Editorial.

This issue begins with an invited paper by Ronald Melzack, continuing the "Distinguished Contribution Series" begun in 1990 by my predecessor, Gordon Winocur. Professor Melzack is known world-wide for his research on pain. In 1965, together with Patrick Wall, he proposed the gate control theory, an entirely new conception of pain. For the first time, there was an explicit physiological model emphasizing the role played by the brain as well as by the spinal cord, leading to a new integration of psychological and physiological contributions to pain, as well as to new avenues for the control of pain. This theory has been highly influential, as a quick look in virtually any textbook in biology or medicine will confirm. Professor Melzack's continuing development of his ideas is presented with remarkable clarity in his books and in his many journal articles. It is, therefore, especially exciting for CJEP to be the first to publish a sketch of his new neuromatrix theory. When the book developing this theory is published, it too will no doubt have an immediate and major impact. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

éditorial.

This issue begins with an invited paper by Ronald Melzack, continuing the "Distinguished Contribution Series" begun in 1990 by my predecessor, Gordon Winocur. Professor Melzack is known world-wide for his research on pain. In 1965, together with Patrick Wall, he proposed the gate control theory, an entirely new conception of pain. For the first time, there was an explicit physiological model emphasizing the role played by the brain as well as by the spinal cord, leading to a new integration of psychological and physiological contributions to pain, as well as to new avenues for the control of pain. This theory has been highly influential, as a quick look in virtually any textbook in biology or medicine will confirm. Professor Melzack's continuing development of his ideas is presented with remarkable clarity in his books and in his many journal articles. It is, therefore, especially exciting for CJEP to be the first to publish a sketch of his new neuromatrix theory. When the book developing this theory is published, it too will no doubt have an immediate and major impact. (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)     

Toward a theory of pain: Relief of chronic pain by prefrontal leucotomy, opiates, placebos, and hypnosis.

Research concerned with the neurological correlates of the pain response and how this response can be mitigated or eliminated by various clinical procedures permit several tentative conclusions: (a) pain producing stimuli activate a variety of nerve fibers rather than activating specific "pain" nerve pathways. (b) Pain producing stimuli set off patterns of neural impulses which are different from those produced by other stimuli. (c) Discomfit due to pain is not necessarily present when the noxious stimulus has been discriminated. Discomfit can be eliminated by various clinical procedures without necessarily altering the sensation of pain. (d) Mitigation of discomfort by clinical procedures appears to be secondary to their more generalized effect, i.e., anxiety reduction. 174-item bibliog. (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)     

Some comments on "Congenital insensitivity to pain: A critique."

A note on the paper by R. A. Sternbach (see record 1963-07503-001) to correct the statement attributed to this author (S. F. Schneider) that the latter considers the syndrome of indifference to pain a defense mechanism, which, in fact, was not the case. A distinction is made between syndrome and defense. A summary of the neuropathologic findings on one of Schneider's cases is presented. Since these findings were equivocal in pathologic significance and thus inconclusive, an explanation of the anomaly on the basis of neural deficit remains as hypothetical as those based upon psychological factors. Sternbach's concluding generalization that pain is not a necessary component in normal personality development is felt to be premature, since the evidence is hardly adequate at this time to describe how the absence of pain may effect personality. (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 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)     

Chronic pain alters drug self-administration: Implications for addiction and pain mechanisms.

This review article focuses on the impact that the presence of pain has on drug self-administration in rodents, and the potential for using self-administration to study both addiction and pain, as well as their interaction. The literature on the effects of noxious input to the brain on both spinal and supraspinal neuronal activity is reviewed as well as the evidence that human and rodent neurobiology is affected similarly by noxious stimulation. The convergence of peripheral input to somatosensory systems with limbic forebrain structures is briefly discussed in the context of how the activity of one system may influence activity within the other system. Finally, the literature on how pain influences drug-seeking behaviors in rodents is reviewed, with a final discussion of how these techniques might be able to contribute to the development of novel analgesic treatments that minimize addiction and tolerance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Is self-concealment associated with acute and chronic pain?

Objective: Self-concealment is the predisposition to hide negative personal information. The present research examined whether self-concealment was associated with acute and chronic pain. Methods: In Study 1, undergraduate students (N = 44) completed an online questionnaire packet and then completed a cold-pressor task in the laboratory. In Study 2, individuals with chronic pain (N = 85) completed an online survey. Results: Study 1: Trait self-concealment was negatively associated with pain tolerance. Study 2: Self-concealment of chronic pain (hiding aspects of one's chronic pain condition from others) was associated with higher levels of self-reported pain and lower psychological well-being, independent of disclosure of feelings regarding pain. Furthermore, this association was mediated by autonomy and competence needs. Conclusions: Self-concealment was found to be associated with higher levels of pain in both healthy and chronic pain samples. Moreover, the findings also suggest that intervention methods using the self-determination theory framework (i.e., autonomy and competence supportive) might be effective for individuals with chronic pain. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Depression history and coping with chronic pain: A daily process analysis.

This study examined how a previous episode of depression is related to daily pain and reactions to pain among individuals with fibromyalgia, a chronic pain syndrome. Seventy-one women with fibromyalgia (including 30 who were previously depressed) rated their pain and mood 3 times daily for 30 days. Each night, participants rated the extent to which they responded to pain by catastrophizing, how much control they had over that day's pain, their ways of coping with pain that day, and the effectiveness of their coping efforts. Multivariate multilevel regression models revealed that after controlling for neuroticism and current depressive symptoms, formerly depressed and never-depressed individuals differed in how they coped with increased pain and in how they appraised the efficacy of their coping efforts. Formerly depressed participants who also reported more current depressive symptoms showed a greater decline in pleasant mood on more painful days than did formerly depressed participants who were experiencing fewer current depressive symptoms. These findings illustrate how a history of depression can be captured in the dynamics of daily life. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Empathy gaps for social pain: Why people underestimate the pain of social suffering.

In 5 studies, the authors examined the hypothesis that people have systematically distorted beliefs about the pain of social suffering. By integrating research on empathy gaps for physical pain (Loewenstein, 1996) with social pain theory (MacDonald & Leary, 2005), the authors generated the hypothesis that people generally underestimate the severity of social pain (ostracism, shame, etc.)—a biased judgment that is only corrected when people actively experience social pain for themselves. Using a social exclusion manipulation, Studies 1–4 found that nonexcluded participants consistently underestimated the severity of social pain compared with excluded participants, who had a heightened appreciation for social pain. This empathy gap for social pain occurred when participants evaluated both the pain of others (interpersonal empathy gap) as well as the pain participants themselves experienced in the past (intrapersonal empathy gap). The authors argue that beliefs about social pain are important because they govern how people react to socially distressing events. In Study 5, middle school teachers were asked to evaluate policies regarding emotional bullying at school. This revealed that actively experiencing social pain heightened the estimated pain of emotional bullying, which in turn led teachers to recommend both more comprehensive treatment for bullied students and greater punishment for students who bully. (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)     

1986 CPA award for distinguished contributions to psychology as a science.

The 1986 recipient of the Canadian Psychological Association's Award for Distinguished Contributions to Psychology as a Science is Dr. Ronald Melzack, Professor of Psychology at McGill University. Throughout his distinguished and prolific research career, Dr. Melzack has made fundamental contributions to our understanding of pain. Through careful experiment and innovative theory he has shown that the phenomenon of pain can be understood only in terms of the interaction between physiological processes, mental states, and social beliefs. He is perhaps best known for his "gate control" theory of pain, formulated in conjunction with Patrick Wall in 1965, which provides a theoretical basis for this interaction and which has exerted an immense influence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The relation of pain and depression with various health-promoting behaviors in African American elders.

Purpose/Objective: In this study, the authors investigated how presence of pain interferes with various health behaviors in a sample of urban African American elders, examining depression as a potential mediator. Research Method/Design: 74 African Americans over the age of 60 years and residing in Detroit participated in both self-report questionnaires and physical performance measures. Regression analyses were used to determine the effect of pain interference on health behaviors, and partial correlations were used to determine whether depression mediated the relations. Results: The authors found that pain interference was significantly related to physical functioning and frequency of aerobic exercise. The latter relation (pain interference and frequency of exercise) was partially mediated by depression. Conclusions/Implications: Given these findings, the effect of pain interference on health behaviors is neither simple nor direct, and depression may be a key variable. Identification and treatment of pain and depression in older persons may reduce physical impairment and health care costs. (PsycINFO Database Record (c) 2010 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)     

Effects of anger suppression on pain severity and pain behaviors among chronic pain patients: Evaluation of an ironic process model.

Objective: Evidence for links between anger inhibition or suppression and chronic pain severity is based mostly on studies with correlation designs. Following from ironic process theory, we proposed that attempts to suppress angry thoughts during provocation would increase subsequent pain intensity among chronic low back pain (CLBP) patients, and do so through paradoxically enhanced accessibility of anger. Design: CLBP patients (N = 58) were assigned to suppression and nonsuppression conditions while performing a computer maze task with a harassing confederate. A structured pain behavior task (SPBT) followed. Main outcome measures: Self-reported anger, anxiety, and sadness following maze task. Self-reported pain severity and number of observed pain behaviors during SPBT. Results: Patients told to suppress during provocation: (a) reported greater anger following the maze task, reported greater pain intensity during the SPBT, and exhibited more pain behaviors than patients not suppressing; (b) postmaze anger levels significantly mediated group differences on pain behaviors. Conclusion: Attempts by CLBP patients to suppress anger may aggravate pain related to their clinical condition through ironically increased feelings of anger. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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)