The journal of pain : official journal of the American Pain Society
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It is generally assumed that individuals exhibiting high pain inhibition also tend to exhibit low pain facilitation, but little research has examined this association in individuals with pain. The aims of this cross-sectional study were 1) to examine the association between measures of conditioned pain modulation (CPM) and temporal summation (TS) in individuals with chronic pain, and 2) to examine whether this association was moderated by demographic (age, sex), psychological (depression, catastrophizing), or medication-related (opioid use) variables. Individuals (N= 190) with back or neck pain completed questionnaires and underwent a series of quantitative sensory testing procedures assessing CPM and TS. ⋯ The magnitude of CPM was lower for opioid users than nonusers, suggesting that opioid use might dampen the functioning of endogenous pain-inhibitory systems and possibly contribute to a discordance between measures of pain inhibition and pain facilitation. PERSPECTIVE: Results of the present study indicated that greater endogenous pain-inhibitory capacity is associated with lower levels of pain facilitation. This association, however, was not significant among opioid users, suggesting that opioids might compromise the functioning and interrelationship between endogenous pain modulatory systems.
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Peripheral neuropathic pain is among the most prevalent types of neuropathic pain. No comprehensive peripheral neuropathic pain classification system that incorporates contemporary clinical, diagnostic, biological, and psychological information exists. To address this need, this article covers the taxonomy for 4 focal or segmental peripheral neuropathic pain disorders, as part of the Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks (ACTTION) public-private partnership and the American Pain Society (APS) collaborative to develop a standardized, evidence-based taxonomy initiative: the ACTTION-APS Pain Taxonomy (AAPT). ⋯ PERSPECTIVE: The AAPT peripheral neuropathic pain taxonomy subdivides the peripheral neuropathic pain disorders into those that are generalized and symmetric and those that are focal or segmental and asymmetric. In this article, we cover the focal and segmental disorders: postherpetic neuralgia, persistent posttraumatic neuropathic pain, complex regional pain disorder, and trigeminal neuralgia. The taxonomy is evidence-based and multidimensional, with the following dimensions: 1) core diagnostic criteria; 2) common features; 3) common medical and psychiatric comorbidities; 4) neurobiological, psychosocial, and functional consequences; and 5) putative neurobiological and psychosocial mechanisms, risk factors, and protective factors.
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An important predictor of opioid overdose is co-use of benzodiazepines, which are often prescribed for anxiety. Coping with anxiety may be particularly difficult among individuals with a history of abuse, as it is often linked to higher pain severity and poorer coping skills. We explored whether abuse history moderated the association between anxiety and benzodiazepine use among current opioid users. ⋯ Providers should be aware of life history factors, including abuse, that may drive the need for medication. Perspective: This article examines the association between history of abuse victimization and co-use of benzodiazepines among chronic pain patients reporting current opioid use. The findings suggest that cumulative victimization across the lifespan may contribute to co-use by increasing sensitivity to psychological or physical distress or by negatively impacting coping skills.
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Persistent pain in young people in the community is common, but individuals vary in how much pain impacts daily life. Information-processing accounts of chronic pain partly attribute the fear and avoidance of pain, as well as associated interference, to a set of involuntary biases, including the preferential allocation of attention resources toward potential threats. Far less research has focused on the role of voluntary goal-directed attention control processes, the ability to flexibly direct attention toward and away from threats, in explaining pain-associated interference. ⋯ If replicated, these findings may have implications for understanding and managing the pain-associated disability in adolescents with chronic pain. PERSPECTIVE: Young people with moderately and highly interfering pain responded slower on an easy search task after seeing a pain face than after seeing a neutral face. If replicated, these findings could mean that boosting the ability to control attention toward and away from threatening cues is an effective strategy for managing interference from pain.
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This study examined pre-existing depression as a risk factor for the development of chronic spinal pain, and pre-existing chronic spinal pain as a risk factor for the development of depression. Data from the National Comorbidity Survey, a stratified sample of 5,001 participants evaluated in 1990 to 1992 (NCS-1) and again in 2000 to 2001 (NCS-2) were used to address these associations. Cox regression was used to estimate hazard ratios and time-to-incidence after NCS-1. ⋯ The results are discussed in terms of the need to assess the presence of both disorders given the presence of one. PERSPECTIVE: Chronic spinal pain and depressive disorders, especially chronic depression, increase the likelihood for the subsequent development of the other condition. The results underscore the need to routinely assess for the presence of both disorders given the presence of one to mitigate the effects of developing comorbid conditions.