The Clinical journal of pain
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Randomized Controlled Trial Comparative Study
A Randomized, Single-Blind, Controlled, Parallel Assignment Study of Exercise Versus Education as Adjuvant in the Treatment of Peripheral Neuropathic Pain.
Some forms of chronic pain are receptive to exercise therapy for maintenance of pain relief. We evaluated the impact of a balanced exercise program in the management of human peripheral neuropathic pain compared with an educational intervention. ⋯ A balanced exercise program was beneficial for exercise capacity, but produced only a medium-sized effect without statistical significance. A small sample size and unexpectedly high dropout rates may have limited our ability to demonstrate statistically significant improvement in pain relief.
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Chronic opioid therapy (COT) is associated with various adverse outcomes, especially at higher doses, yet little is known about predictors of sustained higher-dose COT. This study aimed to ascertain, among higher-dose COT patients, the association of patient-perceived pros and cons of opioids with continued higher-dose use 1 year later. ⋯ The large majority of patients continued using higher-dose opioids regardless of baseline characteristics. These findings suggest the difficulty of reducing opioid dose among chronic higher-dose opioid users.
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Randomized Controlled Trial
Mindfulness-based Cognitive Therapy for the Treatment of Headache Pain: A Pilot Study.
This pilot study reports the findings of a randomized controlled trial (RCT) investigating the feasibility, tolerability, acceptability, and initial estimates of efficacy of mindfulness-based cognitive therapy (MBCT) compared to a delayed treatment (DT) control for headache pain. It was hypothesized that MBCT would be a viable treatment approach and that compared to DT, would elicit significant improvement in primary headache pain-related outcomes and secondary cognitive-related outcomes. ⋯ This study empirically examined MBCT for the treatment of headache pain. Results indicated that MBCT is a feasible, tolerable, acceptable, and potentially efficacious intervention for patients with headache pain. This study provides a research base for future RCTs comparing MBCT to attention control, and future comparative effectiveness studies of MBCT and cognitive-behavioral therapy.
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To compare test-retest variability of palpation between a new palpometer and manual palpation using (1) right or left hand, (2) index or middle finger, (3) randomized or fixed sequence of force levels, (4) palpation on soft or hard surface, and (5) palpation for 2 or 10 seconds. ⋯ The palpometer had low test-retest variability and provided a more accurate and reproducible pressure stimulus than manual palpation. The findings of this study may help to standardize palpation of human muscles required for accurate and reliable diagnosis of musculoskeletal pain conditions.
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To describe and understand varieties and characteristics of sensitization contributing to hyperalgesia in participants with chronic pain conditions. ⋯ The widespread sensitization for irritable bowel syndrome and TMD participants does not rely on mechanisms of spatial and temporal summation often invoked to explain widespread hyperalgesia associated with chronic pain. Increased sensitivity during descending series of stimulation of an arm or leg but not the face indicates a propensity for sensitization of nociceptive input to the spinal cord. Abnormally prolonged sensitization for FM participants reveals a unique influence of widespread chronic pain referred to deep somatic tissues.