The Clinical journal of pain
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Randomized Controlled Trial
Sensory and affective pain descriptors respond differentially to pharmacological interventions in neuropathic conditions.
Pain management is limited by inability to match a patient's condition-and pain mechanisms-to optimal treatment(s). Much is known about pain treatment from animal investigations, but antinociceptive mechanisms cannot be readily explored in clinical studies. Evidence suggests that self-report verbal pain descriptors characterize important pain dimensions and may reflect diverse underlying mechanisms. ⋯ These results point to the hypothesis that sensory and affective pain descriptor profiles exhibit a treatment-specific response. Larger, more definitive, investigations to evaluate treatment-specific effects on multiple sensory and affective pain descriptors, and prediction of treatment response by these descriptors, will advance efforts toward developing and implementing more effective individualized pain therapies.
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Randomized Controlled Trial
Anxiety but not social stressors predict 12-month depression and pain severity.
To determine whether baseline anxiety and social stressors as well their early change (first 3 months) predict 12-month depression and pain severity. ⋯ Anxiety, but not social stressors predict 12-month depression and pain severity. The presence of comorbid anxiety should be considered in the assessment and treatment of patients with musculoskeletal pain and depression, particularly as a factor that may adversely affect treatment response.
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Little is known about how opioid prescriptions for chronic pain are initiated. We sought to describe patterns of prescription opioid initiation, identify correlates of opioid initiation, and examine correlates of receipt of chronic opioid therapy (COT) among veterans with persistent noncancer pain. ⋯ Opioid initiations are common among veterans with persistent pain, but most veterans are not prescribed opioids long-term. Psychiatric disorders and substance use disorders are associated with receiving COT. Many Veterans receiving COT are concurrently prescribed benzodiazepines and many do not receive urine drug screening; additional study regarding practices that optimize safety of COT in this population is indicated.
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Although acupuncture has been frequently used for acute nonspecific low back pain (LBP), relevant systematic reviews indicate sparse and inconclusive evidence. This systematic review aimed at critically evaluating the evidence for/against acupuncture for acute LBP. ⋯ The current evidence is encouraging in that acupuncture may be more effective than medication for symptom improvement or relieve pain better than sham acupuncture in acute LBP. The present findings should be confirmed by future studies that overcome the methodological limitations of the studies evaluated in our review.
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Multicenter Study
Cost effectiveness of intrathecal drug therapy in management of chronic nonmalignant pain.
To evaluate the cost effectiveness of intrathecal drug therapy (IDT) compared with conventional medical management (CMM) for patients with refractory chronic noncancer pain. ⋯ IDT is cost effective compared with CMM in the management of chronic noncancer pain.