Making sense of everyday pain

A social constructionist analysis is reported of how sense is made of everyday pain. Q factor analysis is used within a critical framework as Q methodology. Sixty-one participants completed the procedure. Eight factors or accounts of everyday pain were derived. These are reported as pain as malfunction, pain as self-growth, pain as spiritual growth, pain as alien invasion, pain as coping and control, pain as abuse, pain as homeostatic mechanism and pain and power. Common to all of the accounts is the theme of how pain relates to self, and in particular, of whether pain can change self. This theme is expanded and discussed in terms of how self is protected and legitimated in a context of pain as a fundamental threat. Implications of this study for how to understand the experience of 'abnormal' pain are discussed, as are possible new research routes.     

Fear-Avoidance Beliefs and Temporal Summation of Evoked Thermal Pain Influence Self-Report of Disability in Patients With Chronic Low Back Pain

INTRODUCTION: Quantitative sensory testing has demonstrated a promising link between experimentally determined pain sensitivity and clinical pain. However, previous studies of quantitative sensory testing have not routinely considered the important influence of psychological factors on clinical pain. This study investigated whether measures of thermal pain sensitivity (temporal summation, first pulse response, and tolerance) contributed to clinical pain reports for patients with chronic low back pain, after controlling for depression or fear-avoidance beliefs about work. METHOD: Consecutive patients (n=27) with chronic low back pain were recruited from an interdisciplinary pain rehabilitation program in Jacksonville, FL. Patients completed validated self-report questionnaires for depression, fear-avoidance beliefs, clinical pain intensity, and clinical pain related disability. Patients also underwent quantitative sensory testing from previously described protocols to determine thermal pain sensitivity (temporal summation, first pulse response, and tolerance). Hierarchical regression models investigated the contribution of depression and thermal pain sensitivity to clinical pain intensity, and fear-avoidance beliefs and thermal pain sensitivity to clinical pain related disability. RESULTS: None of the measures of thermal pain sensitivity contributed to clinical pain intensity after controlling for depression. Temporal summation of evoked thermal pain significantly contributed to clinical pain disability after controlling for fear-avoidance beliefs about work. CONCLUSION: Measures of thermal pain sensitivity did not contribute to pain intensity, after controlling for depression. Fear-avoidance beliefs about work and temporal summation of evoked thermal pain significantly influenced pain related disability. These factors should be considered as potential outcome predictors for patients with work-related low back pain. SIGNIFICANCE: This study supported the neuromatrix theory of pain for patients with CLBP, as cognitive-evaluative factor contributed to pain perception, and cognitive-evaluative and sensory-discriminative factors uniquely contributed to an action program in response to chronic pain. Future research will determine if a predictive model consisting of fear-avoidance beliefs and temporal summation of evoked thermal pain has predictive validity for determining clinical outcome in rehabilitation or vocational settings.     

整体疼痛评估量表在老年慢性疼痛护理的应用

目的 分析比较整体疼痛评估量表及修订版的面部表情疼痛量表,在老年慢性疼痛患者护理管理模式中的应用效果,探讨整体疼痛评估量表在疼痛科病房疼痛护理管理质量中的作用及量表的信度和效度评价.方法 选取2014年6月-2015年6月在疼痛科病房住院治疗的年龄≥60岁的老年慢性疼痛患者60例,平均分为试验组及对照组,其中试验组30例疼痛患者采用整体评估量表结合疼痛护理常规流程进行护理,对照组30例运用疼痛患者修订版的面部表情疼痛量表结合疼痛护理常规流程进行护理,动态评估患者疼痛情况,比较两组患者住院总天数、止痛药使用减少率、疼痛缓解程度及疼痛管理满意度.结果 采用整体疼痛评估量表护理模式的患者住院总天数、止痛药使用率小于采用修订版的面部表情疼痛量表护理模式的患者,差异具有统计学意义(P＜0.05);且在疼痛缓解程度及疼痛管理满意度指标上大于采用修订版的面部表情疼痛量表护理模式的患者,两者差异均具有统计学意义(P＜0.05).结论 将整体疼痛评估量表应用于疼痛科疼痛护理管理模式中,使疼痛护理管理标准化、规范化、质量化,提高患者的疼痛控制质量,有效减少患者住院天数及止痛药的使用频率,增加疼痛缓解程度及疼痛管理满意度,有助于提高疼痛护理管理水平.     

A Lens Model Approach to the Communication of Pain

Two studies examined the expression and detection of suppressed, genuine, and exaggerated pain. In Study 1, videotaped participants underwent an acute laboratory pain stressor and completed pain ratings. In Study 2, the lens model examined the cues encoders displayed while in pain (facial expressions of pain and viewers’ global impressions), the cues decoders used to infer pain in the videotaped encoders, and decoders’ accuracy in making judgments of pain. Results revealed expression differences between the suppressed, genuine, and exaggerated pain such that exaggerated expressions contained more tightened facial expressions while genuine expressions of pain contained more open facial expressions of pain. Decoders were accurate at detecting pain only in the exaggerated pain expressions. These results highlight the need for improving providers’ accuracy in detecting pain intensity for suppressed, genuine, and exaggerated pain displays. Trainings should focus on teaching providers that patients who appear more agitated and less composed may be suppressing pain, while patients who appear more tense and determined may be exaggerating pain. Finally, patients who seem to not be in that much pain because they are not showing tightened facial expressions may actually be experiencing higher intensities of genuine pain.     

Magnesium for Pain Treatment in 2021? State of the Art

Background: Magnesium (Mg) is commonly used in clinical practice for acute and chronic pain and has been reported to reduce pain intensity and analgesics consumption in a number of studies. Results are, however, contested. Objectives: This review aims to investigate randomised clinical trials (RCTs) on the effectiveness of Mg treatment on pain and analgesics consumption in situations including post-operative pain, migraine, renal pain, chronic pain, neuropathic pain and fibromyalgia. Results: The literature search identified 81 RCTs (n = 5447 patients) on Mg treatment in pain (50 RCTs in post-operative pain, 18 RCTs in migraine, 5 RCTs in renal pain, 6 RCTs in chronic/neuropathic pain, 2 RCTs in fibromyalgia). Conclusion: The level of evidence for the efficacy of Mg in reducing pain and analgesics consumption is globally modest and studies are not very numerous in chronic pain. A number of gaps have been identified in the literature that need to be addressed especially in methodology, rheumatic disease, and cancer. Additional clinical trials are needed to achieve a sufficient level of evidence and to better optimize the use of Mg for pain and pain comorbidities in order to improve the quality of life of patients who are in pain.     

Parents and Physiotherapists Recognition of Non-Verbal Communication of Pain in Individuals with Cerebral Palsy

Pain assessment is difficult in individuals with cerebral palsy (CP). This is of particular relevance in children with communication difficulties, when non-verbal pain behaviors could be essential for appropriate pain recognition. Parents are considered good proxies in the recognition of pain in their children; however, health professionals also need a good understanding of their patients’ pain experience. This study aims at analyzing the agreement between parents’ and physiotherapists’ assessments of verbal and non-verbal pain behaviors in individuals with CP. A written survey about pain characteristics and non-verbal pain expression of 96 persons with CP (45 classified as communicative, and 51 as non-communicative individuals) was performed. Parents and physiotherapists displayed a high agreement in their estimations of the presence of chronic pain, healthcare seeking, pain intensity and pain interference, as well as in non-verbal pain behaviors. Physiotherapists and parents can recognize pain behaviors in individuals with CP regardless of communication disabilities.     

Pain management in a medical walk-in clinic: link between recommended processes and pain relief.

BACKGROUND: While most recommended pain management practices have been developed for hospitalised patients, little is known about their relevance for ambulatory patients presenting with acute pain. OBJECTIVE: In this study, we explored the relationship between patients' reported use of recommended pain management practices and pain relief in outpatients. METHOD: 703 adult patients who presented with pain at the medical walk-in clinic of the University Hospitals of Geneva, Switzerland, were included in a mailed cross-sectional survey. They completed a self-administered questionnaire with specific items on self reports of pain and pain management processes. MAIN OUTCOME MEASURES: Patient's self reports on pain and pain management processes. RESULTS: Of the 703 patients presenting with pain, 40% reported complete pain relief after their visit at the medical walk-in clinic. After adjustment for age, sex, origin, general health and intensity of pain, patients' self-report of complete pain relief was associated with availability of medical doctors (OR = 5.6; 95% CI 2.1-14.7 for excellent vs. poor availability), availability of nurses (OR = 2.6; 95% CI 1.2-6.0 for excellent vs. poor availability), waiting < 10 min for pain medication (OR = 4.6; 95% CI 2.2-9.8), regular assessment of pain (OR = 1.7; 95% CI 1.02-2.7) and having received information about pain and its management (OR = 3.0; 95% CI 1.8-4.9). CONCLUSIONS: Self-reported pain relief was associated with more frequent use of recommended pain management processes. These recommendations initially developed for hospitalized patients should also be encouraged for ambulatory care patients.     

Medication and treatment use in primary care patients with chronic pain of predominantly neuropathic origin

BACKGROUND: Neuropathic pain is widely recognized as one of the most difficult pain syndromes to treat and presents a significant challenge for pain clinicians and GPs. METHODS: The Self-complete Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) questionnaire, recently validated for identifying pain of predominantly neuropathic origin (POPNO), was sent to 6000 adults identified from general practices in the UK. The questionnaire also contained items about chronic pain identification, medications and treatments received for pain and the pain relief these provided. RESULTS: In total, 1420/3002 (48%) of respondents indicated that they suffered with any chronic pain. These were further categorized as those with chronic pain who were S-LANSS negative ['chronic pain (non-POPNO)' group, n = 1179] and those with chronic pain who were S-LANSS positive, indicating the presence of POPNO ('chronic POPNO' group, n = 241). Questions relating to treatments and medications were completed by 88% of the respondents (1244/1420). The chronic POPNO group was more likely to receive multiple pain medications (37% versus 21% took two or more pain medications, P < 0.001) and stronger painkillers [e.g. opioids odds ratio 1.94; 95% confidence interval 1.10, 3.42]. Despite this, they reported less effective pain relief than the non-POPNO chronic pain group. CONCLUSION: Patients in primary care reporting chronic pain were found generally to obtain incomplete relief from their medication with chronic POPNO patients reporting less relief. It is important that patients with any chronic pain are identified and managed appropriately according to their distinct treatment needs.     

Holistic assessment of chronic pain among elders

This pilot study assessed pain using 7 dimensions of pain (physiologic, behavioral, sensory, affective, cognitive, sociocultural, and spiritual) to better understand and identify patterns of elder response to chronic pain within a holistic framework. Previously validated instruments were used to assess 150 cognitively intact subjects, aged 65 years and older, with chronic pain. Thirteen patterns were identified reflecting distinct patterns of pain response. Two patterns comprised 85% of the responses: (1) high spiritual well-being, low physiologic pain, and high perceived independent functioning; and (2) high spiritual well-being, low physiologic pain, and lower perceived independent functioning. The 11 other patterns of pain response also varied in their responses to the pain experience. These responses reflect the unique and holistic experience of chronic pain among older adults. Holistic assessment enhances the understanding of the pain specific to the individual. Self-perceived functional dependence and the spiritual component significantly influence chronic pain experiences.     

疼痛教育对胃大部切除术后疼痛护理质量的影响

目的探讨疼痛教育对胃大部切除术后疼痛护理质量的影响。方法84例拟施行胃大部切除术的患者随机分为疼痛教育组(干预组)与未给予疼痛教育组(对照组),每组各42例。干预组由责任护士在手术前一天给予疼痛教育,对照组未给予疼痛教育。术后24h评估镇痛需求和镇痛治疗满意度;评估术后48h内睡眠时间;评估术后恢复情况(首次下床活动时间、首次肛门排气时间)。结果干预组术后镇痛需求和疼痛治疗满意度明显高于对照组(p<0.01);术后48h内睡眠时间明显长于对照组(p<0.01);首次下床活动时间及首次肛门排气时间均早于对照组(p<0.05)。结论疼痛教育能显著提高胃大部切除术患者的术后镇痛需求与治疗满意度,改善了疼痛护理质量,同时促进了患者的早日康复。     

Pain,Pain Catastrophizing,and Individual Differences in Executive Function in Adolescence

Many adolescents will experience pain at some point in their development that can lead to poor quality of life. The largest risk factor for pain is tendency to magnify and ruminate on pain, known as pain catastrophizing. One mechanism of catastrophizing may be difficulties with executive function, or the ability to cognitively control information. The objective of the current study was to determine if adolescent executive function difficulties relate to high catastrophizing and pain. Fifty adolescents completed measures of pain, pain catastrophizing, and executive function. Path models revealed relations among gender, executive function domains, pain catastrophizing domains, and pain. In general, pain catastrophizing was associated with problems with shifting and inhibition. Females reported high catastrophizing and pain, partially explained by executive function difficulty. Executive function difficulty may help clinicians identify adolescents prone to catastrophize painful events. Interventions addressing these difficulties may reduce catastrophizing as well as pain intensity and duration.     

Living with Chronic Pain: A Dynamic Learning Process

This study focuses on how patients describe and manage their pain in their everyday life. The data consist of interviews with 37 patients undergoing treatment for chronic pain. The study focuses on how experiences of pain are mediated and interpreted with the help of the individual's discursive resources. It is argued that this kind of resource is important in constituting a structure of relations between a suffering person, pain and context. In the analysis of the material a four-step procedure was used, including both formal and content-related aspects. It was found that the patients describe chronic pain as a dynamic phenomenon. Patients learn about their pain by actively constituting relations among themselves, the pain and their activities. For the patients, chronic pain is a structured phenomenon. Patients often describe how pain is initiated, worsens and is alleviated. Patients thereby learn to distinguish different figures in their pain, which they are able to relate to in their management of pain. This suggests that a life in pain could be seen as an apprenticeship process. The heart of the matter in this process is learning to become sensitive to and flexible towards variations in the pain and potential pain triggers in the environment. This knowledge is important, as mastering pain is a balancing act between inner resources and environmental circumstances.     

Multidimensional continuous pain assessment chart (MCPAC) for terminal cancer patients: a preliminary report

Current use of pain measures is limited in clinical practice. The common pain measures neither target nor monitor the changes that occur with time with regard to the effect of other parameters associated with pain control. Changes in parameters, such as pain type, various pharmacological and nonpharmacological interventions, dosage of medications, and use of rescue doses, usually complicate pain control in terminal cancer patients. The authors propose use of a multidimensional, continuous pain chart that permits better assessment and control of pain. The chart integrates visual analogue pain assessment, special treatment techniques, regular medications and rescue doses, co-analgesics, pain categories, parameters relating to quality of life, sleep, and mobility. A total of 1,178 assessments were performed in 100 consecutive patients with full compliance. The chart permitted a continuous monitoring of patients 'most important needs concerned with pain control and was easily integrated into the hospice daily routines. We conclude that the chart represents an effective and friendly graphic tool to monitor pain and associated parameters that relate to the quality of the broad spectrum of pain control. The hope is that this tool may improve pain control by hospice professionals and facilitate communication between patients and the interdisciplinary team members.     

A rare differential diagnosis to occupational neck pain: bilateral stylohyoid syndrome

Chronic neck pain is widely prevalent and a common source of disability in the working-age population. Etiology of chronic neck pain includes neck sprain, mechanical or muscular neck pain, myofascial pain syndrome, postural neck pain as well as pain due to degenerative changes.     

Pain catastrophizing and kinesiophobia: predictors of chronic low back pain

By using a population-based cohort of the general Dutch population, the authors studied whether an excessively negative orientation toward pain (pain catastrophizing) and fear of movement/(re)injury (kinesiophobia) are important in the etiology of chronic low back pain and associated disability, as clinical studies have suggested. A total of 1,845 of the 2,338 inhabitants (without severe disease) aged 25-64 years who participated in a 1998 population-based questionnaire survey on musculoskeletal pain were sent a second questionnaire after 6 months; 1,571 (85 percent) participated. For subjects with low back pain at baseline, a high level of pain catastrophizing predicted low back pain at follow-up (odds ratio (OR) = 1.7, 95% confidence interval (CI): 1.0, 2.8) and chronic low back pain (OR = 1.7, 95% CI: 1.0, 2.3), in particular severe low back pain (OR = 3.0, 95% CI: 1.7, 5.2) and low back pain with disability (OR = 3.0, 95% CI: 1.7, 5.4). A high level of kinesiophobia showed similar associations. The significant associations remained after adjustment for pain duration, pain severity, or disability at baseline. For those without low back pain at baseline, a high level of pain catastrophizing or kinesiophobia predicted low back pain with disability during follow-up. These cognitive and emotional factors should be considered when prevention programs are developed for chronic low back pain and related disability.     

The impact of psychosocial work factors on musculoskeletal pain: a prospective study

A prospective cohort study investigated how psychosocial work factors predict musculoskeletal pain. A total of 721 workers at 226 automobile repair garages answered two questionnaires distributed with a 1-year interval. The predictor variables were psychological demands, decision authority, social support, and management support. The outcome variables were neck pain, low back pain, and an index of pain from seven different parts of the body in the past 30 days. The best predictors were low decision authority and management support. Low decision authority predicted neck pain, low back pain, and total musculoskeletal pain when adjusted for the effect of the respective musculoskeletal pain measured in the first survey, for age, and for gender. Low management support predicted both low back pain and general musculoskeletal pain. The study indicates that psychosocial factors at work may predict musculoskeletal pain.     

Health care costs, work productivity and activity impairment in non-malignant chronic pain patients

This study explores the costs of non-malignant chronic pain in patients awaiting treatment in a multidisciplinary pain clinic in a hospital setting. Health care costs due to chronic pain are particular high during the first year after pain onset, and remain high compared with health care costs before pain onset. The majority of chronic pain patients incur the costs of alternative treatments. Chronic pain causes production losses at work, as well as impairment of non-work activities.     

Maternal influences in adolescents' pain self-management: A qualitative investigation

Abstract

The family, particularly mothers, has been shown to have a profound impact on children's pain expression and coping. However, the cumulative effect of maternal influences on adolescents' pain experiences is unknown. By adolescence, young people demonstrate independence concerning their own health; this is apparent in decisions to self-medicate for recurrent pain. How adolescents acquire independence in pain management has not been addressed adequately in the literature. The present study assessed maternal influences in adolescents' autonomy in pain management choices by employing a qualitative methodology. Face-to-face semi-structured interviews were carried out with 20 mother–adolescent dyads. Although adolescents reported self-medicating for recurrent pain, analgesic use was largely mother-assisted. Intergenerational transmission of information about pain and pain management was clear. Mothers transmitted information to adolescents through pain management practices and knowledge of analgesics. Shared attitudes and pain management strategies underscored the role of mothers as models for and essential facilitators of their adolescents' transition towards autonomy in pain management. Mechanisms by which mothers transmitted information to adolescents about pain and pain management were primarily verbal communications and modelling. The findings from this study provide further support for maternal influences on children's pain expression, as well as evidence for maternal influences on adolescents' pain management choices.