Effects of familial pain models on pain complaints and coping strategies

The roles of ethnicity, sex, and parental pain modeling in rating of experienced and imagined pain events

To investigate the association of ethnicity, sex, and parental pain modeling on the evaluation of experienced and imagined painful events, 173 healthy volunteers (96 women) completed the Prior Pain Experience Questionnaire, a 79-question assessment of the intensity of painful events, and a questionnaire regarding exposure to parental pain models. Consistent with existing literature, greater ratings of experienced pain were noted among Black versus White participants. Parental pain modeling was associated with higher imagined pain ratings, but only when the parent matched the participant's sex. This effect was greater among White and Asian participants than Black or Hispanic participants, implying ethno-cultural effects may moderate the influence of pain modeling on the evaluation of imagined pain events. The clinical implications of these findings, as well as the predictive ability of imagined pain ratings for determining future experiences of pain, should be investigated in future studies.

Representations: an important key to understanding workers' coping behaviors during rehabilitation and the return-to-work process

INTRODUCTION

Every year many workers are excluded from work because of a work disability attributable to a musculoskeletal disorder (MSD). Factors associated with the development and persistence of the work disability can be related to the worker, work environment, compensation policies, healthcare system and insurance system. Workers' understanding/representations of their disability are associated with coping behaviors aimed at helping them adapt to or solve their health problem. A representation is a complex, organized entity incorporating thoughts, beliefs, and attitudes regarding a particular subject. Representations have been studied in anthropology, sociology and psychology since the 1960s, but often in a compartmentalized way. These representations provide an important key to understanding what motivates workers during rehabilitation and the return-to-work process. To build upon disciplinary knowledge and better understand workers' efforts to cope with their persistent disability, this article therefore aims to pool the different knowledge available on the illness representation concept, from the fields of anthropology, sociology and psychology in order to gain a better understanding of its application in the MSD context.

METHODS

An electronic literature search (French, English) from 1960 on was conducted in medical, paramedical and social science databases (MedLINE, PsychINFO, CINAHL, etc.) using predetermined key words. After screening abstracts based on a set of criteria, content analysis was performed on the 131 articles retained.

RESULTS

The theoretical models and approaches can be divided into three categories: (1) personal experience; (2) interactionist; and (3) sociocultural. The models found in sociology and anthropology are mainly descriptive and developed in a medical context, and only rarely in an occupational health context. However, these models could add elements to psychosocial models that are more dynamic and oriented toward understanding the reasons behind specific behaviors.

CONCLUSION

Bridging the gap between these disciplines will help us achieve a new level of knowledge that will, by taking social interactions into account, enhance understanding of workers' representations, and the behaviors they adopt to manage their MSD-related disability.

Back pain in school children--where to from here?

Back pain is now recognised to occur early in childhood and is associated with high prevalence rates when estimated by survey. This review paper considers the risk factors associated with back pain in children aged 11-14 years, and particularly those present in a school setting. The risk factors most significantly associated with back pain are primarily characteristics of the individual with less strong associations with factors present in the school environment. The majority of intervention studies undertaken in a school setting have focussed on the effect of school furniture on posture and comfort and were of short-term duration. There is a need for further research in order to achieve a better understanding of the risk factors present in a school environment and to address ways to reduce the currently recognised perceived problem of back pain among school children. A strategy for an evidence-based longitudinal intervention study is proposed, with the content outlined under the headings: policy, school equipment and furniture, individual and family.

Symptom interactions as mechanisms underlying symptom pairs and clusters

PURPOSE

To present a summary of the potential shared or interactive mechanisms underlying an exemplar symptom pair: sleep disturbances and pain.

ORGANIZING CONSTRUCT

Understanding of the multidimensional shared and interactive mechanisms underlying symptoms pairs and clusters has the potential to enhance symptom management.

METHODS

Reviews of the literature were conducted to search for information on shared or interactive mechanisms underlying sleep disturbances and pain; minimal data were available. Relevant information about individual symptoms was outlined and categorized in areas often used to describe the multidimensional nature of symptoms, including the physiological, psychological, behavioral, and sociocultural domains. This information was examined for relationships and commonalities.

CONCLUSIONS

Many potential shared and interactive mechanisms underlying the symptom pair of sleep disturbances and pain were identified. These results indicate the need for further work and theory development in this area. The symptom interactional framework is a beginning conceptual perspective designed to facilitate this work. Implications for interdisciplinary translational research designed to optimize symptom management are discussed.

Gender differences in post-operative pain and patient controlled analgesia use among adolescent surgical patients

The aim of this study was to explore gender differences in anticipatory emotional distress, coping strategies, post-operative pain perception, and patient-controlled analgesia (PCA) use among adolescent surgical patients. One hundred and two 12-18-year-old adolescents undergoing surgeries with overnight hospital stay were recruited. Participants completed pre-operative measures of anxiety and anticipated pain. Post-operatively, they reported on coping skills, post-operative anxiety, and pain. Data on PCA use were recorded from medical records. Girls reported higher levels of pre-operative state anxiety and anticipated more pain. After surgery, girls and boys differed on their lowest daily pain ratings and average daily pain ratings, with girls reporting more pain in both cases. Reports of highest daily pain were similar across genders. Gender was found to moderate the relationship between anticipatory distress and post-operative pain, such that higher anticipatory distress before surgery predicted more post-operative pain for girls, but not for boys. Patterns of PCA use did not vary by gender on post-operative days 0 or 1. Findings suggest that adolescent boys' and girls' pain experiences are different in several important respects, although somewhat less divergent than has been reported in samples of adult males and females. Results have implications for the development of targeted intervention strategies to help adolescents cope effectively with acute post-operative pain.

Schmerzbezogene Kognitionen, Schmerzprobleme und körperliche Beschwerden bei Kindern von Schmerzpatienten und gesunden Eltern

Zusammenfassung. Ziel dieser Studie war es zu prüfen, inwieweit Kinder von Schmerzpatienten ein höheres Risiko haben, bereits im Kindesalter unter körperlichen Beschwerden und Schmerzen zu leiden. Von Interesse waren insbesondere potentielle Mechanismen, die den Einfluß eines elterlichen Schmerzmodells mediieren. Insgesamt nahmen 19 Schmerzpatienten und 20 gesunde Eltern sowie ihre Kinder an einer Befragung teil, im Rahmen derer schmerzbezogene Kognitionen, körperliche Beschwerden und Schmerzen bei den Kindern sowie schmerzbezogene Kognitionen und die Beeinträchtigung durch sowie der Umgang mit Schmerzen bei den Eltern erfaßt wurden. Die beiden Gruppen von Kindern unterschieden sich nicht signifikant bezüglich ihrer schmerzbezogenen Kognitionen, körperlichen Beschwerden und Schmerzprobleme. Jedoch gaben die Kinder von Schmerzpatienten, sofern sie unter rezidivierenden Schmerzen litten, eine signifikant längere Schmerzgeschichte an. Schmerzbezogene Kognitionen der Eltern und Kinder korrelierten besonders deutlich in der Gruppe von Schmerzpatienten. Die Schwere des elterlichen Schmerzproblems, die schmerzbedingte subjektive Beeinträchtigung und affektive Verstimmung sowie negative schmerzbezogene Kognitionen der Eltern gingen mit ungünstigen schmerzbezogenen Kognitionen, einem höheren Ausmaß an körperlichen Beschwerden und einer längeren Chronizität von Schmerzbeschwerden auf seiten der Kinder einher. In Übereinstimmung mit den Grundannahmen psychobiologischer Modelle chronischen Schmerzes werden die Befunde als Hinweis für die Bedeutung von Modellernen als Risikofaktor für die Entstehung einer Vulnerabilität für körperliche Beschwerden und Schmerzprobleme bei Kindern von Schmerzpatienten diskutiert.

Effects of familial pain models on daily pain indices and performance during the cold pressor task

To understand better the role of pain history in current response to pain episodes, this research examined pain-related indices from the patient's family of origin and their relationships to the patient's coping with acute pain. Participants were 42 healthy men and women who provided information about their own and their family's pain history and then were administered a cold pressor task. High frequency of family pain modeling was associated with higher frequency of current pain episodes, more types of pain, greater intensity, and also lower physiological arousal and subjective pain ratings during the cold pressor. The findings underscore the relationships between familial pain modeling and current pain-related functioning.

[The clinical picture of the chronic pain patient-Analysis of a pain outpatient clinic using headache as an example.]

INTRODUCTION

Patients with chronic headache are seen in an interdisciplinary pain clinic after many years of treatment. Compared with other pain syndromes, the standards for diagnosis and treatment are widely accepted according to the guidelines of the International Headache Society. Nevertheless, many patients continue to suffer. Analysis of their special clinical features may help to clarify what kind of conditions potentially cause chronicity.

PATIENTS AND METHODS

A total of 193 patients were seen in 1992-1993 in our pain clinic. Epidemiological, medical and psychological data were analyzed retrospectively. Classification of headache syndromes and pain behavior was based on the criteria of the International Headache Society, taxonomy of the Multiaxial Pain Classification System for Somatic Dimensions (MASK-S) and "Stages of Chronicity". Important psychodynamic factors were taken from standardized psychological interviews.

RESULTS

The patients had a mean age of 46 years; 67 % of them were female. Fifty-three percent of the patients suffered from chronic tension headache; a high percentage was suspected to be caused by analgesic intake. Because of their pain behavior, 68 % were classified as being in an advanced chronic stage with a poor prognosis. The most important findings of the psychological diagnosis was that 40 % of patients had a depressive style of conflict solving.

CONCLUSIONS

The results are discussed with respect to their relevance in explaining development of chronic pain, as seen in selected headache patients in an interdisciplinary pain clinic.

The incidence of back pain and headache among Swedish school children

Musculoskeletal pain is exceedingly common in young adults. With the aim of studying these symptoms in schoolchildren, a questionnaire survey was carried out among children 8, 11, 13 and 17 years old. The prevalence of back pain and headaches in 1,245 schoolchildren was studied. Twenty-nine per cent of the students reported back pain and 48% headache. In all age groups studied, both back pain and headaches were more common among girls than boys. Girls also reported more frequent symptoms than boys. In a longitudinal study 471 schoolchildren were asked a second time 2 years later. Nine per cent reported back pain and 30% headache in both surveys. Five per cent reported both back pain and headache on both occasions. Despite the reported symptoms most of the pupils did not report health problems. However, pupils with reported pain on both occasions may constitute a risk group for future chronic pain. There were statistically significant relationships between social, psychological and emotional factors and reported symptoms. No relationship between physical factors and reported symptoms were noted. The observed relationships are not proof of causal relations but did indicate areas of problems which make interventions targeting pupils at risk an appropriate measure.

Pain and families. I. Etiology, maintenance, and psychosocial impact

This is the first part of a two-part extended review on the interdependency between chronic pain and families. This paper will address the role of the family in the etiology and maintenance of chronic pain and will describe the reciprocal impact of chronic pain on families. Different conceptualizations of the role of the family and the available empirical evidence related to 3 central questions, namely, 'do families play an etiological role in chronic pain?,' 'does the family maintain the chronic pain problem?,' and 'is there a negative impact of chronic pain on the family?' will be critically examined. The second, companion paper will address the issue of the inclusion of family members in the assessment and treatment of chronic pain. Finally, recommendations for future research will be made.