Dissociation proneness and pain hyposensitivity in current and remitted borderline personality disorder

Abstract

Background

Stress‐related dissociation has been shown to negatively co‐vary with pain perception in current borderline personality disorder (cBPD). While remission of the disorder (rBPD) is associated with normalized pain perception, it remains unclear whether dissociation proneness is still enhanced in this group and how this feature interacts with pain sensitivity.

Methods

Twenty‐five cBPD patients, 20 rBPD patients, and 24 healthy controls (HC) participated in an experiment using the script‐driven imagery approach. We presented a personalized stressful and neutral narrative. After listening to the scripts, dissociation and heat pain thresholds (HPT) were assessed.

Results

Compared to HC, cBPD patients showed enhanced dissociation and exhibited significantly enhanced HPT in the neutral condition, while rBPD participants were in between. After listening to the stress script, both clinical groups exhibited enhanced dissociation scores. Current BPD participants responded with significantly higher HPT, while rBPD only showed a trend in the same direction. However, both BPD groups showed significantly increased HPT compared to the HC in the stress condition, but did not differ from each other. Dissociation proneness correlated significantly positively with pain hyposensitivity only in cBPD.

Conclusion

Dissociation proneness is enhanced in both BPD groups. This feature is clearly positively related to pain hyposensitivity in cBPD, but not in rBPD. However, the data indicate that stress causes the pain perception in rBPD to drift away from that obtained in HC. These results highlight the volatile state of BPD remission and might have important implications for the care of BPD patients in the remitted stage.

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Breakthrough pain is not a fixed fraction of constant cancer pain

Abstract

This journal recently published a paper by Currow et al., entitled "A randomised, double‐blind, crossover, dose ranging study to determine the optimal dose of oral opioid to treat breakthrough pain for patients with advanced cancer already established on regular opioids” (Currow et al., 2010). Currow et al. demonstrated that for breakthrough pain (BTP) there were no differences between giving rescue opioids doses of 1/6, 1/8 or 1/12 of the scheduled daily opioid dose.

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Necessary Components of Psychological Treatment for Chronic Pain: More Packages for Groups or Process‐Based Therapy for Individuals?

Abstract

This journal recently published a paper by Sharpe et al., entitled “Necessary components of psychological treatments in chronic pain management programs: A Delphi study” (Sharpe, Jones, Ashton‐James, Nicholas, & Refshauge, 2020). These researcher sought the views of authors of relevant RCTs published up to September 2016 and supplemented these with input from psychologists working in pain management programs in Australia.

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Psychological and pain profiles in persons with patellofemoral pain as the primary symptom

Abstract

Background

Patellofemoral pain (PFP) is defined biomechanically, but is characterised by features that fit poorly within nociceptive pain. Mechanisms associated with central sensitisation may explain why, for some, symptoms appear nociplastic. This study compares psychological and somatosensory characteristics between those with persistent PFP and controls.

Methods

150 adults with PFP were compared to 61 controls. All participants completed a survey evaluating participant characteristics, PFP‐related constructs and psychological factors: anxiety, depression, pain catastrophizing, kinesiophobia, pain self‐efficacy. Participants also attended a session of somatosensory testing, which included knee and elbow thermal and mechanical detection and pain thresholds, conditioned pain modulation (CPM), and temporal summation of pain (TSP). Differences were evaluated using analysis of covariance (sex as covariate). Multivariate backward stepwise linear regression examined how psychological and somatosensory variables relate to PFP (Knee injury & Osteoarthritis Outcome Score‐patellofemoral).

Results

The PFP group had multimodal reduced pain thresholds at the knee and elbow (Standardised Mean Difference (SMD), p: 0.86 to 1.2, <0.001), reduced mechanical detection at the elbow (0.43, 0.01) and higher TSP (0.41, 0.01). CPM was not different. Psychological features demonstrated small effects (0.47‐0.59, 0.01‐0.04). The PFP group had a 55% (95% CI: 0.47 to 0.62) risk of kinesiophobia and an 11% (0.06 to 0.15) reduced pain self‐efficacy risk. Kinesiophobia, knee pressure pain threshold, pain self‐efficacy and pain catastrophizing explained 40% of KOOS‐PF variance (p = <0.001).

Conclusions

Widespread hyperalgesia and evidence of symptom amplification may reflect nociplastic pain. Clinicians should be aware that kinesiophobia and the nociplastic pain may characterise the condition.

Significance

(1) Individuals with patellofemoral pain have widespread reduced pain thresholds to pressure and thermal stimuli. (2) Mechanically‐induced pain is likely amplified in those with patellofemoral pain. (3) Pain‐related fear is highly prevalent and helps explain patellofemoral pain‐related disability.

What’s already known about this topic?

(1) Pressure pain threshold can be lower in individuals with patellofemoral pain.

What does this study add?

(1) This is the first study to explore a combined range of psychological and psychophysical tests in patellofemoral pain. (2) This study provides strong evidence of nociplastic pain in patellofemoral pain.

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Interpretation biases and visual attention in the processing of ambiguous information in chronic pain

Abstract

Background

Theories propose that interpretation biases and attentional biases might account for the maintenance of chronic pain symptoms, but the interactions between these two forms of biases in the context of chronic pain are understudied.

Methods

To fill this gap, sixty‐three participants (40 females) with and without chronic pain completed an interpretation bias task that measures participants’ interpretation styles in ambiguous scenarios and a novel eye‐tracking task where participants freely viewed neutral faces that were given ambiguous pain‐/health‐related labels (i.e., “doctor”, “patient” and “healthy people”). Eye movements were analysed with the Hidden Markov Models (EMHMM) approach, a machine‐learning data‐driven method that clusters people’s eye movements into different strategy subgroups.

Results

Adults with chronic pain endorsed more negative interpretations for scenarios related to immediate bodily injury and long‐term illness than healthy controls, but they did not differ significantly in terms of their eye movements on ambiguous faces. Across groups, people who interpreted illness‐related scenarios in a more negative way also focused more on the nose region and less on the eye region when looking at patients’ and healthy people’s faces and, to a lesser extent, doctors’ faces. This association between interpretive and attentional processing was particularly apparent in participants with chronic pain.

Conclusions

In sum, the present study provided evidence for the interplay between multiple forms of cognitive biases. Future studies should investigate whether this interaction might influence subsequent functioning in people with chronic pain.

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Lack of relationship between epidermal denervation by capsaicin and incisional pain behaviors: a laser scanning confocal microscopy study in rats

Abstract

Background

Spontaneous pain after surgical incision is a significant problem for most post‐operative patients. Pain management that relies on opioids is hindered by numerous side effects, fueling interest in non‐opioid alternatives and multimodal approaches. Subcutaneous capsaicin infiltration has shown potential for reducing post‐operative pain, but there are unanswered questions about safety and possible side effects. In adult rats, we characterized the analgesic effects of pre‐operative capsaicin infiltration into the skin prior to plantar incision and assessed wound healing and epidermal innervation.

Methods

The surgical site on the plantar surface of the rat hind paw was infiltrated with 1% capsaicin or vehicle 30 minutes or 1 week prior to surgical incision. Spontaneous and evoked pain behaviors were assessed. Digital images of incised hind paws were used to quantify the surface area of the wound after suture removal. Epidermal nerve fiber quantification was performed on peri‐incisional tissue biopsies.

Results

Intraplantar administration of capsaicin 30 minutes before surgical incision attenuated spontaneous pain behaviors, heat hyperalgesia, epidermal innervation, but it did not alter the rate of wound healing. Incisional pain hypersensitivity returned to baseline 2 weeks post‐incision, at a time when no recovery of epidermal innervation is observed.

Conclusions

Subcutaneous infiltration of capsaicin prior to surgical incision attenuated incision‐induced pain behaviors and reduced epidermal innervation around the incision site. The long‐lasting epidermal denervation by capsaicin had no impact in the rate of wound healing and recovery from pain behaviors.

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Global, regional, and national burden of neck pain in the general population, 1990-2017: systematic analysis of the Global Burden of Disease Study 2017

AbstractObjectiveTo use data from the Global Burden of Disease Study between 1990 and 2017 to report the rates and trends of point prevalence, annual incidence, and years lived with disability for...

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