Pain research & management : the journal of the Canadian Pain Society = journal de la société canadienne pour le traitement de la douleur
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A number of variables reflecting attentional and emotional mechanisms of processing pain-related information have recently attracted interest, ie, fear of pain, pain catastrophizing, hypervigilance and attentional bias to pain. These variables can be assessed by explicit measures based on conscious self-report, or by implicit measures assessing mainly preconscious stages of information processing such as behavioural or electrophysiological tests. Convergent validity within implicit measures was assumed to be high, as was the discriminant validity between implicit and explicit measures. ⋯ All variables appeared to be only weakly associated. The attempt to organize the field of variables targeting attentional and emotional mechanisms of processing pain-related information using concepts such as implicit and explicit measures failed as far as the present test on convergent⁄discriminant validity proved.
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The effectiveness of intrathecal opioids (ITOs) for postoperative analgesia has been limited by reduced opioid dosing because of opioid-related side effects, most importantly respiratory depression. To overcome these limitations, high-dose intrathecal morphine was combined with a continuous intravenous (IV) postoperative naloxone infusion. The aim of the present chart analysis was to investigate the safety and efficacy of high-dose ITOs combined with IV naloxone compared with IV opioid analgesia alone. ⋯ High-dose ITOs combined with a postoperative IV naloxone infusion provided excellent analgesia for major pelvic surgery. The IV naloxone infusion combined with high-dose ITOs appeared to control opioid side effects without affecting analgesia.
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Fibromyalgia remains underdiagnosed and suboptimally treated even though it affects an estimated 3.3% of Canadians. The present study examines knowledge and attitudinal challenges affecting optimal care. ⋯ Findings revealed the presence of GP attitudinal and confidence challenges in caring for fibromyalgia patients. As care of fibromyalgia patients moves to general practices, these fundamental competencies must be addressed to assure that all patients receive the quality of care necessary to manage their disease and to empower physicians to be more professionally effective. As stated by one patient, "Why are we being penalized for having this disability?"
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The entire primary care record of six patients attending a community-based education/exercise self-management program for chronic noncancer pain (YMCA Pain Exercise/Education Program [Y-PEP]) was reviewed. Medical visits, consultations and hospital admissions were coded as related or unrelated to their pain diagnoses. Mood disruption, financial concerns, conflicts with employers/insurers, analgesic doses, medication side effects and major life events were also recorded. ⋯ After attending Y-PEP, health care use fell for four of six patients and two returned to work. Primary care physicians need to recognize the functional limitations and psychosocial complications experienced by their chronic pain patients. A program such as Y-PEP may promote active self-management strategies resulting in lowered health care use.
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Few studies have examined the relationship between disability and borderline personality symptomatology, and, among those that have, findings have been inconsistent. In the present study, the relationship between medical disability and borderline personality symptomatology was examined in a sample of chronic pain patients. ⋯ Findings suggest that among chronic pain patients, there may be no meaningful relationship between having ever been on medical disability and borderline personality symptomatology.