Pain medicine : the official journal of the American Academy of Pain Medicine
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Pain catastrophizing (PC) is a cognitive/emotional response to and in anticipation of pain, which may be maladaptive, further exacerbating pain and the difficulty in emotion regulation (ER). There is a lack of research on the interplay between PC and ER and its impact on pain. Our aim was to investigate whether ER exacerbated the pain experience through PC. ⋯ Our results highlight the importance of several cognitive and emotional constructs: Non-acceptance of negative emotions, lack of emotional awareness, magnification of pain experience, and a sense of helplessness. Further, by showing the indirect effects from PC in affecting ER and pain, we posit that ER, mediated by PC, may serve a critical role in influencing the pain experience in chronic pain patients.
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As psychologically-based interventions have been shown to have clinical utility for adults with chronic pain generally, a similar benefit might be expected in the management of chronic neuropathic pain (NeuP). However, to date this has not been established, with existing systematic reviews on this topic being hampered by the scarcity of Randomised Controlled Trials (RCTs). This review aimed to identify the type of psychologically-based interventions studied for adults with chronic NeuP. It also aimed to assess whether there are enough RCTs to justify undertaking an updated systematic review. ⋯ Cognitive Behavioural Therapy was the most common therapeutic approach identified, whereas mindfulness/meditation was the most frequently used technique. Almost half to two-thirds of the studies reported significant improvements in either pain, disability, or distress, suggesting psychologically-based interventions are potentially beneficial for adults with chronic NeuP. An updated systematic review seems warranted.
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Observational Study
Improvement of Sleep and Pain with Lemborexant Administration in Patients with Chronic Pain: A Retrospective Observational Study.
Patients with chronic pain often have sleep disturbances, and many patients receive sleep medications in addition to analgesics. Although there have been scattered reports of negative pain-sleep interactions, only a few reports have investigated the efficacy of sleep medication interventions in patients with chronic pain for improving sleep disturbances and reducing pain. We retrospectively examined whether lemborexant, an orexin receptor antagonist, is effective in improving sleep disturbances and reducing pain in patients with chronic pain. This study was approved by the Ethics Committee of our hospital. ⋯ Patients who were already taking other sleep medications, such as benzodiazepines were switched to 5 mg of lemborexant after all the other sleep medications were discontinued. Those who had not yet used sleeping pills were started on 5 mg of lemborexant. During the study course, the dose of lemborexant was adjusted at the discretion of the attending physician, based on improvement of insomnia symptoms and secondary symptoms, such as daytime sleepiness and lightheadedness. The study finally included 21 patients, excluding 5 who could not continue taking lemborexant due to side effects, such as lightheadedness. The AIS scores significantly improved, decreasing from baseline (mean ± standard deviation: 12.5 ± 4.9) to 2 weeks (7.8 ± 3.1) and 4 weeks (5.3 ± 2.9) after the start of lemborexant. No significant difference was observed in the degree of improvement in sleep disturbance between patients with or without previous sleep medications, and there was also no statistically significant improvement in the NRS score before (6.1 ± 2.7) and after 2 weeks (5.5 ± 2.3) and 4 weeks (5.9 ± 2.2) from treatment initiation.