The journal of pain : official journal of the American Pain Society
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Providers are being asked to decrease the emphasis and overutilization of long-term opioid therapy, but many are left without proper guidance on appropriate utilization of nonopioid therapies. Furthermore, therapeutic options are quite limited and many providers lack confidence in distinguishing available alternatives. When first-line therapy has failed in a patient, there is an apparent lack of knowledge on how to proceed with choosing subsequent therapy. ⋯ Sodium channel blocker doses used in certain pain syndromes are outlined with a call for further research to better understand their place in chronic pain management. Identification of sodium channel subtypes with links to specific pain conditions and the ability to target them hints at the potential for truly individualized therapy. Sodium channel inhibitors are underutilized on the basis of available evidence, and emerging research has identified this area as promising for additional clinical trials to better guide clinical practice.
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Symptoms of post-traumatic stress disorder (PTSS) and chronic pain have been shown to co-occur at high rates in adolescents and this co-occurrence is linked to worse pain and quality of life. Sleep disturbance has been posited as a mechanism underlying this co-occurrence in conceptual models of mutual maintenance. This study examined the mediating role of sleep in the relationship between PTSS and pain in youth (aged 10-17 years) with chronic pain. ⋯ Findings revealed that, over and above the influence of associated demographic characteristics (age, race) and anxiety symptoms, sleep quality partially mediated the relationships between PTSS and pain intensity and interference for youth with chronic pain. Specifically, higher levels of PTSS was linked to higher levels of pain intensity and pain interference, and these relationships were partially explained by poor sleep quality. Findings highlight the potential mechanistic role of sleep in explaining the co-occurrence of chronic pain and PTSS and suggest sleep might be an important target in future interventions.
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Review
The Role of Self-Efficacy on the Prognosis of Chronic Musculoskeletal Pain: a Systematic Review.
Evidence suggests that self-efficacy can play an essential role as a protective factor as well as a mediator in the relationship between pain and disability in people suffering from chronic musculoskeletal pain. This study systematically reviewed and critically appraised the role of self-efficacy on the prognosis of chronic musculoskeletal pain. Study selection was on the basis of longitudinal studies testing the prognostic value of self-efficacy in chronic musculoskeletal pain. ⋯ Our results suggest that higher self-efficacy levels are associated with greater physical functioning, physical activity participation, health status, work status, satisfaction with the performance, efficacy beliefs, and lower levels of pain intensity, disability, disease activity, depressive symptoms, presence of tender points, fatigue, and presenteeism. Despite the low quality of evidence of included studies, clinicians should be encouraged identify people with chronic musculoskeletal pain who present low self-efficacy levels before prescribing any therapy. It may help clinicians in their clinical decision-making and timely and specific consultations with-or referral to-other health care providers.
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Multicenter Study
Differential Impact of Patient Weight on Pain-Related Judgments About Male and Female Chronic Low Back Pain Patients.
Compared with men, women report more pain and are at increased risk for having pain discounted or misattributed to psychological causes. Overweight individuals experience high rates of pain and may receive suboptimal care because of provider bias. Research suggests the social consequences of being overweight are worse for women than men, and that gender and weight uniquely and interactively affect pain experience and care. ⋯ Results suggest that the pain of normal and overweight women and obese men was discounted (judged as less intense, less interfering, more exaggerated, and less attributable to medical factors) and judged as less in need of treatment (treated with less opioids and workplace accommodations). Across all weight categories, women's pain was attributed more to psychological factors and was more likely to receive recommendations for psychological therapy than men's pain. These findings highlight the differential effect of patient weight on pain-related judgements about women and men.
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The rubber hand illusion (RHI) has been shown to alter the experience of pain, although studies have yielded inconsistent results. In this experiment we tested the influence of the RHI on the intensity of pain caused by electric stimuli. Electric stimuli were delivered to participants' experimental and control hands before RHI induction (control condition) and afterward (experimental condition), in a procedure that was double-blind with respect to location and strength of noxious stimulation. ⋯ In addition, in the experimental condition the perceived location of noxious stimulation applied to the experimental hand drifted toward the rubber hand. Our data suggest that the link between bodily illusions and pain could be modulated by uncertainty about location of pain and the affected body part. Future studies should aim to determine which aspects of altered body awareness lead to pain sensitization.