The pain behavior scale: Modification and validation for outpatient use

The present study investigated the validity of an inpatient pain behavior rating scale modified for outpatient use. A series of 43 consecutive outpatients referred for evaluation of chronic pain was examined using the Pain Behavior Scale (PBS) and other psychometric instruments. Analyses revealed significantly higher Pain Behavior Scale scores for low back and multiple pain-site groups. The results also indicated a high degree of internal consistency of the scale. A multiple regression analysis, predicting observed pain behavior from reported pain behavior, indicated that decreased activity accounted for 32% of the variance in the PBS score. A similar regression for pain experience found that the pain level and the sensory scale score on the McGill Pain Questionnaire accounted for 39% of the PBS variance. Psychological characteristics including disease conviction, self-control, depression, and anxiety explained 45% of the variability in the PBS score. Thus, the scale is related to pain intensity, interference with activities, and a variety of psychological characteristics. The scale provides a measure of observable pain behavior that is also relatively independent of these clinical data sources. The Pain Behavior Scale as modified for outpatient use provides a brief index of pain behavior with potential use in the comprehensive evaluation of the pain patient.     

老年慢性疼痛患者疼痛接受与疼痛程度的相关关系

了解老年慢性疼痛患者疼痛接受与疼痛程度,探讨两者的相关关系.采用简易慢性疼痛接受问卷（CPAQ-8）中文版、简化McGill疼痛问卷（SF-MPQ）与一般情况调查表对335例老年疼痛患者进行调查.结果纳入有效样本308例,SF-MPQ总体平均分为（50.24±23.35）分,中文版CPAQ-8总体平均得分（21.74±5.97）分.老年慢性疼痛患者的受教育程度、疼痛期、疼痛部位及疼痛点数目等差异有统计学意义（P＜0.05）.疼痛接受与疼痛程度呈负相关（P＜0.01）,即接受程度越高者,其疼痛程度越低.     

Psychosocial Subgroups, Coping, and Chronic Low-Back Pain

The purpose of this study was to compare psychosocial subgroups in terms of pain coping strategies, pain severity, physical impairment, pain behavior, affective distress, and response to pain management treatment. The Multidimensional Pain Inventory (MPI) was used to classify 67 chronic low-back pain (CLBP) patients into the following psychosocial subgroups: Dysfunctional, Interpersonally Distressed, Adaptive Coping, and Anomalous. These MPI subgroups were compared on the Pain Behavior Checklist, Behavioral Observation Measure of Pain Behavior, Revised Coping Strategies Questionnaire, and Chronic Disease Index. The Dysfunctional subgroup reported significantly more pain behavior, disability, affective distress, and catastrophizing than either the Interpersonally Distressed subgroup or Adaptive Copers, but were not significantly different on measures of adaptive coping strategies. The percentage of dropouts from treatment was significantly less among Adaptive Copers (11%) than among the Dysfunctional (33%) or Interpersonally Distressed (47%) subgroups. Differences in affective distress found among the MPI subgroups at baseline were not evident at the posttreatment assessment. The present findings support the use of MPI psychosocial subgroup analysis to enhance our understanding of differential response to chronic pain and pain management intervention.     

Pain: Biopsychosocial Mechanisms and Management

Traditionally, pain has been viewed as a sensory event warning of tissue damage or illness. This explanation fails to account for many of the experiences of people suffering from clinically painful conditions. Over the past two decades, a new biopsychosocial perspective on pain has emerged. This perspective emphasizes that pain is a dynamic process that not only is influenced by biological, psychological, and social mechanisms of pain, but also produces biological, psychological, and social changes that can affect future responses to pain. This review presents findings from recent studies of the biological, psychological, and social mechanisms of pain and discusses the implications of these findings for pain research, assessment, prevention, and treatment, as well as for health care policy.     

治疼必需知痛

疼痛是人体可感知所有伤害性刺激中最难以忍受的恶性刺激,医学范畴下的疼痛是指组织损伤的前提下产生的＂躯体的不愉快的疼感觉＂加上＂与之相匹配的痛苦情感体验＂两方面内容。长期以来我们的医疗行为＂过多关注组织损伤对疼的调控、忽视了痛苦体验的人文关怀＂制约了我们服务层次。新的生物医学模式下诊疗工作强调细化疼痛分类、躯体与心理并重,以专科诊疗思路指导临床,提高医务人员对病痛的理解、引导供需匹配式的人性医疗服务是时代发展务实之举。     

The relationship of depression and somatic focus to experimental and clinical pain in chronic pain patients

Abstract

The present study examined Fields' proposal that depression increases the sensory experience of pain in part through greater somatic focus. Experimental and clinical pain measures were compared to self-report of depression and somatic focus in 60 chronic pain patients. Depression scores were unrelated to pain threshold or tolerance on the cold-pressor test. However, as hypothesized by Fields, path analytic models suggested that depression had a direct influence on the evaluative and affective aspects of pain, but the relationship between depression and sensory pain was mediated by somatic focus. These results provide partial support for Fields' neurobiological model of pain and depression.     

疼痛恐惧的形成及其对疼痛知觉的影响

脑岛、杏仁核是疼痛恐惧形成的重要神经网络中心。疼痛恐惧增强了慢性疼痛患者的疼痛知觉体验, 进而加剧抑郁、焦虑情绪和功能损伤程度。脑岛、杏仁核、前额皮层和前扣带回是疼痛恐惧影响疼痛知觉的重要神经基础。通过认知方法干预疼痛恐惧可以改善患者的抑郁、焦虑情绪, 减少功能损伤。未来研究应拓展疼痛恐惧的测量工具, 采用功能磁共振成像技术进一步揭示疼痛恐惧影响慢性疼痛患者疼痛知觉的神经机制。     

疼痛表征在自我和他人间的一致性效应

在以往研究中“pain matrix”被认为是加工自我和他人疼痛信息的特异性神经机制, 也可能是个体对他人疼痛共情的原因。但是最近的研究发现非疼痛的感觉刺激也能激活该脑区, 因此疼痛表征在自我和他人间是否存在一致性受到质疑。研究采用启动范式从两个方面入手探索自身疼痛和疼痛共情间是否存在一致性关系。实验一使用疼痛和非疼痛图片为启动刺激, 疼痛或热刺激为靶刺激, 发现相对于非疼痛图片, 疼痛图片启动下被试对自身疼痛刺激的反应时减少, 疼痛水平和情绪反应增强。实验二使用疼痛和热刺激为启动刺激, 疼痛或非疼痛图片为靶刺激, 发现相对于热刺激, 疼痛刺激启动下被试对疼痛图片的反应时减少。同时, 在两个实验中非疼痛的靶刺激都不受启动刺激的影响。这说明疼痛表征在自我和他人间存在一致性效应。     

Neural basis of affective touch and pain: A novel model suggests possible targets for pain amelioration

Pain is one of the most common health problems and has a severe impact on quality of life. Yet, a suitable and efficient treatment is still not available for all patient populations suffering from pain. Interestingly, recent research shows that low threshold mechanosensory C-tactile (CT) fibres have a modulatory influence on pain. CT-fibres are activated by slow gentle stroking of the hairy skin, providing a pleasant sensation. Consequently, slow gentle stroking is known as affective touch. Currently, a clear overview of the way affective touch modulates pain, at a neural level, is missing. This review aims to present such an overview. To explain the interaction between affective touch and pain, first the neural basis of the affective touch system and the neural processing of pain will be described. To clarify these systems, a schematic illustration will be provided in every section. Hereafter, a novel model of interactions between affective touch and pain systems will be introduced. Finally, since affective touch might be suitable as a new treatment for chronic pain, possible clinical implications will be discussed.     

婴儿的痛觉

婴儿痛觉对婴儿的生长发育有重要意义, 已经日益引发研究者的兴趣。痛觉本质上是一种不愉悦的感官和情绪体验, 是通过早年与伤害有关的经历习得的。在心理学角度, 在介绍婴儿痛觉概念、神经生理机制、评估工具的基础上, 系统梳理痛觉对婴儿生长发育的影响及其影响因素十分必要。后续研究需继续完善婴儿痛觉的测量方法, 考察疼痛反应在不同文化和不同群体间的差异。     

The Social Pain Posit

Although discussion of social pain has become popular among researchers in psychology and behavioural neuroscience, the philosophical community has yet to pay it any direct attention. Social pain is characterized as the emotional reaction to the perception of the loss or devaluation of desired relationships. These are argued to comprise a pain type and are explicitly intended to include the everyday sub-types grief, jealousy, heartbreak, rejection, and hurt feelings. Social pain is accordingly posited as a nested type of pain encompassing multiple emotional sub-types. Call this the social pain posit. This article focuses on whether we should endorse the social pain posit and, in particular, whether social pain is pain. I present the four lines of evidence for the social pain posit that are currently offered in the literature and I argue that each provides only inadequate support, taken either individually or together. I close by considering the significance of the presented argument for philosophical theorizing about the nature and the moral significance of affective experiences in particular and mental taxonomizing more generally.     

加强小儿围术期疼痛管理——医学伦理的必然要求

近年小儿围术期疼痛管理日益引起人们的重视。小儿围术期疼痛管理包括围术期疼痛的监测和评估,疼痛治疗的原则和策略等方面的内容。鉴于儿童是一个相对独立的利益群体,即使新生儿在围术期也有完善的疼痛治疗的需求,重视小儿围术期的疼痛诉求,体现了对小儿的人文关怀和基本权力的维护,是医学伦理的必然要求。     

急性疼痛与慢性疼痛对奖赏加工的影响及神经机制

疼痛和奖赏能够为个体提供不同的行为动机和主观价值体验,寻求奖赏和避免疼痛对于生存都很重要。疼痛可划分为急性疼痛和慢性疼痛,奖赏可区分为预期阶段的动机成分和体验阶段的享乐成分。奖赏对疼痛的抑制作用已经被广泛证实,但关于疼痛对奖赏的影响,目前的研究结果并不一致。因此需要进一步区分并探究急性疼痛与慢性疼痛对奖赏加工不同阶段的影响,分析两种疼痛对奖赏加工产生不一致影响的现象。这种现象出现的原因可能与急性疼痛向慢性疼痛转变过程中出现的奖赏加工能力缺陷有关。未来可以考虑从改善奖赏加工能力缺陷的角度进行检测和治疗,提前预防急性疼痛向慢性疼痛转变。     

How does persistent pain develop? An analysis of the relationship between psychological variables, pain and function across stages of chronicity

The fear-avoidance model is an attempt to underscore the importance of cognitive and behavioral factors, in a chain of events linking pain to disability. However, it is not clear at what time point the psychological variables within the model begin to be prominent. The aim of this study was to investigate the role of these psychological variables in the development of a chronic musculoskeletal pain problem. Three stages of chronicity, defined by duration of pain, provided a proxy for the developmental process: <1 year (N=48), 1-3 years (N=47) and >3 years (N=89). Subjects completed questionnaires on fear of movement, catastrophizing, depression, pain and function. The results indicate that the relationship between fear of movement and function is moderated by the stage of chronicity. Regression analyses showed that fear of movement did not explain any variance in the group with pain duration <1 year. Fear of movement did explain variance in the groups with pain duration of 1-3 years and >3 years. This suggests that the time point in the development of a musculoskeletal pain problem might be an essential aspect of the importance of the relationship between psychological components and function.     

Understanding the relationship between attachment style, pain appraisal and illness behavior in women

Insecure attachment has been hypothesized to be an important factor for understanding the experience of pain. Considering the Attachment-Diathesis Model of Chronic Pain developed by Meredith, Ownsworth, and Strong (2008), this cross-sectional study examines the relationship between attachment style, pain appraisal, and illness behavior. Two hundred healthy women recruited from community contexts completed a battery of self-report measures including the Short-form McGill Pain Questionnaire, Pain Catastrophizing Scale, Pain Anxiety Symptoms Scale-20, Pain Vigilance and Awareness Questionnaire, Illness Attitude Scales, Beck Anxiety Inventory, Beck Depression Inventory, and the Experiences in Close Relationships Questionnaire-Revised. The results showed that attachment anxiety was significantly correlated with pain catastrophizing, pain-related fear, depression, and illness behavior. However, attachment anxiety and avoidance were not associated with pain intensity. Attachment anxiety moderated the relationship between pain catastrophizing and illness behavior, and between pain hypervigilance and illness behavior. Pain catastrophizing and pain-related fear partially mediated the effect of attachment anxiety on illness behavior. The findings highlight potential contributions of attachment style and pain appraisal for explaining illness behavior. This study supports earlier reports and suggests the usefulness of assessing attachment style for early identification of people who might exhibit a high risk of dysfunctional responses to pain. Our findings also suggest that increasing people's insight about their attachment style and modifying some associated dysfunctional responses may be important in the treatment of chronic pain.     

Individual experiences of an acceptance-based pain management programme: An interpretative phenomenological analysis

Acceptance of pain has been found to play an important role in adjusting to chronic pain, and the evidence-base is growing with regards to the effectiveness of acceptance-based interventions such as acceptance and commitment therapy, mindfulness and contextual cognitive behavioural therapy within pain management settings. Despite the growing interest in such interventions, previous studies into acceptance-based pain management programmes (PMPs) are quantitative and the exact processes at work during such programmes remain unknown. This study aims to add to previous quantitative research in the area by qualitatively exploring individual experiences of attending an acceptance-based PMP and identifying the key constituents of the programme that participants felt facilitated change. Semi-structured interviews (n = 6) were analysed using interpretative phenomenological analysis, and five themes emerged: I’m not alone, others understand my pain, Freedom from pain taking over, A new self – one with pain, Parts of the programme participants felt facilitated change and Exercise is possible. These findings are then considered in relation to past research and relevant constructs in the literature. Implications for future research and clinical practice are also discussed alongside participant reflections and suggested areas for improvement.     

疼痛背景下时距知觉的变化

时距知觉指对数百毫秒到数个小时时长的知觉, 是日常生活中许多活动的基础。时距知觉受到相当多因素的影响, 如唤醒、注意、动机等。疼痛是一种多维度的心理及生理现象, 包含有感觉分辨、情绪动机、认知评价三个成分。近期研究证明时距知觉会在疼痛背景下发生改变。疼痛背景下时距知觉的相关研究主要涉及三个方面：(1)健康被试对疼痛面孔的时距知觉; (2)实验室诱发疼痛对健康被试时距知觉的影响; (3)临床疼痛患者的时距知觉变化。探索疼痛背景下时距知觉的变化, 可以为理解疼痛的发生发展机制以及时间知觉的机制提供一个新视角。