The Effectiveness of Thermal Neuromodulation Using Precise Heat in the Treatment of Chronic Low Back Pain Over 60 Days: An In-Home User Trial.

Purpose: Two previous independent double-blind randomized studies demonstrated that thermal neuromodulation using high temperature pulsed heat reduced pain in subjects with chronic low back pain. The present study examined the effects of high temperature pulsed heat via an experimental device in a real-world In-Home Use Trial (IHUT) over a sixty-day period.

Materials And Methods: This in-home study recruited 34 subjects with chronic low back pain, provided them with an experimental device that delivered treatment session of high temperature pulsed heat up to 45°C, and followed them for eight weeks.

Properties of Thermal Analgesia in a Human Chronic Low Back Pain Model.

Purpose: For years, heat has been used for comfort and analgesia is recommended as a first-line therapy in many clinical guidelines. Yet, there are questions that remain about the actual effectiveness of heat for a condition as common as chronic low back pain, and factors such as time of onset, optimal temperature, and duration of effect.

Materials And Methods: A randomized double-blinded controlled trial was designed to compare the analgesic response to heat delivered via pulses at 45°C (experimental group, N=49) to steady heat at 37°C (control group, N=51) in subjects with longstanding low back pain.

KnowPain-50: a tool for assessing physician pain management education.

Background: Despite a need for better physician pain management education, there are no widely accepted assessment or outcome measures to support this work.

Objective: Create a self-assessment tool to measure physician educational needs and the effectiveness of chronic pain educational programs.

Design: We used expert consensus to draft a 142-item survey that covered essential areas of chronic pain management.

Educating generalist physicians about chronic pain: live experts and online education can provide durable benefits.

Objective: Determine whether lectures by national experts and a publicly available online program with similar educational objectives can improve knowledge, attitudes, and beliefs (KAB) important to chronic pain management.

Design: A pretest-posttest randomized design with two active educational interventions in two different physician groups and a third physician group that received live education on a different topic to control for outside influences, including retesting effects, on our evaluation.

Participants: A total of 136 community-based primary care physicians met eligibility criteria.

Safety and acceptability of the research lumbar puncture.

Three hundred forty-two subjects underwent 428 research lumbar punctures for studies of cerebrospinal fluid (CSF) biomarkers. Subjects were 67 Alzheimer disease or mild cognitive impairment (AD/MCI) patients and 275 cognitively normal adults aged 21 to 88. Lumbar puncture was performed in the lateral decubitus or sitting position using the Sprotte 24 g atraumatic spinal needle.

A clinical trial of distraction techniques for pain and anxiety control during cataract surgery.

This research study evaluates the effectiveness of distraction interventions on subject perceptions of discomfort or pain and anxiety during the ocular anesthetic injection prior to cataract surgery. Eighty subjects received either usual care, usual care with massage, usual care with verbal coaching and slow breathing, or usual care with massage and verbal coaching and slow breathing combined as different types of distraction interventions. After the ocular anesthetic injection(s), the subjects rated their level of experienced discomfort or pain and anxiety on a Likert scale of 0 to 10.

Developing a computerized data collection and decision support system for cancer pain management.

Contemporary nursing practice needs reengineering to deliver its service effectively and efficiently. Using computer technology to support clinicians' decision making may be a parsimonious way to provide high-quality, patient-centered, efficient care. The process of developing the PAINReportIt and PAINConsultN system is described, and the results of two pilot studies in which the system was tested are summarized.

An interactive computer tutorial to teach pain assessment.

Under-treated pain is a significant problem. Health care institutions are under increasing pressure from patients and accreditation bodies to improve staff training in pain management. Pain assessment, a necessary pre-cursor to good pain management, is a complex multi-step process requiring sophisticated understanding and superior communication skills.

Teaching Brief Interventions for Smoking Cessation via an Interactive Computer-based Tutorial.

Many current smokers do not plan on quitting any time soon. For these smokers, the immediate treatment goal is not a quit attempt, but an increase in readiness to stop smoking. In the present study we developed an interactive multimedia simulation and tutoring environment that teaches healthcare professionals to provide brief motivational interviewing-based smoking cessation interventions tailored to the patient's current readiness to change.

Pain response to perineuromal injection of normal saline, epinephrine, and lidocaine in humans.

In animal neuroma models the application of alpha-adrenergic agonists causes a burst of spontaneous afferent activity. The increased activity has been hypothesized to generate nociceptive input. Corroborative work in humans, however, has not been done.

Intrathecal methadone: a dose-response study and comparison with intrathecal morphine 0.5 mg.

The analgesic and adverse effects of intrathecal methadone 5 mg, 10 mg and 20 mg were assessed and compared with intrathecal morphine 0.5 mg. The study was conducted on 38 patients who underwent total knee or hip replacement surgery.

A comparison of the effects of intrathecal fentanyl and lidocaine on established postamputation stump pain.

Eight patients with established lower limb postamputation stump pain were given lumbar intrathecal fentanyl 25 micrograms and lidocaine 70 mg 2 weeks apart in an attempt to better understand the role of peripheral and central mechanisms in this condition. Baseline pain was recorded and then analgetic and side effects and their duration were assessed. Three self-administered questionnaires with appropriate psychometric proprieties were given to the patients.

The effect of intravenous lidocaine, tocainide, and mexiletine on spontaneously active fibers originating in rat sciatic neuromas.

The effects of intravenously administered subanesthetic concentrations of lidocaine, tocainide, and mexiletine on spontaneously active fibers (SAFs) originating in 7-day-old rat sciatic neuromas were studied. Control injections of normal saline caused no decrease in SAF or discharge rate. Lidocaine and tocainide given in incremental doses of 5, 10, 15, 20 and up to 25 mg/kg caused nearly all observed SAFs to stop firing.

Relief of persistent postamputation stump and phantom limb pain with intrathecal fentanyl.

Two patients with postamputation stump and phantom limb pain respectively responded favorably to intrathecal fentanyl which temporarily abolished the pain, normalized sensations and produced euphoria without supraspinal effects. One of the patients subsequently received intrathecal, extradural and intravenous fentanyl as well as intrathecal lidocaine. The neuraxial (intrathecal and epidural) fentanyl temporarily abolished the pain.

Pain responses to perineuromal injection of normal saline, gallamine, and lidocaine in humans.

Rat neurons have shown an increase of spontaneously active fibers to systemically administered potassium channel blocking agents such as tetraethylammonium chloride (TEA) and gallamine. Neuroma formation and spontaneous activity have been associated with autotomy in rats and pain in humans. To evaluate the chemosensitivity of human neurons to potassium channel blocking agents, 9 subjects with neuroma pain underwent perineuromal injection in a single-blinded fashion of normal saline, gallamine, and lidocaine.