The Clinical journal of pain
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Randomized Controlled Trial Comparative Study Clinical Trial
The effect of small doses of botulinum toxin a on neck-shoulder myofascial pain syndrome: a double-blind, randomized, and controlled crossover trial.
Myofascial pain syndrome is a common cause of muscular pain in the shoulder-neck region. Injections of large amounts of botulinum toxin A have been found to be beneficial for the alleviation of myofascial pain, but large doses of this toxin may cause paresis of the muscle and other adverse events. The aim of this work was to determine the effect of small doses (5 U) of botulinum toxin A (BTA) injected directly into the painful trigger points of the muscles, using a double-blind crossover technique. ⋯ Our study shows that there was no difference between the effect of small doses of botulinum toxin A and those of physiological saline in the treatment of myofascial pain syndrome.
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Comparative Study
Clinically significant change in pain intensity ratings in persons with spinal cord injury or amputation.
To examine the clinical significance of changes in chronic pain in 2 disability groups: spinal cord injury and lower limb amputation. ⋯ These findings are generally consistent with similar findings in other pain populations, and, in light of previous research, support an approximate 33% decrease in pain as a reasonable standard for meaningful change across chronic pain conditions. Percent change scores may be more useful for comparing the effects of pain treatments across samples or conditions because they are less biased by pretreatment pain level.
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Comparative Study
Tunneled epidural catheter infections in noncancer pain: increased risk in patients with neuropathic pain/complex regional pain syndrome.
Tunneled epidural catheters are often used to control pain and facilitate rehabilitation in patients with regional pain syndromes. A cohort retrospective study design was undertaken to evaluate the risk of catheter-related infection in patients who underwent a TEC placement to manage their chronic noncancer regional pain over a 5-year period. ⋯ The higher risk of tunneled epidural catheter infection observed in patients with neuropathic pain (particularly complex regional pain syndrome) warrants further study.
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Comparative Study
Electronic momentary assessment in chronic pain I: psychological pain responses as predictors of pain intensity.
Electronic momentary assessment was employed to substantiate the relevance of psychological functioning in chronic pain. More than 7,100 electronic diaries from 80 patients with varying IASP classified types of chronic pain served to investigate to what extent fear-avoidance, cognitive and spousal solicitous and punishing pain responses explained fluctuations in pain intensity and whether patients with pre-chronic, recently chronic and persistently chronic pain differed in this regard. ⋯ Exaggerated negative interpretations of pain, and fear that movement will induce or increase pain strongly predicted CPD pain intensity. Spousal responses-assessed only when the spouse was with the patient who at that moment was in actual pain-may more strongly affect immobility due to pain than pain intensity per se (see part II of the study). The findings substantiate the importance of catastrophizing, fear and vigilance identified primarily in low back pain and extend this to other forms of chronic pain. The compelling evidence of momentary within-patients differences underscores that these must be accounted for in chronic pain research and practice.
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Comparative Study Clinical Trial
Hypoalgesia in the referred pain areas after bilateral injections of hypertonic saline into the trapezius muscles of men and women: a potential experimental model of gender-specific differences.
The study was to assess the local pain intensity, referred pain patterns, and changes in the pressure pain thresholds of the local and referred pain areas following bilateral injections of hypertonic saline into trapezius muscles and to delineate gender differences in pain profile and the possible modulation of pressure pain thresholds. ⋯ These findings indicate that both excitatory and inhibitory mechanisms modulate pain response characteristics in bilateral neck-shoulder pain conditions and suggest that there may be a more potent inhibitory control mechanism in men than women. This experimental model may be potentially used to detect gender differences in descending inhibition.