Exploring the contextual role of pain severity as a moderator of the relationship between activity patterns and the physical and mental functioning of women with fibromyalgia

Abstract

Introduction

In past years, and mostly due to contextual psychological therapies, it has been argued that particular behavioral patterns may be useful in certain contexts, but not in others. The goal of this study has been to explore whether pain severity is indeed a contextual factor influencing the relationship between two controversial activity patterns, namely pacing and persistence, and functionality in people with fibromyalgia.

Methods

Participants were 231 women diagnosed with fibromyalgia. A multivariate regression was conducted to explore the moderating role of pain severity in the relationship between activity patterns and outcomes (i.e. fibromyalgia impact and depressive symptoms).

Results

Excessive persistence (interaction: t=‐2.45, p=0.015) and pain‐contingent persistence (interaction: t=‐2.13, p=0.034) were more strongly associated with fibromyalgia impact when people experienced less severe pain. Pacing for pain reduction was only significantly related to depressive symptoms at very severe (M=10) pain levels (interaction: β=‐0.18, t=‐2.73).

Conclusions

The results here reported suggest that the context in which behavior occurs is relevant when the utility of certain behavior patterns is considered. The clinical implications of this are clear, as it would justify adapting the recommendations given to patients according to their pain severity status.

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Systemic inflammatory markers in neck pain: A systematic review with meta‐analysis

Abstract

Background and Objective

Mechanisms underpinning symptoms in non‐traumatic neck pain (NTNP) and whiplash‐associated disorder (WAD) are not comprehensively understood. There is emerging evidence of systemic inflammation in musculoskeletal pain conditions, including neck and back pain. The aim of this systematic review was to determine if raised blood inflammatory markers are associated with neck pain.

Databases and Data Treatment

MEDLINE, EMBASE, Cochrane Library, CINAHL and Web of Science databases were searched. Two independent reviewers identified studies for inclusion and extracted data. Meta‐analysis was performed by random effects model to calculate standard mean differences (SMDs). Risk of bias of individual studies was assessed using the Newcastle–Ottawa Scale. Overall quality of evidence from meta‐analysis was assessed by Grades of Recommendation, Assessment, Development and Evaluation approach.

Results

In total, 10 studies were included comprising 706 participants. Three studies provided data for acute WAD, two for chronic WAD, four for chronic NTNP and one for chronic mixed WAD and NTNP. Meta‐analysis indicated increased interleukin 1β (SMD: 0.84 [95% CI 0.24, 1.44], p = .01, I² = 59%) and tumour necrosis factor α (SMD: 0.59 [0.09, 1.09], p = .02, I² = 45%) in chronic neck pain compared to controls, but no increase in monocyte chemoattractant protein‐1. Some inflammatory markers were associated with clinical variables (including pain intensity and disability). Quality of evidence was mostly low due to small samples and high heterogeneity.

Conclusions

Findings imply that raised blood inflammatory markers are present in chronic neck pain, which may represent an ongoing inflammatory process in this population.

Significance

This systematic review advances our understanding of neck pain pathophysiology by demonstrating the presence of systemic inflammation in chronic neck pain, in the form of raised IL‐1β and TNFα. Further, numerous inflammatory markers were associated with clinical variables, including pain intensity, disability and hyperalgesia. These findings imply that systemic inflammation may contribute to mechanisms underlying neck pain.

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Movement, posture and low back pain. How do they relate? A replicated single‐case design in 12 people with persistent, disabling low back pain

Abstract

Background

Movement and posture are commonly believed to relate to non‐specific low back pain (NSLBP). While people with NSLBP appear to move and posture themselves differently from those without NSLBP, changes in movement and posture infrequently relate to improvements in NSLBP when analysed at a group‐level. Additionally, little is known about how movement or posture change when clinical outcome improves.

Methods

Within‐person relationships were investigated using a replicated, repeated measures, single‐case design in 12 people with persistent, disabling NSLBP. Individually relevant movement and posture were captured using wearable sensors on up to 20 occasions over a 22‐week period (5‐week baseline, 12‐week physiotherapy‐led intervention, 5‐week follow‐up), while pain and activity limitation were collected concomitantly. A series of cross‐correlation analyses estimated the presence, strength, and direction of relationships.

Results

Many participants (n = 10/12) had strong (e.g. r = 0.91, p = <0.001) relationships between changes in movement or posture and changes in pain and activity limitation, while some showed no strong association. Where relationships were observed, clinical improvement predominantly (93% or 57/61 relationships) related to increased spinal movement range and velocity during forward bending and lifting, reduced lumbar muscle EMG activity at maximum voluntary flexion, and increased posterior‐pelvic‐tilt during sitting and standing.

Conclusion

Within‐person changes to individually relevant movement and posture appear to often relate to clinical outcome, but not always. When changes were related, movement and posture appear to return towards being ‘less protective’, however causal directions remain unknown. Important activities, movements, and postural parameters varied across the participants, highlighting the potential importance of individualized management.

Significance

Changes to individually relevant movement and posture appear to often relate to clinical outcome, but not always. Patient‐specific activities, and movement or postural parameters that related to improved pain and activity limitation, varied across the 12 participants, highlighting the potential importance of individualised management. Where clinical improvements were related to changes in movement or posture, participants consistently returned towards being ‘less protective’ (increased range and speed of movement, increased posterior‐pelvic‐tilt during sitting and standing). Mechanisms and generalizability remain unclear.

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Spinal manipulation for the management of cervicogenic headache: A systematic review and meta‐analysis

Abstract

Background

Spinal manipulative therapy (SMT) is frequently used to manage cervicogenic headache (CGHA). No meta‐analysis has investigated the effectiveness of SMT exclusively for CGHA.

Objective

To evaluate the effectiveness of SMT for CGHA.

Databases and Data Treatment

Five databases identified randomized controlled trials comparing SMT with other manual therapies. The PEDro scale assessed the risk‐of‐bias. Pain and disability data were extracted and converted to a common scale. A random effects model was used for several follow‐up periods. GRADE described the quality of evidence.

Results

Seven trials were eligible. At short‐term follow‐up, there was a significant, small effect favouring SMT for pain intensity (mean difference [MD] −10.88 [95% CI, −17.94, −3.82]) and small effects for pain frequency (standardized mean difference [SMD] −0.35 [95% CI, −0.66, −0.04]). There was no effect for pain duration (SMD − 0.08 [95% CI, −0.47, 0.32]). There was a significant, small effect favouring SMT for disability (MD − 13.31 [95% CI, −18.07, −8.56]). At intermediate follow‐up, there was no significant effects for pain intensity (MD − 9.77 [−24.21 to 4.68]) and a significant, small effect favouring SMT for pain frequency (SMD − 0.32 [−0.63 to − 0.00]). At long‐term follow‐up, there was no significant effects for pain intensity (MD − 0.76 [−5.89 to 4.37]) and for pain frequency (SMD − 0.37 [−0.84 to 0.10]).

Conclusion

For CGHA, SMT provides small, superior short‐term benefits for pain intensity, frequency and disability, but not pain duration, however, high‐quality evidence in this field is lacking. The long‐term impact is not significant.

Significance

CGHA are a common headache disorder. SMT can be considered an effective treatment modality, with this review suggesting it providing superior, small, short‐term effects for pain intensity, frequency and disability when compared with other manual therapies. These findings may help clinicians in practice better understand the treatment effects of SMT alone for CGHA.

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Sustained perturbation in functional connectivity induced by cold pain

Abstract

Background

Functional connectivity (FC) perturbations have been reported in multiple chronic pain phenotypes, but the nature of reported changes varies between cohorts and may relate to the consequences of living with chronic‐pain related comorbidities, such as anxiety and depression. Healthy volunteer studies provide opportunities to study the effects of tonic noxious stimulation independently of these sequelae. Connectivity changes in task negative and positive networks, for example, the default mode and salience networks (DMN/SN), respectively, have been described, but how these and other connectivity networks, for example, those governing descending pain control are affected by the presence of tonic, noxious stimulation in healthy, pain‐free individuals, remains unknown.

Method

In 20 healthy volunteers, we assessed FC prior to, during, and following tonic cold painful stimulation in the ventromedial prefrontal cortex (vmPFC), rostral anterior insula (rAI), subgenual anterior cingulate cortex (ACC) and periaqueductal grey (PAG). We also recorded subjectively reported pain using a computerised visual analogue scale.

Results

We saw DMN FC changes during painful stimulation and that inter‐network connectivity between the rAI with the vmPFC increased during pain, whereas PAG‐precuneus FC decreased. Pain‐induced FC alterations persisted following noxious stimulation. FC changes related to the magnitude of individuals' subjectively reported pain.

Conclusions

We demonstrate FC changes during and following tonic cold‐pain in healthy participants. Similarities between our findings and reports of patients with chronic pain suggest that some FC changes observed in these patients may relate to the presence of an ongoing afferent nociceptive drive.

Significance

How pain‐related resting state networks are affected by tonic cold‐pain remains unknown. We investigated functional connectivity alterations during and following tonic cold pain in healthy volunteers. Cold pain perturbed the functional connectivity of the ventro‐medial prefrontal cortex, anterior insula, and the periacquaductal grey area. These connectivity changes were associated with the magnitude of individuals’ reported pain. We suggest that some connectivity changes described in chronic pain patients may be due to an ongoing afferent peripheral drive.

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Nuisance mediators and missing data in mediation analyses of pain trials

European Journal of Pain, Volume 24, Issue 9, Page 1651-1652, October 2020.

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Pain memory in patients with chronic pain versus asymptomatic individuals: A prospective cohort study

Abstract

Background

The main objective of this study was to assess pain memory as well as long‐term episodic memory, both in patients with chronic pain (CP) and in asymptomatic participants (AP).

Methods

A prospective cohort study design was used. Sixty‐eight participants were divided into two groups: CP (n = 34) and AP (n = 34). The protocol consisted of taking eight tests, four painful provocation tests and four distracting tests, and completing a memory test on the order of the tests at the end of the experiment and at 1‐month post‐experiment.

Results

Patients with CP showed acceptable concordance in the classification, in ascending order from lower to higher pain perception, both post‐experiment and 1‐month post‐experiment (κ = 0.41–0.60, p < .001). No differences were found regarding recall of the order of the tests, but differences were found in painful tests isolated only post‐experiment in the CP group with a moderate effect size (p < .05, d = 0.77).

Conclusions

Patients with CP had a more reliable memory than AP in relation to the memory of the pain caused experimentally until at least 1 month after the experiment. Interspersing distraction tests appeared to result in increased complexity and difficulty in coding and decoding information in patients with CP, leading to similar reliable long‐term memory consolidation in comparison with AP.

Significance

Treatments directed towards chronic pain should consider the influence of painful memories and their establishment towards long‐term explicit episodic memories in patients with chronic pain, as well as the influence of cognitive‐evaluative and affective‐motivational variables on memory. Not causing pain while implementing a treatment whose objective is to reduce pain could reduce the probability of developing new painful memories in patients with chronic pain.

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Visual trajectory pattern as prognostic factors for neck pain

Abstract

Background

A novel approach capturing both temporal variation and pain intensity of neck pain is by visual trajectory patterns. Recently, both previous and expected visual trajectory patterns were identified as stronger predictors of outcome than traditional measures of pain history and psychological distress. Our aim was to examine patient characteristics within the various previous and expected patterns, relationship between the two patterns and predictive value of a variable combining the previous and expected patterns.

Methods

Patients with neck pain (n = 932) consulting chiropractors were included. Baseline measures included pain intensity, disability, psychological variables and symptom history and expectations. Participants reported global perceived effect after 12 weeks. Analyses included descriptive statistics and logistic regression.

Results

Pain intensity, disability, psychological and worse outcome expectations increased from a single pain episode to severe ongoing pain of previous and expected patterns. Having a severe pain history was associated with poor prognosis, particularly if combined with negative expectations. The variable combining previous and expected patterns had a discriminative ability similar to that of other predictors AUC = 0.64 (95% CI = 0.60–0–67) versus AUC = 0.66 (95% CI = 0.62–0.70). The model with highest discriminative ability was achieved when adding the combined patterns to other predictors AUC = 0.70 (95% CI = 0.66–0.73).

Conclusion

The study indicates that pain expectations are formed by pain history. The patients’ expectations were similar to or more optimistic compared with their pain history. The prognostic ability of the model including a simplified combination of previous and expected patterns, together with a few other predictors, suggests that the trajectory patterns might have potential for clinical use.

Significance

The dynamic nature of neck pain can be captured by visual illustrations of trajectory patterns. We report, that trajectory patterns of pain history and future expectations to some extent are related. The patterns also reflect a difference in severity assessed by higher degree of symptoms and distress. Moreover, the visual trajectory patterns predict outcome at 12‐weeks. Since the patterns are easily applicable, they might have potential as a clinical tool.

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Crying out in pain—A systematic review into the validity of vocalization as an indicator for pain

Abstract

Background

Vocalization is often used to assess pain, sometimes combined with other behaviours such as facial expressions. Contrary to facial expressions, however, for vocalization, there is little evidence available on the association with pain. The aim of this systematic review was to critically analyse the association between vocalization and pain, to explore if vocalizations can be used as a “stand‐alone” indicator for pain.

Methods

The search was performed according to the Prisma Guidelines for systematic reviews and meta‐analysis. The following terms were used: “Pain Measurement,” “Vocalization” and “Verbalization.” The study population included verbal and non‐verbal individuals, including older people and children. The search was performed in three different databases: PubMed, Embase and CINAHL. A total of 35 studies were selected for detailed investigation. Quality assessments were made using two grading systems: Grading of Recommendations Assessment Development and Evaluation system and the Newcastle‐Ottawa scale.

Results

An association between vocalization and pain was found in most studies, particularly when different types of vocalizations were included in the investigation. Different types of vocalization, but also different types of pain, shape this association. The association is observed within all groups of individuals, although age, amongst others, may have an influence on preferred type of vocalization.

Conclusions

There is an association between vocalization and pain. However, vocalization as a “stand‐alone” indicator for pain indicates only a limited aspect of this multifactorial phenomenon. Using vocalization as an indicator for pain may be more reliable if other pain indicators are also taken into account.

Significance

Vocalizations are frequently used in pain scales, although not yet thoroughly investigated as a “single indicator” for pain, like, e.g. facial expression. This review confirms the role of vocalizations in pain scales, and stresses that vocalizations might be more reliable if used in combination with other pain indicators.

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Examining what factors mediate treatment effect in chronic low back pain: A mediation analysis of a Cognitive Functional Therapy clinical trial

Abstract

Background

Cognitive Functional Therapy (CFT) is a physiotherapist‐led individualized intervention for people with people with non‐specific chronic low back pain (CLBP), involving biopsychosocial pain education, graded movement exposure and lifestyle coaching.

Methods

A multicentre randomized controlled trial (RCT), including 206 participants with CLBP in Ireland, supported CFT’s effectiveness for reducing disability, but not pain, compared to a group exercise and education intervention. In this study, causal mediation analysis was used to determine whether the effect of CFT on disability and the lack of effect on pain (relative to a group exercise and education intervention) is mediated by certain psychological and lifestyle factors. Hypothesized mediators measured were pain self‐efficacy, stress, fear of physical activity, coping, depression, anxiety and sleep, at 6 months. The outcomes measured were functional disability and pain intensity at 12 months.

Results

This causal mediation study shows that the majority of benefit of CFT (relative to a group exercise and education intervention) for disability is due to increasing pain self‐efficacy.

Conclusion

Conclusion: CFT did not improve the majority of the hypothesized mediators (stress, fear of physical activity, coping, depression, anxiety and sleep) and these mediators were not associated with either disability or pain. Unfortunately, the proportion of missing data in this study is substantial and these findings can only be considered hypothesis‐generating. Therefore, future research should examine replicating the results of this study to verify the role of self‐efficacy and other proposed mediators (e.g. stress, coping, sleep, fear) on clinical outcomes.

Significance

An exploration of seven potential mediators was undertaken to determine the effect of Cognitive Functional Therapy (CFT) on disability and pain intensity in individuals with chronic low back pain compared to a group exercise and education intervention. CFT improved pain self‐efficacy, which was associated with disability and pain outcomes. CFT did not improve the other six potential mediators (stress, fear of physical activity, coping, depression, anxiety and sleep) and these were not associated with disability or pain. The proportion of missing data in this study is substantial and these findings should be considered hypothesis‐generating only.

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Emotions matter: The role of emotional approach coping in chronic pain

Abstract

Background

Emotional approach coping (EAC) is a potentially adaptive emotion‐focused coping style that involves understanding or processing one's emotions and expressing them appropriately. Although EAC has been studied in various populations, little is known about this construct among people with chronic pain, including potential mediators such as negative affect, which might link EAC to pain‐related variables, and moderators of these relationships.

Methods

Participants (N = 670; 76% women; 30% older adults—age 60 or over) with chronic pain completed online the Emotional Approach Coping Scale and measures of pain severity, pain interference and negative affect. Analyses correlated EAC to pain severity and interference and tested whether gender and age group (older adults versus young/middle‐age adults) moderated the mediated relationships of EAC with pain‐related variables through negative affect.

Results

Findings reveal that higher EAC was associated with lower pain intensity through lower negative affect in the young/middle‐age portion of the sample, but not older adults. Also, higher EAC was associated with lower pain interference through lower negative affect among women in the sample, but not men. The associations of EAC to pain intensity and interference are small in magnitude, however, and should be considered preliminary.

Conclusion

EAC is associated with lower pain intensity in young/middle‐age adults and lower pain interference in women, and lower negative affect mediates these relationships. These results suggest the potential value of assessing and bolstering emotional approach coping processes in some people with chronic pain.

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Characterizing pain flares in adolescent inflammatory and non‐inflammatory musculoskeletal disorders: A qualitative study using an interpretative phenomenological approach

Abstract

Background

Adolescents with musculoskeletal disorders experience acute exacerbations in pain, colloquially called “pain flares” in adult literature. This study aimed to explore adolescents' lived experience of pain flares, including what pain flares are, why they occur, how they are managed and what lasting effects they have on adolescents.

Methods

A sample of 10 adolescents diagnosed with juvenile idiopathic arthritis or chronic idiopathic pain syndrome were recruited from a tertiary hospital in the UK. Data were collected using semi‐structured interviews and visual aids, and analysed using interpretative phenomenological analysis.

Results

Four broad themes were identified which describe as a journey of change from participants: (a) daily life with pain, where adolescents report a level of pain that is “normal” for them which they can tolerate and continue their daily routines around; (b) pre‐flare period, where adolescents begin to notice pain increasing beyond normal levels and employ preventative strategies to reduce the risk of symptoms developing into a flare; (c) flare period, where adolescents describe the symptoms, frequency, duration, impact and their attempts to manage flares; to their (d) post‐flare period, where symptoms begin to return to baseline levels and adolescents take actions to regain the level of normality experienced in daily life.

Conclusion

This study has identified a number of components of the pain flare experience. Findings show that pain flares are more than an increase in pain intensity; they are multi‐layered and require other features to change. These findings help to differentiate pain flares from typical fluctuations in pain.

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Parental (non‐)pain attending verbalizations moderate the relationship between child attention and memory bias for pain

Abstract

Background

Children's negatively biased pain‐related memories (i.e. recalling pain as being more intense or fearful than initially reported) have been recognized as a key factor in explaining child pain development. While mechanisms underlying children's pain memory development remain poorly understood, attention biases and parent language have been implicated in conceptual models. This study examined the association between child pain‐related attention and memory biases and the moderating role of parental pain and non‐pain attending verbalizations.

Methods

Participants were 51 school children and one of their parents. Probability of initial fixation and gaze duration to pain were assessed using eye tracking methodology. Children performed a cold pressor task (CPT) and reported on experienced pain intensity and pain‐related fear. A 3‐minute parent–child interaction upon CPT completion allowed measurement of parental pain and non‐pain attending verbalizations. Children's pain‐related memories were elicited 2 weeks later.

Results

Findings indicated that the relationship between maintained attention to pain and fear memory bias was moderated by parental non‐pain attending verbalizations such that higher gaze duration bias was positively associated with fear memory bias but only among children whose parents demonstrated low levels of non‐pain attending verbalizations. The opposite pattern was observed for children whose parents showed high levels of non‐pain attending verbalizations. No such effects were observed for child initial attention bias to pain, memory bias for pain and parental pain attending verbalizations.

Conclusions

Findings highlight the importance of parental and child pain‐related variables as well as their interaction in understanding negatively biased pain‐related memories.

Significance

This study on child pain memories is the first to highlight that characteristics of the social context, such as parental (non‐)pain‐related verbalizations, as well as factors related to the intra‐individual experience of pain, such as child attention bias to pain, should be studied jointly, as they interact with each other in their effect on the emergence of negatively biased memories of painful events.

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Assessing thermal sensitivity using transient heat and cold stimuli combined with a Bayesian adaptive method in a clinical setting: A proof of concept study

Abstract

Background

Quantitative sensory testing of thermal detection abilities is used as a clinical tool to assess the function of pain pathways. The most common procedure to assess thermal sensitivity, the ‘method of limits’, provides a quick but rough estimate of detection thresholds. Here, we investigate the potential of evaluating not only the threshold but also the slope of the psychometric functions for cold and warm detection.

Method

A convenience sample of 15 patients with diabetes mellitus (DM) and 15 age‐matched healthy controls (HC) was tested. Thirty brief (100 ms) stimuli of each modality were applied to the volar wrist and foot dorsum. Cold and warm stimuli were delivered with a Peltier thermode and a temperature‐controlled CO₂ laser, respectively. Stimulus intensities were dynamically selected using an adaptive Bayesian algorithm (psi method) maximizing information gain for threshold and slope estimation. ROC analyses were used to assess the ability of slopes, thresholds and the combination of both to discriminate between groups.

Results

Assessment of the slope and threshold of the psychometric function for thermal detection took about 10 min. The ability to detect warmth was not reduced in DM patients as compared to HC. Cold detection performance assessed using slope or threshold parameters separated DM from HC with good discriminative power. Discrimination was further increased when both parameters were used together (93% sensitivity and 87% specificity), indicating that they provide complementary information on patient status.

Conclusion

The psi method may be an interesting alternative to the classical method of limits for thermal QST.

Significance

Current QST protocols provide an incomplete and potentially biased estimate of sensory detection performance. We propose a method that estimates the slope and the threshold of the psychometric function, defining heat and cold sensory detection performance, in only a few minutes. Furthermore, we provide preliminary evidence that combining slope and threshold parameters of cold detection performance leads to a better discriminative ability than relying solely on the threshold.

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Trajectories of post‐surgical pain in infants admitted to neonatal intensive care

Abstract

Background

The aim of this study was (a) to statistically identify distinct trajectories of pain following surgery in infants less than 6 months of age, and (b) to compare these trajectories to descriptions of chronic pain in infants in the neonatal intensive care unit (NICU).

Methods

This was a retrospective medical record review of infants admitted to a NICU between 2008 and 2018 following surgery. All infants who underwent one major procedure to the abdomen or thorax and returned to the NICU following surgery were included. Pain was assessed regularly using a validated Pain Assessment Tool. Group‐based trajectory analysis was used to determine the trajectory of recovery from pain following surgery.

Results

A total of 726 infants were included in the study. A two‐group trajectory model, defined as typical and atypical pain trajectories, was selected. The typical group (n = 467) consisted of infants who had significantly fewer days (1.5 ± 2.3 vs 5.3 ± 5.5, p < .001) and recorded instances of pain (2.0 ± 3.4 vs 9.7 ± 10.5, p < .001) compared to infants in the atypical group (n = 259). The incidence of iatrogenic neonatal abstinence syndrome was greater in the atypical than the typical group (11% vs 5%, p = .001).

Conclusions

This study has revealed two distinct pain trajectories in infants after surgery. While recovery from pain occurs within days in the typical group, the atypical group demonstrates pain for a significantly longer period, often weeks and months following surgery. This latter group adheres closely to current descriptions of chronic pain in infants.

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Issue Information

European Journal of Pain, Volume 24, Issue 9, Page 1649-1650, October 2020.

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Reduced pain and analgesic use after acoustic binaural beats therapy in chronic pain ‐ A double‐blind randomized control cross‐over trial

Abstract

Background

Binaural Beats (BB) consist of two artificial acoustic stimuli with different frequency, presented simultaneously but independently to each ear. The human brain perceives and synchronizes to this frequency difference (entrainment). Aim of this study was to test the hypothesis that brain entrainment to a lower function rhythm, with BB application, can decrease pain perception and analgesic medication use, in chronic pain patients.

Methods

In a double blind, randomized, cross‐over trial, BB at 5Hz (theta rhythm) were applied for 30 minutes, under simultaneous electroencephalogram recordings, followed by liberal, on demand use by chronic pain patients for a week, compared to sham stimulation (SS). Pain as the main outcome (numeric scale, NRS), stress (STAI) and medication usage (defined daily doses, DDD) were assessed at baseline, 30 minutes and week's end.

Results

Perceived pain (NRS) was significantly reduced in BB intervention (5.6±2.3 to 3.4±2.6, p<0.001), compared to SS (5.2±2.1 to 4.8±2.3, p=0.78), during the first 30‐minute phase, as well as at the week's end (to 3.9±2.5 compared to 5.5±2.6 respectively, p<0.001). The mean EEG theta power at 5Hz was significantly increased only during BB application. Stress was significantly reduced at 30 minutes in both interventions but remained reduced only in the BB group at the week's end. Analgesic medication consumption (DDD, g) during the week was significantly less in the BB intervention (3.9±3.7 vs. 4.6±4.1, p<0.05), while reporting equal to SS mean levels of pain.

Conclusions

Acoustic BB reduced pain intensity, stress and analgesic use, compared to SS, in chronic pain patients.

Significance

This study provides evidence that theta rhythm binaural beats can alleviate pain intensity, both after a brief 30 minute and a longer one week on‐demand intervention. The subsequent significant reduction in analgesic medication consumption in chronic pain patients' daily living could offer a valuable tool, augmenting the effect of existing pain therapies.

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The impact of chronic pain on patients and spouses: Consequences on occupational status, distribution of household chores and care‐giving burden

Abstract

Background

Informal care‐giving by spouses has become frequent in chronic pain settings. However, the impact of pain on occupational, functional and health outcomes in spouses has not been systematically investigated.

Aims

The goal of the present study was to examine the impact of pain on both patient and spousal outcomes.

Methods

In the present study, the impact of chronic pain on 114 heterosexual dyads was explored (patients: 59% females, average age = 57.81 years, SD = 11.85; spouses: 41% females, average age = 57.32 years, SD = 12.15).

Results

Overall, both patients and spouses reported important consequences of pain on outcomes, including occupational status distribution of household chores and marital satisfaction). Almost 52% of spouses indicated a high‐to‐severe burden. A multivariate model with spouse and patient factors accounted for 37.8% of the variance of this burden. In the model, patient disability (β = 0.36, p = .002), spouses’ change in occupational status (β = 0.26, p = .002) and spousal perception of marital adjustment (β = −0.36, p < .001) were uniquely associated with burden.

Conclusions

The results indicate that the impact of chronic pain should be evaluated both for patients and spouses and point to patient and spouse factors that might contribute to spousal burden, which might help guide family interventions in a more effective manner.

Significance

Research has shown that chronic pain poses a significant burden on individuals, which increases their reliance on others for assistance. However, the burden of informal care‐giving assumed by spouses of patients with chronic pain has not been systematically investigated. This study offers new insights into the impact of chronic pain on patients and their spouses, which might provide empirical foundation for the development of new avenues for intervention aimed at promoting adjustment in patients with chronic pain and spouses who act as informal caregivers.

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The response‐time relationship and covariate effects of acupuncture for chronic pain: A systematic review and model‐based longitudinal meta‐analysis

Abstract

Background and Objective

Critical clinical questions regarding how soon and how long the analgesic effect will be achieved by acupuncture, as well as who will be responsive to acupuncture, need further address. The aim of the study was to investigate the response‐time relationship and covariate effects of acupuncture.

Databases and Data Treatment

PubMed and EMBASE were searched up to December 2018 for randomized controlled trials that involved sham acupuncture, true acupuncture and conventional therapy. We used a model‐based longitudinal meta‐analysis to characterize the response‐time profile of these treatments.

Results

Seventy‐seven randomized clinical trials involved chronic shoulder, neck, knee and low back pain were included. The response‐time analysis suggested that the treatment duration of acupuncture will be 5 weeks or more to achieve 80% of maximum analgesic effect. Moreover a lower baseline pain intensity and the location of low back pain resulted in a lower pain relief of acupuncture intervention. The absolute maximum analgesic effects of sham acupuncture and conventional therapy were 22.6 and 15.8 points at a 0–100 NRS scale. The absolute effect of true acupuncture was 26.1 points for low back pain (relative effect of 3.5 and 9.4 points to sham and conventional therapy), 34.9 points for other pain body locations (relative effect of 12.3 and 19.1 points to sham and conventional therapy), in patients with a baseline pain intensity of 60 points.

Conclusion

The treatment duration of acupuncture will not be less than 5 weeks to achieve 80% maximum analgesic effect. Higher analgesic effect was related to higher baseline pain intensity and pain location of neck, shoulder and knee.

Significance

Our systematic review and meta‐analysis provides the clear evidence for the treatment duration and significant related covariates of acupuncture intervention for chronic pain. These results provide useful suggestion for acupuncture intervention in clinical pain management.

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Prescription of exercises for the treatment of chronic pain along the continuum of nociplastic pain: a systematic review with meta‐analysis

Abstract

Background and Objective

To compare different exercise prescriptions for patients with chronic pain along the continuum of nociplastic pain: fibromyalgia, chronic whiplash‐associated disorders (CWAD), and chronic idiopathic neck pain (CINP).

Databases and Data Treatment

Randomized controlled trials comparing different exercise parameters were included. The search was performed in the databases Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, and PEDro. Data on the parameters for the physical exercise programs for pain management were extracted for analysis.

Results

Fifty studies with 3,562 participants were included. For fibromyalgia, both aerobic or strengthening exercises were similar and better than stretching exercises alone. Exercises could be performed in 50‐ to 60‐minute supervised sessions, 2 to 3 times a week, for 13 weeks or more. For CWAD, body awareness exercises were similar to combined exercises, and there was no difference in adding sling exercises to a strengthening exercise program. The exercises could be performed in 90‐minute supervised sessions, twice a week, for 10 to 16 weeks. For CINP, motor control exercises and nonspecific muscle strengthening had a similar effect. Exercises could be performed in 30‐ to 60‐minute supervised sessions, 2 to 3 times a week, for 7 to 12 weeks.

Conclusions

The choice of parameters regarding exercises should emphasize global exercises in nociplastic pain conditions (such as fibromyalgia and CWAD) and specific exercises in non‐nociplastic pain conditions (such as CINP) and be based on patient's preference and therapist's skills.

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Six‐year trends in postoperative prescribing and use of multimodal analgesics following total hip and knee arthroplasty: A single‐site observational study of pain management

Abstract

Background

Guidelines for acute postoperative pain management recommend administering analgesics in multimodal combination to facilitate synergistic benefit, reduce opioid requirements and decrease side‐effects. However, limited observational research has examined the extent to which multimodal analgesics are prescribed and administered postoperatively following joint replacement.

Methods

In this longitudinal study, we used three‐point prevalence surveys to observe the 6‐year trends in prescribing and use of multimodal analgesics on the orthopaedic wards of a single Australian private hospital. We collected baseline postoperative data from total hip and knee arthroplasty patients in May/June 2010 (Time 1, n = 86), and follow‐up data at 1 year (Time 2, n = 199) and 5 years (Time 3, n = 188). During the follow‐up, data on prescribing practices were presented to anaesthetists.

Results

We found a statistically significant increase in the prescribing (p < 0.001) and use (p < 0.001) of multimodal analgesics over time. The use of multimodal analgesics was associated with lower rest pain (p = 0.027) and clinically significant reduction in interference with activities (p < 0.001) and sleep (p < 0.001). However, dynamic pain was high and rescue opioids were likely under‐administered at all time points. Furthermore, while patients reported high levels of side‐effects, use of adjuvant medications was low.

Conclusions

We observed significant practice change in inpatient analgesic prescribing in favour of multimodal analgesia, in keeping with contemporary recommendations. Surveys, however, appeared to identify a clinical gap in the bedside assessment and management of breakthrough pain and medication side‐effects, requiring additional targeted interventions.

Significance

Evaluation of 6‐year trends in a large Australian metropolitan private hospital indicated substantial growth in postoperative multimodal analgesic prescribing. In the context of growing global awareness concerning multimodal analgesia, findings suggested diffusion of best‐evidence prescribing into clinical practice. Findings indicated the effects of postoperative multimodal analgesia in real‐world conditions outside of experimental trials. Postoperative multimodal analgesia in the clinical setting was only associated with a modest reduction in rest pain, but substantially reduced interference from pain on activities and sleep.

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The impact of parental contact upon cortical noxious‐related activity in human neonates

Abstract

Background

Neonates display strong behavioural, physiological and cortical responses to tissue‐damaging procedures. Parental contact can successfully regulate general behavioural and physiological reactivity of the infant, but it is not known whether it can influence noxious‐related activity in the brain. Brain activity is highly dependent upon maternal presence in animal models, and therefore this could be an important contextual factor in human infant pain‐related brain activity.

Methods

Global topographic analysis was used to identify the presence and inter‐group differences in noxious‐related activity in three separate parental contexts. EEG was recorded during a clinically required heel lance in three age and sex‐matched groups of neonates (a) while held by a parent in skin‐to‐skin (n = 9), (b) while held by a parent with clothing (n = 9) or (c) not held at all, but in individualized care (n = 9).

Results

The lance elicited a sequence of 4–5 event‐related potentials (ERPs), including the noxious ERP (nERP), which was smallest for infants held skin‐to‐skin and largest for infants held with clothing (p=0.016). The nERP was then followed by additional and divergent long‐latency ERPs (> 750 ms post‐lance), not previously described, in each of the groups, suggesting the engagement of different higher level cortical processes depending on parental contact.

Conclusions

These results show the importance of considering contextual factors in determining infant brain activity and reveal the powerful influence of parental contact upon noxious‐related activity across the developing human brain.

Significance

This observational study found that the way in which the neonatal brain processes a noxious stimulus is altered by the type of contact the infant has with their mother. Specifically, being held in skin‐to‐skin reduces the magnitude of noxious‐related cortical activity. This work has also shown that different neural mechanisms are engaged depending on the mother/infant context, suggesting maternal contact can change how a baby's brain processes a noxious stimulus.

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Comparison of five conditioned pain modulation paradigms and influencing personal factors in healthy adults

Abstract

Background

Conditioned pain modulation (CPM) methods are experimental procedures to assess presumed descending nociceptive modulatory pathways. Various CPM‐methods are currently used, making the comparison of results difficult. The aim of this study was to compare five conditioning stimuli and to evaluate the influencing effects of personal factors on CPM‐efficacy.

Methods

101 healthy pain‐free adults (50 males, 51 females) participated in this cross‐sectional study with repeated measures design. The CPM‐method consisted of hot water immersion (46°C, HWI), cold pressor test (12°C, CPT), cold pack application, and single and double ischemic occlusion as conditioning stimuli in randomized order. Pressure pain threshold was used as test stimulus at the mm. trapezius and quadriceps for all CPM‐protocols.

Results

All CPM‐protocols resulted in effective CPM, although cold pack application revealed smaller CPM‐magnitudes compared to all other methods at both muscles, except single ischemic occlusion at the m. quadriceps. A smaller CPM‐effect at the m. trapezius was shown when CPM was provoked by single ischemic occlusion compared to the CPT.

Chronic stress, gender, attentional focus, age, physical activity and perceived pain are all influencing factors, in various conditioning stimuli at the mm. trapezius and quadriceps.

Conclusions

CPT and HWI seem to be the most appropriate conditioned pain modulation paradigms for research settings, while single and double ischemic occlusion seem to be more useful for clinical settings. Influencing factors to be considered are gender, age, stress, physical activity, perceived pain and attentional focus to the conditioning stimulus, but depend on the test site and exerted method.

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The impact of parental contact upon cortical noxious‐related activity in human neonates

Abstract

Background

Neonates display strong behavioural, physiological and cortical responses to tissue‐damaging procedures. Parental contact can successfully regulate general behavioural and physiological reactivity of the infant, but it is not known whether it can influence noxious‐related activity in the brain. Brain activity is highly dependent upon maternal presence in animal models, and therefore this could be an important contextual factor in human infant pain‐related brain activity.

Methods

Global topographic analysis was used to identify the presence and inter‐group differences in noxious‐related activity in three separate parental contexts. EEG was recorded during a clinically required heel lance in three age and sex‐matched groups of neonates (a) while held by a parent in skin‐to‐skin (n = 9), (b) while held by a parent with clothing (n = 9) or (c) not held at all, but in individualized care (n = 9).

Results

The lance elicited a sequence of 4–5 event‐related potentials (ERPs), including the noxious ERP (nERP), which was smallest for infants held skin‐to‐skin and largest for infants held with clothing (p=0.016). The nERP was then followed by additional and divergent long‐latency ERPs (> 750 ms post‐lance), not previously described, in each of the groups, suggesting the engagement of different higher level cortical processes depending on parental contact.

Conclusions

These results show the importance of considering contextual factors in determining infant brain activity and reveal the powerful influence of parental contact upon noxious‐related activity across the developing human brain.

Significance

This observational study found that the way in which the neonatal brain processes a noxious stimulus is altered by the type of contact the infant has with their mother. Specifically, being held in skin‐to‐skin reduces the magnitude of noxious‐related cortical activity. This work has also shown that different neural mechanisms are engaged depending on the mother/infant context, suggesting maternal contact can change how a baby's brain processes a noxious stimulus.

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Overactivity assessment in chronic pain: the development and psychometric evaluation of a multifaceted self‐report assessment

Abstract

Background

Overactivity in the context of chronic pain (i.e. activity engagement that significantly exacerbates pain) is an important clinical issue that has gained empirical attention in the last decade. Current assessment concepts of overactivity tend to focus on frequency to quantify the severity of the pain behaviour. This study aimed to develop and validate a more comprehensive self‐assessment, the Overactivity in Persistent Pain Assessment (OPPA).

Methods

A sample of 333 individuals with chronic pain completed the OPPA. A subset of 202 individuals also completed a set of existing measures of pain‐related outcomes and activity patterns. The remaining 131 participants were provided with a second copy of the OPPA to fill in one week following their initial assessment.

Results

A principal component analysis confirmed that the OPPA items were best represented by a single construct. The OPPA was found to correlate with pain‐related measures in an expected way that is supported by both theory and qualitative data. When compared to existing overactivity measures, the OPPA was the only measure to contribute significantly to the regression models predicting higher levels of pain severity, more pain interference and lower levels of activity participation after controlling for age, gender and activity avoidance. In addition, the OPPA scale exhibited acceptable internal consistency and good test‐retest reliability.

Conclusion

The results of this study reinforce the potentially important role of overactivity in the maintenance of pain‐related suffering and supports a corresponding assessment tool with preliminary psychometric evidence for clinical and research applications.

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Overactivity assessment in chronic pain: the development and psychometric evaluation of a multifaceted self‐report assessment

Abstract

Background

Overactivity in the context of chronic pain (i.e. activity engagement that significantly exacerbates pain) is an important clinical issue that has gained empirical attention in the last decade. Current assessment concepts of overactivity tend to focus on frequency to quantify the severity of the pain behaviour. This study aimed to develop and validate a more comprehensive self‐assessment, the Overactivity in Persistent Pain Assessment (OPPA).

Methods

A sample of 333 individuals with chronic pain completed the OPPA. A subset of 202 individuals also completed a set of existing measures of pain‐related outcomes and activity patterns. The remaining 131 participants were provided with a second copy of the OPPA to fill in one week following their initial assessment.

Results

A principal component analysis confirmed that the OPPA items were best represented by a single construct. The OPPA was found to correlate with pain‐related measures in an expected way that is supported by both theory and qualitative data. When compared to existing overactivity measures, the OPPA was the only measure to contribute significantly to the regression models predicting higher levels of pain severity, more pain interference and lower levels of activity participation after controlling for age, gender and activity avoidance. In addition, the OPPA scale exhibited acceptable internal consistency and good test‐retest reliability.

Conclusion

The results of this study reinforce the potentially important role of overactivity in the maintenance of pain‐related suffering and supports a corresponding assessment tool with preliminary psychometric evidence for clinical and research applications.

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Blockade of Bradykinin Receptors or Angiotensin II Type 2 Receptor Prevents Paclitaxel‐Associated Acute Pain Syndrome in Mice

Abstract

Background

Paclitaxel (PCX) is the first‐line choice for the treatment of several types of cancer, including breast, ovarian and lung cancers. However, patients who receive even a single dose with PCX commonly develop mechanical and cold allodynia, a symptom known as PCX‐associated acute pain syndrome (P‐APS). Here we assessed possible involvement of kinin–kallikrein and renin‐angiotensin systems in P‐APS in mice.

Methods

Male mice C57Bl/6 wild type (WT) and knockouts for bradykinin receptors, B1 (B1^‐/‐) and B2 (B2^‐/‐), were used. Mechanical and cold allodynia were evaluated by using von Frey filaments and acetone test, respectively. P‐APS was induced by administration of PCX 4 mg/kg, i.v. ACE inhibitors (captopril and enalapril), antagonists for angiotensin II type 1 (losartan) and type 2 ([AT2R]; PD123319 and EMA 401) receptors were administrated prior the treatment with PCX. RT‐PCR was used to analyze the expression of mRNA for B1, B2 and AT2R receptors.

Results

Administration of PCX in B1^‐/‐ and B2^‐/‐ mice induced lower mechanical and cold allodynia compared to the WT. However, the pre‐treatment with ACE inhibitors reduced the development of mechanical and cold allodynia in P‐APS. Surprisingly, we found that mice pre‐treatment with the PD123319 or EMA401, but not losartan, prevented the development of mechanical and cold allodynia induced by PCX.

Conclusion

Our results demonstrated the involvement of bradykinin receptors B1 and B2 as well as AT2R in the induction of P‐APS in mice and suggest the use of AT2R antagonists as a potential therapy for the prevention of P‐APS in humans.

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Psychometric Properties of the Multidimensional Impression of Change in a Cohort of Pediatric Patients With Pain

Publication date: October 2020

Source: Archives of Physical Medicine and Rehabilitation, Volume 101, Issue 10

Author(s): Christine M. Gagnon, Paul Scholten, Diane Amstutz, Lauren Henderson, Gadi Revivo

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Longitudinal Monitoring of Pain Associated Distress With the Optimal Screening for Prediction of Referral and Outcome Yellow Flag Tool: Predicting Reduction in Pain Intensity and Disability

Publication date: October 2020

Source: Archives of Physical Medicine and Rehabilitation, Volume 101, Issue 10

Author(s): Steven Z. George, Cai Li, Sheng Luo, Maggie E. Horn, Trevor A. Lentz

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Discrete and Dynamic Postoperative Pain Catastrophizing Trajectories Across 6 Months: A Prospective Observational Study

Publication date: October 2020

Source: Archives of Physical Medicine and Rehabilitation, Volume 101, Issue 10

Author(s): Nicholas A. Giordano, Alexandra Kane, Kalyn C. Jannace, Winifred Rojas, Mary Jo Lindl, Eugenio Lujan, Harold Gelfand, Michael L. Kent, Krista B. Highland

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Comparison of the Effects of Vapocoolant Spray and Topical Anesthetic Cream on Pain During Intraarticular Injection of the Shoulder: A Randomized Double-Blind Controlled Trial

Publication date: October 2020

Source: Archives of Physical Medicine and Rehabilitation, Volume 101, Issue 10

Author(s): Young-Eun Moon, Sang-Hyun Kim, Hyun Seok, Seung Yeol Lee

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Factors associated with physician consultation and medication use in children and adolescents with chronic pain: A scoping review and original data

Abstract

Background

Although pediatric chronic pain is common, it is not yet clear which individuals with chronic pain are likely to seek health care for their pain. The aims of this study were to summarize the current evidence of characteristics of children and adolescents with chronic pain who consult a physician or use medication for their pain. Additionally, we aimed to expand knowledge by further investigating key, and promising, factors in a large community sample of adolescents.

Methods

Firstly, using scoping review methodology, studies on health care utilization in paediatric chronic pain were identified by systematic literature search. Out of 1158 articles, 12 were included for data extraction. Secondly, in a population‐based cross‐sectional survey, data of N=2280 adolescents (10‐18 years), and their parents (N=1464), were analyzed. Univariable logistic and multivariable LASSO regression models were calculated for adolescents with chronic pain (n=749) to identify predictors of physician visits or analgesics intake due to pain, controlling for acute illness and injury.

Results

The scoping review identified higher pain intensity, frequency, severity and pain‐related disability as significant individual factors associated with physician consultation. Female sex and higher pain intensity were associated with medication consumption. Multivariable analyses with cross‐sectional data revealed only pain‐related school absence to be associated with physician consultation; analgesic medication use was associated with school absence and higher pain intensity.

Conclusion

Original data from this study support prior findings. School absence and pain intensity, plausible surrogates for pain severity, are the most relevant factors in health care utilization due to chronic pain.

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Pain, Sensitization, and physical performances in patients with chronic painful knee osteoarthritis or chronic pain following total knee arthroplasty: an explorative study

Abstract

Background

The aim of this study was to assess clinical pain, pain sensitization, and physical performances to profile patients with chronic painful knee osteoarthritis (OA) or pain after total knee arthroplasty (TKA). Examining the interactions between pain mechanisms and physical performances would enable us to investigate the underlying explanatory relationships between these parameters.

Methods

In this explorative study, 70 patients with chronic painful knee OA (N=46) or chronic pain after TKA (N=24) were assessed for clinical pain, quantitative sensory profiling (mechanical pinprick pain sensitivity, temporal summation (TS), and conditioned pain modulation), physical performances (chair stand, walk, and stair climb tests), and self‐reported outcomes. Between‐group comparisons were made using ANCOVA tests and associations between outcomes were analyzed using multivariate linear regression models.

Results

Overall, no differences between groups regarding clinical pain and quantitative sensory profiling outcomes were observed. Physical performances were lower in the TKA group compared with the OA group with moderate‐to‐large effect sizes, and a tendency towards better scores in self‐reported outcomes for the OA group was observed with small‐to‐moderate effect sizes. Self‐reported function seems to be associated with physical performances in the TKA group. Sensitization (TS) appears to be associated with poorer physical performances in the OA group.

Conclusions

Similar profiles for pain intensity, signs of sensitization, and conditioned pain modulation were observed. Patients with TKA seem to have impaired physical performance compared with the OA group, underlining the importance of targeting physical performances. Only the OA patients showed an association between sensitization (TS) and physical performance.

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The effect of in‐session exposure in Fear‐Avoidance treatment of chronic low back pain: A randomized controlled trial

Abstract

Background

Treatment based on the Fear‐Avoidance (FA) model has been found to be effective with chronic low back pain (CLBP), and in‐vivo exposure of fear evoking movements is proposed as a key change mechanism. Exposure tasks may be conducted in the session (in‐session exposure; ISE), in other real life situations (between sessions exposure) as part of homework assignments, or both. Utilizing a randomized, controlled dismantling study design, the aim of this study was to examine the unique effects of ISE in FA‐treatment of CLBP.

Methods

Patients (N = 90) with CLBP as primary medical complaint were randomized to receive six sessions of either a) FA‐treatment with ISE (FA‐ISE) or b) FA‐treatment without ISE (FA), allowing for between sessions exposure in both treatment groups. Patients were assessed with a large battery of outcome measures at four time‐points (pre‐treatment, post‐treatment, after a booster‐session and at 1 year follow‐up) including pain intensity, pain catastrophizing, self‐efficacy, physical performance and quality of life.

Results

Both treatment groups (FA‐ISE, FA) demonstrated statistically significant improvements on primary and most secondary outcomes, with mostly non‐significant between‐group differences.

Conclusions

No added benefit was found for the inclusion of ISE of feared movements in FA‐treatment for CLBP, delivered in a group format to participants with moderate elevated levels of fear‐avoidance beliefs.

Significance

This study adds to the existing research literature demonstrating FA‐treatment to be effective with CLBP, but further experimental studies are needed in order to examine under what circumstances ISE of feared movements may add to positive treatment outcomes.

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Physiologic osteoclasts are not sufficient to induce skeletal pain in mice

Abstract

Background

Increased bone resorption is driven by augmented osteoclast activity in pathological states of the bone, including osteoporosis, fracture, and metastatic bone cancer. Pain is a frequent co‐morbidity in bone pathologies, and adequate pain management is necessary for symptomatic relief. Bone cancer is associated with severe skeletal pain and dysregulated bone remodeling, while increased osteoclast activity and bone pain are also observed in osteoporosis and during fracture repair. However, the effects of altered osteoclast activity and bone resorption on nociceptive processing of bone afferents remains unclear.

Methods

This study investigates whether physiologic osteoclasts and resulting changes in bone resorption can induce skeletal pain. We first assessed correlation between changes in bone microarchitecture (through µCT) and skeletal pain using standardised behavioural phenotyping assays in a mouse model of metastatic bone cancer. We then investigated whether increased activity of physiologic osteoclasts, and the associated bone resorption, is sufficient to induce skeletal pain using mouse models of localized and widespread bone resorption following administration of exogenous receptor activator of nuclear factor kappa B ligand (RANKL).

Results

Our data demonstrates that mice with bone cancer exhibit progressive pain behaviours that correlate with increased bone resorption at the tumour site. Systemic RANKL injections enhance osteoclast activity and associated bone resorption, without producing any changes in motor function or pain behaviours at both early and late timepoints.

Conclusion

These findings suggest activation of homeostatic osteoclasts alone is not sufficient to induce skeletal pain in mice.

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Letter to the Editor on “Chronic Pain Self-Management Support With Pain Science Education and Exercise (COMMENCE) for People With Chronic Pain and Multiple Comorbidities: A Randomized Controlled Trial”

Publication date: Available online 19 September 2020

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Erika T. Yih, Julie K. Silver

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How the giant stinging tree of Australia can inflict months of agony

Nature, Published online: 17 September 2020; doi:10.1038/d41586-020-02668-9

A new type of peptide produces pain so intense that sometimes even morphine cannot quell it.

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High individual pain variability in people living with HIV: a graphical analysis

Abstract

Background

People living with HIV (PLWH) frequently experience pain. Following calls to analyze individual‐level data in addition to group‐level data in pain studies, we compared individual and group‐level changes in pain prevalence, intensity and number of pain sites over 48‐weeks in a large cohort of PLWH. This is the largest ever cohort study of pain in PLWH, and is the first to report pain at the level of the individual.

Methods

Participants included all participants with complete pain records from a randomized clinical trial (RCT) for the treatment of HIV (n = 787/1053). At weeks 0, 12, 24, 36 and 48 we assessed participants’ pain in the last week; presence of pain, and if present, the intensity and locations of the pain. We used standard averaging methods to describe data at the group‐level, and unique graphical reporting methods to analyse data at the level of the individual.

Results

Group‐level data demonstrated a trend for pain prevalence to decline over time (19% week 0, 12% week 48). Worst pain intensity remained stable (median between 4/10 and 5/10), as did the number (median = 1) and common sites of pain across the 48 weeks. In contrast, individual‐level data demonstrated high intra‐individual variability with regards to the presence of pain, and the intensity and location of the pain.

Conclusions

While our group‐level data were similar to previous longitudinal studies, an apparent reduction in pain over 48 weeks, the individual‐level data showed large variability within individuals in that same time frame.

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I. Indices of Pain Intensity derived from Ecological Momentary Assessments: Rationale and Stakeholder Preferences

Pain assessment that fully represents patients’ experiences with pain is essential for chronic pain research and management. Self-reports of pain intensity represent the primary outcome in most pain clinical trials and are nearly universally assessed during patient encounters15,28,46. However, it is widely acknowledged that current pain measurement can and should be improved22,46. There are various aspects of pain that can provide information of diagnostic importance and that can reflect change due to treatment.

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Transcranial direct current stimulation accelerates the onset of exercise-induced hypoalgesia: a randomised controlled study

Exercise-induced hypoalgesia (EIH) describes a transient reduction in pain intensity and sensitivity that follows a single bout of exercise.40 This hypoalgesic response is one mechanism thought to underpin the success of exercise as a conservative treatment for musculoskeletal pain.71 Indeed, there is some evidence demonstrating that short-term pain relief following exercise increases confidence and adherence to regular activity.41,54,74 However, accumulating evidence suggests that a single bout of exercise produces weak or inconsistent effects on pain sensitivity in patients with persistent pain.

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Ecological Momentary Assessment of Social Interactions: Associations with Depression, Anxiety, Pain, and Fatigue in Individuals with Mild Stroke

Publication date: Available online 9 September 2020

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Anna J. Neff, Yejin Lee, Christopher L. Metts, Alex W.K. Wong

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Chronic chest pain in a 29 year old man

This anteroposterior computed tomography reconstruction scan (fig 1) shows polyostotic fibrous dysplasia in a 29 year old man. He was first seen at age 21 with recurrent left chest pain, which was...

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Prevalence and Incidence of Phantom Limb Pain, Phantom Limb Sensations and Telescoping in Amputees: A Systematic Rapid Review

Abstract

Background and Objective

This systematic, rapid review aimed to critically appraise and synthesise the recent literature (2014‐2019) evaluating the incidence and prevalence of post‐amputation phantom limb pain (PLP) and sensation (PLS).

Databases and Data Treatment

Five databases (Medline, Embase, Emcare, PsychInfo, Web of Science) and Google Scholar were searched, with two independent reviewers completing eligibility screening, risk of bias assessment, and data extraction.

Results

The search identified 1350 studies with 12 cross‐sectional and 3 prospective studies included. Studies evaluated traumatic (n=5), atraumatic (n=4), and combined traumatic/atraumatic (n=6) amputee populations, ranging from one month to 33 years post‐amputation. Study heterogeneity prevented data pooling. The majority of studies had a high risk of bias, primarily due to limited generalisability. Three studies evaluated PLP incidence, ranging from 2.2% (atraumatic; one month) to 41% (combined; three months) and 82% (combined; 12 months). Only one study evaluated PLS/telescoping incidence. Across contrasting populations, PLP point prevalence was between 6.7%‐88.1%, one to three‐month period prevalence was between 49%‐93.5%, and lifetime prevalence was high at 76%‐87%. Point prevalence of PLS was 32.4%‐90%, period prevalence was 65% (one month) and 56.9% (three month), and lifetime prevalence was 87%. Telescoping was less prevalent, highest amongst traumatic amputees (24.6%) within a one‐month prevalence period. Variations in population type (e.g., amputation characteristics) and incidence and prevalence measures likely influence the large variability seen here.

Conclusions

This review found that lifetime prevalence was the highest, with most individuals experiencing some type of phantom phenomena at some point post‐amputation.

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Altered brainstem pain modulating circuitry functional connectivity in chronic painful Temporomandibular Disorder

It is well established from preclinical studies that the brainstem contains multiple circuits that can modulate incoming nociceptive information. For example, regions such as the midbrain periaqueductal gray (PAG), the rostral ventromedial medulla (RVM), the locus coeruleus (LC), and the subnucleus reticularis dorsalis (SRD) can directly and indirectly inhibit and facilitate activity at the primary nociceptive synapse and thus influence nociceptive transmission to higher brain areas.5,7,22,35,47 Spontaneous activity within this network, particularly within the RVM, is dynamic and can fluctuate between inhibitory and facilitatory outputs even on short timescales in the order of seconds and minutes.

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Association between quadrivalent human papillomavirus vaccination and selected syndromes with autonomic dysfunction in Danish females: population based, self-controlled, case series analysis

AbstractObjectiveTo evaluate the association between quadrivalent human papillomavirus vaccination and syndromes with autonomic dysfunction, such as chronic fatigue syndrome, complex regional pain...

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The Effectiveness of Parental Distraction During Children’s Acute Pain: The Moderating Effect of Socioeconomic Status

Abstract

Background

Parental responses to children’s pain shape how children interpret and cope with pain symptoms through parental modeling and operant conditioning. Evidence suggests that parental distraction is effective in reducing children’s acute pain responses, but findings are inconsistent across pain tolerance, intensity, and unpleasantness, and are limited to samples of primarily middle and upper‐middle class families. Although socioeconomically disadvantaged families may have fewer psychological resources to cope with pain, no studies have examined whether the utility of parent distraction varies by family socioeconomic status (SES). The current study tested the hypothesis that relations between parental distraction and acute pain responses in children vary by family SES, with children from higher versus lower SES families experiencing more substantial benefits.

Methods

Children’s pain symptoms and parents’ use of verbal distraction during a cold pressor task were examined in a community sample of 530 twin children aged 7‐12 years old and their primary caregivers.

Results

Parental distraction was positively associated with children‘s pain tolerance and unrelated to intensity and unpleasantness, but these associations are qualified by significant moderation. In families with higher SES, parental distraction was an effective technique in children’s pain management, associated with more pain tolerance, and less pain intensity and unpleasantness. However, for families with lower SES, these same benefits were not present.

Conclusions

Findings suggest that the effectiveness of parental distraction for children’s acute pain may depend on family SES.

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Perceived validation and criticism in pain: development of a new measure in chronic pain

ABSTRACT

Background

Research suggests that the way others react to a pain flare‐up impacts on psychological and pain‐related symptoms in chronic pain (CP). Experiencing validation from others is associated with less negative emotions and better functioning. Contrarily, experiencing criticism is linked to greater pain intensity and worse functioning. Nonetheless, studies are limited by an exclusive focus on spouses rather than significant other relationships, the use of proxy constructs (e.g., social support, responsiveness, solicitousness) rather than specific measures of validation and criticism, and a focus on significant others′ behavior rather than patients′ subjective experience. This study examines the psychometric properties of a new measure ‐ Perceived Validation and Criticism in Pain Questionnaire (PVCPQ), and tests its contribution to functional impairment beyond pain intensity, sociodemographic and medical‐related variables, positive and negative affect, safeness, and compassion from others.

Methods

Women with CP (N=172), 130 (75.6%) of whom had fibromyalgia, completed an online battery of questionnaires (PVCPQ; numeric pain rating scale; work and social adjustment scale; positive and negative affect schedule; social and pleasure scale; compassionate engagement and action scale). Exploratory factor analysis (EFA), reliability analysis, correlational analysis and hierarchical regression analysis were performed.

Results

EFA showed a 23‐item two‐factor solution with good psychometric properties. Criticism in pain (but not validation in pain) contributed to functional impairment above and beyond the variance explained by pain intensity, sociodemographic and medical variables, positive and negative affect, safeness and compassion from others.

Conclusions

These findings suggest that the PVCPQ is a psychometrically valid new measure of perceived validation and criticism in pain that contributes to explaining pain‐related functional impairment.

from Wiley: European Journal of Pain: Table of Contents https://ift.tt/3jDq2Gn
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