. We also reviewed the current evidence about the use of new very interesting modality to control postoperative pain after laparoscopy: pre-emptive nebulization of local anesthetic in abdominal cavity. As opioids are currently widely used to control chronic oncologic and non-oncologic pain, in this review we analyzed the level of evidence for their use, how to manage them better and psychological factors that can affect their success and/or determine addiction. Finally, we summarized the current evidence about Failed Back Surgery Syndrome focalizing our attention both in diagnosing it correctly and treating this syndrome with specific knowledge of the anatomic space that we have to approach and applying the possible treatments depending on pain pathophysiology and patient characteristics. In conclusion, it is important to try to personalize even better the therapy of patients with acute and chronic pain through a more accurate knowledge of anatomy, pathophysiology of pain, pharmacokinetic of pain drugs and of new device/therapies available.
Topics: Acute Pain; Back Pain; Chronic Pain; Humans; Neoplasms; Pain, Postoperative; Treatment Failure
PubMed: 22095106
DOI: No ID Found