Pain
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Randomized Controlled Trial
A shared decision-making approach to taper postoperative opioids in spine surgery patients with preoperative opioid use: a randomized controlled trial.
Persistent opioid use is common after surgery, and patients with preoperative opioid use represent a major challenge in this regard. The aim of this randomized controlled trial was to determine the effect of a personalized opioid tapering plan vs standard of care in patients with a preoperative opioid use undergoing spine surgery at Aarhus University Hospital, Denmark. Postoperative outcomes included opioid use, pain, contacts with the healthcare system, patient satisfaction, and withdrawal symptoms. ⋯ There was no difference in satisfaction with pain treatment over the first 2 weeks or the incidence of withdrawal symptoms during the first month after discharge. Pain intensity was similar between both groups at all time points. These results suggest that a personalized tapering plan at discharge combined with telephone counselling 1 week after discharge assists patients in postoperative opioid tapering.
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It is a common belief that weather affects pain. Therefore, we hypothesized that weather can affect pain tolerance. This study used data from over 18,000 subjects aged 40 years or older from the general population, who participated in the Tromsø Study 7. ⋯ Pressure pain tolerance and CPT correlated with meteorological variables, and these correlations changed over time. Finally, temperature and barometric pressure predicted future values of PPT. These findings suggest that weather has a causal and dynamic effect on pain tolerance, which supports the common belief that weather affects pain.
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Randomized Controlled Trial
Effectiveness of training physical therapists in pain neuroscience education for patients with chronic spine pain: cluster-randomized trial.
Chronic spinal pain poses complex challenges for health care around the world and is in need of effective interventions. Pain neuroscience education (PNE) is a promising intervention hypothesized to improve pain and disability by changing individuals' beliefs, perceptions, and expectations about pain. Pain neuroscience education has shown promise in small, controlled trials when implemented in tightly controlled situations. ⋯ The PNE group demonstrated significant greater improvements in pain self-efficacy at 12 and 2 weeks compared with no intervention (mean difference = 3.65 [95% CI: 0.00-7.29], P = 0.049 and = 3.08 [95% CI: 0.07 to -6.09], P = 0.045, respectively). However, a similar percentage of participants in both control (41.1%) and treatment (44.4%) groups reported having received the treatment per fidelity question (yes or no to pain discussed as a perceived threat) at 2 weeks. Pragmatic PT PNE training and delivery failed to produce significant functional changes in patients with chronic spinal pain but did produce significant improvement in pain self-efficacy over UC PT.
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Randomized Controlled Trial
Validating a biosignature predicting placebo pill response in chronic pain in the settings of a randomized controlled trial.
The objective of this study is to validate a placebo pill response predictive model-a biosignature-that classifies chronic pain patients into placebo responders (predicted-PTxResp) and nonresponders (predicted-PTxNonR) and test whether it can dissociate placebo and active treatment responses. The model, based on psychological and brain functional connectivity, was derived in our previous study and blindly applied to current trial participants. Ninety-four chronic low back pain (CLBP) patients were classified into predicted-PTxResp or predicted-PTxNonR and randomized into no treatment, placebo treatment, or naproxen treatment. ⋯ At a single subject level, the biosignature better predicted placebo nonresponders, with poor accuracy. One component of the biosignature (dorsolateral prefrontal cortex-precentral gyrus functional connectivity) could be generalized across 3 placebo studies and in 2 different cohorts-CLBP and osteoarthritis pain patients. This study shows that a biosignature can predict placebo response at a group level in the setting of a randomized controlled trial.