The Clinical journal of pain
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Multicenter Study Observational Study
Sensitivity of the DN4 in Screening for Neuropathic Pain Syndromes.
Several tools have been developed to screen for neuropathic pain. This study examined the sensitivity of the Douleur Neuropathique en 4 Questions (DN4) in screening for various neuropathic pain syndromes. ⋯ The DN4 performed well; however, sensitivity varied by syndrome and the lowest sensitivity was found for trigeminal neuralgia. A positive DN4 was associated with greater pain catastrophizing, disability and anxiety/depression, which may be because of disease severity, and/or these scales may reflect magnification of sensory symptoms and findings. Future research should examine how the DN4 could be refined to improve its sensitivity for specific neuropathic pain conditions.
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PainDETECT is a self-report questionnaire that can be used to identify features of neuropathic pain. A proportion of patients with knee osteoarthritis (OA) score highly on the PainDETECT questionnaire. This study aimed to determine whether those with a higher "positive neuropathic" score on the PainDETECT questionnaire also had greater pain, hypersensitivity, and reduced function compared with individuals with knee OA with lower PainDETECT scores. ⋯ This study identified a specific subgroup of people with knee OA who exhibited PainDETECT scores in the "positive neuropathic" category. These individuals experienced increased levels of pain, widespread, multimodality hyperalgesia, and greater functional impairment than the remaining cohort. Identification of OA patients with this pain phenotype may permit more targeted and effective pain management.
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To quantify the extent to which the participant-provider interaction influences the response to sham treatment following exercised-induced acute musculoskeletal pain. ⋯ Positive expectations before a sham treatment enhanced reduction in pain intensity but did not improve functional impairments following exercise-induced acute musculoskeletal injury.
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Randomized Controlled Trial
Obesity Moderates the Effects of Motivational Interviewing Treatment Outcomes in Fibromyalgia.
Obesity is a common comorbid condition among patients with fibromyalgia (FM). Our objective was to assess if obesity moderates the treatment benefits of exercise-based motivational interviewing (MI) for FM. ⋯ This is the first study to show that obesity negatively affects the treatment efficacy of MI in patients with FM. Our findings suggest that exercise-based MI may be more effective if initiated after weight loss is achieved.
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Posttraumatic stress disorder (PTSD) is common in chronic posttraumatic pain. Theoretical models suggest that attentional biases (AB) contribute to the development and maintenance of chronic pain and PTSD; however, the influence of AB on clinical and heat pain sensitivity in chronic posttraumatic pain patients is unknown. This study investigated AB for linguistic pain-related stimuli and trauma-related stimuli, and clinical and thermal sensitivity in patients with chronic posttraumatic pain with and without PTSD. ⋯ These results suggest that attentional avoidance is associated with increased chronic posttraumatic pain. The causal contribution of attentional avoidance to pain outcomes remains unclear.