The journal of pain : official journal of the American Pain Society
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Neuropsychological (NP) performance has been associated with psychosocial treatment outcomes in nonpain conditions, but has never been investigated in chronic pain. We performed a secondary analysis on the association of baseline NP performance with treatment outcomes among veterans with chronic pain (N = 117) undergoing an 8-week acceptance and commitment therapy (ACT) intervention. Participants completed measures of pain interference, pain severity, quality of life, activity levels, depression, and pain-related anxiety at baseline, midtreatment, and post-treatment. ⋯ Specifically, relatively lower executive functioning and processing speed was associated with greater decreases in depressive symptoms, and relatively lower processing speed was associated with greater decreases in pain-related anxiety. Consistent with research in nonpain conditions, those with relatively lower NP functioning received greater benefit from psychosocial treatment, although most study outcomes did not differ as a function of NP performance. Our results suggest relatively lower NP functioning is not contraindicated for participation in psychosocial interventions like ACT but instead may be associated with greater relief.
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After the 2011 Institute of Medicine report on chronic pain, the Interagency Pain Research Coordinating Committee (IPRCC) was created to enhance research efforts among federal agencies. The IPRCC and Office of Pain Policy at the National Institutes of Health collaborated to identify gaps in knowledge and address them via a Federal Pain Research Strategy (FPRS). Interdisciplinary work groups (WGs) were established to make research recommendations in 5 areas: prevention of acute and chronic pain, acute pain and acute pain management, transition from acute to chronic pain, chronic pain and chronic pain management, and disparities in pain and pain care; cross-cutting issues were also considered. ⋯ The one deemed "greatest near-term value" was to optimize public health strategies to educate patients on managing pain; that deemed "most impactful" was to determine an association between patient and intervention factors. Other recommendations were related to the epidemiology of acute pain from health care procedures, the epidemiology of acute pain from work-related injuries, safety and effectiveness of management of pain associated with health care procedures, optimizing approaches to acute postsurgical pain, and safety and effectiveness of early interventions for tertiary prevention. Stakeholders, including federally sponsored research programs, researchers, health care providers, policy makers, patients, and others should work together to implement recommendations and address important gaps.
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The objective of this prospective long-term follow-up study was to investigate whether somatosensory function is altered among young adults born preterm with very low birth weight (VLBW; ≤1,500 g) or small for gestational age (SGA; <10th percentile) at term. In a blinded quantitative sensory testing protocol, we determined thermal detection, thermal pain, and pressure pain thresholds and the response to prolonged supra-threshold heat among 51 VLBW, 66 term SGA, and 86 term-born controls (birth weight ≥10th percentile) at 28 years. Self-reported chronic pain was also investigated. ⋯ Within the VLBW group, neonatal mechanical ventilation was associated with reduced sensitivity to cool, and length of mechanical ventilation correlated with lower pressure pain thresholds. The response to prolonged supra-threshold heat was similar between the groups, and the prevalence of self-reported chronic pain was not reliably different. In conclusion, low birth weight young adults were as sensitive to thermal and pain stimuli as term-born, normal birth weight controls, with the same sex differences.
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Generalized hyperalgesia and impaired pain modulation are reported in chronic low back pain (LBP). Few studies have tested whether these features are present in the acute phase. This study aimed to test for differences in pain presentation in early-acute LBP and evaluate the potential contribution of other factors to variation in sensitivity. ⋯ Four subgroups with distinct features were identified: "high sensitivity," "low CPM efficacy," "high sensitivity/low CPM efficacy," and "low sensitivity/high CPM efficacy." Various factors such as sleep and alcohol were associated with each pain measure. Results provide evidence for generalized hyperalgesia in many, but not all, individuals during acute LBP, with variation accounted for by several factors. Specific pain phenotypes provide candidate features to test in longitudinal studies of LBP outcome.
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Pain is a common but often ignored symptom in patients with myotonic dystrophy type 2 (DM2). In this explorative study, we assessed qualitative and quantitative aspects of pain in DM2 using 4 questionnaires and quantitative sensory testing. A disease control group (fibromyalgia [FMS]) as well as healthy controls were used to compare the results, because pain in DM2 shows many clinical similarities to pain in FMS. ⋯ Peripheral mechanisms of pain seem to play a role in DM2. The widespreadness of the hyperalgesia suggests central sensitization, but this finding was not supported by the other results. This study opens new avenues for further research and eventually novel treatment strategies, in DM2 as well as in other muscular disorders.