The Clinical journal of pain
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This article analyzes the Pain Terminology adopted by the International Association for the Study of Pain (IASP), noting that most of their pain categories are defined in terms of a reference standard of "normal" pain. Given the lack of any officially adopted operational definition of the word "normal," we argue that the use of this word expresses and maintains a paradigm that drives many clinicians' reasoning about their patients' pain. We offer evidence that this uninterrogated paradigm is being tacitly used to differentiate legitimate pain reports from malingering and drug seeking. ⋯ We conclude that evidence for consistency in the experience and expression of pain and for clinician accuracy in evaluating the veracity of that pain is lacking; therefore, the logical preconditions needed for a rationalized, evidence-based prototype of "normal" pain have yet to be met. We conclude that the use of "normal" as a reference standard leads to ineffective and inhumane management of patient pain and to the danger that third parties, such as insurance companies and drug enforcement agencies, will use this unsubstantiated reference standard to arbitrarily limit pain therapy options. The authors recommend that the word "normal" be expunged from the International Association for the Study of Pain, Pain Terminology.
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The present retrospective case review study sought to analyze the cost-utility, expressed in cost/quality-adjusted life years (QALY), of current chronic spinal pain treatments. In addition, it expands upon previously published data evaluating the efficacy of interdisciplinary pain management in relation to medication management. ⋯ Average cost-utility ratios for both interdisciplinary treatment groups, ranging from 57,627 dollars /QALY to 75,885 dollars /QALY, were within established cost-effective parameters (20,000 dollars to 100,000 dollars /QALY, generally considered a good value), whereas cost-utility ratios for the standard care treatment groups were not interpretable because of a decrease in QALYs from pretreatment to posttreatment.
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Many studies report a higher prevalence of musculoskeletal pain in women than in men. This paper presents an overview of sex differences in musculoskeletal pain with specific attention for: different parameters for duration of musculoskeletal pain (ie, 1-y period prevalence, point prevalence, prevalence of chronic pain, and prevalence of persistent chronic pain); and (2) different anatomic pain sites. ⋯ The present study shows that women have higher prevalence rates of musculoskeletal pain in most anatomic pain sites, no matter the duration of musculoskeletal pain. Future research should focus on explaining these sex differences with the ultimate goal to develop better prevention and management strategies for musculoskeletal pain in both men and women.
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Comment Letter Comparative Study
Author's response"Opioid tolerance often ignored".