The journal of pain : official journal of the American Pain Society
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The purpose of this study was to develop and validate a brief, clinically relevant, multidimensional interview to assess pain burden among children and adolescents with sickle cell disease (SCD). The Sickle Cell Disease Pain Burden Interview-Youth (SCPBI-Y) was developed using a panel of experts, patients, and caregivers. Validation was undertaken with children and youth with SCD, ages 7 to 21 years (N = 129), recruited from 4 urban children's hospitals. Participants were recruited from inpatient (n = 62) and outpatient (n = 67) settings. The SCPBI-Y demonstrated strong internal consistency reliability, cross-informant concordance (child-caregiver), and test-retest reliability (outpatient setting). Moderate construct validity was found with validated measures of functional ability, pain, and quality of life. The SCPBI-Y demonstrated construct validity using a contrasted group approach between youth in inpatient versus outpatient settings and by severity of SCD symptoms, suggesting that youth in inpatient settings and with higher disease severity exhibited greater pain burden. Discriminant validity was found between SCPBI-Y and mood. Our preliminary findings suggest that the SCPBI-Y is a valid and reliable multidimensional interview that can be used in different clinical settings to evaluate pain burden among children and adolescents with SCD. ⋯ Multifaceted pain assessments are salient in providing optimal care to children and adolescents with SCD; however, current evaluations are lengthy and cumbersome to administer clinically. The current study introduces and validates a brief, clinically useful multidimensional interview to evaluate pain burden specific to youth with SCD.
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Chronic pain, chronic fatigue, and depressive mood are prevalent conditions in people with spinal cord injury (SCI). The objective of this research was to investigate the relationship between these conditions in adults with SCI. Multivariate analysis of variance, contingency analyses, and hierarchical regression were used to determine the nature of the relationship, as well as the contribution to this relationship of self-efficacy, a potential mediator variable. Seventy participants with SCI living in the community completed an assessment regimen of demographic and psychometric measures, including validated measures of pain, fatigue, depressive mood, and self-efficacy. Results indicated that participants with high levels of chronic pain had clinically elevated depressive mood, confusion, fatigue, anxiety and anger, low vigor, and poor self-efficacy. Participants with high chronic pain had 8 times the odds of having depressive mood and 9 times the odds of having chronic fatigue. Regression analyses revealed that chronic pain contributed significantly to elevated depressive mood and that self-efficacy mediated (cushioned) the impact of chronic pain on mood. Furthermore, both chronic pain and depressive mood were shown to contribute independently to chronic fatigue. Implications of these results for managing chronic pain in adults with SCI are discussed. ⋯ The relationship between pain, negative mood, fatigue, and self-efficacy in adults with SCI was explored. Results support a model that proposes that chronic pain lowers mood, which is mediated (lessened) by self-efficacy, whereas pain and mood independently increase chronic fatigue. Results provide direction for treating chronic pain in SCI.
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Crossing the hands over the body midline reduces the perceived intensity of nociceptive stimuli applied to the hands by impairing the ability to localize somatosensory stimuli. The neural basis of this "crossed-hands analgesia" has not been investigated previously, although it has been proposed that the effect may be modulated by multimodal areas. We used functional magnetic resonance imaging to test the hypothesis that crossed-hands analgesia is mediated by higher-order multimodal areas rather than by specific somatosensory ones. Participants lay in the scanner while mechanical painful stimuli were applied to their hands held in either a crossed or uncrossed position. They reported significantly lower perceived intensity of pain when their hands were crossed. Although activations elicited by stimuli applied to the crossed hands revealed significantly greater blood oxygen level-dependent responses in the anterior cingulate cortex, the insula, and the medial frontal gyrus, the blood oxygen level-dependent responses in the superior parietal lobe were greater with the hands uncrossed. Our results provide evidence that crossed-hands analgesia is mediated by higher-order frontoparietal multimodal areas involved in sustaining and updating body and spatial representations. ⋯ We found crossed-hands analgesia to be mediated by multimodal areas, such as the posterior parietal, cingulate, and insular cortices, implicated in space and body representation. Our findings highlight how the perceived intensity of painful stimuli is shaped by how we represent our body and the space surrounding it.
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The assessment of persistent pain often relies on recalling and then summarizing the entire pain experience using a single rating. Newer methodologies, such as the Original Pain Recall Assessment, ask people to recall the pain they experienced over a specific period of time by tracing a single line in a graph to represent their pain levels. One advantage of this approach is that one can compare recalled levels of pain with actual daily diary pain ratings. This methodology was used to investigate the effects of neuroticism on the recall of levels and patterns of persistent pain. The study involved 70 participants who completed a measure of neuroticism, depressive symptoms, and up to 15 daily diaries that asked for ratings of pain intensity, pain unpleasantness, and activity interference due to pain. Following completion of the daily diary period, the participants were asked to recall the entire diary period using the Original Pain Recall Assessment methodology. The analyses revealed that higher levels of neuroticism were related to significantly better recall of the variability of pain unpleasantness over time. Furthermore, individuals who reported higher levels of depressive symptoms were less accurate in the recall of pain in general. ⋯ Memory for pain is crucial in the assessment of pain, with little research devoted to the study of this topic. The current study demonstrates that people higher on neuroticism had better recall of pain unpleasantness, and people with higher levels of depressive symptoms had poorer recall of pain in general.