Pain medicine : the official journal of the American Academy of Pain Medicine
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The prevalence of chronic nonmalignant pain (CNMP), the lack of confidence and reward among trainees and providers caring for patients with CNMP, and the lack of a comprehensive curriculum in pain management prompted the creation of the Virginia Commonwealth University (VCU) Chronic Nonmalignant Pain Management curriculum, an innovative e-learning resource. This article describes the development of the curriculum and presents initial evaluation data. ⋯ The VCU Chronic Nonmalignant Pain Management curriculum is an e-learning resource that has the potential to fill a significant training void. Design and content changes have been made as a result of initial evaluation data. Data from ongoing evaluation will allow curricular refinement.
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Review
Trigger point injections for chronic non-malignant musculoskeletal pain: a systematic review.
This systematic review assessed the available published evidence on the efficacy and safety of using trigger point injection (TPI) to treat patients with chronic non-malignant musculoskeletal pain that had persisted for at least 3 months. ⋯ The efficacy of TPI is no more certain than it was a decade ago as, overall, there is no clear evidence of either benefit or ineffectiveness. The only advantage of injecting anesthetic into trigger points may be to reduce the pain of the needling process, which may not be an insignificant benefit.
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Randomized Controlled Trial
The effect of preemptive analgesia in postoperative pain relief--a prospective double-blind randomized study.
To analyze the effect of infiltration of local anesthetics on postoperative pain relief. ⋯ Local anesthetic infiltration before and/or after abdominal hysterectomy does not reduce the intensity of postoperative pain and analgesic requirements.
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To ascertain the self-reported reasons for participation in the clinical research of chronic low back pain and to evaluate those reasons in the context of informed consent and the concept of therapeutic misconception. This is the belief that research participation is equivalent to clinical care. ⋯ Assessing the adequacy of informed consent requires a thorough understanding of how subjects viewed a study and their reasons for participation. Quantitative-based surveys may not capture the complexities of reasons for study participation. Reasons of personal benefit, seemingly contradictory reasons for participation, or overriding desire for relief may all affect the quality of informed consent. Yet, these issues may not automatically signal the presence of TM.
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Case Reports
Therapeutic pudendal nerve blocks using corticosteroids cure pelvic pain after failure of sacral neuromodulation.
A patient with bladder frequency and urgency associated with pelvic pain had no control of symptoms by previous bladder distention, hysterectomy, or sacral nerve root stimulator. A clinical and neurophysiological diagnosis of pudendal neuropathy was made. Treatment with a nerve protection program and pudendal nerve perineural injections of local anesthetics and corticosteroids has provided total symptomatic relief that is durable.