吗啡皮下自控镇痛泵治疗难治性癌痛的前瞻性多中心随机对照研究

摘要 目的：观察吗啡皮下自控镇痛泵治疗难治性癌痛的临床疗效。方法：采用前瞻性多中心随机对照研究,应用治疗方法分为试验组和对照组,其中试验组使用皮下自控阵痛泵给药,对照组口服吗啡片剂,5 d为一疗程,共计观察3疗程。观察两组患者治疗后疼痛积分改善情况;每疗程吗啡日均用量;疼痛起效时间、最佳缓解时间;镇痛维持时间及剂量稳定天数、爆发痛情况;生活质量改善及不良反应发生率;疗程费用情况。结果：两组患者数字疼痛评分法(numerical rating scale,NRS)评分在治疗后均较镇痛前显著降低（P＜0.05）;在吗啡用量比较方面,试验组吗啡用量显著低于对照组同期用量;试验组在疼痛缓解时间、疼痛最佳缓解时间方面均显著优于对照组;治疗期间试验组平均镇痛维持时间明显长于对照组（P＜0.05）;两组患者治疗后体力状况分析标准(performance status,PS)评分较治疗前显著改善;试验组便秘、嗜睡不良反应发生率显著低于对照组（P＜0.05）。试验组每疗程费用明显低于对照组,具有明显经济优势。结论：吗啡皮下自控镇痛泵给药方式控制难治性癌痛临床疗效确切,止痛效果明显。与对照组比较,疼痛起效时间短,疗程较吗啡用量少,不良反应发生率低,改善了患者生活质量,且减轻了患者经济压力。     

Whole-body vibration mediates mechanical hypersensitivity through Aβ-fiber and C-fiber thermal sensation in a chronic pain model

Whole-body vibration (WBV), which is widely used as a type of exercise, involves the use of vibratory stimuli and it is used for rehabilitation and sports performance programmes. This study aimed to investigate the effect of WBV treatment in a chronic pain model after 10 WBV sessions. An animal model (chronic pain) was applied in 60 male Wistar rats (±180 g, 12 weeks old) and the animals were treated with low intensity exercise (treadmill), WBV (vibrating platform), and a combined treatment involving both. The controls on the platform were set to a frequency of 42 Hz with 2 mm peak-to-peak displacement, g ≈ 7, in a spiral mode. Before and after the vibration exposure, sensitivity was determined. Aβ-fibers-mediated mechanical sensitivity thresholds (touch-pressure) were measured using a pressure meter. C-fibers-mediated thermal perception thresholds (hot pain) were measured with a hot plate. After each session, WBV influenced the discharge of skin touch-pressure receptors, reducing mechanical sensitivity in the WBV groups (P < 0.05). Comparing the conditions “before vs. after”, thermal perception thresholds (hot pain) started to decrease significantly after the third WBV session (P < 0.05). WBV decreases mechanical hyperalgesia after all sessions and thermal sensitivity after the third session with the use of WBV.     

Purinergic signalling in spinal pain processing

Purinergic Signalling - Purinergic signalling plays important roles in somatosensory and nociceptive transmission in the dorsal horn of the spinal cord under physiological and pathophysiological...     

Contribution of P2X4 receptor in pain associated with rheumatoid arthritis: a review

Purinergic Signalling - Pain is the most common symptom reported by patients with rheumatoid arthritis (RA) even after the resolution of chronic joint inflammation. It is believed that...     

Performance of a simplified HEART score and HEART-GP score for evaluating chest pain in urgent primary care

BackgroundChest pain is a common symptom in urgent primary care. The distinction between urgent and non-urgent causes can be challenging. A modified version of the HEART score, in which troponin is omitted (‘simplified HEART’) or replaced by the so-called ‘sense of alarm’ (HEART-GP), may aid in risk stratification.MethodThis study involved a retrospective, observational cohort of consecutive patients evaluated for chest pain at a large-scale, out-of-hours, regional primary care facility in the Netherlands, with 6‑week follow-up for major adverse cardiac events (MACEs). The outcome of interest is diagnostic accuracy, including positive predictive value (PPV) and negative predictive value (NPV).ResultsWe included 664 patients; MACEs occurred in 4.8% (n = 32). For  simplified HEART and HEART-GP, we found C‑statistics of 0.86 (95% confidence interval (CI) 0.80–0.91) and 0.90 (95% CI 0.85–0.95), respectively. Optimal diagnostic accuracy was found for a simplified HEART score ≥2 (PPV 9%, NPV 99.7%), HEART-GP score ≥3 (PPV 11%, NPV 99.7%) and HEART-GP score ≥4 (PPV 16%, NPV 99.4%). Physicians referred 157 patients (23.6%) and missed 6 MACEs. A simplified HEART score ≥2 would have picked up 5 cases, at the expense of 332 referrals (50.0%, p < 0.001). A HEART-GP score of ≥3 and ≥4 would have detected 5 and 3 MACEs and led to 293 (44.1%, p < 0.001) and 186 (28.0%, p = 0.18) referrals, respectively.ConclusionHEART-score modifications including the physicians’ ‘sense of alarm’ may be used as a risk stratification tool for chest pain in primary care in the absence of routine access to troponin assays. Further validation is warranted.Supplementary InformationThe online version of this article (10.1007/s12471-020-01529-4) contains supplementary material, which is available to authorized users.     

Cluster analysis of pressure pain threshold maps from the trapezius muscle

The aim of this study was to investigate and present a new mapping method to describe muscle pain sensitivity based on the assessment of pressure pain threshold (PPT) over the trapezius muscle. PPT data were recorded from 36 points in 20 healthy males using a standardised grid. Points were clustered using the K-means algorithm with a fixed initialisation procedure. The total number of clusters was determined on the basis of (1) R ² evaluation of the clustering outcome compared against a desired 95% reduction in variance criterion and (2) the number of empty clusters. A minimum of three clusters were found which fulfilled the criteria. The proposed method enables the identification of a relation between the muscle subdivisions and pressure pain sensitivity within the trapezius. Further, the cluster analysis will enable the study of differences in pain sensitivity distributions between patients and controls and quantify the effect of intervention (physical or pharmacological treatments).