The Clinical journal of pain
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Randomized Controlled Trial Comparative Study Clinical Trial
The utility of comparative local anesthetic blocks versus placebo-controlled blocks for the diagnosis of cervical zygapophysial joint pain.
The development of target-specific local anesthetic blocks has enabled pain physicians to explore the anatomical source of chronic spinal pain. However, such blocks rely on subjective responses and may be subject to the placebo effect. Comparative local anesthetic blocks have been advocated as a means of identifying true-positive cases and excluding placebo responders. This paradigm employs two local anesthetics with different durations of action; only patients who obtain reproducible relief and correctly identify the longer-acting agent are considered positive. ⋯ Whether physicians use comparative or placebo-controlled blocks depends upon the implications of their results. If innocuous therapy will be prescribed, comparative blocks might suffice. However, when diagnostic certainty is critical, such as in a medicolegal context or when surgical intervention is contemplated, placebo-controlled blocks are recommended.
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Clinical Trial Controlled Clinical Trial
Do changes in patient beliefs and coping strategies predict temporomandibular disorder treatment outcomes?
This study examined the applicability of the cognitive-behavioral model for temporomandibular disorders (TMD) by determining whether changes in TMD patient pain-related beliefs and coping over the course of treatment related to improvement in symptoms and disability and whether patients' posttreatment beliefs and coping predicted future pain and functioning. ⋯ Pretreatment to 3-month follow-up changes in beliefs and coping are associated modestly with TMD patient improvement after conservative dental treatment with and without a brief cognitive-behavioral intervention. Research is needed to develop interventions that produce greater decreases in disease conviction, passive coping, and perceived inability to control pain and to determine whether these changes mediate symptom and disability improvement.
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Very little is known about the cues parents use to assess pain in their children. This study has described the cues (verbal and nonverbal) parents reported using to determine how their children felt following surgery. ⋯ Parents frequently cited using verbal report and appetite as cues to how their children were feeling. A variety of other cue types were also reported by parents, including activity level, sleep quality, visible/audible discomfort, and physiological observations. Cue types were not significantly related to the child's gender, and only one cue type was significantly related to the child's age (appetite was used more often for older children than younger children). The presence or absence of illness behavior cues (e.g., protective behavior, visible/audible discomfort) as well as disruptions to normal behavior pattern cues (e.g., sleep, level of activity) was related, in the expected direction, to the pain intensity ratings. This study provides insights into the cues parents use to assess pain in their children and serves as a foundation for future studies on parents' assessment of children's pain.
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The purpose of this study was to investigate the effects of continuous epidural blockade on acute zoster-associated pain, compared with intermittent epidural blocks. ⋯ Continuous epidural blockade for patients with acute zoster can shorten the duration of treatment and may reduce the incidence of postherpetic neuralgia.