Pain medicine : the official journal of the American Academy of Pain Medicine
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Randomized Controlled Trial
Opioid use as a predictor of pain outcomes in Iraq and Afghanistan Veterans with chronic pain: Analysis of a randomized controlled trial.
Our objectives were to: 1) assess the relationship between self-reported opioid use and baseline demographics, clinical characteristics and pain outcomes; and 2) examine whether baseline opioid use moderated the intervention effect on outcomes at 9 months. ⋯ In a stepped-care trial for pain, patients reporting baseline opioid use had greater improvement in pain disability at 9 months compared to patients not reporting opioid use.
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Randomized Controlled Trial
Efficacy of anodal suboccipital direct current stimulation for endogenous pain modulation and tonic thermal pain control in healthy participants: a randomised controlled clinical trial.
The aim of this study was to assess whether anodal DCS applied to the suboccipital (SO) target area could potentiate antinociception assessed primarily with conditioned pain modulation of tonic thermal test stimuli. ⋯ Although heterotopic CPM was not facilitated with either SO-DCS or M1-DCS, a general significant inhibition of tonic cold pain intensity was demonstrated following both interventions. The general effects of active DCS compared to sham on tonic cold pain-irrespective of the M1 or SO target-need to be confirmed using standard quantitative sensory testing.
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Review
Assessing variation in state opioid tapering laws: Comparing state laws with the CDC guideline.
In 2016, the Center for Disease Control and Prevention released an opioid prescribing guideline for primary care in response to opioid overdose deaths. Despite efforts to encourage safer prescribing practices, experts and federal agencies suspect prescribing guidelines may be misapplied in clinical practice, resulting in abrupt tapering from opioid therapy. Although state laws likely influence prescriber behavior, little is known about state tapering laws. Thus, we examined the scope and variation of state tapering laws compared with federal opioid guidelines. ⋯ State tapering laws incorporate some federal guideline attributes but most lack attributes deemed critical by experts. Without clear instruction, patients risk inappropriate tapering and discontinuation of opioid therapy. Given these findings, policymakers should consider addressing this gap.
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Randomized Controlled Trial
Effect of pregabalin on the EC50 of intravenous alfentanil in capsaicin induced pain.
To apply the sequential up-down method to a human experimental pain model in order to examine the opioid-sparing effect of oral pregabalin on intravenous alfentanil. ⋯ When the intradermal capsaicin-induced pain model was used in healthy volunteers, oral pregabalin had no opioid-sparing effects on intravenous alfentanil. This experimental model may be useful in studying analgesic interactions.
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Observational Study
First-year trajectories of medical cannabis use among adults taking opioids for chronic pain: an observational cohort study.
To describe first-year trajectories of medical cannabis use and identify characteristics associated with patterns of use in a cohort of adults using opioids for chronic pain. ⋯ Three clusters of medical cannabis use patterns emerged and were stable over time. Results suggest that structural factors related to race/ethnicity and employment may be major drivers of medical cannabis use, even among adults certified for its use.