The Clinical journal of pain
-
Randomized Controlled Trial
The influence of physical activity on pain thresholds in patients with depression and multiple somatoform symptoms.
Pain is a common symptom with high occurrence in somatoform syndromes and depressive disorders. Research in this area often focuses on experimental induction of pain and subsequent assessment of pain thresholds, ensuring repeatable stimuli of defined quality. Results on sensitivity to experimental pain in major depression are inconclusive, and data on pain thresholds in multiple somatoform symptoms are scarce. The goals of the present study were to differentiate between groups regarding the pressure pain thresholds, and to investigate the possible influence of physical activity on the pain thresholds in these groups. We postulate that physical fitness and physical activity influence pain thresholds in depression and persons with multiple somatoform symptoms. ⋯ Short low-graded exercise can have reducing effects on perception of pressure pain. Physical activity level is a relevant covariate when using pressure pain assessment. Reduced general fitness can partially account for lower pain thresholds in depression.
-
Randomized Controlled Trial
A randomized controlled trial of cognitive-behavioral therapy for the treatment of PTSD in the context of chronic whiplash.
Whiplash-associated disorders (WAD) are common and involve both physical and psychological impairments. Research has shown that persistent posttraumatic stress symptoms are associated with poorer functional recovery and physical therapy outcomes. Trauma-focused cognitive-behavioral therapy (TF-CBT) has shown moderate effectiveness in chronic pain samples. However, to date, there have been no clinical trials within WAD. Thus, this study will report on the effectiveness of TF-CBT in individuals meeting the criteria for current chronic WAD and posttraumatic stress disorder (PTSD). ⋯ This study provides support for the effectiveness of TF-CBT to target PTSD symptoms within chronic WAD. The finding that treatment of PTSD resulted in improvements in neck disability and quality of life and changes in cold pain thresholds highlights the complex and interrelating mechanisms that underlie both WAD and PTSD. Clinical implications of the findings and future research directions are discussed.
-
Randomized Controlled Trial Multicenter Study
Efficacy and safety of duloxetine 30 mg/d in patients with fibromyalgia: a randomized, double-blind, placebo-controlled study.
To evaluate the efficacy and safety of duloxetine 30 mg/d in adults with fibromyalgia. ⋯ Duloxetine 30 mg/d did not significantly reduce pain severity in patients with fibromyalgia. However, duloxetine-treated patients reported global improvement in symptoms and function. Safety findings were consistent with the known duloxetine safety profile.
-
Review Case Reports
Updated perspectives on occipital nerve stimulator lead migration: case report and literature review.
Patients with occipital neuralgia are often refractory to or intolerant of standard pharmacological and interventional management strategies. Although occipital nerve stimulation (ONS) may provide a unique alternative for such cases, a steep technical learning curve still exists. Lead migration (LM) is among the most challenging issues facing implanters performing ONS implantation. We present an unusual case of LM after ONS implantation and discuss technical aspects for successful revision. ⋯ In an era in which reducing health care expenditures is becoming increasingly important, current complication rates could curtail future acceptance and utilization of ONS. This fact and our case report underscore the importance of a continued drive toward technical advances and a reduction in complications associated with this important treatment modality. Further prospective investigation into the mechanism of action, mechanism of complications, optimization of surgical techniques, and long-term efficacy is warranted.
-
Randomized Controlled Trial
Follow-up of yoga of awareness for fibromyalgia: results at 3 months and replication in the wait-list group.
Published preliminary findings from a randomized-controlled trial suggest that an 8-week Yoga of Awareness intervention may be effective for improving symptoms, functional deficits, and coping abilities in fibromyalgia. The primary aims of this study were to evaluate the same intervention's posttreatment effects in a wait-list group and to test the intervention's effects at 3-month follow-up in the immediate treatment group. ⋯ These findings indicate that the benefits of Yoga of Awareness in fibromyalgia are replicable and can be maintained.