151
|
Groeneweg G, Huygen FJPM, Niehof SP, Wesseldijk F, Bussmann JBJ, Schasfoort FC, Stronks DL, Zijlstra FJ. Effect of tadalafil on blood flow, pain, and function in chronic cold complex regional pain syndrome: a randomized controlled trial. BMC Musculoskelet Disord 2008; 9:143. [PMID: 18937830 PMCID: PMC2575214 DOI: 10.1186/1471-2474-9-143] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2008] [Accepted: 10/20/2008] [Indexed: 12/30/2022] Open
Abstract
Background This double-blind, randomized, controlled trial investigated the effect of the phosphodiesterase-5 inhibitor tadalafil on the microcirculation in patients with cold Complex Regional Pain Syndrome (CRPS) in one lower extremity. Methods Twenty-four patients received 20 mg tadalafil or placebo daily for 12 weeks. The patients also participated in a physical therapy program. The primary outcome measure was temperature difference between the CRPS side and the contralateral side, determined by measuring the skin temperature with videothermography. Secondary outcomes were: pain measured on a Visual Analogue Scale, muscle force measured with a MicroFet 2 dynamometer, and level of activity measured with an Activity Monitor (AM) and walking tests. Results At the end of the study period, the temperature asymmetry was not significantly reduced in the tadalafil group compared with the placebo group, but there was a significant and clinically relevant reduction of pain in the tadalafil group. Muscle force improved in both treatment groups and the AM revealed small, non-significant improvements in time spent standing, walking, and the number of short walking periods. Conclusion Tadalafil may be a promising new treatment for patients that have chronic cold CRPS due to endothelial dysfunction, and deserves further investigation. Trial Registration The registration number in the Dutch Trial Register is ISRCTN60226869.
Collapse
Affiliation(s)
- George Groeneweg
- Department of Anesthesiology, subdivision Pain Treatment Centre, Erasmus MC, Rotterdam, the Netherlands.
| | | | | | | | | | | | | | | |
Collapse
|
152
|
Lamé IE, Peters ML, Kessels AG, Van Kleef M, Patijn J. Test—retest stability of the Pain Catastrophizing Scale and the Tampa Scale for Kinesiophobia in Chronic Pain over a Longer Period of Time. J Health Psychol 2008; 13:820-6. [DOI: 10.1177/1359105308093866] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The objective of this study was to investigate the test—retest stability of the Pain Catastrophizing Scale (PCS), the Tampa Scale for Kinesiophobia (TSK) and their subscales in chronic pain patients over relatively long period of times like those that are most often seen in clinical practice. Fifty non-malignant chronic pain patients filled out the PCS and TSK twice with a mean interval between testing of 52 days. Both assessment instruments showed sufficient test—retest stability, even with long time intervals between testing.
Collapse
Affiliation(s)
- Inge E. Lamé
- University Hospital Maastricht, The Netherlands, :
| | | | | | | | | |
Collapse
|
153
|
Moseley LG, Zalucki NM, Wiech K. Tactile discrimination, but not tactile stimulation alone, reduces chronic limb pain. Pain 2008; 137:600-608. [DOI: 10.1016/j.pain.2007.10.021] [Citation(s) in RCA: 200] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2007] [Revised: 10/11/2007] [Accepted: 10/22/2007] [Indexed: 12/01/2022]
|
154
|
Does evidence support physiotherapy management of adult Complex Regional Pain Syndrome Type One? A systematic review. Eur J Pain 2008; 13:339-53. [PMID: 18619873 DOI: 10.1016/j.ejpain.2008.05.003] [Citation(s) in RCA: 126] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2007] [Revised: 03/19/2008] [Accepted: 05/01/2008] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To source and critically evaluate the evidence on the effectiveness of Physiotherapy to manage adult CRPS-1. DESIGN Systematic literature review. METHODS Electronic databases, conference proceedings, clinical guidelines and text books were searched for quantitative studies on CRPS-1 in adults where Physiotherapy was a sole or significant component of the intervention. Data were extracted according to predefined criteria by two independent reviewers. Methodological quality was assessed using the Critical Review Form. RESULTS The search strategy identified 1320 potential articles. Of these, 14 articles, representing 11 studies, met inclusion criteria. There were five randomised controlled trials, one comparative study and five case series. Methodological quality was dependent on study type, with randomised controlled trials being higher in quality. Physiotherapy treatments varied between studies and were often provided in combination with medical management. This did not allow for the 'stand-alone' value of Physiotherapy to be determined. Heterogeneity across the studies, with respect to participants, interventions evaluated and outcome measures used, prevented meta-analysis. Narrative synthesis of the results, based on effect size, found there was good to very good quality level II evidence that graded motor imagery is effective in reducing pain in adults with CRPS-1, irrespective of the outcome measure used. No evidence was found to support treatments frequently recommended in clinical guidelines, such as stress loading. CONCLUSIONS Graded motor imagery should be used to reduce pain in adult CRPS-1 patients. Further, the results of this review should be used to update CRPS-1 clinical guidelines.
Collapse
|
155
|
Anxiety disorders and comorbid medical illness. Gen Hosp Psychiatry 2008; 30:208-25. [PMID: 18433653 DOI: 10.1016/j.genhosppsych.2007.12.006] [Citation(s) in RCA: 367] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2007] [Revised: 12/11/2007] [Accepted: 12/11/2007] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To provide an overview of the role of anxiety disorders in medical illness. METHOD The Anxiety Disorders Association of America held a multidisciplinary conference from which conference leaders and speakers reviewed presentations and discussions, considered literature on prevalence, comorbidity, etiology and treatment, and made recommendations for research. Irritable bowel syndrome (IBS), asthma, cardiovascular disease (CVD), cancer and chronic pain were reviewed. RESULTS A substantial literature supports clinically important associations between psychiatric illness and chronic medical conditions. Most research focuses on depression, finding that depression can adversely affect self-care and increase the risk of incident medical illness, complications and mortality. Anxiety disorders are less well studied, but robust epidemiological and clinical evidence shows that anxiety disorders play an equally important role. Biological theories of the interactions between anxiety and IBS, CVD and chronic pain are presented. Available data suggest that anxiety disorders in medically ill patients should not be ignored and could be considered conjointly with depression when developing strategies for screening and intervention, particularly in primary care. CONCLUSIONS Emerging data offer a strong argument for the role of anxiety in medical illness and suggest that anxiety disorders rival depression in terms of risk, comorbidity and outcome. Research programs designed to advance our understanding of the impact of anxiety disorders on medical illness are needed to develop evidence-based approaches to improving patient care.
Collapse
|
156
|
Peters ML, Crombez G. Assessment of Attention to Pain Using Handheld Computer Diaries. PAIN MEDICINE 2007. [DOI: 10.1111/j.1526-4637.2007.00375.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
157
|
Woods MP, Asmundson GJG. Evaluating the efficacy of graded in vivo exposure for the treatment of fear in patients with chronic back pain: a randomized controlled clinical trial. Pain 2007; 136:271-280. [PMID: 17716819 DOI: 10.1016/j.pain.2007.06.037] [Citation(s) in RCA: 187] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2006] [Revised: 06/25/2007] [Accepted: 06/29/2007] [Indexed: 11/23/2022]
Abstract
Psychological treatments for chronic pain, particularly those based upon cognitive behavioural principles, have generally been shown to be efficacious. Recently, a treatment has been developed based upon the fear-avoidance model of chronic musculoskeletal pain, which suggests chronic pain can be relieved by exposing the individual to movements and tasks that have been avoided due to fear of (re)injury. This graded in vivo exposure treatment has been found to be beneficial in case studies. The present investigation utilized a randomized controlled trial method to assess the effectiveness of graded in vivo exposure relative to other conditions. Forty-four chronic low back pain patients were randomly assigned to graded in vivo exposure, graded activity, or a wait-list condition. While only trend differences were observed for pain-related disability, patients in the graded in vivo exposure condition demonstrated (a) significantly greater improvements on measures of fear of pain/movement, fear avoidance beliefs, pain-related anxiety, and pain self-efficacy when compared to those in the graded activity condition, and (b) significantly greater improvements on measures of fear-avoidance beliefs, fear of pain/movement, pain-related anxiety, pain catastrophising, pain experience, and anxiety and depression when compared to those in the wait-list control condition. Additionally, patients in the graded in vivo exposure condition maintained improvements in these areas at one month follow-up. Implications of these findings for the treatment of individuals with chronic low back and other pain conditions are discussed.
Collapse
Affiliation(s)
- Marc P Woods
- Department of Psychology, University of Regina, Regina, SK, S4S 0A2, Canada Faculty of Kinesiology and Health Studies, Department of Psychology, University of Regina, Regina, SK, S4S 0A2, Canada
| | | |
Collapse
|
158
|
Bliokas VV, Cartmill TK, Nagy BJ. Does systematic graded exposure in vivo enhance outcomes in multidisciplinary chronic pain management groups? Clin J Pain 2007; 23:361-74. [PMID: 17449998 DOI: 10.1097/ajp.0b013e31803685dc] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Graded exposure in vivo (GEXP) treatment has been successfully used to reduce levels of pain-related fear and disability in some chronic pain patients, but its effectiveness has not been evaluated in general clinical settings using group-design studies. The purpose of this study was to determine if the systematic incorporation of GEXP into a multidisciplinary chronic pain management group (PMG) treatment program would result in better treatment outcomes than usual PMG treatment. METHODS One hundred forty-three chronic pain patients who were assessed as suitable for an outpatient multidisciplinary chronic PMG program were randomly allocated to 3 experimental conditions; usual PMG, PMG incorporating systematic graded exposure, and wait-list control. RESULTS The clinical outcomes of the 2 treatment conditions were not significantly different, suggesting that the systematic incorporation of GEXP into a multidisciplinary PMG program did not result in better treatment outcomes than usual PMG treatment. Both group treatment programs were associated with significant treatment effects when compared with the wait-list control on measures of pain intensity, fear of movement/(re)injury, pain self-efficacy, activity level, and depression. No treatment effects were found on self-report measures of pain disability or anxiety. DISCUSSION The addition of systematic graded exposure into a multidisciplinary chronic pain management program did not result in better clinical outcomes than the usual group treatment program. The validity of GEXP to the broader population of chronic pain patients warrants further investigation.
Collapse
Affiliation(s)
- Vida V Bliokas
- Rehabilitation Psychology Department and Illawarra Pain Management Service, Port Kembla Hospital, Warrawong, NSW, Australia.
| | | | | |
Collapse
|
159
|
Asmundson GJG, Collimore KC, Bernstein A, Zvolensky MJ, Hadjistavropoulos HD. Is the Latent Structure of Fear of Pain Continuous or Discontinuous Among Pain Patients? Taxometric Analysis of the Pain Anxiety Symptoms Scale. THE JOURNAL OF PAIN 2007; 8:387-95. [PMID: 17276144 DOI: 10.1016/j.jpain.2006.10.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2006] [Revised: 09/29/2006] [Accepted: 10/31/2006] [Indexed: 10/23/2022]
Abstract
UNLABELLED Elevated fear of pain is believed to denote a potential mechanism through which pain is maintained over time; however, our knowledge about fear of pain, its measurement, and its conceptualization is far from complete. It has been assumed that the latent structure of fear of pain is multidimensional and continuous. Although there is factor analytic evidence that it is multidimensional, there have been no empiric efforts to establish whether fear of pain is continuous or discontinuous (ie, taxonic or dichotomous latent class variable) in nature. Using taxometric methods in a sample of 650 patients seeking treatment for musculoskeletal or headache pain, we evaluated the latent structure of fear of pain as indexed by the Pain Anxiety Symptoms Scale. Results from analyses of simulated Monte Carlo data, MAXEIG-HITMAX, and MAMBAC and L-mode external consistency tests indicated that the latent structure of fear of pain was nontaxonic, characterized by latent continuity. Results are discussed in relation to the conceptual understanding of fear of pain, implications for treatment, and future directions for research on issues pertinent to pain-related fear. PERSPECTIVE This article presents an analysis designed to establish whether fear of pain is continuous or discontinuous in clinical samples. The findings, indicating that fear of pain is continuous, are important for understanding the nature of fear of pain and to designing appropriately targeted interventions.
Collapse
Affiliation(s)
- Gordon J G Asmundson
- Anxiety and Illness Behaviors Laboratory, University of Regina, Regina, Saskatchewan, Canada.
| | | | | | | | | |
Collapse
|
160
|
Stewart SH, Asmundson GJG. Anxiety sensitivity and its impact on pain experiences and conditions: a state of the art. Cogn Behav Ther 2007; 35:185-8. [PMID: 17189235 DOI: 10.1080/16506070601090457] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This paper serves as an introduction to the special issue of Cognitive Behaviour Therapy devoted to the topic of anxiety sensitivity (AS) and its impact on pain experiences and conditions. We provide a historical overview of relevant cognitive behavioural models of chronic pain, summarize recent models incorporating the AS construct, and introduce the papers in the special issue. These papers are organized into two sets--basic laboratory-based investigations and relatively more applied studies. We attempt to highlight some of the most important findings from each of these investigations and studies, in turn. Then, we consider several important conclusions derived from the set of special issue papers and the implications of these for the practice of cognitive-behavioural interventions with pain populations. Finally, we make several suggestions for directions for future investigations in this burgeoning area of cognitive behavioural research and practice.
Collapse
Affiliation(s)
- Sherry H Stewart
- Dalhousie University, Department of Psychiatry, Halifax, Nova Scotia, Canada.
| | | |
Collapse
|
161
|
Binder A, Schattschneider J, Baron R. Complex Regional Pain Syndrome Type I (Reflex Sympathetic Dystrophy). Pain Manag 2007. [DOI: 10.1016/b978-0-7216-0334-6.50030-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
162
|
Leeuw M, Goossens MEJB, Linton SJ, Crombez G, Boersma K, Vlaeyen JWS. The Fear-Avoidance Model of Musculoskeletal Pain: Current State of Scientific Evidence. J Behav Med 2006; 30:77-94. [PMID: 17180640 DOI: 10.1007/s10865-006-9085-0] [Citation(s) in RCA: 1355] [Impact Index Per Article: 75.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2006] [Accepted: 10/19/2006] [Indexed: 11/26/2022]
Abstract
Research studies focusing on the fear-avoidance model have expanded considerably since the review by Vlaeyen and Linton (Vlaeyen J. W. S. & Linton, S. J. (2000). Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain, 85(3), 317--332). The fear-avoidance model is a cognitive-behavioral account that explains why a minority of acute low back pain sufferers develop a chronic pain problem. This paper reviews the current state of scientific evidence for the individual components of the model: pain severity, pain catastrophizing, attention to pain, escape/avoidance behavior, disability, disuse, and vulnerabilities. Furthermore, support for the contribution of pain-related fear in the inception of low back pain, the development of chronic low back pain from an acute episode, and the maintenance of enduring pain, will be highlighted. Finally, available evidence on recent clinical applications is provided, and unresolved issues that need further exploration are discussed.
Collapse
Affiliation(s)
- Maaike Leeuw
- Department of Medical, Clinical, and Experimental Psychology, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
| | | | | | | | | | | |
Collapse
|
163
|
|