The journal of pain : official journal of the American Pain Society
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There has been growing interest among researchers and clinicians in the role of ambivalence over emotional expression (AEE) in adjustment to chronic illness. Because of the salience of anger in chronic low back pain, this condition provides a particularly good model in which to examine the role of AEE. This study examined the relation of AEE to pain and anger in a sample of 61 patients with chronic low back pain. Patients completed standardized measures of AEE, pain, and anger. Correlational analyses showed that patients who had higher AEE scores reported higher levels of evaluative and affective pain as well as higher levels of state and trait anger and the tendency to hold in angry thoughts and feelings. Mediational analyses revealed that most of the associations between AEE and pain, and AEE and anger, were independent of one another. These findings suggest that a potentially important relationship exists between AEE and key aspects of living with persistent pain. ⋯ This preliminary study suggests that there is a relation between ambivalence over emotional expression and pain and anger in patients with chronic low back pain. Patients who report greater conflict with regard to expressing emotions may be experiencing higher pain and anger.
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Several medications are recommended for relief of postherpetic neuralgia (PHN). A sequential treatment algorithm has been suggested, but its cost-effectiveness is unclear. We developed a decision model to estimate the cost-effectiveness of this algorithm compared with other sequential medication strategies in 70-year-olds with PHN, using literature data to model medication-related PHN relief while also accounting for severe medication side effects. Hypothetical patients with and without coronary artery disease (CAD) were considered separately, with and without localized pain. Sequential medication switches occurred as the result of inadequate relief or intolerable side effects. Probabilistic sensitivity analyses were performed to estimate the favorability of each medication early in treatment sequences. In patients without CAD, tricyclic and gabapentin were equally favored as initial therapy if mortality with tricyclic use was not increased, but gabapentin was strongly favored if it was. In patients with CAD, gabapentin was overwhelmingly favored. In either patient group, opioids, pregabalin, and tramadol were not favored as initial therapy but were sensible choices later in treatment sequences. The lidocaine patch was a reasonable first choice in patients with localized PHN. Our analysis supports the suggested treatment algorithm, with cost-effectiveness ratios within acceptable ranges for medications given sequentially, based on literature-based estimates of effectiveness and tolerability. ⋯ This article examines the cost-effectiveness of recommended sequential treatment strategies for postherpetic neuralgia. This decision analysis-based synthesis of effectiveness and cost data found that recommended treatment algorithms are also economically reasonable.
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Associations among pain, functional disability, and self-perceived competence were examined in a retrospective record review of the initial clinical evaluations of 115 adolescents (ages 13 to 18 years) with chronic musculoskeletal pain not associated with a specific organic cause. Adolescents self-reported on pain intensity, functional disability, and 9 developmentally relevant domains of self-perceived competence, using the Self-Perception Profile for Adolescents (Harter, 1988). Results confirmed a relation between usual pain intensity and functional disability (r = 0.47, P < .001). A series of multiple regression analyses revealed that adolescents' perceptions of global self-worth significantly moderated the relation between pain and disability. These findings extend our understanding of the relations among self-perception, chronic pain, and disability to include adolescents with chronic musculoskeletal pain syndromes and have future research and therapeutic implications. ⋯ Adolescents with chronic pain syndromes can face significant challenges in accomplishing developmental goals with respect to the pain and disability they experience. Perceptions of self-worth appear to play an important role in understanding the relation between pain and functional disability among adolescents with chronic pain.
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Pregabalin is used for treatment of neuropathic pain conditions. The present study evaluated effects of pregabalin in 2 rat models of muscle-induced hyperalgesia: Inflammatory and noninflammatory. Muscle hyperalgesia (withdrawal threshold to compression of the muscle) and cutaneous hyperalgesia of the paw (withdrawal threshold to von Frey filaments) were measured before and after induction of hyperalgesia and after treatment with pregabalin (saline, 10 to 100 mg/kg i.p.). In the inflammatory model, 3% carrageenan injected into 1 gastrocnemius muscle decreased the mechanical withdrawal threshold of the paw bilaterally and the compression withdrawal threshold of the muscle ipsilaterally 2 weeks later. Pregabalin (10 to 100 mg/kg) increased the compression withdrawal threshold of the inflamed muscle when compared with vehicle controls. Pregabalin also increased the mechanical withdrawal threshold of the paw bilaterally, but only with 100 mg/kg. In the noninflammatory model, 2 unilateral injections of acidic saline into the gastrocnemius muscle produced bilateral cutaneous and muscle hyperalgesia 24 hours after the second injection. Pregabalin (10 to 100 mg/kg i.p.) significantly increased the compression withdrawal thresholds of the muscle and the mechanical withdrawal threshold of the paw bilaterally when compared with vehicle. However, pregabalin also has significant motor effects at the higher doses (60 to 100 mg/kg). Therefore, pregabalin reduces both muscle and cutaneous hyperalgesia that occurs after muscle insult in 2 animal models of muscle pain at doses that do not produce ataxia. ⋯ This study shows that pregabalin reduces both cutaneous and muscle hyperalgesia in inflammatory and noninflammatory models of muscle pain. Thus, pregabalin may be an effective treatment for people with chronic muscle pain.