The Clinical journal of pain
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The short- and long-term efficacy of a multidisciplinary pain management program was evaluated in a group of 35 chronic pain patients. At posttreatment, patients reported lower pain levels, more up-time, less medication consumption, an increase in positive cognitions about pain, and more (psychologically oriented) active coping. ⋯ A theoretical model regarding the impact of the treatment program was discussed. Plans for future efforts to enhance transfer and maintenance of therapeutic benefits were presented.
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Work and injury related musculoskeletal pain is often complicated by psychological and medicolegal factors that obscure the validity of the pain presentation. Pressure algometry and stretching during thiopentone sodium (Pentothal) anesthesia was studied in 45 cases of musculoskeletal injury. ⋯ In unilateral pain cases, a right to left pressure threshold difference of 2.0 kg/cm2 predicted 94% of true organic pain cases and 100% of cases at a pressure threshold of 1.5 kg/cm2 if combined with stretching. Results of stretching painful areas correlated highly with pressure threshold assessments.
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Randomized Controlled Trial Clinical Trial
A controlled trial of the treatment of migraine by acupuncture.
A randomised controlled trial comparing true and sham acupuncture was conducted on 30 patients suffering from chronic migraine. Diary measures of headache and medication intake were recorded throughout the study, and measures of headache quality, anxiety, and pain behaviour were taken. ⋯ True acupuncture was significantly more effective than the control procedure in reducing the pain of migraine headache. Posttreatment reductions in pain scores and medication of 43 and 38%, respectively, were recorded in the true acupuncture group and were maintained at 4-month and 1-year follow-up.
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Reflex sympathetic dystrophy (RSD) usually occurs in an individual who has been experiencing significant personal stress, a state associated with increased discharge of norepinephrine (NE) from perivascular postganglionic sympathetic neurons. RSD is often precipitated by this sequence: traumatic arterial spasm, regional ischemia, neurogenic inflammation, and ischemic/edematous damage to membranes of preterminal perivascular nociceptive neurons. In the natural repair of these membranes, it is suggested that adrenoceptors appear and are ordinarily transitory; but in RSD, they are retained by the increased adjacent NE. This process delays further healing, produces pain, and releases inflammatory substances, resulting in interacting pathophysiologic vicious cycles.
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In an effort to identify components of the chronic pain experience, a sample of 444 chronic pain patients who had completed a battery of self-report measures was divided into two groups. The data from each group were analyzed using principal components analysis. Four factors emerged for one group of patients, which accounted for 57.6% of the variance and represented the dimensions of psychological distress, pain-related disability, pain description, and pain history. ⋯ These factors represented psychological distress, disability, pain intensity, pain sensation, and pain history. The similarity of these factors across groups suggests that they represent stable dimensions of the patient's pain experience. Research implications and methodological considerations are discussed.