Pain
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It has been proposed that goal pursuit plays a role in the development of chronic pain disorders. On the basis of (affective) motivational theories, it was hypothesized that both long-term achievement goals and short-term hedonic goals would be related to increased levels of pain and disability, particularly in patients with high negative affect. Participants with musculoskeletal pain complaints (N=299) completed a battery of questionnaires including a novel goal pursuit questionnaire (GPQ) measuring the extent to which participants preferred hedonic goals (mood-management or pain-avoidance goals) over achievement goals in various situations. ⋯ These findings provide support for the validity of an affective-motivational approach to chronic pain, suggesting that the experience of pain and the interference of pain on daily life activities depends on goal pursuit and negative affect. Interventions aimed at improving disability in chronic pain should address both patient's goal pursuit and negative affect. An affective-motivational approach to chronic pain indicates that achievement and pain-avoidance goals are associated with pain severity and disability, particularly in patients with high negative affect.
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Chronic pain is a common reason for medical visits, but prevalence estimates vary between studies and have rarely included drug treatment data. This study aimed to examine characteristics of chronic pain and its relation to demographic and health factors, and factors associated with treatment of pain with opioid analgesics. A chronic pain module was added to the 2007 Kansas Behavioral Risk Factor Surveillance System (response rate = 61%). ⋯ S. A. Overall, 45.7% of people who take prescription drugs for chronic pain reported taking opioid analgesics.
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Some expert guidelines recommend time-scheduled opioid dosing over pain-contingent dosing for patients receiving chronic opioid therapy (COT). The premise is that time-scheduled dosing results in more stable opioid blood levels and better pain relief, fewer adverse effects, less reinforcement of pain behaviors, and lower addiction risk. We report results of a survey of 1781 patients receiving COT for chronic noncancer pain, in which 967 reported time-scheduled opioid dosing only and 325 reported pain-contingent opioid dosing only. ⋯ Controlled comparative effectiveness research is needed to assess benefits and risks of time-scheduled opioid dosing relative to pain-contingent opioid dosing among COT patients in ambulatory care. Patients with time-scheduled dosing received higher opioid dosage than patients with pain-contingent dosing. Time-scheduled dosing was associated with greater opioid control concerns than pain-contingent dosing.
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Opioid receptors are major actors in pain control and are broadly distributed throughout the nervous system. A major challenge in pain research is the identification of key opioid receptor populations within nociceptive pathways, which control physiological and pathological pain. In particular, the respective contribution of peripheral vs. central receptors remains unclear, and it has not been addressed by genetic approaches. ⋯ Delta receptors in these neurons tonically inhibit mechanical hypersensitivity in both inflammatory and neuropathic pain, and they are essential to mediate delta opioid analgesia under conditions of persistent pain. This delta receptor population represents a feasible therapeutic target to alleviate chronic pain while avoiding adverse central effects. The conditional knockout of delta-opioid receptor in primary afferent Na(V)1.8 neurons augmented mechanical allodynia in persistent pain models and abolished delta opioid analgesia in these models.
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"Pain exposure" physical therapy (PEPT) is a new treatment for patients with complex regional pain syndrome type 1 (CRPS-1) that consists of a progressive-loading exercise program and management of pain-avoidance behavior without the use of specific CRPS-1 medication or analgesics. The aim of this study was to investigate primarily whether PEPT could be applied safely in patients with CRPS-1. Twenty patients with CRPS-1 were consecutively enrolled in the study after giving informed consent. ⋯ Three patients initially showed increased vegetative signs but improved in all other CRPS parameters and showed good functional recovery at follow-up. We conclude that PEPT is a safe and effective treatment for patients with CRPS-1. A progressive-loading exercise program and management of pain-avoidance behavior without the use of specific medication ("pain exposure" physical therapy) is safe and effective for patients with complex regional pain syndrome.