Scandinavian journal of pain
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Background and aim Physicians' attitudes predict clinical decision making and treatment choices, but the association between attitudes and behaviour is complex. Treatment guidelines for non-specific low back pain (LBP) include recommendations of early assessment of psychosocial risk factors forchronic pain, patient education and reassurance. Implication of these principles is demanding, and many patients are not referred for appropriate treatments due to a lack of systematic screening of psychosocial risk factors for chronic pain. ⋯ However on a process level, evaluation and treatment of LBP featured biomechanical principles. LBP guidelines were only partially followed. Implications Clinical behaviour of physicians in the treatment of LBP is complex and only partly explained by attitudes.
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Introduction Chronic musculoskeletal pain represents a significant health problem among adults in Norway. The prevalence of chronic pain can be up to 50% in both genders. However, the prevalence of chronic widespread pain is significantly higher in females than in males. ⋯ Implications Sleep problems must be thoroughly addressed as a possible risk factor for onset or worsening of pain. Elimination of sleep problems in an early phase is an interesting approach in treating chronic pain. More research is needed to illuminate the possible pathogenetic relations between pain, non-specific health complaints, sleep problems and also depression.
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Background and purpose Postherpetic neuralgia (PHN) is a complication of acute herpes zoster (HZ). The evidence base for management of PHN has increased by recent publications. Therefore, we reviewed incidence of HZ, prevalence, risk factors, and mechanism of PHN pain, prevention and treatment of PHN with special interest in studies on adult vaccination and topical application of lidocaine and concentrated capsaicin patch. ⋯ Implications Recent advances in prevention and management of this serious health problem should be better known and implicated: Adult vaccination for prevention of varicella zoster virus reactivation, antiviral drugs and combinations of drugs can reduce the suffering from acute HZ and chronic PHN. Topical lidocaine and capsaicin are now evidence-based therapies that reduce suffering from hypersensitivity and hyperalgesia in patients with PHN. When properly applied, they have few complications.
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Background and purpose 'Central sensitization' (CS) may play a major role in maintaining several chronic pain conditions. CS has been proposed to play a significant role in a range of musculoskeletal pain conditions, such as trapezius myalgia, fibromyalgia, temporomandibular disorders, and low back pain. Whether CS varies over time within an individual is not known. ⋯ The study indicates that 'central sensitization' does not explain intra-individual variations in clinical pain. Implications This study raises the question of the role of 'central sensitization' in clinical musculoskeletal pain disorders. Furthermore, a precise definition of the 'central sensitization' concept is called for.
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Background and purpose Pulsed radiofrequency (PRF) is widely used for the treatment of chronic pain, although its mechanism of action is not known. The evidence of efficacy of PRF for neuropathic pain (NP) conditions is limited. A double-blind, randomized, sham-controlled parallel study was conducted to evaluate the efficacy and safety of PRF in the treatment of peripheral posttraumatic NP. ⋯ Conclusions PRF was well tolerated, but this study failed to show efficacy of PRF over sham treatment for peripheral posttraumatic NP. Implications Based on our results, we do not recommend PRF for peripheral posttraumatic NP. More research of the possible use of PRF for various pain conditions is needed to determine its role in the management of prolonged pains.