Dealing with chronic pain: giving voice to the experiences of mothers with chronic pain and their children

Despite the substantial monetary, personal, and social cost of chronic pain, research into the family life of sufferers is wanting. Parents dealing with chronic pain, as well as their children, have been particularly neglected. Using qualitative interview data from 16 mothers suffering from a variety of chronic pain conditions, and their 21 children, aged 6 to 12 years, we explored the impact of maternal chronic pain on mothers and children. Consistent with a gains-and-loss theory and the strengths perspective, the findings revealed both positive and challenging aspects of pain. Despite the presence of risks--including maternal stress, parenting difficulties, and children's distress--maternal chronic pain also provided opportunities for growth in many families. The findings suggest that maternal chronic pain can catalyze enhanced development as well as adversity. Researchers and clinicians should be aware of the pitfalls facing families dealing with chronic pain, while remaining open to the possibility that some families might flourish.     

Performing occupations under pain: the experience of persons with chronic pain

Chronic pain is known as a complex and subjective phenomenon that challenges healthcare professionals who coach and support clients with chronic pain. The aim of this study was to explore how persons with chronic pain experienced their occupational performance. Eight persons suffering from chronic pain were interviewed and the data was analysed with the constant comparative method. Three themes were identified: "Performing is an ongoing attraction", "Getting used to taking breaks is not easy", and "The challenge to finish performing". "Performing is an ongoing attraction" illustrates the innate need of every human being to be active and also how pleasurable occupations do not influence pain. The ongoing thoughts and emotions while participants stop their performance are described in "Getting used to taking breaks is not easy". This stop and go during every occupation is discussed in the perspective of temporality and occupational performance. In "The challenge to finish performing" the participants describe how they complete certain occupations despite pain. This is discussed with the focus on distraction and flow experience.     

Hulka Clip application as a potential cause of chronic pelvic pain.

A case report of an isolated hydrosalpinx resulting from the placement of two Hulka Clips on the same fallopian tube is presented. This is a previously unreported complication of mechanical sterilization and is suggested as a possible cause of chronic pelvic pain.     

Visualization of chronic neck--shoulder pain: Impaired microcirculation in the upper trapezius muscle in chronic cervico-brachial pain

This study pertains to the 71 patients who had received a diagnosisof cervico-brachial pain syndrome after thorough clinical examinationof a total series of 300 patients, who had been referred tothe National Insurance Hospital in Tranås because of chronicneck pain that interfered with their ability to work. Changesin trapezius muscle blood flow and EMG were examined and relatedto the anamnesis and physical findings. The microcirculationin the upper part of the right and left trapezius muscles wasexamined simultaneously by using optical laser-Doppler single-fibresafter insertion into the muscle directly via the skin. Continuousrecordings were made during stepwise increased static contractiondetermined electro-myographically. Signal processing was performedon-line by computer. MRT of the cervical spine was performedin 12 patients. None showed nerve root affliction. Ten showeda bulging intervertebral disc and two, a narrowed nerve hole(lateral stenosis). The muscle blood flow (LDF) was significantlylower in the most painful side compared with the opposite sidein the group of 41 patients with predominantly unilateral pain(21 women and 20 men). A lowered blood flow was also found whenthe 21 females in this group was compared with a normal controlgroup of 20 healthy women. The patients had lower rms-EMG andEMG mean power frequency (MPF) in the painful side comparedwith the opposite side. A further lowering of the MPF was observedwith induced fatigue. It was concluded that the chronic neckpain in cervico-brachial syndrome can become visualized by thefinding of lowered blood flow of the trapezius muscle whichseems to be an expression of the chronic neck pain.     

Chronic pain in the classroom: teachers' attributions about the causes of chronic pain

BACKGROUND: School absenteeism and other impairments in school function are significant problems among children with chronic pain syndromes; yet, little is known about how chronic pain is perceived in the school setting. The purpose of this study was to examine teachers' attributions about the causes of chronic pain in adolescent students. METHODS: Classroom teachers (n = 260) read vignettes describing a hypothetical student with limb pain. They were presented with a list of possible physical and psychological causes for the pain and asked to identify the causes to which they attributed the pain. Vignettes varied by the presence or absence of (1) documented medical evidence for the pain and (2) communication from the medical team. Teachers also responded to questions assessing their responses to the student in terms of support for academic accommodations and sympathy for the student. RESULTS: Teachers tended to endorse a dualistic (ie, either physical or psychological) model for pain rather than a biopsychosocial model. Documented medical evidence supporting the pain was the most influential factor affecting teachers' attributions about chronic pain. Teachers who attributed the pain to physical causes-either in isolation or in combination with psychological causes-responded more positively toward the student. CONCLUSIONS: Many teachers lack a biopsychosocial framework through which to understand chronic pain syndromes in students. How chronic pain is described to school personnel may affect how teachers understand the pain and respond to it.     

Antidepressants and chronic pain

Successful treatment of pain syndromes is one of the most common and most difficult problems facing family physicians. Frequently analgesics provide inadequate treatment, and clinicians are forced to consider alternatives. This article reviews the neurophysiologic similarities between depression and the chronic pain syndromes and describes several well-designed double-blinded studies that give evidence for the efficacy of antidepressants in chronic pain syndromes. These studies conclude that antidepressants should be considered in chronic pain syndromes that do not respond to analgesics. For chronic pain, antidepressants should be started at a low dosage and increased in a stepwise manner until an improvement in the pain occurs or intolerable side effects intervene. Side effects are a bothersome aspect of antidepressant therapy but are more tolerable at the doses generally needed for pain relief than at antidepressive doses. At least three weeks of antidepressant therapy is generally needed to gain significant relief of symptoms.     

Acupuncture and chronic pain: a criteria-based meta-analysis

A literature search revealed 51 controlled clinical studies on the effectiveness of acupuncture in chronic pain. These studies were reviewed using a list of 18 predefined methodological criteria. A maximum of 100 points for study design could be earned in four main categories: (a) comparability of prognosis, (b) adequate intervention, (c) adequate effect measurement and (d) data presentation. The quality of even the better studies proved to be mediocre. No study earned more than 62% of the maximum score. The results from the better studies (greater than or equal to 50% of the maximum score) are highly contradictory. The efficacy of acupuncture in the treatment of chronic pain remains doubtful.     

Smoking and chronic pain: a real-but-puzzling relationship

Smoking produces profound changes in physiology beyond those associated with the delivery of nicotine to the bloodstream. It has long been known that these changes put patients at risk for heart disease, cancers, and lung diseases. More recently, it has been discovered that smoking is a risk factor for chronic pain. Robust epidemiological evidence is showing that smokers not only have higher rates of chronic pain but also rate their pain as more intense than nonsmokers. Because the relationship between smoking and pain is of relevance to clinicians in many specialties, researchers at Mayo Clinic are examining this relationship in depth. This article describes some of what they and others have discovered in recent years about the interactions between smoking and chronic pain.     

Public images of mental illness: A factor analytic study of causes and symptoms

While most studies of public images of mental illness have dealt with symptoms but not causes, and have largely been based upon asking the public the degree to which they agree with psychiatric definitions of mental illness, this study incorporates cultural inertia theory which states public images of mental illness reflect explanations of mental illness which have been dominant in various periods of Western Civilisation. These explanations are identified as moral, mental and psyche explanations. A battery of items are subjected to factor analysis and the resulting factors, in order of public preferences are (1) Kinship Causes, (2) Mental Causes, (3) Moral Symptoms, (4) Aggressive-Unstable Personality Symptoms, (5) Mental Symptoms, and (6) Moral Causes. The factor analysis largely confirms the hypotheses tested: classification of causes and symptoms used by the public to identify mental illness reflect moral, mental, and interpersonal explanations.     

Managing constraint: the experience of people with chronic pain

This study describes the experience of people with chronic pain. Using the method of grounded theory, 29 chronic pain sufferers were interviewed at an outpatient pain clinic. A model depicting the basic social psychological process of maintaining a normal life through constraint was developed. This process revolved around people's perception of the constraints imposed by pain: bodily constraint (constraint on the body and its relationship to the environment); activity constraint (the constraint on what people could do); and identity constraint (the constraint on what people could be). The degree to which pain had challenged what people had previously accepted as 'normal' was illustrated through their evaluation of the impact of pain. The conclusion of this process of evaluation reflected how people coped with the constraints of pain-whether they were assimilated, accommodated, confronted or subverted. In assimilation, the constraints were absorbed and normal life maintained. In accommodation, the constraints were accepted and normal life re-defined. In confrontation, the constraints were rejected and pre-pain identities and activities pursued despite leading to increased pain levels. In subversion, attempts were made to retain pre-pain identities, and although pain levels were minimized, activities were altered to a significant degree. The limitations imposed by pain often form the focus of people's coping efforts, rather than the pain per se. The desire to retain pre-pain 'normal' lifestyles may underlie people's use of coping strategies that exacerbate pain intensity and pain-related disability. Future research needs to explore both the relationship between adjustment to pain and adjustment to the restrictions associated with ageing, and the role of body techniques and identity management in adjustment to pain in order to understand factors which may promote pain acceptance.     

Hospitalized patients with chronic mental diseases: review of the literature

Alternative approaches to manage mental illness have arisen all over the world with emphasis on outpatient community models. Little is said about chronically hospitalized patients. The purpose of this literature review was to access what researchers have proposed in the past decade concerning the work with chronic mentally ill inpatients. The articles found were divided in topics: characteristics of chronic mentally ill inpatients, their opinion about hospitalization and suggestions to improve the practice. As a conclusion, the authors propose a better assessment with serious studies concerning this clientele, their reality and the possibilities of intervention.     

抑郁症患者的语言使用模式

  目的  比较中国居民1990年与2019年抑郁症疾病负担,为抑郁症的预防控制提供参考依据。  方法  收集全球疾病负担（GBD）2019中中国居民1990年和2019年的抑郁症发病数和伤残调整寿命年（DALYs）,比较1990年与2019年中国居民抑郁症的变化情况。  结果  中国居民2019年抑郁症的发病数和DALY分别为41005280例和7561985人年,较1990年的31303436例和5486751人年增加了31.0 % 和37.8 %;抑郁症的标化发病率和标化DALYs率由1990年的2647.72/10万和470.65/10万下降至2019年的2301.41/10万和416.95/10万。与1990年相比,男性居民2019年抑郁症的发病数和DALYs增加了37.0 % 和41.9 %,均高于女性居民的27.8 % 和35.5 %;标化发病率和标化DALYs率降低了7.8 % 和7.6 %,均低于女性的16.5 % 和14.2 %。2019年10～49岁男性、女性和总人群抑郁症DALYs率均低于1990年,≥ 50岁男性、女性和总人群抑郁症DALYs率均高于1990年。1990年和2019年重度抑郁症DALYs分别为4006829人年和5087997人年,分别占抑郁症总疾病负担的73.0 % 和67.3 %,是中国居民抑郁症疾病负担最为严重的病种;2019年中国居民重度抑郁症和心境恶劣DALYs率分别较1990年增加了5.7 % 和39.1 %,心境恶劣疾病负担增加明显。  结论  中国女性居民仍占抑郁症疾病负担的主导地位,但男性和中老年居民抑郁症疾病负担有所增加,心境恶劣的疾病负担亦增加明显,应予以重视。     

Pediatric chronic pain: there is hope

Chronic pain is prevalent in children and can limit their ability to attend school, socialize with peers, and participate in physical activity. This article describes the advantages of using a multidisciplinary approach to evaluating and treating children with chronic pain and discusses medications and techniques for managing pain and restoring functionality.     

Effects of physical and mental stressors on muscle pain

Physical and mental stressors as risk factors for pain development are discussed. These multifaceted stressor terms are narrowed down so that physical stressors are represented by muscle activity recorded by electromyography (EMG), while mental stress is considered synonymous with psychosocial stress in vocational studies; in experimental studies cognitive stress is used as a model. Pain in the shoulder and neck are focused and related to EMG recordings of activity in the trapezius muscle. Major challenges in this field include proper risk assessment at low physical work loads and criteria for evaluating stress as a risk factor. A 3-factor conceptual model is presented in which the independent dimensions physical work load, mental stress, and individual sensitivity determine the risk of shoulder and neck complaints. It is pointed out that a predominant reduction in physical work load for many jobs and an increasing interaction between work conditions and the general life situation of workers pose particular challenges for risk assessment.     

Ends of the line: diversity among chronic pain centers.

Chronic pain may cause an endless search for care for its sufferers, while presenting a persistently intractable problem for physicians and disability administrators faced with an illness that defies both conventional medical thinking and established disability compensation mechanisms. In the past 15 years pain centers have mushroomed. Some pain specialists, who are typically based on these centers, have claimed to provide comprehensive treatment for chronic pain and definitive solutions to problems of disability policy. However, pain control is not yet a unified field. Approaches to treatment vary and the definitions of the objects of treatment, i.e. chronic pain syndromes, differ. This paper describes the lines of diversity which characterize this emerging field of health care through an explanatory, cross-sectional survey of 25 pain treatment facilities operating in a single urban community. Pain centers were found to vary with respect to the following dimensions: institutional affiliation, professional background of the staff, treatment modalities offered, populations served, patient selection criteria, types of pain condition treated, and diagnostic and etiologic frames of reference. Pain centers may present a diverse array of options in a pain sufferer's search for care. In addition, the reliance on pain specialists for a resolution of complex problems of disability policy may be premature.     

Medical knowledge and the intractable patient: the case of chronic low back pain

Chronic low back pain (CLBP) is endemic in Western societies, and while a good deal of attention has been paid to the lay experience of such pain, much less sociological attention has been paid to the way in which medical ideas about it have been formulated. This paper takes the latter course, tracing the development of clinical notions about the relationship between pathological signs and expressed symptoms from the 1820's to the 1930's, and then placing these developments in the context of postwar notions of 'somatization'. We point to the extent to which the disparity between expressed symptoms, pathological signs and perceived disability in CLBP has led to the moral character of the sufferer forming a constant subtext to medical discourse about the condition. We also note the extent to which medical ideas themselves have been constructed in intimate linkage with socio-legal questions of compensation and worker's insurance.