Articles: pain-measurement.
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The estimated probability of progressing from phase 3 analgesic clinical trials to regulatory approval is approximately 57%, suggesting that a considerable number of treatments with phase 2 trial results deemed sufficiently successful to progress to phase 3 do not yield positive phase 3 results. Deficiencies in the quality of clinical trial conduct could account for some of this failure. An Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials meeting was convened to identify potential areas for improvement in trial conduct in order to improve assay sensitivity (ie, ability of trials to detect a true treatment effect). ⋯ Future research regarding the effects of these strategies will help identify the most efficient use of resources for conducting high quality clinical trials. PERSPECTIVE: Every effort should be made to optimize the quality of clinical trial data. This manuscript discusses considerations to improve conduct of pain clinical trials based on research in multiple medical fields and the expert consensus of pain researchers and stakeholders from academia, regulatory agencies, and industry.
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There has been growing interest in examining pain-related activity patterns and their relationships to psychosocial functioning. The Patterns of Activity Measure-Pain (POAM-P) is frequently used to measure 3 pain-related activity patterns: avoidance, overdoing, and pacing. Although the POAM-P possesses excellent psychometric properties, its length may limit its utility where multiple measures of functioning are required or the time available for assessment is limited. The present studies describe the development and evaluation of a short-form version of this measure. ⋯ The short-form of the POAM-P possesses good psychometric properties and correlates well with the long-form of the measure. It appears to be a promising addition to existing measures of pain-related activity. It may be useful as an addition to questionnaire batteries that comprehensively assess the psychosocial functioning of individuals with ongoing pain.
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A method for modeling the acute pain trajectory using the simple linear fit of an individual's pain intensity scores after surgery was developed and affords more precise measurement than conventional pain assessment. However, the method has the disadvantage of using only the slope without considering the intercept. The purpose of this study was to verify our modification of the pain trajectory model including slope and intercept and to identify clusters. ⋯ Our results suggest that the pain trajectory using the slope and intercept is quite useful for predicting postoperative pain at 30 days after surgery. Additionally, patients were classified into 4 groups using the slope and intercept. By considering both the slope and intercept, clinicians may be able to detect the risk for prolonged pain earlier than other methods.
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Brain research bulletin · Sep 2020
Modulatory role of hippocampal dopamine receptors in antinociceptive responses induced by chemical stimulation of the lateral hypothalamus in an animal model of persistent inflammatory pain.
The lateral hypothalamus (LH) plays a complicated role in the modulation of inflammatory pain. There are a number of connections between the LH and the hippocampus. This study evaluated the pain modulatory role of intra-CA1 dopamine receptors in LH chemical stimulation-induced antinociception in the formalin test (persistent inflammatory pain model). ⋯ The inhibitory effects of the D1 or D2-like dopamine receptor antagonist on LH chemical stimulation-induced analgesia was nearly the same in the both phases of formalin-induced pain-related behaviors. The findings show that the LH-CA1 pathway contributes to the modulation of formalin-induced pain. Moreover, the results indicate that D1- and D2-like dopamine receptors in the CA1 participate in the LH chemical stimulation-induced antinociception.
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Curr Pain Headache Rep · Aug 2020
ReviewNeurosurgical Evaluation for Patients with Chronic Lower Back Pain.
Chronic low back pain (CLBP) is a major cause of disability in the USA, and it affects approximately 1 in 4 Americans. CLBP patients are commonly referred to or seek out neurosurgical evaluations and opinions for treatment and management. ⋯ Literature shows that only a minority of patients with CLBP may benefit from a surgical procedure. These patients that present to clinic often have been ailing for a considerable amount of time and are eager for effective treatment to alleviate pain. However, determining if a patient with CLBP is a surgical candidate is predicated upon having no success of pain relief with non-operative management. Patients with CLBP require thorough and adequate imaging, clinical exam, and diagnostic evaluation. When adequate non-operative management was provided, and proven fruitless, the patient may be considered an operative candidate. In this manuscript, a framework is presented for workup and evaluation of patients with CLBP.