European journal of pain : EJP
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Chronic pain in children and adolescents gives rise to high healthcare costs. Successful treatment is supposed to reduce the economic burden. The objective of this study was to determine the changes in healthcare utilization and expenditures from 1 year before (Pre) intensive interdisciplinary pain treatment (IIPT) to the first (Post 1) and second (Post 2) years after discharge in a sample of paediatric chronic pain patients. ⋯ This study analyses original claims data from paediatric chronic pain patients in the year before and up to 2 years after intensive interdisciplinary pain treatment in a specialized paediatric pain centre. The analysis of long-term data reveals a continuous cost reduction after intensive interdisciplinary pain treatment and a change in the subsequent outpatient treatment.
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Randomized Controlled Trial
Refinement and validation of a tool for stratifying patients with musculoskeletal pain.
Patients with musculoskeletal pain in different body sites share common prognostic factors. Using prognosis to stratify and treatment match can be clinically and cost-effective. We aimed to refine and validate the Keele STarT MSK Tool for prognostic stratification of musculoskeletal pain patients. ⋯ The paper presents the first musculoskeletal pain prognostic stratification tool specifically for use among all primary care patients with the five most common musculoskeletal pain presentations (back, neck, knee, shoulder or multisite pain). The Keele STarT MSK Tool identifies groups of musculoskeletal pain patients with clearly different characteristics and prognosis. Using this tool for stratification and treatment matching may be clinically and cost-effective.
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Randomized Controlled Trial
Improvement in pain interference and function by an allied health pain management program: results of a randomised trial.
Chronic pain is a significant health problem worldwide and requires a biopsychosocial treatment approach. Access to traditional pain medicine specialist services is limited and innovative treatment models are required to support patients in tertiary care. The study evaluated the clinical effectiveness and safety of the Treatment Access Pathway (TAP), an allied health expanded scope model of care which included innovative group assessment and collaboration with patients to create individualized treatment plans. ⋯ The study tests effectiveness and safety of an expanded scope allied health-led chronic pain program. Despite a high attrition rate, the study showed reduced pain interference and increased physical function in those who completed the protocol. The results are promising and support introduction of this model as an adjunct to existing traditional chronic pain models of care, with a particular focus on improving participant retention in the program. Additionally, the model of care can be used as a standalone chronic pain model of care where no other pain management resources are available. The study was registered on ANZCTR (Trial ID: ACTRN12617001284358).
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Clinical guidelines agree that preventive treatment should be considered in patients with uncontrolled migraine despite acute medications or patients with ≥4 migraine days per month. However, the criteria to define the effectiveness of treatment and the factors that inform the decision to (dis)continue it are not clearly defined in clinical practice. ⋯ In clinical practice, criteria to define the effectiveness of migraine preventive treatment and factors that guide treatment stop or continuation are not clearly defined. In this simulated clinical setting study, a reduction in the use of acute migraine medications was the factor associated with preventive treatment effectiveness definition. This study also revealed that factors strongly associated with the decision of treatment continuation in real life are the acute migraine medications use and a positive patient's perception of treatment effectiveness.
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Visual deprivation leads to behavioural adaptations. Early visual deprivation has greater effects on sensory systems compared with late visual deprivation. Although this has been well studied, the impact of visual deprivation on pain sensitivity has scarcely been investigated. In humans, one study indicates that pain sensitivity is increased in early, but not late-onset blindness. In animals, one study indicates that sensitivity to noxious stimulation is increased in anophthalmic mice, but the impact of late visual deprivation on sensitivity remains unknown. The aim of this behavioural study was to examine sensitivity to noxious stimulation in mice with early and late visual deprivation. We hypothesized that visual deprivation would have different effects on sensitivity to noxious stimulation depending on its onset. ⋯ Sensory deprivation induces behavioural adaptions. For most sensory systems, the extent of these adaptations generally depends on the stage of cerebral development. In contrast, the present results indicate that for the nociceptive system, both early and late visual deprivation have similar effects. Anophthalmic, dark-reared mice and adult mice deprived of vision for two months showed thermal and mechanical hypersensitivity. This shows a clear interaction between visual and nociceptive systems and has implications for the biological significance of pain in the blind.