The Clinical journal of pain
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Randomized Controlled Trial
Effects of intensity of Transcutaneous Electrical Nerve Stimulation (TENS) on pressure pain threshold and blood pressure in healthy humans: A randomized, double-blind, placebo-controlled trial.
Transcutaneous electrical nerve stimulation (TENS) is primarily used for pain relief. However, evidence is beginning to emerge that TENS may also have a lowering effect on systemic blood pressure (BP). The purpose of this study was to investigate the comparative effects of 2 intensities on pressure pain threshold (PPT) and resting BP in healthy humans, using low-frequency stimulation applied segmentally to the pain site. ⋯ These results affirm that high levels of intensity are of fundamental importance in effective TENS dosage. This also applies for low frequency, segmental stimulation. Resting BP seems not to be dependent on intensity.
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Multicenter Study Clinical Trial
Cross-sectional assessment of the consequences of a GTP cyclohydrolase 1 haplotype for specialized tertiary outpatient pain care.
Reduced-function variants of the guanosine triphosphate cyclohydrolase gene (GCH1) have been associated with reduced pain in well-defined cohorts of patients and healthy volunteers. We addressed the question whether this genetic association plays a role in outpatient pain therapy. ⋯ The results strength the support for a modest yet reproducible and consistent pain-protective effect associated with a GCH1 haplotype known to reduce GCH1 and thus BH4 up-regulation. Pending independent verification, the results might point to a prophylactic role of decreased GCH1 up-regulation delaying the need for pain therapy.
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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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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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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.