European journal of pain : EJP
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Comparative Study
A comparison of the clinical features of fibromyalgia syndrome in different settings.
The "funnel hypothesis" of fibromyalgia syndrome (FMS) assumes that the high levels of somatic and psychological symptoms reported by FMS-patients are due to a selection bias of patients seeking for medical specialist care. We tested the hypothesis by comparing FMS-patients from a general population sample and different clinical settings. ⋯ We found a "funnel" between FMS-persons of the general population and FMS-patients of clinical settings, but not between patients of different levels of care. Patients contacting the health care system did not differ in clinical features.
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We studied the associations of widespread pain with other pain and functional measures among patients with chronic epicondylitis. A total of 190 patients (66% females) participated in the study; with a mean age 43.7, mean duration of symptoms 48weeks, chronic lateral (n=160) and medial (n=30) epicondylitis. We analysed clinical status, grip strength and cubital pain thresholds and interviewed pain and disability, leisure time physical activity, strenuous hobby activities for arms, duration of symptoms, other systemic and upper extremity disorders, arm operations, and work ability. ⋯ It was also related to upper extremity disorders and arm surgery, but not with operated epicondylitis, other systemic diseases, workload or work ability. In addition, 39% of patients without other disease reported widespread pain. Widespread pain is common in chronic epicondylitis with and without other diseases, and is related to high pain scores, decreased function of the arm, long duration of symptoms, sick leave, and with a low level of physical activity.
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Although women report feeling more pain than men their pain is often under-valued as compared to men's pain. We argue that such biases are not universal, being either enhanced or suppressed by context-related variables pertaining to the situation, the patient and the perceiver. Consequently, we aimed at understanding the effects of pain duration, patient's distress and the judge's sex on sex-related biases in pain judgements. ⋯ Moreover, only the judgments on the woman's pain were moderated by such contextual variables. Finally, male students were more biased than females. Implications for gender equality in pain treatments are drawn.
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Withdrawal of opioid medication in patients with chronic pain has a drop-out and relapse problem. ⋯ To avoid drop-out and relapse clinical practice need to screen for depressive symptoms, pain intensity, and abstinence. This article presents significant reliability of scales useful within dependency centers. They can be used to identify these risk factors for drop-out and relapse, respectively, when initiating the withdrawal process. Taking these risk factors into consideration could improve the outcome of the withdrawal process by preventing drop-out and relapse.