Athletes' inclination to play through pain: a coping perspective

Previous studies have shown how social networks lead athletes to accept pain as a "part of the game," which generates pressure on athletes to continue competing despite being in pain. Little is known, however, about the potential coping strategies that are related to pain behavior in sport. This study of 205 combat athletes examined whether pain coping strategies, including distraction from pain, praying, reinterpreting pain sensations, ignoring pain, and pain catastrophizing, are related to athletes' inclination to play through pain. Results revealed that pain catastrophizing led athletes to reduce their physical involvement in their sport activity. Of particular interest was the moderating effect of ignoring pain such that ignoring pain significantly attenuated the negative effect of pain intensity on athletes' inclination to play through pain. Few studies have tested and supported the contribution of pain coping to the prediction of behavior in real sport situations. By identifying which coping strategies athletes could use to maintain their physical involvement despite being in (sometimes intense) pain, the current study makes an important contribution for tailoring pain management programs for this at-risk population.     

Athletes' inclination to play through pain: a coping perspective

Previous studies have shown how social networks lead athletes to accept pain as a “part of the game,” which generates pressure on athletes to continue competing despite being in pain. Little is known, however, about the potential coping strategies that are related to pain behavior in sport. This study of 205 combat athletes examined whether pain coping strategies, including distraction from pain, praying, reinterpreting pain sensations, ignoring pain, and pain catastrophizing, are related to athletes’ inclination to play through pain. Results revealed that pain catastrophizing led athletes to reduce their physical involvement in their sport activity. Of particular interest was the moderating effect of ignoring pain such that ignoring pain significantly attenuated the negative effect of pain intensity on athletes’ inclination to play through pain. Few studies have tested and supported the contribution of pain coping to the prediction of behavior in real sport situations. By identifying which coping strategies athletes could use to maintain their physical involvement despite being in (sometimes intense) pain, the current study makes an important contribution for tailoring pain management programs for this at-risk population.     

抑制功能在疼痛中的作用

自生物心理社会模型提出以来, 利用心理因素预防和治疗疼痛备受关注, 越来越多的研究表明抑制功能在疼痛发展和恢复阶段起关键作用。疼痛诱发的自我防御机制通过争夺认知资源影响抑制功能, 反之低抑制功能个体在应对疼痛干扰中表现较差, 进而影响着疼痛的预期和学习。现有关于抑制功能影响疼痛的研究主要基于相关设计, 未来应进一步明确二者的因果关系。深入理解疼痛与抑制功能相互作用的认知机制有助于指导抑制功能对慢性疼痛的靶向干预。     

Maladaptive Cognitions and Chronic Pain: Epidemiology,Neurobiology, and Treatment

Maladaptive cognitions are widespread and play a significant role in the development of chronic pain. (1) Catastrophizing seems to increase the risk of chronicity. In the laboratory it amplifies temporal summation of pain with repeated stimulation and delays the disengagement of attention from pain. In neuroimaging it is associated with increased activation in regions of the cortex involved in attention, the aversiveness of pain, and possibly pain intensity. (2) Fearful anticipation of pain seems to pre-activate brain regions involved in both the sensory and emotional intensity of pain and primes a stronger initial pain response. It may lead to abnormal patterns of muscle recruitment that, speculatively, may predispose to injury. (3) Belief that normal activity should be avoided seems to promote unnecessary long-term disability in nonspecific low back pain. Extreme guarding may intensify pain through loss of inhibition from motor cortex. (4) Educational programs targeting maladaptive beliefs have shown benefit in the primary prevention of chronic back pain in both pain-free and acute pain populations. In established chronic pain, cognitive-behavioral therapy has shown efficacy in improving pain intensity, coping and pain behaviors when compared with usual treatment. (5) Possible future research directions and clinical implications are discussed.     

Pain intensity and pain unpleasantness in triathletes: A study examining their associations with pain catastrophizing and pain expectations

ObjectiveTriathletes represent a growing and unique population of individuals willing to endure significant mental and physical stress to practice the sport they love. However, little is known about the pain experienced while training for and competing in a triathlon and how psychological factors influence this experience. This study will assess pain experienced by triathletes in training and competition, and investigate the association between pain catastrophizing and pain expectations with triathlon pain intensity and pain unpleasantness.DesignIn this observational study, a sample of 261 triathletes completed two online surveys before and after participating in a triathlon.ResultsModerate levels of pain intensity and pain unpleasantness were reported during training and competition. Pain catastrophizing was positively associated with expected and actual triathlon pain unpleasantness, but not with pain intensity. Expected pain intensity was also significantly associated with pain intensity experienced while competing, whereas expected pain unpleasantness was significantly related to both triathlon pain intensity and unpleasantness. Finally, regression analysis revealed pain catastrophizing and pain expectations to be unique predictors of triathlon pain intensity and pain unpleasantness.ConclusionThis study highlights the important role of psychological factors in triathletes' experience of pain and could eventually help tailor interventions aimed at improving the practice of triathlon.     

癌痛治疗指南解析

对多国成人癌痛指南进行检索、回顾,发现近年癌痛治疗领域新进展和各国普遍遵循的共同原则,为临床医生改进癌痛治疗提供参考。采用现有的互联网临床实践指南检索平台,对成人癌痛指南进行检索,分析各国指南的异同之处,重点对疼痛评估、WHO三阶梯药物治疗及辅助治疗进行比较、归纳。全面的癌痛评估是指痛治疗的必要前提,也是众多癌痛指南强调的重点;按疼痛程度选择三阶梯镇痛药物仍是药物止痛的基本原则;口服途径是止痛治疗的首选给药途径;第一阶梯药物中阿司匹林的应用逐渐淡化,NSAIDs的毒性反应受到关注;第二阶梯药物的选择更灵活。应根据疼痛性质、患者的具体情况合理选择复合制荆。吗啡仍是强阿片类药物中的首选,可用于中、重度疼痛的治疗。因此,我国成人癌痛治疗需要改进,应重点推广全面的疼痛评估,提倡根据患者的具体情况合理、灵活的选择三阶梯药物,个体化治疗是止痛治疗的关键。     

Pain language of bone marrow transplantation patients.

Previous studies have shown that hypnosis may be effective in reducing intensity of pain among bone marrow transplantation patients whereas cognitive behavioral intervention without imagery was not effective for this group of patients. Since hypnosis alters patients' perception of pain and cognitive behavioral intervention changes patients' beliefs and improves their coping with pain, we hypothesized that sensory pain is more important than affective pain in understanding the pain experience of patients undergoing bone marrow transplantation. To test this hypothesis we administered the McGill Pain Questionnaire longitudinally to 50 consecutive eligible recipients of bone marrow transplantation during hospitalization to assess the different dimensions of pain they experienced. Consistent with our hypothesis, sensory pain fluctuated with treatment stages, and the pattern was consistent with previous findings. Patients reported significantly higher sensory pain than affective pain at all assessment points. In contrast, affective pain remained low and stable throughout the treatment. Our results contribute to the understanding of the nature of pain in bone marrow transplantation and suggest pain management strategies that focus on sensory pain as in hypnosis are more useful for such patients.     

The development of the multidimensional locus of pain control questionnaire (MLPC): Factor structure,reliability, and validity

This study was conducted to develop a comprehensive Multidimensional Locus of Pain Control questionnaire (MLPC) and to examine how locus of pain control is related to pain appraisals, pain coping strategies, and adjustment to chronic pain. Subjects were 170 chronic headache patients. By means of factor analysis, four subscales were derived: an Internal, a Chance, a Physician, and a Medication locus of pain control orientation scale. The reliability and validity of the subscales appeared to be satisfactory. The results of the present study indicate that the locus of pain control orientation is significantly related to pain appraisals such as perceived pain control and catastrophizing and, to a lesser degree, to coping strategies as measured by the Coping Strategies Questionnaire (CSQ). However, almost no relationship was observed between locus of pain control and adjustment to pain. Further research with the MLPC in different chronic pain populations is warranted in order to investigate whether the results found in this study can be generalized to chronic pain patients in general.     

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。     

The relationship between greater mindfulness and less subjective experience of chronic pain: Mediating functions of pain management self‐efficacy and emotional intelligence

Previous research shows a connection between greater mindfulness and less subjective experience of pain. The present study examined whether pain management self‐efficacy and emotional intelligence mediate this relationship in individuals experiencing chronic pain. Two hundred participants experiencing chronic pain completed measures of mindfulness, experience of pain, pain management self‐efficacy, and emotional intelligence. Greater mindfulness was associated with less subjective experience of pain, greater pain management self‐efficacy, and more emotional intelligence. More pain management self‐efficacy and higher emotional intelligence were associated with less subjective experience of pain. Emotional intelligence and pain management self‐efficacy significantly mediated the relationship between mindfulness and pain. The connection between greater mindfulness and less subjective experience of pain may be due to mindfulness providing a foundation for emotional functioning and behavioural regulation that result in reductions in the experience of pain.     

Prior exposure to extreme pain alters neural response to pain in others

In the extant literature examining the brain mechanisms implicated in pain perception, researchers have theorized that the overlapping responses to pain in the self and in others mark the human capacity for empathy. Here we investigated how prior exposure to extreme pain affects pain perception, by assessing the dynamics of pain processing in veterans who were previously exposed to severe injury. Forty-three participants (28 pain-exposed and 15 controls) underwent whole-head magnetoencephalography (MEG) while viewing photographs of limbs in painful and nonpainful (neutral) conditions. Among controls, an early (0–220 ms) “pain effect” in the posterior cingulate and sensorimotor cortices, and a later (760–900 ms) “pain effect” in the posterior cingulate cortex, superior temporal gyrus/insula, and fusiform gyrus were found, indicated by enhanced alpha suppression to the pain versus nonpain conditions. Importantly, pain-exposed participants exhibited an atypical pain response in the posterior cingulate cortex, indicated by a normative response to pain, but no pain-to-no-pain differentiation. This may suggest that individuals exposed to extreme pain may perceive neutral stimuli as potentially threatening. Our findings demonstrate alterations in pain perception following extreme pain exposure, chart the sequence from automatic to evaluative pain processing, and emphasize the importance of considering past experiences in studying the neural response to others’ states.     

Prediction of experimental pain sensitivity by attention to pain-related stimuli in healthy individuals

The aim of the present study was to assess the predictive power of the processing of pain-related information, comprising concepts of hypervigilance to pain, pain catastrophizing, and pain-related anxiety (questionnaires) as well as attentional processes related to pain-related stimuli (dot-probe task) in explaining individual differences in experimental pain sensitivity (pressure/thermal pain threshold). In 160 healthy participants (ages 13-61; 80 females), results of hierarchical multiple regression analyses showed that self-reported hypervigilance contributed significantly to the prediction of pain sensitivity, whereas pain catastrophizing and anxiety did not. However, inconsistent with prediction, the effect was in the opposite direction, indicating that vigilance to pain sensations or stimuli is associated with lower pain sensitivity in healthy individuals. Entering the attentional bias indices from the dot-probe task showed that an increased bias to pain words is related to higher experimental pain sensitivity, which confirms the hypothesis.     

Memory of pain induced by physical exercise

The aim of this study was to assess the memory of pain induced by running a marathon and the factors that influence it. Sixty-two marathon runners participated in the study, which comprised two phases. Immediately after a participant had reached the finishing line of the marathon, they were asked to rate the intensity and the unpleasantness of their pain and the emotions they felt at that time. Either three or six months later they were asked again to rate the intensity and the unpleasantness of the same pain experience. Regardless of the length of recall delay, participants underestimated both recalled pain intensity and unpleasantness. The pain and negative affect reported at the time of the pain experience accounted for 24% of the total variance in predicting recalled pain intensity and 22% of the total variance in predicting recalled pain unpleasantness. Positive affect at the time of pain experience was not a significant predictor of both the recalled pain intensity and pain unpleasantness. It is concluded that pain induced by physical exercise is not remembered accurately and the pain and negative affect experienced influence recall. Further research is needed on the influence of positive affect on the memory of pain.     

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。     

Sex Differences in Clinical Pain: A Multisample Study

A recent meta-analysis of the experimental pain literature revealed effect sizes of .55 for pain threshold and .57 for pain tolerance, indicating a moderate difference in pain perception between men and women, with women reporting an increased sensitivity to pain. The current study investigated the relationship between sex and clinical pain ratings, in patients seeking care at a tertiary care facility. Five samples of chronic pain patients were recruited from several diverse clinics associated with the University of Florida. Analyses of clinical pain ratings revealed similar effect sizes for all samples, ranging from –.07 to –.25, indicating small differences, with women reporting higher levels of clinical pain. This is the first paper to report effect sizes for differences in report of pain in samples of chronic pain patients presenting for treatment at a tertiary care facility.     

Pain anxiety, acceptance, and outcomes among individuals with HIV and chronic pain: a preliminary investigation

The current study investigated the role of during treatment changes in pain anxiety in the relation between during treatment changes in pain acceptance and chronic pain outcomes. Participants included 45 (15 women) adults (M_age = 50.42, SD = 7.69) who were HIV positive and experienced chronic pain. They were offered 12 weekly, 90-min group CBT sessions to increase understanding about chronic pain and to improve coping skills. Four hierarchical regression analyses were conducted to examine the mediating role of treatment changes in pain anxiety in the relation between treatment changes in pain acceptance and chronic pain outcomes. Results suggest that increases in pain acceptance during treatment were associated with decreased levels of pain anxiety during treatment, as well as decreases in pain-related impairment at treatment completion. Furthermore, decreases in pain anxiety during treatment were associated with decreases in pain-related impairment at treatment completion. Finally, treatment changes in pain anxiety were found to partially mediate the association between treatment changes in pain acceptance and pain-related impairment at treatment completion. Results are discussed within the context of better understanding the processes of change within a CBT model for chronic pain patients.     

A thematic analysis of attributions to others for the origins and ongoing nature of pain in community pain sufferers

Research suggests that pain sufferers can attribute their pain to others. However, this work is scarce, lacking in detail and does not focus on any particular time during the pain experience. To understand how these attributions operate in pain, this study sought to examine as an exclusive focus the types, context of, and rationale for attributions made to others for the origins and ongoing nature of pain. A community pain sample was voluntarily recruited into the study to gain a comprehensive understanding of these attributions and minimise potential group-specific bias. Sixty-two participants were interviewed using semi-structured questions about cause, responsibility and blame for pain. Data were analysed using a thematic analysis. Attributions to others emerged across interview questions. Acquaintances, professionals and strangers were implicated in pain onset for reasons including negligence, accident and attack. Few additional attributions were made for pain now. Those made were mostly to medical professionals for perceived poor treatment of an original pain condition encompassing issues related to compliance, diagnosis and treatment and searching for alternative pain solutions. This research provides insight into the social context in which pain attributions to others are reported, and provides the basis for research into largely untapped areas including the implications particular attributions have for adjustment to pain and relationships with others.     

Comparative effectiveness of CBT interventions for co-morbid chronic pain & insomnia: A pilot study

IntroductionChronic pain is difficult to treat and often precedes or exacerbates sleep disturbances such as insomnia. Insomnia, in turn, can amplify the pain experience. Both conditions are associated with inflammatory processes, which may be involved in the bi-directional relationship between pain and sleep. Cognitive behavioral therapy (CBT) for pain and CBT for insomnia are evidence based interventions for, respectively, chronic pain and insomnia. The study objectives were to determine the feasibility of combining CBT for pain and for insomnia and to assess the effects of the combined intervention and the stand alone interventions on pain, sleep, and mood outcomes compared to a control condition.MethodsTwenty-one adults with co-occurring chronic pain and chronic insomnia were randomized to either CBT for pain, CBT for insomnia, combined CBT for pain and insomnia, or a wait-list control condition.ResultsThe combined CBT intervention was feasible to deliver and produced significant improvements in sleep, disability from pain, depression and fatigue compared to the control condition. Overall, the combined intervention appeared to have a strong advantage over CBT for pain on most outcomes, modest advantage over both CBT for insomnia in reducing insomnia severity in chronic pain patients.DiscussionCBT for pain and CBT for insomnia may be combined with good results for patients with co-occurring chronic pain and insomnia.     

PHASE AND SEX EFFECTS IN PAIN PERCEPTION: A CRITICAL REVIEW

The psychological literature in pain perception is reviewed to clarify the influence of sex and menstrual phase on the phenomenon of pain. An attempt is made to resolve some of the discrepancies in the reported findings by taking special note of the methodological differences in the pain studies. The appropriateness of the measures of pain threshold, pain tolerance, discrimination accuracy, and of response bias to the study of pain are discussed.