European journal of pain : EJP
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Diagnostic labels may influence treatment intentions. We examined the effect of labelling low back pain (LBP) on beliefs about imaging, second opinion, surgery, seriousness, recovery, work, and physical activities. ⋯ "Episode of back pain", "lumbar sprain" and "non-specific LBP" reduced need for imaging, surgery and second opinion compared to "arthritis", "degeneration" and "disc bulge" among public and patients with LBP as well as reducing the perceived seriousness of LBP and enhancing recovery expectations. The impact of labels appears most relevant among those at risk of poor outcome (participants with current LBP who had a history of seeking care).
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In March 2020, state-wide lockdowns were declared in many countries, including Spain. Citizens were confined to their homes and remotely supported activities were prioritized as an alternative to in-person interactions. Previous data suggest that remote and self-management interventions may be successful at reducing pain and related psychological variables. However, individual factors influencing the effectiveness of these interventions remain to be identified. We aimed to investigate the psychological and motivational factors moderating changes in pain observed in chiropractic patients undertaking a novel telehealth self-management programme. ⋯ In the context of COVID-19, when introducing remote and self-management strategies, pain cognitions and motivational factors should be taken into consideration to foster adherence and yield better pain outcomes.
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There is limited research on the long-term effectiveness of epidural steroid injections (ESI) in older adults despite the high prevalence of back and leg pain in this age group. We tested the hypotheses that older adults undergoing ESI, compared to patients not receiving ESI: 1) have worse pain, disability and quality of life ("outcomes") pre-ESI, 2) have improved outcomes after ESI, and 3) have improved outcomes due to a specific ESI effect. ⋯ Older adults treated with ESI have long-term improvement. However, the improvement is unlikely the result of a specific ESI effect.
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Recently a new classification system for chronic pain was included in the 11th edition of the International Classification of Diseases (ICD-11). This study aims to investigate how expectancies of coping, i.e. pain catastrophizing and general self-efficacy, are associated with ICD-11 chronic pain categories in a large pain clinic population. Further, we investigate how coping expectancies are associated with pain-related disability, cross-sectionally and longitudinally across the novel pain classifications. ⋯ Coping expectancies, pain intensity and pain-related disability appear similar across the novel chronic pain classifications, indicating that all pain patients may benefit from targeting these variables. Consistent with recent developments in stress theory, helplessness and self-efficacy were cross-sectionally associated with negative pain outcomes.
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Prelimbic medial prefrontal cortex (PL-mPFC) and nucleus accumbens core region (NAcc) play an important role in supporting several executive cognitive mechanisms, such as spatial working-memory (WM). Recently, this circuit has been also associated with both sensory and affective components of pain. However, it is still unclear whether this circuit is endogenously engaged in neuropathic pain-related cognitive dysfunctions. ⋯ Selective optogenetic inhibition of prefrontal-striatal microcircuit reverses pain-related working memory deficits, but has no significant impact on pain responses. Neuropathic pain underlies an increase of functional connectivity between the nucleus accumbens core area and the prelimbic medial prefrontal cortex mediated by theta-band activity.