The Clinical journal of pain
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Randomized Controlled Trial Clinical Trial
Treatment expectancy affects the outcome of cognitive-behavioral interventions in chronic pain.
Patients' initial beliefs about the success of a given pain treatment are shown to have an important influence on the final treatment outcome. The aims of the paper are to assess determinants of patients' treatment expectancy and to examine the extent to which treatment expectancy predicts the short-term and long-term outcome of cognitive-behavioral treatment of chronic pain. This study employs the data of 2 pooled randomized clinical trials evaluating the effectiveness of cognitive-behavioral interventions for 171 patients with fibromyalgia and chronic low back pain. ⋯ A regression model of 3 factors (better pain coping and control, active and positive interpretation of pain, and less disability compensation) significantly explained 10% of the variance in pretreatment expectancy. Pretreatment expectancy significantly predicted each of the 4 outcome measures immediately after treatment and at 12 months follow-up. This study corroborates the importance of treatment expectation before entering a cognitive-behavioral intervention in patients with chronic musculoskeletal pain.
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A large and diverse number of treatments have been shown to be effective in reducing pain and other symptoms for a minority but statistically significant number of patients in different chronic pain syndromes. The means by which such different treatments achieve similar outcomes is not well understood. In this paper, the importance of considering patient heterogeneity for those who may be diagnosed with the same medical syndrome is discussed. ⋯ The importance of subdividing (splitting) patients into meaningful groups is described. Studies presenting data on the identification of patient subgroups based on psychosocial and behavioral characteristics and the reliability and validity of this approach are presented. Some initial attempts to demonstrate the potential for matching treatments to patient subgroups are described.
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This research was designed to test the hypothesis that presurgery "catastrophizing" would predict postsurgical pain and postsurgical analgesic consumption. ⋯ The pattern of findings suggests that high catastrophizing scores may be a risk factor for heightened pain following surgery. Clinical and theoretical implications of the findings are addressed.
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Randomized Controlled Trial Clinical Trial
Is the effect of inguinal field block with 0.5% bupivacaine on postoperative pain after hernia repair enhanced by addition of ketorolac or S(+) ketamine?
The aim of the study was to assess whether coadministration of S(+) ketamine or ketorolac would enhance or prolong local analgesic effect of bupivacaine after inguinal hernia repair. ⋯ The addition of S(+)-ketamine or ketorolac only minimally improves the analgesic effect of bupivacaine. This may be related to the tension-free hernia repair technique associated with low postoperative pain.
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The aim of this paper is to acquaint pain researchers and practitioners with recent developments in the single-case experimental approach and their potential to allow for tailoring the treatment and its evaluation to the specific complaints, aptitudes, or profile of the individual patient, without violating the canons of good science and practice. After contrasting the single-case experimental approach and the case-study approach, we show the possibilities of customization in design, measurement, and test statistics. ⋯ With our emphasis on: 1) randomization in the design; 2) the possibilities for a statistical test (together with the determination of power and the calculation of effect sizes); 3) the importance of reliable and valid measurement; and 4) the role of replication, we demonstrate how internal validity, statistical-conclusion validity, construct validity, and external validity concerns can be dealt with within a single-case experimental approach framework. Finally, the many research examples and references to clinical work illustrate the usefulness of the approach.