The Clinical journal of pain
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Joint and bone alterations are seldom mentioned in the diagnostic criteria for complex regional pain syndrome (CRPS) even though they are important for long-term outcome. Altered periarticular bone metabolism can be detected by 3-phase bone scintigraphy (TPBS). Although frequently examining the diagnostic efficacy of TPBS is debatable. ⋯ In conclusion, TPBS is a highly specific tool for diagnosing CRPS of the upper limb. ROI evaluation of phase 3 within the first 5 months after onset of CRPS is an appropriate additional diagnostic tool to confirm or exclude CRPS of the upper extremity.
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Comparative Study
Comparison of a pain management program with usual care in a pain management center for people with spinal cord injury-related chronic pain.
To evaluate the effectiveness of a specifically modified group-based, multidisciplinary cognitive-behavioral pain management program (PMP) in comparison to usual care in a clinical sample of people with spinal cord injury (SCI)-related chronic pain. ⋯ This study demonstrates that a PMP may offer benefits to clinical populations with SCI-related chronic pain in a pain management center. The reported improvements were of a magnitude to be clinically significant. However, some of the initial benefits reported were not maintained at the nine month follow-up. The interventions may need to be augmented to address the effects of SCI-related psychologic variables that may impact upon the individual's ability to benefit from a PMP.
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Review Historical Article
Psychologic factors in the development of complex regional pain syndrome: history, myth, and evidence.
The present paper examines the literature that addresses psychologic aspects involved in complex regional pain syndrome from a historic perspective to provide a rationale for the emergence of psychologic theories to explain its pathogenesis. The support of such perspective is then analyzed through the review of evidence-based studies. ⋯ An analysis of the Zeitgeist when complex regional pain syndrome was first described helps to understand the long-standing theories associated with a psychological theory of its etiology. This understanding should help to undermine the perpetuation of such claims which may contribute to undertreatment and misdiagnosis. To be consistent with todays Zeitgeist we must incorporate psychologic aspects, which while not causal in nature or exclusive of complex regional pain syndrome, are strongly associated with a wide spectrum of chronic pain disorders.
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Earlier studies have associated improvements in chronic pain outcomes with various consultation attributes, including: the legitimization of people's chronic pain experience, affective components of the therapeutic relationship, and reaching decisions about people's care through collaboration. Although studies have used patient self-report measures to examine how certain aspects of consultations contribute to managing chronic pain. The psychometric quality of these measures seems to have not been independently appraised to date. ⋯ Each of the included measures assessed differing aspects of consultations, and their potential clinical and research uses are discussed. Recommendations are made to improve the psychometric quality of the included measures. In summary, more psychometric research needs to be undertaken to improve the existing measures' quality and broaden the scope of chronic pain consultation measures before studies may be conducted to develop a comprehensive understanding of the manner in which consultation attributes influence chronic pain outcomes.