Startseite Pharmacological modulation of chronic pain after whiplash injury
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Pharmacological modulation of chronic pain after whiplash injury

  • Michele Curatolo EMAIL logo
Veröffentlicht/Copyright: 1. Juli 2012
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Scandinavian Journal of Pain
Aus der Zeitschrift Scandinavian Journal of Pain Band 3 Heft 3

Chronic pain after whiplash injury is a largely unresolved medical and social problem. By definition, symptoms follow a trauma, which is in most cases a motorvehicle accident. The majority of patients recover, but for those who have persisting complaints an odyssey begins. Imaging techniques rarely reveal changes that explain the magnitude of symptoms [1]. As a result, patients are frequently told that they have nothing serious. Nevertheless, pain persists and is frequently associated with disability and depression. Many sufferers stop working. Some patients experience progressive spread of pain to body regions that are distant from the site of injury [2], which additionally complicates the understanding of the disease. Not uncommonly, the lack of understanding of the cause of pain leads to mistrust and questions as to whether the symptoms are real, or rather some sort of gain is behind the complaints. The resulting sense of perceived injustice is an additional factor for disability [3], further worsening the overall clinical picture.

The general perception of clinicians, lawyers, judges and insurances is that the nature of whiplash-associated disorders is unknown. However, an evaluation of the available literature reveals that many aspects of the pathophysiology of this condition have become clear. Basic research in animal models, kinematics, kinetics and biomechanics support the concept that lesions occur after a whiplash injury and these lesions can produce nociception [4]. Clinical research has provided strong evidence that the zygapophysial (facet) joints are sources of pain in whiplash patients [5,6], which is concordant with extensive data from animal and bioengineer research [7,8]. Unfortunately, these lesions are not visible by imaging techniques. A recent investigation with magnetic resonance imaging has shown that patients in the acute phase of a whiplash injury have more pathological findings than matched healthy controls, but reliability, sensitivity and specificity of the findings is poor [1]. Positron Emission Tomography has revealed signs of inflammation in whiplash patients, but the clinical significance needs to be investigated by further studies [9]. On average, patients with pain after whiplash injury display facilitation of central pain processes [2,10,11], which may explain exaggerated pain in the presence of limited tissue damage. Psychosocial factors are associated with central hypersensitivity [12] and have been shown to affect the outcome of whiplash injuries [13]. Thus, important progresses have been made in our understanding of the pathophysiology of whiplash. Because the importance of different mechanisms is likely to vary across patients, the clinical challenge is to identify which factors play a role in the determination of symptoms in individual patients. To date, a comprehensive assessment of the different potential contributors is essential to formulate a working hypothesis for an individualized treatment.

Whenever the cause of pain cannot be identified or removed, drug treatment is an option. Oddly, research on the efficacy of analgesics in whiplash-associated disorders is extremely sparse [14]. The paper by Persson et al. in this issue of the Scandinavial Journal of Pain [15] analyzes the response of patients with chronic pain after whiplash injury to intravenous infusions of morphine, ketamine and an active placebo (midazolam). The drugs were administered as single doses. A variety of assessments of the psychosocial status and quality of life were made. Responses were categorized as positive or negative based on the cutoff of 50% pain relief. The study was completed in 94 patients, which is a considerable number in the frame of whiplash clinical research. Among patients who did not respond to placebo, 47% were morphine responders, 41% ketamine responders, 25% responded to both drugs and 37% to neither drug.

Because of the extreme paucity of data on the efficacy of drugs in chronic pain after whiplash injury, this study is important. It suggests that this pain condition might be modulated by opioids and NMDA-antagonists in part of patients. Although links between this finding and mechanistic aspects should be made with caution, the data support the view that whiplash injury is associated with changes in central modulatory processes. The interindividual response was variable, and some patients did not respond to any drug. In the field of chronic pain, this is not a unique feature of whiplash. Several factors may account for lack of analgesic effect, such as individual dose–response relationship or pharmacogenetic polymorphisms [16]. Interestingly, the group of patients who did not respond to morphine or ketamine displayed a trend for a worse performance in some of the psychometric tests, supporting clinical observations that psychic disorders may represent obstacles to the efficacy of treatments. Clearly, this finding needs to be confirmed by studies that are designed and powered to address this question.

The study has limitations. Responses to single drug doses do not necessarily imply long-term efficacy. On the other hand, lack of effect after a single administration does not rule out efficacy with long term treatment, since central modulating effects might become clinically detectable after days or weeks of drug exposure. The study did not test the combination of the two drugs. In a study on patients with post herpes zoster pain, a chronic central and peripheral neuropathic pain, morphine and ketamine had a more pronounced analgesic effect when both drugs were given together, compared with single drug administrations [17]. The use of midazolam as active placebo may be questioned, due to the antihyperalgesic and hypoalgesic effects of GABAA-agonists in a large amount of animal studies [18], confirmed by some clinical investigations [19]. Thus, an undetermined proportion of the placebo responders might actually be responders to GABAA-agonists.

In summary, the study by Persson et al. shed some additional light on the pathophysiology and management of whiplashassociated disorders. Most patients do respond to drug treatment, at least in the short term. The hope is that most of these patients would respond also on the long term, a hypothesis that needs to be tested by further clinical trials. Furthermore, the finding does not support the view that pain after whiplash injury has nothing to do with nociceptive processes. Hopefully, the study will motivate researchers to perform pharmacological trials on the middle- and long-term efficacy of drugs in whiplash-associated disorders.

DOI of refers to article:10.1016/j.sjpain.2012.01.003.

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References

[1] Anderson SE, Boesch C, Zimmermann H, Busato A, Hodler J, Bingisser R, Ulbrich EJ, Nidecker A, Buitrago-Tellez CH, Bonel HM, Heini P, Schaeren S, Sturzenegger M. Are there cervical spine findings at mr imaging that are specific to acute symptomatic whiplash injury? A prospective controlled study with four experienced blinded readers. Radiology 2012;262:567–75.Suche in Google Scholar

[2] Kasch H, Qerama E, Kongsted A, Bach FW, Bendix T, Jensen TS. Deep muscle pain, tender points and recovery in acute whiplash patients: a 1-year follow-up study. Pain 2008;140:65–73.Suche in Google Scholar

[3] Sullivan MJ, Thibault P, Simmonds MJ, Milioto M, Cantin AP, Velly AM. Pain, perceived injustice and the persistence of post-traumatic stress symptoms during the course of rehabilitation for whiplash injuries. Pain 2009;145:325–31.Suche in Google Scholar

[4] Curatolo M, Bogduk N, Ivancic PC, McLean SA, Siegmund GP, Winkelstein BA. The role of tissue damage in whiplash-associated disorders: discussion paper 1. Spine 2011;36:S309–15.Suche in Google Scholar

[5] Lord SM, Barnsley L, Wallis BJ, Bogduk N. Chronic cervical zygapophysial joint pain after whiplash. A placebo-controlled prevalence study. Spine 1996;21:1737–45.Suche in Google Scholar

[6] Lord SM, Barnsley L, Wallis BJ, McDonald GJ, Bogduk N. Percutaneous radi of requency neurotomy for chronic cervical zygapophyseal-joint pain. N Engl J Med 1996;335:1721–6.Suche in Google Scholar

[7] Winkelstein BA. How can animal models inform on the transition to chronic symptoms in whiplash? Spine 2011;36:S218–25.Suche in Google Scholar

[8] Siegmund GP. What occupant kinematics and neuromuscular responses tell us about whiplash injury. Spine 2011;36:S175–9.Suche in Google Scholar

[9] Linnman C, Appel L, Fredrikson M, Gordh T, Soderlund A, Langstrom B, Engler H. Elevated [11c]-d-deprenyl uptake in chronic whiplash associated disorder suggests persistent musculoskeletal inflammation. PLoS One 2011;6: e19182.Suche in Google Scholar

[10] Sterling M, Hodkinson E, Pettiford C, Souvlis T, Curatolo M. Psychologic factors are related to some sensory pain thresholds but not nociceptive flexion reflex threshold in chronic whiplash. Clin J Pain 2008;24:124–30.Suche in Google Scholar

[11] Sterling M, Jull G, Vicenzino B, Kenardy J. Sensory hypersensitivity occurs soon after whiplash injury and is associated with poor recovery. Pain 2003;104:509–17.Suche in Google Scholar

[12] Jensen TS. High prevalence of posttraumatic stress disorder (ptsd) and pain sensitization in two scandinavian samples of patients referred for pain rehabilitation. Scand J Pain 2012;3:38.Suche in Google Scholar

[13] Carroll LJ, Holm LW, Hogg-Johnson S, Cote P, Cassidy JD, Haldeman S, Nordin M, Hurwitz EL, Carragee EJ, van der Velde G, Peloso PM, Guzman J. Course and prognostic factors for neck pain in whiplash-associated disorders (wad): results of the bone and joint decade 2000-2010 task force on neck pain and its associated disorders. Spine 2008;33:S83–92.Suche in Google Scholar

[14] Peloso PM, Gross AR, Haines TA, Trinh K, Goldsmith CH, Aker P. Medicinal and injection therapies for mechanical neck disorders: a cochrane systematic review. J Rheumatol 2006;33:957–67.Suche in Google Scholar

[15] Persson M, Sörensen J, Gerdle B. Whiplash-associated disorders (wad): responses to pharmacological challenges and psychometric tests. Scand J Pain 2012;3:151–63.Suche in Google Scholar

[16] Stamer UM, Stuber F. Genetic factors in pain and its treatment. Curr Opin Anaesthesiol 2007;20:478–84.Suche in Google Scholar

[17] Stubhaug A. Ketamine in the treatment of spontaneous ongoing pain and evoked pain. Studies in humans with chronic neuropathic pain, acute postoperative pain, or experimental pain (thesis d. Med. Science). Olso: University of Oslo; 1999.Suche in Google Scholar

[18] Zeilhofer HU, Zeilhofer UB. Spinal dis-inhibition in inflammatory pain. Neurosci Lett 2008;437:170–4.Suche in Google Scholar

[19] Ho KM, Ismail H. Use of intrathecal midazolam to improve perioperative analgesia: a meta-analysis. Anaesth Intensive Care 2008;36:365–73.Suche in Google Scholar
Published Online: 2012-07-01
Published in Print: 2012-07-01

© 2012 Scandinavian Association for the Study of Pain

Artikel in diesem Heft

  1. Editorial comment
  2. Spontaneous pain is reduced by conditioning pain modulation in peripheral neuropathy but not in fibromyalgia—Implications for different pain mechanisms
  3. Clinical pain research
  4. Differential pain modulation in patients with peripheral neuropathic pain and fibromyalgia
  5. Editorial comment
  6. Pulsed radiofrequency—Time for a clinical pause and more science
  7. Clinical pain research
  8. Pulsed radiofrequency in peripheral posttraumatic neuropathic pain: A double blind sham controlled randomized clinical trial
  9. Editorial comment
  10. Phantom pains and sensations – how does it feel? Only the patient really knows
  11. Clinical pain research
  12. Phantom phenomena – Their perceived qualities and consequences from the patient’s perspective
  13. Editorial comment
  14. Impact of mental stressor on conditioned pain modulation
  15. Original experimental
  16. The effect of a mental stressor on conditioned pain modulation in healthy subjects
  17. Editorial comment
  18. Pharmacological modulation of chronic pain after whiplash injury
  19. Clinical pain research
  20. Whiplash Associated Disorders (WAD): Responses to pharmacological challenges and psychometric tests
  21. Editorial comment
  22. Why are autonomic responses to pressure pain different from those to heat pain and ischaemic pain?
  23. Original experimental
  24. Cardiovascular responses to and modulation of pressure pain sensitivity in normotensive, pain-free women
  25. Correspondence
  26. Piriformis muscle injection guided by sciatic nerve stimulation: Quick, simple, and safe technique
  27. Correspondence
  28. Musculus piriformis syndrome: Localization and injection therapy—Comment to letter from Mayo-Moldes M et al. [1]
  29. Abstracts
  30. The “pain matrix” reloaded
  31. Abstracts
  32. Endpoints in animal pain models
  33. Abstracts
  34. Evaluating pain-related behavior in spinal cord injury
  35. Abstracts
  36. The role of the amygdala in sensory and emotional-like pain behavior in neuropathic animals
  37. Abstracts
  38. Peripheral and central pain mechanisms—From animal models to clinical research
  39. Abstracts
  40. Human experimental models of central sensitization—Do they bridge the gap between animal models and clinical observations?
  41. Abstracts
  42. Assessment of central sensitization in the clinic. Is it possible?
  43. Abstracts
  44. Migraine neurobiology and treatment
  45. Abstracts
  46. Chronic headaches–Goals and obstacles
  47. Abstracts
  48. Trigeminal neuralgia and other cranial neuralgias
  49. Abstracts
  50. Temporomandibular disorders: Pathophysiology and diagnosis
  51. Abstracts
  52. HIV-associated painful polyneuropathy
  53. Abstracts
  54. Keynote: Neuronal and glial signalling in pain neuroplasticity
  55. Abstracts
  56. Neuropathic pain—From guidelines to clinical practice
  57. Abstracts
  58. Postoperative pain treatment. What’s the evidence—And how to use it?
  59. Abstracts
  60. NSAIDs in postoperative pain
  61. Abstracts
  62. How should we prevent persistent postoperative pain?
  63. Abstracts
  64. Opioids: Genetics and receptors
  65. Abstracts
  66. Chronic pain and sleep disorders
  67. Abstracts
  68. Population-based studies on chronic pain: The role of opioids
  69. Abstracts
  70. Living beyond pain: Acceptance and commitment therapy
  71. Abstracts
  72. Modality specific alterations of esophageal sensitivity caused by longstanding diabetes mellitus
  73. Abstracts
  74. Validation of a porcine behavioural model of UVB induced inflammatory pain
  75. Abstracts
  76. Recovery after a lumbar disc herniation is dependent on a gender and OPRM1 Asn40Asp genotype interaction
  77. Abstracts
  78. Pain sensitivity changes in chronic pain patients with and without spinal cord stimulation assessed by nociceptive withdrawal reflex thresholds and electrical pain thresholds
  79. Abstracts
  80. Acceptance and commitment therapy for fibromyalgia: A randomized controlled trial
  81. Abstracts
  82. Sortilins in neuropathic pain
  83. Abstracts
  84. Systematic review of neuropathic component in persistent post-surgical pain
  85. Abstracts
  86. Pain prevalence in a university hospital in Iceland
  87. Abstracts
  88. The effect of tail-docking neonate piglets on ATF-3 and NR2B immunoreactivity in coccygeal dorsal root ganglia and spinal cord dorsal horn neurons: Preliminary data
  89. Abstracts
  90. Na+/K+-ATPase dependent regulation of astrocyte Ca2+ signalling: A novel mechanism for modulation of long-term pain?
  91. Abstracts
  92. Glutamate attenuates nitric oxide release from isolated trigeminal ganglion satellite glial cells
  93. Abstracts
  94. Acute behavioural responses to tail docking in piglets – Effects of increasing docking length?
  95. Abstracts
  96. Dose and administration-period play a key role in the effect of ceftriaxone on neuropathic pain in CCI-operated rats
  97. Abstracts
  98. Translational aspects of rectal evoked potentials: A comparative study in rats and humans
  99. Abstracts
  100. Time-course of analgesic effects of botulinum neurotoxin type A (BoNTA) on human experimental model of pain induced by injection of glutamate into temporalis muscle
  101. Abstracts
  102. The effect of nerve compression and capsaicin on contact heat evoked potentials (CHEPs) related to Aδ and C fibers
  103. Abstracts
  104. Effect of specific trapezius exercises vs. coordination training on corticomotor control of neck muscles
  105. Abstracts
  106. SNP in TNFα T308G is predictive for persistent postoperative pain following inguinal hernia surgery
  107. Abstracts
  108. Chronic pain in thoracotomy
  109. Abstracts
  110. The variability in thermal threshold-assessments in post-thoracotomy pain syndrome
  111. Abstracts
  112. Persistent pain, sensory disturbances and functional impairment after adjuvant chemotherapy for breast cancer
  113. Abstracts
  114. Neuroplastic alterations in brain responses to painful visceral stimulations reflects individual neuropathic symptoms in diabetes mellitus patients
  115. Abstracts
  116. Exercise and conditioned pain modulation have different effects on cuff pressure pain tolerance in humans
  117. Abstracts
  118. Hyperalgesia in human skin and deep-tissues inside and outside of a UVB irradiated area
  119. Abstracts
  120. Effect of experimental jaw muscle pain on bite force during mastication
  121. Abstracts
  122. Reflex threshold assessment methodology for evaluation of central sensitisation is vulnerable to EMG crosstalk
  123. Abstracts
  124. Cognitive modulation of experimental pain at spinal and cortical levels
  125. Abstracts
  126. Influence of emotionally loaded visual and gustatory stimuli on pain perception
  127. Abstracts
  128. Modulating pain with augmented reality
  129. Abstracts
  130. Offset analgesia: A reproducibility study
  131. Abstracts
  132. Visualization of painful process in peripheral tissue using positron emission tomography and [11C]-D-deprenyl
  133. Abstracts
  134. Mirror-image sensory dysfunction in the post-thoracotomy pain syndrome
  135. Abstracts
  136. Genetic variation in opioid receptor genes and sensitivity to experimental pain in male and female healthy volunteers
  137. Abstracts
  138. Mechanical sensitivity in migraine patients during attack, remission, and pain-free periods:A preliminary study
  139. Abstracts
  140. Multivariate pattern analysis of evoked brain potentials by temporal matching pursuit and support vector machine
  141. Abstracts
  142. Pain following stroke: A prospective study
  143. Abstracts
  144. Chronic thoracic pain in children after cardiac surgery
  145. Abstracts
  146. Chronic pain after breast augmentation is associated with both signs of peripheral nerve injury and central nervous mechanisms
  147. Abstracts
  148. Sensory phenotypes in patients with peripheral neuropathic pain evaluated with quantitative sensory testing
  149. Abstracts
  150. Is health related quality of life related to the pattern of chronic pain?
  151. Abstracts
  152. Comparison between ropivacaine local infiltration analgesia with ketorolac or placebo for total knee replacement surgery
  153. Abstracts
  154. Treatment with topical capsaicin: Experience from a pain clinic
  155. Abstracts
  156. Distribution of concussion related symptoms after whiplash injury in risk strata
  157. Abstracts
  158. HIV/AIDS in different cultures
  159. Abstracts
  160. Pain perception is altered in patients with medication-overuse headache but can improve after detoxification
  161. Abstracts
  162. Detoxification in a structured programme is effective for medication-overuse headache
https://doi.org/10.1016/j.sjpain.2012.02.008

Artikel in diesem Heft

  1. Editorial comment
  2. Spontaneous pain is reduced by conditioning pain modulation in peripheral neuropathy but not in fibromyalgia—Implications for different pain mechanisms
  3. Clinical pain research
  4. Differential pain modulation in patients with peripheral neuropathic pain and fibromyalgia
  5. Editorial comment
  6. Pulsed radiofrequency—Time for a clinical pause and more science
  7. Clinical pain research
  8. Pulsed radiofrequency in peripheral posttraumatic neuropathic pain: A double blind sham controlled randomized clinical trial
  9. Editorial comment
  10. Phantom pains and sensations – how does it feel? Only the patient really knows
  11. Clinical pain research
  12. Phantom phenomena – Their perceived qualities and consequences from the patient’s perspective
  13. Editorial comment
  14. Impact of mental stressor on conditioned pain modulation
  15. Original experimental
  16. The effect of a mental stressor on conditioned pain modulation in healthy subjects
  17. Editorial comment
  18. Pharmacological modulation of chronic pain after whiplash injury
  19. Clinical pain research
  20. Whiplash Associated Disorders (WAD): Responses to pharmacological challenges and psychometric tests
  21. Editorial comment
  22. Why are autonomic responses to pressure pain different from those to heat pain and ischaemic pain?
  23. Original experimental
  24. Cardiovascular responses to and modulation of pressure pain sensitivity in normotensive, pain-free women
  25. Correspondence
  26. Piriformis muscle injection guided by sciatic nerve stimulation: Quick, simple, and safe technique
  27. Correspondence
  28. Musculus piriformis syndrome: Localization and injection therapy—Comment to letter from Mayo-Moldes M et al. [1]
  29. Abstracts
  30. The “pain matrix” reloaded
  31. Abstracts
  32. Endpoints in animal pain models
  33. Abstracts
  34. Evaluating pain-related behavior in spinal cord injury
  35. Abstracts
  36. The role of the amygdala in sensory and emotional-like pain behavior in neuropathic animals
  37. Abstracts
  38. Peripheral and central pain mechanisms—From animal models to clinical research
  39. Abstracts
  40. Human experimental models of central sensitization—Do they bridge the gap between animal models and clinical observations?
  41. Abstracts
  42. Assessment of central sensitization in the clinic. Is it possible?
  43. Abstracts
  44. Migraine neurobiology and treatment
  45. Abstracts
  46. Chronic headaches–Goals and obstacles
  47. Abstracts
  48. Trigeminal neuralgia and other cranial neuralgias
  49. Abstracts
  50. Temporomandibular disorders: Pathophysiology and diagnosis
  51. Abstracts
  52. HIV-associated painful polyneuropathy
  53. Abstracts
  54. Keynote: Neuronal and glial signalling in pain neuroplasticity
  55. Abstracts
  56. Neuropathic pain—From guidelines to clinical practice
  57. Abstracts
  58. Postoperative pain treatment. What’s the evidence—And how to use it?
  59. Abstracts
  60. NSAIDs in postoperative pain
  61. Abstracts
  62. How should we prevent persistent postoperative pain?
  63. Abstracts
  64. Opioids: Genetics and receptors
  65. Abstracts
  66. Chronic pain and sleep disorders
  67. Abstracts
  68. Population-based studies on chronic pain: The role of opioids
  69. Abstracts
  70. Living beyond pain: Acceptance and commitment therapy
  71. Abstracts
  72. Modality specific alterations of esophageal sensitivity caused by longstanding diabetes mellitus
  73. Abstracts
  74. Validation of a porcine behavioural model of UVB induced inflammatory pain
  75. Abstracts
  76. Recovery after a lumbar disc herniation is dependent on a gender and OPRM1 Asn40Asp genotype interaction
  77. Abstracts
  78. Pain sensitivity changes in chronic pain patients with and without spinal cord stimulation assessed by nociceptive withdrawal reflex thresholds and electrical pain thresholds
  79. Abstracts
  80. Acceptance and commitment therapy for fibromyalgia: A randomized controlled trial
  81. Abstracts
  82. Sortilins in neuropathic pain
  83. Abstracts
  84. Systematic review of neuropathic component in persistent post-surgical pain
  85. Abstracts
  86. Pain prevalence in a university hospital in Iceland
  87. Abstracts
  88. The effect of tail-docking neonate piglets on ATF-3 and NR2B immunoreactivity in coccygeal dorsal root ganglia and spinal cord dorsal horn neurons: Preliminary data
  89. Abstracts
  90. Na+/K+-ATPase dependent regulation of astrocyte Ca2+ signalling: A novel mechanism for modulation of long-term pain?
  91. Abstracts
  92. Glutamate attenuates nitric oxide release from isolated trigeminal ganglion satellite glial cells
  93. Abstracts
  94. Acute behavioural responses to tail docking in piglets – Effects of increasing docking length?
  95. Abstracts
  96. Dose and administration-period play a key role in the effect of ceftriaxone on neuropathic pain in CCI-operated rats
  97. Abstracts
  98. Translational aspects of rectal evoked potentials: A comparative study in rats and humans
  99. Abstracts
  100. Time-course of analgesic effects of botulinum neurotoxin type A (BoNTA) on human experimental model of pain induced by injection of glutamate into temporalis muscle
  101. Abstracts
  102. The effect of nerve compression and capsaicin on contact heat evoked potentials (CHEPs) related to Aδ and C fibers
  103. Abstracts
  104. Effect of specific trapezius exercises vs. coordination training on corticomotor control of neck muscles
  105. Abstracts
  106. SNP in TNFα T308G is predictive for persistent postoperative pain following inguinal hernia surgery
  107. Abstracts
  108. Chronic pain in thoracotomy
  109. Abstracts
  110. The variability in thermal threshold-assessments in post-thoracotomy pain syndrome
  111. Abstracts
  112. Persistent pain, sensory disturbances and functional impairment after adjuvant chemotherapy for breast cancer
  113. Abstracts
  114. Neuroplastic alterations in brain responses to painful visceral stimulations reflects individual neuropathic symptoms in diabetes mellitus patients
  115. Abstracts
  116. Exercise and conditioned pain modulation have different effects on cuff pressure pain tolerance in humans
  117. Abstracts
  118. Hyperalgesia in human skin and deep-tissues inside and outside of a UVB irradiated area
  119. Abstracts
  120. Effect of experimental jaw muscle pain on bite force during mastication
  121. Abstracts
  122. Reflex threshold assessment methodology for evaluation of central sensitisation is vulnerable to EMG crosstalk
  123. Abstracts
  124. Cognitive modulation of experimental pain at spinal and cortical levels
  125. Abstracts
  126. Influence of emotionally loaded visual and gustatory stimuli on pain perception
  127. Abstracts
  128. Modulating pain with augmented reality
  129. Abstracts
  130. Offset analgesia: A reproducibility study
  131. Abstracts
  132. Visualization of painful process in peripheral tissue using positron emission tomography and [11C]-D-deprenyl
  133. Abstracts
  134. Mirror-image sensory dysfunction in the post-thoracotomy pain syndrome
  135. Abstracts
  136. Genetic variation in opioid receptor genes and sensitivity to experimental pain in male and female healthy volunteers
  137. Abstracts
  138. Mechanical sensitivity in migraine patients during attack, remission, and pain-free periods:A preliminary study
  139. Abstracts
  140. Multivariate pattern analysis of evoked brain potentials by temporal matching pursuit and support vector machine
  141. Abstracts
  142. Pain following stroke: A prospective study
  143. Abstracts
  144. Chronic thoracic pain in children after cardiac surgery
  145. Abstracts
  146. Chronic pain after breast augmentation is associated with both signs of peripheral nerve injury and central nervous mechanisms
  147. Abstracts
  148. Sensory phenotypes in patients with peripheral neuropathic pain evaluated with quantitative sensory testing
  149. Abstracts
  150. Is health related quality of life related to the pattern of chronic pain?
  151. Abstracts
  152. Comparison between ropivacaine local infiltration analgesia with ketorolac or placebo for total knee replacement surgery
  153. Abstracts
  154. Treatment with topical capsaicin: Experience from a pain clinic
  155. Abstracts
  156. Distribution of concussion related symptoms after whiplash injury in risk strata
  157. Abstracts
  158. HIV/AIDS in different cultures
  159. Abstracts
  160. Pain perception is altered in patients with medication-overuse headache but can improve after detoxification
  161. Abstracts
  162. Detoxification in a structured programme is effective for medication-overuse headache
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