The Clinical journal of pain
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Randomized Controlled Trial
Effect of postoperative analgesia on energy metabolism and role of cyclooxygenase-2 inhibitors for postoperative pain management after abdominal surgery in adults.
It is questionable whether the stress response to surgery is necessary. The objective of this study was to evaluate the effectiveness of postoperative analgesia on energy metabolism and compare cyclooxygenase-2 selective inhibitor with tramadol in postoperative pain management after major abdominal surgery. ⋯ These results confirm that sufficient postoperative analgesia may be efficient to reduce some of the stress responses to operative trauma. In addition, intravenous parecoxib (40 mg bid) followed by oral celecoxib (0.2 g bid) is as effective as intravenous tramadol (0.1 g tid) with continued oral tramadol (0.1 g tid) after major abdominal surgery.
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Review Meta Analysis
The characteristics and quality of randomized controlled trials in neuropathic pain: a descriptive study based on a systematic review.
Evidence from randomized controlled trials is regarded as the gold standard in clinical research and yet the quality of the conduct and reporting of trials is variable, even post-Consolidated Standards of Reporting Trials. This study arose from a systematic review and cost-effectiveness analysis of treatment for neuropathic pain. The aim was to provide a description of the included trials and investigate trends in study characteristics and measures of quality over time. ⋯ There have been a number of improvements regarding the quality and reporting of randomized controlled trials in neuropathic pain, but some failings remain that at best make some results difficult to interpret and at worst lead to bias.
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Review Meta Analysis Comparative Study
The impact of low back-related leg pain on outcomes as compared with low back pain alone: a systematic review of the literature.
Low back pain (LBP) with leg pain, especially with findings of nerve root involvement, is considered as a poor prognostic indicator although it seems to have a favorable natural resolution. It is unclear whether patients with LBP and leg pain are at the more severe end of the spectrum as compared with patients with LBP alone or whether they are a distinct subgroup that would perhaps benefit from early identification of the condition and more targeted interventions. The purpose of this study was to investigate the impact of LBP-related leg pain on outcomes and use of health resources as compared with patients with LBP alone. ⋯ LBP with pain radiating to the leg appears to be associated with increased pain, disability, poor quality of life, and increased use of health resources compared with LBP alone. These findings argue for early identification of these cases by health care professionals and pursuing effective treatments.
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Review
Central sensitization and altered central pain processing in chronic low back pain: fact or myth?
The purpose of this narrative review is to analyze the available literature concerning central sensitization and altered central pain processing in patients with chronic low back pain (LBP). ⋯ It tempting to speculate that ongoing nociception is associated with cortical and subcortical reorganization and may play an important role in the process of the chronification of LBP. Future prospective research should explore to what extent these changes are reversible and if this reversibility is associated with improved functioning of patients.
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Clinical Trial
A multidimensional approach to pain assessment in critically ill infants during a painful procedure.
Inferring the pain level of a critically ill infant is complex. The ability to accurately extract the appropriate pain cues from observations is often jeopardized when heavy sedation and muscular blocking agents are administered. Near-infrared spectroscopy is a noninvasive method that may provide the bridge between behavioral observational indicators and cortical pain processing. We aimed to describe regional cerebral and systemic hemodynamic changes, as well as behavioral reactions in critically ill infants with congenital heart defects during chest-drain removal after cardiac surgery. ⋯ We demonstrated with a multidimensional pain assessment approach that significant cerebral, physiological, and behavioral activity was present in response to a noxious procedure in critically ill infants despite the administration of analgesic treatment. Considering that the sedating agent significantly dampened pain behaviors, assessment of cerebral hemodynamic in the context of pain seems to be an important addition.