The Clinical journal of pain
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Randomized Controlled Trial
The Effect of Adding Dexmedetomidine to Levobupivacaine for Interscalene Block for Postoperative Pain Management After Arthroscopic Shoulder Surgery.
Arthroscopic subacromial decompression may cause substantial postoperative pain. We undertook a randomized controlled trial to examine whether adding dexmedetomidine to the local anesthetic in an interscalene brachial plexus block and subsequent patient-controlled interscalene analgesia (PCIA) regime improved postoperative pain scores, patient satisfaction, rescue analgesic requirement, and local anesthetic consumption. ⋯ Addition of dexmedetomidine to levobupivacaine for interscalene brachial plexus block decreases pain scores and increases patient satisfaction after arthroscopic subacromial decompression.
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Randomized Controlled Trial
Low Back Pain Patient Subgroups in Primary Care - Pain Characteristics, Psychosocial Determinants and Health Care Utilization.
In industrialized countries, low back pain (LBP) is one of the leading causes for prolonged sick leave, early retirement, and high health care costs. Providing the same treatments to all patients is neither effective nor feasible, and may impede patients' recovery. Recent studies have outlined the need for subgroup-specific treatment allocation. ⋯ Our study adds substantially to the knowledge of LBP-related case-mix in primary care. Information on differential health care needs may be inferred from our study, enabling decision makers to allocate resources more appropriately and to reduce costs.
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Identifying mechanisms that mediate recovery is imperative to improve outcomes in low back pain (LBP). Qualitative studies suggest that guilt may be such a mechanism, but research on this concept is scarce, and reliable instruments to measure pain-related guilt are not available. ⋯ The findings suggest that pain-related guilt is common and is associated with clinical outcomes. Prospective research is needed to examine the role of guilt as a predictor, moderator, and mediator of patients' outcomes.
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Variations of the Analgesia Nociception Index During Propofol Anesthesia for Total Knee Replacement.
The Analgesia Nociception Index (ANI) monitor measures the relative parasympathetic tone as a surrogate for the antinociception/nociception balance during general anesthesia. The aims of this observational study were to test whether ANI could early detect hemodynamic reactivity (HemodR) during propofol anesthesia, measure pain in conscious patients after surgery, and determine ANI predictive thresholds. ⋯ ANI measures during propofol anesthesia are coherent with the evolution of the analgesia/nociception balance, although its performance decreases in awake patients. Further clinical validation should focus on demonstrating the benefit of maintaining ANI over 63 during surgery.
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Pain is a complex common health problem, with important implications for quality of life and with huge economic consequences. Pain can be elicited due to tissue damage, as well as other multiple factors such as inflammation and oxidative stress. Can there be 1 therapeutic pathway that may target multiple etiologic factors in pain? ⋯ In this article, we show evidence for the relationships between vagal nerve activity and pain, and between vagal nerve activity and 5 factors that are etiologic to pain. Given the evidence and effects of the vagus nerve activation in pain, people involved in pain therapy may need to seriously consider activation of this nerve.