Pain medicine : the official journal of the American Academy of Pain Medicine
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Gabapentin (GBP), originally an antiepileptic drug, is more commonly used in the treatment of pain, including headache disorders. Off-label GBP is used in headache disorders with some success, some failure, and much debate. Due to this ambiguity, a clinical evidence literature review was performed investigating GBP's efficacy in headache disorders. ⋯ Despite the conflicting evidence surrounding select studies, a significant amount of evidence shows that GBP has benefit for a majority of primary headache syndromes, including chronic daily headaches. GBP has some efficacy in migraine headache, but not sufficient evidence to suggest primary therapy. When primary headache treatments fail, a GBP trial may be considered in the individual patient.
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As part of a series of articles designed to deconstruct chronic low back pain (CLBP) in older adults, this article focuses on maladaptive coping--a significant contributor of psychological distress, increased pain, and heightened disability in older adults with CLBP. ⋯ To promote early engagement in skill-focused treatments, providers can routinely evaluate pain coping strategies in older adults with CLBP using a treatment algorithm.
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Review Meta Analysis
A Systematic Review and Meta-Analysis on the Effectiveness of Graded Activity and Graded Exposure for Chronic Nonspecific Low Back Pain.
Our aim was to systematically review and meta-analyze the effectiveness of graded activity (GA) or graded exposure (GEXP) for chronic nonspecific low back pain (CNSLBP). ⋯ Limited evidence has been found to show that GA significantly reduces disability in the short and long term when compared with the CG in CNSLBP. There is moderate evidence that GEXP more effectively decreases catastrophizing than GA in the short term. No difference was found between GA and other exercise for any variable.
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This is a hypothesis-article suggesting an entirely new framework for understanding and treating longstanding pain. Most medical and psychological models are described with boxes and arrows. ⋯ To date no models that have been provided - and tested in a scientific satisfactory way - lays out a plan for specific assessment due to a specific causal explanation, and in the end serves the clinicians, patients and researcher with tools on how to address the specific pain condition to every individual pain patient's condition. By applying the Ising model (from physics) on the phenomenon of chronification of pain, one is able to detangle all these factors, and thus have a model that both suggests an explanation of the condition and outlines how one might target the treatment of chronic pain patients with the use of network science.