Chronic pain in children

Chronic pain in children was reviewed in two major categories: disease-related pain and recurrent pain syndromes. Problems with the traditional dichotomy of organic versus psychogenic origins of such pain were noted. Additionally, disturbing trends in the pharmacological management of children's chronic pain were discussed. Furthermore, applications of psychological interventions to both pain categories were outlined and have shown exciting potential for the amelioration of a number of children's chronic pain problems. However, research in this area is only beginning to demonstrate efficacy and controlled outcome studies are few in number. Finally, a brief review of strategies for the assessment of children's chronic pain was presented and revealed an area also in its infancy.     

Chronic benign pain

Chronic benign pain (CBP) can be defined as a type of unpleasant sensory experience that arises from inflammation, visceral stress or damage, or other such pathophysiologic process(es), and that is not associated with a metastatic process. A patient's complaint of pain should be taken seriously by the practitioner, both in terms of the discomfort evoked and the likelihood that the potential cause of the pain requires diagnostic evaluation. This article reviews the diagnosis and treatment of the following common conditions associated with CBP syndromes: fibromyalgia, lower back pain syndrome, sickle-cell disease, reflex sympathetic dystrophy syndrome, and peripheral neuropathies.     

Chronic pain conceptualization and religious interpretation

The pastoral counselor often interviews patients suffering from chronic pain. Many of them express religious notions about their suffering. This article examines some traditional concepts of pain and types of religious interpretations, and proposes appropiate roles for the pastoral counselor.     

Chronic pain: A family perspective

The McMaster Model of Family Functioning has been used to assess and treat a variety of family problems and has also proven efficacious in family practice, psychiatric and rehabilitation settings. This articles attempts to add to the list by its application to families with a chronic pain sufferer. It is demonstrated that the model, with its systemic approach and behavioral orientation, offers a conceptual base particularly well suited to the problems of chronic pain patients and their families.     

Chronic pelvic pain: A meta-analytic review

Abstract

Chronic pelvic pain (CPP) in women of reproductive age is a common complaint; for many women no identifiable pathology can be found. Research has suggested that women who have chronic pelvic pain without obvious pathology differ on a range of psychological characteristics, such as anxiety and depression, compared with those with identified pathology. A meta-analysis of 22 studies was undertaken to clarify these issues. Results showed that there were no significant differences on a range of psychological variables between women who were identified, via laparoscopy and clinical judgement, as having organic disorders and those who were not so identified. When women with chronic pelvic pain were compared with pain-free groups a profile of elevated depression, anxiety, neuroticism and psychopathology was found which is consistent with findings from studies of other painful conditions.     

Chronic pain,compensation and clinical knowledge

The nosological status of the putative clinical entity of compensation neurosis and the relationship of chronic pain complaints to compensation are explored. It is concluded that, using the traditional criteria of diagnostic validity, there is no support for the view that a specific type of psychiatric disorder related to compensation or litigation can be demonstrated. Although it has been generally considered that chronic pain complaints reflect an underlying disease state, recent evidence has shown that in the medico-legal setting the nature of the compensation system and the level of available benefits have a marked influence on both the rate of chronic pain complaints and the duration of pain related work incapacity.     

Chronic pain as a posture towards the world

This article discusses what chronic pain is “about”, what the intentional object is of pain, and what is the intentional relation like? My approach is based on Maurice Merleau‐Ponty’s phenomenology, with an aim is to understand a two‐way relationship: how the sufferers bestow meaning on chronic pain, and how pain, on the other hand, signifies peoples’ life. In contrast to biomedical and cognitive‐behavioral theories, chronic pain is not only meaningful, but as an intentional emotion as well; it does not simply “happen” in the nervous system. I analyzed meanings assigned to pain through the narratives of three patients with chronic pain. Pain is described as creating a discontinuity in the patient’s Lebenswelt at the narrative level. When attempting to find meaning to their pain, patients point both to everyday life and biomedical referents. The structure of bestowing meaning is, metaphorically, like a necklace with everyday world and biomedical interpretations strung like beads, one after the other. The intentional object of pain, on the contrary, is constituted of the patients’ world in its wholeness. My results don’t confirm Drew Leder’s idea of disrupted intentionality, but underline directness as the basic relation of human experience also in case of pain and disease. Pain in itself is an e‐movere, an intense passionate movement, an intentional relation with and a bodily posture taken towards the world.     

Chronic low back pain and depression in a sample of veterans

The relationship between chronic low back pain and scores on depression was examined in a sample of 31 veterans who completed a depression inventory. Analysis indicated that those with chronic low back pain scored significantly higher on depression than those without.     

Acceptance of chronic pain in fibromyalgia patients: adaptation of Chronic Pain Acceptance Questionnaire (CPAQ) in a Spanish population

Acceptance of chronic pain appears as an important factor in the personal ability to restore functioning in the presence of chronic pain. The Chronic Pain Acceptance Questionnaire (CPAQ) is currently the only instrument used to assess the acceptance of pain in people who suffer chronic pain. The revised 20-item version of McCracken and cols. (2004) showed satisfactory psychometric properties. Nevertheless, the CPAQ has not been used in Spain in fibromyalgia patients. The first goal of the study is to examine the Spanish translation of the CPAQ and assess its psychometric properties in a sample of 145 subjects with a diagnosis of fibromyalgia. The second purpose was to analyze the relationships between the CPAQ and other important measures of pain adjustment. Results of exploratory factor analysis indicated that the two-factor model, in a 15-item test, provided a good fit to the data in fibromyalgia patients. Regression analyses showed strong relations with criteria variables (pain intensity, anxiety, depression, etc.) though the subscale Activity Engagement contributed more than Pain Willingness to the prediction of criteria variables.     

Chronic pain: a reformulation of the cognitive-behavioural model.

The last few decades has seen psychological theories of chronic pain dominated by behavioural concepts and particularly, by the operant model as described by Fordyce et al. (1968: Fordyce, W., Fowler, R., & DeLateur, B. (1968) An application of behavior modification technique to a problem of chronic pain. Behaviour Research and Therapy, 6, 105-107, 1976: Fordyce, W.E. (1976) Behavioral methods for chronic pain and illness. St Louis, MO: C. V Moseby). More recently, cognitive constructs have been included, giving the impression that the operant theory of chronic pain has been replaced by a cognitive-behavioural theory (CBT). Given the fact that CBTs were introduced essentially to overcome some inherent problems with operant theory, it is notable that they are still very much based on operant theory and continue to be founded upon operant principles. Further, the extent to which CBTs (at this stage) have included contemporary cognitive research has been limited. This paper argues that it is of questionable validity to continue to include problematic concepts (e.g., operant principles) into a revised theory (e.g., CBT). Instead, consistent with research from other areas (particularly the anxiety disorders), chronic pain and the problems associated with it may be better explained by a reformulated cognitive-behavioural theory which although not ignoring the observable behaviours of pain patients and their associations with social reinforcers, interprets these phenomena from a cognitive perspective. Thus, a modified CBT is proffered, focusing more directly on patients' thoughts about, and appraisals of, their pain. Evidence in support of such a theory is provided, as are suggestions for further research and the implications such a theory has for treatment.     

Distress in spouses of chronic pain patients

This paper critiques the research on distress in spouses of chronic pain patients and includes a review of two studies of spouses conducted at the Miriam Hospital Chronic Pain Research Unit. The clinical implications of this research are discussed and case material is presented to illustrate the role of spouse distress in the treatment of patients with chronic pain. Future directions for research in this area are recommended.The research conducted at the Miriam Hospital Chronic Pain Research Unit was supported by the Alcohol, Drug and Mental Health Administration of the National Institute of Mental Health, Small Grants Program, Grant No. 1 R03 MH39257001A1.