Pain Research and Treatment The latest articles from Hindawi Publishing Corporation © 2015 , Hindawi Publishing Corporation . All rights reserved. Noninterventional Study of Transdermal Fentanyl (Fentavera) Matrix Patches in Chronic Pain Patients: Analgesic and Quality of Life Effects Wed, 11 Mar 2015 06:44:52 +0000 Fentanyl is considered to be an effective, transdermal treatment of chronic, cancer, and noncancer pain. This noninterventional, clinical practice-based study, on 426 patients attending 42 practices, assessed a proprietary, Aloe vera-containing, transdermal fentanyl matrix patch (Fentavera), for its analgesic effects, patients’ quality of life (QoL) effects, tolerability, and adhesiveness. Study outcomes were mean changes from baseline of patient (11-point scales) and physician (5-point scales) ratings. After 1 and 2 months treatment, there were significant () decreases in patients’ ratings of pain intensity, and impairment of walking, general activity, sleep quality, and QoL. For each parameter, the patient response rate was >30% at 2 months (response = 2-point decrease on 11-point rating scale). In a large majority of patients, the physicians rated the matrix patch as good or very good for analgesic effect, systemic and local tolerance, and adhesiveness. There were 30 adverse events in 4.2% of patients and analgesic comedications were reduced during treatment compared to before treatment. It is concluded, from this population-based data, that the proprietary, transdermal fentanyl matrix patch is effective and safe for chronic pain management in clinical practice, with significant positive analgesic and QoL effects, while being well tolerated and exhibiting good or very good adhesiveness. Manuel Heim Copyright © 2015 Manuel Heim. All rights reserved. The Efficacy of Intranasal Desmopressin as an Adjuvant in the Acute Renal Colic Pain Management Mon, 08 Dec 2014 12:56:17 +0000 The aim of this study was to compare analgesic effect of intramuscular (IM) sodium diclofenac and intranasal desmopressin combination with IM sodium diclofenac alone in patients with acute renal colic. In this randomized double-blind clinical trial, all patients aged 18 to 55 years who were diagnosed as acute renal colic and met the inclusion and exclusion criteria were randomized into two groups to receive 40 μg intranasal desmopressin spray and 75 mg IM sodium diclofenac combination (Group A) or 75 mg IM sodium diclofenac alone (Group B). The pain score of patients was assessed using a visual analogue scale (VAS) at baseline, 15, 30, 45, and 60 minutes after administration. Of all 159 patients who were assessed for eligibility finally, the results of 120 patients were analyzed. There was no significant difference regarding age and gender between two groups. The baseline VAS score was not significantly different between two groups (). The Mean ± SD scores of two groups reduced 15 minutes after drug administration, but this decrease was significantly more in Group A compared with Group B (). This pattern continued in minutes 30, 45, and 60 of drug administration. Our results showed that desmopressin could be used as an effective adjuvant in acute renal colic pain management. Kambiz Masoumi, Ali Asgari Darian, Arash Forouzan, Hassan Barzegari, Fakher Rahim, Maryam Feli, Mehdi Fallah Bagher Sheidaii, and Samaneh Porozan Copyright © 2014 Kambiz Masoumi et al. All rights reserved. Comment on “Short-Term Efficacy of Ultramicronized Palmitoylethanolamide in Peripheral Neuropathic Pain” Thu, 27 Nov 2014 07:17:56 +0000 R. Kriek Copyright © 2014 R. Kriek. All rights reserved. Perineural Dexamethasone to Improve Postoperative Analgesia with Peripheral Nerve Blocks: A Meta-Analysis of Randomized Controlled Trials Tue, 18 Nov 2014 08:58:32 +0000 Background. The overall effect of perineural dexamethasone on postoperative analgesia outcomes has yet to be quantified. The main objective of this quantitative review was to evaluate the effect of perineural dexamethasone as a nerve block adjunct on postoperative analgesia outcomes. Methods. A systematic search was performed to identify randomized controlled trials that evaluated the effects of perineural dexamethasone as a block adjunct on postoperative pain outcomes in patients receiving regional anesthesia. Meta-analysis was performed using a random-effect model. Results. Nine randomized trials with 760 subjects were included. The weighted mean difference (99% CI) of the combined effects favored perineural dexamethasone over control for analgesia duration, 473 (264 to 682) minutes, and motor block duration, 500 (154 to 846) minutes. Postoperative opioid consumption was also reduced in the perineural dexamethasone group compared to control, −8.5 (−12.3 to −4.6) mg of IV morphine equivalents. No significant neurological symptoms could have been attributed to the use of perineural dexamethasone. Conclusions. Perineural dexamethasone improves postoperative pain outcomes when given as an adjunct to brachial plexus blocks. There were no reports of persistent nerve injury attributed to perineural administration of the drug. Gildasio S. De Oliveira Jr., Lucas J. Castro Alves, Autoun Nader, Mark C. Kendall, Rohit Rahangdale, and Robert J. McCarthy Copyright © 2014 Gildasio S. De Oliveira Jr. et al. All rights reserved. Mastalgia: Prevalence at a Sub-Saharan African Tertiary Hospital Tue, 30 Sep 2014 06:16:07 +0000 Introduction. Mastalgia is a common breast condition among women referred to breast clinics worldwide. Whereas the prevalence is known in the Western world and Asia, the prevalence of the disease is unknown in many African countries. The aim of this study therefore was to determine the prevalence and describe factors associated with mastalgia among women attending a tertiary hospital in sub-Saharan Africa. Methods. A cross-sectional study was done in Kampala, Uganda. Mastalgia was defined as self-reported breast pain (unilateral or bilateral) for a period not less than two months. A pretested questionnaire was used to collect the data and statistical analysis was performed using SPSS version 11. Ethical approval was obtained. Results. Out of the 1048 women who presented to the breast clinic during the study period, 168 (16%) were diagnosed with mastalgia in the absence of breast cancer. Noncyclical and cyclical mastalgia were 22/168 (13%) and 5/168 (3%), respectively. The onset of noncyclical category as compared to the cyclical type of mastalgia was observed to manifest before 24 years of age (). Conclusion. Mastalgia was a common condition among women in this sub-Saharan African setting as is elsewhere. The early onset mastalgia in this sub-Saharan African study requires further exploration for determination of its risk factors. T. Makumbi, M. Galukande, and A. Gakwaya Copyright © 2014 T. Makumbi et al. All rights reserved. Loss of Central Inhibition: Implications for Behavioral Hypersensitivity after Contusive Spinal Cord Injury in Rats Sun, 10 Aug 2014 11:36:40 +0000 Behavioral hypersensitivity is common following spinal cord injury (SCI), producing significant discomfort and often developing into chronic pain syndromes. While the mechanisms underlying the development of behavioral hypersensitivity after SCI are poorly understood, previous studies of SCI contusion have shown an increase in amino acids, namely, aspartate and glutamate, along with a decrease in GABA and glycine, particularly below the injury. The current study sought to identify alterations in key enzymes and receptors involved in mediating central inhibition via GABA and glycine after a clinically-relevant contusion SCI model. Following thoracic (T8) 25.0 mm NYU contusion SCI in rodents, significant and persistent behavioral hypersensitivity developed as evidenced by cutaneous allodynia and thermal hyperalgesia. Biochemical analyses confirmed upregulation of glutamate receptor GluR3 with downregulation of the GABA synthesizing enzyme (GAD65/67) and the glycine receptor 3 (GLRA3), notably below the injury. Combined, these changes result in the disinhibition of excitatory impulses and contribute to behavioral hyperexcitability. This study demonstrates a loss of central inhibition and the development of behavioral hypersensitivity in a contusive SCI paradigm. Future use of this model will permit the evaluation of different antinociceptive strategies and help in the elucidation of new targets for the treatment of neuropathic pain. Yerko A. Berrocal, Vania W. Almeida, Rocio Puentes, Eric P. Knott, Jaclyn F. Hechtman, Mary Garland, and Damien D. Pearse Copyright © 2014 Yerko A. Berrocal et al. All rights reserved. Risk Assessment of Opioid Misuse in Italian Patients with Chronic Noncancer Pain Sun, 10 Aug 2014 00:00:00 +0000 Objective. Opioid therapy in patients with chronic noncancer pain must be preceded by evaluation of the risk of opioid misuse. The aim of this study was to evaluate the predictive validity of the Italian translation of the Pain Medication Questionnaire (PMQ) and of the Diagnosis Intractability Risk and Efficacy Score (DIRE) in chronic pain patients. Design. 75 chronic noncancer pain patients treated with opioids were enrolled and followed longitudinally. Risk of opioid misuse was evaluated through PMQ, DIRE, and the physician’s clinical evaluation. Pain experience and psychological characteristics were assessed through specific self-report instruments. At follow-ups, pain intensity, aberrant drug behaviors, and presence of the prescribed opioid and of illegal substances in urine were also checked. Results. PMQ demonstrated good internal consistency (Cronbach’s ) and test-retest reliability . Significant correlations were found between higher PMQ scores and the number of aberrant drug behaviors detected at 2-, 4-, and 6-month follow-ups . Also the DIRE demonstrated good predictive validity. Conclusions. The results obtained with specific tools are more reliable than the clinician’s evaluation alone in predicting the risk of opioid misuse; regular monitoring and psychological intervention will contribute to improving compliance and outcome of long-term opioid use. Renata Ferrari, Genni Duse, Michela Capraro, and Marco Visentin Copyright © 2014 Renata Ferrari et al. All rights reserved. Pain and Anxiety versus Sense of Family Support in Lung Cancer Patients Sun, 13 Jul 2014 10:03:01 +0000 Lung cancer is a stressful condition for both patient and family. The anxiety and pain accompanying cancer and its treatment have a significant negative influence on the patient’s quality of life. The aim of this study was to investigate the correlation between anxiety, pain, and perceived family support in a sample of lung cancer patients. The sample consisted of a total of 101 lung cancer outpatients receiving treatment at the oncology department of a general hospital. Anxiety, pain (severity and impact on everyday life), and perceived family support were assessed using Spielberger’s State-Trait Anxiety Inventory, the Brief Pain Inventory, and the Family Support Scale, respectively. Statistical analyses revealed correlations between anxiety, pain, and family support as perceived by the patients. The intensity of pain had a positive correlation with both state and trait anxiety and a negative correlation with family support. Anxiety (state and trait) had a significant negative correlation with family support. In conclusion, high prevalence rates of anxiety disorders were observed in lung cancer patients. Females appeared more susceptible to anxiety symptoms with a less sense of family support. A negative correlation was evidenced between family support and anxiety and a positive one between anxiety and pain. Dimitra Lekka, Argiro Pachi, Athanasios Tselebis, Georgios Zafeiropoulos, Dionisios Bratis, Argiri Evmolpidi, Ioannis Ilias, Athanasios Karkanias, Georgios Moussas, Nikolaos Tzanakis, and Konstantinos N. Syrigos Copyright © 2014 Dimitra Lekka et al. All rights reserved. Topical Anesthesia for Cataract Surgery: The Patients' Perspective Tue, 24 Jun 2014 00:00:00 +0000 Purpose. To evaluate the analgesic efficacy of 0.5% propacaine hydrochloride as topical anesthesia during phacoemulsification surgery. Methods. Intraoperative pain intensity was assessed using a 5-category verbal rating scale during each of three surgical stages. Pain scores from each surgical stage and total pain scores were compared for the factors of patient age, gender, cataract laterality, and type. Results. In comparison of cataract type subgroups, the mean total pain scores and mean stage 2 pain scores in both white mature cataract (WMC) and corticonuclear plus posterior subcapsular cataract (CN + PSC) groups were significantly higher than in the PSC-only (PSC) group . Conclusion. Phacoemulsification with topical anesthesia is not a completely painless procedure. Pain intensity varies with cataract type and stage of surgery. Aytekin Apil, Baki Kartal, Metin Ekinci, Halil Huseyin Cagatay, Sadullah Keles, Erdinc Ceylan, and Ozgur Cakici Copyright © 2014 Aytekin Apil et al. All rights reserved. Feasibility of Collecting Vulvar Pain Variability and Its Correlates Using Prospective Collection with Smartphones Tue, 10 Jun 2014 05:58:26 +0000 Context. Vulvar pain level may fluctuate in women with vulvodynia even in the absence of therapy; however, there is little evidence suggesting which factors may be associated with variability. Objective. Determine the feasibility of using smartphones to collect prospective data on vulvar pain and factors that may influence vulvar pain level. Methods. 24 clinically confirmed women were enrolled from a population-based study and asked to answer five questions using their smartphones each week for one month. Questions assessed vulvar pain level (0–10), presence of pain upon wakening, pain elsewhere in their body, treatment use, and intercourse. Results. Women completed 100% of their scheduled surveys, with acceptability measures highly endorsed. Vulvar pain ratings had a standard deviation within women of 1.6, with greater variation on average among those with higher average pain levels (). On the weeks when a woman reported waking with pain, her vulvar pain level was higher by 1.82 on average (). Overall, average vulvar pain level was not significantly associated with the frequency of reporting other body pains (). Conclusion. Our smartphone tracking system promoted excellent compliance with weekly tracking of factors that are otherwise difficult to recall, some of which were highly associated with vulvar pain level. Ruby H. N. Nguyen, Rachael M. Turner, Jared Sieling, David A. Williams, James S. Hodges, and Bernard L. Harlow Copyright © 2014 Ruby H. N. Nguyen et al. All rights reserved. Short-Term Efficacy of Ultramicronized Palmitoylethanolamide in Peripheral Neuropathic Pain Tue, 20 May 2014 11:29:47 +0000 Introduction. This study evaluates the efficacy of palmitoylethanolamide ultramicronized (PEA-um) as an add-on treatment in patients with diabetic or traumatic neuropathic pain (NP). Methods. 30 patients with chronic NP were assessed with Visual Analogue Scale (VAS), NP Symptom Inventory (NPSI), and Health Questionnaire Five Dimensions (EQ-5D), both at baseline and after 10 and 40 days of treatment with 1200 mg/die of PEA-um. All other therapies were maintained stable during the follow-up period. Results. VAS mean score significantly improved within the first 10 days, ranging from 8.20 ± 1.53 to 6.40 ± 1.83 (), with a further decrease to 5.80 ± 2.04 () after 40 days of PEA-um administration. Moreover, NPSI total score improved from 5.2 ± 1.5 to 3.8 ± 2.1 (: 0.025) and EQ-5D ranged from −0.30 ± 0.65 to 0.5 ± 0.34 () between T0 and T2. Conclusions. This study reports the prospective short-term efficacy data of oral PEA-um in patients with diabetic or traumatic NP. A significant improvement was observed both in VAS and NPSI scores and in quality of life scales after 40 days of treatment, although some limitations should be considered, including the short followup and the open-label study design. Dario Cocito, Erdita Peci, Palma Ciaramitaro, Aristide Merola, and Leonardo Lopiano Copyright © 2014 Dario Cocito et al. All rights reserved. Intra-Articular Analgesia and Steroid Reduce Pain Sensitivity in Knee OA Patients: An Interventional Cohort Study Wed, 07 May 2014 12:57:05 +0000 Objectives. To assess the effects of intra-articular therapy on pain sensitivity in the knee and surrounding tissues in knee OA patients. Methods. Twenty-five knee OA patients with symptomatic knee OA were included in this interventional cohort study. Pressure pain thresholds (PPT) were recorded before, immediately after, and two weeks after ultrasound guided intra-articular injection of lidocaine combined with glucocorticosteroid. Computer-controlled and manual pressure algometers were used to assess PPT on the knee, vastus lateralis, tibialis anterior, and the extensor carpi radialis longus muscles (control site). Results. Significantly increased PPTs were found following intra-articular injection, at both the knee and the surrounding muscles . The treatment effects were sustained for two weeks, and at some points the effect was even greater at two weeks . Albeit not statistically significant, a similar trend was observed at the control site. Conclusions. Intra-articular anesthesia, combined with glucocorticosteroid, reduced pain sensitivity in both the knee and surrounding muscles for at least two weeks. Tanja Schjødt Jørgensen, Thomas Graven-Nielsen, Karen Ellegaard, Bente Danneskiold-Samsøe, Henning Bliddal, and Marius Henriksen Copyright © 2014 Tanja Schjødt Jørgensen et al. All rights reserved. Pathogenesis of Painful Diabetic Neuropathy Tue, 06 May 2014 00:00:00 +0000 The prevalence of diabetes is rising globally and, as a result, its associated complications are also rising. Painful diabetic neuropathy (PDN) is a well-known complication of diabetes and the most common cause of all neuropathic pain. About one-third of all diabetes patients suffer from PDN. It has a huge effect on a person’s daily life, both physically and mentally. Despite huge advances in diabetes and neurology, the exact mechanism of pain causation in PDN is still not clear. The origin of pain could be in the peripheral nerves of the central nervous system. In this review, we discuss various possible mechanisms of the pathogenesis of pain in PDN. We discuss the role of hyperglycaemia in altering the physiology of peripheral nerves. We also describe central mechanisms of pain. Amir Aslam, Jaipaul Singh, and Satyan Rajbhandari Copyright © 2014 Amir Aslam et al. All rights reserved. Clinical Characteristics, Patient-Reported Outcomes, and Previous Therapeutic Management of Patients with Uncontrolled Neuropathic Pain Referred to Pain Clinics Mon, 05 May 2014 12:37:19 +0000 Background. The aim of this report was to evaluate the clinical profile and previous management of patients with uncontrolled neuropathic pain who were referred to pain clinics. Methods. We included adult patients with uncontrolled pain who had a score of in the DN4 questionnaire. In addition to sociodemographic and clinical data, we evaluated pain levels using a visual analog scale as well as anxiety, depression, sleep, disability, and treatment satisfaction employing validated tools. Results. A total of 755 patients were included in the study. The patients were predominantly referred to pain clinics by traumatologists (34.3%) and primary care physicians (16.7%). The most common diagnoses were radiculopathy (43%) and pain of oncological origin (14.3%). The major cause for uncontrolled pain was suboptimal treatment (88%). Fifty-three percent of the patients were depressed, 43% had clinical anxiety, 50% rated their overall health as bad or very bad, and 45% noted that their disease was severely or extremely interfering with their daily activities. Conclusions. Our results showed that uncontrolled neuropathic pain is a common phenomenon among the specialties that address these clinical entities and, regardless of its etiology, uncontrolled pain is associated with a dramatic impact on patient well-being. José de Andrés, José-Luis de la Calle, María Pérez, and Vanessa López Copyright © 2014 José de Andrés et al. All rights reserved. Effect of Pregabalin and Dexamethasone on Postoperative Analgesia after Septoplasty Thu, 24 Apr 2014 13:50:18 +0000 Objectives. The aim of this study was to explore effect of a combination of pregabalin and dexamethasone on pain control after septoplasty operations. Methods. In this study, 90 patients who were scheduled for septoplasty under general anesthesia were randomly assigned into groups that received either placebo (Group C), pregabalin (Group P), or pregabalin and dexamethasone (Group PD). Preoperatively, patients received either pregabalin 300 mg one hour before surgery, dexamethasone 8 mg intravenously during induction, or placebo according to their allocation. Postoperative pain treatment included tramadol and diclofenac sodium 30 minutes before the end of the operation. Numeric rating scale (NRS) for pain assessment, side effects, and consumption of tramadol, pethidine, and ondansetron were recorded. Results. The median NRS score at the postoperative 0 and the 2nd h was significantly higher in Group C than in Group P and Group PD ( for both). The 24 h tramadol and pethidine, consumptions were significantly reduced in Groups P and PD compared to Group C (). The incidence of blurred vision was significantly higher in Group PD compared to Group C within both 0–2 h and 0–24 h periods (, resp.). Conclusions. We conclude that administration of 300 mg pregabalin preoperatively may be an adequate choice for pain control after septoplasty. Addition of dexamethasone does not significantly reduce pain in these patients. Abdullah Demirhan, Akcan Akkaya, Umit Yasar Tekelioglu, Tayfun Apuhan, Murat Bilgi, Veysel Yurttas, Hakan Bayir, Isa Yildiz, Uzeyir Gok, and Hasan Kocoglu Copyright © 2014 Abdullah Demirhan et al. All rights reserved. Psychological Reactions and Persistent Facial Pain following Enucleation Wed, 23 Apr 2014 13:49:25 +0000 Background. Enucleation is a psychologically and physically traumatic event associated with chronic pain. It would be desirable to better predict which patients will have pain after surgery. Methods. A cross-sectional postal questionnaire study of adults undergoing enucleation captured the demographic details, Pain Quality Assessment Scale (PQAS), Pain Catastrophizing Scale (PCS), and the Facial Pain Assessment questionnaire. Patients were classified as suffering from chronic pain if they reported a pain score of >1 out of 10 on the numerical pain score (NRS). Results. Seventeen of 60 adults participated in the study. 47% of patients reported chronic pain (mean pain score = 1.4 ± 0.7, ); 25% experienced pain daily. No difference in age, surgical side, reason for surgery, or the duration of time since the surgery was noted. All patients had low PQAS scores and 50% of individuals with persistent pain were concerned about their facial appearance. There was no significant difference in the level of catastrophization noted in patients with or without pain or between the subgroups (rumination, magnification, or helplessness). Conclusions. Although persistent pain following enucleation affected a significant number of patients, the pain intensity was mild. Enucleation influenced the physical perception some individuals had of themselves. Dominic Hegarty, Daniel Coakley, and Ian Dooley Copyright © 2014 Dominic Hegarty et al. All rights reserved. Etiology and Use of the “Hanging Drop” Technique: A Review Tue, 15 Apr 2014 14:11:11 +0000 Background. The hanging drop (HD) technique presumably relies on the presence of subatmospheric epidural pressure. It is not clear whether this negative pressure is intrinsic or an artifact and how it is affected by body position. There are few data to indicate how often HD is currently being used. Methods. We identified studies that measured subatmospheric pressures and looked at the effect of the sitting position. We also looked at the technique used for cervical and thoracic epidural anesthesia in the last 10 years. Results. Intrinsic subatmospheric pressures were measured in the thoracic and cervical spine. Three trials studied the effect of body position, indicating a higher incidence of subatmospheric pressures when sitting. The results show lower epidural pressure (−10.7 mmHg) with the sitting position. 28.8% of trials of cervical and thoracic epidural anesthesia that documented the technique used, utilized the HD technique. When adjusting for possible bias, the rate of HD use can be as low as 11.7%. Conclusions. Intrinsic negative pressure might be present in the cervical and thoracic epidural space. This effect is more pronounced when sitting. This position might be preferable when using HD. Future studies are needed to compare it with the loss of resistance technique. Ludmil Todorov and Timothy VadeBoncouer Copyright © 2014 Ludmil Todorov and Timothy VadeBoncouer. All rights reserved. Morphine versus Nalbuphine for Open Gynaecological Surgery: A Randomized Controlled Double Blinded Trial Mon, 14 Apr 2014 16:46:50 +0000 Introduction. Pain is the commonest morbidity after open surgical procedures. The most effective treatment of postoperative pain is opioid therapy. Morphine, the commonly used opioid, is associated with many side effects including respiratory depression, sedation, postoperative nausea vomiting, and pruritus. Nalbuphine, on the other hand, is known to cause less respiratory depression. Thus this study was undertaken to compare the intraoperative and postoperative analgesic efficacy and side effect profile of the two drugs. Methodology. 60 patients undergoing open gynaecological surgery were randomized to receive either morphine (Group M) or nalbuphine (Group N) in the intraoperative and postoperative period. Intraoperative analgesic efficacy (measured by need for rescue analgesics), postoperative pain by visual analogue scale, and side effects like postoperative nausea, vomiting, sedation, respiratory depression, and pruritus were compared in both groups. Intraoperative and postoperative heart rate and blood pressure were also compared between the groups. Results. Need for intraoperative analgesia was significantly more in Group N (). Postoperative VAS scores were significantly different between the groups at various time points; however, none of the patients required any rescue analgesia. The incidence of various side effects was not significantly different between the groups. The haemodynamic profile of patients was comparable between the groups in both intraoperative and postoperative period. Conclusion. Nalbuphine provides less effective intraoperative analgesia than morphine in patients undergoing open gynaecological surgery under general anaesthesia. Both drugs, however, provided similar postoperative analgesia and had similar haemodynamic and side effect profile. Shiv Akshat, Rashmi Ramachandran, Vimi Rewari, Chandralekha, Anjan Trikha, and Renu Sinha Copyright © 2014 Shiv Akshat et al. All rights reserved. The Beliefs of Third-Level Healthcare Students towards Low-Back Pain Thu, 10 Apr 2014 07:01:27 +0000 Objectives. Beliefs held by healthcare providers are part of the complex recovery of a patient with low-back pain (LBP). The aim of this study was to investigate the attitudes and beliefs of Irish university healthcare students towards LBP. Methods. Physiotherapy (), medicine (), nursing, and midwifery () students completed the survey. Demographic data, LBP related beliefs [Back Beliefs Questionnaire (BBQ) and the Fear Avoidance Beliefs Questionnaire physical subsection (FABQ-PA)] were collected. Results. Two hundred and seventy-one students responded (response rate 29%). Student physiotherapists had significantly lower FABQ () scores than medical (95% CI [−5.492, −1.406]) and nursing students (95% CI [−7.718, −22.307]). Physiotherapy students had significantly higher BBQ scores () than medical (95% CI [1.490, 5.406]) and nursing students (95% CI [6.098, 11.283]). Beliefs of physiotherapy and medical students were significantly better among fourth-year year than first-year students () but were not significantly different for nursing students ( for FABQ and for BBQ). Conclusions. Physiotherapy students had more positive beliefs towards LBP than medical and nursing students. Physiotherapy and medical students’ beliefs towards LBP significantly improved over the course of their studies. Norelee Kennedy, John Healy, and Kieran O'Sullivan Copyright © 2014 Norelee Kennedy et al. All rights reserved. Is Hippocampus Susceptible to Antinociceptive Tolerance to NSAIDs Like the Periaqueductal Grey? Wed, 09 Apr 2014 08:47:00 +0000 Emotional distress is the most undesirable feature of painful experience. Numerous studies have demonstrated the important role of the limbic system in the affective-motivational component of pain. The purpose of this paper was to examine whether microinjection of nonsteroidal anti-inflammatory drugs (NSAIDs), Clodifen, Ketorolac, and Xefocam, into the dorsal hippocampus (DH) leads to the development of antinociceptive tolerance in male rats. We found that microinjection of these NSAIDs into the DH induces antinociception as revealed by a latency increase in the tail-flick (TF) and hot plate (HP) tests compared to controls treated with saline into the DH. Subsequent tests on consecutive three days, however, showed that the antinociceptive effect of NSAIDs progressively decreased, suggesting tolerance developed to this effect of NSAIDs. Both pretreatment and posttreatment with the opioid antagonist naloxone into the DH significantly reduced the antinociceptive effect of NSAIDs in both pain models. Our data indicate that microinjection of NSAIDs into the DH induces antinociception which is mediated via the opioid system and exhibits tolerance. Nana Tsiklauri, Ivliane Nozadze, Gulnazi Gurtskaia, and Merab G. Tsagareli Copyright © 2014 Nana Tsiklauri et al. All rights reserved. Micronized Palmitoylethanolamide Reduces the Symptoms of Neuropathic Pain in Diabetic Patients Wed, 02 Apr 2014 12:46:34 +0000 The present study evaluated the effectiveness of micronized palmitoylethanolamide (PEA-m) treatment in reducing the painful symptoms experienced by diabetic patients with peripheral neuropathy. PEA-m, a fatty acid amide of the N-acylethanolamine family, was administered (300 mg twice daily) to 30 diabetic patients suffering from painful diabetic neuropathy. Before treatment start, after 30 and 60 days the following parameters were assessed: painful symptoms of diabetic peripheral neuropathy using the Michigan Neuropathy Screening instrument; intensity of symptoms characteristic of diabetic neuropathic pain by the Total Symptom Score; and intensity of different subcategories of neuropathic pain by the Neuropathic Pain Symptoms Inventory. Hematological and blood chemistry tests to evaluate metabolic control and safety were also performed. Statistical analysis (ANOVA) indicated a highly significant reduction in pain severity () and related symptoms () evaluated by Michigan Neuropathy Screening instrument, Total Symptom Score, and Neuropathic Pain Symptoms Inventory. Hematological and urine analyses did not reveal any alterations associated with PEA-m treatment, and no serious adverse events were reported. These results suggest that PEA-m could be considered as a promising and well-tolerated new treatment for symptomatology experienced by diabetic patients suffering from peripheral neuropathy. Chiara Schifilliti, Lelio Cucinotta, Viviana Fedele, Carmela Ingegnosi, Salvatore Luca, and Carmelo Leotta Copyright © 2014 Chiara Schifilliti et al. All rights reserved. Association between Neck/Shoulder Pain and Trapezius Muscle Tenderness in Office Workers Thu, 27 Mar 2014 11:21:50 +0000 Background. Neck/shoulder pain is a common musculoskeletal disorder among adults. The pain is often assumed to be related to muscular tenderness rather than serious chronic disease. Aim. To determine the association between neck/shoulder pain intensity and trapezius muscle tenderness in office workers. Methods. 653 employees from two large office workplaces in Copenhagen, Denmark, replied to a questionnaire on health and working conditions (mean: age 43 years, body mass index 24 kg·m−2, computer use 90% of work time, 73% women). Respondents rated intensity of neck/shoulder pain during the previous three months on a scale of 0–10 and palpable tenderness of the upper trapezius muscle on a scale of “no tenderness,” “some tenderness,” or “severe tenderness.” Odds ratios for tenderness as a function of neck/shoulder pain intensity were determined using cumulative logistic regression controlled for age, gender, and chronic disease. Results. The prevalence of “no,” “some,” and “severe” tenderness of the trapezius muscle was 18%, 59%, and 23% in women and 51%, 42%, and 7% in men, respectively (chi-square, P < 0.0001). Participants with “no,” “some,” and “severe” tenderness of the trapezius muscle, respectively, rated their neck/shoulder pain intensity to 1.5 (SD 1.6), 3.8 (SD 2.0), and 5.7 (SD 1.9) for women and 1.4 (SD 1.4), 3.1 (SD 2.2), and 5.1 (SD 1.7) for men. For every unit increase in neck/shoulder pain intensity, the OR for one unit increase in trapezius tenderness was 1.86 (95% confidence interval 1.70 to 2.04). Conclusion. In office workers, a strong association between perceived neck/shoulder pain intensity and trapezius muscle tenderness exists. The present study provides reference values of pain intensity among office workers with no, some, and severe tenderness of the trapezius muscle. Mikkel Brandt, Emil Sundstrup, Markus D. Jakobsen, Kenneth Jay, Juan C. Colado, Yuling Wang, Mette K. Zebis, and Lars L. Andersen Copyright © 2014 Mikkel Brandt et al. All rights reserved. Long-Term Persistency of Abnormal Heart Rate Variability following Long NICU Stay and Surgery at Birth Wed, 26 Feb 2014 09:54:55 +0000 Preterm birth is associated with painful procedures during the neonatal intensive care unit (NICU) stay. Full-term newborns can also experience pain, following surgery. These procedures can have long-lasting consequences. It has been shown that children born preterm show pain responses and cardiac alterations. This study aimed to explore the heart rate reactivity to pain in 107 subjects born either preterm or full-term who were between 7 and 25 years old at testing. We also evaluated the effect of pain experienced at birth, as represented by a longer NICU stay, time under ventilation, and surgery at birth. Participants were asked to immerse their right forearm in 10°C water for 2 minutes. Electrocardiograms were recorded at baseline and during the immersion procedure. Full-term subjects showed a stable increase in heart rate throughout the procedure, whereas preterm ones showed a strong increase at the beginning, which decreased over time. Also, preterm and full-term subjects who experienced pain at birth showed higher resting heart rate, stronger sympathetic activity, and lower cardiac vagal activity. Our study demonstrated a long-term impact of a long NICU stay and surgery at birth on cardiac autonomic activity. This could lead to impaired reactions to pain or stress in later life. Mélanie Morin, Serge Marchand, Louis Couturier, Sophie Nadeau, and Sylvie Lafrenaye Copyright © 2014 Mélanie Morin et al. All rights reserved. Comparison of Postoperative Analgesic Effect of Intrathecal Clonidine and Fentanyl Added to Bupivacaine in Patients Undergoing Cesarean Section: A Prospective Randomized Double-Blind Study Tue, 04 Feb 2014 11:32:39 +0000 Objectives. To compare the analgesic efficacy of intrathecal clonidine and fentanyl added to bupivacaine after cesarean section. Methods. Ninety patients scheduled for cesarean section under spinal anesthesia were randomly allocated to one of the three following groups to receive bupivacaine 10 mg combined with 75 µg clonidine (group C), bupivacaine 10 mg combined with 0.5 mL fentanyl (group F), and bupivacaine 10 mg combined with 0.5 mL distilled water (group P), intrathecally. The time to first analgesic request, analgesic requirement in the first 24 hours after surgery, sensory and motor blockade onset time, duration of sensory and motor blockade, the incidence of hypotension, ephedrine requirements, bradycardia, and hypoxemia were recorded. Results. The duration of anesthesia in clonidine group () was longer compared to the placebo () and fentanyl () groups. This difference between group C versus F () and P groups () was significant. Similarly, the mean time to first analgesic request was also longer in group C () than in groups F () and P ( min). This difference between group C versus F () and P groups () was significant. Conclusion. Intrathecal clonidine 75 µg with bupivacaine prolonged the time to first analgesic request compared to fentanyl; however, the total analgesic consumption within the first 24 h postoperative was similar in fentanyl and clonidine groups following cesarean section. This trial is registered with ACTRN12611000909921 and NCT01425658. Marzieh Beigom Khezri, Meisam Rezaei, Morteza Delkhosh Reihany, and Ezzatalsadat Haji Seid Javadi Copyright © 2014 Marzieh Beigom Khezri et al. All rights reserved. Pain Symptoms in Fibromyalgia Patients with and without Provoked Vulvodynia Wed, 29 Jan 2014 00:00:00 +0000 Objective. The aim of the study was to compare the pain symptoms of fibromyalgia patients exhibiting (FMS+PVD) and not exhibiting (FMS) comorbidity with provoked vulvodynia. Study Design. The case control study was performed in 39 patients who had been diagnosed with FMS and accepted to undergo gynaecological examination and in 36 healthy women (C). All patients completed standardized questionnaires for pain intensity, pain area, and psychological functioning. The gynaecological examination included vulvar pain pressure reactivity (Q-tip), pelvic tone assessment (Kegel manoeuver), and a semistructured interview collecting detailed information about pelvic symptoms and sexual function. Results. FMS+PVD patients displayed a higher number of associated symptoms than FMS patients. The vulvar excitability was significantly higher in FMS+PVD than in FMS and in both groups than in Controls. Half of FMS+PVD patients were positive to Kegel manoeuver and displayed higher scores in widespread pain intensity, STAI-Y2, and CESD levels than Kegel negative patients. Conclusions. The study reveals that increased vulvar pain excitability may occur in FMS patients independently of the presence of coital pain. Results suggest that coital pain develops in patients with higher FMS symptoms severity due to the cooperative effects of peripheral and central sensitization mechanisms. Anna Ghizzani, Valentina Di Sabatino, Anna Lisa Suman, Giovanni Biasi, Enrica Laura Santarcangelo, and Giancarlo Carli Copyright © 2014 Anna Ghizzani et al. All rights reserved. Can Fluctuations in Vital Signs Be Used for Pain Assessment in Critically Ill Patients with a Traumatic Brain Injury? Wed, 22 Jan 2014 13:51:16 +0000 Background. Many critically ill patients with a traumatic brain injury (TBI) are unable to communicate. While observation of behaviors is recommended for pain assessment in nonverbal populations, they are undetectable in TBI patients who are under the effects of neuroblocking agents. Aim. This study aimed to validate the use of vital signs for pain detection in critically ill TBI patients. Methods. Using a repeated measure within subject design, participants () were observed for 1 minute before (baseline), during, and 15 minutes after two procedures: noninvasive blood pressure: NIBP (nonnociceptive) and turning (nociceptive). At each assessment, vital signs (e.g., systolic, diastolic, mean arterial pressure (MAP), heart rate (HR), respiratory rate (RR), capillary saturation (SpO2), end-tidal CO2, and intracranial pressure (ICP)) were recorded. Results. Significant fluctuations () in diastolic (), HR (), SpO2 (), and ICP () were found across assessments, but they were similar during both procedures. In contrast, RR was found to increase exclusively during turning (; ) and was correlated to participants’ self-report. Conclusions. Findings from this study support previous ones that vital signs are not specific for pain detection. While RR could be a potential pain indicator in critical care, further research is warranted to support its validity in TBI patients with different LOC. Caroline Arbour, Manon Choinière, Jane Topolovec-Vranic, Carmen G. Loiselle, and Céline Gélinas Copyright © 2014 Caroline Arbour et al. All rights reserved. Perioperative Multimodal Anesthesia Using Regional Techniques in the Aging Surgical Patient Mon, 20 Jan 2014 13:10:59 +0000 Background. Elderly patients have unique age-related comorbidities that may lead to an increase in postoperative complications involving neurological, pulmonary, cardiac, and endocrine systems. There has been an increase in the number of elderly patients undergoing surgery as this portion of the population is increasing in numbers. Despite advances in perioperative anesthesia and analgesia along with improved delivery systems, monotherapy with opioids continues to be the mainstay for treatment of postop pain. Reliance on only opioids can oftentimes lead to inadequate pain control or increase in the incidence of adverse events. Multimodal analgesia incorporating regional anesthesia is a promising alternative that may reduce needs for high doses and dependence on opioids along with any potential associated adverse effects. Methods. The following databases were searched for relevant published trials: Cochrane Central Register of Controlled Trials and PubMed. Textbooks and meeting supplements were also utilized. The authors assessed trial quality and extracted data. Conclusions. Multimodal drug therapy and perioperative regional techniques can be very effective to perioperative pain management in the elderly. Regional anesthesia as part of multimodal perioperative treatment can often reduce postoperative neurological, pulmonary, cardiac, and endocrine complications. Regional anesthesia/analgesia has not been proven to improve long-term morbidity but does benefit immediate postoperative pain control. In addition, multimodal drug therapy utilizes a variety of nonopioid analgesic medications in order to minimize dosages and adverse effects from opioids while maximizing analgesic effect and benefit. Diana Nordquist and Thomas M. Halaszynski Copyright © 2014 Diana Nordquist and Thomas M. Halaszynski. All rights reserved. Pain Prevalence and Management in an Internal Medicine Setting in Italy Mon, 20 Jan 2014 11:58:51 +0000 Background. Since data on pain evaluation and management in patients admitted to internal medicine wards (IMWs) are limited, we aimed to evaluate these aspects in a cohort of internistic patients. Methods. We considered all patients consecutively admitted from June to December 2011 to our unit. Age, gender, and length-of-hospital-stay (LOS) were recorded. Comorbidities were arbitrarily defined, and pain severity was evaluated by Numeric Rating Scale (NRS) on admission and discharge. Results. The final sample consisted of 526 patients (mean age years; 308 women). Significant pain (NRS ≥ 3) was detected in 63% of cases, and severe (NRS ≥ 7) in 7.6%. Pain was successfully treated, and NRS decreased from 4.65 ± 2.05 to 0.89 ± 1.3 (). Compared with subjects with NRS < 3, those with significant pain were older (75.5 ± 13.9 versus 72.9 ± 14.5 years, ), and had a higher LOS (7.9 ± 6.1 versus 7.3 ± 6.8, ). Significant pain was independently associated with age (OR 0.984, ), cancer (OR 3.347, ), musculoskeletal disease (OR 3.054, ), biliary disease (OR 3.100, ), and bowel disease (OR 3.100, ). Conclusion. In an internal medicine setting, multiple diseases represent significant cause of pain. Prompt pain evaluation and management should be performed as soon as possible, in order to avoid patients’ suffering and reduce the need of hospital stay. Fabio Fabbian, Alfredo De Giorgi, Marco Pala, Alessandra Mallozzi Menegatti, Massimo Gallerani, and Roberto Manfredini Copyright © 2014 Fabio Fabbian et al. All rights reserved. Parental Catastrophizing Partially Mediates the Association between Parent-Reported Child Pain Behavior and Parental Protective Responses Mon, 20 Jan 2014 07:22:37 +0000 This study sought to model and test the role of parental catastrophizing in relationship to parent-reported child pain behavior and parental protective (solicitous) responses to child pain in a sample of children with Inflammatory Bowel Disease and their parents ( dyads). Parents completed measures designed to assess cognitions about and responses to their child’s abdominal pain. They also rated their child’s pain behavior. Mediation analyses were performed using regression-based techniques and bootstrapping. Results supported a model treating parent-reported child pain behavior as the predictor, parental catastrophizing as the mediator, and parental protective responses as the outcome. Parent-reported child pain behavior predicted parental protective responses and this association was mediated by parental catastrophizing about child pain: indirect effect (SE) = 2.08 (0.56); 95% CI = 1.09, 3.30. The proportion of the total effect mediated was 68%. Findings suggest that interventions designed to modify maladaptive parental responses to children’s pain behaviors should assess, as well as target, parental catastrophizing cognitions about their child’s pain. Shelby L. Langer, Joan M. Romano, Lloyd Mancl, and Rona L. Levy Copyright © 2014 Shelby L. Langer et al. All rights reserved. The Pain Frequency-Severity-Duration Scale as a Measure of Pain: Preliminary Validation in a Pediatric Chronic Pain Sample Mon, 20 Jan 2014 07:21:44 +0000 Typically, pain is measured by intensity and sensory characteristics. Although intensity is one of the most common dimensions of pain assessment, it has been suggested that measuring pain intensity in isolation is only capturing part of the pain experience and may not lead to an accurate measurement of how pain impacts a child’s daily functioning. The current study aimed to develop a measure that would capture pain intensity along with frequency and duration in a clinical sample of youth diagnosed with chronic pain. The pain-frequency-severity-duration (PFSD) scale was developed and data were collected from a multidisciplinary pain clinic at a large, midwestern children’s hospital. Validated measures of functional limitations and health related quality of life were also collected. Significant correlations were found between the PFSD composite score, functional limitations, and health related quality of life. Future research should continue to evaluate this questionnaire utilizing other validated pain measures and other areas potentially impacted by chronic pain and with more diverse samples. This initial finding suggests that the PFSD is a convenient self-reported measure and is strongly related to health related quality of life and functional disability. Katherine S. Salamon, W. Hobart Davies, Melissa R. Fuentes, Steven J. Weisman, and Keri R. Hainsworth Copyright © 2014 Katherine S. Salamon et al. All rights reserved.