The journal of pain : official journal of the American Pain Society
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Randomized Controlled Trial
We discount the pain of others when pain has no medical explanation.
The present studies investigated the impact of medical and psychosocial information on the observer's estimations of pain, emotional responses, and behavioral tendencies toward another person in pain. Participants were recruited from the community (study 1: N = 39 women, 10 men; study 2: N = 41 women, 12 men) and viewed videos of 4 patients expressing pain, paired with vignettes describing absence or presence of 1) medical evidence for the pain and 2) psychosocial influences on the pain experience. A similar methodology was used for studies 1 and 2, except for the explicit manipulation of the presence/absence of psychosocial influences in study 2. For each patient video, participant estimations of each patient's pain and their own distress, sympathy, and inclination to help were assessed. In both studies, results indicated lower ratings on all measures when medical evidence for pain was absent. Overall, no effect of psychosocial influences was found, except in study 2 where participants indicated feeling less distress when psychosocial influences were present. The findings suggest that pain is taken less seriously when there is no medical evidence for the pain. The findings are discussed in terms of potential mechanisms underlying pain estimations as well as implications for caregiving behavior. ⋯ The present studies indicate that observers take the pain of others less seriously in the absence of clear medical evidence for the pain. These findings are important to further understand the social context in which pain for which there is no clear medical explanation is experienced.
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The recently revised version of the Short-Form McGill Pain Questionnaire (SF-MPQ-2) was created to assess both neuropathic and non-neuropathic pain. The current study extends prior research by testing the reliability and validity of the SF-MPQ-2 in a sample of U.S. veteran patients with a range of chronic pain diagnoses. Participants (N = 186) completed the SF-MPQ-2, a sociodemographic questionnaire, the Structured Clinical Interview for the DSM-IV, and self-report pain and psychiatric measures. Pain diagnoses were extracted from the electronic medical record. The SF-MPQ-2 total and scale scores demonstrated good-to-excellent internal consistency. Convergent and discriminant validity were supported, and SF-MPQ-2 total and scale scores increased with number of pain diagnoses and pain severity. Confirmatory factor analyses indicated that a 4-factor model fit the data better than a single-factor model. However, high intercorrelations among the 4 latent constructs were observed, and a second-order global pain construct also emerged. Overall, the SF-MPQ-2 demonstrated excellent reliability and validity in a sample of U.S. veteran patients with chronic neuropathic and non-neuropathic pain. Future psychometric studies of the SF-MPQ-2 should employ longitudinal data to evaluate the ability of scale scores to uniquely predict clinical and health service outcomes. ⋯ This article presents the psychometric properties of a revised version of the SF-MPQ-2. This measure may have great utility as a screening tool in clinical practice and as an outcome measure in clinical trials.
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Recent research has implicated pain-related fear in relation to functional outcomes in children with chronic pain. The current study examined fear of pain, disability, and depression within the context of an intensive pain rehabilitation program. One hundred forty-five children and adolescents who participated in an intensive interdisciplinary pediatric pain rehabilitation day program were assessed in this study. Patients completed measures of pain intensity, pain-related fears, functional disability, and depressive symptoms at admission, discharge, and on average, 2 months postdischarge. After controlling for pain intensity, pain-related fear was significantly related to disability and depressive symptoms at all time points. As predicted, a decline in pain-related fear was significantly associated with a decrease in disability and depressive symptoms. Interestingly, high levels of pain-related fears at admission predicted less reduction in functional disability and depression at discharge, suggesting that high levels of pain-related fear may be a risk factor in relation to treatment outcomes. Overall, results indicate that the relationship between fear of pain and changes in disability and depressive symptoms are closely linked, with fear of pain playing an important role in treatment. ⋯ This paper presents results underscoring the importance of pain-related fear in relation to treatment response for children and adolescents with chronic pain. These findings support the need to develop and implement interventions that target reductions in pain-related fear.
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There is uncertainty about sex differences in exercise-induced muscle pain and muscle damage due to several methodological weaknesses in the literature. This investigation tested the hypothesis that higher levels of exercise-induced muscle pain and muscle damage indicators would be found in women than men when several methodological improvements were executed in the same study. Participants (N = 33; 42% women) with an average age of 23 years (SD = 2.82) consented to participate. After a familiarization session, participants visited the laboratory before and across 4 days after eccentric exercise was completed to induce arm muscle pain and muscle damage. Our primary outcomes were arm pain ratings and pressure pain thresholds. However, we also measured the following indicators of muscle damage: arm girth; resting elbow extension; isometric elbow flexor strength; myoglobin (Mb); tumor necrosis factor (TNFa); interleukin 1beta (IL1b); and total nitric oxide (NO). Temporary induction of muscle damage was indicated by changes in all outcome measures except TNFa and IL1b. In contrast to our hypotheses, women reported moderately lower and less frequent muscle pain than men. Also, women's arm girth and Mb levels increased moderately less than men's, but the differences were not significant. Few large sex differences were detected. ⋯ Lower muscle pain among women than men was detected with corresponding, but nonsignificant sex differences in other muscle damage indicators. Methodological advances may have improved alignment of these results with the nonhuman animal findings. This line of research continues to show exceptions to the generalization that women experience greater pain than men.
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Pain is among the most common symptoms of cancer, with impacts on multiple domains of well-being. Biopsychosocial factors play an important role in adjustment to cancer pain. The Communal Coping Model (CCM), which may elucidate the social context of cancer pain, suggests that people catastrophize to convey distress and elicit support. Attachment style, one's ability to elicit and respond to available support, may be an important factor, but this has not been tested in people with cancer pain. This study examined pain catastrophizing, attachment style and relational context in relation to perceived solicitous, distracting, and punishing responses of significant others to pain in 191 patients with advanced cancer. Consistent with the CCM, higher pain catastrophizing was related to more frequent solicitous and distracting responses. Pain catastrophizing, attachment anxiety, and significant other type interacted in relation to punishing responses. Higher pain catastrophizing was related to less frequent punishing responses only in anxiously attached patients who identified their spouse/partner as their significant other. These results provide support for the CCM of cancer pain, and contribute to refinement of the model. Future research that includes patients and their caregivers is required to further explicate the social context of cancer pain. ⋯ This article investigates the Communal Coping Model in people with cancer pain. In partial support of the model, we found that pain catastrophizing was related to more frequent solicitous and distracting responses but less frequent punishing responses only in anxiously attached patients who identified their spouse/partner as their significant other.