Pain medicine : the official journal of the American Academy of Pain Medicine
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There is growing interest in the use of sublingual buprenorphine for the treatment of chronic pain due to the unique pharmacology of buprenorphine, widespread use of the transdermal buprenorphine patch for chronic pain, and recent availability of sublingual buprenorphine tablets for the treatment of opioid dependence. The aim of this systematic review was to evaluate the evidence from clinical trials that have assessed the effectiveness of sublingual buprenorphine for chronic pain analgesia. ⋯ Preliminary trials suggest a plausible role; however, due to a paucity of high-quality trials, the current evidence is insufficient to determine the effectiveness of sublingual buprenorphine for the treatment of chronic pain. Rigorous further trials are warranted.
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Clinical Trial
Transforaminal epidural steroid injections followed by mechanical diagnosis and therapy to prevent surgery for lumbar disc herniation.
Prospective cohort study. ⋯ The results indicate that a course of TESIs followed by MDT may be able to avoid surgery in a substantial proportion of candidates for herniated lumbar disc surgery.
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Depression and chronic low back pain (CLBP) are both frequent and commonly comorbid in older adults seeking primary care. Serotonin-norepinephrine reuptake inhibitors (SNRIs) such as venlafaxine may be effective in treating comorbid depression and CLBP. For patients with comorbid depression and CLBP, our goal was to identify "easy-to-use" early clinical variables associated with response to 6 weeks of low-dose venlafaxine pharmacotherapy that could be used to construct a clinically useful predictive model in future studies. ⋯ An important minority of patients benefitted from 6 weeks of venlafaxine 150 mg/day. Early improvement in depression and pain at 2 weeks may predict continued improvement at week 6. Future studies must examine whether patients who have a poor initial response may benefit from increasing the SNRI dose, switching, or augmenting with other treatments after 2 weeks of pharmacotherapy.
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Clinical Trial
Three-dimensional computerized mobilization of the cervical spine for the treatment of chronic neck pain: a pilot study.
Manual therapies for chronic neck pain are imprecise, inconsistent, and brief due to therapist fatigue. A previous study showed that computerized mobilization of the cervical spine in the sagittal plane is a safe and potentially effective treatment of chronic neck pain. ⋯ These preliminary results demonstrate that this novel, computerized, three-dimensional cervical mobilization device is probably safe. The data also suggest that this method is effective in alleviating neck pain and associated headache, and in increasing the CROM, although the sample size was small in this open trial.
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The relationship between fatigue and pain has been investigated previously, but little is known about the prevalence of substantial fatigue in patients sick-listed for chronic low back pain (CLBP) and about how fatigue is associated with depression, pain, and long-term disability. The aims of the study were to examine the prevalence of substantial fatigue; associations between fatigue, depression, and pain; and whether fatigue predicted long-term disability. ⋯ The vast majority of the sick-listed CLBP patients reported substantial fatigue. Those with substantial fatigue had more pain and depressive symptoms and a significant risk of reporting more disability at 3, 6, and 12 months. Substantial fatigue is disabling in itself but also involves a risk of developing chronic fatigue syndrome and long-term disability.