Mania reduces perceived pain intensity in patients with chronic pain: preliminary evidence from retrospective archival data

Pain has long been thought to wax and wane in relative proportion to fluctuations in the intensity of noxious stimuli. Dynamic aspects of nociceptive processing, however, remain poorly characterized. Here we show that small decreases (±1–3°C) in noxious stimulus temperatures (47–50°C) evoked changes in perceived pain intensity that were as much as 271% greater than those of equal magnitude increases. These decreases in perceived pain intensity were sufficiently large to be indistinguishable from those evoked by 15°C decreases to clearly innocuous levels. Furthermore, decreases in pain ratings following noxious stimulus offset were significantly greater than those occurring during adaptation to constant temperature stimuli. Together, these findings indicate that an analgesic mechanism is activated during noxious stimulus offset. This analgesic phenomenon may serve as a temporal contrast enhancement mechanism to amplify awareness of stimulus offset and to reinforce escape behaviors. Disruption of this mechanism may contribute importantly to chronic pain.

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How can the Alexithymia and Behavioural Inhibition predict the perceived pain intensity in patients with chronic pain?

Annales Médico-psychologiques revue psychiatrique ◽

10.1016/j.amp.2020.01.015 ◽

2020 ◽

Vol 178 (10) ◽

pp. 996-1001

Author(s):

Marzieh Pahlevan ◽

Mohammad Ali Besharat ◽

Ahmad Borjali ◽

Morteza Naghipoor

Keyword(s):

Chronic Pain ◽

Pain Intensity ◽

Behavioural Inhibition ◽

Perceived Pain

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Effects of Flotation-REST on Muscle Tension Pain

Pain Research and Management ◽

10.1155/2001/768501 ◽

2001 ◽

Vol 6 (4) ◽

pp. 181-189 ◽

Cited By ~ 32

Author(s):

Anette Kjellgren ◽

Ulf Sundequist ◽

Torsten Norlander ◽

Trevor Archer

Keyword(s):

Chronic Pain ◽

Pain Intensity ◽

Muscle Tension ◽

Control Group ◽

Water Tank ◽

Perceived Pain ◽

Environmental Stimulation ◽

Circulating Levels ◽

Stimulation Technique ◽

Experimental Group

The purpose of the present study was to investigate whether the floating form of the restricted environmental stimulation technique (REST) may be applied within the field of pain relief. Flotation-REST consists of a procedure whereby an individual is immersed in a tank filled with water of an extremely high salt concentration. Thirty-seven patients (14 men and 23 women) suffering from chronic pain consisting of aching muscles in the neck and back area participated in the study. They were randomly assigned to either a control group (17 participants) or an experimental group (20 participants). The experimental group received nine opportunities to use the flotation-REST technique in the water tank over a three-week period. The results indicated that the most severe perceived pain intensity was significantly reduced, whereas low perceived pain intensity was not influenced by the floating technique. Further, the results indicated that circulating levels of the noradrenaline metabolite 3-methoxy-4-hydroxyphenylethyleneglycol were reduced significantly in the experimental group but not in the control group following treatment, whereas endorphin levels were not affected by flotation. Flotation-REST treatment also elevated the participants' optimism and reduced the degree of anxiety or depression; at nighttime, patients who underwent flotation fell asleep more easily. The present findings describe possible changes, for the better, in patients presenting with chronic pain complaints.

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Faculty Opinions recommendation of Spinal cord-midbrain functional connectivity is related to perceived pain intensity: a combined spino-cortical FMRI study.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.725387434.793507192 ◽

2015 ◽

Author(s):

Jonathan Dostrovsky ◽

Massieh Moayedi

Keyword(s):

Spinal Cord ◽

Functional Connectivity ◽

Pain Intensity ◽

Fmri Study ◽

Perceived Pain

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Collecting patient reported outcomes to facilitate prescription opioid management: Development and testing of the Opioid Management App (OM-App) (Preprint)

10.2196/preprints.23633 ◽

2020 ◽

Author(s):

Jessica Robinson-Papp ◽

Gabriela Cedillo ◽

Richa Deshpande ◽

Mary Catherine George ◽

Qiuchen Yang ◽

...

Keyword(s):

Chronic Pain ◽

Pain Intensity ◽

Risk Behaviors ◽

Digital Health ◽

Monitoring Program ◽

Prescription Opioid ◽

Research Database ◽

Cross Sectional ◽

Study Duration ◽

Patient Reported

BACKGROUND Collecting patient-reported data needed by clinicians to adhere to opioid prescribing guidelines represents a significant time burden. OBJECTIVE We developed and tested an opioid management app (OM-App) to collect these data directly from patients. METHODS OM-App used a pre-existing digital health platform to deliver daily questions to patients via text-message and organize responses into a dashboard. We pilot tested OM-App over 9 months in 40 diverse participants with HIV who were prescribed opioids for chronic pain. Feasibility outcomes included: ability to export/integrate OM-App data with other research data; patient-reported barriers and adherence to OM-App use; capture of opioid-related harms, risk behaviors and pain intensity/interference; comparison of OM-App data to urine drug testing, prescription drug monitoring program data, and validated questionnaires. RESULTS OM-App data was exported/integrated into the research database after minor modifications. Thirty-nine of 40 participants were able to use OM-App, and over the study duration 70% of all OM-App questions were answered. Although the cross-sectional prevalence of opioid-related harms and risk behaviors reported via OM-App was low, some of these were not obtained via the other measures, and over the study duration all queried harms/risks were reported at least once via OM-App. Clinically meaningful changes in pain intensity/interference were captured. CONCLUSIONS OM-App was used by our diverse patient population to produce clinically relevant opioid- and pain-related data, which was successfully exported and integrated into a research database. These findings suggest that OM-App may be a useful tool for remote monitoring of patients prescribed opioids for chronic pain. CLINICALTRIAL NCT03669939 INTERNATIONAL REGISTERED REPORT RR2-doi:10.1016/j.conctc.2019.100468

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The Pain Situation of Older Home-Care Recipients and Influencing Factors

Innovation in Aging ◽

10.1093/geroni/igaa057.662 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 204-205

Author(s):

Dagmar Dräger ◽

Reinhold Kreutz ◽

Adelheid Kuhlmey ◽

Andrea Budnick ◽

Dagmar Draeger

Keyword(s):

Chronic Pain ◽

Home Care ◽

Older People ◽

Pain Intensity ◽

Prevalence Rate ◽

Severe Pain ◽

Self Report ◽

Primary Data ◽

Common Symptom ◽

Care Recipients

Abstract Chronic pain is a common symptom among older people. The international prevalence rate reaches 50% for older home-care recipients (aged ≥60). The most common causes of pain among older people are degenerative arthropathy and musculoskeletal diseases. Care recipients (81% aged ≥65) constitute a specific sub-group among pain patients, due to the restrictions they experience. In Germany, the prevalence rate in this group is 70%. Currently, no comprehensive information on the pain situation of older home-care recipients exists in Germany. The findings presented are based on a cross-sectional study of older (aged ≥65) home-care recipients (SGB XI) in Berlin, with chronic pain (n=225), capable of self-report (MMST≥18). Structured interviews comprised the primary data source. The pain situation was determined using the German Brief Pain Inventory (BPI-NH). Multiple regression analysis was applied to test how the most severe pain (dependent variable) was influenced by socio-demographic and medical parameters, mental and physical restrictions and pain medication. Analyses of the pain situation show a value of M=4.81 (SD±1.88) on the BPI intensity index, and a BPI pain interference index of M=5.47 (SD±2.15). The most intense pain averaged 6.96 (SD±2.15). On average, respondents reported 16.20 (SD±13.25) pain locations (range: 0-65). The number of pain locations, alongside other factors, had a significant influence, R²=0.038 (corrected R²=0.034), F (1.219) = 8.760, p<0.01), on pain intensity. The findings show severe pain intensity among older home-care recipients not reported in previous findings (e.g. in long-term in-patient care). Action in medical care, nursing care and educational aspects is urgently needed.

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Sleep disturbance in patients attending specialized chronic pain clinics in Denmark: a longitudinal study examining the relationship between sleep and pain outcomes

Scandinavian Journal of Pain ◽

10.1515/sjpain-2020-0155 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Henrik Bjarke Vaegter ◽

Mette Terp Høybye ◽

Frederik Hjorth Bergen ◽

Christine E. Parsons

Keyword(s):

Quality Of Life ◽

Chronic Pain ◽

Sleep Quality ◽

Pain Intensity ◽

Sleep Disturbances ◽

Pain Disability ◽

Pain Clinics ◽

Pain Outcomes

Abstract Objectives Sleep disturbances are highly prevalent in patients with chronic pain. However, the majority of studies to date examining sleep disturbances in patients with chronic pain have been population-based cross-sectional studies. The aims of this study were to 1) examine the frequency of sleep disturbances in patients referred to two interdisciplinary chronic pain clinics in Denmark, 2) explore associations between sleep disturbances and pain intensity, disability and quality of life at baseline and follow-up, and 3) explore whether changes in sleep quality mediated the relationships between pain outcomes at baseline and pain outcomes at follow-up. Methods We carried out a longitudinal observational study, examining patients enrolled in two chronic pain clinics assessed at baseline (n=2,531) and post-treatment follow-up (n=657). Patients reported on their sleep disturbances using the sleep quality subscale of the Karolinska Sleep Questionnaire (KSQ), their pain intensity using 0–10 numerical rating scales, their pain-related disability using the Pain Disability Index (PDI), and quality of life using the EuroQol-VAS scale. The average time between baseline and follow-up was 207 days (SD=154). Results At baseline, the majority of patients reported frequent sleep disturbances. We found a significant association at baseline between self-reported sleep disturbances and pain intensity, pain-related disability, and quality of life, where greater sleep disturbance was associated with poorer outcomes. At follow-up, patients reported significant improvements across all pain and sleep outcomes. In two mediation models, we showed that changes in sleep disturbances from baseline to follow-up were significantly associated with (i) pain intensity at follow-up, and (ii) pain disability at follow-up. However, baseline pain intensity and disability scores were not associated with changes in sleep disturbances and, we did not find evidence for significant mediation of either pain outcome by changes in sleep disturbances. Conclusions Self-reported sleep disturbances were associated with pain outcomes at baseline and follow-up, with greater sleep disturbances associated with poorer pain outcomes. Changes in sleep quality did not mediate the relationships between baseline and follow-up scores for pain intensity and disability. These findings contribute to a growing body of evidence confirming an association between sleep and chronic pain experience, particularly suggestive of a sleep to pain link. Our data following patients after interdisciplinary treatment suggests that improved sleep is a marker for a better outcome after treatment.

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Differential effects of expressive anger regulation on chronic pain intensity in CRPS and non-CRPS limb pain patients

Pain ◽

10.1016/s0304-3959(03)00135-0 ◽

2003 ◽

Vol 104 (3) ◽

pp. 647-654 ◽

Cited By ~ 50

Author(s):

Stephen Bruehl ◽

Ok Yung Chung ◽

John W Burns

Keyword(s):

Chronic Pain ◽

Pain Intensity ◽

Limb Pain ◽

Anger Regulation ◽

Differential Effects ◽

Pain Patients

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Outcomes of a Rehabilitation Programme for Patients with Chronic Back Pain

British Journal of Occupational Therapy ◽

10.1177/030802269505801010 ◽

1995 ◽

Vol 58 (10) ◽

pp. 435-438 ◽

Cited By ~ 4

Author(s):

Monica Moran ◽

Jenny Strong

Keyword(s):

Back Pain ◽

Pain Intensity ◽

Functional Capacity ◽

Chronic Back Pain ◽

Rehabilitation Programme ◽

Therapeutic Interventions ◽

Pain Disability ◽

Perceived Pain ◽

Disability Questionnaire ◽

Objective Outcome

In order to evaluate the effectiveness of a rehabilitation programme for patients with chronic back pain, data on the subjective outcomes of perceived pain intensity (as measured by the Visual Analogue Scale Horizontal) and perceived level of disability (as measured by the Oswestry Low Back Pain Disability Questionnaire), and the objective outcome of functional capacity (as measured by the West Standardised Evaluation), were collected on 51 subjects prior to entry into a back pain rehabilitation programme and at discharge. The results at discharge showed a significant reduction in the perceived level of disability and a significant Increase in the functional capacity. The perceived pain intensity did not change significantly. The discussion focuses on the importance of directing therapeutic interventions towards increasing physical function rather than concentrating on the reduction or elimination of pain.

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