The Clinical journal of pain
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Sleep disturbance is a common comorbidity of chronic pain. Inflammatory processes are dysregulated in sleep disturbance and also contribute to pain sensitivity. Thus, inflammation may play an important role in bidirectional associations between pain and sleep. Little is known about concurrent relationships among chronic pain, sleep, and inflammation. The aim of our study was to examine associations between sleep disturbance and circulating levels of the inflammatory cytokine, interleukin-6 (IL-6), in individuals with and without chronic low back pain. ⋯ Inflammatory processes may play a significant role in the cycles of pain and sleep disturbance. Clinical interventions that improve sleep and reduce concomitant inflammatory dysregulation hold promise for chronic pain management.
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To describe the presence of widespread pressure pain hyperalgesia and myofascial trigger points (TrPs) in neck and shoulder muscles in patients with postmastectomy pain. ⋯ Our findings revealed bilateral widespread pressure pain hypersensitivity in patients with postmastectomy pain. In addition, the local and referred pain elicited by active TrPs reproduced neck and shoulder/axillary complaints in these patients. These results suggest peripheral and central sensitization in patients with postmastectomy pain.
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The aims of this study were 2-fold: (1) to investigate the consequences of opioid use in individuals with chronic pain in the Danish population, and (2) to investigate the development of and recovery from chronic pain from 2000 to 2005. ⋯ The annual incidence for the development of and the recovery from chronic pain was 2.7% and 9.4%, respectively. Increasing age up to 64 years, short education, poor self-rated health, high body mass index, and physical strain at work were predictors of chronic pain. The odds of recovery from chronic pain were almost 4 times higher among individuals not using opioids compared with individuals using opioids. In addition, use of strong opioids was associated with poor health-related quality of life. Furthermore, the results indicated that individuals with chronic pain using strong opioids pain had a higher risk of death than individuals without chronic pain (HR: 1.67; 95% CI: 1.03-2.70). However, this study cannot exclude disease severity as the primary cause of increased mortality.
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Patients' beliefs and expectations about their pain have been identified as important disabling factors in chronic musculoskeletal pain. Besides fear-avoidance beliefs and pain-related fear, cognitions such as thought suppression as well as pain/task persistence behavior have been shown to be associated with pain and disability. The aim of this report is to present a critical evaluation of research, based on the avoidance-endurance model of pain. ⋯ Although both, fear-avoidance and endurance responses have been identified in patients with chronic musculoskeletal pain, currently evidence to confirm their hypothesized consequences for daily functioning is incomplete. Finally, thoughts on the development of differentially targeted and individually scheduled behavioral interventions are reported, including suggestions for further research.