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A Controlled Pilot Trial of PainTracker Self-Manager, a Web-Based Platform Combined with Patient Coaching, to Support Patients' Self-Management of Chronic Pain

• PainTracker Self-Manager improved patients’ confidence in chronic pain self-management• This intervention also improved patients’ satisfaction with pain treatment• In study completers, the intervention also improved activity engagement and pain• The intervention included web-based assessment and education plus clinician coaching

A Controlled Pilot Trial of PainTracker Self-Manager, a Web-Based Platform Combined with Patient Coaching, to Support Patients’ Self-Management of Chronic Pain

Orginally Published At: Pain Journal

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A Comparison of the Assay Sensitivity of Average and Worst Pain Intensity in Pharmacologic Trials: an ACTTION Systematic Review and Meta-Analysis

• Average vs worst pain intensity assay sensitivity not statistically different• Numerically smaller mean and standard deviation for average vs worst pain intensity• No relationship observed between pain condition and difference in assay sensitivity• Many articles ineligible because WPI results not reported

A Comparison of the Assay Sensitivity of Average and Worst Pain Intensity in Pharmacologic Trials: an ACTTION Systematic Review and Meta-Analysis

Orginally Published At: Pain Journal

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Effect on Health Care Costs for Adolescents Receiving Adjunctive Internet-Delivered Cognitive-Behavioral Therapy: Results of a Randomized Controlled Trial

Chronic pain is a costly condition in childhood, with an estimated societal economic cost of $12 billion annually in the United States.16 Indeed, high rates of health service use have been documented for youth with chronic pain around the world including in the United States,15,29,36,40 Europe,19,30 the United Kingdom,33,41 and Asia.26 Recognizing this concern, economic impact was recommended as an important outcome domain to assess in clinical trials for pediatric chronic pain.32

Effect on Health Care Costs for Adolescents Receiving Adjunctive Internet-Delivered Cognitive-Behavioral Therapy: Results of a Randomized Controlled Trial

Orginally Published At: Pain Journal

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Neuropathic pain in leprosy: symptom profile characterization and comparison with neuropathic pain of other etiologies

imageIntroduction:
Previous studies reported a high prevalence of neuropathic pain in leprosy, being especially present in “pharmacologically cured” patients. The presence of neuropathic pain in leprosy poses a supplementary burden in patient’s quality of life, daily activities, and mood.
Objectives:
The aim of this study was to assess whether neuropathic pain in leprosy has similar symptom profile as neuropathic pain of other etiologies and to retrospectively assess the efficacy of neuropathic pain medications regularly prescribed to leprosy.
Methods:
Leprosy and nonleprosy patients had their neuropathic pain characterized by the neuropathic pain symptom inventory (NPSI, ranges from 0 to 100, with 100 being the maximal neuropathic pain intensity) in a first visit. In a second visit, leprosy patients who had significant pain and received pharmacological treatment in the first evaluation were reassessed (NPSI) and had their pain profile and treatment response further characterized, including information on drugs prescribed for neuropathic pain and their respective pain relief.
Results:
The pain characteristics based on NPSI did not significantly differ between leprosy and nonleprosy neuropathic pain patients in visit 1 after correction for multiple analyses, and cluster analyses confirmed these findings (ie, no discrimination between leprosy and nonleprosy groups; Pearson χ2 = 0.072, P = 0.788). The assessment of pain relief response and the drugs taken by each patient, linear regression analysis showed that amitriptyline, when effective, had the highest percentage of analgesic relief.
Conclusions:
Neuropathic pain in leprosy is as heterogeneous as neuropathic pain of other etiologies, further supporting the concept that neuropathic pain is a transetiological entity. Neuropathic pain in leprosy may respond to drugs usually used to control pain of neuropathic profile in general, and amitriptiline may constitute a potential candidate drug for future formal clinical trials aimed at controlling neuropathic pain in leprosy.

Neuropathic pain in leprosy: symptom profile characterization and comparison with neuropathic pain of other etiologies


Orginally Published At: PAIN Reports

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The Long-Term Footprint of Endometriosis: Population-Based Cohort Analysis Reveals Increased Pain Symptoms and Decreased Pain Tolerance at Age 46 Years

Endometriosis is an estrogen-dependent, chronic gynecological disorder associated with pelvic pain and infertility, with a prevalence of 6 to 10% in the general population.6,7,12 Affected women experience dysmenorrhea, deep dyspareunia, dyschezia, and dysuria12,35 associated with low quality of life.8 The disorder is underdiagnosed or there is a delay in diagnosis in many cases leading to chronic pelvic pain (CPP).7,26 Diagnosis is made using laparoscopy or laparotomy, where endometrial lesions are found in extrauterine locations, mainly the peritoneum and ovaries.

The Long-Term Footprint of Endometriosis: Population-Based Cohort Analysis Reveals Increased Pain Symptoms and Decreased Pain Tolerance at Age 46 Years

Orginally Published At: Pain Journal

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Randomized Controlled Trial of Online Acceptance and Commitment Therapy for Fibromyalgia

Fibromyalgia (FM) is a chronic pain disorder of uncertain etiology characterized by widespread pain and numerous potential comorbidities including fatigue, disordered sleep, neurocognitive deficits, gastrointestinal distress, headache, anxiety, and depression.61 This symptomatology often presents in an unpredictable remitting/relapsing cycle that further detracts from patients’ quality of life and results in significantly increased medical costs, health care utilization, and work-related disability.

Randomized Controlled Trial of Online Acceptance and Commitment Therapy for Fibromyalgia

Orginally Published At: Pain Journal

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Research Design Characteristics of Published Pharmacologic Randomized Clinical Trials for Irritable Bowel Syndrome and Chronic Pelvic Pain Conditions: An ACTTION Systematic Review

Chronic pain conditions occurring in the lower abdomen and pelvis are prevalent, often challenging to manage, and can negatively affect health-related quality of life, including psychosocial and sexual well-being.3,8,25,27,32,37 Very few U.S. Food and Drug Administration (FDA) or European Medicines Agency (EMA) approved treatments currently exist for these conditions. The dearth of treatments arises, in part, from methodological challenges in designing randomized clinical trials (RCTs) to evaluate the efficacy of novel treatments in these conditions.

Research Design Characteristics of Published Pharmacologic Randomized Clinical Trials for Irritable Bowel Syndrome and Chronic Pelvic Pain Conditions: An ACTTION Systematic Review

Orginally Published At: Pain Journal

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Ecological Momentary Assessment Methodology in Chronic Pain Research: A Systematic Review

Pain intensity represents the primary outcome in most clinical trials of pain disorders and is nearly universally assessed in chronic pain research.32,79 Chronic pain affects over 11% of the population of the United States,90 and there is an undisputed need for the accurate and reliable assessment of pain. Although alternatives to self-reported pain intensity (eg, observation of pain behaviors64) have previously been considered, self-reports presently constitute the gold standard of pain assessment because they are able to reflect the subjectivity inherent in the pain experience.

Ecological Momentary Assessment Methodology in Chronic Pain Research: A Systematic Review

Orginally Published At: Pain Journal

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Efficacy and Safety of Oral and Transdermal Opioid Analgesics for Musculoskeletal Pain in Older Adults: A Systematic Review of Randomized, Placebo-Controlled Trials

This systematic review with meta-analysis was performed to evaluate the efficacy and safety of using opioid analgesics in older adults with musculoskeletal pain. We searched Cochrane Library, MEDLINE, EMBASE, Web of Science, AMED, CINAHL, and LILACS for randomized controlled trials with mean population age of 60 years or older, comparing the efficacy and safety of opioid analgesics with placebo for musculoskeletal pain conditions. Reviewers extracted data, assessed risk of bias, and evaluated the quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation approach.

Efficacy and Safety of Oral and Transdermal Opioid Analgesics for Musculoskeletal Pain in Older Adults: A Systematic Review of Randomized, Placebo-Controlled Trials

Orginally Published At: Pain Journal

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Complex regional pain syndrome–up-to-date

imageAbstract
Complex regional pain syndrome (CRPS) was described for the first time in the 19th century by Silas Weir Mitchell. After the exclusion of other causes, CRPS is characterised by a typical clinical constellation of pain, sensory, autonomic, motor, or trophic symptoms which can no longer be explained by the initial trauma. These symptoms spread distally and are not limited to innervation territories. If CRPS is not improved in the acute phase and becomes chronic, the visible symptoms change throughout because of the changing pathophysiology; the pain, however, remains. The diagnosis is primarily clinical, although in complex cases further technical examination mainly for exclusion of alternative diagnoses is warranted. In the initial phase, the pathophysiology is dominated by a posttraumatic inflammatory reaction by the activation of the innate and adaptive immune system. In particular, without adequate treatment, central nociceptive sensitization, reorganisation, and implicit learning processes develop, whereas the inflammation moderates. The main symptoms then include movement disorders, alternating skin temperature, sensory loss, hyperalgesia, and body perception disturbances. Psychological factors such as posttraumatic stress or pain-related fear may impact the course and the treatability of CRPS. The treatment should be ideally adjusted to the pathophysiology. Pharmacological treatment maybe particularly effective in acute stages and includes steroids, bisphosphonates, and dimethylsulfoxide cream. Common anti-neuropathic pain drugs can be recommended empirically. Intravenous long-term ketamine administration has shown efficacy in randomised controlled trials, but its repeated application is demanding and has side effects. Important components of the treatment include physio- and occupational therapy including behavioural therapy (eg, graded exposure in vivo and graded motor imaging). If psychosocial comorbidities exist, patients should be appropriately treated and supported. Invasive methods should only be used in specialised centres and in carefully evaluated cases. Considering these fundamentals, CRPS often remains a chronic pain disorder but the devastating cases should become rare.

Complex regional pain syndrome–up-to-date


Orginally Published At: PAIN Reports