Latest & greatest articles for pain

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Top results for pain

121. The Effect of Patient Characteristics on Acupuncture Treatment Outcomes: An Individual Patient Data Meta-Analysis of 20,827 Chronic Pain Patients in Randomized Controlled Trials

The Effect of Patient Characteristics on Acupuncture Treatment Outcomes: An Individual Patient Data Meta-Analysis of 20,827 Chronic Pain Patients in Randomized Controlled Trials To optimally select chronic pain patients for different treatments, as it is of interest to identify patient characteristics that might moderate treatment effect. Our aim was to evaluate the impact of possible moderators on the effect of acupuncture treatment using a large data set.We used data from an individual (...) patient data meta-analysis of high-quality randomized trials of acupuncture for chronic headache and migraine, osteoarthritis, and back, neck, and shoulder pain. Using meta-analytic trial-level and patient-level regression analyses, we explored the impact of 5 documented patient characteristics (patients' age at baseline, sex, pain duration, baseline pain severity and baseline psychological distress) on the effect of acupuncture.A total of 39 trials met the inclusion criteria: 25 use sham-acupuncture

2019 EvidenceUpdates

122. Pain management after laparoscopic hysterectomy: systematic review of literature and PROSPECT recommendations

Pain management after laparoscopic hysterectomy: systematic review of literature and PROSPECT recommendations Laparoscopic hysterectomy is increasingly performed because it is associated with less postoperative pain and earlier recovery as compared with open abdominal hysterectomy. The aim of this systematic review was to evaluate the available literature regarding the management of pain after laparoscopic hysterectomy.Randomized controlled trials evaluating postoperative pain after (...) of shoulder pain, but not abdominal pain.The baseline analgesic regimen for laparoscopic hysterectomy should include acetaminophen, a non-steroidal anti-inflammatory drug, dexamethasone, and opioids as rescue analgesics.© American Society of Regional Anesthesia & Pain Medicine 2019. No commercial re-use. See rights and permissions. Published by BMJ.

2019 EvidenceUpdates

123. Pain coping skills training for African Americans with osteoarthritis: results of a randomized controlled trial

Pain coping skills training for African Americans with osteoarthritis: results of a randomized controlled trial African Americans bear a disproportionate burden of osteoarthritis (OA), but they have been underrepresented in trials of behavioral interventions for pain. This trial examined a culturally tailored pain coping skills training (CST) program, compared to a wait list control group, among 248 African Americans with knee or hip OA. The pain CST program involved 11 telephone-based sessions (...) over 3 months. Outcomes were assessed at baseline, 3 months (primary), and 9 months, and included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale (primary outcome), WOMAC total score and function subscale, PROMIS Pain Interference, Short-Form 12 Mental and Physical Composite Subscales, Coping Strategies Questionnaire-Total Coping Attempts, Pain Catastrophizing Scale, Patient Health Questionnaire-8, Arthritis Self-Efficacy Scale, and Patient Global Impression

2019 EvidenceUpdates

124. Timing of periarticular injection has no effect on postoperative pain and functional recovery in simultaneous bilateral total knee arthroplasty: a prospective randomized, double-blinded trial

Timing of periarticular injection has no effect on postoperative pain and functional recovery in simultaneous bilateral total knee arthroplasty: a prospective randomized, double-blinded trial Given no consensus on optimal timeframe of periarticular multimodal drug injection (PMDI) in knee osteoarthritis patients undergoing total knee arthroplasty (TKA), this study was aimed to compare the postoperative pain and the functional recovery in patients who underwent simultaneous bilateral TKA (SBTKA (...) ) and received PMDI at the different intraoperative time points.This prospective, randomized, double-blinded controlled trial study included 48 patients who underwent SBTKA and received PMDI mixture, either before prosthetic implantation (late PMDI), or just after knee arthrotomy (early PMDI). Each subject's knees were randomly selected to different PMDI administration time points. The outcome parameters were postoperative pain assessed by using a visual analog scale (VAS), the maximal angle of knee flexion

2019 EvidenceUpdates

125. Subdissociative-dose Ketamine Is Effective for Treating Acute Exacerbations of Chronic Pain

Subdissociative-dose Ketamine Is Effective for Treating Acute Exacerbations of Chronic Pain Subdissociative-dose ketamine (SDDK) is used to treat acute pain. We sought to determine if SDDK is effective in relieving acute exacerbations of chronic pain.This study was a randomized double-blind placebo-controlled trial conducted May 2017 to June 2018 at a public teaching hospital (ClinicalTrials.gov #NCT02920528). The primary endpoint was a 20-mm decrease on a 100-mm visual analog scale (VAS) at 60 (...) minutes. Power analysis using three groups (0.5 mg/kg ketamine, 0.25 mg/kg ketamine, or placebo infused over 20 minutes) estimated that 96 subjects were needed for 90% power. Inclusion criteria included age > 18 years, chronic pain > 3 months, and acute exacerbation (VAS ≥ 70 mm). Pain, agitation, and sedation were assessed by VAS at baseline and 20, 40, and 60 minutes after initiation of study drug. Telephone follow-up at 24 to 48 hours used a 10-point numeric rating scale for pain.A total of 106

2019 EvidenceUpdates

126. Insular and anterior cingulate cortex deep stimulation for central neuropathic pain: Disassembling the percept of pain

Insular and anterior cingulate cortex deep stimulation for central neuropathic pain: Disassembling the percept of pain To compare the analgesic effects of stimulation of the anterior cingulate cortex (ACC) or the posterior superior insula (PSI) against sham deep (d) repetitive (r) transcranial magnetic stimulation (TMS) in patients with central neuropathic pain (CNP) after stroke or spinal cord injury in a randomized, double-blinded, sham-controlled, 3-arm parallel study.Participants were (...) randomly allocated into the active PSI-rTMS, ACC-rTMS, sham-PSI-rTMS, or sham-ACC-rTMS arms. Stimulations were performed for 12 weeks, and a comprehensive clinical and pain assessment, psychophysics, and cortical excitability measurements were performed at baseline and during treatment. The main outcome of the study was pain intensity (numeric rating scale [NRS]) after the last stimulation session.Ninety-eight patients (age 55.02 ± 12.13 years) completed the study. NRS score was not significantly

2019 EvidenceUpdates

127. Are opioids effective in the treatment of chronic low back pain?

Are opioids effective in the treatment of chronic low back pain? Are Opioids Effective in the Treatment of Chronic Low Back Pain? – Clinical Correlations Search Are Opioids Effective in the Treatment of Chronic Low Back Pain? April 17, 2019 4 min read By Anna Hirsch Peer Reviewed The use of opioid medications for chronic low back pain, or for any chronic non-cancer pain complaint, is still a source of controversy in the medical community, with a large divide between the recommendations (...) of professional societies and actual physician prescribing data. In the , 1 the 2 and the 3 have all issued guidelines urging caution with the use of opioids for chronic back pain, specifically emphasizing the poor-to-moderate quality of the evidence demonstrating benefit from this therapeutic modality. All three organizations reinforce that opioids should only be used after failure of other non-opioid and non-pharmacologic treatment options and recommend that if physicians choose to prescribe opioids

2019 Clinical Correlations

128. Core im hoofbeats: a 66m w ruq pain, a 41m in afib w rvr and a 50m w syncope

Core im hoofbeats: a 66m w ruq pain, a 41m in afib w rvr and a 50m w syncope Core IM Hoofbeats: A 66M w RUQ pain, a 41M in Afib w RVR and a 50M w Syncope – Clinical Correlations Search Core IM Hoofbeats: A 66M w RUQ pain, a 41M in Afib w RVR and a 50M w Syncope April 10, 2019 1 min read Podcast: | Subscribe: | By Cindy Fang MD, David Kudlowitz MD, John Hwang MD || Illustration by Amy Ou MD || Audio Editing by Richard Chen, Harit Shah For a transcript of the podcast and show notes: Time Stamps (...) New features in this episode [0:30] Case one: 66M w RUQ pain [1:09] Case two: 41M w Afib in RVR [9:26] Case three: 50M w Syncope [14:33] Reveal [19:57] Retrieving illness scripts [22:29] Typical versus Atypical presentation of diseases [26:12] References Feinstein, A R. “An analysis of diagnostic reasoning. I. The domains and disorders of clinical macrobiology.” The Yale journal of biology and medicine vol. 46,3 (1973): 212-32. Nayar, et al. Venous Thromboembolism in Upper Extremity Fractures

2019 Clinical Correlations

129. Effect of adding interferential current stimulation to exercise on outcomes in primary care patients with chronic neck pain: a randomized controlled trial

Effect of adding interferential current stimulation to exercise on outcomes in primary care patients with chronic neck pain: a randomized controlled trial To evaluate the effect of adding interferential current stimulation to exercise on pain, disability, psychological status and range of motion in patients with neck pain.A single-blinded randomized controlled trial.Primary care physiotherapy units.A total of 84 patients diagnosed with non-specific mechanical neck pain. This sample was divided (...) into two groups randomly: experimental (n = 42) versus control group (n = 42).Patients in both groups had a supervised therapeutic exercise programme, with the experimental group having additional interferential current stimulation treatment.The main measures used were intensity of neck pain according to the Visual Analogue Scale; the degree of disability according to the Neck Disability Index and the CORE Outcome Measure; anxiety and depression levels according to the Goldberg scale; apprehension

2019 EvidenceUpdates

130. Pooled analysis of tanezumab efficacy and safety with subgroup analyses of phase III clinical trials in patients with osteoarthritis pain of the knee or hip

Pooled analysis of tanezumab efficacy and safety with subgroup analyses of phase III clinical trials in patients with osteoarthritis pain of the knee or hip A pooled analysis was conducted to evaluate tanezumab efficacy and safety in patients with osteoarthritis (OA), including subgroup analyses of at-risk patients with diabetes, severe OA symptoms, and those aged ≥65 years.Data from phase III placebo-controlled clinical trials of patients with moderate-to-severe OA of the knee or hip were (...) pooled to evaluate tanezumab efficacy (four trials) and safety (nine trials). Patients received intravenous tanezumab, tanezumab plus an oral NSAID (naproxen, celecoxib, or diclofenac), active comparator (naproxen, celecoxib, diclofenac, or oxycodone), or placebo. Efficacy assessments included change from baseline to week 16 in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and physical function scores, Patient's Global Assessment (PGA) of OA, and percentage of patients

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2019 EvidenceUpdates

131. Pain experienced by infants and toddlers at urine collection bag removal: A randomized, controlled, clinical trial

Pain experienced by infants and toddlers at urine collection bag removal: A randomized, controlled, clinical trial In pre-continent children, collection bags are frequently used as a first-line option to obtain a urine specimen. This practice, acknowledged by several guidelines for the step of UTI screening, is driven by a perception of the technique as being more convenient and less painful. However, our own experience led us to consider bag removal as a painful experience.Our aim (...) was to determine whether the use of an oleo-calcareous liniment to aid bag removal reduced the acute pain expressed by young children.This prospective, randomized, controlled, single blind study was carried out in two emergency pediatrics departments. Pre-continent children aged 0-36 months admitted with an indication for urine testing were eligible for the study. Urine for dipstick test screening was obtained using a collection bag. At micturition, the patients were randomized into bag removal

2019 EvidenceUpdates

132. Pain Management for Ambulatory Arthroscopic Anterior Cruciate Ligament Reconstruction: Evidence-Based Recommendations From the Society for Ambulatory Anesthesia

Pain Management for Ambulatory Arthroscopic Anterior Cruciate Ligament Reconstruction: Evidence-Based Recommendations From the Society for Ambulatory Anesthesia Ambulatory arthroscopic anterior cruciate ligament reconstruction is associated with moderate pain, even when nonopioid oral analgesics such as acetaminophen and nonsteroidal anti-inflammatory drugs are used. Regional analgesia can supplement nonopioid oral analgesics and reduce postoperative opioid requirements, but the choice

2019 EvidenceUpdates

133. Treatment Effect Sizes of Mechanical Diagnosis and Therapy for Pain and Disability in Patients With Low Back Pain: A Systematic Review

Treatment Effect Sizes of Mechanical Diagnosis and Therapy for Pain and Disability in Patients With Low Back Pain: A Systematic Review Mechanical Diagnosis and Therapy (MDT) is a treatment-based classification system founded on 3 core principles: classification into diagnostic syndromes, classification-based intervention, and appropriate application of force. Many randomized controlled trials have investigated the efficacy of MDT for low back pain; however, results have varied. The inconsistent (...) delivery of MDT across trials may explain the different findings.To compare treatment effect sizes for pain or disability between trials that delivered MDT consistent with the core principles of the approach and trials that met some or none of these principles.In this systematic review, databases were searched from inception to June 2018 for studies that delivered MDT compared to nonpharmacological, conservative control interventions in patients with low back pain and reported outcomes of pain

2019 EvidenceUpdates

134. Improving paediatric pain management in the emergency department: An integrative literature review

Improving paediatric pain management in the emergency department: An integrative literature review Children presenting to the emergency department continue to experience suboptimal pain management. While evidence-based pain management interventions are available to clinicians, effective and sustainable practice change is yet to be achieved. This practice gap requires a collaborative approach to knowledge translation targeting systems of care.The purpose of this review was to explore systems (...) level change in the emergency department for improved paediatric pain management.Integrative review.CINAHL, Embase, PubMed/Medline, Dynamed, Cochrane, Scopus, Prospero and Joanna Briggs Institute were systematically searched, and clinical guidelines and reference lists scanned.Studies were screened and selected according to the inclusion criteria, and independently appraised for risk of bias. Integrative review methodology informed data extraction and synthesis, focused on organisational context

2019 EvidenceUpdates

135. Restrictive strategy versus usual care for cholecystectomy in patients with gallstones and abdominal pain (SECURE): a multicentre, randomised, parallel-arm, non-inferiority trial. (PubMed)

Restrictive strategy versus usual care for cholecystectomy in patients with gallstones and abdominal pain (SECURE): a multicentre, randomised, parallel-arm, non-inferiority trial. International guidelines advise laparoscopic cholecystectomy to treat symptomatic, uncomplicated gallstones. Usual care regarding cholecystectomy is associated with practice variation and persistent post-cholecystectomy pain in 10-41% of patients. We aimed to compare the non-inferiority of a restrictive strategy (...) with stepwise selection with usual care to assess (in)efficient use of cholecystectomy.We did a multicentre, randomised, parallel-arm, non-inferiority study in 24 academic and non-academic hospitals in the Netherlands. We enrolled patients aged 18-95 years with abdominal pain and ultrasound-proven gallstones or sludge. Patients were randomly assigned (1:1) to either usual care in which selection for cholecystectomy was left to the discretion of the surgeon, or a restrictive strategy with stepwise selection

2019 Lancet Controlled trial quality: predicted high

136. Effect of Doxepin Mouthwash or Diphenhydramine-Lidocaine-Antacid Mouthwash vs Placebo on Radiotherapy-Related Oral Mucositis Pain: The Alliance A221304 Randomized Clinical Trial. (PubMed)

Effect of Doxepin Mouthwash or Diphenhydramine-Lidocaine-Antacid Mouthwash vs Placebo on Radiotherapy-Related Oral Mucositis Pain: The Alliance A221304 Randomized Clinical Trial. Oral mucositis causes substantial morbidity during head and neck radiotherapy. In a randomized study, doxepin mouthwash was shown to reduce oral mucositis-related pain. A common mouthwash comprising diphenhydramine-lidocaine-antacid is also widely used.To evaluate the effect of doxepin mouthwash or diphenhydramine (...) -lidocaine-antacid mouthwash for the treatment of oral mucositis-related pain.A phase 3 randomized trial was conducted from November 1, 2014, to May 16, 2016, at 30 US institutions and included 275 patients who underwent definitive head and neck radiotherapy, had an oral mucositis pain score of 4 points or greater (scale, 0-10), and were followed up for a maximum of 28 days.Ninety-two patients were randomized to doxepin mouthwash (25 mg/5 mL water); 91 patients to diphenhydramine-lidocaine-antacid

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2019 JAMA Controlled trial quality: predicted high

137. Transition from acute to chronic pain after surgery. (PubMed)

Transition from acute to chronic pain after surgery. Over the past decade there has been an increasing reliance on strong opioids to treat acute and chronic pain, which has been associated with a rising epidemic of prescription opioid misuse, abuse, and overdose-related deaths. Deaths from prescription opioids have more than quadrupled in the USA since 1999, and this pattern is now occurring globally. Inappropriate opioid prescribing after surgery, particularly after discharge, is a major cause (...) of this problem. Chronic postsurgical pain, occurring in approximately 10% of patients who have surgery, typically begins as acute postoperative pain that is difficult to control, but soon transitions into a persistent pain condition with neuropathic features that are unresponsive to opioids. Research into how and why this transition occurs has led to a stronger appreciation of opioid-induced hyperalgesia, use of more effective and safer opioid-sparing analgesic regimens, and non-pharmacological interventions

2019 Lancet

138. Transcutaneous electrical nerve stimulation (TENS) for chronic pain - an overview of Cochrane Reviews. (PubMed)

Transcutaneous electrical nerve stimulation (TENS) for chronic pain - an overview of Cochrane Reviews. Chronic pain, considered to be pain lasting more than three months, is a common and often difficult to treat condition that can significantly impact upon function and quality of life. Treatment typically includes pharmacological and non-pharmacological approaches. Transcutaneous electrical nerve stimulation (TENS) is an adjunct non-pharmacological treatment commonly recommended by clinicians (...) and often used by people with pain.To provide an overview of evidence from Cochrane Reviews of the effectiveness of TENS to reduce pain in adults with chronic pain (excluding headache or migraine).To provide an overview of evidence from Cochrane Reviews of the safety of TENS when used to reduce pain in adults with chronic pain (excluding headache or migraine).To identify possible sources of inconsistency in the approaches taken to evaluating the evidence related to TENS for chronic pain (excluding

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2019 Cochrane

139. Analgesic effects of a capacitive-resistive monopolar radiofrequency in patients with myofascial chronic neck pain: a pilot randomized controlled trial. (PubMed)

Analgesic effects of a capacitive-resistive monopolar radiofrequency in patients with myofascial chronic neck pain: a pilot randomized controlled trial. To date, there is a lack of prior studies on the use of capacitive resistive monopolar radiofrequency (RF) to treat neck pain. The objective of this study was to investigate the immediate effect of capacitive resistive monopolar radiofrequency (RF=448 kHz), in comparison with a placebo, on (1) reducing neck pain intensity at myofascial trigger (...) points (MTrP), (2) decreasing neck disability and (3) improving cervical range of motion (CROM).A randomized, double-blind, placebo-controlled trial (NCT02353195) was carried out. Patients with myofascial chronic neck pain (N=24) with active MTrP in one upper trapezius muscle were randomly divided into two groups: a radio-frequency group, which received eight sessions of a monopolar capacitive resistive radio-frequency application over the upper trapezius muscle, and a placebo group (PG), which

2019 Revista da Associacao Medica Brasileira (1992) Controlled trial quality: predicted high

140. Herbal medicinal products or preparations for neuropathic pain. (PubMed)

Herbal medicinal products or preparations for neuropathic pain. Neuropathic pain is a consequence of damage to the central nervous system (CNS), for example, cerebrovascular accident, multiple sclerosis or spinal cord injury, or peripheral nervous system (PNS), for example, painful diabetic neuropathy (PDN), postherpetic neuralgia (PHN), or surgery. Evidence suggests that people suffering from neuropathic pain are likely to seek alternative modes of pain relief such as herbal medicinal products (...) due to adverse events brought about by current pharmacological agents used to treat neuropathic pain. This review includes studies in which participants were treated with herbal medicinal products (topically or ingested) who had experienced neuropathic pain for at least three months.To assess the analgesic efficacy and effectiveness of herbal medicinal products or preparations for neuropathic pain, and the adverse events associated with their use.We searched CENTRAL and the Cochrane Database

2019 Cochrane