Pain medicine : the official journal of the American Academy of Pain Medicine
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The patient acceptable symptom state (PAccSS) is the value beyond which patients consider themselves well. Our aim was to determine the PAccSS of chronic pain in Moroccan outpatients suffering from chronic rheumatic diseases and to identify contributors to PAccSS. ⋯ Half of patients were satisfied of their disease state, while the PAccSS threshold of pain was unexpectedly high. This could be explained by an overestimation of the pain intensity or a Moroccan patients' high tolerance to pain. The main protective factors that contribute to achieving the PAccSS were high educational level, high socioeconomic status, higher functional status, and shorter term disease duration.
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Review Meta Analysis
The effectiveness of lumbar transforaminal injection of steroids: a comprehensive review with systematic analysis of the published data.
To determine the effectiveness of lumbar transforaminal injection of steroids in the treatment of radicular pain. ⋯ In a substantial proportion of patients with lumbar radicular pain caused by contained disc herniations, lumbar transforaminal injection of corticosteroids is effective in reducing pain, restoring function, reducing the need for other health care, and avoiding surgery. The evidence supporting this conclusion was revealed by comprehensive review of all published data and found to be much more compelling than it would have been if the literature review had been of the limited scope of a traditional "systematic review" of randomized, controlled trials only.
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BACKGROUND.: The sacroiliac joint (SIJ) complex has been identified as a common source of chronic low back pain. Radiofrequency (RF) neurotomy has been investigated in recent years as a minimally invasive treatment option for SIJ-mediated low back pain. A number of RF neurotomy methodologies have been investigated, including the use of cooled RF. ⋯ RESULTS.: When stratified by time to final follow-up (4-6, 6-12, and >12 months, respectively): 86%, 71%, and 48% of subjects experienced ≥50% reduction in VAS pain scores, 96%, 93%, and 85% reported their quality of life as much improved or improved, and 100%, 62%, and 67% of opioid users stopped or decreased use of opioids. CONCLUSIONS.: The current results show promising, durable improvements in pain, quality of life, and medication usage in a large European study population, with benefits persisting in some subjects at 20 months after treatment. These results are consistent with previous study findings on the use of cooled RF to treat SIJ-mediated low back pain.
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Chronic pain is a public health concern, and in the last decade, there has been a dramatic increase in the use and abuse of prescription opioids for chronic non-cancer pain. ⋯ The model presented is a patient-centered, efficient, and cost-effective approach to the management of chronic pain.