Does cognitive functioning predict chronic pain in older adult? Results from the CoLaus|PsyCoLaus longitudinal study

Chronic pain (CP) affects more than 30% of people aged 65 and older, and its prevalence increases with increasing age 10. Pain in older adults is often more persistent than in younger ones 18. Regarding the cognitive domains associated with aging, the most important changes are the decrease in processing speed, working memory and executive functions 36,29. In addition, pain-related impairments in several cognitive domains including learning and memory, attention and executive function, processing speed, and psychomotor ability have been reported in various cross-sectional observational studies 2,28,7,24.

from The Journal of Pain https://ift.tt/3kk6dWq
via IFTTT

Challenges and opportunities in translational pain research – An opinion paper of the working group on translational pain research of the European pain federation (EFIC)

Abstract

For decades, basic research on the underlying mechanisms of nociception has held promise to translate into efficacious treatments for patients with pain. Despite great improvement in the understanding of pain physiology and pathophysiology, translation to novel, effective treatments for acute and chronic pain has however been limited, and they remain an unmet medical need. In this opinion paper bringing together pain researchers from very different disciplines, the opportunities and challenges of translational pain research are discussed. The many factors that may prevent the successful translation of bench observations into useful and effective clinical applications are reviewed, including interspecies differences, limited validity of currently available preclinical disease models of pain, and limitations of currently used methods to assess nociception and pain in non‐human and human models of pain. Many paths are explored to address these issues, including the backward translation of observations made in patients and human volunteers into new disease models that are more clinically relevant, improved generalization by taking into account age and sex differences, and the integration of psychobiology into translational pain research. Finally, it is argued that preclinical and clinical stages of developing new treatments for pain can be improved by better preclinical models of pathological pain conditions alongside revised methods to assess treatment‐induced effects on nociception in human and non‐human animals.

Significance:

For decades, basic research of the underlying mechanisms of nociception has held promise to translate into efficacious treatments for patients with pain. Despite great improvement in the understanding of pain physiology and pathophysiology, translation to novel, effective treatments for acute and chronic pain has however been limited, and they remain an unmet medical need.

from Wiley: European Journal of Pain: Table of Contents https://ift.tt/3snjboV
via IFTTT

Nociceptor Overexpression of NaV1.7 Contributes to Chronic Muscle Pain Induced by Early-Life Stress

Chronic musculoskeletal pain syndromes are extremely common and increase in incidence with age, affecting ∼40% of Americans over the age of 65 years.39 They are associated with a marked decrease in quality of life 48 and high economic cost, related to health care expenses, compensation and disability.18 While several studies have shown that a history of early-life stress is an important risk factor for chronic musculoskeletal pain,14,22,37,51,56,66 the mechanisms underlying this relationship remain poorly understood.

from The Journal of Pain https://ift.tt/3qRYzVB
via IFTTT

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

Publication date: March 2021

Source: Archives of Physical Medicine and Rehabilitation, Volume 102, Issue 3

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

from ScienceDirect Publication: Archives of Physical Medicine and Rehabilitation https://ift.tt/2DQg3yu
via IFTTT

Treating Heel Pain in Adults: A Randomized Controlled Trial of Hard vs Modified Soft Custom Orthotics and Heel Pads

Publication date: March 2021

Source: Archives of Physical Medicine and Rehabilitation, Volume 102, Issue 3

Author(s): Deborah A.R. Seligman, Deirdre Dawson, David L. Streiner, David J. Seligman, Aileen Davis

from ScienceDirect Publication: Archives of Physical Medicine and Rehabilitation https://ift.tt/35EdBWI
via IFTTT

Development and Validation of the Brief Assessment of Distress about Pain

Abstract

Background

The experience of pain is a complex interaction of somatic, behavioral, affective, and cognitive components. Negative psychological states (e.g., anxiety, fear, and depression) are intertwined with pain and contribute to poorer outcomes for individuals suffering from chronic and acute pain by exacerbating the overall experience of pain and leading to increased dysfunction, disability, and distress. A need exists for efficient assessment of aversive emotional states that are associated with pain.

Methods

A multi‐stage developmental process included expert judges, two undergraduate samples, and a chronic pain sample. The 4‐item Brief Assessment of Distress about Pain (BADP) scale was developed, assessing anxiety, fear, and depression related to pain, as well as an overall evaluation of distress about pain.

Results

Principal components analyses indicated that the BADP consisted of one factor; inter‐scale correlation coefficients revealed that the BADP was highly related to other measures that assess similar constructs, suggesting evidence for convergent validity. Intra‐scale correlation coefficients indicated that the items of the BADP were only moderately associated with each other. Findings also supported evidence for discriminative validity, test‐retest reliability, and internal consistency of the BADP.

Conclusions

The BADP has good psychometric properties as a measure of negative affectivity related to pain. The scale’s single negative affectivity item may be useful for screening. The BADP helps address a gap in the literature with regard to a brief measure assessing fear, anxiety, depression, and negative affect in relation to pain. Demonstrated utility in a patient sample indicates the measure is suitable for further clinical study.

from Wiley: European Journal of Pain: Table of Contents https://ift.tt/3pV8qJb
via IFTTT

Long‐term outcomes of children with severe chronic pain: Comparison of former patients with a community sample

Abstract

Background

Findings on the short‐ and long‐term effectiveness of intensive interdisciplinary pain treatment (IIPT) for children with severe chronic functional pain are promising. However, a definitive appraisal of long‐term effectiveness cannot be made due to a lack of comparison groups. The aim of the present study was to compare the health status of former patients with the health status of an age‐ and sex‐matched comparison group from the community.

Methods

Data from two samples, a clinical sample of former patients (n=162; aged 14 to 26) and an age‐ and sex‐matched community sample (n=162), were analyzed. Former patients provided data seven years after IIPT. Pain characteristics, physical and mental health status, autonomy, coping and health care utilization were compared between the two samples.

Results

Seven years after treatment, the majority (58%) of the clinical sample were completely pain‐free. Compared to the community sample, the clinical sample demonstrated worse physical and mental health and continued to seek more frequent health care, irrespective of whether or not they experienced ongoing chronic pain. However, the clinical sample reported better coping strategies and a comparable level of autonomy.

Conclusion

Patients experiencing severe chronic pain in childhood who engage in IIPT are likely to have recovered from their pain in early adulthood. Long‐term treatment effects may manifest in better coping strategies. However, reduced mental and physical health status may indicate a negative long‐term effect of early chronic pain experiences or a general vulnerability in people developing a chronic pain condition in childhood.

from Wiley: European Journal of Pain: Table of Contents https://ift.tt/3qPHxY9
via IFTTT

‘External timing’ of placebo analgesia in an experimental model of sustained pain

Abstract

Background

Research on placebo analgesia commonly focuses on the impact of information about direction (i.e. increase or decrease of pain) and magnitude of the expected analgesic effect whereas temporal aspects of expectations have received little attention so far. In a recent study using short‐lasting, low‐intensity stimuli we demonstrated that placebo analgesia onset is influenced by temporal information. Here, we investigate whether the same effect of temporal suggestions can be found in longer lasting, high‐intensity pain in a Cold Pressor Test (CPT).

Methods

Fifty‐three healthy volunteers were allocated to one of three groups. Participants were informed that the application of an (inert‐)cream would reduce pain after 5 minutes (P5) or 30 minutes (P30). The third group was informed that the cream only had hydrating properties (NE). All participants completed the CPT at baseline, and 10 (Test10) and 35 minutes (Test35) following cream application. Percentage change in exposure time (pain tolerance) from baseline to Test10 (Δ₁₀) and to Test35 (Δ₃₅) as well as changes in heart rate (HR) during CPT were compared between the three groups.

Results

Δ ₁₀ was greater in P5 than in NE and P30, indicating that analgesia was only present in the group that was expecting an early onset of analgesia. Δ ₃₅ was greater in P5 and P30 compared to NE, reflecting a delayed onset of analgesia in P30 and maintained analgesia in P5. HR differences between groups were not significant.

Conclusions

Our data suggest that ‘externally timing’ of placebo analgesia may be possible for prolonged types of pain.

from Wiley: European Journal of Pain: Table of Contents https://ift.tt/3dDzPN9
via IFTTT

Prevalence and characteristics of new‐onset pain in COVID‐19 survivors, a controlled study

Abstract

We assessed whether COVID‐19 is associated with de novo pain and de novo chronic pain (CP). This controlled cross‐sectional study was based on phone interviews of patients discharged from hospital after COVID‐19 compared to control group composed of individuals hospitalized during the same period due to non‐COVID‐19 causes. Patients were classifyed as having previous CP based on the ICD‐11/IASP criteria, de novo pain (i.e., any new type of pain, irrespective of the pain status before hospital stay), and de novo CP (i.e. persistent or recurring de novo pain, lasting more than 3 months) after COVID‐19. We asssessed pain prevalence and its characteristics, including headache profile, pain location, intensity, interference, and its relationship with fatigue, and persistent anosmia. Forty‐six COVID‐19 and 73 control patients were included. Both groups had similar sociodemographic characteristics and past medical history. Length of in‐hospital‐stay and ICU admission rates were significantly higher among COVID‐19 survivors, while mechanical ventilation requirement was similar between groups. Pre‐hospitalization pain was lower in COVID‐19 compared to control group (10.9% vs. 42.5%; P=0.001). However, COVID‐19 group had a significantly higher prevalence of de novo pain (65.2% vs. 11.0%, P=0.001), as well as more de novo headache (39.1%) compared to controls (2.7%, p=0.001). New‐onset CP was 19.6% in COVID‐19 patients and 1.4% (P=0.002) in controls. These differences remained significant (p=0.001) even after analyzing exclusively (COVID: n=40; controls: n=34) patients who did not report previous pain before hospital stay. No statistically significant differences were found for mean new‐onset pain intensity and interference with daily activities between both groups. COVID‐19 pain was more frequently located in the head/neck and lower limbs (P<0.05). New‐onset fatigue was more common in COVID‐19 survivors necessitating inpatient hospital care (66.8%) compared to controls (2.5%, p=0.001). COVID‐19 patients who reported anosmia had more new‐onset pain (83.3%) compared to those who did not (48.0%, P=0.024). COVID‐19 was associated with a significantly higher prevalence of de novo CP, chronic daily headache, and new‐onset pain in general, which was associated with persistent anosmia.

from Wiley: European Journal of Pain: Table of Contents https://ift.tt/3sivliY
via IFTTT

Role of the endocannabinoid system in a mouse model of Fragile X undergoing neuropathic pain

Abstract

Background

Neuropathic pain is a complex condition characterized by sensory, cognitive and affective symptoms that magnify the perception of pain. The underlying pathogenic mechanisms are largely unknown and there is an urgent need for the development of novel medications. The endocannabinoid system modulates pain perception and drugs targeting the cannabinoid receptor type 2 (CB2) devoid of psychoactive side effects could emerge as novel analgesics. An interesting model to evaluate the mechanisms underlying resistance to pain is the fragile X mental retardation protein knockout mouse (Fmr1KO), a model of fragile X syndrome that exhibits nociceptive deficits and fails to develop neuropathic pain.

Methods

A partial sciatic nerve ligation was performed to wild‐type (WT) and Fmr1KO mice having (HzCB2 and Fmr1KO‐HzCB2, respectively) or not (WT and Fmr1KO mice) a partial deletion of CB2 to investigate the participation of the endocannabinoid system on the pain‐resistant phenotype of Fmr1KO mice.

Results

Nerve injury induced canonical hypersensitivity in WT and HzCB2 mice, whereas this increased pain sensitivity was absent in Fmr1KO mice. Interestingly, Fmr1KO mice partially lacking CB2 lost this protection against neuropathic pain. Similarly, pain‐induced depressive‐like behavior was observed in WT, HzCB2 and Fmr1KO‐HzCB2 mice, but not in Fmr1KO littermates. Nerve injury evoked different alterations in WT and Fmr1KO mice at spinal and supra‐spinal levels that correlated with these nociceptive and emotional alterations.

Conclusions

This work shows that CB2 is necessary for the protection against neuropathic pain observed in Fmr1KO mice, raising the interest of targeting this receptor for the treatment of neuropathic pain.

from Wiley: European Journal of Pain: Table of Contents https://ift.tt/3khZhcj
via IFTTT

Prospective associations of frequent pain symptoms with suicidal behavior in adolescents

Suicidal behavior is a spectrum of suicidal severity ranging from suicidal ideation, through suicide threats and suicide attempts, to completed suicide3. Non-fatal suicidal behavior including suicidal thought (ST), suicide plan (SP), and suicide attempt (SA) in adolescents is prevalent and a worldwide public health concern19, 23, 38, 45, 53. Epidemiological studies demonstrate that 6% to 26% of adolescents reported having serious suicidal ideation during the past year 24, 44, 47, 3% to 16% having made a suicide plan23, 38, and 5% to 15% having attempted suicide14, 19, 24, 28.

from The Journal of Pain https://ift.tt/3dBONmM
via IFTTT

Fibromyalgia Patients are not only Hypersensitive to Painful Stimuli but also to Sound Stimuli

Fibromyalgia (FM) is characterized by widespread chronic pain, insomnia, fatigue, and memory problems. It also has been associated with hypersensitivity to painful stimuli. Much of the evidence for such abnormalities has come from quantitative sensory testing (QST) of heat, pressure, electrical current, and chemical sensitivity which all depend on spinal cord modulation before transmission to the brain 30. The increased sensitivity of FM patients to noxious peripheral stimuli has been explained by central sensitization of dorsal horn neurons, based on evidence of wide-spread secondary hyperalgesia and abnormal temporal pain summation 12, 65, 66, 69.

from The Journal of Pain https://ift.tt/3aMjR1u
via IFTTT

Pre-exposure, but not overshadowing, inhibits nocebo hyperalgesia

Nocebo hyperalgesia is a pervasive problem that significantly adds to the burden of pain [3, 7, 40, 44]. It occurs when features of the treatment context elicit negative expectancies that amplify pain. Numerous studies demonstrate that nocebo hyperalgesia can influence a range of behavioural, psychophysiological, and neurobiological indices of pain [1, 10, 45, 48]. However, one of the most concerning aspects of nocebo hyperalgesia to emerge recently is that, once established, it seems resistant to extinction [10-12, 57, 58].

from The Journal of Pain https://ift.tt/2ZHluHf
via IFTTT

Pain Prevalence, Chronicity and Impact within Subpopulations Based on Both Hispanic Ancestry and Race: United States, 2010-2017.

The last decade has seen a relative explosion of research presenting national surveillance estimates of pain's prevalence, chronicity, and impact for the United States (U.S.).5,26,40,46,49,50,52,68,70,71,78,79,86 Impetus for this research include the Institute of Medicine's (IOM) 2011 report48 on pain and the 2016 U.S. Department of Health and Human Services (DHHS) National Pain Strategy (NPS),96 both of which identified the need for better national surveillance data to guide the federal research agenda and, in so doing, help policymakers address the closely related pain epidemic and opioid crisis.

from The Journal of Pain https://ift.tt/3sgRRJ9
via IFTTT

Effects of dry needling on muscle stiffness in latent myofascial trigger points: a randomized controlled trial

Current research literature about trigger points (TrPs) has increased in recent years in many countries around the world.8 Clinically, TrPs are classified as active TrPs (ATrPs) in the case of local or referred spontaneous pain which can be reproduced by stimulation, or latent TrPs (LTrPs), if only local or referred pain is produced by stimulation and not spontaneously.34 The presence of LTrPs is common in the general population and there is a high prevalence of pain and other symptoms originating from LTrPs in these muscles,38 with the upper trapezius (UT) being one of the muscles with the highest prevalence of LTrPs.

from The Journal of Pain https://ift.tt/3qQeNP1
via IFTTT

Mechanisms and Pathways of Pain Photobiomodulation: A Narrative Review

The exposure of human biological systems to light is ubiquitous. Importantly, light exposure from the sun determines much of human circadian rhythms and behavior. Sunlight at dawn promotes biological effects including waking, increases in glucocorticoid secretion, and feeding.7 In the modern-day era, however, exposure to light is not limited to sunlight exposure. Artificial indoor lighting and computers present in the workplace and home contribute a significant amount of light exposure.28, 33 Human exposure to light has also increased at night, whether from street lights, night lights, or workplace lights due to night shift work.

from The Journal of Pain https://ift.tt/2ZGPClZ
via IFTTT

Early life chronic inflammatory conditions predict low back pain in adolescence and young adulthood

Abstract

Background

Associations between inflammatory conditions and low back pain (LBP) have been found frequently in older populations. However, the nature of these relationships in younger populations is unknown. This study aimed to investigate the associations between early life chronic or recurrent inflammatory conditions and impactful LBP in adolescence and young adulthood.

Methods

In this longitudinal study, we used data from the Raine Study Gen2 participants at the 1, 2, 3, 5, 8, 10, 14, 17, 20 and 22‐year follow‐ups (N = 2,868). Data were collected on inflammatory conditions from 1 to 22 years of age and occurrences of impactful LBP from 14 to 22 years of age. Longitudinal and cross‐sectional associations between inflammatory conditions and impactful LBP occurrence were examined. Potential dose–response relationships between the number of inflammatory conditions and impactful LBP were also assessed. Logistic regression models were used in the analysis.

Results

Participants with respiratory or atopic conditions during childhood had increased odds of future impactful LBP in adolescence and young adulthood (odds ratio (OR) [95% confidence interval (CI)] = 1.29 [1.07, 1.54] and 1.23 [1.02, 1.49], respectively). There were cross‐sectional associations between inflammatory conditions including respiratory, skin, musculoskeletal, autoimmune and atopic conditions, with impactful LBP. Participants with two illnesses and three or more illnesses had an increased odds (OR [95% CI] =1.68 [1.30, 2.18] and OR [95% CI] =2.12 [1.54, 2.89], respectively) of reporting impactful LBP.

Conclusions

Overall, longitudinal and cross‐sectional associations of respiratory and atopic conditions with impactful LBP in adolescence and young adulthood were identified. More evidence is needed to determine whether there is a causal relationship between chronic inflammatory conditions and impactful LBP.

Significance

Low back pain (LBP) is a prominent and significant health problem and associations between inflammatory conditions and LBP have been found frequently in older populations. We found that children with respiratory or atopic conditions and those with several chronic inflammatory conditions are at increased odds of impactful LBP in adolescence and young adulthood. In clinical practice and future research, there is a need to consider comorbidities also in younger populations.

from Wiley: European Journal of Pain: Table of Contents https://ift.tt/37sjJBl
via IFTTT

Homotopic reduction in laser‐evoked potential amplitude and laser‐pain rating by abdominal acupuncture

Abstract

Background

The neural mechanism underlying the analgesic effect of acupuncture is largely unknown. We aimed at investigating the effect of abdominal acupuncture (AA) on the laser‐evoked potential (LEP) amplitude and laser‐pain rating to stimulation of body parts either homotopic or heterotopic to the treated acupoint.

Methods

Laser‐evoked potentials were recorded from 13 healthy subjects to stimulation of the right wrist (RW), left wrist (LW) and right foot (RF). LEPs were obtained before, during and after the AA stimulation of an abdominal area corresponding to the representation of the RW. Subjective laser‐pain rating was collected after each LEP recording.

Results

The amplitude of the N2/P2 LEP component was significantly reduced during AA and 15 min after needle removal to both RW (F = 4.14, p = .02) and LW (F = 5.48, p = .008) stimulation, while the N2/P2 amplitude to RF stimulation (F = 0.94, p = .4) remained unchanged. Laser‐pain rating was reduced during AA and 15 min after needle removal only to RW stimulation (F = 5.67, p = .007).

Conclusion

Our findings showing an AA effect on LEP components to both the ipsilateral and contralateral region homotopic to the treated area, without any LEP change to stimulation of a heterotopic region, suggest that the AA analgesia is mediated by a segmental spinal mechanism.

Significance

Although abdominal acupuncture has demonstrated to be effective in the reduction in laser‐evoked potential (LEP) amplitude and laser‐pain rating, the exact mechanism of this analgesic effect is not known. In the current study, we found that treatment of an area in the “turtle representation” of the body led to a topographical pattern of LEP amplitude inhibition that can be mediated by a segmental spinal mechanism.

from Wiley: European Journal of Pain: Table of Contents https://ift.tt/2Jt9TXR
via IFTTT

Development and validation of a daily Injustice Experience Questionnaire

Abstract

Background

Patterns of cognitive appraisal related to chronic pain may manifest differentially across time due to a variety of factors, but variability of injustice appraisals across time has not been examined. The current study details the validation of a brief, daily version of the Injustice Experience Questionnaire (IEQ), which measures injustice appraisals related to the experience of pain and disability.

Methods

Injustice Experience Questionnaire items were adapted for daily use and evaluated using cognitive interviews, and the resulting measure was administered for 10 days to two Internet‐based samples of US adults with chronic lower back pain.

Results

Study 1 (N = 126) refined the 12‐item IEQ measure into a six‐item short form; exploratory factor analyses suggested optimal model fit for the two‐factor model established in the original IEQ. Using confirmatory factor analyses, Study 2 (N = 131) replicated the two‐factor structure and demonstrated significant correlations of the Daily IEQ with other relevant constructs to chronic pain, such as pain catastrophizing, pain intensity, pain‐related activity and social interference, depressed mood and anxiety. Daily IEQ items showed a significant degree of clustering (intraclass correlations ranging from .577 to .735) but demonstrated sufficient variability at the daily level to allow for daily‐level analysis.

Conclusions

Injustice appraisals show a sufficient degree of daily variability to warrant their measurement as a time‐varying construct. Further examination of antecedents and correlates of daily injustice appraisals, as well as their potential role as mechanisms of effect, may better explain the dynamics of affective and behavioral responses to chronic pain.

Significance

The current study presents a validation of a daily version of the Injustice Experience Questionnaire in chronic low back pain. Results indicate that injustice appraisals vary significantly from day to day, and daily variability in injustice perception shows robust associations with pain intensity, pain‐related interference in physical and social activity, and mood in chronic low back pain. These results emphasize the importance of assessing injustice perception as a time‐varying, rather than stable construct in future empirical and clinical studies.

from Wiley: European Journal of Pain: Table of Contents https://ift.tt/36y2IpY
via IFTTT

A linguistic analysis of future narratives in adolescents with Complex Regional Pain Syndrome and their pain‐free peers

Abstract

Background

Complex Regional Pain Syndrome (CRPS) is a chronic pain condition that often develops after injury, with a typical onset in adolescence. The impact of chronic pain is far‐reaching, with many adolescents reporting atypical developmental trajectories compared with peers. Social Comparison Theory offers a framework for understanding how such comparisons influence well‐being, whereby a heightened sense of disparity places adolescents at risk of poor cognitive, affective and social outcomes. Using a novel linguistic analysis programme, this study aims to investigate cognitive, affective and social language used by adolescents with CRPS in comparison to their peers during a task reflecting on their futures.

Methods

A story completion task was completed by adolescents with CPRS (n = 49) and adolescents without pain (n = 48). This task involved asking adolescents to describe their imagined future. Narratives were analysed using a novel linguistic analysis programme, focusing on the cognitive, affective and social dimensions.

Results

Findings revealed significant group differences in how adolescents with CRPS described their imagined futures. Adolescents with CRPS used significantly fewer positive affect and more negative affect, anger and sadness words, and greater insight and discrepancy words. No significant groups differences were found for social words.

Conclusions

Substantial differences in cognitive and affective words were found between adolescents with and without CRPS. Findings provide novel insights into current understandings of cognitive, affective and social processes in adolescents living with chronic pain, particularly with regard to adolescent developmental trajectories, and may in turn highlight potential targets in psychosocial interventions for adolescents living with chronic pain.

Significance

Social comparisons are commonly undertaken by adolescents with CRPS in relation to peers, increasing risk for poor cognitive, affective and social outcomes. Findings promote the potential importance of targeting psychosocial factors in treatments for paediatric chronic pain.

from Wiley: European Journal of Pain: Table of Contents https://ift.tt/2KToUCx
via IFTTT

Altered regulation of negative affect in patients with fibromyalgia: A diary study

Abstract

Background

Fibromyalgia is characterized by widespread musculoskeletal pain and often accompanied by cognitive and emotional problems. Adaptation to fibromyalgia may therefore also rely on one's ability to regulate emotional problems. In this study, we examined two indices of emotion regulation, that is, (a) affective instability, involving frequent large fluctuations in self‐reported affect, and (b) resting heart rate variability (HRV).

Methods

Participants were 46 patients with fibromyalgia (M _age = 45.4 years; 39 females) and 46 matched healthy controls (M _age = 44.9 years; 37 females). Heart rate was monitored under resting conditions to derive HRV. Subsequently, participants completed an electronic end‐of‐day diary for 14 consecutive days assessing daily levels of pain, disability, negative affect (NA) and positive affect (PA). Affective instability was operationalized as the mean square of successive differences in daily mood.

Results

Results indicate increased levels of NA instability and reduced levels of HRV in patients with fibromyalgia in comparison with healthy controls. Furthermore, HRV and NA instability were inversely related. Finally, in patients, higher NA instability was related to increased pain disability.

Conclusions

Current findings support the idea that patients with fibromyalgia are confronted with fluctuating emotions. These results may have important implications for treatment as they provide support for the use of emotion regulation skills training in patients with fibromyalgia to impact upon NA instability.

Significance

This study provides novel insight in the link between emotion regulation indices,that is, heart‐rate variability and negative affective (NA) instability, in patients with fibromyalgia, and presents evidence for differences in both emotion regulation indices between patients with fibromyalgia and healthy people. Furthermore, results link increased NA instability with increased levels of daily disability in patients with fibromyalgia. Together, these findings offer support for a key role of emotion regulation in fibromyalgia outcomes, providing pathways for clinical practice.

from Wiley: European Journal of Pain: Table of Contents https://ift.tt/2Jo0yjS
via IFTTT

Faces of clinical pain: Inter‐individual facial activity patterns in shoulder pain patients

Abstract

Background

Facial activity during pain is composed of varying combinations of a few elementary facial responses (so‐called Action Units). A previous study of experimental pain showed that these varying combinations can be clustered into distinct facial activity patterns of pain. In the present study, we examined whether comparable facial activity patterns can also be identified among people suffering from clinical pain; namely, shoulder pain.

Methods

Facial expressions of patients suffering from shoulder pain (N = 126) were recorded while twice undergoing a battery of passive range‐of‐motion tests to their affected limbs (UNBC‐McMaster Shoulder Pain Expression Archive Database), which elicited peaks of acute pain. Facial expressions were analysed using the Facial Action Coding System to extract facial Action Units (AUs). Hierarchical cluster analyses were used to look for characteristic combinations of these AUs.

Results

Cluster analyses revealed four distinct activity patterns during painful movements. Each cluster was composed of different combinations of pain‐indicative AUs, with one AU common to all clusters, namely, “narrowed eyes”. Besides these four clusters, there was a “stoic” pattern, characterized by no discernible facial action. The identified clusters were relatively stable across time and comparable to the facial activity patterns found previously for experimental heat pain.

Conclusions

These findings corroborate the hypothesis that facial expressions of acute pain are not uniform. Instead, they are composed of different combinations of pain‐indicative facial responses, with one omnipresent response, namely, “narrowed eyes”. Raising awareness about these inter‐individually different “faces of pain” could improve the recognition and, thereby, its diagnostic training for professionals, like nurses and physicians.

Significance

Similar to experimental pain, facial activity during evoked pain episodes in shoulder pain patients could be clustered into distinct faces of pain. Each cluster was composed of different combinations of single facial responses, namely: narrowed eyes, which is displayed either alone or in combination with opened mouth or wrinkled nose, or furrowed brows and closed eyes. These distinct faces of pain may inform the training of professionals and computers how to best recognize pain based on facial expressions.

from Wiley: European Journal of Pain: Table of Contents https://ift.tt/35Ufaip
via IFTTT

Analgesic effect of music during wound care among patients with diaphyseal tibial fractures: Randomized controlled trial

Abstract

Background

Evidence is scarce regarding the analgesic effect of music for the relief of acute pain during the care of surgical tibial fracture wounds.

Objective

To evaluate the analgesic effect of music on acute procedural pain during the care of surgical tibial fracture wounds.

Method

This was a randomized, controlled, blinded clinical trial with 70 patients in the immediate postoperative period for diaphyseal tibial fracture surgery. Participants were randomly allocated to two groups: a control group (CG), in which patients received only the institution's standard analgesia, and an intervention group (IG) composed of patients receiving a 30‐min session of music of their own choice, as a complementary method to the institution's standard analgesia. Pain was evaluated during the first postoperative dressing change, using the Numerical Rating Scale (NRS).

Results

The sample was homogeneously composed of men (91.4%), young adults (61.4%), without previous diseases (88.6%) and whose traumas were related to a motorcycle crash (84.3%). The main musical genres chosen by participants were the most popular in their region (61.4%). Those who listened to music presented lower pain scores when compared with those in the CG (IG:2.4 ± 2.4 versus CG:5.8 ± 2.7; p < 0.001; η² = 0.171; p < 0.001).

Conclusion

Listening to music is effective for relieving acute procedural pain during the first post‐operative tibial fracture dressing change. Music should be incorporated into the multimodal analgesia protocols for management of orthopedic postoperative wound care‐related pain.

Significance

Patients with diaphyseal tibial fractures that listened to music before and during the wound dressing change showed less pain when compared to those who received the standardized pharmacologic analgesia alone.

from Wiley: European Journal of Pain: Table of Contents https://ift.tt/2HWdgW2
via IFTTT

Conditioned pain modulation affects the N2/P2 complex but not the N1 wave: A pilot study with laser‐evoked potentials

Abstract

Background

The ‘pain‐inhibits‐pain’ effect stems from neurophysiological mechanisms involving endogenous modulatory systems termed diffuse noxious inhibitory controls (DNIC) or conditioned pain modulation (CPM). Laser‐evoked potentials (LEPs) components, the N2/P2 complex, and the N1 wave, reflect the medial and lateral pain pathway, respectively: anatomically, the lateral thalamic nuclei (LT) project mainly to the somatosensory cortex (N1 generator), while the medial thalamic nuclei (MT) are bound to the limbic cortices (N2/P2 generators).

Methods

We applied a CPM protocol in which the test stimulus was laser stimulation and the conditioning stimulus was a cold pressor test. LEPs recordings were obtained from 15 healthy subjects in three different conditions: baseline, during heterotopic noxious conditioning stimulation (HNCS) and post‐HNCS.

Results

We observed a significant reduction in N2/P2 amplitude during HNCS and a return to pre‐test amplitude post‐HNCS, whereas the N1 wave remained unchanged during and post‐HNCS.

Conclusions

Our results indicate that CPM affects only the medial pain system. The spinothalamic tract (STT) transmits to both the LT and the MT, while the spinoreticulothalamic (SRT) projects only to the MT. The reduction in the amplitude of the N2/P2 complex and the absence of change in the N1 wave suggest that DNIC inhibition on the dorsal horn neurons affects only pain transmission via the SRT, while the neurons that give rise to the STT are not involved. The N1 wave can be a reliable neurophysiological parameter for assessment of STT function in clinical practice, as it does not seem to be influenced by CPM.

Significance

No reports have described the effect of DNIC on lateral and medial pain pathways. We studied the N1 wave and the N2/P2 complex to detect changes during a CPM protocol. We found a reduction in the amplitude of the N2/P2 complex and no change in the N1 wave. This suggests that the DNIC inhibitory effect on dorsal horns neurons affects only pain transmission via the SRT, whereas the neurons that give rise to the STT are not involved.

from Wiley: European Journal of Pain: Table of Contents https://ift.tt/3lwXekB
via IFTTT

The serotonin receptor 2A (HTR2A) rs6313 variant is associated with higher ongoing pain and signs of central sensitization in neuropathic pain patients

Abstract

Background

The serotonin receptor 2A (HTR2A) has been described as an important facilitation mediator of spinal nociceptive processing leading to central sensitization (CS) in animal models of chronic pain. However, whether HTR2A single nucleotide variants (SNVs) modulate neuropathic pain states in patients has not been investigated so far. The aim of this study was to elucidate the potential association of HTR2A variants with sensory abnormalities or ongoing pain in neuropathic pain patients.

Methods

At total of 240 neuropathic pain patients and 253 healthy volunteers were included. Patients were phenotypically characterized using standardized quantitative sensory testing (QST). Patients and controls were genotyped for HTR2A g.‐1438G > A (rs6311) and c.102C > T (rs6313). Genotype‐related differences in QST parameters were assessed considering QST profile clusters, principal somatosensory components and sex.

Results

There was an equal distribution of rs6313 and linked rs6311 between patients and controls. However, the rs6313 variant was significantly associated with a principal component of pinprick hyperalgesia and dynamic mechanical allodynia, indicating enhanced CS in patients with sensory loss (−0.34 ± 0.15 vs. +0.31 ± 0.11 vs., p < .001). In this cluster, the variant allele was also associated with single QST parameters of pinprick hyperalgesia (MPT, +0.64 ± 0.18 vs. −0.34 ± 0.23 p = .002; MPS, +0.66 ± 0.17 vs. −0.09 ± 0.23, p = .009) and ongoing pain was increased by 30%.

Conclusions

The specific association of the rs6313 variant with pinprick hyperalgesia and increased levels of ongoing pain suggests that the HTR2A receptor might be an important modulator in the development of CS in neuropathic pain.

Significance

This article presents new insights into serotonin receptor 2A‐mediating mechanisms of central sensitization in neuropathic pain patients. The rs6313 variant allele was associated with increased mechanical pinprick sensitivity and increased levels of ongoing pain supporting a contribution of central sensitization in the genesis of ongoing pain providing a possible route for mechanism‐based therapies.

from Wiley: European Journal of Pain: Table of Contents https://ift.tt/3nc2tX1
via IFTTT

Modulation of SI and ACC response to noxious and non‐noxious electrical stimuli after the spared nerve injury model of neuropathic pain

Abstract

Background

The current knowledge on the role of SI and ACC in acute pain processing and how these contribute to the development of chronic pain is limited. Our objective was to investigate differences in and modulation of intracortical responses from SI and ACC in response to different intensities of peripheral presumed noxious and non‐noxious stimuli in the acute time frame of a peripheral nerve injury in rats.

Methods

We applied non‐noxious and noxious electrical stimulation pulses through a cuff electrode placed around the sciatic nerve and measured the cortical responses (six electrodes in each cortical area) before and after the spared nerve injury model.

Results

We found that the peak response correlated with the stimulation intensity and that SI and ACC differed in both amplitude and latency of cortical response. The cortical response to both noxious and non‐noxious stimulation showed a trend towards faster processing of non‐noxious stimuli in ACC and increased cortical processing of non‐noxious stimuli in SI after SNI.

Conclusions

We found different responses in SI and ACC to different intensity electrical stimulations based on two features and changes in these features following peripheral nerve injury. We believe that these features may be able to assist to track cortical changes during the chronification of pain in future animal studies.

Significance

This study showed distinct cortical processing of noxious and non‐noxious peripheral stimuli in SI and ACC. The processing latency in ACC and accumulated spiking activity in SI appeared to be modulated by peripheral nerve injury, which elaborated on the function of these two areas in the processing of nociception.

from Wiley: European Journal of Pain: Table of Contents https://ift.tt/3lfT93M
via IFTTT

Preoperative risk factors associated with chronic pain profiles following total knee arthroplasty

ABSTRACT

Background

One in five patients experience chronic pain 12 months following total knee arthroplasty (TKA). This longitudinal study used a person‐centred approach to identify subgroups of patients with distinct chronic pain profiles following TKA and identified preoperative characteristics associated with these profiles.

Methods

On the day before surgery, 202 patients completed questionnaires that assessed pain, interference with functioning, fatigue, anxiety, depression and illness perceptions. Average and worst pain were assessed prior to surgery, on postoperative day 4, at 6 week and at 3 and 12 months following surgery. Using growth mixture modelling, two subgroups with distinct average and worst pain profiles were identified.

Results

Patients in the “lower average” and “lower worst” pain classes had moderate preoperative pain scores that decreased over the remaining 9 months following TKA. Patients in the “higher average” and “higher worst” pain classes had relatively higher preoperative pain scores that increased during the first three months and then decreased slightly over the remaining 9 months. Patients in the higher pain classes had higher interference with function scores; used opioids prior to surgery more often, were more likely to receive a continuous nerve block and ketamine; had higher preoperative fatigue severity and interference scores; and had worse perceptions of illness than patients in the lower pain classes.

Conclusions

These risk factors may be used to identify subgroups of patients at higher risk for more severe pain after TKA. Future studies should test whether modifying these risk factors can improve patients’ outcomes after TKA.

Significance statement

The present study provides a novel and original analysis of pain profiles following total knee arthroplasty that may contribute to our understanding of the transition from acute to chronic pain. Our results may be used to identify patients at higher risk for poorer outcomes based on preoperative risk factors.

from Wiley: European Journal of Pain: Table of Contents https://ift.tt/3ogRhJf
via IFTTT

Impact of Check of Medication Appropriateness (CMA) in optimizing analgesic prescribing: An interrupted time series analysis

Abstract

Background

Pain therapy in inpatients is regularly suboptimal and might be improved by clinical pharmacy services. In our hospital, we have implemented a software‐supported ‘Check of Medication Appropriateness’ (CMA), which is a centralized pharmacist‐led service consisting of a clinical rule‐based screening for potentially inappropriate prescriptions (PIPs), and a subsequent medication review by pharmacists. We aimed to investigate the impact of the CMA on pain‐related prescribing.

Methods

A quasi‐experimental study was performed in a large teaching hospital, using an interrupted time series design. Pre‐implementation, patients were exposed to standard of care. Afterwards, a pain‐focused CMA comprising 12 specific clinical rules pertaining to analgesic prescribing were implemented in the post‐implementation period. A regression model was used to assess the impact of the intervention on the number of pain‐related residual PIPs between both periods. The total number of recommendations and acceptance rate was recorded for the post‐implementation period.

Results

At baseline, a median number of 13.1 (range: 9.5–15.8) residual PIPs per day was observed. After the CMA intervention, the number was reduced to 2.2 (range: 0–9.5) per day. Clinical rules showed an immediate relative reduction of 66% (p < .0001) in pain‐related residual PIPs. A significant decreasing time trend was observed during the post‐implementation period. Post‐implementation, 1683 recommendations were given over 1 year with an acceptance rate of 74.3%.

Conclusions

We proved that the CMA approach reduced the number of pain‐related residual PIPs. More pharmacist involvement and the use of clinical rules during hospital stay should be further promoted to optimize appropriate prescribing of analgesics.

Significance

Prescribing of analgesics should be improved in inpatients to optimize pain control and to reduce iatrogenic harm. The Check of Medication Appropriateness (CMA) approach, comprising a clinical rule‐based screening for patients at risk and a targeted medication review by pharmacists, reduced the number of pain‐related potentially inappropriate prescriptions in a highly significant and sustained manner. This study presents the opportunities of a centralized clinical pharmacy service to help clinicians to further improve analgesic prescribing.

from Wiley: European Journal of Pain: Table of Contents https://ift.tt/36wJJw5
via IFTTT

Validation of the Questionnaire for Symptom Assessment in Pain disorders for Back pain patients (Q‐SAP)

Abstract

Background

Previous studies have shown that not only pain intensity but also impairment of quality of life and functionality are important parameters for the evaluation of treatment of chronic low back pain patients. The aim of the study was to validate a specific self‐questionnaire for symptom assessment and their influence on quality of life and functionality of chronic low back pain patients (Questionnaire for Symptom Assessment in Pain disorders for back pain patients, Q‐SAP).

Methods

The self‐questionnaire consists of two parts (for back and if applicable leg symptoms) and was tested in 152 chronic low back pain patients with and without radiculopathy. Test–retest reliability, exploratory factor analysis, convergent validity, criterion‐related validity and the sensitivity to detect patient reported changes were investigated.

Results

The questionnaire showed a good to excellent test–retest reliability. In the factor analysis nociceptive and neuropathic pain components could be separated and the highest convergent validities were shown for the painDETECT, EQ‐5D‐3L and the FFbH‐R. The criterion‐related validity showed concordance of QST and the Q‐SAP Back for warmth induced pain and numbness. Regarding the sensitivity to patient‐reported changes, a moderate correlation was found for both parts of the questionnaire.

Conclusions

The Q‐SAP was tested as a useful, valid and reliable tool. This new questionnaire records classical nociceptive and neuropathic pain symptoms of chronic low back pain patients depending on their local distribution. Furthermore, the questionnaire records the intensity of these symptoms and their influence on quality of life and functionality and can be used for the evaluation of treatment.

Significance

The Q‐SAP Back/Leg is a new self‐questionnaire for CLBP patients with or without radiating leg pain that precisely assesses neuropathic and nociceptive symptoms. In contrast to other questionnaires, the Q‐SAP Back/Leg evaluates not only symptom intensities but also their impact on the patient's quality of life and functionality. Furthermore, this questionnaire requests the symptoms depending on their anatomical distribution.

from Wiley: European Journal of Pain: Table of Contents https://ift.tt/3oLNepk
via IFTTT

Clinical, psychological and quality of life differences in fibromyalgia patients from secondary and tertiary healthcare

Abstract

Background

The ‘funnel effect’ of Fibromyalgia (FM) assumes that as patients access healthcare services, they present greater severity and a more complex clinical situation than individuals with FM from the general population, but the studies comparing patients treated in different levels of healthcare are scarce. The aim of this study was to analyse the ‘funnel effect’ hypothesis by comparing patients from secondary and tertiary healthcare services.

Methods

A cross‐sectional sample of female patients was selected in secondary (rheumatology practices ‐ RP) and in tertiary healthcare (chronic pain clinics ‐ CPC). Information about sociodemographic, clinical and psychological characteristics was collected and health related quality of life (HRQL) was assessed.

Results

In total, 55 patients from RP and 60 patients from CPC were included in the comparison. Patients from CPC revealed a worst clinical status (higher number of tender points, medical visits and comorbidity), more somatic symptoms (pain and daytime dysfunction levels) and worst emotional status (more anxiety) than patients from RP. Patients attending CPC also revealed a worst HRQL than RP patients although this difference was mediated by the differences in clinical and psychological variables.

Conclusions

Our study supports the ‘funnel effect’ hypothesis among patients of different healthcare levels, with patients from tertiary healthcare services revealing worst clinical status, more somatic and psychological symptoms, and worst HRQL than patients from secondary healthcare services.

Significance

The worst clinical and psychological status and poorer quality of life in the patients from tertiary healthcare (chronic pain clinics) in relation to the patients from secondary healthcare (rheumatology practices) must be taken into account to design studies that assess any of these aspects, to a proper analysis and interpretation of the data, and to define the scope of its generalization, as data from different clinical settings are not directly comparable.

from Wiley: European Journal of Pain: Table of Contents https://ift.tt/2GNcIBC
via IFTTT

Sensory and pain modulation profiles of ongoing central neuropathic extremity pain in multiple sclerosis

Abstract

Background

Central neuropathic extremity pain (CNEP) is the most frequent type of pain in multiple sclerosis (MS). The aim of the present study was to evaluate sensory and pain modulation profiles in MS patients with CNEP.

Methods

In a single‐centre observational study, a group of 56 CNEP MS patients was compared with 63 pain‐free MS patients and with a sex‐ and age‐adjusted control group. Standardized quantitative sensory testing (QST) and dynamic QST (dQST) protocols comprising temporal summation and conditioned pain modulation tests were used to compare sensory profiles.

Results

Loss‐type QST abnormalities in both thermal and mechanical QST modalities prevailed in both MS subgroups and correlated significantly with higher degree of disability expressed as Expanded Disability Status Scale (EDSS). Comparison of sensory phenotypes disclosed a higher frequency of the ‘sensory loss’ prototypic sensory phenotype in the CNEP subgroup (30%) compared with pain‐free MS patients (6%; p = .003).

Conclusion

The role of aging process and higher lesion load in the spinothalamocortical pathway might be possible explanation for pain development in this particular ‘deafferentation’ subtype of central neuropathic pain in MS. We were unable to support the role of central sensitization or endogenous facilitatory and inhibitory mechanisms in the development of CNEP in MS.

Significance

This article presents higher prevalence of the ‘sensory loss’ prototypic sensory phenotype in multiple sclerosis patients with central extremity neuropathic pain compared to pain‐free patients. Higher degree of disability underlines the possible role of higher lesion load in the somatosensory pathways in this particular ‘deafferentation’ type of central neuropathic pain.

from Wiley: European Journal of Pain: Table of Contents https://ift.tt/35jUy3K
via IFTTT

Predicting long‐term postsurgical pain by examining the evolution of acute pain

Abstract

Background

Increased acute postoperative pain intensity has been associated with the development of persistent postsurgical pain (PPP) in mechanistic and clinical investigations, but it remains unclear which aspects of acute pain explain this linkage.

Methods

We analysed clinical postoperative pain intensity assessments using symbolic aggregate approximations (SAX), a graphical way of representing changes between pain states from one patient evaluation to the next, to visualize and understand how pain intensity changes across sequential assessments are associated with the intensity of postoperative pain at 1 (M1) and 6 (M6) months after surgery. SAX‐based acute pain transition patterns were compared using cosine similarity, which indicates the degree to which patterns mirror each other.

Results

This single‐centre prospective cohort study included 364 subjects. Patterns of acute postoperative pain sequential transitions differed between the ‘None’ and ‘Severe’ outcomes at M1 (cosine similarity 0.44) and M6 (cosine similarity 0.49). Stratifications of M6 outcomes by preoperative pain intensity, sex, age group, surgery type and catastrophising showed significant heterogeneity of pain transition patterns within and across strata. Severe‐to‐severe acute pain transitions were common, but not exclusive, in patients with moderate or severe pain intensity at M6.

Conclusions

Clinically, these results suggest that individual pain‐state transitions, even within patient or procedural strata associated with PPP, may not alone offer good predictive information regarding PPP. Longitudinal observation in the immediate postoperative period and consideration of patient‐ and surgery‐specific factors may help indicate which patients are at increased risk of PPP.

Significance

Symbolic aggregate approximations of clinically obtained, acute postoperative pain intraday time series identify different motifs in patients suffering moderate to severe pain 6 months after surgery.

from Wiley: European Journal of Pain: Table of Contents https://ift.tt/3nebOh3
via IFTTT

Physical activity and cold pain tolerance in the general population

Abstract

Background

The relationship between habitual physical activity (PA) and experimental pain tolerance has been investigated in small samples of young, healthy and/or single‐sex volunteers. We used a large, population‐based sample to assess this relationship in men and women with and without chronic pain.

Methods

We used data from the sixth and seventh Tromsø Study surveys (2007–2008; 2015–2016), with assessed pain tolerance of participants with the cold pressor test (CPT: dominant hand in circulating cold water at 3°C, maximum test time 106 s), and self‐reported total amount of habitual PA in leisure time (n = 19,087), exercise frequency (n = 19,388), exercise intensity (n = 18,393) and exercise duration (n = 18,343). A sub‐sample had PA measured by accelerometers (n = 4,922). We used Cox regression to compare CPT tolerance times between self‐reported PA levels. For accelerometer‐measured PA, we estimated hazard ratios for average daily activity counts, and for average daily minutes of moderate‐to‐vigorous PA done in bouts lasting 10 min or more. Models were tested for PA‐sex, and PA‐chronic pain and PA‐moderate‐to‐severe chronic pain interactions.

Results

Leisure‐time PA, exercise intensity and exercise duration were positively associated with CPT tolerance (p < .001; p = .011; p < .001). More PA was associated with higher CPT tolerance. At high levels of leisure‐time PA and exercise intensity, men had a significantly higher CPT tolerance than women. Accelerometer‐measured PA was not associated with CPT tolerance.

Conclusions

This study is one of the first to show that higher self‐reported habitual PA was connected to higher experimental pain tolerance in a population‐based sample, especially for men. This was not found for accelerometer‐measured PA.

Significance

This study finds that higher level of self‐reported leisure‐time physical activity is associated with increased cold pressor pain tolerance in a large population‐based sample. Though present in both sexes, the association is strongest among men. Despite the robust dose–response relationship between pain tolerance and self‐reported activity level, no such relationship was found for accelerometer‐measured activity, reflecting a possible discrepancy in the aspect of physical activity measured. Though the study design does not permit causal conclusions, the findings suggest that increasing physical activity may increase pain tolerance in the general population.

from Wiley: European Journal of Pain: Table of Contents https://ift.tt/35dvFqH
via IFTTT

Issue Information

European Journal of Pain, Volume 25, Issue 3, Page 511-512, March 2021.

from Wiley: European Journal of Pain: Table of Contents https://ift.tt/3ax7ENX
via IFTTT

An irregular ulcer in the rectum

A man in his 50s was referred to hospital by his general practitioner with a suspected rectal lesion after rectal examination. He had also experienced intermittent constipation without rectal pain...

from Latest headlines from BMJ https://ift.tt/3avqchB
via IFTTT

Do not routinely offer imaging for uncomplicated low back pain

What you need to knowLess than 5-10% of all low back pain is due to a specific underlying spinal pathologyThe remaining 90-95% has no indication of a serious cause and should be managed with...

from Latest headlines from BMJ https://ift.tt/3pgA9U9
via IFTTT

Neuro‐Axial Steroid injection in Pain management and COVID‐19 Vaccine

Abstract

The novel coronavirus pandemic (COVID‐19), which began in late 2019, has affected all aspects of our everyday life. The medical ecosystem has changed profoundly, at times stretching its capacity, to provide proper healthcare to all those in need. Recent investigations have focused on the impact of the virus on the emergency departments and intensive care units. However, outpatient care has also been fundamentally transformed since the pandemic. There is no consensus on the best way to manage patients with severe pain during the COVID‐19 pandemic.

from Wiley: European Journal of Pain: Table of Contents https://ift.tt/3jApa6E
via IFTTT

The effect of experimental pain on the excitability of the corticospinal tract in humans: a systematic review and meta‐analysis

ABSTRACT

Background and Objective

Pain influences motor control. Previous reviews observed that pain reduces the excitability of corticospinal projections to muscles tested with transcranial magnetic stimulation. However, the independent effect of the type of pain models (tonic, phasic), pain location and tissues targeted (e.g. muscle, skin) remains unexplored. The objective of this review was to determine the influence of experimental pain and of different methodological factors on the corticospinal excitability.

Databases and Data Treatment: Three electronic databases were searched: Embase, Pubmed and Web of Science. Meta‐analyses were conducted in three consecutive steps to reduce methodological variability: (1) all studies; (2) same pain location; (3) same tissues, pain location and muscle state. Strength of evidence was assessed for each analysis performed.

Results

Forty studies were included in the review and 26 in the meta‐analysis as it focused only on studies using tonic pain. Overall, there was conflicting/moderate evidence of a diminution of corticospinal excitability during and after tonic pain. When considering only pain location, tonic hand and face pain induced a reduction in corticospinal excitability (limited evidence). Both muscle and cutaneous hand pain reduced corticospinal excitability (limited/conflicting evidence). Similar results were observed for phasic pain (limited evidence).

Conclusions

Our results confirm the inhibitory effect of pain on corticospinal excitability for both tonic and phasic pain. This reduction was specific to hand and face pain. Also, both cutaneous and muscle hand pain reduced excitability. The strength of evidence remains limited/conflicting due to methodological/results heterogeneity, risk of bias and the small number of studies. More high‐quality studies are needed to confirm our conclusions.

from Wiley: European Journal of Pain: Table of Contents https://ift.tt/3rSJhAf
via IFTTT

The effect of the anti‐diabetic drug metformin on musculoskeletal pain: a cross‐sectional study with 21,889 individuals from the UK Biobank

Abstract

Background

Although metformin there is growing evidence of metformin’s pleiotropic effects, including possible effects on pain, there is a lack of study investigating the association of metformin with the prevalence of musculoskeletal pain among a large type 2 diabetes cohort.

Methods

Cross‐sectional analyses were conducted with UK Biobank data from 21,889 participants with type 2 diabetes. Type 2 diabetes, metformin use, and musculoskeletal (back, knee, hip, and neck/shoulder) pain were self‐reported. Participants reported musculoskeletal pain that had interfered with their usual activities in the last month (recent pain), and for more than 3 months (chronic pain). We performed logistic regression analyses for recent and chronic pain for each site and for multisite pain among participants with diabetes who did or did not take metformin.

Results

Participants using metformin had lower odds of musculoskeletal pain for back [recent OR 0.91, 95%CI 0.85 to 0.97; chronic OR 0.87, 95%CI 0.81 to 0.93], knee [recent OR 0.91, 95%CI 0.85 to 0.97; chronic OR 0.87, 95%CI 0.81 to 0.94], and neck/shoulder regions [chronic OR 0.92, 95%CI 0.85 to 0.99] but not hip pain. Participants using metformin also had lower odds of reporting chronic multisite musculoskeletal pain. The associations were generally stronger among women.

Conclusions

People with diabetes taking metformin were less likely to report back, knee, neck/shoulder, and multisite musculoskeletal pain than those not taking metformin. Therefore, when treating these patients, clinicians should be aware that metformin may contribute to fewer reports of musculoskeletal pain. These effects should be investigated in future studies.

from Wiley: European Journal of Pain: Table of Contents https://ift.tt/3q8hnQ7
via IFTTT

PAIN CATASTROPHIZING, OPIOID MISUSE, OPIOID USE, AND OPIOID DOSE IN PEOPLE WITH CHRONIC MUSCULOSKELETAL PAIN: A SYSTEMATIC REVIEW

The current epidemic of opioid misuse reported in the USA, Canada, and Europe has caused an enormous public health emergency 2,30. In chronic pain, the prevalence and the socioeconomic burden occasioned by opioid misuse is highly considerable 9,61. People with chronic pain who present opioid use problems are at risk of developing opioid-related morbidity, opioid addiction, opioid overdose, and opioid-related mortality 4,7,43,48. Several factors have emerged as potential risk factors for prescription opioid misuse 17.

from The Journal of Pain https://ift.tt/36ZR0o0
via IFTTT

Reduction of pain and spinal nociceptive transmission by working memory is load dependant

Cognitive-based approaches to pain regulation involve the engagement of attention and working memory (WM) 42, 43, 61. Attention may facilitate or inhibit the processing of painful information 45, 66, 67, while noxious stimuli involuntarily draw attention to protect the body from tissue damage 64. However, this attentional capture is inhibited or reduced when performing a task that requires mental operations 40, 60. These involuntary and voluntary processes interact to regulate the focus of attention51.

from The Journal of Pain https://ift.tt/2OmV5fv
via IFTTT

The association between exposure to domestic abuse in women and the development of syndromes indicating central nervous system sensitisation: a retrospective cohort study using UK primary care records

Abstract

Background

Domestic abuse is a global public health issue. The association between the development of central sensitivity syndromes (CSS) and previous exposure to domestic abuse has been poorly understood particularly within European populations.

Methods

A retrospective cohort study using the ‘The Health Improvement Network,’ (UK primary care medical records) between 1^st January 1995‐ 31^st December 2018. 22,604 adult women exposed to domestic abuse were age matched to 44,671 unexposed women. Average age at cohort entry was 36 years and median follow up was 2.5 years. The outcomes of interest were the development of a variety of syndromes which demonstrate central nervous system sensitisation. Fibromyalgia, chronic fatigue syndrome and temporomandibular joint disorder outcomes have been reported previously. Outcomes were adjusted for the presence of mental ill health.

Results

During the study period, women exposed to domestic abuse experienced an increased risk of developing chronic lower back pain (adjusted incidence rate ratio (aIRR) 2.28; 95% CI 1.85‐2.80), chronic headaches (aIRR 3.15; 95% CI 1.07‐9.23), irritable bowel syndrome (aIRR 1.41; 95% CI 1.25‐1.60) and restless legs syndrome (aIRR 1.89; 95% CI 1.44‐2.48). However, no positive association was seen with the development of interstitial cystitis (aIRR 0.52; 95% CI 0.14‐1.93), vulvodynia (aIRR 0.42; 95% CI 0.14‐1.25) and myofascial pain syndrome (aIRR 1.01; 95% CI 0.28‐3.61).

Conclusion

This study demonstrates the need to consider a past history of domestic abuse in patients presenting with CSS; and also consider preventative approaches in mitigating the risk of developing CSS following exposure to domestic abuse.

from Wiley: European Journal of Pain: Table of Contents https://ift.tt/3jw6iWF
via IFTTT

Efficacy of transforaminal epidural magnesium administration when combined with a local anesthetic and steroid in the management of lower limb radicular pain

Abstract

Background

Lower limb radicular pain resulting from a herniated intervertebral disk is a cause of functional disability and could lead to increased consumption of opioids. We evaluated the efficacy of epidural magnesium combined with a local anesthetic and steroid in the management of this pain.

Methods

This was a prospective, case‐control, randomized, double‐blind study. Fifty patients each received 2 mL bupivacaine, 1 mL (40 mg) methylprednisolone, and 1 mL saline (0.9%) (group C) or magnesium (200 mg) instead of saline (group M). The primary outcome measure was the improvement in the pain score (assessed using a visual analog scale (VAS)), and the secondary outcome was the improvement in the functional ability (assessed using the Modified Oswestry Disability Questionnaire (MODQ)). The VAS and MODQ scores were assessed before and at 1 day, 1 week, 1 month, and 3 months post‐intervention.

Results

The VAS and MODQ scores were significantly better in group M compared to those in group C at all times post‐injection (P‐value < 0.001). Comparisons within the same group showed that the VAS and MODQ scores were significantly better at all post‐injection time points compared to the pre‐injection scores in both group C and group M (P‐values < 0.0001).

Conclusions

Adding magnesium to a local anesthetic and steroid to be injected in the transforaminal epidural space could improve the pain and the quality of life in patients suffering from lower limb radicular pain due to lumbo‐sacral disk herniation, and this improvement could last for up to 3 months.

from Wiley: European Journal of Pain: Table of Contents https://ift.tt/2NfAMjG
via IFTTT

MiRNA‐107 contributes to inflammatory pain by down‐regulating GLT‐1 expression in rat spinal dorsal horn

Abstract

Background

Inflammatory pain is a severe clinical problem that affects the quality of life in patients. However, the currently available treatments for inflammatory pain have limited effect and even causes severe side effects. The aim of this study is to investigate the roles of miRNA‐107 and glutamate transporter 1 (GLT‐1) in inflammatory pain of rats induced by complete Freund’s adjuvant (CFA).

Methods

Paw withdrawal threshold (PWT) of rats were measured by von Frey Filaments. The expressions of miRNA‐107 and GLT‐1 in the lumbar spinal dorsal horn (L4‐L6) were measured with real‐time quantitative PCR and western blotting analysis. Fluorescent in situ hybridization and fluorescent‐immunohistochemistry were employed to detect expression of miRNA‐107, GLT‐1 and co‐location of miRNA‐107 with GLT‐1.

Results

Injection of CFA significantly reduced PWT of rats. The miRNA‐107 expression level was obviously up‐regulated while the GLT‐1 expression level was decreased in the spinal dorsal horn of CFA rats. miRNA‐107 and GLT‐1 were co‐expressed in same cells of spinal dorsal horn in CFA rats. Ceftriaxone, a selective activator of GLT‐1, obviously increased the PWT of CFA rats. Further, antagomir of miRNA‐107 reversed the down‐regulation of GLT‐1 and alleviated CFA‐induced mechanical allodynia of CFA rats.

Conclusions

These results suggest that increase of miR‐107 contributes to inflammatory pain through downregulating GLT‐1 expression, implying a promising strategy for pain therapy.

from Wiley: European Journal of Pain: Table of Contents https://ift.tt/3jwTZco
via IFTTT

EFFECTIVENESS OF DRY NEEDLING THERAPY ON PAIN, HIP MUSCLE STRENGTH AND PHYSICAL FUNCTION IN PATIENTS WITH HIP OSTEOARTHRITIS: A RANDOMIZED CONTROLLED TRIAL.

Publication date: Available online 7 February 2021

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Luis Ceballos-Laita, Sandra Jiménez-del-Barrio, Javier Marín-Zurdo, Alejandro Moreno-Calvo, Javier Marín-Boné, María Isabel Albarova-Corral, Elena Estébanez-de-Miguel

from ScienceDirect Publication: Archives of Physical Medicine and Rehabilitation https://ift.tt/3cPDNSf
via IFTTT

Can Yoga or Physical Therapy for Chronic Low Back Pain Improve Depression and Anxiety Among Adults from a Racially Diverse, Low-Income Community? A Secondary Analysis of a Randomized Controlled Trial.

Publication date: Available online 5 February 2021

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Christopher Joyce, Eric J. Roseen, Julie J. Keysor, K. Douglas Gross, Larry Culpepper, Robert B. Saper

from ScienceDirect Publication: Archives of Physical Medicine and Rehabilitation https://ift.tt/39X5gjk
via IFTTT

Effects of multifocal transcranial direct current stimulation targeting the motor network during prolonged experimental pain

Abstract

Background

Antinociceptive effects of transcranial direct current stimulation (tDCS) over the primary motor cortex (M1) have been extensively studied in the past years. However, M1 does not work in isolation, but it rather interacts within a network, the so‐called resting‐state motor network.

Objective

To explore the anti‐nociceptive effects of a new multifocal tDCS approach administered to regions linked to the resting state motor network (network‐tDCS) compared to sham tDCS.

Methods

Healthy individuals were included in this randomized, parallel and double‐blinded study comprising two consecutive interventions with 24‐h interval of either active (n=19) or sham (n=19) network‐tDCS. Prolonged pain was induced by application of topical capsaicin on the dorsum of the hand during a 24‐h period. Assessments of corticomotor excitability (transcranial magnetic stimulation), pain ratings (numerical rating scale, NRS), skin pain sensitivity on the arm (heat and mechanical), temporal summation of pain (TSP) and conditioned pain modulation (CPM) were performed at baseline (Day1‐baseline), after 25 min of capsaicin application and before the first tDCS session (Day1‐post‐cap), and after the second tDCS session (Day2).

Results

Comparing Day2 to Day1‐baseline measures, there was reduced corticomotor excitability (P<0.05) and impaired CPM‐effect (p<0.05) after sham but not after active network‐tDCS. Pain NRS ratings increased at Day2 compared to Day1‐post‐cap (P<0.01) in both groups whereas no significant changes were found in pain sensitivity and TSP.

Conclusions

Present findings demonstrate that tDCS applied over regions linked to the resting state motor network reverts the inhibition of corticomotor excitability and CPM impairment both provoked by prolonged experimental pain for 24 hours.

from Wiley: European Journal of Pain: Table of Contents https://ift.tt/36LnTEQ
via IFTTT

A wrist injury

A man in his 20s presented with deformity and severe pain in his left shoulder and wrist after a mid-air collision with a motocross bike. The patient’s torso had collided with another rider’s bike,...

from Latest headlines from BMJ https://ift.tt/2YMxHKj
via IFTTT

Beyond Therapy Types: Mindful Self‐Compassion and the Future of Process‐Based Therapy for Chronic Pain

Abstract

This journal recently published a paper by Palao et al., (2021) entitled “Mindful Self‐Compassion Program for Chronic Pain Patients: A Randomized Controlled Trial.” In their study the authors compare a treatment including mindfulness and self‐compassion methods (MSC) with conventional cognitive behavioral therapy (CBT). They recruited people with long standing chronic pain plus significant anxiety or depression (N = 123).

from Wiley: European Journal of Pain: Table of Contents https://ift.tt/3cFn04w
via IFTTT

Is opioid therapy for chronic noncancer pain associated with a greater risk of all‐cause mortality compared to non‐opioid analgesics? A systematic review of propensity score matched observational studies

Abstract

Background

The many risks associated with opioid therapy for chronic noncancer pain (CNCP) have led to questions about use. This is particularly relevant for risk of increased mortality. However, underlying medical conditions of those using opioids may influence mortality findings due to confounding by indication. Similarly, non‐opioid analgesics are also associated with an increased risk of mortality, too.

Methods

We have conducted a systematic review of propensity score matched observational studies comparing mortality associated with opioid use compared to non‐opioid analgesics. Clinicaltrials.gov, Google Scholar, MEDLINE and Scopus were searched from inception to July 2020. Propensity score matched observational studies comparing opioids to non‐opioid analgesics in real world settings were analysed. Primary outcome was pooled adjusted hazard ratio (aHR) of all‐cause death. Effects were summarized by a random effects model.

Results

Four studies with seven study arms and 120 186 patients were analyzed. Pooled aHR for all‐cause death was 1.69 (95% confidence interval [CI] 1.47, 1.95). When mortality risk was confined to out‐of‐hospital deaths, the pooled aHR was 2.12 (95% CI 1.46, 3.09). The most frequent cause of death was cardiovascular death. Before matching, patients with opioids were older and had more somatic diseases than patients with non‐opioids. Despite extensive propensity score matchings and sensitivity analyses, all studies could not fully exclude confounding by indication.

Conclusions

Possibly, opioids are associated with an increased all‐cause mortality risk compared to non‐opioid analgesics. When considering treatment options for patients with CNCP, the possible risk of increased all‐cause mortality with opioids should be discussed.

from Wiley: European Journal of Pain: Table of Contents https://ift.tt/3cGcdqC
via IFTTT

The effect of acute‐experimental pain models on offset analgesia

Abstract

Background

Offset analgesia (OA) is characterized by a disproportionately large decrease in pain perception after a slight decrease in noxious stimulation. In patients with ongoing pain, this response is reduced. The effect is pronounced in painful body areas. The influence of acute pain has not been sufficiently investigated. The aim of this study was to investigate the influence of two experimental acute pain models, measured within the area of acute pain and on the non‐affected opposite side, thereby considering the possible somatotopic nature of OA.

Methods

Healthy, pain‐free volunteers (n = 75) were randomly assigned to one of three groups (cold water, exercise, control group). The “cold water group” immersed one hand into cold water for 3 minutes (Cold Pressor Task), while the “exercise group” performed an isometric grip exercise for 3 minutes. There was no manipulation in the control group. Each experimental pain stimulus was performed at both (dominant, non‐dominant) forearms. The individualized OA paradigm consisted of offset and constant temperature trials. Offset analgesia was measured immediately before, during and after the experimental pain stimuli.

Results

A significant difference in OA was shown during experimental pain when compared to the control condition (exercise vs. control: p<0.001, cold vs. control: p=0.001), with no difference between the experimental conditions (p>0.05). Immediately following the pain stimulation, results were marginally non‐significant (p=0.05).

Conclusions

Experimental painful stimulation reduced OA. This result should be interpreted with caution due to potential influences of conditioned pain modulation or exercise‐induced hypoalgesia as well as possible floor effects.

from Wiley: European Journal of Pain: Table of Contents https://ift.tt/3cBGK92
via IFTTT

Mechanisms of recovery after neck‐specific or general exercises in patients with cervical radiculopathy

Abstract

Background

The mechanisms of action that facilitate improved outcomes after conservative rehabilitation are unclear in individuals with cervical radiculopathy (CR). This study aims to determine the pathways of recovery of disability with different exercise programs in individuals with CR.

Methods

We analysed a dataset of 144 individuals with CR undergoing conservative rehabilitation. Eleven variables collected at baseline, 3, 6, and 12 months follow‐up were used to build a Bayesian Network (BN) model: treatment group (neck‐specific versus general exercises), age, sex, self‐efficacy, catastrophizing, kinesiophobia, anxiety, neck‐arm pain intensity, headache pain intensity, and disability. The model was used to quantify the contribution of different mediating pathways on the outcome of disability at 12th months.

Results

All modelled variables were conditionally independent from treatment groups. A one‐point increase in anxiety at 3^rd month was associated with a 2.45 point increase in 12^th month disability (P<0.001). A one‐point increase in head pain at 3^rd month was associated with a 0.08 point increase in 12^th month disability (P<0.001). Approximately 83% of the effect of anxiety on disability was attributable to self‐efficacy. Approximately 88% of the effect of head pain on disability was attributable to neck‐arm pain.

Conclusions

No psychological or pain related variables mediated the different treatment programs with respect to the outcome of disability. Thus, the specific characteristics investigated in this study did not explain the differences in mechanisms of effect between neck‐specific training and prescribed physical activity. The present study provides candidate modifiable mediators that could be the target of future intervention trials.

from Wiley: European Journal of Pain: Table of Contents https://ift.tt/36CaGhq
via IFTTT

Experimental hand and knee pain cause differential effects on corticomotor excitability

It is well established that both acute and chronic pain affect various aspects of motor control and performance, including changes in muscle strength, endurance, and force control.1,13,26 However, the neural mechanisms that underlie these changes remain incompletely understood.7,11,29

from The Journal of Pain https://ift.tt/2NTBC5I
via IFTTT