European journal of pain : EJP
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To review the clinical and cost-effectiveness of spinal cord stimulation (SCS) in the management of patients with complex regional pain syndrome (CRPS) and identify the potential predictors of SCS outcome. ⋯ SCS appears to be an effective therapy in the management of patients with CRPS type I (Level A evidence) and type II (Level D evidence). Moreover, there is evidence to demonstrate that SCS is a cost-effective treatment for CRPS type I.
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Randomized Controlled Trial Comparative Study
Return to work after comparing outpatient multidisciplinary treatment programs versus treatment in general practice for patients with chronic widespread pain.
Former studies have questioned the quality and effectiveness of multidisciplinary rehabilitation for working-age adults with fibromyalgia and chronic widespread pain (CWP). High-quality trials are needed, and return to work should also be included as an outcome variable. This randomized study evaluated the return-to-work outcome of an extensive and a light multidisciplinary treatment program combining cognitive strategies and exercise versus treatment-as-usual initiated by a general practitioner, for CWP patients. ⋯ Both among men and women, independent of type of treatment, patients with poorer health (poor prognosis) were absent from work more days than patients with good prognosis. In our sample, higher age significantly increased the number of days absent from work, but only for women. The extensive outpatient multidisciplinary treatment program was effective in returning women to work.
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While opioids in increasing doses may produce adverse effects, the same adverse effects may be associated with poor pain control. Moreover, in the clinical setting symptomatic treatment and illness may balance the outcome of opioid titration. Some adverse effects may tend to disappear continuing the treatment in a long-term period. ⋯ The effects reported were often due to multiple causes. A rapid decrease in pain intensity induced by rapid opioid titration does not produce changes in weakness, nausea and vomiting, appetite. While constipation appears the most relevant problem, resistant to common symptomatic treatment, drowsiness initially produced by acute opioid dose increase and the achievement of pain relief, tends to spontaneously decrease, probably as the result of late tolerance. Improved well-being may be the late positive effect of pain relief, also influenced by the setting of home care.
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Most studies concerning pain education of undergraduate medical students focus on knowledge, but little is known about the interviewing skills and pain evaluation. At the end of the fifth study year and at the beginning of the sixth year the students were asked to answer an electronical questionnaire to evaluate how the IASP curriculum on pain had been covered during the studies. In addition, the interviewing skills of the fifth year medical students were assessed using an objective structured clinical examination (OSCE). ⋯ However, only 35% asked about sleep disturbances and 16% about depression. When developing a curriculum on pain education, attention should be paid to pedagogic methods about helping the students to implement the learned knowledge in their practice. Formative assessment of both knowledge and skills is essential for the development of a functional pain curriculum.
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There are few published data on the treatment patterns and burden of neuropathic pain. We have investigated this in a large, observational, cross-sectional survey. ⋯ Patients with neuropathic pain visit their physician frequently and report substantial pain that interferes with daily functioning despite receiving treatment.