Articles: chronic-pain.
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An enriched enrollment randomized withdrawal (EERW) design excludes potential participants who are nonresponders or who cannot tolerate the experimental drug before random assignment. It is unclear whether EERW design has an influence on the efficacy and safety of opioids for chronic noncancer pain (CNCP). ⋯ EERW trial designs appear not to bias the results of efficacy, but they underestimate the adverse effects. The present updated meta- analysis shows that weak and strong opioids are effective for CNCP of both nociceptive and neuropathic origin.
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Clinical rheumatology · Sep 2011
Comparative StudyAn examination of coping styles and expectations for whiplash injury in Germany: comparison with Canadian data.
Cross-sectional cohort study: to examine concurrent expectations and coping style for whiplash injury in injury-naive subjects in Germany. Studies suggest the recovery rate from whiplash injury may be faster in Germany than in Canada. Canadians have a high expectation for chronic pain following whiplash injury and Germans do not. ⋯ Coping style scores and patterns were not different from those previously observed in Canadian studies, but there was no correlation between expectations and coping style among German subjects, a finding that differs from Canadian studies. Although expectations and coping styles may interact or be co-modifiers in the outcomes of whiplash injury in Canadian whiplash victims, in Germany, despite having similar coping styles to Canadians, the lack of expectation for chronic pain may be protective from the effect of passive coping styles. Further studies of coping style as an aetiologic factor in the chronic whiplash syndrome are needed.
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Comparative Study
Adherence to clinical guidelines for opioid therapy for chronic pain in patients with substance use disorder.
Patients with chronic non-cancer pain (CNCP) have high rates of substance use disorders (SUD). SUD complicates pain treatment and may lead to worse outcomes. However, little information is available describing adherence to opioid treatment guidelines for CNCP generally, or guideline adherence for patients with comorbid SUD. ⋯ CNCP patients with SUD were more likely to have mental health appointments and receive UDS monitoring, but not more likely to participate in other aspects of pain care compared to those without SUD. Given data suggesting patients with comorbid SUD may need more intensive treatment to achieve improvements in pain-related function, SUD patients may be at high risk for poor outcomes.
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Clinical rheumatology · Sep 2011
Coping style as a predictor of compliance with referral to active rehabilitation in whiplash patients.
The objective of the study was to determine the odds ratio for compliance with referral to an active treatment program according to coping style in a cohort of acute whiplash-injured subjects. Sixty whiplash patients were assessed within 1 week of their collision for their coping styles and were then questioned 3 weeks later to determine if they had complied with a referral for an active treatment program. Coping style was assessed with the Vanderbilt Pain Management Inventory. ⋯ As a secondary outcome, the odds ratio for reporting prescription medication use for subjects who had a low active/high passive coping style was 6.7 (P=0.038) (95% CI, 1.1-40.4). Those whiplash patients who have a low active/high passive coping style are less likely to attend an active exercise-based rehabilitation program and more likely to use prescription medications in the first 3 weeks following injury. Coping style may affect recovery from whiplash injury through issues of compliance with active therapy and increased reliance on prescription medications.
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Patients with chronic non-cancer pain (CNCP) are common and have a high degree of morbidity. Previous studies document clinician frustration and variability in CNCP management. We conducted this study to gather in-depth clinicians' views about factors that affect management of CNCP. ⋯ Guidelines and increased continuing medical education alone are unlikely to be the solutions to the challenges of CNCP management. Increased evidence for recommendations and resources for more comprehensive care management are needed.