Emotional and neurobehavioural status in chronic pain patients

Influence of the Cognitive and Emotional Status of Patients with Chronic Pain on Treatment Success (Reduction in Pain Intensity and Adherence to Pharmacotherapy): A Prospective Study

This prospective study aimed to determine the cognitive and emotional status among patients with chronic pain and to examine the potential influence on the treatment success, measured by the reduction in pain intensity and adherence to pharmacotherapy. A total of seventy patients were followed for two months. The results of the comparison between patients who did and did not follow the physician’s instructions regarding adherence to pharmacotherapy showed a significant difference in cognitive status and a reduction in pain intensity. Patients who followed the physician’s instructions on taking analgesics had significantly higher scores on the Montreal Cognitive Assessment (MoCA) of cognitive status and a substantially higher reduction in pain intensity. Scores on the MoCA test provide statistically significant indications regarding patients’ decision to follow instructions regarding adherence to pharmacotherapy. Scores on the MoCA test, anxiety, age, and pain intensity (measured with a numeric rating scale—NRS) on admission were identified as potential predictors for the reduction in pain intensity. The linear regression model was statistically significant (χ2 = 40.0, p < 0.001), explained between 43.5% and 61.1% of variance regarding the reduction in pain intensity. The findings of this study show that cognitive status, measured with MoCA, and emotional status, measured with the Depression, Anxiety, and Stress Scale (DASS-21), significantly influence the reduction in pain intensity and adherence to pharmacotherapy. The results suggest that cognitive and emotional status may be potential predictors of treatment success. This finding points to the importance of a biopsychosocial approach in the treatment of chronic pain, where an important emphasis can be placed on the psychosocial determinants of pain.

Effectiveness of Local Cryotherapy Treatment with the Use of Carbon Dioxide and Liquid Nitrogen Among Patients with Low Back Pain Syndrome

Introduction: Low back pain syndromes (LBPS) are common. One of the methods of treating LBPS is local cryotherapy, which can be based on various cooling substances. In the available literature, it is suggested that effective cold treatment may depend on the type and temperature of the cooling substance used. Research objective: The aim of the study was to evaluate the effectiveness of 2 local cryotherapy (Carbon Dioxide and Liquid Nitrogen) types among patients with low back pain syndrome (LBPS). Materials and methods: The study included 60 patients diagnosed with chronic LBPS of discopathic origin. Patients were randomised into 2 study groups. Local cryotherapy treatment with Carbon Dioxide was used in the 1st group (G1), while in the 2nd (G2), cryotherapy treatment with applied Liquid Nitrogen. Two measurements were taken, before and after 2 weeks treatment. The following were used for assessment: centralisation of symptoms (Pain Drawings), pain intensity (Numeral Rating Scale), duration of the current pain episode (Quebec Task Force Classification), level of disability (Roland-Morris Disability Questionnaire), quality and intensity of subjective pain (McGill Pain Questionnaire), patients’ emotional state (Adjectival Scale for Testing Emotions) and self-efficacy related to pain (Pain Self-Efficacy Questionnaire). Statistical analysis was performed via the Student’s t-test for dependent and independent samples. Results: In both study groups, the perceived pain was either completely eliminated or centralised to the spine, hip joint and buttock. The level of pain, disability and pain-related self-efficacy decreased significantly, regardless of the therapy used. In terms of these variables, no greater therapeutic efficacy was demonstrated with either cryostimulation treatment. Qualitative assessment of pain and emotions (especially anxiety and anger) decreased significantly in G1 and G2. However, in the nitrogen-treated group, a significantly greater improvement was noted for WOB:OC, anger and anxiety scores (for these variables, the G2 group started from a higher level prior to therapy). Conclusions: Both analysed treatments are equally effective in terms of variables such as: centralisation of symptoms, level of pain intensity, disability, joy, self-efficacy related to pain, as well as the majority of the analysed MPQ indicators. Cryostimulation with liquid nitrogen may be more effective, but only in improving the WOB: OC index of the MPQ questionnaire and the level of anger and anxiety. Nonetheless, the obtained results do not allow for definitive confirmation of these results. The use of both cryostimulation treatment methods may assist in the treatment process of LBPS.

The impact of lumbosacral alignment on lumbar mobility, functional disability and psychological wellbeing in office workers with chronic low back pain

Background/aims

The lumbosacral curvature of the spine has a special role in its mobility during weight-bearing activities. Office work is a sedentary role, which requires sitting for long durations, having a negative effect on spinal posture. Therefore, low back pain risk factors in office workers are different from other populations. The aim of this study was to examine the effect of lumbosacral joint angle on the lumbar mobility, functional disability, pain intensity and overall health in office workers with chronic low back pain.

Methods

A total of 116 male office workers with chronic low back pain (aged between 30–59 years) participated in this cross-sectional study. The lumbosacral radiography was used to divide the participants into two groups, according to the value of their lumbosacral joint angle: group A (lumbosacral joint angle <20°, n=61) and group B (lumbosacral joint angle group >20°, n=55). The lumbar mobility, functional disability, pain intensity and overall health issues of participants were measured.

Results

The functional disability and pain intensity of individuals in group A were significantly higher than group B (P<0.05). There was a significant decrease in the lumbar flexion and extension range of motion and activities of daily living of those in group A compared to group B (P<0.05). There was a significant increase in emotional health problems and impaired social activity of individuals in group A compared to group B (P<0.05). There were fair positive correlations between lumbosacral joint angle values and functional disability, pain intensity and social activity in office workers in group B (r=0.292, 0.036, 0.333 respectively).

Conclusions

A decreased lumbosacral joint angle increases functional disability and pain intensity, decreasing lumbar mobility and level of functionality. Furthermore, it reduces emotional health and social activity in participants with low back pain. Therefore, measuring the lumbosacral joint angle of patients with chronic low back pain during treatment may be useful to decrease their pain intensity and improve their functional disability and quality of life.

Classification of circadian pain rhythms and pain characteristics in chronic pain patients: An observational study

This study aimed to perform cluster analysis in patients with chronic pain to extract groups with similar circadian rhythms and compare neuropathic pain and psychological factors among these groups to identify differences in pain-related outcomes. A total of 63 community-dwellers with pain lasting at least 3 months and Numerical Rating Scale scores of ≥2 were recruited from 3 medical institutions. Their pain circadian rhythms were evaluated over 7 days by measuring pain intensity at 6-time points per day using a 10-cm visual analog scale. Cluster analysis was performed using 6 variables with standardized visual analog scale values at 6-time points for individual participants to extract groups with similar pain circadian rhythms. The results of the Neuropathic Pain Symptom Inventory and psychological evaluations in each group were compared using the Kruskal-Wallis test. The results revealed 3 clusters with different circadian rhythms of pain. The total and evoked pain subscale Neuropathic Pain Symptom Inventory scores differed among the 3 clusters. The results suggest that a thorough understanding of circadian pain rhythms in chronic pain patients may facilitate the performance of activities of daily living and physical exercise from the perspective of pain management.

Cognition and Pain: A Review

Cognition is defined as the brain's ability to acquire, process, store, and retrieve information. Pain has been described as an unpleasant sensory or emotional experience, and for experiencing pain consciously, cognitive processing becomes imperative. Moreover, evaluation of pain strongly depends on cognition as it requires learning and recall of previous experiences. There could be a possible close link between neural systems involved in cognition and pain processing, and studies have reported an association between pain and cognitive impairment. In this narrative review, we explore the available evidence that has investigated cognitive changes associated with pain. We also examine the anatomical, biochemical, and molecular association of pain and neuro-cognition. Additionally, we focus on the cognitive impairment caused by analgesic medications. There is a need to improve our understanding of pathophysiology and cognitive impairment mechanisms associated with chronic pain and its treatment. This area provides a diverse opportunity for grounding future research, aiding institution of timely interventions to prevent chronic pain and associated cognitive decline, ultimately improving patient care.

Development of a Web Exercise Video for Nursing Intervention in Outpatients With Low Back Pain

The purpose of this study was to develop a Web exercise video for nursing intervention among outpatients with low back pain by applying the analysis-design-development-implementation-evaluation model to promote continuous exercise. During the analysis phase, we assessed the needs for the lower back exercise video as well as details of the current situations of the participants. Additionally, we investigated the intervention methods that the medical practitioners thought would be helpful in promoting lower back exercise. After the design and development phase, a lower back exercise video of 5 minutes 46 seconds was developed. The main contents in the video were the stretching and flexing exercises of the spine and muscles, including "One knee to chest," "Both knees to chest," "Hip bridge," "Prone position to erect spine," "Kneeling back extension," "Kneeling, opposite arm and leg raised," and "Sitting rotation stretch." For the implementation and analysis phase, a pilot test was done. The lower back exercise video was posted on the Web site, and participants watched the video and exercised individually. Participants reported that they were able to use the Web video whenever required, and after following the video a few times, they grew accustomed to the practice and were able to perform it repeatedly to help strengthen the lower back. In the future, experimental research is needed to confirm the effectiveness of exercise using Web video.

Preliminary evaluation of the efficacy, safety, and costs associated with the treatment of chronic pain with medical cannabis

Introduction:

Medical cannabis (MC) is commonly claimed to be an effective treatment for chronic or refractory pain. With interest in MC in the United States growing, as evidenced by the 29 states and 3 US districts that now have public MC programs, the need for clinical evidence supporting this claim has never been greater.

Methods:

This was a retrospective, mirror-image study that investigated MC's effectiveness in patients suffering from chronic pain associated with qualifying conditions for MC in New York State. The primary outcome was to compare European Quality of Life 5 Dimension Questionnaire (EQ-5D) and Pain Quality Assessment Scale (PQAS) scores at baseline and 3 months post-therapy. The secondary outcomes included comparisons of monthly analgesic prescription costs and opioid consumption pre- and post-therapy. Tolerability was assessed by side effect incidence.

Results:

This investigation included 29 subjects. Quality of life and pain improved, measured by change in EQ-5D (Pre 36 – Post 64, P < .0001) and change in PQAS paroxysmal (Pre 6.76 – Post 2.04, P < .0001), surface (Pre 4.20 – Post 1.30, P < .0001), deep (Pre 5.87 – Post 2.03, P < .0001), unpleasant (Pre “miserable” – Post “annoying”, P < .0001). Adverse effects were reported in 10% of subjects.

Discussion:

After 3 months treatment, MC improved quality of life, reduced pain and opioid use, and lead to cost savings. Large randomized clinical trials are warranted to further evaluate the role of MC in the treatment of chronic pain.

Behavioral Inhibition and Activation Systems, and Emotional Regulation in Individuals With Chronic Musculoskeletal Pain

Gray's Reinforcement Sensitivity Theory postulates two distinct neurophysiological systems that underlie thoughts, emotions, and behavior: the Behavioral Inhibition System (BIS) and the Behavioral Approach System (BAS). Preliminary research suggests that both systems may play relevant roles in the adjustment of individuals with chronic pain. However, there is a lack of research on the extent to which emotional regulation (i.e., cognitive reappraisal and expressive suppression) mediates the associations between BIS and BAS activation and emotional responses in individuals with chronic pain. The aim of this study was to test a model of the associations between the BIS and BAS, cognitive reappraisal and expressive suppression, and positive and negative affect in individuals with chronic musculoskeletal pain. In total, 516 participants were interviewed. Structural Equation Modeling was used to estimate the associations between variables. The empirical model showed a good fit to the data (χ²/df = 1.95; RMSEA = 0.04; GFI = 0.99; AGFI = 0.98; CFI = 0.99). The hypothesized model received partial support. The BIS was associated with cognitive reappraisal and expressive suppression; cognitive reappraisal was associated with negative and positive affect; expressive suppression was positively associated with affect; and the BAS was not associated with the emotional regulation strategies assessed. However, the BIS and BAS were both directly associated with negative and positive affect. The results suggest that individuals with chronic pain with higher BIS activation appear to use greater expressive suppression. Cognitive reappraisal strongly mediated the BIS-negative affect association. The results also suggest that BAS activation may have a weak or inconsistent association with emotional regulation approaches in individuals with chronic pain. These data provide new and relevant information on the potential role of the BIS and BAS as predictors of psychological functioning in individuals with chronic pain. They suggest that the BIS-BAS model of chronic pain may need to be modified to take into account the potential negative effects of BAS activation. The findings suggest that treatments for emotional regulation could potentially reduce the negative impact of chronic pain via BIS.

Uncovering the influence of social skills and psychosociological factors on pain sensitivity using structural equation modeling

Pain is a subjective emotional experience that is influenced by psychosociological factors such as social skills, which are defined as problem-solving abilities in social interactions. This study aimed to reveal the relationships among pain, social skills, and other psychosociological factors by using structural equation modeling. A total of 101 healthy volunteers (41 men and 60 women; mean age: 36.6±12.7 years) participated in this study. To evoke participants’ sense of inner pain, we showed them images of painful scenes on a PC screen and asked them to evaluate the pain intensity by using the visual analog scale (VAS). We examined the correlation between social skills and VAS, constructed a hypothetical model based on results from previous studies and the current correlational analysis results, and verified the model’s fit using structural equation modeling. We found significant positive correlations between VAS and total social skills values, as well as between VAS and the “start of relationships” subscales. Structural equation modeling revealed that the values for “start of relationships” had a direct effect on VAS values (path coefficient =0.32, p<0.01). In addition, the “start of relationships” had both a direct and an indirect effect on psychological factors via social support. The results indicated that extroverted people are more sensitive to inner pain and tend to get more social support and maintain a better psychological condition.

Aggression, impulsivity, and suicide risk in benign chronic pain patients - a cross-sectional study

OBJECTIVES

The objective of this study was to investigate the role that psychopathological dimensions as overt aggression and impulsivity play in determining suicide risk in benign chronic pain patients (CPPs). Furthermore we investigated the possible protective/risk factors which promote these negative feelings, analyzing the relationship between CPPs and their caregivers.

METHODS

We enrolled a total of 208 patients, divided into CPPs and controls affected by internistic diseases. Assessment included collection of sociodemographic and health care data, pain characteristics, administration of visual analog scale (VAS), Modified Overt Aggression Scale (MOAS), Barratt Impulsiveness Scale Version 11 (BIS), Hamilton Depression Rating Scale (HDRS), and a caregiver self-administered questionnaire. All variables were statistically analyzed.

RESULTS

A significant difference of VAS, MOAS-total/verbal/auto-aggression, HDRS-total/suicide mean scores between the groups were found. BIS mean score was higher in CPPs misusing analgesics. In CPPs a correlation between MOAS-total/verbal/auto-aggression with BIS mean score, MOAS with HDRS-suicide mean score and BIS with HDRS-suicide mean scores were found. The MOAS and BIS mean scores were significantly higher when caregivers were not supportive.

CONCLUSION

In CPPs, aggression and impulsivity could increase the risk of suicide. Moreover, impulsivity, overt aggression and pain could be interrelated by a common biological core. Our study supports the importance of a multidisciplinary approach in the CPPs management and the necessity to supervise caregivers, which may become risk/protective factors for the development of feelings interfering with the treatment and rehabilitation of CPPs.