The Clinical journal of pain
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Randomized Controlled Trial
Preemptive analgesic effect of ketamine in patients undergoing elective cesarean section.
In this study, the preemptive effect of a small dose of ketamine on postoperative wound pain and morphine consumption in patients undergoing elective cesarean section was evaluated. ⋯ Intraoperative low-dose ketamine had no effect on morphine consumption during 2 to 24 hours after surgery. No significant differences were seen in the pain scores of the 2 groups during the study period. The preoperative administration of 0.5 mg/kg ketamine in patients undergoing cesarean section did not elicit a preemptive analgesic effect.
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Comparative Study
Comparison of a pain management program with usual care in a pain management center for people with spinal cord injury-related chronic pain.
To evaluate the effectiveness of a specifically modified group-based, multidisciplinary cognitive-behavioral pain management program (PMP) in comparison to usual care in a clinical sample of people with spinal cord injury (SCI)-related chronic pain. ⋯ This study demonstrates that a PMP may offer benefits to clinical populations with SCI-related chronic pain in a pain management center. The reported improvements were of a magnitude to be clinically significant. However, some of the initial benefits reported were not maintained at the nine month follow-up. The interventions may need to be augmented to address the effects of SCI-related psychologic variables that may impact upon the individual's ability to benefit from a PMP.
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This study investigated attentional biases for pictorial headache-related stimuli in individuals with chronic headache and healthy controls. ⋯ It is concluded that both hypervigilance and sustained processing are critical factors for the maintenance of chronic pain.
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Little is known about persistent postsurgical pain after lung transplantation with the associated intensive and continuous immunosuppressive treatment. Therefore, we investigated the nationwide incidence of chronic pain after lung transplantations. ⋯ Moderate-to-severe persistent postsurgical pain occurred in 5% to 10% of patients after lung transplantation, which is lower than reported after nontransplant thoracotomy. The specific role of the peritransplant immunosuppression on persistent post-thoracotomy pain should be explored further.
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Review Historical Article
Psychologic factors in the development of complex regional pain syndrome: history, myth, and evidence.
The present paper examines the literature that addresses psychologic aspects involved in complex regional pain syndrome from a historic perspective to provide a rationale for the emergence of psychologic theories to explain its pathogenesis. The support of such perspective is then analyzed through the review of evidence-based studies. ⋯ An analysis of the Zeitgeist when complex regional pain syndrome was first described helps to understand the long-standing theories associated with a psychological theory of its etiology. This understanding should help to undermine the perpetuation of such claims which may contribute to undertreatment and misdiagnosis. To be consistent with todays Zeitgeist we must incorporate psychologic aspects, which while not causal in nature or exclusive of complex regional pain syndrome, are strongly associated with a wide spectrum of chronic pain disorders.