European journal of pain : EJP
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Randomized Controlled Trial
Exposure and cognitive-behavioral therapy for chronic back pain: an RCT on treatment processes.
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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Randomized Controlled Trial
The beta-adrenergic receptor agonist, terbutaline, reduces UVB-induced mechanical sensitization in humans.
Previously, we found in cultures of primary neurons and in animals that sensitized primary neurons can be desensitized by treatment with e.g. beta-adrenergic receptor agonists. We now tested whether also in human sensitization such as UVB-radiation induced sunburn-like hyperalgesia can be reduced by intradermal injection of the beta-adrenergic receptor agonist terbutaline. ⋯ We previously showed in model systems that beta-adrenergic stimulation can not only sensitize but also desensitize nociceptors. Our study shows that also in humans beta-adrenergic agonists desensitize if injected into UVB-sensitized skin. This indicates an analgesic activity of adrenergic agonists in addition to their vasoconstrictory function.
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Previous mass media campaigns have aimed to influence how people manage back pain, with mixed success. Campaigns should target beliefs which are related to the behaviours they aim to change. This systematic review brings together research that has measured the prevalence of beliefs about back pain in the general population and factors associated with these beliefs, including future pain-related outcomes. ⋯ However, future research should explore how beliefs prospectively influence the management of back pain. SIGNIFICANCE: This review brings together studies which have assessed the prevalence of beliefs about back pain, and factors associated with holding them. It highlights that whether or not these beliefs represent important determinants of how people manage pain remains unknown.
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Randomized Controlled Trial
Intraoperative S-ketamine for the reduction of opioid consumption and pain one year after spine surgery: A randomized clinical trial of opioid dependent patients.
We aimed to explore the effect of intraoperative S-ketamine on analgesic consumption and pain one year after spine surgery in chronic opioid-dependent patients undergoing spinal fusion surgery. ⋯ This randomized clinical trial shows that intraoperative ketamine may reduce opioid use and pain and improve labour market attachment one year after spine surgery in an opioid-dependent population.
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Conference abstracts are a potential source of new and relevant information about randomized controlled trials (RCTs). However, their dependability is questionable. The objectives of this study were to quantify the agreement between results of RCTs reported in abstracts presented at the four most recent World Congresses on Pain (WCP) and their corresponding full publications, and to analyse the completeness of reporting in those abstracts. ⋯ Abstracts of RCTs addressing pain are not often dependable information sources; half of them are not published, their reporting quality is suboptimal. When published, 30% of abstracts-full text pairs have discordant results, with 78% discordance when abstracts present preliminary results.