The journal of pain : official journal of the American Pain Society
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Rheumatoid arthritis (RA) is an example of human chronic inflammatory pain. Modern treatments suppress inflammation, yet pain remains a major problem for many people with RA. We hypothesized that discrete RA subgroups might display favorable or unfavorable pain trajectories when receiving treatment, and that baseline characteristics will predict trajectory allocation. ⋯ Discrete persistent and resolving pain trajectories were identified after treatment, both in early and established RA. Smoking and greater disability at baseline predicted persistent pain. Identifying patient subgroups with a poor pain prognosis could enable adjunctive treatment to improve outcomes.
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Chronic pain is a leading cause of work absenteeism and disability compensation. Previous work demonstrates that patients with chronic illness often seek advice, such as whether or not to pursue disability benefits, from peers with similar health conditions. The current study examined the extent that social factors influence patients with chronic pain ("peers") when making disability judgments and recommendations for other patients with chronic pain. ⋯ These judgments may impact patient decision making via peer support programs and online forums. PERSPECTIVE: This study suggests that patients with chronic pain are influenced by patient weight, fault of accident, and physical work demands when making judgments about pain and disability for peers. Future studies should examine the extent such peer-to-peer recommendations influence actual disability-seeking behaviors for pain.
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There is paucity of prospective studies that have examined rates and prognostic indicators of pain severity after a road traffic crash injury. This cohort study involved 1,854 participants aged ≥17 years with a noncatastrophic injury. Primary analyses of pain severity involved 1604 individuals who reported any pain since the injury at baseline Of these, 1,188 and 972 participants were reexamined at the 6- and 12-month follow-up, respectively. ⋯ Several independent contributors to chronic pain identified in this study are modifiable, reinforcing their inclusion as targets in pain management programs. PERSPECTIVE: This cohort study involving participants who sustained a noncatastrophic injury in a road traffic crash established the predictors of pain severity over 12 months. Study findings reiterate and reinforce the importance of being cognizant of a wide spectrum of biopsychosocial predictors both in the management and rehabilitation of injured persons.
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Previous research has revealed that the face is a finely tuned medium for pain communication. Studies assessing the decoding of facial expressions of pain have revealed an interesting discrepancy, namely that, despite eyes narrowing being the most frequent facial expression accompanying pain, individuals mostly rely on brow lowering and nose wrinkling/upper lip raising to evaluate pain. The present study verifies if this discrepancy may reflect an interaction between the features coding pain expressions and the features used by observers and stored in their mental representations. ⋯ Together, these results suggest that the features most saliently coded in the mental representation of facial expressions of pain may reflect a bias toward allocating more weight to the affective information encoded in the face. PERSPECTIVE: This work reveals the relative importance of 3 facial features representing the core of pain expressions during pain decoding. The results show that 2 features are over-represented; this finding may potentially be linked with the estimation biases occurring when clinicians and lay persons evaluate pain based on facial appearance.
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Clinical Trial
Decreasing Pain Ratings in Chronic Arm Pain Through Changing a Virtual Body: Different Strategies for Different Pain Types.
Modifying the visual aspect of a virtual arm that is felt as one's own using immersive virtual reality (VR) modifies pain threshold in healthy subjects, but does it modify pain ratings in chronic pain patients? Our aim was to investigate whether varying properties of a virtual arm co-located with the real arm modulated pain ratings in patients with chronic arm/hand pain because of complex regional pain syndrome (CRPS) type I (without nerve injury) or peripheral nerve injury (PNI). CRPS (n = 9) and PNI (n = 10) patients were immersed in VR and the virtual arm was shown at 4 transparency levels (transparency test) and 3 sizes (size test). We evaluated pain ratings throughout the conditions and assessed the virtual experience, finding that patients with chronic pain can achieve levels of ownership and agency over a virtual arm similar to healthy participants. ⋯ We discuss this through the interactions between body image and pain perception. PERSPECTIVE: "Embodiment" in VR is useful to decrease pain ratings in chronic pain patients, but the best strategy needs to be tuned to the pain etiology. This approach could potentially help patients with chronic pain and clinicians who seek alternatives to pain management for patients.