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PubMedDate not supplied

American pain society pain questionnaire and other pain measures in the assessment of osteoarthritis pain: a pooled analysis of three celecoxib pivotal studies.

The aim of this study was to evaluate the utility of the American Pain Society (APS) questionnaire in the assessment of osteoarthritis (OA) pain and to determine the onset of action of celecoxib in the treatment of acute flare pain in patients with OA of the knee or hip. Pooled data from three pivotal, randomized, double-blind, placebo-controlled, 12-week trials of patients with OA who exhibited a flare of disease activity after withdrawal of nonsteroidal anti-inflammatory drug or analgesic therapy were evaluated. Patients completed the APS Pain Measure Questionnaire, which evaluates pain intensity and quality of life, at baseline and daily for the first 7 days of therapy. In addition, patients underwent a range of standard OA assessments to evaluate the analgesic efficacy of celecoxib up to 12 weeks. Three thousand two hundred fifty-eight patients were enrolled in the three studies, of whom 2041 completed the APS questionnaire (1010 received celecoxib, 513 received naproxen, and 518 received placebo). Within the first 24 hours, celecoxib at a dose of 200 or 400 mg/d significantly reduced the amount of acute pain experienced compared with placebo for four of the five measures, and statistical significance for the remaining parameter, "pain in the last 24 hours," was achieved on day 2. Celecoxib at a dose of 200 to 400 mg/d provided similar efficacy to naproxen at a dose of 1000 mg/d. The pain relief observed with celecoxib was maintained for the APS evaluation period. Long-term efficacy assessments showed the efficacy of 200 mg/d of celecoxib to be continuous and maintained for at least the 12 weeks of the study and that it was equivalent to 400 mg/d of celecoxib and 1000 mg/d of naproxen. This study demonstrates that the APS questionnaire is a useful measure of pain and therapeutic response in OA. Celecoxib furthermore seems to be an effective acute and chronic analgesic in OA.

Aged↗
PubMed1996

[Quality assurance in therapy of chronic pain. Results obtained by a task force of the German Section of the Association for the Study of Pain on psychological assessment of chronic pain. IX. Multidimensional instruments for the assessment of aspects relating to pain and recommendations on standard procedures for diagnosis].

Four multidimensional inventories used as instruments for the assessment of pain are examined: "Fragebogen zur Erfassung der Schmerzverarbeitung' [Questionnaire for Assessment of Level of Coping with Pain], "Kieler Schmerzverarbeitungs-Inventar' [Kiel Inventory of Coping with Pain], "Fragebogen zur Schmerzregulation' [Questionnaire on Pain Regulation], and the German version of the "Multidimensional Pain Inventory'. None of these questionnaires assesses all domains that are important in chronic pain. The recommended standardized assessment routine for pain centres includes the use of a diary, the rating of actual, average and maximum pain intensity, the application of the PDI, a measure of disability, and the FESV, which records cognitive processing and coping. As measures of general psychological dysfunction the ADS for the assessment of depression and the B-L, a symptom checklist, are suggested as instruments suitable for routine use in diagnosis and evaluation.

English Abstract↗
PubMed2003

[Clinical characteristics of children with chronic pain in a pediatric pain unit: oncologic pain versus non-oncologic pain].

BACKGROUND: Despite undoubted scientific advances in the field of chronic pain in children, there is no evidence of clinical application of this knowledge. OBJECTIVE: To describe the experience of a pediatric pain unit (PPU) specifically dedicated to the treatment of chronic pain in children. MATERIAL AND METHODS: We performed an analytic, observational, retrospective, cohort study of the clinical features of the first 42 patients treated for chronic pain in the PPU during a two-year period. The patients were assigned to two groups: an oncologic group and a non-oncologic group. ANOVA was used to analyze quantitative variables and the Chi-square test was used to analyze qualitative variables. RESULTS: No significant differences were found between the two groups in the demographic variables studied (age and sex). Concerning the type of treatment used, no significant differences were found in effectiveness or compliance. However, treatment duration was significantly longer in the non-oncologic group than in the oncologic group (74.2 days vs 37.5 days, p(0.008). The duration of non-oncologic chronic pain before attending the PPU (mean: 557 days) influenced the effectiveness (r 5 0.781; p 5 0.0001) and duration of treatment (r 5 0.61; p 5 0.0051). However, the duration of previous chronic oncologic pain was significantly shorter (mean: 34 days) and showed no influence on treatment effectiveness or duration. CONCLUSIONS: The pediatric population presents chronic pain syndromes that can be appropriately treated in a PPU with conventional, easy to manage analgesics. We recommend the establishment of pediatric pain units similar to those for adults, using a multidisciplinary approach to mitigate children's suffering.

Adolescent↗
PubMed1997

[Quality assurance in chronic pain therapy. Results obtained by a task force of the German Chapter of the International Association for the Study of Pain on psychological Assessment of chronic Pain. Psychological instruments for the assessment of pediatric pain].

The present paper is one in a series of publications reviewing German instruments for the psychological assessment of pain. Part X deals with pain measurement of acute and chronic pain in infants and children. German assessment instruments of pediatric pain together with frequently used instruments of American origin are examined and described. The survey contains self-report and behavioral pain measures. Multidimensional pain interviews for both children and parents, diaries and rating scales, as well as observation measures especially for infants, are examined. Since the selection of pain-assessment instruments is dependent on the age and cognitive level of the children, for each instrument a minimum age limit is given. In cases in which quantitative indices of reliability, validity and objectivity are still needed, the evaluation is based on qualitative quotations.

English Abstract↗
PubMed1993

Self-control expectancy and postsurgical pain: relationships to previous pain, behavior in past pain, familial pain tolerance models, and personality.

The importance of self-control expectancy on postsurgical pain was studied in 126 patients enrolled in a particular clinical setting. The contribution of previous pain experiences, past behaviors, vicarious experiences, and personality traits to self-control expectancy reported by patients was also investigated. To collect this information, a specific questionnaire and a semistructured interview were given before surgery. Minnesota Multiphasic Personality Inventory (MMPI), Eysenck Personality Inventory (EPI), and State-Trait Anxiety Inventory (STAI) personality tests were also administered. Postsurgical pain was assessed by measuring intensity (Visual Analogue Scale, VAS), latency (hr), and duration (days). Results show that expected emotional coping response is crucially related to the whole pain experience (intensity, latency, and duration). Self-control expectancy is associated with mastery behaviors in previous pains, vicarious experiences, and personality traits. These findings suggest that the knowledge of patients' beliefs about their ability to acquire and maintain control over impending pain is useful in predicting and managing postsurgical pain.

Adaptation, Psychological↗
PubMedDate not supplied

Difficult pain syndromes: bone pain, visceral pain, and neuropathic pain.

Cancer pain is prevalent in approximately two thirds of all cancer patients and can undermine the quality of life in this patient population. Uncontrolled pain can cause physical as well as psychological distress in cancer patients. As the disease progresses in cancer, pain and suffering increase. Knowledge about pain management is paramount in the comprehensive treatment of cancer patients. Difficult cancer pain syndromes may arise from interruption of bone, viscera, and neural structures by malignant spread of the disease. Familiarity with opioids, adjuvants, and procedures that can abate pain in cancer patients is discussed in a practical manner for clinical application in this text.

Bone Neoplasms↗
PubMed1986

Pain behavior and pain coping strategies in low back pain and myofascial pain dysfunction syndrome patients.

Pain behavior and pain coping strategies were systematically measured in a group of 32 chronic low back pain (LBP) and 32 myofascial pain dysfunction (MPD) syndrome patients. Both groups reported high levels of psychological distress on the SCL-90R. The LBP patients were significantly less active, took more narcotic and sedative-hypnotic medications, and showed higher levels of motor pain behavior (guarding, rubbing, and bracing) than the MPD patients. The LBP patients used attention diversion, and praying or hoping as pain coping skills to a much greater extent than the MPD patients. The relationship of these findings to prior research is described, and future research needs in this area are identified.

Activities of Daily Living↗
PubMed1999

An international survey of cancer pain characteristics and syndromes. IASP Task Force on Cancer Pain. International Association for the Study of Pain.

The optimal assessment of cancer pain includes a detailed description of pain characteristics and classification by both syndrome and likely mechanisms. In the clinical setting, the interpretation of this information is aided by knowledge of the available clinical experiences on these aspects of the pain. Unfortunately, existing data are limited. There have been few large surveys of cancer pain characteristics and syndromes, and comparative data from patients in different parts of the world are entirely lacking. To better define the characteristics of cancer pain syndromes the Task Force on Cancer Pain of the International Association for the Study of Pain (IASP) conducted a prospective, cross-sectional, international, multicenter survey of pain specialists and their patients. From a total of 100 clinicians who described themselves as cancer pain practitioners in the IASP membership directory, 51 agreed to participate in the survey and a total of 58 provided data. These clinicians resided in 24 countries and evaluated a total of 1095 patients with severe cancer pain mostly requiring opioid medication, using a combination of patient-rated and observer-rated measures. The patient-rated scales comprised a pain intensity measure chosen from the brief pain inventory. The observer-rated information included demographic and tumor-related data, and responses on checklists of pain syndromes and pathophysiologies. Patients were heterogeneous in terms of demographics and tumor-related information. More than 76% had a Kamofsky performance status score < or = 70. Almost one-quarter of the patients experienced two or more pains. A large majority of the patients (92.5%) had one or more pains caused directly by the cancer; 20.8% of patients had one or more pains caused by cancer therapies. The average (SD) duration of pain was 5.9 (10.5) months. Approximately two-thirds of patients (66.7%) reported that the worst pain intensity during the day prior to the survey was > or = 7 on a 10-point numeric scale. The factors that were univariately associated with higher pain intensity included the presence of breakthrough pain, somatic pain or neuropathic pain, age younger than 60 years, and lower performance status score. A multivariate model suggested that the presence of breakthrough pain, somatic pain, and lower performance status were the most important predictors of intense pain. Pains that were inferred by the treating clinician to be nociceptive and due to somatic injury occurred in 71.6% of the patients. Pains labeled nociceptive visceral were noted in 34.7% and pains inferred to have neuropathic mechanisms occurred in 39.7%. In a broad classification, the major pain syndromes comprised bone or joint lesions (41.7% of patients), visceral lesions (28.1%), soft tissue infiltration (28.3%), and peripheral nerve injuries (27.8%). Twenty-two types of pain syndromes were most prevalent. Large differences in the diagnosis of breakthrough pain by clinicians of different countries suggest that this phenomenon is either defined or recognized differently across countries. These data confirm, in segment of the cancer population experiencing severe pain, in different parts of the world, that cancer pain characteristics, syndromes and pathophysiologies are very heterogeneous. Predictors of worsening pain can be identified. The data provide a useful context for the interpretation of pain-related information acquired in both clinical and research settings. They suggest the need for future studies and the potential usefulness of a written checklist for cancer pain syndromes and pathophysiologies.

Cross-Sectional Studies↗
PubMed2001

Pain site and the effects of amputation pain: further clarification of the meaning of mild, moderate, and severe pain.

Research among persons with cancer pain suggests that the association between pain intensity and pain interference is non-linear. That is, pain begins to have a serious impact on functioning when it reaches a certain threshold level (about 5 on 0--10 scales). Often, a second pain threshold can be identified which, once reached, shows an even greater proportional negative impact on functioning. This finding supports the potential clinical utility of classifying pain as mild, moderate, and severe based on the impact of pain on quality of life, and research among persons with cancer pain supports specific cutoffs (mild: 1--4, moderate: 5--6, severe: 7--10, see Pain 61 (1995) 277) for this classification. The current study sought to replicate the non-linear association between pain and pain interference in a non-cancer pain sample, determine whether the cutoffs that have been identified as optimal for cancer patients are also optimal for persons with pain associated with amputation, and determine whether the optimal cutoffs replicate across pain types (in this case, phantom limb, back, and general pain) within a single sample. Two-hundred and five persons with acquired amputation and phantom limb pain, back pain, or both, rated their average pain intensity and degree of pain interference for each type of pain. The results support a non-linear association between pain intensity and pain interference. However, the optimal cutoffs for classifying mild, moderate and severe pain in the present sample replicated the findings for persons with cancer pain only for back pain -- different optimal cutoffs were found for phantom limb and general pain. Moreover, the degree of pain interference appeared to vary as a function of pain type. The same level of back pain interfered more significantly with daily function than phantom limb pain did after pain levels reached five or more (on a 0--10 scale). These findings have implications for understanding the meaning of pain intensity levels, as well as for the assessment of pain intensity in persons with amputation-related pain.

Adult↗
PubMed2004

Body pain area and pain-related negative affect predict clinical pain intensity in patients with fibromyalgia.

UNLABELLED: Patients with fibromyalgia (FM) report widespread chronic musculoskeletal pain. Palpation of 9 paired tender points (TPs) is commonly used for the diagnosis of FM according to criteria specified by the American College of Rheumatology. Although TP palpation can be used to assess deep tissue hypersensitivity, it has failed as a reliable indicator of clinical pain intensity in FM. The sum of local areas of pain (SLAP) obtained from a body pain diagram represents a relevant measure of the spatial extent of clinical pain, a feature most likely important for FM pain. Because spatial summation of pain can be an important determinant of clinical pain intensity, we hypothesized that this measure would predict clinical pain intensity in FM patients. Because pain is strongly associated with negative emotions, we evaluated the relationship of pain-related negative affect (PRNA) with clinical pain intensity in FM. The independent contributions of SLAP, PRNA, and TP count to the variance of clinical pain intensity were assessed in 280 FM patients. Clinical pain intensity of 280 FM patients was measured by using a visual analogue scale. FM patients shaded all painful body areas on body pain diagrams. Dolorimetry was used for TP evaluations. PRNA was assessed with the Medical College of Virginia Pain Questionnaire. Hierarchical linear regression was used to test the association of SLAP, TPs, and PRNA with clinical pain intensity. FM patients' mean visual analogue scale rating (0 to 100) of usual clinical pain was 50.1. Mean SLAP, TP count, and PRNA were 11.4, 16.0, and 44.3, respectively. Hierarchical linear regression analysis identified SLAP, TP count, and PRNA as independent predictors of clinical pain that accounted for 45% of the variance in clinical pain intensity ratings in FM patients. Consistent with the literature, TP count predicted only a small part (4%) of this variance. Our statistical model of body pain areas and negative affect predicts a large portion of the variance of pain intensity in FM. This result suggests that the extent of pain areas and negative emotions are uniquely associated with clinical pain intensity in FM. PERSPECTIVE: The number of painful body areas obtained by body pain diagrams is a better predictor of clinical pain intensity than TPs in FM patients. The combination of painful body areas, TP counts, and PRNA predicts 45% of the clinical pain intensity of FM patients. This finding might be useful for clinical evaluations of FM patients.

Adult↗
PubMedDate not supplied

Stability of pain parameters and pain-related quality of life in adolescents with persistent pain: a three-year follow-up.

OBJECTIVE: Many juveniles with chronic pain of no known organic cause recover. Because adolescents whose pain persists may have chronic pain as adults, a subsample of 42 adolescents from a prevalence study in which continuation of their pain was observed throughout the study period was investigated quantitatively and qualitatively. All mothers (n = 42) completed a questionnaire on the impact of the adolescent's pain on the family. The authors tested the hypothesis that pain parameters, pain-related quality of life, and impact of pain on the family would deteriorate over time. DESIGN: Three-year follow-up questionnaires, diaries, and interviews were used. SETTING: The study was conducted in the general population in the Rotterdam area. PARTICIPANTS: Adolescents (aged 12-18 years) who indicated chronic pain in our previous prevalence study and in a diary and questionnaire each year of the 3-year follow-up were included in the study. RESULTS: The most prevalent pains were limb pain and headache. The pain intensity was mild (33 mm on a visual analog scale), very frequent (72% of all diary entries), and associated with relatively poor functional status and poor psychological and somatic functioning. The pain parameters, pain-related quality of life, and impact of pain on the family (i.e., restrictions in social life and problems in dealing with the stress of the adolescent's pain) remained surprisingly stable across the assessments. The interviews showed that pain had become part of the daily life of several adolescents, who structured their activities and sleeping hours to prevent aggravation of pain. In particular, adolescents with headache reported problems with cognitive activities, whereas those with limb pain and back pain reported problems with physical activities. CONCLUSIONS: For adolescents with persistent pain with no known organic cause, intensity and frequency of pain, quality of life, and impact of pain on the family did not change. Generally, they seemed to cope quite well with their pain. In view of these results, further studies should involve follow-up of adolescents with persistent pain into adulthood to establish the determinants of their pain and to find out whether they maintain their adaptive ways of living with their pain.

Adolescent↗
PubMed2006

Overall fibromyalgia pain is predicted by ratings of local pain and pain-related negative affect--possible role of peripheral tissues.

OBJECTIVES: Despite variable numbers and intensities of local pain areas, fibromyalgia (FM) patients can provide overall clinical pain ratings. We hypothesized that the overall clinical pain is largely determined by the pain intensity of local body areas. Thus, we assessed the role of local body pains as predictors of overall clinical pain in FM patients. METHODS: Ratings of overall clinical pain intensity and pain-related negative affect (PRNA) were obtained from 277 FM patients. In addition, the patients identified painful body areas by shading a body pain diagram and rated the intensity of each pain area using a mechanical visual analogue scale (VAS). Hierarchical regression analyses were used to examine predictors of overall clinical FM pain intensity including PRNA, number of local pain areas, and maximal/average intensity of local pain areas. RESULTS: The average overall clinical pain rating of all FM patients was 4.6 (S.D. 2.3) VAS. The PRNA accounted for 19%, number of painful body areas for 9% and maximal/average local pain for 27% of the variance of overall clinical FM pain (P-values < 0.001). The combination of all factors predicted 55% of the variance in overall clinical pain intensity of FM patients. CONCLUSION: Peripheral factors (maximal/average local pain and number of painful body areas) predicted most of the variance of overall clinical FM pain, suggesting that the input of pain by the peripheral tissues is clinically relevant. About 19% of the pain variance was predicted by PRNA. Thus, peripheral pain and negative affect appear to be particularly relevant for overall FM pain and may represent important targets for future therapies.

Adult↗
PubMed2005

Quality of life in chronic pain is more associated with beliefs about pain, than with pain intensity.

OBJECTIVES: The objectives of this study were to investigate pain cognitions and quality of life of chronic pain patients referred to a multi-disciplinary university pain management clinic and to search for predictors of quality of life. METHODS: A heterogeneous group of 1208 chronic pain patients referred to the Maastricht university hospital pain clinic participated in this cross-sectional study. At the initial assessment, all patients completed a set of questionnaires on demographic variables, cause, location, pain intensity (McGill pain questionnaire, MPQ), pain coping and beliefs (pain coping and cognition list, PCCL), pain catastrophising (pain catastrophising scale, PCS) and eight dimensions of quality of life (Rand-36). RESULTS: The results showed that the present sample of heterogeneous pain patients reported low quality of life on each domain and significantly lower scores than has been found in previous studies with other Dutch chronic pain populations. Patients with low back pain and multiple pain localisations experienced most functional limitations. Women reported more pain, more catastrophising thoughts about pain, more disability and lower vitality and general health. When tested in a multiple regression analysis, pain catastrophising turned out to be the single most important predictor of quality of life. Especially social functioning, vitality, mental health and general health are significantly associated with pain catastrophising. CONCLUSIONS: Patients from a multi-disciplinary university pain clinic experience strikingly low quality of life, whereby low back pain patients and patients with multiple pain localisations have the lowest quality of life. Pain catastrophising showed the strongest association with quality of life, and stronger than pain intensity.

Activities of Daily Living↗
PubMed2005

Phantom pain, residual limb pain, and back pain in amputees: results of a national survey.

OBJECTIVES: To describe the prevalence of amputation-related pain; to ascertain the intensity and affective quality of phantom pain, residual limb pain, back pain, and nonamputated limb pain; and to identify the role that demographics, amputation-related factors, and depressed mood may contribute to the experience of pain in the amputee. DESIGN: Cross-sectional survey. SETTING: A sample of persons who contacted the Amputee Coalition of America from 1998 to 2000 were interviewed by telephone. PARTICIPANTS: A stratified sample by etiology of 914 persons with limb loss. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Prevalence, intensity, and bothersomeness of residual, phantom, and back pain, depressed mood as measured by the Center for Epidemiologic Study Depression Scale, characteristics of the amputation, prosthetic use, and sociodemographic characteristics of the amputee. RESULTS: Nearly all (95%) amputees surveyed reported experiencing 1 or more types of amputation-related pain in the previous 4 weeks. Phantom pain was reported most often (79.9%), with 67.7% reporting residual limb pain and 62.3% back pain. A large proportion of persons with phantom pain and stump pain reported experiencing severe pain (rating 7-10). Across all pain types, a quarter of those with pain reported their pain to be extremely bothersome. Identifiable risk factors for intensity and bothersomeness of amputation-related pain varied greatly by pain site. However, across all pain types, depressive symptoms were found to be a significant predictor of level of pain intensity and bothersomeness. CONCLUSIONS: Chronic pain is highly prevalent among persons with limb loss, regardless of time since amputation. A common predictor of an increased level of intensity and bothersomeness among all pain sites was the presence of depressive symptoms. Further studies are needed to elucidate the relationship between pain and depressive symptoms among amputees.

Age Factors↗
PubMed2002

The influence of experimental pain intensity in the local and referred pain area on somatosensory perception in the area of referred pain.

The aim of this study was to investigate the influence of experimental pain intensity in the local and referred pain area on somatosensory perception thresholds in the area of referred pain. Pain was induced by intramuscular electrical stimulation of the left infraspinatus muscle in 12 healthy individuals. The stimulation corresponded to the local pain threshold ("mild local pain"), the referred pain threshold ("mild referred pain"), and a pain intensity corresponding to 2 on a 10-point category scale in the referred pain area ("moderate referred pain"). Quantitative sensory testing was performed to assess perception thresholds in the referred pain area and the homologous contralateral area before and during stimulation. Perception thresholds to light touch (LTTs), pressure pain (PPTs), and to innocuous as well as noxious warmth and cold were assessed. During stimulation the LTTs increased in the referred pain area compared to baseline, uninfluenced by pain intensity. Perception thresholds to innocuous cold and warmth increased bilaterally during the stimulation, without relation to pain intensity. Heat pain thresholds were not affected. Compared to baseline, PPTs increased bilaterally during stimulation corresponding to "mild local pain" and "mild referred pain", respectively, and a further increase was seen during "moderate referred pain". The decreased sensitivity to innocuous cold, warmth, and pressure pain was bilateral, indicating activation of endogenous net inhibitory mechanisms interacting bilaterally. We found no influence of pain intensity on somatosensory thresholds restricted to the referred pain area and light touch was the only affected modality in the referred pain area only.

Adult↗
PubMed2001

Improving the quality of pain treatment by a tailored pain education programme for cancer patients in chronic pain.

Educational interventions, aiming to increase patients' knowledge and attitude regarding pain, can affect pain treatment. The purpose of this study was to evaluate the effects of a Pain Education Programme (PEP), on adequacy of pain treatment, and to describe characteristics predicting change in adequacy. The PEP consists of a multi-method approach in which patients are educated about the basic principles regarding pain, instructed how to report pain in a pain diary, how to communicate about pain, and how to contact healthcare providers. The effects of the PEP were evaluated taking into consideration the lack of well-established outcome measures to evaluate adequacy of pain treatment, the lack of long-term follow-up, and the influence of missing data.A prospective, randomized study was utilized in which 313 chronic cancer patients were followed-up until 8 weeks postdischarge. Adequacy of pain treatment was evaluated by means of the Amsterdam Pain Management Index (APMI), consisting of an integrated score of patients' Present Pain Intensity, Average Pain Intensity, and Worst Pain Intensity, corrected for patients' Tolerable Present Pain, with the analgesics used by the patient. At pretest, 60% of the patients in the hospital were treated inadequately for their pain. Postdischarge, the control group patients were significantly more inadequately treated at 2 weeks after discharge (56% vs 41%), at 4 weeks after discharge (62% vs 42%) and at 8 weeks after discharge (57% vs 51%) than the intervention group patients. While the level of inadequacy in the control groups remained relatively stable at all assessment points, a slight increase in the percentage of patients being treated inadequately was found in the intervention group patients over time. A beneficial effect of the PEP was found for patients both with and without district nursing. Variables predicting an improvement in adequacy of pain treatment consisted of the PEP, the APMI score at baseline, patients' level of physical functioning, patients' level of social functioning, the extent of adherence to pain medication, patients' pain knowledge, and the amount of analgesics used. These findings suggest that quality of pain treatment in cancer patients with chronic pain can be enhanced by educating patients about pain and improving active participation in their own pain treatment. The benefit from the PEP, however, decreases slightly over time, pointing at a need for ongoing education.

Adult↗
PubMed1989

Labour pain: correlations with menstrual pain and acute low-back pain before and during pregnancy.

Low-back pain is a major component of labour pain in a substantial number of women. The purpose of this study was to determine whether episodes of acute low-back pain prior to pregnancy is a predictor of low-back pain during labour. 114 women received the Short-Form McGill Pain Questionnaire (SF-MPQ) during labour and were asked to describe the pain separately for front and back contraction pain or continuous pain. The day after the birth of the child the women were interviewed to determine whether they had (a) a history of episodes of acute low-back pain before pregnancy, (b) low-back pain during pregnancy, and (c) low-back pain during menstruation. The results show that episodic low-back pain before pregnancy is not correlated with any aspect of labour pain. However, it is significantly correlated with episodes of low-back pain during pregnancy. In contrast, low-back pain during menstruation is significantly correlated with labour pain scores recorded for back and front contraction pain as well as for continuous back pain. The significant correlation of labour pain with back pain during menstruation suggests that both share a common underlying mechanism. Similarly, the correlation of low-back pain during pregnancy with episodes of acute low-back pain before pregnancy suggests that the strain on back muscles during pregnancy may activate the mechanisms that underlie the usual forms of low-back pain.

Abdomen↗
PubMedDate not supplied

Hypervigilance to pain in fibromyalgia: the mediating role of pain intensity and catastrophic thinking about pain.

OBJECTIVE: To investigate the mediating role of pain intensity, catastrophic thinking about pain, and negative affectivity in explaining enhanced attention for pain in patients with fibromyalgia. METHODS: Sixty-four patients with fibromyalgia and 46 patients with chronic low back pain completed self-report instruments of vigilance to pain, negative affectivity, and catastrophic thinking about pain. These measures, along with diagnostic group and pain intensity, were entered into a partial correlational analysis to investigate which variables mediate the relationship between diagnostic group (fibromyalgia vs. chronic low back pain) and vigilance to pain. RESULTS: Fibromyalgia patients reported significantly greater vigilance to pain than patients with chronic low back pain. They also reported higher pain intensity, more negative affectivity, and more catastrophic thinking about pain than patients with chronic low back pain. Vigilance to pain was correlated significantly with pain intensity, negative affectivity, and catastrophic thinking about pain. Further analyses revealed that pain intensity and catastrophic thinking about pain, but not negative affectivity, mediated the relationship between diagnostic group and vigilance to pain. CONCLUSION: Fibromyalgia patients report a heightened vigilance to pain. This vigilance is not a unique characteristic of fibromyalgia but is related to the intensity of pain and catastrophic thinking about pain.

Adult↗