Pain practice : the official journal of World Institute of Pain
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Sleep problems are common in people with low back pain (LBP); however, the mechanisms of how sleep influences pain are complex. To date there is a lack of prospective research on the timing and development of sleep problems in those who have LBP; such information would be useful to identify individuals at risk for poor outcomes. Our aims are to investigate the predictive role of sleep problems on self-report recovery and pain intensity using logistic regression reporting odds ratios (ORs). ⋯ Those with resolving sleep problems (ie, sleep problems present at baseline but not at follow-up) were at decreased odds for nonrecovery (OR 0.50) and pain intensity (0.49). Presenting, persistent, and developing sleep problems have a significant impact on recovery for those with LBP. Clinicians may wish to consider treatment options that can address sleep problems.
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Tension-type headache (TTH) is the most prevalent primary headache. Chronic TTH (CTTH), the most serious form of TTH, is refractory, with a high socio-economic burden. Research studies have shown patients with migraine often had cognitive impairment, but few studies have focused on the cognition in patients with CTTH. ⋯ We also assessed the correlations between the neuroendocrine hormones and Pittsburgh Sleep Quality Index score, 17-term Hamilton's Depression Scale score, pain intensity, and duration of pain to determine whether the neuroendocrine hormones had any associations with these symptoms of CTTH. These results showed that changes in neuroendocrine hormones were involved in these symptoms of CTTH. Intervention with the neuroendocrine state may be a strategy for CTTH treatment.
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Enhanced recovery after surgery programs has incorporated gabapentin as part of a multimodal analgesia protocol. The preemptive use of gabapentin was found to be beneficial due to its opioid-sparing effect. However, excessive sedation and delayed discharge from postanesthesia recovery units are of concern. The aim of this study was to investigate whether preoperative gabapentin increased the length of stay in the recovery unit. ⋯ In the setting of enhanced recovery after surgery, gabapentin did reduce pain scores, but at the cost of delayed discharge from the recovery room. Future studies are needed to evaluate the efficacy of gabapentin in this setting.
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Recognizing expectations and concerns of patients leads to more specialized management plans and greater adherence to treatment and improves outcomes. Little is known about how age impacts on expectations or concerns regarding pain in patients attending a chronic pain clinic. ⋯ We found differences in patient expectations and concerns by age of those attending a chronic pain clinic. These differences can inform the communication process between physician and patient on treatment plans and outcomes.
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As the leading cause of disability among U. S. adults, chronic low back pain (LBP) is one of the most prevalent and challenging musculoskeletal conditions. Neuromodulation provides an opportunity to reduce or eliminate the use of opioids to treat chronic LBP, but the cost and invasiveness of existing methods have limited its broad adoption, especially earlier in the treatment continuum. ⋯ The only adverse event was minor skin irritation caused by a topical dressing. The clinically significant improvements were sustained at least 4 months after start of therapy (79% average reduction in pain; both reported minimal disability; 100% reduction in opioids; 74% reduction nonopioids). The results reveal the utility of this novel, short-term approach and its potential as a minimally invasive neuromodulation therapy for use earlier in the treatment continuum to produce sustained pain relief and reduce or eliminate the need for analgesic medications, including opioids, as well as more expensive and invasive surgical or therapeutic alternatives.