The Clinical journal of pain
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Randomized Controlled Trial Comparative Study Clinical Trial
Optimum pain relief with continuous epidural infusion of local anesthetics shortens the duration of zoster-associated pain.
To investigate effects of continuous epidural infusion (CEI) of 0.5% bupivacaine added to intermittent epidural boluses (IEB) on the duration of zoster-associated pain (ZAP), as compared with continuous infusion of normal saline placebo added to IEB. ⋯ CEI of 0.5% bupivacaine plus IEB was associated with a shorter duration of ZAP and fewer patients with allodynia beyond 30 days, compared with IEB plus normal saline infusion. Patients at high risk for developing postherpetic neuralgia (PHN) can be managed with intensive therapies at the early stage of disease, such as CEI, which maintains effective analgesia and may reduce the burden of PHN.
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Randomized Controlled Trial Comparative Study Clinical Trial
Statistical reanalysis of four recent randomized trials of acupuncture for pain using analysis of covariance.
Acupuncture has been promoted for the treatment of chronic pain. Though many randomized trials have been conducted, these have been criticized for deficiencies of methodology, acupuncture technique, and sample size. Somewhat less emphasis has been placed on methods of statistical analysis. This paper describes 4 recent randomized trials of acupuncture for musculoskeletal or headache pain. Each trial used statistical methods that did not adjust for baseline pain scores and were thus of suboptimal power. The objective of this study is to reanalyze the trials using analysis of covariance (ANCOVA). ⋯ Future trials of acupuncture and other modalities for pain should use efficient statistical methods. ANCOVA is more efficient than unadjusted analysis where used appropriately.
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Comparative Study Clinical Trial
Sustained-release oxycodone dosing survey of chronic pain patients.
To determine the dosing of sustained-release oxycodone that is typically prescribed to achieve pain relief in a mixed group of chronic pain patients. ⋯ In a mixed group of chronic pain patients referred to a university pain management clinic, sustained-release oxycodone was prescribed more often than twice daily (usually every 8 hours) in 67% of patients. Patients maintained on every-12-hour dosing were twice as likely to use regularly scheduled, daily, short-acting opioids to achieve pain relief.
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Comparative Study
Pain assessment in patients with fibromyalgia syndrome: a consideration of methods for clinical trials.
This study was designed to compare 3 commonly used methodologies for assessing clinical pain during trials involving patients diagnosed with fibromyalgia syndrome. Baseline characteristics, characteristics over time, and compliance were evaluated for each of the methods. ⋯ Pain assessment methods relying on recall might contribute to an apparent improvement in clinical trials in the absence of an intervention; such an effect has been considered a "placebo response." Future clinical trials might consider using a real-time approach to pain assessment, which in this study appeared to mitigate against seeing improvement in the absence of an intervention and demonstrated higher levels of patient adherence.
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Randomized Controlled Trial Comparative Study Clinical Trial
A randomized controlled trial of intensive neurophysiology education in chronic low back pain.
Cognitive-behavioral pain management programs typically achieve improvements in pain cognitions, disability, and physical performance. However, it is not known whether the neurophysiology education component of such programs contributes to these outcomes. In chronic low back pain patients, we investigated the effect of neurophysiology education on cognitions, disability, and physical performance. ⋯ Education about pain neurophysiology changes pain cognitions and physical performance but is insufficient by itself to obtain a change in perceived disability. The results suggest that pain neurophysiology education, but not back school type education, should be included in a wider pain management approach.