The Clinical journal of pain
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Whiplash-associated disorders (WAD) have been associated with sensory disturbances such as hypersensitivity or hypoesthesia. Different psychological factors seem to be important for prognosis and symptom presentation in WAD. Multivariate correlations between pain thresholds for pressure (PPT), cold and heat (CPT, HPT), detection thresholds for cold and warmth, pain intensity variables, and psychological aspects in women with chronic WAD (n=28) and in healthy pain-free controls (n=29) were investigated. ⋯ Pain intensity aspects were generally the strongest predictors of PPT in WAD. In contrast, no correlations existed between QST and PPT variables and psychological variables in controls. These results indicate the need to consider that a blend of factors influences the pain thresholds in chronic WAD and emphasize the need for a biopsychosocial model when interpreting QST and PPT variables.
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Multicenter Study Comparative Study
A comparative investigation of observational pain assessment tools for older adults with dementia.
Pain assessment in patients with dementia and severe limitations in ability to communicate can be challenging. The American Geriatrics Society (AGS) encourages the incorporation of 6 behavioral domains (ie, facial expressions, verbalizations/vocalizations, body movements, changes in interpersonal interactions, changes in activity patterns/routines and mental status changes) when conducting pain assessments among seniors with dementia. We investigated 6 observational pain assessment measures (differing with respect to the extent that they cover the AGS-recommended domains) under 2 different pain conditions (ie, influenza vaccination and movement-exacerbated pain) in a sample of long-term care residents with cognitive impairments. Given that a criticism of pain assessment scales is that many of the pain behaviors assessed are highly overlapping with symptoms of delirium, we also investigated the impact of the elimination of delirium-related items. ⋯ Our results provide much needed psychometric information regarding newly developed pain assessments measures for seniors with dementia. The measures differed with respect to ability to differentiate pain-related from non-pain-related states. Moreover, our findings support the utility of comprehensive coverage of the AGS-recommended pain assessment domains.
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Multicenter Study
Addressing parental concerns about pain during childhood vaccination: is there enough time to include pain management in the ambulatory setting?
Pain from vaccine injections remains undertreated, despite the availability of numerous pain-relieving strategies. Healthcare providers report lack of time within current office workflows as a major barrier to routine pain management. The objective was to document the total time involved in outpatient vaccine appointments to test the hypothesis that offering pain-relieving strategies can be practically implemented when considering the element of time to vaccine injection. ⋯ Contrary to healthcare provider perceptions, the timing of outpatient childhood vaccine appointments allows for the inclusion of pain management interventions. Efforts should now focus on educating healthcare providers and parents about the value of pain management and how to implement evidence-based strategies.
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The mild lumbar decompression procedure is a minimally invasive therapy for the treatment of symptomatic lumbar spinal stenosis (LSS). Mild offers LSS patients an early alternative after failed conservative therapy and before open surgery. This report describes 6-month safety and efficacy of mild patients treated at a single center. ⋯ The safety profile of mild, combined with the significant improvement in quality of life for these patients at 6-months is remarkable. Having failed conservative therapy, the high level of effectiveness of the mild procedure is particularly important in this patient population. In this series, mild has been shown to be a safe, effective, and cost-effective treatment for LSS patients with neurogenic claudication.
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This study in children and young adults having cancer-related amputation aimed to examine the incidence of phantom limb pain (PLP) in the first year after amputation and also the proportion of patients who had preamputation pain. ⋯ PLP after cancer-related amputation in children and young adults seems to be common but generally short lived in most patients.