European journal of pain : EJP
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Review Meta Analysis
Effectiveness of motor imagery and action observation training on musculoskeletal pain intensity: A systematic review and meta-analysis.
Movement representation techniques such as motor imagery (MI) and action observation (AO) could play an important role in the field of rehabilitation of patients with musculoskeletal pain; however, the effects of these tools on clinical pain remain unclear. Our objective is therefore to develop a systematic review and meta-analysis of the effects of MI and AO regarding the pain intensity on patients with musculoskeletal pain. ⋯ Movement representation techniques in combination with usual care are capable of producing a decrease in pain intensity compared with conventional treatment, in both post-surgical and chronic pain. However, the very low-quality evidence found regarding these techniques showed that more research is needed for their application in a clinical context.
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Randomized Controlled Trial
A randomised, double-blind, crossover, dose ranging study to determine the optimal dose of oral opioid to treat breakthrough pain for patients with advanced cancer already established on regular opioids.
Pain in people with advanced cancer is prevalent. When a stable dose of opioids is established, people still experience episodic breakthrough pain for which dosing of an immediate release opioid is usually a proportion of the total daily dose. ⋯ Despite the widespread use of immediate release morphine solution for breakthrough cancer pain, the ideal dose derived from background dose has not been determined in an adequately powered randomized, double-blind, crossover, dose ranging study. This study tested three dose levels in people with advanced cancer. Given no differences in time to onset, level of analgesia achieved, nor side effects, the lowest dose tested (1/12th of the daily dose) should be used.
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Placebo effects are considered to be learning phenomena. There is a growing body of evidence supporting the role of both classical conditioning and observational learning in the induction of placebo effects. However, the third basic learning process, operant conditioning, was not considered as a mechanism of placebo effects until very recently. Unlike classically conditioned responses, which are induced by stimuli that precede the behaviour, operant behaviours are shaped and maintained by their consequences. Thus, placebo effects may not only result from pairing an active intervention with the stimuli that accompany its administration (placebo) but also positive (e.g. the ability to perform a desired activity) or negative reinforcement (e.g. pain relief) of placebo administration may increase the frequency of taking placebos in the future. The paper reviews the evidence supporting the idea of operant conditioning as a mechanism of placebo effects and discusses it in the context of the general principles of operant conditioning, the operant conditioning account of pain modulation and research findings on the role of operant conditioning in pain modulation. ⋯ The operant conditioning account of placebo effects is discussed from the theoretical perspective of the general principles of operant conditioning and the operant conditioning account of pain modulation. The paper identifies seven lines of research on the role of operant conditioning in producing placebo effects, and highlights the practical implications of the operant conditioning account of placebo effects both for routine clinical practice and the placebo arms of randomized controlled trials.
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Having to deal on a daily routine with prescriptions in adults with intellectual disability (ID), we systematically reviewed the literature on the specificities of pain interventions in that population, focusing on medication and trying to gather practical information on appropriate pain treatments. Given the scarcity of the literature on the topic, we also discussed the pharmacological considerations to be taken into account when prescribing analgesic drugs in that vulnerable population. ⋯ This review synthesizes the state of research on pain interventions in adults with ID and is one of the rare articles addressing the specificities of analgesic prescriptions in this population.
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The multidimensional array of clinical features and prognostic factors makes it difficult to optimize management within the heterogeneity of patients with common musculoskeletal pain. This study aimed to identify phenotypes across prognostic factors and musculoskeletal complaints. Concurrent and external validity were assessed against an established instrument and a new sample, respectively, and treatment outcome was described. ⋯ This observational prospective study identified five distinct and clinically meaningful phenotypes based on biopsychosocial prognostic factors across common musculoskeletal pain. These phenotypes were independent of primary pain location, showed good external validity, and clear variation in treatment outcome. The findings are particularly valuable as they describe the heterogeneity of patients with musculoskeletal pain and points to a need for more targeted interventions in common musculoskeletal disorders to improve treatment outcome.