The Clinical journal of pain
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Randomized Controlled Trial Comparative Study Clinical Trial
Pain on injection of propofol: the effect of granisetron pretreatment.
To assess the effect of granisetron pretreatment in alleviating propofol injection pain. ⋯ Granisetron pretreatment may be used to reduce the incidence of pain on injection of propofol, an advantage added to the useful prevention of postoperative nausea and vomiting.
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Clinical Trial
Challenges to early prevention and intervention: personal experiences with adherence.
To describe potential adherence-related difficulties encountered in the implementation of a secondary prevention, early intervention study with acute low back pain patients. An additional goal is to provide recommendations, based on the authors' experience, on how best to overcome these potential obstacles for future research. ⋯ Potential difficulties are discussed in the contextual framework of treatment adherence and factors affecting it, including the impact of personality factors, satisfaction, comprehension, side effects, financial issues, length of treatment, type of regimen, social issues, patient beliefs, and biologic factors. It is hoped that the present authors' experience will enable future investigators to anticipate these common problems, and structure their research endeavors accordingly.
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To test the predictive utility of the Orebro Musculoskeletal Pain Screening Questionnaire in identifying patients at risk for developing persistent back pain problems. ⋯ The results underscore that psychological variables are related to outcome 6 months later, and they replicate and extend earlier findings indicating that the Orebro Screening Questionnaire is a clinically reliable and valid instrument. The total score was a relatively good predictor of future absenteeism due to sickness as well as function, but not of pain. The results suggest that the instrument could be of value in isolating patients in need of early interventions and may promote the use of appropriate interventions for patients with psychological risk factors.
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The causes of prolonged disability due to back pain are multiply determined, involving medical, social, and environmental factors. Possible solutions to the problem of prolonged back pain disability have emerged from recent research but few efforts have been made to transfer evidence-based programs to large community settings. ⋯ Phase A: Based on literature review and expert knowledge, the Sherbrooke model was developed and assessed through a population-based, randomized clinical trial. Results at 1-year follow-up showed quicker return to regular work and improvement of quality of life; the 6-year follow-up showed the cost-effectiveness of the method. Phase B: Based on the Sherbrooke model experience and recent evidence, a new program addressing the disability paradigm was developed and implemented in the province of Quebec (Canada). Results at 1- and 3-year follow-ups showed that only 24% of workers were not working owing to their musculoskeletal disorder. The program is presently being tested through a population-based, randomized clinical trial in a population of construction workers. Phase C: To implement the program at a provincial level, a network for management, research and education in work rehabilitation was developed. An external assessment is presently planned to evaluate return to work and economic outcomes and quality of implementation of the program in various settings.
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Medial branch blocks are an important tool for the diagnosis of facet joint arthropathy. The most commonly used technique involves multiple needle placements, one for each nerve blocked. This multiple needle technique may require a large amount of local anesthetic for anesthetizing the skin, thereby increasing the rate of false-positive blocks. ⋯ When performed correctly, the single needle technique provides accuracy similar to the more conventional multiple needle approach during the performance of diagnostic facet joint nerve blocks. Because only one skin entry point is needed, however, this technique may afford several advantages over the multiple needle approach. These may include less patient discomfort, less time required and less radiation exposure since only one C-arm position is used, a smaller volume of local anesthetic, and possibly a lower incidence of false-positive blocks.