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. Multimodal assessment of pain in the esophagus: a new experimental model. Am

Visceral hyperalgesia/allodynia can be induced experimentally and assessed quantitatively by the newly introduced multi-modal psychophysical assessment approach. The significant changes of the experimentally evoked referred pain patterns and of the nociceptive reflex evoked from a distant somatic structure indicate that even short-lasting visceral hyperalgesia can generate generalised sensitisation.

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Experimental pain models for assessment of analgesic effect needs to be reproducible, valid and responding in a uniform way to changes in pain level. The pain system differs in various tissue types and analgesics may have different effects in different tissues. This study assessed the reproducibility of an experimental model using mechanical, thermal and electrical stimulations. Pain was evoked in three tissues: Skin, muscle and viscera. Pain was evoked and assessed in 24 healthy volunteers. The experiment was repeated three times with 30 min. intervals and twice with a weekly interval. Systematic bias, intra-class correlation (ICC) and coefficient of variation (CV) and valid sample sizes for analgesic testing were assessed. The model proved to be feasible. Most tests were unbiased, showing stable means except for the mechanical and thermal stimulation in viscera, which showed decreasing pain thresholds when the tests were repeated with 30 min. intervals. Generally the pain tests showed relatively high CV (mean 71%, range 8-145%). The pain tests showed high ICC's (Ͼ0.80) when repeated on the same day. When the tests were repeated with an interval of one week, ICC was smaller (mean 0.79 range 0.49-0.96). This means that these tests are useful for analgesic testing recruiting useful sample sizes in a crossover (mean 31 range 2-84) and a parallel study (mean 59 range 3-164) design. Application of this experimental pain model in a cross-over study design with appropriate base-line recordings offers a unique opportunity of revealing analgesic effects on pain arising from different tissues.

Sleep complaints are frequent in patients with rheumatoid arthritis (RA) and sleep disturbances may contribute to pain and other daytime complaints. The aims of the current study were to compare ambulatory sleep recordings from consecutively selected patients with RA to those obtained in healthy controls, and to study the relationships between sleep structure and clinical symptoms. Sleep recordings were obtained from 41 out-patients with RA and 19 matched controls. All had clinical examinations and completed different questionnaires. Recordings were scored traditionally and, moreover, the electroencephalography (EEG) was subjected to frequency analysis. For the study of sleep-wake interactions in the patients, a graphical chain model was used. The patients had many sleep-related complaints. An increase in the number of periodic movements of the legs (PML) during sleep was seen in comparison with controls, but otherwise only minor differences were observed in classical sleep stages. Data from frequency analysis showed an increase in alpha (8-12 Hz)-EEG activity in sleep stages non-rapid eye movement (NREM) 2-4 in most sleep cycles. The statistical model demonstrated a complex but independent correlation between morning stiffness, pain and joint tenderness on the one hand, and awakenings, stage NREM2, slow-wave sleep and stage REM on the other, probably reflecting a relationship between sleep patterns and pain in RA. In conclusion, only the increase in PML and alpha-EEG activity distinguished the sleep in RA patients from that of healthy controls. However, the demonstrated interaction between daytime complaints and sleep patterns may increase the understanding and treatment of the disease. In future research, graphical chain models may improve our understanding of complex relationships between multiple variables.

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A marked and parallel increase was seen in both ulcerative colitis and Crohn's disease in both genders during the last 25 years, with a corresponding high prevalence of both diseases.