European journal of pain : EJP
-
The low quality of included trials, insufficient rigour in review methodology, ignorance of key pain issues, small size, and over-optimistic judgements about the direction and magnitude of treatment effects all devalue systematic reviews, supposedly the 'gold standard' of evidence. Available evidence indicates that almost all systematic reviews in the published literature contain fatal flaws likely to make their conclusions incorrect and misleading. ⋯ We argue that results of most systematic reviews should be dismissed. Forensically critical systematic reviews are essential tools to improve the quality of trials and should be encouraged and protected.
-
Review Meta Analysis
Relative contributions of the nervous system, spinal tissue and psychosocial health to non-specific low back pain: Multivariate meta-analysis.
Nervous system, psychosocial and spinal tissue biomarkers are associated with non-specific low back pain (nsLBP), though relative contributions are unclear. ⋯ Spinal structural lesions (e.g. intervertebral disc degeneration), psychosocial (e.g. depression) and nervous system factors (detected by e.g. quantitative sensory tests, structural and functional measures) contribute to non-specific low back pain. However, psychosocial factors may be more compromised than nervous system and spinal imaging biomarkers. This relationship depends on if the pain is acute or chronic. These findings underscore that the 'non-specific' label in back pain should be reconsidered, and more specific multidimensional categories evaluated to guide patient management.
-
Neuropathic pain symptoms and signs of increased pain sensitization in osteoarthritis (OA) patients may explain persistent pain after total joint replacement (TJR). Therefore, identifying genetic markers associated with pain sensitization and neuropathic-like pain phenotypes could be clinically important in identifying targets for early intervention. ⋯ To the best of our knowledge, this is the first GWAS for pain sensitization and the first gene-based meta-analysis of pain sensitization and neuropathic-like pain. Higher pain sensitization and neuropathic pain symptoms are associated with persistent pain after surgery hence, identifying genetic biomarkers and molecular pathways associated with these traits is clinically relevant.
-
Randomized Controlled Trial
A Virtual Reality System for Pain and Anxiety Management during Outpatient Hysteroscopy- A Randomized-Control Trial.
Visual and acoustic virtual reality (VR) has been increasingly explored as a non-pharmacological tool for pain relief in clinical settings. ⋯ The use of a Virtual reality system was found ineffective in reducing pain during and after an office operative hysteroscopy without anaesthesia, in a thorough examination of both continuous physiological parameters and women's self-reported measures.
-
In order to decide between avoiding pain or pursuing competing rewards, pain must be assigned an abstract value that can be traded against that of competing goods. To assess the relationship between subjectively perceived pain and its value, we conducted an experiment where participants had to accept or decline different intensities of painful electric shocks in exchange of monetary rewards. ⋯ This work provides a description of the pain value function indicating how much people are willing to pay to avoid different intensities of pain. We found that the function was curvilinear, suggesting that the same unit of subjective pain has more value in the high vs. low pain range. Moreover, the pain value was influenced by the experimental manipulation of the rewards distribution and of the inter-individual differences in harm avoidance and persistence. Altogether, the present study provides a detailed account of how subjectively experienced pain is assigned value.