The journal of pain : official journal of the American Pain Society
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Attentional biases towards pain-related words of chronic and acute low back pain (LBP) patients were compared with healthy pain-free controls. Specifically, the aims were to determine: 1) whether chronic LBP patients demonstrate attentional biases compared to pain-free controls; 2) whether observed biases are also present in those with acute LBP; and 3) whether observed biases are associated with pain-related fear among the pain groups. Four groups were recruited: 1) acute LBP patients; 2) chronic LBP patients from physiotherapy practices; 3) chronic LBP patients from a tertiary referral pain-management center; and 4) healthy pain-free controls. Participants were assessed on the dot-probe computer task for attentional bias to pain-related words. All 3 pain groups demonstrated biases compared to controls on sensory but not on affective, disability, or threat words. Among the pain groups, those with low and moderate levels of fear of (re)injury demonstrated biases towards sensory pain words that were absent in those with high levels of fear, which is counterintuitive to what the fear of (re)injury model suggests. These results suggest that the experience of pain, rather than duration, is the primary indicator of the presence of pain-related biases. ⋯ Attentional biases are present in chronic and acute pain. Biases towards sensory-pain stimuli were demonstrated regardless of pain duration; however, they were present in those with low and moderate levels of fear of (re)injury only and not those high in fear. These findings are not consistent with the fear of (re)injury model.
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Based on prior research identifying dispositional optimism as a predictor of placebo responding, the present study tested the hypothesis that individuals high in optimism would be more likely to respond to a placebo analgesic. Optimists and pessimists were randomly assigned to a placebo expectation condition or a no expectation condition before a cold pressor task. Blood pressure and heart rate were recorded before and during the cold pressor task, and participant ratings of pain and expectations were obtained immediately after the task. Analysis of the expectation manipulation revealed that the placebo instruction was successful in altering participant expectancy during the cold pressor. Supporting the main hypothesis, dispositional optimism was associated with lower pain ratings in the placebo condition but not in the control condition. Because dispositional optimism can alter placebo responding to laboratory pain, future studies should examine the potential role that this individual difference factor may play in patient responsivity to pharmacological and nonpharmacological treatments for clinical pain. ⋯ This study examined the possibility that individual differences can predict placebo analgesia. Participants were randomly assigned to receive either a placebo expectation or no expectation before a cold pressor task. Dispositional optimism was related to less cold pressor pain in the placebo condition as compared with the control condition.
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Although most cases of temporomandibular muscle and joint disorders (TMJD) are mild and self-limiting, about 10% of TMJD patients develop severe disorders associated with chronic pain and disability. It has been suggested that fibromyalgia and widespread pain play a significant role in TMJD chronicity. This paper assessed the effects of fibromyalgia and widespread pain on clinically significant TMJD pain (GCPS II-IV). Four hundred eighty-five participants recruited from the Minneapolis/St. Paul area through media advertisements and local dentists received examinations and completed the Graded Chronic Pain Scale (GCPS) at baseline and at 18 months. Baseline widespread pain (OR: 2.53, P = .04) and depression (OR: 5.30, P = .005) were associated with onset of clinically significant pain (GCPS II-IV) within 18 months after baseline. The risk associated with baseline fibromyalgia was moderate, but not significant (OR: 2.74, P = .09). Persistence of clinically significant pain was related to fibromyalgia (OR: 2.48, P = .02) and depression (OR: 2.48, P = .02). These results indicate that these centrally generated pain conditions play a role in the onset and persistence of clinically significant TMJD. ⋯ Fibromyalgia and widespread pain should receive important consideration when evaluating and developing a treatment plan for patients with TMJD.
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Comparative Study
A comparison of the DN4 and LANSS questionnaires in the assessment of neuropathic pain: validity and reliability of the Turkish version of DN4.
A screening tool that quickly and correctly differentiates neuropathic pain from non-neuropathic pain is essential. Although there are many screening tools in the assessment of neuropathic pain, many physicians still have the problem of not being able to identify their neuropathic pain patients easily. In this study, we assessed the test-retest reliability, internal consistency, and validity of the Turkish version of DN4 questionnaire. Within the same group of patients, we also compared the DN4 with the LANSS questionnaire. A total of 180 patients (n = 121 with neuropathic pain and n = 59 with non-neuropathic pain characteristics) were enrolled. In our study population, peripheral origin of neuropathic pain, mainly radiculopathies and polyneuropathies, dominated. The reliability and validity of Turkish version of DN4 were found to be high. The sensitivities of the DN4 and the LANSS were 95% and 70.2%, respectively. The specificity of both tests was 96.6%. The strengths and weaknesses of these questionnaires are discussed. ⋯ The Turkish version of DN4 questionnaire is reliable and valid. It is also an easier, quicker, and more sensitive screening tool (1-minute test) compared with the Turkish version of LANSS questionnaire. These features of the DN4 may help clinicians to identify their neuropathic pain patients accurately in daily clinical practice and research studies.
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Quality improvement (QI) is a compilation of methods adapted from psychology, statistics, and operations research to identify factors that contribute to poor treatment outcomes and to design solutions for improvement. Valid and reliable measurement is essential to QI using rigorously developed and tested instruments. The purpose of this article is to describe the evolution of the American Pain Society Patient Outcome Questionnaire (APS-POQ) for QI purposes and present a revised version (R) including instrument psychometrics. An interdisciplinary task force of the APS used a step-wise, empiric approach to revise, test, and examine psychometric properties of the society's original POQ. The APS-POQ-R is designed for use in adult hospital pain management QI activities and measures 6 aspects of quality, including (1) pain severity and relief; (2) impact of pain on activity, sleep, and negative emotions; (3) side effects of treatment; (4) helpfulness of information about pain treatment; (5) ability to participate in pain treatment decisions; and (6) use of nonpharmacological strategies. Adult medical-surgical inpatients (n = 299) from 2 hospitals in different parts of the United States participated in this study. Results provide support for the internal consistency of the instrument subscales, construct validity and clinical feasibility. ⋯ This article presents the initial psychometric properties of the APS-POQ-R for quality improvement purposes of hospitalized adult patients. Validation in additional groups of patients will be needed to demonstrate its generalizability.