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Biomedical subjects

Peter Svensson

Publications and source records attributed to Peter Svensson.

At least 37 records · Page 2Linked to original sources
PubMed2005

Recurrence rate after a first venous thrombosis in patients with familial thrombophilia.

OBJECTIVE: Few comprehensive data are available on the recurrence rate of venous thrombosis in carriers of thrombophilic defects from thrombophilic families. We prospectively determined the recurrence rate after a first venous thrombotic event in patients with familial thrombophilia attributable to factor V Leiden or deficiencies of protein C, S, or antithrombin. METHODS AND RESULTS: Data were gathered during follow-up on the occurrence of risk situations, anticoagulation treatment, and events (eg, venous thrombosis, hemorrhage). Over a mean follow-up period of 5.6 years, 44 of the 180 patients with familial thrombophilia who did not use long-term anticoagulation experienced a recurrent venous thromboembolic event (5.0%/year; 95% CI 3.6 to 6.7) compared with 7 of the 124 patients on long-term anticoagulation (1.1%/year; 95% CI 0.4 to 2.2). Spontaneous events occurred less often in patients on long-term anticoagulation (57%) than in patients without long-term anticoagulation (75%). The highest recurrence rate was found among men with a deficiency in natural anticoagulants or multiple defects and women with antithrombin deficiency. Although long-term anticoagulation treatment decreased the incidence of recurrent events by 80%, it also resulted in a risk of major hemorrhage of 0.8% per year. CONCLUSIONS: Extra care after a first event is required for men with a deficiency in natural anticoagulants or multiple defects and women with antithrombin deficiency.

Adolescent↗
PubMed2005

Exteroceptive suppression periods in masseteric EMG: Use of stimulus-response curves.

The present study documented quantitative changes in the duration and the depth of the exteroceptive suppression (ES) period in the masseteric electromyogram (EMG) using stimulus-response (SR) curves. From six males and six females (20-41 years), the surface masseteric EMG was recorded bilaterally. Visual feedback from the left masseter muscle (MM) allowed a constant clenching level of 30% or 50% maximal voluntary contraction (MVC). Automatic triggering of the stimulus to the left mental nerve occurred when the background EMG remained constant. Eight to twelve stimulus intensities (range, 0-40 mA) were determined based on the subjects' sensory threshold (T). The late ES (ES2) occurred consistently and could be analyzed using SR curves. ES2 in the right MM appeared at 7.3+/-3.1T at 30% MVC, while it was significantly decreased to 5.2+/-2.2T at 50% MVC (P<0.05). The depth of ES2 suppression in the left MM was 69.7+/-5.7% at 30% MVC, and this increased significantly to 76.6+/-5.5% at 50% MVC (P<0.05). In addition, the depth of ES2 suppression in the left MM was significantly higher than that in the right MM at 50% MVC (70.0+/-7.4%, P<0.05). Consequently, it was confirmed that both the appearance and depth of ES may be affected by the level of background EMG. More importantly, the use of multiple stimulation intensities allowed development of reliable SR curves. These SR curves may be used to determine inter-individual differences in ES.

Adult↗
PubMed2005

Effect of experimental posterior temporalis muscle pain on human brainstem reflexes.

OBJECTIVE: To study the modulation of jaw-stretch and blink reflexes by experimental posterior temporalis muscle pain. METHODS: Thirty healthy volunteers (15 males, 25.5+/-0.6 years and 15 females, 27.4 +/- 1.2 years) were included. Short-latency stretch reflex responses were evoked in the masseter and temporalis muscles by fast stretches (1 mm displacement, 10 ms ramp time) and the blink reflexes were evoked by painful electrical pulses (0.5 ms duration), delivered by a concentric electrode placed on the left lower forehead close to the supraorbital foramen before, during and 15 min after a period with experimentally induced muscle pain. RESULTS: The normalized peak-to-peak amplitude of the stretch reflex in the painful temporalis was significantly higher during pain in both males and females compared with pre- and post-pain conditions (P < 0.004). The R2 root mean square (RMS) of the blink reflex decreased significantly during muscle pain as compared to the pre-pain (P < 0.03) in both males and females. CONCLUSIONS: The present results indicated that experimental posterior temporalis muscle pain facilitates the jaw-stretch reflex, whereas the nociceptive specific blink reflex is inhibited. SIGNIFICANCE: Present study suggested that these reflexes are suitable models for probing pontine and medullary pain processing.

Adult↗
PubMed2005

Lack of sex differences in modulation of experimental intraoral pain by diffuse noxious inhibitory controls (DNIC).

The aims of this study were to investigate possible sex differences in (a) intraoral pain evoked by topical application of capsaicin to the gingiva, and (b) the modulation of this pain by diffuse noxious inhibitory controls (DNIC). Three groups with a total of fifty-four healthy volunteers (20 men, 20 women using oral contraceptives (W+OC), 14 women not using (W-OC)) completed the study. In two sessions, intraoral pain was evoked by topical application of 30microL 5% capsaicin to the gingiva. Conditioning stimuli were applied with three min hand immersion in ice water in one session and 30 degrees C water (control) in another session. The capsaicin-evoked pain and the water-evoked pain were evaluated by the participants on visual analogue scales (VAS). No main effects of group in capsaicin-evoked pain (P>0.062) or water-evoked pain (P>0.149) were found. There was a significant group x time interaction (P<0.001) with W+OC reporting lower capsaicin-evoked pain scores than W-OC in the early phase (2-3min) and lower pain scores than men in the later phase (5-11min). The degree of modulation by DNIC did not differ between groups (P=0.636). In conclusion, for a superficial type of intraoral pain, only minor sex differences were found in pain intensity and no differences in the degree of endogenous modulation by DNIC. Female sex and the use of OC may not consistently be associated with higher sensitivity to pain.

Adult↗
PubMed2005

Pain effects of glutamate injections into human jaw or neck muscles.

AIMS: To document and compare the intensity, localization, and quality of pain evoked by glutamate injections into the human masseter or splenius muscles and to determine the effect of glutamate-evoked pain on the pressure pain thresholds (PPTs) in both jaw and neck muscles. METHODS: Twenty-six healthy men were given painful injections of glutamate (1.0 mol/L) and control injections of isotonic saline (0.165 mol/L) into the masseter and splenius muscles. The subjects rated the perceived intensity of pain on a visual analog scale (VAS), drew the area of the pain on maps of the face and neck, and filled out a Danish version of the McGill Pain Questionnaire (MPQ). PPTs were used to assess the sensitivity of the masseter and splenius muscles to mechanical stimuli (n = 11). RESULTS: Glutamate injection into the masseter or splenius evoked pain lasting almost 10 minutes. Peak pain intensity usually occurred within 2 minutes of the injection, and VAS scores of peak pain were significantly higher for the masseter muscle compared with the splenius muscle (paired t test, P = .003). The pain area from the masseter injections did not extend into the neck region, although in some subjects the pain from the neck region extended into the temporal region. There were no significant relationships between the area of perceived pain and the VAS pain scores (Pearson correlation, P > .297). Glutamate-evoked pain in either the masseter or splenius muscles was associated with significant decreases in masseter or splenius PPTs, respectively (2-wayANOVAs, P < .016). Isometric saline injections were almost pain-free and caused no PPT changes. CONCLUSION: The data suggest that the masseter muscle is more sensitive to glutamate injections and mechanical stimuli than the splenius muscle. The relatively limited overlap between the sensory manifestations of pain from masseter and splenius muscles may have potential implications for diagnosis and management of myofascial pain complaints in the craniofacial and neck region.

Adult↗
PubMed2005

Blink reflexes in patients with atypical odontalgia.

AIMS: To use the human blink reflex (BR) to explore possible neuropathic pain mechanisms in patients with atypical odontalgia (AO). METHODS: In 13 AO patients, the BR was elicited using a concentric electrode and recorded bilaterally with surface electromyographic (EMG) electrodes on both orbicularis oculi muscles. Electrical stimuli were applied to the skin above branches of the V1, V2, and V3 nerves and to the V branch contralateral to the painful branch. Sensory and pain thresholds were determined. The BR examination of the painful V branch was repeated during a capsaicin pain-provocation test. The data were analyzed with nonparametric statistics. RESULTS: The BR responses (R2 and R3) evoked by stimulation of V3 were significantly smaller than the BR responses evoked by stimulation of V1 and V2 (P < .004). There were no differences in BR (R2 or R3) between the painful and nonpainful sides (P > .569), and the BR (R2 and R3) was not significantly modulated by experimental pain (P > .080). The sensory thresholds were significantly lower on the painful side compared to the nonpainful side (P = .014). The pain thresholds were not different between sides (P > .910). CONCLUSION: No major differences between the V nociceptive pathways on the right and left sides were found in a relatively small group of AO patients. Future studies that compare BRs in AO patients and healthy volunteers are needed to provide further knowledge on the pain mechanisms in AO.

Adult↗
PubMed2004

Simultaneous modulation of the exteroceptive suppression periods in the trapezius and temporalis muscles by experimental muscle pain.

OBJECTIVE: To investigate whether the exteroceptive suppression (ES) periods in the trapezius and temporalis muscles could be simultaneously modulated by either experimental trapezius muscle pain or temporalis muscle pain. METHODS: Fourteen healthy volunteers participated in two sessions with randomised injections of either hypertonic or isotonic saline into the right trapezius muscle or right temporalis muscle. The pain intensity was continuously scored on a 10 cm electronic visual analogue scale. During muscle contraction, the early (ES1) and late (ES2) reflex in the temporalis and late (ES2) reflex in the trapezius elicited by electrical stimulation of the right infraorbital nerve were recorded pre-, during-, and post-injection. RESULTS: Hypertonic saline injection induced local muscle pain and referred pain with the maximal pain intensity of 6.3+/-0.5 cm in the right trapezius and 6.7+/-0.6 cm in the right temporalis muscles. Injection of either hypertonic or isotonic saline into the right trapezius muscle was associated with significantly shortened ES2 duration and offset time in the injected right trapezius muscle. Only injection of hypertonic saline into the right trapezius muscle could significantly reduce the ES2 offset time and decrease the degree of suppression of ES2 in the right temporalis and left trapezius muscles. Injection of either hypertonic or isotonic saline into the right trapezius muscle evoked no changes in ES2 parameters in the left temporalis muscle. Injection of hypertonic saline, but not isotonic saline, into the right temporalis muscle caused a significantly shorter ES2 offset time and shorter ES2 duration bilaterally in the temporalis and trapezius muscles. CONCLUSIONS: The findings of the present study provide evidence for a bi-directional effects reflecting convergence of muscle afferents from the trigeminal and upper cervical neural systems in humans, which may partly underlie the manifestations of pain referral between these two areas.

Adult↗
PubMed2004

Comparative EEG activation to skin pain and muscle pain induced by capsaicin injection.

Skin pain differs from muscle pain in quality and affective dimension, but it is unknown how the brain processes the nociceptive inputs from skin and muscle differently. To delineate the differential effects of nociceptive inputs from skin and muscle, the EEG topography and power spectra were analysed on the basis of two databases acquired from two separate studies regarding skin (Neurosci. Lett. 305 (2001b) 49) and muscle pain (Exp. Brain Res. 141 (2001c) 195). The same experimental protocol was applied to the same subject-group in the two separate experiments. In the two independent experiments, skin pain and muscle pain were, respectively, induced by intracutaneous and intramuscular injection of capsaicin in the left forearm. Visual analogue scale (VAS) and EEG data acquired before, during the vehicle and capsaicin injections were quantitatively compared. The results showed that the VAS profiles for skin and muscle pain are highly similar in spite of distinct qualities perceived. Skin pain produced a similar but not identical EEG topographic pattern as muscle evoked. Muscle pain induced a significant increase of beta-2 activity in the extensive frontal, parietal and occipital areas compared to skin pain. No difference was found between the vehicle-induced non-painful sensations in skin and muscle. These results implicate that the nociceptive inputs from muscle and skin are processed differently in the similar neural matrix of the brain.

Adult↗
PubMed2004

Central representation of muscle pain and mechanical hyperesthesia in the orofacial region: a positron emission tomography study.

Functional neuroimaging studies of the human brain have revealed a network of brain regions involved in the processing of nociceptive information. However, little is known of the cerebral processing of pain originating from muscles. The aim of this study was to investigate the cerebral activation pattern evoked by experimental jaw-muscle pain and its interference by simultaneous mechanical stimuli, which has been shown to evoke hyperesthesia. Ten healthy subjects participated in a PET study and jaw-muscle pain was induced by bolus injections of 5% hypertonic saline into the right masseter muscle. Repeated von Frey hair stimulation (0.5 Hz) of the skin above the masseter muscle was used as the mechanical stimulus. Hypertonic saline injections caused strong muscle pain spreading to adjacent areas. von Frey stimulation was rated as non-painful but produced hyperesthesia during jaw-muscle pain. Jaw-muscle pain was associated with significant increases in regional cerebral blood flow (rCBF) in the dorsal-posterior insula (bilaterally), anterior cingulate and prefrontal cortices, right posterior parietal cortex, brainstem, cavernous sinus and cerebellum. No rCBF changes occurred in primary or secondary somatosensory cortices. In contrast, von Frey stimulation produced a significant rCBF increase in the contralateral SI face representation. Mechanical hyperesthesia was associated with significant rCBF increases in the subgenual cingulate and the ventroposteromedial and dorsomedial thalamus. These results suggest that the cerebral processing of jaw-muscle pain may differ from the processing of cutaneous pain and that mechanical hyperesthesia, which often is encountered in clinical cases, has a unique representation in the brain.

Adult↗
PubMed2004

Associations between pain and neuromuscular activity in the human jaw and neck muscles.

The aim of this study was to test the effects of glutamate-evoked jaw or neck muscle pain on electromyographic (EMG) activity of jaw and neck muscles in humans. EMG recordings were made from left (MAL) and right (MAR) masseter muscles, and right sternocleidomastoid (SCM) and splenius (SP) muscles in three different head positions (head rest, head back, head right) or during maximal jaw clenching in 19 men. Glutamate (1 M) or isotonic saline was injected into MAR or SP, and induced pain was recorded on visual analogue scales. EMG activity in MAL and MAR was increased in the head back position compared to head rest and head right positions, whereas EMG activity in SCM and SP was progressively increased as the head was moved from rest position to head back to head right positions. Glutamate-evoked MAR pain was associated with increases in EMG activity in MAR, SCM and SP at rest but not in the head back or head right positions. Glutamate-evoked SP pain was associated with an increase in SP EMG activity at rest and a decrease in SCM EMG activity in the head right position. Decreases in jaw clench-related EMG activity were observed in MAL, MAR and SCM muscles only during glutamate-evoked MAR pain. Isotonic saline injections induced no pain or EMG changes. In conclusion, experimental neck pain is not associated with tonic increases in jaw EMG activity although jaw muscle pain can be linked to increases in neck EMG activity with the head and jaw at rest.

Adult↗
PubMed2004

Comparison between CoaguChek S- and Owren-type prothrombin time assay for monitoring anticoagulant therapy.

INTRODUCTION: Anticoagulation therapy with warfarin is monitored by the prothrombin time (PT) assay. The PT is standardized using international normalized ratios (INRs). By keeping the INR within specific values, it is possible to reduce potential complications from the treatment. To facilitate the PT monitoring, point-of-care devices suitable for capillary whole blood measurements have been developed. The aims of this study were to compare the INR values obtained by such a device, CoaguChek S, with those obtained from the Owren-type PT assay and to evaluate the differences seen. MATERIALS AND METHODS: In 351 consecutive warfarin-treated patients, INR was measured in capillary whole blood samples with CoaguChek S and was compared to venous plasma samples analyzed with the Owren PT method. Sixty-nine of these patients, including those deviating the most between the methods, were further evaluated according to levels of factor II (prothrombin), factor V, factor VII, factor X, fibrinogen, activated partial thromboplastin time (aPTT) and antiphospholipid antibodies. RESULTS: The results from CoaguChek S produced a correlation coefficient of 0.81 to the Owren-type PT assay and a concordance of 85.2%. Factor V and fibrinogen correlated significantly (p<0.05) to the degree of deviation between the methods. The presence of antiphospholipid antibodies did not influence the degree of deviation between the two methods. CONCLUSIONS: INR analysis of whole blood with CoaguChek S is comparable with INR measured in plasma with Owren chemistry. The activities of factor V and fibrinogen contribute to the deviation seen between the methods. Differences in sensitivity to antiphospholipid antibodies could not be demonstrated.

Anticoagulants↗
PubMed2004

Reduction of clinical temporomandibular joint pain is associated with a reduction of the jaw-stretch reflex.

AIMS: To examine the jaw-stretch reflex after injection of local anesthetic (LA) into painful temporomandibular joints (TMJs), since the functional role of jaw-stretch reflexes in patients with painful temporomandibular disorders is still not well understood. METHODS: Thirteen female patients with a clinical diagnosis of disc displacement without reduction and TMJ pain participated in this open study. Reflex responses were evoked by fast stretches at 15% of the maximal voluntary contraction level before and after injection of 1 mL carbocaine into the painful TMJ. Electromyographic (EMG) activity was recorded from the left and right masseter and temporalis muscles, and the mean level of prestimulus EMG activity and peak-to-peak amplitude of the stretch reflex were measured. Visual analog scale ratings of TMJ pain and TMJ pressure pain thresholds (PPTs) were also obtained. Eleven healthy women were examined with the same protocol (except for PPT determinations) before and after injection of LA into the TMJ. RESULTS: In patients, injection of LA reduced the TMJ pain during jaw movements and maximum clenching (P < .021) and increased the PPTs in the painful TMJ (P < .01). The prestimulus EMG activity in the masseter on the painful side (feedback muscle) was unaffected by the injection of LA (P > .262). There were no significant side-to-side asymmetries of latency or amplitude measures of the stretch reflex in the patient group. Both the peak-to-peak amplitude and the normalized peak-to-peak amplitude of the stretch reflex were reduced in the masseter and temporalis muscles on the painful side and in the masseter on the nonpainful side after LA injections (P < .048). There were no effects of LA injections into the TMJ in the healthy group on any EMG or stretch parameters. CONCLUSION: These results do not support the notion of asymmetries in the jaw-stretch reflex in patients with TMJ pain, but they do suggest that the reflex sensitivity can be influenced by nociceptive activity from the TMJ area.

Adult↗
PubMed2004

Topical review: new insights into the pathology and diagnosis of disorders of the temporomandibular joint.

The collection of conditions affecting the temporomandibular joint (TMJ) and masticatory muscles, the so-called temporomandibular disorders, can be classified according to the Research Diagnostic Criteria for Temporomandibular Disorders. Of the 3 subgroups--muscle disorders (Group I); disc displacements (Group II); and arthralgia, arthritis, and arthrosis (Group III)--the muscle disorders are most frequently seen in community samples; Group II and Group III diagnoses are less prevalent. This may explain the relative scarcity of studies involving intracapsular TMJ disorders. In this review, new insights into the functional anatomy, imaging, and pathology of disorders of the TMJ are presented. Studies of TMJ dynamics may provide insight into the functional anatomy of the TMJ and thereby into the consequences of Group II and Group III disorders. The clinical use of imaging modalities such as computed tomography and magnetic resonance imaging for the TMJ and related structures remains controversial. Nevertheless, imaging is regularly used in the diagnosis of some Group II and Group III disorders. Magnetic resonance imaging may be of use not only for the visualization of disc displacements but also for the study of bone mineral density of the condyle. Cytokines such as interleukin-1 (IL-1) and tumor necrosis factor alpha (TNFalpha) play an important role in TMJ pathology. For example, IL-1beta, which has been associated with TMJ pain, hyperalgesia, and anterior bite opening, is mostly absent in the synovial fluid of healthy joints. Since both IL-1 and TNFalpha are involved in the development of chronic pain and joint destruction, they may be the targets for specific treatments. While the advances reviewed in this paper are significant, multidisciplinary efforts and formation of international research collaborations will be necessary to continue advancement in the understanding of TMJ pathology and diagnosis.

Arthralgia↗
PubMed2004

Overview on tools and methods to assess neuropathic trigeminal pain.

This article provides a brief overview of the tools and methods that may be useful to assess neuropathic trigeminal pain. Pain is a complex multidimensional and biopsychosocial experience. While the assessment of neuropathic trigeminal pain is complex, there are several meaningful ways available for the systematic assessment of neuropathic pain and its effects and manifestations. The key to such an analysis is a standardized pain history and examination and a good knowledge of pain mechanisms. Patients can be asked to provide detailed information about their spontaneous pain (ie, stimulus-independent pain), eg, quality, intensity, localization, time course, and modifying factors. Stimulus-dependent pain components can be characterized with clinical examination procedures and quantitative psychophysical techniques such as application of mechanical, thermal, chemical, and electrical stimuli. The description of the stimulus-dependent pain is important to reveal the function of the somatosensory system and to map the extent of hyperalgesia, hyperesthesia and allodynia, because the normal relationship between stimulus intensity and perceived intensity is distorted in many neuropathic pain conditions. In addition to the psychophysical techniques, a number of laboratory tests for assessment of trigeminal pain have been developed and tested, although critical information on sensitivity, specificity, and predictive values is still scarce. There is also a need for common guidelines on classification, diagnostic procedures, and management. This will require concerted international, interdisciplinary action.

Cranial Nerve Injuries↗
PubMed2003

Plasticity in corticomotor control of the human tongue musculature induced by tongue-task training.

Transcranial magnetic stimulation (TMS) has been used to assess characteristics of the corticomotor control of the jaw muscles, but less is known about the cortical control of the human tongue and its modification by training. The aim of the present study was to determine the effect of training humans in a novel tongue-protrusion task for 1 week on corticomotor excitability as assessed by changes in electromyographic activity elicited in the tongue musculature by TMS, and in the tongue cortical motor map revealed by TMS. Eleven healthy subjects participated. Stimulus-response curves were generated from the motor evoked potentials (MEPs) recorded in the tongue musculature and, from the first dorsal interosseos (FDI) muscle as a control, at three time periods: at baseline, immediately after the 1-week training period, and at 2-weeks follow-up. In addition, the corticomotor representations of the tongue and FDI muscles were mapped on a 1 x 1 cm scalp grid. The tongue-training task required each subject to protrude the tongue onto a force transducer placed in front of the subject, and consisted of a relax-protrude-hold-relax cycle lasting 12.5 s with 1 N as the target at the hold phase. The subjects repeated this task for 60 min every day for 1 week. All subjects reported moderate levels of fatigue in the tongue during the first training day; however, these subjective reports decreased during the week (ANOVA P<0.001), and the subjects showed a progressive increase in their ability to perform the task successfully ( P<0.001). The threshold for evoking MEPs by TMS in the tongue musculature was significantly decreased after the last training day compared with baseline and the 2-weeks follow-up ( P<0.001). The amplitude of the MEPs in the tongue musculature was significantly increased at higher intensities of TMS after the last training day but returned to baseline values at the 2-weeks follow-up (P = 0.005). No significant effect of the training on MEPs in the FDI was observed (P = 0.493). Analysis of the corticomotor topographic maps revealed a significant ( P<0.05) increase in excitability and, hence, the cortical area from which TMS could evoke MEPs in the tongue, although the center of gravity representation for the tongue or FDI muscles remained stable. The present findings suggest that a specific and reversible plasticity of the corticomotor excitability related to tongue muscle control can be induced when humans learn to perform successfully a novel tongue task.

Adult↗
PubMed2003

Activation of peripheral NMDA receptors contributes to human pain and rat afferent discharges evoked by injection of glutamate into the masseter muscle.

Peripheral N-methyl-d-aspartate (NMDA) receptors are found in deep tissues and may play a role in deep tissue pain. Injection of the endogenous NMDA receptor agonist glutamate into the masseter muscle excites deep craniofacial afferent fibers in rats and evokes pain in human subjects. It is not clear whether peripheral NMDA receptors play a role in these effects of glutamate. Accordingly, the effect of NMDA on afferent activity as well as the effect of locally administered NMDA receptor antagonists on glutamate-evoked afferent discharges in acutely anesthetized rats and muscle pain in human subjects was examined. Injection of NMDA into the masseter muscle evoked afferent discharges in a concentration-related manner. It was found that the NMDA receptor antagonists 2-amino-5-phosphonvalerate (APV, 10 mM), ketamine (10 mM), and dextromethorphan (40 mM) significantly decreased glutamate-evoked afferent discharges. The effects of APV and ketamine, but not dextromethorphan, were selective for glutamate-evoked afferent discharges and did not affect hypertonic saline-evoked afferent discharges. In human experiments, it was found that 10 mM ketamine decreased glutamate-evoked muscle pain but had no effect on hypertonic saline-evoked muscle pain. These results indicate that injection of glutamate into the masseter muscle evokes afferent discharges in rats and muscle pain in humans in part through activation of peripheral NMDA receptors. It is conceivable that activation of peripheral NMDA receptors may contribute to masticatory muscle pain and that peripherally acting NMDA receptor antagonists could prove to be effective analgesics for this type of pain.

Adult↗