Articles: pain-clinics.
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Chronic pain is very common worldwide and can lead to disability, depression and absence from work. Catastrophizing has been proven to affect individuals' belief systems and coping strategies, and it is an essential risk factor for chronic pain. The pain catastrophizing scale (PCS) has been developed for the assessment of catastrophizing. However, a Chinese version of this scale is not available, and physicians are therefore unable to determine which patients are prone to catastrophizing. Additionally, the risk factors for catastrophizing are unknown. ⋯ The PCS has been linguistically translated into simplified Chinese and culturally adapted for a Chinese population with remarkable clinical acceptance, good construct validity, and excellent internal consistency and test-retest reliability. Education, pain duration, marital status, gender, income, and use of pain medications are important factors affecting catastrophizing.
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Slipping rib syndrome is an overlooked cause of persistent abdominal or chest pain. The etiology of this syndrome is not well understood, but the characteristic pain is from hypermobility of the false ribs. ⋯ A simple clinical examination via the hooking maneuver is the most significant feature of its diagnosis. We describe the case of a 41-year-old woman with slipping rib syndrome.
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The present study aimed to identify predicting factors affecting experimental pain stimuli reduction by using 'EyeToy', which is an Immersive Virtual Reality System (IVRS). ⋯ It can be concluded that VR can serve as an effective manipulation for pain reduction in individuals with efficient CPM and in women. These findings constitute a promising platform for future research and hold potential for the improvement and facilitation of clinical treatment.
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Observational Study
National Perioperative Outcomes for Intrathecal Pump, Spinal Cord Stimulator, and Peripheral Nerve Stimulator Procedures.
There is abundant literature on the long-term complications of intrathecal pumps (ITP), spinal cord stimulators (SCS), and peripheral nerve stimulators (PNS) used in the treatment of chronic pain. There is less information, however, on the perioperative complications of these procedures. ⋯ Databases such as NACOR can provide rich information on ITP, SCS, and PNS for physicians performing these procedures. In this sample, ITP procedures, performed on the patients with the most severe cormobidities and often-requiring general anesthesia, were the most likely to be associated with hemodynamic instability, inadequate pain control, and extended PACU stays. Complications relating to the ITP are also the most common reason for an operation. These findings underscore the importance of proper patient selection for ITP and other implantable pain devices, in particular for patients with malignant pain or multiple co-morbidities. To identify the root causes of complications, additional information is needed on the procedure performed (e.g., an implant vs a revision), the surgical technique used, and the device implanted, as well as on specific patient comorbidities. Such information will likely become more available as resources like NACOR expand and as electronic medical record systems and coding become more integrated.
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Clinical Trial
Methadone Pharmacogenetics: CYP2B6 Polymorphisms Determine Plasma Concentrations, Clearance, and Metabolism.
Interindividual variability in methadone disposition remains unexplained, and methadone accidental overdose in pain therapy is a significant public health problem. Cytochrome P4502B6 (CYP2B6) is the principle determinant of clinical methadone elimination. The CYP2B6 gene is highly polymorphic, with several variant alleles. CYP2B6.6, the protein encoded by the CYP2B6*6 polymorphism, deficiently catalyzes methadone metabolism in vitro. This investigation determined the influence of CYP2B6*6, and other allelic variants encountered, on methadone concentrations, clearance, and metabolism. ⋯ CYP2B6 polymorphisms influence methadone plasma concentrations, because of altered methadone metabolism and thus clearance. Genetic influence is greater for oral than IV methadone and S- than R-methadone. CYP2B6 pharmacogenetics explains, in part, interindividual variability in methadone elimination. CYP2B6 genetic effects on methadone metabolism and clearance may identify subjects at risk for methadone toxicity and drug interactions.