The journal of pain : official journal of the American Pain Society
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Heightened anticipation and fear of movement-related pain has been linked to detrimental fear-avoidance behavior in chronic low back pain (cLBP). Spinal manipulative therapy (SMT) has been proposed to work partly by exposing patients to nonharmful but forceful mobilization of the painful joint, thereby disrupting the relationship among pain anticipation, fear, and movement. Here, we investigated the brain processes underpinning pain anticipation and fear of movement in cLBP, and their modulation by SMT, using functional magnetic resonance imaging. ⋯ This study sheds light on the brain processing of anticipated pain and fear of back-straining movement in cLBP, and suggests that SMT may reduce cognitive and affective-motivational aspects of fear-avoidance behavior, along with corresponding brain processes. PERSPECTIVE: This study of cLBP patients investigated how SMT affects clinical pain, expected pain, and fear of physical exercises. The results indicate that one of the mechanisms of SMT may be to reduce pain expectancy, fear of movement, and associated brain responses.
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This focus article addresses the issue of the proper use of terminology in pain research. A review and some revisions of the definitions of pain and nociception in relation to consciousness are presented. From a behavioral viewpoint, it is argued that pain is a conscious assessment of the failure of the organism to protect the body from injury (actual or potential), whereas continuously ongoing subconscious/preconscious nociceptive processes protect the body from injuries. ⋯ The title of the bill itself does not make sense if we adhere to the strict definitions commonly accepted in our field. Thus this article concludes with a plea to properly constrain the narrative with which we describe our research and minimize potential abuse of the science of pain for political interests. Perspective:The focus article goes over the classic definitions of pain and nociception, incorporates novel concepts recently advanced as to their functional differentiation, and is a plea for our research and clinical society to adhere to the proper use of these terms to minimize misinterpretation by society at large.
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Observational Study
Parent Responses to Child Pain During Intensive Interdisciplinary Pain Treatment and 1-Year Follow-Up.
Targeting parents' responses to their child's pain during intensive interdisciplinary pain treatment (IIPT) could influence child functioning. This longitudinal, observational study investigated changes in these responses and concurrent relationships between parent responses and changes in levels of child functioning and pain. Parents of youths 10 to 19 years of age (mean = 15 years, SD = 1.98 years) participated in twice weekly, parent-only groups while their teens were enrolled in IIPT (mean length of treatment = 3.93 weeks, SD = 1.16 weeks). ⋯ PERSPECTIVE: During intensive IIPT, parents made statistically significant changes in responses to their child's pain, which was associated with improvements in child disability, but not child pain. Changes were sustained through 1-year follow-up. Targeting parental responses to child pain is feasible and may relate to improved child functioning.
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Preoperative pain characteristics in patients with osteoarthritis may explain persistent pain after total knee replacement. Fifty patients awaiting total knee replacement and 22 asymptomatic controls were recruited to evaluate the degree of neuropathic pain symptoms and pain sensitization. Patients with OA were pain phenotyped into 2 groups based on the PainDETECT questionnaire: high PainDETECT group (scores ≥19) indicating neuropathic pain-like symptoms and low PainDETECT group (scores <19) indicating nociceptive or mixed pain. ⋯ Patients with OA with high PainDETECT scores had higher postoperative visual analogue scale pain scores than the low PainDETECT patients (P < .0001) and facilitated temporal summation of pain (P = .022) compared with healthy control subjects. Perspective: This study has found that preoperative PainDETECT scores independently predict postoperative pain. Patients with knee OA with neuropathic pain-like symptoms identified using the PainDETECT questionnaire are most at risk of developing chronic postoperative pain after TKR surgery.
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Spouse attributions regarding displays of pain behaviors by their partners with chronic pain may account for subsequent increases in spouse critical/hostile responses toward their partners. People with chronic low back pain (n = 105) and their pain-free spouses (n = 105) completed electronic diary measures 5 times per day for 14 consecutive days. Key items assessed spouse observations of patient pain behavior, attributions regarding these behaviors, and spouse critical/hostile responses toward patients. ⋯ A vital factor linking spouse scrutiny to spouse critical/hostile responses may be the spouse's ascribed reasons for the patient's grimacing, bracing, complaining, and so forth. Perspective: Results indicate that spouse internal and negative attributions for pain behaviors of their partners with chronic pain may influence subsequent spouse critical/hostile reactions to them. Findings suggest that replacing spouse internal and negative attributions with external, compassionate, and accepting explanations may be useful therapeutic targets for couples coping with chronic pain.