Pain
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Few studies have systematically evaluated nonmedical use of prescription opioids (NMU) among U. S. military veterans, those who report pain, and those with human immunodeficiency virus (HIV). An increased understanding of the factors associated with NMU may help providers to balance maintaining patient access to prescription opioids for legitimate medical reasons and reducing the risks of addiction. ⋯ Being overweight (AOR 0.6) or obese (AOR 0.5) and having a higher 12-Item Short-Form Health Survey (SF-12) Mental Component Summary (AOR 0.98) were associated with less NMU. Patients with and without NMU did not differ on HIV status or SF-12 Physical Component Summary. Veterans in care have a high prevalence of NMU that is associated with substance use, medical status, and pain interference, but not HIV status.
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Randomized Controlled Trial
Symptoms of depression and stress mediate the effect of pain on disability.
The mechanism or mechanisms involved in the development of pain-related disability in people with low back pain is unclear. Psychological distress has been identified as one potential pathway by which an episode of pain influences the development of persistent disabling symptoms; however, the relationship has not been formally investigated. This study investigated the causal relationship between pain and disability via psychological distress (and its components depression, stress, and anxiety) by using mediation path analysis. ⋯ The finding that psychological distress only partially (30%) mediated the pain-disability relationship indicates that other factors should also be explored. Further analysis into the components of psychological distress revealed that the symptoms of depression and stress, but not anxiety, are responsible for mediation of the pain-disability relationship. These findings provide an opportunity to decrease the risk of long-term disability through early identification and management of depressive and stress symptoms.
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Contrary to a clinical aphorism that early head and neck cancer is painless, we show that patients who develop head and neck cancer experience significant pain at the time of initial diagnosis. We compared orofacial pain sensitivity in groups of patients with normal oral mucosa, oral precancer, and newly diagnosed oral cancer. The University of California San Francisco Oral Cancer Pain Questionnaire was administered to these patients at their initial visit, before being prescribed analgesics for pain and before any treatment. ⋯ Moreover, oral cancer patients experienced significantly higher function-related, rather than spontaneous, pain qualities. These findings suggest an important predictor for the transition from oral precancer to cancer may be the onset of orofacial pain that is exacerbated during function. Screening patients who have new-onset orofacial pain may lead to a diagnosis of early resectable head and neck cancer and may improve quality of life and survival for head and neck cancer patients.
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The present study aimed to develop norms for the Tampa Scale for Kinesiophobia (TSK), a frequently used measure of fear of movement/(re)injury. Norms were assessed for the TSK total score as well as for scores on the previously proposed TSK activity avoidance and TSK somatic focus scales. Data from Dutch, Canadian, and Swedish pain samples were used (N=3082). ⋯ Gender was predictive of TSK somatic focus scores and age of TSK activity avoidance scores, with male patients having somewhat higher scores than female patients and older patients having higher scores compared with younger patients. In the Canadian (N=510) and Swedish (N=336) samples, gender was predictive of all TSK scales, with male patients having somewhat higher scores than female patients. These norm data may assist the clinician and researcher in the process of decision making and treatment evaluation.