Psychosocial predictors of acute and chronic pain in adolescents undergoing major musculoskeletal surgery

Acute and chronic pain are common experiences after major surgery. Compared to younger children, adolescents are at elevated risk for both acute and chronic pain following surgery.22,46 Negative consequences include delayed recovery and impaired health-related quality of life (HRQOL),45,47,49 making effective pain management a high priority. Despite high prevalence of acute pain (>50%)37,45 and chronic pain (20%),19,26,38,47,53 risk factors for postsurgical pain in youth remain largely unknown.51 Given the influence of a large range of biopsychosocial factors on development of chronic pain,14 it is possible that a different set of risk factors may predict acute versus chronic pain.

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Once an avoider always an avoider? Return of pain-related avoidance after extinction with response prevention

Contemporary theories emphasize the pivotal role of avoidance behaviour in the development and chronification of pain-related disability.24,43,44 Avoiding pain-related stimuli (e.g. movements) is adaptive when pain is acute, but persisting avoidance leads to functional disability through the disengagement from daily-life activities.43,44 Further, it prevents the disconfirmation of erroneous catastrophic beliefs21 and, paradoxically, maintains pain-related fear by conveying the message that a threat really exists.

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

Abstract

Background

Informal caregiving 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.

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Conditional expression of HIV‐1 Tat in the mouse alters the onset and progression of tonic, inflammatory, and neuropathic hypersensitivity in a sex‐dependent manner

Abstract

At least one third of HIV‐1‐afflicted individuals experience peripheral neuropathy. Although the underlying mechanisms are not known, they may involve neurotoxic HIV‐1 proteins. We assessed the influence of the neurotoxic HIV‐1 regulatory protein, Tat, on inflammatory and neuropathic nociceptive behaviors using transgenic male and female transgenic mice that conditionally expressed (or did not express) HIV‐1 Tat_1‐86 in glial fibrillary acidic protein‐expressing glia in the central and peripheral nervous systems. Tat induction significantly attenuated the time spent paw‐licking following formalin injection (2.5%, i.pl.) in both male and female mice. However, significant sex differences were observed in the onset and magnitude of inflammation and sensory sensitivity following complete Freund’s adjuvant (CFA) injection (10%, i.pl.) after Tat activation. Unlike female mice, males showed a significant attenuation of paw swelling and an absence of mechanical/thermal hypersensitivity in response to CFA after Tat induction. Male Tat(+) mice also showed accelerated recovery from chronic constrictive nerve injury (CCI)‐induced neuropathic mechanical and thermal hypersensitivity compared to female Tat(+) mice. Morphine (3.2 mg/kg) fully reversed CCI‐induced mechanical hypersensitivity in female Tat(−) mice, but not in Tat(+) females. The ability of Tat to decrease edema, paw swelling, and limit allodynia suggest a sequela of events in which Tat‐induced functional deficits precede the onset of mechanical hypersensitivity. Moreover, HIV‐1 Tat attenuated responses to inflammatory and neuropathic insults in a sex‐dependent manner. HIV‐1 Tat appears to directly contribute to HIV sensory neuropathy and reveals sex differences in HIV responsiveness and/or the underlying peripheral neuroinflammatory and nociceptive mechanisms.

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Sifting the wheat from the chaff? Evidence for the existence of an asymmetric fibromyalgia phenotype

Abstract

Background

The different phenotypic presentations of fibromyalgia (FM) have been infrequently studied and may have diagnostic and therapeutic implications. The aim of this study was to explore differences between FM patients with classical symmetric (s‐FM) presentation and FM patients with marked asymmetric (a‐FM) pain.

Methods

We performed two consecutive cross‐sectional studies on FM patients and matched healthy volunteers (HV). FM patients were divided into a‐FM (and s‐FM groups according to their score of pain intensity on each body side; patients with a difference of ≥ 40mm in VAS between left and right sides were classified as a‐FM, otherwise classified as s‐FM. Participants (FM=32; HV=31) were assessed for clinical, cortical excitability (CE), quantitative sensory testing (QST) (study 1), and intraepidermal nerve fiber density (IENFD) determinations (study 2).

Results

While pain intensity did not significantly differ between s‐FM and a‐FM patients, pain interference in daily activities was significantly higher in the a‐FM as compared to the s‐FM group (54.7±8.9 and 37.6±13.5; p<0.0001). PPT was significantly lower in the more painful side of a‐FM as compared to the HV (27.7±7.9 and 49.9±13.0; p<0.0001), while PPT in the less painful side of a‐FM was significantly higher than PPT values in the s‐FM (35.8±8.3 and 27.7±5.5; p=0.031). S‐FM and a‐FM had significantly abnormal intracortical inhibition values on CE measurements compared to HV. There were no significant differences in IENFD between groups.

Conclusions

Within the current FM criteria, there exist different phenotypes with clinical, psychophysics, and neurophysiological findings that are not related to peripheral IENFD abnormalities.

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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 responsive to acupuncture, need further address. This study is aim to investigate response‐time relationship and covariate effects of acupuncture.

Databases And Data Treatment

PubMed and EMBASE were searched up to December 2018 for randomised controlled trials that involved sham acupuncture, true acupuncture and conventional therapy. We used model‐based 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. Higher analgesic effect was related to higher baseline pain intensity and pain location of neck, shoulder and knee.

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Reconnecting the Brain with the Rest of the Body in Musculoskeletal Pain Research

Over the past few decades, pain research has greatly strengthened our view of chronic pain as a “disease of the brain.” However, as our knowledge about the role of the nervous system in chronic pain continues to expand, some disconnects are emerging between this knowledge and our understanding of peripheral tissue pathology, particularly for chronic musculoskeletal pain. This article will outline some important gaps that stand in the way of understanding chronic musculoskeletal pain, as well as areas where substantial knowledge exists but is “siloed” in different fields of medicine that need better integration.

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