The journal of pain : official journal of the American Pain Society
-
The primary objective of the present study was to examine the relative importance of pain behaviors and judgmental heuristics (eg, gender stereotypes) in observers' inferences about pain intensity and pain genuineness. Participants (n = 90) observed video depictions of chronic pain patients performing a physically challenging task and were asked to make inferences of pain intensity and pain genuineness. Analyses indicated that observers relied on judgmental heuristics and pain behaviors both when making inferences about pain intensity and when making inferences about pain genuineness. Follow-up analyses, however, revealed that judgmental heuristics (eg, gender stereotypes) were significantly less utilized when observers made inferences about pain genuineness than when observers made inferences about pain intensity. When observers made inferences about pain genuineness, analyses indicated that patients' facial pain behaviors became the most important source of information. Taken together, these findings suggest that observers who are asked to make inferences about the genuineness of others' pain are likely to reduce their reliance on judgmental heuristics in favor of more controlled and thoughtful inferential processes characterized by detailed processing of behavioral information, particularly others' facial pain behaviors. ⋯ The current study provides new insights into the processes that are involved in observers' inferences about pain intensity and pain genuineness. These inferences play an important role in treatment decisions and advances in this domain could ultimately contribute to more effective management of the challenges facing patients with pain-related disorders.
-
The prevalence of pain and pain undertreatment in older persons, along with the many potential detrimental consequences of undertreated pain, pose a substantial burden to the individual, their family, and society. An accurate pain assessment is the foundation for treating pain; yet, thorough pain assessments and regular reassessments are too often neglected. Older adults typically present with multiple pain etiologies, making it all the more imperative that a comprehensive assessment is conducted. ⋯ Following an unsuccessful attempt at self-report from a nonverbal older adult, the potential causes of pain should be explored. Direct observation can then be used to identify behaviors suggestive of pain, and the patient's response to an analgesic trial can be observed. A pain behavior tool can also provide useful information suggesting the presence of pain.
-
Evidence of support for sensory changes during minor depression and sadness is scarce and the neural mechanisms are unclear. We assessed central pain processing engaged in nociceptive C-fiber polymodal activity by examining the perception of a non-noxious unpleasant burning sensation induced by a thermal grill illusion, in 26 nonpatients with minor depression (19 females) and 28 healthy subjects (18 females), between 19 and 61 years old and pain free at the study. Controls were also subjected to induction of transient moods. Subjects with depression reported increased pain perception; this increase was more pronounced for the affective dimension of pain (unpleasantness) than for its sensory dimension (intensity). The perception of pain unpleasantness, pain intensity, and overall pain showed positive and linear correlations with depression levels measured by Zung's and Beck's scales. In controls, sad mood induction only increased the scores assigned to negative mood-describing adjectives; the perception of pain intensity, unpleasantness, and overall pain were significantly increased following sad, but not neutral or elevated, mood inductions. Yet, pain intensity and unpleasantness were correlated linearly and reciprocally to positive, instead of negative, mood-describing adjective scores. Thus, there is a central thermal hyperalgesia in subjects with minor depression and sadness. ⋯ There is a central thermal hyperalgesia in subjects with minor depression, probably associated with an enhanced central processing of nociceptive C-fiber polymodal activity at anterior cingulate cortex, that is predominately expressed as an increased unpleasantness and that could be in part counteracted by behavioral therapies leading to mood elevation.
-
Review
Pharmacological management of persistent pain in older persons: focus on opioids and nonopioids.
Managing persistent pain is challenging, particularly in older adults who often have comorbidities and physiological changes that affect dosing and adverse effect profiles. The latest guideline issued by the American Geriatrics Society in 2009 is an important clinical resource on prescribing analgesics for older adults. This guideline helps form an evidence-based approach to treating persistent pain, along with other current endorsements, such as the relevant disease-specific recommendations by the American College of Rheumatology, the European League Against Rheumatism, and Osteoarthritis Research Society International, as well as opioid-specific guidelines issued by the American Pain Society, the American Academy of Pain Medicine, the Federation of State Medical Boards of the United States, and the American Society of Interventional Pain Physicians. ⋯ Combining analgesics that have multiple mechanisms of action with nonpharmaceutical approaches can be beneficial in providing pain relief. Nontraditional analgesics are also considered on a case-by-case basis, and a few of these options are weakly recommended. Therapies should be initiated at the lowest possible dose and slowly titrated to effect, while tailoring them to the therapeutic and side-effect responses of the individual.