The Clinical journal of pain
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Comparative Study Clinical Trial
Patient compliance with SSRIs and gabapentin in painful diabetic neuropathy.
Anticonvulsants are widely used for treatment of painful diabetic neuropathy. Selective serotonin reuptake inhibitors (SSRIs) are not first-line drugs but are commonly prescribed medicines for chronic pain. The majority of patients are hesitant to use these drug groups, thus their compliance remains an issue. ⋯ The lack of negative effects on quality of life, the better compliance, and the comparable efficiency of SSRIs suggest that these drugs may be considered as alternative to gabapentin in painful diabetic neuropathy.
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Comparative Study
Pain behavior and the development of pain-related disability: the importance of guarding.
To examine prospectively the association between the 4 categories of objectively assessed pain behavior and various disability outcomes. In the present study, relationships among the 4 categories of pain behavior and various disability-related outcomes were examined. ⋯ Guarding behavior may play a role in the transition from acute to chronic pain. The findings underscore the multidimensional nature of pain behavior and suggest that there is value in examining overt pain behaviors in prospective studies of the development of chronic occupational pain disability.
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Comparative Study
Use of tricyclic antidepressants in older patients with diabetic peripheral neuropathy.
To describe patterns of use of tricyclic antidepressants (TCAs) (eg, amitriptyline, nortriptyline) among older patients with diabetic peripheral neuropathy (DPN). ⋯ The high prevalence of contraindications, warnings, or precautions and the low level of TCA exposure suggest that many older patients with DPN who receive TCAs may be inappropriately treated.
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The goal of multidisciplinary treatment for chronic pain is to help patients actively self-manage pain. In this study, we examined predictors of 2 measures of readiness to self-manage pain, namely the Precontemplation and Action subscales of the Pain Stages of Change Questionnaire. In particular, we examined the relative importance of experiences with pain and the primary care physician and beliefs about self-efficacy and pain control in predicting intention to self-manage pain (Precontemplation) and actual use of pain self-management strategies (Action). ⋯ The results of the study are placed within the context of the Motivational Model of Pain Self-Management and provide insight into factors that are associated with motivation to self-manage pain. Future directions for research are discussed with respect to perceptions of pain control and satisfaction with information from physicians, constructs which have previously been overlooked in research on motivation to self-manage pain.
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Randomized Controlled Trial Comparative Study Clinical Trial
A randomized, double-blind, placebo-controlled pilot study of IV morphine-6-glucuronide for postoperative pain relief after knee replacement surgery.
To determine the dose-response effect of intravenous morphine-6-glucuronide (M6G) on acute postoperative pain. ⋯ The analgesic effect of M6G in postoperative pain was demonstrated with 30 mg/70 kg M6G superior to placebo. At this dose, M6G has a long duration of action as determined by a reduction in the use of morphine PCA over 12 and 24 hours.