The purpose of the study is to examine the relationship between the location of the initial onset of back pain as revealed by the subject's pain drawing and the site of maximum muscle tension at rest, while jaw-clenching and during a cold stressor, in men and women. Subjects were 30 males and 30 females divided into three groups of 10 males and 10 females each and designated according to back pain history as no back pain (NBP), upper back pain onset (UBP) and lower back pain onset (LBP). Six bipolar, bilateral electromyographic (EMG) recording sites were instrumented on each subject. EMG levels were recorded from the forehead, forearm, upper back, lower back, thighs and ankles under conditions of rest, jaw-clenching and a cold stressor. Seven hypotheses predicted that EMG levels would distinguish groups and gender of the subjects and that interactions would exist between site of pain onset and EMG elevations.

The effects of a computer program (Health Imagery Technology Systems, HITS) designed to promote attitude and cognitive changes through elicitation of evoked response potentials were evaluated with chronic pain patients. A treatment and control group were used for comparison (52 patients, 22 females, 32 males, mean ages 47). Wechsler Adult Intelligence Scale-Revised subtests, a Semantic Differential scale, the Health Attribution Test, an imagery protocol, the McCoy-Lawlis Pain Drawing, and the Zung Depression scale were used at admission and discharge to measure change. A pre- post-mood thermometer was used with the treatment group. The hypotheses that the treatment group would show significant changes on these measures were tested with a two group repeated measures analysis of variance design. No significant changes were noted for either group on the intellectual measures, on health attitudes, or reports of pain. The similarities subscale showed significant within group variance (F = 5.46, p < .023). One bipolar adjective pair indicated significant differences (F = 4.79, p < .035), possibly a result of chance. One of seven imagery measures suggested a significant improvement in strength of imagery for the treatment group (F = 18.2, p < .00008). Both groups showed significantly improved imagery of body defenses (F = 4.58, £ < .037) and significantly reduced depression scores (F = 15.93, p < .000021). A mood thermometer was measured for the treatment group alone and five situational mood changes were significant in predicted directions. Post hoc discriminant analysis showed significant differences only on one adjective pair (F = 9.75, p < .0029). No combination of variables added to the prediction of group membership. Overall, the effects of the HITS program did not seem strong enough to indicate its value as a treatment modality in chronic pain populations beyond current treatment. It did indicate some significant situational mood effects in positive directions.

京都大学 / 0048 / 新制・課程博士 / 博士(人間健康科学) / 甲第22836号 / 人健博第78号 / 新制||人健||6(附属図書館) / 京都大学大学院医学研究科人間健康科学系専攻 / (主査)教授 高桑 徹也, 教授 木下 彩栄, 教授 村井 俊哉 / 学位規則第4条第1項該当 / Doctor of Human Health Sciences / Kyoto University / DFAM

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BACKGROUND: Health issues facing university students have been an area of increasing concern, with the frequency of anxiety and depression-related disorders rising significantly over the past few years. One characteristic that has been given increasing attention is perfectionism and its contribution to compromised mental functioning. Student health has generally been found to be poor compared to their working counterparts; however, the prevalence and influence of pain among university students still remains misunderstood. This study aims to investigate the co-occurrence of pain and mental health problems, specifically the role of perfectionism, in young adults, aged 18-26, attending college or university within the United States. METHODS: 105 University students from across the United States were recruited to participate in an online survey. Frequency of pain complaints, prevalence of common body areas of pain, and intensity of pain were assessed. Pain behavior, pain interference, anxiety, depression, and self-efficacy were assessed by validated PROMIS measures. Trait dimensions of perfectionism were assessed and analyzed in relation to the other characteristics being evaluated. Group differences between pain groups (no pain vs. pain present; both chronic and non-chronic pain) were assessed using independent samples t-tests. Significant associations between measured variables were determined using bivariate correlations. RESULTS: More than half of the sample displayed clinical levels of anxiety. 76% of the sample reported feeling pain in at least one area of their body, with 72% of the pain group experiencing chronic pain. The pain group had greater anxiety, depression, and pain interference when compared to the pain-free group. From the trait dimensions of perfectionism, Self-Oriented Perfectionism and Socially-Prescribed Perfectionism were positively correlated with anxiety, depression, and pain interference. Only 6% of the sample reported being registered with any school support services. CONCLUSION: This pilot study demonstrated a high prevalence of pain, anxiety, and perfectionism traits in university students, while bringing their low engagement with support resources into recognition. Results suggest the need to provide additional comprehensive resources and support for university students, especially those coping with pain issues. Further research should examine the relationship between pain, perfectionism, and mental health in order to implement appropriate interventions for this vulnerable population. / 2022-06-04T00:00:00Z

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Chronic pain is common and frequently interferes with people’s regular functioning and reduces quality of life. Though pharmacological approaches are used most frequently to treat pain-related issues, the side effects of these medications often lead to other problems. Group therapy has been used and studied for decades in treating pain though it’s general efficacy for addressing pain is not clear. Objectives: to determine group therapy’s efficacy for patients with pain-related issues and whether the effects are moderated by study, patient, leader, or group characteristics. Method: potential articles were selected from searches completed in major databases based on a set of inclusion criteria. A random effects meta-analysis was conducted, and potential moderators were analyzed. Results: we analyzed 57 studies representing 8,933 patients receiving group therapy for pain which produced a significant, small effect (g = 0.28) for reducing pain intensity. Various secondary outcomes such as pain frequency, interference with activities of daily living, physical functioning, catastrophizing, self-efficacy, anxiety, depression, and quality of life were also found to improve significantly. Four significant moderating variables were found to include pain measure used, gender composition, number of sessions, and presence of pain diagnosis. Discussion: results are discussed and compared to those of past meta-analyses regarding both chronic pain and group therapy. Implications for practice and research are provided.

Background: Chronic pain is considered to be a major health issue globally, whereof Italy is one of the highest ranked countries regarding chronic pain prevalence in Europe. Chronic pain has a negative impact on quality of life and functions on a biological, social, and psychological level, which concerns all health professionals. For this reason, health care providers have an important role working with these patients. Aim: This study aims to explore and bring knowledge about Italian physical therapists’ experiences of working with patients with chronic pain. Design: A qualitative method with an exploratory and descriptive design, based on semi structured interviews was used for the purpose of understanding the physical therapists’ experiences of working with patients with chronic pain. Furthermore, the data was analyzed by a qualitative content analysis and had an inductive approach. Results: The analysis generated five categories: The importance of trust and relations, Professional challenges and positive potentials, Physical therapists’ reflection on their own contribution, Physical therapists’ and patients’ different viewpoints and The view on the profession.   Conclusion: This study revealed that Italian physical therapists regard themselves to play a crucial part in the work with patients with chronic pain. It emphasizes the essential parts of the work of gaining the patient’s trust and forming an alliance. Despite the physical therapists’ contribution to these patients, there exist factors that frequently prevent the rehabilitation from being successful. The results could be of value for future physical therapists working with chronic pain. Keywords: Physical therapy, experience, chronic pain, Italy / Bakgrund: Långvarig smärta beräknas vara ett stort globalt hälsoproblem och Italien är ett av de länder i Europa med högst prevalens. Långvarig smärta har en negativ inverkan på livskvalitet och biologiska, sociala samt psykologiska funktioner. Detta berör alla vårdgivare, som har en betydelsefull roll i att upprätthålla och förbättra funktionen samt livskvaliteten hos dessa patienter. Syfte: Denna studie syftar till att utforska och tillföra kunskap om italienska fysioterapeuters upplevelser och erfarenheter av att arbeta med patienter med långvarig smärta. Metod: En kvalitativ metod med explorativ och deskriptiv design, baserad på sju semistrukturerade intervjuer användes i syfte att få djupare förståelse för fysioterapeuters upplevelser och erfarenheter av att arbeta med patienter med långvarig smärta. Vidare, analyserades data med en kvalitativ innehållsanalys med en induktiv ansats. Resultatsammanfattning: Dataanalysen genererade i fem kategorier: The importance of trust and relations, Professional challenges and positive potentials, Physical therapists’ reflection on their own contribution, Physical therapists’ and patients’ different viewpoints och The view on the profession.   Slutsats: Denna studie påvisar att fysioterapeuter i Italien anser sig har en betydelsefull roll för patienter med långvarig smärta. Trots många utmaningar upplevde fysioterapeuterna deras insats som väsentlig för att förbättra patienternas vy på livet och deras livskvalitet. Studien ger insikt i vilka erfarenheter och upplevelser fysioterapeuterna har i arbetet med patientgruppen. Resultatet belyser svårigheter och möjligheter med att arbeta med dessa patienter, vilket kan vara värdefullt för hur fysioterapeuter arbetar med långvarig smärta i framtiden. Nyckelord: Physical therapy, experience, chronic pain, Italy

Pain can have a devastating effect on the quality of life of patients in palliative medicine. Thus far, majority of research has been centered on opioid-based pain management, with a limited empirical evidence for the use of nonopioid medications in palliative care. However, opioid and nonopioid medications such as nonsteroidal anti-inflammatory drugs have their limitations in the clinical use due to risk of adverse effects, therefore, there is a need for more research to be directed to finding an alternative approach to pain management in comfort care setting. The purpose of this article is to discuss a potential new drug that would adequately alleviate pain and enhance quality of life without significant risks of adverse effects that would limit its use. Naltrexone is a reversible competitive antagonist at μ-opioid and κ-opioid receptors, which when used at standard doses of 50 to 150 mg was initially intended for use in opioid and alcohol use disorders. However, it was discovered that its use in low doses follows alternate pharmacodynamic pathways with various effects. When used in doses of 1 to 5 mg it acts as a glial modulator with a neuroprotective effect via inhibition of microglial activation. It binds to Toll-like receptor 4 and acts as an antagonist, therefore inhibiting the downstream cellular signaling pathways that ultimately lead to pro-inflammatory cytokines, therefore reducing inflammatory response. Its other mode of action involves transient opioid receptor blockade ensuing from low-dose use which upregulates opioid signaling resulting in increased levels of endogenous opioid production, known as opioid rebound effect. Low dose naltrexone has gained popularity as an off-label treatment of several autoimmune diseases including multiple sclerosis and inflammatory bowel disease, as well as chronic pain disorders including fibromyalgia, complex regional pain syndrome, and diabetic neuropathy. Low-dose naltrexone (LDN) may also have utility in improving mood disorders and the potential to enhance the quality of life. This article will therefore propose the potential off-label use of LDN in management of nonmalignant pain in the palliative medicine setting.

OBJECTIVE: To examine how parent factors assessed at a multidisciplinary pain clinic evaluation predict child psychological and functional outcomes at four-month follow-up. After controlling for child baseline functioning, we predicted that parent distress and behavior would significantly predict child pain-related psychological and functional outcomes. METHODS: Among the 321 patients with chronic pain (ages 8-17) and their parents who presented for a multidisciplinary evaluation, 195 completed measures at baseline and at four-month follow-up via REDCap surveys. Patients completed measures of pain catastrophizing, pain-related fear and avoidance, generalized anxiety, depressive symptoms, functional disability, and somatic symptoms. Parents completed measures of pain catastrophizing, pain-related fear and avoidance, protective responses to pain, and child school functioning. Associations between parent and child distress and behavior were examined cross-sectionally at the time of the pain clinic evaluation, and longitudinally (i.e., parent at evaluation and child at follow-up). Lastly, using step-wise hierarchical regression analyses, we controlled for child baseline measures and examined the degree to which parent distress and behaviors predicted child outcomes at four-month follow-up. RESULTS: As hypothesized, parent distress and behavior was correlated with child distress and functioning at the time of evaluation with many of these associations persisting at four-month follow-up. For the regression analyses, after controlling for baseline child depressive symptoms, parent avoidance of activities (b = .24, p < .01) and parent helplessness (b = -.14, p < .10) reported at baseline significantly predicted child depressive symptoms at four-month follow-up. After controlling for baseline child pain catastrophizing, only parent pain-related fear reported at baseline (b = .15, p < .05) emerged as a significant predictor of child pain catastrophizing at four-month follow-up. Lastly after controlling for child school functioning at baseline, parent avoidance of activities (b = -.27, p < .01) and parent protective behavior (b = -.18, p < .05) reported at baseline emerged as significant predictors of child school functioning at four-month follow-up. Parent distress and behavior did not significantly predict child anxiety, pain-related fear, avoidance of activities, somatic symptoms, or functional disability at follow-up, after controlling for baseline functioning. CONCLUSIONS: Across parent factors, parent helplessness, avoidance of activities, pain-related fear, and protective behavior emerged as predictors of child outcomes four months after a multidisciplinary pain clinic evaluation. The results from this study provide initial data regarding the influence of parent emotions and behavior on child function over time. In addition, the results suggest potential targets for pain treatment interventions that go beyond the typical focus on child emotions and behaviors to include influential parent factors.