The journal of pain : official journal of the American Pain Society
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Partner behavioral responses to pain can have a significant impact on patient pain and depression, but little is known about why partners respond in specific ways. Using a cognitive-behavioral model, the present study examined whether partner cognitions were associated with partner behavioral responses, which prior work has found to predict patient pain and depressive symptoms. Participants were 354 women with provoked vestibulodynia and their partners. Partner pain-related cognitions were assessed using the partner versions of the Pain Catastrophizing Scale and Extended Attributional Style Questionnaire, whereas their behavioral responses to pain were assessed with the Multidimensional Pain Inventory. Patient pain was measured using a numeric rating scale, and depressive symptoms were assessed using the Beck Depression Inventory-II. Path analysis was used to examine the proposed model. Partner catastrophizing and negative attributions were associated with negative partner responses, which were associated with higher patient pain. It was also found that partner pain catastrophizing was associated with solicitous partner responses, which in turn were associated with higher patient pain and depressive symptoms. The effect of partner cognitions on patient outcomes was partially mediated by partner behavioral responses. Findings highlight the importance of assessing partner cognitions, both in research and as a target for intervention. ⋯ The present study presents a cognitive-behavioral model to partially explain how significant others' thoughts about pain have an effect on patient pain and depressive symptoms. Findings may inform cognitive-behavioral therapy for couples coping with PVD.
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Pain is often the focus of research and clinical care in fibromyalgia (FM); however, cognitive dysfunction is also a common, distressing, and disabling symptom in FM. Current efforts to address this problem are limited by the lack of a comprehensive, valid measure of subjective cognitive dysfunction in FM that is easily interpretable, accessible, and brief. The purpose of this study was to leverage cognitive functioning item banks that were developed as part of the Patient Reported Outcomes Measurement Information System (PROMIS) to devise a 10-item short form measure of cognitive functioning for use in FM. In study 1, a nationwide (U.S.) sample of 1,035 adults with FM (age range = 18-82, 95.2% female) completed 2 cognitive item pools. Factor analyses and item response theory analyses were used to identify dimensionality and optimally performing items. A recommended 10-item measure, called the Multidimensional Inventory of Subjective Cognitive Impairment (MISCI) was created. In study 2, 232 adults with FM completed the MISCI and a legacy measure of cognitive functioning that is used in FM clinical trials, the Multiple Ability Self-Report Questionnaire (MASQ). The MISCI showed excellent internal reliability, low ceiling/floor effects, and good convergent validity with the MASQ (r = -.82). ⋯ This paper presents the MISCI, a 10-item measure of cognitive dysfunction in FM, developed through classical test theory and item response theory. This brief but comprehensive measure shows evidence of excellent construct validity through large correlations with a lengthy legacy measure of cognitive functioning.
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Few studies have examined the involvement of specific subregions of the prefrontal cortex in complex regional pain syndrome (CRPS). We analyzed cortical thickness to identify morphologic differences in local brain structures between patients with CRPS and healthy control subjects (HCs). Furthermore, we evaluated the correlation between cortical thickness and neurocognitive function. Cortical thickness was measured in 25 patients with CRPS and 25 HCs using the FreeSurfer method. Pain severity and psychiatric symptoms were assessed using the Short Form McGill Pain Questionnaire and the Beck Depression and Anxiety Inventories, respectively. Neurocognitive function was assessed via the Wisconsin Card Sorting Test and the stop-signal task. The right dorsolateral prefrontal cortex and left ventromedial prefrontal cortex were significantly thinner in CRPS patients than in HCs. CRPS patients made more perseveration errors on the Wisconsin Card Sorting Test and had longer stop-signal task reaction times than HCs. Although the Beck Depression Inventory and the Beck Anxiety Inventory differ significantly between the groups, they were not correlated with cortical thickness. Our study suggests that the pathophysiology of CRPS may be related to reduced cortical thickness in the dorsolateral prefrontal cortex and the ventromedial prefrontal cortex. The structural alterations in dorsolateral prefrontal cortex may explain executive dysfunction and disinhibited pain perception in CRPS. ⋯ The present study reports decreased cortical thickness in the prefrontal cortex and neurocognitive dysfunctions in patients with CRPS. These findings may contribute to the understanding of pain-related impairments in cognitive function and could help explain the symptoms or progression of CRPS.
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The interaction of patient race, provider bias, and clinical ambiguity on pain management decisions.
Although racial disparities in pain care are widely reported, much remains to be known about the role of provider and contextual factors. We used computer-simulated patients to examine the influence of patient race, provider racial bias, and clinical ambiguity on pain decisions. One hundred twenty-nine medical residents/fellows made assessment (pain intensity) and treatment (opioid and nonopioid analgesics) decisions for 12 virtual patients with acute pain. Race (black/white) and clinical ambiguity (high/low) were manipulated across vignettes. Participants completed the Implicit Association Test and feeling thermometers, which assess implicit and explicit racial biases, respectively. Individual- and group-level analyses indicated that race and ambiguity had an interactive effect on providers' decisions, such that decisions varied as a function of ambiguity for white but not for black patients. Individual differences across providers were observed for the effect of race and ambiguity on decisions; however, providers' implicit and explicit biases did not account for this variability. These data highlight the complexity of racial disparities and suggest that differences in care between white and black patients are, in part, attributable to the nature (ie, ambiguity) of the clinical scenario. The current study suggests that interventions to reduce disparities should differentially target patient, provider, and contextual factors. ⋯ This study examined the unique and collective influence of patient race, provider racial bias, and clinical ambiguity on providers' pain management decisions. These results could inform the development of interventions aimed at reducing disparities and improving pain care.
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Studies report that viewing the body or keeping one's arms crossed while receiving painful stimuli may have an analgesic effect. Interestingly, changes in ratings of pain are accompanied by a reduction of brain metabolism or of laser evoked potentials amplitude. What remains unknown is the link between visual analgesia and crossed-arms related analgesia. Here, we investigated pain perception and laser evoked potentials in 3 visual contexts while participants kept their arms in a crossed or uncrossed position during vision of 1) one's own hand, 2) a neutral object in the same spatial location, and 3) a fixation cross placed in front of the participant. We found that having vision of the affected body part in the crossed-arms position was associated with a significant reduction in pain reports. However, no analgesic effect of having vision of the hand in an uncrossed position or of crossing the arms alone was found. The increase of the late vertex laser evoked potential P2 amplitude indexed a general effect of vision of the hand. Our results hint at a complex interaction between cross-modal input and body representation in different spatial frames of reference and at the same time question the effect of visual analgesia and crossed-arms analgesia alone. ⋯ We found that nociceptive stimuli delivered to the hand in a crossed-arms position evoke less pain than in a canonical anatomic position. Yet we report no significant analgesic effect of vision or crossing the arms on their own. These findings foster the integration of visuospatial and proprioceptive information in rehabilitation protocols.