The Clinical journal of pain
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This study aimed to analyze the associations among depressive and anxiety and pain symptoms in patients diagnosed with chronic pain. ⋯ The results support focusing psychosocial interventions in chronic pain treatment not only on reducing pain, anxiety, and sleep symptoms but also on enhancing positive affect. Future research is needed to replicate these findings using repeated within-person measures designs.
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Tonic spinal cord stimulation (SCS) is currently used to treat neuropathic pain. With this type of stimulation, an implantable pulse generator generates electrical paresthesias in the affected area through 1 or more epidural leads. The goal of this study was to evaluate the impact of tonic SCS on the sensory perception of chronic pain patients using quantitative sensory testing (QST). ⋯ It is not clear that the slight changes observed were clinically significant and induced any changes in patients' daily life. Globally, our results suggest that SCS does not have a significant effect on sensory perception.
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Because musculoskeletal pain problems are so prevalent, new methods of evaluating and treating patients are needed to increase effectiveness. Subgrouping is a method wherein patients are classified into defined groups on the basis of psychosocial factors with the expectation of more specific and tailored treatments can be prescribed for them. For those seeking care for a new episode, the risk of developing chronic pain-related disability is assessed, whereas, for those with existing pain, the risk for the maintenance of the chronic pain problem is evaluated. ⋯ We conclude that it is possible to reliably subgroup patients with musculoskeletal problems. Likewise, treatments that address the risk factors in the screening procedure may enhance outcomes compared with treatment as usual. More work is needed, however, to better understand the mechanism, so that assessment methods can be improved, and treatment specific to subgroups can be developed and evaluated.
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What is it that motivates our actions? As human beings, existing as part of complex societies, the actions we take are subject to multiple, often competing motives. Spanning non-conscious reflexes, cognitively derived choice as well as long- and short-term goals, our actions allow us to make sense of our environment. Pain disrupts action and hijacks our intentions. Whilst considered adaptive when temporary, pain that persists continues to interrupt and can threaten our ability to actively investigate a changing world. ⋯ In taking a wide view of pain and action, we expose the nuances within drive to goal behaviour in the presence of pain. This has implications for the clinic, specifically in relation to assessing the multifactorial influences that shape action in pain. But it also seeks to go further, considering the broader environment in which we make decisions and the influence that other professionals, outside of typical healthcare roles, may play a part in the maintenance and resolution of pain.
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Pain is a complex and highly subjective phenomenon that can be modulated by several factors. On the basis of results from experimental and clinical studies, the existence of endogenous pain modulatory mechanisms that can increase or diminish the experience of pain is now accepted. ⋯ On the basis of current knowledge on the role of exercise, stress, and cognitive pain control strategies on the modulation of pain, implications for treatment will be discussed.