Pain medicine : the official journal of the American Academy of Pain Medicine
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Patient satisfaction surveys, such as Press Ganey, are flawed metrics for the emergency department setting and also in broader pain medicine. National experts discuss the pitfalls of applying such measures in pain care, and the potential unintended negative consequences to patients and providers alike. Evaluators, administrators, and payers are challenged to understand the limitations of Press Ganey and patient satisfactions in pain treatment, and the field is challenged to develop meaningful and valid metrics for best practices and competencies.
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Randomized Controlled Trial Multicenter Study
Experience and challenges presented by a multicenter crossover study of combination analgesic therapy for the treatment of painful HIV-associated polyneuropathies.
There is limited evidence for efficacy of analgesics as monotherapy for neuropathic pain associated with HIV-associated polyneuropathies, in spite of demonstrated efficacy in other neuropathic pain conditions. We evaluated the tolerability and analgesic efficacy of duloxetine, methadone, and the combination of duloxetine-methadone compared with placebo. ⋯ Challenges with participant recruitment and poor retention precluded trial completion to its planned targets, limiting our evaluation of the analgesic efficacy of the study treatments. Challenges to successful completion of this study and lessons learned are discussed.
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Repetitive transcranial magnetic stimulation (rTMS) has been shown to effectively treat depression, and its potential value in pain management is emphasized by recent studies. Transcranial magnetic stimulation (TMS)-evoked activity in the prefrontal cortex may be associated with corticolimbic inhibitory circuits capable of decreasing pain perception. The present exploratory pilot study used functional magnetic resonance imaging (fMRI) to examine the effects of left prefrontal rTMS on brain activity and pain perception. ⋯ Findings suggest that prefrontal rTMS may be capable of activating inhibitory circuits involved with pain reduction.