The Clinical journal of pain
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The symptoms of posttraumatic stress disorder (PTSD) and chronic pain are thought to interact to increase the severity and impact of both conditions, but the mechanisms by which they interact remain unclear. This study examines the relationship between PTSD and chronic pain and whether indices of Psychological Flexibility mediate the relationship between these 2 conditions. ⋯ Processes from the Psychological Flexibility model were identified as mediators of the relationship between PTSD and chronic pain in people seeking treatment for chronic pain. The Psychological Flexibility model may be useful as an overarching model to help understand the relationship between PTSD and chronic pain. It is possible that targeting pain-related acceptance, committed action, and cognitive fusion (among other processes) in the treatment of chronic pain may produce corresponding improvements in comorbid symptoms of PTSD when these are present and may reduce impacts of PTSD on outcomes of chronic pain. Conversely, targeting of these processes in the treatment of PTSD may produce similar improvements for symptoms of chronic pain. Further research to evaluate these possibilities is needed.
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Many psychopharmacologic agents are used as primary or adjuncts in pain management. Atypical antipsychotics (AAs) have also been used as adjuncts in pain management regimens in a variety of manners; however, their efficacy in this capacity is unclear. ⋯ Few studies have been conducted to evaluate the analgesic effects of AAs. The collective findings of multiple studies evaluating olanzapine in pain syndromes suggest a high, yet preliminary level of evidence of efficacy, warranting prospective studies in various pain syndrome contexts. Pharmacological mechanisms of AA action are elaborated, and the findings of this review are discussed. Risk and benefits of using AAs in chronic pain are described, and investigational implications and future directions are explored.
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Previous research on pain memory provides inconsistent evidence about the accuracy of pain recall, and few studies have attempted to examine broad affective and contextual contributions to this phenomenon. The present research aimed to determine the accuracy of postoperative pain recall after 3 months, with respect to the context of the surgery and the congruence of affective states concurrent with the initial experience and its recall. The study also aimed to identify predictors of remembered pain by analyzing a range of sensory, cognitive, and affective factors. ⋯ The results of this study suggest that older orthopedic patients remember postoperative pain correctly after 3 months and that mood dependence effect may contribute to memory of pain. Pain recall after planned surgery seems to depend mainly on the actual experience, while following unplanned surgery it depends on affective factors. Present findings contribute to knowledge about pain memory in older adults and have implications for patients' recovery and best practice in perioperative hospital care.
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Review Meta Analysis
Analgesic Effects of Locally Administered Ketorolac-Based Analgesics after Breast Surgery: A Meta-Analysis of Randomized Controlled Trials.
Reducing postoperative pain following breast surgery is crucial for rapid recovery and shortening hospital stay. Ketorolac, a nonsteroidal anti-inflammatory drug, has been used as a postoperative analgesic in many surgical procedures. We conducted a systemic review and meta-analysis on the efficacy of locally administered ketorolac-based analgesics in managing pain after breast surgery. ⋯ The effects of ketorolac-based analgesics vary as per the surgery and disease type. Locally administered ketorolac-based analgesics decreased postoperative pain in breast surgery patients, and the effect of local ketorolac was better than local bupivacaine. Therefore, ketorolac-based analgesics demonstrate considerable local infiltration during pain management after breast surgery.
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Randomized Controlled Trial
Internet-based Exposure Therapy for Fibromyalgia: A Randomized Controlled Trial.
Fibromyalgia (FM) is a common and disabling chronic pain disorder, for which existing pharmacological and psychological treatments have yet yielded insufficient effects. Previous literature has shown that exposure therapy may be an effective treatment for chronic pain. This study constitutes the first randomized controlled trial evaluating exposure therapy for FM. ⋯ We conclude that iExp seems to be an efficacious treatment for FM compared with no treatment, and the results also highlight the potential increase of accessibility by using the Internet format to deliver psychological treatments for these patients. Future trials with active control conditions are warranted.