Pain
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Randomized Controlled Trial
The development and preliminary validation of the Profile of Chronic Pain: Extended Assessment Battery.
The aim of the present research was the development and validation of a set of instruments, collectively called the Profile of Chronic Pain: Extended Assessment Battery (PCP:EA), designed to be administered to adults (between the ages of 25 to 80) after establishing the existence of a chronic pain problem. The final 86-item version of the PCP:EA consisted of 33 single items assessing: pain location and severity, pain characteristics (e.g. worst daily pain), medication use, health care status, the identity of the most important person in the patient's life, and functional limitations in 10 areas of daily living. In addition, the PCP:EA includes 13 multi-item subscales addressing aspects of coping (guarding, ignoring, task persistence, and positive self-talk), catastrophizing, pain attitudes and beliefs (including disability beliefs, belief in a medical cure for pain, belief in pain control, and pain-induced fear), and positive (tangible and emotional) and negative (insensitivity and impatience) social responses. ⋯ Stratified sampling was employed to assure equal gender and age group representation across three age groupings (25-44; 45-64; 65-80). Two survey studies provided strong evidence for the hypothesized factor structure, internal consistency, independence from response bias, and validity of the PCP:EA. Moreover, the presence of normative data enhance the diagnostic and prescriptive utility of the instrument.
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Controlled Clinical Trial
Pain-related emotions modulate experimental pain perception and autonomic responses.
The effect of emotions on pain perception is generally recognized but the underlying mechanisms remain unclear. Here, emotions related to pain were induced in healthy volunteers using hypnosis, during 1-min immersions of the hand in painfully hot water. In Experiment 1, hypnotic suggestions were designed to induce various positive or negative emotions. ⋯ Correlation and multiple regression analyses suggest that negative emotions and desire for relief influence primarily pain affect and that pain-evoked autonomic responses are strongly associated with pain affect. These results confirm the hypothesized influence of the desire for relief on pain perception, and particularly on pain affect, and support the functional relation between pain affect and autonomic nociceptive responses. This study provides further experimental confirmation that pain-related emotions influence pain perception and pain-related physiological responses.
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Randomized Controlled Trial
Intersession coping skill practice mediates the relationship between readiness for self-management treatment and goal accomplishment.
Underlying pain self-management treatments is the expectation that patients must adhere to coping skill practice recommendations to obtain treatment benefits. Recently, a model of motivation for pain treatment has proposed that patients' readiness to adopt a self-management approach serves as a predictor of active participation in treatment, and ultimately, of improved outcomes. This study compared the ability of pain readiness to change, as measured by the Pain Stages of Change Questionnaire (PSOCQ), and self-efficacy (SE) ratings, to predict adherence and goal accomplishment in cognitive-behavioral therapy (CBT) for chronic pain. ⋯ SE did not significantly predict either criterion. The statistical relationship between pre-treatment PSOCQ and behavioral goal accomplishment was significantly attenuated when intersession adherence was taken into account. These data provide support for a motivational model of pain treatment that asserts adherence to therapist recommendations for coping skill practice mediates readiness to change and self-reported goal attainments.
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Couple congruence on ratings of pain severity and disability were examined using hierarchical linear modeling. Older community Individuals with Chronic Pain (ICPs) and their spouses completed the Multidimensional Pain Inventory (pain severity, interference, negative spouse responses to pain), Sickness Impact Profile (physical disability, psychosocial disability), and the Mood and Anxiety Symptom Questionnaire (psychological distress). Both spouses reported on ICPs' pain and disability as well as their own psychological distress. ⋯ ICPs' perceptions of negative spouse responses were also positively associated with couples' ratings of physical and psychosocial disability. In terms of congruence, ICP distress was associated with incongruence on interference, physical disability, and psychosocial disability whereas spouse distress predicted incongruence on pain severity, and interference. This study suggests that understanding couples' pain outcome ratings involves an awareness of factors that might influence their perceptions and behaviors.
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Controlled Clinical Trial
Anxiety and depression associated with migraine: influence on migraine subjects' disability and quality of life, and acute migraine management.
Anxiety and depression are reported to be frequently associated with migraine but how they impact on migraine-related disability, migraine subjects' quality of life, and medical and therapeutic management of migraine attacks has not been investigated. FRAMIG 3 is a nation-wide population-based postal survey carried out in France according to the 2004 international classification of headache disorders. ⋯ Although, migraine-associated anxiety and depression do not appear to influence the drugs taken by migraine subjects for the acute treatment of migraine attacks, perceived treatment efficacy and satisfaction with treatment are lower in subjects with anxiety alone or combined with depression than in subjects with neither anxiety nor depression. Anxiety and depression should be systemically looked for and cared for in subjects consulting for migraine.