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Journal: Pain medicine (Malden, Mass.)

153

Pain is multi-dimensional and may be better addressed through a holistic, biopsychosocial approach. Massage therapy is commonly practiced among patients seeking pain management; however, its efficacy is unclear. This systematic review and meta-analysis is the first to rigorously assess the quality of massage therapy research and evidence for its efficacy in treating pain, function-related and health-related quality of life in cancer populations.

Concepts: Epidemiology, Disease, Evaluation, The Canon of Medicine, Evidence-based medicine, Systematic review, Randomized controlled trial, Meta-analysis

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Prolonged exposure to opioids is known to produce neuroplastic changes in animals; however, few studies have investigated the effects of short-term prescription opioid use in humans. A previous study from our laboratory demonstrated a dosage-correlated volumetric decrease in the right amygdala of participants administered oral morphine daily for 1 month. The purpose of this current study was to replicate and extend the initial findings.

Concepts: Spinal disc herniation, Low back pain, Nuclear magnetic resonance, Magnetic resonance imaging, Opioid, Pain, Morphine, Hydromorphone

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Pain is multi-dimensional and may be better addressed through a holistic, biopsychosocial approach. Massage therapy is commonly practiced among patients seeking pain management; however, its efficacy is unclear. This systematic review and meta-analysis is the first to rigorously assess the quality of massage therapy research and evidence for its efficacy in treating pain, function-related and health-related quality of life outcomes across all pain populations.

Concepts: Epidemiology, Biology, Evaluation, Evidence-based medicine, Systematic review, Randomized controlled trial, Meta-analysis, Publication bias

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To determine the prevalence of chronic pain, its causes, severity, management, impact on sleep, mood and activity levels, and general practitioner (GP) and patient satisfaction with pain management.

Concepts: Medical terms, Patient, Physician, Pain, General practitioner, Chronic pain, Pain management, General practice

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OBJECTIVE: Neuropathic pain is an area of unmet clinical need. The objective of this study was to define the pharmacokinetics, oral bioavailability, and efficacy in rats of small molecule antagonists of the angiotensin II type 2 receptor (AT2 R) for the relief of neuropathic pain. DESIGN AND METHODS.: Adult male Sprague-Dawley (SD) rats received single intravenous (1-10 mg/kg) or oral (5-10 mg/kg) bolus doses of EMA200, EMA300, EMA400 or EMA401 (S-enantiomer of EMA400). Blood samples were collected immediately pre-dose and at specified times over a 12- to 24-hour post-dosing period. Liquid chromatography tandem mass spectrometry was used to measure plasma drug concentrations. Efficacy was assessed in adult male SD rats with a unilateral chronic constriction injury (CCI) of the sciatic nerve. RESULTS.: After intravenous administration in rats, mean (±standard error of the mean) plasma clearance for EMA200, EMA300, EMA400, and EMA401 was 9.3, 6.1, 0.7, and 1.1 L/hour/kg, respectively. After oral dosing, the dose-normalized systemic exposures of EMA400 and EMA401 were 20- to 30-fold and 50- to 60-fold higher than that for EMA300 and EMA200, respectively. The oral bioavailability of EMA400 and EMA401 was similar at ∼30%, whereas it was only 5.9% and 7.1% for EMA200 and EMA300, respectively. In CCI rats, single intraperitoneal bolus doses of EMA200, EMA300, and EMA400 evoked dose-dependent pain relief. The pain relief potency rank order in CCI rats was EMA400 > EMA300 > EMA200 in agreement with the dose-normalized systemic exposure rank order in SD rats. CONCLUSION.: The small molecule AT2 R antagonist, EMA401, is in clinical development as a novel analgesic for the relief of neuropathic pain.

Concepts: Protein, Pharmacology, Mass spectrometry, Intravenous therapy, Pain, Angiotensin, Pharmacokinetics, Angiotensin II receptor type 2

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OBJECTIVE: The aim of this study was to assess validity, reliability, and sensitivity of the Persian version of the short-form McGill Pain Questionnaire 2 (SF-MPQ-2) in patients with neuropathic and non-neuropathic pain. DESIGN: Beaton’s guideline was used to translate and adapt the SF-MPQ-2 to Persian. SUBJECTS: One hundred eighty-four patients with subacute and chronic non-neuropathic pain and 74 patients with painful diabetic peripheral neuropathy (total 258) attending multidisciplinary pain clinic participated in the study. OUTCOME MEASURES: Internal consistency and intraclass correlation coefficient (ICC) were estimated for participants who had completed the questionnaire in the morning and evening of the first day. The visual analog scale (VAS) and the present pain intensity (PPI) were also recorded to test convergent validity of the questionnaire. Sensitivity to change was examined after a standard treatment and validated by means of the patient global impression of change (PGIC) in addition to VAS and PPI. Exploratory factor analysis (EFA) was used to find possible components. RESULTS: Cronbach’s alpha was 0.906, which showed high internal consistency. ICC (0.941) revealed test-retest reliability. There was high correlation between the mean VAS and the mean total score (r = 0.926). Patients in different levels of PPI and PGIC exhibited significant differences among their mean total scores (P < 0.05). EFA revealed four components similar to the original SF-MPQ-2. CONCLUSION: The Persian translation of the expanded and revised version of the SF-MPQ-2 is a highly reliable, sensitive, and valid instrument to evaluate pain in patients with and without neuropathic etiology.

Concepts: Statistics, Psychometrics, Pain, Reliability, Cronbach's alpha, Internal consistency, Comparison of assessments, Peripheral neuropathy

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Pain qualities may reflect neurobiological mechanisms and guide therapy. The objective was to assess whether pain qualities were associated with satisfaction with pain relief in subjects with neuropathic pain.

Concepts: Pain, Suffering, Pain management, Peripheral neuropathy, Neuropathic pain

24

To evaluate the frequency with which migraine patients initiated behavioral migraine treatment following a headache specialist recommendation and the predictors for initiating behavioral migraine treatment.

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BACKGROUND : Transdermal therapeutic system fentanyl with a drug release rate of 12 µg/h should be of special value in pediatric cancer pain control. Such a fentanyl formulation allows for a stepwise dose increase, similar to that reported for sustained-release morphine. PATIENTS AND METHODS : Sixty-four male and female pediatric patients with moderate to severe chronic cancer pain, ages ranging 2-14 years, were included. Patients did not receive opioids prior to enrollment. Patients were observed for pain relief using the Visual Analog Scale and the Wong-Baker FACES Pain Rating Scale, play performance score, and for side effects. RESULTS : There was significant improvement of visual analog scale and FACES pain scores from the baseline to the second day of application (P < 0.001). By the 15th day, scores reached 1.18 ± 0.393 and 1.13 ± 0.35, respectively (P < 0.001). Play performance scale improved from the third day of application of the patch when compared with the baseline (P < 0.001), reaching 55.02 ± 8.35 (P < 0.001) at the end of the study. The sedation score increased on the second day to 2 in 10 patients and to 3 in 54 patients. By the seventh day, 56 patients had a sedation score of 1. All patients returned to baseline by the 15th day. Itching was reported in 16 cases, and erythema occurred in 10 cases. No significant side effects were reported. CONCLUSION : Transdermal fentanyl was found to be an effective, safe, and well-tolerated treatment for pediatric cancer-related pain in opioid-naive patients with chronic moderate to severe pain. In this study population, evaluation of vital signs and physical examination did not suggest any safety concerns while using transdermal fentanyl.

Concepts: Pharmacology, Transdermal patch, Anesthesia, Pain, Buprenorphine, Suffering, Pain management, Fentanyl

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Pain is multi-dimensional and may be better addressed through a holistic, biopsychosocial approach. Massage therapy is commonly practiced among patients seeking pain management; however, its efficacy is unclear. This systematic review and meta-analysis is the first to rigorously assess the quality of the evidence for massage therapy’s efficacy in treating pain, function-related, and health-related quality of life outcomes in surgical pain populations.

Concepts: Medicine, Epidemiology, Evaluation, Evidence-based medicine, Systematic review, Randomized controlled trial, Meta-analysis, Publication bias