Psychology

Pain, fatigue, and depression commonly co-occur as a symptom cluster in pathological inflammatory states. Psychosocial stressors such as loneliness may lead to similar states through shared mechanisms. We investigated the association of loneliness with pain, fatigue, and depression in older adults. Using Health and Retirement Study data ( = 11,766), we measured cross-sectional prevalence of frequent, moderate to severe pain; severe fatigue; depressive symptoms; and co-occurrence of symptoms surpassing threshold levels (i.e., symptom cluster). Logistic regression models evaluated associations with loneliness. Pain, fatigue, and depression were reported in 19.2%, 20.0%, and 15.3% of the total sample, respectively. The symptom cluster was seen in 4.9% overall; prevalence in lonely individuals was significantly increased (11.6% vs. 2.3%,  < .0001). After adjusting for demographic variables, loneliness associated with the symptom cluster (adjusted OR = 3.39, 95% CI = 2.91, 3.95) and each symptom (pain adjusted OR = 1.61, 95% CI = 1.48, 1.76; fatigue adjusted OR = 2.02, 95% CI = 1.85, 2.20; depression adjusted OR = 4.34, 95% CI = 3.93, 4.79). Loneliness strongly associates with the symptom cluster of pain, fatigue, and depression. Further research should examine causal relationships and investigate whether interventions targeting loneliness mitigate pain, fatigue, and depression.

Neuropathic pain (NeuP) can be difficult to diagnose and manage in children. Data regarding prevalence and sex-dependent differences are limited, and more detailed phenotyping is needed. This observational cohort study recruited adolescents (10-17 years) with NeuP or complex regional pain syndrome (CRPS). After pain history and NeuP questionnaires, quantitative sensory testing was performed. Individual z-score plots were calculated with body-region control measures and matched to mechanism-related sensory profiles (sensory loss, thermal hyperalgesia, and mechanical hyperalgesia). Conditioned pain modulation was assessed with pressure pain threshold and a contralateral cold conditioning stimulus, and meaningful conditioned pain modulation defined as twice the standard error of measurement. Patients and parents completed validated questionnaires for child quality of life (QoL), pain catastrophizing, and self-reported anxiety/depression. Males (n = 23) and females (n = 43) with NeuP (n = 52) or CRPS (n = 14) reported moderate-severe pain with neuropathic sensory descriptors. Mixed patterns of sensory gain/loss at pain sites were not sex-dependent. Thermal hyperalgesia was common in both NeuP and CRPS, whereas sensory loss occurred only with NeuP and in a smaller proportion than adult cohorts. Conditioned pain modulation was inhibitory in 54%, facilitatory in 14%, and nonresponders had variable cold conditioning sensitivity. Males and females reported marked impairment of QoL, increased emotional distress, and pain catastrophising. Child-parent QoL scores correlated, but catastrophizing scores were discordant when parents or adolescents reported higher anxiety/depression. NeuP in adolescents is associated with significant pain, physical impairment, and psychosocial impairment. Quantifying alterations in somatosensory profiles, descending modulation, child and parent psychological function will inform individualized therapy and stratification for future clinical trials.

Previous studies suggest that truncal regional anaesthesia (TRA), including techniques such as paravertebral block, may contribute significantly to analgesia after mastectomy. However, the severity and impact of postoperative pain varies markedly amongst individuals, making the identification of patients who would benefit most from TRA a potentially important step toward personalised perioperative care.

To determine the short-term effect of graded motor imagery (GMI) on the affective components of pain and range of motion in subjects with chronic shoulder pain syndrome.

Non-specific chronic low back pain (CLBP) is a multifactorial disorder. Pain-related fear and altered movement preparation are considered to be key factors in the chronification process. Interactions between both have been hypothesized, but studies examining the influence of situational fear on movement preparation in low back pain (LBP) are wanting, as well as studies differentiating between recurrent LBP (RLBP) and CLBP. Therefore, this study examined whether experimentally induced pain-related fear influences movement preparation. In healthy controls (n=32), RLBP (n=31) and CLBP (n=30) patients central and peripheral measures of movement preparation were assessed by concurrently measuring trunk muscle anticipatory postural adjustments (APA) with EMG and Contingent Negative Variation (CNV) with EEG during performance of rapid arm movements (RAM). Two conditions were compared, one without (no fear) and one with (fear) possibility of painful stimulation to the back during RAM. Visual analogue scales were used to assess pain-related expectations/fear in both conditions. The experimentally induced fear of pain during movement performance led to an increase in CNV-amplitude, which was similar in all three groups. Concerning APAs no effects of fear were found, but group differences with generally delayed APAs in CLBP compared to controls and RLBP patients were evident. These results suggest that with fear an attentional redirection towards more conscious central movement preparation strategies occurs. Furthermore, differences in movement preparation in RLBP and CLBP patients exist, which could explain why RLBP patients have more recovery capabilities than CLBP.

To describe the protocol of a randomized controlled trial to evaluate the effectiveness and mechanisms of three behavioral interventions.