Pain medicine : the official journal of the American Academy of Pain Medicine
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Review Meta Analysis
What are the clinical criteria justifying spinal manipulative therapy for neck pain?- a systematic review of randomized controlled trials.
Manipulation and mobilization are used to treat neck pain. However, little is known about the diagnostic criteria used to determine the need for manipulation in cases of neck pain. The primary aim of this study was to determine what diagnostic criteria are used to identify which neck pain sufferers should receive spinal manipulation or mobilization. ⋯ This systematic review highlights the absence of reliable and valid diagnostic protocols to determine the need for spinal manipulation in persons presenting with non-serious, idiopathic, or whiplash-associated (grade II) neck pain. Guidelines requiring the reporting of valid diagnostic criteria are needed to improve the quality of RCTs concerning manual therapy.
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Comparative Study
Medical cost impact of intrathecal drug delivery for noncancer pain.
As healthcare budgets continue to contract, there is increased payer scrutiny on the use of implantable intrathecal drug-infusion devices. This study utilizes claims data to evaluate the economic effects of intrathecal drug delivery (IDD) based on health services utilization and costs of care before and after implantation. ⋯ The authors found that patients receiving an implantable IDD system may experience reduced cumulative future medical costs relative to anticipated costs in the absence of receiving IDD. This finding complements published literature on the cost-effectiveness of IDD.
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Patients with dementia, whose ability to provide self-report of pain is often impaired, are in crucial need of observers who can detect and judge the patients' pain-indicative behaviors appropriately, in order to initiate treatment. The facial display of pain promises to be especially informative for that purpose. The major aim of the study was to investigate, whether facial pain displays of patients with dementia can be as easily interpreted as facial displays of individuals without cognitive impairment and whether nurses have learned-through their professional training and work experience-to better read the facial display of pain compared with a control group. ⋯ Without further contextual information, "professional" observers do not show a superior competence in inferring pain in others by reading their facial display. Therefore, additional training seems needed to reliably prevent that pain goes unnoticed in patients with dementia.
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Chronic pain and major depression have been associated with alterations of the hypothalamus-pituitary-adrenal axis (HPA) activity. Previous studies suggested that HPA activity is diminished in chronic pain but increased in depression. However, little is known about the effects of experimentally induced acute pain on cortisol secretion in patients with chronic pain and depression. ⋯ Across groups, experimental heat pain stimuli did not elicit a significant cortisol response. Chronic pain appears to be associated with low cortisol secretion. The mechanisms linking chronic pain with low cortisol deserve further study.