The Clinical journal of pain
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Randomized Controlled Trial Comparative Study
Biofeedback-based Cognitive-Behavioral Treatment Compared With Occlusal Splint for Temporomandibular Disorder: A Randomized Controlled Trial.
Cognitive-behavioral treatment has proven efficacy for chronic temporomandibular disorder (TMD). However, most patients receive dental treatment that may not address psychological comorbidities often present in TMD. The aim of the present study was to evaluate the efficacy of biofeedback-based cognitive-behavioral treatment (BFB-CBT) versus dental treatment with occlusal splint (OS). Moreover, changes in nocturnal masseter muscle activity (NMMA) were investigated. ⋯ The fact that BFB-CBT resulted in larger improvements in pain coping skills, and was well accepted by the patients, underlines the importance and feasibility of psychological treatments in the clinical management of TMD.
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Considerable attention has been paid to assessing the risk factors for the development of disability following neck pain (NP) in the general population, but we still lack knowledge regarding disability in NP patients referred to a specialist level of care. This study investigated the associations among the socio-demographic characteristics, work ability, self-reported pain, emotional distress, fear of movement and disability of NP patients referred to a specialised neck and back outpatient clinic. In total, 221 patients participated in this cross-sectional study, which was conducted from December 2007 to December 2009. ⋯ These results suggest that emotion should be considered in any assessment of patients with chronic NP and targeting emotional factors should be an integral part of treatment strategies.
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Clinical Trial
A 3-Year, Open-Label, Flexible-Dosing Study of Milnacipran for the Treatment of Fibromyalgia.
To evaluate the effects of long-term milnacipran treatment in fibromyalgia patients. ⋯ No new safety concerns were identified in this long-term study. Sustained symptom improvements were found in fibromyalgia patients who received up to 3.25 years of milnacipran treatment.
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Late diagnosis and management of complex regional pain syndrome (CRPS) can have severe consequences. We report the case of a young adolescent who failed several months of medical and physical therapy for CRPS, which was initially limited to one extremity but then spread to the remaining extremities. ⋯ The extensive use of regional anesthesia techniques can greatly benefit patients with CRPS during the acute phase of the rehabilitation process, which includes appropriate physical, and occupational therapy and psychological interventions. It is critical to continue physical therapy and psychological support after discharge from the hospital.
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Case Reports
Cauda Equina Syndrome After Spinal Epidural Steroid Injection Into an Unrecognized Paraganglioma.
Clinically significant spinal hemorrhage is an extremely rare but potentially devastating complication of spinal epidural steroid injection. We report a rare case of cauda equina syndrome after spinal epidural injection that inadvertently penetrated an unrecognized spinal paraganglioma. ⋯ The presented case indicates the importance of a thorough history, physical examination, and imaging assessment before spinal epidural steroid injection.