The Clinical journal of pain
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Review Comparative Study
Complex regional pain syndrome type I: use of the International Association for the Study of Pain diagnostic criteria defined in 1994.
The objective was to assess the reported use in recent publications of the diagnostic criteria for complex regional pain syndrome type I (CRPS I) proposed by the International Association for the Study of Pain (IASP) in 1994. ⋯ If the diagnostic criteria for CRPS I are not used uniformly, the populations in clinical studies may not be uniform either. Whether different authors are describing the same syndrome and whether their findings can be compared is open to question. On the basis of the results of this study, it is concluded that the IASP criteria for CRPS I are poorly used in clinical studies.
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Randomized Controlled Trial Comparative Study Clinical Trial
The treatment of fear of movement/(re)injury in chronic low back pain: further evidence on the effectiveness of exposure in vivo.
Several cognitive-behavioral factors contribute to the persistence of pain disability in patients with chronic back pain. Fear-avoidance beliefs and fear of movement/(re)injury in particular have been shown to be strong predictors of physical performance and pain disability. Patients reporting substantial pain-related fear might benefit from exposure in vivo to a set of individually tailored, fear-eliciting, and hierarchically ordered physical movements rather than more general graded activity. ⋯ Time series analysis of the daily measures showed that improvements in pain-related fear and pain catastrophizing occurred only during the exposure in vivo and not during the graded activity, irrespective of the treatment order. Analysis of the pretreatment to post-treatment differences also revealed that decreases in pain-related fear also concurred with decreases in pain disability and pain vigilance and an increase in physical activity levels. All improvements remained at the 1-year follow-up.
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The pharmacological effects of the opioid analgesics are derived from their complex interactions with three opioid receptor types (mu, delta, and kappa; morphine is an agonist at the mu opioid receptor). These receptors are found in the periphery, at presynaptic and postsynaptic sites in the spinal cord dorsal horn, and in the brain stem, thalamus, and cortex, in what constitutes the ascending pain transmission system, as well as structures that comprise a descending inhibitory system that modulates pain at the level of the spinal cord. ⋯ A number of opioids are available for clinical use, including morphine, hydromorphone, levorphanol, oxymorphone, methadone, meperidine, oxycodone, and fentanyl, and their advantages and disadvantages for the management of pain are discussed. An understanding of the pharmacokinetic properties, as well as issues related to opioid rotation, tolerance, dependence, and addiction are essential aspects of the clinical pharmacology of opioids for pain.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of multiple against single pain intensity measurements in complex regional pain syndrome type I: analysis of 54 patients.
To describe the comparison of multiple and single pain ratings in patients with complex regional pain syndrome type I (CRPS I). ⋯ In patients with CRPS I a single pain rating is an accurate predictor of the average pain measured by a multiple pain-rating test. Moreover, both assessments are accurate enough to determine changes in pain over time with an effective treatment.
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The purpose of this article is to provide a review of the prevalence, assessment, and treatment of common psychiatric disorders found among patients with opioid dependence. Dependence on opioids can include both persons who are physically dependent on opioids and persons who fulfill the criteria for a syndrome of opioid dependence, such as that found in the Diagnostic and Statistical Manual, fourth edition (DSM-IV). The latter grouping of persons typically abuse illicit opioids, and prevalence of comorbid conditions and approaches in diagnosis and treatment have been studied in these patients. ⋯ When evaluating and planning treatment of opioid-dependent patients with concurrent psychiatric symptoms, it is important to determine if such symptoms are independent of the substance use or substance induced. In the former case, treatment should follow routine clinical practice, whereas in the latter case, treatment stability in substance use should be the first therapeutic step. The presence of a pain condition can further complicate assessment and treatment, as either pain itself or treatments used for pain may produce symptoms that overlap with psychiatric disorders.