The journal of pain : official journal of the American Pain Society
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Review Meta Analysis
Local infiltration analgesia for postoperative pain after hip arthroplasty: a systematic review and meta-analysis.
Postoperative pain after hip arthroplasty (HA) is very common and severe. Currently, use of routine analgesic methods is often accompanied by adverse events (AEs). Local infiltration analgesia (LIA) for controlling pain has been a therapeutic option in many surgical procedures. However, its analgesic efficacy in HA and its safety remain unclear. Data from 9 randomized controlled trials, involving 760 participants, comparing the effect of LIA with that of placebo infiltration or no infiltration on patients undergoing HA were retrieved from an electronic database, and the pain scores, analgesic consumption, and AEs were analyzed. Effects were summarized using weighted mean differences, standardized mean differences, or odds ratio with fixed or random effect models. There was strong evidence of an association between LIA and reduced pain scores at 4 hours at rest (P < .00001) and with motion (P < .00001), 6 hours with motion (P = .02), and 24 hours at rest (P = .01), and decreased analgesic consumption during 0 to 24 hours (P = .001) after HA. These analgesic efficacies for LIA were not accompanied by any increased risk for AEs. However, the current meta-analysis did not reveal any associations between LIA and the reduced pain scores or analgesic consumption at other time points. The results suggest that LIA can be used for controlling pain after HA because of its efficacy in reducing pain scores and thus can reduce analgesic consumption on the first day without increased risk of AEs. ⋯ This is the first pooled database meta-analysis to assess the analgesic effects and safety of LIA in controlling pain after HA. The derived information offers direct evidence that LIA can be used for patients undergoing HA because of its ability to reduce pain scores and analgesic consumption without any additional AEs.
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Review Meta Analysis
Self-efficacy and chronic pain outcomes: a meta-analytic review.
A meta-analysis was performed to evaluate overall strengths of relation between self-efficacy (SE) and functioning (pain severity, functional impairment, affective distress) in chronic pain samples, as well as potential moderating effects of sociodemographic characteristics and methodologic factors on these associations. In sum, 86 samples (N = 15,616) fulfilled selection criteria for analysis. SE had negative overall correlations with impairment, affective distress, and pain severity although considerable heterogeneity was observed for all effect sizes. Age, pain duration, SE scale content (SE for functioning despite pain vs SE for pain control vs SE for managing other symptoms such as emotional distress) and type of impairment measure (self-report vs task performance) had significant moderating effects on SE-impairment associations. SE-affective distress relations were moderated by employment status and SE scale content. Finally, moderator analyses of studies having longitudinal designs indicated associations between baseline SE, and each outcome at follow-up remained significant in prospective studies that had statistically controlled for effects of baseline responses on that outcome. Hence, SE is a robust correlate of key outcomes related to chronic pain and a potentially important risk/protective factor that has implications for subsequent functioning in affected groups. ⋯ Meta-analysis indicated that SE has significant overall associations with impairment, affective distress, and pain severity within chronic pain samples and identified several factors that contribute to variability in effect sizes. Findings highlighted SE as a robust correlate and potentially important risk/protective factor for subsequent adjustment in affected groups.
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Randomized Controlled Trial Multicenter Study Comparative Study
Safety and efficacy of once-daily hydromorphone extended-release versus twice-daily oxycodone hydrochloride controlled-release in chinese patients with cancer pain: a phase 3, randomized, double-blind, multicenter study.
Noninferiority of the efficacy of once-daily hydromorphone hydrochloride extended-release (hydromorphone ER) compared with twice-daily oxycodone hydrochloride controlled-release (oxycodone CR) was investigated in this randomized, double-blind study in Chinese patients with moderate to severe cancer pain requiring strong oral opioid analgesics. Randomization (1:1) to hydromorphone ER (8-32 mg) or oxycodone CR (10-40 mg) was followed by dose titration (up to 8 days) and dose maintenance (28 days, weekly visits). Primary endpoint was change from baseline to end of study in "worst pain in the past 24 hours" of Brief Pain Inventory (Short Form) score on last observation carried forward (per protocol set). A total of 137 of 260 randomized patients completed maintenance phase (hydromorphone ER: n = 70; oxycodone CR: n = 67); per protocol set: 81 patients. Mean age was 53.1 years (range: 18-70 years; males: 65.3%); most common Eastern Cooperative Oncology Group performance status = 2. Least square mean difference between 2 treatment groups for primary endpoint using analysis of covariance (baseline score, covariate) was -.1 (95% confidence interval: -1.3, 1.1), with upper bound of 95% confidence interval <1.5 (predefined noninferiority margin). Most common reason for deaths was disease progression (hydromorphone ER: 6.3%; oxycodone CR: 12.7%). Treatment-emergent adverse events were comparable between treatment groups. Hydromorphone ER was noninferior to oxycodone CR in alleviating cancer pain and was well tolerated. ⋯ This article demonstrates clinical noninferiority of the efficacy of once-daily hydromorphone ER compared with twice-daily oxycodone CR in alleviating cancer pain in Chinese patients, with comparable safety profiles between the 2 treatment groups. Thus, a treatment option with the potential for a reduced dosing frequency exists for health care providers and patients.
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The insular cortex (IC) and cingulate cortex (CC) are critically involved in pain perception. Previously we demonstrated that fibromyalgia (FM) patients have greater connectivity between the insula and default mode network at rest, and that changes in the degree of this connectivity were associated with changes in the intensity of ongoing clinical pain. In this study we more thoroughly evaluated the degree of resting-state connectivity to multiple regions of the IC in individuals with FM and healthy controls. We also investigated the relationship between connectivity, experimental pain, and current clinical chronic pain. Functional connectivity was assessed using resting-state functional magnetic resonance imaging in 18 FM patients and 18 age- and sex-matched healthy controls using predefined seed regions in the anterior, middle, and posterior IC. FM patients exhibited greater connectivity between 1) right mid IC and right mid/posterior CC and right mid IC, 2) right posterior IC and left CC, and 3) right anterior IC and left superior temporal gyrus. Healthy controls displayed greater connectivity between left anterior IC and bilateral medial frontal gyrus/anterior cingulate cortex; and left posterior IC and right superior frontal gyrus. Within the FM group, greater connectivity between the IC and CC was associated with decreased pressure-pain thresholds. ⋯ These data provide further support for altered resting-state connectivity between the IC and other brain regions known to participate in pain perception/modulation, which may play a pathogenic role in conditions such as FM. We speculate that altered IC connectivity is associated with the experience of chronic pain in individuals with FM.