The Clinical journal of pain
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Randomized Controlled Trial Observational Study
Pain and Recovery After Total Knee Arthroplasty: A Twelve Months Follow-up After a Prospective Randomized Study Evaluating Nefopam and Ketamine for Early Rehabilitation.
Ketamine and nefopam has been documented to decrease pain intensity and improve rehabilitation after total knee arthroplasty (TKA). We conducted a follow-up study of a previously randomized clinical trial to determine the prevalence and risk factors of chronic pain 1 year after TKA and to assess the role of perioperative administration of ketamine and nefopam. ⋯ After TKA, the intensity of postoperative pain is a risk factor of chronic pain on movement. Intraoperative ketamine seems to improve long-term results of rehabilitation in this setting.
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Randomized Controlled Trial
Evidence-Based Development and Initial Validation of the Pain Assessment Checklist for Seniors with Limited Ability to Communicate-II (Pacslac-II).
Our goal was to develop and validate, based on theoretical and empirical knowledge, the Pain Assessment Checklist for Seniors with Limited Ability to Communicate (PACSLAC-II), a shorter tool that would improve on the PACSLAC, while addressing limitations of the original version. ⋯ Findings indicate that the empirical and theoretically driven revisions to the PACSLAC led to improved ability to differentiate between pain and nonpain states, while retaining its clinical utility.
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Randomized Controlled Trial
Effects of tDCS Induced Motor Cortex Modulation on Pain in HTLV-1: A Blind Randomized Clinical Trial.
We aimed to evaluate the effects of transcranial direct current stimulation (tDCS) on chronic pain in human T-lymphotropic virus type I-infected patients. ⋯ The analysis of the main outcomes in this study did not demonstrate a significant advantage of anodal tDCS applied to M1 in patients with human T-lymphotropic virus type I and chronic pain in comparison with sham tDCS, although secondary analysis suggests some superiority of active tDCS over sham. The large placebo effect observed in this study may explain the small differences between sham versus active tDCS.
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This study investigated the bidirectional relationship between the intensity of low back pain (LBP) and sleep disturbance. Further, the study aimed to determine whether any relationship is dependent on pain duration, symptoms of depression and anxiety, and the method of sleep assessment (subjective vs. objective). ⋯ The findings demonstrate that there is a bidirectional relationship between sleep and pain intensity in patients with LBP. The relationship is independent of pain duration and baseline symptoms of depression and anxiety and somewhat dependent on the method of sleep measurement (sleep diary or Armband). Future research is needed to determine whether targeting sleep improvement in patients with LBP contributes to pain reduction.
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Pain diaries are important tools for clinical trials and optimal assay sensitivity of outcomes derived from these diaries is a worthwhile goal. Jensen and colleagues recently reported results suggesting that single-day diary-based outcomes could possibly be as psychometrically sound as outcomes based on taking the average of many diaries. ⋯ We come to a different conclusion than that advanced by Jensen and colleagues and conclude that their results were unusual in that very high test-retest reliability among days was found. With our 4 diary data sets we find that aggregating multiple diaries yields more reliable outcomes and improved sensitivity. We suggest that using single-day diaries will often lead to underpowered studies and that pretesting is advised before adopting single-day diaries. We also suggest that other researchers replicate these findings within their diary-based clinical trials.