The Clinical journal of pain
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Comparative Study
Compliance and persistence of antidepressants versus anticonvulsants in patients with neuropathic pain during the first year of therapy.
Neuropathic pain (NP) is a chronic condition that has human, social, and economic consequences. A variety of agents can be used for treatment; however, antidepressants and anticonvulsants are the 2 classes most widely studied and represent first-line agents in the management of NP. Little information is known about the adherence patterns of these medications during the first year of therapy in patients with NP. ⋯ Compliance and persistence rates were similar for patients with NP diagnosis taking antidepressants and anticonvulsants. Higher compliance was observed among patients taking venlafaxine; however, this population did have a small sample size.
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In previous research a close link between depression and postoperative pain has been described. However, the direction of impact remains unclear. The present longitudinal study aimed to clarify the prognostic value of depressive symptoms for perioperative pain and to explore the causal nature of the association between depressive symptoms and perioperative pain. ⋯ Our results suggest that early postoperative depressive symptoms predicts pain at discharge and preoperative pain predicts postoperative depressive symptoms. In conclusion, perioperative pain therapy should include the treatment of both, pain and depressive symptoms, to achieve sufficient pain relief. The evidence regarding the causal relationships between depressive symptoms and perioperative pain, however, must be tested in future research.
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The underlying mechanism of trichodynia (scalp/hair pain, is unknown). The aim of this study was to characterize chronic trichodynia and to conduct, for the first time, sensory testing in patients with trichodynia to learn about possible underlying mechanisms. ⋯ The cranial hyperalgesia and allodynia, the generalized hyperalgesia, and the correlation between hyperalgesia and chronic pain suggest that trichodynia is related with both peripheral and central sensitization, respectively. The coexistence of hair cycle abnormalities and chronic pain might suggest a common denominator for both phenomena, possibly mediated by proinflammatory agents. Clinical implications are discussed.
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Changes in activity frequently occur as a consequence of ongoing pain. Three activity patterns commonly observed among individuals with ongoing pain are avoidance, overdoing, and pacing. We conducted 2 studies investigating these activity patterns, their interrelationships, and their associations with key psychosocial factors. Study 1 describes the development of a measure, the Patterns of Activity-Pain (POAM-P), to assess these activity patterns; Study 2 examines the psychosocial correlates of these activity patterns. ⋯ The POAM-P has excellent psychometric properties and may be useful in clinical practice to identify activity patterns associated with poorer functioning and to evaluate interventions intended to modify these activity patterns. The present results support previous findings linking avoidance and various negative outcomes. These results also provide evidence that pacing may be related to positive outcomes after treatment.