Do changes in cognitive factors influence outcome following multidisciplinary treatment for chronic pain? A cross-lagged panel analysis.

Changes in maladaptive cognitions may constitute therapeutic processes of multidisciplinary pain programs. A cross-lagged panel design was used to determine whether (a) early-treatment cognitive change predicted late-treatment outcome index change, but not vice versa; and (b) these effects remained significant with depression change controlled. Ninety chronic pain patients, in a 4-week multidisciplinary program, completed measures of catastrophizing, pain helplessness, depression, pain, interference, and activity level at pre-, mid-, and posttreatment. With depression changes controlled, early-treatment catastrophizing and pain helplessness changes predicted late-treatment outcome index changes, but not vice versa; early-treatment depression changes predicted late-treatment activity changes, but not vice versa. Findings advance understanding of pain treatment process and suggest that negative cognition changes may indeed affect improvements in treatment outcome. (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)     

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)     

Review of Depression in the medically ill: An integrated approach.

Reviews the book, Depression in the medically ill: An integrated approach by G. Rodin, J. Craven, and C. Littlefield (see record 1991-97973-000). This book provides an in-depth coverage of current issues in the management of depression in the medically ill. The book is balanced in theoretical perspective and quite comprehensive in coverage of the empirical literature. The authors are well known to the area of depression and physical illness. The book is organized into three main sections dealing with 1) Clinical Presentation, 2) Etiology and Pathogenesis, and 3) Treatment. Numerous case examples are provided throughout to highlight different aspects of symptom presentation, diagnostic problems, and therapeutic management. Notably lacking from the review of prevalence studies is the work examining depression and chronic pain populations. In sum, Rodin et al. have drawn on a vast literature to provide a clear and coherent picture of the current state of knowledge and theory dealing with depression and medical illness. Their book joins a number of recent papers attempting to draw more attention to clinical issues in the management of depression in the medically ill. I would recommend the book to all clinicians who work with medically ill populations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Neck pain prevalence and associated occupational factors in Portuguese office workers

ObjectiveThis study aimed to assess the prevalence of neck pain and to identify associated occupational factors in Portuguese office workers.BackgroundThere is still necessary to quantify the association of the use of new technologies with neck pain in office workers.MethodsSix hundred-and-one office workers completed online questionnaires with questions related to anthropometric parameters, work-related variables, workstation setup, and musculoskeletal pain from the Portuguese version of the Standardized Nordic Musculoskeletal Questionnaire.ResultsThe prevalence of neck pain was 56.1%. An average of 35.6% of the office workers with neck pain reported pain in more than three body segments. The significantly risk factors were “age between 50 and 65” [OR: 1.92 (1.26–2.91) P = 0.002], “working without break for 2 h” [OR: 1.82 (1.00–3.31) P = 0.05], “more than 3 h” [OR: 2.41 (1.35–4.10) P = 0.003], screen localization not centered” [OR: 2.01 (1.01–4.00) P = 0.045], and “use of computer mouse more than 50% of the worktime” [OR: 2.05 (1.14–3.71) P = 0.017].ConclusionThere was a high prevalence of neck pain and a considerable number of painful body segments in office workers. Age, working without break, screen localization and the use of computer mouse where the significant risk factors associated with the development of neck pain.Relevance to industryA high prevalence of neck pain and number of areas with pain in office workers require a detailed pain mechanism assessment. There were associated occupational risk factors for the development of neck pain. Call for concerted actions to explore optimal and efficient management plans.     

Pharmacological Evidence on Augmented Antiallodynia Following Systemic Co-Treatment with GlyT-1 and GlyT-2 Inhibitors in Rat Neuropathic Pain Model

The limited effect of current medications on neuropathic pain (NP) has initiated large efforts to develop effective treatments. Animal studies showed that glycine transporter (GlyT) inhibitors are promising analgesics in NP, though concerns regarding adverse effects were raised. We aimed to study NFPS and Org-25543, GlyT-1 and GlyT-2 inhibitors, respectively and their combination in rat mononeuropathic pain evoked by partial sciatic nerve ligation. Cerebrospinal fluid (CSF) glycine content was also determined by capillary electrophoresis. Subcutaneous (s.c.) 4 mg/kg NFPS or Org-25543 showed analgesia following acute administration (30–60 min). Small doses of each compound failed to produce antiallodynia up to 180 min after the acute administration. However, NFPS (1 mg/kg) produced antiallodynia after four days of treatment. Co-treatment with subanalgesic doses of NFPS (1 mg/kg) and Org-25543 (2 mg/kg) produced analgesia at 60 min and thereafter meanwhile increased significantly the CSF glycine content. This combination alleviated NP without affecting motor function. Test compounds failed to activate G-proteins in spinal cord. To the best of our knowledge for the first time we demonstrated augmented analgesia by combining GlyT-1 and 2 inhibitors. Increased CSF glycine content supports involvement of glycinergic system. Combining selective GlyT inhibitors or developing non-selective GlyT inhibitors might have therapeutic value in NP.     

Stereoselective Synthesis and Antiallodynic Activity of 3-Hydroxylated Paroxetines

The design, stereoselective synthesis and in vivo antiallodynic activity of four novel paroxetine analogs, named 3-hydroxy paroxetines (3HPXs), is reported herein. Among the novel synthesized compounds, three showed an antiallodynic effect, while (R,R)-3HPX was found to be 2.5 times more bioactive than (-)-paroxetine itself in neuropathic rats. Consequently, the current investigation not only discloses a novel promising analgesic drug, but also reveals that functionalization at the C3 position of paroxetine could be as effective as the common functionalization at either C4 or within the sesamol group.     

Effects of personal,psychosocial and occupational factors on low back pain severity in workers

Low back pain (LBP) remains the most common work-related musculoskeletal disorder (WMSD). While most of the LBP research has focused on occupational risk factors, other underlying causal mechanisms may exist since not all workers performing the same task develop an injury. Previous research has identified three primary risk factor categories for LBP (occupational, personal and psychosocial factors); however, few studies have investigated the impact of cross categorical risk factor interactions on LBP. The objective of this study was to investigate the effects of occupational, personal and psychosocial factors, and their interactions, on LBP severity in a population of workers currently suffering from LBP. Sixty LBP patients recruited for the study through local physicians and local announcements, completed questionnaires relating to identified occupational, personal and psychosocial risk factors, and completed an Oswestry Disability Index (ODI). Multiple regression models for predicting LBP severity were developed for each risk factor category and for a combined risk factor model (which included factors from all three risk factor categories) that included two-way interactions. Results showed that the final model consisted of both main effects and interaction terms between risk factor categories and had an adjusted R² value of 0.85, a significant improvement over models developed for the individual categories. These findings illustrate the need to consider all three broad categories of risk factors simultaneously in predicting injury status and in developing effective potential intervention efforts.     

Calmodulin Supports TRPA1 Channel Association with Opioid Receptors and Glutamate NMDA Receptors in the Nervous Tissue

Transient receptor potential ankyrin member 1 (TRPA1) belongs to the family of thermo TRP cation channels that detect harmful temperatures, acids and numerous chemical pollutants. TRPA1 is expressed in nervous tissue, where it participates in the genesis of nociceptive signals in response to noxious stimuli and mediates mechanical hyperalgesia and allodynia associated with different neuropathies. The glutamate N-methyl-d-aspartate receptor (NMDAR), which plays a relevant role in allodynia to mechanical stimuli, is connected via histidine triad nucleotide-binding protein 1 (HINT1) and type 1 sigma receptor (σ1R) to mu-opioid receptors (MORs), which mediate the most potent pain relief. Notably, neuropathic pain causes a reduction in MOR antinociceptive efficacy, which can be reversed by blocking spinal NMDARs and TRPA1 channels. Thus, we studied whether TRPA1 channels form complexes with MORs and NMDARs that may be implicated in the aforementioned nociceptive signals. Our data suggest that TRPA1 channels functionally associate with MORs, delta opioid receptors and NMDARs in the dorsal root ganglia, the spinal cord and brain areas. These associations were altered in response to pharmacological interventions and the induction of inflammatory and also neuropathic pain. The MOR-TRPA1 and NMDAR-TRPA1 associations do not require HINT1 or σ1R but appear to be mediated by calcium-activated calmodulin. Thus, TRPA1 channels may associate with NMDARs to promote ascending acute and chronic pain signals and to control MOR antinociception.