European journal of pain : EJP
-
The fear-avoidance model (FAM) is a leading theoretical paradigm for explaining persistent pain following musculoskeletal injury. The model suggests that as injuries heal, pain-related outcomes are increasingly determined by psychological, rather than physiological factors. Increasing literature, however, suggests that neurophysiological processes related to pain sensitivity also play an important role in chronicity. To date, there has been limited research that has specifically explored the role of pain sensitivity within the FAM. This study addresses this gap by evaluating whether clinical measures of pain sensitivity help explain FAM-related outcomes, beyond model-relevant psychological predictors. ⋯ This study provides evidence for the unique and added value of neurophysiological factors within the Fear Avoidance Model of pain and for the importance of integrating both sensory and psychological factors within both theoretical paradigms and clinical management strategies.
-
Long-term opioid prescribing for musculoskeletal pain is controversial due to uncertainty regarding effectiveness and safety. This study examined the risks of a range of adverse events in a large cohort of patients prescribed long-term opioids using the UK Clinical Practice Research Datalink. ⋯ Long-term opioid use is associated with serious adverse events such as major trauma, addiction and overdose. The risk increases with higher opioid doses. Opioid prescribing should be reviewed before long-term use becomes established, and periodically thereafter to assess ongoing effectiveness.
-
Psychosocial risk factors associated with chronic orofacial pain are amenable to self-management. However, current management involves invasive therapies which lack an evidence base and has the potential to cause iatrogenic harm. ⋯ This systematic review provides clear evidence for effectiveness of combined biomedical and psychological interventions (incorporating self-management approaches) on long-term outcomes in the management of chronic orofacial (principally TMD) pain. Self-management should be a priority for early intervention in primary care in preference to invasive, irreversible and costly therapies. Further research is needed firstly to clarify the relative effectiveness of specific components of self-management, both individually and in conjunction, and secondly on outcomes in other types of chronic orofacial pains.
-
Total intravenous anaesthesia (TIVA) with propofol may reduce pain after surgery compared with inhalational anaesthetic techniques. Whether propofol provides analgesic benefit may be influenced by the surgical procedure and anaesthetic/analgesic regime. Third molar surgery is a consistent and fairly standard surgical technique that provides a good model for postoperative pain. We investigated whether propofol TIVA or sevoflurane (SEVO) inhalational anaesthesia would produce better quality pain relief after third molar surgery. ⋯ Choice of general anaesthetic technique can affect postoperative analgesia. The results of this study suggest that propofol TIVA improves postoperative pain and patient satisfaction after third molar surgery compared to inhalational anaesthesia.
-
Placebo analgesia is explained by two learning processes: classical conditioning and observational learning. A third learning process, operant conditioning, has not previously been investigated as a mechanism of placebo effects. We aimed to induce placebo analgesia by operant conditioning. ⋯ According to the current placebo literature, placebo analgesia can be explained by two learning processes: classical conditioning and observational learning. A third learning process, operant conditioning, has not previously been investigated as a mechanism of placebo effects. Our study reveals that patients can learn placebo analgesia as a result of operant conditioning, suggesting that randomized controlled trials could be improved by controlling the reinforcement that might occur spontaneously when patients interact with, for example, medical personnel.