The Clinical journal of pain
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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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Case Reports
Transcranial direct current stimulation (tDCS) relieved itching in a patient with chronic neuropathic pain.
Itching is often called the second modality of nociception besides pain, and affects many chronic pain patients. ⋯ This case provides a rationale for future studies of neuromodulatory treatments for itch, and indicates a potential clinical use of neuromodulation in patients with unrelieved itching.
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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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Randomized Controlled Trial
Specificity and time-course of attentional bias in chronic headache: a visual-probe investigation.
The specificity and time-course of attentional bias in chronic headache were investigated. Individuals with chronic headache, compared with healthy controls, were hypothesized to show significant attentional bias towards disorder-relevant headache-related images. ⋯ Individuals with chronic headache demonstrate attentional bias towards pain information, which is most prominently shown towards stimuli relevant to their specific disorder. Biases are also more pronounced at longer stimuli presentation times associated with maintained attention. Future research should investigate the clinical implications of attentional bias in chronic headache, and further explore the benefits of attentional bias modification upon patient functioning.