Arguelles, Lester M./ Afari, Niloofar/ Buchwald, Dedra S./ Clauw, Daniel J./
Furner, Sylvia/ Goldberg, Jack. A twin study of posttraumatic stress disorder symptoms and chronic widespread pain. Pain 2006, 124, 150–157.
Abstract
Previous studies of the association between posttraumatic stress disorder (PTSD) and chronic widespread pain (CWP) or fibromyalgia have not examined the role of familial or genetic factors. The goals of this study were to determine if symptoms of PTSD are related to CWP in a genetically informative community-based sample of twin pairs, and if so, to ascertain if the association is due to familial or genetic factors. Data were obtained from the University of Washington Twin Registry, which contains 1042 monozygotic and 828 dizygotic twin pairs. To assess the symptoms of PTSD, we used questions from the Impact of Events Scale (IES). IES scores were partitioned into terciles. CWP was defined as pain located in 3 body regions lasting at least 1 week during the past 3 months. Random-effects regression models, adjusted for demographic features and depression, examined the relationship between IES and CWP. IES scores were strongly associated with CWP (P < 0.0001). Compared to those in the lowest IES tercile, twins in the highest tercile were 3.5 times more likely to report CWP. Although IES scores were associated with CWP more strongly among dizygotic than among monozygotic twins, this difference was not significant. Our findings suggest that PTSD symptoms, as measured by IES, are strongly linked to CWP, but this association is not explained by a common familial or genetic vulnerability to both conditions. Future research is needed to understand the temporal association of PTSD and CWP, as well as the physiological underpinnings of this relationship.

Banks, William A. Mediation of chronic pain: Not by neurons alone. Pain 2006, 124, 1–2.

Block, Keith I. The Demise of the Super-aspirins: An Opportunity for Integrative Medicine? Integrative Cancer Therapies 2005, 4(1), 5-7.
The recent findings of significant cardiac risks with longterm use of the selective COX-2 inhibitors and naproxen leave many patients without access to drugs they may depend on for sustained management of pain. These cardiac risks can arise from disturbances in the ratio of prostacyclin and thromboxane A-2. Integrative medicine offers a variety of interventions that do not disrupt this ratio, including herbs, nutriceuticals, mind-body strategies, and physical care. Clinical studies for evaluating these interventions, and research on sustainable production of those that are natural substances, should be given greater funding priority at this
time.

Bowsher, David. A Case of Visceral Post-Stroke Pain. J Pain Symman 2006, 7(007), 398-400.

Breen, Alan/ Austin, Helen/ Campion-Smith, Charles/ Carr, Eloise/ Mann, Eileen.  ‘‘You feel so hopeless’’: A qualitative study of GP management of acute back pain. European Journal of Pain 2007, 11, 21–29.
Abstract
Background: Biopsychosocial management of non-specific back pain in general practice has been problematical, with frequent inappropriate referral for imaging and secondary care interventions and lack of self-confidence in the ability to provide evidence-based care.
Aims: To examine GP attitudes to managing back pain as a biopsychosocial problem in order to inform future educational strategies that may improve practice.
Methods: Twenty-one GPs from separate practices within the Dorset and Somerset Strategic Health Authority area (UK) participated in telephone interviews leading to the development of vignettes to refine the theoretical framework for subsequent focus group interviews about evidence-based back pain management. Transcripts were analysed thematically.
Results: There were 5 main emergent themes. These were generally negative and dominated by concerns about doctor–patient interaction. They included feelings of frustration, mismatches of perceptions in the doctor–patient relationship, problems in relation to time, challenges and discord between stakeholders in the process (for example, over sickness certification) and a lack of resources for education, awareness and local services to refer to. Psychosocial aspects of the actual care process were rarely raised. Participants
favoured education that is multidisciplinary, in small group format and involves the participation of patients.
Conclusions: This study illustrates the difficulties that GPs may have in applying the relevant evidence for the successful management of back pain. A desire to avoid conflict in the relationship with patients explained much of the problem of implementing evidence in general practice. This indicates a need for insightful educational strategies that involve active GP participation.

Castel, Antoni/ Pérez, Magdalena/ Sala, José/ Padrol, Anna/ Rull, Maria. Effect of hypnotic suggestion on .bromyalgic pain: Comparison between hypnosis and relaxation. European Journal of Pain 2007, 11, 463–468.
Abstract
The main aims of this experimental study are: (1) to compare the relative effects of analgesia suggestions and relaxation suggestions on clinical pain, and (2) to compare the relative effect of relaxation suggestions when they are presented as ‘‘hypnosis’’ and as ‘‘relaxation training’’. Forty-five patients with fibromyalgia were randomly assigned to one of the following experimental conditions: (a) hypnosis with relaxation suggestions; (b) hypnosis with analgesia suggestions; (c) relaxation. Before and after the experimental session, the pain intensity was measured using a visual analogue scale (VAS) and the sensory and affective dimensions were measured with the McGill Pain Questionnaire. The results showed: (1) that hypnosis followed by analgesia suggestions has a greater effect on the intensity of pain and on the sensory dimension of pain than hypnosis followed by relaxation suggestions; (2) that the effect of hypnosis followed by relaxation suggestions is not greater than relaxation. We discuss the implications of the study on our understanding of the importance of suggestions used in hypnosis and of the differences and similarities between hypnotic relaxation and relaxation training.

Colloca, Luana/ Benedetti, Fabrizio. How prior experience shapes placebo analgesia. Pain 2006, 124, 126–133.
Abstract
Some studies indicate that placebo analgesia is stronger when pre-conditioning with effective analgesic treatments is performed, thereby suggesting that the placebo response is a learning phenomenon. Here we further tested this hypothesis in order to better understand when and how previous experience affects the placebo analgesic response. To do this, we used a conditioning procedure whereby the intensity of painful stimulation was reduced surreptitiously, so as to make the subjects believe that an analgesic treatment was effective. This procedure induced strong placebo responses after minutes, and these responses, albeit reduced, lasted up to 4–7 days. In addition, in a second group of subjects we repeated the same conditioning procedure 4–7 days after a totally ineffective analgesic treatment, and found that the placebo responses were remarkably reduced compared to the first group. Thus we obtained small, medium and large placebo responses, depending on several factors, such as the previous positive or negative experience of an analgesic treatment and the time lag between the treatment and the placebo responses. We also ran extinction trials, and found that these effects did not undergo extinction in a time span of several minutes. These findings indicate that placebo analgesia is finely tuned by prior experience and these effects may last, albeit reduced, several days. These results emphasize that the placebo effect is a learning phenomenon in which many factors come into play, and may explain the large variability of the placebo responses that is found in many studies.

Cronje, Ruth J./ Williamson, Owen D. Is Pain Ever ‘‘Normal’’? Clin J Pain 2006, 22, 692–699.
Abstract: This article analyzes the Pain Terminology adopted by the International Association for the Study of Pain (IASP), noting that most of their pain categories are defined in terms of a reference standard of ‘‘normal’’ pain. Given the lack of any officially adopted operational definition of the word ‘‘normal,’’ we argue that the use of this word expresses and maintains a
paradigm that drives many clinicians’ reasoning about their patients’ pain. We offer evidence that this uninterrogated paradigm is being tacitly used to differentiate legitimate pain reports from malingering and drug seeking. We consider this unsubstantiated ‘‘folk’’ sense of ‘‘normal’’ in light of evidence based, rationalized prototypes based on statistical analysis of empirical evidence. We conclude that evidence for consistency in the experience and expression of pain and for clinician accuracy in evaluating the veracity of that pain is lacking; therefore, the logical preconditions needed for a rationalized, evidence-based prototype of ‘‘normal’’ pain have yet to be met. We conclude that the use of ‘‘normal’’ as a reference standard leads to ineffective and inhumane management of patient pain and to the danger that third parties, such as insurance companies and drug enforcement agencies, will use this unsubstantiated reference standard to arbitrarily limit pain therapy options. The authors recommend that the word ‘‘normal’’ be expunged from the International Association for the Study of Pain, Pain Terminology.

Eisenberger, Naomi I./ Jarcho, Johanna M./ Lieberman, Matthew D./ Nalibo, Bruce D. An experimental study of shared sensitivity to physical pain and social rejection. Pain 2006, 126, 132–138.
Abstract
Recent evidence points to a possible overlap in the neural systems underlying the distressing experience that accompanies physical pain and social rejection (Eisenberger et al., 2003). The present study tested two hypotheses that stem from this suggested overlap, namely: (1) that baseline sensitivity to physical pain will predict sensitivity to social rejection and (2) that experiences that heighten social distress will heighten sensitivity to physical pain as well. In the current study, participants’ baseline cutaneous heat pain unpleasantness thresholds were assessed prior to the completion of a task that manipulated feelings of social distress. During this task, participants played a virtual ball-tossing game, allegedly with two other individuals, in which they were either continuously included (social inclusion condition) or they were left out of the game by either never being included or by being overtly excluded (social rejection conditions). At the end of the game, three pain stimuli were delivered and participants rated the unpleasantness of each. Results indicated that greater baseline sensitivity to pain (lower pain unpleasantness thresholds) was associated with greater self-reported social distress in response to the social rejection conditions. Additionally, for those in the social rejection conditions, greater reports of social distress were associated with greater reports of pain unpleasantness to the thermal stimuli delivered at the end of the game. These results provide additional support for the hypothesis that pain distress and social distress share neurocognitive substrates. Implications for clinical populations are discussed.

Elklit, Ask/ Jones, Allan. The Association Between Anxiety and Chronic Pain After Whiplash Injury Gender-specific Effects. Clin J Pain 2006, 22, 487–490.
Objective: There is increasing evidence to suggest that anxiety is related more strongly to chronic pain experience in men relative to women. The aim of the present study was to examine for the first time gender-specific associations between anxiety and chronic pain experience in men and women exposed to whiplash trauma.
Method: One thousand seven hundred and nine people with whiplash (1349 women, 360 men) belonging to the Danish Society for Polio, Traffic, and Accident Victims completed a battery of questionnaires measuring demographic, psychologic, and pain-related factors (including frequency of painful episodes, level of pain interference, number of anatomic regions in which pain was felt, and the level of general disability).
Results: Anxiety was found to be positively related to the level of general disability to a significantly stronger magnitude in men compared with women. A trend difference in correlation magnitude was also found between men and women when comparing anxiety with pain frequency, with the magnitude of correlation being higher in men.
Discussion: The stronger association between anxiety and symptoms of whiplash trauma in men compared with women may be due to gender differences in the attribution of anxiety related autonomic arousal as symptoms of whiplash injury. Alternatively, anxiety may differentially affect the willingness of men and women to report pain and other health indices. Anxiety is an important factor in understanding gender differences in whiplash-related symptoms such as chronic pain and disability, and requires further investigation.

Fernández-de-las-Peñas, César/ Alonso-Blanco, Cristina/ Cuadrado, Maria Luz/ Miangolarra, Juan Carlos/ Barriga, Francisco J./ Pareja, Juan A.
Are Manual Therapies Effective in Reducing Pain From Tension-Type Headache? A Systematic Review. Clin J Pain 2006, 22, 278–285.
Objectives: A systematic review was performed to establish whether manual therapies have specific efficacy in reducing pain from tension-type headache (TTH).
Methods: Computerized literature searches were performed in MEDLINE, EMBASE, AMED, MANTIS, CINAHL, PEDro, and Cochrane databases. Papers were included if they described clinical (open noncontrolled studies) or randomized controlled trials in which any form of manual therapy was used for TTH, and if they were published after 1994 in the English language. The methodologic quality of the trials was assessed using the PEDro scale. Levels of scientific evidence, based on the quality and the outcomes of the studies, were established for each manual therapy: strong, moderate, limited, and inconclusive
evidence.
Results: Only six studies met the inclusion criteria. These trials evaluated different manual therapy modalities: spinal manipulation (three trials), classic massage (one trial), connective tissue manipulation (two trials), soft tissue massage (one trial), Dr. Cyriax’s vertebral mobilization (one trial), manual traction (one trial), and CV-4 craniosacral technique (one trial). Methodologic PEDro quality scores ranged from 2 to 8 points out of a theoretical maximum of 10 points (mean=5.8±2.1). Analysis of the quality and the outcomes of all trials did not provide rigorous evidence that manual therapies have a positive effect in
reducing pain from TTH: spinal manipulative therapy showed inconclusive evidence of effectiveness (level 4), whereas soft tissue techniques showed limited evidence (level 3).
Conclusions: The authors found no rigorous evidence that manual therapies have a positive effect in the evolution of TTH. The most urgent need for further research is to establish the efficacy beyond placebo of the different manual therapies currently applied in patients with TTH.

Hadjimichael, Olympia/ Kerns, Robert D./ Rizzo, Marco A./ Cutter, Gary/ Vollmer, Timothy. Persistent pain and uncomfortable sensations in persons with multiple sclerosis. Pain 2007, 127, 35–41.
Abstract
The experience of pain has been documented in small studies of individuals with multiple sclerosis (MS). The present study examines the prevalence of persistent pain and uncomfortable sensations among participants in the large North American Research Committee on MS (NARCOMS) Patient Registry. Registrants (10,176) responded to a questionnaire on pain and 7579 reported experiencing some level of pain during the month prior to the survey. Among the respondents 49% reported mild to severe pain and 49% of those indicated severe pain. Increased pain intensity was positively associated with gender (more women), multiple pain sites (51% of the severe pain group reported four or more pain sites), and constancy of pain (44% among the group with severe pain). There was also a positive association with increased MS-related disability, relapsing-worsening type of MS, and depression. Respondents with severe pain made greater use of the healthcare system and of prescribed analgesics, but were less likely to be satisfied with their doctors’ efforts to manage their pain. About one-third of the patients with moderate pain and 18% of those with severe pain reported no consultations for their pain. The effects of pain severity were fully evident in the respondents’ daily life, their work, mood, recreational activities and enjoyment of life. Our results indicate that the high prevalence of MS-related severe pain, low satisfaction with management of intense pain, and the perceived interference with quality of life indicators necessitate greater attention by healthcare providers to the management of pain and uncomfortable sensations in the MS population.

Hirsh, Adam T./ George, Steven Z./ Riley, Joseph L./ Robinson, Michael E.
An evaluation of the measurement of pain catastrophizing by the coping strategies questionnaire. European Journal of Pain 2007, 11, 75–81.
Abstract
Measurement and conceptual issues of pain catastrophizing have been raised in the literature. The issues of construct redundancy and measurement overlap have received particular attention, with suggestions that measures of pain catastrophizing are confounded with measures of negative mood, namely depression. The current study sought to investigate these issues in the coping strategies questionnaire-catastrophizing subscale (CSQ-CAT), a widely used measure of pain catastrophizing. Chronic pain patients (n = 152) were recruited from the University of Florida pain clinics and completed a battery of  psychological measures. Regression analyses indicated that measures of depression, anxiety, and anger accounted for 69% and 19% of the variance in measures of pain catastrophizing and pain, respectively. Trait anger and the cognitive and fearful dimensions of depression and anxiety were uniquely
associated with pain catastrophizing. After controlling for measures of negative mood, pain catastrophizing contributed minimally to the prediction of pain. This study suggests that the CSQ-CAT is highly related to measures of negative mood and raises doubts about its measurement of the construct of pain catastrophizing. Results also provide support for theoretical accounts of the relationships between pain catastrophizing, negative mood, and pain. Clinical implications, future research directions, and alternative measures of pain catastrophizing are discussed.

Jackson, Philip L./ Rainville, Pierre/ Decety, Jean. To what extent do we share the pain of others? Insight from the neural bases of pain empathy. Pain 125 (2006) 5–9.

Jellema, Petra/ van der Windt, Daniëlle A.W.M./ van der Horst, Henriëtte E./ Twisk, Jos. W.R./ Stalman, Wim A. B./ Bouter, Lex M. Should treatment of (sub)acute low back pain be aimed at psychosocial prognostic factors? Cluster randomised clinical trial in general practice. BMJ 2005, 331, 84. bmj.com.
Abstract
Objective To compare the effects of a minimal intervention strategy aimed at assessment and modification of psychosocial prognostic factors and usual care for treatment of (sub)acute low back pain in general practice.
Design Cluster randomised clinical trial.
Setting 60 general practitioners in 41 general practices.
Participants 314 patients with non-specific low back pain of less than 12 weeks’ duration, recruited by their general practitioner.
Interventions In the minimal intervention strategy group the general practitioner explored the presence of psychosocial prognostic factors, discussed these factors, set specific goals for reactivation, and provided an educational booklet. The consultation took about 20 minutes. Usual care was not standardised.
Main outcome measures Functional disability (Roland-Morris disability questionnaire), perceived recovery, and sick leave because of low back pain assessed at baseline and after 6, 13, 26, and 52 weeks.
Results The dropout rate was 8% in the minimal intervention strategy group and 9% in the usual care group. Multilevel analyses showed no significant differences between the groups on any outcome measure during 12 months of follow-up in the whole group or in relevant subgroups (patients with high scores on psychosocial measures at baseline or a history of frequent or prolonged low back pain).
Conclusion This study provides no evidence that (Dutch) general practitioners should adopt our new treatment strategy aimed at psychosocial prognostic factors in patients with (sub)acute low back pain. Further research should  examine why our new strategy was not more effective than usual care.

Kulkarni, B./ Bentley, D.E./ Elliott, R./ Julyan, P.J./ Boger, E./ Watson, A./ Boyle, Y./ El-Deredy, W./  Jones, A.K.P. Arthritic Pain Is Processed in Brain Areas Concern With Emotions and Fear. Arthritis & Rheumatism April 2007, 56(4), 1345-54.

Leiknes, Kari A./ Finset, Arnstein/ Moum, Torbjørn/ Sandanger, Inger.
Course and predictors of medically unexplained pain symptoms in the general population. Journal of Psychosomatic Research 2007, 62, 119– 128.
Abstract
Objective: The objective of this study was to explore the course and the predictors of clinically significant medically unexplained pain symptoms (MUS-pain) within the 6 months preceding the interviews at baseline and on follow-up in the general population.
Methods: A Norwegian general population study of 605 persons interviewed with the Composite International Diagnostic Interview Somatoform Section was conducted in 1989/1990 (baseline), and 421 persons (69.6% response rate; 242 women and 179 men) were reinterviewed in 2000/2001 (follow-up). Cases of recent MUS-pain compared with those at baseline were assessed on follow-up. Four blockwise logistic regression analyses were undertaken to find predictors (such as stressful life events, living alone, depression and anxiety, and physical morbidity) for recent MUS-pain in 2001.
Results: A small “stable” group of recent MUS-pain sufferers (8% of all reinterviewed and 33.6% of those with recent MUS-pain at baseline) was evident. In this group almost all were women. In addition to female gender being a significant ( P<.05) marker of recent MUS-pain (which gives a twofold-higher risk compared with men), only depression—not the occurrence of prior recent MUS-pain—remained a significant ( P<.05) predictor in the final model, increasing the likelihood of having recent MUS-pain by threefold. Conclusion: The prognosis of MUS-pain is relatively good, except for a small group (mainly women) that is prone to chronicity. Clinicians should examine for depression when confronted with MUS-pain patients and should be aware of the twofold-higher risk in women for persistent MUS-pain over a long time.

Leonard, Michelle T./ Cano, Annmarie. Pain affects spouses too: Personal experience with pain and catastrophizing as correlates of spouse distress. Pain 2006, 126, 139–146.
Abstract
Chronic pain has adverse effects on individuals with chronic pain (ICPs) as well as their family members. Borrowing from an empathy model described by Goubert et al. (2005), we examined top-down and bottom-up factors that may be related to psychological well-being in the spouses of ICPs. A diverse community sample of 113 middle-aged spouses of individuals with chronic pain (ICPs) completed measures on pain severity and spouse pain catastrophizing (PCS-S; Cano et al., 2005). Results showed that almost half (48.7%) of spouses reported chronic pain themselves and that pain in the spouse accounted for within-couple differences on psychological distress. That is, in couples where only the ICP reported pain, ICP psychological distress was greater than their spouses. However, when both partners reported chronic pain, there was no significant difference in psychological distress between partners. Hierarchical regression analyses showed that spouse magnification catastrophizing was associated with depressive and anxiety symptoms, and that helplessness catastrophizing was associated with depressive symptoms for spouses of ICPs who also reported chronic pain but not for spouses of ICPs without chronic pain. The results are discussed in light of interpersonal processes that may affect spouses’ distress.

Leong, Ian Yi-Onn/ Nuo, Tan Huei. Prevalence of Pain in Nursing Home Residents With Different Cognitive and Communicative Abilities. Clin J Pain Feb 2007, 23(2), 119-127.
Objectives: To determine the prevalence of pain and its impact among nursing homes residents with different cognitive and communication abilities.
Design: Cross-sectional study.
Setting: Three nursing homes in Singapore.
Participants: Residents aged 65 years and above, without a recent change in their cognitive status.
Measurements: Self-reports were obtained whenever possible. Pain severity was measured with the Pain Assessment in Advanced Dementia scale (categorized version) among the uncommunicative. Residents were also assessed with the shortform version of the Geriatric Depression Scale, the Cornell Scale for Depression in Dementia, the state portion of the Spielberger State-Trait Anxiety Inventory, and the Human Activities Profile.
Results: Pain prevalence did not differ between the communicative resident with normal cognition (48.7%), mildly impaired cognition (46.5%), or severely impaired cognition (42.9%). However, the latter 2 groups reported more acute pain than those with normal cognition (7.9% to 14.1% vs. 2.5%). Those with impaired cognition reported constant pain more often, reported fewer total sites of pain, and had more frequent and more severe pain. Regardless of cognitive status, 73.3% to 100% of residents had significant scores on depression or anxiety measures when they reported pain-related mood disturbance. Pain-related reduction in activity was associated with a lower Human Activities Profile score. Sixteen of 36 uncommunicative residents had pain on the Pain Assessment in Advanced Dementia and at least 12 of them had significant mood disturbance.
Conclusions: Cognitive status does not affect pain prevalence; however, it affects the chronicity and characteristics of reported pain. Self-report of pain-related mood involvement is associated with significant mood scores.

Liebenson, Craig. Self-Management: Patient’s Section-Exercises for anterior knee pain. Journal of Bodywork and Movement Therapies 2006 10, 312–313.

Liebregts, Tobias/ Adam, Birgit/ Bertel, Anton/ Lackner, Carolin/ Neumann, Jens/ Talley, Nicholas J./ Gerken, Guido/ Holtmann, Gerald. Psychological stress and the severity of post-inflammatory visceral hyperalgesia. European Journal of Pain 2007,11, 216–222.
Abstract
Objectives: Lowered visceral sensory thresholds are a key finding in at least a subgroup of patients with functional bowel disorders. Stress and inflammation contribute to this altered visceral sensory function. We aimed to elucidate the role of repetitive stress and acute mucosal inflammation, alone and in combination, on sensory function.
Methods: In randomized order, trinitrobenzenesulfonic acid (TNBS) plus the equal amount of ethanol or saline were instilled into the colorectum of female Lewis rats. Colorectal distensions (CRD) were performed with a barostat device (3 min/40 mmHg); to quantify the visceromotor response (VMR) to CRD, electromyographic activity (EMG) of the abdominal muscles was recorded. In randomized order, equal numbers of both treatment groups underwent either seven days (1 h/day) repetitive water avoidance stress (WAS) or sham WAS. CRD’s were conducted 28 days later. Colonic tissue samples were obtained to characterize inflammation and blood samples were taken at day 28 to measure plasma IL-2 levels by enzyme-linked immunosorbent assay (ELISA).
Results: Compared to controls (662 ± 114 μV) TNBS (1081 ± 227 μV), WAS (1366 ± 125 μV) and the combination of both (1477 ± 390 μV) significantly augmented the VMR to CRD. TNBS and/or WAS caused significant inflammatory changes at day 5, while only TNBS + WAS also showed signs of mucosal inflammation on day 14 and significantly elevated IL-2 levels on day 28.
Conclusions: Stress and inflammation cause long lasting alterations of visceral sensory function. Concomitant stress further increases post-inflammatory visceral hyperalgesia.

Lyvers, Michael/ Barling, Norman/ Harding-Clark, Jill. Effect of belief in “psychic healing” on self-reported pain in chronic pain sufferers. Journal of Psychosomatic Research 2006, 60, 59– 61.
Abstract
Objective: The “psychic healing” ability of a well-known Australian psychic was subjected to a televised experimental test.
Methods: Twenty volunteers suffering from chronic pain were recruited by newspaper advertisements. Half were randomly assigned to the treatment or control condition using a double-blind procedure.
Results: Comparison of pre- and posttreatment McGill Pain Questionnaire ratings indicated no effect of psychic healing. However, pretreatment questionnaire ratings of belief in psychic healing and related phenomena were significantly correlated with improvement in McGill Pain Questionnaire ratings irrespective of treatment condition.
Conclusion: Results suggest that anecdotal reports of effective psychic healing and “faith healing” are attributable to the power of belief.

Malmgren-Olsson, Eva-Britt/ Bergdahl, Jan. Temperament and Character Personality Dimensions in Patients With Nonspecific Musculoskeletal Disorders. Clin J Pain 2006, 22, 625–631.
Objective: The aim of this study was to investigate temperament and character dimensions in a group of patients with nonspecific musculoskeletal disorders and to show how personality is related to pain and psychologic distress in pain patients.
Method: A total of 78 patients with musculoskeletal disorders were compared with a matched control group of 118 nonpatients. The Temperament and Character Inventory, the Symptom Check List, and the Multidimensional Pain Inventory were used.
Results: The pain patients differed significantly from the controls and exhibited a personality profile with high harm avoidance and low self-directness, which indicate that patients with nonspecific musculoskeletal pain disorders can be characterized as being cautious, insecure, and pessimistic. In addition, they can be described as having difficulties in accepting responsibility, lack of long-term goals, chronically low self-esteem, and struggle with identity. This is probably a salient characteristic of patients with chronic pain. The results also showed that personality dimensions had a stronger correlation to psychologic distress than to pain. The result indicated that harm avoidance probably is an important personality trait in anxiety states.
Conclusions: The results underline the importance of using instruments assessing personality and psychologic symptoms in patients with nonspecific musculoskeletal disorders both as diagnostic tools and in treatment planning.

McCaffrey, Ruth/ Locsin, Rozzano. The Effect of Music on Pain and Acute Confusion in Older Adults Undergoing Hip and Knee Surgery. Holist Nurs Pract 2006, 20(5), 218–224.
The purpose of this study was to examine the effects of music listening in older adults following hip or knee surgery. Acute confusion and pain after surgery can increase length of stay and reduce function. Study results demonstrate a reduction in acute confusion and pain and improved ambulation and higher satisfaction scores in older adults who listened to music.

McWilliams, Lachlan A./ Asmundson, Gordon J.G. The relationship of adult attachment dimensions to pain-related fear, hypervigilance, and catastrophizing. Pain 2007, 127, 27–34.
Abstract
Despite the prominence of fear-avoidance models of chronic pain, there is a paucity of research regarding the origins of pain related fear. Based on the premise that insecure attachment could be a developmentally based origin of elevated fear of pain, associations between adult attachment dimensions and constructs included in fear-avoidance models of chronic pain were investigated. Consistent with Bartholomew and Horowitz’s [Bartholomew K, Horowitz LM. Attachment styles among young adults: a test of a four-category model. J Pers Soc Psychol 1991;61:226–44.] model, attachment was conceptualized as being comprised of a model of self dimension (i.e., degree of anxiety regarding rejection based on beliefs of personal unworthiness) and a model of others dimension (i.e., degree of interpersonal mistrust and discomfort with interpersonal closeness). A large university student sample free of chronic pain (N = 278) completed a measure of adult romantic attachment (i.e., Experiences in Close Relationships Questionnaire; [Brennan KA, Clark CL, Shaver PR. Self-report measurement of adult attachment: an integrative overview. In: Simpson JA, Rholes WS, editors. Attachment theory and close relationships. New York: The Guilford Press, 1998. p. 46–76.]), the Fear of Pain Questionnaire-III [McNeil DW, Rainwater AJ. Development of the fear of pain questionnaire – III. J Behav Med 1998;21:389–410.], the Pain Vigilance and Awareness Questionnaire [McCracken LM. Attention to pain in persons with chronic pain: a behavioural
approach. Behav Ther 1997;28:271–84.], and the Pain Catastrophizing Scale [Sullivan MJ, Bishop SR, Pivik J. The pain catastrophizing scale: development and validation. Psychol Assess 1995;7:24–532.]. It was hypothesized that insecure attachment would be positively associated with reports of pain-related fear, hypervigilance, and catastrophizing and that the model of self dimension would be the attachment variable most strongly associated with these variables. Correlation and multiple regression analyses supported these hypotheses. The model of self dimension had significant positive associations with each of the fear-avoidance constructs. The model of others dimension had a significant positive association with pain catastrophizing, but was not significantly associated with fear of pain and pain hypervigilance. Future research directions and potential clinical implications are discussed.

Mercadante, Sebastiano/ Ferrera, Patrizia/ Villari, Patrizia/ Casuccio, Alessandra. Opioid Escalation in Patients with Cancer Pain: The Effect of Age. J Pain Symptom Manage 2006, 32, 413-419.
Abstract
Elderly people are commonly considered more susceptible to opioid effects. However, no data regarding the need for opioid escalation in patients already receiving opioids for the management of chronic pain are available. The purpose of this study was to evaluate the differences between younger and older patients during the crucial phase of opioid titration. One hundred consecutive patients with cancer pain requiring further opioid dose refinement were recruited for this cohort study. Pain intensity, dose of opioids, number of opioids used (need to switch), routes of administration used, and opioid-related symptoms were measured from admission until dose stabilization. Opioid escalation indexes (OEIs) were calculated. For the purpose of analysis, patients were divided into three age groups (<65, 65e74, 75 or over). Despite differences in opioid doses at admission (lower in older patients), no differences were found in routes, need to switch, OEI, or other parameters between younger and older patients. Similarly, adverse effects did not significantly differ between the three groups, although an overall distress score worsened in older patients during acute titration and then improved at stabilization time. These data contradict the assumption that older patients who already receive opioids are more susceptible than younger adults to opioid effects during opioid titration. Although the elderly require lower doses, opioid effects do not appear to vary with age in this population. However, the group of patients over 75 was relatively small and data should be interpreted with caution. Careful titration based on the individual response seems appropriate irrespective of age.

Nelson, Pamela J./ Tucker, Sharon. Developing an Intervention to Alter Catastrophizing in Persons With Fibromyalgia. Orthopaedic Nursing May/June 2006, 25(3) 205-214.
Purpose: The purpose of this pilot study was to develop and evaluate a brief psychoeducational intervention to decrease pain catastrophizing, a focus on pain and its negative consequences in patients with fibromyalgia.
Design: A case-study design was used to design the targeted intervention. The intervention was piloted with 2 small groups of patients and family members.
Sample: Thirty-nine patients with fibromyalgia completed the surveys; patients/family members (N = 9) and ten interdisciplinary staff members participated in separate focus groups or e-mail surveys to provide data to develop the intervention. Two additional groups of patients and family members (N = 7) participated in the pilot intervention sessions.
Findings: Catastrophic thinking and associated declines in function were confirmed by survey results and focus group themes. A 2-hour session using self-efficacy theory was developed from these findings and other data sources. The patients/family members in pilot groups reported an increased knowledge of pain catastrophizing and satisfaction with the intervention.
Implications For Nursing Practice: A brief, psychoeducational offering that targets the reduction of catastrophizing is a feasible addition to the usual treatment protocol in a fibromyalgia treatment program and warrants further study. Developing effective treatment for fibromyalgia (FM), a chronic musculoskeletal pain syndrome occurring primarily in Caucasian women of middle age, is a challenge for healthcare professionals. FM occurs in 3.4% of the U.S. population and is the second most frequently given diagnosis in  rheumatology. This syndrome is characterized by fatigue, sleep difficulties, and widespread chronic pain lasting longer than 6 months (Wolfe, 1990). The pain recurs very often and rarely disappears. Because of the decreased functioning in social, occupational, and family domains related to pain, the impact on society is great. Many persons with FM suffer disability or are high utilizers of healthcare (Martin et al., 1996). There is no known treatment or cause for the chronic pain, often requiring persons to “learn to live” with chronic pain.

Neugebauer, Volker. Editorial-The amygdala: Different pains, different mechanisms. Pain 2007, 127, 1–2.

New Study Shows the Need for a Major Overhaul of How United States Manages Chronic Illness. Journal of Hospice and Palliative Nursing July/Aug 2006, 8(4), 191-103.

Patel, Gira/ Euler, David/ Audette, Joseph F. Complementary and Alternative Medicine for Noncancer Pain. Med Clin N Am 2007, 91, 141–167.

Price, Donald D. Do hypnotic analgesic interventions contain placebo effects? Pain 2006, 124, 238–239.

Price, Donald D./ Craggs, Jason/ Verne, G. Nicholas/ Perlstein, William M./
Robinson, Michael E. Placebo analgesia is accompanied by large reductions in pain-related brain activity in irritable bowel syndrome patients. Pain 2007, 127, 63–72.
Abstract
Previous experiments found that placebos produced small decreases in neural activity of pain-related areas of the brain, yet decreases were only statistically significant after termination of stimuli and in proximity to when subjects rated them. These changes could reflect report bias rather than analgesia. This functional magnetic resonance imaging (fMRI) study examined whether placebo analgesia is accompanied by reductions in neural activity in pain-related areas of the brain during the time of stimulation. Brain activity of irritable bowel syndrome patients was measured in response to rectal distension by a balloon barostat. Large reductions in pain and in brain activation within pain-related regions (thalamus, somatosensory cortices, insula, and anterior cingulate cortex) occurred during the placebo condition. Results indicate that decreases in activity were related to placebo suggestion and a second factor (habituation/attention/conditioning). Although many factors influence placebo analgesia, it is accompanied by reduction in pain processing within the brain in clinically relevant conditions.

Rhudy, Jamie L./ Williams, Amy E./ McCabe, Klanci M./ Rambo, Philip L./
Russell, Jennifer L. Emotional modulation of spinal nociception and pain: The impact of predictable noxious stimulation. Pain 2006, 126, 221–233.
Abstract
Recent evidence suggests that emotional picture-viewing is a reliable method of engaging descending modulation of spinal nociception. The present study attempted to replicate these findings and determine the effect of noxious stimulus predictability. Participants viewed pictures from the International Affective Picture System (IAPS), during which pain and nociceptive flexion reflexes (NFR) were elicited by electric shocks delivered to the sural nerve. For half of the participants (n = 25) shocks were preceded by a cue (predictable), whereas the other half received no cue (unpredictable). Results suggested emotion was successfully induced by pictures, but the effect of picture-viewing on the NFR was moderated by the predictability of the shocks. When shock was unpredictable, spinal nociception (NFR) and pain ratings were modulated in parallel. Specifically, pain and NFR magnitudes were lower during pleasant emotions and higher during unpleasant emotions. However, when shocks were predictable, only pain was modulated in this way. NFRs from predictable shocks were not altered by pictures. Further, exploratory analyses found that pain ratings, but not NFRs, were lower during predictable shocks. These data suggest emotional picture-viewing is a reliable method of engaging descending modulation of spinal nociception. However, descending modulation could not be detected in NFRs resulting from predictable noxious stimuli. Although preliminary, this study implies that separate mechanisms are responsible for emotional modulation of nociception at spinal vs. supraspinal levels, and that predictable noxious events may disengage modulation at the spinal level. The current paradigm could serve as a useful tool for studying descending modulation.

Sharav, Yair/ Tal, Michael. Focused hypnotic analgesia: Local and remote effects. Pain 2006, 124, 280–286.
Abstract
Suggestion for hypnotic analgesia aimed at a specific body area is termed ‘‘focused hypnotic analgesia’’. It is not clear, however, whether this analgesia is limited to a specific body location or spread all over the body. Focused hypnotic analgesia was studied, in response to ascending electrical stimuli, when analgesia and stimulation were applied to the same area (local), and when analgesia was applied to one location and stimulation was delivered to a different area (remote). The face or leg served alternately as the local or remote areas, and the effect was tested in 12 high-hypnotizable (HH) and 13 low-hypnotizable (LH) subjects. Hypnotic analgesia in the local site produced a significant pain reduction compared to the remote site in HH subjects (P < 0.0001) but not in LH subjects (P = 0.68). As stimuli increased in intensity the reduction in pain as a result of hypnosis was larger both in HH and LH subjects (P < 0.0001). Nevertheless, significant analgesia occurred in the 3 highest intensities in the local and remote location of HH subjects, but only in 2 highest intensities in the local and 1 in the remote of LH subjects. We conclude that in HH subjects focused hypnotic analgesia is mostly confined to the area aimed at, but some spread of analgesia to remote areas cannot be dismissed all together. Alternatively, this ‘‘spread’’ of analgesia could be due to a placebo effect in the remote area. Focused hypnotic analgesia requires increased attention to the body area aimed at, unlike analgesia achieved by distraction of attention.

Sherman, Karen J./ Cherkin, Daniel C./ Deyo, Richard A./ Erro, Janet H./ Hrbek, Andrea/ Davis, Roger B./ Eisenberg, David M. The Diagnosis and Treatment of Chronic Back Pain by Acupuncturists, Chiropractors, and Massage Therapists. Clin J Pain 2006, 22, 227–234.
Objectives: To describe the diagnostic and therapeutic content of visits for chronic back pain to acupuncturists, chiropractors, and massage therapists.
Methods: Randomly selected acupuncturists, chiropractors, and massage therapists in two states were surveyed, and then eligible providers collected data on consecutive patient visits. The authors analyzed information on diagnosis, treatment, and selfcare recommendations for chronic back pain patients collected during consecutive patient visits to these complementary and alternative medicine (CAM) providers.
Results: Back pain was the most common reason for visits to each of these providers, with chronic back pain representing about 10% of visits to  acupuncturists, 20% of visits to chiropractors, and 12% of visits to massage therapists. Diagnosis by acupuncturists included traditional questioning and inspecting the patient as well as pulse and tongue assessment and palpation of the acupuncture meridians. Treatments usually included acupuncture needling, heat of some sort, and other modalities, such as East Asian massage, herbs,
and/or cupping (application of suction cups to the skin). Lifestyle recommendations were common, particularly exercise and dietary counseling. Visits to chiropractors usually included spinal and muscle/soft tissue examinations and spinal manipulation. Soft tissue techniques (eg, ‘‘active release’’), stretch or strength training, and home exercise recommendations
were much less common. Massage therapists usually performed a tissue assessment and commonly assessed range of motion. They emphasized Swedish, deep tissue, and trigger point massage techniques and usually made self-care recommendations, particularly increased water intake, hot/cold therapy, exercise, and body awareness.
Conclusion: Information on the care patients routinely receive from CAM providers will help physicians better understand these increasingly popular forms of care.

Simon, Daniela/ Craig, Kenneth D./ Miltner, Wolfgang H.R./ Rainville, Pierre.
Brain responses to dynamic facial expressions of pain. Pain 2006, 126, 309–318.
Abstract
The facial expression of pain is a prominent non-verbal pain behaviour, unique and distinct from the expression of basic emotions. Yet, little is known about the neurobiological basis for the communication of pain. Here, subjects performed a sex-discrimination task while we investigated neural responses to implicit processing of dynamic visual stimuli of male or female faces displaying pain or angry expressions, matched on expression intensity and compared to neutral expression. Stimuli were presented in a mixed blocked/event-related design while blood oxygenation level dependent (BOLD) signal was acquired using whole-brain functional magnetic resonance imaging (fMRI) at 1.5 Tesla. Comparable sustained responses to pain and angry faces were found in the superior temporal sulcus (STS). Stronger transient activation was also observed to male expression of pain (Vs neutral and anger) in high-order visual areas (STS and fusiform face area) and in emotion-related areas including the amygdala (highest peak t-value = 10.8), perigenual anterior cingulate cortex (ACC), and SI. Male pain compared to anger expression also activated the ventromedial prefrontal cortex, SII/posterior insula and anterior insula. This is consistent with the hypothesis that the implicit processing of male pain expression triggers an emotional reaction characterized by a threat-related response. Unexpectedly, several areas responsive to male expression, including the amygdala, perigenual ACC, and somatosensory areas, showed a decrease in activation to female pain faces (Vs neutral). This sharp contrast in the response to male and female faces suggests potential differences in the socio-functional role of pain expression in males and females.

Stuifbergen, Alexa K./ Harrison, Tracie C./ Becker, Heather/ Carter, Patricia. Adaptation of a Wellness Intervention for Women With Chronic Disabling Conditions. Journal of Holistic Nursing Mar 2004, 22(1), 12-31.
Women with chronic disabling conditions live with multiple symptoms that decrease their ability to function in society, and they may be at elevated risk for further morbidity with age. Despite research indicating that health-promoting behaviors decrease the risk for further morbidity, few interventions have been designed to help women with chronic disabling conditions promote their health. The purpose of this article is to present the results of a pilot study of a wellness intervention adapted for use with women with fibromyalgia syndrome (FMS). First, the development of the original wellness intervention for women with multiple sclerosis (MS) will be described. Next, the steps taken to adapt the intervention to the needs of women with FMS will be described. Finally, it will be argued that commonalities in symptoms and social experiences and the universal need for health-promoting skills make this intervention adaptable to multiple groups of women with chronic disabling conditions.

Sumanen, Markku/ Rantala, Anna/ Sillanmäki, Lauri H./ Mattila, Kari J.
Childhood adversities experienced by working-age migraine patients.
Journal of Psychosomatic Research 2007, 62, 139– 143.
Abstract
Objective: The objective of this work was to study associations between childhood adversities and migraine. Methods: This is a case–control study of individuals drawn from the Finnish Population Register comprising four age groups: 20–24, 30–34, 40–44, and 50–54 years. Altogether, 21,101 individuals responded to postal questionnaire (response rate=40%). The subjects were asked whether a doctor had told them that they have or have had migraine. They were then requested (through six questions) to think about their childhood adversities. One randomly selected age-matched and sex-matched control for comparison was selected for every patient (n=4046).
Results: Among migraine patients, 76.8% were women. Each of the six childhood adversities was more common among migraine patients than among controls. In conditional logistic regression analysis for matched-pairs data, long-lasting financial difficulties in the family, a family member having been seriously or chronically ill, serious conflicts in the family, and parents having divorced remained statistically significant after adjusting for education, state of health, and depression. Odds ratios varied between 1.22 and 1.29.
Conclusion: Our findings suggest that social factors during childhood are associated with migraine.

Tan, Gabriel/ Alvarez, Julie A./ Jensen, Mark P. Complementary and Alternative Medicine Approaches to Pain Management. J Clin Psychol: In Session 2002, 1-13.
This article argues for and illustrates incorporating complementary and alternative medicine (CAM) interventions into pain treatment plans. Two CAM treatments, cranial electrotherapy stimulation (CES) and selfhypnosis training, are offered in a multidisciplinary pain treatment program. Because these interventions focus on pain relief, they may be of particular interest to patients who have chronic pain who begin treatment with a primary interest in pain reduction. Two cases that illustrate the clinical application of CES and self-hypnosis are presented. When effective, these interventions can help patients have greater confidence in treatments offered by psychologists for pain management and may help make them more open to participating in other psychological interventions that have established efficacy for pain management (e.g., cognitive-behavioral therapy). Because of their brevity, these treatments also can be offered alone to patients who may not have the resources or time to participate in more time-intensive treatment.

Vas, Jorge/ Perea-Milla, Emilio/ Méndez, Camila/ Sánchez Navarro, Cayetana/ Rubio, José María León/ Brioso, Mauricio/ García Obrero, Inmaculada. Efficacy and safety of acupuncture for chronic uncomplicated neck pain: A randomised controlled study. Pain 2006, 126, 245–255.
Abstract
Chronic neck pain is highly prevalent. To determine the efficacy and safety of acupuncture, in comparison with transcutaneous nerve stimulation-placebo (TENS-placebo) in the treatment of chronic uncomplicated neck pain, a single blind prospective study was designed, to be carried out at a Primary Healthcare Centre, with random assignment to two parallel groups and with evaluation and analysis by independent evaluators. A random assignment was made from 123 patients of the 149 initially recruited. These patients had been diagnosed with uncomplicated neck pain and experienced neck motion-related pain intensity equal to or exceeding 30 on a visual analogue scale (VAS) from 0 to 100 mm. The treatment with acupuncture was compared with TENS-placebo, applied over 5 sessions in three weeks. The primary endpoint was the change in maximum pain intensity related to motion of the neck, one week after the final treatment. Sensitivity was analysed per protocol (PP) and variant analyses were by intention to treat (ITT). Adjustment was made for confounders by multiple linear regression, including baseline values and rescue therapy. By ITT analysis, the change in the pain-VAS variable was greater among the experimental group (28.1 (95% CI 21.4–34.7)). The improvements in quality of life (physical aspect), active neck mobility and reduced rescue medication were clinically and statistically significant. In the treatment of the intensity of chronic neck pain, acupuncture is more effective than the placebo treatment and presents a safety profile making it suitable for routine use in clinical practice.

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