Pain Intensity In Individuals Research Articles

Negative effect of anger on chronic pain intensity is modified by multiple mood states other than anger: A large population-based cross-sectional study in Japan.

To investigate whether mood states other than anger can modify the association between anger and pain intensity in individuals with chronic pain. We analysed 22,059 participants with chronic pain, including 214 participants with rheumatoid arthritis (RA), who completed a questionnaire. The Profile of Mood States short form (POMS-SF) was used to assess six dimensions of mood states (anger-hostility, tension-anxiety, depression-dejection, confusion, fatigue, and vigour). A numerical rating scale (NRS) assessed pain intensity. We examined the association between anger-hostility and the NRS and the relationship between POMS-SF components. Moderation analyses were used to investigate whether the five mood states other than anger-hostility modified the effect of anger-hostility on the NRS. Anger-hostility contributed to pain intensity. Although increased mood states other than vigour were associated with increased pain intensity, these increased mood states appeared to suppress the effect of anger-hostility on pain intensity. Increased vigour was associated with decreased pain intensity and increased the effect of anger-hostility on pain intensity. Mood states other than anger may influence the association between anger and pain intensity in individuals with chronic pain. It is important to focus on complicated mood states and anger in individuals with chronic pain, including RA.

Strength training in addition to neuromuscular exercise and education in individuals with knee osteoarthritis-the effects on pain and sensitization.

There is a lack of evidence of the relative effects of different exercise modes on pain sensitization and pain intensity in individuals with knee osteoarthritis (KOA). Ninety individuals with radiographic and symptomatic KOA, ineligible for knee replacement surgery, were randomized to 12weeks of twice-weekly strength training in addition to neuromuscular exercise and education (ST+NEMEX-EDU) or neuromuscular exercise and education alone (NEMEX-EDU). Outcomes were bilateral, lower-leg, cuff pressure pain- and tolerance thresholds (PPT, PTT), temporal summation (TS), conditioned pain modulation (CPM), self-reported knee pain intensity and number of painful body sites. After 12weeks of exercise, we found significant differences in increases in PPT (-5.01kPa (-8.29 to -1.73, p=.0028)) and PTT (-8.02kPa (-12.22 to -3.82, p=.0002)) in the KOA leg in favour of ST+NEMEX-EDU. We found no difference in effects between groups on TS, CPM or number of painful body sites. In contrast, there were significantly greater pain-relieving effects on VAS mean knee pain during the last week (-8.4mm (-16.2 to -0.5, p=.0364) and during function (-16.0mm (-24.8 to -7.3, p=.0004)) in favour of NEMEX-EDU after 12weeks of exercise. Additional strength training reduced pain sensitization compared to neuromuscular exercise and education alone, but also attenuated the reduction in pain intensity compared to neuromuscular exercise and education alone. The study provides the first dose- and type-specific insight into the effects of a sustained exercise period on pain sensitization in KOA. Future studies are needed to elucidate the role of different exercise modes. This study is an important step towards better understanding the effects of exercise in pain management of chronic musculoskeletal conditions. We found that strength training in addition to neuromuscular exercise and education compared with neuromuscular exercise and education only had a differential impact on pain sensitization and pain intensity, but also that regardless of the exercise mode, the positive effects on pain sensitization and pain intensity were comparable to the effects of other therapeutic interventions for individuals with knee osteoarthritis.

An Examination of Day-to-Day and Intraindividual Pain Variability in Low Back Pain.

This study aimed to capture day-to-day changes in pain intensity in individuals with low back pain (LBP), which may be indicative of patients' ability to modulate their pain levels. A secondary aim was to explore the presence of latent subgroups characterized by pain level, intraindividual pain variability, and change in pain over a 14-day period. Participants were 54 adults with self-reported LBP recruited from outpatient physical therapy clinics and the community. Over the course of 14 days, participants completed daily measures of pain intensity, catastrophizing, pain self-efficacy, and negative affect. Change in pain intensity as well as total amount of intraindividual pain variability were also calculated. Daily increases in maladaptive coping and affective responses (i.e., higher catastrophizing, higher negative affect, lower pain self-efficacy) were associated with increases in pain intensity. A hierarchical cluster analysis revealed three subgroups: 1) moderate pain intensity, moderate pain variability, increase in pain over time; 2) low pain intensity, low pain variability, no change in pain over time; and 3) moderate pain intensity, high pain variability, decrease in pain over time. Cluster 2 demonstrated more adaptive coping and affective responses at baseline and during the 14-day period, and clusters 1 and 3 did not differ in their coping or affective responses. These findings provide support that day-to-day changes in pain, coping, and affective responses are meaningful and provide additional evidence of pain variability as a potential phenotypic characteristic.

Efficacy of the iDBT-Pain skills training intervention to reduce emotional dysregulation and pain intensity in people with chronic pain: protocol for a single-case experimental design with multiple baselines

IntroductionDifficulties in emotional regulation are key to the development and maintenance of chronic pain. Recent evidence shows internet-delivered dialectic behaviour therapy (iDBT) skills training can reduce emotional dysregulation and pain...

Immediate Effects of Dry Needling and Myofascial Release on Local and Widespread Pressure Pain Threshold in Individuals With Active Upper Trapezius Trigger Points: A Randomized Clinical Trial

ObjectiveThis study sought to compare the immediate effects of a single session of dry needling (DN), myofascial release (MR), and sham DN on pressure pain threshold (PPT) and neck pain intensity in individuals with chronic neck pain. MethodsThis was a randomized trial with a blinded outcome assessor. Forty-four individuals with chronic neck pain and unilateral myofascial trigger points in the upper trapezius muscle (UTM) were randomized to receive DN (n = 15), MR (n = 14), or sham DN (n = 15). The PPT over the UTM (ipsilateral and contralateral sides) and the proximal head of the radius (ipsilateral and contralateral to the treated side) and neck pain were assessed immediately and 10 minutes after the intervention. ResultsThere was no significant Group × Time interaction for PPT in the UTM on the treated side (F = 0.63, P = .641) or the contralateral side (F = 1.77, P = .144). However, there was a main effect of time on both the treated side (F = 4.917, P = .001) and the contralateral side (F = 4.70, P = .015), with DN and MR increasing PPT at the UTM. No significant Group × Time × Side interaction was found for PPT at the proximal head of the radius (F = 1.23, P = .276). Within-group analysis revealed a significant increase in PPT on the ipsilateral and contralateral sides in both DN and MR. Neck pain decreased after DN (P < .001), MR (P < .001), and sham DN (P = .008). ConclusionA single application of DN or MR generated local and distant hypalgesic responses superior to placebo. Future trials are needed to examine whether these findings occur in long-term follow-ups.

The Association of Kinesiophobia and Pain Catastrophizing with Pain-Related Disability and Pain Intensity in Obesity and Chronic Lower-Back Pain.

Individuals affected by chronic lower-back pain and obesity have an increased risk of long-lasting disability. In this study, we aimed to explore the contribution of kinesiophobia and pain catastrophizing in explaining pain intensity and pain-related disability in chronic lower-back pain associated to obesity. A cross-sectional study on 106 participants with obesity and chronic lower-back pain was performed. We assessed pain intensity, pain disability, pain catastrophizing, and kinesiophobia levels through self-reporting questionnaire. Hierarchical regressions were performed to assess the role of pain catastrophizing and kinesiophobia on pain intensity and pain disability. According to the results, kinesiophobia, but not pain catastrophing, significantly explained both pain intensity and pain-related disability. Kinesiophobia might play a significant role in enhancing pain-related disability and the pain intensity in individuals with chronic lower-back pain and obesity. We encourage future studies in which beliefs and cognition towards pain might be a therapeutic target in interdisciplinary pain management interventions.

Efeitos de exercícios de Pilates em parâmetros antropométricos e hemodinâmicos de portadores de dor lombar crônica inespecífica: ensaio clínico randomizado

Introdução: Exercícios do método Pilates têm sido utilizados como recurso para modificar parâmetros antropométricos e hemodinâmicos, além de reduzir a intensidade da dor lombar crônica inespecífica (DLCI). Objetivo: Avaliar o comportamento de parâmetros antropométricos e hemodinâmicos e da intensidade dolorosa em indivíduos com DLCI submetidos a um protocolo de exercícios de Pilates no solo ou a estimulação elétrica nervosa transcutânea (TENS). Metodologia: Trata-se de um ensaio clínico randomizado, com 36 portadores de DLCI de ambos os sexos com idades entre 18 a 59 anos. Os indivíduos foram alocados aleatoriamente em grupo controle (GC; n=17), tratado por meio da TENS e grupo de exercícios de Pilates (GP; n=19). Os desfechos primários foram as medidas antropométricas e a porcentagem de gordura. Os desfechos secundários foram a intensidade dolorosa, avaliada por meio da escala analógica visual (EAV), a pressão arterial sistólica (PAS), a pressão arterial diastólica (PAD) e a frequência cardíaca de repouso (FCR). Resultados: Não houve diferença entre os grupos na análise comparativa dos dados antropométricos (P&gt;0,05). Houve redução significativa (P&lt;0,001) da intensidade da DLCI tanto no GC quanto no GP. Foram identificadas reduções significativas na PAS (P=0,002) e na FCR (P=0,029) apenas no GP. Conclusão: Tanto a TENS como os exercícios de Pilates no solo são eficazes na redução da intensidade da DLCI em curto prazo. O protocolo de exercícios de Pilates aplicado neste estudo não provocou alteração de parâmetros antropométricos, porém, foi eficaz na redução dos níveis da PAS e da FCR em curto prazo.

Altered Brainstem Pain-Modulation Circuitry Connectivity During Spontaneous Pain Intensity Fluctuations.

BackgroundChronic pain, particularly that following nerve injury, can occur in the absence of external stimuli. Although the ongoing pain is sometimes continuous, in many individuals the intensity of their pain fluctuates. Experimental animal studies have shown that the brainstem contains circuits that modulate nociceptive information at the primary afferent synapse and these circuits are involved in maintaining ongoing continuous neuropathic pain. However, it remains unknown if these circuits are involved in regulating fluctuations of ongoing neuropathic pain in humans.MethodsWe used functional magnetic resonance imaging to determine whether in 19 subjects with painful trigeminal neuropathy, brainstem pain-modulation circuitry function changes according to moment-to-moment fluctuations in spontaneous pain intensity as rated online over a 12-minute period.ResultsWe found that when pain intensity was spontaneously high, connectivity strengths between regions of the brainstem endogenous pain-modulating circuitry—the midbrain periaqueductal gray, rostral ventromedial medulla (RVM), and the spinal trigeminal nucleus (SpV)—were high, and vice-versa (when pain was low, connectivity was low). Additionally, sliding-window connectivity analysis using 50-second windows revealed a significant positive relationship between ongoing pain intensity and RVM-SpV connectivity over the duration of the 12-minute scan.ConclusionThese data reveal that moment-to-moment changes in brainstem pain-modulation circuitry functioning likely contribute to fluctuations in spontaneous pain intensity in individuals with chronic neuropathic pain.

Examining what factors mediate treatment effect in chronic low back pain: A mediation analysis of a Cognitive Functional Therapy clinical trial.

Cognitive Functional Therapy (CFT) is a physiotherapist-led individualized intervention for people with people with non-specific chronic low back pain (CLBP), involving biopsychosocial pain education, graded movement exposure and lifestyle coaching. A multicentre randomized controlled trial (RCT), including 206 participants with CLBP in Ireland, supported CFT's effectiveness for reducing disability, but not pain, compared to a group exercise and education intervention. In this study, causal mediation analysis was used to determine whether the effect of CFT on disability and the lack of effect on pain (relative to a group exercise and education intervention) is mediated by certain psychological and lifestyle factors. Hypothesized mediators measured were pain self-efficacy, stress, fear of physical activity, coping, depression, anxiety and sleep, at 6months. The outcomes measured were functional disability and pain intensity at 12months. This causal mediation study shows that the majority of benefit of CFT (relative to a group exercise and education intervention) for disability is due to increasing pain self-efficacy. Conclusion: CFT did not improve the majority of the hypothesized mediators (stress, fear of physical activity, coping, depression, anxiety and sleep) and these mediators were not associated with either disability or pain. Unfortunately, the proportion of missing data in this study is substantial and these findings can only be considered hypothesis-generating. Therefore, future research should examine replicating the results of this study to verify the role of self-efficacy and other proposed mediators (e.g. stress, coping, sleep, fear) on clinical outcomes. An exploration of seven potential mediators was undertaken to determine the effect of Cognitive Functional Therapy (CFT) on disability and pain intensity in individuals with chronic low back pain compared to a group exercise and education intervention. CFT improved pain self-efficacy, which was associated with disability and pain outcomes. CFT did not improve the other six potential mediators (stress, fear of physical activity, coping, depression, anxiety and sleep) and these were not associated with disability or pain. The proportion of missing data in this study is substantial and these findings should be considered hypothesis-generating only.

0827 The Association Among Diagnosed and Suspected Sleep Disorders and Pain

Abstract Introduction Poor sleep has increasingly been linked to adverse pain outcomes. Yet, the complex interplay between sleep apnea, insomnia, or comorbid sleep apnea and insomnia (COMISA), and pain are less well understood. The purpose of the present study was twofold: 1) assess pain intensity in individuals with diagnoses of insomnia, sleep apnea, and COMISA, and 2) examine pain intensity in individuals who are at a high risk for having either sleep apnea, insomnia, or both sleep disorders. Methods Participants included 3401 adults (mean age= 42.77, male= 45.6%) who participated in an online study investigating sleep across the lifespan. Sleep apnea and insomnia diagnoses were self-reported while participant risk profiles for these disorders were assessed via the Insomnia Severity Index and the STOP-BANG questionnaire respectively. Average pain intensity over the last two weeks was rated from 0 (no pain) to 100 (very severe). Results Participants with self-reported comorbid sleep disorders reported higher pain scores than individuals with one or no sleep disorder (F(2,3398) = 71.61, p &amp;lt; .001). Among individuals with no previously diagnosed sleep disorder, participants with more insomnia symptoms reported greater pain intensity (F(3,3100) = 201.64, p &amp;lt; .001), as did those with higher scores on the STOP-BANG (F(2,3125) = 46.79, p &amp;lt; .001). Participants with suspected comorbid sleep disorders reported higher pain scores than individuals with either sleep apnea or no sleep disorder, but not insomnia (F(3,2887) = 110.15, p &amp;lt; .001). Conclusion Results suggest that individuals with known sleep disorders report high levels of pain particularly in the context of comorbid sleep apnea and insomnia. Additionally, individuals with suspected, but untreated, sleep disorders also report increased pain. Future research should examine whether treating one of more sleep disorders can improve pain outcomes. Support This work was supported by the National Institute on Aging (K23AG049955, PI: Dzierzewski).

The moderating role of pain catastrophizing on the relationship between partner support and pain intensity: a daily diary study in patients with knee osteoarthritis.

The objective of this study was to examine the day-to-day associations between partner support, pain catastrophizing and pain intensity in individuals with end-stage knee osteoarthritis. In this microlongitudinal cohort study, participants (N = 124) with end-stage knee osteoarthritis completed baseline measures of trait pain catastrophizing and negative affect. Participants also provided daily diary assessments of partner support, pain catastrophizing and pain intensity for a period of 7days using a personal digital assistant. Multilevel analyses revealed that day-to-day fluctuations in pain catastrophizing were associated with pain intensity. Data from multilevel analyses indicated that the main effect of partner support was not significantly associated with pain intensity. Results also indicated the interactions between partner support and both trait and state pain catastrophizing were significant, suggesting that both trait and state pain catastrophizing moderated the relationship between daily partner support and pain intensity. That is, on days when participants experienced low levels of partner support, high catastrophizers reported higher levels of pain intensity than low catastrophizers. In the presence of higher levels of partner support, pain intensity did not differ between high and low catastrophizers. These results are consistent with the Communal Coping Model of pain catastrophizing, and highlight the interpersonal context within which pain catastrophizing impacts pain outcomes. These findings also suggest that future interventions designed to specifically target the dynamic between pain catastrophizing and partner support may improve pain outcomes in individuals with end-stage knee OA.

Are scapulothoracic, glenohumeral and elbow movement and variability in movement related to pain intensity in individuals with chronic shoulder pain?

Are scapulothoracic, glenohumeral and elbow movement and variability in movement related to pain intensity in individuals with chronic shoulder pain?

Mapping the Association between Vitamin D and Low Back Pain: A Systematic Review and MetaAnalysis of Observational Studies

Background: Low back pain (LBP) is the highest contributor to disability worldwide, with current intervention strategies only providing small to moderate analgesic effects. The use of vitamin D supplementation for LBP has gained interest due to its proposed anti-inflammatory and neuromodulatory properties. However, it is still unclear whether vitamin D levels differ between those with and without LBP or if vitamin D levels are associated with pain intensity. Objectives: We aim to investigate the association between vitamin D levels and LBP and to determine if vitamin D levels correlate with pain intensity in individuals with LBP. Study Design: This study was conducted in accordance with the guidelines for performing a Metaanalysis and Systematic Review Of Observational Studies in Epidemiology (MOOSE). Methods: We performed electronic database searches combined keywords relating to vitamin D and LBP in MEDLINE, CINAHL, EMBASE, AMED, WEB OF SCIENCE, and SCOPUS from the earliest record to March 2017. Studies were included if they reported any quantitative measure of vitamin D, such as serum 25-hydroxyvitamin D [25(OH)D], with adequate data in patients with and without LBP or adequate data on pain intensity in patients with LBP. No restriction on the type or duration of LBP, nor the age and gender of patients was applied. Two reviewers independently performed the selection of studies, extracted data, and assessed the methodological quality of the included studies using a modified 15-item Downs and Black checklist. Results: After the removal of duplicates and the screening of titles and abstracts, 105 full texts were evaluated. There were 29 articles included in this systemic review (22 entered into a meta-analysis), including 19 cross-sectional studies, 9 case-control studies, and one single-arm surgical trial where the pre-operative data were used in our analyses. The pooled results from 19 studies showed that individuals with LBP were more likely to have vitamin D deficiency (pooled OR = 1.60, 95% CI: 1.20 - 2.12, P = 0.001, n = 19), severe deficiency (pooled OR = 2.08, 95% CI: 1.19 - 3.64, P = 0.010, n = 7), and lower serum concentrations of 25(OH)D (weighted MD = 3.86, 95% CI: 0.20 - 7.52, P = 0.039, n = 12) compared to those without LBP (where “n” is the number of studies). The association between vitamin D deficiency (pooled OR = 1.83, 95% CI: 1.26 - 2.66, P = 0.002, n = 9) or serum 25(OH)D (weighted MD = 7.64, 95% CI: 4.02 - 11.26, P &lt; 0.001, n = 4) and LBP was stronger for women but failed to be statistically significant for men (pooled OR = 1.06, 95% CI: 0.62 - 1.81, P = 0.213, n = 3). In addition, there were strong associations between vitamin D deficiency and LBP in patients &lt; 60 years old (particularly women). We found minimal evidence to support an association between vitamin D levels and pain intensity in patients with LBP. Limitations: We were unable to investigate whether vitamin D deficiency increases the risk of developing LBP as there were no longitudinal studies included in this review. Conclusion: Vitamin D deficiency is associated with LBP, with stronger associations observed in younger women and those with severe levels of deficiency. The association between vitamin D levels and pain intensity is inconsistent. These results may guide the implementation of future studies on vitamin D supplementation for LBP. PROSPERO Registration No: CRD42016046874. Key words: Vitamin D, low back pain, deficiency, pain intensity, serum 25-hydroxyvitamin D, supplementation, cross-sectional study, case-control study

Self-guided online cognitive behavioral strategies for chemotherapy-induced peripheral neuropathy (CIPN): A multicenter, single blind, randomized, wait-list controlled trial.

e21710 Background: Four in 10 individuals receiving neurotoxic chemotherapy develop chronic painful CIPN, symptoms which negatively influence quality of life and physical function, and may require the withdrawal of effective chemotherapy. However, few recommended pharmacological and no effective non-pharmacological treatments for chronic painful CIPN exist. The purpose of the study was to examine the efficacy of an online cognitive behavioral pain management intervention, the PROactive Self-Management Program for Effects of Cancer Treatment ( PROSPECT), to reduce worst pain intensity in individuals with chronic painful CIPN. The secondary outcomes were average pain intensity, non-painful CIPN symptoms, and impaired function. Methods: Sixty patients with chronic painful CIPN were randomized (1:1 ratio) to receive either 8 weeks of PROSPECT or usual care. A 7-day electronic worst CIPN pain intensity diary was completed at the baseline and eight week time points. At the same time points, participants completed electronic standardized measures of functional impairment, non-painful CIPN symptom severity, and average CIPN pain intensity. Mean change scores from baseline and eight week surveys were compared between groups using ANCOVA adjusting for baseline. Results: Individuals who received the PROSPECT intervention had a mean change in worst pain intensity of -0.94 ( SD = 1.36, Range = -3.29 – 1.29). Those in the control group had a mean change score of 0 ( SD = 1.31, Range = -3.43 – 2.86) ( p = 0.046; d = 0.53) ( n = 38). For the secondary outcomes, no significant mean change score differences were found between groups. Conclusions: PROSPECT use significantly improved worst pain intensity, but not secondary outcomes, in individuals with chronic painful CIPN. A larger study testing PROSPECT is needed to determine if improvements in worst pain intensity may be sustained, to evaluate the effect of the intervention on the secondary outcomes, and to identify mediators of pain-related improvement. If shown to be efficacious with further testing, PROSPECT may be added to pharmacological modalities for the treatment of chronic painful CIPN. Clinical trial information: NCT02760654.

Associations between Measures of Structural Morphometry and Sensorimotor Performance in Individuals with Nonspecific Low Back Pain.

To date, most structural brain imaging studies in individuals with nonspecific low back pain have evaluated volumetric changes. These alterations are particularly found in sensorimotor-related areas. Although it is suggested that specific measures, such as cortical surface area and cortical thickness, reflect different underlying neural architectures, the literature regarding these different measures in individuals with nonspecific low back pain is limited. Therefore, the current study was designed to investigate the association between the performance on a sensorimotor task, more specifically the sit-to-stand-to-sit task, and cortical surface area and cortical thickness in individuals with nonspecific low back pain and healthy controls. Seventeen individuals with nonspecific low back pain and 17 healthy controls were instructed to perform 5 consecutive sit-to-stand-to-sit movements as fast as possible. In addition, T1-weighted anatomic scans of the brain were acquired and analyzed with FreeSurfer. Compared with healthy controls, individuals with nonspecific low back pain needed significantly more time to perform 5 sit-to-stand-to-sit movements (P < .05). Brain morphometric analyses revealed that cortical thickness of the ventrolateral prefrontal cortical regions was increased in patients with nonspecific low back pain compared with controls. Furthermore, decreased cortical thickness of the rostral anterior cingulate cortex was associated with lower sit-to-stand-to-sit performance on an unstable support surface in individuals with nonspecific low back pain and healthy controls (r = -0.47, P < .007). In addition, a positive correlation was found between perceived pain intensity and cortical thickness of the superior frontal gyrus (r = 0.70, P < .002) and the pars opercularis of the inferior ventrolateral prefrontal cortex (r = 0.67, P < .004). Hence, increased cortical thickness was associated with increased levels of pain intensity in individuals with nonspecific low back pain. No associations were found between cortical surface area and the pain characteristics in this group. The current study suggests that cortical thickness may contribute to different aspects of sit-to-stand-to-sit performance and perceived pain intensity in individuals with nonspecific low back pain.

Effectiveness of transcranial direct current stimulation for the management of neuropathic pain after spinal cord injury: a meta-analysis.

To conduct a systematic review and meta-analysis to examine the effect of transcranial direct current stimulation (tDCS) on reducing neuropathic pain intensity in individuals with spinal cord injury (SCI). Medline, CINAHL, EMBASE and PsycINFO databases were searched for all relevant articles published from 1980 to November 2014. Trials were included if (i) tDCS intervention group and a placebo control group were present; (ii) at least 50% of participants in the study had an SCI and there were at least three participants; (iii) participants were aged 18 years or older; and (iv) persistent pain for at least 3 months. Studies were excluded if: (i) the tDCS intervention group was compared with an active treatment group; (ii) there was insufficient reporting detail to enable pooling of data; and (iii) it was a nonclinical trial (that is, reviews, epidemiology, basic sciences). A standardized mean difference (SMD) ± s.e. and 95% confidence interval (CI) was calculated for each outcome of interest and the results were pooled using a fixed or random effects model, as appropriate. Effect sizes were interpreted as: small > 0.2, moderate > 0.5, large > 0.8. Five studies met inclusion criteria of which four were randomized controlled trials and one was a prospective controlled trial. The pooled analysis found a significant effect of tDCS on reducing neuropathic pain after SCI post treatment (SMD = 0.510 ± 0.202; 95% CI, 0.114-0.906; P < 0.012); however, this effect was not maintained at follow-up (SMD = 0.353 ± 0.272; 95% CI, -0.179 to 0.886; P < 0.194). A reduction of 1.33 units on a 10-item scale was observed post treatment. No significant adverse events were reported. Meta-analytic results indicate a moderate effect of tDCS in reducing neuropathic pain among individuals with SCI; however, the effect was not maintained at follow-up. A mean pooled decrease of 1.33 units on a 10-item scale was found post treatment. Several factors were implicated in the effectiveness of tDCS in reducing pain. Due to the limited number of studies and lack of follow-up, more evidence is required before treatment recommendations can be made.

Utilização de diferentes estimulações elétricas para o tratamento da dor em mulheres com disfunção temporomandibular

OBJECTIVE: To analyze pain intensity in individuals with temporomandibular disorder (TMD) who were treated with ten sessions of transcutaneous electrical nerve stimulation (TENS) or high voltage electrical stimulation (HVES). METHODS: Twenty-four women (22.98±1.86 years old) with a diagnosis of TMD in accordance with the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) were selected. 60% of the subjects had a diagnosis of TMD classified as group Ia and 40% as Ia and IIa. They were divided into two groups named the TENS group (TG) and the high voltage group (HVG). Each individual received ten applications of either TENS (10Hz, modulated at 50%, 200µs and motor threshold intensity) or HVES (10Hz, twin pulses of 20µs each at intervals of 100µs between the twin pulses, 100volts and positive pole) twice a week for 30 minutes. To measure the pain intensity, a visual analog scale (VAS) was used. Statistical analyses were performed using Student's t test and simple linear regression. RESULTS: Comparison of the pre and post-TENS conditions showed diminished pain intensity (p<0.05) at most sessions except for sessions 6, 7 and 8. In contrast, HVES reduced the pain intensity at all sessions (p<0.05). Evaluation of the pre-application values showed that both treatments decreased the pain intensity uniformly over the ten sessions (p<0.05). CONCLUSIONS: TENS and HVES both promoted reductions in pain intensity in women with TMD. HVES is a therapeutic resource recommended for such patients.

Anger Expression and Pain: An Overview of Findings and Possible Mechanisms

A tendency to manage anger via direct expression (anger-out) is increasingly recognized as influencing responses to pain. Elevated trait anger-out is associated with increased responsiveness to acute experimental and clinical pain stimuli, and is generally related to elevated chronic pain intensity in individuals with diverse pain conditions. Possible mechanisms for these links are explored, including negative affect, psychodynamics, central adipose tissue, symptom specific muscle reactivity, endogenous opioid dysfunction, and genetics. The opioid dysfunction hypothesis has some experimental support, and simultaneously can account for anger-out's effects on both acute and chronic pain. Factors which may moderate the anger-out/pain link are described, including narcotic use, gender, and genetic polymorphisms. Pain exacerbating effects of trait anger-out are contrasted with the apparent pain inhibitory effects of behavioral anger expression exhibited in anger-provoking contexts. Conceptual issues related to the state versus trait effects of expressive anger regulation are discussed.

Effectiveness of a Home Program of Ischemic Pressure Followed by Sustained Stretch for Treatment of Myofascial Trigger Points

Myofascial trigger points (TPs) are found among patients who have neck and upper back pain. The purpose of this study was to determine the effectiveness of a home program of ischemic pressure followed by sustained stretching for the treatment of myofascial TPs. Forty adults (17 male, 23 female), aged 23 to 58 years (mean=30.6, SD=9.3), with one or more TPs in the neck or upper back participated in this study. Subjects were randomly divided into 2 groups receiving a 5-day home program of either ischemic pressure followed by general sustained stretching of the neck and upper back musculature or a control treatment of active range of motion. Measurements were obtained before the subjects received the home program instruction and on the third day after they discontinued treatment. Trigger point sensitivity was measured with a pressure algometer as pressure pain threshold (PPT). Average pain intensity for a 24-hour period was scored on a visual analog scale (VAS). Subjects also reported the percentage of time in pain over a 24-hour period. A multivariate analysis of covariance, with the pretests as the covariates, was performed and followed by 3 analyses of covariance, 1 for each variable. RESULTS Differences were found between the treatment and control groups for VAS scores and PPT. No difference was found between the groups for percentage of time in pain. A home program, consisting of ischemic pressure and sustained stretching, was shown to be effective in reducing TP sensitivity and pain intensity in individuals with neck and upper back pain. The results of this study indicate that clinicians can treat myofascial TPs through monitoring of a home program of ischemic pressure and stretching.

Comparative reliability and validity of chronic pain intensity measures

Reliable and valid measures of pain are essential for conducting research on chronic pain. The purpose of this longitudinal study was to compare the reliability and validity of several measures of pain intensity. One hundred twenty-three patients with chronic pain were administered telephone interview versions of 0–10 scales of current, worst, least and average pain, immediately prior to beginning a multidisciplinary treatment program. The measures were administered again to these subjects 2 weeks ( n=108), 1 month ( n=106) and 2 months ( n=105) after the end of treatment. The validity (defined as ability to detect changes in pain intensity over the course of treatment up to the 2-month follow-up assessment) and reliability (defined as stability over time in the 2 months after treatment) of these four measures and of composite combinations of these measures were examined. Contrary to prediction, the composite measures did not show a statistically significant superiority to the individual ratings in terms of their ability to detect change in pain intensity from pre-treatment to various points after treatment. The composite scores did, however, show greater stability than did the individual ratings after treatment. The practical conclusions of this study are; (1), individual 0–10 pain intensity ratings have sufficient psychometric strengths to be used in chronic pain research, especially research that involves group comparison designs with relatively large sample sizes, but, (2), composites of 0–10 ratings may be more useful when maximal reliability is necessary, (e.g. in studies with relatively small sample sizes, or in clinical settings where monitoring of changes in pain intensity in individuals is needed).