Does gender affect appraisal of pain and pain coping strategies?

OBJECTIVE: To investigate the impact of gender and a set of pain characteristics on the threat or challenge appraisal of pain and the impact of these appraisals on the coping strategies used to manage the pain. DESIGN: This study used a community telephone survey to examine these relationships for a troublesome pain experienced by respondents in the 2 weeks preceding the interview. STUDY RESPONDENTS: The sampling frame consisted of 1,430 households randomly selected from the Halifax-Dartmouth-Bedford community. Of the 390 respondents with a troublesome pain in the 2 weeks preceding the interview, 309 respondents agreed to participate (79% response rate). RESULTS: Women tended to report more pain located in the head and more somatic problems. They reported significantly more intense pain. For women and men, the most important impact on threat appraisal of pain was overall interference of pain and emotional upset due to pain. These two variables accounted for 48% of the variance in threat appraisal for women and 37% of the variance for men. There was no gender difference in emotional upset due to pain or in the impact of emotional upset on threat appraisal. There was no gender difference in challenge appraisal. Threat appraisal was associated with increased catastrophizing whereas challenge appraisal was associated with positive self-statements. Women reported significantly more problem solving, social support, positive self-statements, and palliative behaviors than did men. CONCLUSIONS: Interference of pain has a greater impact on threat appraisal of pain for women. Increasing threat appraisal is associated with health care utilization for women, but women's more frequent use of several coping strategies is unrelated to their appraisal of pain. Appraisal of pain may have important implications on coping and overall well-being of women and men.     

Prediction of postoperative pain - beneficial to perioperative pain management?

Pain treatment of surgical patients is still a deficient area, even if there are evidence-based possibilities of pain management. The aim of this study is to identify patients with a higher risk of severe postoperative pain at an early stage and improve nurses' pain management by identifying pain predictors whilst including them in analgesic treatment. In addition to the identification of predictors by a literature review, a cross-sectional study with 84 surgical patients of a convenience sample was undertaken to find possible predictors. The enquiry was conducted by means of a questionnaire which the patient had to fill in prior surgery. The intensity of pain was surveyed in a personal interview on the first post-operative day. Correlation analysis was applied to verify the statistical significance of patient characteristics as well as surgical variables. Out of the 14 variables preoperative pain was found to increase the risk of postoperative pain. Comparison with other studies showed inconsistent results for pain predictors, and therefore nursing pain management based on pain predictors seems questionable.     

Observation of therapeutic effect of MSKD in treating late pain from cancer with grade method of pain intensity

SinceAugust１９９８toAugust１９９９，ourhospitalhastreated１２０patientswithlatepainfromcarcinoma．Inthesepatients，６０acceptedtreatmentwithMSKD（controlledreleasetabletofmorphinesulfate），theotherpatientsappliedtherapywithpethidine．Twomethodswerecompared，andtheresultswereshowedasfollowing：１Subjectandmethod１．１SubjectAcohortof２９patients（aged２４to７６averaged５４，９４maleand２６female）wasinvolved．Allpatientshavebeendiagnosedascarcinomainmildorlatestagedefinitely，including２…     

Self-reports of pain intensity and direct observations of pain behavior: when are they correlated?

Meta-analytic techniques were utilized to investigate the relationship between self-reports of pain intensity and direct observations of pain behavior. Estimation of the overall effect size from 29 studies and 85 effect sizes yielded a moderately positive association, z=0.26. High variability across studies permitted a random-effects moderator analysis that determined chronicity of pain, the timing of the pain assessment, the use of global measures of pain behavior, and pain site significantly moderate the relationship between self-reports of pain intensity and direct observations of pain behavior. These findings indicate that self-reports of pain intensity and direct observations of pain behavior are more likely to be significantly related to each other when the individual being studied has acute pain (z=0.35), when the self-report of pain intensity data are collected soon after the observation of pain behavior (z=0.40), when global composite measures are used to quantify pain behavior (z=0.37), and when the person being observed suffers from chronic low back pain (z=0.30). Other factors not found to be significant moderators include: extent of observer training, relevance of the pain-inducing task, and pain behavior observation measure used. The implications of the findings for the assessment of pain are discussed.     

Does the region of pain influence the presence of sensorimotor disturbances in neck pain disorders?

Impairments in sensorimotor control have been demonstrated in neck pain disorders. However, there are more anatomical and neurophysiological connections between the sensorimotor control system and the upper cervical region and thus potential for greater disturbances in those with upper region pain. This study investigated whether sensorimotor impairment was greater in those suffering pain from the upper rather than lower cervical spine region, taking the onset of pain into account.Sixty-four subjects with persistent neck pain were divided into 4 groups -upper and lower region non-traumatic and upper and lower region traumatic. Cervical Joint Position Error (JPE), smooth pursuit neck torsion (SPNT) and standing balance tests were compared between groups.The lower non-traumatic group demonstrated significantly less (p < 0.03) deficit in SPNT compared to all other groups as well as less total energy of sway on the eyes open balance tests (p < 0.05) compared to both traumatic neck pain groups. The upper traumatic group demonstrated significantly greater JPE following rotation to the right (p < 0.04) when compared to both lower groups.Less sensorimotor dysfunction appears to occur in those with lower compared to upper cervical region pain, although this depends on whether trauma is involved in the onset of pain.     

Introduction of family rehabilitation training of low back pain

Background：Lowbackpainisacommonandfrequentdisease，oftenwithsevereischialgianeuralgia．Besidesnormalambulatorytreatmentssuchastractionoflumbarvertebra，computermiddlefre－quentandmassage，trainingoflumbodorsalmyodynamiaoffamilyauxiliarytreatmentisveryessential．Placingasupplementaryinstru－mentmadebyourselvesbelowlowback，lyingseveralhours，makinglumbarvertebralslideforwardandresumethenormalbiomechanicsrelationsoflumbarvertebrabystrentheningphysiologicallordo－sis．Improvethepathologicchangeo…     

Does failure hurt? The effects of failure feedback on pain report,pain tolerance and pain avoidance

In this study an experiment was conducted to examine whether failure experiences have an effect on pain report, pain tolerance and pain avoidance. Furthermore, it was investigated if negative affectivity (NA) affected the impact of failure feedback on pain report, either as a mediator, in the case of negative state affect, or as a moderator when NA as a personality trait was considered. Fifty-four healthy female volunteers were included and randomly assigned to one of three conditions: (1) failure feedback; (2) success feedback; (3) neutral control task. After the manipulation, subjects were given a cold pressor task in order to obtain pain measures. Regarding the effects of failure feedback on pain report, it was found that, in comparison with success feedback, failure feedback led to increased pain report. With regard to pain tolerance, pain was tolerated for longer when preceded by success feedback than when preceded by failure feedback. Differences between failure and control conditions did not reach significance. With regard to pain avoidance, no differences between the conditions were found. The hypothesized mediating role of negative state affect was not found. Though in the hypothesized direction, no significant effect was found for NA-trait moderating the influence of failure on pain. The discussion focuses on a number of research questions that remain to be answered, and the clinical relevance of the effects of failure and success experiences on pain report and pain tolerance.     

Does midazolam enhance pain control in prehospital management of traumatic severe pain?

Purpose

Midazolam comedication with morphine is a routine practice in pre and postoperative patients but has not been evaluated in prehospital setting. We aimed to evaluate the comedication effect of midazolam in the prehospital traumatic adults.

Methods

A prehospital prospective randomized double-blind placebo-controlled trial of intravenous morphine 0.10 mg/kg and midazolam 0.04 mg/kg vs morphine 0.10 mg/kg and placebo. Pain assessment was done using a validated numeric rating scale (NRS). The primary end point was to achieve an efficient analgesic effect (NRS ≤ 3) 20 minutes after the baseline. The secondary end points were treatment safety, total morphine dose required until obtaining NRS ≤ 3, and efficient analgesic effect 30 minutes after the baseline.

Findings

Ninety-one patients were randomized into midazolam (n = 41) and placebo (n = 50) groups. No significant difference in proportion of patients with a pain score ≤ 3 was observed between midazolam (43.6%) and placebo (45.7%) after 20 minutes (P = .849).Secondary end points were similar in regard with proportion of patients with a pain score ≤ 3 at T30, the side effects and adverse events except for drowsiness in midazolam vs placebo, 43.6% vs 6.5% (P < .001). No significant difference in total morphine dose was observed, that is, midazolam (14.09 mg ± 6.64) vs placebo (15.53 mg ± 6.27) (P = .315).

Conclusions

According to our study, midazolam does not enhance pain control as an adjunctive to morphine regimen in the management of trauma-induced pain in prehospital setting. However, such midazolam use seems to be associated with an increase in drowsiness.     

Mechanisms-based classifications of musculoskeletal pain: part 3 of 3: symptoms and signs of nociceptive pain in patients with low back (± leg) pain

As a mechanisms-based classification of pain 'nociceptive pain' (NP) refers to pain attributable to the activation of the peripheral receptive terminals of primary afferent neurones in response to noxious chemical, mechanical or thermal stimuli. The symptoms and signs associated with clinical classifications of NP have not been extensively studied. The purpose of this study was to identify symptoms and signs associated with a clinical classification of NP in patients with low back (± leg) pain. Using a cross-sectional, between-subjects design; four hundred and sixty-four patients with low back (± leg) pain were assessed using a standardised assessment protocol after which their pain was assigned a mechanisms-based classification based on experienced clinical judgement. Clinicians then completed a clinical criteria checklist indicating the presence/absence of various symptoms and signs. A regression analysis identified a cluster of seven clinical criteria predictive of NP, including: 'Pain localised to the area of injury/dysfunction', 'Clear, proportionate mechanical/anatomical nature to aggravating and easing factors', 'Usually intermittent and sharp with movement/mechanical provocation; may be a more constant dull ache or throb at rest', and the absence of 'Pain in association with other dysesthesias', 'Night pain/disturbed sleep', 'Antalgic postures/movement patterns' and 'Pain variously described as burning, shooting, sharp or electric-shock-like'. This cluster was found to have high levels of classification accuracy (sensitivity 90.9%, 95% CI: 86.6-94.1; specificity 91.0%, 95% CI: 86.1-94.6). Pattern recognition of this empirically-derived cluster of symptoms and signs may help clinicians identify an assumed dominance of NP mechanisms in patients with low back pain disorders.     

Mechanisms-based classifications of musculoskeletal pain: part 2 of 3: symptoms and signs of peripheral neuropathic pain in patients with low back (± leg) pain

As a mechanisms-based classification of pain 'peripheral neuropathic pain' (PNP) refers to pain arising from a primary lesion or dysfunction in the peripheral nervous system. Symptoms and signs associated with an assumed dominance of PNP in patients attending for physiotherapy have not been extensively studied. The purpose of this study was to identify symptoms and signs associated with a clinical classification of PNP in patients with low back (± leg) pain. Using a cross-sectional, between-subjects design; four hundred and sixty-four patients with low back (± leg) pain were assessed using a standardised assessment protocol. Patients' pain was assigned a mechanisms-based classification based on experienced clinical judgement. Clinicians then completed a clinical criteria checklist specifying the presence or absence of various clinical criteria. A binary logistic regression analysis with Bayesian model averaging identified a cluster of two symptoms and one sign predictive of PNP, including: 'Pain referred in a dermatomal or cutaneous distribution', 'History of nerve injury, pathology or mechanical compromise' and 'Pain/symptom provocation with mechanical/movement tests (e.g. Active/Passive, Neurodynamic) that move/load/compress neural tissue'. This cluster was found to have high levels of classification accuracy (sensitivity 86.3%, 95% CI: 78.0-92.3; specificity 96.0%, 95% CI: 93.4-97.8; diagnostic odds ratio 150.9, 95% CI: 69.4-328.1). Pattern recognition of this empirically-derived cluster of symptoms and signs may help clinicians identify an assumed dominance of PNP mechanisms in patients with low back pain disorders in a way that might usefully inform subsequent patient management.     

Is pain what the patient says it is? Interpreting an account of pain

This article discusses the integrated approaches to pain that have developed within the pain medicine movement and the hospice and palliative care movement. Such approaches blend biomedical, social, emotional and spiritual aspects of the pain experience. However, patients and healthcare staff may hold different beliefs about pain, such as patients having a medical understanding about pain while healthcare practitioners may use concepts such as 'total pain' or 'psychological pain'. Some of the problems related to interpreting an account of pain are discussed and suggestions are made for developing pain assessment, education and research.     

Does pain mediate the pain interference with sleep problem in chronic pain? Findings from studies for management of diabetic peripheral neuropathic pain with duloxetine

Although sleep problems are common in patients with chronic pain, it is unclear whether pain mediates (causes) impaired sleep. The relationship between pain and sleep has been difficult to investigate because of the potential confounds of depression and somnolence. This report used clinical trials data for duloxetine in the management of diabetic peripheral neuropathic pain (DPNP) to investigate the direction of this association. Data were pooled from three double-blind, randomized, placebo-controlled, 12-week trials of patients with DPNP without mood disorder (n = 1,139). DPNP patients reporting somnolence and those who were receiving sedating concomitant medications were removed from the analyses (n = 93). Efficacy measures included weekly mean scores for average daily pain severity, night pain severity, and pain interference with sleep. Duloxetine at 60 and 120 mg per day separated from placebo for average pain and night pain improvement as early as one week after treatment began, whereas sleep interference improvement separated from placebo at the three visits it was assessed (Weeks 4, 8, and 12). Change in sleep interference was moderately to strongly correlated (P < 0.001) with changes in average pain (r = 0.46) and nighttime pain severity (r = 0.53). These results confirm the association between the improvement in daily pain and nighttime pain, and improvement in sleep interference for a large population without depression or somnolence. Although this association cannot establish causality, these results provide some evidence for the possibility that pain may mediate the sleep problem associated with DPNP and perhaps chronic pain in general.