Pain is an aversive sensory, cognitive, and emotional experience that occurs in a variety of conditions and imposes a substantial individual and public health burden. For nearly three decades, musculoskeletal pain has remained a leading cause of years lived with disability globally.23 In the United States, an estimated 20.4% of adults experience chronic pain that is associated with $560B USD/year of total healthcare costs.15 Chronic musculoskeletal pain is especially prevalent, with 19.6% of Americans aged 20 to 59 reporting chronic low back pain,32 and is commonly characterized by lower physical activity, reduced mobility, and cognitive impairment.
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Monday, June 7, 2021
Thursday, June 3, 2021
Pain in right buttock after carbon monoxide poisoning
A woman in her 30s, eight weeks into her second pregnancy, was found disorientated at home. She had been lying on her right side in bed for about six hours in an airtight room with a coal stove that...
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Tuesday, June 1, 2021
Pain evaluation and prosocial behavior are affected by age and sex
Abstract
Background
Pain assessment and pain care are influenced by the characteristics of both the patient and the caregiver. Some studies suggest that the pain of older persons and of females may be underestimated to a greater extent than the pain of younger and male individuals.
Aims
This study investigated the effect of age and sex on prosocial behavior and pain evaluation.
Methods
40 young (18-30 y/o; 20 women) and 40 older adults (55-82 y/o; 20 women) acted as healthcare professionals rating the pain and offering help to patients of both age groups. Trait empathy and social desirability were measured with questionnaires.
Results
Linear mixed models showed that older and male patients were offered more help and were perceived as being in more intense pain than younger and female patients.
Conclusion
The characteristics of the patients seem to have a greater impact on prosocial behavior and pain assessment compared to those of the observers, which bears significant implications for the treatment of pain in clinical contexts.
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Pain evaluation and prosocial behavior are affected by age and sex
Abstract
Background
Pain assessment and pain care are influenced by the characteristics of both the patient and the caregiver. Some studies suggest that the pain of older persons and of females may be underestimated to a greater extent than the pain of younger and male individuals.
Aims
This study investigated the effect of age and sex on prosocial behavior and pain evaluation.
Methods
40 young (18-30 y/o; 20 women) and 40 older adults (55-82 y/o; 20 women) acted as healthcare professionals rating the pain and offering help to patients of both age groups. Trait empathy and social desirability were measured with questionnaires.
Results
Linear mixed models showed that older and male patients were offered more help and were perceived as being in more intense pain than younger and female patients.
Conclusion
The characteristics of the patients seem to have a greater impact on prosocial behavior and pain assessment compared to those of the observers, which bears significant implications for the treatment of pain in clinical contexts.
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Sunday, May 30, 2021
Placebo effects in low back pain; a systematic review and meta‐analysis of the literature
Abstract
Background and Objective
The current treatments of primary musculoskeletal low back pain (LBP) have a low to moderate efficacy, which might be improved by looking at the contribution of placebo effects. However, the size of true placebo effects in LBP is unknown. Therefore, a systematic review and meta-analysis were executed of randomized controlled trials investigating placebo effects in LBP.
Databases and Data treatment
The study protocol was registered in the international prospective register of systematic reviews Prospero (CRD42019148745). A literature search (in PubMed, Embase, The Cochrane Library, CINAHL and PsycINFO) up to 2021 February 16th yielded 2423 studies. Two independent reviewers assessed eligibility and risk of bias.
Results
Eighteen studies were eligible for the systematic review and 5 for the meta-analysis. Fourteen of the 18 studies were clinical treatment studies, and 4 were experimental studies specifically assessing placebo effects. The clinical treatment studies provided varying evidence for placebo effects in chronic LBP, but insufficient evidence for acute and subacute LBP. Most experimental studies investigating chronic LBP revealed significant placebo effects. The meta-analysis of 5 treatment studies investigating chronic LBP depicted a significant moderate effect size of placebo for pain intensity (SMD = 0.57) and disability (SMD = 0.52).
Conclusions
This review shows a significant contribution of placebo effects to chronic LBP symptom relief in clinical and experimental conditions. The meta-analysis revealed that placebo effects can influence chronic LBP intensity and disability. However, additional studies are required for more supporting evidence and evidence for placebo effects in acute or subacute LBP.
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During Capsaicin‐induced Central Sensitization Brush Allodynia is Associated with Baseline Warmth Sensitivity, Whereas Mechanical Hyperalgesia is Associated with Painful Mechanical Sensibility, Anxiety and Somatization
Abstract
Background
Mechanical hyperalgesia and allodynia incidence varies considerably among neuropathic pain patients. This study explored whether sensory or psychological factors associate with mechanical hyperalgesia and brush allodynia in a human experimental model.
Methods
Sixty-six healthy volunteers (29 male) completed psychological questionnaires and participated in two quantitative sensory testing (QST) sessions. Warmth detection threshold (WDT), heat pain threshold (HPT) and suprathreshold mechanical pain (STMP) ratings were measured before exposure to a capsaicin-heat pain model (C-HP). After C-HP exposure, brush allodynia and STMP were measured in one session, while mechanical hyperalgesia was measured in another session.
Results
WDT and HPT measured in sessions separated by one month demonstrated significant, but moderate levels of reliability (WDT: ICC=0.5, 95%CI[0.28,0.77]; HPT: ICC=0.62, 95%CI[0.40,0.77]). Brush allodynia associated with lower WDT (z=-3.06, p=0.002; ϕ=0.27). Those with allodynia showed greater hyperalgesia intensity (F=7.044, p=0.010, ηp 2=0.107) and area (F=9.319, p=0.004, ηp 2=0.163) than those without allodynia. No psychological self-report measures were significantly different between allodynic and non-allodynic groups. Intensity of hyperalgesia in response to lighter mechanical stimuli was associated with lower HPT, higher STMP ratings, and higher Pain Sensitivity Questionnaire scores at baseline. Hyperalgesia to heavier probe stimuli associated with state anxiety and to a lesser extent somatic awareness. Hyperalgesic area associated with lower baseline HPT and higher STMP ratings. Hyperalgesic area was not correlated with allodynic area across individuals.
Conclusions
These findings support research in neuropathic pain patients and human experimental models that peripheral sensory input and individual sensibility are related to development of mechanical allodynia and hyperalgesia during central sensitization, while psychological factors play a lesser role.
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Placebo effects in low back pain; a systematic review and meta‐analysis of the literature
Abstract
Background and Objective
The current treatments of primary musculoskeletal low back pain (LBP) have a low to moderate efficacy, which might be improved by looking at the contribution of placebo effects. However, the size of true placebo effects in LBP is unknown. Therefore, a systematic review and meta-analysis were executed of randomized controlled trials investigating placebo effects in LBP.
Databases and Data treatment
The study protocol was registered in the international prospective register of systematic reviews Prospero (CRD42019148745). A literature search (in PubMed, Embase, The Cochrane Library, CINAHL and PsycINFO) up to 2021 February 16th yielded 2423 studies. Two independent reviewers assessed eligibility and risk of bias.
Results
Eighteen studies were eligible for the systematic review and 5 for the meta-analysis. Fourteen of the 18 studies were clinical treatment studies, and 4 were experimental studies specifically assessing placebo effects. The clinical treatment studies provided varying evidence for placebo effects in chronic LBP, but insufficient evidence for acute and subacute LBP. Most experimental studies investigating chronic LBP revealed significant placebo effects. The meta-analysis of 5 treatment studies investigating chronic LBP depicted a significant moderate effect size of placebo for pain intensity (SMD = 0.57) and disability (SMD = 0.52).
Conclusions
This review shows a significant contribution of placebo effects to chronic LBP symptom relief in clinical and experimental conditions. The meta-analysis revealed that placebo effects can influence chronic LBP intensity and disability. However, additional studies are required for more supporting evidence and evidence for placebo effects in acute or subacute LBP.
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