Chronic Pain Research Research Articles

Dynamic pain–emotion relations in chronic pain: a theoretical review of moderation studies

Current developments in chronic pain research are changing the focus in the study of pain–emotion relations from the identification of general patterns to the study of dynamic and context-related interactions manifesting both within and between individuals. This shift towards understanding variation at both intra- and interpersonal levels has significant clinical implications for psychological adjustment to chronic pain conditions, and thus represents an important topic for both clinical and health psychology. This article reviews the existing theoretical explanations of these dynamics and their emerging empirical support, and suggests further areas of investigation. A literature search identified research on moderators of pain–emotion relations in chronic pain; existing theories were also examined from this perspective. A theoretical analysis revealed several important contributions, including the concepts of affect differentiation, generalised discrimination ability, resilience, vulnerability, coping, emotion regulation and desynchrony, which are described here together with the relevant empirical research and clinical implications. Important areas for development are the clarification of the common elements and opposing predictions and the empirical examination of mediating mechanisms. Several methodological issues are discussed. This review identifies a rich theoretical basis for research into pain–emotion moderation, and suggests that further examinations of such relationships might hold important clinical consequences.

What Does It Mean to Call Chronic Pain a Brain Disease?

Multiple investigators have recently asked whether neuroimaging has shown that chronic pain is a brain disease. We review the clinical implications of seeing chronic pain as a brain disease. Abnormalities noted on imaging of peripheral structures have previously misled the clinical care of patients with chronic pain. We also cannot assume that the changes associated with chronic pain on neuroimaging are causal. When considering the significance of neuroimaging results, it is important to remember that “disease” is a concept that arises out of clinical medicine, not laboratory science. Following Canguilhem, we believe that disease is best defined as a structural or functional change that causes disvalue to the whole organism. It is important to be cautious in our assertions about chronic pain as a brain disease because these may have negative effects on 1) the therapeutic dialogue between clinicians and patients; 2) the social dialogue about reimbursement for pain treatments and disability due to pain; and 3) the chronic pain research agenda. Considered scientifically, we may be looking for the cause of chronic pain through neuroimaging, but considered clinically, we are in fact often looking to validate pain complaints. We should not yield to the temptation to validate pain with the magnetic resonance imaging scanner (structural or functional). We should not see pain as caused by the brain alone. Pain is not felt by the brain, but by the person. PerspectiveNeuroimaging investigators have argued that brain imaging may demonstrate that chronic pain is a brain disease. We argue that “disease” is a clinical concept and that conceiving of chronic pain as a brain disease can have negative consequences for research and clinical care of patients with chronic pain.

Transforming pain medicine: Adapting to science and society

The field of chronic pain medicine is currently facing enormous challenges. The incidence of chronic pain is increasing worldwide, particularly in the developed world. As a result, chronic pain is imposing a growing burden on Western societies in terms of cost of medical care and lost productivity. This burden is exacerbated by the fact that despite research efforts and a huge expenditure on treatment for chronic pain, clinicians have no highly effective treatments or definitive diagnostic measures for patients. The lack of an objective measure for pain impedes basic research into the biological and psychological mechanisms of chronic pain and clinical research into treatment efficacy. The development of objective measurements of pain and ability to predict treatment responses in the individual patient is critical to improving pain management. Finally, pain medicine must embrace the development of a new evidence-based therapeutic model that recognizes the highly individual nature of responsiveness to pain treatments, integrates bio-psycho-behavioural approaches, and requires proof of clinical effectiveness for the various treatments we offer our patients. In the long-term these approaches will contribute to providing better diagnoses and more effective treatments to lessen the current challenges in pain medicine.

The Role of Fear-Avoidance Cognitions and Behaviors in Patients with Chronic Tinnitus

The current study investigated the role of fear-avoidance—a concept from chronic pain research—in chronic tinnitus. A self-report measure the “Tinnitus Fear-Avoidance Cognitions and Behaviors Scale (T-FAS)” was developed and validated. Furthermore, the role of fear-avoidance behavior as mediator of the relationship between anxiety sensitivity and tinnitus handicap was investigated. From a clinical setting, N = 373 patients with chronic tinnitus completed questionnaires assessing tinnitus handicap (Tinnitus Handicap Inventory), anxiety, depression (Hospital Anxiety and Depression Scale), anxiety sensitivity (Anxiety Sensitivity Index-3), personality factors (Big Five Inventory-10), and fear-avoidance. To analyze the psychometric properties, principal component analysis with parallel component extraction and correlational analyses were used. To examine a possible mediating effect, hierarchical regression analysis was applied. The principal component analysis resulted in a three-factor solution: Fear-avoidance Cognitions, Tinnitus-related Fear-Avoidance Behavior, and Ear-related Fear-Avoidance Behavior. Internal consistency was satisfactory for the total scale and all subscales. High correlations between tinnitus-related handicap scales, depressive and anxiety symptoms, and the T-FAS were found, whereas associations with personality factors were low. Moreover, results indicate a significant partial mediation of fear-avoidance behaviors in the relationship between anxiety sensitivity and the cognitive dimension of tinnitus handicap. Results show that fear-avoidance behavior plays an important role in tinnitus handicap. More attention should be paid to this concept in research and clinical practice of psychotherapy for chronic tinnitus.

Assessment of Physical Activity by Movement Registration Systems in Chronic Pain

Physical activity assessments in chronic pain research have mostly been based on self-report. However, earlier research indicated that chronic pain patients have difficulties in estimating their own daily life activity level. Movement registration systems have been introduced to overcome the limitations of self-reported measures. However, no uniform guidelines for researchers on how to analyze and interpret movement registration data in chronic pain exist. The aim of the study was to provide recommendations for physical activity assessment based on movement registration in patients with chronic pain. First, a systematic review of the procedures and data processing techniques used in movement registration for chronic pain patients will be performed. Second, it will be discussed whether the recommendations for physical activity assessment in healthy individuals are applied in chronic pain research. Last, recommendations regarding assessment procedure and data processing for using movement registration systems in future research in patients with chronic pain will be given. In chronic pain literature, 27 articles on movement registration were identified. According to the recommendations for activity assessment in healthy individuals, the various descriptions of the assessment procedures in these articles were mostly limited. Especially, information regarding the minimal requirements for the assessment period and the method used for calculation of the final outcome variable were often lacking. It is recommended that studies in chronic pain research explicitly apply and report the criteria that have been used to define an assessment day, the total assessment time, and the method for calculating the final test outcome.

Chronic Pain at 4 Months in Hospitalized Trauma Patients

Many studies report on the incidence of chronic pain. However, deficiencies exist in prior research making it difficult to generalize results to trauma patients. This study evaluated the incidence of chronic pain in trauma patients at 4 months posttrauma and effect chronic pain has on life interference. The incidence of chronic pain was present in 79.2% of trauma patients 4 months posttrauma and a strong positive correlation (n = 80, r = 0.79, P < 0.001) existed between chronic pain severity and the effect on life interference. Chronic pain is prevalent and causes significant life interference in traumatically injured patients.

Operant Learning Theory in Pain and Chronic Pain Rehabilitation

The application of operant learning theory on chronic pain by Fordyce has had a huge impact on chronic pain research and management. The operant model focuses on pain behaviors as a major component of the pain problem, and postulates that they are subject to environmental contingencies. The role of operant learning in pain behaviors generally has been supported by experimental studies, which are reviewed in the present article. Subsequently, the rationale, goals, and methods of operant behavioral treatment of chronic pain are outlined. Special attention is paid to three therapeutic techniques (graded activity, activity pacing, and time-contingent medication management), which are discussed in detail with regard to their operationalization, effectiveness, and (possible) mechanisms of action. Criticisms of the operant model are presented, as are suggestions for the optimization of (operant) behavioral treatment efficacy.

Knowledge Transfer: Making Information Work

Welcome to the first columnon KnowledgeTransfer: Making Information Work! My name is Lynn Shaw, I am an occupational scientist, researcher, an associate professor in the School of Occupational Therapy at the University of Western Ontario, and I am an editorial board member of WORK. I have developed a passion for KT through my research in chronic pain and work injuries, my involvement in leading and partnering in KT initiatives in occupational therapy as an educational influential occupational therapist in a work practice network in Ontario and in other professions such as chiropractic and audiology. This column is designed to provide readers with knowledge (evidence, theory and practical knowledge) for use in enhancing knowledge brokering and networking in work related practice, in education, in research, in the community and in the workplace. For this column, a broad definition of knowledge transfer is adopted, knowledge transfer includes the exchanging and sharing of research, policy and procedural knowledge between and among a realm of knowledge producers, knowledge brokers and end users [1,2]. For instance, people from all sectors and institutions are key stakeholders in knowledge exchange andmay include but not limited to the following researchers, health professionals, career counsellors, ergonomic specialists, vocational providers, human resource specialists, workplaces, educators, employers, workers, persons with work injuries, family members, students, insurers, health and safety professionals and regulators etc. The types of knowledge transferred and exchanged in work practice can include, research, procedural information, workplace safety information, health information, career information or other information that has the main aim of enabling workers, and their families, students, health and vocational professionals, workplace parties, educators or recruiters, and trainers to consider the relevance and value of new information to make informative decisions. Use of knowledge can where the word that was facilitate adaptation, accommodation, work style redesign, positive change in behaviours or procedures or policies to prevent injuries, promote health and productivity at work and by workplaces, and assist others to advance vocational pursuits or careers. Mediums for knowledge exchange and transfer are also broadly considered in this column and will include dialogic, group or collective approaches and interactions, as well as use of network approaches, the internet, written text, social media, artistic, photo novella or symbolic expressions, etc. This column will also promote the use of theory to inform different strategies and approaches for effective KT that are sensitive to one-on-one, group or organizational specific needs and preferences. Given that the readers of this journal are international, this column is also designed to advance knowledge transfer that underscores cultural ways of knowing and disseminating informationwithin different contexts relevant to work around the world.

Neurological diseases and pain

Chronic pain is a frequent component of many neurological disorders, affecting 20-40% of patients for many primary neurological diseases. These diseases result from a wide range of pathophysiologies including traumatic injury to the central nervous system, neurodegeneration and neuroinflammation, and exploring the aetiology of pain in these disorders is an opportunity to achieve new insight into pain processing. Whether pain originates in the central or peripheral nervous system, it frequently becomes centralized through maladaptive responses within the central nervous system that can profoundly alter brain systems and thereby behaviour (e.g. depression). Chronic pain should thus be considered a brain disease in which alterations in neural networks affect multiple aspects of brain function, structure and chemistry. The study and treatment of this disease is greatly complicated by the lack of objective measures for either the symptoms or the underlying mechanisms of chronic pain. In pain associated with neurological disease, it is sometimes difficult to obtain even a subjective evaluation of pain, as is the case for patients in a vegetative state or end-stage Alzheimer's disease. It is critical that neurologists become more involved in chronic pain treatment and research (already significant in the fields of migraine and peripheral neuropathies). To achieve this goal, greater efforts are needed to enhance training for neurologists in pain treatment and promote greater interest in the field. This review describes examples of pain in different neurological diseases including primary neurological pain conditions, discusses the therapeutic potential of brain-targeted therapies and highlights the need for objective measures of pain.

Recruitment bias in chronic pain research: whiplash as a model

In science findings which cannot be extrapolated to other settings are of little value. Recruitment methods vary widely across chronic whiplash studies, but it remains unclear whether this generates recruitment bias. The present study aimed to examine whether the recruitment method accounts for differences in health status, social support, and personality traits in patients with chronic whiplash-associated disorders (WAD). Two different recruitment methods were compared: recruiting patients through a local whiplash patient support group (group 1) and local hospital emergency department (group 2). The participants (n=118) filled in a set of questionnaires: the Neck Disability Index, Medical Outcome Study Short-Form General Health Survey, Anamnestic Comparative Self-Assessment measure of overall well-being, Symptom Checklist-90, Dutch Personality Questionnaire, and the Social Support List. The recruitment method (either through the local emergency department or patient support group) accounted for the differences in insufficiency, somatization, disability, quality of life, self-satisfaction, and dominance (all p values <.01). The recruitment methods generated chronic WAD patients comparable for psychoneurotism, social support, self-sufficiency, (social) inadequacy, rigidity, and resentment (p>.01). The recruitment of chronic WAD patients solely through patient support groups generates bias with respect to the various aspects of health status and personality, but not social support. In order to enhance the external validity of study findings, chronic WAD studies should combine a variety of recruitment procedures.

Measuring parent beliefs about child acceptance of pain: A preliminary validation of the Chronic Pain Acceptance Questionnaire, parent report

Parent perceptions of and responses to pain have been identified as important factors in understanding pain-related disability among children and adolescents with chronic pain. The ability to accept chronic pain rather than focus on ways to avoid or control it has been linked to positive outcomes in chronic pain research. To examine parent beliefs about child acceptance of pain, the Chronic Pain Acceptance Questionnaire, parent report (CPAQ-P), was developed and administered to 195 parents of children with persistent pain evaluated in a multidisciplinary pain clinic. Analyses support the internal consistency of the CPAQ-P (α=.89) and 1-month stability estimates were acceptable for the total scale score (α=.72), and results suggest some responsivity to change. Exploratory factor analysis identified a 2-factor model with 4 items removed from the original 20-item measure. Confirmatory factor analysis strongly supported the modified version. For construct validity, parent beliefs about child acceptance were negatively correlated with parent pain catastrophizing and parent fear of pain. Greater acceptance was also negatively associated with protective parent responses to pain. These results support the CPAQ-P as a promising measure for assessing parent beliefs about child acceptance of pain and reinforce the importance of the social context and parental influence on child functioning.

Effects of self-discrepancies on activity-related behaviour: Explaining disability and quality of life in patients with chronic low back pain

In chronic low back pain (CLBP) research, the self-discrepancy model has been applied to explain dysfunctional avoidance and persistence behaviour. The main aim of this study was to evaluate whether specific self-discrepancies in patients with CLBP are associated with the abovementioned types of activity-related behaviour and whether changes in self-discrepancies over time are associated with changes in activity-related behaviour. Furthermore, the aim was to evaluate whether avoidance and persistence behaviour are associated with a higher level of disability and a diminished quality of life and whether changes over time in avoidance and persistence behaviour result in changes in disability and quality of life. A longitudinal cohort study in a sample of patients with CLBP (N = 116), in which self-discrepancies, disability, quality of life, and objectively registered characteristics of activity-related behaviour were measured, was performed to evaluate the pathways in the aforementioned self-discrepancy model. Results indicate that patients with CLBP who feel closer to their ideal-other show more characteristics of persistence behaviour. Patients who move further away from their ideal-own also show more characteristics of persistence behaviour. Furthermore, in patients characterized as avoider, a decrease in a patient’s daily uptime was associated with a decrease of mental health-related quality of life.

Activity Patterns in Chronic Pain: Underlying Dimensions and Associations With Disability and Depressed Mood

Activity patterns are believed to play an important role in the development and perpetuation of chronic pain. So far, 3 important activity patterns have been studied: avoidance behavior, persistence behavior, and pacing behavior. Yet, empirical evidence is limited and inconclusive about the relationships between these activity patterns and important outcomes. Therefore, the present study was aimed at identifying activity patterns by means of factor analyses and determining their relationship with disability and depressive symptomatology in participants with chronic pain (N = 132). Items across different measurement instruments pertaining to 1 particular activity pattern were aggregated, and submitted to factor analysis. Results from 3 separate factor analyses revealed 6 distinct activity patterns: pain avoidance, activity avoidance, task-contingent persistence, excessive persistence, pain-contingent persistence, and pacing. In line with our hypotheses, pain and activity avoidance, and excessive persistence, were related to higher levels of disability and depressive symptomatology. In contrast to hypotheses, pacing was associated with worse outcomes as well. Interestingly, task-contingent persistence was related to lower levels of disability and depressive symptomatology. When controlling for pain and the other activity patterns, excessive persistence and activity avoidance were the most detrimental in terms of relations with depressed mood or disability. Task-contingent persistence appeared to be the least detrimental. Perspective Our findings suggest the existence of several activity patterns, which are differentially related to disability and depressive symptomatology, in participants with chronic pain. The present results are discussed in the light of previous findings, and may provide a new impetus for future studies on activity patterns in chronic pain research.

Design of a prospective comparative effectiveness research model for interventions used in chronic pain management

Chronic pain is a growing problem of immense proportions in terms of patient suffering and cost. The limited ability of available randomized controlled trials to provide an adequate evidence base for long term management of chronic pain demands the implementation new models for chronic pain research. Comparative effectiveness research (CER) measures outcomes of interventions under “real world” conditions in unselected clinical populations. We describe our approach to the design of a prospective CER study in chronic pain patients at 4 hospital based outpatient pain clinics in NYC (1 each at Weill Cornell Medical College and Hospital for Special Surgery and 2 at the Memorial Sloan-Kettering Cancer Center).

A Watershed Year for Interstitial Cystitis

A watershed is occurring in our understanding of interstitial cystitis (IC). Recent publications in The Journal of Urology® and others have added explanations of genetic1 and epigenetic2 influences, documented the time course of the appearance of comorbid disorders3 and shown again how much systemic involvement occurs in most patients.4 A disorder once described as “a hole in the air” may be yielding to investigators looking beyond the bladder to consider the whole individual. The most recent contributions to this expanded view of IC as a problem affecting the bladder rather than as a bladder problem include contributions to an expanded view of phenotyping of IC cases. A recent group concluded, “(Clinically relevant) domains that function outside of the bladder (psychosocial, neurological, tenderness) predict a significant impact on symptoms.”4 A new review added additional evidence for an overlap between urological and nonurological unexplained clinical conditions.5 The article by Ogawa et al (page 1206) in this issue of The Journal focuses on the ulcerative form of IC, which may be different from the nonulcerative form in its extent of systemic involvement. Although their gene expression studies are limited to urothelium, others have reported increased circulating chemokines in patients with IC.6 Concurrent events also are under way at the National Institute of Diabetes, Digestive and Kidney Diseases (NIDDK), which recently established the Multidisciplinary Approach to the Study of Chronic Pelvic Pain research network (http://www. mappnetwork.org). The network is charged to take a new look at urological chronic pelvic pain and is undertaking comprehensive phenotyping activities in patients with these syndromes. Another recently reported systemic biomarker may eventually assist in diagnosing IC in humans and animals.7 However, new knowledge cannot always be accepted and integrated easily. For example, revision of the nosology of the syndrome has been under way for some time. Although IC no longer captures the extent of the problem, if it ever did, it is less clear what the most appropriate name may be. A number of suggestions have been offered, including painful bladder syndrome, bladder pain syndrome and bladder hypersensitivity syndrome. They remain focused on the end organ, still reflecting the perspective of the specialty rather than current understanding of the syndrome. Feinstein recently concluded, “An important principle in naming apparently new ailments is to avoid etiologic titles until the etiologic agent has been suitably demonstrated. A premature causal name can impair a patient’s recovery from the syndrome and impede research that may find the true cause.”8 Regardless of the name eventually chosen, we have reached a time when the description of patients with IC (and these 2 letters may be name enough for the time being) in research and clinical presentations and publications may no longer be restricted to urinary symptoms. A research implication of this new view is the choice of appropriate animal models for studying IC. Acute bladder injury in otherwise healthy animals cannot adequately model the systemic aspects of IC. Fortunately various models in other disciplines are available that exploit the effects of early adverse experience on adult physiology and behavior.9 Although to my knowledge reports of the effects of these maneuvers on voiding function have not yet appeared, the results of evaluating other organs suggest that isolated abnormalities are unlikely. Collaboration with groups that have established these models could rapidly screen for influences on bladder function using relatively simple methods. What has also occurred recently is the retirement of a major driving force behind this renaissance of knowledge about IC, Dr. Lee Nyberg. Leroy M. Nyberg, M.D. and Ph.D., was Director of Urology Programs at NIDDK from 1989 until retirement in September 2009. His portfolio included directing basic and clinical research into IC, and he led NIDDK efforts to understand its etiopathogenesis. Doctor Nyberg was instrumental in developing research programs, mentoring and collaborating with investigators, and speaking at conferences around the world about IC. As an indicator of his influence, there were 317 IC citations in PubMed® from 1929 to the end of 1989 and from 1989 to the end of 2009 a total of 1,678 were added (53 vs 839 per decade), a 16-fold increase. Because of his efforts and those of many others, new leaders in IC research and treatment will emerge. They and their patients have Doctor Nyberg’s determination and persistence to thank for getting us to this new place in the evolution of our understanding of IC.

Preliminary Psychometric Properties of the Chinese Version of the Chronic Pain Coping Inventory (ChCPCI) in a Hong Kong Chinese Population

The Chronic Pain Coping Inventory (CPCI) is a frequently used measure that assesses 8 categories of coping strategies that patients might use to cope with chronic pain. Despite its good psychometric properties and widespread use, the instrument has not been tested for its applicability and validity in non-Western populations, such as among Chinese. This study evaluated the reliability and validity of a Chinese translation of the 42-item CPCI (ChCPCI-42) in a sample of Chinese patients with chronic pain (n = 208). In addition to the ChCPCI-42, the patients were administered the Chronic Pain Grade (CPG) questionnaire, the Pain Catastrophizing Scale (PCS), the Centre for Epidemiological Studies-Depression Scale (CES-D), and questions assessing sociodemographic characteristics. Results of confirmatory factor analyses revealed that of the ChCPCI-42 8 scales, 6 demonstrated acceptable-to-good data-model fit (CFI >or= 0.90) and 2 demonstrated medium fit (CFI >or= 0.85). The 8 scales demonstrated adequate to good internal consistency (Cronbach alpha, 0.69 to 0.79) and correlated with CES-D, PCS, pain intensity, and disability in expected directions. Results of hierarchical multiple regression analyses showed that the ChCPCI-42 scales predicted concurrent depression (F (8,177) = 3.07, P < .01) and pain disability (F (1, 179) = 4.35, P < .001) scores, the Task Persistence scale being the strongest unique predictor among the 8 scales. The findings support the factorial validity and reliability of a 42-item CPCI that can be used among Chinese patients with chronic pain. The report outlines the first validation of the CPCI for use in Hong Kong Chinese. This makes available a suitable instrument for chronic pain research in the Southern Chinese population and will help to elucidate similarities and differences in pain coping between Chinese and other ethnic groups.

Painful Myofascial Trigger Points and Pain Sites in Men With Chronic Prostatitis/Chronic Pelvic Pain Syndrome

A combination of manual physiotherapy and specific relaxation training effectively treats patients with chronic prostatitis/chronic pelvic pain syndrome. However, little information exists on myofascial trigger points and specific chronic pelvic pain symptoms. We documented relationships between trigger point sites and pain symptoms in men with chronic prostatitis/chronic pelvic pain syndrome. We randomly selected a cohort of 72 men who underwent treatment with physiotherapy and relaxation training from 2005 to 2008. Patients self-reported up to 7 pelvic pain sites before treatment and whether palpation of internal and external muscle trigger points reproduced the pain. Fisher's exact test was used to compare palpation responses, ie referral pain, stratified by reported pain site. Pain sensation at each anatomical site was reproduced by palpating at least 2 of 10 designated trigger points. Furthermore, 5 of 7 painful sites could be reproduced at least 50% of the time (p <0.05). The most prevalent pain sites were the penis in 90.3% of men, the perineum in 77.8% and the rectum in 70.8%. Puborectalis/pubococcygeus and rectus abdominis trigger points reproduced penile pain more than 75% of the time (p <0.01). External oblique muscle palpation elicited suprapubic, testicular and groin pain in at least 80% of the patients at the respective pain sites (p <0.01). This report shows relationships between myofascial trigger points and reported painful sites in men with chronic prostatitis/chronic pelvic pain syndrome. Identifying the site of clusters of trigger points inside and outside the pelvic floor may assist in understanding the role of muscles in this disorder and provide focused therapeutic approaches.

Functional Pain Syndromes: Presentation and Pathophysiology

In their foreword to this book, the editors describe the pathophysiology of ‘‘functional’’ pain syndromes as remaining poorly understood. They have undertaken the overwhelming task of clarifying the possible pathophysiology of diverse pain syndromes that have remained a mystery over the decades. Their focus is on the ever elusive functional pain syndromes or disorders that have no identifiable physiologic cause, such as irritable bowel syndrome, vulvodynia, fibromyalgia, interstitial cystitis, and temporomandibular joint disorder. The mechanistic pathways of these syndromes remain nebulous and often result in patients being mismanaged and misdiagnosed. The book is a collaboration of an international panel of expert scientists, researchers, and clinicians in pain management. The experts describe the essential features of common functional syndromes and attempt to bridge the gap in understanding between the basic science and the clinical management of each disorder. The first three sections of this seven part text focus on the somatic, visceral, and common comorbid syndromes, respectively. The following two sections describe neurobiological and genetic mechanisms as possible contributors to chronic pain syndromes, while the final chapters deal with treatment strategies. The initial seven chapters present a general overview and description of the possible pathophysiology of various somatic and visceral pain syndromes. The genetic, behavioural, and comorbid conditions are described for each disorder. The information is described clearly and referenced appropriately. In the chapters following, the roles in functional pain syndromes assumed by psychiatric factors, immunity, and the autonomic nervous system are astutely described. Illustrations, tables, and graphs are suitably integrated into the text. The remaining chapters, which I found most useful, include evidence-based discussions on pharmacologic and non-pharmacologic treatment strategies. Overall, this text provides current and in-depth information on functional chronic pain syndromes. I would recommend it as a reference text for any fellow or physician specializing in chronic pain management and research.

Understanding fibromyalgia: lessons from the broader pain research community.

Fibromyalgia (FM) is a chronic pain condition marked by centrally mediated augmentation of pain and sensory processes. Skepticism has marked the history of this condition, but more recent study has identified neurobiological underpinnings supporting many of the symptoms associated with this condition. Early research in FM had unprecedented latitude within the rheumatology community to borrow heavily from theory and methods being applied in chronic pain research more generally. These insights facilitated rapid advances in FM research, not the least of which was the abandonment of a peripheral focus in favor of studying central mechanisms associated with central augmentation. Currently, rapid-paced discovery is taking place in FM genetics, patient assessment, new therapeutic targets, and novel methods of treatment delivery. Such insights are not likely to be limited in application just to FM and could have relevance to the broader field of pain research as well. This manuscript reviews the history of FM and its diagnosis, evidence supporting central augmentation of pain in FM, potential mechanisms of central augmentation, current approaches to integrated care of FM, and areas of active collaboration between FM research and other chronic pain conditions.

Pain related variables associated with perceived spouse responses to patient pain and well behavior

Chronic pain researchers have recognized associations between spouse responses to patient pain behavior and pain related variables, but this study was one of this first to examine associations between spouse responses to patient well behavior and patient pain related variables. This study also tested associations between spouse responses to patient pain behavior and patient pain related variables. Another aim was to examine the role of pain catastrophizing, a negative mental set about pain, in these associations.