Psychosocial factors and adjustment to chronic pain in persons with physical disabilities: a systematic review

Is There an Association Between Social Support and Pain Among Individuals Living With Multiple Sclerosis?

CONTEXT

Pain is one of the most common symptoms reported by patients living with Multiple Sclerosis (MS). Risk factors associated with pain may include individual's cognitive thinking process, emotional and behavioural response to pain and amount of social support. There is a lack of research on the influence on the amount of social support and its association to pain outcomes.

OBJECTIVE

The primary objective of this study was to determine the association between amount and of social support and its association with odds of pain among individuals with MS.

METHODS

The Survey on Living with Neurological Conditions in Canada (SLNCC) 2011-2012 linked to the Canadian Community Health Survey (CCHS) 2010-2011 was used to carry out a logistic regression model for this analysis (N = 78,623).

MAIN OUTCOME MEASURES

The factors that were assessed were psychological factors, problems with sleeping, self-perceived general health, self-perceived level of stress, number of years living with MS, as well as social factors. The outcome variable was pain.

RESULTS

The amount of social support was found to be significant in that individuals who had 3 or fewer types of social support were 3.02 times more likely (95% CI 1.06 to 8.59) to report being in pain as opposed to individuals who had 4 types of support. The results indicate the importance of self efficacy in overcoming symptoms of MS and the need for more home care services.

Psychosocial resources and chronic pain in individuals with spinal cord injury: evidence from the second Swiss national community survey

STUDY DESIGN

Cross-sectional.

OBJECTIVE

To investigate the associations of a set of psychosocial resources with pain and pain-related factors in individuals with spinal cord injury (SCI) and chronic pain.

SETTING

Community, Switzerland.

METHODS

Data from 1,064 individuals with chronic pain who participated in the second community survey of the Swiss Spinal Cord Injury Cohort Study (Survey 2017) were analyzed. Multiple linear regression modeling was performed to test the hypotheses that higher levels of psychosocial resources (self-efficacy, self-esteem, purpose in life, optimism, hope, social support, sense of belonging) are negatively associated with pain intensity, pain interference and depressive symptoms.

RESULTS

Higher self-esteem, optimism and hope were related to less pain interference and all psychosocial resources under study were negatively associated with depressive symptoms in final models. However, neither of the psychosocial resources was related to pain intensity when models were adjusted for pain interference and depressive symptoms.

CONCLUSIONS

These findings strengthen the evidence that psychosocial resources can have an impact on pain interference and depressive symptoms as pain-related factors, and support the notion that psychosocial resources might be promising targets for pain interventions in individuals with SCI.

Ethnic Differences in the Association Between Pain and Social Support in Iraq and Afghanistan Veterans

OBJECTIVE

Although past research has identified differences in pain between non-Latino white (NLW) and Latino persons, few studies have focused on the influence of social support. The purpose of the present study was to determine if the association between the number of social support sources and ratings of pain intensity and pain interference differed as a function of ethnicity.

DESIGN

Cross-sectional.

SETTING

Veterans Affairs San Diego Healthcare System.

SUBJECTS

Participants were NLW (N = 389) and Latino (N = 207) Iraq and Afghanistan veterans.

METHODS

Linear regression analyses were used to examine the interaction between ethnicity and number of social support sources on pain intensity and pain interference as measured by the Patient-Reported Outcomes Measurement Information System pain inventory.

RESULTS

The association between number of social support sources and pain intensity and interference significantly differed by ethnicity (P < 0.01 and P = 0.01, respectively). Among NLW veterans, there was a significant negative association between number of social support sources and pain intensity. Among Latino veterans, there was a significant positive association between number of social support sources and pain intensity and interference.

CONCLUSIONS

These findings suggest important differences between NLW and Latino Iraq and Afghanistan veterans in the association between social support and pain. Future research should examine ethnic differences in pain-specific support received from the social environment.

Correlation Between Aspects of Perceived Patient Loneliness and Spinal Cord Stimulation Outcomes

OBJECTIVES

Loneliness as a whole has been characterized as a health-related risk factor and is associated with worse outcomes after cardiac procedures. Evidence suggests that chronic pain patients are particularly vulnerable to feeling lonely. We examined the relationship between different aspects of loneliness and one-year postoperative outcomes after spinal cord stimulation (SCS) for chronic pain.

MATERIALS AND METHODS

We contacted 69 patients with thoracic SCS who had participated in our prospective outcomes database with one-year follow-up to complete the validated, abbreviated UCLA Loneliness Scale (UCLA-3). We examined responses on question 9 of the Oswestry Disability Index (ODI), question 12 of the Beck Depression Inventory (BDI), and UCLA-3 due to their relevance to different aspects of loneliness. We conducted regression analyses to determine the relationship between aspects of loneliness and pain outcomes.

RESULTS

We identified that loss of interest in people, companionship, and feeling excluded were associated with pain outcomes. Loss of interest in people was associated with improvement in pain (NRS worst p = 0.021, r = 0.32, NRS least p = 0.004, r = 0.4; NRS right now p = 0.016, r = 0.33). Companionship and feeling excluded were also associated with pain. We examined the interface between depression and total loneliness and found that while both were related to each other, depression was not associated with pain outcomes.

CONCLUSIONS

This study demonstrates an association between loss of interest in people, companionship, and feeling excluded and worse postoperative pain outcomes after receiving SCS. It identifies aspects of loneliness as important factors to consider when predicting the outcomes of SCS therapy for chronic pain control.

Transition from acute to chronic pain: where cells, systems and society meet

Current treatments for chronic pain are often ineffective. At the same as searching for novel therapeutics, there is growing interest in preventing acute pain becoming chronic. While the field is still in its infancy, its knowledge base is increasingly expanding. Certainly, biomedical factors, for example, the type of tissue damage, are important but they are often not modifiable. Psychosocial risk factors (e.g., thoughts and beliefs about pain, mood, social support, workplace problems) are modifiable. There is an increasing body of research that cognitive behavioral therapy can prevent transition. Internet-based delivery of cognitive behavioral therapy improves access. Clinicians need to be aware that they may inadvertently promote pain chronification in their patients by what they say and do.

Life Stressors: Elevations and Disparities Among Older Adults with Pain

OBJECTIVE

To examine stressor elevations among older adults with pain, and gender and race disparities in the dual burdens of late-life pain and stressors.

DESIGN

Cross-sectional.

SETTING

Community.

SUBJECTS

Participants in the Longitudinal Late-Life Health study (LLLH; N = 1,884) and the Health and Retirement Study (HRS; N = 7,704).

METHODS

Pain and stressor measures were harmonized across the LLLH and HRS samples. Analyses of covariance were conducted to determine the effects of older adults' pain, gender, race, and interactions between these factors, on their stressors in nine separate life domains, and in stressors overall.

RESULTS

In both the LLLH and HRS samples, older adults with painful conditions (joint, back, headache, chest pain), more numerous painful conditions, more severe pain, and more pain interference had elevated stressors in all life domains, compared with older adults without or with less serious pain. Pain was more prevalent among women and nonwhites than men and whites. Stressor exposure was higher for men than women in most life domains; it was higher for nonwhites than whites in all life domains. For certain types of pain and life domains, pain and gender, as well as pain and race, interacted to predict stressor elevations.

CONCLUSIONS

Late-life pain is associated with elevations in stressors, and there are gender and race disparities in the dual burdens of heightened pain and elevated stressors in later life. Pain and stressors are not consistently more strongly linked among older women than older men, or among older nonwhite than older white persons.

Which Psychological Factors Are Involved in the Onset and/or Persistence of Musculoskeletal Pain? An Umbrella Review of Systematic Reviews and Meta-Analyses of Prospective Cohort Studies

OBJECTIVE

The objective of this study was to summarize the current status of knowledge about the longitudinal association between vulnerability or protective psychological factors and the onset and/or persistence of musculoskeletal (MSK) pain.

METHODS

PubMed, CINAHL, PsycINFO, PubPsych, Scopus, Web of Science, gray literature, and manual screening of references were searched from inception to June 15, 2019. Systematic reviews with or without meta-analysis that explored the longitudinal association between psychological factors and the onset and/or persistence of MSK pain were identified. The AMSTAR-2 tool was used to assess the risk of bias.

RESULTS

Fifty-nine systematic reviews that included 286 original research studies were included, with a total of 249,657 participants (127,370 with MSK pain and 122,287 without MSK pain at baseline). Overall, our results found that exposure to many psychological vulnerability factors such as depression, anxiety, psychological distress, and fear, among others, may increase the risk of the onset and persistence of MSK pain across time. In addition, our results also showed that a range of psychological factors considered to be "protective" such as self-efficacy beliefs, better mental health, active coping strategies, or favorable expectations of recovery may reduce the risk of the onset and persistence of MSK pain. However, all these systematic reviews were evaluated to have critically low confidence based on the AMSTAR-2 tool, indicating that findings from these reviews may be informative, but should be interpreted with caution.

DISCUSSION

The large number of methodological flaws found across reviews gives rise to a call to action to develop high-quality systematic reviews in this field.

Health and wellness coaching positively impacts individuals with chronic pain and pain-related interference

Objectives

Health and wellness coaching (HWC) interventions have been reported to improve health outcomes for individuals with chronic diseases such as diabetes, cardiovascular disease, or cancer. However, HWC also holds potential as an effective intervention within a biopsychosocial chronic pain management framework. The aim of the present study was to evaluate the effects of HWC on individuals with chronic pain.

Methods

Participants were referred by their primary care provider or insurance company to a comprehensive telephonic 12-month pain management HWC program. Relationships between pain outcomes and physical and psychological factors were retrospectively analyzed. Mixed linear-effects modeling explored whether physical and psychological variables were associated with pain outcomes over time.

Results

Four hundred nineteen participants (female, 58.9%; mean age, 54.8) enrolled in the program and 181 completed the intervention. After 12 months in the program, statistically and clinically significant reductions were observed for pain intensity (Hedges’ g = 1.00) and pain-related interference (Hedges’ g = 1.13). Linear mixed-effects modeling indicated that improvements in physical functioning and psychological factors were associated with improvements in pain intensity.

Discussion

Our results provide a novel analysis on the effects of HWC on chronic pain and pain-related interference. HWC appears to be a promising intervention to improve pain-related outcomes in a population with chronic pain. Further investigation of HWC as an intervention for chronic pain is warranted.

Protective and Risk Factors for Phantom Limb Pain and Residual Limb Pain Severity

INTRODUCTION

The exact mechanisms underlying the development and maintenance of phantom limb pain (PLP) are still unclear. This study aimed to identify the factors affecting pain intensity in patients with chronic, lower limb, traumatic PLP.

METHODS

This is a cross-sectional analysis of patients with PLP. We assessed amputation-related and pain-related clinical and demographic variables. We used univariate and multivariate models to evaluate the associated factors modulating PLP and residual limb pain (RLP) intensity.

RESULTS

We included 71 unilateral traumatic lower limb amputees. Results showed that (1) amputation-related perceptions were experienced by a large majority of the patients with chronic PLP (sensations: 90.1%, n = 64; residual pain: 81.7%, n = 58); (2) PLP intensity has 2 significant protective factors (phantom limb movement and having effective treatment for PLP previously) and 2 significant risk factors (phantom limb sensation intensity and age); and (3) on the other hand, for RLP, risk factors are different: presence of pain before amputation and level of amputation (in addition to the same protective factors).

CONCLUSION

These results suggest different neurobiological mechanisms to explain PLP and RLP intensity. While PLP risk factors seem to be related to maladaptive plasticity, since phantom sensation and older age are associated with more pain, RLP risk factors seem to have components leading to neuropathic pain, such as the amount of neural lesion and previous history of chronic pain. Interestingly, the phantom movement appears to be protective for both phenomena.

Pain and Evil: From Local Nociception to Misery Following Social Harm

Experiencing pain, especially when chronic, is an excruciating condition that should be regarded as a syndrome, if not a disease. People suffering from chronic pain tend to develop psychological discomfort mostly due to lack of acceptance, disbelief, blame. The complexity of pain pathophysiology, plus a wide range of negative psychosocial factors, leads to a more complex suffering that deserves attention and multidisciplinary treatments. The possibility that chronic pain may occur following physical aggression, torture, or persecution raises the issue of evil as a major contributor to pain in its worst representation - when individuals or groups are attacked based on racial, social, gender, religious, political, or other grounds. To explore the complex issue of chronic pain following physical or psychological harm, and to underscore the need for a multidisciplinary approach to reduce the burden of chronic pain, we discuss the biological mechanisms underlying pain state. We seek to clarify those factors leading to pain chronification, as well as personal and social attitudes that confound patients with chronic pain. The importance of family and social environment is also investigated, as well as personality traits of chronic pain patients that may further hamper successful treatment. The presence of chronic pain, modulated by, for example, acceptance of being a victim of premeditated physical and social violence, makes the issue more difficult to comprehend.

Pain in adults with cerebral palsy: A systematic review and meta-analysis of individual participant data

BACKGROUND

There is little focus on adults with cerebral palsy (CP) in research and health care and insufficient knowledge on how to identify and manage pain in this population.

OBJECTIVES

This systematic review and meta-analysis aimed to determine whether pain prevalence in adults with CP is high and to explore variations in pain prevalence of subgroups, pain locations, pain severity and pain interference.

METHODS

Potential datasets were identified by experts in the field and literature searches in Embase, MEDLINE, and Cochrane, from January 2000 to October 2016. Included studies had a representative sample of ≥25 adults with CP and ≥1 pain outcomes. Methodological quality assessment, pain prevalence estimates and logistic regression models for subgroup effects on pain prevalence were conducted.

RESULTS

In total, 17 eligible studies were identified from 4584 publications. A meta-analysis was performed with individual participant data from 15 studies totalling 1243 participants (mean [SD] age 34.3 [12.6] years). Overall mean pain prevalence was 70% (95% CI 62-78). Women were more likely to have pain than men (P<0.001). The odds of pain was increased in adults with gross motor function level II (odds ratio [OR] 1.92, 95% CI 1.22-3.12) and IV (OR 1.77, 95% CI 1.03-4.29). Participants with pain reported pain predominantly in the legs (76%, 95% CI 66-84), and mean pain severity was 3.7/10 (95% CI 2.7-4.7) and pain interference 3.5/10 (95% CI 2.5-4.5).

CONCLUSIONS

This meta-analysis provides the first reliable pain prevalence estimate in a large international sample of adults with CP. The high prevalence of pain, 70%, suggests that adults with CP should be routinely screened for pain and treated accordingly. The range of measurement instruments used by the included studies emphasizes using common outcome measures specific to pain internationally.

Pain Is Inevitable But Suffering Is Optional: Relationship of Pain Coping Strategies to Performance in Multistage Ultramarathon Runners

INTRODUCTION

Ultramarathon runners commonly endure musculoskeletal pain during endurance events. However, the effect of pain coping skills on performance has not been examined.

METHODS

A prospective observational study during three 250 km (155 mi), 6 stage ultramarathons was conducted. Finish line surveys were completed after each of the four 40 km (25 mi) and one 80 km (50 mi) stages of racing. Variables gathered included pain intensity, pain coping strategy use, pain interference, finishing position (quintile), and successful race completion.

RESULTS

A total of 204 participants (age 41.4±10.3 y; 73% male) reported average pain intensity of 3.9 (±2.0 SD) and worst pain intensity of 5.3 (±2.3) on a 0 to 10 scale. They used greater adaptive pain coping strategies (3.0±1.3) relative to maladaptive strategies (1.3±1.1). Worst pain and pain interference increased over each stage of the race for all runners (P<0.001), with worst pain being significantly different by finishing status (P=0.02). Although all runners endured increased pain and interference, the nonfinishers (28 [14%]) had significantly greater differences in changes in pain intensity (P<0.01) and pain interference (P<0.001). Maladaptive pain coping strategies were more common in nonfinishers; with each 1-point increase (0-6 scale), there was a 3 times increase in odds of not finishing the race.

CONCLUSIONS

Although increased pain intensity and pain interference was found in all multistage ultramarathon runners, successful event completion was significantly associated with less maladaptive pain coping. Training in coping with pain may be a beneficial part of ultramarathon preparation.

Pre-consultation biopsychosocial data from patients admitted for management at pain centers in Norway

Background and aims

A bio-psycho-social approach has been recommended in multidisciplinary pain clinics, and in Norway patients with severe chronic nonmalignant pain (CNMP, defined as pain that has persisted for more than 3 months) might be treated at a regional multidisciplinary pain center. The specific aims of this study were (1) to describe characteristics of a sample of outpatients referred and accepted for treatment/management to three regional multidisciplinary pain centers in Norway, (2) to examine patient differences between the centers and (3) to study associations between symptom scores (insomnia, fatigue, depression, anxiety) and patient characteristics.

Methods

Patients, aged 17 years or older with CNMP admitted to and given a date for first consultation at one of three tertiary, multidisciplinary pain centers: St. Olavs Hospital Trondheim University Hospital (STO), Haukeland University Hospital (HUS) and University Hospital of North Norway (UNN), were included in the study. Data on demographics, physical activity, characteristics of pain, previous traumatic events, social network, Insomnia Severity Index (ISI), Chalder Fatigue Questionnaire (CFQ), Hopkins Symptom Checklist-25 (HSCL-25) and SF-36v2® were retrieved from the local quality registry at each pain center.

Results

Data from 1563 patients [mean age 42 (SD 15) years and 63% females] were available for analyses. Average years with pain were 9.3 (SD 9.1). Primary education as highest level of education was reported by 20%, being actively working/student/military by 32%, and no physical activity by 31%. Further, 48% reported widespread pain, 61% reported being exposed to serious life event(s), and 77% reported having a close friend to talk to. Non-worker status, no physical activity, lack of social network, reports of being exposed to serious life event(s) and widespread pain were all characteristics repeatedly associated with clinically high symptom scores. No significant differences between the centers were found in the proportions of patients reporting fatigue nor mean levels of insomnia symptoms. However, the proportion of patients reporting symptoms of anxiety and depression was a little lower at UNN compared with STO and HUS.

Conclusions

Analyses of registry data from three tertiary multidisciplinary pain centers in Norway support previous findings from other registry studies regarding patient characterized: A large proportion being women, many years of pain, low employment rate, low physical activity rate, and a large proportion reporting previous traumatic event(s). Characteristics such as non-work participation, no physical activity, lack of social network, have been exposed to serious life event(s), and chronic widespread pain were all associated with high clinical score levels of insomnia, fatigue, and mental distress. Health related quality of life was low compared to what has been reported for a general population and a range of other patient groups.

Implications

The findings of this study indicate that physical activity and work participation might be two important factors to address in the rehabilitation of patients with chronic non-malignant pain. Future studies should also explore whether pre consultation self-reported data might give direction to rehabilitation modalities.

Investigating the Feasibility of a Modified Quantitative Sensory Testing Approach to Profile Sensory Function and Predict Pain Outcomes Following Intrathecal Baclofen Implant Surgery in Cerebral Palsy

OBJECTIVES

Intrathecal baclofen (ITB) pumps used to manage spasticity in children with cerebral palsy (CP) also improve pain outcomes for some but not all patients. The purpose of this clinical feasibility study was to explore whether a quantitative sensory testing approach could a) be modified and used to subgroup individuals into sensory profiles and b) test whether the profiles were related to postimplant pain outcomes (i.e., pain responsive or pain persistent).

SUBJECTS

A purposeful clinical sample of nine children with CP (mean age = 12.5 years, male = 56%) and complex communication needs participated.

METHODS

A prospective within-subject design was used to measure proxy-reported pain before and after ITB implant. Pain response status was determined by proxy-reported pain intensity change (>50% change in maximum rated intensity). A modified quantitative sensory testing (mQST) procedure was used to assess behavioral responsivity to an array of calibrated sensory (tactile/acute nociceptive) stimuli before surgery.

RESULTS

Seven individuals with presurgical pain had mQST differentiated sensory profiles in relation to ITB pain outcomes and relative to the two individuals with no pain. Presurgically, the ITB pain responsive subgroup (N = 3, maximum rated pain intensity decreased >50% after ITB implant) showed increased behavioral reactivity to an acute nociceptive stimulus and cold stimulus, whereas the ITB pain persistent subgroup (N = 4) showed reduced behavioral reactivity to cold and repeated von Frey stimulation relative to the no pain individuals.

CONCLUSION

Implications for patient selection criteria and stratification to presurgically identify individuals with CP "at risk" for persistent postprocedure pain are discussed.

A cohort study of the association between psychosocial factors and pain in patients with Spinal Cord Injury and Stroke

PURPOSE

To explore associations between psychosocial factors and pain intensity and pain interference in a population with a new neurological injury on admission to rehabilitation, and after six months.

MATERIALS AND METHODS

A longitudinal, prospective cohort study with participants with stroke or Spinal Cord Injury (SCI) completing questionnaires for pain intensity and interference, mental health, pain coping strategies and pain attitudes and beliefs within two weeks of admission to inpatient rehabilitation. After six months, participants completed measures of pain intensity and pain interference only.

RESULTS

In all 32 participants completed the questionnaires at baseline and 19 after six months. Several associations between a person's mental health and certain beliefs were associated with pain outcomes. Additionally, poorer baseline mental health was associated with greater pain intensity and pain interference after six months, and a stronger belief in a medical cure for pain at baseline was associated with less pain intensity and pain interference after six months.

CONCLUSIONS

Psychosocial factors are associated with pain early after stroke and SCI. Psychosocial factors are also associated with pain outcomes several months after stroke and SCI. This highlights the importance of psychosocial factors in both of these populations and their relationship with pain outcomes.

Social Ambivalence and Disease (SAD): A Theoretical Model Aimed at Understanding the Health Implications of Ambivalent Relationships

The protective influence of social relationships on health is widely documented; however, not all relationships are positive, and negative aspects of relationships may be detrimental. Much less is known about the relationships characterized by both positivity and negativity (i.e., ambivalence). This article provides a theoretical framework for considering the influence of ambivalent relationships on physical health, including reasons why ambivalence should be considered separately from relationships characterized as primarily positive (supportive) or primarily negative (aversive). We introduce the social ambivalence and disease (SAD) model as a guide to understanding the social psychological antecedents, processes, and consequences of ambivalent relationships. We conclude by highlighting gaps in the literature and features of the SAD model that may serve as a guide to future research on potential health-relevant pathways of ambivalent relationships.

Health social workers' assessments as part of a specialized pain rehabilitation: a clinical data-mining study

This study examines how health social workers (HSWs) assess the rehabilitation needs of patients with long-term pain. Data were extracted from 66 patient assessments through a retrieval form based on the International Classification of Functioning, Disability, and Health. The assessments included information about relations, work, and recreation. Stress management, problem solving, self-care, participation in community life, and providing personal care were missing in parts of or all assessments. Differences in assessments suggest that information was registered based on traditional gender roles and age. Therefore, HSWs need standardized assessment tools to ensure that assessments are relevant for all patients with long-term pain irrespective of gender or age.

A Dyadic Perspective on Coping and its Effects on Relationship Quality and Psychological Distress in Couples Living with Chronic Pain: A Longitudinal Study

Objective

Dyadic coping is a process of coping within couples that is intended not only to support the patient with chronic pain but also to maintain equilibrium in the relationship. This study aims to investigate the effect of patient-perceived and spouse-reported dyadic coping on both the patient and their partner’s relationship quality and anxiety, stress, and depression over time.

Methods

One hundred thirty-nine couples, with one partner experiencing chronic pain, participated in this study. Spanning three measurements over six months, couples reported on their anxiety, stress, depression, relationship quality, and dyadic coping.

Results

Patient-perceived supportive dyadic coping was positively associated with both partners’ relationship quality but was negatively associated with spouses’ stress over time. Patient-perceived negative dyadic coping was negatively associated with both partners’ relationship quality and positively associated with patients’ depression and spouses’ depression and stress over time. Spouse-reported supportive dyadic coping showed a positive association with their own relationship quality and a negative association with spouses’ depression at baseline and patients’ depression at three-month follow-up. Spouse-reported negative dyadic coping was negatively associated with their relationship quality at baseline and positively associated with their partner’s anxiety and stress at six-month and three-month follow-up, respectively. Similar inference was observed from the findings of growth curve model.

Conclusions

As compared with spouse report, patient perception of dyadic coping is a better predictor of both partners’ relationship quality and psychological outcomes over time. Both partners may benefit from early psychosocial intervention to improve their dyadic coping, relationship quality, and psychological outcomes.

Neurosteroids and neuropathic pain management: Basic evidence and therapeutic perspectives

Complex mechanisms involved in neuropathic pain that represents a major health concern make its management complicated. Because neurosteroids are bioactive steroids endogenously synthesized in the nervous system, including in pain pathways, they appear relevant to develop effective treatments against neuropathic pain. Neurosteroids act in paracrine or autocrine manner through genomic mechanisms and/or via membrane receptors of neurotransmitters that pivotally modulate pain sensation. Basic studies which uncovered a direct link between neuropathic pain symptoms and endogenous neurosteroid production/regulation, paved the way for the investigations of neurosteroid therapeutic potential against pathological pain. Concordantly, antinociceptive properties of synthetic neurosteroids were evidenced in humans and animals. Neurosteroids promote peripheral analgesia mediated by T-type calcium and gamma-aminobutyric acid type A channels, counteract chemotherapy-induced neuropathic pain and ameliorate neuropathic symptoms of injured spinal cord animals by stimulating anti-inflammatory, remyelinating and neuroprotective processes. Together, these data open interesting perspectives for neurosteroid-based strategies to manage/alleviate efficiently neuropathic pain.

Influencing walking behavior can increase the physical activity of patients with chronic pain hospitalized for multidisciplinary rehabilitation: an observational study

Background

Physical therapy and exercising are key components of biopsychosocial rehabilitation for chronic pain. Exercise helps reduce pain and improve physical functions. In addition, a high level of physical activity benefits quality of life and emotional well-being. However, the degree to which hospitalization for extensive rehabilitation effectively increases physical activity has not yet been studied. Therefore, we investigated the physical activity level and the walking behavior of inpatients with musculoskeletal pain. The objectives were 1) to compare physical activity level and walking with or without rehabilitation, 2) to evaluate whether pain site influences physical activity level, and 3) to measure the association between physical activity and pain-related interference with physical functioning.

Methods

During a rehabilitation stay, 272 inpatients with lower limb, spine, or upper limb pain wore an accelerometer over 1 week. We assessed the daily duration of the practice of moderate physical activity and walking. Weekend days, during which the participants went home (days off), were used as a reference for habitual activities. We also evaluated 93 patients before the hospitalization to validate the use of days off as a baseline. Pain interference was measured with the brief pain inventory questionnaire. Generalized linear mixed models analyzed the association between physical activity and walking levels, and 1) rehabilitation participation, 2) pain sites, and 3) pain interference.

Results

Weekend days during the stay have similar physical activity level as days measured before the stay (73 min / day at the clinic, versus 70 min / day at home). Rehabilitation days had significantly higher physical activity levels and walking durations than days off (+ 28 min [+ 37%] and + 32 min [+ 74%], respectively). Mixed models revealed 1) a negative association between physical activity and pain interference, and 2) no effect of pain sites. Overall, patients increased their physical activity level independently of reported pain interference.

Conclusions

Despite their painful condition, the inpatients were able to engage themselves in a higher level of physical activity via increased participation in walking activities. We conclude that walking incentives can be a valid solution to help patients with chronic pain be more physically active.

Electronic supplementary material

The online version of this article (10.1186/s12891-019-2561-9) contains supplementary material, which is available to authorized users.

Resilient to Pain: A Model of How Yoga May Decrease Interference Among People Experiencing Chronic Pain

Chronic musculoskeletal pain is the leading cause of disability globally, yet for the majority of people who experience chronic pain, it does not seriously disable them or interfere with their life. People who experience severe pain yet low disability display a resilient course of pain. Yoga has been shown to decrease disability among people with pain, but it is not known how. Because even the most basic yoga practices possess many of the components thought to be important in fostering resilience, yoga is a promising means of improving resilience and clinical outcomes for people with chronic pain. A validated conceptual model of how the experience of chronic pain is affected by yoga is needed to guide a future research agenda and identify potential targets for chronic pain intervention. Ultimately, an explanatory model could guide the optimization of yoga and other non-pharmacological therapies for the treatment of chronic pain. I present a testable model.

A Reduction in Pain Intensity Is More Strongly Associated With Improved Physical Functioning in Frustration Tolerant Individuals: A Longitudinal Moderation Study in Chronic Pain Patients

OBJECTIVE

The onset and chronification of pain often has devastating consequences on the physical and mental functioning of individuals. Medical interventions are quite efficacious in reducing pain levels. However, changes in physical and mental health status after medical interventions are not proportional. In the past decades, rational/irrational beliefs, especially catastrophizing, have contributed to a better understanding of the pain experience. This study explores whether pain reduction efforts are more beneficial for individuals scoring high in rational thinking (moderation).

METHODS

The study design was longitudinal. Patients were assessed twice, 2 weeks prior to the start of medical treatment at the pain clinic and 6 months after. A total of 163 patients with heterogeneous pain (mostly low back and neck pain) participated in the study. Their mean age was 58.74 years (SD = 14.28) and 61.3% were female.

RESULTS

Overall, there was a reduction in pain intensity (t = 4.25, p < 0.001, d = 0.32). An improvement in physical functioning (t = 4.02, p < 0.001, d = 0.19), but not mental health (t = -0.66, p = 0.511, d = 0.11) was also observed. In the regression analyses, a decrease in pain intensity was moderately associated with improved physical health (β = 0.87, t = 4.96, p < 0.001, R 2 change = 0.177). This association was found to be moderated by frustration tolerance (β = -0.49, t = -2.80, p = 0.006, R 2 change = 0.039). Specifically, post hoc analyses indicated that changes in pain intensity only correlated with changes in physical health when patients reported high frustration tolerance levels (r = 0.47, p = 0.006, M = 7, n = 32), but not when patients were intolerant to frustration (r = 0.28, p = 0.078, M = 17, n = 41).

CONCLUSION

The results suggest that frustration tolerance may render adaptive by facilitating the positive effect that a reduction in pain intensity has on physical health status. The study findings are discussed in the context of personalized therapy with an emphasis on how to maximize the effectiveness of current interventions for pain.

Clinical meaningfulness of duloxetine's effect in Chinese patients with chronic pain due to osteoarthritis: post hoc analyses of a phase 3 randomized trial

Purpose

To evaluate the analgesic effect of duloxetine in Chinese patients with osteoarthritis (OA) of the knee/hip at individual patient level and report the relationship between pain intensity reduction, overall improvement, and physical functioning.

Patients and methods

Post hoc analysis of 13-week, phase 3, parallel-group, randomized, placebo-controlled study of duloxetine in Chinese patients with OA pain. Patients were randomized (1:1, computer-generated, interactive web-response system) to duloxetine (60 mg once daily, n=202) or placebo (n=207). Patients, investigators, and study staff were blinded throughout the study. Duloxetine’s efficacy was evaluated using the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) and the Osteoarthritis Research Society International and Outcome Measures in Rheumatology (OARSI-OMERACT) responder criteria. Analyses were conducted on all randomized patients with a baseline and at least one post-baseline observation.

Results

At study endpoint, the percentage of patients experiencing ≥30% pain intensity reduction (30% responders) was significantly higher in the duloxetine group than in the placebo group (63.4% vs 49.7%; P=0.008). The percentage of patients experiencing ≥50% pain intensity reduction (50% responders) in the duloxetine group was numerically higher than in the placebo group (42.8% vs 34.5%; P=0.098). Most of the 30% and 50% responders to duloxetine treatment felt either “very much improved” or “much improved” on the Patient Global Impression-Improvement at endpoint. The 30% and 50% responders to duloxetine treatment also experienced greater improvements in the Western Ontario and McMaster Universities Osteoarthritis Index physical function scores at endpoint compared with non-responders. The overall percentage of OARSI-OMERACT responders was significantly higher in the duloxetine group vs the placebo group (70.1% vs 54.9%; P=0.003).

Conclusion

Based on IMMPACT and OARSI-OMERACT criteria, the analgesic effect of duloxetine was associated with clinically relevant benefits in Chinese patients with OA of the knee/hip.

ClinicalTrials.gov identifier

NCT01931475.

Exercise-Induced Hypoalgesia in Pain-Free and Chronic Pain Populations: State of the Art and Future Directions

Exercise is considered an important component of effective chronic pain management and it is well-established that long-term exercise training provides pain relief. In healthy, pain-free populations, a single bout of aerobic or resistance exercise typically leads to exercise-induced hypoalgesia (EIH), a generalized reduction in pain and pain sensitivity that occurs during exercise and for some time afterward. In contrast, EIH is more variable in chronic pain populations and is more frequently impaired; with pain and pain sensitivity decreasing, remaining unchanged or, in some cases, even increasing in response to exercise. Pain exacerbation with exercise may be a major barrier to adherence, precipitating a cycle of physical inactivity that can lead to long-term worsening of both pain and disability. To optimize the therapeutic benefits of exercise, it is important to understand how EIH works, why it may be impaired in some people with chronic pain, and how this should be addressed in clinical practice. In this article, we provide an overview of EIH across different chronic pain conditions. We discuss possible biological mechanisms of EIH and the potential influence of sex and psychosocial factors, both in pain-free adults and, where possible, in individuals with chronic pain. The clinical implications of impaired EIH are discussed and recommendations are made for future research, including further exploration of individual differences in EIH, the relationship between exercise dose and EIH, the efficacy of combined treatments and the use of alternative measures to quantify EIH. PERSPECTIVE: This article provides a contemporary review of the acute effects of exercise on pain and pain sensitivity, including in people with chronic pain conditions. Existing findings are critically reviewed, clinical implications are discussed, and recommendations are offered for future research.

Social support buffers the negative influence of perceived injustice on pain interference in people living with HIV and chronic pain

Introduction:

A growing literature attests to the overwhelming prevalence of disabling chronic pain among people living with HIV (PLWH), yet very little is known about psychosocial contributors to poor chronic pain outcomes in this population. Pain-related perception of injustice may promote pain interference by hindering engagement in daily activities among individuals with chronic pain. Social support has been shown to buffer the negative impact of harmful beliefs on well-being and facilitate adjustment to chronic pain.

Objective:

This cross-sectional study tested the buffering hypothesis of social support to determine whether increasing levels of social support mitigate the negative influence of perceived injustice on pain interference.

Methods:

A total of 60 PLWH with chronic pain completed measures of perceived injustice, social support, pain severity, and interference, as well as depressive symptoms.

Results:

In a regression-based model adjusted for age, sex, depressive symptoms, and pain severity, results indicated that social support significantly moderated (ie, buffered) the association between perceived injustice and pain interference (P = 0.028). Specifically, it was found that perceived injustice was significantly associated with greater pain interference among PLWH with low levels of social support (P = 0.047), but not those with intermediate (P = 0.422) or high levels of social support (P = 0.381).

Conclusion:

Pain-related injustice perception reflects harmful beliefs regarding severity of loss consequent to chronic pain development, a sense of unfairness, and irreparability of loss. Access to a social support network may provide an adaptive means of mitigating the negative effects of perceived injustice.

A shared vision of quality of life: Partnering in decision-making to understand families' realities

Quality of life (QOL) measures are increasingly used when important prognostication and treatment decisions need to be made in the care of a critically ill child. Unfortunately, health-care professionals and families experience difficulties when attempting to accurately predict and estimate QOL for a patient. Aspects such as subjectivity, complexity and adaptation to illness play an important role in how QOL is ultimately experienced. This often leads to inaccurate estimates of QOL, when performed by individuals other than the patient, such as clinicians or family members. In order to make decisions in the best interest of the patient, a partnership between families and clinicians must be fostered, based on communication, trust and mutual understanding of values. This article will attempt to describe some of the challenges that come into play when assessing QOL for a patient and will provide tools for building a clinician-family partnership in the decision-making process.

Chronic pain and suicide risk: A comprehensive review

Death by suicide is one of the leading causes of mortality worldwide. Because individuals with chronic pain are at least twice as likely to report suicidal behaviors or to complete suicide, it is of utmost importance to target which risk factors contribute the most to increasing suicidality. This comprehensive review aims to provide an update on research advancements relating to the identification of potential risk factors for suicidality in individuals with chronic pain. Supporting the results of prior reviews, we found robust evidence that chronic pain itself, regardless of type, was an important independent risk factor for suicidality. The only sociodemographic factor found to be associated with suicidality in individuals with chronic pain was being unemployed/disabled. Depressive symptoms, anger problems, harmful habits (e.g. smoking, alcohol misuse, illicit drugs), childhood or adulthood adversities, and family history of depression/suicide were all also identified as general risk factors. Regarding pain-related factors, sleep problems, poorer perceived mental health, concurrent chronic pain conditions, and more frequent episodes of intermittent pain, were all found to be predictors of suicidality. Unexpectedly, pain characteristics (e.g. type, duration, and intensity/severity) and physical status (e.g. pain interference or disability) were not related to suicide risk. We also identified promising new psychosocial factors (e.g. mental defeat, pain catastrophizing, hopelessness, perceived burdensomeness and thwarted belongingness) associated with suicidality outcomes. A large number of these factors are amenable to change through targeted intervention, highlighting the importance of comprehensively assessing chronic pain patients at risk for suicide, while also incorporating a suicide prevention component into chronic pain management programs.

Evaluating psychosocial contributions to chronic pain outcomes

The biopsychosocial model of pain dominates the scientific community's understanding of chronic pain. Indeed, the biopsychosocial approach describes pain and disability as a multidimensional, dynamic integration among physiological, psychological, and social factors that reciprocally influence one another. In this article, we review two categories of studies that evaluate the contributions of psychosocial factors to the experience of chronic pain. First, we consider general psychosocial variables including distress, trauma, and interpersonal factors. Additionally, we discuss pain-specific psychosocial variables including catastrophizing, expectations, and pain-related coping. Together, we present a diverse array of psychological, social, and contextual factors and highlight the need to consider their roles in the development, maintenance, and treatment of chronic pain conditions.

The Nature of Trauma Pain and Its Association with Catastrophizing and Sleep

BACKGROUND

Nearly 2.8 million people are hospitalized in the USA annually for traumatic injuries, which include orthopedic and internal organ injuries. Early post-injury pain is predictive of poor outcomes, including inability to eventually return to work, and long-term psychological distress. The goal of the present study was to improve our scientific understanding of trauma-related pain by examining (1) the nature and frequency of inpatient trauma pain and (2) the associations between inpatient trauma pain, education, opioid analgesic equivalent use, pain catastrophizing, and sleep quality.

METHOD

The study included 120 patients hospitalized at a major level I regional trauma center for the care of (1) closed long bone or calcaneus fractures and/or (2) an intraabdominal injury caused by blunt force trauma and requiring surgical repair (i.e., laparotomy). Medical records were reviewed to obtain demographic information and information about opioid use during hospitalization. In addition, participants were administered measures of average pain intensity, pain catastrophizing, and sleep quality.

RESULTS

Education, opioid analgesic equivalents, catastrophizing, and poor sleep quality together accounted for 28% of the variance of average pain intensity over a 24-h period (p < .001), with each variable making a significant independent association.

CONCLUSION

Two of the factors associated with pain intensity in the study sample-catastrophizing and sleep quality-are modifiable. It is therefore possible that interventions that target these variables in patients who are hospitalized for trauma could potentially result in better long-term outcomes, including a reduced risk for developing chronic pain. Research to evaluate this possibility is warranted.

Beyond solicitousness: a comprehensive review on informal pain-related social support

Adults with chronic pain cite social support (SS) as an important resource. Research has mostly focused on general SS or pain-specific solicitousness, resulting in a limited understanding of the role of SS in pain experiences. Drawing on SS theoretical models, this review aimed to understand how pain-related SS has been conceptualized and measured and how its relationship with pain experiences has been investigated. Arksey and O'Malley scoping review framework guided the study. A database search (2000-2015) was conducted in PsycINFO, CINAHL, MEDLINE, and EMBASE using a combination of subject headings/keywords on pain and SS; 3864 citations were screened; 101 full texts were assessed for eligibility; references of 52 papers were hand searched. Fifty-three studies were included. Most studies were either a-theoretical or drew upon the operant conditioning model. There are several self-report measures and observational systems to operationalize pain-related SS. However, the Multidimensional Pain Inventory remains the most often used, accounting for the centrality of the concept of solicitousness in the literature. Most studies focused on individuals with chronic pain self-report of spousal pain-related SS and investigated its main effects on pain outcomes. Only a minority investigated the role of pain SS within the stress and coping process (as a buffer or mediator). Little is known about mediating pathways, contextual modulation of the effectiveness of SS exchanges, and there are practically no SS-based intervention studies. Drawing on general SS models, the main gaps in pain-related SS research are discussed and research directions for moving this literature beyond solicitousness are proposed.

Mental practice for chronic pain in people with spinal cord injury: a systematic review protocol

REVIEW QUESTION/OBJECTIVE

The primary objective of this systematic review is to identify the effects of mental practice (MP) interventions on chronic neuropathic and nociceptive pain and motor function recovery in individuals after spinal cord injury (SCI). Where possible, this review will also describe the optimal type and dosage (i.e. frequency, intensity and duration) of MP interventions for patients with SCI.

Satisfaction with life in individuals with a lower limb amputation: The importance of active coping and acceptance

The aim of this study was to analyze the relationship between sociodemographic/clinical characteristics, coping strategies and satisfaction with life in individuals with lower limb amputation. Sixty-three individuals with a lower limb amputation due to Diabetes and Peripheral Vascular Disease participated in the study and answered measures of coping strategies and satisfaction with life. Findings revealed high dissatisfaction with life. Acceptance and active coping were the most used coping strategies. Satisfaction with life was positively associated with active and planning coping, religion, acceptance and humour. There were differences in coping strategies according to gender, age, marital status, presence of residual limb pain, prosthesis use and mobility level. Results emphasize the differential role of coping strategies, for each individual. Psychosocial interventions need to take into consideration coping strategies during the process of rehabilitation and be specific regarding individuals` sociodemographic and clinical characteristics. This study may help design interventions that answer individuals with lower limb amputations given that coping strategies are a valuable resource in the promotion of satisfaction with life.

Characterizing Mobility Limitations Among Older African American Men

This study represents an effort to contribute to the limited body of research on biopsychosocial contextual factors that influence or contribute to mobility limitations for older African American men. Specifically, we were interested in examining associations between socio-demographic, physical and emotional health experiences with mobility limitations. A secondary analysis of 1666 older African American men was performed to investigate socio-demographic, mental and physical health correlates to a specific measures of mobility limitation. In the final model, difficulty with self-care, severe pain interference, and problems with usual activities were most strongly associated with mobility limitations. Men who were married were significantly less likely to experience mobility limitations. Findings highlighted the relationship between mobility limitations and difficulty performing activities of daily living. Additional research should examine the impact of poor emotional health and the buffering effects of marriage on mobility for older African American men, a population at high risk of experiencing disparate health outcomes.

Psychosocial predictors in the transition from acute to chronic pain: a systematic review

Chronic non-cancer pain (CNCP) is a major health problem which psychosocial factors have significant implications in. There is a gap in regards to evidence for the prevention of chronicity specifically addressing psychological and social domains. Four databases were searched with terms related to "psychosocial", "acute pain", and "chronic pain". A total of 1,389 studies were identified in which titles, abstracts, and full texts were assessed for inclusion criteria. A data template was used to capture pertinent details, and overall themes and patterns were organized according to type of pain examined and psychosocial variables measured. Of the 18 articles that met inclusion criteria, fifteen (83%) of the articles reported an association between psychosocial factors and chronicity. A total of 5 of the studies (29%) demonstrated that depression was a possible predictor and 6 (35%) of the studies found fear-avoidance to be associated with chronicity. This review provides evidence that psychosocial factors are associated with chronicity within CNCP. These results suggest a need for targeting psychosocial predictors in prevention and early intervention through clinical guidelines and a national strategy to support a cultural change in pain care.