Fear of pain in orofacial pain patients

In the present study, we examined whether fear of pain, dental fear, general indices of psychological distress, and self-reported stress levels differed between 40 orofacial pain patients and 40 gender and age matched control general dental patients. We also explored how fear of pain, as measured by the Fear of Pain Questionnaire-III (J Behav Med 21 (1998) 389), relates to established measures of psychological problems in our sample of patients. Finally, we examined whether fear of pain uniquely and significantly predicts dental fear and psychological distress relative to other theoretically-relevant psychological factors. Our results indicate that fear of severe pain and anxiety-related distress, broadly defined, are particularly elevated in orofacial pain patients relative to matched controls. Additionally, fear of pain shares a significant relation with dental fear but not other general psychological symptomology, and uniquely and significantly predicts dental fear relative to other theoretically-relevant variables. Taken together, these data, in conjunction with other recent studies, suggest greater attention be placed on understanding the fear of pain in orofacial pain patients and its relation to dental fear and anxiety.     

Electronic momentary assessment in chronic pain II: pain and psychological pain responses as predictors of pain disability

OBJECTIVES AND METHODS: More than 7,100 electronic diaries from 80 patients with chronic pain (mean: 89.3, range 30-115) entered multilevel analyses to establish the statistical prediction of disability by pain intensity and by psychological functioning (fear avoidance, cognitive, and spousal pain responses). We also tested the differences between pre-chronic, recently chronic, and persistently chronic pain in the prediction of disability (impaired physical and mental capacity, pain interference with activities, immobility due to pain). RESULTS: Pain intensity explained 8% to 19% of the disability variance. Beyond this psychological functioning explained 7% to 16%: particularly fear-avoidance and cognitive pain responses predicted chronic pain disorder disability; spousal responses predicted immobility better than other aspects of disability. Immobility due to actual pain occurred infrequently. When it did, however, it was better predicted by avoidance behavior in the patient and by spousal discouragement of movement than by actual pain intensity. The prediction of immobility due to pain by, respectively, avoidance behavior and catastrophizing was better in chronic pain (>6 months) and that of physical impairment by catastrophizing better in persistently chronic pain (>12 months) than in pain of shorter duration. DISCUSSION: The psychological prediction of chronic pain disorder disability was determined beyond that accounted for by pain intensity. Nonetheless, psychological functioning explained substantial variance in chronic pain disorder disability. The psychological prediction of immobility and physical impairment was stronger with longer pain duration. Patient characteristics and momentary states of disability-and in particular of immobility-should be carefully distinguished and accounted for in chronic pain disorder.     

From past pain to future pain through the pain of others: Information about other people's pain ratings can alleviate our subsequent pain

Background

Previous studies have shown that pain memories have a profound impact on subsequent pain experiences. This study investigated whether pain ratings derived from other people can modify an individual's memory of past pain. This study also examined whether pain memory modified by others' pain ratings determines subsequent pain experiences.

Methods

Participants were divided into two groups: an experimental group and a control group. Participants in both groups were exposed to pain stimulation; then, they recalled its intensity twice over a period of time; after a break, they were again exposed to pain stimulation of the same intensity. The final sample consisted of 53 participants. The only difference between the experimental group and the control group was that in the former the pain ratings of other alleged participants were presented between the two consecutive pain recalls. These ratings suggested that other people experienced the same pain as less intense.

Results

The pain ratings derived from other people did not alter the pain memory; nevertheless, they affected an individual's next pain experience even for a certain period of time after their presentation. This type of pain-related information shaped participants' subsequent pain experiences regardless of their empathy, conformity, and susceptibility to social influence.

Conclusions

Information on pain derived from other people not only shapes the response to a novel stimulation but also substantially modifies the subsequent experience of that stimulation.

Significance

The study demonstrates the importance of social information on pain and provides evidence that this type of information substantially modifies the subsequent experience of the same pain. These results suggest that social information on pain can be used to alleviate pain associated with recurring medical procedures and thus increase patients' willingness to continue treatment.     

无痛静脉穿刺技术的研究进展

静脉穿刺技术是临床上常用的基础护理操作技术，可通过静脉给药而达到治疗疾病的目的，而穿刺同时引起的疼痛同样令人难以忍受。疼痛是人的一种生理、心理感受，是在实际上或潜在因素造成组织损伤的情感经历。疼痛不只是主观上使人感觉不适，客观上还能引起病人生命体征的改变，打针痛已成为人们脑海里固有的概念，患儿则常以哭闹的方式拒绝穿刺。因此，如何减轻静脉穿刺引起的疼痛，一直成为护理同仁们研究的课题，现就无痛静脉穿刺的方法及技术进展综述如下。     

Role of pain management programmes in chronic pain

Many people in the UK experience chronic pain. This can have a huge effect on a person's life, including their mood, work and family. Pain management programmes are proving effective in helping people to cope with pain and improve their quality of life.     

Retarded disengagement from pain cues: the effects of pain catastrophizing and pain expectancy

The role of operant conditioning for the development and maintenance of chronic pain was examined in 30 chronic back pain patients (CBP) and 30 matched healthy controls. Half of each group was reinforced for increased, half for decreased pain reports while EEG, EOG, heart rate, skin conductance and muscle tension levels were recorded. Both groups showed similar learning rates, however, the CBP patients displayed slower extinction of both the verbal and the cortical (N150) pain response. In addition, the CBP group displayed prolonged elevated electromyogram levels to the task. These data suggest that CBP patients are more easily influenced by operant conditioning factors than healthy controls and this susceptibility may add to the maintenance of the chronic pain problem.     

The dimensionality of pain: palliative care and chronic pain patients differ in their reports of pain intensity and pain interference

The accurate, precise, and consistent assessment of pain is of particular importance in palliative care. The European Palliative Care Research Collaborative is developing a computer-based pain assessment instrument and has been evaluating the content and dimensionality of existing pain questionnaires. The most important dimensions of pain are intensity and interference. However, since pain interference is a consequence of and largely reflects pain intensity, we postulated that it might either provide information to enhance the evaluation of intensity, or that an overall summary measure of pain severity could be constructed by combining the 2 dimensions. Cancer patients in palliative care (n=395) and chronic pain patients (n=168) completed questionnaires that included 23 pain items culled from existing questionnaires. Psychometric analyses confirmed the existence of 2 main dimensions, intensity and interference, and also guided identification of items that contributed most strongly to these dimensions. However, there was strong evidence that the relationship between the intensity and the interference items differs markedly in palliative care patients compared to chronic pain patients. As hypothesized, there was strong correlation between intensity and interference, lending support to the possibility that, for some purposes, these dimensions may be combined to provide a higher-level summary measure of patients' pain experience. We conclude that these dimensions should be kept distinct when assessing patients in general, although for a single type of patient (such as palliative care patients), it may be possible to regard intensity and interference as contributing to an overall measure of pain severity.     

Familial pain models: the relationship between family history of pain and current pain experience

Recent evidence has underscored the importance of parental models and vicarious learning in the etiology of pain behavior. The present study investigated the relationships between the number of familial pain models to which an individual has been exposed, the individual's reports of current pain experiences, and the role of gender. One hundred and twenty male and 168 female college students reporting occasional pain episodes completed the Parameters of Pain Questionnaire. Results indicated that a significant positive relationship exists between the number of pain models in an individual's familial environment and the frequency of his/her current pain reports. Additionally, pain models had a greater impact on females than on males. These findings are discussed in terms of vicarious learning and health locus of control processes.     

Sex-dependent effects of reported familial pain history on recent pain complaints and experimental pain responses

Previous research has demonstrated that both sex and familial pain history can influence clinical pain, and sex is known to affect experimental pain responses. However, the potential interactive effects of sex and family history on pain-related symptoms and experimental pain have not been investigated. This experiment examined recent pain complaints and laboratory pain responses as a function of sex and reported family history of pain in 212 (122 female, 90 male) young adults. All subjects completed questionnaires regarding family history of pain, recent pain experiences, and psychological measures of hypervigilance. Then, warmth detection thresholds, heat pain thresholds and heat pain tolerances were determined. Results revealed sex-dependent influences of familial pain history on recent pain complaints and experimental pain responses. Specifically, a positive family history of pain was associated with increased reports of pain over the previous month and poorer general health as well as enhanced sensitivity to thermal stimuli among females but not males. Higher levels of hypervigilance accounted for some of the family history effects on recent pain complaints but not experimental pain measures. Potential mechanisms underlying these effects of family history among females are discussed.     

Topographic brain measures of human pain and pain responsivity

Individual differences in human pain responsivity were characterized by the 1 degree C cold-pressor test. Behaviorally, a pain-tolerant group (PT = 29 Ss) tolerated the entire 3-min test (means = 180 +/- 0 sec), while a pain-sensitive group (PS = 13 Ss) averaged only 50.31 +/- 20.81 sec of the cold-pressor test (t = 16.75, P less than 0.0001), replicating our earlier studies. Physiologically, the PT group exhibited no mean differences from the PS group in cortical power densities at the baseline stage. Under the noxious stress of the cold-pressor test, both groups exhibited markedly heightened delta and beta cortical power densities. However, the PS subjects showed significantly higher delta power, but not beta power, than the PT subjects. We conclude that heightened delta activity may reflect the stress component of human pain responsivity, and that beta activity reflects the vigilance scanning of pain processes.