Parental reinforcement of recurrent pain: the moderating impact of child depression and anxiety on functional disability

OBJECTIVE: To examine whether children's distress moderates the relationship between parental responses to children's pain behaviors and functional disability. METHODS: Participants were 215 children (ages 8 to 16 years) diagnosed with either headaches, juvenile idiopathic arthritis, or sickle cell disease. Children and parents completed questionnaires assessing sociodemographics, pain, depression, anxiety, parental solicitous responses to pain behaviors, and functional disability. RESULTS: Hierarchical linear regressions computed for parental responses to children's pain significantly predicted child functional disability, controlling for children's pain intensity. Significant interactions between parental solicitous behaviors and child depressive symptoms (beta =.74, p <.01) and between solicitous behaviors and child anxiety symptoms (beta =.91, p <.01) indicated that for children with more psychological distress, parental solicitous behaviors were associated with greater child functional disability. CONCLUSIONS: Child psychological distress may exacerbate the impact of parental solicitous responses to pain on functioning, suggesting the potential role of family intervention to enhance optimal functioning in children with recurrent pain.     

Depressive symptoms and disability in acute and chronic back pain patients

Depression and level of disability are evaluated in acute and chronic low back pain (LBP) patients. To assess the possibility that some somatic symptoms are confounded with pain, the items of the Beck Depression Inventory arc divided into a cognitive-affective and somatic subscale. The sample consisted of 37 chronic LBP patients. 41 acute LBP patients, and 28 healthy participants. The level of disability was assessed by the Oswestry Low Back Pain Disability Questionnaire. Chronic LBP patients, but not acute LBP patients, have more depressive symptoms than controls. Additionally, chronic LBP patients report more somatic symptoms of depression (e.g.. emo ltional and self disturbance complaints) than cognitive-affective symptoms. Finally, correlation statistics reveal significant relations between the level of disability and depression scores. Whereas chronic patients show a significant correlation between the somatic subscale and level of disability, in acute patients the cognitive-affective subscale is significantly related to the level of disability. The findings suggest careful consideration of whether somatic symptoms of depression are related to pain when using self-report measurements of depression in pain patients. The separation of cognitive-affective and somatic symptoms of depression to evaluate pain problems seems appropriate.     

Chronic pain and use of ambulatory health care

Chronic pain status and health care utilization were assessed in a probability sample of 1016 adult HMO enrollees, and among 242 HMO enrollees seeking treatment for Temporomandibular Disorder (TMD) pain. Likelihood of health care contact for a painful symptom: Among persons reporting back pain, headache, chest pain, abdominal pain or temporomandibular pain in the prior six months, we evaluated whether (1) pain characteristics (severity, persistence, recency of onset), and (2) psychological distress were associated with the likelihood of recent use of health care for each pain symptom. Severity, persistence, and recency of onset of pain were generally associated with recent health care contact for a pain symptom. Females with a pain symptom were no more likely than males to report recent health care contact for the symptom after controlling for pain characteristics. The presence of psychological distress did not increase the likelihood of health care contact for individual pain symptoms. However, psychologically distressed persons were more likely to report pain at multiple anatomical sites and to report recent health care contact for one or more of the five pain symptoms (as a group). Chronic pain status and total use of ambulatory health care: Total number of health care visits (irrespective of reason for visit) was measured by automated data. Chronic pain status (summarized across all five anatomical sites) showed a modest correlation with the volume of health care use. Persons with recurrent pain and severe-persistent pain with no pain-related disability days used ambulatory care at rates close to population means. Persons with severe-persistent pain and seven or more pain related disability days used health care at rates substantially above population means. There was a statistically significant association between the volume of health care use and chronic pain after controlling for age, sex, self-rated health status, and psychological distress.     

The biology of symptom-based disorders – time to act

Symptom-based disorders are conditions that are characterised mostly by somatic symptoms rather than objectively identifiable signs. They are very common, including pain and fatigue disorders, functional gastrointestinal and respiratory disorders, and others, and they cause far greater disability than diseases where signs are prominent. Such conditions may sometimes be triggered by infection, as in Post Covid Syndrome (Cabral-Marques et al., 2022; Baiocchi et al., 2022) or physical or psychological trauma. By employing passive immunoglobulin transfer experimental approaches, recent research in several ‘unexplained’ chronic pain conditions has demonstrated that pathogenic IgG autoantibodies can explain several of these conditions' core symptoms and are ubiquitous in patients with severe phenotypes. The promise from placing positive resources into exploring the role of ‘invisible’, functional, non-inflammatory autoantibodies in symptom-based disorders across additional areas of Medicine includes patient empowerment and the development of new diagnostic tests and therapies.     

Support and coronary heart disease: the importance of significant other responses

In addition to the recognized benefits of social support, there is evidence across several health-related disorders suggesting that specific types of support can contribute to negative outcomes. Informed by theory and research examining the role of pain-related interpersonal interactions in the perpetuation of chronic pain, this study examined whether specific responses from significant others to expressions of coronary heart disease(CHD) related symptoms and incapacity are associated with level of symptoms, degree of disability, and depressive symptom severity among persons with symptomatic CHD. Forty-nine persons with CHD completed self-report questionnaires of the constructs of interest. Regression analyses revealed that degree of perceived solicitous responding to CHD symptoms was associated with increased symptom severity, disability, and depressive symptoms. Results are consistent with an operant-conditioning model and suggest that positive attention from significant others contingent on expressions of CHD symptoms may unwittingly serve to reinforce symptom occurrence and expression, concomitant disability, and emotional distress.     

Psychological principles in disability prevention: the case of back pain

This article discusses the need for prevention of disability resulting from persistent pain. The paper focuses on back pain as a way of exemplificating the issues. Although methods are not well developed, it is suggested that the information gained from clinical research with chronic pain patients forms the first step from which disability prevention programs might be constructed. In this paper, a discussion of the psychological principles that might be helpful in this endeavour is presented. Also, several recommendations are made for addressing the prevention of chronic pain-related disability. Copyright © 1998 John Wiley & Sons, Ltd.     

Effects of psychological treatment on cancer patients: a critical review.

Twenty-two studies on the effects of psychological treatment on cancer patients are reviewed. Only studies that compared one or more experimental conditions with at least one control group have been considered. The studies were evaluated with respect to a) research methods, b) psychological interventions, and c) results. Tailored counseling has been shown to be effective with respect to distress, self-concept, (health) locus of control, fatigue, and sexual problems. Structured counseling showed positive effects with respect to depression and distress. Behavioral interventions and hypnosis were effective with respect to specific symptoms such as anxiety, pain, nausea, and vomiting. The research methods, interventions and results of the studies are reviewed critically. Several recommendations for future research are made.     

Racial differences in the physical and psychosocial health among black and white women with chronic pain

Gender-based differences in pain epidemiology, pain threshold, attitudes toward pain management, coping styles and social roles are well described, yet little is known about the chronic pain experience in women or the role race plays. A retrospective analysis of self-reported data using a secondary clinical database was performed to elucidate the relationship between race and pain severity, depression, physical disability, posttraumatic stress disorder (PTSD) as well as affective distress in women with chronic pain. White (n=1,088) and black (n=104) adult women were compared based on their responses to the McGill Pain Questionnaire, Beck Depression Inventory, Pain Disability Index, Posttraumatic Chronic Pain Test and items from the West-Haven Yale Multidisciplinary Pain Inventory. After accounting for sociodemographic, medical, psychological and physical confounders, there was no significant race effect for pain severity or affective distress. However, black women with chronic pain experience more physical impairments than white women with chronic pain (beta = 4.622; p<0.005). Except for the family/home responsibilities, similar differences were found on all PDI subscales. We also found that disability mediates the race-depression relationship such that black women are comparatively more vulnerable to depression as a result of higher disability. Due to the economic, social and emotional impact that disability has on women with chronic pain and their families, these findings have significant implications for chronic pain research as well as its management in black women.     

Chronic pain,impact of pain and pain severity with physical disability in older people—Is there a gender difference?

ObjectiveTo establish if there is any gender difference in associations between chronic pain, impact of pain and pain severity with physical disability.MethodsData from the New South Wales Older People's Health Survey (OPHS), a population based survey of 8881 older people aged 65 years and above were used in the analysis. Chronic pain, pain with interference and pain severity and outcome variable of physical disability were all measured and determined by self report.ResultsPhysical disability were more frequent in respondents reporting chronic pain, pain that interferes with activities and pain that was of moderate and strong to severe severity. Chronic pain was significantly associated with physical disability among men with adjusted prevalence ratio (PR) 1.31 (95% CI 1.19, 1.43) and women with adjusted prevalence ratio (PR) 1.34 (95% CI 1.28, 1.42). The relationships between pain with interference and pain severity with physical disability were similar in older men and older women. However, adjustment for psychological distress and self-rated health led to greater reductions in prevalence ratios for older men than women for all associations.ConclusionThere is no gender difference in associations between pain and physical disability among older people. However, psychological distress accounted for more pain-related physical disability in men than in women.     

Psychological factors in chronic pain: evolution and revolution

Research has demonstrated the importance of psychological factors in coping, quality of life, and disability in chronic pain. Furthermore, the contributions of psychology in the effectiveness of treatment of chronic pain patients have received empirical support. The authors describe a biopsychosocial model of chronic pain and provide an update on research implicating the importance of people's appraisals of their symptoms, their ability to self-manage pain and related problems, and their fears about pain and injury that motivate efforts to avoid exacerbation of symptoms and further injury or reinjury. They provide a selected review to illustrate treatment outcome research, methodological issues, practical, and clinical issues to identify promising directions. Although there remain obstacles, there are also opportunities for psychologists to contribute to improved understanding of pain and treatment of people who suffer from chronic pain. The authors conclude by noting that pain has received a tremendous amount of attention culminating in the passage of a law by the U.S. Congress designating the period 2001-2011 as the "The Decade of Pain Control and Research."     

Total knee replacement: Is it really an effective procedure for all?

Total knee replacement (TKR) is considered an effective intervention for the treatment of chronic knee pain and disability. Yet there is increasing evidence, based on research using patient-based outcome measures, that a significant proportion of patients experience chronic knee pain, functional disability, a poor quality of life and dissatisfaction after TKR. Although some poor outcomes after TKR are due to surgical technique and implant factors, much of the pain and disability after surgery is medically unexplained. A range of possible patient factors could contribute to a poor outcome after TKR. Socio-demographic factors that have been found to correlate with a poor outcome after TKR include female gender, older age and low socio-economical status. Medical factors that are highly predictive of pain and disability after TKR are a greater number of co-morbidities and a worse pre-operative status. A range of psychological factors could be predictive of a poor outcome after surgery including depression, low self-efficacy, poor pain coping strategies, somatization, low social support and patient expectations. It is also proposed that a biological explanation for continuing pain after TKR could involve central sensitisation, a dysfunction of pain modulation by the central nervous system. To improve patient selection for TKR, future research needs to focus on developing a pre-operative screening protocol to identify those patients at risk of medically unexplained pain and disability after TKR.     

A review of studies of the psychological symptoms found at the menopause

The scientific literature was reviewed in order to determine whether psychological symptoms were directly associated with the menopause. Aetiological theories of symptoms include biological, psychological, sociological and multifactorial.There is evidence that psychological symptoms do occur in increased frequency in relationship to declining ovarian function. The severity of these symptoms may be affected by sociological variables. Administration of oestrogens alone or in combination with progestogens appear to alleviate some of the symptoms. More detailed research is needed into the relationship between psychological symptoms and the menopause.     

Longitudinal relationships of depressive symptoms to pain intensity and functional disability among children with disease-related pain

OBJECTIVE: To examine the longitudinal relationship between depressive symptoms at study entry (T1) on pain intensity (PI) and functional disability over a 1-year period among children with either sickle cell disease (SCD) or juvenile idiopathic arthritis (JIA). METHODS: 119 children, ages 8-17 years, completed measures of depression at T1 as well as pain and functional disability at T1, 6-month (T2), and 12-month (T3) follow-ups. Caregivers also rated their child's pain and disability at each time point. General linear mixed modeling was employed to examine longitudinal relationships between study variables. RESULTS: For children with JIA, T1 pain significantly moderated the effects of T1-depressive symptoms on T2 and T3 pain where T1-depressive symptoms predicted future child-reported pain only when T1 pain was relatively mild. Similarly, T1-depressive symptoms predicted future child-reported disability only when initial reports of disability were relatively low. Only family income significantly predicted T2 and T3 pain in children with SCD. CONCLUSIONS: Study findings suggest that T1-depressive symptoms play a role in the longitudinal course of pain symptoms in children with JIA but not in children with SCD.     

A further look at validity of the MMPI with low back patients

Tested the accuracy of the MMPI for two separate predictions: organic vs. functional back disorder, and appropriate vs. inappropriate disability (N = 123). Consistent with other reports, the Low Back and Dorsal scales did not improve upon chance prediction. However, disability was predicted with a high degree of accuracy by Hypochondriasis and Hysteria, which suggested that precedence should be given to these two scales. Because organically based pain and severe psychological symptomatology were not mutually exclusive, the error rate was high when the MMPI was used to predict organicity. Clinicians therefore are urged to avoid predicting whether a physical basis for pain exists and to focus primarily on the psychological aspects of the disability.     

Comparison of Efficacy of Neural Therapy and Physical Therapy in Chronic Low Back Pain

The aim of this prospective study was to evaluate the effects of neural therapy, and physical therapy on level of pain, disability, quality of life, and psychological status in patients with chronic low back pain. Patients admitted to the physical therapy and rehabilitation outpatient clinic with the complaint of low back pain of at least 3 months duration. Group 1 (n=27), physical therapy (PT, hotpack, ultrasound, TENS 15 sessions), group 2 (n=33), neural therapy (NT, 1:1 mixture of 20 mg/mL Lidocaine HCl (Jetokain simplex®) and saline for 5 sessions. For pain, Visual Analogue Scale (VAS), for disability Roland Morris Disability Questionnaire (RMDQ), for quality-of-life Nottingham-Health-Profile (NHP), for depression, and anxiety, Hospital Anxiety-Depression Scale (HADS) were used before and after the treatment. Mean age was 47.3±11.32 years, symptom time was 13.78±11.98 months. There were no differences for demographic variables between groups. Significant improvements were detected for VAS, RMDQ, NHP-Pain, NHP-Physical activity, HADS for both of two groups after treatment. In addition to these findings, significant improvements were found for NHP-Energy, NHP-Social isolation in NT group. The differences of pre- and post-treatment values of parameters were evaluated for each group. Although there were no differences for VAS, NHP-sleep, NHP-Emotional reaction, HADS between groups, RMDQ, NHP-Pain, NHP-Physical activity, NHP-Social isolation were higher in NT than PT before treatment, the improvements for these parameters were better in NT than PT. In conclusion both of NT and PT are effective on pain, function, quality of life, anxiety, and depression in patients with chronic low back pain.     

Aging and osteoarthritis: Central role of the extracellular matrix

Osteoarthritis (OA), is a major cause of severe joint pain, physical disability and quality of life impairment in the aging population across the developed and developing world. Increased catabolism in the extracellular matrix (ECM) of the articular cartilage is a key factor in the development and progression of OA. The molecular mechanisms leading to an impaired matrix turnover have not been fully clarified, however cellular senescence, increased expression of inflammatory mediators as well as oxidative stress in association with an inherently limited regenerative potential of the tissue, are all important contributors to OA development. All these factors are linked to and tend to be maximized by aging. Nonetheless the role of aging in compromising joint stability and function in OA has not been completely clarified yet. This review will systematically analyze cellular and structural changes taking place in the articular cartilage and bone in the pathogenesis of OA which are linked to aging. A particular emphasis will be placed on age-related changes in the phenotype of the articular chondrocytes.     

Psychological correlates of coronary heart disease

The Type A behaviour pattern and other measures of psychological traits and symptom states were assessed in 92 subjects (predominantly male) presenting for coronary angiography. These measures were correlated with three angiographic indices of coronary heart disease (CHD) severity and two clinical indices (angina and the duration of CHD). The only psychological measures associated with atherosclerosis (assessed by angiography) were indices of personality: Type A (the Jenkins Activity Survey), trait tension, trait anxiety and suppression of anger. It was concluded that these traits may have some role in the pathogenesis of coronary atherosclerosis. None of the measures of psychological symptoms showed a significant association with angiography indices. However, depressive symptoms and expressed hostility were associated with the severity of angina and duration of heart disease. It was concluded that these affects are the consequences of the physical disability of CHD.     

生长因子在关节软骨损伤修复中的应用进展

关节是人体重要的运动器官,其组织结构特殊,成熟关节软骨组织没有血供,一旦损伤难以自愈.临床上常用的关节软骨损伤修复手段有微骨裂术、关节软骨移植、关节置换术、软骨组织工程等,但这些方法的修复效果都不理想.生长因子是体内组织分泌的一种具有生物活性的物质,可促进细胞生长、增殖、迁移和分化.软骨发育过程中有许多生长因子参与,如成纤维细胞生长因子(FGF)、骨形态发生蛋白(BMP)、胰岛素样生长因子(IGF)等.研究显示,在关节软骨修复过程中加入外源性生长因子可有效促进关节软骨损伤的修复.对目前应用于关节软骨损伤修复研究中的生长因子进行综述,讨论这些生长因子在关节软骨发育及其在关节软骨修复中的作用,分析生长因子在关节软骨修复应用中存在的问题.     

Empirical descriptors of unelevated MMPI profiles among chronic pain patients: A typological approach

The task of the clinician in evaluating the possible role of psychological factors in patients' pain disability is a most difficult one. This task becomes even more arduous when confronted with unelevated MMPI profiles from patients in whom physical findings are minimal or absent. The current study employs a multivariate, quantitative taxonomic procedure to delineate homogeneous subroupings of chronic pain patients who meet this criterion. Subsequent analyses of base rate data for subgroups across a broad range of pain-related variables provide an actuarial basis for assessment of psychological factors within this population. Results indicate that of five subtypes identified, only one group of patients, who comprise 9% of the total sample are likely to be free of significant psychological components in their pain behavior. Implications for clinical interpretation and future research are discussed.