The Clinical journal of 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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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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Opioids are indicated for the management of procedural pain in neonates. There are limited data describing factors influencing patterns of use. ⋯ Neonatologists frequently report using opioids to manage procedural pain, however, spontaneously breathing infants are less likely to receive them, and their use varies according to infant and procedure characteristics. These data point to the need to further investigate, in a more controlled design, the pharmacologic effects of opioids in this population to better guide clinicians about their optimal use.
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Randomized Controlled Trial Comparative Study Clinical Trial
Intra-articular corticosteroid injections versus pulsed radiofrequency in painful shoulder: a prospective, randomized, single-blinded study.
Chronic shoulder pain treatment is known to be a difficult and long process. The objective of this study is to compare the efficacy of intra-articular corticosteroid injection and pulse radiofrequency (PRF) applied to the suprascapular nerve in patients with shoulder pain. ⋯ Intra-articular injection of corticosteroid and PRF applied to the suprascapular nerve are effective in the treatment of painful shoulder. When 2 treatments are compared, it may be concluded that intra-articular steroid injection was more effective especially in the first weeks regarding pain than the PRF. Further studies are needed to confirm these results in the prospective treatment guidelines.
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Randomized Controlled Trial
Transcutaneous pulsed radiofrequency treatment in patients with painful knee awaiting total knee joint replacement.
Our study was designed to determine if transcutaneous-pulsed radiofrequency treatment (TCPRFT) was able to reduce the pain experienced by patients awaiting total knee joint replacement (TKJR). We conducted a randomized, double-blinded, placebo controlled trial of TCPRFT in patients referred for TKJR to our hospital's Orthopedic Outpatient Clinic. ⋯ We believe this to be the first report of a controlled study of TCPRFT. This pilot study shows a benefit of the technique that justifies future research.