The journal of pain : official journal of the American Pain Society
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Studies in adults have shown that the effects of pain catastrophizing upon others vary from positive to negative responses. There are no studies, however, on the impact of catastrophizing in children upon responses of others. In addition, little is known about why catastrohpizing varies with both positive and negative responses. Attachment may be one important moderator explaining these variable relationships. The present study in 1,332 school children investigated, by means of child-report questionnaires, the relationships between pain catastrophizing and parental responses to pain, and the moderating role of child attachment. Findings indicated that a child's pain catastrophizing had a small but significant positive contribution in explaining child reports of both positive and negative parental responses to pain. However, this relationship was moderated by child attachment; for less securely attached children, higher levels of catastrophizing were associated with more negative parental responses. On the contrary, for more securely attached children, higher levels of catastrophizing were associated with more positive parental responses. The present findings suggest that child attachment may partially explain the variable results regarding the impact of pain catastrophizing upon others' responses. The findings are discussed in terms of the function of pain catastrophizing in interactional processes between parents and children. ⋯ This study in schoolchildren found preliminary evidence for the moderating impact of child attachment in understanding differential patterns of parental responses related to the child's pain catastrophizing. Further exploration of the mechanisms relating catastrophizing and attachment processes might contribute to a better comprehension of the interpersonal nature of pain catastrophizing.
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The Pain Management Index (PMI) is used to assess pain medication adequacy in black and white chronic pain patients (18-50 years) at referral to tertiary pain care. Using WHO guidelines for pain treatment, PMI was calculated from pain severity and drug analgesic potency. From 183 patients recruited, 128 provided treatment information for analyses (53% white, 60% female). Most (51.6%) had adequate PMI. Blacks were prescribed fewer pain medications (P = .03); fewer women had adequate medication strength (P = .04). In hierarchical regression, PMI was predicted at entry by female gender, lower MPI, higher affective MPQ, and a gender X age interaction. Younger men experienced better pain management, reducing toward the PMI level of women by age 50. In the final block, black race, being married, affective pain, and gender X age were associated with higher PMI, female gender and being employed were associated with lower PMI. Women, particularly younger women, were at higher risk for inadequate pain management in a primary care environment. These results support variability in chronic pain care and the need for research focusing on whether these disparities persist with specialized pain care. ⋯ Most people with pain receive initial care in a primary care setting. This study examining the adequacy of pain management prior to specialty pain care showed blacks and women had less adequate pain care at referral. These results suggest the need for interventions and education in the primary care arena to improve pain care.
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Mindfulness involves reducing potential influences from aversive cognitions, sensations, and emotions on behavior. Mindfulness may influence the experience of pain-related anxiety, and thereby enhance other aspects of physical and psychosocial functioning. Thus, the purpose of this study was to investigate a potential mediating role of pain-related anxiety between mindfulness and physical and psychosocial functioning in chronic pain patients. This cross-sectional/correlational study used archival data (N = 226) obtained from the larger Korean Pain Study at a university-based pain-management center in Korea. Based on the inclusion criterion for the present study, archival data were analyzed for a final sample of 179 patients with chronic pain. Structural equation analyses showed that both the partial- and full-mediation models had adequate goodness-of-fit indices for physical and psychosocial functioning. Subsequent chi-square tests, however, indicated that the more parsimonious full-mediation model was preferred to the partial-mediation model for physical and psychosocial functioning. Bootstrapping procedures yielded significant mediation effects of pain-related anxiety in the full-mediation models on physical and psychosocial functioning. These findings suggest that being mindful may lead indirectly to a decrease in the disabling influences of pain-related anxiety, thereby contributing to better physical and psychosocial functioning, rather than playing a direct contributing role for better functioning among chronic pain patients in Korea. ⋯ This article examines the mediating role of pain-related anxiety between mindfulness and physical/psychosocial functioning. Results suggest that mindfulness methods may benefit patients having pain-related anxiety and consequent disability. These benefits may derive from the way processes of mindfulness interact with processes of avoidance and with cognitive influences on emotional suffering.
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Since returning from the Persian Gulf, nearly 100,000 veterans of the first Gulf War (GVs) have reported numerous symptoms with no apparent medical explanation. A primary complaint of these individuals is chronic musculoskeletal pain (CMP). CMP symptoms in GVs are similar to those reported by patients with fibromyalgia (FM), but have not received equivalent scientific attention. Exercise research in CMP patients suggests that acute exercise may exacerbate pain while chronic exercise can reduce pain and improve other symptoms. However, the influence of exercise on GVs with CMP is largely unexplored. This study examined the impact of an acute bout of exercise on pain sensitivity in GVs with CMP. Thirty-two GVs (CMP, n = 15; Control, n = 17) were recruited to complete a series of psychophysical assessments to determine pain sensitivity to heat and pressure stimuli before and after exercise. In response to heat-pain stimuli, GVs with CMP reported higher pain intensity and affect ratings than healthy GVs and exhibited a significant increase in ratings following exercise. GVs with CMP rated exercise as more painful and effortful and were generally more sensitive to heat-pain stimuli than healthy GVs. These results are similar to what has been reported for acute exercise in patients with FM. ⋯ Gulf War veterans with CMP perceive exercise as more painful and effortful than healthy GVs and experience increased pain sensitivity following exercise. These results suggest that similar abnormalities in central nervous system processing of nociceptive information documented in FM may also be occurring in GVs with CMP.
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Ambiguous or blunted responses to sensory and painful stimuli among individuals with severe intellectual disabilities and comorbid communicative impairments put them at risk for having their experience of pain discounted and their expression of pain misinterpreted. Valid measurement procedures of behavioral expression are critical for this vulnerable group of individuals. We investigated a sham-controlled sensory-testing protocol as an approach to guard against observer bias during nonverbal behavioral recording for individuals with intellectual disabilities. Participants were 44 (52% male) adults (mean age = 46, sd = 10) with moderate (14%) and severe to profound (86%) intellectual impairment. The facial behavior of the participants before, during, and after 5 sensory-stimulation modalities (pin prick, light touch, deep pressure, cool, warm) was coded by 3 raters using the Facial Action Coding System (FACS). For each participant, the 5 active sensory trials were randomized with sham trials during which no stimulation was applied. Observers were blinded to active vs sham stimulation status. FACS scores increased significantly during active sensory trials (P < .05) compared with sham trials. There were significant effects for gender, with females more expressive than males (P < .05). There were also significant effects for the presence of self-injurious behavior (SIB), with individuals with SIB more expressive than individuals without SIB (P < .05). The results suggest that the procedure was valid (ie, distinguished between active vs sham sensory stimulation) and provides additional evidence that individuals with significant intellectual impairments are sensitive to tactile stimulation consistent with quantitative sensory-testing protocols. ⋯ This article presents a novel application of a modified approach to quantitative sensory testing for nonverbal adults with intellectual and developmental disabilities. This approach could be important in helping determine sensory issues related to tactile and nociceptive processes among a highly vulnerable group of individuals.