The Clinical journal of pain
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The HELPinKids&Adults knowledge synthesis for the management of vaccination-related pain and high levels of needle fear updated and expanded upon the 2010 HELPinKIDS knowledge synthesis and clinical practice guideline for pain mitigation during vaccine injections in childhood. Interventions for vaccine pain management in adults and treatment of individuals with high levels of needle fear, phobias, or both were included, thereby broadening the reach of this work. The present paper outlines the overarching limitations of this diverse evidence base and provides recommendations for future research. ⋯ The major limitations we identified across systematic reviews were an overall dearth of trials on vaccination, lack of methodological rigor, failure to incorporate important outcomes, poor study reporting, and various sources of heterogeneity. Future research directions in terms of conducting additional trials in the vaccination context, improving methodological quality and rigor, assessment of global acceptability and feasibility of interventions, and inclusion of outcomes that stakeholders consider to be important (eg, compliance) are recommended. Given concerns about pain and fear are known contributors to vaccine hesitancy, improving and expanding this evidence base will be integral to broader efforts to improve vaccine compliance and public health worldwide.
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Randomized Controlled Trial
Predictors of Response in Patients with Post-herpetic Neuralgia and HIV-associated Neuropathy Treated with the 8% Capsaicin Patch (Qutenza®).
Qutenza is a high-dose capsaicin patch used to relieve neuropathic pain from postherpetic neuralgia (PHN) and HIV-associated neuropathy (HIV-AN). In clinical studies, some patients had a dramatic response to the capsaicin patch. Our objective was to determine the baseline characteristics of patients who best benefit from capsaicin patch treatment. ⋯ We identified subpopulations of PHN and HIV-AN patients likely to benefit from the capsaicin patch.
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This systematic review evaluated the effectiveness of psychological interventions for reducing vaccination pain and related outcomes in children and adolescents. ⋯ Psychological interventions with some evidence of benefit in children include: verbal distraction, video distraction, music distraction, and breathing with a toy.
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This systematic review evaluated the effectiveness of physical and procedural interventions for reducing pain and related outcomes during vaccination. ⋯ Interventions with evidence of benefit in select populations include: no aspiration, injecting most painful vaccine last, simultaneous injections, vastus lateralis injection, positioning interventions, non-nutritive sucking, external vibrating device with cold, and muscle tension.
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This study seeks to determine the impact that celecoxib has on patients' postoperative opioid consumption on the basis of whether the patient is opioid naive or opioid tolerant for total hip and knee arthroplasty. ⋯ Both opioid-tolerant and opioid-naive patients benefited from celecoxib therapy, although in different ways. Opioid-tolerant patients saw benefits other than reductions in opioid use; opioid-naive patients had similar benefits, but also had significant reductions in opioid use.