European journal of pain : EJP
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Randomized Controlled Trial
Long-term follow-up of tailored behavioural treatment and exercise based physical therapy in persistent musculoskeletal pain: A randomized controlled trial in primary care.
This study examined long-term effects of a tailored behavioural treatment protocol (TBT), as compared with an exercise based physical therapy protocol (EBT). One-hundred and twenty-two patients who, due to persistent musculoskeletal pain, consulted physical therapists in primary care were originally randomized to either of the two conditions. Follow-up assessments two-year post-treatment were completed by 65 participants. ⋯ Fear of movement/(re)injury increased in the EBT-group, and EBT participants reported higher fear of movement/(re)injury two years post-treatment compared to TBT. The study supports tailoring of treatments in concordance with patients' needs and preferences of activity goals and functional behavioural analyses including predictors of pain-related disability, for successful immediate outcomes and their maintenance in the long run. Exercise-based treatments resulted in somewhat smaller immediate treatment effects but had similar maintenance of effects over the 2-year follow-up period.
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Patients with chronic low back pain (CLBP) often report a disabling decrease in their activity level due to pain. The nature of the association between disability, activity, and pain over time is however, unclear. An intriguing issue here is whether a high level of pain-related disability is associated with a low activity level or are changes in the level of activity over time pain provoking and thus more disabling? The objectives of this study were to investigate associations between disability, pain intensity, pain-related fear, and characteristics of physical activity in patients with CLBP. ⋯ To explain the level of disability regression analyses were performed with disability as dependent variable and pain intensity, pain-related fear, and consecutively the level of physical activity in daily life and fluctuations in physical activity as independent variables. Results, based on 34 patients, showed that activity fluctuations (beta=0.373, p<0.05) rather than the mean activity level over time (beta=-0.052, ns) contributed significantly in explaining disability. The results are discussed in the light of current theories, previous research, and clinical implications.
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Randomized Controlled Trial
Quality discrimination for noxious stimuli in secondary somatosensory cortex: a MEG-study.
A complex cortical network is believed to encode the multi-dimensionality of the human pain experience. In the present study, we used magnetoencephalography (MEG) to examine whether the cortical processing of noxious stimuli with different psychophysical properties differs in primary (S1) and secondary (S2) somatosensory cortices. Noxious low (condition 1) and high (condition 2) current density stimulations of equal stimulus intensities were applied at the left forearm in 12 subjects in a randomised order. ⋯ Higher activations of bilateral S2 were significantly correlated with higher scores for the sensory-discriminative component during condition 2. In contrast, corresponding scores for the affective-motivational pain dimension did not differ between both conditions. Therefore, concerning the sensory dimension of the human pain experience we conclude that the S2 cortex is involved in the encoding of quality discrimination.
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Chronic post-surgical pain (CPSP) by definition develops for the first time after surgery and is not related to any preoperative pain. Preoperative pain is assumed to be a major risk factor for CPSP. Prospective studies to endorse this assumption are missing. ⋯ All patients with CPSP reported on preoperative chronic pain. Patients with preoperative pain, related or not related to the surgical site were significantly at risk to develop CPSP. High preoperative pain chronicity stages and pain severity grades were associated with CPSP. CPSP patients reported poorer mental health related quality of life and more severe psychosomatic dysfunction before and 3 months after surgery.
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The aim of this work was to evaluate the psychometric properties of the Numerical Rating Scale-11 (NRS-11) when used to assess pediatric pain intensity. We performed two studies: 175 schoolchildren, aged 8-12, participated in Study 1 and 63 children undergoing surgery and aged 6-16, participated in Study 2. ⋯ While both sexes and both the younger and older age groups preferred the FPS-R, this preference was more marked among girls and younger children. The NRS-11 has shown an acceptable level of validity for assessing pain intensity in both samples, however, additional research is needed in order to fully clarify the lower age limit in which the NRS-11 can be used.