Pain management nursing : official journal of the American Society of Pain Management Nurses
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Chronic pain in adults with sickle cell disease (SCD) is a complex multidimensional experience that includes biologic, psychologic, sociologic, and spiritual factors. To date, three models of pain associated with SCD (i.e., biomedical model, biopsychosocial model for SCD pain, and Health Beliefs Model) have been published. The biopsychosocial multidimensional approach to chronic pain developed by Turk and Gatchel is a widely used model of chronic pain. ⋯ This model includes the biologic, psychologic, sociologic, and spiritual factors relevant to adults with SCD based on past and current research. The purpose of this paper is to describe an adaptation of Turk and Gatchel's model of chronic pain for adults with SCD and to summarize research findings that support each component of the revised model (i.e., biologic, psychologic, sociologic, spiritual). The paper concludes with a discussion of implications for the use of this model in research.
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The fear avoidance model of chronic pain is well established for specific chronic pain groups and of considerable clinical utility, but it suffers from poor generalizability. Therefore, in this study we examined the role of self-efficacy (SE) in the relationship between pain-related fear (PRF) and three pain-related outcomes-pain severity, disability, and depression-in a more heterogeneous chronic pain sample. Sixty-eight participants between the ages of 18 and 75 years experiencing chronic pain were recruited from the general public. ⋯ And higher catastrophizing, fear of movement, avoidance of pain, and PRF were associated with higher pain severity, disability, and depression. Although complete mediation was not found, post hoc examination of partial correlations revealed that the relationship between PRF and disability was partially mediated by SE; however, SE had no mediatory effect on the relationship between PRF and either pain severity or depression. Within the constraints of a relatively small sample size, we concluded that within a heterogeneous pain population, PRF remains the most integral component of the fear avoidance model.
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Randomized Controlled Trial
Music provided through a portable media player (iPod) blunts pain during physical therapy.
This research studied, 25 adult patients who underwent physical therapy to assess the analgesic effect of distraction with the use of music during physical therapy. Patients randomly underwent physical therapy once with music provided by an iPod and once without music. In both sessions patients underwent identical physical procedures. ⋯ Enjoyment (8.5 ± 1.6), interaction (8.3 ± 1.9), and satisfaction (8.6 ± 1.7) scores with music did not significantly differ in the sessions without music (8.5 ± 2.1, 8.5 ± 1.9, and, 8.5 ± 1.5, respectively); mean stress score was, 3.9 in both sessions. The conclusion of the study is that music provided through a portable media player has an analgesic effect. This can be an effective analgesic strategy during painful physical therapy.
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Persistent pain is a costly epidemic, affecting >50 million Americans with estimated expenditures of >$200 billion annually for direct care and lost productivity. Recent advances in epigenetic/genomic understanding of pain and analgesic response may lead to improvements in pain management and help curtail costs by providing more precise detection of the pain mechanisms involved and thereby more personalized and effective treatments. However, the translation of epigenetic and genomic strategies for pain management into clinical practice will depend on understanding their potential applications. ⋯ The initial discussion focuses on present understanding of nociceptive pathways and alterations that lead to pathologic pain. The discussion then moves to a review of epigenetic mechanisms that have been identified in the transition to and maintenance of persistent pain as well as in the individual's response to analgesics. Potential applications of epigenetics/genomics to identify people at risk and possibly prevent persistent pain and guide diagnosis and the selection of therapeutic modalities are presented.
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Randomized Controlled Trial
Cranial electrical stimulation improves symptoms and functional status in individuals with fibromyalgia.
To investigate the effects of microcurrent cranial electrical stimulation (CES) therapy on reducing pain and its associated symptoms in fibromyalgia (FM), we conducted a randomized, controlled, three-group (active CES device, sham device, and usual care alone [UC]), double-blind study to determine the potential benefit of CES therapy for symptom management in FM. Those individuals using the active CES device had a greater decrease in average pain (p = .023), fatigue (p = .071), and sleep disturbance (p = .001) than individuals using the sham device or those receiving usual care alone over time. Additionally, individuals using the active CES device had improved functional status versus the sham device and UC groups over time (p = .028).