The Clinical journal of pain
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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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Comparative Study
Prospective diary study of nonpainful and painful phantom sensations in a preselected sample of child and adolescent amputees reporting phantom limbs.
To prospectively study factors associated with the occurrence of phantom sensations and pains in a pre-selected sample of child and adolescent amputees reporting phantom limbs. ⋯ Child and adolescent amputees experience phantom sensations and pains on a regular basis over a 1-month period. Differences in triggers of phantom phenomena between boys and girls may be due to differences in activities, awareness, attribution, and willingness to report psychosocial triggers.
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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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The objective of this study is to investigate sympathetic nervous system involvement in 2 patients with painful legs and moving toes. The first case was studied several years after the initiating trauma produced a peripheral nerve lesion and demonstrated the characteristic sequence of progression of pain and moving toes from the injured leg to the contralateral leg. The second case was initially studied within 3 months of an injury that did not produce definitive signs of a peripheral nerve lesion. ⋯ These symptoms and signs disappeared after lumbar sympathectomy, and re-emerged when signs of sympathetic reinnervation were detected. We concluded that sympathetic neuronal discharge may provoke pain by activating an impulse generator in the affected limb. Sympathetic involvement in the painful legs and moving toes syndrome appeared to be greater in the second case than the first, presumably due to differences in the initial injury or stage of the condition.
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Randomized Controlled Trial Comparative Study Clinical Trial
Endogenous opioids and chronic pain intensity: interactions with level of disability.
To test whether endogenous opioid antinociceptive system dysfunction evidenced in response to acute pain stimuli is associated with increased clinical pain intensity in chronic pain sufferers, and to determine whether this association is moderated by disability level. ⋯ These results suggest that endogenous opioid antinociceptive system dysfunction may contribute to elevated acute and chronic pain sensitivity among more disabled chronic pain patients. Among less disabled patients, chronic pain may serve as a primer producing up-regulated opioid antinociceptive responses to acute pain