The Clinical journal of pain
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Chronic opioid therapy (COT) for chronic noncancer pain (CNCP) is characterized by both high rates of patient-initiated discontinuation and by perceived helpfulness among those who sustain opioid use. This study examines predictors of the desire to cut down or stop opioid therapy among patients receiving COT who report that opioids are helpful for relieving pain. ⋯ There are high rates of ambivalence about opioid use among COT recipients who consider opioids helpful for pain relief. Depressed patients are more likely to be ambivalent about use of prescribed opioids. Eliciting patient ambivalence may be helpful in patients who are not benefiting from long-term opioid use as an initial step toward consideration of discontinuation.
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To examine the relationship between knee pain, altered somatosensation, and self-reported instability in individuals with knee osteoarthrosis (OA) during a step-up-and-over task. ⋯ Severe OA may result in both hyperalgesia and hypoesthesia at the affected knee. Perceived instability during functional tasks may be mediated in part by pain in individuals with knee OA.
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With the exception of interdigital neuromas, cutaneous neuromas are relatively rare and often present a diagnostic challenge. ⋯ The diagnosis of cutaneous neuroma should be considered in all patients who have intractable pain and allodynia at unusual locations and in atypical patterns. In addition, ultrasonography can prove very useful in the detection of small cutaneous neuromas if the site of symptoms can be precisely localized.
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Impaired left/right judgment of the affected body part is regarded as a disruption of the body's representation in cortical and subcortical somatosensory and motor areas and has previously been demonstrated in patients with severe neuropathic pain states. It remains unknown whether persistent but less severe pain states are sufficient to induce a similar impairment. ⋯ This study demonstrates that individuals with CTS present with a selective impairment in left/right judgment that is restricted to the affected quadrant. This indicates that left/right judgment is impaired in much less severe pain states than previously demonstrated. The findings are in line with previous reports, which suggested the presence of central mechanisms in patients with CTS.