Predicting pain and pain responses to opioids

10.1016/S1754-3207(08)60009-7European Journal of Pain Supplements1131-3

The balancing act: Endogenous modulation of pain in functional gastrointestinal disorders

10.1136/gutjnl-2011-300253Gut60111589-1599GUTT

Activating endogenous visceral pain modulation: A comparison of heterotopic stimulation methods in healthy controls

10.1016/j.ejpain.2008.09.015European Journal of Pain138836-84

Cortical effects of anticipation and endogenous modulation of visceral pain assessed by functional brain MRI in irritable bowel syndrome patients and healthy controls

10.1016/j.pain.2006.06.017Pain1261-379-9

The effect of high-frequency conditioning stimulation of human skin on reported pain intensity and event-related potentials

Item does not contain fulltextHigh-frequency conditioning electrical stimulation (HFS) of human skin induces an increased pain sensitivity to mechanical stimuli in the surrounding nonconditioned skin. The aim of this study was to investigate the effect of HFS on reported pain sensitivity to single electrical stimuli applied within the area of conditioning stimulation. We also investigated the central nervous system responsiveness to these electrical stimuli by measuring event-related potentials (ERPs). Single electrical test stimuli were applied in the conditioned area before and 30 min after HFS. During electrical test stimulation, the reported pain intensity (numerical rating scale) and EEG (ERPs) were measured. Thirty minutes after conditioning stimulation, we observed a decrease of reported pain intensity at both the conditioned and control (opposite arm) skin site in response to the single electrical test stimuli. In contrast, we observed enhanced ERP amplitudes after HFS at the conditioned skin site, compared with control site, in response to the single electrical test stimuli. Recently, it has been proposed that ERPs, at least partly, reflect a saliency detection system. Therefore, the enhanced ERPs might reflect enhanced saliency to potentially threatening stimuli.6 p

Frequency of provocative factors in epileptic patients admitted for seizures: A prospective study in Singapore

10.1016/j.seizure.2005.07.010Seizure147464-46

Clinical outcome in relation to timing of surgery in chronic pancreatitis: a nomogram to predict pain relief

Item does not contain fulltextOBJECTIVE: To evaluate the effect of timing of surgery on the long-term clinical outcome of surgery in chronic pancreatitis (CP). DESIGN: Cohort study with long-term follow-up. SETTING: Five specialized academic centers. PATIENTS: Patients with CP treated surgically for pain. INTERVENTIONS: Pancreatic resection and drainage procedures for pain relief. MAIN OUTCOME MEASURES: Pain relief (pain visual analogue score </=4), pancreatic function, and quality of life. RESULTS: We included 266 patients with median follow-up of 62 months (interquartile range, 31-112). Results were presented as odds ratios (ORs)with 95% confidence intervals after correction for bias using bootstrap-corrected analysis. Pain relief was achieved in 149 patients (58%). Surgery within 3 years of symptoms was independently associated with more pain relief (OR, 1.8; 95% CI, 1.0-3.4; P = .03) and less endocrine pancreatic insufficiency (OR, 0.57; 95% CI, 0.33-0.96; P = .04). More pain relief was also observed in patients not taking opioids preoperatively (OR, 2.1; 95% CI, 1.2-4.0; P = .006) and who had 5 or fewer endoscopic treatments prior to surgery (OR, 2.5; 95% CI, 1.1-6.3; P = .04). The probability of achieving pain relief varied between 23% and 75%, depending on these risk factors. CONCLUSIONS: The timing of surgery is an important risk factor for clinical outcome in CP. Surgery may need to be considered at an earlier phase than it is now, preferably within 3 years of symptomatic CP. Likelihood of postoperative pain relief can be calculated on an individual basis using the presented nomogram