A prospective, multisite, international validation of the Complex Regional Pain Syndrome Severity Score.

Clinical diagnosis of complex regional pain syndrome (CRPS) is a dichotomous (yes/no) categorization, a format necessary for clinical decision making. Such dichotomous diagnostic categories do not convey an individual's subtle gradations in the severity of the condition over time and have poor statistical power when used as an outcome measure in research. This prospective, international, multicenter study slightly modified and further evaluated the validity of the CRPS Severity Score (CSS), a continuous index of CRPS severity.

Chronic Non-Cancer Pain Management Capacity in Karachi.

Chronic non-cancer pain (CNCP) affects people everywhere in the world, but people in developing countries have far less access to therapies that provide relief. There are often missed opportunities to implement these therapies. Karachi shares many characteristics with megacities of the global south and represents Pakistan in the global city league.

Complex regional pain syndrome: evidence for warm and cold subtypes in a large prospective clinical sample.

Limited research suggests that there may be Warm complex regional pain syndrome (CRPS) and Cold CRPS subtypes, with inflammatory mechanisms contributing most strongly to the former. This study for the first time used an unbiased statistical pattern recognition technique to evaluate whether distinct Warm vs Cold CRPS subtypes can be discerned in the clinical population. An international, multisite study was conducted using standardized procedures to evaluate signs and symptoms in 152 patients with clinical CRPS at baseline, with 3-month follow-up evaluations in 112 of these patients.

Health Services for Management of Chronic Non-Cancer Pain in Kuwait: A Case Study Review.

The experience of chronic pain is universal, yet pain management services delivered by health professionals vary substantially, depending on the context and patient. This review is a part of a series that has examined the issue of chronic non-cancer pain services and management in different global cities. The review is structured as a case study of the availability of management services for people living with chronic non-cancer pain within the context of the Kuwaiti health systems, and the cases are built from evidence in the published literature identified through a comprehensive review process.

Efficacy and adverse effects of medical marijuana for chronic noncancer pain: Systematic review of randomized controlled trials.

Objective: To determine if medical marijuana provides pain relief for patients with chronic noncancer pain (CNCP) and to determine the therapeutic dose, adverse effects, and specific indications.

Data Sources: In April 2014, MEDLINE and EMBASE searches were conducted using the terms chronic noncancer pain, smoked marijuana or cannabinoids, placebo and pain relief, or side effects or adverse events.

Study Selection: An article was selected for inclusion if it evaluated the effect of smoked or vaporized cannabinoids (nonsynthetic) for CNCP; it was designed as a controlled study involving a comparison group, either concurrently or historically; and it was published in English in a peer-review journal.

Characteristics of complex regional pain syndrome in patients referred to a tertiary pain clinic by community physicians, assessed by the Budapest clinical diagnostic criteria.

Objective: The aim of this study was to describe the characteristics of patients referred with complex regional pain syndrome (CRPS) diagnosis to a tertiary care pain center.

Method: Descriptive chart review study of all patients referred by family physicians or community specialists as having CRPS (2006-2010). Data extraction included demographics, pain ratings, and diagnosis utilizing the Budapest CRPS criteria.

Characteristics of chronic noncancer pain patients assessed with the opioid risk tool in a Canadian tertiary care pain clinic.

Background: The Opioid Risk Tool (ORT) is a screening instrument for assessing the risk of opioid-related aberrant behavior in chronic noncancer pain (CNCP) patients.

Objective: This study aims to compare patient characteristics documented in the original ORT study with those identified in CNCP patients assessed using a physician-administered ORT in a tertiary care pain clinic in Toronto, Canada.

Methodology: This was a descriptive cross-sectional study of 322 consecutive new patients referred over 12 months.

Opioids compared with placebo or other treatments for chronic low back pain: an update of the Cochrane Review.

Study Design: Systematic review and meta-analysis.

Objective: To assess the efficacy of opioids in adults with chronic low back pain (CLBP).

Summary Of Background Data: Opioids for CLBP has increased dramatically.

WITHDRAWN: Spinal cord stimulation for chronic pain.

This review is out of date and will not be updated. The content of the review may be of historical interest to readers. The editorial group responsible for this previously published document have withdrawn it from publication.

Opioids compared to placebo or other treatments for chronic low-back pain.

Background: The use of opioids in the long-term management of chronic low-back pain (CLBP) has increased dramatically. Despite this trend, the benefits and risks of these medications remain unclear. This review is an update of a Cochrane review first published in 2007.

Effect of a course-based intervention and effect of medical regulation on physicians' opioid prescribing.

Objective: To examine the effects of an intensive 2-day course on physicians' prescribing of opioids.

Design: Population-based retrospective observational study.

Setting: College of Physicians and Surgeons of Ontario (CPSO) in Toronto.

Systematic review of the quality and generalizability of studies on the effects of opioids on driving and cognitive/psychomotor performance.

Introduction: The effect of opioids on driving performance has been much debated. Driving is a complex task requiring integration of psychomotor, cognitive, motor and decision-making skills, visual-spatial abilities, divided attention, and behavioral and emotional control. The objective of this systematic review was to assess the quality of studies and to revisit the concept that patients on stable opioids are safe to drive as it applies to everyday practice.

Use of a modified Comprehensive Pain Evaluation Questionnaire (CPEQ): characteristics and functional status of patients on entry to a tertiary care pain clinic.

Background: With increasing knowledge of chronic pain, clinicians have attempted to assess chronic pain patients with lengthy assessment tools.

Objectives: To describe the functional and emotional status of patients presenting to a tertiary care pain clinic; to assess the reliability and validity of a diagnostic classification system for chronic pain patients modelled after the Multidimensional Pain Inventory; to provide psychometric data on a modified Comprehensive Pain Evaluation Questionnaire (CPEQ); and to evaluate the relationship between the modified CPEQ construct scores and clusters with Diagnostic and Statistical Manual, Fourth Edition - Text Revision Pain Disorder diagnoses.

Methods: Data on 300 new patients over the course of nine months were collected using standardized assessment procedures plus a modified CPEQ at the Comprehensive Pain Program, Toronto Western Hospital, Toronto, Ontario.

Canadian guideline for safe and effective use of opioids for chronic noncancer pain: clinical summary for family physicians. Part 2: special populations.

Objective: To provide family physicians with a practical clinical summary of opioid prescribing for specific populations based on recommendations from the Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain.

Quality Of Evidence: Researchers for the guideline conducted a systematic review of the literature, focusing on reviews of the effectiveness and safety of opioids in specific populations.

Main Message: Family physicians can minimize the risks of overdose, sedation, misuse, and addiction through the use of strategies tailored to the age and health status of patients.

Canadian guideline for safe and effective use of opioids for chronic noncancer pain: clinical summary for family physicians. Part 1: general population.

Objective: To provide family physicians with a practical clinical summary of the Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain, developed by the National Opioid Use Guideline Group.

Quality Of Evidence: Researchers for the guideline conducted a systematic review of the literature on the effectiveness and safety of opioids for chronic noncancer pain, and drafted a series of recommendations. A panel of 49 clinicians from across Canada reviewed the draft and achieved consensus on 24 recommendations.

A comparison between enriched and nonenriched enrollment randomized withdrawal trials of opioids for chronic noncancer pain.

Background: An enriched enrollment randomized withdrawal (EERW) design excludes potential participants who are nonresponders or who cannot tolerate the experimental drug before random assignment. It is unclear whether EERW design has an influence on the efficacy and safety of opioids for chronic noncancer pain (CNCP).

Objectives: The primary objective was to compare the results from EERW and non-EERW trials of opioids for CNCP.

Trends in opioid use and dosing among socio-economically disadvantaged patients.

Background: Opioid therapy for patients with chronic nonmalignant pain remains controversial, primarily because of safety concerns and the potential for abuse. The objective of this study was to examine trends in opioid utilization for nonmalignant pain among recipients of social assistance and to explore the relation between dose of analgesic and mortality.

Methods: Using a cross-sectional study design, we characterized annual trends in prescriptions for and daily dose of opioid analgesics between 2003 and 2008 for beneficiaries (aged 15 to 64 years) of Ontario's public drug plan.

Chronic noncancer pain: characteristics of patients prescribed opioids by community physicians and referred to a tertiary pain clinic.

Objective: To describe the characteristics of patients with chronic noncancer pain (CNCP) prescribed opioids by community physicians and referred to a tertiary pain clinic.

Design: Cross-sectional, descriptive study.

Setting: A tertiary care, hospital-based pain clinic in Toronto, Ont.

Referring patients with chronic noncancer pain to pain clinics: survey of Ontario family physicians.

Objective: To examine the factors associated with FPs' referrals of patients with chronic noncancer pain to a tertiary care pain clinic.

Design: A questionnaire-based survey; data were analyzed using univariate methods.

Setting: A tertiary care pain clinic in Toronto, Ont.

On the nature of nondermatomal somatosensory deficits.

Objectives: Nondermatomal somatosensory deficits (NDSDs) not conforming to the distribution of peripheral nerves or dermatomes, and often present after a minor injury or with no known inciting event, have long been associated with "hysteria." This article reviews the modern literature concerning NDSDs associated with chronic pain with regard to their prevalence, phenomenology and clinical presentation, clinical assessment, etiology and pathophysiology, relationship with Conversion Disorder and psychological factors, and their treatment and prognosis.

Methods: Past research and relevant literature concerning NDSDs are reviewed and summarized.

Nondermatomal somatosensory deficits: overview of unexplainable negative sensory phenomena in chronic pain patients.

Purpose Of Review: To review the literature and our current understanding of nondermatomal somatosensory deficits (NDSDs) associated with chronic pain in regards to their prevalence, assessment and clinical presentation, cause and pathophysiology, relationship with conversion disorder and psychological factors, as well as their treatment and prognosis.

Recent Findings: NDSDs are negative sensory deficits consisting of partial or total loss of sensation to pinprick, light touch or other cutaneous modalities. Although they had been noted more than a century ago and appear prevalent in chronic pain populations, they are poorly studied.

Analysis of complaints to a tertiary care pain clinic over a nine-year period.

Background: The present study is the result of an internal audit and examines the profiles of complainants and the sources and nature of complaints toward the staff in a tertiary care pain clinic, the Comprehensive Pain Program of the Toronto Western Hospital in Toronto, Ontario.

Methods: All sources of complaints over a nine-year period were reviewed, which included the following: Toronto Western Hospital Patient Relations (PR) records, with a subset of the files qualitatively analyzed in depth regarding the nature of complaints and complainants; complaints that bypassed PR and were addressed directly to the program director against members of the staff; complaints to the College of Physicians and Surgeons of Ontario; and complaints recorded anonymously at rateMDs.com.

Effects of intravenous sodium amobarbital vs lidocaine on pain and sensory abnormalities in patients with spinal cord injury.

Objective: To compare the responses of patients with spinal cord injury (SCI) in regards to pain and sensory abnormalities to single blinded intravenous (i.v.) infusions of normal saline, sodium amobarbital, and lidocaine.