The journal of pain : official journal of the American Pain Society
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Interdisciplinary rehabilitation in fibromyalgia and chronic back pain: a prospective outcome study.
This study aimed to examine short-term and mid-term course of health, biopsychosocial functional ability, and coping performance of patients with fibromyalgia (FM) or chronic back pain (BP) after participation in a standardized 4-week inpatient, interdisciplinary pain rehabilitation program. In a prospective cohort study, assessments were made by using a set of standardized, well-tested self-rating instruments and other parameters before and after the intervention up to the 6-month follow-up with standardized effect sizes (ES) and comparison to population norms. The effects of improvements in health and coping domains on pain reduction were examined by linear regression modeling. The health of the 65 FM and the 60 BP patients at baseline was far worse than expected from the norms. Improvements included ES up to 1.09 for pain, physical role performance, and mental/affective health dimensions and 0.50 in coping at discharge from the clinic. At the 6-month follow-up, all effects were consistently lower but still up to ES = 0.75. Improvements of FM and BP were equal at discharge but slightly better for the FM's mood scales at the 6-month follow-up. Physical and social function, mood, and coping were significantly associated with pain reduction. ⋯ Inpatient, structured interdisciplinary rehabilitation covering elements of cognitive and operant behavioral therapy, graded activity exercise, and adapted drug therapy revealed moderate to large short-term and mid-term improvements in physical and mental health and in the major coping dimensions as captured by comprehensive and specific assessment.
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The purpose of this study was to explore concerns about reporting pain and using analgesics and also to explore whether these concerns were related to the dosage of analgesics used among Taiwanese postoperative patients with pain. The three subscales receiving the highest scores on the BQT-S were time interval, tolerance, and injection. Patients who had hesitated to report pain had significantly higher scores on time interval, fear of tolerance, wound healing, fear of distracting one's physician from treating the disease, a desire to be a good patient, fatalism, and the total BQT-S score than those patients who had not hesitated to report pain. Patients who had hesitated to take medications reported significantly higher scores on time interval, wound healing, fear of distracting one's physician from treating the disease, a desire to be a good patient, fatalism, and the total BQT-S score than did those patients who had not hesitated to use analgesics. BQT-S scores were significant positively in relation to pain intensity and pain interference but were negatively related to dosage of analgesics used. ⋯ This study documented postoperative patient concerns about reporting pain and using analgesics and their impact on adequate management of postoperative pain. Education about pain management for patients and clinicians could be an effective intervention to improve the management of postoperative pain in Taiwan.
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Chronic pain is one of the most prevalent and costly problems in the United States today. Traditional medical treatments for it, though, have not been consistently efficacious or cost-effective. In contrast, more recent comprehensive pain programs (CPPs) have been shown to be both therapeutically efficacious and cost-effective. The present study reviews available evidence demonstrating the therapeutic efficacy and cost-effectiveness of CPPs, relative to conventional medical treatment. Searches of the chronic pain treatment literature during the past decade were conducted for this purpose, using MEDLINE and PSYCHLIT. Studies reporting treatment outcome results for patients with chronic pain were selected, and data on the major outcome variables of self-reported pain, function, healthcare utilization and cost, medication use, work factors, and insurance claims were evaluated. When available, conventional medical treatments were used as the benchmark against which CPPs were evaluated. This review clearly demonstrates that CPPs offer the most efficacious and cost-effective, evidence-based treatment for persons with chronic pain. Unfortunately, such programs are not being taken advantage of because of short-sighted cost-containment policies of third-party payers. ⋯ A comprehensive review was conducted of all studies in the scientific literature reporting treatment outcomes for patients with chronic pain. This review clearly revealed that CPPs offer the most efficacious and cost-effective treatment for persons with chronic pain, relative to a host of widely used conventional medical treatment.
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Randomized Controlled Trial
Virtual reality helmet display quality influences the magnitude of virtual reality analgesia.
Immersive Virtual Reality (VR) distraction can be used in addition to traditional opioids to reduce procedural pain. The current study explored whether a High-Tech-VR helmet (ie, a 60-degree field-of-view head-mounted display) reduces pain more effectively than a Low-Tech-VR helmet (a 35-degree field-of-view head-mounted display). Using a double-blind between-groups design, 77 healthy volunteers (no patients) aged 18-23 were randomly assigned to 1 of 3 groups. Each subject received a brief baseline thermal pain stimulus, and the same stimulus again minutes later while in SnowWorld using a Low-Tech-VR helmet (Group 1), using a High-Tech-VR helmet (Group 2), or receiving no distraction (Group 3, control group). Each participant provided subjective 0-10 ratings of cognitive, sensory, and affective components of pain, and amount of fun during the pain stimulus. Compared to the Low-Tech-VR helmet group, subjects in the High-Tech-VR helmet group reported 34% more reduction in worst pain (P < .05), 46% more reduction in pain unpleasantness (P = .001), 29% more reduction in "time spent thinking about pain" (P < .05), and 32% more fun during the pain stimulus in VR (P < .05). Only 29% of participants in the Low-Tech helmet group, as opposed to 65% of participants in the High-Tech-VR helmet group, showed a clinically significant reduction in pain intensity during virtual reality. These results highlight the importance of using an appropriately designed VR helmet to achieve effective VR analgesia (see ). ⋯ Pain during medical procedures (eg, burn wound care) is often excessive. Adjunctive virtual reality distraction can substantially reduce procedural pain. The results of the present study show that a higher quality VR helmet was more effective at reducing pain than a lower quality VR helmet.