The journal of pain : official journal of the American Pain Society
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Randomized Controlled Trial Clinical Trial
Treatment of chronic low back pain with etoricoxib, a new cyclo-oxygenase-2 selective inhibitor: improvement in pain and disability--a randomized, placebo-controlled, 3-month trial.
We evaluated etoricoxib, a novel COX-2-specific inhibitor, in 319 patients with chronic low back pain (LBP) in this double-blind, placebo-controlled trial. Patients were randomized to a 60 mg dose (n = 103) or 90 mg dose (n = 107) of etoricoxib, or placebo (n = 109), daily for 12 weeks. The primary endpoint was low back pain intensity scale (Visual Analog Scale of 0- to 100-mm) time-weighted average change from baseline over 4 weeks. ⋯ Etoricoxib provided significant improvement from baseline versus placebo in pain intensity (4 weeks: 12.9 mm and 10.3 mm for 60-mg and 90-mg doses, P <.001 for each; 12 weeks: 10.5 mm and 7.5 mm for 60-mg and 90-mg doses, P =.001 and.018, respectively). Etoricoxib at either dose led to significant improvement in other endpoints, including RMDQ scores, bothersomeness scores and global assessments. Etoricoxib given once daily provided significant relief of symptoms, and disability associated with chronic LBP that was observed 1 week after initiating therapy, was maximal at 4 weeks, and was maintained over 3 months.
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The present study investigated selective attention and avoidance of pain-related stimuli by applying a dot-probe paradigm to healthy university students. The study consisted of 2 successive experiments. ⋯ The results from the second experiment showed that presentation time of words, fear of pain scores, and gender in isolation or in interaction with each other did not significantly influence attention to and avoidance of pain-related stimuli. Implications of the results are discussed, and directions for future research are provided.
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The best-known complication of shingles (herpes zoster) is postherpetic neuralgia (PHN). PHN is commonly studied to investigate causes of and treatments for neuropathic pain. However, many patients with shingles experience neuropathic itch accompanying, or instead of, pain. ⋯ In one group, but not in another, there was an increased number of women with PHI. Subjects whose shingles affected the head, face, and neck were more likely to experience PHI than those whose shingles affected the torso. These findings indicate a need for research on zoster-associated itch, including prospective studies on frequency, impact, and treatment.
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Clinical Trial
The relationship between cognitive appraisal, affect, and catastrophizing in patients with chronic pain.
A study was conducted to clarify the nature of catastrophizing, a construct that is frequently referred to in the chronic pain literature. Information regarding 3 affective experience and 3 affect regulation dimensions was gathered from a heterogeneous sample of 104 chronic pain patients by using a semistructured clinical interview and the Affect Regulation and Experience Q-Sort (AREQ). Self-report questionnaires included visual analog pain scales, the Coping Strategies Questionnaire (CSQ), Multidimensional Pain Inventory (MPI), McGill Pain Questionnaire (MPQ), and Center for Epidemiological Studies Depression scale (CES-D). ⋯ Thirty-one percent of the variance in CSQ-Catastrophizing scores was explained by a combination of cognitive appraisal variables (perceived ability to control pain; MPI Life Control) and AREQ scores, even after adjusting for pain severity and chronicity, age, and sex of participants. Results of the study strongly suggest that, rather than thinking of catastrophizing primarily as a cognitive coping construct, it should be described as an elaborate construct made up of both cognitive appraisal and affective components. Implications for tailoring interventions to match individual styles of affect regulation are discussed.
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Review Meta Analysis
Management of opioid side effects in cancer-related and chronic noncancer pain: a systematic review.
Side effects can limit opioid dosage and reduce quality of life. The purpose of this systematic review was to assess the management of opioid side effects in the context of cancer pain management or, in the event that no evidence was available for cancer pain, for chronic noncancer pain. The side effects studied were constipation, pruritus, nausea and vomiting, myoclonus, sedation, respiratory depression, and delirium. ⋯ The lack of well-designed, randomized controlled trials and the heterogeneity of populations and study designs made the drawing of firm conclusions difficult and precluded performance of meta-analysis. The type, strength, and consistency of evidence for available interventions to manage opioid side effects vary from strong (eg, on the use of naloxone to reverse respiratory depression or constipation) to weak (eg, changing from the oral to epidural route of morphine administration to manage sedation). Well-designed trials in the specified populations are required to furnish clinicians with secure evidence on managing opioid side effects successfully.