Articles: pain-measurement.
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To determine if patients receiving chronic opioid therapy can be tapered to lower opioid doses without a subsequent increase in pain. ⋯ Patients in the population studied can be successfully tapered to lower opioid doses and may not necessarily experience more pain.
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The relationships among chronic pain, anxiety, and school functioning are complex, and school functioning is often negatively impacted in youth with chronic pain. The objective of this study was to empirically test a model of associations between constructs predicting school functioning in youth with chronic pain to examine the direct effect of anxiety on school attendance and other indicators of school-related disability. ⋯ Anxiety was a robust predictor of school functioning across a range of domains. Evaluating anxiety symptoms in pediatric chronic pain will likely facilitate case conceptualization and treatment planning. This study supports a shift in focus from pain to anxiety as the driving force of school impairment in youth with chronic pain.
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This study aimed to investigate the association between the clinical symptoms of central lumbar spinal stenosis (CLSS) and morphological parameters using magnetic resonance imaging (MRI) data. ⋯ Larger LFA and LFT values are associated with higher ODI values. A larger DSA and SCA are associated with a longer SWD before claudication occurs. To evaluate CLSS patients, clinicians should more carefully inspect the integral morphological parameters than the individual morphological parameters.
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Self-report, the most widely used, gold standard measurement of pain, is crucial for pain research, diagnosis, and management. However, there are no accurate, reliable methods for detecting dishonesty in self-reports when there is incentive for pain deception. We introduce a novel approach to detecting pain deception by analyzing performance patterns of honest and dishonest psychophysical pain testing. Warmth sensation threshold (WST) and heat pain threshold (HPT) were measured in healthy individuals (N = 37) under 2 conditions: standard instruction (ie, provide sincere reports) and instructions to simulate intense pain (i.e., provide feigned reports) with the intention of deceiving. In the feigned compared with sincere condition, participants had significantly increased WST and decreased HPT. Repeatability and variability indices were indistinguishable between conditions. In a second, separate cohort (N = 24), measurements were repeated with the addition of a sensory interference to influence task performance. When sensory interference during HPT measurement was introduced, feigned pain reports had significantly higher variability and poorer repeatability compared with sincere reports and were distinguishable from sincere reports, with high sensitivity (83%) and specificity (84%). The statistical properties of psychophysical performance under sensory interference provide a method for identifying feigned performance and could be applied to evaluations of pain malingering. ⋯ This article introduces a method to detect whether individuals are being dishonest in psychophysical pain testing. The method could help clinicians to detect chronic pain malingering in contexts in which there is incentive to deceive.
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Am J Health Syst Pharm · Sep 2015
ReviewPathophysiology, assessment, and management of pain in critically ill adults.
The pathophysiology of pain in critically ill patients, the role of pain assessment in optimal pain management, and pharmacologic and nonpharmacologic strategies for pain prevention and treatment are reviewed. ⋯ Acute pain management in the critically ill is a largely underassessed and undertreated area of critical care. Opioids are the cornerstone of treatment, though a multimodal approach may improve patient outcomes and decrease opioid-related adverse events.