Articles: chronic.
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Randomized Controlled Trial
Pain Catastrophizing as a Mediator Between Pain Self-Efficacy and Disease Severity in Patients with Fibromyalgia.
Fibromyalgia (FM) is characterized by chronic widespread pain, fatigue, sleep disturbances, cognitive impairment, and mood disturbance. Both pain catastrophizing and pain self-efficacy have been found to be mediators of pain treatment effectiveness. However, whether pain catastrophizing mediates the association between pain self-efficacy and FM severity remains unclear. ⋯ Pain catastrophizing independently predicts FM severity and mediates the association between pain self-efficacy and FM severity. Pain catastrophizing should be monitored through interventions aimed at improving pain self-efficacy to reduce symptom burden in patients with FM.
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Randomized Controlled Trial
Cost-utility Analysis of Evoke closed-loop Spinal Cord Stimulation for Chronic Back and Leg Pain.
The effectiveness of Evoke closed-loop spinal cord stimulation (CL-SCS), a novel modality of neurostimulation, has been demonstrated in a randomized controlled trial (RCT). The objective of this cost-utility analysis was to develop a de novo economic model to estimate the cost-effectiveness of Evoke CL-SCS when compared with open-loop SCS (OL-SCS) for the management of chronic back and leg pain. ⋯ The results indicate a strong economic case for the use of Evoke CL-SCS in the management of chronic back and leg pain with or without prior spinal surgery with dominance observed at ~5 years.
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Randomized Controlled Trial
Placebo effects contribute to brief online mindfulness interventions for chronic pain: results from an online randomized sham-controlled trial.
Mindfulness apps are becoming popular treatments for chronic pain and mental health, despite mixed evidence supporting their efficacy. Furthermore, it is unclear whether improvements in pain are due to mindfulness-specific effects or placebo effects because no trials have compared mindfulness against a sham control. The objective of this study was to compare mindfulness against 2 sham conditions with differing proximity to mindfulness to characterize the relative contributions of mindfulness-specific and nonspecific processes on chronic pain. ⋯ These findings suggest that improvements in chronic pain unpleasantness following a single session of online-delivered mindfulness meditation may be driven by placebo effects. Nonspecific treatment effects including placebo expectancy and pain catastrophizing may drive immediate pain attenuation rather than theorized mindfulness-specific processes themselves. Further research is needed to understand whether mindfulness-specific effects emerge after longer durations of online training.
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Randomized Controlled Trial
Reductions in kinesiophobia and distress after pain neuroscience education and exercise lead to favourable outcomes: a secondary mediation analysis of a randomized controlled trial in primary care.
Pain neuroscience education combined with exercise (PNE + exercise) is an effective treatment for patients with chronic spinal pain. Yet, however, little is known about its underlying therapeutic mechanisms. Thus, this study aimed to provide the first insights by performing a novel mediation analysis approach in a published randomized controlled trial in primary care where PNE + exercise was compared with standard physiotherapy. ⋯ Changes in catastrophizing and pain intensity did not mediate improvements in any outcome. The mediation analyses with mediator-mediator interactions suggested a potential effect modification rather than causal independence among the mediators. The current results, therefore, support the PNE framework to some extent as well as highlight the need for implementing the recent approaches for mediation analysis to accommodate dependencies among the mediators.
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Randomized Controlled Trial
Conflicts hurt: social stress predicts elevated pain and sadness after mild inflammatory increases.
Individuals respond differently to inflammation. Pain, sadness, and fatigue are common correlates of inflammation among breast cancer survivors. Stress may predict response intensity. ⋯ At each visit, a trained experimenter administered the Daily Inventory of Stressful Events to assess social and nonsocial stress exposure within the past 24 hours. After statistical adjustment for relevant demographic and behavioral covariates, the most consistent results were that survivors who reported more chronic social stress reported more pain and sadness in response to IL-1Ra increases. Frequent and ongoing social stress may sensitize the nervous system to the effects of inflammation, with potential implications for chronic pain and depression risk among breast cancer survivors.