Pain medicine : the official journal of the American Academy of Pain Medicine
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Pain and opioid use are highly prevalent, leading for calls to include nonpharmacological options in pain management, including complementary and integrative health (CIH) therapies. More than 2,000 randomized controlled trials (RCTs) and many systematic reviews have been conducted on CIH therapies, making it difficult to easily understand what type of CIH therapy might be effective for what type of pain. Here we synthesize the strength of the evidence for four types of CIH therapies on pain: acupuncture, therapeutic massage, mindfulness techniques, and tai chi. ⋯ There is sufficient strength of evidence for acupuncture for various types of pain. Individual studies indicate that tai chi, mindfulness, and massage may be promising for multiple types of chronic pain. Additional sufficiently powered RCTs are warranted to indicate tai chi, mindfulness, and massage for other types of pain.
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To discuss the current knowledge on the impact of commonly used biologic agents (i.e., anti-tumor necrosis factor-alpha [anti-TNF-α] and anti-nerve growth factor [anti-NGF]) in the management of low back pain with or without sciatica. ⋯ Overall, anticytokine treatments have limited efficacy in patients with chronic low back pain with or without sciatica. However, larger and better-designed studies may need to be performed in specific patient subpopulations. Low back pain is particularly disabling in younger patients. This group therefore represents a potential target population for investigating the effectiveness of anticytokine therapies, especially where other pharmacological and nonpharmacological management strategies have failed.
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To identify and describe available instruments that can be used to screen patients with acute or subacute low back pain for a chronic low back pain trajectory. ⋯ This review identified numerous instruments developed to assess the likelihood of chronic low back pain in acute and subacute low back pain populations. Of the instruments reviewed, the STarT Back Screening Tool and the Örebro Musculoskeletal Pain Questionnaire demonstrated superior predictive power compared with other instruments. Both screening tools offer evidence of validation, translation into different languages and international application, and usage in various health care settings and provide data on predictive power.
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Myofascial pain is a prevalent chronic pain disorder, affecting a large proportion of the general population. Electric stimulation techniques such as transcutaneous electric stimulation (TENS) and electroacupuncture have been shown to be effective for managing chronic pain conditions including myofascial pain. The goal of this study was to review the literature on the effectiveness of electric stimulation techniques on myofascial pain. ⋯ Electric stimulation is effective at mitigating reported pain intensity at the location of the trigger point. Electroacupuncture presented with significant and larger effect sizes of improvement relative to TENS for reported pain intensity. Given that this review included a small number of studies, there is a need for additional research to confirm its findings. Additionally, studies assessing the parameters and physiological location of treatment are needed to inform the clinical use and recommendations of electric stimulation treatments.
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Diabetes mellitus is associated with a number of complications that can adversely impact patients' quality of life. A common and often painful complication is painful diabetic neuropathy. The aims of this study were to systematically review and summarize evidence from studies of psychological treatments and psychosocial factors related to painful diabetic neuropathy and assess the methodological quality of these studies. ⋯ Research into psychosocial factors in painful diabetic neuropathy is unexpectedly limited. The available evidence is inconsistent and leaves a number of questions unanswered, particularly with respect to causal associations between variables. The evidence reviewed indicates that depression, anxiety, low quality of life, and poor sleep are associated with pain in painful diabetic neuropathy. The disproportionate lack of research into psychological treatments for painful diabetic neuropathy represents a significant opportunity for future research.