The Clinical journal of pain
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One of the most important determinants of the individual pain experience is pain catastrophizing, reflecting an excessively negative cognitive and emotional orientation toward pain. Its assessment by standard questionnaires, which ask participants to reflect on idiosyncratic past painful experiences, is important. It is currently not known whether different types of pain differently shape pain catastrophizing. Furthermore, as the regulation of emotions changes during the life span, age may affect pain catastrophizing, as well. ⋯ This study indicates that for day-to-day pain, catastrophizing significantly depends on pain type. The results suggest the use of pain-type-specific instructions for catastrophizing questionnaires because it may lead to better prediction of clinically relevant pain characteristics, such as pain intensity. Furthermore, pain catastrophizing seems to change during the life span, with a higher engagement of emotional versus sensory pain processing in younger compared with older adults.
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Randomized Controlled Trial
Efficacy of small doses of ketamine with morphine to decrease procedural pain responses during open wound care.
The purpose of this study was to evaluate differences in pain intensity, pain quality, physiological measures, and adverse effects when patients received morphine with saline (MS) compared with morphine and a small dose of ketamine (MK) before an open wound care procedure (WCP). ⋯ Ketamine with morphine significantly reduced procedural wound pain intensity during WCP. Adverse effects and higher diastolic BP occurred with MK. Further research is warranted to determine the optimal analgesic dose of ketamine or if the addition of a benzodiazepine would mitigate the psychotomimetic effects of ketamine.
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To determine the hypoalgesic effects of transcutaneous electrical nerve stimulation (TENS) parameter combinations on experimental models in healthy humans. ⋯ The level of hypoalgesic efficacy of TENS is clearly dependent on TENS parameter combination selection (defined in terms of intensity, frequency, and stimulation site) and experimental pain model. Future clinical RCTs may consider these TENS dose responses.
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Assessing pain in elderly persons, who have diminished capacity to communicate verbally, requires use of observational scales that focus upon nonverbal behavior. Facial expression has been recognized as providing the most specific and sensitive nonverbal cues for pain. This study examined the validity of facial expression components of 6 widely used pain assessment scales developed for elders with dementia. Descriptions of the facial expression of pain vary widely on these scales. ⋯ Facial expression items on observational scales for assessing pain in the elderly benefit from adherence to empirically derived descriptions. Those using the scales should receive specific direction concerning cues to be assessed. Observational scales that provide descriptors that correspond to how people actually display facial expressions of pain perform better at differentiating intensities of pain.
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Clinicians' recognition of patients' concerns is an important component of effective treatment and care. During a consultation, patients often do not express their concerns directly, but rather present them indirectly as hints or cues. The aim of this study was to explore the types of concerns and cues patients expressed in an initial consultation with a nurse at a pain clinic, how and who initiated these cues and concerns, and predictors of these expressions. ⋯ Findings from this study highlight the importance of a patient centered communication style to facilitate the expression of cues and concerns.