Pain
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Randomized Controlled Trial Comparative Study Clinical Trial
Does acupuncture improve the orthopedic management of chronic low back pain--a randomized, blinded, controlled trial with 3 months follow up.
This prospective, randomised controlled trial, with three parallel groups, patient and observer blinded for verum and sham acupuncture and a follow up of 3 months raises the question: "Does a combination of acupuncture and conservative orthopedic treatment improve conservative orthopedic treatment in chronic low back pain (LBP). 186 in-patients of a LBP rehabilitation center with a history of LBP >or=6 weeks, VAS >or=50mm, and no pending compensation claims, were selected; for the three random group 4 weeks of treatment was applied. 174 patients met the protocol criteria and reported after treatment, 124 reported after 3 months follow up. Patients were assorted 4 strata: chronic LBP,
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Gabapentin in neuropathic pain syndromes: a randomised, double-blind, placebo-controlled trial.
A double-blind, randomised, placebo-controlled 8-week study was conducted to evaluate the efficacy and safety of gabapentin in the treatment of neuropathic pain, using doses up to 2400 mg/day. The study used a novel design that was symptom- rather than syndrome-based; an approach that aimed to reflect the realities of clinical practice. Participants had a wide range of neuropathic pain syndromes, with at least two of the following symptoms: allodynia, burning pain, shooting pain, or hyperalgesia. ⋯ Gabapentin was well tolerated and the majority of patients completed the study (79 versus 73% for placebo). The most common adverse events were mild to moderate dizziness and somnolence, most of which were transient and occurred during the titration phase. This study shows that gabapentin reduces pain and improves some quality-of-life measures in patients with a wide range of neuropathic pain syndromes.
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Meta Analysis Comparative Study
A comparison of placebo effects in clinical analgesic trials versus studies of placebo analgesia.
A previous meta-analysis of clinical analgesic trial studies showed generally low magnitudes of placebo analgesia (N. Engl. J. ⋯ This difference as well as differences in effect sizes within studies of placebo mechanisms may be parsimoniously explained by differences in expected pain levels produced by placebo suggestions and by conditioning. Furthermore, some of the studies of placebo analgesic mechanisms indicate that the magnitude of placebo analgesia is higher when the placebo analgesic effect is induced via suggestion combined with conditioning than via suggestion alone or conditioning alone. Based on these findings, we suggest that placebo analgesic effects are most optimally conceptualized in terms of perception of the placebo agent, and therefore a new definition of placebo response is proposed.
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Comparative Study
Catastrophizing is related to pain ratings, but not nociceptive flexion reflex threshold.
Catastrophizing is reliably associated with increased reports of clinical and experimental pain. To test the hypothesis that catastrophizing may heighten pain experience by increasing nociceptive transmission through spinal gating mechanisms, the present study examined catastrophizing as a predictor of pain ratings and nociceptive flexion reflex (NFR) thresholds in 88 young adult men (n=47) and women (n=41). The NFR threshold was defined as the intensity of electrocutaneous sural nerve stimulation required to elicit a withdrawal response from the biceps femoris muscle of the ipsilateral leg. ⋯ Pain catastrophizing was assessed using the catastrophizing subscale of the coping strategies questionnaire (CSQ). Although catastrophizing was positively related to both NRS and SF-MPQ pain ratings, catastrophizing was not significantly related to NFR threshold. These findings suggest that differential modulation of spinal nociceptive input may not account for the relationship between catastrophizing and increased pain.
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This study investigated dimensions of chronic pain and temporomandibular disorders (TMDs) in a census tract sampling of African-American and Caucasian young women enrolled (from racially congruent households) at ages 9-10 in the longitudinal multicenter National Heart Lung and Blood Institute's Growth and Health Study (NGHS). The present study, which examined participants at the California clinical NGHS center when they were 19-23 years old, investigates five commonly reported chronic pains: back, head, face/jaw, abdomen, and chest. Chronic pain grade (CPG) status based on pain self-reports (frequency, duration, severity, and interference with usual activities) is reported for each of the five pain sites. ⋯ Racial differences were not found for back, head, abdomen or chest pains. However, significant racial differences were found regarding facial pain and symptoms related to TMDs above and beyond socioeconomic status (SES) (lifetime prevalence: adjusted odds ratio (aOR)=2.14 and 95% confidence interval (CI)=1.40-3.31; 6 month period prevalence: aOR=2.03 and 95% CI=1.16-3.64). Not only were facial pain and jaw symptoms reported more frequently by Caucasians compared to African-Americans controlling for SES, but they were also reported to have an earlier onset.