European journal of pain : EJP
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This journal recently published a paper by Wager and colleagues, entitled "Long-term outcomes of children with severe chronic pain: Comparison of former patients with a community sample" (Wager et al., in press). This paper demonstrates the lasting positive effects of intensive interdisciplinary pain treatment (IIPT) in children, and adds confidence in the duration of treatment effects through its unprecedented, controlled, 7-year follow-up design. Youth treated in IIPT are those with the most impairing pain; thus, these results are particularly encouraging, with almost 60% of the clinical sample no longer experiencing chronic pain.
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The ultimate goal of pain research is to provide effective routes for pain relief. Nevertheless, the perception pain relief as a change in pain intensity and un-/pleasantness has only been rarely investigated. It has been demonstrated that pain relief has rewarding and reinforcing properties, but it remains unknow whether the perception of pain relief changes when pain reductions occur repeatedly. Further, it remains an open question whether the perception of pain relief depends on the controllability of the preceding pain. ⋯ The perception of pain relief can be modulated similar to the perception of pain by stimulus characteristics and psychological factors. Mechanistic knowledge about such modulating factors is important, because they can determine, for example, the amount of requested pain killers in clinical settings and the efficacy of pain relief as a reinforcing stimulus.
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This study aims to evaluate the efficacy of 10-kHz high-frequency (HF10) devices as a rescue treatment in patients with failure of conventional spinal cord stimulation (SCS) therapy for chronic pain without the need to change the spinal hardware. ⋯ This study shows that high-frequency stimulation may be useful in patients with failure of conventional tonic stimulation for chronic pain, both in the trial phase and in previously implanted subjects. The novelty of this study lies in the use of the implanted epidural electrodes, which avoids the need for further surgery. The results in terms of pain control and recovery of functionality are satisfactory. In addition, variables such as male gender and high body mass index could be predictors of therapy failure.
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The 'Opioid Crisis', which originated in Western countries, has been misrepresented and is misinforming the global public. For 20 years, since the advent of the synthetic opioids, 25,000 Americans, on average, have died annually from opioid-related overdoses. The United States produces and consumes by far the greatest amounts of opioids. ⋯ SIGNIFICANCE: The opioid crisis is, more accurately, a multicomponent global crisis and one that is not fully apparent or well understood. Regulations of the wealthy and powerful to control a surfeit of opioids, which encourages misuse, cannot be allowed to govern legislation in the majority of countries worldwide where citizens have little or no access to opioids to reduce pain and suffering. International conventions must be revised to ensure an optimal balance that allows access to opioids for all those who need them.
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Dependence-like behaviour may complicate withdrawal and increase risk of relapse of medication overuse headache (MOH). The most effective treatment for reducing dependence-like behaviour is unknown. ⋯ Withdrawal combined with preventive medication from start is the treatment strategy that reduces dependence-like behaviour the most in MOH patients. Patients initially considered preventive treatment without withdrawal as the most feasible treatment. However, no difference in feasibility between the three arms was found at 6-month follow-up. Withdrawal combined with preventive medication is recommended for treatment of MOH.