Pain
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Attention is acknowledged as an important factor in the modulation of pain. A recent model proposed that an effective control of pain by attention should not only involve the disengagement of selective attention away from nociceptive stimuli, but should also guarantee that attention is maintained on the processing of pain-unrelated information without being recaptured by the nociceptive stimuli. This model predicts that executive functions are involved in the control of selective attention by preserving goal priorities throughout the achievement of cognitive activities. ⋯ Results showed that, while novel nociceptive stimuli induced greater distraction than regular tactile stimuli in the control condition, the distractive effect was suppressed in the working memory condition. This suggests that actively rehearsing the feature of pain-unrelated and task-relevant targets successfully prevents attention from being captured by novel nociceptive distracters, independently of general task demands. Working memory can help to inhibit the involuntary capture of attention by pain by preserving cognitive goal priorities.
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Randomized Controlled Trial
Duloxetine in patients with central neuropathic pain caused by spinal cord injury or stroke: a randomized, double-blind, placebo-controlled trial.
The mechanisms underlying central neuropathic pain are poorly understood. Pain inhibitory mechanisms including sertononergic and norepinephrine systems may be dysfunctional. In this randomized, double-blinded, placebo-controlled trial we evaluated the effects of duloxetine on pain relief (spontaneous pain and evoked pain), tolerability, health status, and quality of life in patients with central pain related to cerebrovascular lesions or spinal cord lesions. ⋯ No significant differences were observed in the other domains of the SF36, the Pain Disability Index, and the EQ-5D. While this trial showed no significant effect on pain intensity, duloxetine revealed a biologic effect. It would be worthwhile to suspend our judgement and to perform more studies to evaluate the role of duloxetine in modulation of the symptoms of central neuropathic pain.
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The Current Opioid Misuse Measure (COMM), a self-report assessment of past-month aberrant medication-related behaviors, has been validated in specialty pain management patients. The performance characteristics of the COMM were evaluated in primary care (PC) patients with chronic pain. It was hypothesized that the COMM could identify patients with prescription drug use disorder (PDD). ⋯ For chronic pain patients prescribed opioids, the development of PDD is an undesirable complication. Among PC patients with chronic pain-prescribed prescription opioids, the COMM is a promising tool for identifying those with PDD. Among primary care patients with chronic pain-prescribed opioids, the validated Current Opioid Misuse Measure (COMM) is a promising tool for identifying patients with prescription opioid use disorder.
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Chronic pain not only interferes with daily activities, it may also have a negative impact on the perceived integrity of one's self through self-discrepancies. Self-discrepancies are experienced distances between the actual self and self-guides that can exist from 2 perspectives (ie, own and other). Self-discrepancies are associated with negative mood states and incite self-regulatory behavior in order to reduce these discrepancies. ⋯ In contrast to expectations, none of the other self-discrepancies was related to activity patterns. Of interest was that avoidance, but not persistence behavior, was predictive of higher levels of disability and lower levels of quality of life. Support is provided for the role of self-discrepancies in the emotional well-being and behavioural patterns of patients with chronic low back pain.
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Forty-five women with fibromyalgia (FM) engaged in a 30-day electronic diary assessment, recording daily ratings of pain and 2 forms of maladaptive coping: pain catastrophizing and pain attention. Participants were genotyped for the val(158)met single nucleotide polymorphism (rs4680) in the catechol-O-methyltransferase (COMT) gene. COMT genotype moderated the daily relations of both maladaptive coping processes and pain. ⋯ Further, the findings advance our understanding of the role of COMT in FM, suggesting that genetic variation in the val(158)met polymorphism may affect FM pain through pathways of pain-related cognition. This study examined 2 forms of maladaptive coping: pain catastrophizing and pain attention. The findings provide multimeasure and multimethod support for genetic moderation of a maladaptive coping and pain process and suggest that genetic variation in the val(158)met polymorphism may affect fibromyalgia pain through pathways of pain-related cognition.