Female Chronic Pain Patients Research Articles

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.

A Critical Quantitative Approach to Intersectionality: Interrogating Race and Class in the Context of Female Chronic Pain

ABSTRACT Addressing calls to advance critical quantitative approaches to intersectionality, this study used multivariate analysis of variance (MANOVA) to examine how female chronic pain patients’ (N = 350) interactions with their healthcare providers are, in addition to gender, shaped along axes of race and socioeconomic status. Guided by intersectionality and the theory of communicative (dis)enfranchisement (TCD), this study illustrates how quantitative methods can be used to examine how identities intersect with one another and systems of power to produce complex communication processes and outcomes, which might further exacerbate existing disparities. This study offers theoretical, methodological, and practical implications for communication scholars seeking to conduct empirical, quantitative intersectional scholarship.

Quantitative Assessment of Subjective Symptoms and Corneal Sensitivity in Chronic Orbital Pain Patients.

To objectively evaluate the subjective symptoms and characteristics of chronic orbital pain as well as to quantify sensitization of peripheral trigeminal nerves. In this prospective cohort study, patients who previously showed a response to peripheral trigeminal nerve blocks for unilateral, idiopathic chronic orbital pain and healthy subjects completed validated questionnaires assessing headaches, neuropathic signs and symptoms, photophobia, and pain qualities. Corneal sensitivity was measured in both eyes for all subjects with a Cochet-Bonnet aesthesiometer. For pain patients, the full assessment protocol was repeated 2-4 weeks after the study injection, and corneal sensitivity was also measured 30 minutes postinjection. Outcomes assessed were headache, neuropathic pain, and photophobia scores; pain qualities; and corneal sensitivity. Six female chronic orbital pain patients (mean age 48.2 years) and 11 female controls (mean age 47.5) were included. The mean headache, neuropathic pain, and photophobia questionnaire scores were significantly higher for pain patients than for controls (p < 0.001). On sensory testing, 5 pain patients (83.3%) endorsed allodynia, and all 6 (100%) had hyperalgesia in the ipsilateral frontal nerve dermatome. No controls had allodynia or hyperalgesia. Corneal sensitivity was similar between eyes in pain patients and between groups. Questionnaire scores and corneal sensitivity did not change significantly after the injection. Chronic orbital pain patients have a measurable reduction in quality of life due to headaches and photophobia. The supraorbital and supratrochlear nerves are sensitized, resulting in cutaneous hypersensitivity in the corresponding dermatome, but corneal nerves have normal sensitivity.

Changes in Muscle Morphology in Female Chronic Neck Pain Patients Using Magnetic Resonance Imaging.

Population-based cross-sectional study. The aim of this study was to gain a better understanding of changes in muscle morphology in patients with chronic idiopathic neck pain (CINP) and chronic whiplash-associated disorder (CWAD). Worldwide, neck pain (NP) is a common health problem with high socioeconomic burden. A high percentage of these patients evolves toward chronic symptoms. Efficacy of treatments for these complaints remains variable. In current literature, changes in muscle morphology (muscle fat infiltration and cross-sectional area) have been reported in patients with NP, both CWAD and CINP. However, no strong conclusions could be made. In this study, magnetic resonance imaging was used to obtain data on muscle morphology from 14 cervical flexor and extensor muscles in 117 female subjects with NP (CWAD = 37; CINP = 45) and healthy controls (HC = 35). The CWAD group had a significantly larger muscle fat infiltration in some extensor (semispinalis and splenius capitis, trapezius, obliquus capitis inferior) and flexor (sternocleidomastoid) muscles compared to the CINP and/or HC group. A significantly larger (muscle) cross-sectional area was found in some extensor (levator scapulae, semispinalis capitis, trapezius) and flexor (longus colli, longus capitis, sternocleidomastoid) muscles in the HC group compared to the CINP and/or CWAD group. No clear associations were found between group differences and factors as pain duration, kinesiophobia, and disability. The results in this study suggest changes in muscle morphology in both NP cohorts. These results show some similarities with earlier findings in this research domain. Further studies based on controlled longitudinal designs are needed to facilitate data compilation, to draw stronger conclusions, and to integrate them into the treatment of patients with chronic NP.Level of Evidence: 4.

Psychological Profiles of Patients in a Multidisciplinary Chronic Pain Management Program in Central Taiwan

Many studies have suggested that multidisciplinary care is an effective pain management method; however, this care mode is still not commonly seen in Taiwan. The current study focused on patients within the first multidisciplinary pain management program in Taiwan. The first aim of this study was to investigate the effectiveness of the first multidisciplinary pain management program in Taiwan in terms of improving chronic pain patients' mood, sleep quality, and pain. The second aim was to determine whether improvement in mood or sleep quality was predictive of improvement in pain, and vice versa. Patients from a pain clinic were invited to join a multidisciplinary pain management program. They were assessed each month for improvement in mood, pain, and sleep quality. This study reviewed the medical records of these patients. Twenty male and thirteen female chronic non-malignant pain patients aged between 23 and 64 from a pain clinic. During the first visit, a clinical psychologist assessed the mental health of patients before patients undertook education delivered by nine other professionals in the program. Participants' mood, pain, and sleep quality were assessed monthly. The study used repeated measures analysis of variance to identify changes in patients' mood, pain, and sleep quality after three months of multidisciplinary care. We used linear regression to assess whether changes in mood or sleep quality could predict improvement in pain, and vice versa. The level of anxiety decreased, and sleep quality improved significantly, over the duration of care. The severities of depression and sleep disturbance decreased as the least pain experienced in the past week showed improvement. Improvement in sleep quality was predictive of improvement in least pain. The multidisciplinary pain management program was effective in improving patients' anxiety and sleep quality. Decreased pain brought about improvement in mood. We also found a reciprocal association between improvements in the least pain experienced in the past week and sleep quality.

PC-FACS

PC-FACS

Pain and Depressive Symptoms: Exploring Cognitive Fusion and Self-Compassion in a Moderated Mediation Model

The association between chronic pain (CP) and depression is complex and influenced by several psychological processes. Cognitive fusion (i.e. being entangled with one´s internal experiences) and self-compassion (i.e. being touched by one´s suffering, with a motivation to alleviate it) have been hypothesized as relevant psychological processes in physical and mental health, but few studies have addressed them in CP, and none in a comprehensive model relating pain intensity and depressive symptoms. This study tests, in a moderated mediation model, the mediator role of cognitive fusion between pain intensity and depressive symptoms, and the moderator effect of self-compassion in this mediation. In a cross-sectional study, 231 female CP patients (Age: M = 48.51, SD = 10.89) responded online self-report measures. PROCESS, an SPSS macro for conducting path analysis modeling, was used to test the hypothesized model. The model explained 63% of depressive symptoms, and cognitive fusion mediates the association between pain intensity and depressive symptoms. Also, self-compassion moderates this mediation (regardless of self-compassion being low, moderate or high). Although pain intensity is a predictor of depressive symptoms, fusion with thinking in general mediates this association, this relationship is buffered when patients are able to respond to setbacks and perceived shortcomings with self-kindness and warmth. Clinical and theoretical implications are discussed.

Differential Effect of Patient Weight on Pain-Related Judgements About Male and Female Chronic Low Back Pain Patients

Compared with men, women report more pain and are at increased risk for having pain discounted or misattributed to psychological causes. Overweight individuals experience high rates of pain and may receive suboptimal care because of provider bias. Research suggests the social consequences of being overweight are worse for women than men, and that gender and weight uniquely and interactively affect pain experience and care. Healthy participants (n = 616) viewed 6 videos of back pain patients (1 female and 1 male of normal weight, overweight, and obese categories) performing a functional task. Participants provided judgements/ratings regarding patient pain (intensity, interference, exaggeration), potential sources of patient pain (medical, psychological), and treatment recommendations (opioids, psychological therapy, seek workplace accommodations). Results suggest that the pain of normal and overweight women and obese men was discounted (judged as less intense, less interfering, more exaggerated, and less attributable to medical factors) and judged as less in need of treatment (treated with less opioids and workplace accommodations). Across all weight categories, women's pain was attributed more to psychological factors and was more likely to receive recommendations for psychological therapy than men's pain. These findings highlight the differential effect of patient weight on pain-related judgements about women and men. PerspectiveThis article examines the relationships among patient weight, patient gender, and observers' pain appraisals and treatment recommendations. These findings highlight the differential effect of patient weight on pain-related judgements about women and men and indicate the need for research to determine how these judgements affect treatment decisions in clinical settings.

Sex-based differences in brain alterations across chronic pain conditions.

Common brain mechanisms are thought to play a significant role across a multitude of chronic pain syndromes. In addition, there is strong evidence for the existence of sex differences in the prevalence of chronic pain and in the neurobiology of pain. Thus, it is important to consider sex when developing general principals of pain neurobiology. The goal of the current Mini-Review is to evaluate what is known about sex-specific brain alterations across multiple chronic pain populations. A total of 15 sex difference and 143 single-sex articles were identified from among 412 chronic pain neuroimaging articles. Results from sex difference studies indicate more prominent primary sensorimotor structural and functional alterations in female chronic pain patients compared with male chronic pain patients: differences in the nature and degree of insula alterations, with greater insula reactivity in male patients; differences in the degree of anterior cingulate structural alterations; and differences in emotional-arousal reactivity. Qualitative comparisons of male-specific and female-specific studies appear to be consistent with the results from sex difference studies. Given these differences, mixed-sex studies of chronic pain risk creating biased data or missing important information and single-sex studies have limited generalizability. The advent of large-scale neuroimaging databases will likely aid in building a more comprehensive understanding of sex differences and commonalities in brain mechanisms underlying chronic pain. © 2016 Wiley Periodicals, Inc.

Acupuncture–brain interactions as hypothesized by mood scale recordings

Mood expressions encompassing positive scales like “activity, elation, contemplation, calmness” and negative scales like “anger, excitement, depression, fatigue” were applied for introducing a new tool to assess the effects of acupuncture on brain structures. Traditional acupuncture points defined in the literature for their effects on task negative and task positive brain structures were applied to chronic disease patients supposed to have dominant negative mood scales. Burn-out syndrome (n=10) and female chronic pain patients (n=22) showed a significant improvement on positive mood scales and a decline in negative mood scales after 10 acupuncture sessions. We observed a direct effect of acupuncture on brain structures in 5 burn-out syndrome patients showing an immediate, fast suppression of unusual slow high amplitude EEG waves in response to acupuncture needle rotation. These EEG waves described here for the first time in awake patients disappeared after 10 sessions but gradually returned after 1–1.5years without acupuncture. This was accompanied with deterioration of positive mood scales and a return to negative mood scales. Both male (n=16) and female chronic pain patients reported a significant decrease of pain intensity after 10 sessions. Female patients only, however, showed a linear correlation between initial pain intensity and pain relief as well as a linear correlation between changes in pain intensity and mood scales accompanied by a drop of their heart rate during the acupuncture sessions. We hypothesized that mood scale recordings are a sensitive and specific new tool to reveal individual acupuncture–brain interaction.

Exploration of Affirmation of Childhood Molestation (Sexual Abuse) in Chronic Pain Patients, Acute Pain Patients, Community Patients With Pain and Community Nonpatients Without Pain

To further explore the controversy as to whether childhood molestation is associated with chronic pain in adulthood. Community nonpatients without pain (CNPWP), community patients with pain (CPWP), acute pain patients (APPs), and chronic pain patients (CPPs) were compared for endorsement of affirmation of childhood molestation by chi-square. Logistic regression was utilized to predict affirmation in male and female CPPs. A significantly higher percentage of male APPs affirmed molestation versus CNPWP and CPWP. No other comparisons were statistically significant for males. For females, no comparisons were significant. For male CPPs, the behavior health inventory-2 (BHI-2) survivor of violence scale and 1 item from this scale predicted affirmation. The following BHI-2 scales and items predicted affirmation for female CPPs: muscular bracing and survivor of violence scales; the item "I have been a victim of many sexual attacks"; and the item "My father was kind and loving to me when I was growing up" (scored opposite direction). In female PWCP, the prevalence of childhood molestation is not greater than in a number of unique comparison groups. Unique predictors of childhood molestation are yet to be identified.

Relationship status and quality moderate daily pain-related changes in physical disability, affect, and cognitions in women with chronic pain

The objectives of this study were to examine whether (1) daily pain-related changes in physical functioning differed between happily partnered, unhappily partnered, and unpartnered female chronic pain patients, and (2) affect and pain cognitions mediated the partner status effect on pain-related changes in physical functioning. Two hundred fifty-one women with chronic pain due to osteoarthritis and/or fibromyalgia completed 30 daily electronic diaries assessing pain, affect, pain-related cognitions, and physical functioning. Patients living with a romantic partner also completed a modified version of the Locke-Wallace Marital Adjustment Scale to assess relationship satisfaction. Multilevel modeling revealed that patients in satisfying unions showed more adaptive daily pain-related changes in physical functioning, pain coping difficulty, and catastrophizing compared to those in unsatisfying unions and those who were unpartnered. Both partnered groups also showed more adaptive pain-related changes in positive affect compared to the unpartnered group. The impact of relationship status on pain-related changes in physical functioning was partly mediated by the pain cognitions catastrophizing and coping difficulty. These results indicate that happily partnered pain patients show less pain-related physical disability and more adaptive affective and cognitive responses to daily pain changes than do unhappily partnered and unpartnered patients. Living in a happy union may bolster the capacity of patients to sustain a sense of pain coping efficacy during pain episodes, which in turn, minimizes pain-related physical activity limitations.

Disability and Borderline Personality Disorder in Chronic Pain Patients

Few studies have examined the relationship between disability and borderline personality symptomatology, and, among those that have, findings have been inconsistent. In the present study, the relationship between medical disability and borderline personality symptomatology was examined in a sample of chronic pain patients. In a consecutive insured sample of male and female chronic pain patients (n=117), who were being initially evaluated by an outpatient pain specialist, the criterion of having "ever been on medical disability" and features of borderline personality disorder were examined using the borderline personality scale of the Personality Diagnostic Questionnaire-4. While 35% of participants acknowledged having ever been on medical disability, there was no statistically significant difference between those with a history versus those without a history of medical disability with regard to the prevalence of borderline personality symptomatology. Findings suggest that among chronic pain patients, there may be no meaningful relationship between having ever been on medical disability and borderline personality symptomatology.

(318) Using electronic diaries to monitor intervention compliance in chronic pain

The use of electronic diaries for monitoring symptoms has proven efficacious in a variety of medical populations. However, there is little evidence on the use of electronic diaries as a tool to enhance daily use of a behavioral intervention with chronic pain patients. The goal of this study was to assess whether use of an electronic diary was associated with symptom change and consistent use of a diaphragmatic breathing intervention over a two-week period. Participants were 20 female chronic pain patients (13 fibromyalgia, 7 masticatory myofascial pain).

Pain from psychosomatic point of view-interdisciplinary diagnostic and multifactorial approach in an outpatient clinic

Pain is a psychosomatic occurrence, primarily considering its neurobiological aspects. Chronic pain patients suffer from psychic comorbidities or even psychic diseases as somatoform disorders which often remain mis- and respectively underdiagnosed and consecutive untreated. Psychic comorbidities influence the pain in a neurobiological sense by lowering the pain threshold. Wrong treatments, somatic fixation, operations, chronification, iatrogenic impairment and psychosocial problems are possible consequences. It is fundamental to integrate the trias of pain, stress and affect into the diagnostics and treatments. The neurobiological stress axis, HPA- and LC-NE, is known to be activated by nociceptive- neuropathic input via cytokinins and influence pain. Chronic negative strain of the stress system may have neurobiological consequences as damage of the pain depressant systems, inter alia degeneration of hippocampus.An interdisciplinary approach is inevitable and broad clinical diagnostics of high importance. Therefore we established a broad network of interdisciplinary liaisons with rheumatology, internal medicine, orthopaedics and dentistry. In our outpatient clinic we analyzed female and male chronic pain patients from different medical departments. They all had a complex and long lasting history of pain.We applied clinical interviews and different test-parametric methods and figured out that undiscovered psychic comorbidities, wrong medication and specific biographic aspects in a biopsychosocial kind are inter alia the key factors of chronic pain suffering.Our data demonstrate that an interdisciplinary approach considering pain as multifactor genesis and integrating neurobiological, biographic and psychosocial components is necessary to treat chronic pain patients and prevent further chronification.

Sequentially allocated clinical trial of rhythmic stabilization exercises and TENS in women with chronic low back pain

Objective: To examine the effectiveness of rhythmic stabilization exercises and transcutaneous electrical nerve stimulation (TENS) and their combination in treating women with chronic low back pain. Design: Sequentially allocated, single-blinded and controlled study, with a two-month follow-up. Setting: The data were collected in a patient rehabilitation setting. Subjects: A total of 92 women (34—46 years old) with chronic low back pain were studied. Interventions: Sequential allocation was undertaken into four groups: `rhythmic stabilization' (n=23), `rhythmic stabilization — TENS' (n=23), TENS (n=23), and a placebo group (n = 23). Each programme lasted for four weeks. All outcome measures were assessed prior to, immediately after, four weeks and eight weeks post intervention. Main measures: Data were obtained on functional disability, pain intensity, trunk extension range of motion, dynamic endurance of trunk flexion and static endurance of trunk extension. Results: A total of 88 patients provided two-month follow-up data. The `rhythmic stabilization' and the `rhythmic stabilization — TENS' groups displayed statistically significant (P<0.05) improvements in functional disability and pain intensity (ranging from 21.2 to 42.8%), trunk extension range of motion (ranging from 6.5 to 25.5%), dynamic endurance of trunk flexion and static endurance of trunk extension (ranging from 13.5 to 74.3%) compared with the remaining groups. Conclusions: The rhythmic stabilization programmes resulted in more gains in women with chronic low back pain regarding the present outcome variables compared with the other groups; therefore, its application in female chronic low back pain patients aged 34—46 years is recommended.

Generalized and symptom‐specific sensitization of chronic itch and pain

Physicians are frequently confronted with patients reporting severe itch and pain. Particularly in patients suffering from persistent itch and pain, central and peripheral sensitization processes are assumed to be involved in the long-term maintenance and aggravation of the symptoms. The present study explores generalized and symptom-specific sensitization processes in patients suffering from persistent itch and pain. Specifically, it examines whether patients with chronic itch and pain are more sensitive to somatosensory stimuli (generalized sensitization) and simultaneously perceive somatosensory stimuli as a symptom of their main physical complaint, e.g. pain in chronic pain patients (symptom-specific sensitization). Thresholds for different mechanical and electrical sensory stimuli of Quantitative Sensory Testing were determined in 15 female patients suffering from chronic itch associated with atopic dermatitis, 15 female chronic pain patients diagnosed with fibromyalgia, and 19 female healthy controls. Intensities of itch and pain sensations were rated on a visual analogue scale. As expected, the patient groups had significantly lower tolerance thresholds for the somatosensory stimuli applied than the healthy controls, supporting generalized sensitization. Moreover, patients with chronic itch consistently reported more itch, while patients with chronic pain partly reported more pain in response to analogous somatosensory stimuli than the healthy controls and the other patient group, indicating symptom-specific sensitization. The present study provides preliminary support that both generalized and symptom-specific sensitization processes play a role in the regulation and processing of somatosensory stimulation of patients with chronic itch and pain.

Cervical Electromyogram Profile Differences Between Patients of Neck Pain and Control

A comparative analysis of electromyogram (EMG) signals of patients of cervical pain and normal controls. To determine the differences between frequency and time domain parameters of EMG signals of patients of cervical pain and normal controls. No diagnostic technique has emerged as a satisfactory tool for identification of spinal pain. Seventeen male and 17 female chronic neck pain patients without cervical radiculopathy were recruited through neurology EMG clinic. The controls consisted of 30 male and 33 female subjects with no history of neck pain in the past 12 months. All subjects performed flexion, left anterolateral flexion, left lateral flexion, left posterolateral extension, and extension to pain threshold/20% maximum voluntary contraction and pain tolerance/maximum voluntary contraction in random order. The descriptive statistics for body weight normalized strength, normalized peak EMG, time to onset, time to peak, median frequency, mean power frequency, and frequency bands were calculated. These variables were subjected to analysis of variance and logistic regression to distinguish between patients and controls. The normalized peak EMG of patients was significantly greater than those of controls in both maximal and submaximal exertions (P < 0.01). Whereas there was no consistent pattern in time to peak EMG, the time to onset of EMG revealed that the left sternocleidomastoid was always recruited before the onset of torque. A lack of significant difference in the median frequency of the 2 samples indicates that the pain did not disturb the muscle conduction velocity. Using discriminant logistic regression on frequency domain and time domain parameters, up to 97% of patients and controls were correctly classified with the resubstitution method. Surface EMG can be used successfully in distinguishing chronic pain patients and controls, and efficacy of treatment regimes.

Alexithymia and anxiety in female chronic pain patients

ObjectivesAlexithymia is highly prevalent among chronic pain patients. Pain is a remarkable cause for high levels of chronic anxiety. The purpose of this study was to investigate the prevalence of alexithymia and to determine anxiety levels among DSM-IV somatoform pain disorder (chronic pain) female patients and to examine the relationship between alexithymia and the self-reporting of pain.MethodsThirty adult females (mean age: 34,63 ± 10,62 years), who applied to the outpatient psychiatry clinic at a public hospital with the diagnosis of chronic pain disorder (DSM-IV), were included in the study. Thirty seven healthy females (mean age: 34,46 ± 7,43 years), who matched for sociodemographic features with the patient group, consisted the control group. A sociodemographic data form, 26-item Toronto Alexithymia Scale (TAS-26), Spielberger Trait Anxiety Inventory (STAI) were administered to each subject and information was obtained on several aspects of the patients' pain, including intensity (measured by VAS), and duration.ResultsChronic pain patients were found significantly more alexithymic than controls. There was a positive correlation between TAS-26 scores and the duration of pain. The alexithymic and nonalexithymic group did not differ in their perception of pain. Neither positive correlation nor significant difference was found between alexithymia and trait anxiety in pain patients.DiscussionAlexithymia may be important in addressing the diversity of subjective factors involved in pain. The conceptualization of alexithymia as a personality trait as well as a secondary state reaction is underlined by our data.

Sleep disturbance in female chronic pain patients

Abstract Aim: Chronic pain patients frequently complain of sleep problems. The purpose of this study is to search for the complaint of insomnia among chronic pain patients and, if present, to compare the sleep items within two different scales: one, observer-rated, and the other self-rated. Method: The study was based on outpatients of a psychiatry clinic in a general hospital. The sample comprised 90 female patients, attending for the complaint of chronic pain. All patients were given a sociodemographic form to complete. Information was obtained on several aspects of the patients' pain, including site, severity, quality and duration. All patients were also questioned regarding their sleeping habits, such as, initial or late sleep disturbance, morning fatigue, daytime naps, total sleep in a 24 h period, and disturbance in different areas of functioning. The 21-item Beck Depression Inventory (BDI) and the Hamilton Rating Scale for Depression (HRSD) were used to assess the severity of the patients' insomnia...