The Clinical journal of pain
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In previous research a close link between depression and postoperative pain has been described. However, the direction of impact remains unclear. The present longitudinal study aimed to clarify the prognostic value of depressive symptoms for perioperative pain and to explore the causal nature of the association between depressive symptoms and perioperative pain. ⋯ Our results suggest that early postoperative depressive symptoms predicts pain at discharge and preoperative pain predicts postoperative depressive symptoms. In conclusion, perioperative pain therapy should include the treatment of both, pain and depressive symptoms, to achieve sufficient pain relief. The evidence regarding the causal relationships between depressive symptoms and perioperative pain, however, must be tested in future research.
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Comparative Study
Compliance and persistence of antidepressants versus anticonvulsants in patients with neuropathic pain during the first year of therapy.
Neuropathic pain (NP) is a chronic condition that has human, social, and economic consequences. A variety of agents can be used for treatment; however, antidepressants and anticonvulsants are the 2 classes most widely studied and represent first-line agents in the management of NP. Little information is known about the adherence patterns of these medications during the first year of therapy in patients with NP. ⋯ Compliance and persistence rates were similar for patients with NP diagnosis taking antidepressants and anticonvulsants. Higher compliance was observed among patients taking venlafaxine; however, this population did have a small sample size.
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Evidence of pain alterations in trauma-exposed individuals has been found. The presence of posttraumatic stress disorder (PTSD) may be explaining these alterations, as some of the psychological characteristics of PTSD are hypothesized to increase pain response. ⋯ The results suggest that although trauma-exposed individuals are not more sensitive to painful stimulation, they evaluate pain in a more negative way. Exposure to trauma itself, but not to PTSD, may explain the differences found in pain unpleasantness.
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Changes in activity frequently occur as a consequence of ongoing pain. Three activity patterns commonly observed among individuals with ongoing pain are avoidance, overdoing, and pacing. We conducted 2 studies investigating these activity patterns, their interrelationships, and their associations with key psychosocial factors. Study 1 describes the development of a measure, the Patterns of Activity-Pain (POAM-P), to assess these activity patterns; Study 2 examines the psychosocial correlates of these activity patterns. ⋯ The POAM-P has excellent psychometric properties and may be useful in clinical practice to identify activity patterns associated with poorer functioning and to evaluate interventions intended to modify these activity patterns. The present results support previous findings linking avoidance and various negative outcomes. These results also provide evidence that pacing may be related to positive outcomes after treatment.
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To understand the factors that contribute to patient and physician global outcome ratings and the extent to which receiving different doses of opioids or placebo might influence the importance of these factors better. ⋯ The findings underscore the importance of change in pain intensity as a key correlate of ratings of global improvement. However, pain intensity is not the only important factor. In the current sample, improvement in both physical and psychological functioning made independent contributions to improvements in ratings of osteoarthritis status, supporting global ratings as assessing multicomponent domains. Overall, the findings suggest that when a patient or physician reports that the patient is "doing better," the patient is likely reporting less pain intensity and engaging in more physical activity and feeling better emotionally.