The Clinical journal of pain
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Clinical Trial
Pain and aberrant drug-related behaviors in medically ill patients with and without histories of substance abuse.
This study evaluated the prevalence and correlates of aberrant drug-taking behaviors in two populations: patients with HIV-related pain and a history of substance abuse (n = 73) and patients with cancer pain and no history of substance abuse (n = 100). ⋯ These data suggest that AIDS patients with histories of substance abuse receiving opioid therapy are more symptomatic, have more distress, experience more interference from residual pain, and engage in more problematic drug-related behaviors than patients with no history of drug abuse receiving opioids for cancer pain. Treatment of substance abusers with pain requires skills that complement best practices in opioid prescribing. Better approaches to the long-term treatment of these populations are needed.
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Case Reports
Warning headache of subarachnoid hemorrhage and infarction due to vertebrobasilar artery dissection.
The authors describe the clinical features of headache in patients with vertebrobasilar artery dissection (VBAD) and emphasize the importance of recognition of warning headaches preceding subarachnoid hemorrhage. Headache in VBAD is already recognized, but the natural history and clinical features of the warning headache have not been well elucidated. ⋯ The present study confirms a high frequency of headache in patients with VBAD. Sudden severe occipital and nuchal pain, even without subarachnoid hemorrhage or any neurologic deficit, should be considered as a warning sign of subarachnoid hemorrhage. Computed tomography, magnetic resonance imaging, and magnetic resonance angiography should be performed urgently for screening of patients with a warning headache to prevent resultant life-threatening major vascular events.
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To study whether the sensitivity to noxious and innocuous heat varies across the body. ⋯ The sensitivity to noxious heat is uniform across the body when measured with a reaction-time-free method (Method of Levels), but is greater in proximal than in distal regions, when measured with a reaction-time-dependent method (Method of Limits). Regardless of measuring method, the sensitivity to innocuous heat is not uniform across the body. It is concluded that the Method of Levels is preferred when heat-pain threshold is to be compared between body regions. For heat-pain threshold, within-patient comparisons can be made between each pair of regions tested. However, for warm sensation threshold, within-patient comparisons should be conducted between contralateral symmetrical regions.
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Understanding the psychological processes that underlie the development of a chronic pain problem is important to improve prevention and treatment. The aim of this study was to test whether distinct profiles of variables within the fear-avoidance model could be identified and could be related to disability in a meaningful way. ⋯ Distinct profiles of psychological functioning could be extracted and meaningfully related to future disability. These profiles give support to the fear-avoidance model and underscore the need to address the psychological aspects of the pain experience early on.
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To identify the sites and intensity of pain in patients with patellofemoral pain syndrome. ⋯ In these patients with patellofemoral pain syndrome, the major source of pain was the patella subchondral bone.