The Clinical journal of pain
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Almost 100 years after the first report of the thalamic syndrome, the scientific basis for the treatment of central post-stroke pain (CPSP) is remarkably small. Therefore, the authors aimed to provide evidence-based recommendations for the treatment of CPSP. ⋯ Amitriptyline, lamotrigine, and gabapentin provide a more favorable efficacy and safety profile than the classic antiepileptic drugs carbamazepine and phenytoin, for which no placebo-controlled evidence of efficacy was found. Clinical trials are urgently needed to optimize pharmacologic treatment of CPSP.
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The goal of this study was to examine the relative contribution of helplessness, fear of pain, and passive pain-coping to pain level, disability, and depression in chronic pain patients attending an interdisciplinary pain center. ⋯ These findings indicate a role for helplessness and passive pain-coping in chronic pain patients and suggest that both may be relevant in the treatment of pain level, disability, and/or depression.
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Vertebral body fractures (VBFs) are the most common complication of osteoporosis. Minimally invasive placement of cement to stabilize VBFs results in significant pain reduction and improved performance of daily activities. The authors describe a modified percutaneous vertebroplasty (PV) procedure during which a cavity is created manually in the VBF, allowing the cement to be injected with less resistance. ⋯ The Cavity Creation System is a safe, cost-effective treatment of VBF resulting in good/excellent pain relief and an improved quality of life.
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Multicenter Study Clinical Trial
Treatment of chronic plantar fasciitis with Botulinum toxin A: preliminary clinical results.
Based on recent results in chronic lateral epicondylitis we decided to investigate the efficacy of Botulinum toxin A (BTX-A) for treatment of chronic therapy resistant plantar fasciitis. Nine patients with an average duration of symptoms of 14 months and at least two prior conservative treatments received a one injection of 200 units of BTX-A (Dysport) subfascially into the painful area. The patients documented pain at rest and during weight-bearing after 2, 6, 10 and 14 weeks by a visual analogue scale. ⋯ The effect was still present at the latest follow-up of 14 weeks. Similarly, the pain at rest was reduced to less than half of the initial value at any follow-up. All patients were satisfied and did not require further treatment.
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Despite the growing use of opioids for persisting noncancer pain, evidence for their effectiveness is limited, especially in relation to functional outcomes. Guidelines have been developed for prescribers, but their utility is untested. This review examines the use of opioids in this population from a biopsychosocial perspective and makes a number of recommendations. ⋯ The available evidence indicates that by themselves, oral opioids generally achieve only modest reductions in pain levels in patients with chronic noncancer pain. Functional outcomes are inconsistent across studies. There are questions about the timing of their use and patient selection. There are risks in trials of opioids only after other conservative interventions have been tried unsuccessfully. Also, in some patients, ongoing use of opioids risks repeated over-doing of pain-generating activities and reinforcing escape/avoidance responses that promote disability. These risks may be lessened by assessment of current use of pain self-management strategies among potential candidates for opioids. This offers advantages in promoting collaborative management of persisting pain as well as better pain and functional outcomes. In this view, opioids may be considered as one possible element of a management plan rather than the primary treatment.