The Clinical journal of pain
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Randomized Controlled Trial Comparative Study Clinical Trial
Effectiveness of virtual reality-based pain control with multiple treatments.
The current study explored whether immersive virtual reality continues to reduce pain (via distraction) with repeated use. ⋯ Although the small sample size limits generalizability. results provide converging preliminary evidence that virtual reality can function as a strong nonpharmacological pain reduction technique for burn patients during physical therapy. Results suggest that virtual reality does not diminish in analgesic effectiveness with three (and possibly more) uses. Virtual reality may also have analgesic potential for other painful procedures or pain populations. Practical implications are discussed.
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The objective of this article is to provide a brief overview of the major psychosocial risk factors impacting recovery from spine surgery. ⋯ Presurgical psychological screening should be included in the medical diagnostic process of spine surgery candidates, especially when the major goal is pain reduction, or when the surgeon recognizes the existence of psychosocial risk factors. Suggestions for future directions in the development of presurgical psychological screening procedures are also given.
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Advances in neurobiology serve as the basis for current and evolving implantable pain modalities, consisting of neurostimulation and neuraxial drug administration systems. Appropriate treatment of pain begins with an accurate diagnosis based on thorough physical and behavioral evaluations. ⋯ Patients with chronic pain are subject to neurophysiological, emotional, and behavioral influences that govern their perception of pain and of pain relief. Therefore, treatment of chronic pain is multidisciplinary, drawing on cognitive and behavioral psychological therapies, functional rehabilitation, orthopedic and neurologic surgery, medications, nerve blockade, neuroaugmentative procedures, and sometimes neurodestructive procedures. Appropriate selection of patients helps ensure that implantable therapies are used for those who are most likely to benefit.
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The specific use of psychological screenings to determine appropriateness for lumbar discectomy surgery and predict outcomes is not well understood. Data from spine surgery as a whole are not likely generalizable to the patient with a significant disc herniation considering surgery. As opposed to most "back pain syndromes," acute and subacute sciatica from disc hemiation has a very high chance of dramatic and lasting improvement with surgery. ⋯ However, the same psychometric profile in those patients with chronic sciatica pain and disability does predict worse outcomes compared with chronic pain in less emotionally distressed patients. The data suggest that the ability to rapidly relieve pain in the case of disc herniation may limit the morbid effects of psychological distress seen in many back pain syndromes. With prolonged pain and emotional distress, however, adverse and possibly self-perpetuating psychological and social changes may significantly decrease the impact of disc surgery.
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Comparative Study
A comparison of blacks and whites seeking treatment for chronic pain.
Most conceptualizations of chronic pain acknowledge the importance of culture and social circumstances. Cultural and social influences may differ for persons of different racial or ethnic groups, and this circumstance may lead them to experience and adjust differently to pain. The current study compared adjustment to chronic pain by blacks and whites seeking treatment for chronic pain. ⋯ These results show that blacks and whites with chronic pain experience pain differently. Several factors may underlie these differences, including family situation, health care experiences, or other unmeasured behavioral, environmental, or social influences. Other investigators should attempt to replicate these findings and more closely examine variables that may explain them.