Objectives:To describe and compare fear of childbirth and in-labor pain intensity between primiparas and multiparas and explore the association between the amount of actual pain relief and fear of childbirth.Methods:A...Objectives:To describe and compare fear of childbirth and in-labor pain intensity between primiparas and multiparas and explore the association between the amount of actual pain relief and fear of childbirth.Methods:A convenience sampling method was used.A total of 260 women undergoing spontaneous or induced labor,including 97 primiparas and 163 multiparas,were recruited in a large academic specialized hospital in Guangzhou,China,from February 2018 to August 2019.The clinical data of maternal and neonatal were extracted from a structured electronic medical record system.Other demographic information,such as employment and family monthly income,was collected by a questionnaire.The Numeric Rating Scale(NRS)and the Chinese version of the Childbirth Attitude Questionnaire(C-CAQ)were applied to assess maternal in-labor pain intensity and fear of childbirth.The analgesic consumption and the frequency of manual boluses as rescue analgesia were stored and collected from the analgesia pump.Results:Eighty-two(84.5%)primiparas and ninety-nine(60.7%)multiparas received epidural analgesia(P<0.001).In the epidural subgroup,the primiparous average fear of childbirth(36.46±10.93)was higher than that of the multiparas(32.06±10.23)(P¼0.007).However,multiparas reported more intense in-labor pain[8.0(8.0,9.0)vs.8.0(7.0,8.0)],had more successful manual boluses per hour[2.68(1.65,3.85)vs.1.77(0.90,2.47)],more hourly analgesic consumption[23.00(16.00,28.25)vs.17.24(11.52,21.36)mL]and more average analgesic consumption[0.35(0.24,0.45)vs.0.26(0.19,0.35)mL/(h$kg)]than the primiparas(P<0.05).Spearman’s correlation analysis showed that the maximum in-labor pain was weakly positively correlated with fear of childbirth(r¼0.09)(P<0.05),hourly analgesic consumption(r¼0.16)(P<0.01)and average analgesic consumption(r¼0.17)(P<0.05).No statistically significant association was uncovered between analgesic consumption and maternal fear of childbirth.Conclusions:Fear of childbirth is a potential predictor of labor pain intensity.Further study is needed to explore its role and value in pain management during delivery.Parity is not a determinant of pain relief use and should not be a preconceived preference of obstetric care team members to determine the distribution of epidural analgesia,especially when analgesia resources are insufficient.展开更多
Objectives To evaluate the effects of white noise on pain-related cortical response,pain score,and behavioral and physiological parameters in neonates with procedural pain.Methods A double-blind,randomized controlled ...Objectives To evaluate the effects of white noise on pain-related cortical response,pain score,and behavioral and physiological parameters in neonates with procedural pain.Methods A double-blind,randomized controlled trial was conducted.Sixty-six neonates from the Neonatal Intensive Care Unit in a university-affiliated general hospital were randomly assigned to listen to white noise at 50 dB(experimental group)or 0 dB(control group)2 min before radial artery blood sampling and continued until 5 min after needle withdrawal.Pain-related cortical response was measured by regional cerebral oxygen saturation(rScO_(2))monitored with near-infrared spectroscopy,and facial expressions and physiological parameters were recorded by two video cameras.Two assessors scored the Premature Infant Pain Profile-Revised(PIPP-R)independently when viewing the videos.Primary outcomes were pain score and rScO_(2)during arterial puncture and 5 min after needle withdrawal.Secondary outcomes were pulse oximetric oxygen saturation(SpO_(2))and heart rate(HR)during arterial puncture,and duration of painful expressions.The study was registered at the Chinese Clinical Trial Registry(ChiCTR2200055571).Results Sixty neonates(experimental group,n=29;control group,n=31)were included in the final analysis.The maximum PIPP-R score in the experimental and control groups was 12.00(9.50,13.00),12.50(10.50,13.75),respectively(median difference−0.5,95%CI−2.0 to 0.5),and minimum rScO_(2)was(61.22±3.07)%,(61.32±2.79)%,respectively(mean difference−0.325,95%CI−1.382 to 0.732),without significant differences.During arterial puncture,the mean rScO_(2),HR,and SpO_(2)did not differ between groups.After needle withdrawal,the trends for rScO_(2),PIPP-R score,and facial expression returning to baseline were different between the two groups without statistical significance.Conclusion The white noise intervention did not show beneficial effects on pain-related cortical response as well as pain score,behavioral and physiological parameters in neonates with procedural pain.展开更多
32 cases of the third lumbar transverse process syndrome were treated mainly byelectroacupuncture at Huatuojiaji points of the first and second lumbar vertebrae, andanother 30 cases of the syndrome by conventional acu...32 cases of the third lumbar transverse process syndrome were treated mainly byelectroacupuncture at Huatuojiaji points of the first and second lumbar vertebrae, andanother 30 cases of the syndrome by conventional acupuncture as the controls. The resultsshowed that treatment by electroacupuncture at Huatuojiaji points was superior inanalgesic effect and clinical total effective rate to that by conventional acupuncture. It isconsidered that the mechanism of treatment by electroacupuncture at Huatuojiaji pointsis related to the trunk of posterior ramus of the spinal nerve where the points are located.展开更多
Aims:Animal-assisted therapy(AAT)relieves pain by creating a relaxed and comfortable environment to reduce anxiety in children.Yet little is known about its effects on pain in children.This study aims to systematicall...Aims:Animal-assisted therapy(AAT)relieves pain by creating a relaxed and comfortable environment to reduce anxiety in children.Yet little is known about its effects on pain in children.This study aims to systematically evaluate the effects of AAT on pain in children.Methods:Eight databases including PubMed,Cochrane Library,Web of Science,CINAHL Complete,Chinese Biomedical Database(CBM),Weipu Database(VIP),China Knowledge Resource Integrated Database(CNKI)and Wanfang Database were retrieved,and all randomized controlled trials or controlled clinical trial using AAT on children’s pain were recruited from inception to October 2019.Two reviewers independently screened literature,extracted data and assessed the risk of bias of the included studies.RevMan 5.3 software was employed for meta-analysis.Results:Seven published studies containing 4 RCTs and 3 CCTs were included for the systematic review.The results of meta-analysis showed that AAT could reduce children’s pain when compared with the control group[MD=-0.53,95%CI(-0.77,-0.30),P<0.00001].Conclusion:Current evidence shows that AAT can relieve pain in children to some extent.Considering the limited quality and quantity of the available studies,more high quality studies should be performed to verify the above conclusion.展开更多
To determine whether pain has psycho-social associations in adult Crohn’s disease (CD) patients.METHODSPatients completed demographics, disease status, Patient Harvey-Bradshaw Index (P-HBI), Short Form Health Survey ...To determine whether pain has psycho-social associations in adult Crohn’s disease (CD) patients.METHODSPatients completed demographics, disease status, Patient Harvey-Bradshaw Index (P-HBI), Short Form Health Survey (SF-36), Short Inflammatory Bowel Disease Questionnaire (SIBDQ), and five socio-psychological questionnaires: Brief Symptom Inventory, Brief COPE Inventory, Family Assessment Device, Satisfaction with Life Scale, and Work Productivity and Activity Impairment Questionnaire. Pain sub-scales in P-HBI, SF-36 and SIBDQ measures were recoded into 4 identical scores for univariate and multinomial logistic regression analysis of associations with psycho-social variables.RESULTSThe cohort comprised 594 patients, mean age 38.6 ± 14.8 years, women 52.5%, P-HBI 5.76 ± 5.15. P-HBI, SF-36 and SIBDQ broadly agreed in their assessment of pain intensity. More severe pain was significantly associated with female gender, low socio-economic status, unemployment, Israeli birth and smoking. Higher pain scores correlated positively with psychological stress, dysfunctional coping strategies, poor family relationships, absenteeism, presenteeism, productivity loss and activity impairment and all WPAI sub-scores. Patients exhibiting greater satisfaction with life had less pain. The regression showed increasing odds ratios for psychological stress (lowest 2.26, highest 12.17) and female gender (highest 3.19) with increasing pain. Internet-recruited patients were sicker and differed from hardcopy questionnaire patients in their associations with pain.CONCLUSIONPain measures in P-HBI, SF-36 and SIBDQ correlate with psycho-social pathology in CD. Physicians should be aware also of these relationships in approaching CD patients with pain.展开更多
Chronic neuropathic pain is a refractory symptom in clinical practice due to nervous injury or inflammation, and affects millions of people all over the world. Although the neuronal functioning of pain pathways has be...Chronic neuropathic pain is a refractory symptom in clinical practice due to nervous injury or inflammation, and affects millions of people all over the world. Although the neuronal functioning of pain pathways has been studied for many years, the induction and maintenance of this non-adaptive, pathological pain is still poorly understood. Recent evidence indicates that protease-activated receptors (PARs) participate in the initiation and maintenance of neuropathic pain and play a key role in mediating the interactions of nerve cells. Firstly, following nerve injury, alterations in neuron and neuron function induce an abnormal increase of some neurotransmitters and neuromodulators, such as substance P (SP), calcitonin gene-related peptide (CGRP), prostaglandins, kinins, and so on. Such abnormal factors can act on neuron reversely and then induce pain sensation directly, or activate glial cells (astrocytes and microglia) mediated by PARs, which trigger and accelerate the progress of neuropathic pain. Secondly, when the noxious factors invade, glial cells are activated as the first barrier of nervous system and secret many neuroinflammatory factors. These inflammatory factors have effects on PARs (especially PAR1 and PAR2) in the neurons around, and then aggravate the status of pain. Thirdly, in the progress of neuroinflammatory pain, microglia is activated first and initiates the status of pain, and then inflammatory factors and complements from microglia activate astrocytes and maintain or make the pain worse. All of these actions is protective to neurons first, but then turns to a kind of nociception and forms the feeling of pain under the continuous noxious stimuli. Conclusively, PARs may play an important role in the formation and maintenance of chronic pain through mediating the interactions among nerve cells, which may be a novel target in the study and control of neuropathic pain. This article focuses on recent developments of PARs in the progress of neuropathic pain, and provides a framework for addressing the major questions for the future.展开更多
Neuropathic pain is chronic pain generated by disorders of the peripheral and central nervous system, including skull base tumours. A skull base tumour can be any type of tumour that forms in the skull base, and this ...Neuropathic pain is chronic pain generated by disorders of the peripheral and central nervous system, including skull base tumours. A skull base tumour can be any type of tumour that forms in the skull base, and this includes vestibular schwannomas which arise from the sheath of the inner ear vestibulocochlear nerve(eighth cranial nerve). Growth of the tumour, surgical resection, and/or stereotactic radiotherapy may result incompression and/or irritation of the fifth cranial nerve(trigeminal nerve) resulting in facial pain and/or numbness. Non-trigeminal afferent input may contribute to the wide constellation of symptoms seen in orofacial pain patients. The purpose of this report was to develop a decision tool to guide the recognition and treatment of neuropathic pain in this specialized population. Recommendations for treatment are based on evidence presented in Canadian and international neuropathic treatment guidelines. Algorithms are included for assessment and treatment of adult patients with agents that are recognized to have analgesic efficacy within the broad context of neuropathic pain.展开更多
Objective： To analyze and gain the interlinking degree of the cancer pain with patients＇ cancer-species, sexuality and age etc. Methods： The information of narcotic drugs used for cancer pain patients in our hospit...Objective： To analyze and gain the interlinking degree of the cancer pain with patients＇ cancer-species, sexuality and age etc. Methods： The information of narcotic drugs used for cancer pain patients in our hospital （Gansu Province Turnout Hospital, China） during 2002-2007 were typed in designed EXCEL form, then counted and analyzed. Results： The total number of cancer pain patients used narcotic drugs during 2002-2007 was 6891 （n = 6891 ）, among them, 4164 （60.44%） were males, and 2727 （39.56%） females. The top-range of cancer-species in those patients was as follows： lung cancer （20.39%）, gastric cancer （14.85%）, esophageal cancer （9.71%）, hysterocarcinoma （6.79%）, liver cancer （6.70%） and breast cancer （6.31%）. Conclusion： （a） The male number of cancer pain patients using narcotic drugs is higher than the female number （1.53：1）. （b） In the cases of lung cancer, gastric cancer, esophageal cancer, liver cancer and kidney cancer, the male numbers are twice more than the female numbers, and the difference between the two groups are significant. （c） Most of the cancer pain patients （over 87%） are over 40 years old.展开更多
Background： Trigeminal neuralgia （TN） is a neuropathic pain syndrome. It is the most frequent cranial neuralgia and defined as sudden, usually unilateral and lightning-like, knife-like or burning-like recurrent epi...Background： Trigeminal neuralgia （TN） is a neuropathic pain syndrome. It is the most frequent cranial neuralgia and defined as sudden, usually unilateral and lightning-like, knife-like or burning-like recurrent episodes of pain within the distribution area of one or more divisions of the trigeminal nerve. Here we reported that an 81-year-old woman with TN who complained of severe pain on her right face showed a complete clinical relief after comprehensive therapy containing fire needle, filiform needle and blood-letting therapy. Methods： The patient was applied fire needle combined with filiform needle therapy （3 times / week for 4 months） and three consecutive fire needle combined with blood-letting therapy （3 times / week for one week）. Fire needle was inserted into the back points of Du meridian, the first lateral line of bladder meridian, the right spreading area of the trigeminal nerve and the points around the pain radiation site. The filiform needle acupuncture was applied to the points on the right face including Yuyao （EX-HN4）, Yangbai （GB14）, Toulinqi （GB15）, et al; points on the abdomen including Xiawan （RN10）, Qihai （RN16）, Guanyuan （RN14） and the bilateral points including Tianshu （ST25）, Daheng （SP15）, Zusanli （ST36）, et al. Finally, the three-edged fire needle punctured the points of Yangbai （GB41）, Shangguan （GB3）, Jiache （ST6） on the right face accompanied by the cupping method on the bleeding points. Results： The patient reported the complete disappearance of pain and could open mouth and eat normally. The face was normal and no triggering pain recurred after one-month follow-up. Conclusions： The fire needle combined with blood-letting therapy can cure the TN and might provide an alternative non-drug therapy for those patients who still suffered from TN after other medical treatments or whom that refused surgical treatment.展开更多
Pain perception and its genesis in the human brain have been reviewed recently. In the current article, the reports on pain modulation in the human brain were reviewed from higher cortical regulation, i.e. top-down ef...Pain perception and its genesis in the human brain have been reviewed recently. In the current article, the reports on pain modulation in the human brain were reviewed from higher cortical regulation, i.e. top-down effect, particularly studied in psychological determinants. Pain modulation can be examined by gene therapy, physical modulation, pharmacological modulation, psychological modulation, and pathophysiological modulation. In psychological modulation, this article exam- ined （a） willed determination, （b） distraction, （c） placebo, （d） hypnosis, （e） meditation, （f） qi-gong, （g） belief, and （h） emotions, respectively, in the brain function for pain modulation. In each, the operational definition, cortical processing, neuroimaging, and pain modulation were systematically deliberated. However, not all studies had featured the brain modulation processing but rather demonstrated potential effects on human pain. In our own studies on the emotional modulation on human pain, we observed that emotions could be induced from music melodies or pictures perception for reduction of tonic human pain, mainly in potentiation of the posterior alpha EEG fields, likely resulted from underneath activities of precuneous in regulation of consciousness, including pain perception. To sum, higher brain functions become the leading edge research in all sciences. How to solve the information bit of thinking and feeling in the brain can be the greatest challenge of human intelligence. Application of higher cortical modulation of human pain and suffering can lead to the progress of social humanity and civilization.展开更多
Objective:To evaluate the efficacy and safety of acupuncture for the treatment of knee osteoarthritis and to provide evidence for its use in clinical practice.Methods:Eight databases were extensively searched up to Ma...Objective:To evaluate the efficacy and safety of acupuncture for the treatment of knee osteoarthritis and to provide evidence for its use in clinical practice.Methods:Eight databases were extensively searched up to March 2018.Randomized controlled trials(RCTs)comparing the efficacy of acupuncture with sham acupuncture or no acupuncture for knee osteoarthritis were included.Study selection,data extraction and quality assessment were independently conducted by two reviewers.The Cochrane Collaboration's tool was used for assessing the risk of bias.Results:A total of 18 RCTs were included,involving a total of 3522 participants.The results showed that acupuncture was superior to sham acupuncture in relieving pain(SMD=-0.34,95%CI:-0.57 to-0.11,I^2=85%,P=0.003)and improving physical function(SMD=-0.34,95%CI:-0.57 to-0.11,I^2=85%,P=0.003).In comparison to the no-acupuncture group,the acupuncture group also showed significant advantages in relieving pain(SMD=-0.79,95%CI:-1.15 to-0.43,I^2=87%,P<0.0001)and improving physical function(SMD=-0.75,95%CI:-1.19 to-0.31,I^2=91%,P=0.0008).Sensitivity analyses suggested that the results were robust,and Egger's test found no potential publication bias.Conclusion:In the treatment of knee osteoarthritis,the acupuncture group had significant advantages over sham acupuncture or no-acupuncture groups in relieving pain and improving physical function.展开更多
文摘Objectives:To describe and compare fear of childbirth and in-labor pain intensity between primiparas and multiparas and explore the association between the amount of actual pain relief and fear of childbirth.Methods:A convenience sampling method was used.A total of 260 women undergoing spontaneous or induced labor,including 97 primiparas and 163 multiparas,were recruited in a large academic specialized hospital in Guangzhou,China,from February 2018 to August 2019.The clinical data of maternal and neonatal were extracted from a structured electronic medical record system.Other demographic information,such as employment and family monthly income,was collected by a questionnaire.The Numeric Rating Scale(NRS)and the Chinese version of the Childbirth Attitude Questionnaire(C-CAQ)were applied to assess maternal in-labor pain intensity and fear of childbirth.The analgesic consumption and the frequency of manual boluses as rescue analgesia were stored and collected from the analgesia pump.Results:Eighty-two(84.5%)primiparas and ninety-nine(60.7%)multiparas received epidural analgesia(P<0.001).In the epidural subgroup,the primiparous average fear of childbirth(36.46±10.93)was higher than that of the multiparas(32.06±10.23)(P¼0.007).However,multiparas reported more intense in-labor pain[8.0(8.0,9.0)vs.8.0(7.0,8.0)],had more successful manual boluses per hour[2.68(1.65,3.85)vs.1.77(0.90,2.47)],more hourly analgesic consumption[23.00(16.00,28.25)vs.17.24(11.52,21.36)mL]and more average analgesic consumption[0.35(0.24,0.45)vs.0.26(0.19,0.35)mL/(h$kg)]than the primiparas(P<0.05).Spearman’s correlation analysis showed that the maximum in-labor pain was weakly positively correlated with fear of childbirth(r¼0.09)(P<0.05),hourly analgesic consumption(r¼0.16)(P<0.01)and average analgesic consumption(r¼0.17)(P<0.05).No statistically significant association was uncovered between analgesic consumption and maternal fear of childbirth.Conclusions:Fear of childbirth is a potential predictor of labor pain intensity.Further study is needed to explore its role and value in pain management during delivery.Parity is not a determinant of pain relief use and should not be a preconceived preference of obstetric care team members to determine the distribution of epidural analgesia,especially when analgesia resources are insufficient.
基金This work was supported by grants from Guangdong Nurse Association[gdshsxh2021a058]Department of Science and Technology of Guangdong Province[2014A020212396].
文摘Objectives To evaluate the effects of white noise on pain-related cortical response,pain score,and behavioral and physiological parameters in neonates with procedural pain.Methods A double-blind,randomized controlled trial was conducted.Sixty-six neonates from the Neonatal Intensive Care Unit in a university-affiliated general hospital were randomly assigned to listen to white noise at 50 dB(experimental group)or 0 dB(control group)2 min before radial artery blood sampling and continued until 5 min after needle withdrawal.Pain-related cortical response was measured by regional cerebral oxygen saturation(rScO_(2))monitored with near-infrared spectroscopy,and facial expressions and physiological parameters were recorded by two video cameras.Two assessors scored the Premature Infant Pain Profile-Revised(PIPP-R)independently when viewing the videos.Primary outcomes were pain score and rScO_(2)during arterial puncture and 5 min after needle withdrawal.Secondary outcomes were pulse oximetric oxygen saturation(SpO_(2))and heart rate(HR)during arterial puncture,and duration of painful expressions.The study was registered at the Chinese Clinical Trial Registry(ChiCTR2200055571).Results Sixty neonates(experimental group,n=29;control group,n=31)were included in the final analysis.The maximum PIPP-R score in the experimental and control groups was 12.00(9.50,13.00),12.50(10.50,13.75),respectively(median difference−0.5,95%CI−2.0 to 0.5),and minimum rScO_(2)was(61.22±3.07)%,(61.32±2.79)%,respectively(mean difference−0.325,95%CI−1.382 to 0.732),without significant differences.During arterial puncture,the mean rScO_(2),HR,and SpO_(2)did not differ between groups.After needle withdrawal,the trends for rScO_(2),PIPP-R score,and facial expression returning to baseline were different between the two groups without statistical significance.Conclusion The white noise intervention did not show beneficial effects on pain-related cortical response as well as pain score,behavioral and physiological parameters in neonates with procedural pain.
文摘32 cases of the third lumbar transverse process syndrome were treated mainly byelectroacupuncture at Huatuojiaji points of the first and second lumbar vertebrae, andanother 30 cases of the syndrome by conventional acupuncture as the controls. The resultsshowed that treatment by electroacupuncture at Huatuojiaji points was superior inanalgesic effect and clinical total effective rate to that by conventional acupuncture. It isconsidered that the mechanism of treatment by electroacupuncture at Huatuojiaji pointsis related to the trunk of posterior ramus of the spinal nerve where the points are located.
基金National Nature Science Foundation of China(grant No.71704071).
文摘Aims:Animal-assisted therapy(AAT)relieves pain by creating a relaxed and comfortable environment to reduce anxiety in children.Yet little is known about its effects on pain in children.This study aims to systematically evaluate the effects of AAT on pain in children.Methods:Eight databases including PubMed,Cochrane Library,Web of Science,CINAHL Complete,Chinese Biomedical Database(CBM),Weipu Database(VIP),China Knowledge Resource Integrated Database(CNKI)and Wanfang Database were retrieved,and all randomized controlled trials or controlled clinical trial using AAT on children’s pain were recruited from inception to October 2019.Two reviewers independently screened literature,extracted data and assessed the risk of bias of the included studies.RevMan 5.3 software was employed for meta-analysis.Results:Seven published studies containing 4 RCTs and 3 CCTs were included for the systematic review.The results of meta-analysis showed that AAT could reduce children’s pain when compared with the control group[MD=-0.53,95%CI(-0.77,-0.30),P<0.00001].Conclusion:Current evidence shows that AAT can relieve pain in children to some extent.Considering the limited quality and quantity of the available studies,more high quality studies should be performed to verify the above conclusion.
基金a generous grant from The Leona M.and Harry B.Helmsley Charitable Trust
文摘To determine whether pain has psycho-social associations in adult Crohn’s disease (CD) patients.METHODSPatients completed demographics, disease status, Patient Harvey-Bradshaw Index (P-HBI), Short Form Health Survey (SF-36), Short Inflammatory Bowel Disease Questionnaire (SIBDQ), and five socio-psychological questionnaires: Brief Symptom Inventory, Brief COPE Inventory, Family Assessment Device, Satisfaction with Life Scale, and Work Productivity and Activity Impairment Questionnaire. Pain sub-scales in P-HBI, SF-36 and SIBDQ measures were recoded into 4 identical scores for univariate and multinomial logistic regression analysis of associations with psycho-social variables.RESULTSThe cohort comprised 594 patients, mean age 38.6 ± 14.8 years, women 52.5%, P-HBI 5.76 ± 5.15. P-HBI, SF-36 and SIBDQ broadly agreed in their assessment of pain intensity. More severe pain was significantly associated with female gender, low socio-economic status, unemployment, Israeli birth and smoking. Higher pain scores correlated positively with psychological stress, dysfunctional coping strategies, poor family relationships, absenteeism, presenteeism, productivity loss and activity impairment and all WPAI sub-scores. Patients exhibiting greater satisfaction with life had less pain. The regression showed increasing odds ratios for psychological stress (lowest 2.26, highest 12.17) and female gender (highest 3.19) with increasing pain. Internet-recruited patients were sicker and differed from hardcopy questionnaire patients in their associations with pain.CONCLUSIONPain measures in P-HBI, SF-36 and SIBDQ correlate with psycho-social pathology in CD. Physicians should be aware also of these relationships in approaching CD patients with pain.
基金Supported by the National Natural Science Foundation of China (30672022)
文摘Chronic neuropathic pain is a refractory symptom in clinical practice due to nervous injury or inflammation, and affects millions of people all over the world. Although the neuronal functioning of pain pathways has been studied for many years, the induction and maintenance of this non-adaptive, pathological pain is still poorly understood. Recent evidence indicates that protease-activated receptors (PARs) participate in the initiation and maintenance of neuropathic pain and play a key role in mediating the interactions of nerve cells. Firstly, following nerve injury, alterations in neuron and neuron function induce an abnormal increase of some neurotransmitters and neuromodulators, such as substance P (SP), calcitonin gene-related peptide (CGRP), prostaglandins, kinins, and so on. Such abnormal factors can act on neuron reversely and then induce pain sensation directly, or activate glial cells (astrocytes and microglia) mediated by PARs, which trigger and accelerate the progress of neuropathic pain. Secondly, when the noxious factors invade, glial cells are activated as the first barrier of nervous system and secret many neuroinflammatory factors. These inflammatory factors have effects on PARs (especially PAR1 and PAR2) in the neurons around, and then aggravate the status of pain. Thirdly, in the progress of neuroinflammatory pain, microglia is activated first and initiates the status of pain, and then inflammatory factors and complements from microglia activate astrocytes and maintain or make the pain worse. All of these actions is protective to neurons first, but then turns to a kind of nociception and forms the feeling of pain under the continuous noxious stimuli. Conclusively, PARs may play an important role in the formation and maintenance of chronic pain through mediating the interactions among nerve cells, which may be a novel target in the study and control of neuropathic pain. This article focuses on recent developments of PARs in the progress of neuropathic pain, and provides a framework for addressing the major questions for the future.
文摘Neuropathic pain is chronic pain generated by disorders of the peripheral and central nervous system, including skull base tumours. A skull base tumour can be any type of tumour that forms in the skull base, and this includes vestibular schwannomas which arise from the sheath of the inner ear vestibulocochlear nerve(eighth cranial nerve). Growth of the tumour, surgical resection, and/or stereotactic radiotherapy may result incompression and/or irritation of the fifth cranial nerve(trigeminal nerve) resulting in facial pain and/or numbness. Non-trigeminal afferent input may contribute to the wide constellation of symptoms seen in orofacial pain patients. The purpose of this report was to develop a decision tool to guide the recognition and treatment of neuropathic pain in this specialized population. Recommendations for treatment are based on evidence presented in Canadian and international neuropathic treatment guidelines. Algorithms are included for assessment and treatment of adult patients with agents that are recognized to have analgesic efficacy within the broad context of neuropathic pain.
文摘Objective： To analyze and gain the interlinking degree of the cancer pain with patients＇ cancer-species, sexuality and age etc. Methods： The information of narcotic drugs used for cancer pain patients in our hospital （Gansu Province Turnout Hospital, China） during 2002-2007 were typed in designed EXCEL form, then counted and analyzed. Results： The total number of cancer pain patients used narcotic drugs during 2002-2007 was 6891 （n = 6891 ）, among them, 4164 （60.44%） were males, and 2727 （39.56%） females. The top-range of cancer-species in those patients was as follows： lung cancer （20.39%）, gastric cancer （14.85%）, esophageal cancer （9.71%）, hysterocarcinoma （6.79%）, liver cancer （6.70%） and breast cancer （6.31%）. Conclusion： （a） The male number of cancer pain patients using narcotic drugs is higher than the female number （1.53：1）. （b） In the cases of lung cancer, gastric cancer, esophageal cancer, liver cancer and kidney cancer, the male numbers are twice more than the female numbers, and the difference between the two groups are significant. （c） Most of the cancer pain patients （over 87%） are over 40 years old.
文摘Background： Trigeminal neuralgia （TN） is a neuropathic pain syndrome. It is the most frequent cranial neuralgia and defined as sudden, usually unilateral and lightning-like, knife-like or burning-like recurrent episodes of pain within the distribution area of one or more divisions of the trigeminal nerve. Here we reported that an 81-year-old woman with TN who complained of severe pain on her right face showed a complete clinical relief after comprehensive therapy containing fire needle, filiform needle and blood-letting therapy. Methods： The patient was applied fire needle combined with filiform needle therapy （3 times / week for 4 months） and three consecutive fire needle combined with blood-letting therapy （3 times / week for one week）. Fire needle was inserted into the back points of Du meridian, the first lateral line of bladder meridian, the right spreading area of the trigeminal nerve and the points around the pain radiation site. The filiform needle acupuncture was applied to the points on the right face including Yuyao （EX-HN4）, Yangbai （GB14）, Toulinqi （GB15）, et al; points on the abdomen including Xiawan （RN10）, Qihai （RN16）, Guanyuan （RN14） and the bilateral points including Tianshu （ST25）, Daheng （SP15）, Zusanli （ST36）, et al. Finally, the three-edged fire needle punctured the points of Yangbai （GB41）, Shangguan （GB3）, Jiache （ST6） on the right face accompanied by the cupping method on the bleeding points. Results： The patient reported the complete disappearance of pain and could open mouth and eat normally. The face was normal and no triggering pain recurred after one-month follow-up. Conclusions： The fire needle combined with blood-letting therapy can cure the TN and might provide an alternative non-drug therapy for those patients who still suffered from TN after other medical treatments or whom that refused surgical treatment.
基金supported by the National Natural Science Foundation of China (No.30770691),Beijing Municipal Government for Advancement of Sciences,and Capital Medical University for Innovation Awards
文摘Pain perception and its genesis in the human brain have been reviewed recently. In the current article, the reports on pain modulation in the human brain were reviewed from higher cortical regulation, i.e. top-down effect, particularly studied in psychological determinants. Pain modulation can be examined by gene therapy, physical modulation, pharmacological modulation, psychological modulation, and pathophysiological modulation. In psychological modulation, this article exam- ined （a） willed determination, （b） distraction, （c） placebo, （d） hypnosis, （e） meditation, （f） qi-gong, （g） belief, and （h） emotions, respectively, in the brain function for pain modulation. In each, the operational definition, cortical processing, neuroimaging, and pain modulation were systematically deliberated. However, not all studies had featured the brain modulation processing but rather demonstrated potential effects on human pain. In our own studies on the emotional modulation on human pain, we observed that emotions could be induced from music melodies or pictures perception for reduction of tonic human pain, mainly in potentiation of the posterior alpha EEG fields, likely resulted from underneath activities of precuneous in regulation of consciousness, including pain perception. To sum, higher brain functions become the leading edge research in all sciences. How to solve the information bit of thinking and feeling in the brain can be the greatest challenge of human intelligence. Application of higher cortical modulation of human pain and suffering can lead to the progress of social humanity and civilization.
文摘Objective:To evaluate the efficacy and safety of acupuncture for the treatment of knee osteoarthritis and to provide evidence for its use in clinical practice.Methods:Eight databases were extensively searched up to March 2018.Randomized controlled trials(RCTs)comparing the efficacy of acupuncture with sham acupuncture or no acupuncture for knee osteoarthritis were included.Study selection,data extraction and quality assessment were independently conducted by two reviewers.The Cochrane Collaboration's tool was used for assessing the risk of bias.Results:A total of 18 RCTs were included,involving a total of 3522 participants.The results showed that acupuncture was superior to sham acupuncture in relieving pain(SMD=-0.34,95%CI:-0.57 to-0.11,I^2=85%,P=0.003)and improving physical function(SMD=-0.34,95%CI:-0.57 to-0.11,I^2=85%,P=0.003).In comparison to the no-acupuncture group,the acupuncture group also showed significant advantages in relieving pain(SMD=-0.79,95%CI:-1.15 to-0.43,I^2=87%,P<0.0001)and improving physical function(SMD=-0.75,95%CI:-1.19 to-0.31,I^2=91%,P=0.0008).Sensitivity analyses suggested that the results were robust,and Egger's test found no potential publication bias.Conclusion:In the treatment of knee osteoarthritis,the acupuncture group had significant advantages over sham acupuncture or no-acupuncture groups in relieving pain and improving physical function.
