The Clinical journal of pain
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Treatment for musculoskeletal disorders in primary care in Sweden is generally initiated with advice and medication. Second-line therapy is physiotherapy and/or injection and radiography; third-line therapy is referral to an orthopedist. Manual therapy is not routine. It is a challenge to identify patients who benefit from treatment by different specialists. The current referral strategy probably contributes to long waiting lists in orthopedic departments, which is costly and implies prolonged suffering for the patients. The aim of this health economic evaluation was to compare costs and outcomes from naprapathic manual therapy (NMT) with orthopedic standard care for common, low-prioritized, nonsurgical musculoskeletal disorders, after second-line treatment. ⋯ It is plausible that improved outcomes and reasonable cost savings for low-prioritized nonsurgical outpatients would be attainable if NMT were available as an additional standard care option in orthopedic outpatient clinics.
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Chronic pain patients' pain-related social support preferences have received little clinical or research attention. However, recent research utilizing the Pain Response Preference Questionnaire (PRPQ) has indicated that such preferences are related to pain-related disability. This study investigated whether pain-related social support preferences: (1) were related to disability levels, (2) predicted changes in pain and disability following a group-based treatment program, and (3) changed from pretreatment to posttreatment. ⋯ Additional research aimed at identifying the processes underlying the association between pain-related support preferences and disability is warranted. Given the potentially important role that a desire for solicitous support may play in shaping the social context of pain, understanding the unexpected changes in Solicitude scale scores found in the present study may be particularly important for improving self-management treatments for chronic pain.
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Cognitive and emotional factors are known to influence peoples' pain experiences in many conditions, including low back pain. However, in complex regional pain syndrome (CRPS), their role is unclear. This study aimed to assess the relationships between psychological factors, pain, and disability in CRPS, compared with low back pain. This could help to identify target variables for psychological treatment. ⋯ In CRPS, disability and pain severity were more strongly associated with psychological factors than they were in low back pain. Cause and effect relationships could not be established by this cross-sectional study.
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As long-term opioid analgesic therapy has gained increasing clinical and societal acceptance over the past 2 decades, morbidity and mortality related to the misuse of these drugs have increased in lockstep. Hence, monitoring for opioid-related problems, largely through urine drug testing, has become a central component of risk mitigation in long-term opioid therapy. Despite the increasing use of urine drug testing, little has been written about the ethical aspects of its application. In this paper, we analyze multiple aspects of drug testing-rationale for testing, specimen collection, ordering and interpretation, and response to inappropriate test results-through the principlist lens, using the ethical principles of beneficence, nonmaleficence, justice, and autonomy.
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Randomized Controlled Trial
Effect of modulated-frequency and modulated-intensity transcutaneous electrical nerve stimulation after abdominal surgery: a randomized controlled trial.
This study aimed to evaluate the effectiveness of transcutaneous electrical nerve stimulation (TENS) for treatment of postoperative pain and pulmonary functions (vital capacity [VC]; cough peak flow, [CPF]) in patients who underwent abdominal surgery. ⋯ TENS is a valuable treatment to alleviate postoperative pain and improve pulmonary functions (ie, VC, CPF) in patients following abdominal surgery.