The Clinical journal of pain
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Multicenter Study Comparative Study
A comparative investigation of observational pain assessment tools for older adults with dementia.
Pain assessment in patients with dementia and severe limitations in ability to communicate can be challenging. The American Geriatrics Society (AGS) encourages the incorporation of 6 behavioral domains (ie, facial expressions, verbalizations/vocalizations, body movements, changes in interpersonal interactions, changes in activity patterns/routines and mental status changes) when conducting pain assessments among seniors with dementia. We investigated 6 observational pain assessment measures (differing with respect to the extent that they cover the AGS-recommended domains) under 2 different pain conditions (ie, influenza vaccination and movement-exacerbated pain) in a sample of long-term care residents with cognitive impairments. Given that a criticism of pain assessment scales is that many of the pain behaviors assessed are highly overlapping with symptoms of delirium, we also investigated the impact of the elimination of delirium-related items. ⋯ Our results provide much needed psychometric information regarding newly developed pain assessments measures for seniors with dementia. The measures differed with respect to ability to differentiate pain-related from non-pain-related states. Moreover, our findings support the utility of comprehensive coverage of the AGS-recommended pain assessment domains.
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This study in children and young adults having cancer-related amputation aimed to examine the incidence of phantom limb pain (PLP) in the first year after amputation and also the proportion of patients who had preamputation pain. ⋯ PLP after cancer-related amputation in children and young adults seems to be common but generally short lived in most patients.
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Randomized Controlled Trial
Exercise and Auricular Acupuncture for Chronic Low-back Pain: A Feasibility Randomized-controlled Trial.
To evaluate the feasibility of a randomized-controlled trial (RCT) investigating the effects of adding auricular acupuncture (AA) to exercise for participants with chronic low-back pain (CLBP). ⋯ Findings of this study showed that a main RCT is feasible and that 56 participants per group would need to be recruited, using multiple recruitment approaches. AA was safe and demonstrated additional benefits when combined with exercise for people with CLBP, which requires confirmation in a fully powered RCT.
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Whiplash-associated disorders (WAD) have been associated with sensory disturbances such as hypersensitivity or hypoesthesia. Different psychological factors seem to be important for prognosis and symptom presentation in WAD. Multivariate correlations between pain thresholds for pressure (PPT), cold and heat (CPT, HPT), detection thresholds for cold and warmth, pain intensity variables, and psychological aspects in women with chronic WAD (n=28) and in healthy pain-free controls (n=29) were investigated. ⋯ Pain intensity aspects were generally the strongest predictors of PPT in WAD. In contrast, no correlations existed between QST and PPT variables and psychological variables in controls. These results indicate the need to consider that a blend of factors influences the pain thresholds in chronic WAD and emphasize the need for a biopsychosocial model when interpreting QST and PPT variables.