Articles: pain-clinics.
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Objective. The current study attempted to identify and characterize distinct CP subgroups based on their level of dispositional personality traits. The secondary objective was to compare the difference among the subgroups in mood, coping, and disability. ⋯ The study identified a high risk group of CP individuals whose level of personality traits significantly correlated with impaired mood and coping. Use of pharmacological treatment alone may not be successful in improving clinical outcomes among these individuals. Instead, a more comprehensive treatment involving psychological treatments may be important in managing the personality traits that interfere with recovery.
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Characterising the clinical course of back pain by mean pain scores over time may not adequately reflect the complexity of the clinical course of acute low back pain. We analysed pain scores over 12 weeks for 1585 patients with acute low back pain presenting to primary care to identify distinct pain trajectory groups and baseline patient characteristics associated with membership of each cluster. This was a secondary analysis of the PACE trial that evaluated paracetamol for acute low back pain. ⋯ Belief in greater risk of persistence was associated with nonrecovery, but not delayed recovery. Higher pain intensity, longer duration, and workers' compensation were associated with persistent high pain, whereas older age and increased number of episodes were associated with fluctuating pain. Identification of discrete pain trajectory groups offers the potential to better manage acute low back pain.
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Background. Anxiety sensitivity (AS) and experiential avoidance (EA) have been shown to have an interactive effect on the response an individual has to chronic pain (CP) potentially resulting in long term negative outcomes. Objective. ⋯ Significant improvement in disability (p < 0.05) was only seen among those with lower levels of EA and AS. Conclusions. This cluster analysis demonstrated that EA had a greater influence on mood impairment, while both EA and AS levels affected disability outcomes among individuals with CP.
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Comparative Study
Hypoalgesia After Exercise and the Cold Pressor Test is Reduced in Chronic Musculoskeletal Pain Patients With High Pain Sensitivity.
In chronic pain patients, impaired conditioned pain modulation (CPM) and exercise-induced hypoalgesia (EIH) have been reported. No studies have compared CPM and EIH in chronic musculoskeletal pain patients with high pain sensitivity (HPS) and low pain sensitivity (LPS). ⋯ CPM and EIH were partly impaired in chronic pain patients with high versus less pain sensitivity, suggesting that the CPM and EIH responses depend on the degree of pain sensitivity. This has clinical implications as clinicians should evaluate pain sensitivity when considering treatment options utilizing the descending modulatory pain control.
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The scope of this literature review was to assess the safety and the efficacy of spinal cord stimulation (SCS) for the treatment of chronic pain syndromes originating from refractory angina pectoris and peripheral vascular disease compared with conservative management. ⋯ SCS is a minimally invasive and reversible pain intervention. On the basis of the current literature, SCS may be an alternative treatment strategy in refractory angina pectoris and peripheral vascular disease patients, presenting a low surgical risk profile. However, further clinical trials with larger sample sizes and extended follow-up are required to confirm this finding.