Fear-Avoidance,Pain Acceptance and Adjustment to Chronic Pain: A Cross-Sectional Study on a Sample of 686 Patients with Chronic Spinal Pain

Background

Prior studies found a range of psychological factors related to the perception of pain, maintenance of pain and disability.

Purpose

The aim of this study was to investigate the role of pain fear-avoidance and pain acceptance in chronic pain adjustment. The influence of two diathesis variables (resilience and experiential avoidance) was also analyzed.

Methods

The sample was composed of 686 patients with chronic spinal pain. Structural equation modelling analyses were used to test the hypothetical model.

Results

Experiential avoidance was associated with pain fear-avoidance, and resilience was strongly associated with pain acceptance. Pain acceptance was negatively associated with negative mood, functional impairment and pain intensity. However, pain fear-avoidance was positively and significantly associated with negative mood but had no association with pain intensity. There was a path from functional impairment to pain fear-avoidance.

Conclusions

Resilience and experiential avoidance appear as variables which could explain individual differences in pain experience.     

Sonographic Predictors in Patients with Hemiplegic Shoulder Pain: A Cross-Sectional Study

ObjectivesTo evaluate the sonographic findings of soft tissues more comprehensively, to investigate the relationship between sonographic pathologies and clinical features, and to determine the predicted factors that may interfere with the most common sonographic findings in patients with hemplegic shoulder pain (HSP) .MethodsSixty-four consecutive stroke patients with HSP admitted to inpatient clinic were included in this cross-sectional study. Demographic, clinical, and sonographic findings were recorded. Patients were assigned to poor or good motor function groups according to the Brunnstrom motor recovery (BMR) stages.ResultsThere were abnormal sonographic findings in 63 patients (98.4%). A significant reverse correlation was found between the sonographic grading and functional independence measure (p=0.005) and a positive correlation with energy level (p=0.044). The main risk factors were age for acromioclavicular joint degeneration, BMR stage for glenohumeral joint subluxation, subacromial-subdeltoid bursitis for partial-thickness rotator cuff tear, and Pittsburgh Sleep Quality Index for long head of the biceps tenosynovitis.ConclusionAge, motor recovery, subacromial-subdeltoid bursitis, and sleep quality were the strongest predictors of different sonographic findings in HSP patients. Functional capacity and energy level are negatively affected by an increased number of abnormal sonographic findings. Therefore, sonographic evaluation of shoulder soft tissue lesions eventually might provide a more constructive rehabilitation approach to achieve optimal outcomes, particularly in elderly patients with poor motor function and sleep quality.     

Integration of Pharmacological and Psychological Treatment of Chronic Pain Patients: A Preliminary Study

Two types of psychological treatment, applied relaxation and applied relaxation plus an operant package, were compared to either flupentixol 0.5 mg or placebo. The data indicated that flupentixol in general had a better effect than placebo, and that combining flupentixol and applied relaxation resulted in the best reductions of subjective pain, while flupentixol combined with applied relaxation plus operant treatment led to the best improvements in activity. Since the number of subjects in this study was small, these results are of a preliminary nature.     

Depression and Somatic Symptoms May Influence on Chronic Prostatitis/Chronic Pelvic Pain Syndrome: A Preliminary Study

The present study is the first one to investigate the impacts of depression and somatization on the disease severity and quality of life (QoL) in patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). The Korean version of National Institutes of Health (NIH)- Chronic Prostatitis Symptom Index (CPSI) for severity of CP/CPPS. Korean version of Patient Health Questionnaire-9 (PHQ-9) for depression, Korean version of Patient Health Questionnaire-15 (PHQ-15) for somatization, and Korean version of EuroQol Questionnaire-5 Dimensions (EQ-5D)- [(EQ-5D utility index and visual analog scale (EQ-5D VAS)] for QoL, were administered. Eighty patients were enrolled. The NIH-CPSI total scores were significantly higher in those with depression (25.3%, p=0.01) or somatization (23.2%, p=0.03) than in those without. These trends toward significantly negative influence of depression and somatic symptoms on QoL were also observed. Our preliminary results indicate that depression and somatization may have negative influence on the symptom severity and QoL in patients with CP/CPPS. However, adequately-powered and more well-designed studies are mandatory to prove our results.     

Spinal Morphine in Nonmalignant Chronic Pain: A Retrospective Study in 39 Patients

It was the purpose of this study to retrospectively test the safety and efficacy of the use of intraspinal analgesics in a diverse population of patients with chronic nonmalignant pain. This study was conducted in 39 patients, refractory to conventional therapies for intrathecal therapy. Twenty‐two patients had neuropathic pain and 17 had nociceptive pain. The mean follow‐up of this patient population was 2.2 years with a range of 36 months to 6.5 years. Analgesia with intraspinal morphine, initial and final dose of intraspinal agents used, stability of morphine dose over time, and side effects and complications with or without bupivacaine and/or clonidine was assessed after 6 months of treatment, and at the end of study. After 6 months, three patients discontinued the study for differing reasons, 28 patients (77.8%) reported excellent results, and five patients (14%) reported good results. One patient reported no pain relief with intraspinal morphine and bupivacaine and five patients reported insufficient or no pain relief. At final assessment, 20 patients (55.6%) reported excellent results with no differences based on pain type or pain syndrome and eight patients (22.2%) reported good analgesia. Morphine doses remained stable throughout treatment, with an average dose of 2 mg per patient. Ninety‐one percent of patients were satisfied with the method used and considered it superior to all previous therapeutic techniques tried, improving their quality of life. As for complications, one patient developed a clostridial infection during the immediate postoperative period which required pump removal and one patient developed severe urinary retention requiring system removal. There were three catheter obstructions (two in the same patient) and one catheter disconnection. Other patient‐reported side effects were not considered significant by the authors to be mentioned here. After more than 6 years of experience with spinal infusion of morphine, either alone or admixed with other spinal analgesics, in patients with pain of nonmalignant origin, we consider the technique to be helpful in selected patients not responding to oral treatment or when untoward side effects exist with oral treatment. The advantages, as regards to analgesic efficacy and quality of life, clearly outweigh the drawbacks of the long‐term use of spinal morphine.     

Correct Sciatic Nerve Management to Apply Ultrasound-Guided Percutaneous Neuromodulation in Patients With Chronic Low Back Pain: A Pilot Study

BackgroundThe objectives of this study were to evaluate the effects of an ultrasound (US)-guided percutaneous neuromodulation (PNM) intervention on the sciatic nerve, regarding pain, hip range of motion (ROM), balance, and functionality in patients with chronic low back pain (LBP); and to determine the optimal anatomical location of sciatic nerve stimulation to obtain therapeutic benefits in such patients.Materials and MethodsThirty patients with chronic LBP were recruited and divided randomly into three groups. All patients received a single percutaneous electrical stimulation intervention on the sciatic nerve, with a different anatomical application location for each group (proximal, middle, and distal). Level of pain, hip passive ROM, dynamic balance, and Oswestry disability index were analyzed. All variables were calculated before the intervention, immediately postintervention, 48 hours and one week after the intervention, except the LBP questionnaire (before, and 48 hours and one week after the intervention).ResultsAll interventions decreased the level of pain and increased the ROM, balance, and functionality. Besides, these therapeutic effects were maintained during one week, regardless of the anatomical location of application.ConclusionsThe choice of an anatomical location of application of the US-guided PNM on the sciatic nerve by the physiotherapist does not influence the improvement of pain, ROM, balance, and function in patients with chronic LBP.     

Effects of Pleasant Ambient Fragrances on Dental Fear: Comparing Apples and Oranges

Previous studies showed that orange odor reduces the anticipatory anxiety and improves the mood of patients waiting for scheduled appointments in small dental practices. We replicated these previous studies in the setting of three large dental clinics. In addition, we investigated whether another pleasant fruity smell (apple odor) is similarly associated with reduced anxiety. We included 219 patients (117 males, 102 females) between the ages of 18 and 81 in this study. While they were waiting for dental treatment, the participants were either exposed to the ambient odor of orange (N?=?81) or apple (N?=?69), or they received no stimulation. State anxiety, mood, and perceived level of pain of the participants were assessed using questionnaires. Statistical analysis showed no significant difference between the responses of patients in each of the three experimental groups. We therefore conclude that orange and apple odors have no effect on the anticipatory anxiety or mood of patients waiting for scheduled appointments in large dental clinics.     

Detecting Malingering in Traumatic Brain Injury and Chronic Pain: A Comparison of Three Forced-Choice Symptom Validity Tests

Individual and joint malingering detection accuracy of the Portland Digit Recognition Test (PDRT), Test of Memory Malingering (TOMM), and Word Memory Test (WMT) was examined in traumatic brain injury (TBI; 43 non-malingering, 27 malingering) and chronic pain (CP; 42 non-malingering, 58 malingering) using a known-groups design. At published cutoffs, the PDRT and TOMM were very specific but failed to detect about 50% of malingerers; the WMT was sensitive but prone to false positive errors. ROC analyses demonstrated comparable accuracy across all three tests. Joint classification accuracy was superior to that of the individual tests. Clinical and research implications are discussed.     

Pain and Depression: A Neurobiological Perspective of Their Relationship

Remarkable progresses have been achieved regarding the understanding of the neurobiological bases of pain and depression. The principal role of neurotransmitters, neuromodulators, and neurohormones has been proposed in the development of pain and depression. With the progression of molecular biology, an intricate interaction among biological factors accountable to the development and management of pain and depression has been also shown in a numerous preclinical and clinical researches. This mini-review will briefly describe the current issues and future research direction for better understanding of the relationship between pain and depression.     

Determinants Influencing the Prestroke Health Behaviors and Cardiovascular Disease Risk of Stroke Patients: A Cross-Sectional Study

Background: Knowledge about stroke and stroke prevention may provide motivation to lead a healthy lifestyle to prevent stroke. The goal of this study is to quantify the knowledge of stroke and stroke prevention of patients with a recent stroke and its association with health behaviors and cardiovascular disease risk. Methods: We conducted a prospective cross-sectional study utilizing consecutive stroke admissions at 2 hospitals in Vancouver, Canada. We included patients within 48-72 hours of admission. Stroke knowledge was measured prior to any hospital education. The Health-Promoting Lifestyle Profile II (HPLP II), a 52-item self-report scale was used to quantify health behavior for the week prior to the stroke. The cardiovascular risk score was calculated. Hierarchical multiple regression was used to assess the determinants of HPLP II and cardiovascular disease risk. Results: We enrolled patients with primarily mild stroke (n = 100). The mean age of participants was 66.6 ± 13.6 years and 60% were male. The participants had poor knowledge of stroke symptoms and risk factors. In the first regression analysis, the final model explained 27% of the variance in health behavior (F (6, 93) = 5.69, p = <0.001) with only age and knowledge of risk factors as statistically significant variables. In the second regression analysis, the final model explained 15% of the variance in cardiovascular disease risk (F (7, 84) = 2.163, p = 0.046) with only physical activity remaining as a statistically significant variable. Conclusion: The findings would inform the development of novel programs to improve the knowledge and health behavior for prevention of stroke.     

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.     

Triangular Stimulation Method Utilizing Combination Spinal Cord Stimulation With Peripheral Subcutaneous Field Stimulation for Chronic Pain Patients: A Retrospective Study

Objectives: This retrospective data collection study aims to evaluate the responses of patients who have been implanted with a neuromodulation system using a combination of spinal cord stimulation (SCS) and peripheral subcutaneous field stimulation (PSFS) leads for chronic intractable pain. Materials and Methods: Forty patients with chronic, intractable pain implanted with both SCS and PSFS leads were enrolled in a retrospective data collection study. Pre‐implant data (demographics, pain levels, pain location, and medication use) and post‐implant data (pain levels, medication use, and device programming reports) were compared to measure short‐ and long‐term improvements in pain for a period of approximately six months. Device system use and parameter data were collected. Results: The majority of patients experienced immediate and short‐term pain relief and reduction in oral pain medications as a result of combination SCS/PSFS therapy. The improvements were maintained for some, but not all patients by six months. Patients cycled through multiple programs over follow‐up; the use of triangular stimulation was consistent over time, and by six months, patients preferred this program over others. Limitations of the retrospective chart review included missing data and variable follow‐up times, and may have made determinations of long‐term efficacy difficult. Conclusions: This study demonstrates that combination SCS and PSFS therapy is potentially a beneficial treatment option for reducing pain levels and oral pain medication compared with baseline in previously resistive chronic pain patients. There is a need for further study of this therapy in a greater number of subjects and in a prospective, controlled setting. In the author's general experience, triangular stimulation is very effective for treating isolated low back pain, because it covers larger topographic areas of the lower back than flow or field stimulation. An investigational device exemption study will be necessary for subcutaneous field stimulation indicated for focal isolated pain to be adequately investigated and utilized by physicians in the future.