Delivery Methods and Dosage of Pain Neuroscience Education, Cognitive Behavioral Therapy, and Mindfulness

Publication date: December 2019

Source: Archives of Physical Medicine and Rehabilitation, Volume 100, Issue 12

Author(s): Lisa Spiker, Zachary Walston, Patricia Pruszynski, Matthew Wronsky, Alex Lettner

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A Scoping Review of Falls and Physical Activity among Community-Dwelling Older Adults with Pain

Publication date: December 2019

Source: Archives of Physical Medicine and Rehabilitation, Volume 100, Issue 12

Author(s): Libbey Bowen, Mari Griffioen

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[Clinical Picture] Seeing red degeneration in uterine fibroids in pregnancy: proceed with caution

A 32-year-old pregnant woman was admitted to our hospital at 18 weeks of gestation with a 5-day history of severe, sharp, and constant abdominal pain. She had no significant medical history and prior to this pain, the pregnancy had been uneventful. On admission, the woman looked pale and was in severe discomfort. Her vital signs were normal. At physical examination we found tenderness in the right lower quadrant of her abdomen but no peritonism. The gravid uterus was soft with a palpable mass at the fundus: there was no vaginal bleeding.

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Integrated behavioral treatment for Veterans with co-morbid chronic pain and hazardous opioid use: A randomized controlled pilot trial

Chronic pain, defined as pain that persists longer than three months, is common, costly, and debilitating.10,26,35,50 The preponderance of the available evidence suggests that problems associated with chronic pain have been exacerbated by exponential increases in prescribed opioids over the past few decades.3,4 Overall opioid prescription rates have doubled in this century, from 11% to 20% of all pain-related ambulatory and office-based medical visits, while overall rates of pain as a primary symptom and prescription rates of non-opioid analgesics remained unchanged.

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Investigating the Influence and a Potential Mechanism of Self-compassion on Experimental Pain: Evidence from a Compassionate Self-talk Protocol and Heart Rate Variability

Self-compassion is conceptualized as the ability to be kind and caring toward oneself in times of suffering, failure, or perceived inadequacy.35,36 A number of studies have demonstrated the role of self-compassion in protecting emotional well-being against negative life events.3,4,30-32,52,57 In the field of pain research, increasing evidence has identified a positive association between self-compassion and emotional well-being in people with chronic pain,5,15,20,46,56 while the effects of self-compassion on pain perception are mixed.

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A pain in the neck

A 39 year old woman presented with a one week history of progressive swelling and pain on the right side of her neck that was aggravated by eating. She had no relevant dental history. She was...

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Perioperative intravenous low‐dose ketamine for neuropathic pain after major lower back surgery: A randomized, placebo‐controlled study

Abstract

Background

Chronic pain after major lower back surgery is frequent. We investigated in adults the effect of perioperative low‐dose ketamine on neuropathic lower back pain, assessed by the DN4 questionnaire, six and 12 months after major lower back surgery.

Methods

In this single‐centre randomized trial, 80 patients received intravenous ketamine 0.25 mg/kg preoperatively, followed by 0.25 mg/kg hr^‐1 intraoperatively, and 0.1 mg/kg hr^‐1 from 1 hr before the end of surgery until the end of recovery room stay; 80 controls received placebo.

Results

Preoperatively, 47.4% of patients in the ketamine group and 46.3% in the placebo group had neuropathic pain; 10% and 3.8%, respectively, were using strong opioids. At the end of the infusion, the median cumulative dose of ketamine was 84.8 mg (IQR 67.4–106.7) and the median plasma level was 97 ng/ml (IQR 77.9–128.0). At six months, 28.8% of patients in the ketamine group and 23.5% in the placebo group had neuropathic pain (absolute difference, 5.2%; 95% CI −10.7 to 21.1; p = .607). At 12 months, 26.4% of patients in the ketamine group and 17.9% in the placebo group had neuropathic pain (absolute difference 8.5%; 95% CI −6.7 to 23.6; p = .319).

Conclusions

In this patient population with a high prevalence of neuropathic lower back pain undergoing major lower back surgery, a perioperative intravenous low‐dose ketamine infusion did not have an effect on the prevalence of neuropathic lower back pain at six or 12 months postoperatively.

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