Articles: pain-clinics.
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Review Meta Analysis
Racial and ethnic differences in the use of lumbar imaging, opioid analgesics and spinal surgery for low back pain: a systematic review and meta-analysis.
There is a substantial gap between evidence and clinical care for low back pain (LBP) worldwide despite recommendations of best practice specified in clinical practice guidelines. The aim of this systematic review was to identify disparities associated with race or ethnicity in the use of lumbar imaging, opioid analgesics, and spinal surgery in people with LBP. ⋯ This systematic review and meta-analysis revealed that people with low back pain from the minority racial/ethnic backgrounds were less likely to be prescribed opioid analgesics and undergo spinal surgery than the majority counterparts. Strategic interventions to improve the access to, and the value of, clinical care for minority populations with low back pain are warranted.
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Randomized Controlled Trial
Adjuvanted recombinant zoster vaccine decreases herpes zoster-associated pain and the use of pain medication across three randomized, placebo-controlled trials.
Herpes zoster (HZ) and HZ-associated pain greatly affect patients' quality of life, particularly in older and immunocompromised adults, for whom comorbidities and polypharmacy are often reported. Three phase III, randomized, placebo-controlled clinical trials have reported the adjuvanted recombinant zoster vaccine (RZV) as highly efficacious in preventing HZ and reducing pain severity in healthy adults ≥50 years old (Zoster Efficacy Study [ZOE]-50 study, NCT01165177) and ≥70 years old (ZOE-70; NCT01165229) and in immunocompromised adults ≥18 years old undergoing autologous hematopoietic stem cell transplantation (ZOE-HSCT; NCT01610414). Here, we investigated efficacy of RZV in reducing (i) the duration of clinically significant pain (Zoster Brief Pain Inventory pain score ≥3) and (ii) HZ-associated pain medication use and duration of use in participants with confirmed HZ ("breakthrough cases") from the 3 studies. ⋯ Although a similar trend was observed in the ZOE-50 and ZOE-70 studies, the results were not statistically significant because of the high vaccine efficacy (VE) against HZ resulting in rare breakthrough cases. VE in reducing pain medication use (39.6%; P -value: 0.008) and duration of medication use (49.3%, P -value: 0.040) was reported in the ZOE-70 study; corresponding positive VE estimates were observed in the ZOE-50 and ZOE-HSCT studies but were not statistically significant. Data reported here demonstrate efficacy of RZV in reducing HZ-associated pain duration and pain medication use in breakthrough cases, thereby improving quality of life of those with HZ.
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Minerva anestesiologica · Apr 2023
Randomized Controlled TrialUse of a curved needle to facilitate four-in-one nerve block performance after total knee arthroplasty in elderly patients: a randomized clinical trial.
Peripheral nerve block is the main analgesic technique for total knee arthroplasty (TKA) in elderly patients. Accurate delivery of the needle tip to the target nerve under ultrasound-guided is a prerequisite for successful nerve block. Failed needle-tip positioning in sciatic nerve (SN) or medial femoral cutaneous nerve (MFCN) block can be due to anatomical structure shadow. The aim of the study was to compare curved and straight needles in regard to the time needed to perform the nerve block for TKA in elderly patients. ⋯ The use of a curved needle can reduce the time required to perform the nerve block, with reduction in the number of attempts and needle redirections. Curved needle also resulted in lesser procedural pain and higher satisfaction compared with the straight needle.
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Randomized Controlled Trial Comparative Study
Comparative Study of the Effect of Lidocaine Spray and Ice Spray on the Pain Intensity During Intramuscular Injection: A Randomized Clinical Trial.
Intramuscular injection is one of the most common, invasive, and painful ways to deliver medicine to the body. ⋯ Both ice and lidocaine spray can be effectively used to reduce the intensity of intramuscular injection pain; however, it seems that ice spray is a more effective, safe, and affordable method.
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Early evidence suggests human assumed central sensitization (HACS) is present in some people with acute low back pain (LBP). Factors influencing individual variation in HACS during acute LBP have not been fully explored. We aimed to examine the evidence for HACS in acute LBP and the contribution of brain-derived neurotrophic factor (BDNF), clinical, psychological and demographic factors to HACS. ⋯ Human assumed central sensitization (HACS) is present in acute low back pain (LBP) but factors contributing to individual variation are not fully explored. This study investigated the relationship between factors such as brain derived neurotrophic factor (BDNF) and HACS in acute LBP. Our findings indicate that HACS was present in specific LBP subgroups but BDNF was unrelated to HACS. Combinations of BDNF genotype, demographic and psychological factors explained a small proportion of the variation in sensory measures during acute LBP.