The Clinical journal of pain
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To evaluate the contribution of pain severity, physical pathology, demographic factors, initiators of symptoms, affective distress, behavioral expressions of pain, and functional activity levels in physicians' decisions to prescribe opioid medication for chronic noncancer pain patients. ⋯ Physicians' practice in prescribing of opioids appears to be influenced most by patients' nonverbal communications of pain, distress, and suffering. Some of the factors not directly evaluated in this study that may also contribute to the decision to prescribe opioids for chronic noncancer pain patients are discussed.
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Tricyclic antidepressants (TCA) have been shown to provide analgesia for a variety of neuropathic and headache pain syndromes regardless of the presence of depression. There is a high incidence of depression in patients with chronic pain, thereby making tricyclic antidepressants particularly suitable for chronic pain patients. We wanted to study patterns of use of tricyclic antidepressants in our Pain Management Center (Beth Israel Hospital, Boston, MA, U.S.A.) primarily to answer four questions: (1) What percentage of all patients were treated with tricyclic antidepressants? (2) How many patients were treated with each antidepressant, and what was the dose range used for individual antidepressants? (3) Were tricyclic antidepressants beneficial for chronic pain, and was that response dependent on a particular dose? (4) Did patients receive an adequate TCA trial, and what factors led to the discontinuation of a TCA trial? ⋯ Tricyclic antidepressants were used in 25% of patients referred to a multidisciplinary pain center and were commonly used in low to intermediate doses, even in situations in which there were neither side effects nor optimal clinical response.
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To evaluate the relationships between patient and physician pretreatment expectations of pain relief and subsequent pain relief reported by chronic pain patients immediately after treatment. ⋯ The results of this study suggest that physicians are better predictors than are patients of patients responses to these procedures and/or that physicians may somehow subtly communicate their expectations to patients during the procedure, and these expectations then influence patient response. Patient pretreatment expectations may not always play a significant role in nonspecific treatment effects.
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To examine possible deficiencies in endogenous pain modulating mechanisms in fibromyalgia patients compared with matched pain-free control subjects. DESIGN/SUBJECTS/METHODOLOGY: Pain reduction was investigated in 25 female patients with fibromyalgia and 26 age-matched healthy women using the diffuse noxious inhibitory controls (DNIC) paradigm. Tonic thermal stimuli at painful and nonpainful intensities, tailored to individual heat pain thresholds, were employed to induce pain inhibition. The anticipated effect was assessed by measuring the electrical pain threshold and detection threshold, using a double staircase method. Only nontender control points were stimulated (thermode on the foot, electrodes on the inner forearm). ⋯ Pain modulation, produced by a concurrent tonic stimulus in healthy persons, was not seen in the fibromyalgia group. The patients either had deficient pain modulation or were unable to tolerate a tonic stimulus intense enough to engage a modulatory process. It remains to be established whether the pain reduction found in the healthy subjects was the conventional DNIC effect, another effect (e.g., distraction), or a combination of both.
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To examine the impact of preinjury job perceptions on chronic pain patients (CPPs) return to work after pain facility treatment. ⋯ There is a relationship between preinjury job perceptions and actual return to work after pain facility treatment. Voiced "intent" not to return to the preinjury type of job is highly predictive of not returning to work after pain facility treatment.