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Catastrophizing and pain-related fear predict failure to maintain treatment gains following participation in a pain rehabilitation program

imageThe present study explored whether pain-related psychosocial risk factors played a role in determining whether treatment gains were maintained following participation in a rehabilitation intervention for musculoskeletal injury. The study sample consisted of 310 individuals (163 women, 147 men) with work-related musculoskeletal conditions who were enrolled in a physical rehabilitation program. Measures of pain severity, pain catastrophizing and pain-related fear were completed at the time of admission and at the time of discharge. Pain severity was assessed again at 1-year postdischarge. Participants were classified as “recovered” if they showed a decrease in pain of at least 2 points and rated their pain at discharge as less than 4/10. Recovered participants were considered to have failed to maintain treatment gains if their pain ratings increased by at least 2 points from discharge assessment to 1-year follow-up, and they rated their pain as 4/10 or greater at 1-year follow-up. The results of a logistic regression revealed that participants with high posttreatment scores on measures of catastrophizing and fear of pain were at increased risk of failing to maintain treatment gains. The findings suggest that unless end-of-treatment scores on catastrophizing and fear of pain fall below the risk range, treatment-related reductions in pain severity may not be maintained in the long term. The clinical and theoretical implications of the findings are discussed.

Catastrophizing and pain-related fear predict failure to maintain treatment gains following participation in a pain rehabilitation program


Orginally Published At: PAIN Reports

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The dark side of opioids in pain management: basic science explains clinical observation

imageIntroduction:
In the past 2 decades, opioids have been used increasingly for the treatment of persistent pain, and doses have tended to creep up. As basic science elucidates mechanisms of pain and analgesia, the cross talk between central pain and opioid actions becomes clearer.
Objectives:
We aimed to examine the published literature on basic science explaining pronociceptive opioid actions, and apply this knowledge to clinical observation.
Methods:
We reviewed the existing literature on the pronociceptive actions of opioids, both preclinical and clinical studies.
Results:
Basic science provides a rationale for the clinical observation that opioids sometimes increase rather than decrease pain. Central sensitization (hyperalgesia) underlies pain chronification, but can also be produced by high dose and high potency opioids. Many of the same mechanisms account for both central pain and opioid hyperalgesia.
Conclusion:
Newly revealed basic mechanisms suggest possible avenues for drug development and new drug therapies that could alter pain sensitization through endogenous and exogenous opioid mechanisms. Recent changes in practice such as the introduction of titration-to-effect for opioids have resulted in higher doses used in the clinic setting than ever seen previously. New basic science knowledge hints that these newer dosing practices may need to be reexamined. When pain worsens in a patient taking opioids, can we be assured that this is not because of the opioids, and can we alter this negative effect of opioids through different dosing strategies or new drug intervention?

The dark side of opioids in pain management: basic science explains clinical observation


Orginally Published At: PAIN Reports

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Low Load Exercises With Partial Vascular Occlusion Effective for OA Knee Pain

Combining partial vascular occlusion (PVO) with low to moderate-intensity resistance exercise training may be a way for patients with knee OA to participate in quadriceps strengthening.

Low Load Exercises With Partial Vascular Occlusion Effective for OA Knee Pain


Orginally Published At: Musculoskeletal Pain