OBJECTIVES:To clarify the importance of avoidance, pacing, and overdoing pain-related activity management patterns as predictors of adjustment in patients with fibromyalgia syndrome.
METHODS:A total ...of 119 tertiary care patients with fibromyalgia syndrome who agreed to be part of an activity management pain program completed a survey, which requested information about demographics, pain intensity and pain interference, psychological and physical function, and pain-related activity management patterns. Hierarchical regression analyses were used to identify the unique contributions of the 3 different pain-related activity management patterns (avoidance, pacing, and overdoing) to the prediction of pain interference, psychological function, and physical function.
RESULTS:The avoidance pattern was a significant and unique predictor of worse psychological and physical function as well as greater pain interference. Pacing was significantly associated with less pain interference and better psychological function, whereas overdoing was not found to predict patient functioning.
DISCUSSION:The findings confirm the importance of pain-related activity management patterns as predictors of patient function, and support the necessity of addressing these factors in chronic pain treatment. In addition, the results suggest that targeting increases in activity pacing and decreases in pain avoidance, specifically, might yield the best patient outcomes. However, further research to evaluate this possibility is necessary.
Pain is highly prevalent in patients with cancer-nearly 40% report moderate-severe pain, which is commonly treated with opioids. Increasing cancer survivorship, opioid epidemics in some regions of ...the world, and limited opioid access in other regions have focused attention on nonopioid treatments. Given the limitations of monotherapy, combining nonopioids-such as antiepileptics and antidepressants-have shown promise in noncancer pain. This review seeks to evaluate efficacy of nonopioid combinations for cancer-related pain. Systematic searches of PubMed, EMBASE, and Cochrane CENTRAL were conducted for double-blind, randomized, controlled trials comparing a nonopioid combination with at least one of its components and/or placebo. This search yielded 4 randomized controlled trials, published between 1998 and 2019 involving studies of (1) imipramine + diclofenac; (2) mitoxantrone + prednisone + clodronate; (3) pentoxifylline + tocopherol + clodronate; and (4) duloxetine + pregabalin + opioid. In the first 3 of these trials, trends favouring combination efficacy failed to reach statistical significance. However, in the fourth trial, duloxetine + pregabalin + opioid was superior to pregabalin + opioid. This review illustrates recognition for the need to evaluate nonopioid drug combinations in cancer pain, although few trials have been published to date. Given the growing practice of prescribing more than 1 nonopioid for cancer pain and the need to expand the evidence base for rational combination therapy, more high-quality trials in this area are needed.
IntroductionEvidence suggests a role for Central nervous system glia in pain transmission and in augmenting maladaptive opioid effects. Identification of drugs that modulate glia has guided the ...evaluation of glial suppression as a pain management strategy. This planned systematic review will describe evidence of the efficacy and adverse effects of glial-modulating drugs in pain management.Methods and analysisA detailed search will be conducted on the Cochrane Central Register of Controlled Trials, Medline, and Embase from their inception until the date the final searches are run to identify relevant randomised controlled trials. The reference lists of retrieved studies, as well as online trial registries, will also be searched. English language, randomised, double-blind trials comparing various glial-modulating drugs with placebo and/or other comparators, with participant-reported pain assessment, will be included. Two reviewers will independently evaluate studies for eligibility, extract data and assess trial quality and potential bias. Risk of bias will be assessed using criteria outlined in the Cochrane Handbook for Systematic Review of Interventions. Primary outcomes for this review will include any validated measure of pain intensity and/or pain relief. Dichotomous data will be used to calculate risk ratio and number needed to treat or harm. The quality of evidence will be assessed using Grading of Recommendations Assessment, Development and Evaluation.Ethics and disseminationThis systematic review does not require formal ethics approval. The findings will be disseminated through peer-reviewed publications and conference presentations.PROSPERO registration numberCRD42021262074.
Clinical practice guidelines.
To develop the first Canadian clinical practice guidelines for screening and diagnosis of neuropathic pain in people with spinal cord injury (SCI).
The guidelines are ...relevant for inpatient and outpatient SCI rehabilitation settings in Canada.
The CanPainSCI Working Group reviewed evidence to address clinical questions regarding screening and diagnosis of neuropathic pain after SCI. A consensus process was followed to achieve agreement on recommendations and clinical considerations.
Twelve recommendations, based on expert consensus, were developed for the screening and diagnosis of neuropathic pain after SCI. The recommendations address methods for assessment, documentation tools, team member accountability, frequency of screening and considerations for diagnostic investigation. Important clinical considerations accompany each recommendation.
The expert Working Group developed recommendations for the screening and diagnosis of neuropathic pain after SCI that should be used to inform practice.
Background
Neuropathic pain (NP), a complication of several conditions (eg, diabetic neuropathy and varicella zoster), is a common challenging problem, and there is a growing need to develop safe and ...effective nonopioid treatments. Sleep disturbance is commonly associated with NP because pain intensity in NP conditions is often worse at night. The pineal hormone melatonin has been shown to reduce pain in both preclinical and clinical settings, in addition to multiple trials demonstrating efficacy for primary insomnia and delayed sleep phase syndrome.
Objective
We propose to conduct a clinical trial to evaluate the efficacy and safety of melatonin for NP.
Methods
Using a double-blind, placebo-controlled, crossover design, 30 adults with NP will be randomly allocated to one of two sequences of treatment with melatonin and placebo. During each of the two treatment periods, participants will take capsules containing melatonin or placebo for 4 weeks, followed by a 7-day washout period. The primary outcome will be mean daily pain intensity (scored 0-10) at maximally tolerated doses (MTDs) during each period. Secondary outcomes, assessed at MTDs, will include global improvement, adverse events, mood, and quality of life.
Results
This trial was registered in the International Standard Randomized Controlled Trial registry May 4, 2022 (ISRCTN #16215617), attained conditional ethics approval May 9, 2022 (Queen’s University Health Sciences & Affiliated Teaching Hospitals Research Ethics Board protocol number ANAE-387-22), and recruitment is set to start August 2022.
Conclusions
This trial will provide rigorous evidence comparing the efficacy of melatonin to that of placebo in the treatment of NP.
Trial Registration
ISRCTN Registry 16215617; https://www.isrctn.com/ISRCTN16215617
International Registered Report Identifier (IRRID)
PRR1-10.2196/40025
Radiation-induced mucositis (RIM) pain confers substantial morbidity for head and neck cancer (HNC) patients undergoing radiotherapy alone (RT) or chemoradiotherapy (CRT), often reducing treatment ...compliance. However, no standard currently exists for the treatment of RIM, and high dose opioid therapy, with its associated side effects and increased risk for chronic opioid use, remains the cornerstone of HNC pain management. The goal of this randomized clinical trial is to compare multimodal analgesia using analgesic medications with different mechanisms of action, to the institutional standard of opioid analgesia alone, in order to ascertain the optimal analgesic regimen for the management of RIM pain in HNC patients.
In this open-label, single-institution, non-inferiority, randomized clinical trial, sixty-two patients with mucosal head and neck malignancies treated with curative-intent radiation will be randomized in a 1:1 ratio, stratified by RT or CRT, between Arm 1: opioid analgesia alone as per the institutional standard, or Arm 2: multimodal analgesia using Pregabalin, Acetaminophen, and Naproxen, in addition to opioids, if required. The primary endpoint is the average 11-Numeric Rating Scale (11-NRS) score for pain during the last week of radiation treatment. Secondary endpoints include: average weekly opioid use, duration of opioid requirement, average daily 11-NRS score for pain, average weekly opioids dispensed, quality of life, hospitalizations for analgesic medication-induced complications, time to feeding tube insertion, weight loss, toxicity, treatment interruptions, and death within 3 months of completing RT treatment. Patients are eligible once analgesia is required for moderate 4/10 pain.
This study will assess the efficacy and safety of multimodal analgesia and its impact on opioid requirements, clinical outcomes, and quality of life, as a potential new standard treatment for RIM pain in HNC patients undergoing definitive RT or CRT.
ClinicalTrials.gov Identifier: NCT04221165 . Date of registration: January 9, 2020. Appendix 2 reports the World Health Organization trial registration dataset.
Resumo Liderança é considerada um tema relevante para os estudos organizacionais, fato que pode ser verificado pela existência de diversos periódicos acadêmicos dedicados exclusivamente ao tema. ...Contudo, apesar da proliferação de periódicos e várias publicações sobre o tema, a definição de liderança ainda é vaga, sendo geralmente considerada pelo mainstream um atributo masculino de líderes individuais heroicos. Assim, este artigo busca realizar uma análise crítica do mainstream sobre liderança, tendo-se como lente de análise a ontologia pós-estruturalista sobre o tema. Portanto, este artigo objetiva contribuir com o debate ontológico sobre liderança ao abordar o que é liderança para o pós-estruturalismo, enfatizando suas diferenças ontológicas em relação ao mainstream. O pós-estruturalismo promove uma ontologia de liderança alternativa ao mainstream que rompe com a concepção universal de liderança ao evidenciar sua característica microssocial e discursiva, concebendo liderança como um processo discursivo micropolítico, sendo fundamental para a entendimento da ontologia pós-estruturalista de liderança compreender (1) a produção das identidades de líderes e seguidores e (2) a materialidade da liderança.
Resumen El liderazgo se considera un tema relevante para los estudios organizacionales, un hecho que puede verificarse por la existencia de varias revistas académicas dedicadas exclusivamente al tema. Sin embargo, a pesar de la proliferación de publicaciones sobre el tema, la definición de liderazgo sigue siendo vaga, y considerada por el mainstream como un atributo masculino de líderes heroicos individuales. Así, este artículo busca llevar a cabo un análisis crítico del mainstream sobre liderazgo, teniendo como lente de análisis la ontología posestructuralista sobre el tema. Por lo tanto, este artículo tiene como objetivo contribuir al debate ontológico sobre liderazgo al abordar qué es el liderazgo para el posestructuralismo, enfatizando sus diferencias ontológicas en relación con el mainstream. El posestructuralismo promueve una ontología del liderazgo alternativa al mainstream que rompe con la concepción universal de liderazgo al evidenciar su característica microsocial y discursiva, concibiendo el liderazgo como un proceso discursivo micropolítico, haciéndose fundamental para la comprensión de la ontología posestructuralista del liderazgo entender (1) la producción de las identidades de los líderes y seguidores y (2) la materialidad del liderazgo.
Abstract Leadership is considered a relevant topic for organizational studies, which can be verified by the numerous academic journals dedicated exclusively to the theme. However, despite the proliferation of journals and several publications on the subject, the definition of leadership is still vague, generally considered by the mainstream to be a male attribute of heroic individual leaders. This article presents a critical analysis of the mainstream on leadership, focused on analyzing the poststructuralist ontology on leadership. The study contributes to the ontological debate on leadership by addressing what leadership is for poststructuralism, emphasizing its ontological differences in relation to the mainstream. Poststructuralism promotes an alternative ontology of leadership to the mainstream that breaks with the universal conception of leadership by highlighting its microsocial and discursive characteristic, conceiving leadership as a micro-political discursive process. It is fundamental for understanding the poststructuralist ontology of leadership to comprehend (1) the production of the identities of leaders and followers and (2) the materiality of leadership.
Summary
Background The use of opioid analgesics for chronic non-cancer pain is controversial. Some surveys report good pain relief and improvement in performance while others suggest a poor outcome ...with a propensity to psychological dependence or addiction.
Methods We undertook a randomised double-blind crossover study to test the hypothesis that oral morphine relieves pain and improves the quality of life in patients with chronic regional pain of soft tissue or musculoskeletal origin who have not responded to codeine, antiinflammatory agents, and antidepressants. Morphine was administered as a sustained-release preparation in doses up to 60 mg twice daily and compared with benztropine (active placebo) in doses up to 1 mg twice daily over three-week titration, six-week evaluation, and two-week washout phases. Pain intensity, pain relief, and drug liking were rated weekly and psychological features, functional status, and cognition were assessed at baseline and at the end of each evaluation phase.
Findings After dose titration in the 46 patients who completed the study, the mean daily doses of drugs were morphine 83·5 mg and benztropine 1·7 mg. On visual analogue scales, the morphine group showed a reduction in pain intensity relative to placebo in period I (p=0·01) and this group also fared better in a crossover analysis of the sum of pain intensity differences from baseline (p=0·02). No other significant differences were detected.
Interpretation In patients with treatment-resistant chronic regional pain of soft-tissue or musculoskeletal origin, nine weeks of oral morphine in doses up to 120 mg daily may confer analgesic benefit with a low risk of addiction but is unlikely to yield psychological or functional improvement.
Fibromyalgia is a condition with widespread muscle pain. Prevalence studies showed that 2% to 7% of the population have fibromyalgia, which affects approximately one million Canadians. Fibromyalgia ...is most common in women, but it also involves men and children. As with most chronic illnesses, the causes of fibromyalgia are unknown. However, recent research supports underlying abnormalities in the central nervous system, which supports fibromyalgia as a chronic disease state and valid clinical entity. Pain is the primary symptom, often accompanied by overwhelming fatigue, sleep dysfunction and cognitive impairment. In 1990, the American College of Rheumatology developed diagnostic criteria for the diagnosis of fibromyalgia. Lifestyle changes, including pacing of activities and aerobic exercise, are very important in managing fibromyalgia symptoms. Emotional and behavioural therapy can also be helpful. Controlled trials of antidepressants, gabapentinoids, tramadol, zopiclone and sodium oxybate have shown effectiveness in fibromyalgia patients. Pregabalin and duloxetine were recently approved in the United States. Effective management of fibromyalgia is complex and requires a multidisciplinary treatment approach. Response and tolerance of different therapeutic interventions vary from patient to patient. Recent advances in the pathophysiology of fibromyalgia offer hope for new and improved therapies in the management of this disabling condition.
Thin-film silicon solar cells need efficient light absorption to achieve high efficiencies. The standard light trapping approach consists of a randomly textured transparent substrate and a highly ...reflective back contact. In this case, light scattering at the rough TCO–silicon interface leads to a prolonged absorption path and consequently to an increased short circuit current. In this study, we will discuss a new approach based on silver nanoparticles to improve the light absorption in the thin-film silicon solar cells. Raman and SNOM measurements and theoretical investigations on systems with metallic nanoparticles indicate a strong increase of the electric field in their surrounding when they are irradiated by light. Moreover, nanoparticles with the proper diameter can enhance light scattering. In this study, we have investigated the influence of silver nanoparticles with different sizes on the optoelectronic properties of amorphous and microcrystalline silicon solar cells. The nanoparticles are located at the back contact of the thin-film solar cell deposited in a n–i–p layer sequence.
PDF
