Pain Research and Treatment The latest articles from Hindawi Publishing Corporation © 2015 , Hindawi Publishing Corporation . All rights reserved. Retracted: Is Hippocampus Susceptible to Antinociceptive Tolerance to NSAIDs Like the Periaqueductal Grey? Tue, 24 Nov 2015 11:40:02 +0000 Pain Research and Treatment Copyright © 2015 Pain Research and Treatment. All rights reserved. Comparison of Dry Needling versus Orthopedic Manual Therapy in Patients with Myofascial Chronic Neck Pain: A Single-Blind, Randomized Pilot Study Tue, 10 Nov 2015 07:59:23 +0000 Objective. The aim of this study was to compare the efficacy of three interventions for the treatment of myofascial chronic neck pain. Methods. Thirty-six patients were randomly assigned to one of three intervention groups: orthopedic manual therapy (OMT), dry needling and stretching (DN-S), and soft tissue techniques (STT). All groups received two treatment sessions with a 48 h time interval. Outcome measures included neck pain intensity measured using a visual analogue scale, cervical range of motion (ROM), pressure pain threshold for measuring mechanical hyperalgesia, and two self-reported questionnaires (neck disability index and pain catastrophizing scale). Results. The ANOVA revealed significant differences for the group × time interaction for neck disability, neck pain intensity, and pain catastrophizing. The DN-S and OMT groups reduced neck disability. Only the OMT group showed decreases in mechanical hyperalgesia and pain catastrophizing. The cervical ROM increased in OMT (i.e., flexion, side-bending, and rotation) and DN-S (i.e., side-bending and rotation) groups. Conclusions. The three interventions are all effective in reducing pain intensity. Reduction in mechanical hyperalgesia and pain catastrophizing was only observed in the OMT group. Cervical ROM improved in the DN-S and OMT groups and also neck disability being only clinically relevant for OMT group. Irene Campa-Moran, Etelvina Rey-Gudin, Josué Fernández-Carnero, Alba Paris-Alemany, Alfonso Gil-Martinez, Sergio Lerma Lara, Almudena Prieto-Baquero, José Luis Alonso-Perez, and Roy La Touche Copyright © 2015 Irene Campa-Moran et al. All rights reserved. Morphine versus Hydromorphone: Does Choice of Opioid Influence Outcomes? Sun, 01 Nov 2015 13:03:23 +0000 Morphine has traditionally been considered the first line agent for analgesia in hospitals; however, in the last few years there has been a shift towards the use of hydromorphone as a first line agent. We conducted a hospital population based observational study to evaluate the increasing use of hydromorphone over morphine in both medical and surgical populations. Additionally, we assessed the effect of this trend on three key outcomes, including adverse events, length of stay, and readmission rates. We evaluated data from the University Health Systems Consortium. Data from 38 hospitals from October 2010 to September 2013 was analyzed for patients treated with either hydromorphone or morphine. The use of morphine steadily decreased while use of hydromorphone increased in both medical and surgical groups. Rescue drugs were used more frequently in patients treated with hydromorphone in comparison to patients treated with morphine . Patients receiving morphine tended to stay in the hospital for almost one day longer than patients receiving hydromorphone. However, 30-day all cause readmission rates were significantly higher in patients treated with hydromorphone . Our study highlights that the choice of hydromorphone versus morphine may influence outcomes. There are implications related to resource utilization and these outcomes. Padma Gulur, Katharine Koury, Paul Arnstein, Hang Lee, Patricia McCarthy, Christopher Coley, and Elizabeth Mort Copyright © 2015 Padma Gulur et al. All rights reserved. Associations between Wage System and Risk Factors for Musculoskeletal Disorders among Construction Workers Wed, 28 Oct 2015 09:47:02 +0000 Piece rate and performance based wage systems are common in the construction industry. Construction workers are known to have an increased risk of pain and musculoskeletal disorders (MSD). In this cross-sectional questionnaire study, we examined the association between wage system and (1) physical exertion, (2) time pressure, (3) pain, and (4) fatigue. The participants comprised 456 male Danish construction workers working on one of three different wage systems: group based performance wage, individually based performance wage, and time based wage system. The statistical analyses indicated differences between the wage systems in relation to physical exertion () and time pressure () but not to pain or fatigue. Workers on group based performance wage scored higher (i.e., worse) than workers on individual performance based wage and workers with an hourly/monthly wage. In conclusion, group performance based wage was associated with higher levels of physical exertion and time pressure. Accordingly, group performance based wage can be viewed as a factor that has the potential to complicate prevention of MSD among construction workers. Since performance based wage systems are common in many countries across the world, more attention should be paid to the health effects of these types of payment. Jeppe Zielinski Nguyen Ajslev, Roger Persson, and Lars Louis Andersen Copyright © 2015 Jeppe Zielinski Nguyen Ajslev et al. All rights reserved. Physicians Experience with and Expectations of the Safety and Tolerability of WHO-Step III Opioids for Chronic (Low) Back Pain: Post Hoc Analysis of Data from a German Cross-Sectional Physician Survey Mon, 19 Oct 2015 06:34:16 +0000 Objective. To describe physicians’ daily life experience with WHO-step III opioids in the treatment of chronic (low) back pain (CLBP). Methods. Post hoc analysis of data from a cross-sectional online survey with 4.283 Germany physicians. Results. With a reported median use in 17% of affected patients, WHO-step III opioids play a minor role in treatment of CLBP in daily practice associated with a broad spectrum of positive and negative effects. If prescribed, potent opioids were reported to show clinically relevant effects (such as ≥50% pain relief) in approximately 3 of 4 patients (median 72%). Analgesic effects reported are frequently related with adverse events (AEs). Only 20% of patients were reported to remain free of any AE. Most frequently reported AE was constipation (50%), also graded highest for AE-related daily life restrictions (median 46%). Specific AE countermeasures were reported to be necessary in approximately half of patients (median 45%); nevertheless AE-related premature discontinuation rates reported were high (median 22%). Fentanyl/morphine were the most/least prevalently prescribed potent opioids mentioned (median 20 versus 8%). Conclusion. Overall, use of WHO-step III opioids for CLBP is low. AEs, especially constipation, are commonly reported and interfere significantly with analgesic effects in daily practice. Nevertheless, beneficial effects outweigh related AEs in most patients with CLBP. Michael A. Ueberall, Alice Eberhardt, and Gerhard H. H. Mueller-Schwefe Copyright © 2015 Michael A. Ueberall et al. All rights reserved. The Association between Patient-Reported Pain and Doctors’ Language Proficiency in Clinical Practice Mon, 21 Sep 2015 06:47:49 +0000 Patients’ limited literacy and language fluency of different kinds cause them problems in navigating the medical interview. However, it is not known how physicians’ native language skills affect the reported intensity of pain among Finnish emergency patients. Data were collected with two consecutive questionnaires in 16 healthcare centres and outpatient departments along the Finnish coast. Swedish and Finnish speaking 18–65-year-old emergency patients were eligible for this study. Our patients were predominantly Finnish speakers. Patient-rated poor language skills in Finnish among the physicians in ED setting increased statistically significantly pain reported by the Finnish speaking patients and their dissatisfaction with the health service. These patients were also less motivated to adhere to the instructions given by their physician. Patients speaking various languages reported less degree of pain. Foreign physicians’ poor language proficiency in Finnish was expected to explain only some of the patients’ pain experience. Physicians’ good native language skills may help to reduce pain experience. Despite concordant language communication, other unknown barriers in the interaction might reduce the magnitude of pain reported. Marianne Mustajoki, Tom Forsén, and Timo Kauppila Copyright © 2015 Marianne Mustajoki et al. All rights reserved. A Novel Association between Femoroacetabular Impingement and Anterior Knee Pain Mon, 14 Sep 2015 06:12:35 +0000 Background. For a long time it has been accepted that the main problem in the anterior knee pain (AKP) patient is in the patella. Currently, literature supports the link between abnormal hip function and AKP. Objective. Our objective is to investigate if Cam femoroacetabular impingement (FAI) resolution is related to the outcome in pain and disability in patients with chronic AKP recalcitrant to conservative treatment associated with Cam FAI. Material and Methods. A retrospective study on 7 patients with chronic AKP associated with FAI type Cam was performed. Knee and hip pain were measured with the visual analogue scale (VAS), knee disability with the Kujala scale, and hip disability with the Nonarthritic Hip Score (NAHS). Results. The VAS knee pain score and VAS hip pain score had a significant improvement postoperatively. At final follow-up, there was significant improvement in all functional scores (Kujala score and NAHS). Conclusion. Our finding supports the link between Cam FAI and AKP in some young patients. Assessment of Cam FAI should be considered as a part of the physical examination of patients with AKP, mainly in cases with pain recalcitrant to conservative treatment. Vicente Sanchis-Alfonso, Marc Tey, and Joan Carles Monllau Copyright © 2015 Vicente Sanchis-Alfonso et al. All rights reserved. Pain Management in Pregnancy: Multimodal Approaches Sun, 13 Sep 2015 14:09:22 +0000 Nonobstetrical causes of pain during pregnancy are very common and can be incapacitating if not treated appropriately. Recent reports in the literature show that a significant percentage of pregnant women are treated with opioids during pregnancy. To address common pain conditions that present during pregnancy and the available pharmacological and nonpharmacological treatment options, for each of the pain conditions identified, a search using MEDLINE, PubMed, Embase, and Cochrane databases was performed. The quality of the evidence was evaluated in the context of study design. This paper is a narrative summary of the results obtained from individual reviews. There were significant disparities in the studies in terms of design, research and methodology, and outcomes analyzed. There is reasonable evidence available for pharmacological approaches; however, these are also associated with adverse events. Evidence for nonpharmacological approaches is limited and hence their efficacy is unclear, although they do appear to be primarily safe. A multimodal approach using a combination of nonpharmacological and pharmacological options to treat these pain conditions is likely to have the most benefit while limiting risk. Research trials with sound methodology and analysis of outcome data are needed. Shalini Shah, Esther T. Banh, Katharine Koury, Gaurav Bhatia, Roneeta Nandi, and Padma Gulur Copyright © 2015 Shalini Shah et al. All rights reserved. Central Sensitization and Perceived Indoor Climate among Workers with Chronic Upper-Limb Pain: Cross-Sectional Study Sun, 06 Sep 2015 12:02:03 +0000 Monitoring of indoor climate is an essential part of occupational health and safety. While questionnaires are commonly used for surveillance, not all workers may perceive an identical indoor climate similarly. The aim of this study was to evaluate perceived indoor climate among workers with chronic pain compared with pain-free colleagues and to determine the influence of central sensitization on this perception. Eighty-two male slaughterhouse workers, 49 with upper-limb chronic pain and 33 pain-free controls, replied to a questionnaire with 13 items of indoor climate complaints. Pressure pain threshold (PPT) was measured in muscles of the arm, shoulder, and lower leg. Cross-sectional associations were determined using general linear models controlled for age, smoking, and job position. The number of indoor climate complaints was twice as high among workers with chronic pain compared with pain-free controls (1.8 [95% CI: 1.3–2.3] versus 0.9 [0.4–1.5], resp.). PPT of the nonpainful leg muscle was negatively associated with the number of complaints. Workers with chronic pain reported more indoor climate complaints than pain-free controls despite similar actual indoor climate. Previous studies that did not account for musculoskeletal pain in questionnaire assessment of indoor climate may be biased. Central sensitization likely explains the present findings. Emil Sundstrup, Markus D. Jakobsen, Mikkel Brandt, Kenneth Jay, Roger Persson, and Lars L. Andersen Copyright © 2015 Emil Sundstrup et al. All rights reserved. Practice of Pain Management by Indian Healthcare Practitioners: Results of a Paper Based Questionnaire Survey Sun, 23 Aug 2015 12:01:37 +0000 Objective. Understanding factors while selecting an analgesic and its usage pattern by Indian healthcare practitioners (HCPs). Methods. Questionnaire-based survey was conducted among six healthcare specialties. Results. Total 448 HCPs participated. Patient’s age (72.8%, 74.4%, 87.5%, and 78.9%) and duration of therapy (70.8%, 66.2%, 69.6%, and 73.6%) were main attributes for selecting an opioid according to general practitioners (GPs), dentists, consulting physicians (CPs), and surgeons, respectively. Patient’s age was important factor while selecting NSAID according to 77.60%, 66.91%, and 84.20% of GPs, dentists, surgeons, respectively. For mild pain, paracetamol was the choice according to 77%, 78.57% and 74% of GPs, CPs, and surgeons, respectively. For moderate pain, 77%, 87.50%, 68%, and 80.30% of GPs, CPs, surgeons and orthopedicians, respectively, preferred the use of paracetamol + tramadol combination. For moderate pain, NSAID + paracetamol and paracetamol+diclofenac were used by 68.94% and 47.73% of orthopedicians, respectively. Lack of pain clinic (38.8%) in city was commonly cited reason for not referring patients to pain clinics. Conclusion. Patient’s age, duration of therapy, comorbid conditions, frequency of dosing, and severity of pain are important parameters while selecting analgesics. Paracetamol and its combinations are commonly used for mild and moderate pain, respectively. Pain clinics currently have limited presence in India. Gauri Billa, Mukesh Gabhane, and Swati Biswas Copyright © 2015 Gauri Billa et al. All rights reserved. Classifying Patients with Chronic Pelvic Pain into Levels of Biopsychosocial Dysfunction Using Latent Class Modeling of Patient Reported Outcome Measures Tue, 18 Aug 2015 08:46:19 +0000 Chronic pelvic pain affects multiple aspects of a patient’s physical, social, and emotional functioning. Latent class analysis (LCA) of Patient Reported Outcome Measures Information System (PROMIS) domains has the potential to improve clinical insight into these patients’ pain. Based on the 11 PROMIS domains applied to patients referred for evaluation in a chronic pelvic pain specialty center, exploratory factor analysis (EFA) was used to identify unidimensional superdomains. Latent profile analysis (LPA) was performed to identify the number of homogeneous classes present and to further define the pain classification system. The EFA combined the 11 PROMIS domains into four unidimensional superdomains of biopsychosocial dysfunction: Pain, Negative Affect, Fatigue, and Social Function. Based on multiple fit criteria, a latent class model revealed four distinct classes of CPP: No dysfunction (3.2%); Low Dysfunction (17.8%); Moderate Dysfunction (53.2%); and High Dysfunction (25.8%). This study is the first description of a novel approach to the complex disease process such as chronic pelvic pain and was validated by demographic, medical, and psychosocial variables. In addition to an essentially normal class, three classes of increasing biopsychosocial dysfunction were identified. The LCA approach has the potential for application to other complex multifactorial disease processes. Bradford W. Fenton, Scott F. Grey, Krystel Tossone, Michele McCarroll, and Vivian E. Von Gruenigen Copyright © 2015 Bradford W. Fenton et al. All rights reserved. Radiofrequency for the Treatment of Lumbar Radicular Pain: Impact on Surgical Indications Sun, 16 Aug 2015 07:45:49 +0000 Study Design. Quasiexperimental study. Objective. To investigate whether radiofrequency treatment can preclude the need for spinal surgery in both the short term and long term. Background. Radiofrequency is commonly used to treat lumbosacral radicular pain. Only few studies have evaluated its effects on surgical indications. Methods. We conducted a quasiexperimental study of 43 patients who had been scheduled for spinal surgery. Radiofrequency was indicated for 25 patients. The primary endpoint was the decision of the patient to reject spinal surgery 1 month and 1 year after treatment (pulsed radiofrequency of dorsal root ganglion, 76%; conventional radiofrequency of the medial branch, 12%; combined technique, 12%). The primary endpoint was the decision of the patient to reject spinal surgery 1 month and 1 year after treatment. In addition, we also evaluated adverse effects, ODI, NRS. Results. We observed after treatment with radiofrequency 80% of patients rejected spinal surgery in the short term and 76% in the long term. We conclude that radiofrequency is a useful treatment strategy that can achieve very similar outcomes to spinal surgery. Patients also reported a very high level of satisfaction (84% satisfied/very satisfied). We also found that optimization of the electrical parameters of the radiofrequency improved the outcome of this technique. José Manuel Trinidad, Ana Isabel Carnota, Inmaculada Failde, and Luis Miguel Torres Copyright © 2015 José Manuel Trinidad et al. All rights reserved. Usefulness of the Pain Tracking Technique in Acute Mechanical Low Back Pain Thu, 09 Jul 2015 07:49:14 +0000 Objective. To evaluate the usefulness of the pain tracking technique in acute mechanical low back pain. Method. We performed an experimental prospective (longitudinal) explanatory study between January 2011 and September 2012. The sample was randomly divided into two groups. Patients were assessed at the start and end of the treatment using the visual analogue scale and the Waddell test. Treatment consisted in applying the pain tracking technique to the study group and interferential current therapy to the control group. At the end of treatment, cryotherapy was applied for 10 minutes. The Wilcoxon signed-rank test and the Mann Whitney test were used. They were performed with a predetermined significance level of . Results. Pain was triggered by prolonged static posture and intense physical labor and intensified through trunk movements and when sitting and standing. The greatest relief was reported in lateral decubitus position and in William’s position. The majority of the patients had contracture. Pain and disability were modified with the rehabilitation treatment in both groups. Conclusions. Both the pain tracking and interferential current techniques combined with cryotherapy are useful treatments for acute mechanical low back pain. The onset of analgesia is faster when using the pain tracking technique. Tania Bravo Acosta, Jorge E. Martín Cordero, Solangel Hernández Tápanes, Isis Pedroso Morales, José Ignacio Fernández Cuesta, and Maritza Leyva Serrano Copyright © 2015 Tania Bravo Acosta et al. All rights reserved. The Verbal Rating Scale Is Reliable for Assessment of Postoperative Pain in Hip Fracture Patients Wed, 20 May 2015 09:52:33 +0000 Background. Hip fracture patients represent a challenge to pain rating due to the high prevalence of cognitive impairment. Methods. Patients prospectively rated pain on the VRS. Furthermore, patients described the changes in pain after raising their leg, with one of five descriptors. Agreement between paired measures on the VRS at rest and by passive straight leg raise with a one-minute interval between ratings at rest and three-minute interval for straight leg raise was expressed by kappa coefficients. Reliability of this assessment of pain using the VRS was compared to the validity of assessing possible change in pain from the selected descriptors. Cognitive status was quantified by the short Orientation-Memory-Concentration Test. Results. 110 patients were included. Paired scores with maximum disagreement of one scale point reached 97% at rest and 95% at straight leg raise. Linear weighted kappa coefficients ranged from 0.68 (95% CI = 0.59–0.77) at leg raise to 0.75 (95% CI = 0.65–0.85) at rest. Unweighted kappa coefficients of agreement in recalled pain compared to agreement of paired VRS scores ranged from 0.57 (95% CI = 0.49–0.65) to 0.36 (95% CI = 0.31–0.41). Interpretation. The VRS is reliable for assessment of pain after hip fracture. The validity of intermittent questioning about possible change in pain intensity is poor. Rune Dueholm Bech, Jens Lauritsen, Ole Ovesen, and Søren Overgaard Copyright © 2015 Rune Dueholm Bech et al. All rights reserved. Vitamin D and Pain: Vitamin D and Its Role in the Aetiology and Maintenance of Chronic Pain States and Associated Comorbidities Sun, 19 Apr 2015 07:20:42 +0000 The emergence of new data suggests that the benefits of Vitamin D extend beyond healthy bones. This paper looks at Vitamin D and its role in the aetiology and maintenance of chronic pain states and associated comorbidities. The interfaces between pain and Vitamin D and the mechanisms of action of Vitamin D on pain processes are explored. Finally the association between Vitamin D and pain comorbidities such as sleep and depression is investigated. The paper shows that Vitamin D exerts anatomic, hormonal, neurological, and immunological influences on pain manifestation, thereby playing a role in the aetiology and maintenance of chronic pain states and associated comorbidities. More research is necessary to determine whether Vitamin D is useful in the treatment of various pain conditions and whether or not the effect is limited to patients who are deficient in Vitamin D. Edward A. Shipton and Elspeth E. Shipton Copyright © 2015 Edward A. Shipton and Elspeth E. Shipton. All rights reserved. Using Computed Tomography Scans and Patient Demographic Data to Estimate Thoracic Epidural Space Depth Thu, 16 Apr 2015 12:51:35 +0000 Background and Objectives. Previous studies have used varying methods to estimate the depth of the epidural space prior to placement of an epidural catheter. We aim to use computed tomography scans, patient demographics, and vertebral level to estimate the depth of the loss of resistance for placement of thoracic epidural catheters. Methods. The records of consecutive patients who received a thoracic epidural catheter were reviewed. Patient demographics, epidural placement site, and technique were collected. Preoperative computed tomography scans were reviewed to measure the skin to epidural space distance. Linear regression was used for a multivariate analysis. Results. The records of 218 patients were reviewed. The mean loss of resistance measurement was significantly larger than the mean computed tomography epidural space depth measurement by 0.79 cm (). Our final multivariate model, adjusted for demographic and epidural technique, showed a positive correlation between the loss of resistance and the computed tomography epidural space depth measurement (, ). Conclusions. The measured loss of resistance is positively correlated with the computed tomography epidural space depth measurement and patient demographics. For patients undergoing thoracic or abdominal surgery, estimating the loss of resistance can be a valuable tool. Alyssa Kosturakis, Jose Soliz, Jackson Su, Juan P. Cata, Lei Feng, Nusrat Harun, Ashley Amsbaugh, and Rodolfo Gebhardt Copyright © 2015 Alyssa Kosturakis et al. 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.