The Clinical journal of pain
-
Randomized Controlled Trial
Effects of pain and prescription opioid use on outcomes in a collaborative care intervention for anxiety.
To determine the effects of pain and opioid pain medication use on clinical and functional outcomes in 1004 primary care patients with an anxiety disorder randomized to receive the Coordinated Anxiety Learning and Management (CALM) collaborative care intervention (cognitive-behavioral therapy and/or medication) versus usual care. ⋯ Anxious patients with pain benefit as much as those without pain from cognitive-behavioral therapy and medication treatment. Among patients with pain, however, there is some evidence of a reduced anxiety treatment response in those taking opioid medication, which should be further studied.
-
Randomized Controlled Trial
Combining Cognitive-Behavioral Therapy and Milnacipran for Fibromyalgia: A Feasibility Randomized-controlled Trial.
To evaluate the feasibility of a randomized-controlled trial and to obtain estimates of the effects of combined cognitive-behavioral therapy (CBT) and milnacipran for the treatment of fibromyalgia. ⋯ In this pilot study, a therapeutic approach that combines phone-based CBT and milnacipran was feasible and acceptable. Moreover, the preliminary data supports conducting a fully powered randomized-controlled trial.
-
Randomized Controlled Trial
Peripheral neurostimulation and specific motor training of deep abdominal muscles improve posturomotor control in chronic low back pain.
Chronic low back pain (CLBP) is associated with an impaired control of transversus abdominis/internal oblique muscle (TrA/IO), volitionally and during anticipatory postural adjustment (delay) along with maladaptive reorganization of primary motor cortex (M1). Specific training of deep trunk muscles and repetitive peripheral magnetic stimulation (RPMS) improve motor control. We thus tested whether RPMS over TrA/IO combined with training could promote TrA/IO motor control and decrease pain beyond the gains already reached in CLBP. ⋯ This study supports that peripheral neurostimulation (adjuvant to training) could improve TrA/IO motor learning and pain in CLBP associated with motor impairment. Testing of enlarged samples over several sessions should question the long-term influence of this new approach in CLBP.
-
Neuropathic pain is often worse at night; however, little is known about pain rhythmicity during waking hours. We aimed to replicate previous observations of diurnal pain progression, evaluate associations between diurnal rhythmicity and clinical factors, and evaluate the impact of diurnal rhythmicity on treatment response. ⋯ These observations suggest that neuropathic pain progressively increases throughout the day with clinically relevant morning-evening differences and further indicate that sex and underlying etiology may be important determinants of diurnal rhythmicity in neuropathic pain. Consideration of these patterns may guide improved therapeutic strategies and stimulate new directions of research that will improve our understanding and treatment of neuropathic pain.
-
Mirror-image sensory dysfunction (MISD) has not been systematically characterized in persistent postoperative pain. ⋯ MISD is a common finding in PTPS patients and deserves further study involving mechanism and clinical implications.