Articles: pain-measurement.
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Low back pain is a common musculoskeletal condition with substantial individual and societal costs. Standardized self-report questionnaires are commonly used in clinical practice to identify prognostic risk factors and tailor interventions for low back pain. However, most of these low back pain questionnaires have been developed in Western cultures and may not be clinically applicable to other cultures. These cultural aspects have not been explored. This study aimed to investigate the cultural assumptions underlying back pain questionnaires and the potential implications of using standardized questionnaires with non-Western populations. ⋯ Findings suggest that questionnaires could potentially negatively affect the patient-clinician rapport and lead to inaccurate and unanticipated results when used with culturally and linguistically diverse populations. Findings are also likely to be applicable to people with low back pain more broadly, regardless of culture. Implications include a need for cultural sensitivity when using questionnaires, greater consideration of when to use these measures, and adaptations to the use/design of standardized questionnaires.
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Emerg. Med. Clin. North Am. · Feb 2020
ReviewThe Emergent Evaluation and Treatment of Neck and Back Pain.
Neck and back pain are among the most common symptom-related complaints for visits to the emergency department (ED). They contribute to high levels of lost work days, disability, and health care use. ⋯ This article discusses the efficient and effective evaluation, management, and treatment of patients with neck and back pain in the ED. Emphasis is placed on vertebral osteomyelitis, epidural abscess, acute transverse myelitis, epidural compression syndrome, spinal malignancy, and spinal stenosis.
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Meta Analysis
Intraoperative methadone administration and postoperative pain control: a systematic review and meta-analysis.
Postoperative pain is not adequately managed in greater than 40% of surgical patients and is a high priority for perioperative research. In this meta-analysis, we examined studies comparing postoperative opioid consumption and pain scores in surgical patients who received methadone by any route vs those who received another opioid by any route. Studies were identified from PubMed, Cochrane, Web of Science, EMBASE, and Scopus from January 1966 to November 2018. ⋯ The results demonstrate that surgical patients who received intraoperative methadone had lower postoperative opioid consumption, generally reported lower pain scores and experienced better satisfaction with analgesia. However, these advantages need to be weighed carefully against dangerous risks with perioperative methadone, specifically respiratory depression and arrhythmia. Future studies should explore logistics, safety, and cost effectiveness.
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Microvascular decompression (MVD) is a potentially curative surgery for drug-resistant trigeminal neuralgia (TN). Predictors of pain freedom after MVD are not fully understood. ⋯ Approximately three-quarters of patients with drug-resistant TN achieve pain freedom after MVD. Shorter disease duration, arterial compression, and type 1 Burchiel classification may predict more favorable outcome. These results may improve patient selection and provider expectations.
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Multicenter Study
A Prospective Study of Dorsal Root Ganglion Stimulation for Non-Operated Discogenic Low Back Pain.
Disruptions of lumbar intervertebral discs may lead to severe discogenic low back pain (LBP). Severe pain has a deleterious effect on physical function and quality of life. Spinal cord stimulation (SCS) is a robust treatment for many neuropathic pain conditions. New innovations may be well-suited to treat neuropathic chronic LBP, including discogenic pain. The aim of this prospective study was to determine the effect of dorsal root ganglion (DRG) stimulation for a well-selected group of patients with discogenic LBP with no history of previous back surgeries. ⋯ DRG stimulation treatment for discogenic LBP improved the level of pain, function, and quality of life. Further research is necessary into efficacy of DRG stimulation in patients with chronic discogenic LBP and to determine the place of SCS in the treatment algorithm.