Articles: chronic.
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An emerging concept in the chronic pain literature, high-impact chronic pain (HICP), refers to pain that occurs very frequently and results in major disruption of daily life. Previous epidemiologic investigations have noted that lower educational attainment, age, and race appear to be associated with the frequency of HICP, but condition-specific investigations of HICP have been less common. ⋯ These findings suggest that HICP affects more than 1 out of 5 UCPPS patients, with significant associated morbidity. Demographic and clinical characteristics associated with HICP may be useful for identifying at-risk UCPPS patients.
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The objective was to investigate if cryoneurolysis were superior to sham in reducing pain intensity in patients with chronic knee osteoarthritis. We hypothesized that cryoneurolysis was an effective and safe therapy to reduce chronic pain in patients with knee osteoarthritis. ⋯ This study did not show a clinically relevant reduction in pain after intervention comparing cryoneurolysis and sham. Further studies are needed.
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Tranexamic acid is an anti-fibrinolytic agent routinely used during hip and knee joint replacement surgery to minimize bleeding. Chronic kidney disease is a common chronic health problem seen among adults requiring major arthroplasty surgery. Tranexamic acid is renally cleared and may accumulate in chronic kidney disease. Optimal tranexamic acid dosing and dose adjustment for chronic kidney disease patients needing major arthroplasty is unknown. The objective of this study was to serially measure plasma tranexamic acid concentrations in patients with varied kidney function undergoing hip or knee replacement surgery for population pharmacokinetic modelling and to guide new dosing recommendations. ⋯ Using population pharmacokinetic modelling and simulation, we recommend a new dosing regimen to optimize the anti-fibrinolytic effect of tranexamic acid and avoid excessive dosing.
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This study investigates the associations between early childhood adversities, stress perception, and fibromyalgia syndrome (FMS). Although the interconnection between dysregulated stress systems and FMS is well documented, the interconnection between early adversities and FMS remains less understood. This study explores the relationship of early-life stress and FMS by examining its mediation through perceived stress, and acute and chronic endocrine stress indicators. ⋯ Our findings indicate that early-life adversity is a significant determinant of the development of FMS, with the relationship between these factors mediated by perceived stress rather than by endocrine stress indicators. These results underscore the critical role of stress perception in the development and management of FMS, suggesting that perceived stress may serve as a valuable therapeutic target. Incorporating trauma-informed and stress-targeted care into treatment strategies could significantly improve outcomes for individuals with FMS, emphasizing the importance of addressing psychological factors alongside physical symptoms.
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Reviews of the effectiveness of medicinal cannabis for chronic pain vary in their conclusions. IASP has identified that a key missing evidence in this debate is data from observational cohort studies, analyzed with comparative effectiveness methods. In a medically supervised context to the use of marijuana for chronic pain, we identified 440 patients certified for medical marijuana by pain specialists in a single healthcare system. ⋯ Using the causal inference method of stratified modeling, logistic regression revealed an odds ratio of 2.6 in favor of medical marijuana vs medication treatment (P < 0.01). Potential harms data were not available in the PORT registry. Medical marijuana was comparatively more effective than prescription medications for the treatment of chronic pain at 3 months, although the populations compared were slightly different.