ArticleLiterature Review

Evaluating psychosocial contributions to chronic pain outcomes

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Abstract

The biopsychosocial model of pain dominates the scientific community's understanding of chronic pain. Indeed, the biopsychosocial approach describes pain and disability as a multidimensional, dynamic integration among physiological, psychological, and social factors that reciprocally influence one another. In this article, we review two categories of studies that evaluate the contributions of psychosocial factors to the experience of chronic pain. First, we consider general psychosocial variables including distress, trauma, and interpersonal factors. Additionally, we discuss pain-specific psychosocial variables including catastrophizing, expectations, and pain-related coping. Together, we present a diverse array of psychological, social, and contextual factors and highlight the need to consider their roles in the development, maintenance, and treatment of chronic pain conditions.

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... As is evident from the sections above summarizing neural circuitry involved in addiction and chronic pain, the boundary between the neurobiological and psychological aspects of these conditions is somewhat arbitrary. Likewise, the boundary between the psychological and social components is poorly defined, reflecting the central concept of the BPS model, that health and disease involve biological, psychological, and social factors that influence one another in a reciprocal, highly dynamic manner [54]. Meints and Edwards (2018) divide psychosocial variables involved in chronic pain into two main categories. ...
... Meints and Edwards (2018) divide psychosocial variables involved in chronic pain into two main categories. General psychosocial factors include affect, trauma, social/interpersonal disposition, sex-and race-related disparities, and pain-specific psychosocial factors include catastrophizing, coping, expectations, and self-efficacy [54]. Another way of conceptualizing the division is factors that predispose an individual to develop chronic pain and those that emerge as a consequence of pain. ...
... Symptoms of depression and anxiety are prominent in both episodic and chronic cluster headaches, with those in the chronic subset being less likely to cognitively reframe their pain sensations and more likely to ruminate [55]. In contrast to the bidirectional nature of negative affect and SUD, depression and anxiety are strong predictors of pain and related disability, but neither pain nor related disability appear to be good predictors of depression and anxiety [54]. Affective factors are a strong predictors of opioid misuse, with mood disorders, anxiety disorders, and chronic pain conditions either preceding or overlapping with OUD [9, 56-60]. ...
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The recent surge in opioid-related deaths has brought poor pain management practices to the forefront of our nation’s collective consciousness. However, improving treatments for chronic pain, substance use disorders (SUD), and comorbid expression of both requires a better understanding of the pathophysiology involved in their development. In this chapter, the authors present the argument that chronic pain and SUD can be conceptualized similarly from a biopsychosocial perspective to inform a better approach to treatment. The authors describe the common neurobehavioral mechanisms of SUD and chronic pain, then discuss the efficacy of several psychotherapeutic methods employed to combat chronic pain, addiction, and related disorders. Such methods may contribute to positive health outcomes in managing chronic pain and curbing drug addiction by reducing the role of opioid analgesics for long-term pain management.
... 1,2,32 It is important to underline that relationships between pain and such psychological factors are likely to be bidirectional, meaning that they likely influence each other reciprocally. 41,61 Although the bulk of existing research within PFP is biomechanically oriented, there is increasing evidence paralleling that in the other musculoskeletal pain conditions mentioned earlier, suggesting that psychological factors may be important to consider also in PFP. 38 A recent systematic review found that anxiety, depression, catastrophizing, and pain-related fear may be elevated in individuals with PFP. ...
... 2,32 Higher self-efficacy is predictive of more positive health outcomes in a broad spectrum of pain conditions. 32,41 Higher knee self-efficacy, or the belief in one's ability to perform knee-related activities, is closely associated with better outcomes in cohorts who have sustained ACL injuries. 59 Emotional distress (symptoms of anxiety and depression), on the other hand, is strongly associated with poorer outcomes of pain and function in musculoskeletal pain. ...
... 61 The relationship between emotional distress and pain appears to be reciprocal. 41,61 In this cohort, quadriceps strength was not significantly associated with symptoms of PFP as measured using the AKPS or with quality of life in multivariable models. This lack of association runs counter to explanatory models for PFP in which quadriceps strength is an important factor influencing patellofemoral joint loading and thereby development of pain. ...
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Background Patellofemoral pain (PFP) is commonly described and approached in biomechanical terms despite strong evidence that psychosocial factors such as kinesiophobia, emotional distress, and self-efficacy are important in long-standing musculoskeletal pain. Purpose To describe levels of self-efficacy, emotional distress, kinesiophobia, and widespread pain in a cohort with long-standing PFP and determine their association with measures of pain, function, and health-related quality of life. Study Design Cross-sectional study; Level of evidence, 3. Methods Included were 112 patients with PFP (age range, 16-40 years) who had been recruited to a randomized controlled trial. Seven baseline factors (patient sex, pain duration, number of pain sites throughout the body, kinesiophobia [Tampa Scale of Kinesiophobia], emotional distress [Hopkins Symptom Checklist], self-efficacy, and knee extension strength) were investigated for associations with the following outcomes: symptoms of PFP (Anterior Knee Pain Scale), pain (worst and usual), and health-related quality of life (5-level EuroQol-5 Dimensions [EQ-5D-5L]). We used bivariate models and multivariable linear regression models with a stepwise backward removal method to find associations with the outcomes. Internal validation was conducted, and adjusted coefficients after shrinkage are presented. Results Of the study patients, 28% reported emotional distress (Hopkins Symptom Checklist ≥1.75), 69% reported multiple pain sites, and 33% had widespread pain. The kinesiophobia score was elevated, with a mean score of 35.4 ± 8.2. Self-efficacy was strongly associated with better function (Anterior Knee Pain Scale) and health-related quality of life (EQ-5D-5L) as well as lower pain scores in bivariate and multivariable models. Self-efficacy and emotional distress explained 50% of the variance in health-related quality of life (EQ-5D-5L). Conclusion Our findings support other studies of PFP suggesting elevated levels of kinesiophobia and emotional distress and higher rates of widespread pain compared with the general population or pain-free controls. Higher self-efficacy was associated with better function and health-related quality of life. Together with emotional distress, it explained half the variance of health-related life quality. The results underline the importance of approaching these patients in a biopsychosocial model. Registration NCT02114294 ( ClinicalTrials.gov identifier).
... It is part of the interactive complex of biopsychosocial processes that contribute to the development and maintenance of chronic pain and influence the results of pain treatment. The combination of chronic pain with depression increases the risk of developing disability and suicide [2]. ...
... The experience of pain is defined as "emotional and psychological factors affect the way a person interprets or perceives neurochemically transmitted signals of noxious stimulation, and conversely, perceptions of the noxious stimuli determine that person's emotional and psychological reactions to the physical sensations" [3]. Depression and anxiety are emotional factors that play a major role in forming the experiences of chronic pain [2]. Anxiety symptoms often accompany the depressive episode in chronic pain patients [4]. ...
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Depression is a psychological factor that affects not only the pain sensation but also the pain experiences. Purpose: The aim of the study was to analyze and summarize the specifics and dynamics of chronic pain experiences in patients with depression. Materials and methods: A sample of 120 patients with chronic pain was studied. Sixty-one patients had clinically manifested depressive episodes, and the other fifty-nine – had no depression. The study was phased. The second stage was performed three months after the first. The patients with depression received antidepressant treatment between the two stages. The sample was evaluated with: 1) quantitative methods: HAM-D-17 for the severity of depression, Spielberger's questionnaire for state and trait anxiety degree and VAS for pain intensity; and 2) qualitative method – content-analysis of the answers to the question "What does pain mean to you?". Results: The mean age of the sample was 51.90 (SD=11.94). Women predominate (81.7%) over men (18.3%). The group with depression had a high degree of state and trait anxiety and moderate pain intensity. The content-analysis revealed that the experience of pain as punishment was specific for patients with depression. The reduction of the mean value of the severity of depression from moderate to mild in the second stage influenced the dynamics of the pain experiences in the direction of a limitation. Conclusion: Depression is a factor influencing the meaning of chronic pain experience. The search for depressive symptoms and specific experiences and their intervention is substantial in the management of chronic pain.
... Considering the importance of introducing the biopsychosocial approach in the care of patients with a chronic disorder, this review wanted to provide an overview regarding the psychological impact and the resultant QoL involvement of porphyrias, a group of rare chronic heme metabolism disorders [76]. We attempted to summarize all 20 original articles of the last 35 years regarding this topic, underling the differences between results obtained by quantitative or qualitative approaches. ...
... Over the past few decades, the recent emerging trends to diagnose, treat, and manage AHPs have resulted in defining them as a chronic and not only intermittent disease triggered by certain predisposing factors [76,82]. With regard to EPP, a wider health perspective should be developed to consolidate the fact that it is a chronic disease and not just a seasonal one [92][93][94]. ...
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The World Health Organization (WHO) describes “health” as a state of physical, mental, and social well-being and not merely the absence of disease or infirmity. Therefore, a biopsychosocial approach should be considered as an integral part of patients’ management. In this review, we summarize the available data starting from 1986 on the biological, psychological, and social aspects of porphyrias in order to provide a useful tool for clinicians about the missing knowledge within this field. Porphyrias are a group of rare metabolic disorders affecting the heme biosynthetic pathway and can be categorized into hepatic and erythropoietic. Here, a total of 20 articles reporting the psychological and the quality of life (QoL) data of porphyria patients affected by acute hepatic porphyrias (AHPs), Porphyria Cutanea Tarda (PCT), and Erythropoietic Protoporphyria (EPP) were analyzed. These 13 articles include reported quantitative methods using questionnaires, while the reaming articles employed qualitative descriptive approaches through direct interviews with patients by psychology professionals. We conclude that the use of questionnaires limits the complete description of all areas of a patient’s life compared to a direct interview with specialists. However, only a combined use of these methods could be the best approach for the correct disorder management.
... Acute orthopedic injuries are common, costly, and often associated with chronic pain and disability, even after a successful physical recovery (1)(2)(3)(4). Psychosocial factors (e.g., anxiety, depression, pain catastrophizing, pain anxiety) play a significant role in recovery from injury (5), surgical procedures (6), and chronic pain disorders (7,8), predisposing those with musculoskeletal injuries to chronic pain and disability, regardless of injury location, severity, or type (9)(10)(11). The biopsychosocial model (i.e., the theoretical model emphasizing the interplay of biological, psychological, and social factors that impact health (12,13)) supports the implementation of integrated care models to help target the often under-addressed psychosocial component of physical illnesses and injuries. ...
... In the context of the increasing relevancy of integrated care models, improving integration of psychosocial initiatives in medical settings is important. This is especially true within orthopedics, since psychosocial factors are known to contribute to recovery from acute orthopedic injuries (9)(10)(11). Strategies for educating providers about psychosocial aspects of recovery and psychosocial initiatives can increase provider buy-in and self-efficacy, thus improving referral processes to psychosocial care and facilitating recovery of orthopedic patients by promoting productive pain management, and targeting the disability spiral, catastrophic thinking about pain, and kinesiophobia (20,33,34). ...
Article
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Introduction: Psychosocial factors (e.g., depression, anxiety) increase risk for chronic pain, disability, and other health complications following acute orthopedic traumatic injury. Orthopedic providers lack skills to address these factors. Education around psychosocial factors of recovery and psychosocial clinical and research initiatives could address this gap. The purpose of this study was to understand orthopedic trauma providers’ preferences for the design and distribution of educational materials to facilitate psychosocial initiative implementation. Methods: We conducted live-video, semi-structured focus groups with outpatient orthopedic trauma providers across three Level 1 Trauma Centers, using a hybrid inductive-deductive approach to analyze qualitative data and extract themes and subthemes characterizing providers’ recommendations for appropriate psychosocial education. Results: Four themes described providers’ recommendations for receiving educational materials: (1) provide foundational knowledge and tools about psychosocial factors; (2) provide information regarding a psychosocial initiative's purpose and procedures; (3) leverage educational materials to maximize buy-in to psychosocial clinical research initiatives; and (4) deliver information concisely, clearly, and electronically. Conclusion: Orthopedic providers recommended ways to optimize design and dissemination of education on psychosocial care. Optimizing knowledge of psychosocial factors and clinical and research initiatives facilitates providers’ ability to appropriately target the often-underdressed psychosocial component of recovery in orthopedics.
... According to the biopsychosocial model of health and illness, interactions between biological, psychological, and social factors determine the cause, manifestation, and outcome of health and disease. [1][2][3][4][5] Traditionally, pediatrics focuses on all these domains when treating children. With the introduction of 'positive health' in pediatrics, which defines health as 'a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity', mind-body health practices have gained popularity. [6][7][8] Within the group of mind-body health practices, medical hypnotherapy has shown to be one of the most effective techniques to treat children and is used as an adjunct to so-called conventional care for pediatric and adolescent patients. ...
... 60%), whereas patients with fear for medical procedures almost never experienced multiple symptoms (7%). Median duration of treatment was 4 (1-32) months and the median number of hypnotherapy sessions was 4 (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). During the period of medical hypnotherapy, 21% (N=45) of all patients were also receiving another form of treatment. ...
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Background: Medical hypnotherapy has shown to be an effective treatment in specified conditions such as abdominal pain or headache. Since 2016 the Beatrix children’s hospital, a tertiary care center, offers medical hypnotherapy for a high variety of complex symptom disorders in pediatric patients.Methods: This retrospective COHORT study analyzed the characteristics of pediatric patients treated with medical hypnotherapy in a tertiary care center as well as the effectiveness of the treatment.Results: 214 patients with complex chronic symptoms were treated with medical hypnotherapy. 48% Percent of all patients referred had more than one symptom and 59% of them had had their symptoms for over a year. An overall improvement of symptoms was achieved in 76% of all patients.Conclusions: Medical hypnotherapy seems an effective treatment for patients with multiple chronic and complex symptoms even in a tertiary clinical setting.
... Moderation is indicated when the moderator predicts the difference score between the instances of the within-subjects variable. We included depression, anxiety, pain catastrophizing, and mindfulness as potential moderators as these variables have been shown to be related to treatment-related changes in pain outcomes (39). ...
... However, future studies should examine possible mediating effects of changes in negative affect in driving the effects of MM+RAVANS on back pain severity, over a full course of therapy. We should note that high levels of negative affect are a robust risk factor for treatment non-response and for deleterious longterm outcomes in patients with chronic pain (39,45). The development and refinement of interventions that produce substantial benefits in these high-risk patients is of particular importance to the field, as this group does not seem to be optimally managed by current pharmacologic treatments. ...
Article
Objective Respiratory-gated Auricular Vagal Afferent Nerve stimulation (RAVANS) is a safe nonpharmacological approach to managing chronic pain. The purpose of the current study was to examine (1) the feasibility and acceptability of RAVANS, combined with mindful meditation (MM) for chronic low back pain (CLBP), (2) the potential synergy of MM+RAVANS on improving pain, and (3) possible moderators of the influence of MM+RAVANS on pain. Design Pilot feasibility and acceptability study Setting Pain management center at large academic medical center Subjects Nineteen adults with CLBP and previous MM training Methods Participants attended two sessions during which they completed quantitative sensory testing (QST), rated pain severity, and completed a MM+stimulation session. Participants received RAVANS during one visit and sham stimulation during the other, randomized in order. Following intervention, participants repeated QST. Results MM+RAVANS was well tolerated, acceptable, and feasible to provide relief for CLBP. Both MM+stimulation sessions resulted in improved back pain severity, punctate pain ratings, and pressure pain threshold. Individuals with greater negative affect showed greater back pain improvement from MM+RAVANS while those with greater mindfulness showed greater back pain improvement from MM+sham. Conclusions Results suggest that for CLBP patients with prior MM training, the analgesic effects of MM may have overshadowed effects of RAVANS given the brief single session MM+RAVANS intervention. However, those with greater negative affect may benefit from combined MM+RAVANS.
... In Europe, more than 50% of adults reported experiencing headache in the last year (6). Even minor pain can affect work productivity, increase absenteeism, and in chronic or severe cases, cause disability (7,8). To understand the full impact of pain on wellbeing, it is important to consider its prevalence, intensity, and the affected individual's levels of emotional stress and dysfunction in daily life activities. ...
... The survey included questions about pain location by broad regions of the body (with the possibility of adding a comment about a specific region) and pain severity scored using a 10-point scale, where 10 indicated very strong pain and 1 was very weak pain. For analysis, the pain was categorized as mild (score of 1-4), moderate (score of 5-7), or severe (score of [8][9][10]. ...
Article
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The problem of painful and disabling work-related musculoskeletal disorders (MSDs) is increasing in many employment sectors of Latvia. Official statistics may underestimate the proportion of affected employees, causing delays in preventive interventions, ineffective rehabilitation, and a reduction of the workforce. This study investigated the prevalence of painful health conditions among Latvian workers by analyzing survey data and comparing these to official statistics on registered occupational diseases (ODs). A total of 2,446 workers participated in the state-level “Work conditions and risks in Latvia, 2017–2018” survey that included questions about pain lasting longer than 3 days during the previous year. The frequency of subjective reports on the presence, severity, and location of pain and related behaviors was assessed in relation to sex, age, education, and job position. Descriptive statistics and cross tabulation with the chi-squared test as well as multinomial logistic regression were applied to the data. Overall, 27.7% of respondents (n = 678) reported experiencing pain, predominantly in the lower back (14.3%) and mostly moderate (47.1%) or severe (45.1%). Only one-fifth of respondents (20.5%) took sick leave from work and one-third (29.0%) did not take action to alleviate their pain. Participants aged 55–74 years had a significantly higher odds ratio (OR) for pain in at least one body region—including hands and legs—than those aged 18–24 years. Women had significantly higher odds of headache (OR = 2.55) and neck pain (OR = 1.85) than men. Respondents with a primary or elementary education level had higher odds of pain in at least one body region (OR = 1.60) and in the lower back (OR = 1.86), while those with secondary education had higher odds of pain in hands (OR = 1.51) than employees with higher education. Unskilled workers had significantly higher odds of pain in hands (OR = 2.42) and legs (OR = 2.12) than directors. Official data revealed a dramatic increase in the proportion of MSDs and related disabilities in the last decade, reaching 75.5% of all first registered ODs in 2019. These results demonstrate a high prevalence of painful conditions among Latvian employees; urgent attention to diagnostics, treatment, and prevention is needed to ensure the musculoskeletal health and productivity of this population.
... Several epidemiological studies of chronic pain have well documented that the prevalence of chronic pain and depression is higher in women than men (Williams et al., 2003;Fillingim et al., 2009;Ruau et al., 2012;Vetvik and MacGregor, 2017). Although social and cultural factors may contribute to the differences (Meints and Edwards, 2018;Mills et al., 2019), biological factors cannot be ignored. However, the preclinical studies of pain and its associated affective disorders have been largely relied on male rodents. ...
... These findings are consistent with the emerging evidences, suggesting that clear differences existed in the mechanisms underlying chronic pain processing and the development of affective disorders during chronic pain progression at the system, cellular, and molecular levels (Barthas et al., 2015;Zhu et al., 2021). Such mechanistic differences may contribute to the differential sensitivity and tolerance of chronic pain and susceptibility to pain-induced depression, as well as differential treatment options for female and male patients (Bartley and Fillingim, 2013;Meints and Edwards, 2018). By directly comparing female and male transcriptomes in the two brain hub regions for the comorbidity of pain and depression, our study provides a useful resource for further dissecting and understanding the mechanisms contributing to the dynamic interaction of neuropathic pain and depression. ...
Article
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Neuropathic pain is a chronic debilitating condition with a high comorbidity with depression. Clinical reports and animal studies have suggested that both the medial prefrontal cortex (mPFC) and the anterior cingulate cortex (ACC) are critically implicated in regulating the affective symptoms of neuropathic pain. Neuropathic pain induces differential long-term structural, functional, and biochemical changes in both regions, which are thought to be regulated by multiple waves of gene transcription. However, the differences in the transcriptomic profiles changed by neuropathic pain between these regions are largely unknown. Furthermore, women are more susceptible to pain and depression than men. The molecular mechanisms underlying this sexual dimorphism remain to be explored. Here, we performed RNA sequencing and analyzed the transcriptomic profiles of the mPFC and ACC of female and male mice at 2 weeks after spared nerve injury (SNI), an early time point when the mice began to show mild depressive symptoms. Our results showed that the SNI-induced transcriptomic changes in female and male mice were largely distinct. Interestingly, the female mice exhibited more robust transcriptomic changes in the ACC than male, whereas the opposite pattern occurred in the mPFC. Cell type enrichment analyses revealed that the differentially expressed genes involved genes enriched in neurons, various types of glia and endothelial cells. We further performed gene set enrichment analysis (GSEA), which revealed significant de-enrichment of myelin sheath development in both female and male mPFC after SNI. In the female ACC, gene sets for synaptic organization were enriched, and gene sets for extracellular matrix were de-enriched after SNI, while such signatures were absent in male ACC. Collectively, these findings revealed region-specific and sexual dimorphism at the transcriptional levels induced by neuropathic pain, and provided novel therapeutic targets for chronic pain and its associated affective disorders.
... Eine zunehmende Zahl internationaler Studien unterstreicht den Einfluss von Erwartung auf den Schmerz und seine Behandlung [24,42,49]. Die Erwartung gilt als eines der Kernelemente des Placebo-sowie Noceboeffekts [3] und kann somit einen positiven oder negativen Einfluss auf die Behandlung und den Krankheitsverlauf haben. ...
... Erwartungen beeinflussen ebenfalls die Rehabilitation nach akuten Körpertraumata [46]. Positive Erwartungen gelten als protektiver Faktor im Übergang von akuten zu chronischen Schmerzen [42]. Auch bei chronischen Schmerzen ist der modulierende Einfluss von positiven Erwartungen belegt [14,22,70]. ...
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Background Chronic low back pain is a serious persistent illness with profound personal and socioeconomic impact. Interdisciplinary multimodal pain therapy (IMPT) is one of the few evidence-based treatment options for chronic pain. Although it is known that pain perception, as well as its chronification and treatment are affected by patient expectations, only few clinical interventions or guidelines on how to modulate these effects exist.Objectives The aim of this study was to demonstrate the impact of expectancy as a predictor for pain and related outcomes. To this end, we will present explorative pilot data from an observational cohort at our clinic.Methods The study shows preliminary data of a prospective longitudinal observational study of up to 41 chronic back pain patients who followed an IMPT at the back pain center in Essen. Data were collected at admission (T0), at discharge (T1), and 3 months after discharge (T2). Primary outcomes were pain intensity and disability. Additionally, we measured treatment expectancy at admission. We used linear regression to analyze the impact of pretreatment expectancy on the primary outcome measures.ResultsIMPT led to a significant improvement in pain intensity and disability. The effect on pain intensity was stable over three months after discharge and disability declined even further. Expectancy was a significant predictor of improvement in pain intensity and explained approximately 15% of the variance.DiscussionExpectancy is an important predictor of treatment outcome in IMPT. In clinical practice, valid methods should therefore be established to reduce negative and promote positive expectations.
... Chronic pain is a relatively common clinical condition with a high incidence, with approximately 15~20% of outpatients suffering from chronic pain. Chronic pain, which usually persists or recurs for more than 3~6 months, has a large impact on people's quality of life and physical and mental health [2,3]. Cervical epidural catheterization is a common pain treatment method widely used in the diagnosis and treatment of various parts of the human body [4,5]. ...
... In equation (1), x ðsÞ and y ðsÞ stood for the coordinate positions of the control point. 2 Computational and Mathematical Methods in Medicine Snake converged towards the boundary or target mainly by the combined action of internal and external forces. Minimum energy was at equilibrium position. ...
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The objective of this research was to investigate the application effect of cervical spine magnetic resonance imaging (MRI) image segmentation algorithm guidance in the treatment of chronic pain with cervical epidural puncture. A total of 72 patients with chronic pain were selected and divided into a cervical spine MRI image-guided group (group A) and a blind puncture group with traditional experience (group B). The results showed that the puncture time of group A was 9.9 ± 8.2 (min), while that of group B was 15.2 ± 8.9 (min), so the puncture time of patients in group A was significantly shorter than that of group B ( P < 0.05 ). The incidences of pain at the puncture site of patients in group A and group B were 6% and 10%, respectively. The incidence of pain at the puncture site in group A was significantly lower than that in group B ( P < 0.05 ). The success rate of the first puncture in group A was 78%, and that in group B was 54%. The success rate of the first puncture in group A was significantly higher than that in group B ( P < 0.05 ). The complication rate of group A was 22.22%, and that of group B was 80.56%. The incidence of complications in group A was significantly lower than that in group B ( P < 0.05 ). In addition, there was no significant difference in the puncture depth between the two groups ( P > 0.05 ). In summary, the guidance of cervical spine MRI image segmentation algorithm can reduce the time and times of puncture and improve the success rate of puncture, thereby reducing the incidence of postoperative complications.
... Furthermore, numerous psychological factors may impede recovery like high levels of acute stress and development of PTSD symptoms after the injury [16] as well as negative cognitive and emotional perceptions and unhelpful behaviors, such as fear of avoidance, related to the symptoms [17][18][19]. Important parallels seem here to exist between PCS and other complex only partly medically explained conditions like chronic whiplash-associated disorder [20], and chronic pain [21] where negative illness perceptions and maladaptive illness behaviors have also shown to play a role for poorer outcome [22,23]. ...
Article
Background The incidence of hospital-treated concussion is 100–300/100,000 person years. Reporting of long-lasting post-concussion symptoms (PCS) is estimated at 5–15%. Attachment insecurity is a potential vulnerability factor for physical illness and poorer disease outcomes in general. This study aimed to explore associations between attachment insecurity and PCS in young people sustaining a concussion. Methods This cross-sectional study was embedded in a cohort of 15–30-year-old patients (n = 3080) 3 months after sustaining a concussion. Data were obtained from a database and questionnaires. PCS were measured by the Rivermead Post-Concussion Symptoms Questionnaire and attachment dimensions (anxiety and avoidance) by the Experiences in Close Relationships-Relationship Structures Questionnaire. Multiple linear regression models were performed to investigate the association between the attachment dimensions and PCS with adjustment for demographic, injury-related and psychological factors and with additional testing for interaction between the attachment dimensions. Results In the final study sample, comprising 973 patients (31.6%), we found an interaction between the attachment dimensions. Hence, the effect of attachment anxiety on PCS was statistically insignificant at low avoidance (25th percentile) but significant at high avoidance (75th percentile, β = 0.64 (95%CI: 0.02; 1.26)), whereas the effect of attachment avoidance was significant regardless of level of attachment anxiety (25th percentile, β = 1.09 (95%CI: 0.18; 2.01); 75th percentile, β = 2.71 (95%CI: 1.80; 3.61)). Conclusion Attachment insecurity, especially characterised by high avoidance in combination with high anxiety, also called fearful attachment, is associated with PCS. Considering the attachment perspective can potentially improve health care for this patient group.
... Differences in the percentages of Black versus NHW individuals adhering to the five quintiles in the dietary patterns were larger, with the most prominent difference being found in a high adherence (quintile 5) to a Southern dietary pattern (Black 38%; NHW 11%). There was a significant increase in the RR of pain among those who strongly adhered to the Southern dietary pattern (41%), even after controlling for other factors [51][52][53][54][55]. The increases seen in this dietary patterns were not seen in diet patterns of 'higher quality' (higher in essential nutrients and lower in calories, saturated fats and refined carbohydrates), such as the plant-based pattern of eating where we identified a decreased RR of pain among those who strongly adhered to a plant-based dietary pattern (22%). ...
Article
Aim: Determine if dietary patterns affect risk of pain. Methods: Data from 16,061 participants (55.4% females, 32.3% Black, age 65 ± 9 years) in the REGARDS study were categorized based on the adherence to previous dietary patterns reflecting the prevalent foods within each (convenience, alcohol/salads, plant-based, sweets/fats and ‘southern’). A modified Poisson regression model was used to determine whether dietary patterns were associated with relative risk (RR) of pain. Results: High adherence to ‘Southern’ dietary pattern was associated with a 41% (95% CI: 23, 61%) increase in RR of pain. High adherence to a plant-based dietary pattern showed a 22% (95% CI: 11, 31%) decrease in the RR of pain. Conclusion: Poor quality dietary patterns increase the RR of pain, while plant-based patterns lowered the RR. Diet patterns should be incorporated into medical history.
... Many scholars also stated that pain is a high-level psychosocial cognitive process, which is affected by multiple factors such as biology, psychology, and social factors. [1,2,23] Pain and depression can exacerbate each other. [24] Increased individual anxiety can lead to decreased tolerance to pain and increase the severity of pain. ...
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Pain is a common health problem for hospitalized patients. It is necessary to understand the factors that affect patients' pain to provide individual and complete pain management. This study explored the severity and incidence of pain in hospitalized patients on the admission day, during the hospitalization, and the discharge day, and explored the predictive factors that affect the patient's pain on the discharge day.This was a retrospective study that reviewed the medical records of 73,814 hospitalized patients from January 2016 to April 2018. The number of pain assessments was 471,339.The incidence of pain on the discharge day of patients was significantly higher than that on the admission day. The factors that affect and predict the pain of patients on discharge day include the degree of pain on the day of admission, emotional distress on the day of discharge, disease category, gender, age, and length of stay in hospital. It shows that the higher the degree of pain on the day of admission, the higher the degree of emotional distress on the day of discharge, female patients, younger patients, longer hospitalization days, and surgical and gynecological patients have significantly higher pain levels on the day of discharge (P < .05).This study found that the incidence of pain on the discharge day of patients was 46.5%. Previous pain level, disease category, emotional distress, gender, age, and length of hospital stay were important factors affecting patient pain on the discharge day. The influencing factors of patient pain should be fully assessed to provide individual and complete pain management, and improve patient quality of life after discharge.
... [2][3][4] Pain is a multidimensional subjective experience that both affects and is affected by a number of biological (eg, pain diagnosis), psychological (eg, the meaning of pain, pain-related beliefs, pain coping responses), social (eg, significant others contingent response), and spiritual (eg, type, frequency, and impact of spiritual practices) factors. [5][6][7][8][9][10] As a result, chronic pain has traditionally been viewed as a cluster of stressors, 11,12 consisting of the distress associated with [1] the experience of pain, [2] the potential causes of pain, and [3] the negative impacts of pain. 13 Researchers have developed a number of theoretical models to explain the role that psychosocial factors have in pain and function in individuals with chronic pain. ...
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Purpose: Chronic pain is a multidimensional experience that is influenced by biological, psychological, social, and spiritual factors. The Meaning Making Model is a recent cognitive-behavioral model that has been developed to understand how psychosocial factors influence adjustment to stressful events, such as having a chronic illness. This qualitative study aims to understand the potential utility of this model for understanding the role of meaning making in adjustment to chronic pain. Patients and methods: Eighteen community-dwelling adults with chronic low back pain or chronic pain due to osteoarthritis participated in four focus groups. Participants were asked open-ended questions about their pain experience, pain-related beliefs, meaning of pain, and the perceived association between pain and their meaning in life and sense of purpose. Data were submitted to thematic analysis and the identified themes were considered in light of the Meaning Making Model. Results: Three overarching themes emerged, each of which included two themes. The first overarching theme - “appraised meaning of pain” – included the themes “causal attributions” and “primary appraisals.” The second - meaning making processes – included the themes “assimilation” and “accommodation.” The third - ”meanings made” - included the themes “pain as an opportunity” and “acceptance.” Conclusion: The key themes that emerged as individuals with chronic pain discussed pain and its impact are consistent with those that would be hypothesized as important from the Meaning Making Model, providing preliminary support for the utility of this model in the context of chronic pain. People with chronic pain appear to appraise pain in terms of its cause, controllability, threat, loss, or challenge. When a discrepancy between the appraised meaning of pain and one’s global meaning emerged, participants engaged in meaning making processes (accommodation and assimilation), resulting in meanings made, such as a reappraised meaning of pain, perceptions of growth, and acceptance. Journal of Pain Research, 14, 2295-2311; Dove Medical Press.
... Our findings are consistent with the body of evidence indicating that cognitive and emotional psychological factors increase the risk of the development of pain (Huguet et al., 2016;O'Sullivan et al., 2019;Smith et al., 2017). Andreucci et al. (2021) reported similar findings suggesting that externalizing symptoms in early adolescence (age of 13), and to some extent internalizing symptoms, increases the odds of having musculoskeletal pain at the age of 17. Psychological distress has been associated with the transition from acute to chronic pain and the development of disabling pain conditions in children and adults (Hasenbring et al., 2001;Huguet et al., 2016;Meints & Edwards, 2018;Smith et al., 2017). The novel contribution of this paper is the temporal ordering of events, capturing early childhood distress and a critical period of time for the onset of spinal pain with impact in adolescents. ...
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Background Spinal pain (SP), including neck and back pain, is common and often associated with poor mental health and reduced quality of life of adolescents. Contemporary understanding of SP favours a biopsychosocial approach, and emerging evidence suggests stronger influence of psychological rather than other factors. Objectives We aimed to investigate if experiencing psychological distress in early childhood increases the risk of spinal pain with impact during adolescence. Methods 1175 adolescents from a prospective cohort study (Raine Study Gen2) were included. Psychological distress was assessed at ages 2, 5, 8 and 10 using Child Behaviour Check List (CBCL). CBCL total and subscale scores (internalising and externalising symptoms) were converted to age-standardized scores and dichotomized according to t-scores (>60=high distress). Life-time spinal pain, including low back, mid back, or neck/shoulder, was measured at age 17. We were interested in adolescent SP with impact (care seeking, medication use, school absenteeism, daily activity interference, leisure activity interference) and defined cases as SP with impact (one or more) or greater impact (two or more) impacts. We investigated the longitudinal associations between childhood psychological distress and adolescent SP using univariate and multivariable logistic regression models. Results Psychological distress in childhood increased the odds of adolescent SP with impact by 33% (OR 1.33; 95% CI 1.01-1.76), but not spinal pain with greater impact (OR 1.22; 95% 0.83 to 1.80). Internalizing symptoms were associated with SP with greater impact and externalizing symptoms with SP with impact after adjusting for a range of potential child and family confounders. Conclusion Psychological distress in childhood increases the risk of SP with impact in adolescence and may be a promising prevention target.
... The only other study of chronic pain in LGMD [13] also found positive associations between pain and anxiety and depression, indicating that pain may contribute to psychological distress in LGMD. It is possible that pain and psychological distress may feed into one another and worsen both pain and psychological distress [49][50][51][52] and influence the success of pharmacological and psychosocial treatments of chronic pain [53][54][55][56]. Thus, it may be advantageous to address the psychological distress of LGMD-patients in a rehabilitation intervention. ...
Article
Purpose The aim was to investigate the prevalence, characteristics, predictors, and consequences of chronic pain in a national cohort of patients with limb-girdle muscular dystrophy (LGMD). Materials and methods Questionnaires were sent to all Danish LGMD patients (≥18 years of age) registered with the National Rehabilitation Center for Neuromuscular Diseases. Results Of 209 patients, 121 responded. 44.7% of the patients experienced persistent (daily or constant) chronic pain lasting more than 3 months. 21.0% of patients experienced chronic pain that was not daily. Most pain patients experienced three or more pain problems, primarily in the lower back, neck, shoulders, hips, and legs. Symptoms suggestive of neuropathic pain were sometimes present. Patients with persistent chronic pain reported moderate pain interference with daily activities, greater psychological distress, and lower quality of life compared to patients without pain but did not differ regarding physical functioning. Sex, age, LGMD duration, LGMD type, mechanical ventilation use, mobility, arm function, or performance on activities of daily living did not predict chronic pain. Conclusion Chronic pain is common in patients with LGMD. Chronic pain should be considered an important component of LGMD and addressed in the clinic and rehabilitation setting from a biopsychosocial perspective. • Implication for rehabilitation • Chronic pain is highly prevalent in patients with limb-girdle muscular dystrophy. • Health professionals need to systematically ask patients about pain and the influence of pain on everyday life irrespective of LGMD-duration and extent of muscle wastage. • Chronic pain and psychological distress need to be addressed in the clinic and rehabilitation setting as an additional disabling component of LGMD and this should be done within a biopsychosocial framework.
... The impact of pain on people's lives is enormous economically, as well as physically and emotionally. 21, 30 Wallace and colleagues recently documented the intricate intersection of structural violence, stigma, and pain in diverse and marginalized groups with chronic pain. 49 Groups at high risk for pain and inadequate pain treatment include individuals who identify as a racial/ethnic and indigenous minority, experience low socioeconomic resources, and those of older age. ...
Article
Racial equity is imperative to the future and integrity of scientific inquiry. In 2020, citizens of the United States (and globally) witnessed one of the most vile and egregious experiences of police brutality and systemic racism in recent history, the public execution of a Black American man. While some may isolate this and other similar events from influencing the scientific endeavors of pain researchers, events such as this can have a direct impact on the study, lived experience, and expression of pain in Black Americans. To truly understand the biopsychosocial effects of inequality and injustice on pain disparities, we must consider the unintended consequences that our current research approaches can have in limiting the reliability and validity of scientific discovery. As we reflect on our current research practices in an effort to improve pain science, this perspective article discusses ways to initiate positive change in order to advance the science of pain in more equitable ways, not just for Black Americans, but for all individuals that identify as part of an underrepresented group.
... Now more than ever, there is growing recognition that chronic pain is a complex and multidimensional experience, stemming from the interrelationship between biological, psychological, and social factors (2). Factors such as age, gender, genetics, and tissue health combined, not only with beliefs, expectations, and emotions, but also with socioeconomical and interpersonal elements, may influence the way patients experience or express their pain (3). This biopsychosocial model provides a framework to understand and treat people with chronic pain (4,5). ...
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Background: The biopsychosocial-spiritual model recognizes the impact of religious factors in modulating the experience of pain. Religious beliefs are factors that can influence perceptions, emotions, and behavior, all of which have important implications on health, pain experience, and treatment outcomes. Objectives: The aim of the present study was to identify if and how religious beliefs and attitudes can influence pain intensity, pain interference, pain-related beliefs and cognitions, emotions, and coping among patients with chronic musculoskeletal pain. Study design: Systematic review. Methods: This systematic review was conducted and reported, following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines (PRISMA). An electronic search was conducted in 4 online databases (PubMed, Embase, Web of science, and PsychArticles) and complemented with a hand search (PROSPERO registry: CRD42020161289). Two reviewers independently performed eligibility screening, risk of bias assessment, and data extraction. The risk of bias of the included studies was assessed using the Newcastle Ottawa Scale. Results: Nine cross-sectional studies and one case-control study were included in the review. The methodological quality of the included studies ranged from low to high. The results gathered regarding the association between religiosity and pain intensity, disability, or pain interference were found to be conflicting. Limited evidence suggests that religiosity is positively associated with worse pain-related beliefs and cognitions, worse pain-related emotion, and better pain acceptance. There is insufficient data available to support the claim that religiosity is negatively associated with physical functioning and pain-related self-efficacy in people with chronic musculoskeletal pain. Limitations: The number of included studies was small, with a low level of evidence, and a possible risk of bias. Conclusion: This systematic review shows low evidence and conflicting results for the presence of associations between religiosity and different pain domains such as pain intensity, disability, and pain-related cognitions or emotions in people with chronic musculoskeletal pain.
... 7,9,17,[46][47][48][49][50] Only 1 study in our review examined psychiatric comorbidities, 35 which is surprising given evidence that psychological and social factors seem to play a critical role in the development and maintenance of TMDs. 11,13,[51][52][53] One reason for this gap in the literature could be that many studies examining psychological outcomes in TMD populations have focused on self-report outcomes such as catastrophizing and somatization 54-59 instead of formally diagnosed psychiatric disorders (for example, major depressive disorder). There is no question that psychological dimensions such as shifts in mood are relevant for patients with TMD and their treatment. ...
Article
Background This systematic review was designed to evaluate the presence of comorbid conditions among patients with temporomandibular disorders (TMDs). Types of Studies Reviewed The authors reviewed studies that reported the prevalence or incidence of chronic pain conditions or psychiatric disorders (anxiety, mood, personality disorders) among patients with any type of TMD. The authors calculated sample size–weighted prevalence estimates when data were reported in 2 or more studies for the same comorbid condition. Results A total of 9 prevalence studies and no incidence studies were eligible for review; 8 of the studies examined chronic pain comorbidities. Weighted estimates showed high prevalence of pain comorbidities across studies, including current chronic back pain (66%), myofascial syndrome (50%), chronic stomach pain (50%), chronic migraine headache (40%), irritable bowel syndrome (19%), and fibromyalgia (14%). A single study examined psychiatric disorders and found that current depression was the most prevalent disorder identified (17.5%). Conclusions and Practical Implications There is a high prevalence of comorbid chronic pain conditions among patients with TMDs, with more than 50% of patients reporting chronic back pain, myofascial syndrome, and chronic stomach pain. Psychiatric disorders among patients with different types of TMDs were studied less commonly in this pain population. Knowledge of the distribution of these and other comorbid disease conditions among patients with different types of TMDs can help dentists and other health care providers to identify personalized treatment strategies, including the coordination of care across medical specialties.
... Pain is subjective and has both biological and psychosocial aspects, the latter being important particularly in chronic pain conditions [4]. Pain chronicity is a central concept when considering long-term implications of pain. ...
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Background Pain is known to be socioeconomically patterned and associated with disability. However, knowledge is scarce concerning life-course socioeconomic circumstances and pain among young adults. Our aim was to examine the associations of childhood and current socioeconomic circumstances with acute pain and chronic pain with low and high disability levels among young Finnish municipal employees. Methods We analysed questionnaire data retrieved from the Young Helsinki Health Study ( n=4683) covering 18–39-year-old employees of the City of Helsinki, Finland. We included multiple indicators of childhood and current socioeconomic circumstances and examined their associations with acute pain and with chronic pain with low and high disability levels. The level of chronic pain-related disability was assessed by the chronic pain grade questionnaire. Multinomial logistic regression analyses were conducted with stepwise adjustments for sociodemographic, socioeconomic and health-related covariates. Results Childhood and current socioeconomic disadvantage were associated with acute and chronic pain, particularly with chronic pain with high disability level. The strongest associations after adjustments for covariates remained between chronic pain with high disability level and low educational level (odds ratio (OR) 3.38, 95% confidence interval (CI) 2.18–5.24), manual occupation (OR 3.75, 95% CI 1.92–7.34) and experiencing frequent economic difficulties (OR 3.07, 95% CI 2.00–4.70). Conclusions Pain is a common complaint that contributes to disability among young employees, particularly the most socioeconomically vulnerable. There is a socioeconomic gradient in both pain chronicity and the level of chronic pain-related disability. Life-course socioeconomic factors should be considered in pain-preventing strategies and in clinical practice.
... As the pain will bring pain to the patient when the pain occurs, if it is a frequent attack, it will cause the people to suffer from sleep disturbance, lack of appetite, depression, and even personality distortion, which will bring huge damages to individuals, families, and society. It exerts a serious impact on people's lives and health [4][5][6]. Studies have shown that in patients suffering from pain, a part of the cortex and the subcortical areas of the brain are usually activated [7,8]. ...
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The balanced iterative reducing and clustering using hierarchies (BIRCH) method was adopted to optimize the results of the resting-state functional magnetic resonance imaging (RS-fMRI) to analyze the changes in the brain function of patients with chronic pain accompanied by poor emotion or abnormal sleep quality in this study, so as to provide data support for the prevention and treatment of clinical chronic pain with poor emotion or sleep quality. 159 patients with chronic pain who visited the hospital were selected as the research objects, and they were grouped according to the presence or absence of abnormalities in emotion and sleep. The patients without poor emotion and sleep quality were set as the control group (60 cases), and the patients with the above symptoms were defined in the observation group (90 cases). The brain function was detected by RS-fMRI technology based on the BIRCH algorithm. The results showed that the rand index (RI), adjustment of RI (ARI), and Fowlkes–Mallows index (FMI) results in the k-means, flow cytometry (FCM), and BIRCH algorithms were 0.82, 0.71, and 0.88, respectively. The scores of Hamilton Depression Scale (HAHD), Hamilton Anxiety Scale (HAMA), and Pittsburgh Sleep Quality Index (PSQI) were 7.26 ± 3.95, 7.94 ± 3.15, and 8.03 ± 4.67 in the observation group and 4.03 ± 1.95, 5.13 ± 2.35, and 4.43 ± 2.07 in the control group; the higher proportion of RS-fMRI was with abnormal brain signal connections. A score of 7 or more meant that the number of brain abnormalities was more than 90% and that of less than 7 was less than 40%, showing a statistically obvious difference in contrast P<0.05. Therefore, the BIRCH clustering algorithm showed reliable value in the optimization of RS-fMRI images, and RS-fMRI showed high application value in evaluating the emotion and sleep quality of patients with chronic pain.
... Les recherches de ces dernières années soutiennent cependant l'existence d'un lien bidirectionnel entre facteurs psychosociaux et douleur chronique [6]. Il est donc diffi cile de savoir si ces derniers sont des causes ou des conséquences de la douleur chronique [6,19]. ...
... One possible explanation for this could be that due to time constraints, GPs mainly focus on identifiable and treatable pathology [28] and disregard social factors, as described in our results. The biopsychosocial model is supported with empirical evidence, but in practice the psychosocial factors are often viewed as secondary and as a reaction to the pain [29]. Moreover, Knoop et al. [30] found that guidelines for chronic low back pain vary widely regarding recommendations for prognostic psychosocial factors. ...
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Around 20% of the Dutch population is living with chronic musculoskeletal pain (CMP), which is a complex and multifactorial problem. This complexity makes it hard to define a classification system, which results in non-satisfactory referring from the general practitioner (GP). CMP is often explained using the biopsychosocial model in which biological, psychological and social factors cause and maintain the pain. The presented study investigated the factors related to the GPs’ referral for patients with CMP to further treatment. Using convenience sampling, semi-structured interviews and a focus group were conducted among 14 GPs. The interviews were iteratively analyzed using inductive conventional content analysis. Analysis of the interviews demonstrated that there were 28 referral factors that were mentioned by more than 50% of the interviewed GPs. The results showed that the GPs were mostly focussing on the physical (e.g. pain location) and psychological (e.g. acceptation of pain) factors, indicating that they lack focus on the social factors. Furthermore, unfamiliarity of GPs with treatment options was a noteworthy finding. The referral of patients with CMP by GPs is complex and based on multiple factors. To improve referral, it is recommended to include social factors in the decision-making process and to increase the familiarity of the GPs with available treatments.
... 2 It is a multidimensional phenomenon and prognosis is heavily influenced by a diverse array of psychosocial variables including distress levels, coping mechanisms and contextual factors. 3 According to the 11th edition of International Classification of Diseases classification, there are two broad groups: (1) 'chronic primary pain' which includes conditions such as non-specific low back pain and fibromyalgia (FM), that is, those conditions where the cause is not known; and (2) 'chronic secondary pain' which encompasses cancerrelated pain, neuropathic pain, visceral pain, post-traumatic and postsurgical pain, headache and orofacial pain, and musculoskeletal pain. This revised taxonomy allows for recognition of chronic pain as a health condition in its own right. ...
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Introduction Chronic pain conditions are a leading cause of disease and disability. They are associated with symptoms such as fatigue, sleep and mood disturbances. Minimal evidence is available to support effective treatments and alternatives treatment approaches are called for. Photobiomodulation therapy has been highlighted as one promising option. A whole-body therapy device (NovoTHOR) has recently been developed with a number of potential advantages for people with chronic pain. Research is needed to consider the feasibility of this device. Methods and analysis A single-centre single-armed (no placebo group) feasibility study with an embedded qualitative component will be conducted. The intervention will comprise 18 treatments over 6 weeks, with 6-month follow up, in the whole-body photobiomodulation device. A non-probability sample of 20 adult participants with a clinician diagnosis of chronic axial pain, polyarthralgia, myofascial pain, or widespread pain will be recruited (self- and clinician referral). Outcome measures will focus on acceptability of trial processes with a view to guiding a definitive randomised controlled trial. Analyses will utilise descriptive statistics for quantitative aspects. The qualitative element will be assessed by means of a participant-reported experience questionnaire post-intervention and semi-structured audio-recorded interviews at 3 stages; pre-, mid- and post-intervention. The latter will be transcribed verbatim and a reflexive thematic analysis will be used to identify emerging themes. Exploratory outcomes (participant-reported and performance-based measures) will be analysed according to data distribution. Ethics and dissemination The study has received ethical approval from the Leicester Central Research and Ethics Committee. Findings will be disseminated via local chronic pain groups, public register update, submission for presentation at scientific meetings and open-access peer-reviewed journals, and via academic social networks.
... Additional studies conclude that psychosocial factors are associated with baseline and recurring clinical characteristics in patients with chronic pain [16,25]. A broad range of cognitive and affective psychosocial factors expose vulnerabilities and undermine an individual's ability to manage pain [26]. The lack of specific treatable pathology, the passivity of current healthcare models, and dismal outcomes underscore the psychosocial factors as appreciable contributors to the development and perpetuation of chronic pain and disability. ...
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Background: Chronic pain and the accompanying level of disability is a healthcare crisis that reaches epidemic proportions and is now considered a world level crisis. Chronic non-specific low back pain (CNLBP) contributes a significant proportion to the chronic pain population. CNLBP occurs with overlapping psychosocial factors. This study was design to investigate specific psychosocial factors and their influence on reported disability in a population with CNLBP. Methods: The specific psychosocial factors examined included fear, catastrophizing, depression, and pain self-efficacy. This cross-sectional correlational study investigated the mediating role between pain self-efficacy, the specific psychosocial factors, and reported disability. The study recruited 61 female and 29 male participants from physical therapy clinics. The participants were between 20-to-60 years of age and diagnosed with CNLBP. All participants completed the Fear Avoidance Belief Questionnaire, The Pain Catastrophizing Scale, The Patient Health Questionnaire-9, The Pain Self-Efficacy Questionnaire, and The Lumbar Oswestry Disability Index. The battery of questionnaires measured fear of physical activity, pain catastrophizing, depression, pain self-efficacy, and reported disability. Multivariate regression and mediation analyses was used to analyse the data. Results: The principal finding was a strong inverse relationship between pain self-efficacy and reported disability with a p-value < 0.001. Further, pain self-efficacy was considered a statistical mediator with consistent p-value < 0.001 for the specific psychosocial factors investigated within this data set. Pain self-efficacy was considered to have a mediating role between reported fear of physical activity and disability, reported pain catastrophizing and disability, and reported depression and disability. Additionally, age and reported pain levels proved to be statistically significant. Adjustments for age and pain level did not alter the role of pain self-efficacy. Conclusion: The results identified a mediating role for pain self-efficacy between the specific psychosocial factors (fear, catastrophizing, and depression) and reported disability. Pain self-efficacy plays a more significant role in the relationships between these specific psychosocial factors and reported disability with CNLBP than previously considered.
... The biopsychosocial model of pain, which guided us in writing this review, hypothesizes that pain is dependent on interconnected biological, psychological, and social variables specific to the individual experiencing pain. 35,66 As such, the model allows for exploration of the complex mechanisms by which ACE exposure colors the experience of acute and chronic burn pain in survivors of childhood adversity (Fig. 1). In the biological domain, these mechanisms may include central sensitization, alterations in HPA axis and immune functions, and changes in epigenetic processes. ...
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Adverse childhood experiences (ACEs) affect over half of the adults in the United States and are known to contribute to the development of a wide variety of negative health and behavioral outcomes. The consequences of ACE exposure have been studied in patient populations that include individuals with gynecologic, orthopedic, metabolic, autoimmune, cardiovascular, and gastrointestinal conditions among others. Findings indicate that ACEs not only increase risks for chronic pain but also influence emotional responses to pain in many of these individuals. A growing body of research suggests that these effects may be the result of long-lasting changes induced by ACEs in neurobiological systems during early development. However, one area that is still largely unexplored concerns the effects of ACEs on burn patients, who account for almost 450,000 hospitalizations in the United States annually. Patients with severe burns frequently suffer from persistent pain that affects their well-being long after the acute injury, but considerable variability has been observed in the experience of pain across individuals. A literature search was conducted in CINAHL and PubMed to evaluate the possibility that previously documented ACE-induced changes in biological, psychological, and social processes might contribute to these differences. Findings suggest that better understanding of the role that ACEs play in burn outcomes could lead to improved treatment strategies, but further empirical research is needed to identify the predictors and mechanisms that dictate individual differences in pain outcomes in patients with ACE exposure and to clarify the role that ACE-related alterations play in early healing and recovery from burn injuries.
... Те лежат в основата на нейните афективно-мотивационни и когнитивно оценяващи аспекти. Страхът от болката, самоефективността и способността за контрол над болката, вярванията, стратегиите за справяне с болката, катастрофалното мислене са основни и взаимосвързани фактори, които предопределят преминаването на острата към хронична болка [29,31,43]. ...
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Pain and depression as comorbidity, that includes both somatic and psychopathlogical symptoms, is a widely spread phenomenon. There are proven connections on different levels that exist between them: neurobiological, (neuroanatomical, neurobiochemical and neuroendocrine), psychological and phenomenological. These levels of association correspond to the concept of the biopsychosocial model of the nature of the pain. Depression is a risk factor for the occurrence of disabilities, the worsening of the quality of life and the manifestation of autoaggressive behavior in patients with chronic pain. At often times, the depressive symptoms among this group of patients remain unidentified or underestimated. In relation to this, the role of the psychiatrist as an expert in a multidisciplinary team for management and treatment of pain is crucial. Besides the clinical assessment of the depressive symptoms, an introduction of the phenomenological methods as a regular means is necessary. Delving into the essence of the experiences of patients, suffering from chronic pain, as well as into their analyses, would facilitate and improve the processes of personalized assessment, prognosis and choice of therapeutic behavior.
... The biopsychosocial model of pain chronification emphasizes the importance of psychosocial factors in addition to biological factors in the development and maintenance of pain [1]. Among the psychological factors related to pain, anxiety and fear (emotional aspects of pain) in particular may play important roles in establishing chronic pain [2]. In addition, pain catastrophizing is common in chronic pain patients, where anxiety and fear of pain are further reinforced by negative affectivity and threatening illness information [3]. ...
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It is well known that exercise produces analgesic effects (exercise-induced hypoalgesia (EIH)) in animal models and chronic pain patients, but the brain mechanisms underlying these EIH effects, especially concerning the emotional aspects of pain, are not yet fully understood. In this review, we describe drastic changes in the mesocorticolimbic system of the brain which permit the induction of EIH effects. The amygdala (Amyg) is a critical node for the regulation of emotions, such as fear and anxiety, which are closely associated with chronic pain. In our recent studies using neuropathic pain (NPP) model mice, we extensively examined the association between the Amyg and EIH effects. We found that voluntary exercise (VE) activated glutamate (Glu) neurons in the medial basal Amyg projecting to the nucleus accumbens (NAc) lateral shell, while it almost completely suppressed NPP-induced activation of GABA neurons in the central nucleus of the Amyg (CeA). Furthermore, VE significantly inhibited activation of pyramidal neurons in the ventral hippocampus-CA1 region, which play important roles in contextual fear conditioning and the retrieval of fear memory. This review describes novel information concerning the brain mechanisms underlying EIH effects as a result of overcoming the fear-avoidance belief of chronic pain.
... It is manifested that those healthy participants with a lower level of attentional bias to negative information tend to have greater effects of HD-tDCS on relieving pain intensity. With the knowledge that patients with chronic pain have more negative attitudes and beliefs, such as pain catastrophizing and fear of pain, as well as negative bias toward pain (Vlaeyen and Linton, 2000;Keogh et al., 2004;Bushnell et al., 2013;Meints and Edwards, 2018), the affective turning of the attentional system could direct attention to negatively-valanced information more frequently and consequently, leading to poor responses to pharmacological interventions of pain (Mankovsky et al., 2012;Burns et al., 2017;Sharifzadeh et al., 2017). For instance, chronic pain patients with less pain catastrophizing or fear of pain tend to exhibit better treatment outcomes (Werneke et al., 2009;Sparkes et al., 2015). ...
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Some clinical studies have shown promising effects of transcranial direct current stimulation (tDCS) over the primary motor cortex (M1) on pain relief. Nevertheless, a few studies reported no significant analgesic effects of tDCS, likely due to the complexity of clinical pain conditions. Human experimental pain models that utilize indices of pain in response to well-controlled noxious stimuli can avoid many confounds that are present in the clinical data. This study aimed to investigate the effects of high-definition tDCS (HD-tDCS) stimulation over M1 on sensitivity to experimental pain and assess whether these effects could be influenced by the pain-related cognitions and emotions. A randomized, double-blinded, crossover, and sham-controlled design was adopted. A total of 28 healthy participants received anodal, cathodal, or sham HD-tDCS over M1 (1 mA for 20 min) in different sessions, in which montage has the advantage of producing more focal stimulation. Using a cold pressor test, several indices reflecting the sensitivity to cold pain were measured immediately after HD-tDCS stimulation, such as cold pain threshold and tolerance and cold pain intensity and unpleasantness ratings. Results showed that only anodal HD-tDCS significantly increased cold pain threshold when compared with sham stimulation. Neither anodal nor cathodal HD-tDCS showed significant analgesic effects on cold pain tolerance, pain intensity, and unpleasantness ratings. Correlation analysis revealed that individuals that a had lower level of attentional bias to negative information benefited more from attenuating pain intensity rating induced by anodal HD-tDCS. Therefore, single-session anodal HD-tDCS modulates the sensory-discriminative aspect of pain perception as indexed by the increased pain threshold. In addition, the modulating effects of HD-tDCS on attenuating pain intensity to suprathreshold pain could be influenced by the participant’s negative attentional bias, which deserves to be taken into consideration in the clinical applications.
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Background: Pain is a common symptom in patients with amyotrophic lateral sclerosis (ALS). Coping plays a central role in adjustment to pain. Objective: This study evaluates the use of different pain coping strategies in patients with ALS and investigates the interplay of maladaptive coping, and the patient's affective state and pain. Methods: One hundred and fifty ALS patients from three German outpatient clinics completed the Brief Pain Inventory (BPI), the ALS-Functional Rating Scale-Extension (ALSFRS-EX), the ALS Depression Inventory (ADI-12), the subscale "emotional functioning" of the ALS Assessment Questionnaire (ALSAQ-40) and the Coping Strategies Questionnaire (CSQ). Based upon the results of correlational analyses, multiple regression analyses were performed to identify predictors of pain severity and to explore factors contributing to maladaptive coping. Results: Pain was prevalent in 56% (n = 84) of the patients. Patients applied different adaptive coping strategies as well as the maladaptive strategy "catastrophizing". Regression analysis indicated that the CSQ-subscale "catastrophizing" significantly predicted pain intensity, explaining 34.0% of the variance (p < 0.001). Pain-related catastrophizing was associated with higher pain-related functional impairments and worse emotional functioning. The ADI-12 sum score as an indicator for depressive symptoms contributed significantly to the maladaptive coping strategy "catastrophizing" (p < 0.001) and explained 40.8% of the variance. Conclusion: Patients with ALS apply different strategies to cope with pain. Catastrophizing is an important determinant of higher pain intensity ratings and is associated with higher pain interferences and decreased emotional well-being. Pain-related catastrophizing is promoted by depressive symptoms. Catastrophizing and depressive symptoms thus represent important targets of individualized pain-management strategies.
Article
Background Recent studies indicate that the assessment of conditioned pain modulation (CPM) responses and emotional factors can provide important information regarding chronification mechanisms, choices for more efficient therapeutic strategies, and clinical variables supporting a therapeutic prognosis. Aims To investigate the impact of nonspecific chronic low back pain (NSCLBP) on CPM and psychosocial factors in individuals with NSCLBP compared with healthy controls. Design Case-control study. Methods Eighteen patients with NSCLBP and 18 healthy controls were recruited for this study. Pain intensity and affective-emotional aspects of pain, functional disability, kinesiophobia, depression, anxiety, and catastrophizing pain were obtained using a questionnaire. A CPM protocol was established to assess the functioning of the descending inhibitory system, with a cold pressor test as a conditioning stimulus and pressure pain threshold as a test stimulus. The maximal isometric strength of the trunk extensors also was evaluated. Results Healthy participants demonstrated a greater CPM response than those with NSCLBP. Patients with NSCLBP exhibited significantly lower pressure pain threshold than healthy subjects. Moreover, patients with NSCLBP presented with a considerable exacerbation of cognitive-behavioral changes. NSCLBP patients showed diminished maximal isometric strength of the trunk extensor compared to healthy subjects. Conclusions The endogenous pain inhibition system is reduced in patients with NSCLBP, with significant cognitive-behavioral changes indicated by high levels of anxiety and moderate pain intensity. Setting Clinical School of Physical Therapy of the Federal University of Delta of Parnaíba, Piauí - Brazil. Participants/Subjects 36 subjects with and without NSCLBP.
Article
Despite the huge development of pain management in the past decades, pain remains elusive and many patients still remain in the middle of the ford struggling between low drug efficacy and their overuse. A reason for pain elusiveness is its nature of subjective phenomenon, escaping the meshes of the objectivist, mechanist-reductionist net prevailing in medicine. Actually, pain is not only a symptom but an essential aspect of life, consciousness and contact with the world and its noetic and autonoetic components play a key role in the development of the concepts of pleasure-unpleasure and good-evil. The intensity and tolerability of pain and suffering also depends on what the pain means to the patient. The outstanding effects of placebo and nocebo, behavioral and non-pharmacological techniques warrant the need for a shift from the traditional positivist idea of patient as passive carrier of disease to the patient as active player of recovery and move toward a patient's centered approach exploiting individual resources for recovery. Among the mentioned techniques, hypnosis has proved to increase pain threshold up to the level of surgical analgesia, improve acute and chronic pain as well as coping and resilience, helping to decrease both drug overuse and the costs of pharmacological therapy. The wealth of available data suggest the need for a holistic approach, aiming to take care of the individual as an inseparable mind-body unit in its interplay with the environment, where patient's inner world, his/her experience and cognition are taken into due account as powerful resources for recovery through a phenomenological-existential approach.
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Depression is a factor that probably affect not only the sensation of pain, but also the pain experiences. The aim of the study was to analyze and summarize the specific experiences during pain in patients with chronic pain and depression. Materials and methods: A phase study of a sample of 120 patients with chronic pain was performed in two stages with a period of three months between them. According to the presence of a depressive episode, the sample was organized into two groups – 61 patients without depression and 59 patients with symptoms of depression. All patients with depression were treated with antidepressants between the two stages. Two types of methods were used to assess the sample: 1) quantitative methods – HAM-D-17 – to assess the severity of depression, Spielberger questionnaire – to assess the degree of state and trait anxiety and VAS – to assess the pain intensity; 2) qualitative method – content-analysis of the answers to the question "How do you feel during pain?". Results: The mean age of the sample was 51.90 ± 11.94. The share of women predominated (81.7%) over that of men (18.3%). The group with depression had high mean values of state and trait anxiety during the two stages of the study. In the first stage, when the mean value of the severity of depression was moderate, the content-analysis revealed specific experiences during pain of despair, low self-esteem, guilt, and suicidal ideation. The reduction of the mean value of the severity of depression from moderate to mild in the second stage, led to a decrease in the number of specific experiences. Conclusion: Depression affects the specifics of experiences during pain, revealing a potential risk of auto-aggressive behavior. Therefore, the search for symptoms of depression and specific experiences during pain and their intervention can be substantial in the coping with chronic pain.
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This review had three aims: 1) describe the measures used to assess health-related quality of life (HRQL) in pediatric patients diagnosed with sickle cell disease (SCD); 2) document the biopsychosocial factors related to HRQL in pediatric patients diagnosed with SCD; and 3) complete a meta-analysis comparing HRQL in pediatric patients diagnosed with SCD to healthy controls. Included studies were published in English, quantitatively assessed HRQL as a primary aim, in both SCD and controls, and included participants between 0 and 21 years of age. The final review included 66 articles, with a total of 8642 participants with SCD, 4 months-21 years of age, and 62,458 controls, 5–27 years of age. HRQL was predominately measured using the Pediatric Quality of Life Inventory Generic Core and Sickle Cell Disease Module. Meta-analyses revealed children with SCD had significantly worse HRQL compared to healthy controls (standardized mean difference = −0.93, 95% CI = −1.25, −0.61, p < 0.00001). Worse HRQL was associated with more severe SCD, female sex, and pain. The findings indicate that children with SCD are at risk for worse HRQL compared to their healthy peers and their HRQL may be impacted by several biopsychosocial factors. Future research is needed to examine how sociocultural factors uniquely impact this population and their overall quality of life.
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A dor nociplástica é ligada à sensibilização central (SC) da dor, que é a amplificação da sinalização dos neurônios nociceptivos no sistema nervoso central à entrada somatossensorial aferente. Ocorre por alterações neuroplásticas associadas à atividade nervosa espontânea, campos receptivos expandidos e aumento da resposta neural na medula espinhal. Do ponto de vista neurobiológico, há um desequilíbrio entre neurotransmissores nociceptivos (substância P, glutamato) e antinociceptivos (serotonina, noradrenalina). Estudos funcionais de imagem cerebral demonstram atividade cerebral aumentada em áreas envolvidas na percepção da dor (ínsula, córtex cingulado anterior e córtex pré-frontal) e regiões não relacionadas à dor (núcleos do tronco cerebral, córtex frontal dorsolateral e córtex parietal). As principais características das síndromes nociplásticas são: predominância no sexo feminino, agregação familiar, longo tempo de evolução de dor multifocal, hiperalgesia, alodinia, coexistência de várias condições de dor crônica, alta frequência de comorbidades, presença de sensibilizadores psicológicos e pouca ou nenhuma resposta a tratamentos com ação periférica (anti-inflamatórios não esteroidais, glicocorticoides, injeções e cirurgias). Três aspectos clínicos são importantes na discriminação da dor centralizada: acometimento difuso, sem território neuroanatômico específico; intensidade desproporcional à natureza da lesão ou doença; e hipersensibilidade dos sentidos não relacionada ao sistema musculoesquelético. Entretanto, a presença de estímulo nociceptivo persistente, como pontos-gatilho miofascial ou doença que causa dor crônica como osteoartrite e artrite reumatoide, bem como existência de lesão neuropática, podem perpetuar o mecanismo de sensibilização central. O tratamento inclui medidas não farmacológicas (exercícios físicos, terapia cognitivo-comportamental, acupuntura) e farmacológicas (inibidores da recaptação de serotonina/noradrenalina, gabapentinoides, antidepressivos tricíclicos, tramadol, naltrexona). Unitermos: Dor nociplástica. Sensibilização central, somatossensorial. Dor crônica. Fibromialgia.
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Objective We evaluated exercise interventions for cognitive appraisal of chronic low-back pain (cLBP) in an underserved population. Methods We conducted a secondary analysis of the Back to Health Trial, showing yoga to be non-inferior to physical therapy (PT) for pain and function outcomes among adults with cLBP (n = 320) recruited from primary care clinics with predominantly low-income patients. Participants were randomized to 12 weeks of yoga, PT, or education. Cognitive appraisal was assessed using the Pain Self-Efficacy Questionnaire (PSEQ), Coping Strategies Questionnaire (CSQ) and Fear Avoidance Beliefs Questionnaire (FABQ). Using multiple imputation and linear regression, we estimated within- and between-group changes in cognitive appraisal at 12 and 52 weeks, with baseline and the education group as references. Results Participants (mean age = 46) were mostly female (64%), black (57%), and 54% had an annual household income <$30,000. All three groups showed improvements in PSEQ (range 0–60) at 12 weeks (yoga, mean difference [MD]=7.0, 95%CI: 4.9, 9.0; PT, MD = 6.9, 95%CI: 4.7, 9.1; and education, MD = 3.4, 95%CI: 0.54, 6.3), with yoga and PT improvements being clinically meaningful. At 12 weeks, improvements in catastrophizing (CSQ, range 0–36) were largest among yoga and PT groups (MD=-3.0, 95%CI: -4.4, -1.6; MD=-2.7, 95%CI: -4.2, -1.2, respectively). Changes in FABQ were small. No statistically significant between-group differences were observed on PSEQ, CSQ, or FABQ at either time point. Many of the changes observed at 12 weeks were sustained at 52 weeks. Conclusion All three interventions were associated with improvements in self-efficacy and catastrophizing among low-income racially-diverse adults with cLBP. Trial registration ClinicalTrials.gov Identifier NCT01343927
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Interest in the role of sex as a biological variable has increased, including a mandate for the study of both sexes in NIH-funded research. As sex differences exist in both human chronic pain conditions and rodent models of nociception, it is critical to understand the impact of sex in nociceptive assays. Choice-based thermal nociceptive tests permit the study of avoidance responses to thermal stimuli compared to traditional nociceptive assays, which measure nocifensive reactions. However, to date no comparison of male and female responses to choice-based tests has been published. Herein, we examined the effect of sex on two choice-based thermal nociceptive tests, the thermal gradient test and the temperature place preference test, in adult rats. The activation of a 10°C-to-47°C thermal gradient results in an increase in time spent in the 10°C zone in females, compared to a reduction in males. Additionally, in a temperature place preference test pairing a surface temperature of 22°C with either 5°C, 10°C, 47°C, or 50°C, females appeared to have overall greater tolerance for non-ambient temperatures. Males spent less than 50% of their time in every non-22°C zone, whereas in females this was only observed when testing 5°C and 50°C. Together, these results suggest that male rats show more avoidance behavior than females to both hot and cold non-ambient temperatures when given free access to multiple zones, including at milder temperatures than those typically used to evoke a nociceptive response in traditional hot and cold plate tests.
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Abstract. Normally, the process of adolescence is quite painful and complicated, and it is important to distinguish those conditions that do not require long-term treatment and psychiatric care from pathological states requiring accurate diagnosis. This report aims to raise the issue of difficulties and specifics in assessing personality in adolescence with the standard methods used in clinical practice in Bulgaria. For this purpose, the results from the application of two of the most commonly used methods in clinical practice in our country are presented: the short form of a questionnaire for the study of personality MMPI (71) and the Thematic apperception test. The studied sample of adolescents (N=230, 55% girls), between 14 and 16 years, was divided into two subgroups: adolescents with “psychotic” type of profile and adolescents with “neurotic” type of profile. The data was collected in the course of twelve years (2010-2022), in multi-profile hospital “Sv. Marina” – Varna, both from the child and adolescent psychiatric clinic and from consultations of adolescents in the pediatric clinic. The study found good indicators of the reliability of MMPI short-term scales (71) in the adolescent group between 14 and 16 years of age (Cronbach’s alpha values from 0.53 to 0.73), while for a more detailed assessment of personality predisposition, experiences, and feelings, the combination of self-assessment and projective methods might be helpful.
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The management of patients with chronic pain is one of the most important issues In medicine and public health. Chronic pain conditions cause substantial suffering for patients, their significant others and society over years and even decades and increases healthcare utilization resources including the cost of medical care, loss of productivity and provision of disability services. Primary care providers are at the frontline in the identification and management of patients with chronic pain, as the majority of patients enter the healthcare system through primary care and are managed by primary care providers. Due to the complexity of chronic pain and the range of issues involved, the accurate diagnosis of the causes of pain and the formulation of effective treatment plans presents significant challenges in the primary care setting. In this review, we use the classification of pain types based on pathophysiology as the template to guide the assessment, treatment, and monitoring of patients with chronic pain conditions. We outline key methods that can be used to efficiently and accurately diagnose the putative pathophysiological mechanisms underlying chronic pain conditions and describe how this information should be used to tailor the treatment plan to meet the patient's needs. We discuss methods to evaluate patients and the impact of treatment plans over a series of consultations, with a particular focus on strategies to improve the patient's ability to self-manage their pain and related symptoms and perform daily functions despite persistent pain. Finally, we introduce the mnemonic RATE (Recognize, Assess, Treat, and Evaluate) as a general strategy that healthcare providers can use to aid their management of patients presenting with chronic pain.
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Introduction Despite evidence showing that tinnitus can have a detrimental impact on significant others (SOs), no standardized self-reported measure is currently available that specifically assesses the presence of third-party disability for tinnitus. The aim of this study was to develop and assess the psychometric properties of a newly developed self-reported measure for SOs of tinnitus and assess how scores could be meaningfully interpreted. Methods The research consisted of two phases. During Phase I, the Consequences of Tinnitus on Significant Others Questionnaire (CTSOQ) was developed using the The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidance. Phase II included the assessment of psychometric properties of the CTSOQ including the construct validity, internal consistency, interpretability, and responsiveness. Pairs of 194 individuals with tinnitus and their SOs completed a series of online questionnaires. SOs completed the CTSOQ measure while individuals with tinnitus completed measures related to tinnitus distress, anxiety, depression, insomnia, and quality of life. Results A 25 item CTSOQ was developed using a formative model. The questionnaire validation process indicated good psychometric properties with an internal consistency of .93 and inter-item correlation of .60. Support was found for the construct and discriminative validity of the measure. Floor and ceiling effects were negligible. Scores can be meaningfully interpreted to indicate mild, significant, or severe effect of tinnitus on SOs. The questionnaire was also found to be responsive to treatment-related changes. Conclusions The CTSOQ was found to have sufficient measurement properties suggesting that it is a suitable measure of third-party disability for SOs of individuals with tinnitus. Further research should be initiated to measure face validity and what scores reflect clinically meaningful change.
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Aim To explore whether the relationship between mental health diagnosis (i.e., mood or neurotic, stress-related, or somatoform disorder) and pain is moderated by language in patients with limited English proficiency (LEP). Southeast Asian languages (i.e., Hmong, Lao, Khmer) and Spanish were compared with English. Method A retrospective data mining study was conducted (n = 79,109 visits). Pain scores, language, mental health diagnoses, age, sex, race, ethnicity, and pain diagnosis were obtained from electronic medical records. Cragg two-equation hurdle regression explored: (1) the effect of patient language and mental health diagnosis on pain and (2) the interaction between language and mental health diagnosis on pain. Results Visits were primarily for female (62.45%), White (80.10%), not Hispanic/Latino (96.06%), and English-speaking (97.85%) patients. Spanish or Southeast Asian language increased chances of reporting any pain (i.e., pain score of 0 versus ≥1) and pain severity in visits with pain scores ≥1, whereas mental health diagnosis decreased chances of reporting any pain and pain severity. The combination of Southeast Asian language and mood disorder contributed to higher chances of reporting any pain (odds ratio [OR] = 1.78, p<.001) but no difference in severity. A similar trend was observed for Southeast Asian language and neurotic disorder (OR = 1.29, p=.143). In contrast, the combination of Spanish language and mood (p = .066) or neurotic (p = .289) disorder contributed to lower pain severity but did not change the chances of reporting any pain. Conclusions LEP and patient language should be considered during pain assessment within the context of mental health.
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Background Patient race, ethnicity, and culture including language are intertwined and may influence patient reporting of pain severity. Purpose To describe documentation of patient's self-reported pain presence and severity by race, ethnicity, and language, specifically, Spanish, Hmong, Lao, or Khmer requiring an interpreter or English. Design and Sample Retrospective, electronic health record clinical data mining study of 79,195 patient visits with documented pain scores from one primary care clinic. Methods Hurdle regression was used to explore the effect of race, ethnicity, and language on the chances of having any pain (vs. no pain) and pain severity for visits with pain scores ≥1, controlling for age, sex, and documentation of a pain diagnosis. Mann-Whitney tests were used to explore the influence of English vs. non-English language on pain severity within a race or ethnicity category. Results Pain scores were higher for limited English proficiency, compared with English-speaking, patients within the Asian race or Hispanic/Latino ethnicity category. Older age, female sex, pain diagnosis, Black or African American race, and Spanish or Lao language increased the chance of having any pain. These same factors, plus American Indian or Alaska Native race, contributed to higher pain severity. Asian race, in contrast, decreased the chance of reporting any pain and contributed to lesser pain severity. Conclusions Race, in addition to a new area of focus, language, impacted both the chances of reporting any pain and pain severity. Additional research is needed on the impact of language barriers on pain severity reporting, documentation, and differences in pain outcomes and disparities.
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Background: Chronic Whiplash Associated Disorders (CWAD) are characterized by long-lasting symptoms of neck pain occurring after an acceleration-deceleration injury. Central sensitization (CS) has been suggested as the possible underlying mechanism for these symptoms, and is characterized by changes in the central nervous system. Besides CS, psychological factors are believed to play an important role in the experience of (chronic) pain. Objective: Investigating the relationships between self-reported pain, disability, quality of life, psychological factors and symptoms of CS; and electrical-based quantitative sensory testing (QST) outcomes in CWAD patients. Secondly, to investigate the differences in QST between CWAD patients and healthy controls. Methods: 72 CWAD patients and 55 healthy controls underwent electrical stimuli-based QST. Detection and pain thresholds (EPT), temporal summation (TS) and conditioned pain modulation (CPM) were examined. Spearman correlation and linear mixed models analyses were performed to assess respectively the hypothesized associations and group differences in QST. Results: The Pain Catastrophizing magnification subscale correlated with the left wrist EPT (r=-0.332;P=0.004), and the Pain Anxiety Symptom Scale-20 with the left wrist (r=-0.325;P=0.005) and ankle (r=-0.330;P=0.005) EPT. TS at the ankle correlated with the CS Inventory (r=0.303;P=0.010), Short Form 36 pain subscale (r=-0.325;P=0.005), and Illness Perception Questionnaire revised consequences subscale (r=0.325;P=0.005). EPTs left (P=0.011) and right wrist (P=0.023) were lower in the CWAD group, but CPM and TS did not differ between groups. Conclusion: QST outcomes relate to psychological constructs, rather than to self-reported pain intensity and distribution. Local hyperalgesia was found in patients with CWAD, but no differences in endogenous pain facilitation nor inhibition.
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The brain stem and brain are involved in chronic pain processing and sensation. This may involve changes in gene expression through epigenetic alterations [1]. Chronic pain is also a learned experience which involves the brain [2]. In chronic pain, thresholds to pain sensation decrease such that pain may be produced by nonpainful stimuli.
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Chronic pain is a significant public health problem, and the prevalence and societal impact continues to worsen annually. Multiple cognitive and emotional factors are known to modulate pain, including pain catastrophizing, which contributes to pain facilitation and is associated with altered resting-state functional connectivity in pain-related cortical and subcortical circuitry. Pain and catastrophizing levels are reported to be higher in non-Hispanic black (NHB) compared with non-Hispanic White (NHW) individuals. The current study, a substudy of a larger ongoing observational cohort investigation, investigated the pathways by which ethnicity/race influences the relationship between pain catastrophizing, clinical pain, and resting-state functional connectivity between anterior cingulate cortex (ACC), dorsolateral prefrontal cortex (dlPFC), insula, and primary somatosensory cortex (S1). Participants included 136 (66 NHBs and 70 NHWs) community-dwelling adults with knee osteoarthritis. Participants completed the Coping Strategies Questionnaire-Revised Pain Catastrophizing subscale and Western Ontario and McMaster Universities Osteoarthritis Index. Magnetic resonance imaging data were obtained, and resting-state functional connectivity was analyzed. Relative to NHW, the NHB participants were younger, reported lower income, were less likely to be married, and self-reported greater clinical pain and pain catastrophizing (ps < 0.05). Ethnicity/race moderated the mediation effects of catastrophizing on the relationship between clinical pain and resting-state functional connectivity between the ACC, dlPFC, insula, and S1. These results indicate the NHB and NHW groups demonstrated different relationships between pain, catastrophizing, and functional connectivity. These results provide evidence for a potentially important role of ethnicity/race in the interrelationships among pain, catastrophizing, and resting-state functional connectivity.
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Introdução O início da pandemia de Covid-19 impactou a população mundial, trazendo a necessidade imediata de modificações comportamentais. A Organização Mundial de Saúde (OMS) recomendou uma série de restrições sanitárias para evitar a proliferação do vírus e a contenção da mortalidade 1. O uso de álcool gel, máscaras, quarentena, isolamento social e lockdown (medida de bloqueio total para evitar a circulação de pessoas) começaram a fazer parte do cotidiano da população. A alta letalidade do novo vírus e a insegurança diante de um cenário de incertezas trouxeram vários estressores psicossociais. As pessoas passaram a conviver, diariamente, com o medo da contaminação e da morte, com o impacto emocional do distanciamento social e com os efeitos do retraimento da economia. Diante disso, a OMS expressou preocupação não só em relação à saúde física, como também mental dos indivíduos 2. Essa preocupação foi legitimada pela identificação, em vários países do mundo, de aumentos de sintomas de depressão, ansiedade, estresse, insônia e estresse pós-traumático 3. O acesso aos serviços de saúde, em geral, ficou mais limitado, fazendo com que as pessoas tivessem maiores dificuldades para iniciar ou dar continuidade a seus tratamentos de saúde. No Brasil, esse quadro tornou-se ainda mais grave, acrescendo-se à precarização dos serviços de saúde no país 4. Entre os pacientes que foram gravemente afetados estavam os que possuíam o diagnóstico de dor crônica. Em definição recentemente revisada, a Associação Internacional para o Estudo da Dor (IASP) conceitua a dor como "uma experiência sensitiva e emocional desagradável associada, ou semelhante àquela associada, a uma lesão tecidual real ou potencial" 5. É denominada dor crônica aquela que persiste por mais de três meses, constituindo-se uma doença por si só. A dor crônica exerce um enorme impacto sobre a saúde e a vida dos indivíduos, gerando limitações de movimentos, incapacidade funcional, sofrimento emocional e piora na qualidade de vida. Afeta mais de 30% da população mundial 6 e imprime altos encargos socioeconômicos aos
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IntroductionManaging patients with chronic pain can be complex and requires specialized clinical knowledge and advanced communication skills. Simulation-based learning has been shown to improve learning outcomes for complex competencies and could be a valuable resource for trainees in chronic pain medicine.Methods We assessed the need for a simulation-based course for trainees in chronic pain medicine at McMaster University in Canada. The needs assessment consisted of three steps: (1) literature review to identify preexisting needs assessments, (2) targeted interviews with six healthcare professionals in chronic pain management, and (3) an analysis of 366 routinely collected patient experience surveys.ResultsThe systematic review identified a small body of related literature and no previous needs assessment. We identified the following key competencies and skills that trainees in pain medicine need to develop: (1) communicating with distressed patients using skills such as de-escalation, active listening, and motivational interviewing, (2) managing patients in difficult emotional situations such as poorly controlled pain or showing signs of opioid misuse, and (3) recognizing and managing mental health issues related to chronic pain using appropriate instruments.DiscussionSuggestions for scenarios included the following: (1) consulting a patient with poor pain control and running out of treatment options, (2) managing a patient with suspected inappropriate opioid use, and (3) diagnosing depression in a patient suffering from chronic pain and developing an appropriate treatment plan.Conclusion We propose the development of suggested scenarios into simulation-based courses, and test and refine them together with trainees and experts in pain medicine.
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Background The search for risk factors of pain after breast cancer, which affects a considerable proportion of the women, has primarily focused on clinical factors. The aim of this meta-analysis was to explore the less well-studied psychosocial predictors of pain after breast cancer treatment. Methods Two independent searches were conducted in PubMed, PsycINFO, Web of Science, and CINAHL. Eligible studies were prospective, observational studies of women aged ≥18 years, diagnosed and treated for nonmetastatic breast cancer ≥3 months previously. Additional inclusion criteria were that studies had assessed at least one pain outcome and at least one psychosocial predictor. The psychosocial predictors investigated included: 1) psychological–behavioral states, 2) psychological traits, and 3) social support. Effect size correlations (ESr) were chosen as the effect size and pooled using a random effects model. We also explored a number of study characteristics as possible moderators of the effect with meta-regression. Results Of the total of 13 eligible studies identified, most studies measured psychosocial predictors at presurgery. Neither psychological–behavioral states (ESr: 0.05; p=0.13; K=11) nor psychological traits (ESr: 0.02; p=0.48; K=6) emerged as statistically significant predictors of pain. In contrast, higher levels of social support were statistically significantly associated with less pain (ESr: −0.24; p<0.001; K=4). In studies of psychological–behavioral states, longer follow-up was associated with smaller effect sizes (p=0.023). Furthermore, older mean sample age was associated with larger effect sizes for both psychological–behavioral states (p=0.0004) and psychological traits (p=0.035). Conclusion The results of this meta-analysis suggest that psychosocial factors measured at presurgery may only be of modest predictive value in identifying women at risk of developing pain after breast cancer treatment. While speculative, psychosocial factors may play a larger role in the postsurgery trajectory, which could be valuable to investigate in future studies.
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Fibromyalgia (FM) syndrome is characterized by chronic widespread pain, muscle tenderness and emotional distress. Previous studies found reduced endogenous pain modulation in FM. This deficiency of pain modulation may be related to the attributes of chronic pain and other clinical symptoms experienced in patients with FM. Thus, we tested whether there is a link between the clinical symptoms of FM and functional connectivity (FC) of the periaqueductal gray (PAG), a key node of pain modulation. We acquired resting state 3T functional MRI (rsfMRI) data from 23 female patients with FM and 16 age- and sex- matched healthy controls (HC) and assessed FM symptoms with the Brief Pain Inventory (BPI), Fibromyalgia Impact Questionnaire (FIQ), Hospital Anxiety and Depression Scale (HADS) and Pain Catastrophizing Scale (PCS). We found that patients with FM exhibit statistically significant disruptions in PAG FC, particularly with brain regions implicated in negative affect, self-awareness and saliency. Specifically, we found that, compared to HCs, the FM patients had stronger PAG FC with the lingual gyrus and hippocampus but weaker PAG FC with regions associated with motor/executive functions, the salience (SN) and default mode networks (DMN). The attenuated PAG FC was also negatively correlated with FIQ scores, and positively correlated with the magnification subscale of the PCS. These alterations were correlated with emotional and behavioral symptoms of FM. Our study implicates the PAG as a site of dysfunction contributing to the clinical manifestations and pain in FM.
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Background Central sensitization is an important epiphenomenon of the adult migraine, clinically expressed by allodynia, pericranial tenderness and comorbidity for fibromyalgia in a relevant number of patients. This study aimed to evaluate the frequency and the clinical characteristics of allodynia, pericranial tenderness, and comorbidity for Juvenile Fibromialgia (JFM) in a cohort of migraine children selected in a tertiary headache center. Methods This was an observational cross-sectional study on 8–15 years old migraine patients. Allodynia was assessed by a questionnaire. Pericranial tenderness and comorbidity for JFM as well as their possible association with poor quality of life and migraine related disability, and with other clinical symptoms as anxiety, depression, sleep disorders and pain catastrophizing, were also evaluated. Results One hundred and fifty one patients were selected, including chronic migraine (n°47), migraine without aura (n° 92) and migraine with aura (n° 12) sufferers. Allodynia was reported in the 96,6% and pericranial tenderness was observed in the 68.8% of patients. Pericranial tenderness was more severe in patients with more frequent migraine and shorter sleep duration. Allodynia seemed associated with anxiety, pain catastrophizing and high disability scores. Comorbidity for JFM was present in the 0.03% ofpatients. These children presented with a severe depression and a significant reduction of quality of life as compared to the other patients. Conclusions This study outlined a relevant presence of symptoms of central sensitization among children with migraine. Severe allodynia and comorbidity for JFM seemed to cause a general decline of quality of life, which would suggest the opportunity of a routine assessment of these clinical features.
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Emerging research suggests that pain may persist longer-term for many children after major surgery, with significant effects on their health outcomes. This systematic review identified the prevalence of chronic postsurgical pain (CPSP) in children after surgery, and determined presurgical biomedical and psychosocial risk factors associated with CPSP prevalence or severity. Prospective studies assessing CPSP 3 to 12 months after surgery in children 6 to 18 years of age published in English in MedLine, EMBASE, PsycINFO, and Cochrane Database of Systematic Reviews since 1996 were eligible for inclusion. Of 16,084 abstracts yielded by the search, 123 full articles were assessed for eligibility, and 12 studies were included in the review. Overall quality of included studies assessed using the Quality in Prognostic Studies tool was low. On the basis of 4 studies with a total of 628 participants across all surgery types, median prevalence of CPSP across studies was 20% (25th percentile = 14.5%, 75th percentile = 38%) at 12 months after surgery. Presurgical pain intensity, child anxiety, child pain coping efficacy, and parental pain catastrophizing were the only presurgical factors identified as predictive of CPSP. Biological and medical factors assessed were not associated with CPSP in any study. Well designed studies examining prevalence and predictors of CPSP are critically needed in children. Perspective In this systematic review, the median prevalence of CPSP in children was 20% across studies. Presurgical pain intensity, and child and parent psychosocial factors predicted CPSP. Additional resources and interventions are needed for youth who report persistent pain after surgery.
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Fibromyalgia (FM) is a complex syndrome characterized by chronic widespread pain, hyperalgesia, and other disabling symptoms. Although the brain response to experimental pain in FM patients has been the object of intense investigation, the biological underpinnings of painful after-sensations (PAS), and their relation to negative affect have received little attention. In this cross-sectional cohort study, subjects with FM (n = 53) and healthy controls (n = 17) were assessed for PAS using exposure to a sustained, moderately painful cuff stimulus to the leg, individually calibrated to a target pain intensity of 40 of 100. Despite requiring lower cuff pressures to achieve the target pain level, FM patients reported more pronounced PAS 15 seconds after the end of cuff stimulation, which correlated positively with clinical pain scores. Functional magnetic resonance imaging revealed reduced deactivation of the medial temporal lobe (MTL; amygdala, hippocampus, parahippocampal gyrus) in FM patients, during pain stimulation, as well as in the ensuing poststimulation period, when PAS are experienced. Moreover, the functional magnetic resonance imaging signal measured during the poststimulation period in the MTL, as well as in the insular and anterior middle cingulate and medial prefrontal cortices, correlated with the severity of reported PAS by FM patients. These results suggest that the MTL plays a role in PAS in FM patients. Perspective PAS are more common and severe in FM, and are associated with clinical pain and catastrophizing. PAS severity is also associated with less MTL deactivation, suggesting that the MTL, a core node of the default mode network, may be important in the prolongation of pain sensation in FM.
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Advances in our understanding of the human pain experience have shifted much of the focus of pain research from the periphery to the brain. Current hypotheses suggest that the progression of migraine depends on abnormal functioning of neurons in multiple brain regions. Accordingly, we sought to capture functional brain changes induced by the application of an inflammatory cocktail known as inflammatory soup (IS), to the dura mater across multiple brain networks. Specifically, we aimed to determine whether IS alters additional neural networks indirectly related to the primary nociceptive pathways via the spinal cord to the thalamus and cortex. IS comprises an acidic combination of bradykinin, serotonin, histamine and prostaglandin PGE2 and was introduced to basic pain research as a tool to activate and sensitize peripheral nociceptors when studying pathological pain conditions associated with allodynia and hyperalgesia. Using this model of intracranial pain, we found that dural application of IS in awake, fully conscious, rats enhanced thalamic, hypothalamic, hippocampal and somatosensory cortex responses to mechanical stimulation of the face (compared to sham synthetic interstitial fluid administration). Furthermore, resting state MRI data revealed altered functional connectivity in a number of networks previously identified in clinical chronic pain populations. These included the default mode, sensorimotor, interoceptive (Salience) and autonomic networks. The findings suggest that activation and sensitization of meningeal nociceptors by IS can enhance the extent to which the brain processes nociceptive signaling, define new level of modulation of affective and cognitive responses to pain; set new tone for hypothalamic regulation of autonomic outflow to the cranium; and change cerebellar functions.
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Unlabelled: The psychosocial and functional consequences of chronic pain disorders have been well documented as having significant effects on the experience of pain, presentation to health care providers, responsiveness to and participation in treatment, disability, and health-related quality of life. Thus, psychosocial and functional consequences have been incorporated as 1 of the 5 dimensions within the integrated Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks (ACTTION)-American Pain Society (APS) Pain Taxonomy (AAPT): 1) core diagnostic criteria; 2) common features; 3) common medical comorbidities; 4) neurobiological, psychosocial, and functional consequences; and 5) putative neurobiological and psychosocial mechanisms, risk factors, and protective factors. In this article we review the rationale for a biopsychosocial perspective, on the basis of current evidence, and describe a set of key psychosocial and behavioral factors (eg, mood/affect, coping resources, expectations, sleep quality, physical function, and pain-related interference with daily activities) that are important consequences of persistent pain and that should be considered when classifying patients within the comprehensive AAPT chronic pain structure. We include an overview of measures and procedures that have been developed to assess this set of factors and that can be used as part of the comprehensive assessment and classification of pain and to address specific research questions. Perspective: Psychosocial and functional consequences are important considerations in the classification of individuals with chronic pain. A set of key psychosocial and behavioral factors (eg, mood/affect, coping resources, expectations, sleep quality, physical function, and pain-related interference with daily activities) that should be considered when classifying patients within the comprehensive classification of chronic pain disorders developed by the AAPT are outlined and examples of assessment methods for each are described.
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There is tremendous inter-patient variability in the response to analgesic therapy (even for efficacious treatments), which can be the source of great frustration in clinical practice. This has led to calls for "precision medicine", or personalized pain therapeutics (i.e., empirically-based algorithms that determine the optimal treatments, or treatment combinations, for individual patients) that would presumably improve both the clinical care of patients with pain, and the success rates for putative analgesic drugs in Phase 2 and 3 clinical trials. However, before implementing this approach, the characteristics of individual patients or subgroups of patients that increase or decrease the response to a specific treatment need to be identified. The challenge is to identify the measurable phenotypic characteristics of patients that are most predictive of individual variation in analgesic treatment outcomes, and the measurement tools that are best suited to evaluate these characteristics. In this article, we present evidence on the most promising of these phenotypic characteristics for use in future research, including psychosocial factors, symptom characteristics, sleep patterns, responses to noxious stimulation, endogenous pain-modulatory processes, and response to pharmacologic challenge. We provide evidence-based recommendations for core phenotyping domains and recommend measures of each domain.
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While a majority of research has focused on adult fibromyalgia (FM), recent evidence has provided insights into the presence and impact of FM in children and adolescents. Commonly referred as juvenile fibromyalgia (JFM), youths, particularly adolescent girls, present with persistent widespread pain and cardinal symptoms observed in adult FM. A majority of youth with JFM continue to experience symptoms into adulthood, which highlights the importance of early recognition and intervention. Some differences are observed between adult and juvenile-onset FM syndrome with regard to comorbidities (e.g., joint hypermobility is common in JFM). Psychological comorbidities are common but less severe in JFM. Compared to adult FM, approved pharmacological treatments for JFM are lacking, but non-pharmacologic approaches (e.g., cognitive-behavioral therapy and exercise) show promise. A number of conceptual issues still remain including (1) directly comparing similarities and differences in symptoms and (2) identifying shared and unique mechanisms underlying FM in adults and youths.
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Unlabelled: Compared with white individuals, black individuals experience greater pain across clinical and experimental modalities. These race differences may be due to differences in pain-related coping. Several studies examined the relationship between race and pain coping; however, no meta-analytic review has summarized this relationship or attempted to account for differences across studies. The goal of this meta-analytic review was to quantify race differences in the overall use of pain coping strategies as well as specific coping strategies. Relevant studies were identified using electronic databases, an ancestry search, and by contacting authors for unpublished data. Of 150 studies identified, 19 met inclusion criteria, resulting in 6,489 participants and 123 effect sizes. All of the included studies were conducted in the United States. Mean effect sizes were calculated using a random effects model. Compared with white individuals, black individuals used pain coping strategies more frequently overall (standardized mean difference [d] = .25, P < .01), with the largest differences observed for praying (d = .70) and catastrophizing (d = .40). White individuals engaged in task persistence more than black individuals (d = -.28). These results suggest that black individuals use coping strategies more frequently, specifically strategies associated with poorer pain outcomes. Future research should examine the extent to which the use of these strategies mediates race differences in the pain experience. Perspective: Results of this meta-analysis examining race differences in pain-related coping indicate that, compared with white individuals, black individuals use coping strategies more frequently, specifically those involving praying and catastrophizing. These differences in coping may help to explain race differences in the pain experience.
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Perspective: To examine whether sex and gender affect willingness to participate in pain studies, we assessed gender identification in male and female participants, then attempted to recruit them to participate in a pain study. Males who agree to participate in pain studies are significantly higher in masculine gender identification than males who decline to participate or females who agree to participate. Males who agreed to participate were particularly high in aggressiveness and competitiveness.
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Background: In chronic pain, patients' coping affects their adaptation. In two studies, we examined the role of pain catastrophizing, a maladaptive coping strategy, in pain, distress, and disability. In Study 2 we compared catastrophizing to pain acceptance and to other coping strategies. Methods: Study 1. Chronic pain patients (N = 428) were assessed four times as to their pain, disability, catastrophizing, and distress (depression and anxiety). Study 2. Patients (N = 165) were assessed as to coping and pain acceptance, pain, related distress, depression, hope, suicidal ideations, perceived burdensomeness, and thwarted belongingness. Results: Study 1. A Structural Equation Modeling (SEM) analysis revealed that Time 1 Pain-based catastrophizing prospectively predicted pain (β =.36, p < .001). Distress prospectively predicted pain related disability (β = .34, p <.001). Study 2. Pain-based catastrophizing predicted sensory pain (β = .22, p = .018), depression (β = .43, p < .001), and suicidal ideation (O.R. = 1.88), which were also predicted by depression and perceived burdensomeness. Distraction predicted sensory pain (β = .21, p = .017, respectively). Activity engagement predicted low levels of depression (β = -.29, p < .001, respectively), and willingness to accept pain predicted low pain-related distress (β = -.16, p = .05). Conclusions: Pain catastro-phizing and pain acceptance constitute risk and resilience factors. Both should be assessed and targeted in pain management.
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Traumatic brain injury (TBI) is the cause for long-term disability in more than 3 million patients in the US alone, with chronic pain being the most frequently reported complain. To date, predisposing mechanisms for chronic pain in TBI patients are largely unknown. Psychological disorders, including post-traumatic stress disorder, depression and anxiety following TBI are commonly reported comorbidities to post-traumatic pain. Long term consequences can be debilitating and affect quality of life even when the injury is mild. In this review, we present the most commonly reported chronic pain conditions across the spectrum of severity of TBI, mainly focusing on mild TBI. We discuss chronic post- traumatic headaches, widespread pain as well as post-traumatic central pain. We discuss pain in the context of injury severity and military versus civilian populations. We are only starting to understand the biological mechanisms behind post-traumatic pain and associated psychological distress following TBI, with genetic, biochemical and imaging studies pointing to the dopaminergic, neurotrophic factors and the role of Apolipoprotein. Physiological and neurological mechanisms are proposed to partially explain this interaction between post-traumatic pain and psychological distress. Nevertheless, the evidence for the role of structural brain damage remains incomplete and to a large extent debatable, as it is still difficult to establish clear causality between brain trauma and chronic pain. Finally, general aspects of management of chronic pain post-TBI are addressed.
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Background Many cancer survivors feel unprepared for the physical and psychosocial challenges that accompany the post-treatment care transition (i.e., re-entry phase), including management of cancer-related symptoms. Few studies have investigated personal and contextual factors associated with the extent of preparedness for re-entry or how they are related to cancer-related symptom management. PurposeData from the American Cancer Society’s Cancer Survivor Transition Study examined (1) characteristics of breast, prostate, and colorectal cancer survivors (n = 1188) within the first year of completing treatment who are most and least prepared for re-entry; and (2) how preparedness level and other characteristics are related to cancer-related symptom management. Methods Stanton and colleagues’ [1] conceptual model of survivorship guided the selection of interpersonal/environmental, individual, and disease/treatment-related characteristics as potential contributors to levels of preparedness and cancer-related symptom management using regression tree and multivariate linear regression analyses. ResultsSurvivors, on average, felt moderately prepared for the transition to post-treatment care. Lowest levels of preparedness were found among survivors with relatively high depressive symptoms, low perceived quality of oncology-provided survivorship care, and limited discussion about potential side effects with a health professional. Poorer symptom management was associated with younger age, having more comorbid conditions, and lower preparedness, social support, and spirituality. Conclusion Survivors who feel unprepared for the transition to post-treatment care report poorer cancer-related symptom management. Identification of factors associated with low perceived preparedness and poor cancer-related symptom management will assist in risk stratification and development of tailored interventions to meet the needs of cancer survivors during re-entry.
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Objective: The operant theory of chronic pain and related research suggest pain-related solicitous support promotes disability. The current study investigated the hypotheses that solicitous support is positively associated with both disability and relationship satisfaction and that these relationships are moderated by the level of desire for this type of support. Methods: Patients with chronic pain (N = 147) and in a relationship were recruited from a multidisciplinary pain treatment center. They provided self-reports of the amount of three types of pain-related support wanted and received (i.e., solicitous, encouragement, and suppression), disability, and relationship satisfaction. Results: A hierarchical regression analysis indicated that solicitous support received was not significantly associated with disability. However, a moderation effect was found regarding encouragement. Encouragement received was negatively associated with disability, and this relationship was strongest at lower levels of interest in encouragement. Solicitous support received had a large positive association with relationship satisfaction. Conclusions: The findings suggest the influence of pain-related support is more complex than suggested by the operant conditioning model of chronic pain, which emphasizes the possible detrimental impact of solicitous support. Further research is warranted regarding the potential relationship enhancing effects of solicitous support and the influence of encouragement on disability experienced by those with chronic pain.
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The demographic factors of sex, age, and race/ethnicity are well recognized as relevant to pain sensitivity and clinical pain expression. Of these, sex differences have been the most frequently studied, and most of the literature describes greater pain sensitivity for women. The other 2 factors have been less frequently evaluated, and current literature is not definitive. Taking advantage of the large Orofacial Pain: Prospective Evaluation and Risk Assessment (OPPERA) study cohort, we evaluated the association of sex, age, and self-reported race with 34 measures of pressure, mechanical, and thermal pain sensitivity encompassing threshold and suprathreshold perception. Women were significantly more pain-sensitive than men for 29 of 34 measures. Age effects were small, and only significant for 7 of 34 measures, however, the age range was limited (18-44 years of age). Race/ethnicity differences varied across groups and pain assessment type. Non-Hispanic white individuals were less pain-sensitive than African-American (for 21 of 34 measures), Hispanic (19 of 34), and Asian (6 of 34) individuals. No pain threshold measure showed significant racial differences, whereas several suprathreshold pain measures did. This suggests that racial differences are not related to tissue characteristics or inherent nociceptor sensitivity. Rather, the differences observed for suprathreshold pain ratings or tolerance are more likely related to differences in central nociceptive processing, including modulation imposed by cognitive, psychological, and/or affective factors. Perspective: The influence of sex, age, and race/ethnicity on various aspects of pain sensitivity, encompassing threshold and suprathreshold measures and multiple stimulus modalities, allows for a more complete evaluation of the relevance of these demographic factors to acute pain perception.
Article
Objective. To evaluate the effects of a spouse-assisted pain-coping skills training intervention on pain, psychological disability, physical disability, pain-coping, and pain behavior in patients with osteoarthritis (OA) of the knees. Methods. Eighty-eight OA patients with persistent knee pain were randomly assigned to 1 of 3 conditions: 1) spouse-assisted pain-coping skills training, (spouse-assisted CST), 2) a conventional CST intervention with no spouse involvement (CST), or 3) an arthritis education-spousal support (AE-SS) control condition. All treatment was carried out in 10 weekly, 2-hour group sessions. Results. Data analysis revealed that at the completion of treatment, patients in the spouse-assisted CST condition had significantly lower levels of pain, psychological disability, and pain behavior, and higher scores on measures of coping attempts, marital adjustment, and self-efficacy than patients in the AE-SS control condition. Compared to patients in the AE-SS control condition, patients who received CST without spouse involvement had significantly higher post-treatment levels of self-efficacy and marital adjustment and showed a tendency toward lower levels of pain and psychological disability and higher scores on measures of coping attempts and ratings of the perceived effectiveness of pain-coping strategies. Conclusion. These findings suggest that spouse-assisted CST has potential as a method for reducing pain and disability in OA patients.
Article
Objective. Ethnic groups may experience or report pain differently; thus, we compared ethnic differences on pain coping strategies and control beliefs, and the relationships of these variables to health status, among women with rheumatoid arthritis (RA). Methods. Using a sample of 100 women (48 African-American, 52 Caucasian), we related pain coping strategies and control beliefs to pain severity, activity levels, and affective state, controlling for socioeconomics, behavioral impairment, and disease activity. Results. Ethnic groups did not differ in pain severity or negative affect, but African-Americans were less physically active. African-Americans used more coping techniques involving diverting attention and praying/hoping; Caucasians used more coping techniques involving ignoring pain. The relationships of praying/hoping and reinterpreting pain to RA adjustment differed by ethnic group. In contrast, ignoring pain, coping statements, and stronger control beliefs predicted better health status, and diverting attention predicted more pain for all patients. Conclusion. There are ethnic differences in the use of coping strategies that should be acknowledged when helping RA patients cope with their disease, but control beliefs and several coping strategies predict pain and adjustment, regardless of ethnicity.
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Unlabelled: The recently proposed Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks (ACTTION)-American Pain Society (APS) Pain Taxonomy (AAPT) provides an evidence-based, multidimensional, chronic pain classification s