Assessment of conditioned pain modulation in healthy participants and patients with chronic pain: manifestations and implications for pain progression

Purpose of review The purpose of this review is to summarize recent findings on conditioned pain modulation (CPM) in humans with a focus on methodology, factors modulating CPM, and the potential for CPM as a clinical marker for pain progression. Recent findings CPM can be evoked by combining different stimulus modalities with good reliability; sequential CPM effects are stable over time with limited carryover effects. Optimism and pain catastrophizing might influence pain inhibition. Further, studies suggest that the CPM effect can be improved by gabapentinoids, transcranial direct current stimulation to cortical structures, and exercise and that long-term opioid use might impair CPM in patients with chronic pain. Clinical evidence suggests that preoperative impaired CPM may predict more severe chronic postoperative pain. The effect of pain duration on CPM impairment has been challenged by recent studies. Summary As CPM methodology is optimized, studies are revealing factors that can modulate descending pain inhibitory pathways. Understanding underlying mechanisms of CPM will improve the utility of CPM in a clinical setting and potentially lead to personalized treatments for chronic pain patients.
Source: Current Opinion in Supportive and Palliative Care - Category: Palliative Care Tags: PAIN: NON-MALIGNANT DISEASES: Edited by Anthony H. Dickenson and Kirsty Bannister Source Type: research

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Conclusion: There is substantial inadequacy in pain management in patients with cancer. The BPI-SF should be routinely used to evaluate pain severity, and analgesics should be prescribed equitably without discrimination with regard to gender and socioeconomic status of patients.
Source: Indian Journal of Palliative Care - Category: Palliative Care Authors: Source Type: research
Conclusion: This RCT shows that perioperative pregabalin may not have a role in the prevention of chronic pain after breast surgeries.
Source: Indian Journal of Palliative Care - Category: Palliative Care Authors: Source Type: research
Conclusions: Indian medical practitioners felt the need for formal pain management training. There is a lack of consensus on how to manage the pain using opioid analgesics. Tough regulations on medical and scientific use of opioids are the most commonly reported barrier to prescribing them.
Source: Indian Journal of Palliative Care - Category: Palliative Care Authors: Source Type: research
Abhijit S Nair, Srinivasa Shyam Prasad Mantha, Kodisharapu Praveen Kumar, Basanth Kumar RayaniIndian Journal of Palliative Care 2019 25(4):595-596
Source: Indian Journal of Palliative Care - Category: Palliative Care Authors: Source Type: research
by Drew Rosielle (@drosielle)A Series of Observations on Opioids By a Palliative Doc Who Prescribes A Lot of Opioids But Also Has Questions.This is the 5th post in a series about opioids, with a focus on how my thinking about opioids has changed over the years. See also:Part 1 – Introduction, General Disclaimers, Hand-Wringing, and a Hand-Crafted Graph.Part 2 – We Were Wrong 20 years Ago, Our Current Response to the Opioid Crisis is Wrong, But We Should Still Be Helping Most of our Long-Term Patients Reduce Their Opioid DosesPart 3 – Opioids Have Ceiling Effects, High-Doses are Rarely Therapeutic, and Ano...
Source: Pallimed: A Hospice and Palliative Medicine Blog - Category: Palliative Care Tags: cancer opioids pain rosielle The profession Source Type: blogs
by Drew Rosielle (@drosielle)A Series of Observations on Opioids By a Palliative Doc Who Prescribes A Lot of Opioids But Also Has Questions.This is the 5th post in a series about opioids, with a focus on how my thinking about opioids has changed over the years. See also:Part 1 – Introduction, General Disclaimers, Hand-Wringing, and a Hand-Crafted Graph.Part 2 – We Were Wrong 20 years Ago, Our Current Response to the Opioid Crisis is Wrong, But We Should Still Be Helping Most of our Long-Term Patients Reduce Their Opioid DosesPart 3 – Opioids Have Ceiling Effects, High-Doses are Rarely Therapeutic, and Ano...
Source: Pallimed: A Hospice and Palliative Medicine Blog - Category: Palliative Care Tags: opioid pain rosielle The profession Source Type: blogs
by Drew Rosielle (@drosielle)This is the second in a series of several posts about many aspects of my current thinking about opioids.The first post is here:Part 1 – Introduction, General Disclaimers, Hand-Wringing, and a Hand-Crafted Graph.Over-prescribing fueled the current drug overdose epidemic, and many of us who thought we were stamping out needless suffering contributed to the epidemic.A lot of what I read and believed about opioids early on in my career was wrong.I ’m old enough to remember those heady days in which there was a pretty large and ‘successful’ movement in American medicine to gr...
Source: Pallimed: A Hospice and Palliative Medicine Blog - Category: Palliative Care Tags: opioids pain rosielle The profession Source Type: blogs
This study aimed to determine the extent of caregiver burden as a possible mediator on the effectiveness of a home-based palliative care program. METHOD: Sixty-six palliative patients (56% women; mean age + SD = 71, 6 ± 17.7) and their caregivers were assessed with measures for physical, emotional, and psychological symptoms before and 1 month after the start of a home-based palliative care program. RESULTS: The association between caregiver burden and palliative outcomes was corroborated with a categorical regression model (p
Source: Palliative and Supportive Care - Category: Palliative Care Authors: Tags: Palliat Support Care Source Type: research
CONCLUSIONS: It was not possible to identify predictors of in-hospital death after ventilatory support withdrawal. Palliative extubation requires specialized care, with the presence and availability of a multidisciplinary team with adequate training in symptom control and palliative care. PMID: 31493370 [PubMed - as supplied by publisher]
Source: Jornal de Pediatria - Category: Pediatrics Authors: Tags: J Pediatr (Rio J) Source Type: research
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Source: Pain Physician - Category: Anesthesiology Authors: Tags: Schmerz Source Type: research
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