The journal of pain : official journal of the American Pain Society
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Because of a lack of evidence to support any treatment for phantom limb pain (PLP), interest has turned to preventing it instead. However, like other areas of PLP research, there is little consensus regarding factors that may be associated with the development of PLP. This study was devised to identify physical and psychological factors associated with PLP development and maintenance. It was a prospective study of 59 patients listed for amputation of a lower limb due to peripheral vascular disease. Each was interviewed before amputation, and the survivors were reinterviewed 6 months afterward. Pain and coping style were the primary outcome measures. The use of high levels of passive coping strategies (P = .001), especially catastrophizing (P = .02) before amputation, were found to be associated with PLP development. Pain was only weakly associated with the presence of PLP 6 months after amputation. The ability to move the phantom (P = .01) and stump pain (P = .01) were postamputation factors associated with PLP. The complexity of the relationship between previous pain and coping style and the development of PLP is discussed alongside aspects of pain memory. Pre-emptive treatment of PLP will need to include psychological as well as physical interventions. ⋯ During this study, preamputation passive coping (especially catastrophizing) was found to be associated with the development of PLP. This knowledge will help researchers and clinicians to identify future targets for pre-emption of this condition because once established, PLP is difficult to treat.
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Chronic nonmalignant pain affects a significant number of adults, with many requiring opioid medications to manage their symptoms. Although the content of typical opioid contracts (OCs) has been explored, no studies have examined the literacy demands and formatting characteristics of OCs currently used throughout the United States. We evaluated 162 English-language OCs submitted to us by current American Pain Society members residing in the United States. OCs were evaluated for reading grade level and formatting characteristics. The mean readability of OCs was at grade level 13.8 +/- 1.3 (range = 10-17), whereas the average text point size was 11.0 +/- 1.4 (range = 6-16). Active voice was used exclusively in almost half of OCs (n = 79, 48.8%). Most OCs contained not only sophisticated medical language but multisyllable, nonmedical terms and vocabulary not used in typical everyday conversation. Overall, most OCs reviewed presented information at much too high a reading grade level, and with formatting characteristics that probably would make these documents difficult for the average patient to fully comprehend. ⋯ This study indicates that there is a mismatch between the reading demands of most OCs and the actual health literacy skills of American adults. Accordingly, those developing OCs should be cognizant of the actual literacy abilities of their patient population and design and evaluate OCs accordingly.
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Pain coping and pain-related cognitions are considered important for the understanding of chronic pain in children. Based on a systematic literature search, 4 instruments were identified that assess a range of pain coping strategies and one questionnaire focusing on pain-related cognitions. Three of these tools have good psychometric quality. Yet, only the Pain Coping Questionnaire (PCQ) has been widely used across different pain conditions and by several international research groups. We designed the Pain-Related Cognitions Questionnaire for Children (PRCQ-C) as an abbreviated German version of the PCQ. Factorial, construct, and external validity were tested in a sample of 401 children and adolescents (7-18 years) comprising 253 school children and 148 children having recurrent pain. The proposed 3 subscales, "catastrophizing," "problem-solving," and "positive self-statements," were confirmed, all having good internal consistency and retest reliability. No age and only marginal gender differences were observed. Catastrophizing was associated with dysphoric mood, trait anxiety, and current pain activity. Subgroups of pain patients differed with regard to catastrophizing and positive self-statements. ⋯ The PRCQ-C is a brief instrument for the assessment of pain-related cognitions in children and adolescents. It supports the validity of the PCQ, demonstrates its use in an abbreviated version and extends its international availability.
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Anxiety sensitivity (AS), or the fear of anxiety sensations, has been shown to independently predict poorer health-related quality of life (HRQOL) in adults with chronic pain. Specifically, AS was found to contribute to decrements in psychological well-being and social functioning but not to decrements in physical functioning. Existing studies have not examined the relationship between AS and HRQOL in children with chronic pain. The present study used multivariate regression analysis to test the association between AS and self-reported HRQOL in 87 children (62 girls; mean age = 14.4 years +/-2.3) presenting for treatment at a tertiary, multidisciplinary clinic specializing in pediatric chronic pain. After controlling for key sociodemographic and pain-related characteristics, higher AS was associated with poorer perceived general and mental health, greater impairment in family activities, lower self-esteem, increased behavior problems, and more social/academic limitations due to emotional problems. AS accounted for 4% to 28% of incremental variance in these HRQOL domains above and beyond the demographic and pain-related variables. However, AS was not significantly associated with physical functioning or with academic/social limitations due to physical health. Additional research is required to delineate possible mechanisms by which AS may influence certain aspects of children's HRQOL but not others. ⋯ The present findings support the evaluation of AS in pediatric chronic pain patients as part of a comprehensive assessment battery. The links between AS and multiple HRQOL domains suggest that treatment components aimed at reducing AS may lead to enhanced psychosocial well-being in children with chronic pain.