The Clinical journal of pain
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Randomized Controlled Trial Clinical Trial
Treatment expectancy affects the outcome of cognitive-behavioral interventions in chronic pain.
Patients' initial beliefs about the success of a given pain treatment are shown to have an important influence on the final treatment outcome. The aims of the paper are to assess determinants of patients' treatment expectancy and to examine the extent to which treatment expectancy predicts the short-term and long-term outcome of cognitive-behavioral treatment of chronic pain. This study employs the data of 2 pooled randomized clinical trials evaluating the effectiveness of cognitive-behavioral interventions for 171 patients with fibromyalgia and chronic low back pain. ⋯ A regression model of 3 factors (better pain coping and control, active and positive interpretation of pain, and less disability compensation) significantly explained 10% of the variance in pretreatment expectancy. Pretreatment expectancy significantly predicted each of the 4 outcome measures immediately after treatment and at 12 months follow-up. This study corroborates the importance of treatment expectation before entering a cognitive-behavioral intervention in patients with chronic musculoskeletal pain.
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Randomized Controlled Trial Clinical Trial
Is the effect of inguinal field block with 0.5% bupivacaine on postoperative pain after hernia repair enhanced by addition of ketorolac or S(+) ketamine?
The aim of the study was to assess whether coadministration of S(+) ketamine or ketorolac would enhance or prolong local analgesic effect of bupivacaine after inguinal hernia repair. ⋯ The addition of S(+)-ketamine or ketorolac only minimally improves the analgesic effect of bupivacaine. This may be related to the tension-free hernia repair technique associated with low postoperative pain.
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Randomized Controlled Trial Comparative Study Clinical Trial
Detecting deception in facial expressions of pain: accuracy and training.
Clinicians tend to assign greater weight to nonverbal expression than to patient self-report when judging the location and severity of pain. However, patients can be successful at dissimulating facial expressions of pain, as posed expressions resemble genuine expressions in the frequency and intensity of pain-related facial actions. The present research examined individual differences in the ability to discriminate genuine and deceptive facial pain displays and whether different models of training in cues to deception would improve detection skills. ⋯ For each condition, the participants rated pain intensity and unpleasantness, decided which category each of the 4 video clips represented, and described cues they used to arrive at decisions. There were significant individual differences in accuracy, with females more accurate than males, but accuracy was unrelated to past pain experience, empathy, or the number or type of facial cues used. Immediate corrective feedback led to significant improvements in participants' detection accuracy, whereas there was no support for the use of an information-based training program.
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Randomized Controlled Trial Comparative Study Clinical Trial
Optimum pain relief with continuous epidural infusion of local anesthetics shortens the duration of zoster-associated pain.
To investigate effects of continuous epidural infusion (CEI) of 0.5% bupivacaine added to intermittent epidural boluses (IEB) on the duration of zoster-associated pain (ZAP), as compared with continuous infusion of normal saline placebo added to IEB. ⋯ CEI of 0.5% bupivacaine plus IEB was associated with a shorter duration of ZAP and fewer patients with allodynia beyond 30 days, compared with IEB plus normal saline infusion. Patients at high risk for developing postherpetic neuralgia (PHN) can be managed with intensive therapies at the early stage of disease, such as CEI, which maintains effective analgesia and may reduce the burden of PHN.
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Randomized Controlled Trial Comparative Study Clinical Trial
Statistical reanalysis of four recent randomized trials of acupuncture for pain using analysis of covariance.
Acupuncture has been promoted for the treatment of chronic pain. Though many randomized trials have been conducted, these have been criticized for deficiencies of methodology, acupuncture technique, and sample size. Somewhat less emphasis has been placed on methods of statistical analysis. This paper describes 4 recent randomized trials of acupuncture for musculoskeletal or headache pain. Each trial used statistical methods that did not adjust for baseline pain scores and were thus of suboptimal power. The objective of this study is to reanalyze the trials using analysis of covariance (ANCOVA). ⋯ Future trials of acupuncture and other modalities for pain should use efficient statistical methods. ANCOVA is more efficient than unadjusted analysis where used appropriately.