European journal of pain : EJP
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Randomized Controlled Trial
Expectations of recovery: A prognostic factor in patients with neck pain undergoing manual therapy treatment.
Expectations have been investigated in populations seeking care for neck pain, however not considering potential confounding factors. The aim of this study was to investigate if pretreatment expectations of recovery is a prognostic factor for recovery from neck pain at 7 weeks follow-up in patients seeking manual therapy treatment. ⋯ Our results suggest that expectations of recovery is a prognostic factor for recovery in patients with neck pain seeking manual therapy treatment. WHAT DOES THIS STUDY ADD?: We found that high expectations of recovery yielded a higher probability of recovery compared to having low expectations, also when considering potential confounding factors. Expectations seemed to have a more distinct influence on recovery among men.
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Observational Study
Perceived pain extent is associated with disability, depression and self-efficacy in individuals with whiplash-associated disorders.
Completion of a pain drawing is a familiar task in those presenting with whiplash-associated disorders (WAD). Some people report pain almost over their entire body. Yet the reasons for larger pain extent have not been fully explored. ⋯ By utilizing a novel method for pain extent quantification, this study shows that widespread pain is associated with a number of factors including perceived disability, depression and self-efficacy in individuals with chronic WAD. Widespread pain should alert the clinician to consider more specific psychological screening, particularly for depression and self-efficacy, in patients with WAD. WHAT DOES THIS STUDY ADD?: Women with chronic WAD, those with unsettled insurance claims and those with poorer financial status perceive more widespread pain. When controlling for these factors, larger pain areas remain associated with perceived pain and disability, depression and self-efficacy. The pain drawing is useful to support psychological screening in people with chronic WAD.
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Placebo analgesia refers to the reduction in pain due to the administration of an inert treatment. It is induced by expectations of pain relief which are enhanced by learning mechanisms. In healthy humans, prior positive experiences enhance the placebo response. However, the effects of patients' prior experiences with treatment on placebo responses have not yet been examined. This study investigated how verbal information, learning and treatment history influence the magnitude of placebo analgesia in chronic pain. ⋯ We could show that placebo responses to both acute and chronic pain are high in pain treatment settings and that treatment history modulates this effect. Different mechanisms might underlie placebo responses to acute and chronic pain. Our findings highlight the necessity of considering placebo responses and treatment history in the treatment of chronic pain. WHAT DOES THIS STUDY ADD?: Placebo analgesia following verbal information of potent pain relief is high in chronic pain patients in a clinical setting. It is modulated by treatment history. Different mechanisms might underlie placebo analgesia to acute and chronic pain.
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A growing field of investigation into social justice cognitions and pain suggests perceived injustice has a negative impact on pain, but little is known about individual variation in the impact of a perceived injustice. One published study found that individuals with a strong rather than a weak just-world belief reported greater pain from the cold pressor task after experiencing a perceived injustice, but an overt measure of perceived unfairness is needed to investigate this relationship. ⋯ Recalled personal injustice unrelated to one's current pain experience had a negative impact on pain and anxiety associated with the cold pressor task. These findings indicate that intervention development should be cognizant of the role of everyday injustices and not just those related to pain, on the pain experience. WHAT DOES THIS STUDY ADD?: This study shows that, independent of just-world beliefs, perceived unfairness associated with a recalled injustice unrelated to pain has a negative impact on the experience of acute pain.
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Chronic pain is often associated with sensorimotor dysfunction but little is known about the early impact of limb fracture on sensory and motor performance. This exploratory study sought to assess these changes in patients with recent wrist and ankle fractures. A secondary aim was to determine the incidence of Complex Regional Pain Syndrome (CRPS) and its clinical features. ⋯ Limb fracture is associated with changes in pain perceptions, motor planning, and disruption to body perception. Signs and symptoms of CRPS, ongoing pain and delayed recovery post-fracture are common. WHAT DOES THIS STUDY ADD?: In the immediate post-fracture period: Body perception disturbance is reported in the fractured limb. Imagined movements of the fractured limb are less vivid and associated with pain This study contributes to the incidence literature on CRPS.