European journal of pain : EJP
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Randomized Controlled Trial
Attention focus, trait anxiety and pain perception in patients undergoing colposcopy.
Few studies have compared the relative efficacy of attention-focus strategies in reducing clinical pain. Colposcopy, a medical diagnostic examination performed to identify premalignant cervical cell changes, elicits both anxiety and pain in patients, while allowing little or no behavioural control over the event. Employing a multi-group experimental design, the present study sought to investigate how different types of attention-focus strategies impacted upon pain perception, state anxiety and affect, in a sample of 123 colposcopy patients. ⋯ Pre-colposcopy pain expectancy, but not trait anxiety, was found to be positively related to colposcopy-related pain. It was further demonstrated that heightened state anxiety following colposcopy was due to experienced pain and pain unpleasantness, rather than to aspects of the pre-colposcopy prediction of pain. The results have implications for management of acute clinical pain.
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Neuropathic pain is strongly associated with mood disorders like anxiety and depression. Corticotropin-releasing factor (CRF) plays a prominent role in these disorders as it is up-regulated in limbic structures such as the amygdala, upon experimentally induced neuropathy. This review discusses recent literature on the role of CRF in pain processing and highlights the amygdala as a potential hot spot in supraspinal descending pain control. ⋯ Here, CRFR2 can be recruited by either high (pharmacological) concentrations of CRF or by endogenous CRFR2 ligands, the urocortins, leading to analgesia (pain termination). This on-off switching of pain is completed by redistribution of the CRF receptors to their initial activity state. We furthermore propose that in neuropathic pain, this mechanism is dysregulated and causes a state of permanent hyperalgesia, and present an integrative (patho)physiological model for the way disturbed CRF receptor signalling in the amygdala could initiate neuropathic pain.
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To study the associations of sociodemographic factors, working conditions, lifestyle and previous pain in the spine with new onset chronic neck pain (NP). ⋯ We found potentially modifiable predictors of chronic NP among employees: workplace bullying, sleep problems, and high body mass index in women, and work-related emotional exhaustion in men. In both genders, previous acute NP and chronic LBP were predictive of chronic NP.
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Pain markedly activates the hypothalamic-pituitary-adrenal (HPA) axis and increases plasma corticosterone release interfering significantly with nociceptive behaviour as well as the mechanism of action of analgesic drugs. ⋯ Our data indicate that HPA axis activation in acute and chronic pain models is time dependent and may be dissociated from evoked hyperalgesia. Therefore, HPA-axis activation represents an important variable to be considered when designing experimental assays of persistent pain as well as for interpretation of data.
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The effect of catechol-O-methyltransferase polymorphisms on pain is modified by depressive symptoms.
Variations within the catechol-O-methyltransferase (COMT) gene have been associated with pain severity in temporomandibular disorders (TMDs). Psychological factors such as personal conflicts, life stress and depression, are well known to be associated with onset, severity and chronicity of pain disorders. ⋯ Our results indicate that variants within the COMT gene are associated with pain perception. However, this association is highly moderated by the absence or presence of lifetime depressive symptoms.