Pain medicine : the official journal of the American Academy of Pain Medicine
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To investigate the prevalence and the type of mental comorbidity in a population-based sample of subjects with non-specific chronic back pain. ⋯ The consistent diagnoses of anxiety, fear, and avoidance in these subjects indicate that also primary care health professionals should consider anxiety disorders in patients with chronic pain, in addition to the affective disorders that are most frequently self-reported in pain patients.
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What can we learn from first-year medical students' perceptions of pain in the primary care setting?
Pain concerns are one of the leading causes of visits to primary care. However, practicing physicians find managing pain frustrating and complex. There is little information about how undergraduate medical students approach pain and its management. This study aimed to explore first-year medical students' perceptions of pain-related patient encounters in the primary care setting. ⋯ First-year medical students identified pain as a major concern in their early clinical experience. Students' perceptions of pain-related encounters can inform curriculum design and may ultimately benefit both physicians and the patients.
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Randomized Controlled Trial
Intra- and postoperative very low dose intravenous ketamine infusion does not increase pain relief after major spine surgery in patients with preoperative narcotic analgesic intake.
This study aims to demonstrate the analgesic efficacy and opioid-sparing effect of low dose ketamine in patients with preoperative narcotic intake undergoing major spine surgery. ⋯ The addition of IV very low dose ketamine infusion regimen did not improve postoperative analgesia. Side effects were not increased with low dose ketamine.
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Multicenter Study Clinical Trial
A multi-center analysis evaluating factors associated with spinal cord stimulation outcome in chronic pain patients.
In addition to its conventional use as a treatment for refractory neuropathic extremity pain, spinal cord stimulation (SCS) has recently emerged as a possible treatment for visceral and arthritic pain. But concurrent with the expansion of possible conditions amenable to SCS, other studies have questioned the long-term efficacy of SCS for traditional indications. These disparate findings argue strongly for the refinement of selection criteria. The purpose of this study is to identify correlates of outcome for SCS. ⋯ Although weak associations with outcome were noted for several clinical variables, none was strongly associated with trial and permanent implantation results. The strongest predictor of a negative SCS outcome was obtaining <50% pain relief during the trial period.
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Review
An evolutionary stress-response hypothesis for chronic widespread pain (fibromyalgia syndrome).
The study aimed to seek a unifying biological basis for the phenomena encompassed in fibromyalgia syndrome (chronic widespread pain and associated morbidities). ⋯ Drawing on diverse findings in neurobiology, immunology, physiology, and comparative biology, we suggest that the form of central sensitization that leads to the profound phenomenological features of chronic widespread pain is part of a whole-organism stress response, which is evolutionarily conserved, following a general pattern found in the simplest living systems.