Pain
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Comparative Study
Chronic pain-associated behaviors in the nursing home: resident versus caregiver perceptions.
Pain assessment in nursing home residents poses challenges since many of these individuals are too cognitively impaired to respond to traditional self-report instruments. Assessment of pain behavior in this population offers a logical alternative. The purpose of this study was to compare perceptions of behaviors identified as being pain-related in 42 nursing home residents with chronic pain, as reported by residents themselves, their nursing home caregivers and their family caregivers. ⋯ Confidence in pain rating was high for both nurse (on average, 7.2 on a scale of 0-10) and family (on average, 6.7) caregivers. Seventy-one percent of nurses felt that pain assessment is more difficult in demented individuals, but that cognitive function does not influence pain prevalence. While nursing home residents with chronic pain and their caregivers have different perceptions regarding which behaviors are pain-related, additional studies are required to determine the underpinnings of these differing perceptions and to determine the extent to which formal pain behavior observation protocols will be useful for evaluating nursing home residents with chronic pain.
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To clarify the relationships between physical, and psychosocial components of chronic pain, a path analytic model was tested conceptualizing self efficacy as a mediator of disability. In turn, disability was hypothesized to mediate depression. This model could help explain the circumstances under which disability develops and why so many chronic pain patients become depressed. ⋯ Therefore, the lack of belief in ones own ability to manage pain, cope and function despite persistent pain, is a significant predictor of the extent to which individuals with chronic pain become disabled and/or depressed. Nevertheless, these mediators did not eliminate the strong impact that high pain intensity has on disability and depression. Therefore, therapy should target multiple goals, including: pain reduction, functional improvement and the enhancement of self efficacy beliefs.
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The Chronic Pain Coping Inventory (CPCI; Jensen, M. P., Turner, J. A., Romano, J. ⋯ Several CPCI subscales were also found to be significantly and uniquely related to measures of concurrent adjustment, even after taking CSQ subscales and demographic and pain-related variables into account. These results suggest the CPCI is a valuable tool, above and beyond established coping measures, in the clinical assessment and research of pain. Directions for future research are discussed.
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We studied the associations between psychosocial variables and sick-leave among patients with musculoskeletal pain. Patients (n = 586) seeking care to relieve their pain at health care and physiotherapy centres, completed a questionnaire about such variables as clinical characteristics (e.g. pain intensity), psychological well-being (e.g. burnout, depression) and coping strategies. The results show that the patients who had been on sick-leave for >30 days (n = 217), were significantly more often divorced, immigrants, blue-collar workers and less educated than the rest of the sample. ⋯ After controlling for possible confounders, multivariate regression analyses showed that the strongest predictors of the disability index were symptoms of burnout and posttraumatic stress reactions. The results confirm that emotional distress, coping style and perceived disability are associated with sick-leave, after controlling for pain parameters and sociodemographic variables. The high levels of emotional distress and the poor coping capacity reported by the patients with a long history of absence due to illness suggest that cognitive behavioural interventions ought to be integrated in the treatment of musculoskeletal pain.
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In the this study we have investigated the threshold plasma concentration of lidocaine for reversal of mechanical 'allodynia' in a neuropathic pain model in the rat, defined the concentration-dependent limits of that reversal and compared the acute reversal during intravenous drug infusion with the persistent relief of allodynia assayed 48 h later. Actions of i.v. lidocaine on ipsilateral and contralateral legs were also assessed. Forty rats were sorted into five groups (n = 7-10) and underwent spinal root (L5-6) ligation to produce allodynia, as quantified by a lower force of von Frey hairs at the plantar hindpaw required to elicit paw withdrawal (PWT, paw withdrawal threshold). ⋯ Contralateral allodynia, despite its acute reversal during infusion to 2.1 microg/ml and higher, was not persistently relieved after infusion of lidocaine to any concentration. Repeated infusions to subthreshold levels (<2 microg/ml) did not provide persisting relief of allodynia on either side, and infusions of saline were impotent. These findings show that experimental allodynia results from multiple factors, only some of which are sensitive to lidocaine treatment, and that prolonged reversal of allodynia is limited in extent and likely influenced by pre-existing factors.