European journal of pain : EJP
-
Review
Understanding fear of pain in chronic pain: interoceptive fear conditioning as a novel approach.
The current review deals with interoceptive conditioning as a viable mechanism maintaining fear of pain: The available literature suggests that interoceptive - i.e., internal bodily - sensations may become predictors of pain and will subsequently elicit fear of pain. After a short overview of interoceptive (fear) conditioning and its role in the maintenance of panic disorder, the existing literature on conditioning in the field of pain and fear of pain is reviewed. Next, the authors propose an interoceptive fear conditioning model of fear of pain, suggesting that bodily sensations can function as predictors of pain and as conditioned stimuli become endowed with the capacity to elicit an (anticipatory) fear response. The review concludes with a number of theoretical and clinical considerations, introducing interoceptive exposure as a potentially effective treatment for fear of pain.
-
Despite the increased recognition of paediatric chronic pain, centres for providing appropriate treatment are scarce, and much remains unknown about optimal treatment approaches. The purpose of this study was to investigate effectiveness of multimodal outpatient treatment (MOT) through the examination of treatment pathways and long-term outcomes. ⋯ MOT appears to be beneficial for children with chronic pain. A short intensive intervention (comprising of a total of 2.5-h) can lead to substantial improvements even for severely affected children.
-
Multicenter Study
The association between psychological factors and the development of complex regional pain syndrome type 1 (CRPS1)--a prospective multicenter study.
The objective of this study was to investigate the association between psychological factors and complex regional pain syndrome type 1 (CRPS1). A prospective multicenter cohort study was performed involving the emergency room of three hospitals, and patients age 18years or older, with a single fracture, were included in the study. At baseline (T0), participants completed a questionnaire covering demographic, psychological (Symptom Checklist-90), and medical variables. ⋯ None of the psychological factors predicted the development of CRPS1. The scores on the Symptom Checklist-90 subscales fell into the range of the general population and were, in most cases, average or below average when compared with those of pain patients or psychiatric patients. No empirical evidence supports a diagnosis of CRPS1 patients as psychologically different, and the current results indicate that there is no association between psychological factors and CRPS1.
-
The long-term course of long-standing low back pain is largely unknown since long-term data are scarce. ⋯ Low back pain in the population is characterized as very dynamic which challenges epidemiological studies highly. Long-term information on the course of back pain is needed to define severe subgroups.
-
Experimental evidence suggests impairment of inhibitory intracortical circuits in migraine, while not much is known about activity of facilitatory intracortical circuits. In the present work we evaluated the effects of high frequency-repetitive transcranial magnetic stimulation (hf-rTMS) on the activity of facilitatory circuits of motor cortex in 18 patients affected by migraine with aura and 18 healthy subjects. Trains of 10 stimuli were applied to the motor cortex at 5-Hz frequency with recording of the EMG traces from the contralateral abductor pollicis brevis muscle (APB). ⋯ Conversely, when rTMS was applied at 130%, we observed MEP potentiation in healthy subjects and paradoxical MEP inhibition in migraineurs. In treated patients, levetiracetam inhibited MEP size at both 110% and 130% intensity of stimulation. Our findings reveal an opposite response of migraine motor cortex to 5-Hz rTMS when it is delivered at different stimulation intensities, providing evidence of both hyper-responsivity and self-limiting hyperexcitability capacity, in line with studies supporting the concept that under conditions of cortical hyperexcitability inhibitory mechanisms of homeostatic plasticity could be activated.