APS Press Room
News Highlights from The Journal of Pain • March 2005
The Peer Review Journal of the American Pain Society
| For immediate release | Contact: Chuck Weber (847) 705-1802 |
The following news highlights summarize selected articles in the current (March 2005) issue of The Journal of Pain (Vol.6, No. 3), the peer-reviewed scientific journal of the American Pain Society (APS). Based in Glenview, Ill., APS is a multidisciplinary educational and scientific organization dedicated to serving people in pain.
The opinions and ideas expressed in articles appearing in The Journal of Pain do not necessarily reflect those of the editor and publisher or of the American Pain Society.
The S-LANSS Score for Identifying Pain of Predominantly Neuropathic Origin: Validation for Use in Clinical and Postal Research
Michael I. Bennett, et al, Universities of Leeds, and Aberdeen and Kings College, United Kingdom
The Leeds Assessment of Neuropathic Symptoms and Signs pain scale (LANNS) is a simple and valid tool for identifying patients whose pain is dominated by neuropathic mechanisms. In this study, 200 patients with chronic pain were asked to complete the S-LANNS questionnaire unaided and, following completion, researchers administered this questionnaire and another measurement tool, the Neuropathic Pain Questionnaire (NPQ). In addition, the LANNS survey was sent to 160 community patients and 150 newly referred patients waiting for pain clinic assessment.
The results showed the S-LANSS scale correctly identified 75 percent of the pain types when self administered and 80 percent in the interview format. There were significant correlations with the NPQ scale. The authors concluded that the S-LANNS measurement is a valid and reliable self-administered survey for identifying neuropathic pain in the clinic and by mail. Although S-LANSS correctly identifies three in four neuropathic pain cases, some patients with nociceptive pain appear to have a number of neuropathic traits and some with neuropathic pain have few. The researchers noted that patients with chronic pain who are S-LANSS-negative or NPQ-negative will respond to conventional analgesics regardless of clinical diagnosis. Also, those with more overt features of neuropathic pain might require additional therapies, such as co-analgesics.
Functional Magnetic Resonance Imaging and Diffusion Tensor Imaging in a Case of Central Poststroke Pain
Mohamed L. Seghier, et al, University Hospital of Geneva, Switzerland
Many stroke patients have neuropathic pain that negatively impacts their recovery. In these cases, patients experience constant or intermittent pain on the side of the body damaged by the stroke. In this study, researchers evaluated functional magnetic resonance imaging to determine if it would be useful in assessing the impact of lesions within the neurological pain processing systems.
Results from studying a 65-year-old male stroke patient showed the imaging modalities do provide information about anatomic and functional neurological variables associated with post-stroke pain. The researchers noted the findings seem to support the role of central, more than peripheral, components of the pain processing systems in governing the emergence of post-stroke pain.
Personality Traits Associated with Perception of Noxious Stimuli in Women with Vulvar Vestibulitis Syndrome
Michal Granot, University of Haifa, Israel
Vulvar vestibulitis syndrome (VVS) is characterized by severe pain and tenderness in the vaginal area and is associated with enhanced pain sensitivity. The aim of this study was to determine if personality traits assessed by the Cloniger scale are associated with augmented pain perception in women with VVS. Quantitative sensory tests were given to 98 subjects with VVS and in a control group of 135. The results showed that the VVS subjects scored higher on personality traits characterized by the Cloniger sale as harm avoidance and reward dependence. After regression analysis, however, Dr. Granot concluded that women with VVS were more sensitive to noxious stimuli, regardless of their personality traits. He further noted the enhanced pain perception might reflect the tendency of women with VVS to respond intensely to signals of reward and to elevate the perceived harm of pain. This might lead to overestimating potential harm and avoiding perceived hazards.
ALVIMOPAN: AN ORAL, PERIPHERALLY ACTING MU OPIOID RECEPTOR AGONIST FOR TREATMENT OF OPIOID INDUCED BOWEL DYSFUNCTION
Daniel M. Paulson, et al, VA Medical Center, Richmond Va.
In many patients, opioids impair normal bowel function and also cause nausea and vomiting. For this study, researchers evaluated oral alvimopan, a novel peripheral opioid receptor antagonist, as a possible agent to reverse the inhibitory effect of opioids on gastrointestinal transit without influencing analgesia. The efficacy of the drug was studied vs. placebo for 21 days in 168 patients with opioid-induced bowel dysfunction. The outcome of the study showed that alvimopan was well tolerated, did not compromise analgesia, and demonstrated significant efficacy for management of opioid-induced bowel dysfunction.
TREATMENT OF PAIN IN PATIENTS WITH RENAL INSUFFICIENCY; THE WHO THREE-STEP LADDER ADAPTED
Vincent Launay-Vachner, et al, Department of Nephrology, Pitie-Salpetriere Hospital, Paris, France
The World Health Organization’s three-step approach to managing pain introduces opioids in Step 2 in combination with aspirin and other drugs to treat moderate to severe pain, and in Step 3 for moderate to severe pain, primarily in cancer patients unable to get relief from the combinations in Step 2. This approach has been widely adopted for treating all types of pain, but it has been critically evaluated for patients with renal insufficiency. In this article, the authors evaluate the pharmacokinetics of numerous types of pain medications to assess their potential nephrotoxicity.
Modifications to the WHO approach were recommended for treating pain in patients with renal insufficiency:
- For patients whose creatinine clearance is within 80 and 50 mL/min, no pain medication adjustments are required.
- For hemodialysis patients, renal tolerance isn’t a problem, therefore, the renal effects of NSAIDS should not be considered as a reason to limit their use.
- For kidney transplant patients treated with immunosuppressive drugs that might be nephrotoxic, use of pain medications with risk for renal toxicity is not recommended.