The journal of pain : official journal of the American Pain Society
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Existing evidence indicates that pain catastrophizing is associated with enhanced pain reports and lower pain threshold/tolerance levels, but is not significantly related to nociceptive flexion reflex (NFR) threshold in healthy and clinical pain samples. This suggests pain catastrophizing may modulate pain threshold at a supraspinal level without influencing descending modulation of spinal nociceptive inputs. To examine this issue further, the present study assessed NFR threshold, electrocutaneous pain threshold, and electrocutaneous pain tolerance, as well as subjective ratings of noxious stimuli in a sample of 105 healthy adults. Pain catastrophizing was assessed prior to testing using traditional instructions and after pain testing with instructions to report on cognitions during testing (situation-specific catastrophizing). As expected, NFR threshold was correlated with pain sensitivity measures, but uncorrelated with both measures of catastrophizing. Although situation-specific catastrophizing was correlated with some pain outcomes, neither catastrophizing measure (traditional or situation specific) moderated the relationship between NFR and pain sensitivity. These findings confirm and extend existing evidence that catastrophizing influences pain reports through supraspinal mechanisms (eg, memory, report bias, attention) without altering transmission of spinal nociceptive signals. ⋯ Assessing catastrophic thoughts related to a specific painful event (situation-specific catastrophizing) provides important additional information regarding the negative cognitions that influence pain-related processes. However, neither situation-specific nor traditionally measured pain catastrophizing appear to enhance pain by engaging descending controls to influence spinal nociceptive processes.
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Mild knee pain is a common symptom in later life. Despite this fact, there are few data on the impact of it worsening or how individuals alter their appraisals and behavior when it becomes severe. We sought to describe the changes that accompany a substantial deterioration in characteristic knee pain. A nested case-control analysis of existing cohort data identified 57 adults aged over 50 years experiencing progression from mild to severe characteristic pain intensity 18 months later and compared them, before and after this transition, with 228 controls whose knee pain did not progress. Worsening knee pain was accompanied by a marked increase in pain frequency and extent, functional limitation, depressive symptoms, catastrophising, praying and hoping, and use of oral and topical analgesia. Most individuals consulted a general practitioner either during or after this episode. Although relatively rare, substantial deterioration in knee pain has a major impact on those affected. Timely presentation to primary care, addressing potentially unhelpful appraisals and coping strategies, reinforcing core nonpharmacological management, and future research to identify triggering events for substantial deterioration and loss of adequate pain control should be part of an agenda to improve care for this important minority of older adults with knee pain. ⋯ This article describes what happens when the common symptom of mild knee pain in later life becomes significantly worse. The results may help clinicians understand the health impact, changes in patient appraisal and coping, and treatments that typically accompany this change in symptoms.