Pain medicine : the official journal of the American Academy of Pain Medicine
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This multinational, Internet-based survey was designed to assess the prevalence, frequency, severity, and impact of opioid-induced bowel dysfunction (OBD) in patients receiving opioid therapy for chronic pain and taking laxatives. ⋯ The survey findings confirm that OBD occurs frequently, despite the use of laxatives, in individuals taking daily oral opioids for chronic pain. These gastrointestinal symptoms add to the burden already experienced by chronic pain patients, negatively impacting quality of life and, in some cases, affecting opioid treatment itself.
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Invasive stimulation of the motor cortex has been used for years to alleviate chronic intractable pain in humans. In our study, we have investigated the effect of transcranial direct current stimulation (tDCS), a noninvasive stimulation method, for manipulating the excitability of cortical motor areas on laser evoked potentials (LEP) and acute pain perception. DESIGNS AND SETTINGS: The amplitude of the N1, N2, and P2 LEP components of 10 healthy volunteers were evaluated prior to and following anodal, cathodal, and sham stimulation of the primary motor cortex. In a separate experiment subjective, pain rating scores of 16 healthy subjects in two perceptual categories (warm sensation, mild pain) were also analyzed. ⋯ The possible underlying mechanisms of our findings in view of recent neuroimaging studies are discussed. To our knowledge this study is the first to demonstrate the mild antinociceptive effect of tDCS over the primary motor cortex in healthy volunteers.
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To determine participant experience of exercise programs for nonspecific chronic low back pain (NSCLBP). Systematic reviews have concluded that exercise is effective for decreasing pain and improving function in adults with NSCLBP. Participation is a key ingredient in exercise and patient's experiences during these programs may be important in influencing outcomes. ⋯ The ramifications of stigma and discrimination are enduring, potentially disabling and appear to interfere with care-seeking, rehabilitation participation, and potentially, rehabilitation outcomes. Public and health professional education, low back pain-specific support groups and dissemination of success stories may help to alleviate stigma.
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Review
Trigger point injections for chronic non-malignant musculoskeletal pain: a systematic review.
This systematic review assessed the available published evidence on the efficacy and safety of using trigger point injection (TPI) to treat patients with chronic non-malignant musculoskeletal pain that had persisted for at least 3 months. ⋯ The efficacy of TPI is no more certain than it was a decade ago as, overall, there is no clear evidence of either benefit or ineffectiveness. The only advantage of injecting anesthetic into trigger points may be to reduce the pain of the needling process, which may not be an insignificant benefit.
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Uncertainty often surrounds judgments of pain, especially when pain is chronic. In order to simplify their decisions, providers adduce information from a variety of sources. Unfortunately, an extensive literature suggests that the information that is brought to bear actually can bias pain judgments, resulting in judgments that consistently differ from patient reports, with a potential negative impact on treatment. ⋯ In order to minimize the uncertainty that can characterize symptoms such as chronic pain, practitioners bring information to bear on pain assessment that can lead to misjudgments. While intuitively appealing, much of the information that is considered often has little association with pain severity and/or adjustment. A more rational decision-making process can reduce the judgment errors common to pain assessment and treatment.