Relationship between pain symptoms and referred sensory and trophic changes in patients with gallbladder pathology
ABSTRACT The relationship was investigated between algogenic potential of gallbladder pathology and occurrence/extent of sensory and trophic changes in the referred area. Five groups of subjects were studied, with: symptomatic gallbladder calculosis (3-20 colics); asymptomatic calculosis; symptomatic gallbladder shape abnormality (8-18 colics); asymptomatic shape abnormality; normal gallbladder/no symptoms. At the cystic point (CP) and contralaterally, all underwent measurement of: pain thresholds to electrical stimulation of skin, subcutis and muscle; thickness of subcutis and muscle via ultrasounds. Contralaterally to CP, all thresholds were not significantly different in the five groups. At CP, subcutis and muscle thresholds were significantly lower in symptomatic vs asymptomatic patients and/or normals (0.0001<P< 0.05). In symptomatic cases, at CP compared to contralaterally, subcutis and muscle thresholds were significantly lower (0.0001<P<0.02), subcutis thickness was significantly higher and muscle thickness significantly lower (0.006<P<0.02). Subcutis and muscle thresholds at CP in symptomatic patients were significantly and inversely correlated linearly to the number of colics (P<0.0004; P<0.0001). Patients with symptomatic calculosis were re-evaluated after 6 months; those not presenting further colics showed a significant increase in subcutis and muscle thresholds at CP, while those who continued presenting colics showed a further significant threshold decrease (0.01<P<0.05); tissue thickness did not vary. Referred hyperalgesia and altered trophism from the gallbladder only occur in painful pathology, their extent being modulated by the amount of perceived pain. The results suggest different mechanisms by which visceral nociceptive inputs trigger sensory vs trophic changes in the referred area.
Article: Myofascial Pelvic Pain[Show abstract] [Hide abstract]
ABSTRACT: Individuals with pelvic pain commonly present with complaints of pain located anywhere below the umbilicus radiating to the top of their thighs or genital region. The somatovisceral convergence that occurs within the pelvic region exemplifies why examination of not only the organs but also the muscles, connective tissues (fascia), and neurologic input to the region should be performed for women with pelvic pain. The susceptibility of the pelvic floor musculature to the development of myofascial pain has been attributed to unique functional demands of this muscle. Conservative interventions should be considered to address the impairments found on physical examination.Obstetrics and Gynecology Clinics of North America 09/2014; 41(3). DOI:10.1016/j.ogc.2014.04.003 · 1.40 Impact Factor
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ABSTRACT: To evaluate whether a diclofenac epolamine + heparin topical (plaster) is more effective than diclofenac plaster alone in reducing deep somatic hyperalgesia in subjects without spontaneous pain and whether the effect is linked to or independent of the anti-edematous action of heparin. Prospective, double-blind, randomized and controlled, four-arm parallel design trial. One hundred and four patients (84 women, 20 men, mean age 42.2 ± 13.3 years), with deep somatic hyperalgesia in one thigh, randomly assigned to one of 4 groups of 26 each. Each group underwent one of the following plaster treatments on one thigh: diclofenac+heparin; diclofenac; heparin; placebo, for 7 days, renewing the plaster every 24 hours. Before treatment (day 1), at day 4 and day 8, assessment of (a) pressure and electrical pain thresholds of vastus lateralis and overlying subcutis and skin; and (b) structure/thickness of subcutis and muscle with ultrasounds at the same level. During treatment, in placebo and heparin, no significant threshold changes, except subcutis thresholds which increased slightly (P < 0.02); in diclofenac and diclofenac+heparin, significant increase in all thresholds (0.0001 < P < 0.04). Electrical muscle pain thresholds increased significantly more in diclofenac+heparin than in diclofenac, heparin, and placebo (0.0001 < P < 0.04). In all groups: no edema and thickness changes at ultrasounds in muscle and subcutis. Topical diclofenac+heparin is significantly more effective than diclofenac alone in reducing muscle hyperalgesia in subjects without spontaneous pain, independently of the anti-edematous action of heparin. The results provide a rationale for the use of diclofenac+heparin also in algogenic conditions without evident signs of injury/edema/hematoma.Pain Practice 01/2014; 15(1). DOI:10.1111/papr.12161 · 2.18 Impact Factor
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ABSTRACT: The primary objectives of this study were to explore the pain experience following gynecological laparoscopy performed for non-acute pain conditions and to determine whether pre-operative psychological tests and quantitative tests of sensitization can predict postoperative pain. Participants included 61 women undergoing laparoscopy for non-acute pain (n=61). A second group of 16 women undergoing tubal ligation was included to explore whether laparoscopy induced a painful postoperative response in women without preoperative pain. Subjective tests included numeric pain scale, pain catastrophizing scale, depression scale, global assessment of change and the McGill Pain Questionnaire Short Form. Quantitative sensory testing included abdominal cutaneous allodynia, trigger points and reduced pain thresholds. The non-acute pain sample had 80% power to detect a difference of 0.5 SD in average pain levels. Analysis included parametric and non-parametric comparisons of groups, univariate and linear regression analysis of clinically relevant variables. In women undergoing tubal ligation, pain levels were low pre-and postoperatively. In women undergoing surgery for non-acute pain, pain levels at 6 months and all psychological test scores were significantly reduced compared to baseline (p< 0.001 and p=0.001, respectively). Amongst those with positive quantitative pain tests of sensitization at baseline, average postoperative pain was also significantly reduced (p<0.001). Univariate analysis demonstrated only tests of sensitization correlated with change in average pain level (p=0.01). Regression analysis suggested that baseline pain, catastrophizing and the presence of cutaneous allodynia significantly predicted pain levels six months after surgery (p<0.001). Pain following laparoscopic surgery for non-acute painful conditions can be predicted by baseline pain, catastrophizing and the presence of allodynia, a simple q-tip test indicating sensitization.American journal of obstetrics and gynecology 04/2014; 211(4). DOI:10.1016/j.ajog.2014.04.010 · 3.97 Impact Factor