The Clinical journal of pain
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Randomized Controlled Trial Comparative Study
The Subjective Psychoactive Effects of Oral Dronabinol Studied in a Randomized, Controlled Crossover Clinical Trial For Pain.
The oral cannabinoid dronabinol has similar psychoactive effects to smoking marijuana.
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The aim of this study was to (1) test the concurrent validity of brief screening questions for 5 psychosocial constructs (anxiety, depression, social isolation, catastrophization, and fear of movement) and (2) translate into Danish and validate those screening questions. ⋯ The concurrent validity of these screening questions was comparable to, or better than, alternate questions previously reported, and stable across age, sex, pain intensity, pain duration, and counties. On the basis of the observed likelihood ratios, all of the screening questions provided moderate or strong evidence to rule in or out an extreme score on each psychosocial construct. Given the ease of administration of these brief screening questions, their prognostic and treatment implications should be investigated.
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Randomized Controlled Trial
Perioperative Epidural or Intravenous Ketamine Does Not Improve the Effectiveness of Thoracic Epidural Analgesia for Acute and Chronic Pain After Thoracotomy.
Persistent postsurgical pain (PPP) after thoracotomy effect 50% to 80%. Nerve damage and central sensitization involving NDMDAr activation may play an important role. This study evaluates the efficacy of adding intravenous (IV) or epidural ketamine to thoracic epidural analgesia (TEA) after thoracotomy. ⋯ Adding epidural or IV racemic ketamine to TEA after thoracotomy did not lead to any reduction in PPP or allodynia. Epidural administration produced similar plasma ketamine levels to the IV route.
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The purpose of this study was to develop a brief knowledge survey about chronic noncancer pain that could be used as a reliable and valid measure of a provider's pain management knowledge. ⋯ The psychometric properties of the KnowPain-12 support its potential as an instrument for measuring provider pain management knowledge. The ability to assess pain management knowledge with a brief measure will be useful for developing future research studies and specific pain management knowledge intervention approaches for health care providers.
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Fibromyalgia (FM) syndrome is characterized by widespread pain that is exacerbated by cold and stress but relieved by warmth. We review the points along thermal and pain pathways where temperature may influence pain. We also present evidence addressing the possibility that brown adipose tissue activity is linked to the pain of FM given that cold initiates thermogenesis in brown adipose tissue through adrenergic activity, whereas warmth suspends thermogenesis. ⋯ This results in lower body temperatures, lower metabolic rates, and lower circulating cortisol/corticosterone in response to stress--characteristics of FM. In the periphery, sympathetic nerves to brown adipose also project to surrounding tissues, including tender points characterizing FM. As a result, the musculoskeletal hyperalgesia associated with conditions such as FM may result from referred pain in the adjacent muscle and skin.