Pain medicine : the official journal of the American Academy of Pain Medicine
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The primary objective of this pilot study is to understand the relationship between physicians' characteristics and physicians' management decisions about pain. The secondary aim is to understand how patient characteristics, including race/ethnicity and socioeconomic status (SES) may affect these treatment decisions in chronic low back pain. ⋯ Our study is the first randomized controlled study assessing patient and treatment variables in the management of chronic pain. It suggests that physicians' demographic variables and perhaps patient demographic variables influence pain management decisions.
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Randomized Controlled Trial
Brain functional changes and duloxetine treatment response in fibromyalgia: a pilot study.
Serotonin-norepinephrine reuptake inhibitor (SNRI) antidepressant medications may have efficacy in relieving pain associated with fibromyalgia syndrome (FMS), even in the absence of major depressive disorder (MDD). Current practice is to use a trial-and-error treatment strategy, often requiring 8-12 weeks to determine the effectiveness of a given pharmacological intervention. The ability to predict response to antidepressant medications would facilitate clinical management of FMS. Prior work in MDD has shown that the quantitative electroencephalographic (QEEG) cordance biomarker of brain functional changes early in the course of antidepressant treatment is related to later clinical response. We hypothesized that cordance might also predict response to antidepressant medications for symptoms of FMS. ⋯ This pilot study suggests that QEEG biomarkers may prove useful for predicting improvement in painful symptoms during SNRI treatment in FMS. Larger studies are needed to confirm this finding.
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In the multimodal treatment approach to chronic back pain, interventional back procedures are often reserved for those who do not improve after more conservative management. Psychological screening prior to lumbar surgery or spinal cord stimulation (SCS) has been widely recommended to help identify suitable candidates and to predict possible complications or poor outcome from treatment. However, it remains unclear which, if any, variables are most predictive of pain-related treatment outcomes. ⋯ At present, while there is insufficient empirical evidence that psychological screening before surgery or device implantation helps to improve treatment outcomes, the current literature suggests that psychological factors such as somatization, depression, anxiety, and poor coping, are important predictors of poor outcome. More research is needed to show if early identification and treatment of these factors through psychological screening will enhance treatment outcome.
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1) To determine the psychometric properties of a Persian-language version of the Pain Self-Efficacy Questionnaire (P-PSEQ) in Iranian chronic pain patients; and 2) to evaluate the validity of the P-PSEQ in another Iranian chronic pain sample. ⋯ The psychometric properties of the P-PSEQ were confirmed. Consistent with findings in other countries with other language versions of the same scale, pain self-efficacy beliefs are associated with levels of physical disability, depression and general health status of chronic pain patients, over and above the influence of pain severity in this sample of Iranians with chronic pain.
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Case Reports
Opioid-free balanced anesthesia for cervical ganglionectomy subsequent to recent ultra rapid opioid detoxification.
To perform an opioid-free, balanced anesthetic for an Active Duty soldier undergoing cervical ganglionectomy for intractable occipital neuralgia 7 days after ultra rapid opioid detoxification (UROD) under general anesthesia. ⋯ This patient successfully completed a perioperative and postoperative course using ketamine and dexmedetomidine infusions, in addition to other non-opioid adjuncts. The patient returned to her Active Duty station, with increased functional capacity and remains opioid-free.