The Clinical journal of pain
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Case Reports
Single-Fiber Recordings of Nociceptive Fibers in Patients With HSAN Type V With Congenital Insensitivity to Pain.
Nerve growth factor (NGF) is a protein important for growth and survival, but also for modulation of sensitivity of nociceptors and sympathetic neurons. The purpose of the present study was to investigate the effects of reduced NGF signaling in patients with hereditary sensory and autonomic neuropathies type V, congenital insensitivity to pain, caused by a mutation of the NGFβ gene, including a characterization of single nociceptive fibers using microneurography (MNG). ⋯ The findings of grossly intact pain thresholds compared with anamnestic insensitivity of pain in deep somatic tissue such as bone suggest a gradient of impairment dependent on different NGF availability in various tissues. Even though these patients in some aspects report insensitivity to pain, they also report chronic spontaneous pain as their main symptom, strikingly highlighting differential mechanisms of insensitivity to evoked pain versus spontaneous pain.
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Adolescents with chronic pain often report inattention and poor memory. There has been little research on cognitive function in this population. The goal of this preliminary pilot study was to examine differences in cognitive function between adolescents with chronic pain to pain-free adolescents. ⋯ This pilot study is the first study to examine differences in working memory and attention between participants with chronic pain and pain-free adolescents. Our findings suggest that chronic pain may negatively affect adolescents' working memory function and highlights the risk for cognitive difficulties and problems with educational progression in addition to negative health and social effects associated with chronic pain. The study provides a starting point for more research and has the potential to direct better identification and treatment of these cognitive deficits.
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Longitudinal population-based studies on the natural course of nonspecific chronic back pain (nsCBP) concerning the spatial extent of pain are scarce. This study aims to assess the natural course of nsCBP patients concerning their spatial extent of pain and physical impairment over time. ⋯ Most nsCBP patients report a stable pain extent over the time of the study, whereas a constant spread of pain is observed only in a minority of nsCBP patients. These findings challenge the concept of a continuous transition from local to widespread pain.
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The experience of chronic pain critically alters one's ability to interact with their environment. One fundamental issue that has received little attention, however, is whether chronic pain disrupts how one perceives their environment in the first place. The Economy of Action hypothesis purports that the environment is spatially scaled according to the ability of the observer. Under this hypothesis it has been proposed that the perception of the world is different between those with and without chronic pain. Such a possibility has profound implications for the investigation and treatment of pain. The present investigation tested the application of this hypothesis to a heterogenous chronic pain population. ⋯ The application of the Economy of Action hypothesis and the notion of spatial perceptual scaling as a means to assess and treat the experience of chronic pain are not supported by the results of this study.
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Acceptance and Commitment Therapy (ACT) has been shown to be an effective treatment for chronic pain in young people. Cognitive fusion is a key concept of ACT that is hypothesized to contribute to distress and suffering. In this study, we sought to: (1) test hypothesized associations between cognitive fusion and pain intensity, disability, and catastrophizing; and (2) examine the function of cognitive fusion as a possible mediator between catastrophizing and disability. ⋯ The findings indicate that cognitive fusion is moderately to strongly associated with pain-related outcomes, which support the need for further research to (1) better understand the relationship between cognitive fusion and adjustment to chronic pain, and (2) determine whether the benefits of treatments such as ACT are mediated, at least in part, by reductions in cognitive fusion.