The Clinical journal of pain
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Randomized Controlled Trial
The pain quality response profile of oxymorphone extended release in the treatment of low back pain.
In controlled trials of analgesics, the primary outcome variable is most often a measure of global pain intensity. However, because pain is associated with a variety of pain sensations, the effects of analgesic treatments on different sensations could go undetected if specific pain qualities are not assessed. This study sought to evaluate the utility of assessing the multiple components of non-neuropathic pain in an analgesic clinical trial. ⋯ The results indicate that oxymorphone ER has different effects on different pain qualities of low back pain. The responsivity of the PQAS items and scales to the results of treatment with an effective and generally well-tolerated dose of an analgesic, and the ability of the PQAS items and scales to discriminate between an active analgesic and placebo, support their validity as outcome measures. The findings support the utility of using pain descriptor measures for (1) identifying the effects of pain treatments on different pain qualities and (2) targeting pain treatments to those patients who experience certain types of pain.
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The present study aimed to investigate the effectiveness of a 3-week multimodal inpatient pain program for children and adolescents with chronic pain. ⋯ Results of the study are promising in at least 2 ways: (1) a multimodal inpatient program might stop the negative effects of chronic pain, disability, and emotional distress in children and adolescents, and (2) the exploration of clinical significance testing has demonstrated utility and can be applied to future effectiveness studies in pediatric pain.
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Opioids have been used for medicinal and analgesic purposes for centuries. However, their negative effects on the endocrine system, which have been known for some times, are barely discussed in modern medicine. Therefore, we conducted a systematic review of the impact of opioids on the endocrine system. ⋯ Opioid-induced hypogonadism seems to be a common complication of therapeutic or illicit opioid use. Patients on long-term opioid therapy should be prospectively monitored, and in cases of opioid-induced hypogonadism, we recommend nonopioid pain management, opioid rotation, or sex hormone supplementation after careful consideration of the risks and benefits.
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On pathophysiologic grounds, fibromyalgia (FM) is characterized by a deficit in diffuse noxious inhibitory controls (DNIC), but the role of depressive symptoms on these mechanisms has not been investigated. We hypothesized that the deficit in pain inhibition would be more pronounced in FM patients with depressive symptoms (FM+D), relative to patients without such symptoms (FM-D). ⋯ We found that FM+D patients have a more pronounced deficit in pain inhibition as well increased clinical pain. As such, these results show the usefulness of combining psychologic factors and psychophysical measures to identify subgroups of FM patients. These results may have implications for future treatment of FM patients with and without comorbid depressive symptoms.
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Pain hypervigilance--a strong attentional bias toward pain--is thought to accompany chronic pain and modulate pain management. Its usefulness as predisposing factor for the development and maintenance of pain has been discussed. The aim of our study was to demonstrate the predictive power of hypervigilance for the development of acute postoperative pain. ⋯ Hypervigilance proved to be a powerful predictor of subjective acute postoperative pain, but was less useful with regard to the amount of requested analgesics. The overlap with other psychologic predictors (affective state, experimental pain sensitivity, and cortisol reactivity) is sufficiently small to consider hypervigilance a promising supplement in psychologic predictor research.