The Clinical journal of pain
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Pain is the cardinal feature in fibromyalgia syndrome (FM) and increases the risk of anxiety and depression. Patients with FM frequently report sleep disturbances as well. Sleep may mediate the association between pain and emotional symptoms, an idea which has been scarcely studied. The objective of this study was to uncover the role of subjective and objective sleep characteristics as mediators of the relationship between pain and anxiety and depression in FM. ⋯ These findings show a high prevalence of sleep problems in individuals with FM and suggest that they play a role in the relationship between pain and anxiety and depression. In fact, the impact of chronic pain on the later emotional variables was mediated not only by self-efficacy but also by subjective sleep quality and, especially, by objective sleep efficiency.
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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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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.
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Randomized Controlled Trial Observational Study
Pain and Recovery After Total Knee Arthroplasty: A Twelve Months Follow-up After a Prospective Randomized Study Evaluating Nefopam and Ketamine for Early Rehabilitation.
Ketamine and nefopam has been documented to decrease pain intensity and improve rehabilitation after total knee arthroplasty (TKA). We conducted a follow-up study of a previously randomized clinical trial to determine the prevalence and risk factors of chronic pain 1 year after TKA and to assess the role of perioperative administration of ketamine and nefopam. ⋯ After TKA, the intensity of postoperative pain is a risk factor of chronic pain on movement. Intraoperative ketamine seems to improve long-term results of rehabilitation in this setting.