The Clinical journal of pain
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Comparative Study
Preferences, Experience, and Attitudes in the Management of Chronic Pain and Depression: A Comparison of Physicians and Medical Students.
The current study investigated clinicians' treatment preferences for chronic pain and depression and the extent to which these preferences were related to clinicians' experience and attitudes. ⋯ Physicians and medical students shared a general preference for "low-risk," self-management approaches for chronic pain and depression; however, they differed in their recommendations for some specific treatments. Participants' attitudes toward patients with pain and depression were associated with their preferences and accounted for the differences in their treatment decisions. These results suggest a need for early and continuing education to reduce clinicians' negative attitudes toward and improve the management of patients with chronic pain and depression.
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Randomized Controlled Trial
Evidence-Based Development and Initial Validation of the Pain Assessment Checklist for Seniors with Limited Ability to Communicate-II (Pacslac-II).
Our goal was to develop and validate, based on theoretical and empirical knowledge, the Pain Assessment Checklist for Seniors with Limited Ability to Communicate (PACSLAC-II), a shorter tool that would improve on the PACSLAC, while addressing limitations of the original version. ⋯ Findings indicate that the empirical and theoretically driven revisions to the PACSLAC led to improved ability to differentiate between pain and nonpain states, while retaining its clinical utility.
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Randomized Controlled Trial
Effects of tDCS Induced Motor Cortex Modulation on Pain in HTLV-1: A Blind Randomized Clinical Trial.
We aimed to evaluate the effects of transcranial direct current stimulation (tDCS) on chronic pain in human T-lymphotropic virus type I-infected patients. ⋯ The analysis of the main outcomes in this study did not demonstrate a significant advantage of anodal tDCS applied to M1 in patients with human T-lymphotropic virus type I and chronic pain in comparison with sham tDCS, although secondary analysis suggests some superiority of active tDCS over sham. The large placebo effect observed in this study may explain the small differences between sham versus active tDCS.
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This study investigated the bidirectional relationship between the intensity of low back pain (LBP) and sleep disturbance. Further, the study aimed to determine whether any relationship is dependent on pain duration, symptoms of depression and anxiety, and the method of sleep assessment (subjective vs. objective). ⋯ The findings demonstrate that there is a bidirectional relationship between sleep and pain intensity in patients with LBP. The relationship is independent of pain duration and baseline symptoms of depression and anxiety and somewhat dependent on the method of sleep measurement (sleep diary or Armband). Future research is needed to determine whether targeting sleep improvement in patients with LBP contributes to pain reduction.
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Measures of central pain processing like conditioned pain modulation and suprathreshold heat pain response (SHPR) have been described to assess different components of central pain modulatory mechanisms. Central pain processing potentially plays a role in the development of postsurgical pain, however, the role of conditioned pain modulation and SHPR in explaining postoperative clinical pain and disability is still unclear. ⋯ The present study suggests that baseline measures of central pain processing were not predictive of 6-month postoperative pain outcome. Instead, the 3-month change in SHPR might be a relevant factor in the transition to an elevated 6-month postoperative pain and disability outcomes. In patients with shoulder pain, the 3-month change in a measure of central pain processing might be a relevant factor in the transition to elevated 6-month postoperative pain and disability scores.