The journal of pain : official journal of the American Pain Society
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Acceptance of chronic pain has become an important concept in understanding and predicting that chronic pain sufferers can remain engaged with meaningful aspects of life. Assessment of acceptance has been facilitated by the development of Chronic Pain Acceptance Questionnaire (CPAQ). In this study, we aimed to test the reliability and validity of translated Chinese version of CPAQ to use this important tool in the future management of Hong Kong Chinese patients with chronic nonmalignant pain. Content validity was established by consensus formed among a panel of 5 experts in clinical psychology and pain specialty during the process of forward and backward translations. Test-retest reliability was examined by completing the Chinese CPAQ twice, 2 weeks apart, by 54 patients. A total of 224 Chinese patients with chronic nonmalignant pain attending our cluster multidisciplinary pain clinic were asked to complete a battery of psychometric instruments in Chinese, including an intake form for demographic data, Hospital Anxiety and Depression Score (HADS), Medical Outcome Study Short Form 36 (SF-36), Pain Catastrophizing Scale (PCS), and Pain Self-Efficacy Questionnaire (PSEQ). Analysis results showed that Chinese CPAQ had good test-retest reliability (intraclass correlation coefficient, 0.79) and internal consistency reliability (Cronbach alpha = 0.79). The Chinese CPAQ score was significantly correlated to anxiety, depression, pain catastrophizing, pain self-efficacy, and physical and psychosocial disability. Scree plot and Principal Components Factor analysis confirmed the same 2-factor construct as the original English CPAQ. Construct validity of the Chinese CPAQ can therefore be supported. In conclusion, the Chinese CPAQ is a reliable clinical assessment tool with valid construct for acceptance measurement in our heterogeneous Chinese patients sample with chronic nonmalignant pain. ⋯ This article confirms the reliability and validity of a Chinese version of the CPAQ. The Chinese CPAQ can then be used by pain clinicians caring for Chinese chronic pain patients worldwide for acceptance-based psychometric assessment as well as therapies.
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Randomized Controlled Trial
Acute opioid administration improves work-related exercise performance in patients with chronic back pain.
We studied the impact of acute opioid administration on work-related exercise performance in patients with chronic back pain. A double-blinded, random-order, placebo-controlled, crossover trial was conducted. Subjects were predominantly men (63%), with a mean age of 49 years. Subjects performed a continuous lifting and lowering test to voluntary fatigue at a load equivalent to 33% of their predetermined maximal lifting load twice: Once after receiving a single intravenous dose of 1 mug/kg fentanyl (a narcotic analgesic) and once after saline placebo. Of the 30 subjects undergoing testing, 3 subjects were unable to complete testing due to medication-induced nausea. Subjects lifted on average 29.4 +/- 17.9 kg under the influence of fentanyl versus 25.6 +/- 3.1 kg with placebo (effect size = 0.23). Time to fatigue was higher in the fentanyl group (312 +/- 251.4 vs 231 +/- 199.9 seconds, effect size = 0.40), and these subjects also performed more total work (7004 +/- 5144 vs 4748 +/- 3147 J, effect size = 0.72). Opioid analgesia improves lifting performance in the short term in individuals with chronic back pain. Longer trials of the effectiveness of opioid analgesia as an adjunct to functional restoration programs are recommended. ⋯ This article presents the results of a clinical trial showing that acute opioid administration improves work-related exercise performance in individuals with chronic back pain. Longer trials of the effectiveness of opioid analgesia as an adjunct to functional restoration programs are recommended.
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Our group previously demonstrated that changes in mood induced by pleasant or unpleasant odors affect the perceived unpleasantness of painful heat stimuli, without significantly altering perceived pain intensity. In the present study, we examined whether changing mood by viewing emotionally laden visual stimuli also preferentially alters pain unpleasantness. Twelve female subjects immersed their right hand in hot water while observing a video showing a person experiencing the same type of pain (ie, model condition), unpleasant scenes not involving people (ie, disasters condition), or a cityscape video (ie, cityscape condition). Subjects were asked to rate pain intensity, pain unpleasantness, mood, anxiety/calmness, and video unpleasantness, and their skin conductance was measured throughout the experiment. Pain unpleasantness (but not intensity) ratings were higher during the disasters condition, which was associated with the worst mood, than during the cityscape condition; neither mood nor pain unpleasantness was altered in the model video compared with the cityscape video. Moreover, mood was significantly correlated with pain unpleasantness but not with pain intensity. Because these results are similar to those observed when odors were used to alter mood, we conclude that the effects of mood on the affective components of pain are independent of mood induction technique used. ⋯ This article provides new evidence that changes in mood affect the pain experience by preferentially modulating pain unpleasantness. This finding could potentially help health professionals to treat pain symptoms in patients with altered mood, suggesting methods of pain management aimed at easing the affective, along with the sensory, components of pain.
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To identify the effects of mindfulness meditation on older adults with chronic low back pain (CLBP), we conducted a qualitative study based on grounded theory and used content analysis of diary entries from older adults who had participated in a clinical trial of an 8-week mindfulness meditation program. Participants were 27 adults > or = 65 years of age with CLBP of at least moderate severity and of at least 3 months duration. We found several themes reflecting the beneficial effects of mindfulness meditation on pain, attention, sleep, and achieving well-being. Various methods of pain reduction were used, including distraction, increased body awareness leading to behavior change, better pain coping, and direct pain reduction through meditation. Participants described improved attention skills. A number of participants reported improved sleep latency as well as quality of sleep. Participants described achieving well-being during and after a meditation session that had immediate effects on mood elevation but also long-term global effects on improved quality of life. Several themes were identified related to pain reduction, improved attention, improved sleep, and achieving well-being resulting from mindfulness meditation that suggest it has promising potential as a nonpharmacologic treatment of chronic pain for older adults. ⋯ Community-dwelling older adults with chronic low back pain experience numerous benefits from mindfulness meditation including less pain, improved attention, better sleep, enhanced well-being, and improved quality of life. Additional research is needed to determine how mindfulness meditation works and how it might help with other chronic illnesses.
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Practice Guideline
Core outcome domains and measures for pediatric acute and chronic/recurrent pain clinical trials: PedIMMPACT recommendations.
Under the auspices of the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT), 26 professionals from academia, governmental agencies, and the pharmaceutical industry participated in a 2-stage Delphi poll and a consensus meeting that identified core outcome domains and measures that should be considered in clinical trials of treatments for acute and chronic pain in children and adolescents. Consensus was refined by consultation with the international pediatric pain community through announcement of our recommendations on the Pediatric Pain List and inviting and incorporating comments from external sources. There was consensus that investigators conducting pediatric acute pain clinical trials should consider assessing outcomes in pain intensity; global judgment of satisfaction with treatment; symptoms and adverse events; physical recovery; emotional response; and economic factors. There was also agreement that investigators conducting pediatric clinical trials in chronic and recurrent pain should consider assessing outcomes in pain intensity; physical functioning; emotional functioning; role functioning; symptoms and adverse events; global judgment of satisfaction with treatment; sleep; and economic factors. Specific measures or measurement strategies were recommended for different age groups for each domain. ⋯ Based on systematic review and consensus of experts, core domains and measures for clinical trials to treat pain in children and adolescents were defined. This will assist in comparison and pooling of data and promote evidence-based treatment, encourage complete reporting of outcomes, simplify the review of proposals and manuscripts, and facilitate clinicians making informed decisions regarding treatment.