The Clinical journal of pain
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Radiofrequency denervation of lumbar facet joints in the treatment of chronic low back pain: a randomized, double-blind, sham lesion-controlled trial.
Radiofrequency facet joint denervation procedures have been common practice for 2 decades in treatment of chronic low back pain. We designed this multicenter, randomized, double-blind, sham treatment controlled trial to determine the efficacy of radiofrequency facet joint denervation, as it is routinely performed. ⋯ The combined outcome measure and VAS showed no difference between radiofrequency and sham, though in both groups, significant VAS improvement occurred. The global perceived effect was in favor of radiofrequency. In selected patients, radiofrequency facet joint denervation appears to be more effective than sham treatment.
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The synthetic opioid methadone has generated much interest in recent years among clinicians involved in the management of intractable chronic cancer pain. Its use as an analgesic is starting to extend to the treatment of noncancer pain, particularly neuropathic pain. Unfortunately, the evidence for its use in the management of neuropathic pain is limited to a few case studies. ⋯ Methadone was effective at relieving pain and ameliorating quality of life and sleep in 62% of patients. These findings suggest that methadone can offer an acceptable success rate for the treatment of neuropathic pain. Prospective randomized, placebo-controlled studies are now needed to examine more rigorously the benefits of methadone for this type of pain.
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Local steroid injections for tennis elbow: does the pain get worse before it gets better?: Results from a randomized controlled trial.
To compare the early effects of local corticosteroid injection, naproxen, and placebo as treatments for tennis elbow in primary care. Specifically, to find out whether the extra pain reduction experienced by patients who are given the steroid injection in the short-term would be realized within the first 5 days of treatment and to attempt to assess how much extra pain may be associated with the injection initially. ⋯ Steroid injection was associated with an increase in reported pain for the first 24 hours of treatment, but the therapeutic benefits compared with naproxen and placebo were evident 3 to 4 days after the start of treatment.
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Comparative Study
Reports of memory functioning by patients with chronic pain.
Patients with chronic pain often complain of memory and concentration difficulties. The purpose of this study was to explore the influence of a set of variables that previous research has associated with memory complaints in patients with chronic pain: anxiety and depression, benzodiazepine use, chronicity of pain, and age. Special attention is paid to catastrophizing and to the differential role played by its 3 components: magnification, helplessness, and rumination. ⋯ The results support the hypothesis that emotional distress (depression and anxiety) plays an important role in memory complaints in patients with chronic pain, as well as rumination, the intrusive component of catastrophizing. Clinicians should be aware of these factors in the evaluation of memory complaints in patients with chronic pain.
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Comparative Study
Is temporomandibular pain in chronic whiplash-associated disorders part of a more widespread pain syndrome?
The prevalence of temporomandibular disorders in patients with chronic whiplash-associated disorder is a controversial issue that may be influenced by the widespread pain character and psychologic distress frequently observed in patients with chronic pain. The aim of this study was to determine the prevalence of temporomandibular disorder pain, widespread pain, and psychologic distress in persons with chronic whiplash-associated disorder pain, using a controlled, single blind study design. The prevalence of temporomandibular disorder pain in the chronic whiplash-associated disorder pain group was compared with 2 control groups: a chronic neck pain group and a no neck pain group. ⋯ The higher prevalence of widespread pain and psychologic distress in patients with chronic whiplash-associated disorder suggests that the higher prevalence of temporomandibular disorder pain in these patients is part of a more widespread chronic pain disorder.