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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Comparative Study
Comparison of the cold pressor test and contact thermode-delivered cold stimuli for the assessment of cold pain sensitivity.
Sensitivity to suprathreshold cold pain stimuli constitutes an important part of comprehensive pain sensitivity testing and can be assessed by the cold pressor test or by using a contact thermode-based testing device. One major difference between the 2 methods is the size of the surface area stimulated, which is thought to affect both recruitment of endogenous pain control mechanisms and vasomotor reactions. It is therefore not clear if the 2 methods can be used interchangeably for the assessment of cold pain. Here we applied 60-second-long stimuli at approximately 3 degrees C to the hands of 47 subjects by both methods. Pain intensity ratings (on a scale from 0 to 10) were significantly higher in the cold pressor test than in the thermode cold test (6.3 +/- 1.8 vs 3.9 +/- 2), associated with a higher rate of dropouts within the 60 seconds (64 vs 11%). Nonetheless, pain intensity ratings obtained with both methods were highly correlated (r = .70). However, the thermode cold test shared a larger amount of variance with 1 or more of the other pain intensity rating tests (phasic and tonic heat, pinprick) than the cold pressor test (53% vs 30%) while the cold pressor test contained a larger proportion of unique variance (39 vs 26%). ⋯ This article compares 2 methods of cold pain assessment in humans and analyzes their relationship to heat and pinprick pain. It could help researchers select the appropriate cold pain test for their study. It may also promote our understanding of commonalities and differences between different pain modalities.
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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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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.