Articles: chronic-pain.
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Failed back surgery syndrome represents one of the most frequent etiologies of chronic back pain and is a major public health issue. Neurostimulation has currently not been validated in the treatment of back pain because of technological limitations in implantable spinal cord stimulation (SCS) systems. New-generation leads using several columns of stimulation can generate longitudinal and/or transverse stimulation fields into the spinal cord. ⋯ These results suggest that multicolumn leads can reliably generate back pain coverage and favor pain relief outcomes. This may lead physicians to reconsider new indications for spinal cord stimulation. Expanding neurostimulation perspectives to intractable back pain syndromes could become realistic in the near future.
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SUMMARY Pain is a complex behavior process, the anatomy and physiology of which is not completely understood, and is subject to continuous exploration and research. Following on the heels of Melzack and Wall's gate control theory of pain (1965), Shealey et al., in 1967, were the first to implant stimulation electrodes over the dorsal columns in an attempt to provide relief for patients with chronic, intractable pain. ⋯ In contrast to conventional medical management, SCS offers long-lasting symptom relief, improved quality of life and functional capability, often achieving these goals at a reduced cost. This article illustrates the present status, challenges and future of SCS.
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SUMMARY ⋯ In routine Slovenian clinical practice, transdermal buprenorphine provided efficient analgesia and was well-tolerated in patients with chronic moderate-to-severe cancer pain or chronic severe noncancer pain insufficiently controlled by nonopioids and, as the study results indicate, also in chronic severe noncancer pain insufficiently controlled by weak opioids.
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To determine whether there are differences in the personal socioeconomic costs of healthcare access between transdermal (TD) and oral opioid use in a rural population with chronic noncancer pain (CNCP). ⋯ The personal socioeconomic costs of healthcare access for rural patients with CNCP are similar for TD and oral opioid use. The prolonged analgesic affect of TD opioids may be advantageous for rural population.
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With increasing knowledge of chronic pain, clinicians have attempted to assess chronic pain patients with lengthy assessment tools. ⋯ The CPEQ, either the original or modified version, yields reproducible results consistent with the results of other studies. This technique may usefully classify chronic pain patients, but more work is needed to determine the meaning of the CPEQ clusters, what psychological or biomedical variables are associated with CPEQ constructs or clusters, and whether this instrument may assist in treatment planning or predict response to treatment.