Pain research & management : the journal of the Canadian Pain Society = journal de la société canadienne pour le traitement de la douleur
-
One of the perplexing features of pain is the wide variability in patients' responses to ostensibly the same extent of physical pathology. A range of cognitive, affective and behavioural factors are related to the perception of pain, maintenance of pain and disability, exacerbation of pain and response to treatment. Moreover, there is some evidence that individual differences and prior learning history also have a significant influence on the experience of pain and related disability. ⋯ This model proposes a sequential process to explain the variation observed among people following a relatively minor trauma. The model is intended to be heuristic. It may be a useful conceptualization that can serve to guide prevention efforts and the development of treatment interventions.
-
Randomized Controlled Trial Comparative Study Clinical Trial
A randomized treatment study to compare the efficacy of repeated nerve blocks with cognitive therapy for control of chronic head and neck pain.
This prospective study compared the efficacy of two antinociceptive modalities: nerve blocks and cognitive therapy. A consecutive series of patients receiving nerve block therapy was invited to take part in a six-week randomized comparison of nerve blocks and cognitive therapy. Sixty-eight of 102 patients approached by telephone agreed to participate. ⋯ Mean VAS scores in the cognitive therapy group rose during the trial. However, the mean VAS score of the remaining four in the last week was below the initial group mean. Patients who had been receiving nerve blocks proved willing to remain in the study if allocated to the nerve block group and unwilling to remain in the cognitive therapy group while foregoing their accustomed treatment.
-
Editorial Comment
Nerve blocks and cognitive therapy: a beneficial failure.
-
Case Reports Comparative Study Clinical Trial
Can pain-related fear be reduced? The application of cognitive-behavioural exposure in vivo.
Although cognitive-behavioural treatments of patients with chronic pain generally are reported to be effective, customization might increase their effectiveness. One possible way to customize treatment is to focus the intervention on the supposed mechanism underlying the transition from acute to chronic pain disability. Evidence is accumulating in support of the conjecture that pain-related fear and associated avoidance behaviours are crucial in the development and maintenance of chronic pain disability. ⋯ Randomization tests for AB designs revealed dramatic changes in pain-related fear and pain catastrophizing. In both cases, pain intensity also decreased significantly, but at a slower pace. Differences before and after treatment revealed clinically significant improvements in pain vigilance and pain disability.