The Clinical journal of pain
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Multicenter Study Controlled Clinical Trial
Establishing an optimal "cutoff" threshold for diagnostic lumbar facet blocks: a prospective correlational study.
Diagnostic medial branch blocks (MBB) are considered the reference standard for diagnosing facetogenic pain and selecting patients for radiofrequency (RF) denervation. Great controversy exists regarding the ideal cutoff for designating a block as positive. The purpose of this study is to determine the optimal pain relief threshold for selecting patients for RF denervation after diagnostic MBB. ⋯ Employing more stringent selection criteria for lumbar facet RF is likely to result in withholding a beneficial procedure from a substantial number of patients, without improving success rates.
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Activity pacing (AP) is a concept that is central to many chronic pain theories and treatments, yet there remains confusion regarding its definition and effects. ⋯ Future research on AP should be based on a clear theoretical foundation, consider the context in which the AP behavior occurs and the type of pacing problem ("underactivity" vs. "overactivity"), and should examine the impact of AP treatment on multiple clinical outcomes. We provide a provisional definition of AP and specific recommendations that we believe will move the field forward.
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Randomized Controlled Trial
Cognitive testing and revision of the pain quality assessment scale.
To revise the Pain Quality Assessment Scale (PQAS) using feedback from patients to further increase its validity. ⋯ testing can be used to improve the understandability of pain measures. The results of cognitive testing with the PQAS indicated that much of the content of the original instructions and items were understandable as written, but that minor changes could be made to make them even clearer to patients with chronic pain. The changes made resulted in a revised PQAS that is more understandable and may therefore be even more useful than with the original PQAS.
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In previous research a close link between depression and postoperative pain has been described. However, the direction of impact remains unclear. The present longitudinal study aimed to clarify the prognostic value of depressive symptoms for perioperative pain and to explore the causal nature of the association between depressive symptoms and perioperative pain. ⋯ Our results suggest that early postoperative depressive symptoms predicts pain at discharge and preoperative pain predicts postoperative depressive symptoms. In conclusion, perioperative pain therapy should include the treatment of both, pain and depressive symptoms, to achieve sufficient pain relief. The evidence regarding the causal relationships between depressive symptoms and perioperative pain, however, must be tested in future research.
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Evidence of pain alterations in trauma-exposed individuals has been found. The presence of posttraumatic stress disorder (PTSD) may be explaining these alterations, as some of the psychological characteristics of PTSD are hypothesized to increase pain response. ⋯ The results suggest that although trauma-exposed individuals are not more sensitive to painful stimulation, they evaluate pain in a more negative way. Exposure to trauma itself, but not to PTSD, may explain the differences found in pain unpleasantness.