The Clinical journal of pain
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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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This article attempts to cover pragmatic clinical considerations involved in the use of cannabinergic medicines in pain practice, including geographical and historical considerations, pharmacokinetics, pharmacodynamics, adverse effects, drug interactions, indications, and contraindications. Topics include molecular considerations such as the 10-fold greater abundance of cannabinoid type 1 receptors compared to µ-opioid receptors in the central nervous system and anatomic distributions of cannabinoid receptors in pain circuits. ⋯ Cannabis and other cannabinergic medicines' efficacies for relieving pain have been studied in RCTs, most of which have demonstrated a beneficial effect for this indication, although most trials are short-term. Adverse effects are generally nonserious and well tolerated. Incorporating cannabinergic medicine topics into pain medicine education seems warranted and continuing clinical research and empiric treatment trials are appropriate.
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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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Comparative Study
Comparative outcomes of cooled versus traditional radiofrequency ablation of the lateral branches for sacroiliac joint pain.
Sacroiliac joint pain is a common cause of low back pain (LBP). Cooled radiofrequency ablation (c-RFA) of the lateral branches was recently introduced with the hypothesis that it creates larger lesions to overcome the anatomic variability of the lateral branches and achieve better outcomes as compared with the traditional radiofrequency approach (t-RFA). The objective of this comparative study is to determine if c-RFA is superior over t-RFA in providing longer pain relief. ⋯ This study did not reveal evidence that c-RFA of the lateral branches provides longer relief of sacroiliac joint pain as compared with t-RFA.
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To determine whether black patients are less likely to be screened for pain than white patients. ⋯ Rates of screening were lower among black patients. The magnitude of this disparity was small and was explained, in part, by racial variation in prior health care utilization.