Articles: chronic-pain.
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Randomized Controlled Trial
Predicting the outcome of a cognitive-behavioral group training for patients with unexplained physical symptoms: a one-year follow-up study.
Although Cognitive-Behavioral Therapy (CBT) is effective for Unexplained Physical Symptoms (UPS), some therapists in clinical practice seem to believe that CBT outcome will diminish if psychiatric comorbidity is present. The result is that patients with a psychiatric comorbidity are redirected from treatment for UPS into treatment for mental health problems. To explore whether this selection and allocation are appropriate, we explored whether CBT outcomes in UPS could be predicted by variables assessed at baseline and used in routine-practice assessments. ⋯ As the predictors do not seem to predict CBT outcome consistently over time, the need for selection and allocation of patients for CBT is doubtful. It seems that this would unnecessarily deprive patients of effective treatment.
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Clinical Trial
Continuous versus intermittent spinal cord stimulation: an analysis of factors influencing clinical efficacy.
Spinal cord stimulation (SCS) has, for decades, been shown to be successful in a variety of chronic neuropathic pain syndromes. However, there is a paucity of reports in the literature comparing different stimulation patterns. The impact of different stimulation patterns upon outcome remains to be determined, as well as how the latter is influenced by the duration of the post-SCS pain-free interval. ⋯ Our data showed an equal effectiveness of SCS in the intermittent and in the continuous stimulation mode. The duration of the post-SCS pain-free interval may be predictive for the choice of the most effective individual stimulation pattern and deserves further investigation.
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To estimate the prevalence of widespread pain (WP) according to the American College of Rheumatology, 1990, in women with chronic low back pain (CLBP) consulting primary health care and to evaluate the differences in body function, activity, participation, environmental factors, health-related quality of life, and other health-related aspects between patients having CLBP with or without WP. ⋯ Twenty-eight percent fulfilled the American College of Rheumatology 1990 criteria for WP. When WP was present, patients reported significantly more impaired body functions, more severe activity limitations, and participation restrictions. Environmental factors, health-related quality of life, and other health-related aspects were also negatively impacted. It is suggested that the presence of WP should be evaluated in female patients with CLBP.
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When prescribing opioids to treat chronic pain, physicians face the dilemma of balancing effective pain management while avoiding iatrogenic opioid addiction. Through mailed surveys, the current study assessed concerns, perceptions, and practices of primary care physicians related to this dilemma. Of the 35 (43%) physicians that replied, 32 (91.4%) reported to prescribe opioids for pain. ⋯ Most physicians (71.5%) rated their knowledge/comfort of treatment/management of opioid dependence as being low. Although these physicians believed training is essential to learning about the risks involved with chronic pain and opioid dependence, many of these physicians evaluated their own medical training in these areas as unsatisfactory. Training programs may better equip primary care physicians when addressing the treatment of chronic pain and addiction to opioids.
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Bmc Musculoskel Dis · Jan 2012
Comparative StudyPerceived physical exertion during healthcare work and prognosis for recovery from long-term pain in different body regions: Prospective cohort study.
The prevalence of musculoskeletal pain is high among healthcare workers. Knowledge about risk factors at work is needed to efficiently target preventive strategies. This study estimates the prognosis for recovery from long-term musculoskeletal pain in different body regions among healthcare workers with different levels of perceived physical exertion during healthcare work. ⋯ In the present study, healthcare workers with light perceived physical exertion during healthcare work had the best prognosis for recovery from long-term pain in the low back and neck/shoulders. This suggests that efforts to reduce perceived exertion during work may improve recovery from chronic pain.