Pain physician
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Randomized Controlled Trial
High dose intrathecal morphine for major abdominal cancer surgery: a prospective double-blind, dose-finding clinical study.
Despite 30 years of clinical research, we still do not know the optimal dose of intrathecal morphine (ITM) when used alone. ⋯ One mg ITM provided superior analgesia for 48 hours postoperative compared with 0.2 mg and 0.5 mg ITM with a nonsignificant difference in the incidence of side effects. Further studies of larger sample size are recommended to confirm these findings.
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Rising prescription opioid use and abuse have prompted widespread concern. However, to date there have been few rigorous investigations into the policies and events which may have contributed to these trends. ⋯ This study provides temporal evidence for a rise in prescription opioid use after implementation of health organization accreditation criteria requiring standardized management of all individuals with pain.
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About 1% of patients suffering from chronic migraine do not respond to medications and require more invasive treatments. Occipital nerve stimulation (ONS) is one of these new therapeutic options. The aim of this data review is to evaluate the clinical impact of ONS and whether the neuropsychological aspects of anxiety and depression can be considered as predictors of therapeutic effects. ⋯ ONS seems to be an effective and safe treatment for chronic migraine. The effects of ONS can be optimized by a multidisciplinary diagnostic and therapeutic approach, especially for the importance of the psychological factors in pain perception and their correlation with a good therapeutic outcome. Our experience highlighted that a multidisciplinary team which includes psychological support and psychosocial rehabilitation is essential for the success of this therapy.
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Multicenter Study
Examination of symptom clusters in acute and chronic pain patients.
Symptom clusters have not been previously explored in acute pain patients (APPs) and chronic pain patients (CPPs) with non-cancer pain. ⋯ APPs and CPPs are characterized by symptom comorbidities that form clusters. In CPPs, cluster number and cluster symptom makeup are affected by pain level. This has implications for clinical practice and future research.
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Several countries developed guidelines in order to provide a systematic approach for treatment of (chronic) lower back pain. The risk of suffering from (chronic) lower back pain differs significantly within the general population. A serious lack of research exists concerning the risk factor "dysfunctional behavior of the subjects in terms of acute lower back pain." ⋯ The study revealed a lack of awareness of common available guidelines and an uneven distribution of existing knowledge throughout the population. Passive coping strategies like taking pain medication or ointment therapy were favored over active coping strategies like gymnastics, physical activities, and relaxation exercises. Respondents with a higher level of education suffered significantly less often from lower back pain and tended toward active treatment strategies. Respondents with lower levels of education more often demanded passive treatment strategies. The general population, especially those with lower education, is not sufficiently aware of behavioral strategies for managing lower back pain as proposed in available guidelines.