The Clinical journal of pain
-
Although those in the field of pain management have long recognized the multidimensional character of pain, global pain intensity remains the most frequently assessed domain measured in clinical trials of pain treatments. However, a number of specific pain qualities have been shown to be associated with neuropathic versus nociceptive pain and, as such, can be used for diagnostic purposes. ⋯ A number of such measures are currently available, each with its strengths and weaknesses. These measures are reviewed, and potential future uses of these tools are discussed.
-
The concept of rational polypharmacy is now well established in the field of pain management. This concept has evolved in concert with progress in understanding the pathophysiologic mechanisms of pain diseases and disorders and how medications affect these processes. ⋯ This article will review how pain diagnosis, pain mechanisms, pain phenomenology, medication efficacy, and risk profile influence medication selection in pain medicine practice, with a selective focus on the treatment of neuropathic pain. In addition, the role of psychosocial factors as they affect pain management will be discussed.
-
Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
The validity of the neuropathic pain scale for assessing diabetic neuropathic pain in a clinical trial.
In controlled trials of analgesics for the treatment of neuropathic pain, the primary outcome variable is most often a measure of global pain intensity. However, because neuropathic pain is associated with a variety of pain sensations, the effects of analgesic treatments on different sensations could go undetected if specific pain qualities are not assessed. This study sought to evaluate the utility of assessing the multiple components of neuropathic pain in an analgesic clinical trial. ⋯ These findings support the utility of the NPS for characterizing the multidimensional nature of the neuropathic pain experience and for detecting changes in neuropathic pain with treatment.
-
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.
-
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.