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Clinical Journal of Pain
Journal Prestige (SJR): 1.406
Citation Impact (citeScore): 3
Number of Followers: 23  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 0749-8047 - ISSN (Online) 1536-5409
Published by LWW Wolters Kluwer Homepage  [301 journals]
  • Inches, Centimeters, and Yards: Overlooked Definition Choices Inhibit
           Interpretation of Morphine Equivalence

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      Authors: Dasgupta; Nabarun; Wang, Yanning; Bae, Jungjun; Kinlaw, Alan C.; Chidgey, Brooke A.; Cooper, Toska; Delcher, Chris
      Abstract: imageObjective: Morphine-standardized doses are used in clinical practice and research to account for molecular potency. Ninety milligrams of morphine equivalents (MME) per day are considered a “high dose” risk threshold in guidelines, laws, and by payers. Although ubiquitously cited, the “CDC definition” of daily MME lacks a clearly defined denominator. Our objective was to assess denominator-dependency on “high dose” classification across competing definitions.Methods: To identify definitional variants, we reviewed literature and electronic prescribing tools, yielding 4 unique definitions. Using Prescription Drug Monitoring Programs data (July to September 2018), we conducted a population-based cohort study of 3,916,461 patients receiving outpatient opioid analgesics in California (CA) and Florida (FL). The binary outcome was whether patients were deemed “high dose” (>90 MME/d) compared across 4 definitions. We calculated I2 for heterogeneity attributable to the definition.Results: Among 9,436,640 prescriptions, 42% overlapped, which led denominator definitions to impact daily MME values. Across definitions, average daily MME varied 3-fold (range: 17 to 52 [CA] and 23 to 65 mg [FL]). Across definitions, prevalence of “high dose” individuals ranged 5.9% to 14.2% (FL) and 3.5% to 10.3% (CA). Definitional variation alone would impact a hypothetical surveillance study trying to establish how much more “high dose” prescribing was present in FL than CA: from 39% to 84% more. Meta-analyses revealed strong heterogeneity (I2 range: 86% to 99%). In sensitivity analysis, including unit interval 90.0 to 90.9 increased “high dose” population fraction by 15%.Discussion: While 90 MME may have cautionary mnemonic benefits, without harmonization of calculation, its utility is limited. Comparison between studies using daily MME requires explicit attention to definitional variation.
      PubDate: Sun, 01 Aug 2021 00:00:00 GMT-
       
  • Perceived Injustice Is Associated With Pain-related Function and Mood in
           Youth With Acute Musculoskeletal Pain

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      Authors: Battison; Eleanor A.J.; Wilson, Anna C.; Holley, Amy L.
      Abstract: imageObjectives: Perceived injustice (PI), which is one’s appraisal of justice or fairness regarding the pain experience, is an emerging area of interest in pediatric pain research. No previous studies have investigated PI in youth with acute pain. To fill this gap, this study examined (1) associations among PI, pain-related function, and psychological function in treatment-seeking youth with acute musculoskeletal (MSK) pain, and (2) the impact of parent-child PI discordance on children’s pain and psychosocial function.Materials and Methods: Participants were youth (aged 11 to 17, 55% male) with acute pain (onset
      PubDate: Sun, 01 Aug 2021 00:00:00 GMT-
       
  • Sickle Cell Disease and Pain: Is it all Vaso-occlusive Crises'

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      Authors: Ramsay; Zachary; Bartlett, Rachel; Ali, Amza; Grant, Justin; Gordon-Strachan, Georgiana; Asnani, Monika
      Abstract: imageObjectives: Acute pain is the main complication of sickle cell disease. Chronic pain (CP) and neuropathic pain (NP) may also be experienced, but have not been formally described in Jamaican patients. A cross-sectional study was conducted to determine their prevalence and characteristics, and to determine the common pain locations and modalities of management.Materials and Methods: All well individuals with sickle cell disease patients 14 years and older, not pregnant and without a history of clinical stroke were consecutively recruited. Anthropometric measurements, hematology studies, an analgesia checklist, and the Adult Sickle Cell Quality of Life Measurement Information System questionnaire were completed. The painDETECT questionnaire was completed to describe NP and pain patterns—from which CP was defined.Results: There were 257 patients in total, with 55.6% being females; the mean age of the patients was 31.7±12 years, and 75% had the SS genotype. Almost all patients (92.6%) had had an acute pain crisis in their lifetime and 72.4% in the last year. The mean severity at last attack was 6.8±3.1 on a scale of 0 to 10. The prevalences of CP and NP were 21.5% and 17.9%, respectively. Female sex, the presence of current leg ulcers, and the use of a strong opioid in the last 4 weeks produced higher odds of NP, whereas older age, milder genotypes, and daily analgesic use had the highest odds of CP. Opioids were used by 40.1% of the patients in the previous 4 weeks, whereas nonpharmacological treatments such as physiotherapy was less used, but reported to be very effective.Discussion: CP and NP should be assessed during routine care of sickle cell pain so that targeted therapies can be applied.
      PubDate: Sun, 01 Aug 2021 00:00:00 GMT-
       
  • Heart Rate Variability and Pain Sensitivity in Chronic Low Back Pain
           Patients Exposed to Passive Viewing of Photographs of Daily Activities

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      Authors: Bandeira; Pâmela M.; Reis, Felipe J.J.; Muniz, Fernanda D.N.; Chaves, Anna C.S.; Fernandes, Orlando Jr; Arruda-Sanchez, Tiago
      Abstract: imageObjective: Investigation if emotional reactivity by measuring heart rate variability (HRV) and pressure pain sensitivity during a passive visualization task in participants with chronic low back pain (CLBP).Materials and Methods: This case-control study was composed of 47 participants with CLBP and 47 asymptomatic participants. Both groups were submitted to a passive visualization task using 27 pictures from PHODA (Photograph Series of Daily Activities). HRV frequency domains were measured before, during, and after the task. Pressure pain threshold and pain intensity were also measured before and after the task.Results: The adjusted mean difference was statistically significant for HRV frequency domains during the visualization task, including low frequency [−5.92; 95% confidence interval (CI)=−9.60 to −2.23], high frequency (−0.71; 95% CI=−1.02 to −0.39), and low-frequency/high-frequency ratio (8.82; 95% CI=5.19 to 12.45). Pressure pain threshold decreased after the task in the CLBP group in all body sites, and pain intensity increased (−0.8; 95% CI=−1.16 to −0.39).Discussion: Aversive environmental stimuli, such as visual cues, may generate defensive physiological reactions. HRV can provide a measure that reflects the perceptions of threat and safety in the environment. Participants with CLBP presented changes in sympathovagal balance during passive visualization of pictures of daily activities, higher pain sensitivity, and high pain intensity when they were exposed to a passive visualization task using pictures of daily living that may arouse fears of harm.
      PubDate: Sun, 01 Aug 2021 00:00:00 GMT-
       
  • Reassuring Patients With Low Back Pain in Primary Care Consultations: Does
           it Happen, and Does it Matter' A ChiCo Cohort Study

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      Authors: Simonsen; Gitte D.; Jensen, Tue S.; Kongsted, Alice
      Abstract: imageObjectives: Reassurance is an important part of treatment for low back pain (LBP). The Consultation-based Reassurance Questionnaire measures patients’ perceived reassurance after health care consultations on 4 subdomains (ie, Data-gathering, Relationship-building, Generic reassurance, Cognitive reassurance). The objectives of this study were to investigate associations between the level of reassurance and outcomes and to investigate if the associations were moderated by patients’ risk profile.Materials and Methods: Adult patients consulting chiropractors for LBP were emailed the Consultation-based Reassurance Questionnaire directly after the consultation. Outcomes were Global Perceived Effect (GPE) after 2 weeks, and pain (Numeric Rating Scale) and disability (Roland-Morris Disability Questionnaire) 2 weeks and 3 months following treatment. Associations with GPE were tested in logistic mixed models. Associations between each reassurance domain and pain and disability were tested in longitudinal analyses using linear mixed models. Moderations by risk profile were tested by introducing an interaction between risk groups and reassurance level. All models were controlled for several potential confounders.Results: A total of 2056 patients were included in the study, with 46% reporting LBP for less than a week. Associations between reassurance level and improvement in LBP intensity and disability were weak but positive, whereas associations with GPE were potentially clinically relevant. None of the associations were moderated by psychological risk profile.Discussion: Identified associations between reassurance and outcomes were weak, however, for GPE the association might be of a clinically relevant magnitude. The causal relationship is unclear, but with communication always present in a consultation these results suggest that efforts to optimize clinician-patient communication might be worthwhile, also for people with very recent onset of LBP.
      PubDate: Sun, 01 Aug 2021 00:00:00 GMT-
       
  • Impact of the Opioid Epidemic and Associated Prescribing Restrictions on
           People Who Live With Chronic Noncancer Pain in Canada

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      Authors: Kaboré; Jean-Luc; Pagé, M. Gabrielle; Martel, Marc O.; Dassieu, Lise; Hudspith, Maria; Moor, Gregg; Sutton, Kathryn; Roy, Jean-Sébastien; Williamson, Owen D.; Choinière, Manon
      Abstract: imageObjectives: Little is known about the consequences of the opioid epidemic on people living with chronic noncancer pain (CNCP). This study examined this issue in people who lived in the most impacted province by opioid overdoses in Canada (British Columbia [BC]) or one of the least impacted (Quebec [QC]), and examined the factors associated with opioid use.Materials and Methods: This cross-sectional study was carried out in adults living in BC (N=304) and QC (N=1071) who reported CNCP (≥3 months) and completed an online questionnaire that was tailored to their opioid status.Results: Almost twice as many participants in BC as in QC were proposed to cease their opioid medication in the past year (P
      PubDate: Sun, 01 Aug 2021 00:00:00 GMT-
       
  • The Utility of an Anxiety Screening Measure in Youth With Functional
           Abdominal Pain Disorders and Clinical Characteristics Associated With
           Presence of Anxiety

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      Authors: Aggarwal Dutta; Richa; Ely, Samantha L.; Cunningham, Natoshia R.
      Abstract: imageObjectives: Anxiety is common in youth with functional abdominal pain disorders (FAPD) and is related to increased pain-related impairment. However, it is unknown if self-reported anxiety on a clinical screener represents a true anxiety disorder diagnosis in youth with FAPD. Further, little is known about clinical characteristics in youth with FAPD and comorbid anxiety (ANX). Therefore, we evaluated whether the clinical cutoff on the Screen for Anxiety and Related Disorders (SCARED) corresponded with the presence of an anxiety disorder. We predicted a more clinically complex profile (eg, increased pain-related impairment, psychological problems, and family risk factors) in youth with FAPD+ANX compared with youth with FAPD alone.Materials and Methods: Participants completed measures of anxiety, functional disability, pain intensity, pain catastrophizing, and mood, and underwent a semistructured diagnostic interview to assess for psychological disorders. Caregivers completed family characteristics and caregiver distress measures. Analyses of group differences were conducted using χ2 and multivariate tests.Results: The SCARED appears to be a good proxy for an anxiety disorder in youth with FAPD, particularly for generalized anxiety disorder and social anxiety disorder. Youth with FAPD+ANX reported higher rates of pain-related disability and depressive symptoms compared with those with FAPD alone, but other clinical characteristics and family risk factors were comparable across groups.Discussion: Findings support the use of the SCARED as a proxy for an anxiety disorder diagnosis in youth with FAPD and suggest youth with FAPD+ANX may have a more complex clinical profile categorized by greater mental health and health-related impairment as compared with youth with FAPD alone.
      PubDate: Sun, 01 Aug 2021 00:00:00 GMT-
       
  • Comparison of the Analgesic Effects of Intravenous Infusion of
           Dexmedetomidine Versus Bilateral Superficial Cervical Plexus Block After
           Thyroidectomy: A Randomized Controlled Trial

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      Authors: Xing; Jibin; Wu, Ranliang; Liang, Ling; Fang, Hongyi; Chen, Liubing; Luo, Chenfang
      Abstract: imageObjectives: Dexmedetomidine (DEX) is widely used in clinical practice because of its safety and effectiveness. Superficial cervical plexus block (SCPB) can reduce pain in thyroid surgery. The objective of this study was to investigated whether intravenous DEX has an equivalent analgesic effect and patients’ satisfaction to SCPB for thyroid surgery.Materials and Methods: Ninety patients who had been scheduled for thyroidectomy under general anesthesia with endotracheal intubation were randomly divided into 3 groups. Group D: DEX was administered intravenously at an initial dose of 1 µg/kg over 10 minutes; then induction and endotracheal intubation performed, and then a continuous intravenous infusion of DEX was administered at a rate of 0.4 μg/kg/h until 30 minutes before the end of surgery. Group B: ultrasound-guided bilateral SCPB was performed, with 10 mL of 0.375% ropivacaine injected on each side. Group C: intravenous saline was administered at the same rate and dose as in group D. Patients’ perioperative status, visual analog scale scores, complications and patients’ satisfaction were recorded.Results: The pain at rest at 1 hour after extubation and the movement-evoked pain within 24 hours after extubation were significantly lower in groups D and B than in group C. Patients’ satisfaction was significantly higher in groups D and B than in group C. There was no difference in pain at rest, movement-evoked pain and patients’ satisfaction between group D and B.Conclusions: Perioperative intravenous infusion of DEX can effectively reduce wound pain after thyroidectomy, and the analgesic effect is equivalent to that of bilateral SCPB.
      PubDate: Sun, 01 Aug 2021 00:00:00 GMT-
       
  • The Use of Magnesium Sulfate and Peripheral Nerve Blocks: An Updated
           Meta-analysis and Systematic Review

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      Authors: Zeng; Jie; Chen, Qi; Yu, Cong; Zhou, Ju; Yang, Bin
      Abstract: imageObjectives: With the popularization of ultrasound, nerve blocks have been widely implemented in current clinical practice. Although, they have seen limited success due to their shorter duration and suboptimal analgesia. Magnesium sulfate as a local anesthetic adjuvant for peripheral nerve blocks could enhance the effects of local anesthetics. However, previous investigations have not thoroughly investigated the analgesic efficacy of magnesium sulfate as an adjunct to local anesthetics for peripheral nerve blocks. Thus, we attempted to fill the gap in the existing literature by conducting a meta-analysis.Materials and Methods: We performed of a quantitative systematic review of randomized controlled trials published between May 30, 2011 and November 1, 2018. Inclusion criteria were: (1) magnesium sulfate used as adjuvant mixed with local anesthetic for nerve blockade, (2) complete articles and published abstracts of randomized controlled trials, (3) English language.Primary and Secondary Outcome Measures: The primary outcome measures were time of onset, total duration of the sensory blockade, and Visual Analog Scale pain scores. The secondary outcomes were postoperative oral and intravenous analgesics consumption and the incidence of nausea and vomiting.Results: The 21 trials analyzed in this study included 1323 patients. Magnesium sulfate effectively prolonged the total duration of sensory blockade (mean difference [MD]=114.59 min, 95% confidence interval [CI]: 89.31-139.88), reducing Visual Analog Scale pain scores at 6 hours (MD=1.36 points, 95% CI: −2.09 to −0.63) and 12 hours (MD=1.54 points, 95% CI: −2.56 to −0.53) postsurgery. Magnesium sulfate also effectively reduced postoperative analgesic use within 24 hours postsurgery (standard MD=−2.06, 95% CI: −2.67 to −1.35). Furthermore, adjuvant magnesium sulfate significantly reduced the incidence of nausea and vomiting after transversus abdominis plane blockade (odds ratio: 0.39, 95% CI: 0.18-0.81).Conclusion: Adjuvant magnesium sulfate enhanced the anesthetic effects of local anesthetics and improved postoperative analgesia following the perineural blockade.
      PubDate: Sun, 01 Aug 2021 00:00:00 GMT-
       
  • Behavioral Test (BAT-Back): Preliminary Evidence for a Successful
           Predictor of Treatment Outcome After Exposure Treatment for Chronic Low
           Back Pain

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      Authors: Hancock; Mark J.; Kent, Peter; Smith, Anne
      Abstract: No abstract available
      PubDate: Sun, 01 Aug 2021 00:00:00 GMT-
       
 
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