Pain
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Review Meta Analysis Comparative Study
Comparing patients' and clinician-researchers' outcome choice for psychological treatment of chronic pain.
In pain treatment, outcomes are generally defined by researchers and clinicians, predominantly using patient self-report. A large-scale survey of people with chronic pain found a more extensive range of treatment outcomes rated important (Turk et al., "Identifying important outcome domains for chronic pain clinical trials: an IMMPACT survey of people with pain." PAIN 2008;137:276-85) than are conventionally used (Turk et al., "Core outcome domains for chronic pain clinical trials: IMMPACT recommendations." PAIN 2003;106:337-45). We compared outcomes from 60 randomised, controlled trials of cognitive and/or behavioural treatment for persistent pain with the 19 domains rated as most important in the survey. ⋯ Five of the 19 outcomes important to survey respondents were not measured at all, and 8 rarely. There was a positive, although modest, correlation between the methodological quality of trials and their coverage of survey respondents' outcomes. We lack measures in many areas of outcome valued by people with chronic pain, and we need to extend routine measurement of trial outcomes.
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The comorbidity of pain syndromes and trauma-related syndromes has been shown to be high. However, there have been limited data, especially in civilian medical populations, on the role of trauma-related disorders such as posttraumatic stress disorder (PTSD) on chronic pain and pain medication use. We analyzed 647 general hospital patients in primary care and obstetrics and gynecological waiting rooms for the experience of trauma and PTSD-related stress disorders. ⋯ When analyzing the separate PTSD symptom subclusters (re-experiencing, avoidance, and hyperarousal), all symptom clusters were significantly related to pain and pain-related impairment ratings, but only the avoidance cluster was significantly related to prior opioid pain medication use. We conclude that PTSD and trauma-related disorders are common in impoverished medical populations and that their presence should be examined in patients with pain syndromes. Furthermore, these data suggest that PTSD and pain may share a vulnerability pathway, including the endogenous opioid neurotransmission systems.
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Randomized Controlled Trial Multicenter Study Comparative Study
Efficacy and safety of tanezumab in the treatment of chronic low back pain.
Increased nerve growth factor levels are associated with chronic pain conditions, including chronic low back pain (LBP). This study examined safety and analgesic efficacy of tanezumab, a humanized anti-nerve growth factor antibody, in adults with chronic LBP. Patients received intravenous tanezumab 200 μg/kg plus oral placebo (n=88), intravenous placebo plus oral naproxen 500 mg twice a day (n=88), or intravenous placebo plus oral placebo (n=41). ⋯ Nine patients (4 of whom were tanezumab-treated) discontinued due to AEs. In conclusion, tanezumab resulted in analgesic efficacy that was clinically and statistically superior to placebo and naproxen in patients with chronic LBP. Tanezumab clinical development is on regulatory hold due to AEs in osteoarthritis patients.
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Comparative Study
Clinically important difference thresholds of the visual analog scale: a conceptual model for identifying meaningful intraindividual changes for pain intensity.
The aim of this study was to estimate a range of clinically important difference (CID) values of the visual analog scale for pain intensity (VAS-PI), and to assess the effect of patient baseline characteristics on VAS change scores. Data from a prospective cohort study with 678 patients with subacute and chronic temporomandibular disorder pain were analyzed. Patients were divided into 9 cohorts on the basis of the baseline VAS score and the duration of pain. ⋯ For the VAS change scores, the main effect of the variable baseline pain level was significant (F=107.09, P<.001). However, there was no significant baseline pain level by duration of pain interaction effect (F=1.13, P=.340). On the basis of the results, we advocate the choice of a single CID value according to the context of the patient's baseline level of pain.
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Comparative Study
Chronic idiopathic pain in adolescence--high prevalence and disability: the young HUNT Study 2008.
The aim of this study was to determine the prevalence of self-reported chronic idiopathic pain among adolescents in relation to age and gender, and to explore how pain interferes with daily activities. The study was performed in Nord-Trøndelag County, Norway in 2006-2008. All adolescents were invited to participate; the response rate was 78%. ⋯ A high number of pain-associated disabilities were reported, and 58.5% described difficulties doing daily activities in leisure time. Subjective disabilities were higher in girls, and increased with the frequency of pain and the number of pain locations, as shown by high disability in adolescents with musculoskeletal pain in 3 or more locations. Chronic idiopathic pain, especially multisite pain, is common among adolescents, and those suffering from it report a major impact on several areas of daily living.