Mechanism-based pain diagnosis - Issues for analgesic drug development

Department of Anesthesia and Critical Care, Massachusetts General Hospital and Harvard Medical School, Boston, USA.
Anesthesiology (Impact Factor: 6.17). 08/2001; 95(1):241-9. DOI: 10.1097/00000542-200107000-00034
Source: PubMed
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    ABSTRACT: Accurate assessment of pain or sensory function in clinical practice is challenging. Quantitative Sensory Testing (QST) is a standardized approach to measuring pain and sensory thresholds or tolerances as a means of assessing the functionality of neural pathways from the receptors along the afferent fibers to the brains. This paper reviews two simple QST techniques potentially useful to clinical practice: the Cold Stress Test and Ten Test. The background, evidence for clinical measurement properties and feasibility issues are considered. Keywords Quantitative evaluation, sensory test, pain, sensation, threshold
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    ABSTRACT: Pain is a common presenting and often persistent symptom for children with rheumatological disease. Pain is not clearly related to disease severity in children with inflammatory juvenile idiopathic arthritis, and presentations of non-inflammatory musculoskeletal pain are common but there is limited evidence to guide management. Pain assessment must extend beyond measures of pain severity to more fully evaluate characteristics of pain, functional impact and psychosocial effects and family interactions. Evaluation of mechanisms of joint pain in adults has identified potential treatment targets, but additional studies are required as the acute and long-term impacts of pain and injury change during postnatal development. Genotyping, sensory evaluation and neuroimaging may better characterize chronic musculoskeletal pain, identify high-risk groups and/or provide additional outcome measures to monitor disease and treatment progress. An integrated approach to management is required to effectively select and target interventions, reduce pain and disability and improve long-term outcome.
    Bailli&egrave re s Best Practice and Research in Clinical Rheumatology 04/2014; 28(2):213–228. DOI:10.1016/j.berh.2014.03.007 · 3.06 Impact Factor
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