European journal of pain : EJP
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To improve treatment outcomes, it is essential to understand the processes involved in therapeutic change. The aim of this study was to investigate the processes involved in treatment of individuals with chronic lower back pain (CLBP) and high fear-avoidance. Graded in vivo exposure (Exposure), a specific treatment, and cognitive-behavioural therapy (CBT), a general treatment, were compared. ⋯ We identified several treatment processes (e.g., reduction of fear of movement, enhancement of self-efficacy), which were associated with disability reduction during the management of chronic pain and fear-avoidance. These processes appeared to be equally important for Exposure and CBT. Practitioners should optimize these processes to improve their patients' functioning.
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Posttraumatic stress disorder (PTSD) symptoms are highly prevalent after whiplash and associated with pain-related symptoms. While mutual maintenance between pain and PTSD has been suggested, knowledge on individual differences in the course of these symptoms is needed. The present study aimed to identify trajectories of PTSD symptoms following whiplash and test predictors and functional outcomes of such trajectories. ⋯ Distinct recovery patterns after whiplash were identified with a significant subgroup reporting elevated and slightly increasing PTSD symptoms over time, highlighting both recovery variability and the presence of PTSD symptoms in a significant subgroup of individuals with whiplash. This subgroup also displayed enhanced pain-related disability over time compared to the recovering and resilient subgroups, thereby linking PTSD symptoms to functional pain outcomes over time. These findings suggest that clinicians should be attentive of potential PTSD symptoms in whiplash patients.
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Economic evaluations which estimate cost-effectiveness of potential treatments can guide decisions about real-world healthcare services. We performed an economic evaluation of a healthy lifestyle intervention targeting weight loss, physical activity and diet for patients with chronic low back pain, who are overweight or obese. ⋯ This is an economic evaluation of a randomized controlled trial of a healthy lifestyle intervention for chronic low back pain. The findings suggest that a healthy lifestyle intervention may be cost-effective relative to usual care.
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The antineoplastic drugs cisplatin and vincristine induce peripheral neuropathies. The sigma-1 receptor (σ1R) is expressed in areas of pain control, and its blockade with the novel selective antagonist MR-309 has shown efficacy in nociceptive and neuropathic pain models. Our goal was to test whether this compound reduces neuropathic signs provoked by these antitumoural drugs. ⋯ σ1R antagonism could be an interesting and new option to palliate antitumoural neuropathies.