The Clinical journal of pain
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To systematically review the current evidence for the effectiveness of Virtual Reality (VR), in conjunction with pharmacologic analgesia on reducing pain and anxiety in burn injury patients undergoing wound dressing changes and physiotherapy management compared with pharmacologic analgesia alone or other forms of distraction. ⋯ This is the first known systematic review to report on the effectiveness of VR, in conjunction with pharmacologic analgesia on reducing pain and anxiety in burn injury patients undergoing wound dressing changes and physiotherapy management compared with pharmacologic analgesia alone or other forms of distraction. Used as an adjunct to the current burn pain management regimens, VR could possibly assist health professionals in making the rehabilitation process for burn patients less excruciating, thereby improving functional outcomes. Further research investigating the effect of VR on anxiety in burn injury patients is warranted.
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To determine (1) the natural history of prescription opioid use, (2) the predictors of long-term opioid use, and (3) the association between opioid dose and pain and function in a large cohort of workers with recent back injuries. ⋯ For the small group of workers with compensable back injuries who receive opioids longer-term (111/1843, 6%), opioid doses increase substantially and only a minority shows clinically important improvement in pain and function. The amount of prescribed opioid received early after injury strongly predicts long-term use. More research is needed to understand clinical decisions to continue or increase opioid therapy after back injury.
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Randomized Controlled Trial
A randomized controlled trial of the ShotBlocker for children's immunization distress.
Vaccinations protect children against deadly diseases and approximately 30 immunizations are recommended for children by 6 years of age. However, immunization injections cause negative short-term and long-term consequences for children. The Gate Control Theory of pain suggests that physical interventions (eg, rubbing the site) may be helpful, but they are not well validated for children's acute pain. This randomized trial examined the effectiveness of the ShotBlocker, a physical intervention designed to decrease children's injection pain. ⋯ The data do not support the effectiveness of the ShotBlocker for acute pediatric pain relief. Clinical and theoretical implications are discussed.
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To systematically identify and critically assess clinical trials that use enriched enrollment randomized withdrawal (EERW) trial design as a methodology for assessing the effect of analgesics pain. ⋯ EERW trials are an emerging type of study design that in certain settings may offer advantages over traditional trial designs in characterizing the effects of analgesic medications.
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Intralipid has been proposed as a treatment option for local anesthetic (LA) toxicity, which does not respond to traditional resuscitation methods. This paper presents a case report of a patient who developed signs of local anesthetic toxicity and was subsequently treated with 20% Intralipid with a positive response. Some background and practical applications regarding this treatment are discussed.