ISSN:0749-8047    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

The peripheral apparatus of muscle pain consists of nociceptors that can be excited by endogenous substances and mechanical stimuli. Histologically, the nociceptors are free nerve endings supplied by group III (thin myelinated) and group IV (nonmyelinated) afferents with conduction velocities less than 30 m/s. At the molecular level, nociceptors have receptors for algesic substances, such as bradykinin, serotonin, and prostagladin E2. The purinergic receptors and tetrodotoxin-resistant sodium channels might be new important targets for the treatment of muscle pain. Algesic substances (capsaicin, bradykinin, serotonin, potassium chloride, and hypertonic saline) and other stimuli (ischemia, strong mechanical stimuli, and electrical stimuli) have been shown to induce nociception from muscle in animals and muscle pain in humans. Muscle nociceptors can be sensitized to chemical and mechanical stimuli. Contrary to a former belief, the sensitization is not an unspecific process; rather, it is caused by endogenous algesic substances binding to highly specific receptor molecules in the membrane of the nociceptive ending. For example, animal studies showed that serotonin sensitizes muscle nociceptors to chemical and mechanical stimuli. Later, human studies showed that serotonin combined with bradykinin induces muscle hyperalgesia to pressure. The sensitization process by endogenous substances that are likely to be released during trauma or inflammatory injury is probably the best established peripheral mechanism for muscle tenderness and hyperalgesia.

ISSN:0749-8047    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:0749-8047    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Epidemiologic, clinical, and experimental evidence points to sex differences in musculoskeletal pain. Adult women more often have musculoskeletal problems than do men. Discrepant findings regarding the presence of such differences during childhood and adolescence continue. Biologic and psychosocial factors might account for these differences. The authors review evidence showing that mechanically induced pressure is more likely to show sex differences than other noxious stimuli and to discriminate between individuals suffering from musculoskeletal pain and matched controls. The authors suggest that a state of increased pain sensitivity, with a peripheral or central origin, predisposes individuals to chronic muscle pain conditions, and that there are sex differences in the operation of these mechanisms; women are vulnerable to the development and maintenance of musculoskeletal pain conditions.

ISSN:0749-8047    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Objective:The authors aimed to provide an educational update on the current evidence of the effectiveness of drug therapy in the treatment of musculoskeletal pain and to offer a perspective of possible future developments.Design:The authors used a pragmatic review of data provided by available systematic reviews and seminal controlled studies pertaining to the treatment of regional musculoskeletal pain problems.Results:Epidural steroids may offer limited, short-term benefit for sciatica. Local injections of steroids are either ineffective or provide short-lasting benefits. Nonsteroidal anti-inflammatory drugs and opioids reduce pain, but the effect size is modest. The literature does not support convincingly the use of antidepressants. Certain muscle relaxants may be useful in the treatment of back pain. Hyaluronic acid, neutraceutical agents, avocado-soybean unsaponifiable agents, oxaceprol and diacerein may be effective in the treatment of osteoarthritis, but the information regarding these new agents does not allow wholesale endorsement of these substances. Selective epidural injection of steroids at a target nerve root approached through the intervertebral foramin has the potential to replace the traditional epidural approach. Long-acting, C-fiber-specific local anesthetics are under investigation and could provide long-lasting pain relief without motor or sensory impairment. In the future, central hypersensitivity in chronic musculoskeletal pain might be treated using antagonists of the N-methyl-D-aspartate receptor. Cannabinoid agents produce antinociception and prevent experimentally induced hyperalgesia in animals, and they may find a role in pain management. Methods to optimize drug combinations are available.Conclusions:The effectiveness of the currently available drugs in the treatment of musculoskeletal pain conditions is disappointing. Recent developments may open new perspectives in this area of pain medicine.

ISSN:0749-8047    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Background:Several types of physical therapy are used in the management of painful musculoskeletal disorders. These treatment modalities can be broadly categorized as electrotherapy modalities (e.g., transcutaneous electrical nerve stimulation), acupuncture, thermal modalities (e.g., moist heat, ultrasound), manual therapies (e.g., manipulation or massage), or exercise. Within each of these broad categories significant variations in treatment parameters are possible.Objective:To consider the evidence base for each of these main categories of physical therapy in the management of musculoskeletal pain.Method:To consider the available evidence related to clinical effectiveness and then to review evidence from basic science studies evaluating potentially therapeutic effects of the various therapies.Results:There seems to be evidence from basic science research to suggest that many of the therapies could have potentially therapeutic effects. However, there appears to be limited high-quality evidence from randomized clinical trials to support the therapeutic effectiveness of several of the therapies.Conclusions:There is some preliminary evidence to support the use of manual therapies, exercise, and acupuncture in the management of some categories of musculoskeletal pain. Limitations of the existing research base are discussed and recommendations for areas of future research are provided.

ISSN:0749-8047    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Objective:The objective of this study was to describe a pilot treatment of temporomandibular joint pain by linearly polarized near-infrared irradiation.Design:A prospective clinical study.Setting:University teaching hospital.Patients:Patients comprised 20 women (mean age ±SD: 26.6 ± 15.2 years) with unilateral temporomandibular pain. The patients had already received other conservative treatments, but temporomandibular pain did not attenuate.Intervention:Linearly polarized near-infrared irradiation with the Super Lizer was used.Results:The painless interincisal distance of the mouth opening, which is one of the objective parameters of temporomandibular dysfunction, and the visual analogue scale of the affected temporomandibular joint before treatment were 33.4 ± 6.5 mm and 5.0 ± 2.7 points, respectively. Pilot linearly polarized near-infrared irradiation was applied weekly to the skin areas overlying four painful points. The present treatment alleviated temporomandibular pain after the patients had received only four weekly irradiation treatments, with final measured values of the visual analogue scale being 1.4 ± 1.6 points. The final painless mouth-opening distance increased by 7.6 ± 4.6 mm compared with the first measured distance without complications.Conclusion:This pilot treatment using the Super Lizer provided relief from temporomandibular pain over a period of 4 weeks.

ISSN:0749-8047    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

The tendency to "catastrophize" during painful stimulation contributes to more intense pain experience and increased emotional distress. Catastrophizing has been broadly conceived as an exaggerated negative "mental set" brought to bear during painful experiences. Although findings have been consistent in showing a relation between catastrophizing and pain, research in this area has proceeded in the relative absence of a guiding theoretical framework. This article reviews the literature on the relation between catastrophizing and pain and examines the relative strengths and limitations of different theoretical models that could be advanced to account for the pattern of available findings. The article evaluates the explanatory power of a schema activation model, an appraisal model, an attention model, and a communal coping model of pain perception. It is suggested that catastrophizing might best be viewed from the perspective of hierarchical levels of analysis, where social factors and social goals may play a role in the development and maintenance of catastrophizing, whereas appraisal-related processes may point to the mechanisms that link catastrophizing to pain experience. Directions for future research are suggested.

ISSN:0749-8047    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Progress in advancing understanding of the role of "catastrophizing" in pain and associated physical and psychosocial disability may be furthered by (1) consideration of the construct of catastrophizing, (2) evaluation of the extent to which currently available measures of pain catastrophizing tap into that construct, (3) investigation of the relation of catastrophizing to personal trait variables (e.g., neuroticism and worry), and (4) identification of the conditions (or states) under which catastrophizing is most likely to occur. In this article, the authors discuss these issues and suggest directions for future research.

ISSN:0749-8047    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Objective:Because morphine affects various immune functions, patient-controlled analgesia with morphine may further deteriorate the immune mechanisms after surgery. Therefore, the purpose of this study was to determine differences between morphine patient-controlled analgesia and a combination of morphine and ketorolac in interleukin-6 and interleukin-10 responses, and in analgesia and morphine-related side effects.Design:Prospective study.Patients:Twenty-two patients who underwent abdominal hysterectomy were classified randomly into two groups: (1) patient-controlled analgesia with morphine; and (2) patient-controlled analgesia with a combination of morphine and ketorolac. Blood samples to measure cytokines were collected at preoperatively, immediately postoperatively, and 2 hours, 4 hours, and 24 hours postoperatively.Outcome Measures:Plasma was separated and frozen until the analysis of cytokines using enzyme-linked immunosorbent assays. Postoperative pain was assessed using a visual analog score. Sedation was checked based on a protocol developed at the Samsung Medical Center.Results:In the two groups, interleukin-6 increased immediately postoperatively, and it remained consistent for 24 hours. Interleukin-10 concentrations peaked at 2 hours postoperatively and progressively decreased. Cytokine concentrations between the two groups were significantly different for interleukin-6 24 hours postoperatively (p= 0.026) and for interleukin-10 4 hours postoperatively (p= 0.045). Total analgesic use was not different, but morphine consumption was significantly different (p= 0.037 at 4 hours postoperatively,p= 0.015 at 24 hours postoperatively). Pain scores, sedation, and side effects were unaffected by the patient-controlled analgesia regimen.Conclusions:The authors conclude that supplementation using ketorolac plus administration of morphine modifies cytokine responses and may contribute to immune augmentations during postoperative periods.

ISSN:0749-8047    

出版商:OVID    

年代:2001

数据来源: OVID