The Clinical journal of pain
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In order to maximize the therapeutic benefits of cognitive behavioral therapy (CBT) for chronic pain, individuals need to be motivated to adopt a self-management approach. The Pain Stages of Change Questionnaire (PSOCQ) was developed to measure patients’ readiness to adopt a self-management approach to chronic pain. The present study examined whether pre- and post-treatment PSOCQ change scores among chronic low back pain patients could predict six and twelve-month follow-up outcomes, and the stability of post-treatment PSOCQ scores during follow-up. ⋯ Changes in patients’ attitudes toward adopting a pain self-management approach may serve as one of the therapeutic mechanisms and predict long-term function. This study also revealed that changed attitudes toward chronic pain self-management remain quite stable over time. Adoption of beliefs consistent with chronic pain self-management during treatment may promote sustained benefits.
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Evidence for the effectiveness of intensive interdisciplinary pain treatment (IIPT) for pediatric chronic pain is growing; however, little research has considered factors that contribute to differences in patients' treatment response. The present study utilized multilevel modeling to examine trajectory of change over time in functional disability from clinic assessment to 6-month follow-up in pediatric patients participating in IIPT, considering spatial distribution of pain, coping efficacy, and pain intensity. ⋯ Overall, spatial distribution of pain, coping efficacy, and pain intensity played an important role in patients' response to treatment. Better understanding of these variables could improve treatment response, particularly for the most severely disabled chronic pain patients.
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The objective of this study was to review the current scientific evidence on the role of Enhanced Recovery After Surgery (ERAS) implementations in reducing postoperative opioid consumption and their potential association with the risk reduction for long-term opioid use, physical opioid dependency, and opioid addiction. ⋯ Identification and management of pre-existing psychosocial factors, comorbid pain entities, and chronic opioid use have a significant impact on the severity of postoperative pain. Different multimodal analgesia approaches have been associated with reduced postoperative pain scores and opioid consumption. Health care providers, patients, and family members should recognize the advantages of opioid-free analgesia techniques in postoperative pain management. As part of ERAS protocols, transitional pain services may consider current therapeutic alternatives for acute and long-term pain management that include minimizing perioperative opioid use and establishing adequate opioid prescription practices.
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Decades of research have convincingly shown that fear of pain and pain-related avoidance behavior are important precursors of disability in daily life. Reduced activity as a consequence of avoidance, however, cannot be blamed for chronic disability in all patients. A contrasting behavior, pain-related dysfunctional endurance in a task and overactivity has to be considered. Currently, there is a need to better understand the psychological determinants of overactivity, dysfunctional endurance, and neurobiomechanical consequences. ⋯ This narrative review brings together different research lines on overactivity, pain-related endurance, and supposed neuromuscular consequences. Clinicians should distinguish between patients who rest and escape from pain at low levels of pain, but who have high levels of fear of pain and those who predominantly persist in activities despite severely increasing pain until a break will be enforced by intolerable pain levels.