An emotional component analysis of chronic pain

Seeking central hopelessness symptoms which direct link to resilience among parents of children with autism spectrum disorder in China-A network perspective

The intervention process for children with autism spectrum disorder (ASD) is inextricably associated with their parents' mental health problems, such as hopelessness, which may adversely affect resilience and indirectly impact the effectiveness of interventions for their children. Hence, the motivation to help parents of children with ASD reduce hopelessness prompted us to conduct the present study and explore the interrelationship between hopelessness symptoms and resilience. This study evaluated hopelessness and resilience using the Beck Hopelessness Scale (BHS) and the Connor-Davidson Resilience Scale (CD-RISC). Participants met the criteria for their children's ASD diagnosis by a psychiatrist (N = 448; 54.69% mothers; Meanage  = 34.59 years, SDage  = 4.94 years). Moreover, we used symptom network analysis to examine the variability in network structure between fathers and mothers. The flow function was applied to examine which hopelessness symptoms were directly or indirectly associated with resilience. The results showed that #BHS11 (i.e., unpleasantness-ahead) was the central symptom found in the network structure for all parents and fathers, while #BHS17 (i.e., no-future-satisfaction) was the central symptom in the network structure for mothers. Additionally, #BHS6 ([NOT] expect-to-succeed) was directly and positively associated with resilience in all three network structures (i.e., all parents, fathers, and mothers). The results of the present study provide evidence that influential symptoms should be addressed and offer guidance for further interventions to reduce hopelessness and enhance resilience among parents of children with ASD.

Lateral preoptic area glutamate neurons relay nociceptive information to the ventral tegmental area

The ventral tegmental area (VTA) has been proposed to play a role in pain, but the brain structures modulating VTA activity in response to nociceptive stimuli remain unclear. Here, we demonstrate that the lateral preoptic area (LPO) glutamate neurons relay nociceptive information to the VTA. These LPO glutamatergic neurons synapsing on VTA neurons respond to nociceptive stimulation and conditioned stimuli predicting nociceptive stimulation and also mediate aversion. In contrast, LPO GABA neurons synapsing in the VTA mediate reward. By ultrastructural quantitative synaptic analysis, ex vivo electrophysiology, and functional neuroanatomy we identify a complex circuitry between LPO glutamatergic and GABAergic neurons and VTA dopaminergic, GABAergic, and glutamatergic neurons. We conclude that LPO glutamatergic neurons play a causal role in the processing of nociceptive stimuli and in relaying information about nociceptive stimuli. The pathway from LPO glutamatergic neurons to the VTA represents an unpredicted interface between peripheral nociceptive information and the limbic system.

Evaluating Drivers of the Patient Experience Triangle: Stress, Anxiety, and Frustration

Patient experience is a widely used indicator for assessing the quality-of-care process during a patient's journey in hospital. However, the literature rarely discusses three components: patient stress, anxiety, and frustration. Furthermore, little is known about what drives each component during hospital visits. In order to explore this, we utilized data from a patient experience survey, including patient- and provider-related determinants, that was administered at a local hospital in Abu Dhabi, UAE. A machine-learning-based random forest (RF) algorithm, along with its embedded importance analysis function feature, was used to explore and rank the drivers of patient stress, anxiety, and frustration throughout two stages of the patient journey: registration and consultation. The attribute 'age' was identified as the primary patient-related determinant driving patient stress, anxiety, and frustration throughout the registration and consultation stages. In the registration stage, 'total time taken for registration' was the key driver of patient stress, whereas 'courtesy demonstrated by the registration staff in meeting your needs' was the key driver of anxiety and frustration. In the consultation step, 'waiting time to see the doctor/physician' was the key driver of both patient stress and frustration, whereas 'the doctor/physician was able to explain your symptoms using language that was easy to understand' was the main driver of anxiety. The RF algorithm provided valuable insights, showing the relative importance of factors affecting patient stress, anxiety, and frustration throughout the registration and consultation stages. Healthcare managers can utilize and allocate resources to improve the overall patient experience during hospital visits based on the importance of patient- and provider-related determinants.

Emotional Imagery Influences the Adaptive Force in Young Women: Unpleasant Imagery Reduces Instantaneously the Muscular Holding Capacity

The link between emotions and motor function has been known for decades but is still not clarified. The Adaptive Force (AF) describes the neuromuscular capability to adapt to increasing forces and was suggested to be especially vulnerable to interfering inputs. This study investigated the influence of pleasant and unpleasant food imagery on the manually assessed AF of elbow and hip flexors objectified by a handheld device in 12 healthy women. The maximal isometric AF was significantly reduced during unpleasant vs. pleasant imagery and baseline (p < 0.001, dz = 0.98−1.61). During unpleasant imagery, muscle lengthening started at 59.00 ± 22.50% of maximal AF, in contrast to baseline and pleasant imagery, during which the isometric position could be maintained mostly during the entire force increase up to ~97.90 ± 5.00% of maximal AF. Healthy participants showed an immediately impaired holding function triggered by unpleasant imagery, presumably related to negative emotions. Hence, AF seems to be suitable to test instantaneously the effect of emotions on motor function. Since musculoskeletal complaints can result from muscular instability, the findings provide insights into the understanding of the causal chain of linked musculoskeletal pain and mental stress. A case example (current stress vs. positive imagery) suggests that the approach presented in this study might have future implications for psychomotor diagnostics and therapeutics.

Psychological profiles in adults with knee OA-related pain: a replication study

Introduction

Psychological factors have been associated with knee osteoarthritis pain severity and treatment outcomes, yet their combined contribution to phenotypic heterogeneity is poorly understood. In particular, empirically derived psychological profiles must be replicated before they can be targeted or considered for treatment studies. The objectives of this study were to (1) confirm previously identified psychological profiles using unsupervised clustering methods in persons with knee osteoarthritis pain, (2) determine the replicability of profiles using supervised machine learning in a different sample, and (3) examine associations with clinical pain, brain structure, and experimental pain.

Methods

Participants included two cohorts of individuals with knee osteoarthritis pain recruited as part of the multisite UPLOAD1 (n = 270, mean age = 56.8 ± 7.6, male = 37%) and UPLOAD2 (n = 164, mean age = 57.73 ± 7.8, male = 36%) studies. Similar psychological constructs (e.g. optimism, coping, somatization, affect, depression, and anxiety), sociodemographic and clinical characteristics, and somatosensory function were assessed across samples. UPLOAD2 participants also completed brain magnetic resonance imaging. Unsupervised hierarchical clustering analysis was first conducted in UPLOAD1 data to derive clusters, followed by supervised linear discriminative analysis to predict group membership in UPLOAD2 data. Associations among cluster membership and clinical variables were assessed, controlling for age, sex, education, ethnicity/race, study site, and number of pain sites.

Results

Four distinct profiles emerged in UPLOAD1 and were replicated in UPLOAD2. Identified psychological profiles were associated with psychological variables (ps < 0.001), and clinical outcomes (ps = 0.001-0.03), indicating good internal and external validation of the cluster solution. Significant associations between psychological profiles and somatosensory function and brain structure were also found.

Conclusions

This study highlights the importance of considering the biopsychosocial model in knee osteoarthritis pain assessment and treatment.

[Distress tolerance and experience of chronic pain]

INTRODUCTION

Chronic pain is a highly prevalent condition that is associated with distressing somatic and emotional experiences. Consequently, an individual's distress tolerance, the perceived capacity to tolerate negative psychological and physical states, may influence their pain experience. This effect could be explained in part by a reduction in the catastrophic interpretation of pain which is associated with increased pain intensity and interference in everyday activities.

AIMS

The first aim of this study was to explore the association between the components of the 5-factor model of distress tolerance and (1) pain intensity and (2) pain interference in everyday activities. The secondary aim was to assess the potential mediating effect of pain catastrophizing in the eventual association between components of distress tolerance and (1) pain intensity or (2) pain interference in everyday activities.

METHOD

This is a cross-sectional study of adult (18 years or older) university students and staff with chronic pain (3 months). They were invited to complete the online questionnaire through an email invitation. Pain intensity and interference in everyday functioning were assessed with the corresponding subscales of the Brief Pain Inventory. The following instruments were used to assess the components of the 5-factor model of distress tolerance: Ambiguity Tolerance Scale (tolerance to ambiguity), Intolerance to Uncertainty Scale (reversed score: tolerance to uncertainty), Discomfort Intolerance Scale (reversed score: discomfort tolerance), Distress Tolerance Scale (tolerance to negative emotions), Frustration Discomfort Scale (tolerance to frustration). Participants also completed the Pain Catastrophizing Scale.

RESULTS

Eighty participants were recruited (57 % women, mean age=33.09; standard deviation=12,87). Tolerance to negative emotions was the only component of distress tolerance that was associated with pain (ß=-0.04; 95% CI): -0.07--0.01; t (78)=-3.06, p<0.01) or pain interference in everyday functioning (ß=-0.07; 95% CI: -0.10--0.03; t (78)=-3.97, p<0.01), independently of the others. Combined with age, these factors explained 16.2 % of the variance in pain intensity and 19.4 % of the variance in pain interference. Pain catastrophizing partially mediated the association between tolerance to negative emotions and pain interference in everyday functioning, but it was not involved in the association between tolerance to negative emotions and pain intensity.

CONCLUSION

Tolerance to negative emotions appears to be the most relevant aspect of distress tolerance in the context of chronic pain and is a potential clinical target that is independent and complementary from pain catastrophizing.

Adaptive Force and emotionally related imaginations - preliminary results suggest a reduction of the maximal holding capacity as reaction to disgusting food imagination

The link between emotions and motor control has been discussed for years. The measurement of the Adaptive Force (AF) provides the possibility to get insights into the adaptive control of the neuromuscular system in reaction to external forces. It was hypothesized that the holding isometric AF is especially vulnerable to disturbing inputs. Here, the behavior of the AF under the influence of positive (tasty) vs. negative (disgusting) food imaginations was investigated. The AF was examined in n = 12 cases using an objectified manual muscle test of the hip flexors, elbow flexors or pectoralis major muscle, performed by one of two experienced testers while the participants imagined their most tasty or most disgusting food. The reaction force and the limb position were measured by a handheld device. While the slope of force rises and the maximal AF did not differ significantly between tasty and disgusting imaginations (p > 0.05), the maximal isometric AF was significantly lower and the AF at the onset of oscillations was significantly higher under disgusting vs. tasty imaginations (both p = 0.001). A proper length tension control of muscles seems to be a crucial functional parameter of the neuromuscular system which can be impaired instantaneously by emotionally related negative imaginations. This might be a potential approach to evaluate somatic reactions to emotions.

Age as an Independent Predictor of Adult Spinal Cord Stimulation Pain Outcomes

INTRODUCTION

Spinal cord stimulation (SCS) is an efficacious chronic pain treatment most commonly used in middle-aged patients. Results from previous studies that investigated SCS' effects in older patient populations have been equivocal. We examine whether SCS outcomes correlate with age.

METHODS

We retrospectively examined prospectively collected outcomes from 189 patients who underwent SCS at Albany Medical Center between 2012 and 2020. The patients completed the Numerical Rating Scale (NRS), McGill Pain Questionnaire (MPQ), Oswestry Disability Index (ODI), Beck Depression Inventory (BDI), and Pain Catastrophizing Scale (PCS) preoperatively and 1 year postoperatively. The mean percent change in each outcome was determined and compared via a regression analysis to determine relationships between patient age and each respective outcome metrics. Demographics were compared between patients aged under 65 versus those aged 65 and older via χ2 tests.

RESULTS

All subjects demonstrated the expected improvement on NRS, BDI, PCS, and MPQ from baseline to 1-year follow-up, with several demonstrating statistically significant changes: NRS-worst pain (18.66%, p < 0.001), NRS-least pain (26.9%, p < 0.001), NRS-average pain (26.9%, p < 0.01), NRS-current pain (26.4%, p < 0.001), ODI (19.6%, p < 0.001), PCS (29.8%, p < 0.001), and MPQ (29.4%, p < 0.001). There was no significant difference between patients aged under 65 versus those aged 65 and older based on lead type (p = 0.454). Six patients (3.1%) had lead migration, one of whom was 65 or older. Regression analysis revealed improvements in MPQ-sensory and MPQ-affective scores as age increased (p < 0.001, R2 = 0.09; p = 0.046, R2 = 0.05, respectively). Age did not correlate with NRS, ODI, BDI, or PCS. Diagnosis, spinal level of SCS, and lead type were not found to influence any respective outcome measure based on covariate analysis.

CONCLUSION

This study represents the largest study where age was correlated to specific pain, depression, and disability outcomes following SCS. We provide evidence that SCS outcomes are equivalent, or better, in older patients following SCS. Based on these findings, SCS is a viable option for treatment of chronic pain in elderly patient populations.

Placebo Effects on Stress, but Not on Pain Reports. A Multi-Experiment Study

Background

Contextual factors, such as participant/experimenter sex may moderate the placebo effects. We tested whether the participant and experimenter sex modulated placebo effects on experimentally induced pain and associated stress.

Objective

To investigate if (i) participant sex and (ii) experimenter sex influence placebo analgesia and subjective and physiological stress in two experiments employing a within-subjects and a mixed design, respectively. Placebo effects were investigated in pain reports, stress, and blood pressure.

Methods

Participants received painful stimulations and a placebo cream. In Experiment One (N = 59) participants underwent a placebo condition (PC) and a natural history condition (NHC) in random order. A placebo cream was applied in the PC and then the heat stimulation temperature was surreptitiously lowered. Identical stimulations were administered in the NHC, but with no cream, no information, and no lowered temperature. In Experiment Two, participants (N = 93) were randomly assigned to three groups receiving either a placebo cream with surreptitiously lowered intensity of electric stimuli (Placebo, PG), a placebo cream (Cream-Control, CCG) without changing the stimuli, or lowered intensity, but with no cream (Pain-Control, PCG) in a mixed design. All participants in both experiments received the same stimuli in the post-test as in the pre-test. Four experimenters (two females) in Experiment One, and five experimenters (two females) in Experiment Two conducted the studies.

Results

No placebo effect was seen on pain. However, there were placebo effects on stress, moderated by participant and experimenter sex: in Experiment One males in the PC had lower diastolic blood pressure (DBP) compared to males in the NHC. Participants in the PC had lower DBP compared to the NHC when tested by a female. In Experiment Two, participants expected more cream effectiveness when a female experimenter administered it, and reported lower stress in the PG compared to the PCG when tested by females.

Conclusion

Our findings highlight a distinction between placebo effects on pain and on associated stress. Secondly, female experimenters recorded lower physiological and subjective stress, higher effectiveness expectations, and lower pain from both sexes compared to male experimenters. Possible reasons for the failure to find a pain placebo effect are discussed.

"It's disappointing and it's pretty frustrating, because it feels like it's something that will never go away." A qualitative study exploring individuals' beliefs and experiences of Achilles tendinopathy

Background

Achilles tendinopathy (AT) is a common and often persistent musculoskeletal disorder affecting both athletic and non-athletic populations. Despite the relatively high incidence there is little insight into the impact and perceptions of tendinopathy from the individual’s perspective. Increased awareness of the impact and perceptions around individuals’ experiences with Achilles tendinopathy may provide crucial insights for the management of what is often a complex, persistent, and disabling MSK disorder.

Purpose

To qualitatively explore the lived experiences of individuals with AT.

Design

A qualitative, interpretive description design was performed using semi-structured telephone interviews.

Methods

Semi-structured interviews were conducted on 15 participants (8 male and 7 female) with AT. Thematic analysis was performed using the guidelines laid out by Braun and Clarke. The study has been reported in accordance with the consolidated criteria for reporting qualitative research (COREQ) checklist.

Results

Four main themes were identified from the data: 1) beliefs and perceptions surrounding AT: “If I'm over training or something, I don't really know”, 2) the biopsychosocial impact of AT: “I think it restricts me in a lot of things that I would be able to do”, 3) individuals’ experiences with the management process: “You want it to happen now. You're doing all this stuff and it's just very slow progress”, and 4) future prognosis and outlook in individuals with AT: “I see myself better”.

Conclusions

This study offers a unique insight into the profound impact and consequences of Achilles tendinopathy in a mixed sample of both athletic and non-athletic individuals. The findings of this study have important clinical implications. Specifically, it highlights the need for clinicians to recognize and adopt treatment approaches to embrace a more biopsychosocial approach for the management of tendinopathy.

The mechanisms of pain tolerance and pain-related anxiety in acute pain

This study emphasizes the role of pain catastrophizing and state anxiety on pain tolerance and pain-related anxiety. Response expectancies for pain tolerance and pain intensity were tested as potential mediators. A cold-pressor task was used on a healthy sample. Measures were taken before and after cold-pressor procedure, while aversive versus neutral information regarding the cold-pressor task was given prior to the pain induction. An exploratory path model was conducted. Similar paths for pain tolerance and for pain-related anxiety were shown in aversive condition. Also, psychological measures may explain pain experience in aversive context.

An Examination of Pain's Relationship to Sleep Fragmentation and Disordered Breathing Across Common Sleep Disorders

Objective

Short sleep duration and insomnia have been linked to higher pain and an increased risk of developing chronic pain, but relatively little research has examined the contribution of sleep disordered breathing (SDB) to pain. This study examined the unique contributions of SDB and insomnia to chronic pain.

Subjects

Adult patients referred to an academic sleep center for overnight polysomnography were invited to participate.

Methods

Participants (N = 105) completed questionnaires about their sleep and pain, including the Insomnia Severity Index, Medical College of Virginia Pain Questionnaire, and two weeks of sleep/pain diaries.

Results

Most participants (80.00%) reported chronic pain, and the likelihood of having chronic pain did not differ by sleep disorder. However, there was a significant difference in pain intensity; individuals with comorbid obstructive sleep apnea (OSA)/insomnia reported an average pain intensity that was 20 points (out of 100) higher than individuals with insomnia or no diagnosis and 28 points higher than those with OSA, controlling for participant sex (Ps < 0.05). In a hierarchical regression, pain was unrelated to measures of sleep fragmentation (apnea-hypopnea index, spontaneous arousals, periodic leg movement arousals) and nocturnal hypoxemia (SaO2 nadir, time at or below 88% SaO2).

Conclusions

Polysomnography measures of SDB severity and sleep fragmentation were unrelated to pain intensity. However, comorbid OSA/insomnia was associated with significantly higher pain (compared with either disorder in isolation), a finding that has implications for the treatment of chronic pain and possibly for understanding the mechanisms of chronic pain.

The sensory and affective components of pain: are they differentially modifiable dimensions or inseparable aspects of a unitary experience? A systematic review

BACKGROUND

Pain is recognised to have both a sensory dimension (intensity) and an affective dimension (unpleasantness). Pain feels like a single unpleasant bodily experience, but investigations of human pain have long considered these two dimensions of pain to be separable and differentially modifiable. The evidence underpinning this separability and differential modifiability is seldom presented. We aimed to fill this gap by evaluating the current evidence base for whether or not the sensory and affective dimensions of pain can be selectively modulated using cognitive manipulations.

METHODS

A rigorous systematic search, based on a priori search terms and consultation with field experts, yielded 4270 articles. A detailed screening process was based on the following recommendations: (i) evaluation of effectiveness; (ii) examination of methodological rigour, including each study having an a priori intention to cognitively modulate one of the two dimensions of pain; and (iii) sound theoretical reasoning. These were used to ensure that included studies definitively answered the research question.

RESULTS

After in-depth critique of all 12 articles that met the inclusion criteria, we found that there is no compelling evidence that the sensory and affective dimensions of pain can be selectively and intentionally modulated using cognitive manipulations in humans.

CONCLUSIONS

We offer potential explanations for this discrepancy between assumptions and evidence and contend that this finding highlights several important questions for the field, from both the research and clinical perspectives.

Associations between Religiosity, Spirituality, and Happiness among Adults Living with Neurological Illness

The study examined the associations between religiosity, spirituality, and happiness in 354 outpatients suffering from neurological disorders. After accounting for severity of cognitive decline, physical activity level, depression severity, and demographic variables (i.e., subject age, sex, ethnicity, and marital status) multivariate linear regression revealed a unique association between the Spiritual Well-Being Existential Spirituality scale (SWBS ES), and not the SWBS Religious Scale (SWBS RS), with both the Pemberton Remembered Happiness Index (PHI R) (p < 0.001), and the Pemberton Experienced Happiness Index (PHI E) (p < 0.001). Interventions focused on existential spirituality may improve health related quality of life among adult medical patients with neurological illness.

Factors associated with pain and analgesic consumption following non-surgical periodontal therapy under local anaesthesia and carried out by dental students

AIM

Evaluate factors associated with pain and analgesic consumption following non-surgical periodontal therapy.

MATERIALS AND METHODS

The sample consisted of 218 patients with chronic periodontitis, submitted to non-surgical scaling and root planing under local anaesthesia at a public dental service in southern Brazil. The data collection instruments included a demographic questionnaire, as well as State-Trait Anxiety Inventory, Corah's Dental Anxiety Scale, Visual Analogue Scale, Numerical Rating Scale and Verbal Rating Scale. The presence and intensity of pain were evaluated at 2, 6, 12, 24 and 48 hr after scaling and root planing.

RESULTS

A total of 52.3% of the patients reported mild intensity pain at some point during the 48 hr after scaling and root planing with local anaesthesia. Smoking (PR = 1.47; 95% CI = 1.16-1.65), severe periodontal inflammation (PR = 1.31; 95% CI = 1.09-1.58) and dental anxiety (PR = 1.24; 95% CI = 1.03-1.49) were associated with postoperative pain after adjusting for age, gender and state and trait anxiety scores. Moreover, 46.8% of the subjects used analgesics at some time during the 48-hr follow-up period and dental anxiety was the only factor associated with postoperative analgesic use.

CONCLUSIONS

Smoking, severe periodontal inflammation and dental anxiety were identified as factors associated with pain after non-surgical scaling and root planing with local anaesthesia. Dental anxiety was also a factor associated with postoperative analgesic use.

Exploring Tinnitus-Induced Disablement by Persistent Frustration in Aging Individuals: A Grounded Theory Study

Background: Qualitative research can help to improve the management of patients, meet their expectations and assist physicians in alleviating their suffering. The perception of moment-to-moment variability in tinnitus annoyance is an emerging field of exploration. This study sought to enlighten variability in tinnitus-induced disablement using a qualitative approach. Methods: Twelve participants (six females, six males, aged 51-79) were recruited via the French Tinnitus Association Journal for participation in recorded semi-structured interviews. Each participant had three interviews lasting 1 h, the sessions being separated one from the other by 2 weeks. Following recommendations of Charmaz (2014), the second and third interviews were aimed at gathering rich data, by enhancing the participants' reflexivity in the circumstances of distress caused by tinnitus. After transcription, the data (n = 36 interviews) were analyzed using the approach to Grounded Theory proposed by Strauss and Corbin (1998). Results: Tinnitus as persistent frustration emerged as being the core category uniting all the other categories of the study. Hence, the core category accounted for the broader scope in participants' experience of chronic tinnitus. It is suggested that tinnitus-induced disablement varied according to the degree of frustration felt by the participants in not being able to achieve their goals. The implications of this were analyzed using the following categories: "Losing body ownership," "Lacking perspectives," and "Persevering through difficulties." Based on these findings, we draw a substantive theory of tinnitus tolerance that promotes an active, disciplined and individualized approach to tinnitus-induced disablement. The model distinguishes pathways from sustained suffering to reduced annoyance (i.e., emerging tolerance). It accounts for difficulties that the participants experienced with a perceived unchanged annoyance over time. Furthermore, this model identifies a set of new attitudes toward oneself and others that tinnitus tolerance would entail. Conclusion: The subjective experience of frustration enlightens tinnitus-induced disablement, offering new perspectives for long-term self-management. Modulation of frustration, rather than moderation of tinnitus interference, is suggested as a new approach to the clinical management of tinnitus-related distress.

The structural model of pain, cognitive strategies, and negative emotions in functional gastrointestinal disorders

Background:

Patients with functional gastrointestinal disorders (FGIDs) may use specific coping strategies. We intend to provide a mediating role of the relationship between pain (intensity and acceptance), cognitive emotion regulation strategies, and negative emotions in patients with FGIDs.

Materials and Methods:

Participants were 176 inpatients, all experiencing significant FGIDs symptomatology as confirmed by gastroenterologists. Patients completed data on cognitive emotion regulation questionnaire, short form of depression, anxiety, stress scale, chronic pain acceptance questionnaire-revised, and pain intensity scale. Data were analyzed using structural equation modeling method.

Results:

The pain intensity had significantly direct effect on cognitive emotion regulation strategies and indirect effect on negative emotions. Besides, the mediating role of negative emotions in the relationship between the strategies and pain acceptance were supported, whereas indirect relationships between pain intensity and acceptance through cognitive strategies were not confirmed.

Conclusion:

The results of the study emphasize the role of pain intensity in the development of negative emotions through cognitive strategies and the role of the strategies in pain acceptance through negative emotions. In fact, cognitive strategies to be related to pain and emotions.

Contributions of physical function and satisfaction with social roles to emotional distress in chronic pain: a Collaborative Health Outcomes Information Registry (CHOIR) study

Individuals with chronic pain show greater vulnerability to depression or anger than those without chronic pain, and also show greater interpersonal difficulties and physical disability. The present study examined data from 675 individuals with chronic pain during their initial visits to a tertiary care pain clinic using assessments from Stanford University's Collaborative Health Outcomes Information Registry (CHOIR). Using a path modeling analysis, the mediating roles of Patient-Reported Outcomes Measurement Information Systems (PROMIS) Physical Function and PROMIS Satisfaction with Social Roles and Activities were tested between pain intensity and PROMIS Depression and Anger. Pain intensity significantly predicted both depression and anger, and both physical function and satisfaction with social roles mediated these relationships when modeled in separate 1-mediator models. Notably, however, when modeled together, ratings of satisfaction with social roles mediated the relationship between physical function and both anger and depression. Our results suggest that the process by which chronic pain disrupts emotional well-being involves both physical function and disrupted social functioning. However, the more salient factor in determining pain-related emotional distress seems to be disruption of social relationships, than global physical impairment. These results highlight the particular importance of social factors to pain-related distress, and highlight social functioning as an important target for clinical intervention in chronic pain.

The role of anger in psychosocial subgrouping for patients with low back pain

BACKGROUND

Low back pain (LBP) is a common and costly condition that often becomes chronic if not properly addressed. Recent research has shown that psychosocial symptoms can complicate LBP, necessitating more comprehensive screening measures.

AIM

The present study investigated the role of psychosocial factors, including anger regulation, in pain and disability using a screening measure designed for LBP treated with physical therapy.

METHODS

One hundred three LBP patients initiating physical therapy completed an established screening measure to assess risk for developing chronic pain, and psychosocial measures assessing anger, depression, anxiety, fear-avoidance, and pain-catastrophizing before and after 4 weeks of treatment. Dependent variables were pain intensity, physical impairment, and patient-reported disability. Risk subgrouping based on anger and other psychosocial measures was examined using established screening methods and through using an empirical statistical approach.

RESULTS

Analyses revealed that risk subgroups differed according to corresponding levels of negative affect, as opposed to anger alone. General psychosocial distress also predicted disability posttreatment, but, interestingly, did not have a strong relationship to pain. Subsequent hierarchical agglomerative clustering procedures divided patients into overall high-distress and low-distress groups, with follow-up analyses revealing that the high-distress group had higher baseline measures of pain, disability, and impairment.

CONCLUSIONS

Findings suggest that anger may be part of a generalized negative affect rather than a unique predictor when assessing risk for pain and disability in LBP treatment. Continued research in the area of screening for psychosocial prognostic indicators in LBP may ultimately guide treatment protocols in physical therapy for more comprehensive patient care.

Anger arousal and behavioral anger regulation in everyday life among patients with chronic low back pain: Relationships to patient pain and function

OBJECTIVE

The objective of this study was to determine the degree to which patient anger arousal and behavioral anger regulation (expression, inhibition) occurring in the course of daily life was related to patient pain and function as rated by patients and their spouses.

METHOD

Married couples (N = 105) (one spouse with chronic low back pain) completed electronic daily diaries, with assessments 5 times/day for 14 days. Patients completed items on their own state anger, behavioral anger expression and inhibition, and pain-related factors. Spouses completed items on their observations of patient pain-related factors. Hierarchical linear modeling was used to test concurrent and lagged relationships.

RESULTS

Patient-reported increases in state anger were related to their reports of concurrent increases in pain and pain interference and to spouse reports of patient pain and pain behavior. Patient-reported increases in behavioral anger expression were related to lagged increases in pain intensity and interference and decreases in function. Most of these relationships remained significant with state anger controlled. Patient-reported increases in behavioral anger inhibition were related to concurrent increases in pain interference and decreases in function, which also remained significant with state anger controlled. Patient-reported increases in state anger were related to lagged increases in spouse reports of patient pain intensity and pain behaviors.

CONCLUSIONS

Results indicate that in patients with chronic pain, anger arousal and behavioral anger expression and inhibition in everyday life are related to elevated pain intensity and decreased function as reported by patients. Spouse ratings show some degree of concordance with patient reports.

Sarcoma excision and pattern of complicating sensory neuropathy

A potential complication of sarcoma excision surgery is a sensory neurological dysfunction around the surgical scar. This study utilised both objective and subjective sensation assessment modalities, to evaluate 22 patients after sarcoma surgery, for a sensory deficit. 93% had an objective sensory deficit. Light touch is less likely to be damaged than pinprick sensation, and two-point discrimination is significantly reduced around the scar. Results also show that an increased scar size leads to an increased light touch and pinprick deficit and that two-point discriminatory ability around the scar improves as time after surgery elapses. 91% had a subjective deficit, most likely tingling or pain, and numbness was most probable with lower limb sarcomas. Results also demonstrated that there were no significant relationships between any specific subjective and objective deficits. In conclusion, sensory disturbance after sarcoma surgery is common and debilitating. Efforts to minimize scar length are paramount in the prevention of sensory deficit. Sensation may also recover to an extent; thus, sensory reeducation techniques must become an integral aspect of management plans. Finally to obtain a comprehensive assessment of sensory function, both objective and subjective assessment techniques must be utilised.

Avaliação da qualidade de vida e do tratamento fisioterapêutico em pacientes com cervicalgia crônica

INTRODUÇÃO: Para analisar a efetividade do tratamento fisioterapêutico no paciente com dor crônica cervical, este trabalho teve como objetivo avaliar antes e após o tratamento fisioterapêutico: a qualidade de vida com o instrumento WHOQOL-100 e a melhora na amplitude de movimento usando um goniômetro. MATERIAIS E MÉTODOS: Participaram deste estudo 15 pacientes (10 mulheres e 5 homens). O nível de significância adotado foi de p < 0,05. RESULTADOS: Foi verificada melhora significativa após o tratamento fisioterapêutico no domínio I - físico (p = 0,0117); domínio II - psicológico (p = 0,004); domínio III - nível de independência (p = 0,0006); domínio IV - relações sociais (p < 0,0001); e no domínio V - ambiente (p = 0,0019); e também na amplitude articular dos movimentos de flexão cervical (p < 0,0001), extensão cervical (p = 0,0004), inclinação lateral á direita (p < 0,0001) inclinação lateral à esquerda (p < 0,0001), rotação lateral à direita (p < 0,0001) e rotação lateral à esquerda (p < 0,0001). DISCUSSÃO: Andersen et al. (17) relataram que exercícios de alongamento melhoram de forma significativa a amplitude de movimento articular em mulheres com cervicalgia crônica. Chiu et al. (20) observaram melhora na dor crônica cervical e na limitação articular após seis semanas de tratamento com TENS e exercícios. CONCLUSÃO: O presente estudo conclui que a intervenção fisioterapêutica composta de exercícios de alongamento, técnicas de relaxamento, massagens e eletroterapia foram benéficos para melhorar a qualidade de vida e a flexibilidade nos pacientes com cervicalgia crônica.

The Relationship between Marital Status and Psychological Resilience in Chronic Pain

We examined the relationship between marital status and a 2-stage model of pain-related effect, consisting of pain unpleasantness and suffering. We studied 1914 chronic pain patients using multivariate analysis of covariance (MANCOVA) to clarify whether marital status was a determinant factor in the emotional or ideational suffering associated with chronic pain after controlling for pain sensation intensity, age, and ethnicity. Marital status was unrelated to immediate unpleasantness (P = 0.08). We found a strong association with emotional suffering (P < 0.0001) but not with negative illness beliefs (P = 0.44). Interestingly, widowed subjects experienced significantly less frustration, fear, and anger than all other groups (married, divorced, separated, or single). A final MANCOVA including sex as a covariate revealed that the emotional response to pain was the same for both widow and widower. Only those individuals whose spouse died experienced less emotional turmoil in the face of a condition threatening their lifestyle. These data suggest that after experiencing the death of a spouse, an individual may derive some “emotional inoculation” against future lifestyle threat.

Self-reported interoceptive awareness in primary care patients with past or current low back pain

Background

Mind–body interactions play a major role in the prognosis of chronic pain, and mind–body therapies such as meditation, yoga, Tai Chi, and Feldenkrais presumably provide benefits for pain patients. The Multidimensional Assessment of Interoceptive Awareness (MAIA) scales, designed to measure key aspects of mind–body interaction, were developed and validated with individuals practicing mind–body therapies, but have never been used in pain patients.

Methods

We administered the MAIA to primary care patients with past or current low back pain and explored differences in the performance of the MAIA scales between this and the original validation sample. We compared scale means, exploratory item cluster and confirmatory factor analyses, scale–scale correlations, and internal-consistency reliability between the two samples and explored correlations with validity measures.

Results

Responses were analyzed from 435 patients, of whom 40% reported current pain. Cross-sectional comparison between the two groups showed marked differences in eight aspects of interoceptive awareness. Factor and cluster analyses generally confirmed the conceptual model with its eight dimensions in a pain population. Correlations with validity measures were in the expected direction. Internal-consistency reliability was good for six of eight MAIA scales. We provided specific suggestions for their further development.

Conclusion

Self-reported aspects of interoceptive awareness differ between primary care patients with past or current low back pain and mind–body trained individuals, suggesting further research is warranted on the question whether mind–body therapies can alter interoceptive attentional styles with pain. The MAIA may be useful in assessing changes in aspects of interoceptive awareness and in exploring the mechanism of action in trials of mind–body interventions in pain patients.

Structural brain anomalies and chronic pain: a quantitative meta-analysis of gray matter volume

The diversity of chronic pain syndromes and the methods employed to study them make integrating experimental findings challenging. This study performed coordinate-based meta-analyses using voxel-based morphometry imaging results to examine gray matter volume (GMV) differences between chronic pain patients and healthy controls. There were 12 clusters where GMV was decreased in patients compared with controls, including many regions thought to be part of the "pain matrix" of regions involved in pain perception, but also including many other regions that are not commonly regarded as pain-processing areas. The right hippocampus and parahippocampal gyrus were the only regions noted to have increased GMV in patients. Functional characterizations were implemented using the BrainMap database to determine which behavioral domains were significantly represented in these regions. The most common behavioral domains associated with these regions were cognitive, affective, and perceptual domains. Because many of these regions are not classically connected with pain and because there was such significance in functionality outside of perception, it is proposed that many of these regions are related to the constellation of comorbidities of chronic pain, such as fatigue and cognitive and emotional impairments. Further research into the mechanisms of GMV changes could provide a perspective on these findings.

PERSPECTIVE

Quantitative meta-analyses revealed structural differences between brains of individuals with chronic pain and healthy controls. These differences may be related to comorbidities of chronic pain.

Anger regulation style, anger arousal and acute pain sensitivity: evidence for an endogenous opioid "triggering" model

Findings suggest that greater tendency to express anger is associated with greater sensitivity to acute pain via endogenous opioid system dysfunction, but past studies have not addressed the role of anger arousal. We used a 2 × 2 factorial design with Drug Condition (placebo or opioid blockade with naltrexone) crossed with Task Order (anger-induction/pain-induction or pain-induction/anger-induction), and with continuous Anger-out Subscale scores. Drug × Task Order × Anger-out Subscale interactions were tested for pain intensity during a 4-min ischemic pain task performed by 146 healthy people. A significant Drug × Task Order × Anger-out Subscale interaction was dissected to reveal different patterns of pain intensity changes during the pain task for high anger-out participants who underwent pain-induction prior to anger-induction compared to those high in anger-out in the opposite order. Namely, when angered prior to pain, high anger-out participants appeared to exhibit low pain intensity under placebo that was not shown by high anger-out participants who received naltrexone. Results hint that people with a pronounced tendency to express anger may suffer from inadequate opioid function under simple pain-induction, but may experience analgesic benefit to some extent from the opioid triggering properties of strong anger arousal.

Chronic pain as a narratological distress: a phenomenological study

OBJECTIVES

This paper reports finding from a study that focused on people living with chronic pain, chronicling their experiences of pain and emotional distress, and their social and personal narratives.

METHODS

The paper presents an interpretative phenomenological analysis (IPA) of six interviews conducted with men and women aged between 27 and 61. The interviews were taken from a larger study of the experience of chronic pain.

FINDINGS

Chronic pain is a double faced phenomenon: a vivid and total experience on one hand, an elusive and deceptive phenomenon on the other. The nature of this phenomenon - together with the medical and public discourse that ignores and delegitimizes chronic pain this condition - prompts people to question their own experiences and to face what we define as a narratological distress.

DISCUSSION

Narratological distress is the internal battle between two unwanted narratives: The elusive delegitimizing narrative of denial, which seeks to ignore the experience of pain; and the narrative that acknowledges the pain, but with the price of accepting oneself as "ill" or "disabled."

Talk of frustration in the narratives of people with chronic pain

OBJECTIVES

To improve understanding of the sources of frustration for people with chronic pain and consider the potential influence of frustration on the chronic pain experience and relationships with health professionals.

METHODS

Qualitative in-depth interviews with a diverse, maximum variation sample of 46 participants with chronic pain, 30 of whom talked about frustration. Analysis paid close attention to how people talked about their frustration as well as what they said.

RESULTS

Frustration is a multi-faceted emotion and its effects are cumulative. Sources of frustration include interference with everyday activities, the interruption of life goals and roles and the unpredictability of pain; here we focus on the frustrations associated with the invisibility of chronic pain and the perceived limitations of diagnosis and pain management (both related to the perceived legitimacy of the condition). Several of the participants who had lived with chronic pain for many years described overcoming, or managing, their frustrations.

DISCUSSION

If patients think that their pain is not being believed this is clearly a barrier to an effective consultation. Communication with chronic pain patients may improve if the frustration of living with an invisible, debilitating condition that is hard to diagnose and treat is explicitly (and perhaps repeatedly) acknowledged by the health professional.

Test-retest reliability of multidimensional dyspnea profile recall ratings in the emergency department: a prospective, longitudinal study

BACKGROUND

Dyspnea is among the most common reasons for emergency department (ED) visits by patients with cardiopulmonary disease who are commonly asked to recall the symptoms that prompted them to come to the ED. The reliability of recalled dyspnea has not been systematically investigated in ED patients.

METHODS

Patients with chronic or acute cardiopulmonary conditions who came to the ED with dyspnea (N = 154) completed the Multidimensional Dyspnea Profile (MDP) several times during the visit and in a follow-up visit 4 to 6 weeks later (n = 68). The MDP has 12 items with numerical ratings of intensity, unpleasantness, sensory qualities, and emotions associated with how breathing felt when participants decided to come to the ED (recall MDP) or at the time of administration ("now" MDP). The recall MDP was administered twice in the ED and once during the follow-up visit. Principal components analysis (PCA) with varimax rotation was used to assess domain structure of the recall MDP. Internal consistency reliability was assessed with Cronbach's alpha. Test-retest reliability was assessed with intraclass correlation coefficients (ICCs) for absolute agreement for individual items and domains.

RESULTS

PCA of the recall MDP was consistent with two domains (Immediate Perception, 7 items, Cronbach's alpha = .89 to .94; Emotional Response, 5 items; Cronbach's alpha = .81 to .85). Test-retest ICCs for the recall MDP during the ED visit ranged from .70 to .87 for individual items and were .93 and .94 for the Immediate Perception and Emotional Response domains. ICCs were much lower for the interval between the ED visit and follow-up, both for individual items (.28 to .66) and for the Immediate Perception and Emotional Response domains (.72 and .78, respectively).

CONCLUSIONS

During an ED visit, recall MDP ratings of dyspnea at the time participants decided to seek care in the ED are reliable and sufficiently stable, both for individual items and the two domains, that a time lag between arrival and questionnaire administration does not critically affect recall of perceptual and emotional characteristics immediately prior to the visit. However, test-retest reliability of recall over a 4- to 6-week interval is poor for individual items and significantly attenuated for the two domains.

Administering ziconotide and monitoring patients treated with ziconotide: expert opinions

Some patients with chronic pain who are intolerant of or refractory to treatment with systemic analgesics may benefit from intrathecal therapy. Ziconotide is the first nonopioid analgesic approved by the United States Food and Drug Administration for intrathecal administration. Several randomized, double-blind, placebo-controlled clinical trials have demonstrated the efficacy and safety of ziconotide. However, the maximum recommended dosing and titration schedule provided in the prescribing information may be too aggressive for some patients, and experience has demonstrated that ziconotide is better tolerated with slower titration to a lower maximum dose. Efficacy can be assessed by an evaluation of changes in pain, functionality, and quality of life. Cognitive adverse events may be subtle; therefore, it is important that health care professionals not only monitor patients for signs and symptoms of cognitive adverse events, but also teach family members how to do the same. Careful patient assessment and monitoring can help optimize the potential benefit from treatment with ziconotide.

The opiate analgesic buprenorphine decreases proliferation of adult hippocampal neuroblasts and increases survival of their progeny

Although opiate drugs of abuse have been shown to decrease adult hippocampal neurogenesis, the impact of opiate analgesics has not been tested. North American regulatory boards governing the ethical treatment of experimental animals require the administration of analgesics, such as buprenorphine, following minor surgical interventions. Here, we show that two commonly used post-operative buprenorphine dosing regimes significantly inhibit the proliferation of doublecortin-positive neuroblasts but not other hippocampal stem and progenitor cell populations in adult mice. Buprenorphine, administered in schedules of three 0.05 mg/kg subcutaneous injections over a single day or seven 0.05 mg/kg injections over a 3-day period decreased the number of actively proliferating 5-iodo-2'-deoxyuridine-labeled doublecortin-positive cells for up to 6 days after opiate withdrawal. The minimal (three injection), but not standard (seven injection), analgesic paradigm also reduced basal indices of hippocampal progenitor cell apoptosis and enhanced survival of newly born cells for up to 28 days. Taken together, these data provide the first evidence that the routine administration of opiate analgesics has transient but long-lasting effects on neurogenesis and further emphasize that analgesic dosage and schedule should be reported and considered when interpreting the magnitude of neural stem and progenitor cell activation in response to in vivo intervention.

Pain scores are not predictive of pain medication utilization

Objective. To compare Visual Analogue Scale (VAS) scores with overall postoperative pain medication requirements including cumulative dose and patterns of medication utilization and to determine whether VAS scores predict pain medication utilization. Methods. VAS scores and pain medication data were collected from participants in a randomized trial of the utility of phenazopyridine for improved pain control following gynecologic surgery. Results. The mean age of the 219 participants was 54 (range19 to 94). We did not detect any association between VAS and pain medication utilization for patient-controlled anesthesia (PCA) or RN administered (intravenous or oral) medications. We also did not detect any association between the number of VAS scores recorded and mean pain scores. Conclusion. Postoperative VAS scores do not predict pain medication use in catheterized women inpatients following gynecologic surgery. Increased pain severity, as reflected by higher VAS scores, is not associated with an increase in pain assessment. Our findings suggest that VAS scores are of limited utility for optimal pain control. Alternative or complimentary methods may improve pain management.

Pain-related emotions in early stages of recovery in whiplash-associated disorders: their presence, intensity, and association with pain recovery

OBJECTIVE

Psychological factors such as depression affect recovery after whiplash-associated disorders. This study examined the prevalence of pain-related emotions, such as frustration, anger, and anxiety, and their predictive value for postcrash pain recovery during a 1-year follow-up.

METHODS

A population-based prospective cohort study design was used. Self-reported pain-related depression, anxiety, fear, anger, and frustration were assessed using 100-mm visual analog scales (VASs) at 6 weeks after crash in 2986 persons with traffic-related whiplash-associated disorder. Multivariable logistic regression was used to assess the relationship between the intensity of these pain-related emotions and pain recovery at 4 and 12 months after crash. Pain was measured at all time points on a 100-mm VAS, and pain recovery was defined as a score of 10 or lower.

RESULTS

Pain-related frustration was the most intense, with a mean score of 52. Only 3% of the cohort reported having no pain-related frustration, and 4% reported no pain-related anxiety. Multivariable logistic regression models revealed that each pain-related emotion increased the risk of failing to recover (odds ratios for each point increase on the 100-mm VAS), ranging from 1.011 to 1.015. Specifically, with each 10-point increase in pain-related emotion, the odds of failing to achieve pain recovery at 4 months was increased by 14% (p < .001) for depression, 15% (p < .001) for anxiety, 11% (p < .001) for fear, 12% (p < .001) for anger, and 11% (p < .001) for frustration.

CONCLUSIONS

These findings suggest that it may be beneficial for health care providers to address emotional status related to pain in the first few weeks after a whiplash injury.

Anger suppression and subsequent pain behaviors among chronic low back pain patients: moderating effects of anger regulation style

BACKGROUND

Suppression of anger is linked to subsequent pain intensity among chronic low back patients, but it is not clear whether anger regulation style (trait anger-out, anger-in) moderates these effects or if aroused anger accounts for links between anger regulation style and pain.

METHOD

Chronic low back pain patients (N=58) were assigned to Suppression or No Suppression conditions for a task with harassing confederate and then underwent structured pain behavior procedures. Spielberger Anger Expression Inventory tapped trait anger-out (AOS) and anger-in (AIS).

RESULTS

Regressions tested Emotion Regulation condition × AOS and AIS effects on outcomes. AOS was related to grimacing and sighing for Suppression condition patients. AIS was related negatively to guarding and bracing for Suppression condition patients. Anger report partly mediated effects for AOS and AIS.

CONCLUSIONS

Anger regulation style moderated effects of state anger suppression on subsequent pain behaviors, effects that were partly explained by aroused anger.

Defining racial and ethnic disparities in pain management

BACKGROUND

Substantial pain prevalence is as high as 40% in community populations. There is consistent evidence that racial/ethnic minority individuals are overrepresented among those who experience such pain and whose pain management is inadequate.

QUESTIONS/PURPOSES

The objectives of this paper are to (1) define parameters of and summarize evidence pertinent to racial/ethnic minority disparities in pain management, (2) identify factors contributing to observed disparities, and (3) identify strategies to minimize the disparities.

METHODS

Scientific literature was selectively reviewed addressing pain epidemiology, differences in pain management of non-Hispanic whites versus racial/ethnic minority groups, and patient and physician factors contributing to such differences.

RESULTS

Racial/ethnic minorities consistently receive less adequate treatment for acute and chronic pain than non-Hispanic whites, even after controlling for age, gender, and pain intensity. Pain intensity underreporting appears to be a major contribution of minority individuals to pain management disparities. The major contribution by physicians to such disparities appears to reflect limited awareness of their own cultural beliefs and stereotypes regarding pain, minority individuals, and use of narcotic analgesics.

CONCLUSIONS

Racial/ethnic minority patients with pain need to be empowered to accurately report pain intensity levels, and physicians who treat such patients need to acknowledge their own belief systems regarding pain and develop strategies to overcome unconscious, but potentially harmful, negative stereotyping of minority patients.

Role of pain catastrophizing during pain processing in a cohort of patients with chronic and severe arthritic knee pain

We examined the relationship between catastrophizing and a 3-stage model of pain processing, consisting of pain sensation intensity (stage 1), pain unpleasantness (stage 2), and suffering (stage 3). We studied 310 patients with chronic and severe osteoarthritic knee pain (68.7% female) using 4 competing structural equation models. A strong relationship was found between the suffering construct and its indicators. Of the 4 theoretically plausible models, we found a model with 3 specific pathways of pain sensation leading to the final stage of pain-related suffering. A unique contribution of this study is the integration of catastrophizing into the 3 pain stages. In this model, catastrophizing mediates the relationship between pain-related unpleasantness and suffering, as well as the relationship between sensation and suffering through unpleasantness. Psychological intervention targeting catastrophizing could provide reduction of pain-related suffering that adds to the benefits of therapies directed toward the primary sensory and immediate unpleasant dimensions of pain. These results emphasize the benefit of integrating knowledge of the psychological and neural mechanisms of pain. Catastrophizing makes a unique contribution to suffering apart from the contribution of immediate unpleasantness. The study results emphasize the benefit of integrating knowledge of the psychological and neural mechanisms of pain, and the importance of psychological intervention targeting catastrophizing to reduce pain-related suffering.

Anger suppression predicts pain, emotional, and cardiovascular responses to the cold pressor

BACKGROUND

Manipulated anger suppression has been shown to heighten pain and anger responses to pain.

PURPOSE

We examined whether individual differences in self-reported anger suppression predicted pain, anger, and blood pressure responses to acute pain.

METHODS

Healthy participants (N = 47) underwent an anger-provoking speech task followed by a cold pressor pain task. Participants reported their degree of suppression of thoughts and feelings related to the speech. Pain intensity ratings were obtained throughout the cold pressor. Self-reported anger, anxiety and positive emotion, as well as ratings of sensory, general distress, and anger-specific elements of pain were obtained following the cold pressor. Systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) were recorded throughout.

RESULTS

Self-reported suppression predicted greater pain intensity ratings, perception of sensory and anger-specific elements of pain, and self-reported anger in response to the cold pressor. Associations between self-reported suppression and pain intensity and ratings of anger-specific elements of pain were statistically mediated by pain-induced changes in self-reported anger, whereas the effect of suppression on sensory pain ratings was not. Self-reported suppression was also correlated inversely with SBP responses to the cold pressor.

CONCLUSIONS

Consistent with an ironic process model and prior studies involving experimental manipulation of suppression, self-reported suppression of anger predicted greater pain intensity and perception of the anger-specific element of pain. Findings also suggest that suppression might attenuate homeostatic pressor responses to acute pain.

Correlations between quality of life and psychological factors in patients with chronic neck pain

The purpose of this study was to investigate health-related quality of life (HRQOL) and associated factors in patients with chronic neck pain (CNP). The HRQOL of patients with CNP was assessed by the Short Form-36 questionnaire in this cross-sectional study. To evaluate the psychological factors related to HRQOL, the Eysenck Personality Questionnaire, Chinese Health Questionnaire, and Beck Anxiety Inventory were used. The scores for the eight subscales of Short Form-36 were all lower than the Taiwanese age-matched normative values (p < 0.001). The two most strongly affected subscales were the role-physical subscale and the bodily pain subscale; both scores were below half the score of the age-/sex-matched normative values. The physical components summary score, a summary measure, was moderately correlated with age (rho = -0.43), education level (rho = 0.37) and Beck Anxiety Inventory score (rho = -0.36). The mental components summary score was moderately to highly correlated with the Chinese Health Questionnaire score (rho = -0.72), the neuroticism domain of Eysenck Personality Questionnaire (rho = -0.52) and Beck Anxiety Inventory score (rho = -0.41). The HRQOL of patients with CNP was worse than that of normal subjects across all domains. Furthermore, patients with a neurotic personality, minor psychiatric morbidity and higher anxiety status showed poor mental health, as measured by the Short Form-36. We found that patients with CNP had multiple physical and mental health problems in terms of. The mental health of patients with CNP was strongly associated with various psychological factors. Comprehensive assessment of the physical and mental functioning of patients with CNP can improve the management and care of these patients.

Influences of adult-onset diabetes on orofacial pain and related health behaviors

OBJECTIVES

This study tested the hypothesis that persons with orofacial pain and comorbid adult-onset diabetes will experience greater functional and emotional impact than persons experiencing orofacial pain without diabetes.

METHODS

A random-digit dialing sampling procedure was used for a disproportionate probability sample of 10,341 persons who were screened for orofacial pain in the past 6 months and diabetes. This paper reports on 1,767 individuals reporting toothache pain and 877 reporting painful oral sores. A structured telephone interview assessed diabetes history, orofacial pain characteristics, oral health-care behaviors, and emotional and functional impacts of orofacial pain.

RESULTS

The 6-month point prevalence was 16.8 percent for toothache pain, 8.9 percent for painful oral sores, and 9.6 percent for adult-onset diabetes. Individuals with comorbid orofacial pain and adult-onset diabetes differed significantly on many of the pain characteristics and health behaviors compared with nondiabetic sufferers of orofacial pain. Diabetics were more likely than nondiabetics to have pain every day, to suffer negative emotions associated with pain, to experience disruption of daily activities and sleep, to make an emergency room visit for orofacial pain, and to report the current need for a pain-related health-care visit.

CONCLUSIONS

Although diabetes is well known to be associated with neuropathic pain, these results indicate that the experience of nociceptive pain is exacerbated by diabetes. Findings have significance for the subjective experience of oral pain, dental-care outcomes, and health-related quality of life associated with oral-health outcomes among individuals with diabetes.

Endogenous opioids may buffer effects of anger arousal on sensitivity to subsequent pain

Evidence suggests that anger and pain are related, yet it is not clear by what mechanisms anger may influence pain. We have proposed that effects of anger states and traits on pain sensitivity are partly opioid mediated. In this study, we test the extent to which analgesic effects of acute anger arousal on subsequent pain sensitivity are opioid mediated by subjecting healthy participants to anger-induction and pain either under opioid blockade (oral naltrexone) or placebo. Participants were 160 healthy individuals. A double-blind, placebo-controlled, between-subjects opioid blockade design is used, with participants assigned randomly to one of two drug conditions (placebo or naltrexone), and to one of two Task Orders (anger-induction followed by pain or vice versa). Results of ANOVAs show significant Drug Condition x Task Order interactions for sensory pain ratings (MPQ-Sensory) and angry and nervous affect during pain-induction, such that participants who underwent anger-induction prior to pain while under opioid blockade (naltrexone) reported more pain, and anger and nervousness than those who underwent the tasks in the same order, but did so on placebo. Results suggest that for people with intact opioid systems, acute anger arousal may trigger endogenous opioid release that reduces subsequent responsiveness to pain. Conversely, impaired endogenous opioid function, such as that found among some chronic pain patients, may leave certain people without optimal buffering from the otherwise hyperalgesic affects of anger arousal, and so may lead to greater pain and suffering following upsetting or angry events.