The Clinical journal of pain
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Case Reports
Painful hallucinations and somatic delusions in a patient with the possible diagnosis of neuroborreliosis.
Neuroborreliosis has become the most frequently recognized tick-borne infection of the nervous system in Europe and the United States. In addition to dermatological, cardiac, articular, and neurologic manifestations, psychiatric disorders such as depression, panic attacks, and schizophrenia-like psychosis can also arise. We report on a 61-year-old woman who developed a severe pain syndrome following several tick bites. ⋯ However, increasing delusions disclosed a psychotic episode, which ceased over time. We discuss therapeutic difficulties and psychiatric complications in the absence of a clear-cut diagnosis of neuroborreliosis. Although this patient might have suffered from late-onset schizophrenia with painful hallucinations right from the start of her disease, the case highlights psychiatric complications that might be associated with neuroborreliosis.
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Comparative Study
What do patients expect from their first visit to a pain clinic?
To examine patients' expectations of their first outpatient visit to a pain clinic. We asked patients what would be the most satisfying and the most disappointing outcomes of their visit and whether they expected changes in medication and further investigations to result from their consultation. ⋯ For patients attending pain clinics, the explanation of their pain problem is rated as important as the cure or relief of their pain. Improved understanding of patient expectations by pain clinic clinicians may lead to greater patient satisfaction and reduced treatment dropout.
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Comparative Study
Working through the pain: a controlled study of the impact of persistent pain on performing a computer task.
A large percentage of employees experience persistent pain while at work. This situation can become costly to employers with large amounts of lost production-time, absenteeism, and long-term disability. The link or transition between working through (ignoring) pain and disabling pain is unknown. This paper presents the results of a controlled study examining the impact of persistent pain on performance in a working population. Benefits of early detection are discussed. ⋯ Unlike other studies that either induced pain or used persons with complex pain conditions, this study used participants with a low level of pain intensity and had a majority still engaged in full-time employment. Our results found that people with persistent low-level pain demonstrate a reduction in performance compared with controls. Our study revealed that using a sensitive tool to detect minor performance deficits could indicate pain interference. The early detection of pain interference would provide an opportunity for prevention programs to have a pre-emptive effect on work-related musculoskeletal disorders.
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Randomized Controlled Trial Meta Analysis Comparative Study Clinical Trial
The time to onset and overall analgesic efficacy of rofecoxib 50 mg: a meta-analysis of 13 randomized clinical trials.
To determine the time to onset of analgesia of rofecoxib based on a patient-level meta-analysis of randomized, placebo-controlled, postoperative oral surgery pain studies. ⋯ In this meta-analysis of over 1200 rofecoxib-treated patients, a single dose of rofecoxib 50 mg demonstrated a rapid onset of analgesia in approximately half an hour combined with sustained effectiveness, supporting its use as a treatment of acute pain.
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To evaluate muscle strength, as a component of physical deconditioning, and central activation ratio, representing the performance level during testing, in patients with chronic low back pain as compared to healthy controls, and to evaluate the contribution of cognitive-behavioral and pain-related factors to the central activation ration of patients with chronic low back pain. ⋯ When interpreting decreased muscle strength in terms of physical deconditioning in patients with chronic low back pain, submaximal performance has to be taken into account. The results suggest that patients with chronic low back pain who report increased psychologic distress and a higher level of current pain tend to show increased inhibition of muscle activity, leading to submaximal performance.