The Clinical journal of pain
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Randomized Controlled Trial
Evaluation of efficacy of the perioperative administration of Venlafaxine or gabapentin on acute and chronic postmastectomy pain.
Postmastectomy pain syndrome is a neuropathic pain syndrome that is known to develop after breast surgery. Preemptive analgesia has been shown to be efficacious in reducing postoperative pain, and may be effective in reducing the incidence of certain types of neuropathic pain. We investigated the analgesic efficacy of Venlafaxine and gabapentin on acute and chronic pain associated with cancer breast surgery. ⋯ Venlafaxine 37.5 mg/d extended release or gabapentin 300 mg/d have equipotent effects (except on the first day in venlafaxine group) in reducing analgesic requirements, although gabapentin is more effective in reducing pain after movement. Venlafaxine significantly reduced the incidence of postmastectomy pain syndromes (chronic pain) 6 months in women having breast cancer surgery. Gabapentin had no effect on chronic pain except decreasing incidence of burning pain.
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The use of strong opioids for treatment of noncancer chronic pain has increased. However, strong evidence for sustained pain relief and improved function is lacking. Controversy prevails, whether hormonal changes are induced by long-term treatment with opioids. The purpose of this study was to investigate the occurrence of endocrine dysfunction in chronic pain patients on long-term opioid treatment. ⋯ Long-term treatment of chronic pain with strong opioids causes side effects that can be attributed to hormonal abnormalities caused by opioid-induced inhibition of hypothalamic-pituitary function. Hormone substitution can be indicated to treat symptoms. Decreasing the opioid dose or stopping the opioid treatment can reverse endocrine dysfunction. This needs to be recognized by all practitioners treating chronic pain patients with opioids.
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Randomized Controlled Trial
The effectiveness of an Acceptance and Commitment Therapy self-help intervention for chronic pain.
To evaluate the effectiveness of an Acceptance Commitment Therapy based self-help book for people with chronic pain. ⋯ These findings support the hypothesis that using the self-help book, with minimal therapist contact adds value to the lives of people who experience chronic pain.
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To examine how the Adult Responses to Children's Symptoms (ARCS) does in a sample of children and adolescents with a variety of complex chronic pain conditions and to further validate the ARCS by examining associations among the subscale scores and patients' functional disability and depressive symptoms. ⋯ This study provides the first-known examination of the factor structure of the ARCS in a large sample of pediatric patients with diverse chronic pain conditions. Confirmatory factor analyses indicate that the ARCS is a valid measure for use with children and adolescents presenting to outpatient pain clinics with a variety of chronic pain complaints.
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Lumbar flexion-relaxation is a well-known phenomenon that can reliably be seen in normal participants, but not in most chronic low back pain (CLBP) participants. No earlier studies have investigated any specific clinical intervention designed to correct abnormal flexion-relaxation. The objective of this study was to evaluate the contribution of a surface EMG-assisted stretching (SEMGAS) biofeedback training protocol, within a functional restoration treatment program, on flexion range of motion (ROM) and erector spinae surface EMG (SEMG) during maximum voluntary flexion (MVF). ⋯ Interdisciplinary functional restoration rehabilitation of CLBP participants is effective for increasing ROM and other functional measures, but the addition of a SEMGAS biofeedback training protocol can result in normalization of the flexion-relaxation phenomenon, so that these participants are comparable with a pain-free control group.