Articles: chronic-pain.
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Normative data for the coping styles and psychogenic attitudes of the Millon Behavioral Health Inventory (MBHI) for male and female chronic pain patients (CPPs) with mixed pain diagnoses have previously been reported and compared with normative MBHI manual data. However, results from other studies have suggested that CPPs with myofascial pain syndrome (MPS) may need to be considered as a distinct group in psychiatric/psychological studies. The purpose of the present study was then to provide normative data for each MBHI scale for male and female CPPs with MPS and to compare these data with MBHI manual norms for similarities and differences. ⋯ The pattern of the results indicated that CPPs with MPS, especially males, differ from the MBHI Manual normative data counterparts. These differences appear to be greater than those for CPPs with mixed pain diagnoses. Differences in MBHI scale scores between CPPs with MPS and MBHI Manual normative data counterparts may be related to a number of issues, such as whether differences in state factors reflecting depression and anxiety might affect trait factors purportedly measured by the MBHI.
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Ten percent to 15% of patients with chronic pain experience intolerable side effects or inadequate analgesia with continuous intrathecal morphine therapy. Although clinical experience suggests that rotation to hydromorphone (Dilaudid) can reduce side effects and recapture analgesia, there have been only scattered reports of long-term intrathecal hydromorphone use in patients with nonmalignant pain. The purpose of this study is to review the safety and effectiveness of continuous intrathecal hydromorphone in the management of patients with nonmalignant pain in whom continuous intrathecal morphine therapy has failed. ⋯ Hydromorphone can be a safe, analgesic alternative for long-term intrathecal management of nonmalignant pain among patients in whom morphine fails because of pharmacological side effects or inadequate pain relief.
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The role of physician variability in pain management is unknown. ⋯ Lower expectations for relief and less satisfaction in its management may contribute to the undertreatment of chronic pain. Perceptions of regulatory scrutiny may contribute to suboptimal pain management. These preliminary data highlight physician variability in pain decision making while providing insights into educational needs.
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Randomized Controlled Trial Clinical Trial
Fear-avoidance behavior and anticipation of pain in patients with chronic low back pain: a randomized controlled study.
In a randomized controlled study, we investigated whether pain anticipation and fear-avoidance beliefs will lead to behavioral avoidance. ⋯ Results confirm that pain anticipation and fear-avoidance beliefs significantly influence the behavior of patients with low back pain in that they motivate avoidance behavior. Therapists must be aware of the powerful effects of cognitive processes, which can give rise to fear of pain and, consequently, avoidance behavior.
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Evaluation of the age related prevalence of persistent low back pain has been estimated to be consistently higher in the elderly compared to the younger population. Facet joints have been shown to be the cause of chronic low back pain in 15% to 45% of the patients in controlled studies. Prevalence of facet joint mediated pain has not been studied in the elderly. ⋯ Facet joints were investigated with diagnostic blocks initially using lidocaine 1% followed by bupivacaine 0.25%, usually 2 weeks apart. The prevalence of facet joint mediated pain was determined to be 30% in the adults and 52% in the elderly, which was significantly higher with a false positive rate of 26% in adults and 33% in the elderly. In conclusion, the results of this study show that facet joint mediated pain is a significant problem in all patients suffering with chronic low back pain with the prevalence of 52% in the elderly and 30% in adults.