The Clinical journal of pain
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Immersive virtual reality (IVR) therapy has been explored as an adjunct therapy for the management of acute pain among children and adults for several conditions. Therapeutic approaches have traditionally involved medication and physiotherapy but such approaches are limited over time by their cost and side effects. This review seeks to critically evaluate the evidence for and against IVR as an adjunctive therapy for acute clinical pain applications. ⋯ This review found moderate evidence for the reduction of pain and functional impairment after IVR in patients with acute pain. Further high-quality studies are required for the conclusive judgment of its effectiveness in acute pain, to establish potential benefits for chronic pain, and for safety.
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The buprenorphine transdermal delivery system (BTDS) is indicated for reduction of pain in moderate to severe chronic low back pain (CLBP), which can affect patients' ability to perform routine activities of daily living (ADLs). This post hoc analysis of clinical trial data examines the impact of BTDS treatment on CLBP patients' ability to perform ADLs that relate to functioning with low back pain. ⋯ These results suggest that for patients with moderate to severe CLBP, 12 weeks use of BTDS improves the ability to carry out certain ADLs related to sleeping, lifting, bending, and working.
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Randomized Controlled Trial
The Effect of Adding Dexmedetomidine to Levobupivacaine for Interscalene Block for Postoperative Pain Management After Arthroscopic Shoulder Surgery.
Arthroscopic subacromial decompression may cause substantial postoperative pain. We undertook a randomized controlled trial to examine whether adding dexmedetomidine to the local anesthetic in an interscalene brachial plexus block and subsequent patient-controlled interscalene analgesia (PCIA) regime improved postoperative pain scores, patient satisfaction, rescue analgesic requirement, and local anesthetic consumption. ⋯ Addition of dexmedetomidine to levobupivacaine for interscalene brachial plexus block decreases pain scores and increases patient satisfaction after arthroscopic subacromial decompression.
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Randomized Controlled Trial
Low Back Pain Patient Subgroups in Primary Care - Pain Characteristics, Psychosocial Determinants and Health Care Utilization.
In industrialized countries, low back pain (LBP) is one of the leading causes for prolonged sick leave, early retirement, and high health care costs. Providing the same treatments to all patients is neither effective nor feasible, and may impede patients' recovery. Recent studies have outlined the need for subgroup-specific treatment allocation. ⋯ Our study adds substantially to the knowledge of LBP-related case-mix in primary care. Information on differential health care needs may be inferred from our study, enabling decision makers to allocate resources more appropriately and to reduce costs.
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Identifying mechanisms that mediate recovery is imperative to improve outcomes in low back pain (LBP). Qualitative studies suggest that guilt may be such a mechanism, but research on this concept is scarce, and reliable instruments to measure pain-related guilt are not available. ⋯ The findings suggest that pain-related guilt is common and is associated with clinical outcomes. Prospective research is needed to examine the role of guilt as a predictor, moderator, and mediator of patients' outcomes.