The Clinical journal of pain
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Randomized Controlled Trial Meta Analysis
Single-dose Intra-articular Bupivacaine Versus Morphine After Arthroscopic Knee Surgery: A Meta-analysis of Randomized Controlled Studies.
This meta-analysis compared the earliest clinical effects of intra-articular bupivacaine and morphine for pain management following arthroscopic knee surgery. ⋯ Level II-meta-analysis of Level I and II studies.
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Activity pacing is a common intervention for patients with chronic pain. Over the past decade a number of instruments have been developed to measure this construct, but their comparative psychometric properties have not been examined. ⋯ Current measures of activity pacing are inadequate. New measures are needed that are based on specific theoretical models; these measures should also make the goal or intent of pacing behaviors explicit. Improvements in the assessment of activity pacing will likely lead to a better understanding of the pacing construct and the effects of pacing interventions.
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Gabapentin (GBP), originally an antiepileptic drug, is more commonly used in the treatment of neuropathic pain. In recent years, GBP has been used as an adjunct or primary therapy in non-neuropathic pain, most commonly for the treatment of perioperative and cancer pain. ⋯ Although efficacy varies, multiple well-designed clinical trials have demonstrated reduced pain and analgesic use with otolaryngology, orthopedic, mastectomy, and abdominal/pelvic surgical perioperative use of GBP, whereas there is limited or no efficacy for cardiothoracic surgery. Cancer pain studies have had greater design variability, often nonblinded, with pain benefit being mild to moderate, and more efficacious with partial neuropathic pain quality. Overall, GBP seems to have significant benefit in neuropathic and non-neuropathic pain associated with the perioperative period and cancer. Considering its favorable side effect profile, GBP represents a beneficial pain adjunctive therapy, beyond neuropathic symptoms.
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Increasing rates of opioid use disorders (OUDs) (abuse and dependence) among patients prescribed opioids are a significant public health concern. We investigated the association between exposure to prescription opioids and incident OUDs among individuals with a new episode of a chronic noncancer pain (CNCP) condition. ⋯ Among individuals with a new CNCP episode, prescription opioid exposure was a strong risk factor for incident OUDs; magnitudes of effects were large. Duration of opioid therapy was more important than daily dose in determining OUD risk.
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To investigate whether obesity is associated with musculoskeletal pain in children. ⋯ Obesity in children was associated with increased overall and lower limb musculoskeletal pain, for which body mass index was a stronger predictor than adiposity. Clinicians treating obese children should screen for pain and prescribe exercise programs that take their symptoms into account.