The Clinical journal of pain
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The synthetic opioid methadone has generated much interest in recent years among clinicians involved in the management of intractable chronic cancer pain. Its use as an analgesic is starting to extend to the treatment of noncancer pain, particularly neuropathic pain. Unfortunately, the evidence for its use in the management of neuropathic pain is limited to a few case studies. ⋯ Methadone was effective at relieving pain and ameliorating quality of life and sleep in 62% of patients. These findings suggest that methadone can offer an acceptable success rate for the treatment of neuropathic pain. Prospective randomized, placebo-controlled studies are now needed to examine more rigorously the benefits of methadone for this type of pain.
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Comparative Study
Reports of memory functioning by patients with chronic pain.
Patients with chronic pain often complain of memory and concentration difficulties. The purpose of this study was to explore the influence of a set of variables that previous research has associated with memory complaints in patients with chronic pain: anxiety and depression, benzodiazepine use, chronicity of pain, and age. Special attention is paid to catastrophizing and to the differential role played by its 3 components: magnification, helplessness, and rumination. ⋯ The results support the hypothesis that emotional distress (depression and anxiety) plays an important role in memory complaints in patients with chronic pain, as well as rumination, the intrusive component of catastrophizing. Clinicians should be aware of these factors in the evaluation of memory complaints in patients with chronic pain.
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Randomized Controlled Trial Comparative Study Clinical Trial
Tiagabine and gabapentin for the management of chronic pain.
Agents that modulate gamma-aminobutyric acid transmission, such as gabapentin, are widely used for the management of chronic pain disorders/syndromes; however, the usefulness of the selective gamma-aminobutyric acid reuptake inhibitor tiagabine in this therapeutic area has yet to be investigated. This study evaluated the effectiveness and safety of tiagabine and gabapentin for the treatment of chronic pain. ⋯ These results suggest that tiagabine and gabapentin are effective in the management of chronic pain, with tiagabine having a greater beneficial effect on sleep quality.
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Comparative Study
Are the changes in postural control associated with low back pain caused by pain interference?
Voluntary limb movements are associated with involuntary and automatic postural adjustments of the trunk muscles. These postural adjustments occur prior to movement and prevent unwanted perturbation of the trunk. In low back pain, postural adjustments of the trunk muscles are altered such that the deep trunk muscles are consistently delayed and the superficial trunk muscles are sometimes augmented. This alteration of postural adjustments may reflect disruption of normal postural control imparted by reduced central nervous system resources available during pain, so-called "pain interference," or reflect adoption of an alternate postural adjustment strategy. ⋯ The results suggest that altered postural adjustments of the trunk muscles during pain are not caused by pain interference but are likely to reflect development and adoption of an alternate postural adjustment strategy, which may serve to limit the amplitude and velocity of trunk excursion caused by arm movement.
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Radiofrequency denervation of lumbar facet joints in the treatment of chronic low back pain: a randomized, double-blind, sham lesion-controlled trial.
Radiofrequency facet joint denervation procedures have been common practice for 2 decades in treatment of chronic low back pain. We designed this multicenter, randomized, double-blind, sham treatment controlled trial to determine the efficacy of radiofrequency facet joint denervation, as it is routinely performed. ⋯ The combined outcome measure and VAS showed no difference between radiofrequency and sham, though in both groups, significant VAS improvement occurred. The global perceived effect was in favor of radiofrequency. In selected patients, radiofrequency facet joint denervation appears to be more effective than sham treatment.