Treatment Of Pain In Individuals Research Articles

Individualized Pain Treatment in Chronic Pancreatitis (INPAIN): An International, Multicenter, Investigator-initiated, Prospective, Cohort Study.

Pain is the foremost complication of chronic pancreatitis (CP), affecting about 70% of patients. However, the pathophysiological understanding and management of CP-related pain is complex, likely as patients have diverse "pain phenotypes" responding differently to treatment. This study aims to develop a bedside test panel to identify distinct pain phenotypes, investigate the temporal evolution, and determine whether they can be used to predict treatment response. The INPAIN study is an international, multi-center, observational, longitudinal cohort study comprised of 4 sub-studies. The studies will prospectively enroll 400 CP patients (50 without pain and 350 with pain) and 50 control subjects, conducting biannual observations for four years. The test panel is comprised of comprehensive subjective and objective assessment parameters. Statistical analysis strategies differ across the sub-studies. A model to predict treatment efficacy will be developed using various machine learning techniques, including an artificial intelligence approach, with internal cross-validation. Trajectories in pain parameters will be characterized by graphical analysis and mixed effect models. The INPAIN study aims to comprehensively understand pain in CP through a test panel developed for routine clinical use. This tool has the potential to personalize treatments, improve clinical practice, enhance patient care, improve quality of life, and minimize treatment side effects.

Pain mechanisms in the transgender individual: a review.

Provide an overview of the literature addressing major areas pertinent to pain in transgender persons and to identify areas of primary relevance for future research. A team of scholars that have previously published on different areas of related research met periodically though zoom conferencing between April 2021 and February 2023 to discuss relevant literature with the goal of providing an overview on the incidence, phenotype, and mechanisms of pain in transgender patients. Review sections were written after gathering information from systematic literature searches of published or publicly available electronic literature to be compiled for publication as part of a topical series on gender and pain in the Frontiers in Pain Research. While transgender individuals represent a significant and increasingly visible component of the population, many researchers and clinicians are not well informed about the diversity in gender identity, physiology, hormonal status, and gender-affirming medical procedures utilized by transgender and other gender diverse patients. Transgender and cisgender people present with many of the same medical concerns, but research and treatment of these medical needs must reflect an appreciation of how differences in sex, gender, gender-affirming medical procedures, and minoritized status impact pain. While significant advances have occurred in our appreciation of pain, the review indicates the need to support more targeted research on treatment and prevention of pain in transgender individuals. This is particularly relevant both for gender-affirming medical interventions and related medical care. Of particular importance is the need for large long-term follow-up studies to ascertain best practices for such procedures. A multi-disciplinary approach with personalized interventions is of particular importance to move forward.

Mindful SensoriMotor Therapy combined with brain modulation for the treatment of pain in individuals with disarticulation or nerve injuries: a single-arm clinical trial

IntroductionNeuropathic pain is a complex and demanding medical condition that is often difficult to treat. Regardless of the cause, the impairment, lesion or damage to the nervous system can lead...

Interpretable Machine Learning May Help Personalize Topical Analgesics for Pain Patients

Purpose: Topical analgesics have gained acceptance in guidelines for the treatment of pain. The Kailo Pain Patch® is a topically applied analgesic adhesive patch, with a recent study showing reduced pain severity and interference scales in comparison to a control group. However, as with any analgesic modality, treatment response is variable. Advances in technology, such as pharmacogenomic evaluation and machine learning (artificial intelligence) have emerged as tools to assist clinicians with selecting the most suitable treatments for a variety of disease states. There is limited data on the use of these technologies for pain management; only limited studies have applied machine learning to personalize the treatment of chronic pain patients. This report analyzed the PREVENT Study using an existing modified interpretable machine learning method to personalize the selection of the most suitable protocol for use of the Kailo Pain Patch® and other topical analgesics. Patients and methods: Data from the IRB-approved observational PREVENT study were used in the present analysis of 128 (89 females,39 males) chronic pain patients and 20 controls answering the Brief Pain (BPI) questionnaire along with additional questions in the baseline and after 30 days of treatment with the Kailo Pain Patch®. An interpretable machine-learning model was used to build pain outcome prediction models. This method is a multi-objective ensemble classification/regression technique, which combines multi-objective evolutionary algorithms with Support Vector Machines, Random Forests, and feature filtering techniques to optimize the classification model and minimize the utilized feature subset. Three basic endpoints were examined as outputs to the prediction models including Total BPI Severity, Total BPI Interference, and Total medication changes in the follow- up period. Both classification and regression models were constructed for these endpoints and a “leave-one-out” cross-validation strategy was used to evaluate the generalization ability, classification, and regression performance of the deployed models. Results: Experimental results showed that the trained models with the proposed machine learning method were able to predict endpoints with extremely high accuracy, with the AUC exceeding 90% and Spearman correlation metric exceeding 0.4 for all endpoints, overcoming the classification and regression performances of other benchmark models, including the recently introduced XGBoost. The interpretable machine learning method was able to reduce the number of significant features to 15 and was able to identify some of the most important characteristics of responders and non-responders allowing for a personalized approach to creating an individualized pain treatment approach. Applying the trained model in a previous IRB-approved Observational Study (OPERA) dataset (631 chronic pain patients) demonstrated that most of the participants (>70%) who did not benefit from other topical analgesics therapies, as well as more than 50% of responders to OPERA study medications, would have noted improvement from the pain patch studied in PREVENT. Conclusions: Artificial intelligence and machine learning technologies are advancing multiple areas in fields of medicine, including pain management. A model has been developed which continues to be refined; here we show use of that model for predicting response to topical analgesic therapies. We will continue to refine these tools and make them available to front-line clinicians through a user-friendly web interface (https://kailo.insybio.com/) that can be used to support analgesic clinical decision making [15 questions].

Pain management after tonsillectomy-by demand or by-the-clock-is there a difference?

To improve pain management after tonsillectomy (TE) by comparing individual analgesic management by demand versus a fixed-scheduled analgesic treatment protocol in a prospective trial. Forty consecutive patients received individual pain treatment by demand (control group) followed by 40 patients who were treated by a fixed-scheduled four-staged escalating analgesic protocol (intervention group) after TE. Minimum and maximum pain as well as pain on ambulation (NRS 0-10) on the first postoperative day were defined as primary objectives. Secondary endpoints comprised the analgesic score, treatment-related side effects/pain-associated impairments, wish for more pain medication, and patient satisfaction. Patients were surveyed using the standardized and validated "Quality Improvement in Postoperative Pain Treatment" (QUIPS) questionnaire. Patients of the control group reported comparable minimum (2.03 ± 1.42 vs 2.38 ± 1.79, P = 0.337, r = 0.110) and maximum pain (6.65 ± 2.10 vs 6.93 ± 1.86, P = 0.536, r = 0.07) and pain on ambulation (4.73 ± 2.26 vs 5.18 ± 2.19, P = 0.370, r = 0.10) compared to the intervention group. Patients in both groups were comparably well satisfied with the pain treatment (7.53 ± 2.40 vs 7.73 ± 2.30, P = 0.704, r = 0.04), experienced similar side effects and functional impairments (P > 0.050, Φ < 0.3), and did not ask for much more analgesic medication (P = 0.152, Φ = 0.160). Pain control following TE was not distinctly affected by applying a fixed-scheduled analgesic treatment protocol compared to individual analgesic therapy. In conclusion, analgesic treatment after TE remains unsatisfying. Consequently, further efforts are needed to achieve a standardized and effective approach to the underlying pathophysiological causes of pain following TE.

The Effect of Muscle Energy Technique and Posture Correction Exercises on Pain and Function in Patients with Non-specific Chronic Neck Pain Having Forward Head Posture-a Randomized Controlled Trail.

BackgroundNeck pain is a common problem in individuals despite different types of working patterns. Forward head posture is a common identified cause of chronic neck pain in patients. The effect of long-term forward head posture can be loss of function which can limit individuals’ capacity to work or do activities of daily living; hence it becomes necessary to intervene with muscle strengthening to improve neck stability, as well as mobility.PurposeTo assess effectiveness of muscle energy technique (MET) and posture correction exercises on pain and function in patients with non-specific chronic neck pain having forward head posture.Study SettingOutpatient department of Dr. D. Y. Patil College of Physiotherapy, Pune, India.ParticipantsBoth males and females between the ages of 21–60 years with a cranio-vertebral angle of less than 48° were included in study.Research DesignA randomized clinical trial.MethodologyMET group received muscle energy treatment + posture correction exercises, and control group receiving neck range of motion treatment. Outcomes measures were pain (Numerical Pain Rating Scale), function (Neck Disability Index), and cranio-vertebral angle (MB ruler).ResultsForty-eight subjects were included in the analysis, with 23 participants in Group A (MET) and 25 in Group B (Control). While both groups showed within-group improvements, Group A had significantly greater decreases in neck pain (p < .001), Neck Disability Index scores (p < .001), and significantly greater improvements in cranio-vertebral angles (p < .025) compared to group B.ConclusionThe combined effect of MET and posture correction exercises provides significantly greater results than neck range of motion treatment, and muscle energy technique should be included in the treatment of non-specific chronic neck pain in individuals with forward head posture.

Ethnic Disparities in Treatment of Chronic Pain in Individuals with Parkinson's Disease Living in the United Kingdom.

ABSTRACTBackgroundOver 80% people with Parkinson's disease (PD; PwP) live with chronic pain.ObjectiveWhether ethnic disparities in receipt of appropriate analgesia exist among PwP with chronic pain living in the United Kingdom (UK).MethodsA retrospective datamining of an existing King's PD Pain Questionnaire validation study dataset enrolling 300 PwP.Results69 PwP: 23 Black (57% female), 23 Asian (57% female) and 23 White (65% female) had similar pain burden on the King's PD Pain Scale. Significantly more White PwP (83%) received pain relief compared to Black (48%) and Asian (43%) PwP (p = 0.016). The difference was most evident for opioid analgesics (White 43% vs. Black 4% vs. Asian 4%, p ≤ 0.001).ConclusionsEthnic disparities in the analgesic use among PwP with chronic pain living in the UK are evident in this retrospective analysis, prompting large‐scale studies and reinforcement of interventions to tackle the impact ethnicity might have on the successful analgesia.

The Potential Clinical Utility of Pressure-Based vs. Heat-Based Paradigms to Measure Conditioned Pain Modulation in Healthy Individuals and Those With Chronic Pain.

Conditioned pain modulation (CPM) is a physiological measure thought to reflect an individual's endogenous pain modulation system. CPM varies across individuals and provides insight into chronic pain pathophysiology. There is growing evidence that CPM may help predict individual pain treatment outcome. However, paradigm variabilities and practical issues have impeded widespread clinical adoption of CPM assessment. This study aimed to compare two CPM paradigms in people with chronic pain and healthy individuals. A total of 30 individuals (12 chronic pain, 18 healthy) underwent two CPM paradigms. The heat CPM paradigm acquired pain intensity ratings evoked by a test stimulus (TS) applied before and during the conditioning stimulus (CS). The pressure CPM paradigm acquired continuous pain intensity ratings of a gradually increasing TS, before and during CS. Pain intensity was rated from 0 (no pain) to 100 (worst pain imaginable); Pain50 is the stimulus level for a response rated 50. Heat and pressure CPM were calculated as a change in TS pain intensity ratings at Pain50, where negative CPM scores indicate pain inhibition. We also determined CPM in the pressure paradigm as change in pressure pain detection threshold (PDT). We found that in healthy individuals the CPM effect was significantly more inhibitory using the pressure paradigm than the heat paradigm. The pressure CPM effect was also significantly more inhibitory when based on changes at Pain50 than at PDT. However, in individuals with chronic pain there was no significant difference in pressure CPM compared to heat or PDT CPM. There was no significant correlation between clinical pain measures (painDETECT and Brief Pain Inventory) and paradigm type (heat vs. pressure), although heat-based CPM and painDETECT scores showed a trend. Importantly, the pressure paradigm could be administered in less time than the heat paradigm. Thus, our study indicates that in healthy individuals, interpretation of CPM findings should consider potential modality-dependent effects. However, in individuals with chronic pain, either heat or pressure paradigms can similarly be used to assess CPM. Given the practical advantages of the pressure paradigm (e.g., short test time, ease of use), we propose this approach to be well-suited for clinical adoption.

Multicenter Study of Pain in Osteogenesis Imperfecta

<h3>Research Objectives</h3> To investigate the frequency and type of pain by disease severity and the treatment of pain in individuals with osteogenesis imperfecta (OI), a genetic disorder and member of the rare disease family. <h3>Design</h3> Cross-sectional analysis. <h3>Setting</h3> Subjects were enrolled in a longitudinal multicenter study of OI. <h3>Participants</h3> The study included 558 individuals with a clinical or molecular diagnosis of OI, classified as OI type I (44%), type III (20%), type IV (27%), and other (9%). Median age was 12.4 years (0.0 - 67.2 years). <h3>Interventions</h3> N/A. <h3>Main Outcome Measures</h3> Rare Diseases Clinical Research Network, Brittle Bone Disorders Consortium: Clinical Assessment Instrument: presence, type of pain and pharmacological treatment used for pain relief. <h3>Results</h3> 62% of subjects reported pain (25% acute; 26% chronic; 11% acute & chronic). Acute pain did not change significantly across age groups (p=0.13), but the frequency of chronic pain increased with age, being highest in adults (p < 0.01). Acute pain was significantly more frequent in OI type III when compared with OI type I (p < 0.05). The prevalence of chronic pain did not vary significantly (p=0.69) across OI types. Pain was identified as a limitation to walking by 38% of individuals. Bisphosphonates (BPs) were the pharmacological treatment most frequently used (54% BP; 13% NSAIDs; 28% No treatment). Those with OI types III and IV receiving intravenous BPs treatment had less chronic pain compared with non-treated peers (p < 0.01). <h3>Conclusions</h3> A majority of individuals with OI experience pain. Chronic pain increases with age across all disease types while acute pain is more frequent in OI type III. The study underscores the need for additional research to address causes of pain, treatment effectiveness, and the impact of pain on mobility for individuals with OI. <h3>Author(s) Disclosuress</h3> The study was supported by 1) BBDC (1U54AR068069), a part of the NCATS RDCRN. BBDC is funded through ORDR, NCATS, NIAMS, NIDCR, and NICHD, 2) HHS/NIDILRR 90ARHF0006-01, 3) OREC at Marquette University, and 4) Shriners Hospitals for Children.

Individual Traits and Pain Treatment: The Case of Hypnotizability.

Individual Traits and Pain Treatment: The Case of Hypnotizability.

Beyond Amitriptyline: A Pediatric and Adolescent Oriented Narrative Review of the Analgesic Properties of Psychotropic Medications for the Treatment of Complex Pain and Headache Disorders.

Children and adolescents with recurrent or chronic pain and headache are a complex and heterogenous population. Patients are best served by multi-specialty, multidisciplinary teams to assess and create tailored, individualized pain treatment and rehabilitation plans. Due to the complex nature of pain, generalizing pharmacologic treatment recommendations in children with recurrent or chronic pains is challenging. This is particularly true of complicated patients with co-existing painful and psychiatric conditions. There is an unfortunate dearth of evidence to support many pharmacologic therapies to treat children with chronic pain and headache. This narrative review hopes to supplement the available treatment options for this complex population by reviewing the pediatric and adult literature for analgesic properties of medications that also have psychiatric indication. The medications reviewed belong to medication classes typically described as antidepressants, alpha 2 delta ligands, mood stabilizers, anti-psychotics, anti-sympathetic agents, and stimulants.

Pain treatment in old age: special features and recommendations

For geriatric patients with chronic pain, acomprehensive well-coordinated pain management is pivotal to ensure the best possible pain relief and to minimize as far as possible preventable negative side effects of treatment. Description of the difficulties in pain management of geriatric patients with respect to general basic rules that are worth paying attention to and presentation of pharmacological and non-pharmacological treatment options. This article describes the special features of pain management in older patients and gives recommendations on the use of analgesics and potential drug interactions in geriatric patients with organ dysfunction. Furthermore, individual substance groups are described with respect to their use in geriatric patients based on the recent literature. The aim of an individualized pain treatment in older and multimorbid patients is the relief of pain to an appropriate level, preservation of mobility, self-reliance and autonomy of each individual. The ability to participate in social activities as well as improvement in the quality of life need to be the focus of pharmacological and non-pharmacological treatment.

Current Evidence Lacking to Guide Clinical Practice for Spinal Cord Stimulation in the Treatment of Neuropathic Pain in Spinal Cord Injury: A Review of the Literature and a Proposal for Future Study.

Chronic pain is commonly reported in individuals with spinal cord injuries (SCIs), with recent prevalence reported as high as 80%. Uncontrolled pain is known to decrease quality of life, attenuate mood, and impact sleep. Spinal cord stimulation (SCS) for the treatment of refractory pain was first used in the SCI population in 1972. To date there have been no randomized controlled trials examining the effect of SCS on neuropathic pain post-SCI. A literature review in 2009 identified 27 studies, the majority prior to 2000, that included at least 1 patient with SCI. Given the significant advancements in the field of SCS, this review examines the updated evidence of SCS for the treatment of neuropathic pain in individuals with SCI and provides guidance on future investigations. MEDLINE and EMBASE databases were searched. All published reports, case series, and clinical trials reviewing SCS for neuropathic pain that included at least 1 individual with SCI were included. The initial search identified 376 reports, of which 22 met inclusion criteria, for a total of 69 patients. All reports were of very low quality. A majority of the reported patients were male, underwent tonic stimulation, and reportedly experienced improvement in pain and spasticity, with decreased use of pain medication. The synthesized findings from primarily case studies support the safety of SCS in SCI with the suggestion of potential pain relief benefit; however, data from low-quality studies are insufficient for informing clinical practice. A well-designed, prospective clinical trial is proposed to further investigate this indication.

Effects of Spicy Stimulation and Spicy-Food Consumption on Human Pain Sensitivity: A Healthy Volunteer Study

Spicy-food intake has been shown to affect various human physiological systems and diseases. This study tested the analgesia effect caused by stimulation of a spicy sensation (spicy stimulation) and explored the effect of spicy-food consumption on human basal pain sensitivity. A total of 60 healthy undergraduates were included in the primary study. Placebo and sweet stimulation were used as reference interventions. Pressure and cold-pain thresholds were measured before and after taste stimulation. The frequency of spicy-food intake was also evaluated. An additional 100 subjects were recruited to validate the results. Compared to placebo stimulation, both pressure and cold-pain thresholds increased during spicy stimulation (P < .05). The increased thresholds remained, even when the taste stimulation residue was nearly eliminated (P < .05). The pressure (10.0 [2.1] vs 12.7 [3.0] kg/cm2, P < .001) and cold-pain (4.4 [1.6] vs 6.2 [2.7] seconds, P = .003) thresholds in subjects who consume spicy food ≥3 days/week were significantly lower than in those who consume it <3 days/week. In the validation population, the frequency of spicy-food intake was negatively associated with subjects’ pressure (β = −.218, P = .013) and cold-pain (β = −.205, P = .035) thresholds. Spicy stimulation has an analgesia effect on adults that persists even after the taste stimulation stops. Conversely, a long-term spicy diet can reduce the human basal pain threshold. Trial RegistrationThe study protocol was approved by the Medical Ethics Committee of the Second Affiliated Hospital of Army Medical University, People's Liberation Army (identification No., 2017-023-01), and it was registered on the Chinese Clinical Trial Registry at www.chictr.org.cn (No. ChiCTR1800015053). PerspectiveThis study directly examined the effects of stimulation of a spicy sensation on adult pain sensitivity and was the first to explore the relationship between long-term spicy-food intake and human pain sensitivity. The results provide evidence for future clinical pain intervention and individualized pain treatment.

Managing Sickle Cell Disease Patients with Acute Pain Crisis in the Most Appropriate Setting

Introduction: Pain is the top concern of individuals with sickle cell disease (SCD). Acute painful vaso-occlusive episodes in SCD are the leading cause of emergency department (ED) encounters and frequent hospital admissions. Well-documented disparities include significant delay and under treatment of SCD patients with acute pain crisis in the ED. An acute care observation unit (ACOU) staffed with SCD specialists can help to address these disparities. SCD patients treated in a dedicated ACOU have a 40% lower admission rate than patients treated in the ED. An expedited transfer and treatment program at our dedicated sickle ACOU at the University of Illinois Hospital (UIH) was implemented with the goal of improving overall care and decreasing the hospital admission rate for SCD patients. Method: This is an outcome study of individuals with SCD &gt;16 years of age who presented with an acute painful episode to UIH. A quality improvement project used the Plan-Do-Study-Act translation method. The following key areas were identified for intervention: 1) established criteria for direct ACOU admission, 2) expedited transfer to the ACOU from the ED, 3) addition of a third provider to expand hours, and 4) establishing a consistent but individualized pain treatment plan across the ED and ACOU. The number of admissions to hospital of patients with SCD was examined from September 2018 through August 2019. Applying the Donabedian triad of Structure, Process, and Outcomes, we demonstrated improved outcome and decrease hospitalization. Results: There were 877 admissions to the ACOU from January to July of 2019, which is an increase of 37% compared to the same period in 2018. Of the 877 admissions, 793 were discharged home (90.4%) as compared to 88.6 % in 2018. The average time to first dose of opioids in the ACOU in 2019 was 55 minutes with and average decrease in the pain score of 2.62 during an average length of stay of 4:18 hours. Conclusions: Expedited care and treatment with a focus on improving quality and improving access resulted in increased volume of patients treated and decreased rate of admission to the hospital. Allocating resources to a dedicated sickle acute care observation unit can significantly decrease inpatient hospitalizations. Table. Disclosures No relevant conflicts of interest to declare.

Pain mechanisms in hereditary palmoplantar keratodermas.

Palmoplantar keratodermas (PPKs) are a heterogeneous group of skin disorders characterized by thickening of the epidermis on the palms of the hands and soles of the feet. Individuals with PPKs report varying degrees of palmoplantar pain that can severely affect quality of life. To provide an overview of the scope of pain in hereditary PPKs and highlight candidate mechanisms underlying this pain. In this review, we discuss several forms of hereditary PPKs, with a focus on the incidence, nature, candidate underlying mechanisms and treatment of pain in these conditions. We also synthesize this information with current understanding of the mechanisms contributing to pathological pain in other conditions. Pain is a major problem for many, but not all individuals with hereditary PPK. This pain remains poorly understood, inconsistently reported and inadequately treated. The heterogeneity of pain prevalence and presentations across the many forms of PPK suggests that there may exist corresponding heterogeneity in the cellular and molecular mechanisms that drive and shape PPK-associated pain. Some candidate mechanisms include structural (e.g. fissures and blisters), infectious and immune/inflammatory processes. However, a growing body of evidence also supports the occurrence of localized neuropathic alterations in the affected skin of individuals with PPK, which might contribute to their pain. Greater understanding of these diverse mechanisms may provide a rational basis for the development of improved and targeted approaches to prevention and treatment of pain in individuals with PPK. What's already known about this topic? Pain is a prominent symptom in hereditary palmoplantar keratodermas (PPKs). Pain in patients with PPK can be difficult to treat. Pain mechanisms in PPKs are poorly understood. What does this study add? This study defines multiple potential sources of pain in PPK, including both structural lesions (fissures, blisters) and specific cell types. This review highlights the variability of pain among several forms of hereditary PPK. This study provides mechanistic insights into how neuropathic and inflammatory mechanisms might contribute to pain in some forms of PPK.

Paracetamol and Pain Modulation by TRPV1, UGT2B15, SULT1A1 Genotypes: A Randomized Clinical Trial in Healthy Volunteers.

The influence of the genetic polymorphism of enzymes and receptors involved in paracetamol metabolism and mechanism of action has not been investigated. This trial in healthy volunteers investigated the link between paracetamol pain relief and the genetic polymorphism of 23 enzymes and receptors. This randomized double-blind crossover controlled pilot study took place in the Clinical Pharmacology Department, University Hospital, Clermont-Ferrand, France. Forty-seven Caucasian volunteers were recruited. The trial consisted of two randomized sessions one week apart with oral paracetamol or placebo, and pain changes were evaluated with mechanical pain stimuli. The genetic polymorphism of 23 enzymes and receptors was studied, and correlations were made with pain relief. All tests are two-sided with a type I error at 0.05. Paracetamol was antinociceptive compared with placebo (222 ± 482 kPaxmin vs 23 ± 431 kPaxmin; P = 0.0047), and the study showed 30 paracetamol responders and 17 paracetamol nonresponders. Responders were characterized by TRPV1rs224534 A allele, UGT2B15rs1902023 TT genotype, and SULT1A1rs9282861 GG genotype (P < 0.05 for all). These findings confirm for the first time the involvement of a specific TRPV1 rs224534 variant in paracetamol antinociception. They also reveal a new antinociceptive role for specific variants of hepatic phase II enzymes associated with paracetamol metabolism. The study warrants larger clinical trials on these potential genomic markers of paracetamol analgesia in patients. Confirmation of the present findings would open the way to effective individualized pain treatment with paracetamol, the most commonly used analgesic worldwide.

The Palliative Radiotherapy and Inflammation Study (PRAIS) - protocol for a longitudinal observational multicenter study on patients with cancer induced bone pain

BackgroundRadiation therapy (RT) results in pain relief for about 6 of 10 patients with cancer induced bone pain (CIBP) caused by bone metastases. The high number of non-responders, the long median time from RT to pain response and the risk of adverse effects, makes it important to determine predictors of treatment response. Clinical features such as cancer type, performance status and pain intensity, and biomarkers for osteoclast activity are proposed as predictors of response to RT. However, results are inconsistent and there is a need for better predictors of RT response. A similar argument can be stated for the development of cachexia; there are currently no predictors that can identify patients who will develop cachexia later in the cancer disease trajectory. Experimental and preclinical studies show that pain, depression and cachexia are related to inflammation. However, it is not known if inflammatory biomarkers can predict CIBP, depression or development of cachexia.MethodsThis multicenter, multinational longitudinal observational study will include 600 adult patients receiving RT for CIBP. Demographic data, clinical variables, osteoclast and inflammatory biomarkers will be assessed before start of RT, and 3, 8, 16, 24 and 52 weeks after last course of RT. The primary aim of the study is to identify potential predictors for pain relief from RT. Secondary aims are to explore potential predictors for development of cachexia, the longitudinal relationship between pain intensity and depression, and if inflammatory biomarkers are associated with changes in pain intensity, cachexia and depression during one-year follow up.DiscussionThe immediate clinical implication of the PRAIS study is to identify potential predictive factors for a RT response on CIBP, and thereby reduce non-efficacious RT. Patient benefits are fewer hospital visits, reduced risk of adverse effects and more individualized pain treatment. The long-term clinical implication of the PRAIS study is to improve the knowledge about inflammation in relation to CIBP, cachexia and depression and potentially identify associations and mechanisms that can be targeted for treatment.Trial registrationClinicalTrials.gov NCT02107664, date of registration April 8, 2014 (retrospectively registered).Trial sponsorThe European Palliative Care Research Centre (PRC), Department of Clinical and Molecular Medicine, NTNU, Faculty of medicine and Health Sciences, Trondheim, N-7491, Norway.

Eficácia da reeducação postural global na dor de indivíduos com disfunção temporomandibular: uma revisão sistemática

INTRODUÇÃO: Disfunção temporomandibular (DTM) é caracterizada por um conjunto de alterações funcionais, que envolvem fatores predisponentes, iniciantes e perpetuantes. Considerando que os desvios posturais desorganizam a harmonia corporal entre a postura da mandíbula e todo o sistema esquelético, várias modalidades fisioterapêuticas foram propostas no tratamento da DTM, incluindo a Reeducação Postura Global (RPG). OBJETIVO: Avaliar sistematicamente as evidências sobre a eficácia da RPG no tratamento da dor em indivíduos com DTM. MÉTODOS: Revisão sistemática realizada pesquisa nas bases de dados, maio a setembro 2017, Pubmed, Biblioteca Virtual em Saúde (Lilacs, Scielo e Medline), PEDro e Cochrane Library. Os critérios de inclusão: Ensaios clínicos randomizados (ECR) e Ensaios clínicos controlados (ECC); artigos publicados em língua inglesa, portuguesa e espanhola; que abordavam sobre o tratamento com RPG; com indivíduos adultos &gt; 18 e ?60 anos; diagnosticados com DTM; que continham avaliação da dor. Excluídos: estudos duplicados; que utilizaram exercícios para pacientes pós-cirúrgico e que apresentassem doenças sistêmicas ou qualquer afecção que afetasse o sistema osteomioarticular; que avaliaram pacientes com histórico de trauma facial ou cervical e em uso de medicamentos. RESULTADOS: Um total de 349 artigos foram encontrados, que após a eliminação de duplicatas, filtragem de títulos, resumos e leitura de texto completo foram incluídos na pesquisa três estudos, o que evidenciou a eficácia da RPG na redução da dor. CONCLUSÃO: Considerando os resultados obtidos neste estudo, foi possível concluir que a RPG demonstra ser eficaz na redução da dor presente na DTM. Porém, faz-se necessários mais ensaios clínicos randomizados com maior rigor metodológico, protocolos mais bem definidos, que possam auxiliar na tomada de decisão clínica e que contemplem também a comparação do tratamento entre homens e mulheres.

Applications of sensory and physiological measurement in oral-facial dental pain.

Dentists regularly employ a variety of self‐report and sensory techniques to aid in the diagnosis and treatment of tooth‐related disease. Many of these techniques leverage principles borrowed from psychophysics, the quantitative measurement of the relationship between stimuli and evoked sensations, which falls under the larger umbrella of quantitative sensory testing (QST). However, most clinicians fail to meet the bar for what could be considered quantitative sensory testing, and instead focus on qualitative and dichotomous “yes/no” aspects of sensory experience. With our current subjective measurements for pain assessments, diagnosis and treatment of dental pain in young children and individuals (any age) with severe cognitive impairment rely extensively on third‐party observations. Consequently, the limitation of inadequate pain diagnosis can lead to poor pain management. In this review, it discusses mechanisms that underlie acute and chronic dental pain. It details the measurement of somatosensory responses and pulpal blood flow as objective measures of tooth health and pain. It proposes that bridging these varied methodologies will significantly improve diagnosis and treatment of orofacial pain and pathology. It concludes that improving the precision of sensory measurements could yield important improvements in diagnostic challenges in pulpal pathology for noncommunicative and cognitively impaired individuals.