Pain
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Clinical Trial
Identification of cut-points for mild, moderate and severe pain due to diabetic peripheral neuropathy.
This study identified discrete categories of pain severity in a sample of patients with painful diabetic peripheral neuropathy (DPN), through derivation of cut-points on a 0-10 scale of pain severity (Brief Pain Inventory-DPN, BPI-DPN). Subjects were participants in a burden of illness survey (N=255). Serlin and colleagues' method establishing cut-points for cancer pain was adapted, considering all possible cut-points between 4 and 8. ⋯ Patients in the three categories differed significantly on patient-rated outcomes (Medical Outcomes Study Short Form-12v2 Mental and Physical Component Summaries and EuroQOL utility score), and on DPN-related healthcare visits (P<0.001). The labels 'mild, moderate and severe' Worst and Average Pain corresponded with patients' ratings of their pain using a verbal rating scale. This research shows that three categories of DPN pain severity can be identified based on interference with daily function, and that these categories are associated with patient outcomes and medical utilization.
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Comment Letter Comparative Study
Motor cortex disinhibition in complex regional pain syndrome (CRPS)-a unilateral or bilateral phenomenon?
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Clinical Trial Controlled Clinical Trial
Hypersensitivity to cutaneous thermal nociceptive stimuli in irritable bowel syndrome.
Irritable bowel syndrome (IBS) is a common intestinal ailment of which the pathophysiological mechanisms are not well understood. Most IBS patients demonstrate enhanced perception, visceral hypersensitivity, in response to distension of the gut lumen but there are conflicting results about changes in somatic sensitivity. This study focused on the possible contribution of abnormal pain sensitization due to positive feedback (vicious pain cycle) that affects somatic tissues due to viscero-somatic convergence. ⋯ Sensitization of IBS patients was not limited to symptomatic dermatomes (calf) but extended evenly across the body, including to the face (no sensitization gradient from foot to face). Also, the difference between IBS and control groups did not depend on the evoked pain intensity level, i.e. the degree of sensitization of IBS patients was similar near threshold (10% on the visual analog scale) and at higher intensities. Lastly, no correlation was found between IBS subjects' pain sensitivity of any of the three test sites and their ratings of spontaneous pain.
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Randomized Controlled Trial Clinical Trial
Effect of Iyengar yoga therapy for chronic low back pain.
Low back pain is a significant public health problem and one of the most commonly reported reasons for the use of Complementary Alternative Medicine. A randomized control trial was conducted in subjects with non-specific chronic low back pain comparing Iyengar yoga therapy to an educational control group. Both programs were 16 weeks long. ⋯ Multivariate analyses of outcomes in the categories of medical, functional, psychological and behavioral factors indicated that significant differences between groups existed in functional and medical outcomes but not for the psychological or behavioral outcomes. Univariate analyses of medical and functional outcomes revealed significant reductions in pain intensity (64%), functional disability (77%) and pain medication usage (88%) in the yoga group at the post and 3-month follow-up assessments. These preliminary data indicate that the majority of self-referred persons with mild chronic low back pain will comply to and report improvement on medical and functional pain-related outcomes from Iyengar yoga therapy.
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Multicenter Study Clinical Trial
Possible selves in chronic pain: self-pain enmeshment, adjustment and acceptance.
The aim of this study was to test whether enmeshment of self and pain predicted adjustment (depression and acceptance) in a chronic pain population. 89 chronic pain patients completed standardized self-report measures of depression and acceptance and generated characteristics describing their current actual self, hoped-for self and feared-for self, and made judgments about the degree to which their future possible selves (hoped-for and feared-for) were dependent on the absence or presence of pain, i.e. enmeshed with pain. Hierarchical multiple regression analyses showed that after accounting for the influence of demographics (age, gender), pain characteristics and the degree of role interference attributable to pain, the proportion of hoped-for self characteristics that could be achieved even with the presence of pain predicted the magnitude of depression and acceptance scores. The findings are discussed with reference to the enmeshment hypothesis and theories of self-discrepancy, self-regulation and hopelessness.