Pain
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Previous research suggests that for people living with chronic pain, pain expectancy can undermine access to adaptive resources and functioning. We tested and replicated the unique effect of pain expectancy on subsequent pain through 2 daily diary studies. We also extended previous findings by examining cognitive and affective antecedents of pain expectancy and the consequences of pain expectancy for daily social enjoyment and stress. ⋯ Consistent with study 1, more than usual evening pain expectancy was related to greater next morning pain. We also found that next morning pain predicted next afternoon social enjoyment but not social stress. The findings of these 2 studies point to the importance of promoting positive affect and reducing pain expectancy as a way of decreasing the detrimental effect of chronic pain on enjoyable social experiences.
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Obesity is associated with numerous chronic diseases, including musculoskeletal (MSK) pain, which affects on quality of life (QoL). There is, however, limited research providing a comprehensive MSK pain profile of an obese cohort. This retrospective study used a patient database at a national weight management service. ⋯ Patients who slept fewer hours and had poorer functional outcomes were more likely to have LBP; patients who were divorced, had lower QoL, and more frequent nocturia were more likely to have knee pain (P < 0.05). Multisite MSK pain is prevalent and severe in obese patients and is negatively associated with most self-report and functional outcomes. This high prevalence suggests that pain management strategies must be considered when treating obesity.
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Temporal summation of nociceptive inputs may be an important pathophysiological mechanism in temporomandibular disorders (TMD) pain; however, it remains unknown how natural jaw function relates to underlying pain mechanisms. This study evaluated changes in pain and movement patterns during repeated jaw movements in patients with painful temporomandibular joints (TMJ) compared with healthy controls. Twenty patients with TMD with TMJ pain, and an anterior disk displacement without reduction and 20 age- and gender-matched healthy volunteers were included. ⋯ In the control group, however, total opening distance (P = 0.499), maximum opening velocity (P = 0.064), and average closing velocity (P = 0.261) remained unchanged, whereas average opening velocity (P = 0.040) and maximum closing velocity (P = 0.039) increased. The study demonstrates that repeated jaw movements constitute a sufficient and adequate stimulation for triggering temporal summation effects associated with significant inhibition of motor function in painful TMJs. These findings have practical implications for diagnosis of TMD pain and for more mechanism-driven management protocols in the future.
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Increased prescribing of opioids for chronic noncancer pain is associated with significant social costs, including overdose and addiction. In this context, there is interest in interdisciplinary chronic pain rehabilitation programs focusing on self-management and minimizing opioid use. This study examined outcomes of patients weaned from opioids in an ICPRP from 2007 to 2012. ⋯ Anxiety predicted completion, and functional impairment predicted opioid resumption within 1 year of discharge. Results suggest that patients on COT can be successfully weaned with long-term benefits in pain, mood, and function. Targeting anxiety and functional restoration may increase success rates.
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Medical cannabis (MC) is used for a variety of conditions including chronic pain. The goal of this report was to provide an in-depth qualitative exploration of patient perspectives on the strengths and limitations of MC. Members of MC dispensaries (N = 984) in New England including two-thirds with a history of chronic pain completed an online survey. ⋯ Analysis of answers to "What is it that you like most about MC?" (N = 2592 responses) identified 10 themes, including health benefits (36.0% of responses, eg, "Changes perception and experience of my chronic pain."), the product (14.2%, eg, "Knowing exactly what strain you are getting"), nonhealth benefits (14.1%), general considerations (10.3%), and medications (7.1%). Responses (N = 1678) to "What is it that you like least about MC?" identified 12 themes, including money (28.4%, eg, "The cost is expensive for someone on a fixed income"), effects (21.7%, eg, "The effects on my lungs"), the view of others (11.4%), access (8.2%), and method of administration (7.1%). These findings provide a patient-centered view on the advantages (eg, efficacy in pain treatment, reduced use of other medications) and disadvantages (eg, economic and stigma) of MC.