The Clinical journal of pain
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Minalcipran has been approved for the treatment of fibromyalgia in several countries including Australia. Australian agency considered that the overall efficacy is moderate, although clinically significant, and could be translated into a real and strong improvement in some patients. The determination of the characteristics of patients who could benefit the most from milnacipran (MLN) is the primary objective of this manuscript. ⋯ Clustering and predictive data-mining methods provide additional insight about fibromyalgia, its symptoms, and treatment. The information is useful to physicians to optimize prescriptions in the daily practice and to regulatory bodies to refine indications.
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Mental defeat has been implicated in precipitating suicide with effects not explained by depression. It has also been found to be elevated in people who are most distressed and disabled by chronic pain. This study examined the role of mental defeat in predicting suicide intent among chronic pain patients and compared the predictive value of mental defeat with other established pain and psychological constructs. ⋯ Mental defeat may be a key indicator for heightened suicide risk. Therapeutic interventions targeting mental defeat offer a novel avenue for reducing suicide risk in chronic pain patients.
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Randomized Controlled Trial
Self-reported Recovery is Associated with Improvement in Localised Hyperalgesia Among Adolescent Females with Patellofemoral Pain - Results from a Cluster Randomised Trial.
Adolescent females with patellofemoral pain (PFP) have localized (around the knee) and distal (tibialis anterior muscle) hyperalgesia assessed by decreased pressure pain thresholds (PPT). This may have implications for treating PFP as both localized and central pain mechanisms may contribute to the manifestations of pain. The objective of this study was to compare the change in localized and distal hyperalgesia among female adolescents with PFP deeming themselves recovered compared with those not recovered 3 months after patient education with or without exercise therapy. ⋯ Female adolescents with PFP who rated themselves as recovered had a larger reduction in localized hyperalgesia compared with those not recovered.
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Randomized Controlled Trial
The SPADE Symptom Cluster in Primary Care Patients with Chronic Pain.
Sleep disturbance, pain, anxiety, depression, and low energy/fatigue, the SPADE pentad, are the most prevalent and co-occurring symptoms in the general population and clinical practice. Co-occurrence of SPADE symptoms may produce additive impairment and negatively affect treatment response, potentially undermining patients' health and functioning. The purpose of this paper is to determine: (1) prevalence and comorbidity (ie, clustering) of SPADE symptoms; (2) internal reliability and construct validity of a composite SPADE symptom score derived from the Patient-Reported Outcomes Measurement Information System (PROMIS) measures; and (3) whether improvement in somatic symptom burden represented by a composite score predicted subsequent measures of functional status at 3 and 12 months follow-up. ⋯ Brief PROMIS measures may be useful in evaluating SPADE symptoms and overall symptom burden. Because symptom burden may predict functional status outcomes, better identification and management of comorbid symptoms may be warranted.
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To examine sleep disturbances in the POINT cohort study consisting of participants prescribed long-term opioids for chronic noncancer pain (CNCP), and to examine the relationship between sleep and measures of pain, physical and mental health, substance use, and medication use at the baseline interview. ⋯ High levels of sleep problems were reported in this community sample of CNCP patients prescribed long-term opioids, and were associated with mental health problems and increased medication use. Nonmedication approaches to addressing sleep problems should be prioritized in this population.