Pain
-
Our aim was to asses the efficacy of deep brain stimulation in post-stroke neuropathic pain. Since 2000, 15 patients with post-stroke intractable neuropathic pain were treated with deep brain stimulation of the periventricular gray area (PVG), sensory thalamus (Ventroposterolateral nucleus-VPL) or both. ⋯ However, there is a wide variation between patients. This study demonstrates that it is an effective treatment in 70% of such patients.
-
Clinical Trial
Acute low back pain: pain-related fear and pain catastrophizing influence physical performance and perceived disability.
Pain-related fear and pain catastrophizing are associated with disability and actual performance in chronic pain patients. In acute low back pain (LBP), little is known about the prediction of actual performance or perceived disability by pain-related fear and pain catastrophizing. This experimental, cross-sectional study aimed at examining whether pain-related fear and pain catastrophizing were associated with actual performance and perceived disability. ⋯ Using the Roland Disability Questionnaire as a measure of perceived disability, both pain-related fear and pain catastrophizing, as measured with the Pain Catastrophizing Scale, were significantly predictive of perceived disability and more strongly than pain intensity was. The results of the current study suggest that pain-related fear is an important factor influencing daily activities in individuals suffering an episode of acute LBP. The study results have important clinical implications, especially in the development of preventive strategies for chronic LBP.
-
Randomized Controlled Trial
Mechanisms of placebo analgesia: rACC recruitment of a subcortical antinociceptive network.
Placebo analgesia is one of the most striking examples of the cognitive modulation of pain perception and the underlying mechanisms are finally beginning to be understood. According to pharmacological studies, the endogenous opioid system is essential for placebo analgesia. Recent functional imaging data provides evidence that the rostral anterior cingulate cortex (rACC) represents a crucial cortical area for this type of endogenous pain control. ⋯ BOLD-responses to the painful laser-stimulation during the placebo and no-placebo condition were assessed using event-related fMRI. After having confirmed placebo related activity in the rACC, a connectivity analysis identified placebo dependent contributions of rACC activity with bilateral amygdalae and the periaqueductal gray (PAG). This finding supports the view that placebo analgesia depends on the enhanced functional connectivity of the rACC with subcortical brain structures that are crucial for conditioned learning and descending inhibition of nociception.
-
Clinical Trial
The relationship of adult attachment to emotion, catastrophizing, control, threshold and tolerance, in experimentally-induced pain.
Although insecure attachment has been associated with a range of variables linked with problematic adjustment to chronic pain, the causal direction of these relationships remains unclear. Adult attachment style is, theoretically, developmentally antecedent to cognitions, emotions and behaviours (and might therefore be expected to contribute to maladjustment). It can also be argued, however, that the experience of chronic pain increases attachment insecurity. ⋯ Of particular interest were findings that attachment style moderated the effects of pain intensity on the tendency to catastrophize, such that insecurely attached individuals were more likely to catastrophize when reporting high pain intensity. This is the first study to link attachment with perceptions of pain in a pain-free sample. These findings cast anxious attachment as a vulnerability factor for chronic pain following acute episodes of pain, while secure attachment may provide more resilience.
-
Low back pain (LBP) is a common symptom among adults but little is known about its persistence over time in defined populations. The aim of this study was to examine the persistence of LBP among a cohort of industrial employees studied in four successive surveys during a total of 28 years. Cross-tabulations and logistic regression was used to estimate the interdependence of LBP occurrence at the surveys. ⋯ The odds ratio of local LBP at the 5-, 10-, or 28-year follow-up for those with such pain at baseline vs. not were 6.0 (95% CI 4.3-8.3), 4.7 (3.3-6.6) and 4.0 (2.6-6.3), adjusted for age, gender and occupational class. The respective figures for radiating LBP were 8.5 (5.7-12.5), 6.7 (4.4-10.1) and 2.3 (1.5-3.6). We conclude that LBP is commonly recurrent.