Injury-related Pain Research Articles

Impact of the interaction between self-efficacy, symptoms and catastrophising on disability, quality of life and health in with chronic pain patients

Purpose. To investigate the interactions between self-efficacy – including subcomponents – and symptoms (pain, depression and anxiety), catastrophising, disability, quality of life and health in a population of patients with chronic pain.Method. The study used 433 patients with chronic pain including 47 patients with spinal cord injury-related pain, 150 patients with chronic whiplash-associated disorders and 236 patients with fibromyalgia. The participants answered a postal questionnaire that provided background data, pain intensity and duration and psychological- and health-related variables.Results. In the multivariate context, depression, anxiety, catastrophising and disability were intercorrelated. Self-efficacy correlated positively with variables of quality of life and general health. These two groups of variables were negatively correlated. The pain variables – duration of pain, pain intensity and spreading of pain – formed a third group of variables. Self-efficacy function was negatively correlated to these three pain variables. When regressing disability, quality of life and health, we found that self-efficacy had a positive impact whereas symptoms, catastrophising and pain had a negative influence on these aspects. Different patterns of influencing variables were discerned for the three different analyses, and specific patterns of the subscales of self-efficacy corresponded to specific patterns of negative factors for the outcome of disability, quality of life and health.Conclusion. There is a complex interaction of psychological factors and symptoms and their positive and negative influence on disability, quality of life and health. The results indicate that it might be important to assess and influence both enhancing and detoriating factors to ensure an effective pain management programme.

988 IMPACT OF THE INTERACTION BETWEEN SELFEFFICACY, SYMPTOMS, AND CATASTROPHIZING ON DISABILITY, QUALITY OF LIFE, AND HEALTH IN CHRONIC PAIN PATIENTS

Purpose. To investigate the interactions between self-efficacy – including subcomponents – and symptoms (pain, depression and anxiety), catastrophising, disability, quality of life and health in a population of patients with chronic pain. Method. The study used 433 patients with chronic pain including 47 patients with spinal cord injury-related pain, 150 patients with chronic whiplash-associated disorders and 236 patients with fibromyalgia. The participants answered a postal questionnaire that provided background data, pain intensity and duration and psychological- and health-related variables. Results. In the multivariate context, depression, anxiety, catastrophising and disability were intercorrelated. Self-efficacy correlated positively with variables of quality of life and general health. These two groups of variables were negatively correlated. The pain variables – duration of pain, pain intensity and spreading of pain – formed a third group of variables. Self-efficacy function was negatively correlated to these three pain variables. When regressing disability, quality of life and health, we found that self-efficacy had a positive impact whereas symptoms, catastrophising and pain had a negative influence on these aspects. Different patterns of influencing variables were discerned for the three different analyses, and specific patterns of the subscales of self-efficacy corresponded to specific patterns of negative factors for the outcome of disability, quality of life and health. Conclusion. There is a complex interaction of psychological factors and symptoms and their positive and negative influence on disability, quality of life and health. The results indicate that it might be important to assess and influence both enhancing and detoriating factors to ensure an effective pain management programme.

Abnormal gait, due to inflammation but not nerve injury, reflects enhanced nociception in preclinical pain models

Validation of gait analysis has the potential to bridge the gap between data from animal pain models and clinical observations. The goal of these studies was to compare alterations in gait due to inflammation or nerve injury to traditional pain measurements in animals. Pharmacological experiments determined whether gait alterations were related to enhanced nociception, edema, or motor nerve dysfunction. Gait was analyzed using an automated system (DigiGait) after injection of an inflammatory agent (carrageenan; CARR or FCA; Freund's complete adjuvant) or nerve injury (axotomy; AXO, partial sciatic nerve ligation; PSNL, spinal nerve ligation; SNL or chronic constriction injury; CCI). All models caused significant alterations in gait and thermal (inflammatory) or mechanical (nerve injury) hyperalgesia. Both indomethacin and morphine were able to block or reverse thermal hyperalgesia and normalize gait in the CARR model. Indomethacin partially blocked and did not reverse paw edema, suggesting that gait alterations must be primarily driven by enhanced nociception. In nerve injury models, AXO, PSNL, CCI, and SNL caused changes to the largest number of gait indices with the rank order being AXO > PSNL = CCI > > SNL. Gabapentin and duloxetine reversed mechanical hyperalgesia but did not normalize gait in any nerve injury model. Collectively, these data suggest that pain is the primary driver of abnormal gait in models of inflammatory but not nerve injury-related pain and suggests that, in the latter, disruption in gait is due to perturbation to the motor system. Gait may therefore constitute an alternative and potentially clinically relevant measure of pain due to inflammation.

The complex interplay between pain intensity, depression, anxiety and catastrophising with respect to quality of life and disability

Purpose. To identify subgroups of patients with chronic pain based on the occurrence of depression, anxiety and catastrophising and the duration of pain and pain intensity. In addition to this, the relationship between the subgroups with respect to background variables, diagnosis, pain-related disability and perceived quality of life are investigated.Methods. This study used 433 patients with chronic pain including 47 patients with spinal cord injury-related pain, 150 with chronic whiplash associated disorders and 236 with fibromyalgia. The participants answered a postal questionnaire that provided background data, pain intensity and duration and psychological and health-related items.Results. On the basis of depression, anxiety, catastrophising, pain intensity and duration, we identified subgroups of patients with chronic pain that differed with respect to perceived quality of life, disability and diagnosis. The psychological factors, especially depression, significantly influenced perceived quality of life and disability. Pain intensity and duration play a minor role with respect to quality of life, although pain intensity is associated to perceived disability.Conclusions. The results of this study highlight the importance of not looking at patients with chronic pain as a homogenous entity. A detailed assessment, including psychological factors with emphasis on depressive symptoms, might be essential for planning and carrying through treatment and rehabilitation.

Post-traumatic stress, depression, and anxiety in patients with injury-related chronic pain: A pilot study

To investigate, in patients with injury-related chronic pain, pain intensity, levels of post-traumatic stress, anxiety and depressions. One hundred and sixty patients aged 17-62 years, admitted for assessment to the Pain Rehabilitation Clinic at the Umeå University Hospital, Umeå Sweden, for chronic pain caused by an injury, answered a set of questionnaires to assess post-traumatic stress (Impact of Event Scale [IES]), pain intensity (VAS), depression, and anxiety (Hospital Anxiety and Depression Scale [HAD]). Moderate to severe post-traumatic stress was reported by 48.1% of the patients. Possible-probable anxiety on the HAD was scored by 44.5% and possible-probable depression by 45.2%. Pain intensity (VAS) was significantly correlated to post-traumatic stress (r = 0.183, p = 0.022), the HAD-scores anxiety (r = 0.186, p = 0.0021), and depression (r = 0.252, p = 0.002). No statistically significant differences were found between genders for post-traumatic stress, pain intensity, anxiety, or depression. Participants with moderate to severe stress reaction reported statistically significant higher anxiety scores on the HAD (p = 0.030) in comparison with patients with mild stress. The findings of relationships between pain intensity, post-traumatic stress, depression, and anxiety may have implications for clinicians and underline the importance of considering all these factors when managing patients with injury-related chronic pain.

Spinal cord injury-related pain in rehabilitation: A cross-sectional study of relationships with cognitions, mood and physical function

Although psychological aspects of SCI-related pain have been investigated in those with chronic pain, little data is available regarding these factors in those early in the course of the injury. Using a sample admitted for SCI rehabilitation, this paper describes the relationships between usual pain intensity, mood, disability and both pain and SCI-related psychological factors. The sample were largely similar to other samples of individuals with SCI-related chronic pain in terms of mood, but were noted to be less catastrophic in their thinking about pain than a comparative pain clinic sample. They also reported SCI self-efficacy and acceptance scores consistent with other SCI samples. Compared with other SCI populations there were mixed findings in relation to physical disability. Consistent with previous findings in chronic pain SCI samples, usual pain intensity was found to have a strong relationship with symptoms of anxiety and depression, and pain-related life interference. SCI acceptance was significantly negatively associated with depression scores, pain catastrophizing was significantly positively associated with both anxiety and depression scores, and SCI self-efficacy was significantly negatively associated with both anxiety and depression scores. SCI self-efficacy was also significantly positively associated with physical function scores. These findings suggest that pain-related psychological factors may have importance even early in the clinical course following SCI, but that it is important, however, to consider more general SCI-related psychological factors alongside them. In addition, these findings suggest the possibility that early interventions based upon the cognitive behavioural treatment of pain may be integrated into SCI rehabilitation programmes.

Prevalence of Pain in Patients 1 Year After Major Trauma

To describe the prevalence of pain in a large cohort of trauma patients 1 year after injury and to examine personal, injury, and treatment factors that predict the presence of chronic pain in these patients. Sixty-nine hospitals in 14 states in the United States. There were 3047 patients (10 371 weighted) aged 18 to 84 years who were admitted to the hospital because of acute trauma and survived to 12 months after injury. Pain 12 months after injury measured with the Chronic Pain Grade Scale. At 12 months after injury, 62.7% of patients reported injury-related pain. Most patients had pain in more than 1 body region, and the mean (SD) severity of pain in the last month was 5.5 (4.8) on a 10-point scale. The reported presence of pain varied with age and was more common in women and those who had untreated depression before injury. Pain at 3 months was predictive of both the presence and higher severity of pain at 12 months. Lower pain severity was reported by patients with a college education and those with no previous functional limitations. Most trauma patients have moderately severe pain from their injuries 1 year later. Earlier and more intensive interventions to treat pain in trauma patients may be needed.

Effectiveness of Oxycodone, Ibuprofen, or the Combination in the Initial Management of Orthopedic Injury-Related Pain in Children

Orthopedic injuries comprise a majority of the indications for analgesia in the emergency department. Oxycodone and ibuprofen have demonstrated efficacy for this indication, but no studies have compared these drugs in children. Our objective was to investigate the effectiveness of oxycodone, ibuprofen, or their combination for the management of orthopedic injury-related pain in children. This prospective, randomized, double-blinded, clinical trial compared the effectiveness of oxycodone, ibuprofen, and the combination in children (age, 6-18 years), with pain from a suspected orthopedic injury. Subjects were block-randomized to receive 1 of the 3 treatment regimens. Pain was assessed with the Faces Pain Scale (FPS) and Visual Analog Scale at baseline, postimmobilization, 30, 60, 90, and 120 minutes postmedication. The change in the FPS score over time was compared between the 3 treatment groups using a generalized estimating equation model. Although all 3 treatment groups demonstrated a decrease in the FPS score over time, there were no significant differences between the groups. Among the 66 total children enrolled in the 3 treatment groups, there were no statistically significant differences in demographics or injury characteristics. There were 28 subjects with fractures. Immobilization of the injury demonstrated a significant reduction in the FPS score. Subjects in the combination treatment group reported more adverse effects. Oxycodone, ibuprofen, and the combination all provide effective analgesia for mild-to-moderate orthopedic injuries in children. Oxycodone or ibuprofen, alone, can be given, thereby avoiding the increase in adverse effects when given together.

Reduced or painful jaw movement after collision-related injuries: A population-based study

The authors report the incidence of and factors associated with reduced and/or painful jaw movement after motor vehicle collisions that resulted in whiplash-associated disorders (WADs). All adults filing collision-related personal injury claims during an 18-month period in Saskatchewan, Canada, were evaluated via questionnaire to determine demographic characteristics, precollision health (including jaw pain), collision parameters and collision-related symptoms, including reduced and/or painful jaw movement and injury-related neck pain. The authors excluded patients who were hospitalized for more than two days and those who sustained injuries as a pedestrian, bicyclist or motorcyclist. In determining incidence rates, the authors also excluded those who had had jaw pain before the collision. The incidence of reduced and/or painful jaw movement was 14.9 percent (n = 1,158), and it was higher in subjects with WADs (15.8 percent) than in those without WADs (4.7 percent; relative risk = 3.36, 95 percent confidence interval, 2.36 to 4.78). Within the WAD injuries, multivariable logistic regression revealed that the onset of reduced and/or painful jaw movement was associated with female sex; age < 50 years; having hit one's head in the collision; and postinjury symptoms of difficulty swallowing, ringing in the ears, dizziness or unsteadiness, and more intense neck pain. Collision parameters, such as head position at the time of the crash and headrest use and type, were not associated with onset of jaw symptoms. Reduced or painful jaw movement was more common in people with WADs than in those with other collision-related injuries. Among those with WADs, reduced or painful jaw movement was more common in women and younger people. Reduced or painful jaw movement is an important aspect of WADs, and more studies are needed to determine how to best assess and treat this problem.

PI-44Correlation of CYP2D6 genotype with response to oxycodone in orthopedic injury related pain

BACKGROUND Inter-individual variability in response and adverse effects to oxycodone in pediatric patients may be due to CYP2D6 enzyme genetic variation. Intermediate or poor metabolizer (IM, PM) genotypes have impaired oxymorphone formation and may have altered response to oxycodone. This study assessed clinical response and presence of adverse events of oxycodone treatment as a function of CYP2D6 genotype. METHODS Randomized double blind prospective clinical trial in a tertiary care emergency department. 66 children (6–18 y) with orthopedic injuries were randomized to single dose oxycodone (0.1, 0.15 or 0.2 mg/kg). DNA was obtained via buccal swab and CYP2D6 genotype determined. Pain was assessed by Faces Pain Scale (FPS) at baseline, and 20, 40 and 60 minutes post-dose. RESULTS Dose groups were comparable for demographics and baseline FPS scores. Each group had effective analgesia as evidenced by significant reduction of FPS scores from baseline (p < 0.001). No FPS score differences were demonstrated between dose groups at any time point. No significant adverse events occurred. One patient was a PM (mean FPS = 5.5). IM (n=15, FPS = 3.4 ± 2.6) reported lower FPS scores than extensive metabolizers (EM) reported (n=36, FPS = 4.7 ± 3.0). A GEE model accounted for repeated measures, and found the difference between EM and IM was non-significant (model coefficient 0.88 (-0.20, 1.97), p = 0.11). CONCLUSION Findings suggest clinical response to oxycodone varies with CYP2D6 genotype but further study is indicated. Clinical Pharmacology & Therapeutics (2005) 79, P18–P18; doi: 10.1016/j.clpt.2005.12.065

Hyperpolarization-Activated, Cation-Nonselective, Cyclic Nucleotide-Modulated Channel Blockade Alleviates Mechanical Allodynia and Suppresses Ectopic Discharge in Spinal Nerve Ligated Rats

Abnormal spontaneous firing is well described in axotomized sensory neurons and likely contributes to nerve injury-induced pain. The hyperpolarization-activated current I h initiates spontaneous, rhythmic depolarization in the sinoatrial node and central neurons. This study was undertaken to investigate the possible contribution of I h to primary afferent ectopic discharge and pain behavior in nerve-injured rats. Nerve injury was produced by tight ligation of lumbar spinal nerves (L5/6). Two weeks later, rats showed marked mechanical allodynia. Withdrawal thresholds were measured before and after administration of saline or the specific I h antagonist ZD7288 (1, 3, or 10 mg/kg, intraperitoneally). ZD7288 dose-dependently reversed mechanical allodynia. In a second experiment, we performed both in vivo and in vitro extracellular single unit recordings from teased dorsal root fascicles. Intravenous infusion (2.5 or 5 mg/kg) of ZD7288 during a period of 10 minutes significantly blocked ectopic discharges in vivo. Perfusion (25 to 100 μmol/L) of ZD7288 for 5 minutes in vitro almost completely blocked ectopic discharges from large myelinated fibers (Aβ) while partially suppressing ectopic discharge from thinly myelinated fibers (Aδ). We conclude from these data that in axotomized sensory neurons, a ZD7288-sensitive current contributes to spontaneous discharges in myelinated fibers. Thus, I h might substantially contribute to the pathophysiology of nerve injury-related neuropathic pain. Perspective The current study investigated the mechanism of abnormal spontaneous discharges (ectopic discharges) from axotomized sensory afferents. Ectopic discharges are a main driving source of nerve injury-induced neuropathic pain. Understanding the mechanism of ectopic discharges and identifying how to control them will be useful toward developing new therapies.

Patient characteristics and clinical management of patients with shoulder pain in U.S. primary care settings: Secondary data analysis of the National Ambulatory Medical Care Survey

BackgroundAlthough shoulder pain is a commonly encountered problem in primary care, there are few studies examining its presenting characteristics and clinical management in this setting.MethodsWe performed secondary data analysis of 692 office visits for shoulder pain collected through the National Ambulatory Medical Care Survey (Survey years 1993–2000). Information on demographic characteristics, history and place of injury, and clinical management (physician order of imaging, physiotherapy, and steroid intraarticular injection) were examined.ResultsShoulder pain was associated with an injury in one third (33.2% (230/692)) of office visits in this population of US primary care physicians. Males, and younger adults (age ≤ 52) more often associated their shoulder pain with previous injury, but there were no racial differences in injury status. Injury-related shoulder pain was related to work in over one-fifth (21.3% (43/202)) of visits.An x-ray was performed in 29.0% (164/566) of office visits, a finding that did not differ by gender, race, or by age status. Other imaging (CT scan, MRI, or ultrasound) was infrequently performed (6.5%, 37/566).Physiotherapy was ordered in 23.9% (135/566) of visits for shoulder pain. Younger adults and patients with a history of injury more often had physiotherapy ordered, but there was no significant difference in the ordering of physiotherapy by gender or race. Examination of the use of intraarticular injection was not possible with this data set.ConclusionThese data from the largest sample of patients with shoulder pain presenting to primary care settings offer insights into the presenting characteristics and clinical management of shoulder pain at the primary care level. The National Ambulatory Medical Care Survey is a useful resource for examining the clinical management of specific symptoms in U.S. primary care offices.

Myofascial pain disorders: theory to therapy.

Voluntary muscle is the largest human organ system. The musculotendinous contractual unit sustains posture against gravity and actuates movement against inertia. Muscular injury can occur when soft tissues are exposed to single or recurrent episodes of biomechanical overloading. Muscular pain is often attributed to a myofascial pain disorder, a condition originally described by Drs Janet Travell and David Simons. Among patients seeking treatment from a variety of medical specialists, myofascial pain has been reported to vary from 30% to 93% depending on the subspecialty practice and setting. Forty-four million Americans are estimated to have myofascial pain; however, controversy exists between medical specialists regarding the diagnostic criteria for myofascial pain disorders and their existence as a pathological entity. Muscles with activity or injury-related pain are usually abnormally shortened with increased tone and tension. In addition, myofascial pain disorders are characterised by the presence of tender, firm nodules called trigger points. Within each trigger point is a hyperirritable spot, the 'taut-band', which is composed of hypercontracted extrafusal muscle fibres. Palpation of this spot within the trigger point provokes radiating, aching-type pain into localised reference zones. Research suggests that myofascial pain and dysfunction with characteristic trigger points and taut-bands are a spinal reflex disorder caused by a reverberating circuit of sustained neural activity in a specific spinal cord segment. The treatment of myofascial pain disorders requires that symptomatic trigger points and muscles are identified as primary or ancillary pain generators. Mechanical, thermal and chemical treatments, which neurophysiologically or physically denervate the neural loop of the trigger point, can result in reduced pain and temporary resolution of muscular overcontraction. Most experts believe that appropriate treatment should be directed at the trigger point to restore normal muscle length and proper biomechanical orientation of myofascial elements, followed by treatment that includes strengthening and stretching of the affected muscle. Chronic myofascial pain is usually a product of both physical and psychosocial influences that complicate convalescence.

Animal models of neuropathic pain.

Despite its prevalence, nerve injury-related (neuropathic) pain in humans is not well understood and, as such, remains difficult to manage (, , ). A variety of clinical conditions can lead to neuropathic pain, which contributes to our lack of understanding of this phenomenon. Although there is substantial etiological heterogeneity among neuropathic pain conditions, commonalities exist. For example, most patients present with combinations of spontaneous and stimulus-evoked pain, the latter of which is characterized by a hypersensitivity to previously innocuous tactile or thermal stimuli (allodynia). To improve our understanding of neuropathic pain, the challenge for basic scientists has been twofold: 1) to develop animal models of persistent pain that more closely mimic clinical pain in humans; and 2) to ensure high reproducibility, within and between animals, across different investigators and laboratories.

Treatments for chronic pain associated with spinal cord injuries: many are tried, few are helpful.

The objective was to investigate, in two community samples of people with spinal cord injuries, the frequency of use of different pain treatments and the perceived helpfulness of these treatments. A postal survey was conducted in the community. The participants were 471 persons aged 18 years or older who had spinal cord injuries and pain. There were 2 separate samples (n = 308 and n = 163). The pain treatments used, the helpfulness of these treatments, and the Chronic Pain Grade questionnaire answers were assessed. Respondents reported multiple pain treatments (range of 0-14 and median of 4 in sample 1; range of 0-16 and median of 4 in sample 2). The most commonly reported treatments were oral medications and physical therapy. Medication types most commonly reported were nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, and opioids. The treatments rated as most helpful were opioid medications, physical therapy, and diazepam therapy, and those rated as least helpful were spinal cord stimulation, counseling or psychotherapy, administration of acetaminophen, and administration of amitriptyline. Alternative treatments reported as most helpful were massage therapy and use of marijuana. Acupuncture was tried by many but was rated as only moderately helpful. This survey of two large samples of community-dwelling individuals with spinal cord injury-related chronic pain indicates that multiple pain treatments are tried but only a few are rated as more than somewhat helpful. Furthermore, the treatments that are most commonly reported are not always those that are rated as most helpful. The findings point to a number of potentially fruitful directions for future research.

Psychological and Behavioral Issues in the Treatment of Pain After Spinal Cord Injury

Spinal cord injury-related pain is associated with several psychosocial problems, including increased levels of depression, anxiety, fatigue, anger, familial/social difficulties, and general psychosocial impairment. Treatment is often inadequate; significant numbers of patients perceive a need for additional treatment or are dissatisfied with the treatments received. The understanding of pain as a multidimensional problem that requires a biopsychosocial perspective may lead to more comprehensive and effective treatment. Psychological and behavioral considerations in treatment planning are presented. Additional research is needed, but there are indications that cognitive-behavioral therapy may be useful in the treatment of SCI-related pain, and patients are willing to use these techniques.

Changes in neuronal receptive field characteristics in caudal brain stem following chronic spinal cord injury.

Chronic spinal cord injury pain is poorly understood and, thus, not effectively relieved by traditional treatments. In the present study, a variety of partial, severe and sham chronic spinal lesions were made in 31 male rats at spinal level T8. During routine care/handling and brief behavioral testing of the animals throughout the 30-day recovery period, the majority of those with severe contusion injuries (verified histologically) showed signs of mechanical hypersensitivity on the dorsolateral trunk just rostral to the level of injury (i.e., upper thoracic territory). Terminal electrophysiological experiments were performed on all rats (urethane anesthesia). Single unit recordings were made at two supraspinal locations within the caudal brainstem, the nucleus reticularis gigantocellularis and nucleus reticularis gigantocellularis pars alpha. Neurons in these areas normally receive bilateral nociceptive somatovisceral inputs from many parts of the body. Seventy-three percent of the animals with severe contusion injuries developed novel low-threshold neuronal responses to stimulation of the dorsolateral trunk (upper thoracic territory). This amount was significantly greater than for animals with more moderate spinal lesions (dorsal or lateral hemisection; 29% and 25%, respectively) or sham controls (0%). These data suggest (1) that the spinal contusion is a reliable model for studies of the neural mechanisms that underly central spinal cord injury-related pain and (2) that the caudal brainstem is one supraspinal location where neurons undergo significant changes in responsiveness following severe chronic spinal cord injury. The observed plasticity is likely part of the central reorganization producing the multitude of sensory disturbances that surface following spinal cord injury.

A case of spinal cord injury-related pain with baseline rCBF brain SPECT imaging and beneficial response to gabapentin

Central pain following spinal cord injury is poorly understood, and is often resistant to conventional pain therapy regimens. We describe an individual with paraplegia who for many years experienced rapidly fluctuating, severe, unilateral pain below the level of his lesion. Prior to the initiation of pharmacological treatment, regional cerebral blood flow (rCBF) was measured during PAIN and NON-PAIN states using single photon emission computed tomography (SPECT). When experiencing pain, the subject had increased anterior cingulate gyrus blood flow, increased thalamic blood flow bilaterally and increased somatosensory cortex blood flow contralaterally but decreased caudate blood flow bilaterally. The subject's subsequent clinical course included a trial of gabapentin which produced a substantial reduction in frequency and average intensity of his episodic pain and which has been maintained for almost 2 years. This case demonstrates the correspondence between rCBF and pain associated with spinal cord injury and also suggests the potential utility of gabapentin for treatment of this central pain state.

Pain Education and Management in the Rehabilitation from Sports Injury

This article addresses the essential role that pain plays in the rehabilitation of sports injury. It will describe important information and approaches that applied sport psychologists can use to more effectively manage pain in injured athletes. The article includes a brief discussion of the most accepted theories of pain. Types of pain that injured athletes may experience and how they can learn to discriminate between them will be discussed. The article will also consider how pain can be a useful tool as information about injured athletes’ current status in recovery and the need to modify their rehabilitation regimens. The value of measuring pain will be examined with emphasis on determining a simple and easy means of assessing pain. Next, the article will examine why nonpharmacological pain management may be a useful adjunct to pharmacological pain control. Then, a brief description of the most commonly used pain medications and a detailed description of common nonpharmacological pain-management strategies will be furnished. A discussion of how nonpharmacological pain management can be incorporated into the traditional rehabilitation process will be offered. Finally, the article will describe the role that sport psychologists can play in the management of sport injury-related pain. The objective of this article is to provide applied practitioners with the knowledge and tools necessary to assist injured athletes in mitigating the pain they will experience during recovery as a means of facilitating their rehabilitation and return to sport.

Pain memories in phantom limbs: a case study

Pain experienced in a limb prior to amputation may influence the course of phantom limb pain many months later. Katz and Melzack (1990)found that 42% of their sample reported a ‘somatosensory pain memory’ which resembled the quality and location of a painful, or non-painful pre-amputation sensation. For many amputees, pain memories are vivid experiences which incorporate both emotional and sensory aspects of the pre-amputation pain (Katz 1992). Katz and Melzack (1990)suggest that sensory input will ‘trigger’ somatosensory pain memories while the affective component of a pain memory is generated by the intensity, quality and location of the current experience of phantom limb pain. The present case study used a diary design to examine whether ‘triggers’ could be identified for somatosensory pain memories. Over a 9-month period, the patient reported daily experience of ongoing phantom limb pain, generally confined to the distal part of the limb, and 5 episodes of injury-related phantom limb pain, primarily experienced in the calf of the missing limb. A ‘trigger’ was identified for each of the episodes of injury-related phantom limb pain, and a significant finding in this study was that two episodes of injury-related phantom limb pain were associated with cognitive and/or emotional, rather than sensory ‘triggers’.