The journal of pain : official journal of the American Pain Society
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Randomized Controlled Trial
Attention and Nocebo Hyperalgesia: Testing a Novel Virtual Reality Attention Bias Modification Paradigm.
Nocebo effects in pain (nocebo hyperalgesia) have received significant attention recently, with negative expectancies and anxiety proposed to be explanatory factors. While both expectancy and anxiety can bias attention, attention has been rarely explored as a potential mechanism involved in nocebo hyperalgesia. The present study aimed to explore whether attention bias modification (ABM) using an immersive, ecologically valid VR paradigm successfully induced attention biases (AB) and subsequently influenced nocebo hyperalgesia. ⋯ Unexpected effects of ABM were observed for state anxiety and anticipatory anxiety, whereby training away from pain exacerbated each, which necessitates further exploration. PERSPECTIVE: This article tests the efficacy of a novel attention bias modification paradigm, designed in virtual reality, for inducing pain-related biases, and whether these biases exacerbate or inoculate against nocebo hyperalgesia. While pain-related biases were successfully induced, there was no relationship with the strength of induced nocebo hyperalgesia.
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Multiple large longitudinal cohorts provide opportunities to address questions about predictors of pain and pain trajectories, even when not anticipated in the design of the historical databases. This focus article uses 2 empirical examples to illustrate the processes of assessing the measurement properties of data from large cohort studies to answer questions about pain. In both examples, data were screened to select candidate variables that captured the impact of chronic pain on self-care activities, productivity, and social activities. ⋯ In conjunction with its Supplementary Material, this focus article aims to encourage exploration of these valuable prospectively collected data to support researchers to make explicit the relationships between items in the databases and constructs of interest in pain research and to use empirical methods to estimate the possible biases in these variables. PERSPECTIVE: This focus article outlines a theory-driven approach for fitting new measurement models to data from large cohort studies and evaluating their psychometric properties. This aims to help researchers develop an empirical understanding of the gains and limitations connected with the process of repurposing the data stored in these datasets.
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A variety of factors are associated with the development and maintenance of chronic pain in children. Identifying modifiable factors associated with pediatric chronic pain is important to use them as target outcomes in the development and evaluation of interventions for the prevention and management of chronic pain. This study aimed to reach expert consensus on factors associated with pediatric chronic pain and their modifiability and population-level effect. ⋯ Expert consensus was established about modifiable and population-level factors associated with pediatric chronic pain through this web-based modified Delphi study, guiding target outcomes for its prevention and management. PERSPECTIVE: This article presents the results of a modified Delphi study with pediatric pain experts to gain consensus on factors associated with pediatric chronic pain. Relationship strength, modifiability, and population-level effect of associated factors were rated to identify areas of research priority and interventions aiming to reduce the development and maintenance of chronic pain in children.
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The transition from acute to chronic low back pain (LBP) in community settings is not well understood. The purpose of this study was to assess the feasibility of recruitment and estimate the transition and continuation of chronic LBP. We also explored characteristics associated with this transition to chronic LBP. ⋯ Acute LBP is a common condition in the community and frequently transitions to chronic LBP, suggesting the potential for substantial burden in the community. PERSPECTIVE: This article presents the feasibility of conducting a community-based study to describe the transition, continuation, and psychosocial predictors of acute to chronic low back pain. These findings could help identify community participants at high risk of incident and continued chronic low back pain.
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The need for culturally tailored pain care is well-recognized, yet few studies report how existing interventions can be adapted to the needs of culturally and linguistically diverse populations. This report describes a formative mixed-methods approach using intervention mapping-adapt and the expanded framework for reporting adaptations and modifications to evidence-based interventions to adapt and report modifications of an existing physical therapy intervention for Latino persons with chronic spine pain in Federally Qualified Health clinics in the southwestern United States. Mixed methods included literature reviews, patient surveys, an Adaptation Advisory Panel, and sequential case series with semistructured interviews. ⋯ Sequential case series supported feasibility and acceptability of the adapted intervention in the target population. PERSPECTIVE: We describe adaptation and reporting of an evidence-based physical therapy intervention for a culturally and linguistically diverse population. Greater rigor and transparency using tools such as intervention mapping-adapt and framework for reporting adaptations and modifications to evidence-based interventions will accelerate efforts to reduce ethnic and racial disparities in pain rehabilitation.