NCT01645150.

Neuropathic pain (NP) and its treatment are considered to constitute an unmet need, with a high-multidimensional impact on society and the sufferer. The broad spectrum of opioid analgesics is considered beneficial for acute pain, yet these drugs pose serious controversial issues due to the potential for adverse behavior and a higher chance of tolerance and addiction in long-term use. Opioids like other first-line medications for NP, will not be useful for every patient suffering from chronic NP. However, due to their possible adverse effects, opioids are considered as second-or third-line medications by various guidelines. Therefore, this literature review was conducted to evaluate the status of opioids in NP and to asses if any recent research has shed further evidence on their efficacy or the contrary. The literature reviewed showed that the mechanisms underlying NP, may themselves contribute to the reduced effect of opioids in this condition. Also, various genetic polymorphisms affecting pharmacokinetic and pharmacodynamic factors are discussed, providing further evidence for the variability in opioid response. Although opioids may reduce NP, nociceptive pain tends to be more responsive to opioids compared to NP. Also, opioids seem to be more effective in intermediate term studies of up to 12 weeks and being mostly effective in peripheral NP compared to supraspinal NP and being least effective in central NP. However, there is still no robust evidence that any specific opioid agent is better than any other one for NP, but it is possible that opioids targeting multiple mechanisms may provide benefit. A limitation of many trials is the lack of consideration for the comorbid psychological aspects of NP, which tend to lower opioid analgesia.

Background: This study investigated whether current smoking and a higher nicotine dependency were associated with chronic low back pain (LBP), lumbar related leg pain (sciatica) and/or radicular neuropathic pain. Methods: A cross-sectional study was conducted on 150 patients (mean age, 60.1 ± 13.1 yr). Demographic data, the International Association for the Study of Pain (IASP) neuropathic pain grade, STarT Back tool, and the Fagerström test were completed. A control group (n = 50) was recruited. Results: There was a significant difference between current smokers and nonsmokers in the chronic LBP group in the mean pain score (P = 0.025), total STarT Back score (P = 0.015), worst pain location (P = 0.020), most distal pain radiation (P = 0.042), and in the IASP neuropathic pain grade (P = 0.026). There was a significant difference in the mean Fagerström score between the four IASP neuropathic pain grades (P = 0.005). Current smoking yielded an odds ratio (OR) of 3.071 (P = 0.011) for developing chronic LBP and sciatica, and an OR of 4.028 (P = 0.002) for obtaining an IASP "definite/probable" neuropathic pain grade, for both cohorts. The likelihood for chronic LBP and sciatica increased by 40.9% (P = 0.007), while the likelihood for an IASP neuropathic grade of "definite/probable" increased by 50.8% (P = 0.002), for both cohorts, for every one unit increase in the Fagerström score. Conclusions: A current smoking status and higher nicotine dependence increase the odds for chronic LBP, sciatica and radicular neuropathic pain.

This review, with the help of a case study, provides a detailed account of the possible biopsychosocial risk factors underlying piriformis muscle syndrome, post discectomy. The diagnostic process including imaging, nerve conduction studies, musculoskeletal examination coupled with provocation maneuvers, palpation, and the musculoskeletal differential diagnosis of buttock pain is illustrated. Reference is made to the aberrant sciatic nerve anatomy and to the myofascial component which is frequently reported to underlie piriformis muscle syndrome. Additionally, the use of validated neuropathic pain assessment tools in grading the possibility of neuropathic pain due to piriformis muscle syndrome is discussed. The prevalence and mechanisms of piriformis muscle syndrome, especially post sipnal surgery, are reviewed. Evidence-based multidisciplinary management underlying this condition is discussed. In refractory cases, treatment escalation, using intramuscular botulinum neurotoxin injection, usually yields very positive results and long-term pain resolution, as evidenced by the case study.

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Is chronic low back pain and radicular neuropathic pain associated with smoking and a higher nicotine dependence? A cross-sectional study using the DN4 and the Fagerström test for nicotine dependence Kronik bel ağrısı ve radiküler nöropatik ağrı, sigara içme ve daha yüksek nikotin bağımlılığı ile ilişkili midir? Nikotin bağımlılığı için DN4 ve Fagerström testinin kullanıldığı kesitsel bir çalışma

PA showed an upward linear trend in female (ptrend = .04) and young adult (ptrend = .009) immigrants. Work-related PA showed an upward linear trend in young adult immigrants (ptrend = .01). Recreational PA indicated an upward linear trend in young adult (ptrend = .03) and Mexican American (ptrend < .001) immigrants and in immigrants living in the U.S. for 15-29 years (ptrend = .02). In contrast, we observed downward linear trends in transit-related PA for immigrants across male (ptrend = .04), middle-aged adult (ptrend = .01) and non-Hispanic Black groups (ptrend = .004) and in immigrants living in the U.S. for 15-29 years (ptrend = .03). CONCLUSION: Although there was no significant linear trend in four domains of PA in the overall U.S. immigrant sample, the trends of domain-specific PA differed across various subgroups. Future work is needed to explore the underlying mechanisms driving the observed patterns. In addition, continuous monitoring of PA trends is required to better understand the behavioral changes of U.S. immigrants and predict their health outcomes.