The journal of pain : official journal of the American Pain Society
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In chronic pain, pain-related fear seems to overgeneralize to safe stimuli, thus contributing to excessive fear and avoidance behavior. Evidence shows that pain-related fear can be acquired and generalized based on conceptual knowledge. Using a fear conditioning paradigm, we investigated whether this concept-based pain-related fear could also be extinguished. ⋯ This is the first study to demonstrate extinction of concept-based pain-related fear, thus providing evidence for the potential of extinction-based techniques in the treatment of conceptual pain-related fear. PERSPECTIVE: This study demonstrates the acquisition, generalization, and extinction of concept-based pain-related fear in healthy participants. These are the first results to show that concept-based pain-related fear can be extinguished, suggesting that conceptual relationships between fear-inducing stimuli may also be important to consider in clinical practice.
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Despite widespread use as a chronic pain management strategy, pacing has been linked with higher levels of pain and disability. A recent meta-analysis found a positive correlation between existing measures of pacing and avoidance, which may partially account for these poorer outcomes. A measure was developed to differentiate pacing from avoidance by emphasizing non-pain-contingent pacing behaviors and nonavoidance of pain. ⋯ PERSPECTIVE: The NAPS assesses activity pacing in chronic pain without artefactual overlap with avoidance. Associations were found between more frequent pacing, as measured by the NAPS, and better psychological functioning. Clearly differentiating pacing from avoidance allows for accurate assessment of the role of pacing in chronic pain management.
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Review Meta Analysis
Do People With Chronic Musculoskeletal Pain Have Impaired Motor Imagery? A Meta-analytical Systematic Review of the Left/Right Judgment Task.
The left/right judgment task (LRJT) is the most commonly used method of assessing motor imagery performance. Abnormally long response times are thought to reflect delayed processing of body/spatial representations, and poor accuracy is thought to reflect disrupted cortical proprioceptive representations or body schema. Slower and less accurate responses on the LRJT have been reported in a variety of chronic musculoskeletal pain conditions. ⋯ PERSPECTIVES: This review synthesizes evidence of altered motor imagery performance using the LRJT across chronic musculoskeletal pain conditions. Consistent evidence was found for altered motor imagery performance in peripheral pain conditions, but evidence was less consistent for axial conditions. Treatment to restore a normal body schema may be beneficial in chronic limb and facial pain.