The Clinical journal of pain
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Randomized Controlled Trial
Efficacy and safety of lumbar epidural dexamethasone versus methylprednisolone in the treatment of lumbar radiculopathy: a comparison of soluble versus particulate steroids.
The literature is limited in the comparative efficacy and safety of dexamethasone phosphate (DP) compared with methylprednisolone acetate (MPA) in the treatment of lumbar radiculopathy by epidural injection. This study attempts to test the hypothesis that 2 corticosteroids are equivalent in efficacy and side effects. ⋯ Nonparticulate DP seems to be close to the safety and effectiveness of particulate MPA in the treatment of lumbar radiculopathy. There is, however, a statistically nonsignificant trend toward less pain relief and shorter duration of action that may be clarified in a larger and longer duration study.
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Increased sensitivity to pressure is commonly associated with painful musculoskeletal conditions, including whiplash-associated disorders (WADs). Pressure pain thresholds (PPTs) close to the site of presumed tissue damage are thought to represent the degree of peripheral nociceptive sensitization. PPTs over healthy tissue, away from the site of injury, are a marker of central nervous system hyperexcitability. There is uncertainty, however, as to what extent does the sensitization of the nociceptive system, whether peripheral or central, contribute to the ongoing, habitual pain experienced by people with WAD. ⋯ The competing explanations for these findings are that either PPTs provide a poor marker of peripheral and central sensitivity or that these processes are only weakly related to the day-to-day pain experienced by patients with WAD. The latter explanation is supported by the confounding effect of psychological factors on pain score.
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Randomized Controlled Trial
A randomized, controlled investigation of motor cortex transcranial magnetic stimulation (TMS) effects on quantitative sensory measures in healthy adults: evaluation of TMS device parameters.
There is emerging evidence that transcranial magnetic stimulation (TMS) can produce analgesic effects in clinical samples and in healthy adults undergoing experimentally induced pain; and the field of minimally invasive brain stimulation for the management of pain is expanding rapidly. Although motor cortex is the most widely used cortical target for TMS in the management of neuropathic pain, few studies have systematically investigated the analgesic effects of a full range of device parameters to provide initial hints about what stimulation intensities and frequencies are most helpful (or even potentially harmful) to patients. Further, there is considerable inconsistency between studies with respect to laboratory pain measurement procedures, TMS treatment parameters, sophistication of the sham methods, and sample sizes. ⋯ Overall, TMS was associated with statistically significant effects on warm and cool sensory thresholds, cold pain thresholds, suprathreshold stimulus unpleasantness ratings, and wind-up pain. With respect to device parameter effects, higher frequency stimulation seems to be associated with the most analgesic and antisensitivity effects with the exception of intermittent theta-burst stimulation. The present findings support several clinical research findings suggesting that higher TMS frequencies tend to be associated with the most clinical benefit in patients with chronic pain.
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Randomized Controlled Trial Comparative Study
Clinical effectiveness of botulinum toxin type B in the treatment of subacromial bursitis or shoulder impingement syndrome.
Subacromial steroid injections are used as a treatment method in subacromial bursitis (SB) or shoulder impingement syndrome (SIS). However, the steroid effect is relatively restricted to the short-term and repeated injections are frequently required, which contributes to unwanted side effects. As an alternative, botulinum toxin (BT) has recently been used for pain relief. This study aimed to investigate the clinical effectiveness of BT type B and to compare this with the effectiveness of steroids. ⋯ BT type B can be a useful strategy and has great potential for replacing steroids as a treatment for SB or SIS.
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Randomized Controlled Trial Multicenter Study
Patient characteristics and variation in treatment outcomes: which patients benefit most from acupuncture for chronic pain?
The aim of this study was to identify patients' characteristics that increase or decrease their benefit from acupuncture treatment of chronic pain. ⋯ Future research to clarify the modifying effects with special focus on patients' expectations and other psychological variables is needed.