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At least 19 recordsLinked to original sources
PubMed2001

The effects of failure feedback and pain-related fear on pain report, pain tolerance, and pain avoidance in chronic low back pain patients.

The aim of this study was to investigate the influence of non-pain-related failure experiences and pain-related fear on pain report, pain tolerance and pain avoidance in chronic low back pain (CLBP) patients. Moreover, the mediating and moderating role of negative affectivity (trait-NA) in the relationship between failure experiences and pain was examined. Seventy-six patients were divided into high and low pain-related fear groups and within each group they were randomly assigned to the failure or success feedback condition. In the first part of the study patients completed a 'social empathy test' and experimenter 1 subsequently delivered false failure or success feedback. A second experimenter, who was blind for the condition, subsequently administered two lifting tasks in order to obtain measures of pain report, tolerance and avoidance. Failure feedback did have an effect on pain avoidance but unexpectedly, and not as hypothesized, pain avoidance was reduced instead of enhanced. With regard to pain report and pain tolerance similar patterns were found, but these were not statistically significant. The effect of failure feedback on pain avoidance was moderated by trait-NA. Only in the subgroup of patients who scored low on trait-NA did failure feedback decrease pain avoidance. State-NA did not mediate the effects of feedback. In line with previous findings, pain-related fear resulted in lower pain tolerance. Moreover, this study was the first to show that pain-related fear predicted higher pain report in CLBP patients. Pain-related fear did not predict pain avoidance when pre-lifting pain and gender were controlled for. Finally, pre-lifting pain turned out to be the strongest predictor with regard to all pain measures. The role of pain-related fear and unexpected findings with regard to feedback are discussed as well as some clinical implications.

Adaptation, Psychological↗
PubMed2006

Electronic momentary assessment in chronic pain II: pain and psychological pain responses as predictors of pain disability.

OBJECTIVES AND METHODS: More than 7,100 electronic diaries from 80 patients with chronic pain (mean: 89.3, range 30-115) entered multilevel analyses to establish the statistical prediction of disability by pain intensity and by psychological functioning (fear avoidance, cognitive, and spousal pain responses). We also tested the differences between pre-chronic, recently chronic, and persistently chronic pain in the prediction of disability (impaired physical and mental capacity, pain interference with activities, immobility due to pain). RESULTS: Pain intensity explained 8% to 19% of the disability variance. Beyond this psychological functioning explained 7% to 16%: particularly fear-avoidance and cognitive pain responses predicted chronic pain disorder disability; spousal responses predicted immobility better than other aspects of disability. Immobility due to actual pain occurred infrequently. When it did, however, it was better predicted by avoidance behavior in the patient and by spousal discouragement of movement than by actual pain intensity. The prediction of immobility due to pain by, respectively, avoidance behavior and catastrophizing was better in chronic pain (>6 months) and that of physical impairment by catastrophizing better in persistently chronic pain (>12 months) than in pain of shorter duration. DISCUSSION: The psychological prediction of chronic pain disorder disability was determined beyond that accounted for by pain intensity. Nonetheless, psychological functioning explained substantial variance in chronic pain disorder disability. The psychological prediction of immobility and physical impairment was stronger with longer pain duration. Patient characteristics and momentary states of disability-and in particular of immobility-should be carefully distinguished and accounted for in chronic pain disorder.

Adult↗
PubMed2005

Fear of pain, not pain catastrophizing, predicts acute pain intensity, but neither factor predicts tolerance or blood pressure reactivity: an experimental investigation in pain-free individuals.

Previous studies of the Fear-Avoidance Model of Exaggerated Pain Perception have commonly included patients with chronic low back pain, making it difficult to determine which psychological factors led to the development of an "exaggerated pain perception". This study investigated the validity of the Fear-Avoidance Model of Exaggerated Pain Perception by considering the influence of fear of pain and pain catastrophizing on acute pain perception, after considering sex and anxiety. Thirty-two males and 34 females completed the State-Trait Anxiety Inventory, the Fear of Pain Questionnaire, and the Coping Strategies Questionnaire. Subjects underwent a cold pressor procedure and tolerance, pain intensity, and blood pressure reactivity were measured. Sex, anxiety, fear of pain, and pain catastrophizing were simultaneously entered into separate multiple regression models to predict different components of pain perception. Tolerance was not predicted by fear of pain, pain catastrophizing, or anxiety. Pain intensity at threshold and tolerance were significantly predicted by fear of pain, only. Blood pressure reactivity to pain was significantly predicted by anxiety, only. These results suggest that fear of pain may have a stronger influence on acute pain intensity when compared to pain catastrophizing, while neither of the factors predicted tolerance or blood pressure reactivity.

Acute Disease↗
PubMed2000

Painful pricks and prickle pains: is there a relation between children's ratings of venipuncture pain and parental assessments of usual reaction to other pains?

OBJECTIVE: The objective of this study was to examine whether parental assessment of a child's usual behavioral reaction to common painful events predicts the child's ratings of needle pain intensity from routine venipuncture. DESIGN: Children aged 3 to 12 years (n = 88) used the Faces Pain Scale to rate how much venipuncture hurt and also indicated whether the pain was more, less, or the same as expected. The child's parent (mother) used the same scale to predict how much the needle would hurt the child as well as to rate the child's pain as observed at the time of venipuncture. Parents also estimated their child's usual reaction to six common painful events. An independent observer used a behavioral checklist to rate the child's pain response at the time of venipuncture as well as to assign a global pain rating on the Faces Pain Scale. OUTCOME MEASURES: The Faces Pain Scale and a behavioral checklist (scoring facial, vocal, motor, and verbal reactions) were used in this study. RESULTS AND CONCLUSIONS: Those children who reported venipuncture as hurting more than expected also gave the highest mean needle pain ratings and tended to have their pain underpredicted by their parents before venipuncture. For these children, parental estimates of reactions to other painful events proved to be a useful predictor of self-reported needle pain. Parent and child ratings of pain agreed more closely for those parents who indicated having relied on what their child "did" rather than "said." Additionally, and consistent with previous studies, independent observation of children's facial responses was the most useful indicator of needle pain severity. Preparation of children for venipuncture may be enhanced by asking a parent beforehand how the child usually responds to everyday pain. Specifically, reaction to other sharp time-limited pains (e.g., finger pinch, stepping on a prickle) may provide a useful guide to identifying which children will report experiencing greater pain than expected from venipuncture.

Child↗
PubMed1985

The McGill Pain Questionnaire in the assessment of phasic and tonic experimental pain: behavioral evaluation of the 'pain inhibiting pain' effect.

The McGill Pain Questionnaire (MPQ), supplemented with a German version, was administered to 10 healthy subjects to evaluate two laboratory pain models. Ischemia pain was induced as a tonic pain model and electrical intracutaneous stimuli were applied as a model of phasic pain. In addition, both pain models were employed simultaneously in order to evaluate their mutual influence. Tonic pain was rated higher than phasic pain on the affective, evaluative and miscellaneous MPQ subscales. Furthermore, the sensory descriptor choices for the two pain models were dissimilar, although the number of words chosen as well as the intensity represented by these words were of equal magnitude. These findings indicate that the sensory quality of the pain models is different and that the aversive component is much greater for the tonic pain than for the phasic pain. When applied simultaneously, tonic pain was able to inhibit phasic pain perception. This modulation could be demonstrated on visual analog scales of intensity (-44%) and aversiveness (-49%), on a 10-point category scale (-27%), and on the MPQ scores present pain intensity (PPI) (-29%), number of words chosen (NWC) (-25%) and pain rating intensity (PRI) (-28%). Differences were significant on the 5% level for the visual analog scales, the category scale and PPI. Evaluation of the MPQ subscales revealed that mainly the affective dimension of phasic pain was reduced under concurrent tonic pain. It is concluded that the MPQ is as well-suited to characterize differential analgesic effects as it is to differentiate properties of pain models.

Adult↗
PubMed2006

Pain-related impairment and health care utilization in children and adolescents: a comparison of orofacial pain with abdominal pain, back pain, and headache.

OBJECTIVE: The purpose was to compare orofacial (temporomandibular) pain with other pain complaints regarding impairment and health care utilization in a sample of 1,011 children and adolescents from a metropolitan area in Germany. METHOD AND MATERIALS: Individuals aged 10 to 18 years were sampled in schools using a 2-stage cluster technique. Orofacial pain in the previous month was assessed according to the Research Diagnostic Criteria for Temporomandibular Disorders. Additionally, participants were questioned about headache, back pain, abdominal pain, pain-related impairment, and health care utilization (visits to doctors, analgesic consumption) in the previous month. RESULTS: Headache was reported by 50% (95% CI: 45% to 56%) of participants, stomach pain by 36% (95% CI: 32% to 41%), back pain by 31% (95% CI: 25% to 36%), and orofacial pain by 15% (95% CI: 12% to 18%). Girls were more affected than boys. The range of "severe" and "very severe" impairment lay between 8% (orofacial pain) and 22% (headache). The range of treatment demand was between 10% and 17% (orofacial pain: 15%), and the range for analgesic consumption between 18% and 24% (orofacial pain: 22%). The more pain experienced, the more impairment, doctor consultations, and analgesic consumption were reported (Chi2test: P < 0.05). Risk of orofacial pain was 60% higher for subjects with head, back, and/or abdominal pain (odds ratio: 1.6; 95% CI: 1.3 to 1.9). CONCLUSION: In children and adolescents, orofacial pain occurs about half as often as other pain complaints. However, relative to their prevalence the different pain complaints are similar regarding impairment and health care utilization.

Abdominal Pain↗
PubMed2004

Electronic diary assessment of pain-related fear, attention to pain, and pain intensity in chronic low back pain patients.

The present study investigated the relationships between pain-related fear, attention to pain, and pain intensity in daily life in patients with chronic low back pain. An experience sampling methodology was used in which electronic diary data were collected by means of palmtop computers from 40 chronic low back pain patients who were followed for one week. Attention to pain was hypothesized to mediate the relation between pain-related fear and pain intensity. Further, pain-related fear as a trait characteristic was expected to moderate the relation between attention to pain and pain intensity. Multi-level analysis was used for all analyses. Although the tested mediation models yielded statistically significant mediation effects, the sizes of these effects were relatively small and clinically irrelevant. Instead, results suggested that pain-related fear and attention to pain independently predicted pain intensity. No evidence for moderation of the relation between attention to pain and pain intensity by pain-related fear as a trait characteristic was found. Implications of the results from this study are discussed and suggestions for future research are provided.

Adaptation, Psychological↗
PubMed1999

Pain-related fear is more disabling than pain itself: evidence on the role of pain-related fear in chronic back pain disability.

There is growing evidence for the idea that in back pain patients, pain-related fear (fear of pain/physical activity/(re)injury) may be more disabling than pain itself. A number of questionnaires have been developed to quantify pain-related fears, including the Fear-Avoidance Beliefs Questionnaire (FABQ), the Tampa Scale for Kinesiophobia (TSK), and the Pain Anxiety Symptoms Scale (PASS). A total of 104 patients, presenting to a rehabilitation center or a comprehensive pain clinic with chronic low back pain were studied in three independent studies aimed at (1) replicating that pain-related fear is more disabling than pain itself (2) investigating the association between pain-related fear and poor behavioral performance and (3) investigating whether pain-related fear measures are better predictors of disability and behavioral performance than measures of general negative affect or general negative pain beliefs (e.g. pain catastrophizing). All three studies showed similar results. Highest correlations were found among the pain-related fear measures and measures of self-reported disability and behavioral performance. Even when controlling for sociodemographics, multiple regression analyses revealed that the subscales of the FABQ and the TSK were superior in predicting self-reported disability and poor behavioral performance. The PASS appeared more strongly associated with pain catastrophizing and negative affect, and was less predictive of pain disability and behavioral performance. Implications for chronic back pain assessment, prevention and treatment are discussed.

Adult↗
PubMed2005

The cancer pain experience of Israeli adults 65 years and older: the influence of pain interference, symptom severity, and knowledge and attitudes on pain and pain control.

GOALS: Little is known about Israeli elders' cancer pain experience. The purpose of this study was to explore the cancer pain experience, including pain intensity, pain management index, pain interference, symptom severity, and knowledge and attitudes toward pain and pain control. PATIENTS AND METHODS: Descriptive cross-sectional methods were used to obtain data with four instruments. The patients were 39 Israelis 65 years and older who were receiving outpatient treatment for cancer in a major hospital center in Israel. RESULTS: Results showed that over half (56.7%) reported severe worst pain and had negative pain management indexes (56.4%). In addition, knowledge and attitudes toward pain and pain control were poor (54.55%). There were no significant relationships between pain intensity and other variables. However, pain interference demonstrated a significant positive relationship with symptom severity. Post hoc analysis revealed that Ashkenazi Jewish and more educated patients reported significantly less pain interference than Sephardic Jewish patients. CONCLUSION: Larger samples representative of the cultural differences in Israel are needed to more definitively identify elements of the cancer pain experience in Israeli elders that can be addressed to improve pain management.

Aged↗
PubMed1997

Prevalence of pain combinations and overall pain: a study of headache, stomach pain and back pain among school-children.

The prevalence of pain combinations among school children is addressed in view of earlier findings of high pain prevalence in this population. The study considers the prevalence of combinations of three common pains headache, stomach pain and back pain-in a random national sample of 2173 Icelandic 11-12 and 15-16 year-old school children. According to the results from this study there is a 78.2% prevalence of monthly pain. One or more instances of weekly pain is experienced by 40.4% of the children, and 15.6% experience two or three pains weekly. Relevance of gender is greater when dealing with combinations of monthly than weekly pain. Combinations of weekly pains are more gender related than single weekly pains. Girls have significantly more frequent overall pain than boys. The distribution of pain combinations varies by age but not overall pain. The study yields important information about the extent of the overall problem of pain among school children and indicates the need to further study the correlates of different pain combinations in this age group.

Abdominal Pain↗
PubMed1996

Relationship of subjective disability with pain intensity, pain duration, pain location, and work-related factors in nonoperated patients with chronic low back pain.

OBJECTIVE: A cross-sectional study on patients with chronic low back pain to compare relationships between subjective disability and pain intensity, pain duration, pain location, and work-related factors. DESIGN AND SUBJECTS: One hundred and seven outpatients with low back pain, with or without radiation to the legs, of at least 3 months' duration, were administered a comprehensive back patient questionnaire. The questionnaire included the Pain Disability Index (PDI) for the assessment of overall perceived disability and assessments of pain intensity, duration, and location and two pretested short-form work questionnaires. None of the patients had undergone a back operation. SETTING: Tertiary care center. RESULTS: There was evidence of significant interrelationships between the PDI and pain intensity (low back pain, r = 0.53, p < 0.001; leg pain, r = 0.32, p < 0.01; and buttock pain, r = 0.36, p < 0.01), pain location (significantly higher scores with distal pain radiation), and work-related factors (a work load sum score of r = 0.31, p < 0.01; significantly higher scores in patients on sick leave). CONCLUSIONS: The results suggest that subjective disability in patients with chronic low back pain overlaps with both pain and work-related factors. The observations support the multidimensionality of low back disability.

Adolescent↗
PubMed2006

[Effects of pain control education on pain control barrier, postoperative pain and pain control satisfaction in gynecological patients].

PURPOSE: The purpose of this study was to evaluate the effects of preoperative pain control education on the pain control barrier, postoperative pain and pain control satisfaction in gynecological patients. METHOD: The study was a quasi-experimental research design. There were 58 subjects who were admitted for gynecological surgery to D University Hospital in B city. Pain control education was provided individually to the experimental group one day before their operation day for 20 minutes with the 'Pain Control Guide Book' in the patient's admission room. The education book was made by researchers based on pain management references and patient interviews. For assessing the pain control barrier, a simplified version of Barriers Questionnaire was used, postoperative pain was assessed on a numeric scale(0-10) and satisfaction of pain control was assessed by one question. RESULTS: The pain control barrier(F=15.828, p<.001) and the post pain score of the experimental group was lower than that of the control group. In addition, pain control satisfaction of the experimental group(t=3.612, p<.001) was higher than the control group's. CONCLUSION: With the above results, preoperative pain control education could be an effective nursing intervention for pain control of surgical patients.

Adult↗
PubMed2001

Imaging the pain of low back pain: functional magnetic resonance imaging in combination with monitoring subjective pain perception allows the study of clinical pain states.

Most brain imaging studies of pain are done using a two-state subtraction design (state-related design). More recently event-related functional magnetic reasonance imaging (fMRI) has also been used for studying pain. Both designs severely limit the application of the technology to clinical pain states. Recently we demonstrated that monitoring time fluctuations of perceived pain could be used with fMRI to identify brain regions involved in conscious, subjective perception of pain. Here we extend the methodology to demonstrate that the same approach can be used to study clinical pain states. Subjects are equipped with a finger-spanning device to continuously rate and log their perceived pain during fMRI data collection. These ratings are convolved with a canonical hemodynamic response function to generate predictor waveforms with which related brain activity can be identified. Chronic low back pain patients and a normal volunteer were used. In one series of fMRI scans the patient simply lies in the scanner and indicates spontaneous fluctuations of the subjective pain. In other fMRI scans, a straight-leg raising procedure is performed to exacerbate the back pain. In the normal volunteer, fMRI scans were done during painful and non-painful straight-leg raisings. The results indicate the feasibility of differentiating between different pain states. We argue that the approach can be generalized to identify brain circuitry underlying diverse clinical pain conditions.

Brain Mapping↗
PubMed2003

The Zero Acceptance of Pain (ZAP) Quality Improvement Project: evaluation of pain severity, pain interference, global quality of life, and pain-related costs.

The Zero Acceptance of Pain (ZAP) Quality Improvement Project was a multi-site effort to improve the lives of outpatients with cancer pain by enhancing the clinical practice of pain assessment and management. Independent samples of patients completed self-report measures of severity of pain, pain interference, global quality of life, pain treatment satisfaction, general medical treatment satisfaction, pain attitudes, and pain-related medical costs before and after the implementation of ZAP. Results suggested that ZAP decreased the severity of recent pain, decreased interference of pain on daily functioning, and improved satisfaction with pain treatment and attitudes about addiction to opioid medication. Direct medical costs consisting of pain-related hospitalizations, emergency department visits, and physician office visits were greatly reduced. In summary, the findings of this study support the idea that clinic-based efforts to improve the practice of pain management are effective in improving the lives of cancer patients who are experiencing pain.

Adult↗
PubMed2002

Nurse-led pain management program: effect on self-efficacy, pain intensity, pain-related disability, and depressive symptoms in chronic pain patients.

Nurses routinely use a variety of nonpharmacologic and patient education interventions designed to reduce pain and promote independence. Research on group programs that combine these nursing strategies in a systematic approach provides evidence that chronic pain patients can realize an enhanced confidence in their ability to manage pain (improved self-efficacy) in addition to reductions in pain, emotional distress, and disability. The purpose of this study was to investigate the effect of participating in a nurse-led cognitive-behavioral treatment (CBT) pain management program on self-efficacy, pain intensity, pain-related disability, and depressive symptoms among patients with chronic pain. Pre- and postprogram data from 154 participants were examined to identify changes in pain intensity, self-efficacy, disability, and depressive symptoms. Mean differences, effect sizes, and 95% confidence intervals were computed for the study variables and paired t-tests were done to determine if changes were significant. Z-scores were then calculated. Pearson product moment correlations were examined to test the association between changes in self-efficacy and changes in the other variables of interest. Patients in this study reported significant improvements in all scores postprogram. Self-efficacy, pain-intensity, pain-related disability, and symptoms of depression can be changed through participation in a nurse-led outpatient CBT program. In concert with results from other research on CBT pain programs this study provides further evidence that reduction in suffering and improved sense of well-being is possible even for people who have experienced pain for many years.

Activities of Daily Living↗
PubMed1997

[Quality control in the therapy of chronic pain. Results obtained by a task force of the German Section of the International Association for the Study of Pain on psychological assessment of chronic pain. XI. Assessment and multiaxial classification of pain].

This paper reviews instruments in German language for the psychological assessment and classification of pain. Usually chronic pain syndromes are classified within the International Classification of Diseases (ICD). Instead of the psychiatric chapter of the ICD, it is possible to use the Diagnostic and Statistical Manual of Mental Disorders (DSM). The proposed classification system of the International Association of the Study of Pain (IASP) is based on a multiaxial solution. The numerous ways to classify chronic pain include many problems and limits, especially in the case of an interdisciplinary assessment. They provide no specific system for classifying pain syndromes. They are impractical to handle and restrict classifying pain as either somatogenic or psychogenic. It is not possible to describe both sides in one diagnosis without loss of information. As a result of this situation, a task force of the German Chapter of the International Association for the Study of Pain developed a Multiaxial Classification of Pain (Multiaxiale Schmerzklassifikation; MASK) as an advanced system of pain assessment and an alternative to the common classification systems. MASK embraces a somatic (MASK-S) and a psychological (MASK-P) part. Both parts constitute an 'interdisciplinary diagnosis'. MASK-S enables classifying a pain syndrome using hierarchical levels, with progredient specific degrees of differentiation. In addition there are 6 axes to describe pain syndromes qualitatively and quantitatively (e.g. localization, quality). The psychosocial part (MASK-P) embraces 5 main levels (1. behavioral, 2. emotional, 3. cognitive, 4. stress-related, 5. habitual personal factors) and 2 additional levels (6. functional coherence, 7. ICD/DSM-diagnosis additional). The MASK-P part of the diagnosis is composed of graduation on these levels. Differential axis of the pain syndromes are described phenomenologically and specifically. MASK provides the possibility of establishing an integrative, interdisciplinary diagnosis.

English Abstract↗
PubMed2006

Inner experience of pain: imagination of pain while viewing images showing painful events forms subjective pain representation in human brain.

Pain is an unpleasant sensation, and at the same time, it is always subjective and affective. Ten healthy subjects viewed 3 counterbalanced blocks of images from the International Affective Picture System: images showing painful events and those evoking emotions of fear and rest. They were instructed to imagine pain in their own body while viewing each image showing a painful event (the imagination of pain). Using functional magnetic resonance imaging, we compared cerebral hemodynamic responses during the imagination of pain with those to emotions of fear and rest. The results show that the imagination of pain is associated with increased activity in several brain regions involved in the pain-related neural network, notably the anterior cingulate cortex (ACC), right anterior insula, cerebellum, posterior parietal cortex, and secondary somatosensory cortex region, whereas increased activity in the ACC and amygdala is associated with the viewing of images evoking fear. Our results indicate that the imagination of pain even without physical injury engages the cortical representations of the pain-related neural network more specifically than emotions of fear and rest; it also engages the common representation (i.e., in ACC) between the imagination of pain and the emotion of fear.

Adult↗
PubMed2004

Alpha-1 adrenoceptor hyperresponsiveness in three neuropathic pain states: complex regional pain syndrome 1, diabetic peripheral neuropathic pain and central pain states following spinal cord injury.

The pathophysiology of the pain associated with complex regional pain syndrome, spinal cord injury and diabetic peripheral neuropathy is not known. The pain of complex regional pain syndrome has often been attributed to abnormal sympathetic nervous system activity based on the presence of vasomotor instability and a frequently reported positive response, albeit a temporary response, to sympathetic blockade. In contrast, the pain below the level of spinal cord injury and diabetic peripheral neuropathy are generally seen as deafferentation phenomena. Each of these pain states has been associated with abnormal sympathetic nervous system function and increased peripheral alpha-1 adrenoceptor activity. This increased responsiveness may be a consequence of alpha-1 adrenoceptor postsynaptic hypersensitivity, or alpha-2 adrenoceptor presynaptic dysfunction with diminished noradrenaline reuptake, increased concentrations of noradrenaline in the synaptic cleft and increased stimulation of otherwise normal alpha-1 adrenoceptors. Plausible mechanisms based on animal research by which alpha-1 adrenoceptor hyperresponsiveness can lead to chronic neuropathic-like pain have been reported. This raises the intriguing possibility that sympathetic nervous system dysfunction may be an important factor in the generation of pain in many neuropathic pain states. Although results to date have been mixed, there may be a greater role for new drugs which target peripheral alpha-2 adrenoceptors (agonists) or alpha-1 adrenoceptors (antagonists).

Animals↗