Assessment and management of pain in the older adult.

Objective: To discuss the unique issues related to pain in older adults and to outline methods for assessment and treatment of geriatric pain. Synthesis: A model for pain assessment and treatment in the older adult is presented. Existing data indicate that cognitive-behavioral treatments are effective for pain management in older adults, although modification in treatment procedures may be needed to optimize treatment outcome. Conclusion: Geriatric pain is an understudied and undertreated problem. Multidisciplinary assessment and treatment should focus on pain reduction, relieving emotional distress, and improving function, with the ultimate goal of reducing disability and improving quality of life. Severe, disabling pain is not part of normal aging and should be assessed and treated. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Negative emotions, pain, and functioning.

We used linear structural equations (path model analysis) to examine associations among negative emotions, pain, and functioning in a large sample (N = 511) of veterans with chronic pain. We postulated and tested a model where pain and functioning affect negative emotions and where negative emotions affect pain and functioning. The findings confirm a strong relationship between negative emotions, pain, and functioning in our sample, particularly as the variable Pain Interference affects Depression. In a significant but weaker relationship, we also found that Anxiety has a direct effect on patients' perception of their Disability. Specifically, the data support a model where increased Pain Interference, Pain Severity, Depression and Anxiety all lead to increased Disability. Findings that Pain Interference and Depression appear to play a major role in the relationships between pain and negative emotions support the need for experimental studies to understand the causal impact of these variables on patient functioning. In the meantime, the findings suggest that Pain Interference, Depression, and Anxiety, in addition to Pain Severity, should all be targets of chronic pain treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clinician's comment on the management of pain in arthritis.

The arthritic diseases are major sources of pain or disability, although they differ in etiology and treatment approach. For diseases such as RA, inflammation is the predominant mechanism that leads to systemic complaints such as pain as well as local destruction of cartilage and bone. In contrast, OA is primarily a degenerative process and, although inflammation may occur, it differs in quality and extent from that in the systemic inflammatory arthritidies. For both conditions, psychosocial interventions have significant positive benefits, but their application involves careful consideration of a variety of factors. These factors include the following: diagnosis, disease activity, damage, disease stage, patient age and demographics, presence of comorbidities, and availability of alternative or adjunctive approaches. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Childhood pain: Current issues, research, and management.

Reviews the book, Childhood pain: Current issues, research, and management by Dorothea M. Ross and Sheila A. Ross (1988). This book is an amalgamation of what is known about assessment and control of pain in children. It should be of interest to anyone involved with clinical pain in children, especially pediatricians, nurses, child life workers, and clinical psychologists. Coverage of topics in this book is extensive, with slightly more attention given to non-pharmacologic strategies for pain management, the authors' area of expertise. The style is easy to read and the inclusion of case studies and quotes from children make it credible. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The influence of preferred coping style and cognitive strategy on laboratory-induced pain.

Objective: To evaluate the effects of matching an individual's coping style (low, mixed, or high monitoring) to an appropriate cognitive strategy (distraction or sensation monitoring) to improve pain management. Design: This study used a split-plot factorial design in a laboratory setting. Main Outcome Measures: Main outcomes were pain threshold, pain tolerance, pain intensity, pain affect, and anxiety. Results: The results of the 2 × 3 × 3 (Experimental Condition × Coping Style × Trial) analysis of variance (ANOVA) interaction were significant for pain threshold scores, F(4, 178) = 2.95, p     

Opioids and the treatment of chronic pain: Controversies, current status, and future directions.

Opioids have been regarded for millennia as among the most effective drugs for the treatment of pain. Their use in the management of acute severe pain and chronic pain related to advanced medical illness is considered the standard of care in most of the world. In contrast, the long-term administration of an opioid for the treatment of chronic noncancer pain continues to be controversial. Concerns related to effectiveness, safety, and abuse liability have evolved over decades, sometimes driving a more restrictive perspective and sometimes leading to a greater willingness to endorse this treatment. The past several decades in the United States have been characterized by attitudes that have shifted repeatedly in response to clinical and epidemiological observations, and events in the legal and regulatory communities. The interface between the legitimate medical use of opioids to provide analgesia and the phenomena associated with abuse and addiction continues to challenge the clinical community, leading to uncertainly about the appropriate role of these drugs in the treatment of pain. This narrative review briefly describes the neurobiology of opioids and then focuses on the complex issues at this interface between analgesia and abuse, including terminology, clinical challenges, and the potential for new agents, such as buprenorphine, to influence practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relationship between the MMPI-2 and psychosocial measures in a heterogeneous pain population.

Objective: A prior study demonstrated the utility of an MMPI-2 profile pattern, formerly known as the Floating Profile, for identifying treatment complications in the context of pain management. Retermed the Disability Profile (DP), this profile comprised a large proportion of the chronic musculoskeletal pain sample studied, and it was associated with several negative treatment outcomes. Method: This current study was designed to further evaluate the DP, but within a more heterogeneous pain population, while also comparing 3 other MMPI-2 profile patterns and 5 specific pain categories on behavioral and psychosocial measures administered at an initial intake evaluation. A total of 755 participants were evaluated. Results: Results clearly demonstrated the utility of the DP, with its association with significant impairment and disability in the pain population at the intake evaluation. Conclusions: A heterogeneous pain population is likely to include a number of individuals who demonstrate a pattern of behavior consistent with the initial findings of the DP characteristics. Those participants demonstrating a DP appear to have more complications during treatment and will likely require more thorough interventions at multiple points during treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Feeling pain and being in pain, 2nd edition.

Reviews the book, Feeling pain and being in pain, 2nd edition by Nikola Grahek (see record 2007-00636-000). This remarkable little book was originally published in Germany in 2001 and saved from obscurity by Daniel Dennett, who ensured its republication after the author's untimely death. It claims to provide no new theory and no new data on pain but instead walks the reader through a number of phenomena that eventually lead one to see pain in a new light. What makes this book such a gem is the refusal of its author to stray from what is known or can be known. No far-fetched notions of the relationship between pain and psychology, frequently encountered in the psychological pain literature, intrude on his prudent figuring; nor is there a promise of what is just around the corner, claims of what further research is needed, and so on. Grahek sticks to the clinical and neurophysiological data, for they are already sufficiently rich to allow him to characterise those very different features of the pain experience: feeling pain versus being in pain. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The social communication model of pain.

Everybody is an expert on pain, by virtue of biological preparedness and personal experience. Unfortunately, this expertise fails large numbers of people, and we must improve our understanding through theoretical and research advances. A vast research-based literature on the nature and management of pain is now available, and there have been dramatic advances in our understanding and management of pain. Nevertheless, there continue to be major problems in the management of severe acute pain and chronic pain. It is argued that a formulation of pain that explicitly focuses upon social factors would more readily address human needs than models that focus upon biophysical and/or psychological factors alone (intrapersonal processes). Although ancient protective biological systems provide for escape and avoidance of pain, evolution of human capacities for cognitive processing and social adaptation necessitate a model of pain incorporating these capabilities (interpersonal processes). The more inclusive and comprehensive social communication model of pain is described and illustrated. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The biopsychosocial approach to chronic pain: Scientific advances and future directions.

The prevalence and cost of chronic pain is a major physical and mental health care problem in the United States today. As a result, there has been a recent explosion of research on chronic pain, with significant advances in better understanding its etiology, assessment, and treatment. The purpose of the present article is to provide a review of the most noteworthy developments in the field. The biopsychosocial model is now widely accepted as the most heuristic approach to chronic pain. With this model in mind, a review of the basic neuroscience processes of pain (the bio part of biopsychosocial), as well as the psychosocial factors, is presented. This spans research on how psychological and social factors can interact with brain processes to influence health and illness as well as on the development of new technologies, such as brain imaging, that provide new insights into brain-pain mechanisms. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Psychosocial factors in pain: Critical perspectives.

Reviews the book, Psychosocial factors in pain: Critical perspectives edited by Robert J. Gatchel and Dennis C. Turk (see record 1999-02275-000). This edited volume is divided into three sections. The first presents the biopsychosocial context, the second examines special topics and populations, and the third focuses on prevention and management. The editors have attracted the cream of the crop of researchers in different areas. The coverage of topics is broad and most issues and disorders that one would expect are well covered. Indeed, some areas that are often not included in discussion of psychosocial factors, such as religious and spiritual issues, upper extremity disorders, and pain management in primary care, are included. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The reduction of uncertainty concerning future pain.

Ss received series of electric shocks to the forearm in which the temporal schedule and the sequence of shock intensities were associated with varying levels of randomness or uncertainty. The Ss were permitted an instrumental response which produced, in advance, information concerning 1 or both of these aspects of the shocks. Such information functioned as a strong positive reinforcement for most Ss. Instrumental response rate was a significant increasing function of the degree of uncertainty associated with the shock series, and occurred significantly more often for information concerning the temporal occurrence of shock than for its intensity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sex-related influences on pain: A review of mechanisms and clinical implications.

Objective: To review the literature regarding gender-related influences on the experience of pain. Methods: Medline searches and reference lists were used to locate published articles regarding gender differences in pain. Results: Women are at increased risk for many clinical pain conditions and for increased severity of clinical pain relative to men. Women typically report lower pain threshold and tolerance and higher pain ratings than men in laboratory research. Contributing factors include sex hormones, pain modulatory systems, family history, stereotypic sex roles, and affective/cognitive factors. Conclusions: The clinical implications of gender differences in pain responses are discussed, including gender differences in pain treatment outcomes. Gender-related factors affect pain considerably and merit additional attention in pain research and treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Hypnosis and clinical pain.

Hypnosis has been demonstrated to reduce analogue pain, and studies on the mechanisms of laboratory pain reduction have provided useful applications to clinical populations. Studies showing central nervous system activity during hypnotic procedures offer preliminary information concerning possible physiological mechanisms of hypnotic analgesia. Randomized controlled studies with clinical populations indicate that hypnosis has a reliable and significant impact on acute procedural pain and chronic pain conditions, Methodological issues of this body of research are discussed, as are methods to better integrate hypnosis into comprehensive pain treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Correlates of pain interference in multiple sclerosis.

Objectives: To describe pain interference and explore its associations with several indexes of health and psychosocial functioning among veterans with multiple sclerosis (MS). Study Design: Cohort study linking computerized medical records and survey questionnaire. Participants: Four hundred fifty-one veterans with MS. Outcome Measures: Pain Effects Scale, Patient Health Questionnaire, Modified Social Support Survey, items from the Short Form Health Survey and the North American Research Consortium on MS Registry Survey (NARCOMS) Performance Scales. Results: Participants reported a moderate level of overall pain interference. Increased fatigue, poorer general health, and greater depression symptom severity each were significantly associated with higher levels of pain interference. Conclusions: Pain interference in MS is associated with a variety of other clinically meaningful indexes of functioning. Pain in MS should be treated aggressively to minimize functional impairment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Handbook of pain assessment, second edition.

Reviews the book, Handbook of pain assessment, second edition edited by Dennis C. Turk and Ronald Melzack (see record 2001-05101-000). This book is a comprehensive review of the state of the art of pain assessment. The book consists of 36 chapters organized in six major sections, an introduction and a conclusion. The sections are: measurement of pain, assessment of behavioural expressions of pain, medical and physical evaluations, psychological evaluation, specified pain states, and methodological issues. The Handbook of pain assessment should be in every university and health centre library. All health professionals and students who see patients who have pain (and that is probably all of them) should have this text readily available. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Introduction to the featured section: Pain—from mechanisms to management.

Over the past 30 years, health psychologists have been at the forefront of pain research. Behavioral and psychological research has not only led to new insights into the nature of the pain experience, it has also led to the development of new behavioral and psychological pain management protocols. Although many individuals who have chronic pain respond well to behavioral or cognitive-behavioral treatment protocols, there are individuals who show little or no response to these treatment regimens. Tailoring treatment plans for refractory pain sufferers requires that we go beyond simple, minor adjustments to our standard treatment protocols. Rather, we need to more carefully assess the fundamental mechanisms that underpin the pain experience of treatment-resistant patients and develop new treatment approaches that effectively address these mechanisms. What mechanisms are responsible for flares in pain or pain episodes? Are there specific underlying mechanisms that can explain the persistence of pain? Finally, are there mechanisms that can explain why some people who use specific coping strategies report reduced pain, while others do not? The three articles that are included in this featured section are important because they provide some indications of how we might begin to address some of these questions. All three studies address pain mechanisms, although each does so from a different perspective. For health psychologists working in the pain research area, the challenge for the future is to translate an enlightened understanding of pain mechanisms into new and more effective treatments. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Pharmacological Management of Chronic Pain: I. Fibromyalgia and Neuropathic Pain.

This brief review surveys pharmacotherapy for some of the most common forms of chronic pain: musculoskeletal pain and neuropathic pain. Head pain is among the most common types of chronic pain, but will be discussed in a separate column. Because the extensive pharmacopoeia for pain cannot be distilled into a brief article, this summary focuses only on psychotropic agents used in the management of chronic pain. (PsycINFO Database Record (c) 2010 APA, all rights reserved)