This document summarizes research on the relationship between catastrophizing and pain in rheumatic diseases like arthritis and fibromyalgia. It finds that catastrophizing, which includes negatively magnifying and ruminating about pain, is associated with greater reported pain severity, affective distress, tenderness, disability, and worse treatment outcomes. Higher catastrophizing is also related to increased pain sensitivity and central nervous system processing of pain. The mechanisms by which catastrophizing influences pain experience may include reducing active coping and health behaviors, amplifying attention to pain, and sensitizing central pain processing pathways in the brain and spinal cord.
This document summarizes a study that examined the relationships between neuroticism, pain catastrophizing, pain-related fear, and vigilance to pain in patients with chronic low back pain. The study found:
1) Pain catastrophizing and pain-related fear mediated the relationship between neuroticism and vigilance to pain.
2) Vigilance to pain was associated with heightened pain severity.
3) Neuroticism moderated the relationship between pain severity and catastrophic thinking about pain, such that high neurotic individuals who experienced more severe pain were more prone to catastrophic thinking.
The results support the idea that vigilance to pain depends on catastrophic thinking and pain-related fear, and that
Chronic pelvic pain is a complex condition with no single cause. It often involves both physical and psychological factors. The document discusses the evaluation and treatment of chronic pelvic pain. It describes how understanding of the condition has evolved over time to recognize that visible pathology often does not fully explain a patient's pain. A multidisciplinary approach is needed that considers potential contributors beyond just organic findings, such as muscle tension, trauma history, and central sensitization. A thorough history and physical exam aim to identify all potential pain generators that can be addressed through treatment.
No poison can kill a positive thinker and no medicine can cure a negative thinker. Pain is a complex perceptual experience. Pain is a major public health problem. Beat back pain without surgery and conquer pain without painkillers. Delays have dangerous ends. Knee braces invite injury. Chronic pain affects one in three people in the United States. There are more Americans suffering from chronic pain than with diabetes, heart disease, and cancer combined. Chronic pain is caused by degeneration, illnesses, injuries, surgeries, and treatment side effects. Pain is a major public health problem and is the most common reason why Americans use complementary and integrative health practices. Recent imaging evidence suggests a possible hypothalamic origin for a headache attack, but further research is needed. A migraine is associated with a modest increase in the risk of ischemic stroke.
EWMA 2014 - EP490 THE CHARACTERISTICS OF WOUND PAIN ASSOCIATED WITH DIABETES-...EWMA
This study examined the prevalence and characteristics of wound pain in diabetes-related foot ulcers. It found that over 50% of patients reported experiencing wound pain based on formal pain assessment tools, even though some did not report pain to their podiatrist. Pain was described as tender, brief, or intermittent. Both neuropathic and neuroischaemic ulcers had low reported pain intensity and little effect on quality of life. The study concludes wound pain may be underassessed clinically and more research is needed to understand differences in pain between ulcer types.
Pain catastrophizing is associated with health indicesPaul Coelho, MD
This study examined the association between pain catastrophizing and health outcomes in a sample of 1,164 people with musculoskeletal pain from a Dutch community sample. The health outcomes studied were specialist consultation, use of pain medication, and absenteeism or work disability. The results showed that higher levels of pain catastrophizing, as well as greater pain intensity and presence of pain in multiple locations, were significantly associated with increased specialist consultation, use of pain medication, and absenteeism or work disability. The authors conclude that pain catastrophizing may play an important role in maintaining pain problems and contributing to detrimental health consequences.
Artigo (4) importante para a preparação para o curso de dor lombar crônica. "Características sensoriais da dor lombar crônica inespecífica: uma investigação de subgrupos."
Tapering Long Term Opioid Therapy in Chronic Noncancer PainAde Wijaya
1) Tapering long-term opioid therapy in patients with chronic non-cancer pain can cause withdrawal symptoms and increased pain in the short term or relapse and reduced function in the long term.
2) A slow taper of 10% reduction every 5-7 days is recommended to minimize withdrawal symptoms and improve adherence. Adjunct therapies and psychological support may help during the taper.
3) Optimized nonopioid treatment, interventional procedures, and addressing factors like depression can improve taper outcomes for patients on long-term opioid therapy for chronic non-cancer pain.
Complex Regional Pain Syndrome (CRPS) is a chronic pain condition characterized by disproportionate pain, sensory disturbances, and autonomic and motor changes in an extremity. It can develop after an injury, surgery or other precipitating events. The pathophysiology is not fully understood but may involve the sympathetic nervous system, neurogenic inflammation, and central changes in pain processing. Diagnosis is based on clinical criteria including reports of ongoing pain, sensory changes, and signs of autonomic dysfunction. Treatment is multidisciplinary and aims to reduce pain and prevent disability through medications, physical therapy, occupational therapy, and other approaches. Prognosis varies but many patients experience some resolution of symptoms within months or years.
This document summarizes a study that examined the relationships between neuroticism, pain catastrophizing, pain-related fear, and vigilance to pain in patients with chronic low back pain. The study found:
1) Pain catastrophizing and pain-related fear mediated the relationship between neuroticism and vigilance to pain.
2) Vigilance to pain was associated with heightened pain severity.
3) Neuroticism moderated the relationship between pain severity and catastrophic thinking about pain, such that high neurotic individuals who experienced more severe pain were more prone to catastrophic thinking.
The results support the idea that vigilance to pain depends on catastrophic thinking and pain-related fear, and that
Chronic pelvic pain is a complex condition with no single cause. It often involves both physical and psychological factors. The document discusses the evaluation and treatment of chronic pelvic pain. It describes how understanding of the condition has evolved over time to recognize that visible pathology often does not fully explain a patient's pain. A multidisciplinary approach is needed that considers potential contributors beyond just organic findings, such as muscle tension, trauma history, and central sensitization. A thorough history and physical exam aim to identify all potential pain generators that can be addressed through treatment.
No poison can kill a positive thinker and no medicine can cure a negative thinker. Pain is a complex perceptual experience. Pain is a major public health problem. Beat back pain without surgery and conquer pain without painkillers. Delays have dangerous ends. Knee braces invite injury. Chronic pain affects one in three people in the United States. There are more Americans suffering from chronic pain than with diabetes, heart disease, and cancer combined. Chronic pain is caused by degeneration, illnesses, injuries, surgeries, and treatment side effects. Pain is a major public health problem and is the most common reason why Americans use complementary and integrative health practices. Recent imaging evidence suggests a possible hypothalamic origin for a headache attack, but further research is needed. A migraine is associated with a modest increase in the risk of ischemic stroke.
EWMA 2014 - EP490 THE CHARACTERISTICS OF WOUND PAIN ASSOCIATED WITH DIABETES-...EWMA
This study examined the prevalence and characteristics of wound pain in diabetes-related foot ulcers. It found that over 50% of patients reported experiencing wound pain based on formal pain assessment tools, even though some did not report pain to their podiatrist. Pain was described as tender, brief, or intermittent. Both neuropathic and neuroischaemic ulcers had low reported pain intensity and little effect on quality of life. The study concludes wound pain may be underassessed clinically and more research is needed to understand differences in pain between ulcer types.
Pain catastrophizing is associated with health indicesPaul Coelho, MD
This study examined the association between pain catastrophizing and health outcomes in a sample of 1,164 people with musculoskeletal pain from a Dutch community sample. The health outcomes studied were specialist consultation, use of pain medication, and absenteeism or work disability. The results showed that higher levels of pain catastrophizing, as well as greater pain intensity and presence of pain in multiple locations, were significantly associated with increased specialist consultation, use of pain medication, and absenteeism or work disability. The authors conclude that pain catastrophizing may play an important role in maintaining pain problems and contributing to detrimental health consequences.
Artigo (4) importante para a preparação para o curso de dor lombar crônica. "Características sensoriais da dor lombar crônica inespecífica: uma investigação de subgrupos."
Tapering Long Term Opioid Therapy in Chronic Noncancer PainAde Wijaya
1) Tapering long-term opioid therapy in patients with chronic non-cancer pain can cause withdrawal symptoms and increased pain in the short term or relapse and reduced function in the long term.
2) A slow taper of 10% reduction every 5-7 days is recommended to minimize withdrawal symptoms and improve adherence. Adjunct therapies and psychological support may help during the taper.
3) Optimized nonopioid treatment, interventional procedures, and addressing factors like depression can improve taper outcomes for patients on long-term opioid therapy for chronic non-cancer pain.
Complex Regional Pain Syndrome (CRPS) is a chronic pain condition characterized by disproportionate pain, sensory disturbances, and autonomic and motor changes in an extremity. It can develop after an injury, surgery or other precipitating events. The pathophysiology is not fully understood but may involve the sympathetic nervous system, neurogenic inflammation, and central changes in pain processing. Diagnosis is based on clinical criteria including reports of ongoing pain, sensory changes, and signs of autonomic dysfunction. Treatment is multidisciplinary and aims to reduce pain and prevent disability through medications, physical therapy, occupational therapy, and other approaches. Prognosis varies but many patients experience some resolution of symptoms within months or years.
Role of Stem Cell Transplantation in the Treatment of Ulcerative ColitisMohammed Fathy Zaky
This document provides an introduction and overview of ulcerative colitis. It defines ulcerative colitis and discusses its symptoms, classifications based on disease extent and severity, pathophysiology involving the intestinal immune system, and potential etiological factors including genetics. The aim of the work is stated as investigating the role of autologous bone marrow stem cell intravenous injection in treating cases of ulcerative colitis.
This study aimed to assess the feasibility of conducting a randomized controlled trial comparing an osteopathic approach to usual general practice care for patients with chronic low back pain. The study recruited 9 participants with chronic low back pain from one general practice and randomized them to either receive up to 8 osteopathic treatments or usual care. Follow up rates were poor, but participant feedback on the osteopathic treatment was positive. The study demonstrated that recruiting adequate participants from multiple general practices for a randomized controlled trial of osteopathy for chronic low back pain is feasible.
This document discusses opioid induced hyperalgesia (OIH), where increased pain results from opioid use. OIH is caused by changes in the glutaminergic and descending pain pathways in the central nervous system. Patients at risk include those on long-term opioids, perioperative opioid use, and acute opioid administration. OIH presents as diffuse pain not explained by the original condition and increases with higher opioid doses. Management focuses on tapering opioids while adding adjuvant medications targeting NMDA receptors or other pain mechanisms to modulate OIH. A multidisciplinary approach is needed given the complex pathophysiology.
This document summarizes a study examining the relationship between migraine and fibromyalgia. The study had two phases:
1) It compared pain sensitivity and fibromyalgia symptoms in patients with fibromyalgia only, migraine only, or comorbid fibromyalgia and migraine. It found that comorbid patients had the lowest pain thresholds and most severe fibromyalgia symptoms.
2) It examined the effects of migraine prevention treatment on fibromyalgia symptoms in comorbid patients. Effective migraine prevention treatment significantly improved fibromyalgia pain and hypersensitivity.
The results suggest that comorbidity between fibromyalgia and migraine is associated with greater central sensitization and fibromyalgia severity compared to either condition alone. Migraine attacks may trigger fibromyalgia flares, and reducing migraine frequency through prevention treatment can alleviate fibromyalgia symptoms.
International Journal of Pharmaceutical Science Invention (IJPSI) is an international journal intended for professionals and researchers in all fields of Pahrmaceutical Science. IJPSI publishes research articles and reviews within the whole field Pharmacy and Pharmaceutical Science, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online.
This document discusses several aspects of managing elderly patients with multiple chronic conditions (multimorbidity). It notes that multimorbidity is highly prevalent in the elderly and impacts physical and cognitive functioning, depression, mortality and hospitalization. It also discusses how multimorbidity affects the management of specific conditions like COPD, diabetes, heart failure, osteoporosis, dementia and hypertension. The document emphasizes that clinical guidelines focused on single diseases do not adequately address the complexity of multimorbid elderly patients.
Was recently asked to discuss whether there is evidence to support the use of B vitamins in managing different aches and pains. Here's my talk delivered last 16 Sept 2016 at the 12th Post Graduate Course of the East Avenue Medical Center Department of Internal Medicine.
Abstract: This study was undertaken to characterize pain in
individuals with hereditary multiple exostosis (HME). Two hundred
ninety-three patients with HME completed a questionnaire designed
to assess pain as well as its impact on their life. Eighty-four percent of
participants reported having pain, indicating that pain is a real
problem in HME. Of those with pain, 55.1% had generalized pain.
Two factors were found to be associated with pain outcome: HMErelated
complications and surgery. Individuals who had HME-related
complications were five times more likely to have pain, while those
who had surgery were 3.8 more likely to have pain. No differences
were found between males and females with respect to pain, surgery,
or HME-related complications. The results of this study indicate that
the number of individuals with HME who have pain has been
underestimated and that pain is a problem that must be addressed
when caring for individuals with HME.
Key Words: hereditary multiple exostosis, pain, exostoses, osteochondromas,
support group
(J Pediatr Orthop 2005;25:369–376)
This document summarizes research on chronic post-surgical pain (CPSP) over the past 10 years. It finds that CPSP is a significant problem affecting large numbers of patients. While studies of CPSP have improved, definition and measurement issues remain. Recent research has focused on risk factors in hopes of prevention. Severe acute post-operative pain emerges as an influential risk factor. Further research is still needed to better understand mechanisms and improve treatment of CPSP.
This document summarizes evidence from research studies on the effectiveness of biofeedback-based interventions for various health conditions, rating the level of evidence on a scale from 1 to 4. It finds level 1 evidence for biofeedback helping problems like anxiety, arthritis, asthma, chronic pain, diabetes and others. Higher levels of evidence (3-4) are found for biofeedback reducing headaches, high blood pressure, insomnia, irritable bowel syndrome and temporomandibular disorders. The strongest evidence is for randomized controlled trials comparing biofeedback to no treatment or an alternative.
Pain is the production (out put ) of the brain.
Pain is invisible disease, we can’t see it like other disease, such as struma, fracture or blind.
What you have to do is to believe what ever the patient says.
Pain is what ever the patient says it is
Pain is invisible diseases, but is real for patient.
Prevention of Lower Extremity Stress FracturesJA Larson
This document summarizes a systematic review of the literature on preventing stress fractures in athletes and soldiers. It identifies 176 relevant studies, including 20 diagnostic case series, 66 clinical case series, 52 epidemiological studies, and 9 intervention trials. The review finds that bone scans are more sensitive but less specific than x-rays for diagnosing stress fractures. It also examines the reported incidence of stress fractures in military recruits and trainees. The goal of the review is to evaluate research on causes and risk factors of stress fractures, what is known about prevention, and make recommendations for future research.
This study examined the relationship between heart rate variability (HRV) and self-reported pain, pain interference, and emotional well-being in adolescents and young adults with neurofibromatosis type 1 (NF1) and plexiform neurofibromas. 24 participants underwent electrocardiograms to measure HRV and completed questionnaires on pain and functioning. Results showed HRV was significantly correlated with pain interference but not pain intensity or disease severity, suggesting those with lower HRV and more chronic pain interpretation may experience greater interference in daily life. Psychological inflexibility was also associated with increased pain interference. Future acceptance-based therapies may help reduce interference and increase HRV by improving psychological flexibility around chronic pain.
1. The document discusses different types of pain including acute pain, neuropathic pain, and chronic pain.
2. It defines acute pain as a normal physiological response to tissue damage, such as from surgery, trauma, or acute illness. Chronic pain persists beyond normal tissue healing time.
3. Neuropathic pain is initiated or caused by primary lesions or dysfunction in the nervous system and can involve both peripheral and central nervous system pathways.
The emotional brain a a predictor and amplifier of chronic pain.Paul Coelho, MD
This document summarizes recent research on chronic pain and advances in understanding its mechanisms. It makes three key points:
1) Studying the brains of chronic pain patients through neuroimaging has been crucial for understanding chronic pain, as it reveals how the brain is reorganized in chronic pain conditions in ways not explained by peripheral sensitization alone.
2) Different chronic pain conditions are associated with distinct brain changes, suggesting chronic pain involves plastic reorganization of the brain beyond simply reflecting ongoing nociception.
3) An emerging area of focus is the role of the corticolimbic system (emotional brain regions) in predicting vulnerability to chronic pain and amplifying pain experiences, challenging the view that chronic pain is solely driven
Nyeri adalah penggabungan perasaan sensorik dan emosional yang dipengaruhi oleh berbagai faktor.
Nyeri memiliki dua dimensi yg jelas, dimensi inderawi dan emosional
Peran dimensi emosional lebih dominan dibanding inderawi utamanya pada nyeri kronik.
1) The document discusses a scientific workshop focused on changing paradigms for understanding chronic pelvic pain.
2) It notes that the traditional biomedical model of focusing only on medical/surgical therapies has failed many patients, and the workshop aimed to develop alternative conceptual frameworks.
3) A key topic was the role of the nervous system in pain perception and the potential for central and peripheral sensitization to chronic pain independent of the initial cause. Alterations in nerve receptors and neuroendocrine mediators noted in sensitization might provide treatment targets.
HISTORY OF 3-STEP LADDER WHO
1980 – WHO establishes Cancer Control Programme
Cancer prevention
Early diagnosis with curative treatment
Pain relief and palliative care
1986 – ” Cancer Pain Relief “ published by WHO
Step Ladder WHO
Updated on 1996
Worldwide acceptance protocol
Today, worldwide consensus favouring its used for management of all pain associated with serious illness
1. The study examines heterogeneous sensory patterns in patients experiencing chronic pain after hernia surgery (post-herniotomy pain) using quantitative sensory testing (QST).
2. QST revealed both sensory loss and hypersensitivity in most patients, suggesting a major neuropathic pain component. However, QST only provides descriptive data and does not fully explain underlying pathophysiology.
3. There was considerable overlap in sensory findings between patients with and without post-herniotomy pain, indicating additional pain mechanisms not detected by QST, such as anxiety. Integrating QST with other functional and structural assessments may provide deeper insights.
The document describes a case study of a 58-year-old man referred to physical therapy for low back pain. During the initial evaluation, the physical therapist discovered an abdominal aortic aneurysm (AAA) as the likely cause of the patient's symptoms through abdominal palpation. Computed tomography imaging confirmed a 5.5 cm AAA. The purpose of the case study was to demonstrate the clinical reasoning that led to the identification of an AAA despite the patient's reported mechanical low back pain, and to describe an evidence-based approach for evaluating patients with possible AAAs.
Common Brain Mechanisms Between Pain & AddictionPaul Coelho, MD
This document summarizes a perspective on common brain mechanisms of chronic pain and addiction. It proposes that chronic pain involves neuroadaptations similar to those seen in addiction, including reward deficiency, impaired inhibitory control, incentive sensitization, aberrant learning, and anti-reward allostatic neuroadaptations. The document provides epidemiological context on the prevalence and costs of chronic pain. It then reviews models of reward and addiction neurobiology and discusses how chronic pain may disrupt normal hedonic homeostasis in a manner analogous to addiction through an allostatic load. The perspective aims to inform improved chronic pain treatment by drawing parallels to addiction theories and interventions.
Role of Stem Cell Transplantation in the Treatment of Ulcerative ColitisMohammed Fathy Zaky
This document provides an introduction and overview of ulcerative colitis. It defines ulcerative colitis and discusses its symptoms, classifications based on disease extent and severity, pathophysiology involving the intestinal immune system, and potential etiological factors including genetics. The aim of the work is stated as investigating the role of autologous bone marrow stem cell intravenous injection in treating cases of ulcerative colitis.
This study aimed to assess the feasibility of conducting a randomized controlled trial comparing an osteopathic approach to usual general practice care for patients with chronic low back pain. The study recruited 9 participants with chronic low back pain from one general practice and randomized them to either receive up to 8 osteopathic treatments or usual care. Follow up rates were poor, but participant feedback on the osteopathic treatment was positive. The study demonstrated that recruiting adequate participants from multiple general practices for a randomized controlled trial of osteopathy for chronic low back pain is feasible.
This document discusses opioid induced hyperalgesia (OIH), where increased pain results from opioid use. OIH is caused by changes in the glutaminergic and descending pain pathways in the central nervous system. Patients at risk include those on long-term opioids, perioperative opioid use, and acute opioid administration. OIH presents as diffuse pain not explained by the original condition and increases with higher opioid doses. Management focuses on tapering opioids while adding adjuvant medications targeting NMDA receptors or other pain mechanisms to modulate OIH. A multidisciplinary approach is needed given the complex pathophysiology.
This document summarizes a study examining the relationship between migraine and fibromyalgia. The study had two phases:
1) It compared pain sensitivity and fibromyalgia symptoms in patients with fibromyalgia only, migraine only, or comorbid fibromyalgia and migraine. It found that comorbid patients had the lowest pain thresholds and most severe fibromyalgia symptoms.
2) It examined the effects of migraine prevention treatment on fibromyalgia symptoms in comorbid patients. Effective migraine prevention treatment significantly improved fibromyalgia pain and hypersensitivity.
The results suggest that comorbidity between fibromyalgia and migraine is associated with greater central sensitization and fibromyalgia severity compared to either condition alone. Migraine attacks may trigger fibromyalgia flares, and reducing migraine frequency through prevention treatment can alleviate fibromyalgia symptoms.
International Journal of Pharmaceutical Science Invention (IJPSI) is an international journal intended for professionals and researchers in all fields of Pahrmaceutical Science. IJPSI publishes research articles and reviews within the whole field Pharmacy and Pharmaceutical Science, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online.
This document discusses several aspects of managing elderly patients with multiple chronic conditions (multimorbidity). It notes that multimorbidity is highly prevalent in the elderly and impacts physical and cognitive functioning, depression, mortality and hospitalization. It also discusses how multimorbidity affects the management of specific conditions like COPD, diabetes, heart failure, osteoporosis, dementia and hypertension. The document emphasizes that clinical guidelines focused on single diseases do not adequately address the complexity of multimorbid elderly patients.
Was recently asked to discuss whether there is evidence to support the use of B vitamins in managing different aches and pains. Here's my talk delivered last 16 Sept 2016 at the 12th Post Graduate Course of the East Avenue Medical Center Department of Internal Medicine.
Abstract: This study was undertaken to characterize pain in
individuals with hereditary multiple exostosis (HME). Two hundred
ninety-three patients with HME completed a questionnaire designed
to assess pain as well as its impact on their life. Eighty-four percent of
participants reported having pain, indicating that pain is a real
problem in HME. Of those with pain, 55.1% had generalized pain.
Two factors were found to be associated with pain outcome: HMErelated
complications and surgery. Individuals who had HME-related
complications were five times more likely to have pain, while those
who had surgery were 3.8 more likely to have pain. No differences
were found between males and females with respect to pain, surgery,
or HME-related complications. The results of this study indicate that
the number of individuals with HME who have pain has been
underestimated and that pain is a problem that must be addressed
when caring for individuals with HME.
Key Words: hereditary multiple exostosis, pain, exostoses, osteochondromas,
support group
(J Pediatr Orthop 2005;25:369–376)
This document summarizes research on chronic post-surgical pain (CPSP) over the past 10 years. It finds that CPSP is a significant problem affecting large numbers of patients. While studies of CPSP have improved, definition and measurement issues remain. Recent research has focused on risk factors in hopes of prevention. Severe acute post-operative pain emerges as an influential risk factor. Further research is still needed to better understand mechanisms and improve treatment of CPSP.
This document summarizes evidence from research studies on the effectiveness of biofeedback-based interventions for various health conditions, rating the level of evidence on a scale from 1 to 4. It finds level 1 evidence for biofeedback helping problems like anxiety, arthritis, asthma, chronic pain, diabetes and others. Higher levels of evidence (3-4) are found for biofeedback reducing headaches, high blood pressure, insomnia, irritable bowel syndrome and temporomandibular disorders. The strongest evidence is for randomized controlled trials comparing biofeedback to no treatment or an alternative.
Pain is the production (out put ) of the brain.
Pain is invisible disease, we can’t see it like other disease, such as struma, fracture or blind.
What you have to do is to believe what ever the patient says.
Pain is what ever the patient says it is
Pain is invisible diseases, but is real for patient.
Prevention of Lower Extremity Stress FracturesJA Larson
This document summarizes a systematic review of the literature on preventing stress fractures in athletes and soldiers. It identifies 176 relevant studies, including 20 diagnostic case series, 66 clinical case series, 52 epidemiological studies, and 9 intervention trials. The review finds that bone scans are more sensitive but less specific than x-rays for diagnosing stress fractures. It also examines the reported incidence of stress fractures in military recruits and trainees. The goal of the review is to evaluate research on causes and risk factors of stress fractures, what is known about prevention, and make recommendations for future research.
This study examined the relationship between heart rate variability (HRV) and self-reported pain, pain interference, and emotional well-being in adolescents and young adults with neurofibromatosis type 1 (NF1) and plexiform neurofibromas. 24 participants underwent electrocardiograms to measure HRV and completed questionnaires on pain and functioning. Results showed HRV was significantly correlated with pain interference but not pain intensity or disease severity, suggesting those with lower HRV and more chronic pain interpretation may experience greater interference in daily life. Psychological inflexibility was also associated with increased pain interference. Future acceptance-based therapies may help reduce interference and increase HRV by improving psychological flexibility around chronic pain.
1. The document discusses different types of pain including acute pain, neuropathic pain, and chronic pain.
2. It defines acute pain as a normal physiological response to tissue damage, such as from surgery, trauma, or acute illness. Chronic pain persists beyond normal tissue healing time.
3. Neuropathic pain is initiated or caused by primary lesions or dysfunction in the nervous system and can involve both peripheral and central nervous system pathways.
The emotional brain a a predictor and amplifier of chronic pain.Paul Coelho, MD
This document summarizes recent research on chronic pain and advances in understanding its mechanisms. It makes three key points:
1) Studying the brains of chronic pain patients through neuroimaging has been crucial for understanding chronic pain, as it reveals how the brain is reorganized in chronic pain conditions in ways not explained by peripheral sensitization alone.
2) Different chronic pain conditions are associated with distinct brain changes, suggesting chronic pain involves plastic reorganization of the brain beyond simply reflecting ongoing nociception.
3) An emerging area of focus is the role of the corticolimbic system (emotional brain regions) in predicting vulnerability to chronic pain and amplifying pain experiences, challenging the view that chronic pain is solely driven
Nyeri adalah penggabungan perasaan sensorik dan emosional yang dipengaruhi oleh berbagai faktor.
Nyeri memiliki dua dimensi yg jelas, dimensi inderawi dan emosional
Peran dimensi emosional lebih dominan dibanding inderawi utamanya pada nyeri kronik.
1) The document discusses a scientific workshop focused on changing paradigms for understanding chronic pelvic pain.
2) It notes that the traditional biomedical model of focusing only on medical/surgical therapies has failed many patients, and the workshop aimed to develop alternative conceptual frameworks.
3) A key topic was the role of the nervous system in pain perception and the potential for central and peripheral sensitization to chronic pain independent of the initial cause. Alterations in nerve receptors and neuroendocrine mediators noted in sensitization might provide treatment targets.
HISTORY OF 3-STEP LADDER WHO
1980 – WHO establishes Cancer Control Programme
Cancer prevention
Early diagnosis with curative treatment
Pain relief and palliative care
1986 – ” Cancer Pain Relief “ published by WHO
Step Ladder WHO
Updated on 1996
Worldwide acceptance protocol
Today, worldwide consensus favouring its used for management of all pain associated with serious illness
1. The study examines heterogeneous sensory patterns in patients experiencing chronic pain after hernia surgery (post-herniotomy pain) using quantitative sensory testing (QST).
2. QST revealed both sensory loss and hypersensitivity in most patients, suggesting a major neuropathic pain component. However, QST only provides descriptive data and does not fully explain underlying pathophysiology.
3. There was considerable overlap in sensory findings between patients with and without post-herniotomy pain, indicating additional pain mechanisms not detected by QST, such as anxiety. Integrating QST with other functional and structural assessments may provide deeper insights.
The document describes a case study of a 58-year-old man referred to physical therapy for low back pain. During the initial evaluation, the physical therapist discovered an abdominal aortic aneurysm (AAA) as the likely cause of the patient's symptoms through abdominal palpation. Computed tomography imaging confirmed a 5.5 cm AAA. The purpose of the case study was to demonstrate the clinical reasoning that led to the identification of an AAA despite the patient's reported mechanical low back pain, and to describe an evidence-based approach for evaluating patients with possible AAAs.
Common Brain Mechanisms Between Pain & AddictionPaul Coelho, MD
This document summarizes a perspective on common brain mechanisms of chronic pain and addiction. It proposes that chronic pain involves neuroadaptations similar to those seen in addiction, including reward deficiency, impaired inhibitory control, incentive sensitization, aberrant learning, and anti-reward allostatic neuroadaptations. The document provides epidemiological context on the prevalence and costs of chronic pain. It then reviews models of reward and addiction neurobiology and discusses how chronic pain may disrupt normal hedonic homeostasis in a manner analogous to addiction through an allostatic load. The perspective aims to inform improved chronic pain treatment by drawing parallels to addiction theories and interventions.
This presentation summarizes a proposed study looking at the effects of communication patterns on OsteoArthritis pain. Though my proposed study is not identical with the pain study I researched during my 2008-2009 academic year, it reflects the depth of my understanding and my ability to develop an effective and innovative research proposal.
contentserver__5_.pdfAging & Mental Health, January 2007; .docxdonnajames55
contentserver__5_.pdf
Aging & Mental Health, January 2007; 11(1): 89–98
ORIGINAL ARTICLE
The relationship of optimism, pain and social support to well-being in
older adults with osteoarthritis
V. M. FERREIRA & A. M. SHERMAN
Brandeis University, Waltham, MA, US
(Received 30 August 2005; accepted 13 March 2006)
Abstract
Improving the psychological well-being of individuals with osteoarthritis (OA) is an important concern because the
condition is highly prevalent and has no known cure. Few studies have assessed the joint contribution of social, personality,
and physical factors in relation to well-being for OA patients. In a cross-sectional sample of older adults with OA (n ¼ 73,
73% female), we assessed the role of support perceptions, optimism and pain in depressive symptoms and life satisfaction.
Greater optimism and support were significantly related to both greater life satisfaction and lower depressive symptoms.
Further, optimism partially mediated the relationship of pain to life satisfaction, while support partially mediated the role of
pain in depressive symptoms. The interplay of these variables in relation to well-being is discussed in the context of chronic
illness and older adulthood.
Introduction
Many older adults (85% of those over 75) currently
experience a painful and often disabling disease,
osteoarthritis (OA), for which there is no known cure
(Sack, 1995). Osteoarthritis can negatively impact
many aspects of life, including both social and
physical functioning (Bookwala, Harralson, &
Parmalee, 2003) through pain, physical and psycho-
social limitations on valued activities, as well as
comorbid depressive symptoms (Penninx et al.,
1998). It is important to investigate factors that
relate to psychological health outcomes of OA
patients in order to better understand how to
improve well-being. As Keefe and his colleagues
suggest (Keefe & Bonk, 1999; Keefe et al., 2002),
there exists a complex interplay of symptomology,
social and psychological factors in arthritis patients.
In the following sections, we review the role of
optimism, social support, and pain as important
correlates of psychological well-being, particularly
for older adults.
Pain
The common and persistent nature of pain asso-
ciated with OA (Schumacker, 1988) may be a reason
for the variability in the well-being of OA patients
(e.g., de Vellis et al., 1986; Klinger, Spaulding,
Polatajko, MacKinnon, & Miller, 1999). Pain has a
strong relationship with many other health-
related variables in older adults with arthritis
(Roberts, Matecjyck, & Anthony, 1996). In OA
samples, greater pain is a stressor linked to lower
social support and well-being (de Vellis et al., 1986).
Pain is also associated with greater depressive
symptoms (Bookwala et al., 2003; Klinger et al.,
1999) and lower life satisfaction (Laborde & Powers,
1985) in patients with OA. However, Blixen and
Kippes (1999) present contrasting evidence showing
that pain from OA is unrelated to life sat.
STUDY PROTOCOL Open AccessPain coping skills training for .docxdeanmtaylor1545
STUDY PROTOCOL Open Access
Pain coping skills training for African
Americans with osteoarthritis (STAART):
study protocol of a randomized controlled
trial
Leah A. Schrubbe1,2*, Scott G. Ravyts1,2, Bernadette C. Benas1,2, Lisa C. Campbell7, Crystal W. Cené2,
Cynthia J. Coffman3,5, Alexander H. Gunn1,2, Francis J. Keefe6, Caroline T. Nagle1,2, Eugene Z. Oddone3,4,
Tamara J. Somers6, Catherine L. Stanwyck3,4, Shannon S. Taylor3 and Kelli D. Allen1,2,3
Abstract
Background: African Americans bear a disproportionate burden of osteoarthritis (OA), with higher prevalence rates,
more severe pain, and more functional limitations. One key barrier to addressing these disparities has been limited
engagement of African Americans in the development and evaluation of behavioral interventions for management
of OA. Pain Coping Skills Training (CST) is a cognitive-behavioral intervention with shown efficacy to improve
OA-related pain and other outcomes. Emerging data indicate pain CST may be a promising intervention for reducing
racial disparities in OA symptom severity. However, there are important gaps in this research, including incorporation of
stakeholder perspectives (e.g. cultural appropriateness, strategies for implementation into clinical practice) and testing
pain CST specifically among African Americans with OA. This study will evaluate the effectiveness of a culturally
enhanced pain CST program among African Americans with OA.
Methods/Design: This is a randomized controlled trial among 248 participants with symptomatic hip or knee OA, with
equal allocation to a pain CST group and a wait list (WL) control group. The pain CST program incorporated feedback
from patients and other stakeholders and involves 11 weekly telephone-based sessions. Outcomes are assessed at
baseline, 12 weeks (primary time point), and 36 weeks (to assess maintenance of treatment effects). The primary outcome
is the Western Ontario and McMaster Universities Osteoarthritis Index, and secondary outcomes include self-efficacy, pain
coping, pain interference, quality of life, depressive symptoms, and global assessment of change. Linear mixed models
will be used to compare the pain CST group to the WL control group and explore whether participant characteristics
are associated with differential improvement in the pain CST program. This research is in compliance with the Helsinki
Declaration and was approved by the Institutional Review Boards of the University of North Carolina at Chapel Hill,
Durham Veterans Affairs Medical Center, East Carolina University, and Duke University Health System.
Discussion: This culturally enhanced pain CST program could have a substantial impact on outcomes for African
Americans with OA and may be a key strategy in the reduction of racial health disparities.
Trial registration: ClinicalTrials.gov, NCT02560922, registered 9/22/2015.
(Continued on next page)
* Correspondence: [email protected]
1Thurston Arthritis Research Center, University of Nor.
The document provides an introduction and overview of back disorders and low back pain. It discusses several key points in 3 sentences:
Back pain is highly prevalent and causes major disability. A variety of individual, psychosocial, and occupational factors can increase the risk of developing back pain. Recent research also indicates there are important genetic factors influencing severe low back pain and certain genes have been associated with lumbar disc disease.
The association between a history of lifetime traumatic events and pain sever...Paul Coelho, MD
This study examined the associations between a history of lifetime abuse and affective distress, fibromyalgia symptoms, pain severity, interference, and physical functioning in 3,081 chronic pain patients. The study found that those with a history of abuse had greater depression, anxiety, worse physical functioning, greater pain severity, worse pain interference, higher catastrophizing, and higher scores on the 2011 Fibromyalgia Survey criteria. Mediation models showed that fibromyalgia survey scores and affective distress independently mediated the relationship between abuse history and pain severity and physical functioning. The findings support a biopsychosocial model where affective distress and fibromyalgia symptoms interact to play roles in how abuse relates to increased pain morbidity.
PAIN & AGING SECTIONOriginal Research ArticleAutonomic.docxbunyansaturnina
PAIN & AGING SECTION
Original Research Article
Autonomic, Behavioral, and Subjective Pain
Responses in Alzheimer’s Disease
Paul A. Beach, PhD,*
,†
Jonathan T. Huck, BS,
†
Melodie M. Miranda, MD,‡
and Andrea C. Bozoki, MD
†,§
*Michigan State University College of Osteopathic
Medicine, DO/PhD Training Program, East Lansing,
Michigan, USA;
†
Michigan State University Neuro-
science Program, East Lansing, Michigan, USA;
‡
Michigan State University College of Human Medi-
cine, East Lansing, Michigan, USA;
§
Michigan State
University Department of Neurology and Ophthalmol-
ogy, East Lansing, Michigan, USA
Reprint requests to: Paul A. Beach, PhD, Michigan
State University Department of Neurology and Oph-
thalmology, B-444 Clinical Center, 788 Service Road,
East Lansing, MI 48824, USA. Tel: 517-432-9277;
Fax: 517-432-9414; E-mail: [email protected]
Conflict of interest: The authors declare no conflicts of
interest.
Abstract
Objective. To compare autonomic, behavioral, and
subjective pain responses of patients with Alzhei-
mer’s disease (AD) to those of healthy seniors (HS).
As few studies have examined patients with severe
Alzheimer’s disease (sAD), we emphasized inclusion
of these patients together with mild/moderate Alzhei-
mer’s disease (mAD) patients to characterize pain
responses potentially affected by disease severity.
Design. A controlled cross-sectional study involv-
ing repeated measures behavioral pain testing.
Setting. An outpatient clinical setting and local
nursing facilities.
Subjects. Community dwelling HS controls (N 5 33)
and individuals with chart-confirmed diagnoses of
AD (N 5 38, Diagnostic and Statistical Manual-IV
criteria).
Methods. HS and AD groups were compared in their
responses to repeated applications of five pressure
intensities (1–5 kg) on the distal forearm. Auto-
nomic responses (heart rate [HR]), pain behaviors
(vocal, facial, and bodily as scored by the Pain
Assessment in Advanced Dementia [PAINAD]
scale), and subjective pain ratings (Faces Pain
Scale-Revised) were measured.
Results. HR responses to pressure stimuli were dif-
ferentially affected based on AD severity: sAD
patients had generally decreased HR reactivity com-
pared with other groups (P < 0.01). In contrast, pain
behaviors were increased in AD regardless of sever-
ity (P < 0.001), compared with HS, for all but the low-
est pressure intensity. Increased behaviors
occurred in all measured domains of the PAINAD
(P < 0.005). While sAD were unreliable subjective
reporters, mAD patients (N 5 17) rated low level
pressures as more painful than HS (P < 0.01).
Conclusion. These findings provide behavioral and
subjective-report evidence of increased acute pain
sensitivity in AD, which should be taken into con-
sideration with respect to pain management across
the spectrum of AD severity.
Key Words. Alzheimer’s Disease; Dementia;
Elderly; Behavior; Acute Pain
Introduction
Reliable detection and treatment of pain in elderly per-
sons wi.
Chronic pain: Role of tricyclic antidepressants, dolsulepinSudhir Kumar
Chronic pain is common. Depression often co-exist with chronic pain. This article looks at the pathophysiology, prevalence of chronic pain and depression. The role of TCA, especially dosulepin and amitriptyline has been discussed.
—Pain following Spinal Cord Injury (SCI) is very common. So this study was conducted to find out prevalence, associated factors and pattern of Neuropathic Pain (NP) among SCI patients, for which 494 consecutive eligible patients of Spinal Cord Injury (SCI) admitted in the Department were evaluated for NP. It was observed that 13.76% of SCI patients complained of neuropathic pain. In 21 to 30 years age group 23.13% and 61.76% cases of neuropathic pain had dorso-lumbar injury. 48.30% cases of neuropathic pain had onset in 2 nd and 3 rd week. Discomfort was more at night (36.76%), in below the knee area and dorsum of the foot. Hot burning type of sensation was the commonest descriptor of NP and range of movement (ROM) exercises and tepid cold water sponging were relieving factors.
the presentation gives a detail information about the seronegative spondyloarthropathy. this ppt also provide recent evidences to frame the rehab protocol.
This document summarizes a presentation on osteoarthritis (OA) phenotypes and risk factors. The presentation discusses evidence that OA may consist of distinct subtypes including generalized vs. joint-specific, secondary vs. primary, painful vs. non-painful, and malaligned vs. neutrally aligned joints. Identifying OA phenotypes is important for developing effective prevention and treatment strategies that may differ between subtypes.
This document reviews theoretical perspectives on the relationship between catastrophizing and pain. It summarizes research showing that catastrophizing is consistently associated with increased pain experience, pain behavior, illness behavior, and disability. The research has proceeded without a clear theoretical framework to explain these relationships. The document evaluates potential models, including schema activation, appraisal, attention, and communal coping models. It suggests catastrophizing may best be understood through a hierarchical model where social factors influence development and maintenance of catastrophizing, while cognitive appraisal processes link it to pain experience. Future research addressing gaps is needed.
This study examined psychological factors that may predict problematic outcomes following total knee arthroplasty (TKA). 75 patients completed measures of pain catastrophizing, pain-related fears, depression, and pain/function before and 6 weeks after TKA surgery. Results showed that pre-surgical pain and pain catastrophizing uniquely predicted greater post-surgical pain severity. Pre-surgical pain-related fears predicted worse function at follow-up in initial analyses but not when accounting for other medical factors. The findings suggest different psychological factors may influence post-surgical pain versus function. Targeting psychological risk factors could potentially improve outcomes after TKA.
The document discusses an innovative neuromodulation technique called Scrambler Therapy (ST) for treating Complex Regional Pain Syndrome (CRPS). A study was conducted on 37 patients with CRPS Type I who received 10 ST treatment sessions. Patients reported pain levels before, during, and 6 months after treatment using the Visual Analog Scale (VAS) and Brief Pain Inventory (BPI). Results showed significantly reduced pain scores after ST compared to before. A control group of 42 neuralgia patients undergoing the same ST treatment showed similar pain reductions. The study provides evidence that ST is an effective treatment for reducing chronic neuropathic pain like CRPS.
Psychological correlates of acute post surgical pain.Paul Coelho, MD
This systematic review and meta-analysis examines relationships between presurgical psychological factors and acute postsurgical pain (APSP). Fifty-three studies were included. Pain catastrophizing, optimism, expectation of pain, neuroticism, anxiety, negative affect, and depression were found to be likely associated with APSP, while locus of control was unlikely associated. Meta-analyses showed pain catastrophizing had the strongest link to APSP. Patients reporting lower levels of pain catastrophizing and higher optimism/expectations tended to experience less APSP.
Chronic pain is common. If we don’t suffer from it ourselves, chances are we know someone who does. Changes in the structure and function of the brain are thought to underlie chronic pain. The good news is that these changes are not hardwired. Many things can be done to influence how the brain processes pain signals including exercise, healthy eating, and better sleep, as well as thinking more adaptive thoughts, positive emotions, and feeling love and connected. This session will highlight the neuroscience related to chronic pain and how engaging in simple self-management strategies can result in less pain and a more rewarding life.
This presentation comes from the Spring Patient Education conference presented by the Scleroderma Patient Education Conference presented by the Scleroderma Foundation of Greater Chicago.
Chronic pain is common. If we don’t suffer from it ourselves, chances are we know someone who does. Changes in the structure and function of the brain are thought to underlie chronic pain. The good news is that these changes are not hardwired. Many things can be done to influence how the brain processes pain signals including exercise, healthy eating, and better sleep, as well as thinking more adaptive thoughts, positive emotions, and feeling love and connected. This session will highlight the neuroscience related to chronic pain and how engaging in simple self-management strategies can result in less pain and a more rewarding life.
This presentation comes from the Spring Patient Education conference presented by the Scleroderma Patient Education Conference presented by the Scleroderma Foundation of Greater Chicago.
Properties of the brain's emotional learning circuitry predict the transition to chronic pain. In a longitudinal study, individuals with acute back pain were scanned over a year-long period. The strength of functional connectivity between the medial prefrontal cortex and nucleus accumbens at the initial scan predicted whether the individual would transition to chronic pain with over 80% accuracy. Future studies are needed to understand the mechanisms driving pain chronicity, with the goal of developing novel therapies to prevent the transition to chronic pain.
Similar to Edwards et al-2006 Catastrophizing (20)
This document contains summaries of several research papers on topics related to chronic pain, suicide risk, and bipolar disorder:
1) One study found that tapering opioid doses for chronic pain patients was associated with increased risks of overdose and mental health crisis compared to patients who did not taper. Higher tapering speeds were linked to even greater risks.
2) Another study observed chronic pain patients undergoing opioid tapering or transition to buprenorphine treatment. Higher initial opioid doses predicted needing buprenorphine, and benzodiazepine use predicted dropout. Pain levels varied after treatment.
3) Research on combat veterans found that those exposed to combat had higher rates of PTSD, suicide attempts, strokes and chronic pain
Labeling Woefulness: The Social Construction of FibromyalgiaPaul Coelho, MD
This document discusses the social construction of fibromyalgia and how it has been established as a legitimate disease label despite a lack of clear biological or clinical evidence. It argues that fibromyalgia serves social and economic purposes for various groups, including patients, doctors, pharmaceutical companies, and the media, but poses risks by medicalizing psychosocial problems. The document proposes that widespread pain is a normal human experience for some that is best addressed by exploring psychosocial factors rather than believing the solution lies in neurobiology. Examining fibromyalgia as a social construct may be more helpful for patients than continuing to medicalize their experiences.
Outcomes in Long-term Opioid Tapering and Buprenorphine Transition: A Retrosp...Paul Coelho, MD
This study analyzed outcomes for 240 patients with chronic pain who were prescribed long-term opioid therapy above 90 mg morphine-equivalent daily doses. Patients were offered an outpatient opioid taper or transition to buprenorphine if taper was not tolerated. 44.6% successfully tapered, 18.8% transitioned to buprenorphine, and 36.6% dropped out of treatment. Higher initial opioid doses predicted needing buprenorphine, and benzodiazepine/z-drug use predicted greater dropout. Pain intensity changes after treatment were mixed, with over half of tapered patients reporting increased pain and about half of transitioned patients reporting decreased pain.
This document appears to be a questionnaire assessing symptoms of widespread pain and calculating a WPI (Widespread Pain Index) score and SS (Symptom Severity) score. It asks the respondent to indicate areas of pain on a diagram and rate the severity of symptoms like fatigue, thinking difficulties, and unrefreshed sleep. It also inquires about additional symptoms like abdominal pain, depression, and headaches. The final section rates pain-related worry and fear on a scale. Additional questions determine if the respondent has a workers compensation or disability claim related to their pain complaint.
Fibromyalgia is a condition that causes chronic aches and pains all over the body, fatigue, and often a sleep disorder. The doctor diagnosed the patient with fibromyalgia based on a score of 13 or more on the fibromyalgia questionnaire from the American College of Rheumatology, which is consistent with the syndrome. By focusing on and managing the diagnosis of fibromyalgia, the patient's other pain symptoms can decrease.
This document contains two studies related to psychological treatments for chronic conditions:
1) A study of chronic fatigue syndrome patients found that poorer outcomes were predicted by membership in a self-help group, receiving sickness benefits, and symptoms of dysphoria. Severity and duration of symptoms did not predict response.
2) A randomized controlled trial of 125 fibromyalgia patients compared operant behavioral therapy, cognitive behavioral therapy, and attention placebo. Both behavioral therapies significantly reduced pain intensity while cognitive therapy improved cognitive and affective variables and operant therapy improved physical functioning and behaviors. The attention placebo resulted in no improvement or deterioration.
This document summarizes three studies on the risks and efficacy of opioids for chronic non-cancer pain (CNP). The first study finds that while opioids were associated with small improvements in pain and physical functioning compared to placebo, they also increased the risk of vomiting. Comparisons to other medications found similar benefits to pain and functioning. The second study finds no difference in pain-related function between opioid and non-opioid groups over 12 months, and higher rates of adverse effects and pain intensity in the opioid group. The third study finds limited effectiveness of opioids for CNP, as opioid users did not report improvements in outcomes after 2 years. Regarding risks, higher opioid doses are associated with increased overdose risk across several patient groups in
1) This randomized clinical trial compared opioid vs nonopioid medication therapy over 12 months for patients with chronic back, hip, or knee pain.
2) It found no significant difference in pain-related function between the two groups, but pain intensity was significantly better in the nonopioid group. Adverse effects were significantly more common in the opioid group.
3) The study concludes that opioid therapy was not superior to nonopioid medications for improving pain-related function over 12 months, and the results do not support initiating opioids for moderate to severe chronic musculoskeletal pain.
Mortality quadrupled among opioid-driven hospitalizations notably within lowe...Paul Coelho, MD
This study analyzed national hospitalization data from 1993-2014 to examine trends in mortality and characteristics of hospitalizations related to opioids compared to other drug and non-drug hospitalizations. The key findings were:
1) Mortality among opioid-related hospitalizations quadrupled from 0.43% before 2000 to 2.02% in 2014, increasing 0.12 percentage points per year relative to other drug hospitalizations.
2) While total opioid-related hospitalizations remained stable, diagnoses shifted from opioid dependence/abuse to opioid/heroin poisoning, which have higher mortality rates. Hospitalizations for poisoning grew by 0.01 per 1,000 people annually after 2000.
3) Patients hospitalized for opioid/
Prescriptions filled following an opioid-related hospitalization.Paul Coelho, MD
This study analyzed prescription drug fills within 30 days of discharge for 36,719 patients hospitalized for opioid misuse. Only 16.7% received medications approved for opioid dependence, while 40.3% filled antidepressant prescriptions and 22.4% filled opioid pain medication prescriptions. Concurrently, 13.9% filled benzodiazepine prescriptions and 7.4% filled both benzodiazepine and opioid prescriptions, indicating a need for improved education on risks. Overall, more effort is required to ensure patients receive recommended post-hospitalization treatment and support services.
This study examined the risk of psychiatric hospitalization in the offspring (second generation) of Finns who were evacuated to Sweden without parents during World War II (first generation), compared to offspring of Finns who were not evacuated. The study found that daughters of mothers who were evacuated during childhood had an elevated risk of psychiatric hospitalization, especially for mood disorders. However, there was no increased risk found for offspring of evacuated fathers or for male offspring of evacuated mothers. This suggests that early childhood adversity experienced by the first generation, such as war-related trauma, may be associated with mental health problems that persist into the second generation.
Correlation of opioid mortality with prescriptions and social determinants -a...Paul Coelho, MD
This study analyzed Medicare Part D data from 2013-2014 to examine the relationship between opioid prescription rates, socioeconomic factors, and opioid-related mortality rates at the county level in the United States. The results showed that higher county-level opioid prescription rates, especially those from emergency medicine, family medicine, internal medicine, and physician assistants, were associated with higher opioid-related mortality rates. Higher poverty levels and proportions of white populations in counties also correlated with increased mortality. Additionally, prescribers in the highest quartile of opioid prescription rates had a disproportionate impact on mortality compared to the remaining 75% of prescribers.
This report examines CMS's oversight of Medicare Part D beneficiaries who receive opioid prescriptions and providers who prescribe opioids to these beneficiaries. It finds that while CMS provides guidance to Part D plan sponsors on monitoring beneficiaries at high risk of opioid overuse, it lacks complete data on the full population of beneficiaries at risk. It also finds that CMS oversees prescribing through its contractor NBI MEDIC but does not specifically analyze opioid prescription data or require reporting on actions taken regarding inappropriate opioid prescribing. The report concludes that CMS needs more comprehensive oversight to reduce the risks of opioid misuse, overdose, and inappropriate prescribing among Medicare beneficiaries.
This study analyzed opioid prescription trends among medical specialties in the U.S. from 2007-2012 using a national prescription database. The key findings were:
- Primary care specialties (family practice, internal medicine, general practice) accounted for nearly half of all dispensed opioid prescriptions in 2012.
- Specialties treating pain conditions like pain medicine, surgery, and physical medicine had the highest rates of opioid prescribing.
- Overall opioid prescribing rates increased from 2007-2010 but stabilized from 2010-2012 as most specialties reduced rates.
- The greatest increase in opioid prescribing was among physical medicine specialists, while the largest decreases were in emergency medicine and dentistry.
The place-of-antipsychotics-in-the-therapy-of-anxiety-disorders-and-obsessive...Paul Coelho, MD
This document summarizes a research article about the use of antipsychotic drugs in the treatment of anxiety disorders and obsessive-compulsive disorders. The review finds evidence that certain second-generation antipsychotics (SGAPs), like quetiapine, risperidone, and aripiprazole, can be effective for generalized anxiety disorder (GAD) and obsessive-compulsive disorder (OCD). Quetiapine in particular receives a recommendation as a first-line treatment for GAD. However, the review finds insufficient evidence for SGAPs in the treatment of social anxiety disorder and panic disorder. First-generation antipsychotics are not recommended for any anxiety disorders based on their side effect profiles
Structured opioid refill clinic epic smartphrases Paul Coelho, MD
#*** I explained to the patient the risks of combining opioids and benzodiazepines based on medical literature. We agreed to slowly taper the patient off benzodiazepines and trial safer alternatives for sleep and anxiety issues.
#*** I showed the patient their fibromyalgia screening questionnaire results, which were consistent with a fibromyalgia diagnosis. Fibromyalgia can amplify other painful conditions and is often the primary source of morbidity when present with other chronic pain diagnoses.
#*** We discussed the patient's high risk opioid regimen based on their dose exceeding CDC guidelines. While willing to work on a harm reduction plan, it will require a taper or switching to buprenorphine due to safety concerns.
Opioids for the Treatment of Chronic Pain: Mistakes Made, Lessons Learned, an...Paul Coelho, MD
This document summarizes the key issues regarding the use of opioids for chronic pain treatment:
1) An overreliance on opioids to treat chronic pain has contributed to the prescription opioid abuse epidemic in the US, as outpatient use allows for abuse and diversion of these addictive drugs.
2) While clinical trials show opioids effectively treat acute pain and are initially effective for chronic pain, real-world use reveals increased risks of abuse, addiction, and poor functional outcomes over the long-term.
3) The evidence supporting chronic opioid therapy was limited and observational in nature, yet convinced the medical community until larger population studies showed increased abuse rates contrary to initial assumptions.
The potential adverse influence of physicians’ words.Paul Coelho, MD
The physician's words can inadvertently amplify patients' symptoms and increase somatic distress if not carefully considered. Learning about potential side effects from medications, procedures, or test results can lead patients to experience and report those effects more frequently through psychological mechanisms like misattribution and increased attention to bodily sensations. Discussing concepts like nocebo and viscerosomatic amplification with patients can help provide reassuring explanations for symptoms and make them feel less intrusive. Physicians should thoughtfully consider their word choices and focus on benefits as well as side effects to minimize undue distress.
This document is an evidence report published by the Institute for Clinical and Economic Review (ICER) that evaluates the comparative clinical effectiveness and value of cognitive and mind-body therapies for chronic low back and neck pain. It was authored by Jeffrey Tice and others from ICER. The report assesses the clinical evidence on therapies such as cognitive behavioral therapy and mindfulness-based stress reduction and presents economic analyses of the long-term cost-effectiveness and potential budget impact of these therapies. It also incorporates input from clinical experts and stakeholders.
MBC Support Group for Black Women – Insights in Genetic Testing.pdfbkling
Christina Spears, breast cancer genetic counselor at the Ohio State University Comprehensive Cancer Center, joined us for the MBC Support Group for Black Women to discuss the importance of genetic testing in communities of color and answer pressing questions.
Let's Talk About It: Breast Cancer (What is Mindset and Does it Really Matter?)bkling
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PET CT beginners Guide covers some of the underrepresented topics in PET CTMiadAlsulami
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LGBTQ+ Adults: Unique Opportunities and Inclusive Approaches to CareVITASAuthor
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2. catastrophizers and noncatastrophizers, most research
treats catastrophizing as a continuous, normally distrib-
uted variable (1). In our database of patients with pain,
there is wide variability around the mean catastrophizing
score (Figure 2). Catastrophizing also exists on a contin-
uum in healthy, pain-free individuals (9); indeed, higher
catastrophizing, assessed in pain-free adults, predicts the
future development of chronic pain and pain-related
health care utilization (10,11). A rich area of debate has
centered on whether catastrophizing is best conceptual-
ized as a stable and enduring trait, such as a dimension of
personality, or as a modifiable characteristic (1,12), with
some evidence supporting both positions. Several studies
report a high test–retest stability of catastrophizing mea-
sured over time frames of up to a year in patients with RA
and in other samples (7,13). In contrast, catastrophizing
often decreases when patients undergo cognitive-behav-
ioral therapy (CBT; a set of psychologist-delivered inter-
ventions designed to facilitate the development of self-
management skills, including regulating one’s thoughts,
emotions, and behaviors) (14,15), indicating that cata-
strophizing can be altered by treatment.
Adverse Outcomes of Catastrophizing
Pain severity. Cross-sectionally, catastrophizing relates
to higher pain severity among patients with RA (16–18)
and OA (19,20). High levels of catastrophizing are also
associated with more severe and widespread pain and
more emotional disturbance among individuals with FM
(21–24) and scleroderma (25). In general, these associa-
tions persist even after statistically controlling for depres-
sion, anxiety, or neuroticism (20,26). Several prospective
studies have illustrated the longitudinal association of
catastrophizing with pain in RA. In daily diary studies,
patients with RA who exhibited greater catastrophizing
reported more day-to-day pain and attention to pain than
low catastrophizers (26,27). Findings from another pro-
spective study suggested that baseline catastrophizing
scores predicted enhanced pain and depression in patients
with RA at 1-year followup (28). Catastrophizing may also
influence the success of pain-related treatments in patients
with musculoskeletal disease. In studies of patients with
OA recovering from knee surgery (29,30), higher preoper-
ative levels of catastrophizing were associated with more
pain and disability up to 6 months postoperatively.
Whether catastrophizing predicts the onset of painful
rheumatic conditions is not known, although high cata-
strophizing was shown to be a risk factor for the onset of
low back pain and disability in a population-based study
(10,11).
Pain sensitivity. Catastrophizing shows positive associ-
ations with tender point counts in both population studies
of musculoskeletal tenderness and clinic-based samples of
patients with FM (24,31–33). Hyperalgesia, or enhanced
responsiveness to painful stimuli, is a defining feature of
FM but has also been noted in patients with RA (34–39)
and OA (40–42). Catastrophizing may be correlated with
some of these hyperalgesic responses. For example, cata-
strophizing was associated with decreased heat pain
threshold and tolerance in women with FM (43), reduced
pain tolerance during a cold pressor test in patients with
juvenile rheumatoid arthritis (JRA) (44,45), and lower pain
threshold and tolerance in response to electrical stimula-
tion among patients with OA (46). Recent evidence from
our laboratory suggests that higher catastrophizing relates
to greater central nervous system (CNS) sensitization dur-
ing sustained pain (47), which may account for the con-
sistent positive relationship between catastrophizing and
pain sensitivity.
Figure 2. Distribution of Coping Strategies Questionnaire (CSQ)
catastrophizing subscale scores in a sample of 2,257 patients
experiencing heterogeneous chronic pain syndromes (unpub-
lished data). Scores on the CSQ catastrophizing subscale range
from 0 to 6.
Figure 1. The Pain Catastrophizing Scale (7). Total scores range
from 0 to 52.
326 Edwards et al
3. Depression. In general, catastrophizing is strongly asso-
ciated with measures of negative affect (1). Multiple inves-
tigators have documented positive associations between
catastrophizing and depressive symptoms in FM (21,
23,43). Similar findings have been reported in patients
with RA (16), and we have observed a significant Pearson’s
correlation (r ϭ 0.65) between catastrophizing and scores
on the Beck Depression Inventory in several hundred in-
dividuals with scleroderma. Prospective studies have doc-
umented the association of high catastrophizing at base-
line with increases in depressive symptoms over periods
of up to 1 year in patients with RA (13) and FM (28). In a
recent diary study of patients with OA, catastrophizing
showed concurrent and prospective relationships with
more intense negative mood (i.e., increases in catastroph-
izing on a given day related to worsened mood that same
day and on the next day) (19). Taken together, these find-
ings suggest that in the context of chronic pain, catastroph-
izing may contribute to depressed mood on a short- and
long-term basis. Interestingly, virtually no research to date
has examined associations between pain-related cata-
strophizing and formally assessed (e.g., by structured in-
terview) psychiatric diagnoses such as posttraumatic
stress disorder, generalized anxiety disorder, etc., which
represents an important avenue for future catastrophizing
research.
Disability. Catastrophizing shows robust associations
with self-reported disability and with more objective indi-
ces of function such as returning to work. In patients with
OA, catastrophizing relates to higher levels of observed
pain behaviors and functional limitations during standard-
ized activity tests (20). Among patients with OA undergo-
ing knee surgery, catastrophizing prospectively predicted
postsurgical disability, even after controlling for other psy-
chosocial factors (29). Importantly, although pain severity
is often a primary determinant of disability, RA studies
have established that catastrophizing predicts disability
even after controlling for pain severity (16,48). Finally,
catastrophizing and other indices of poor pain coping are
prospectively associated with reductions in objectively
measured mobility and muscle strength over periods of up
to 5 years in patients with RA (49,50). These findings are
consistent with studies of low back pain (51–53) in which
catastrophizers reported more pain and reduced function
during standardized physical tasks (e.g., range-of-motion
exercises, etc.).
Physiologic indices of disease activity in RA. Multiple
RA studies have reported positive relationships between
catastrophizing (or helplessness, one component of cata-
strophizing) and elevated disease activity (54–58). Al-
though much of this research is cross-sectional, at least 1
longitudinal RA study has shown that catastrophizing pro-
spectively predicted worsening disease activity (defined
by erythrocyte sedimentation rate [ESR] and joint counts)
(26). Among patients with JRA, catastrophizing directly
influences physicians’ global assessments of disease (59),
with higher catastrophizing predicting more severe dis-
ease assessment. Whereas most of these studies did not
control for symptoms of anxiety or depression, a recent RA
study concluded that although helplessness was strongly
positively associated (i.e., 15% shared variance) with ele-
vated high-sensitivity C-reactive protein (CRP) levels, anx-
iety and depression were either unrelated or only mod-
estly related to CRP (60). Finally, prospective RA research
has also revealed that baseline helplessness predicts future
increases in ESR (61) as well as mortality (62,63), even
when controlling for baseline disease severity. Whether
catastrophizing directly impacts other physiologic systems
such as the sympathetic nervous system or the hypotha-
lamic–pituitary–adrenal axis is uncertain; cold pressor
studies have demonstrated that high catastrophizing does
not predict cortisol reactivity to pain (64), but does predict
sustained increases in myocardial contractility (65), a po-
tential index of sympathetic activity. Although it is un-
clear how catastrophizing influences disease severity,
helplessness does correlate with less effective medication
use (66) and less positive health behavior such as exercise
(67), suggesting several plausible pathways by which cata-
strophizing could enhance disease, reduce physical
health, and promote mortality.
Additional outcomes. The impact of catastrophizing on
outcomes can be fairly broad (i.e., not limited to pain). For
example, catastrophizing is related to greater reports of
fatigue among women with breast cancer (68,69), in-
creased constitutional symptoms such as nausea in indi-
viduals with infections (70), reduced maternal social in-
volvement among new mothers (71), and dissatisfaction
with treatment among patients being treated for gastroin-
testinal symptoms (72). From a societal perspective, cata-
strophizing is an important variable to understand because
it relates to greater health care utilization and use of pain-
related medications in the general population (11,73),
even after controlling for pain intensity.
Hypothesized Mechanisms of Action
Catastrophizing interferes with pain-coping and bene-
ficial health behaviors. Perceptions of helplessness and
pessimism may diminish the likelihood that high cata-
strophizers anticipate positive outcomes from other cop-
ing efforts, which may therefore be underutilized (1). In 2
experimental pain studies, individuals who were high
catastrophizers reported using fewer active coping strate-
gies (e.g., distraction, relaxation, etc.) during a cold pressor
test (7,74). Catastrophizing also relates to lower coping
efficacy in patients with OA (19) and RA (18); indeed, in
this latter study, higher levels of catastrophizing were as-
sociated with reduced perceptions of coping self efficacy
on the part of both the patient and his or her spouse.
Finally, as noted above, helplessness (one component of
catastrophizing) correlates with reduced adherence to
medication regimens (66) and less positive health behav-
iors such as exercise (67), each of which could potentially
lead to increases in musculoskeletal pain symptoms.
Catastrophizing increases attention to pain. Some re-
search has also examined the hypothesis that catastroph-
izing enhances the experience of pain via its effects on
Catastrophizing and Pain 327
4. attentional processes. That is, high levels of catastrophiz-
ing may lead individuals to attend selectively and in-
tensely to pain-related stimuli. Catastrophizers experience
more difficulty controlling or suppressing pain-related
thoughts than do noncatastrophizers, they ruminate more
about their pain, and their cognitive and physical perfor-
mance are more disrupted by anticipation of pain (51,75–
77). In patients with FM, catastrophizing is strongly cor-
related with increased attention to pain (78) and greater
vigilance to bodily sensations (36,79).
Catastrophizing amplifies pain processing in the CNS.
Incoming signals in the CNS are subject to modulation at a
variety of sites from the spinal cord to the cortex (80). One
hypothesized mechanism by which catastrophizing im-
pacts the experience of pain promotes sensitization or
interfering with pain inhibition in the CNS (1,21,43,47).
An early study suggested that reducing catastrophizing
resulted in the activation of descending endogenous opi-
oid systems that inhibited nociception (81). A more recent
functional magnetic resonance imaging study of patients
with FM indicated that high catastrophizers showed en-
hanced activity in cortical regions involved in the affective
processing of pain, such as the anterior cingulate cortex
and insular cortex, during the experience of acute pain
(21). Recent data from our laboratory also suggest that
catastrophizing may be directly associated with CNS pain-
facilitatory processes in the spinal cord (82). Overall, pre-
liminary evidence indicates that catastrophizing may am-
plify pain processing at multiple CNS loci, with some
researchers postulating that bidirectional relationships be-
tween catastrophizing and nociceptive processing may
contribute to the chronicity of many pain conditions (1).
Catastrophizing has a maladaptive impact on the social
environment. The communal coping model of catastroph-
izing postulates that expressions of catastrophizing func-
tion to maximize access to supportive responses from oth-
ers, and that these social responses may then reinforce
displays of pain and expressions of catastrophizing
(1,83,84). In support of the model, catastrophizers are per-
ceived by others as less able to manage pain, and are more
likely to seek social support (18,48,85,86). It is interesting
to consider that daily diary studies of patients with RA
suggest that expressing emotions and seeking social sup-
port, which may reflect catastrophizing, are prospectively
associated with greater arthritis pain (87–90). Also note-
worthy is the finding that high levels of catastrophizing are
associated with greater perceived stress and less non–
pain-related social support within the social network
(86,91), suggesting that more frequent catastrophizing may
have paradoxical effects by both eliciting more solicitous
responses to pain (92) and reducing the general availabil-
ity of support, potentially by enhancing distress in others
(93).
Implications for Treatment
Screening for psychosocial risk factors that predict poor
treatment outcome is not widespread, but it may hold
promise as a low-cost means to identify individuals who
would benefit most from adjunctive treatments. For exam-
ple, given that catastrophizing is a risk factor for poor
surgical outcomes (29,30), long-term treatment success
may be maximized by offering CBT either presurgery or
concurrently with surgery to those who exhibit high levels
of catastrophizing. We should also note that reducing cata-
strophizing is particularly important in the context of pre-
venting disability. As several RA studies have demon-
strated, the degree of physical disability exhibited by
patients is a function not solely of pain frequency or in-
tensity, but also of the degree of catastrophizing, suggest-
ing that simple pain reduction is not an adequate treat-
ment goal. In this regard, exposure paradigms are an
important part of behavioral treatments for painful condi-
tions such as FM, RA, and OA; interventions designed to
increase physical activity levels may result in greater pain
in the short term, but by reducing catastrophizing and
enhancing self efficacy, these interventions are likely to
reduce long-term pain and disability (94,95).
Chronic pain and disability are increasingly managed by
multidisciplinary means; analgesic regimens are fre-
quently supplemented by physical therapy or psychologi-
cal interventions for individuals experiencing persistent
pain from rheumatic diseases (96–98). Indeed, for patients
with FM, nonpharmacologic adjunctive therapies may
demonstrate benefits superior to those provided by anal-
gesic medications (96,99). Emerging evidence indicates
that catastrophizing may be an important mediating vari-
able contributing directly to the outcomes of such treat-
ments. In 2 previous studies, decreases in catastrophizing
correlated with reductions in levels of depression and pain
behaviors (such as distorted mobility and verbal and non-
verbal complaints) among patients undergoing pain treat-
ment (14,100). Subsequent work using more sophisticated
analytic techniques has extended these findings; during
multidisciplinary pain treatment, early reductions in cata-
strophizing are associated with greater improvements in
pain later in treatment, whereas individuals whose cata-
strophizing does not change demonstrate few or no bene-
fits from multidisciplinary interventions (15,101–103).
Previous studies of cognitive and behavioral interventions
for pain suggest that these methods are effective in de-
creasing pain-related catastrophizing (14,15,104), and
based on these findings, it may be of great importance to
target catastrophizing early in the multidisciplinary man-
agement of pain. Future treatment studies in patients with
rheumatic disease may benefit from the assessment of cata-
strophizing pre- and posttreatment, the consideration of
catastrophizing as a mediator or moderator of treatment
effects, and a more fine-grained analysis of the pathways
by which catastrophizing impacts important outcomes.
A crucial unanswered question is whether catastrophiz-
ing is a cause or consequence of chronic pain (1,12). Some
indirect evidence bears on this issue, although no longitu-
dinal studies have yet examined whether catastrophizing
changes following the development of chronic pain. First,
catastrophizing tends to be stable over time in both healthy
adults and patients with pain, showing high test–retest
reliability measured over weeks or months (7,13). Recent
data have also suggested that catastrophizing, measured
initially when patients were experiencing acute pain and
328 Edwards et al
5. remeasured several weeks later when they were pain free,
did not change when patients’ pain was alleviated (47). In
contrast, as noted above, self report of catastrophizing
often decreases when patients undergo CBT (14,15), indi-
cating that it may be substantially modifiable. Finally,
studies using daily diary methodologies offer a unique
opportunity to examine the dynamic properties of cata-
strophizing because these methodologies allow assess-
ment of variability both within persons (i.e., variation from
time point to time point) and between persons. A recent
diary study in patients with chronic pain highlighted the
short-term stability of catastrophizing: individuals dif-
fered substantially in how much they catastrophized, but a
given person was likely to show similar levels of cata-
strophizing across the 2-week period, despite fluctuations
in pain (105). Collectively, catastrophizing appears to de-
velop relatively early in life (106,107) and to possess many
stable, trait-like characteristics, but it is clearly also ame-
nable to reduction by certain types of psychosocial treat-
ment.
Conclusions
Catastrophizing shows strong influences on many pain-
related outcomes in patients with rheumatic disease, with
multiple mechanisms of action accounting for its effects
(Figure 3). Because it is robustly correlated with treatment
success, catastrophizing represents an appealing target for
multidisciplinary pain-management interventions. Be-
cause catastrophizing may act via numerous pathways,
multimodal treatments incorporating pharmacologic, cog-
nitive, behavioral, and potentially social interventions are
perhaps most likely to succeed in ameliorating its effects.
Unfortunately, no published studies have evaluated the
efficacy of pharmacologic interventions in the reduction of
catastrophizing, which represents an important area for
future research. However, CBT and multidisciplinary
treatments consistently reduce catastrophizing, even in
samples of patients with long-standing complaints. For
example, in patients reporting chronic pain for Ͼ12 years,
a 4-week group CBT intervention delivered by a psychol-
ogist improved PCS scores by ϳ40% from pre- to posttreat-
ment (108). At present, little information is available on
the management of catastrophizing in patients with rheu-
matic disease, although based on the broader chronic pain
literature, patients with high levels of catastrophizing are
likely to benefit from referrals to a pain psychologist or to
other health professionals with expertise in CBT. Finally,
given that catastrophizing relates to enhanced inflamma-
tory processes and disease activity in RA, the refinement
and application of cognitive, behavioral, and other inter-
ventions designed to diminish catastrophizing in patients
with arthritis would potentially represent an important
development in disease management.
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