The Clinical journal of pain
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The objective of this article is to provide a brief overview of the major psychosocial risk factors impacting recovery from spine surgery. ⋯ Presurgical psychological screening should be included in the medical diagnostic process of spine surgery candidates, especially when the major goal is pain reduction, or when the surgeon recognizes the existence of psychosocial risk factors. Suggestions for future directions in the development of presurgical psychological screening procedures are also given.
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The proper medicinal use of opioids, in light of their notorious history and current relation to social ills, continues to be debated and remains unclear in several areas of medicine. This article will review several areas and points of controversy related to screening for potential problematic opioid behavior in chronic nonmalignant pain patients. Controversy over the prescription of opioids for chronic nonmalignant pain continues, despite the growing acceptance of this practice. ⋯ Although clinical observations exist about risk factors for opioid misuse in chronic pain patients, there is limited research. Further, the area of prescreening for problematic drug behavior is in its infancy. However, researchers have begun to delve into this challenging area and the application of rigorous empirical research will bring us closer to identifying those patients at risk so that their pain is managed without destructive outcomes in other areas of their life.
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Randomized Controlled Trial Comparative Study Clinical Trial
Effectiveness of virtual reality-based pain control with multiple treatments.
The current study explored whether immersive virtual reality continues to reduce pain (via distraction) with repeated use. ⋯ Although the small sample size limits generalizability. results provide converging preliminary evidence that virtual reality can function as a strong nonpharmacological pain reduction technique for burn patients during physical therapy. Results suggest that virtual reality does not diminish in analgesic effectiveness with three (and possibly more) uses. Virtual reality may also have analgesic potential for other painful procedures or pain populations. Practical implications are discussed.
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Advances in neurobiology serve as the basis for current and evolving implantable pain modalities, consisting of neurostimulation and neuraxial drug administration systems. Appropriate treatment of pain begins with an accurate diagnosis based on thorough physical and behavioral evaluations. ⋯ Patients with chronic pain are subject to neurophysiological, emotional, and behavioral influences that govern their perception of pain and of pain relief. Therefore, treatment of chronic pain is multidisciplinary, drawing on cognitive and behavioral psychological therapies, functional rehabilitation, orthopedic and neurologic surgery, medications, nerve blockade, neuroaugmentative procedures, and sometimes neurodestructive procedures. Appropriate selection of patients helps ensure that implantable therapies are used for those who are most likely to benefit.