Headache in Petrous Apicitis: A Case Report of Chronic Migraine-like Headache Due to Peripheral Pathology

 AbstractObjective: To report a case of petrous apicitis that manifested as chronic migraine without aura and to discuss the pathophysiological mechanisms behind this presentation. Background:Petrous apicitis is a r...
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An Evolutionary Medicine Perspective on Pain and Its Disorders

Abstract: Enormous progress in understanding the mechanisms that mediate pain can be augmented by an evolutionary medicine perspective on how the capacity for pain gives selective advantages, the trade-offs that shaped t...
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Euphorbia Bicolor (Euphorbiaceae) Latex Phytochemicals Induce Long-Lasting Non-Opioid Peripheral Analgesia in a Rat Model of Inflammatory Pain

The negative side effects of opioid-based narcotics underscore the search for alternative non-opioid bioactive compounds that act on the peripheral nervous system to avoid central nervous system-mediated side effects. Th...
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Rethinking Opioid Dose Tapering, Prescription Opioid Dependence, and Indications for Buprenorphine

The expanded use of opioids for chronic pain has created a population of patients prescribed long-term opioid therapy lasting years or decades. Doses are often above the thresholds suggested in the 2016 Centers for Disea...
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The Fear Reduction Exercised Early (FREE) Approach to Management of Low Back Pain in General Practice: A Pragmatic Cluster-Randomized Controlled Trial

Effective and cost-effective primary care treatments for low back pain (LBP) are required to reduce the burden of the world's most disabling condition. This study aimed to compare the clinical effectiveness and cost-effectiveness of the Fear Reduction Exercised Early (FREE) approach to LBP (intervention) with usual general practitioner (GP) care (control).

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A Cell-Penetrating Scorpion Toxin Enables Mode-Specific Modulation of TRPA1 and Pain

TRPA1 is a chemosensory ion channel that functions as a sentinel for structurally diverse electrophilic irritants. Channel activation occurs through an unusual mechanism involving covalent modification of cysteine residu...
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Mortality After Discontinuation of Primary Care–Based Chronic Opioid Therapy for Pain: A Retrospective Cohort Study

 Despite known risks of using chronic opioid therapy (COT) for pain, the risks of discontinuation of COT are largely uncharacterized. The objective of this study was to evaluate mortality, prescription opioid use, and primary care utilization of patients discontinued from COT, compared with patients maintained on opioids.

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Prospective Cohort Study of Caffeinated Beverage Intake as a Potential Trigger of Headaches Among Migraineurs

 The purpose of the study was to evaluate the role of caffeinated beverage intake as a potential trigger of migraine headaches on that day or on the following day.

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Ketamine Infusion for Pain Control in Elderly Patients with Multiple Rib Fractures: Results of a Randomized Controlled Trial

Abstract: INTRODUCTION: Rib fractures are associated with increased mortality, particularly in the elderly. While opiate-based pain regimens remain the cornerstone of rib fracture management, issues related to opioids ha...
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Pain Neurology

Abstract: Pain is often the initial complaint for which patients seek medical care presenting both a diagnostic and therapeutic challenge to the primary care provider. The appreciation of pain is not merely the result of...
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Remote Surveillance Technologies: Realizing the Aim of Right Patient, Right Data, Right Time

Abstract: The convergence of multiple recent developments in health care information technology and monitoring devices has made possible the creation of remote patient surveillance systems that increase the timeliness and quality of patient care. More convenient, less invasive monitoring devices, including patches, wearables, and biosensors, now allow for continuous physiological data to be gleaned from patients in a variety of care settings across the perioperative experience. These data can be bound into a single data repository, creating so-called data lakes. The high volume and diversity of data in these repositories must be processed into standard formats that can be queried in real time. These data can then be used by sophisticated prediction algorithms currently under development, enabling the early recognition of patterns of clinical deterioration otherwise undetectable to humans.

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Shifting Brain Circuits in Pain Chronicity

The evaluation of brain changes to a specific pain condition in pediatric and adult patients allows for insights into potential mechanisms of pain chronicity and possibly long-term brain changes. Here we focused on the p...
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Evaluation of Clinical Outcomes in an Interdisciplinary Abdominal Pain Clinic: A Retrospective, Exploratory Review

Pediatric functional gastrointestinal disorders (FGIDs) are common and well-accepted to be etiologically complex in terms of the contribution of biological, psychological, and social factors to symptom presentations. Non...
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Managing Cluster Headache

Cluster headache is a neurological disorder that presents with unilateral severe headache associated with ipsilateral cranial autonomic symptoms. Cluster headache attacks often occur more than once a day, and typically m...
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Does Disordered Sleep Moderate the Relationship Between Pain, Disability, and Downstream Healthcare Utilization in Patients with Low Back Pain? A Longitudinal Cohort from the US Military Health System

The purpose was to evaluate the influence of disordered sleep on the relationship between pain and healthcare utilization (HCU) and pain-related disability and HCU in individuals with low back pain (LBP).

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Rimegepant, an Oral Calcitonin Gene–Related Peptide Receptor Antagonist, for Migraine

Calcitonin gene–related peptide receptor has been implicated in the pathogenesis of migraine. Rimegepant is an orally administered, small-molecule, calcitonin gene–related peptide receptor antagonist that may be effective in acute migraine treatment.

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Transfer of Complex Regional Pain Syndrome to Mice via Human Autoantibodies is Mediated by Interleukin-1–Induced Mechanisms.

 Complex regional pain syndrome (CRPS) is a poorly understood painful condition, which typically arises after distal limb trauma; 20% of patients may develop lifelong severe incessant pain with few therapeutic options. In this study, we show that immunoglobulin G autoantibodies from patients with severe, persistent CRPS, on transfer to hind paw-injured mice, elicit important features of the clinical condition and profound glial activation in pain-related brain regions. Blockade of the proinflammatory cytokine interleukin-1 (IL-1) both prevents and reverses these changes. Our findings suggest that antibody-mediated autoimmunity contributes to the development of severe CRPS after injury and that blockade of IL-1 actions may be an attractive therapeutic prospect. Investigation of autoantibody contribution to other unexplained chronic pain syndromes seems warranted.
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Associations Between Gabapentinoids and Suicidal Behavior, Unintentional Overdoses, Injuries, Road Traffic Incidents, and Violent Crime: Population Based Cohort Study in Sweden

Abstract: OBJECTIVE: To examine associations between gabapentinoids and adverse outcomes related to coordination disturbances (head or body injuries, or both and road traffic incidents or offences), mental health (suicid...
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Trigeminal Autonomic Cephalalgias Presenting in a Multidisciplinary Tertiary Orofacial Pain Clinic

Abstract: Orofacial pain may have a variety of causes and offers a significant clinical challenge for its diagnosis and management. Objective: To assess the headache disorders presenting in a tertiary multidisciplinary o...
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The Neuroinflammatory Component of Negative Affect in Patients with Chronic Pain

Abstract: Negative affect (NA) is a significant cause of disability for chronic pain patients. While little is known about the mechanism underlying pain-comorbid NA, previous studies have implicated neuroinflammation in the pathophysiology of both depression and chronic pain. Here, we tested the hypothesis that NA in pain patients is linked to elevations in the brain levels of the glial marker 18 kDa translocator protein (TSPO), and changes in functional connectivity. 25 cLBP patients (42.4 ± 13 years old; 13F, 12M) with chronic low back pain (cLBP) and 27 healthy control subjects (48.9 ± 13 years old; 14F, 13M) received an integrated (i.e., simultaneous) positron emission tomography (PET)/magnetic resonance imaging (MRI) brain scan with the second-generation TSPO ligand [11C]PBR28.

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Remote Electrical Neuromodulation (REN) Relieves Acute Migraine: A Randomized, Double‐Blind, Placebo‐Controlled, Multicenter Trial

There is a significant unmet need for novel effective well‐tolerated acute migraine treatments. REN is a novel acute migraine treatment that stimulates upper arm peripheral nerves to induce conditioned pain modulation – ...
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The Effectiveness of Hypnosis for Pain Relief: A Systematic Review and Meta-Analysis of 85 Controlled Experimental Trials

The current meta-analysis aimed to quantify the effectiveness of hypnosis for reducing pain and identify factors that influence efficacy. Six major databases were systematically searched for trials comparing hypnotic inductions with no-intervention control conditions on pain ratings, threshold and tolerance using experimentally-evoked pain models in healthy participants. Random effects meta-analysis found analgesic effects of hypnosis for all pain outcomes.

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App-Based Multidisciplinary Back Pain Treatment Versus Combined Physiotherapy Plus Online Education: a Randomized Controlled Trial

Non-specific low back pain (LBP) is one of the leading causes of global disability. Multidisciplinary pain treatment (MPT) programs comprising educational, physical, and psychological interventions have shown positive treatment effects on LBP. Nonetheless, such programs are costly and treatment opportunities are often limited to specialized medical centers. mHealth and other digital interventions may be a promising method to successfully support patient self-management in LBP. To address these issues, we investigated the clinical effects of a multidisciplinary mHealth back pain App (Kaia App) in a randomized controlled trial (registered at German Clinical Trials Register under DRKS00016329).

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Emotional Mirror Neurons in the Rat's Anterior Cingulate Cortex

How do the emotions of others affect us? The human anterior cingulate cortex (ACC) responds while experiencing pain in the self and witnessing pain in others, but the underlying cellular mechanisms remain poorly understood. Here we show the rat ACC (area 24) contains neurons responding when a rat experiences pain as triggered by a laser and while witnessing another rat receive footshocks. Most of these neurons do not respond to a fear-conditioned sound (CS).
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Anterior Nucleus of Paraventricular Thalamus Mediates Chronic Mechanical Hyperalgesia

Pain-related diseases are the top leading causes of life disability. Identifying brain regions involved in persistent neuronal changes will provide new insights for developing efficient chronic pain treatment. Here, we showed that anterior nucleus of paraventricular thalamus (PVA) plays an essential role in the development of mechanical hyperalgesia in neuropathic and inflammatory pain models in mice.  

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TENS Efficacy on Acute Back Pain in an Emergency Department Triage

Transcutaneous Electrical Nerve Stimulation (TENS) devices produce a gentle electrical stimulation that when applied through pads applied directly to the skin, has a noticeable effect in reducing pain associated with various types of injuries and ailments.

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Neoline Is the Active Ingredient of Processed Aconite Root Against Murine Peripheral Neuropathic Pain Model, and Its Pharmacokinetics in Rats

 The present study investigated the effects of PA on a murine peripheral neuropathy model induced by intraperitoneal injection of paclitaxel and partial ligation of the sciatic nerve (Seltzer model), and identified its active ingredients.
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Insular and Anterior Cingulate Cortex Deep Stimulation for Central Neuropathic Pain: Disassembling the Percept of Pain.

Objective: To compare the analgesic effects of stimulation of the anterior cingulate cortex (ACC) or the posterior superior insula (PSI) against sham deep (d) repetitive (r) transcranial magnetic stimulation (TMS) in patients with central neuropathic pain (CNP) after stroke or spinal cord injury in a randomized, double-blinded, sham-controlled, 3-arm parallel study. 

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TRPV1 promotes opioid analgesia during inflammation

 Abstract: Pain and inflammation are inherently linked responses to injury, infection, or chronic diseases. Given that acute inflammation in humans or mice enhances the analgesic properties of opioids, there is much interest in determining the inflammatory transducers that prime opioid receptor signaling in primary afferent nociceptors.

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Enhanced Recovery After Spine Surgery: A Systematic Review.

Enhanced recovery after surgery (ERAS) is a multidimensional approach to improving the care of surgical patients using subspecialty- and procedure-specific evidence-based protocols. The literature provides evidence of the benefits of ERAS implementation, which include expedited functional recovery, decreased postoperative morbidity, reduced costs, and improved subjective patient experience.

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A Clinical Overview of Off-label Use of Gabapentinoid Drugs

The gabapentinoid drugs gabapentin and pregabalin were originally developed as antiseizure drugs but now are prescribed mainly for treatment of pain. For gabapentin, the only pain-related indication approved by the US Food and Drug Administration (FDA) is postherpetic neuralgia. For pregabalin, FDA-approved indications related to pain are limited to postherpetic neuralgia, neuropathic pain associated with diabetic neuropathy or spinal cord injury, and fibromyalgia.

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Assessment of the FDA Risk Evaluation and Mitigation Strategy for Transmucosal Immediate-Release Fentanyl Products

 Did the US Food and Drug Administration's (FDA's) Transmucosal Immediate-Release Fentanyl (TIRF) Risk Evaluation and Mitigation Strategy (REMS) meet its goal of preventing inappropriate use of TIRF products, such a...
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Transcription Factor Sp4 Is Required for Hyperalgesic State Persistence

Understanding how painful hypersensitive states develop and persist beyond the initial hours to days is critically important in the effort to devise strategies to prevent and/or reverse chronic painful states. Read the a...
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Glial Ensheathment of the Somatodendritic Compartment Regulates Sensory Neuron Structure and Activity

Sensory neurons perceive environmental cues and are important of organismal survival. Peripheral sensory neurons interact intimately with glial cells. While the function of axonal ensheathment by glia is well studied, le...
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Effects of Microencapsulated Olfactory Ensheathing Cell Transplantation on Neuropathic Pain and P2X7 Receptor Expression in the L4-5 Spinal Cord Segment

The aim of this study was to determine the role of microencapsulated olfactory ensheathing cell (MC-OEC) transplantation in rats with sciatic nerve injury-induced pain, and its relationship with P2 × 7 receptor expressio...
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Use of Prescription Opioids and Initiation of Fatal 2-Vehicle Crashes

The prevalence of prescription opioids detected in fatally injured drivers has increased markedly in the past 2 decades in the United States. It is unclear whether driver use of prescription opioids plays a role in fatal...
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A New Painkiller Nanomedicine to Bypass the Blood-Brain Barrier and the Use of Morphine

The clinical use of endogenous neuropeptides has historically been limited due to pharmacokinetic issues, including plasma stability and blood-brain barrier permeability. In this study, we show that the rapidly metaboliz...
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Predicting Inadequate Postoperative Pain Management in Depressed Patients: A Machine Learning Approach

Widely-prescribed prodrug opioids (e.g., hydrocodone) require conversion by liver enzyme CYP-2D6 to exert their analgesic effects. The most commonly prescribed antidepressant, selective serotonin reuptake inhibitors (SSR...
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Prevention of Prescription Opioid Misuse and Projected Overdose Deaths in the United States

What is the projected effect of lowering incident nonmedical prescription opioid use on the future trajectory of the opioid overdose crisis in the United States?

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The Pain of Sleep Loss: A Brain Characterization in Humans

Sleep loss increases the experience of pain. However, the brain mechanisms underlying altered pain processing following sleep deprivation are unknown. Moreover, it remains unclear whether ecologically modest night-to-nig...
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Gender Bias in Pediatric Pain Assessment

Accurate assessment of pain is central to diagnosis and treatment in healthcare, especially in pediatrics. However, few studies have examined potential biases in adult observer ratings of children's pain. Read the abstra...
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Pain Abstracts

Association of Prescribed Opioids with Increased Risk of Community-Acquired Pneumonia Among Patients With and Without HIV What is the association between prescribed opioids and community-acquired pneumonia requiring hosp...
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