The journal of pain : official journal of the American Pain Society
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Multicenter Study Observational Study
Effectiveness of Opioids for Chronic Noncancer Pain: A Two-Year Multicenter, Prospective Cohort Study With Propensity Score Matching.
Opioid use in chronic non cancer pain (CNCP) is still controversial regarding their effectiveness and safety. We conducted a 2-year prospective cohort study in 4 multidisciplinary chronic pain clinics to assess long-term opioid effectiveness in CNCP patients. All adult CNCP patients consecutively admitted to their first consultation were recruited. ⋯ PERSPECTIVE: This study adds important additional evidence concerning the controversial use of opioids in CNCP management. Opioid users presented no improvement regarding pain relief, functional outcomes and quality of life over 2 years of follow-up. Therefore, our results support and highlight the limited effectiveness of opioids in long-term CNCP management.
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Previous research has revealed that the face is a finely tuned medium for pain communication. Studies assessing the decoding of facial expressions of pain have revealed an interesting discrepancy, namely that, despite eyes narrowing being the most frequent facial expression accompanying pain, individuals mostly rely on brow lowering and nose wrinkling/upper lip raising to evaluate pain. The present study verifies if this discrepancy may reflect an interaction between the features coding pain expressions and the features used by observers and stored in their mental representations. ⋯ Together, these results suggest that the features most saliently coded in the mental representation of facial expressions of pain may reflect a bias toward allocating more weight to the affective information encoded in the face. PERSPECTIVE: This work reveals the relative importance of 3 facial features representing the core of pain expressions during pain decoding. The results show that 2 features are over-represented; this finding may potentially be linked with the estimation biases occurring when clinicians and lay persons evaluate pain based on facial appearance.
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Rheumatoid arthritis (RA) is an example of human chronic inflammatory pain. Modern treatments suppress inflammation, yet pain remains a major problem for many people with RA. We hypothesized that discrete RA subgroups might display favorable or unfavorable pain trajectories when receiving treatment, and that baseline characteristics will predict trajectory allocation. ⋯ Discrete persistent and resolving pain trajectories were identified after treatment, both in early and established RA. Smoking and greater disability at baseline predicted persistent pain. Identifying patient subgroups with a poor pain prognosis could enable adjunctive treatment to improve outcomes.
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Fibromyalgia (FM) is a common chronic pain disorder that presents diagnostic challenges for clinicians. Several classification, diagnostic and screening criteria have been developed over the years, but there continues to be a need to develop criteria that reflect the current understanding of FM and are practical for use by clinicians and researchers. The Analgesic, Anesthetic, and Addiction Clinical Trial Translations Innovations Opportunities and Networks (ACTTION) public-private partnership with the U. ⋯ PERSPECTIVE: The ACTTION-APS FM taxonomy provides an evidence-based diagnostic system for FM. The taxonomy includes diagnostic criteria, common features, comorbidities, consequences, and putative mechanisms. This approach might improve the recognition of FM in clinical practice.
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Mindfulness-based training reduces pain in clinical and experimental settings. Evidence suggests that these beneficial effects are facilitated via an increased focus on the present moment and a reduced emotional enhancement of pain. Most of the existing literature has focused on mindfulness as a learned skill and on the neural mechanisms that underlie the acquisition of this skill. ⋯ PERSPECTIVE: Mindfulness research mostly focuses on mindfulness as a trained skill rather than a trait. Consistent with trained-mindfulness studies, we demonstrate that mindfulness is associated with variations in neural connectivity linked to sensory and evaluative processes. These findings indicate that trait mindfulness serves as a marker for individual differences in pain coping.