Chronic Overlapping Pain Conditions Research Articles

Chronic Overlapping Pain Conditions and Nociplastic Pain

Chronic Overlapping Pain Conditions (COPCs) are a subset of chronic pain conditions commonly comorbid with one another and more prevalent in women and assigned female at birth (AFAB) individuals. Pain experience in these conditions may better fit with a new mechanistic pain descriptor, nociplastic pain, and nociplastic pain may represent a shared underlying factor among COPCs. We applied GenomicSEM common-factor genome wide association study (GWAS) and multivariate transcriptome-wide association (TWAS) analyses to existing GWAS output for six COPCs in order to find genetic variation associated with nociplastic pain, followed by genetic correlation (linkage-disequilibrium score regression), gene-set and tissue enrichment analyses. We found 24 independent single nucleotide polymorphisms (SNPs), and 127 unique genes significantly associated with nociplastic pain, and showed nociplastic pain to be a polygenic trait with significant SNP-heritability. We found significant genetic overlap between multisite chronic pain and nociplastic pain, and to a smaller extent with rheumatoid arthritis and a neuropathic pain phenotype. Tissue enrichment analyses highlighted cardiac and thyroid tissue, and gene set enrichment analyses emphasized potential shared mechanisms in cognitive, personality, and metabolic traits and nociplastic pain along with distinct pathology in migraine and headache. We use a well-powered network approach to investigate nociplastic pain using existing COPC GWAS output, and show nociplastic pain to be a complex, heritable trait, in addition to contributing to understanding of potential mechanisms in development of nociplastic pain.

Structural MRI findings in the brain related to pain distribution in chronic overlapping pain conditions: An explorative case-control study in females with fibromyalgia, temporomandibular disorder-related chronic pain and pain-free controls.

Few neuroimaging studies have investigated structural brain differences associated with variations in pain distribution. To explore structural differences of the brain in fibromyalgia (FM), temporomandibular disorder pain (TMD) and healthy pain-free controls (CON) using structural and diffusion MRI. A case-control exploratory study with three study groups with different pain distribution were recruited: FM (n = 16; mean age [standard deviation]: 44 [14] years), TMD (n = 17, 39 [14] years) and CON (n = 10, 37 [14] years). Participants were recruited at the University Dental Clinic in Malmö, Sweden. T1-weighted and diffusion MRIs were acquired, clinical and psychosocial measures were obtained. Main outcome measures were subcortical volume, cortical thickness, white matter microstructure and whole brain grey matter intensity. Patients with FM had smaller volume in the right thalamus than patients with TMD (p = .020) and CON (p = .030). The right thalamus volume was negatively correlated to pain intensity (r = -0.37, p = .022) and pain-related disability (r = -0.45, p = .004). The FM group had lower cortical thickness in the right anterior prefrontal cortex than CON (p = .005). Cortical thickness in this area was negatively correlated to pain intensity (r [37] = - 0.48, p = .002). This study suggests that thalamus grey matter alterations are associated with FM and TMD, and that anterior prefrontal cortex grey matter alterations are associated with FM but not TMD. Studies on chronic overlapping pain conditions are needed in relation to possible nociplastic pain mechanisms in the brain and central nervous system.

Chronic Overlapping Pain Conditions in people with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS): a sample from the Multi-site Clinical Assessment of ME/CFS (MCAM) study

BackgroundChronic overlapping pain conditions (COPCs), pain-related conditions that frequently occur together, may occur in patients with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and could impact illness severity. This study aimed to identify comorbid COPCs in patients with ME/CFS and evaluate their impact on illness severity.MethodsWe used data from 923 participants in the Multi-Site Clinical Assessment of ME/CFS study, conducted in seven U.S. specialty clinics between 2012 and 2020, who completed the baseline assessment (595 ME/CFS and 328 healthy controls (HC)). COPCs included chronic low back pain (cLBP), chronic migraine/headache (cMHA), fibromyalgia (FM), interstitial cystitis/irritable bladder (IC/IB), irritable bowel syndrome (IBS), temporomandibular disorder (TMD). Illness severity was assessed through questionnaires measuring symptoms and functioning. Multivariate analysis of variance and analysis of covariance models were used for analyses. Log-binomial regression analyses were used to compute prevalence of COPCs and prevalence ratios (PR) between groups with 95% confidence intervals. Both unadjusted and adjusted results with age and sex are presented.Results76% of participants with ME/CFS had at least one COPCs compared to 17.4% of HC. Among ME/CFS participants, cMHA was most prevalent (48.1%), followed by FM (45.0%), cLBP (33.1%), and IBS (31.6%). All individual COPCs, except TMD, were significantly more frequent in females than males. The unadjusted PR (ME/CFS compared to HC) was highest for FM [147.74 (95% confidence interval (CI) = 20.83-1047.75], followed by cLBP [39.45 (12.73-122.27)], and IC/IB [13.78 (1.88-101.24)]. The significance and order did not change after age and sex adjustment. The COPC comorbidities of cLBP and FM each had a significant impact on most health measures, particularly in pain attributes (Cohen’s d effect size 0.8 or larger). While the impact of COPC comorbidities on non-pain attributes and quality of life measures was less pronounced than that on pain, statistically significant differences between ME/CFS participants with and without COPCs were still evident.ConclusionsMore than 75% of ME/CFS participants had one or more COPCs. Multiple COPCs further exacerbated illness severity, especially among females with ME/CFS. Assessment and management of COPCs may help improve the health and quality of life for patients with ME/CFS.

Predictors of response in PROMIS-global in a chronic low back pain specialty clinic: STarTBack and chronic overlapping pain conditions.

Tools, such as the STarTBack Screening Tool (SBT), have been developed to identify risks of progressing to chronic disability in low back pain (LBP) patients in the primary care population. However, less is known about predictors of change in function after treatment in the specialty care population. We pursued a retrospective observational cohort study involving LBP patients seen in a multidisciplinary specialty clinic to assess which features can predict change in function at follow-up. The SBT was administered at initial visit, and a variety of patient characteristics were available in the chart including the presence of chronic overlapping pain conditions (COPCs). Patient Reported Outcomes Measurement Information System-10 (PROMIS-10) global physical health (PH) and global mental health (MH) were measured at baseline and at pragmatic time points during follow-up. Linear regression was used to estimate adjusted associations between available features and changes in PROMIS scores. 241patients were followed for a mean of 17.0 ± 7.5months. Mean baseline pain was 6.7 (SD 2.1), PROMIS-10 global MH score was 44.8 (SD 9.3), and PH score was 39.4 (SD 8.6). 29.7% were low-risk on the SBT, 41.8% were medium-risk, and 28.5% were high-risk. Mean change in MH and PH scores from baseline to the follow-up questionnaire were 0.86 (SD 8.11) and 2.39 (SD 7.52), respectively. Compared to low-risk patients, high-risk patients had a mean 4.35points greater improvement in their MH score (p= 0.004) and a mean 3.54points greater improvement in PH score (p= 0.006). Fewer COPCs also predicted greater improvement in MH and PH. SBT and the presence of COPC, which can be assessed at initial presentation to a specialty clinic, can predict change in PROMIS following treatment. Effort is needed to identify other factors that can help predict change in function after treatment in the specialty care setting.

Assessing the mediating role of disenfranchising talk on the well-being of female patients with chronic overlapping pain conditions

ObjectiveDisenfranchising talk (DT) occurs when health care providers discredit, silence, and stereotype patients. Although ample research has suggested associations among negative patient-provider interactions and poorer well-being, this study is the first to investigate the mediating role of patient-provider DT in exacerbating poorer pain-related health correlates. MethodsFemale patients living with chronic overlapping pain conditions (N = 348) completed a cross-sectional survey including measures of DT, pain severity, pain catastrophizing, and pain disability, as well as demographic information. Structural equation modeling in AMOS 29 assessed whether DT mediated the relationship between age, educational attainment, and sexual orientation (demographics), and pain severity, catastrophizing, and disability (pain-related health correlates). ResultsStructural equation modeling revealed that DT mediated the relationship between age, educational attainment, and sexual orientation on pain-related health correlates, such that younger and LGBQA+ patients and those with less educational attainment reported heightened pain severity, catastrophizing, and disability when they also reported DT. ConclusionIn contrast to scholarship assessing how demographics and pain-related variables influence patient-provider communication, this study instead investigated the mediating role of DT in pain-related health correlates. Practice implicationsProviders should avoid discrediting, silencing, or stereotyping female chronic pain patients’ pain to potentially avoid exacerbating pain-related health correlates.

“It comes in waves”: A relational dialectics approach to exploring living grief in U.S. emerging adults with invisible illness

Experiencing the onset of (invisible) chronic illness in emerging adulthood prompts a unique grieving process that is disenfranchised due to social discourses that sanction grief to death-related loss. Guided by relational dialectics theory, the present study analyzes the retrospective narratives of 57 emerging adults with acquired invisible illness (e.g., chronic overlapping pain conditions, autoimmune disease) about their meanings of grief. We interrogate competing discourses of grief to illustrate how participants make meaning of invisible, chronic illness and its resulting losses. Contrapuntal analysis led to the identification of a dominant Discourse of Grief as a Tsunami (DGAT) and marginalized Discourse of Grief as Waves (DGAW). The interplay of these discourses constructed meaning through dialogically contractive practices, synchronic interplay, and dialogic transformation. We offer implications for critical interpersonal and health communication theorizing and practical applications for individuals wading through the unique grief of chronic illness. Limitations and future directions are discussed.

Health Care Utilization by Patients With Chronic Pelvic Pain.

To describe the patterns of health care utilization among patients with chronic pelvic pain. Deidentified administrative claims data from the OptumLabs Data Warehouse were used. Adult female patients who had their first medical claim for chronic pelvic pain between January 1, 2016, and December 31, 2019, were included. Utilization was examined for 12 months after the index diagnosis. The greedy nearest neighbor matching method was used to identify a control group of individuals without chronic pelvic pain. Comparisons were made between those with and those without chronic pelvic pain using χ2 tests for categorical data and Wilcoxon rank-sum tests for continuous data. In total, 18,400 patients were analyzed in the chronic pelvic pain cohort. Patients with chronic pelvic pain had a higher rate of chronic overlapping pain conditions. Patients with chronic pelvic pain had higher rates of health care utilization across all queried indices. They had more outpatient office visits; 55.5% had 10 or more office visits. Patients with chronic pelvic pain showed higher utilization of the emergency department (ED) (6.3 visits vs 1.9 visits; P<.001). Urine culture and pelvic ultrasonography were the most utilized tests. One-third of patients with chronic pelvic pain utilized physical therapy (PT), and 13% utilized psychological or behavioral therapy. Patients with chronic pelvic pain had higher rates of hysterectomy (8.9% vs 0.6%). The average total health care costs per patient with chronic pelvic pain per year was $12,254. Patients with chronic pelvic pain have higher rates of chronic overlapping pain conditions and undergo more ED visits, imaging tests, and hysterectomies than patients without chronic pelvic pain. Improving access to multidisciplinary care, increasing utilization of interventions such as PT and psychological or behavioral therapy, and reducing ED utilization may be possible targets to help reduce overall health care costs and improve patient care.

Beyond vulvodynia: from a correct diagnosis to a multidisciplinary care program. A referral center experience.

Vulvodynia is a chronic pain condition without an identifiable cause. As such, it is a diagnosis of exclusion, and all other causes of vulvar pain should be excluded. Although a standard treatment for vulvodynia has not been established yet, multidisciplinary care programs appear to be effective. The aim of this retrospective monocentric study was to analyze the prevalence of vulvodynia among women referred to our institution for a suspected diagnosis and to evaluate the efficacy of a multidimensional treatment plan. The primary outcome was the prevalence of vulvodynia following differential diagnosis. Secondary outcomes included: prevalence of the differential diagnoses, symptom resolution rate following treatment, and the relation between persistence of symptoms and (a) patients' age; (b) coexisting chronic overlapping pain conditions (COPCs). After having ruled out all other causes of vulvar pain, only 40.1% of women were considered as affected by vulvodynia. The most frequent differential diagnoses included lower genital tract infections (25.3%), vulvar lichen sclerosus (17.6%) and vulvovaginal atrophy (8.2%). Following a multidisciplinary care program, resolution of symptoms was observed in 13.6% cases, improvement in 64.3% and persistence in 21.9%. We did not find a statistically significant association between persistence of symptoms and age > 38years (OR 2.10; p = 0.30). Women with one or more COPCs other than vulvodynia had a 75% increased risk of not obtaining a resolution of symptoms (OR 1.75; p = 0.44). A thorough differential diagnosis and a multidisciplinary care program may represent a first way out of the muddle in the management of these patients.

Social health in young women with chronic pain.

Chronic pain may negatively affect social functioning, but no study to date has examined the specific social impact of different chronic pain conditions in young women, and whether living with multiple chronic overlapping pain conditions (COPCs) differently influences social domains. This study aimed to assess social functioning (social isolation, hostility, informational support satisfaction, social roles, emotional support, friendships, and family relationships) among young women with chronic pain compared with pain-free controls and to test whether the number of COPCs influenced the extent of social burden. Participants aged 18 to 30 years with a physician-confirmed diagnoses of migraine, fibromyalgia, or temporomandibular disorder (TMD) and pain-free controls were invited to participate from across the United States. After confirming eligibility, participants completed a 1-hour REDCap online questionnaire assessing social functioning. One hundred four participants (mean age 24.54 ± 3.35 years) were included (n = 26 with TMD, n = 25 with fibromyalgia, n = 25 with migraine, and n = 28 controls). All 3 chronic pain groups combined reported worse functioning than controls on friendship (P = 0.038), social isolation (P = 0.002), and social roles (P < 0.001). There were no differences on social variables between the 3 chronic pain groups (all P's > 0.05). Compared with those with 3 COPCs, participants with 1 condition reported better family relationships (P = 0.024). Experience of chronic pain-regardless of the specific pain condition-may negatively affect some areas of social functioning in young women.

Preliminary Validation of a General Factor Model of Chronic Overlapping Pain Conditions

Chronic overlapping pain conditions (COPCs) by definition, frequently co-occur, perhaps reflecting their shared etiologies. Their overlapping nature presents a methodological challenge, possibly masking associations between COPCs and health outcomes attributable to either general or specific processes. To address this challenge, we used population-based cohort data to evaluate the predictive validity of a bifactor model of 9 self-reported COPCs by assessing its association with incident pain-related clinical diagnoses; pain-relevant pharmacotherapy; and other health outcomes. We obtained data from a 2005 to 2006 study of Swedish adult twins linked with health data from nationwide registers through 2016 (N = 25,418). We then fit a bifactor model comprising a general COPC factor and 2 independent specific factors measuring pain-related somatic symptoms and neck and shoulder pain. Accounting for age, biological sex, and cancer, the general factor was associated with increased risk of all pain-related outcomes (eg, COPC diagnosis adjusted odds ratio [aOR], 1.71; 95% confidence interval [1.62, 1.81]), most mental health-related outcomes (eg, depression aOR, 1.72 [1.60, 1.85]), and overdose and mortality (eg, all-cause mortality aOR, 1.25 [1.09, 1.43]). The somatic symptoms specific factor was associated with pain-relevant pharmacotherapy (eg, prescribed opioids aOR, 1.25 [1.15, 1.36]), most mental health-related outcomes (eg, depression aOR, 1.95 [1.70, 2.23]), and overdose (eg, nonfatal overdose aOR, 1.66 [1.31, 2.10]). The neck and shoulder pain-specific factor was weakly and inconsistently associated with the outcomes. Findings provide initial support for the validity and utility of a general-factor model of COPCs as a tool to strengthen understanding of co-occurrence, etiology, and consequences of chronic pain. PerspectiveThis article presents associations between a novel measurement model of COPCs and various health outcomes. Findings provide support for measuring pain across multiple domains rather than only measuring pain specific to one physical location in both research and clinical contexts.

Presence of endometriosis and chronic overlapping pain conditions negatively impacts the pain experience in women with chronic pelvic-abdominal pain: A cross-sectional survey.

Evidence of overlap between endometriosis and chronic pain conditions is emerging; however, little is known about how the pain experience differs based on the presence or absence of endometriosis. In a sample of women reporting chronic pelvic-abdominal pain (CPP), the aim of this study was to characterize differences in pain symptomatology between women with and without endometriosis and to examine the influence of chronic overlapping pain conditions (COPCs) on pain among these two groups. This was a cross-sectional study, based on an online survey. Participants (aged 18+ years) completed a survey collecting pain diagnoses and symptoms assessing pelvic pain severity, pain interference, and pain impact. Independent sample t-tests, chi-square, and multiple linear regression models were employed to analyze group differences in pain symptomatology and COPCs. Of the 525 respondents with CPP, 25% (n = 133) reported having endometriosis. Women with endometriosis were younger at the onset of pelvic pain, relative to women without endometriosis (p = 0.04). There were no differences in age, race, ethnicity, or duration of pelvic pain between women with and without endometriosis. Women with endometriosis reported higher pelvic pain severity (+0.8, 95% CI = 0.4-1.1), pain interference (+5.9, 95% CI = 2.4-9.3), and pain impact (+1.9, 95% CI = 0.8-2.9). Endometriosis was associated with a higher number of COPCs (p = 0.003), with 25% (n = 33) of women reporting ⩾3 overlapping pain conditions compared with 12% (n = 45) of those without endometriosis. Women with endometriosis had a higher frequency of fibromyalgia (p < 0.001), chronic fatigue syndrome (p < 0.001), and temporomandibular disorder (p = 0.001). The number of COPCs was associated with higher pain severity, interference, and impact, independently of endometriosis. Women with endometriosis experienced higher levels of pain-related burden and COPCs compared with those without endometriosis. Pain intensity, interference, and impact increased with a higher number of pain conditions regardless of endometriosis presence.

Communication work about chronic pain: A mixed methods application and extension of the integrative theory of communication work

ABSTRACT Guided by the integrative theory of communication work, we present a computational and qualitative analysis of Reddit comments authored by patient-users living with chronic overlapping pain conditions. We first employed computational text analysis to compress the data corpus via structural topic modeling. The community detection algorithm Louvain was employed to identify communities of topics within the data. Then, we extracted a subset of the data and performed a computer-aided qualitative thematic co-occurrence analysis. Topic modeling revealed 35 topics and five thematic communities. The qualitative analysis revealed that these topics mapped onto and extended the typology of communication work and contributing factors and identified co-occurrence patterns both among and across research questions. Our findings offer methodological, theoretical, and practical implications.

A step towards better understanding chronic overlapping pain conditions.

A step towards better understanding chronic overlapping pain conditions.

Temporomandibular Disorders Treatments and Its Effects on Headaches

Objective: temporomandibular Disorders (TMD) are the most common causes of chronic orofacial pain and, along with primary headaches, are considered Chronic Overlapping Pain Conditions (COPCs). The aim of this study is to evaluate TMD treatment effects in individuals with comorbid headaches. Methods: a systematic review was conducted over a search in the database up to October 2020. Selected studies were randomized clinical trials with individuals diagnosed with TMD and comorbid headaches compared to a control group after treatments for TMD. All included studies were evaluated for their methodological quality through the Cochrane Collaboration tool for assessing the risk of bias. Results: seven studies fulfilled the inclusion criteria and were applied in the review, with a total of 432 participants. Four studies were included in a meta-analysis. There was no significative mean difference in the frequency of headache after TMD treatment, nor for a reduction in pain, after TMD intervention for less than 12 weeks. Although for an individual with a TMD intervention period higher than 12 weeks, there was a significant reduction in pain. Conclusion: there is moderate evidence that painful TMD therapies for 12 weeks or higher reduce headache intensity in individuals with painful TMD and headaches. Simultaneous management of TMD and headache must be prioritized for more effective results on both conditions.

Proposal for targeted, neo-evolutionary-oriented secondary prevention of early-onset endometriosis and adenomyosis. Part II: medical interventions.

According to consistent epidemiological data, the slope of the incidence curve of endometriosis rises rapidly and sharply around the age of 25 years. The delay in diagnosis is generally reported to be between 5 and 8 years in adult women, but it appears to be over 10 years in adolescents. If this is true, the actual onset of endometriosis in many young women would be chronologically placed in the early postmenarchal years. Ovulation and menstruation are inflammatory events that, when occurring repeatedly for years, may theoretically favour the early development of endometriosis and adenomyosis. Moreover, repeated acute dysmenorrhoea episodes after menarche may not only be an indicator of ensuing endometriosis or adenomyosis, but may also promote the transition from acute to chronic pelvic pain through central sensitization mechanisms, as well as the onset of chronic overlapping pain conditions. Therefore, secondary prevention aimed at reducing suffering, limiting lesion progression, and preserving future reproductive potential should be focused on the age group that could benefit most from the intervention, i.e. severely symptomatic adolescents. Early-onset endometriosis and adenomyosis should be promptly suspected even when physical and ultrasound findings are negative, and long-term ovulatory suppression may be established until conception seeking. As nowadays this could mean using hormonal therapies for several years, drug safety evaluation is crucial. In adolescents without recognized major contraindications to oestrogens, the use of very low-dose combined oral contraceptives is associated with a marginal increase in the individual absolute risk of thromboembolic events. Oral contraceptives containing oestradiol instead of ethinyl oestradiol may further limit such risk. Oral, subcutaneous, and intramuscular progestogens do not increase the thromboembolic risk, but may interfere with attainment of peak bone mass in young women. Levonorgestrel-releasing intra-uterine devices may be a safe alternative for adolescents, as amenorrhoea is frequently induced without suppression of the ovarian activity. With regard to oncological risk, the net effect of long-term oestrogen-progestogen combinations use is a small reduction in overall cancer risk. Whether surgery should be considered the first-line approach in young women with chronic pelvic pain symptoms seems questionable. Especially when large endometriomas or infiltrating lesions are not detected at pelvic imaging, laparoscopy should be reserved to adolescents who refuse hormonal treatments or in whom first-line medications are not effective, not tolerated, or contraindicated. Diagnostic and therapeutic algorithms, including self-reported outcome measures, for young individuals with a clinical suspicion of early-onset endometriosis or adenomyosis are proposed.

Chronic overlapping pain conditions increase the risk of long COVID features, regardless of acute COVID status.

Chronic overlapping pain conditions (COPCs) refer to conditions that have similar central nervous system pathophysiologic mechanisms driving widespread pain as well as common comorbid symptoms such as fatigue and problems with sleep, memory, and mood. If COPCs predict the onset of long COVID, this could offer a valuable orientation for long COVID-related research and clinical care. This retrospective cohort study aimed to determine whether having a COPC predicts the onset of long COVID features using US electronic health records and 1:1 propensity score matching without replacement. The study cohorts included (1) people with acute COVID (n = 1,038,402), (2) people with acute influenza (n = 262,092), and (3) a noninfected cohort comprising people with a routine healthcare encounter (n = 1,081,593). Having a COPC increased the risk of long COVID features in all 3 study cohorts. Among those with COVID, having a pre-existing COPC increased the risk by 1.47 (95% CI = 1.46, 1.47). In the influenza cohort, COPCs increased the risk by 1.39 (95% CI = 1.38, 1.40). In the noninfected cohort, COPCs increased the risk by 1.57 (95% CI = 1.56, 1.59). These findings reinforce the likelihood that nociplastic mechanisms play a prominent role in long COVID. Recognizing that this ubiquitous nonspecific syndrome occurs frequently in the population can inform precision medicine therapies that avoid the pitfalls of viewing long COVID exclusively in the framework of postinfectious disease.

MTHFR mutation: Another unifying etiology of chronic overlapping pain conditions

Introduction and Objective:Chronic pelvic pain (CPP) is a heterogeneous condition with multiple etiologies. Better characterization and understanding of CPP will lead to new therapeutic options and individualization of care, especially in patients with chronic overlapping pain syndromes (COPCs), which increase complexity of diagnosis. In this study, we present 6 patients with COPC and complex CPP, non-focal exam, who tested negative for small fiber neuropathy but who reported a history of methylenetetrahydrofolate reductase (MTHFR) mutations, and retrospective review of 76 patients with MTHFR mutation. This study explores through literature review whether MTHFR mutations play a role in the pathogenesis of chronic pelvic pain and overlapping pain conditions in a subset of patients with COPCs. Methods:Study design included an observational study of 6 patients, a retrospective cross-sectional study of 76 patients, and a literature review. Patients at our institution who tested positive for MTHFR mutations were included in the study; most had been seen in the cardiology/hematology clinics due to the association of MTHFR with clotting disorders. Chart review was performed to identify the presence of pain syndromes and specifically CPP. A review of the literature was undertaken to form a hypothesis for mechanisms that could explain the association between MTHFR mutations and chronic overlapping pain syndromes. Results:Of 76 patients with MTHFR mutations seen primarily in non-pain focused cardiology visits, 30 (39%) had some form of pain syndrome documented, 11 of whom (14%) specifically had CPP. The review below suggests that MTHFR plays a role in the maintenance of nerve tissue and conductance, neural tube defects, and paresthesia. Literature review revealed that MTHFR mutations have been linked with chronic pain and pathological processes such as chronic migraine, interstitial cystitis/bladder pain syndrome, sequelae of chronic Lyme disease, and fibromyalgia. Conclusions:The etiology of chronic pelvic pain is complex. Multisystem pain extending beyond the pelvis complicates the differential diagnosis but suggests a systemic cause. MTHFR mutations may play a unifying role in a subset of chronic pelvic pain patients with concomitant chronic overlapping pain syndromes. The mutations may affect folate metabolism pathways in these patients and hinder the ability to maintain nerve fibers over time, leading to dereliction of pain signal conduction. Disturbance of these pathways may have a role in chronic overlapping pain syndromes and complex pelvic pain.

Sex differences in visceral sensitivity and brain activity in a rat model of comorbid pain: a longitudinal study.

Temporomandibular disorder (TMD) and irritable bowel syndrome (IBS) are 2 chronic overlapping pain conditions (COPCs) that present with significant comorbidity. Both conditions are more prevalent in women and are exacerbated by stress. While peripheral mechanisms might contribute to pain hypersensitivity for each individual condition, mechanisms underlying the comorbidity are poorly understood, complicating pain management when multiple conditions are involved. In this study, longitudinal behavioral and functional MRI-based brain changes have been identified in an animal model of TMD-like pain (masseter muscle inflammation followed by stress) that induces de novo IBS-like comorbid visceral pain hypersensitivity in rats. In particular, data indicate that increased activity in the insula and regions of the reward and limbic systems are associated with more pronounced and longer-lasting visceral pain behaviors in female rats, while the faster pain resolution in male rats may be due to increased activity in descending pain inhibitory pathways. These findings suggest the critical role of brain mechanisms in chronic pain conditions and that sex may be a risk factor of developing COPCs.

Grieving “The Death of Possibility”: Memorable Messages of (Dis)Enfranchised Loss in Invisible, Physical Illness

ABSTRACT Guided by theories of communicative disenfranchisement (TCD) and memorable messages (ToMM), this study analyzes 60 open-ended survey responses detailing experiences of grief following the onset of invisible, physical illness (e.g. chronic overlapping pain conditions, autoimmune rheumatic diseases). Employing reflexive thematic analysis, we identify (1) illness-related losses that are disenfranchised by discourses surrounding grief and (2) opportunities to enfranchise these losses via memorable messages. Situated at two points in time, before and after the onset of illness, we identify disenfranchised losses as what once was (e.g. physical [in]dependence, relational connection, images of self, and trust in institutions) and what will never be (e.g. family planning and career dreams). Next, we identify opportunities to disrupt this disenfranchisement through memorable messages of presence (e.g. nonverbal acknowledgment and verbal expressions of belief) and finding the fit (e.g. physical restructuring and community connection). In doing so, we extend theoretical understanding of both memorable messages, in the form that they can take (of experience) and as points of (dis)enfranchisement, and communicative (dis)enfranchisement. This study contributes to a growing body of health communication research on disenfranchising experiences in chronic illness by highlighting a resulting experience of illness not often talked about – illness-related loss and its grief process. Theoretical and practical implications, as well as limitations and future directions, are discussed.

The Chronic Overlapping Pain Condition Screener

Ten Chronic Overlapping Pain Conditions (COPCs) are currently recognized by the National Institutes of Health Pain Consortium (eg, irritable bowel syndrome, chronic migraine headache, and chronic low back pain). These conditions affect millions of Americans; however, assessing these conditions, their co-occurrence, and their relationship to treatment has proven challenging due to time constraints and a lack of standardized measures. We present a Chronic Overlapping Pain Condition-Screener (COPC-S) that is logic-driven, efficient, and freely available in electronic format to nonprofit entities. Thirty experts were convened to identify and modify self-report criteria for each COPC as well as criteria that trigger the administration of the diagnostic criteria from a body map and a brief series of questions. Their recommendations were then programmed into the Research Electronic Data Capture platform and refined for comprehensibility and ease of use by patient focus groups. The electronic screener and physician-administered criteria were both administered to patients with known COPCs in a counter-balanced fashion to determine the level of agreement between methods. The expert panel identified screening items/body map regions and diagnostic criteria for all 10 COPCs. Patients found the content comprehensible and the platform easy to use. Cohen’s Kappa statistics suggested good agreement between the electronic COPC-S and criteria administered by a physician (κ = .813). The COPC-S is an efficient tool for screening multiple COPCs and has applicability to research studies, clinical trials, and clinical practice. PerspectiveAssessing COPCs remains a challenge for researchers and clinicians. The COPC-S is an efficient and logic-driven electronic tool that allows for the rapid screening assessment of 10 COPCs. The instrument may have utility in research and clinical settings.