The journal of pain : official journal of the American Pain Society
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The etiologic role of work-related psychological stress in the development of musculoskeletal pain disorders (MDs) has been systematically investigated. Less clear, however, is the role of perceived stress and life stressors. This review aimed to assess the evidence for an etiologic role of perceived stress and life stressors in the development of chronic MDs. ⋯ The limited number of studies, the poor quality of the evidence, and the heterogeneity of stress measures used across studies suggest that further high quality prospective studies are required to clarify the role of perceived stress and life stressors in the development of chronic MDs. PROSPERO: CRD42017059949 PERSPECTIVE: This review summarizes and critically appraises the evidence for the etiologic role of perceived stress and life stressors in the development of chronic MDs. The limited number of studies, the low quality of the evidence, and the heterogeneity across studies suggest that further research is needed on perceived stress and life stressors in MDs.
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Randomized Controlled Trial
Heterogeneity of treatment effects in a randomized trial of literacy-adapted group cognitive-behavioral therapy, pain psychoeducation, and usual medical care for multiply disadvantaged patients with chronic pain.
Differences among patients can moderate the impact of evidence-based treatments (ie, heterogeneity of treatment effects), leading patients to get more or less benefit. The Learning About My Pain study was a randomized, comparative effectiveness trial of a 10-week literacy-adapted group cognitive-behavioral therapy for chronic pain (CBT) versus pain psychoeducation groups (EDU) versus usual medical care. We examined potential sociodemographic and cognitive moderators of treatment effect among participants with post-treatment assessments (N = 241). ⋯ When provided sufficient guidance and structure in a way that is meaningfully adapted, highly disadvantaged patients achieved as much benefit as less disadvantaged patients, suggesting that the literacy-adapted CBT more successfully met the needs of this population. TRIAL REGISTRATION: clinicaltrials.gov identifier NCT01967342 PERSPECTIVE: This article presents findings related to heterogeneity of treatment effects for simplified group psychosocial treatments for chronic pain. The results suggest that educationally, cognitively, or literacy disadvantaged patients benefit most from the more structured approach of literacy-adapted CBT rather than EDU, whereas less disadvantaged patients benefit from either treatment.
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Cutaneous mechanical hyperalgesia can be induced in healthy volunteers in early phase analgesic studies to model central sensitization, a key mechanism of persistent pain. However, such hyperalgesia is short-lived (a matter of hours), and is used only for assessing only single drug doses. In contrast, postsurgical peri-incisional hyperalgesia may be more persistent and hence be a more useful model for the assessment of the efficacy of new analgesics. ⋯ The findings suggest that central sensitization contributes significantly to mechanical hyperalgesia at the peri-incisional site. The prolonged duration of hyperalgesia would be advantageous as a pain model, but there was considerable variability of mechanical hyperalgesia in the cohort; the challenges of recruitment may limit its use to small, early phase analgesic studies. PERSPECTIVE: Peri-incisional mechanical hyperalgesia persists for ≥4 weeks after open inguinal hernia repair and reflects central sensitization; this may have usefulness as a model of chronic pain to assess the potential of antineuropathic analgesics.
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Adverse Childhood Experiences in Mothers with Chronic Pain and Intergenerational Impact on Children.
Adverse childhood experiences (ACEs; eg, parental divorce, physical or sexual abuse) are more prevalent in individuals with chronic pain compared with the general population. Both increased maternal ACEs and chronic pain have been associated with poor physical and emotional functioning in offspring. However, the mechanisms driving these associations are poorly understood. ⋯ Intervening on maternal depression among mothers with chronic pain may reduce the impact of intergenerational ACE transmission. Perspective: This article presents evidence regarding the intergenerational impact of ACEs in a large sample of mothers with chronic pain and their school-aged children. Maternal depressive symptoms accounted for the relation between maternal ACEs and children's depressive symptoms providing evidence regarding targets for preventive interventions.
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Painful Temporomandibular Disorder is Associated with Migraine in Adolescents: a case-control study.
Some types of primary headaches and temporomandibular disorders (TMD) are comorbid in adults and highly prevalent in adolescents. Herein, we investigated the association of painful TMD with specific headache diagnoses (migraine, tension-type headache) and with headache frequency in adolescents. We also explored the association of headache diagnosis with the number of painful sites in the trigeminal area. ⋯ Migraine and frequency of headache were associated with painful TMD in adolescents. PERSPECTIVE: Migraine and headache frequency were strongly associated with painful TMD in adolescents, and causality must be determined. For now, the presence of 1 condition should raise suspicion of the other and warrants collaboration between orofacial pain specialists and neurologists.