The journal of pain : official journal of the American Pain Society
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Pain catastrophizing is understood as a negative cognitive and emotional response to pain. Researchers, clinicians, advocates, and patients have reported stigmatizing effects of the term on patients when used clinically and in the media. This report describes the results of an international, observational, cross-sectional study investigation of clinician and researcher (professionals) perspectives on the term pain catastrophizing and whether new terminology is needed or desired. ⋯ Results highlight the continual controversy surrounding the term pain catastrophizing and the need for additional research and education to incorporate patient-centered approaches into clinical and public communications. Perspective: We present a content analysis of international clinician and researcher perspectives on the term pain catastrophizing. This investigation provides the largest depiction to date of the controversy surrounding pain catastrophizing and may guide future efforts to decrease stigma in patients with chronic pain and improve patient-clinician communication.
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Untreated or undertreated pain is well established as a significant problem, but unidentified pain is a distinct construct that still needs to be clearly modeled or fully described. This paper aims to develop a conceptual model of unidentified pain in humans with the goal of future development of an unidentified pain risk tool. A multi-phase process was employed consisting sequentially of 1) brainstorming followed by consensus building, 2) peer-review and publication of an integrative theoretical review protocol for "unidentified pain," 3) conduct of the integrative review, and 4) a repeated brainstorming session to identify areas of risk for unidentified pain to produce a conceptual model. ⋯ The development of this conceptual model will be used for future development and psychometric testing of a tool to recognize the risk for unidentified pain in humans. PERSPECTIVE: This focus article describes the development a conceptual model for the concept of unidentified pain in humans. This pain may occur in individuals who experience one or more interactive and cumulative hazards: cognition/communication problems, being alone, absence of a surrogate/proxy report, or presence of known painful conditions or treatments.
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Randomized Controlled Trial
Research Article: The prediction of the analgesic placebo response is moderated by outward-focused attention: a sham, randomized clinical trial of chronic back pain patients.
The within-subject variability (WSV) of pain-intensity reports has gained attention as a predictor of the placebo response but has demonstrated mixed results. We hypothesized that participants' inward- and outward-directed attention will moderate WSV's prediction of the analgesic placebo response. In this sham randomized clinical trial (protocol number NCT05994118); placebo response was induced in chronic back-pain patients (n=113) through a saline injection plus verbal suggestion. ⋯ Better understanding of factors shaping the placebo response could further contribute to both clinical practice and clinical trials. PERSPECTIVE: The current study demonstrates that the prediction of the analgesic placebo response could be improved if relevant personal characteristics are included as moderators of the prediction. Better predictions of the placebo response could contribute to improve both clinical research and clinical care.
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Clinical phenotype and management of sound-induced pain: Insights from adults with pain hyperacusis.
Pain hyperacusis, also known as noxacusis, causes physical pain in response to sounds that do not bother most people. How sound causes excruciating pain that can last for weeks or months is not well understood, resulting in a lack of effective treatments. To gain insight into the underlying mechanisms of the condition, 32 adults attended a virtual focus group to describe their sound-induced pain. ⋯ An interdisciplinary approach to clinical studies and the development of animal models are needed to identify and treat the pathological mechanisms of pain hyperacusis. PERSPECTIVE: This article presents the physical and psychosocial consequences of debilitating sound-induced pain (i.e., pain hyperacusis) and the interventions that sufferers have sought for pain relief. The results are largely consistent with peripheral mechanistic theories (e.g., trigeminal nerve involvement) and will guide future work to investigate neural mechanisms and effective therapies.
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Over 40% of neuropathic pain patients experience mood and cognitive disturbances, often showing reduced response to analgesics, with most affected individuals being female. This highlights the critical role of biological sex in pain-related affective and cognitive disorders, making it essential to understand the emotional and cognitive circuits linked to pain for improving treatment strategies. However, research on sex differences in preclinical pain models is lacking. ⋯ PERSPECTIVE: This manuscript reports the relevance of long-term investigations of sex differences in chronic pain. It shows differential development of somatosensory sensitivity, negative affective states and cognitive impairments in males and females. It emphasizes the importance of including subjects of both sexes in the investigation of pain-related mechanisms and therapeutic management.