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Biomedical subjects

Jacques Devulder

Publications and source records attributed to Jacques Devulder.

11 recordsLinked to original sources
PubMed2006

The relevance of monitoring lamotrigine serum concentrations in chronic pain patients.

Lamotrigine is a novel anticonvulsant initially used in epilepsy treatment. Because of its physiological properties it has subsequently been introduced in pain management and has become an interesting co-analgesic, because it inhibits release of excitatory neurotransmitters, influences different sodium, calcium en potassium channels and elevates the GABA levels. A linear relationship appears to exist between serum concentrations, drug activity and clinical outcome. However, measurement of lamotrigine serum concentrations is very useful for daily dose adjustments in order to prevent toxic reactions. In most studies describing the neuropathic pain-relieving effects of lamotrigine, a daily oral dose of 300 to 400 mg was administered. Some of our patients received 800 mg lamotrigine with better results than when 400 mg doses were used. The serum concentrations in these patients were higher but still below the so-called dangerous level of approximately 15 mg/L. Lamotrigine itself is metabolized by conjugation to form inactive metabolites. Lamotrigine serum concentrations can be influenced by the intake of other drugs metabolized by the cytrochrome P450. As good pain relief depends on adequate lamotrigine serum concentrations and dangerous side effects should be avoided, we recommend to monitor individual concentration levels in relation to lamotrigine dosage. However, skin rash is an important adverse effect of lamotrigine and is independent from plasma concentration levels.

Administration, Oral↗
PubMed2004

Distraction from chronic pain during a pain-inducing activity is associated with greater post-activity pain.

The aim of this study was to investigate the effects of distraction from pain during and after a pain-inducing lifting task in a sample of chronic low back pain (CLBP) patients. Fifty-two CLBP patients (25 males, 27 females; mean age=46.30 years) performed a pain-inducing lifting task twice, once alone and once with a simultaneous cognitive distraction task. The results revealed that (1) distraction had no effect upon self-reported pain during the lifting task, (2) distraction had a paradoxical effect of more pain immediately after the lifting task, (3) both pain-related fear and pain catastrophizing did not moderate the effects of distraction on pain, but (4) catastrophic thinking about pain during the lifting task was related to more vigilance to pain and less engagement in the distracting task. Further investigation of the catastrophizing data showed that the effect of catastrophizing about pain during the lifting task on the cognitive distraction task was mediated by the amount of attention paid to pain. Clinical implications of these findings are discussed.

Activities of Daily Living↗
PubMed2004

Acceptance of the unpleasant reality of chronic pain: effects upon attention to pain and engagement with daily activities.

This paper investigates whether acceptance was related to less attention to pain, and to more engagement with daily activities. The results of two studies are reported. In a first cross-sectional study, 501 chronic pain patients completed self-report instruments on pain severity, attention to pain and acceptance. In a second diary study, 62 patients with chronic pain reported pain intensity, attention to pain and characteristics of goal-directed behaviour 8 times a day using an experience sampling method. Acceptance was measured using a self-report instrument. It was found that acceptance was related to less attention to pain (study 1 and study 2), more engagement with daily activities, a higher motivation to complete activities and a better efficacy to perform daily activities (study 2). Results are discussed in terms of how a positive life despite pain may be preserved by a flexible adjustment of personal goals to current limitations and adversities.

Activities of Daily Living↗
PubMed2003

Acceptance of pain is an independent predictor of mental well-being in patients with chronic pain: empirical evidence and reappraisal.

This paper reports upon: (1) the value of acceptance of pain in predicting well-being in patients suffering from chronic pain and (2) the construct validity of acceptance by comparing two questionnaires designed to measure acceptance (the Chronic Pain Acceptance Questionnaire, CPAQ, unpublished doctoral dissertation, University of Nevada, Reno, NV, 1992 and the Illness Cognitions Questionnaire, ICQ, J Consult Clin Psychol 69 (2001) 1026). The results of two independent cross-sectional studies are reported. Study 1 included 120 patients seeking help in tertiary care settings. In Study 2, 66 patients were recruited from a self-support group for fibromyalgia patients and from a pain clinic. Both studies revealed that acceptance of pain predicted mental well-being beyond pain severity and pain catastrophizing, but did not account for physical functioning. In both instruments, it was found that acceptance of pain was strongly related to engagement in normal life activities and the recognition that pain may not change. Acceptance in both instruments was strongly related to a cognitive control over pain. Study 2 further revealed that the correlation between the CPAQ and the ICQ is moderate, indicating that both instruments measured different aspects of acceptance. It is concluded that acceptance of chronic pain is best conceived of as the shift away from pain to non-pain aspects of life, and the shift away from a search for a cure with an acknowledgement that pain may not change.

Adaptation, Psychological↗
PubMed2002

Central pain: an overview.

Central pain is a particular form of neuropathic pain. Due to lesions in the spinothalamocortical pathways, ectopic neuronal discharges can occur into different neurons of the spinal cord and brain. Functional MRI, and positron emission tomography might be able to visualize ongoing pain activity which is, sometimes the consequence of spinothalamocortical lesions. Sometimes the patient experiences a burning ice-like sensation. This is more frequent in spinal cord lesions than in brain injuries. Some adrenergic, gabergic neurotransmitters, glycine, prostanoids and glutamate may play a role in pain transmission. These transmitters can induce changes in the neuronal membrane potential. Consequently, amitriptyline as an adrenergic reuptake inhibitor and the sodium channel blockers are the drugs of first-choice. A test procedure with placebo, opioids, lignocaine, propofol and ketamine might give some insight into advanced drug treatment. If oral or transdermal drug delivery is not indicated or ineffective, the intrathecal administration route can be attempted with baclofen, clonidine, opioids and midazolam. Invasive electrostimulation is the last treatment option. Thalamic stimulation can be tried in spinal cord injuries, and sensory motor cortex stimulation is sometimes the last resort for brain lesions associated with pain.

Adrenergic Uptake Inhibitors↗
PubMed1996

A case of uncommon withdrawal symptoms after a short period of spinal morphine administration.

A 54-year-old female with chronic failed back surgery syndrome and pain in the back and the right leg was treated by chronic spinal morphine administration by an external pump. After a positive test instillation over a 3-week period the spinal catheter was removed. Within 24 h the patient developed fever, leucocytosis, impaired sense of smell and allodynia and hyperpathia in all 4 limbs. Infection was excluded as a possible cause and a withdrawal after a second test period some weeks later reinitiated the symptoms. The symptoms vanished after restarting the morphine administration. Finally, an internal Medtronic pump was implanted because the patient obtained good pain relief with the test instillation. Good pain relief could be obtained with the daily instillation of 5 mg morphine intrathecally. Fever, leucocytosis, impaired sense of smell, allodynia and hyperpathia in the limbs reappeared a few weeks later. Evaluation showed catheter migration out of the spinal canal.

Analgesics, Opioid↗