Pain medicine : the official journal of the American Academy of Pain Medicine
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This is a structured evidence-based review of all available studies on the relationship between chronic pain and sleep problems as defined by the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM-IV) category of sleep disorder due to a general medical condition. ⋯ The results of this evidence-based structured review indicate that for the pain-sleep studies defined by the DSM-IV category of sleep disorder due to a general medical condition,chronic pain may be etiologically related to that sleep problem. However, these results do not preclude this relationship from being bidirectional.
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Although previous research suggests women report more severe pain than men, evidence for sex-related differences in pain-related disability is conflicting. Also, the impact of psychological factors on sex differences in disability is uncertain. ⋯ Women report greater pain-related disability than do men, even after controlling for depression, anxiety, and other psychological factors. Pain management strategies that target functional disability may be particularly important in the treatment of women with pain.
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Inadvertent cannulation or penetration of the cervical radicular arteries during cervical transformaminal epidural injections (TFESIs) is a serious clinical risk, and purportedly, the cause of possible spinal cord injury sustained during this procedure. ⋯ This observation reinforces the need for contrast injection and real-time digital subtraction fluoroscopy during cervical TFESIs for the prevention of spinal cord injury and fatalities.
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To estimate recent age- and sex-specific changes in long-term opioid prescription among patients with chronic pain in two large American Health Systems. ⋯ No one group showed especially large increases in long-term opioid prescriptions between 2000 and 2005. These results argue against a recent epidemic of opioid prescribing. These trends may result from increased attention to pain in clinical settings, policy or economic changes, or provider and patient openness to opioid therapy. The risks and benefits to patients of these changes are not yet established.
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New concerns have appeared recently in regard to the increasingly complex relationship between physicians and the pharmaceutical or devices industry. The American Academy of Pain Medicine (AAPM) Council on Ethics has discussed the issue, especially focusing on the implication of conflicts of interest for Pain Medicine, and published several recommendations for specific professional situations that the Pain Medicine physician may encounter.