Pain medicine : the official journal of the American Academy of Pain Medicine
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Randomized Controlled Trial
Relationship of the Lateral Rectus Muscle, the Supraorbital Nerve, and Binocular Coordination with Episodic Tension-Type Headaches Frequently Associated with Visual Effort.
To study the relationship between tension-type headaches and the oculomotor system in terms of binocular coordination, mechanosensitivity of the supraorbital nerve, and myofascial trigger points in the lateral rectus muscle, assessing the influence of visual effort caused by using a computer at work. ⋯ The finding of a higher alteration of the sensitivity of the supraorbital nerve, the myofascial trigger points of the lateral rectus, binocular coordination, and the significant influence of visual effort in patients with tension-type headaches suggest a new clinical perspective for problems related to tension-type headaches.
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Observational Study
Trends in Medicalization of Children with Amplified Musculoskeletal Pain Syndrome.
The objective of this survey was to describe trends over time in medicalization of children with Amplified Musculoskeletal Pain Syndrome (AMPS). ⋯ Children with amplified musculoskeletal pain syndrome are becoming increasingly medicalized. Increased medicalization introduces risk of iatrogenic injury and burdens families with unnecessary medical costs. The significant increase in medicalization of children with AMPS is not related to an increase in patient reported pain, which is evidenced by the lack of significant increase in patients' pain score, pain duration, or functional disability at the time of their initial evaluation.
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To examine encounter-level factors associated with opioid dose increases during patients' first year on opioid therapy for chronic pain. ⋯ Most opioid prescriptions were written without face-to-face encounters. One quarter of dose increases contained no documented prescribing rationale. Documented encounter-level factors were not significantly associated with overall opioid dose escalation.
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With the increasing societal awareness of the prevalence and impact of acute pain, there is a need to develop an acute pain classification system that both reflects contemporary mechanistic insights and helps guide future research and treatment. Existing classifications of acute pain conditions are limiting, with a predominant focus on the sensory experience (e.g., pain intensity) and pharmacologic consumption. Consequently, there is a need to more broadly characterize and classify the multidimensional experience of acute pain. ⋯ Significant numbers of patients still suffer from significant acute pain, despite the advent of modern multimodal analgesic strategies. Mismanaged acute pain has a broad societal impact as significant numbers of patients may progress to suffer from chronic pain. An acute pain taxonomy provides a much-needed standardization of clinical diagnostic criteria, which benefits clinical care, research, education, and public policy. For the purposes of the present taxonomy, acute pain is considered to last up to seven days, with prolongation to 30 days being common. The current understanding of acute pain mechanisms poorly differentiates between acute and chronic pain and is often insufficient to distinguish among many types of acute pain conditions. Given the usefulness of the AAPT multidimensional framework, the AAAPT undertook a similar approach to organizing various acute pain conditions.