Chronic Pain Intensity Research Articles

Chronic pain and fatigue in adults with congenital unilateral upper limb deficiency in Norway. A cross-sectional study.

PurposeTo describe Norwegian adults with congenital unilateral upper limb deficiency (CUULD) regarding self-reported chronic pain (intensity, locations, impact on daily life) and fatigue. Analyze associations between chronic pain and demographic/clinical factors and associations between fatigue and demographic/ clinical factors.Materials and methodsCross-sectional study. In 2012, a postal questionnaire was sent to 186 persons with congenital limb deficiency, age ≥ 20 years. Seventy seven persons with CUULD responded and are included in this paper. The questionnaire included questions on demographic and clinical factors, chronic pain (Brief Pain Inventory, Standardized Nordic Questionnaire) and fatigue (Fatigue severity scale (FSS)).ResultsMean age was 42.7 (SD 16.0), 71% were women. Sixty tree % reported chronic pain, many had bilateral pain, most common pain locations were neck (78%) and shoulder/upper arm (78%). However, reported mean pain intensity (3.3 (SD 2.8)) and mean number of pain locations (3.0 (SD 2.5)) were moderate to low. Thirty seven persons reported that pain started in adult age (≥ 19 years). One third reported severe fatigue (FSS ≥ 5). Persons reporting cold sensitivity and severe fatigue were most likely to have chronic pain.ConclusionsCongenital upper limb deficiency increases the risk of self-reported pain in neck, shoulder/upper arm, cold sensitivity and severe fatigue. Pain, fatigue and cold sensitivity may individually affect function, and may together reinforce functional problems. This should be to taken into account when rehabilitation programs are developed. Further studies of more representative samples should be conducted to confirm our findings.

Depressive symptoms in the elderly and its relationship with chronic pain, chronic diseases, sleep quality and physical activity level

ABSTRACT BACKGROUND AND OBJECTIVES: Depressive symptoms are often experienced by the elderly, being a public health problem. The objective of this study was to verify the relation between depressive symptoms and the presence and intensity of chronic pain with sleep quality and physical activity level. METHODS: Research with 385 aged residents in a municipality of Santa Catarina. The Morais adapted questionnaire, the numerical visual pain scale, and the International Physical Activity Questionnaire were used to assess the level and volume of physical activity, the Pittsburgh Sleep Quality Index, and the Geriatric Depression Scale. Data analysis by the Mann-Whitney U test, Chi-square (X2) and Spearman’s correlation. RESULTS: Of the 385 aged evaluated, 30.6% had depressive symptoms. Older people who had depressive symptoms complained more of pain, poor sleep quality and had less physical activity (p=0.001). The X2 values between chronic pain, sleep quality and physical activity level with presence and absence of depression symptoms were 25.078, 27.707 and 9.009, respectively (p<0.05), and the correlation between depressive symptoms and sleep quality was 0.423 (p<0.05). CONCLUSION: Elderly people with depressive symptoms had a higher intensity of pain, worse quality of sleep and lower intensity of physical activity. There was an association between the presence of chronic pain, level of physical activity and quality of sleep with depression symptoms and moderate correlation between depression symptoms and sleep quality

Health literacy, pain intensity and pain perception in patients with chronic pain.

SummaryBackgroundChronic pain poses a large burden for the healthcare system and the individuals concerned. The impact of health literacy (HL) on health status and health outcomes is receiving more and more attention. The aim of this study was to evaluate the association of HL with chronic pain intensity and pain perception.MethodsA total of 121 outpatients suffering from chronic pain (pain duration >3 months) were evaluated. The HL was measured using the health literacy screening questions. Pain intensity was measured with a Visual Analogue Scale (VAS) and pain perception with the short-form McGill Pain Questionnaire (SF-MPQ).ResultsIndividuals with low HL had significantly higher VAS values (Pearson correlation coefficient= −0.270, p = 0.003). Stepwise regression analysis showed that HL has a significant association with pain intensity (odds ratio [OR] = 2.31; 95% confidence interval [CI] 1.11–4.83), even after controlling for age and sex (OR = 2.27; 95% CI 1.07–4.82), but no longer after controlling for education (OR = 2.10; 95% CI 0.95–4.64).ConclusionIndividuals with a higher HL showed less pain intensity, which seems to be caused by a better pain management; therefore, supporting the development of HL in patients with chronic pain could be seen as an important objective of integrated care.

МЕТОДЫ ДИАГНОСТИКИ ПОСЛЕОПЕРАЦИОННОГО СПАЕЧНОГО ПРОЦЕССА В МАЛОМ ТАЗУ У ЖЕНЩИН С ХРОНИЧЕСКОЙ ТАЗОВОЙ БОЛЬЮ НА ФОНЕ НЕДИФФЕРЕНЦИРОВАННОЙ ДИСПЛАЗИИ СОЕДИНИТЕЛЬНОЙ ТКАНИ

Objective: To optimize the diagnostic accuracy of the postoperative adhesion process on the background of undifferentiated connective tissue dysplasia (UCTD) in patients with chronic pelvic pain Methods: The study conducted based on the Regional Clinical Hospital "Regional Clinical Perinatal Center", during which 60 patients diagnosed with tubal and peritoneal infertility. Patients divided into 2 groups based on a modified scoring scale of T. I. Kadurina. A study of genotype-phenotypic predictors carried out by analyzing the expression of UCTD by the method of profiling phenotypic markers, according to a modified scale of T.I. Kadurina. The study of polymorphism of VEGF 634 [rs2010963], IL6-174 [rs1800795] genes, and the evaluation of the adhesion process according to the classification system of the American Fertility Society, the genetic predisposition to the development of the adhesion process by the method of genotyping acetylation and pain intensity on a visual analogue scale. Results: Patients with the grade of UCTD scores equal to 10 or more according to the modified scale of T.I. Kadurina assigned to the high-risk group for pelvic peritoneal adhesions (PPA). Diagnosis of predisposition to adhesions by methods of determining the type of acetylation and ultrasound suggests the presence of adhesions in the small pelvis before surgery in 76.66% and 65% of those examined respectively. The molecular-genetic predictors of UCTD are C/C IL6-174 allele C and C/G VEGFA 634 allele G. The intensity of chronic pelvic pain in the adhesive process depends on the stage of the latter. To predict the risk of development of PPA, the developed mathematical model based on P = 1/(1+еЂ(–z)) and independent predictors should be used: myopia, mitral valve prolapse, IL6-174 [rs1800795], VEGFA 634 [rs2010963] and phenotype of acetylation. Conclusion: Using the method of binary logistic regression on the basis of clinical, anamnestic, experimental and molecular-genetic data makes it possible to determine the probability of development of PPA on the background of UCTD using the formula: P = 1/(1+еЂ(–z)). Keywords: Pelvic peritoneal adhesions, chronic pelvic pain, acetylation, binary logistic regression

Quality of life in the elderly with and without chronic pain

ABSTRACT BACKGROUND AND OBJECTIVES: In the last decade, the elderly population has grown worldwide, both in developed and developing countries. Together with the aging process, the prevalence of chronic diseases and consequently the presence of pain are common and may have a strong impact on the quality of life of the elderly. The objective of this study was to evaluate the quality of life of elderly patients with and without chronic pain and to compare the quality of life with the number of chronic pathologies, pain intensity and age range METHODS: A quantitative, descriptive cross-sectional study carried out in a city in the West of the state of Santa Catarina with a sample of 385 senior people living in the urban area. The instruments of analysis were: the Mental State Mini Exam; the general data questionnaire adapted from Morais, Rodrigues e Gerhardt; The WHOQOL-OLD questionnaire, and a visual numerical scale. For the intergroup comparison, the Mann-Whitney test was used, and Pearson’s correlation was used in the correlations. RESULTS: It was observed the predominance of pain of moderate intensity. Old people with chronic pain have a lower quality of life index than the group without pain regardless the gender, and those who have chronic pain and age above 71 years have a lower quality of life index. CONCLUSION: The presence of chronic pain, number of diseases, pain intensity, female gender and age group above 71 years negatively influenced the quality of life of the elderly studied.

N-of-1 Randomized Trials of Ultra-Micronized Palmitoylethanolamide in Older Patients with Chronic Pain.

Ultra-micronized palmitoylethanolamide (um-PEA) represents an attractive option for chronic pain control in complex older patients at higher risk of adverse effects with traditional analgesics. The aim of this study was to determine the effectiveness of um-PEA versus placebo on chronic pain intensity and function in individual geriatric patients. We performed randomized, blinded N-of-1 trials with two 3-week um-PEA versus placebo comparisons, separated by 2-week washout periods. The study included outpatients aged≥65years with chronic, non-cancer, non-ischemic pain in the back, joints, or limbs. Patients were randomized to Um-PEA 600mg or placebo twice daily. Pain intensity was measured using an 11-point visual numeric scale. Functional impairment was measured using a Back Pain Functional Scale. Impact of each N-of-1 trial was measured on the clinician's intention to treat and confidence. Ten of 11 eligible patients consented over 7months [all female, mean age 83.2years (SD 4.6)]. Three patients interrupted the trial: one had diarrhea (under placebo), one for low adherence, and one for intercurrent pneumonia. A small statistically significant effect in favor of um-PEA was seen at the mixed method analyses in two patients (effect size equal to 8% of the baseline pain). A statistically significant impact on function was found in one patient. After the trial, um-PEA was prescribed to four patients; in two patients the clinician changed their pre-trial intention to treat; the clinician confidence in the treatment plan either increased (5) or remained the same (2). Our experience confirmed that N-of-1 trials may help make personalized evidence-based decisions in complex older patients, with special feasibility considerations. CLINICALTRIALS.GOV: NCT02699281.

Hippocampal morphology mediates biased memories of chronic pain

Experiences and memories are often mismatched. While multiple studies have investigated psychological underpinnings of recall error with respect to emotional events, the neurobiological mechanisms underlying the divergence between experiences and memories remain relatively unexplored in the domain of chronic pain. Here we examined the discrepancy between experienced chronic low back pain (CBP) intensity (twice daily ratings) and remembered pain intensity (n = 48 subjects) relative to psychometric properties, hippocampus morphology, memory capabilities, and personality traits related to reward. 77% of CBP patients exaggerated remembered pain, which depended on their strongest experienced pain and their most recent mood rating. This bias persisted over nearly 1 year and was related to reward memory bias and loss aversion. Shape displacement of a specific region in the left posterior hippocampus mediated personality effects on pain memory bias, predicted pain memory bias in a validation CBP group (n = 21), and accounted for 55% of the variance of pain memory bias. In two independent groups (n = 20/group), morphology of this region was stable over time and unperturbed by the development of chronic pain. These results imply that a localized hippocampal circuit, and personality traits associated with reward processing, largely determine exaggeration of daily pain experiences in chronic pain patients.

Patient with Postthoracotomy Pain

Pain due to thoracotomy is among the most severe pain experienced after surgery. It has both neuropathic and myofascial components. About 50% of patients suffer from chronic postthoracotomy pain 1 year after surgery. Thoracic paravertebral block or thoracic epidural analgesia is recommended as the first-choice therapy for thoracotomy analgesia. Preoperatively initiated thoracic epidural analgesia is associated with better pain control and decreased incidence (and intensity) of chronic postthoracotomy pain compared with postoperative (epidural or intravenous) analgesia. Compared with inhalation anesthesia, total intravenous anesthesia significantly reduced the incidence of chronic postthoracotomy pain syndrome, which is notoriously challenging to treat. Gabapentinoids and antidepressants may be beneficial for the neuropathic component of chronic postthoracotomy pain syndrome. A pregabalin and methylcobalamin combination has been shown to be safe and effective in the treatment of chronic postthoracotomy pain, with minimal side effects. Interventional therapies such as intercostal nerve block or ablation, spinal cord stimulation, and targeted subcutaneous neuromodulation may be indicated in more refractory and debilitating cases. This review contains 1 table, and 57 references. Key words: chronic postthoracotomy pain, cryoneurolysis, intercostal nerve block, open thoracotomy surgery, paravertebral block, postthoracotomy pain, postthoracotomy pain syndrome, spinal cord stimulation, thoracic epidural analgesia, thoracotomy, total intravenous analgesia, video-assisted thoracoscopic surgery

Pain Acceptance as a Predictor of Medical Utilization and School Absenteeism in Adolescents With Chronic Pain.

Identifying factors contributing to high medical utilization and productivity loss is important, given the high cost of pediatric chronic pain. The current study examined chronic pain acceptance as a predictor of medical utilization and school absenteeism in adolescents with chronic pain. In all, 122 adolescents (aged 12-21 years) with chronic pain and their parents/guardians completed questionnaires assessing medical visits (past 6 months), medication usage, and number of school absences (past month). Homebound school status was also reported. Adolescents completed the Chronic Pain Acceptance Questionnaire and pain intensity ratings, and underwent a diagnostic psychological evaluation. Multivariate generalized linear model analyses indicated lower pain acceptance predicted increased inpatient hospitalizations and higher number of opioid and nonopioid prescription medications, controlling for pain intensity, age, and sex. Pain acceptance was not associated with outpatient consultations or number of nonprescription medications. Exploratory moderation analyses indicated lower pain acceptance significantly predicted increased emergency department visits and inpatient hospitalizations for patients diagnosed with an internalizing psychological disorder. Patients in homebound schooling reported low pain acceptance and for those in school full-time, linear regression indicated lower pain acceptance significantly predicted higher number of school absences. Findings suggest that lower pain acceptance contributes to the use of higher-level medical care (especially for adolescents with internalizing disorders) and increased productivity loss owing to school absences or homebound school status. Clinical implications exist for recommending acceptance-based interventions for pain acceptance promotion and continued development of cost-effective, easily disseminated acceptance-based therapy modules to curb the economic burden of chronic pain.

Incidencia y factores asociados al dolor crónico postoperatorio en pacientes llevados a herniorrafia inguinal

IntroductionIn up to 50% of cases, inguinal hernia repair is associated with chronic post-surgical pain, which can be a cause of disability in a proportion of patients. ObjectiveTo estimate the incidence of chronic post-surgical pain and its associated factors in patients taken to inguinal hernia repair. Materials and methodsObservational follow-up study in a cohort of patients. Social, demographic and personal background information was obtained; the incidence and intensity of acute and chronic post-operative pain was determined; and the factors associated with the development of chronic pain were evaluated. Associations were determined in accordance with the nature of the variables. A linear regression was used to assess the role of confounding factors. ResultsOverall, 108 patients were analysed, and of them, 27.8% (n=30) had chronic post-surgical pain. The multivariate analysis showed that the use of general anaesthesia and uncontrolled pain 15days after surgery were associated with a higher risk of developing this condition. In contrast, diclofenac administration was protective. DiscussionChronic post-surgical pain is frequent in this type of surgery. According to this study, the use of peri-operative analgesia together with pain prevention and management within the first post-operative weeks help prevent the development of chronic post-surgical pain. General anaesthesia may increase the risk. Similar studies conducted at a larger scale could help identify other associated factors.

Incidence of chronic post-surgical pain and its associated factors in patients taken to inguinal hernia repair

IntroductionIn up to 50% of cases, inguinal hernia repair is associated with chronic post-surgical pain, which can be a cause of disability in a proportion of patients. ObjectiveTo estimate the incidence of chronic post-surgical pain and its associated factors in patients taken to inguinal hernia repair. Materials and methodsObservational follow-up study in a cohort of patients. Social, demographic and personal background information was obtained; the incidence and intensity of acute and chronic post-operative pain was determined; and the factors associated with the development of chronic pain were evaluated. Associations were determined in accordance with the nature of the variables. A linear regression was used to assess the role of confounding factors. ResultsOverall, 108 patients were analysed, and of them, 27.8% (n=30) had chronic post-surgical pain. The multivariate analysis showed that the use of general anaesthesia and uncontrolled pain 15 days after surgery were associated with a higher risk of developing this condition. In contrast, diclofenac administration was protective. DiscussionChronic post-surgical pain is frequent in this type of surgery. According to this study, the use of peri-operative analgesia together with pain prevention and management within the first post-operative weeks help prevent the development of chronic post-surgical pain. General anaesthesia may increase the risk. Similar studies conducted at a larger scale could help identify other associated factors.

Parents and Physiotherapists Recognition of Non-Verbal Communication of Pain in Individuals with Cerebral Palsy

ABSTRACTPain assessment is difficult in individuals with cerebral palsy (CP). This is of particular relevance in children with communication difficulties, when non-verbal pain behaviors could be essential for appropriate pain recognition. Parents are considered good proxies in the recognition of pain in their children; however, health professionals also need a good understanding of their patients’ pain experience. This study aims at analyzing the agreement between parents’ and physiotherapists’ assessments of verbal and non-verbal pain behaviors in individuals with CP. A written survey about pain characteristics and non-verbal pain expression of 96 persons with CP (45 classified as communicative, and 51 as non-communicative individuals) was performed. Parents and physiotherapists displayed a high agreement in their estimations of the presence of chronic pain, healthcare seeking, pain intensity and pain interference, as well as in non-verbal pain behaviors. Physiotherapists and parents can recognize pain behaviors in individuals with CP regardless of communication disabilities.

Clinical feasibility and changes in chronic intractable pain intensity in patients treated with spinal neurostimulation.

Introducción: La terapia de neuroestimulación eléctrica espinal (NEE) es una opción importante para tratamiento de patologías que cursan con dolor crónico intratable tales como: síndrome de cirugía de espalda fallida lumbar, síndrome doloroso regional complejo tipo 1, angina refractaria. La unidad de Algiología del Complejo Hospitalario “Dr. Arnulfo Arias Madrid” es lugar de colocación de implantes de neuroestimulación en Panamá. Objetivo: Determinar la utilidad clínica y los cambios de intensidad de dolor en pacientes portadores de un neuroestimulador implantado en nuestra institución (enero 2010 - julio 2015). Métodos: Se realizó un estudio de serie de casos retrospectivo. La muestra fue conformada por 15 pacientes a quienes se interrogó con las escalas de intensidad del dolor por EVA, cuestionario de discapacidad de Owestry y test de calidad de vida por fast-espiditest antes y después de la colocación del implante definitivo del NEE.Resultados: Hubo variaciones favorables en los niveles de intensidad de dolor por EVA y de discapacidad física por test de Owestry antes y después de la colocación del neuroestimulador. Los pacientes calificaron su calidad de vida luego del neuroestimulador (mediante cuestionario fast-espiditest) como “mal estado de salud” con dolor moderado que requiere ayuda ocasional en sus actividades diarias. Conclusiones: Este primer estudio sobre la neuroestimulación espinal en pacientes con dolor crónico en Panamá muestra beneficios en disminución de intensidad del dolor, menor discapacidad física y mejor calidad de vida similares a las investigaciones mundiales en el uso de la terapia de neuromodulación.

Pain Catastrophizing Moderates Relationships between Pain Intensity and Opioid Prescription: Nonlinear Sex Differences Revealed Using a Learning Health System.

Pain catastrophizing is a maladaptive response to pain that amplifies chronic pain intensity and distress. Few studies have examined how pain catastrophizing relates to opioid prescription in outpatients with chronic pain. The authors conducted a retrospective observational study of the relationships between opioid prescription, pain intensity, and pain catastrophizing in 1,794 adults (1,129 women; 63%) presenting for new evaluation at a large tertiary care pain treatment center. Data were sourced primarily from an open-source, learning health system and pain registry and secondarily from manual review of electronic medical records. A binary opioid prescription variable (yes/no) constituted the dependent variable; independent variables were age, sex, pain intensity, pain catastrophizing, depression, and anxiety. Most patients were prescribed at least one opioid medication (57%; n = 1,020). A significant interaction and main effects of pain intensity and pain catastrophizing on opioid prescription were noted (P < 0.04). Additive modeling revealed sex differences in the relationship between pain catastrophizing, pain intensity, and opioid prescription, such that opioid prescription became more common at lower levels of pain catastrophizing for women than for men. Results supported the conclusion that pain catastrophizing and sex moderate the relationship between pain intensity and opioid prescription. Although men and women patients had similar Pain Catastrophizing Scale scores, historically "subthreshold" levels of pain catastrophizing were significantly associated with opioid prescription only for women patients. These findings suggest that pain intensity and catastrophizing contribute to different patterns of opioid prescription for men and women patients, highlighting a potential need for examination and intervention in future studies.

THE INFLUENCE OF SINGLE-NUCLEOTIDE POLYMORPHISMS OF CATECHOL-O-METHYLTRANSFERASE GENE ON THE FORMATION OF PAIN SYNDROME AND EFFECTIVENESS OF ANALGESIA IN ONCOLOGICAL PATIENTS

The objective is to study the effect of single-nucleotide polymorphisms (SNPs) of COMT gene on the formation and characteristics of chronic pain, level of anxiety and depression, effectiveness of analgesia in oncological patients. Material and Methods. The study includes 196 patients with oncological pathology. The formation of chronic pain syndrome was estimated in all patients one year after surgery using the assessment of pain intensity by numeric rating scale, pain questionnaire of McGill, PainDetect. Basing on the patients genotyping data the genotypes and haplotypes frequency distribution on SNPs of rs4680, rs740603, rs2097603=rs2070577, rs4633 of COMT gene was estimated. The relationship between different genotypes, haplotypes and chronic pain intensity, severity of ranking index of pain for sensor and affective characteristics on McGill scale, presence of neuropathic component of pain and anxiety was studied in all patients sample. The same analysis was carried out in order to clarify difference in morphine consumption (mg/24h) and severity of adverse side effects such as drowsiness, confusion and hallucinations. Results. It is found that after one year the pain syndrome was developed in 134 patients. It was showed that there is direct relationship between chronic pain intensity, anxiety level and presence of mutant allele on polymorphisms of rs4680 in exon and rs740603 in intron of COMT gene. There was also revealed inverse relationship between morphine requirement and presence of pointed polymorphisms in comparison with the patients who have GG genotype of these markers. Conclusion. The determination of pointed SNPs may be useful for choosing the optimal tactics of analgesia in patients with chronic oncological pain syndrome.

Efficacy and acceptability of long-term norethindrone acetate for the treatment of rectovaginal endometriosis

ObjectiveTo study the efficacy of long-term treatment with norethindrone acetate (NETA) in patients with rectovaginal endometriosis. Study designThis retrospective cohort study included 103 women with pain symptoms caused by rectovaginal endometriosis. Patients received NETA alone (2.5mg/day up to 5mg/day) for 5 years. Primary outcome was the degree of satisfaction with treatment after 5 years of progestin therapy. Secondary outcomes were the assessment of any variation in pain symptoms and the volumetric assessment of the disease by magnetic resonance imaging (MRI). ResultsSixty-one women completed the 5-year follow-up (61/103, 59.2%) with 16 women withdrawing because of adverse effects (38.1%). Overall, 68.8% (42/61) of the women who completed the study were satisfied or very satisfied of this long term NETA treatment. This represents a 40.8% (42/103) of the patients enrolled. Intensity of chronic pelvic pain and deep dyspareunia significantly decreased during treatment (p<0.001 versus baseline at 1 and 5year). Dyschezia improved after 1-year respect to baseline (p=0.008) but remained stable between first and second year (p=0.409). At the end of 5 years treatment, a radiological partial response was observed in 33 patients (55.9%, n 33/59); a stable disease in 19 patients (32.2%, n 19/59). Seven women (7/59, 11.9%) displayed a volumetric increase of rectovaginal endometriosis under NETA treatment. ConclusionFive-year therapy with NETA is safe and well tolerated by women with rectovaginal endometriosis. Due to its low cost and good pharmacological profile, it represents a good candidate for long-term treatment in this setting.

Pain Catastrophizing and Negative Mood States After Spinal Cord Injury: Transitioning From Inpatient Rehabilitation Into the Community.

We studied pain catastrophizing and negative mood states in adults with SCI. Catastrophizing was higher in those with depression, but only after discharge from hospital into the community. Results provide direction for improving treatment of pain catastrophizing in adults with SCI who are depressive and anxious.

Waking EEG Cortical Markers of Chronic Pain and Sleepiness.

Spectral power analyses of EEG recordings are reported to distinguish the cortical activity of individuals with chronic pain from those of controls. Further study of these spectral patterns may provide a greater understanding of the processes associated with chronic pain, in addition to providing potential biometric markers of chronic pain for use in both clinical and research settings. However, sleep deprived groups have demonstrated similar characteristics in their spectral power characteristics, particularly in alpha bandwidth power activity. 103 individuals with chronic pain provided resting awake EEG data in addition to ratings of pain and sleep quality. Two Principal Axis Factor analyses using Promax rotation produced one pain and one sleep factor from relevant questionnaire data provided by participants. These factors were then used to test hypothesized relationships with alpha and theta bandwidth power at the frontal and parietal areas of the cortex. Our findings suggest that reductions in alpha bandwidth power are independently associated with both chronic pain intensity ratings and measures of sleep deficits. Conversely, theta bandwidth power was not found to be associated with either chronic pain or sleep quality measures. This study's findings support that chronic pain intensity and sleep deficits are related to the Alpha spectral bandwidth activity in individuals with chronic pain.

Association Between Chronic Tension-Type Headache Coexistent with Chronic Temporomandibular Disorder Pain and Limitations in Physical and Emotional Functioning: A Case-Control Study.

To assess the association between chronic tension-type headache coexistent with chronic temporomandibular disorder (TMD) pain and severe limitations in physical and emotional functioning. Sample size estimation was used to determine that this case-control study should include 126 subjects. Subjects suffering from chronic TMD who were aged between 18 and 68 were recruited in routine clinical practice. Of the 126 included subjects, 63 had TMD pain associated with chronic tension-type headache (cases) and 63 had TMD pain without a history of tension-type headache (controls). Clinical diagnosis of TMD was made according to the Research Diagnostic Criteria for TMD (RDC/TMD) Axis I criteria, and clinical diagnosis of headache was made according to the International Classification of Headache (ICHD-II). RDC/TMD Axis II criteria were applied to record the scores from the Graded Chronic Pain Scale (GCPS) and the Symptoms Checklist-90-Revised Depression (SCL-DEP) and Somatization (SCL-SOM) scales. A logistic regression analysis was used to assess the relationship between TMD pain with chronic tension-type headache and high levels of depression and somatization severity as scored on the SCLDEP and SCL-SOM scales, respectively, and high pain-related disability (GCPS grade III or IV). Data were adjusted to take into account age, gender, time since TMD pain onset, chronic TMD pain intensity, and characteristic pain intensity. The presence of chronic tension-type headache was significantly associated with severe SCL-DEP (odds ratio [OR] = 7.2; P < .001), severe SCLSOM (OR = 13.8; P < .001), and high pain-related disability (OR = 9.7; P < .001). This study provides evidence of associations between the clinical diagnosis of chronic tension-type headache coexistent with chronic TMD pain and key aspects of physical and emotional functioning reflected in severe depression, severe somatization, and high pain-related disability.

Discriminating between neuropathic pain and sensory hypersensitivity using the Chronic Pain Questions (CPQ)

ABSTRACTObjective: The Chronic Pain Questions (CPQ) were developed for clinical use with the aim of supporting primary care physicians in the screening, assessment and monitoring of patients with chronic pain. the purpose of this study was to examine the ability of the cpq CPQ to discriminate between patients with neuropathic pain (nep) versus those with sensory hypersensitivity (sh).Methods: Adult men and women with a diagnosis of a NeP or SH condition were recruited from 5 clinical sites across the United States. Participants completed a series of self-administered questionnaires, including the CPQ. Continuous variables were compared between groups with independent t-tests; categorical variables were compared with chi-square analyses. A series of exploratory logistic regressions were performed to discern optimal screening criteria for SH using CPQ responses.Results: 98 participants, 68 with physician-confirmed diagnoses of SH and 30 with NeP, participated. 81.6% were female, 73.5% Caucasian, and mean (± SD) age was 58.4 ± 12.6 years. SH participants included significantly more females compared to the NeP group (94.1% vs. 53.3%). Differences in CPQ responses between groups were statistically significant for six of the 14 CPQ items with SH participants having significantly lower scores on specific pain quality questions and significantly higher scores on trouble thinking/remembering (5.3 ± 3.5 vs. 3.0 ± 2.8) and sensitivity to lights/noises/smells (4.8 ± 3.5 vs. 2.7 ± 3.0). No significant differences were found between groups for chronic pain intensity, pain made worse with touch, pain limited to joints, or pain interference with usual activity, sleep or mood. Logistic regression analyses revealed strong c indices (≥0.89) for all models. Consistent findings demonstrated that younger age, female gender, and scores ≥6 for the CPQ question on sensitivity to lights/noises/smells were all predictive of SH.Conclusions: The CPQ can help differentiate between patients with NeP and SH. More research is warranted.