Biobehavioral Approaches to Pain (eBook)

Biobehavioral Approaches to Pain 2
Preface 6
Forward 8
Acknowledgements 10
Contents 12
Contributors 14
Introduction 21
The Experience of Pain and Suffering from Acute and Chronic Pain 30
Introduction 30
Acute Pain 30
Chronic Pain 32
The Transition from Recent Onset Pain to Long-Term Distress and Disability 34
Preventing the Development of Chronic Pain Following Episodes of Acute Pain 35
Common and Distinct Elements of Suffering in Acute and Chronic Pain 36
Developing Approaches to Pain and Suffering 38
Summary 39
References 40
The Neuroanatomy of Pain and Pain Pathways 46
Introduction 46
Peripheral Pathways 46
Nociceptors 47
Peripheral Sensitization and Primary Hypersensitivity 47
Primary Afferents: Somatic and Visceral 48
Chemical Mediators 49
Central Pathways 49
Pathways in the Ventral (Anterior) Quadrant 50
The Spinothalamic Tract 50
Pathways in the Dorsal (Posterior) Quadrant 52
Spinocervical Pathway 52
The Dorsal Column 53
Postsynaptic Dorsal Column Pathway 55
Representation of Nociceptive Sensation in the Brain 56
Thalamic Representation of Pain 57
Cortical Pain Processing 58
Descending Modulatory Pathways 59
Gender Differences in Pain Processing 60
Conclusion 60
Future Directions 61
References 61
The Genetic Epidemiology of Pain 73
Genetic Influences on Pain at the Population Level: The Evidence 73
Cultural, Social and Gender Influences on Pain 74
Twin and Family Studies 76
Genetic Influences on Diseases Characterised by Pain 76
Genetic Influences on Experimental Pain 77
Genetic Influences on Affective, Cognitive and Behavioural Aspects of Pain 80
Genetic Association Studies in Pain 81
The Multifactorial Model 85
Conclusions 85
References 86
Pain and the Placebo Effect 93
Psychological Modulation of Pain 93
The Placebo Effect and Its Measurement 94
From the Sugar Pill to Context Effects: Conditioning and Expectation 95
The Neurobiology of the Placebo Effect 97
How the Brain Produces Placebo Analgesia - The Neuroimaging Studies 99
Placebo and Nocebo 103
Clinical Implications of Placebo Analgesia 105
The Role of Expectation on the Outcome of a Clinical Trial: The ‘‘Principle of Uncertainty’’ 105
The Placebo Therapeutic Potential 106
Patients Without Expectations 107
Conclusions 107
References 108
The Narrative Approach to Pain 113
Introduction: Narrative 113
History: Changes in the Clinical Focus 113
Devotion to the Images 115
Narrative Brings Empathy 116
Narrative in Oncology 116
Pain and Suffering in Oncology 117
Context Counts in Cancer 118
When to Emphasize Narrative/Empathy 118
Final Remarks 119
References 121
Understanding and Enhancing Patient and Partner Adjustment to Disease-Related Pain: A Biopsychosocial Perspective 122
A Biopsychosocial Model of Adjustment to Pain 122
Arthritis 126
Unique Demands of Patient Adjustment to Arthritis 126
Unique Demands of Partner Adjustment to Arthritis 128
Intervention Studies 129
Cancer Pain 132
Unique Demands of Patient Adjustment to Cancer Pain 132
Unique Demands of Partner Adjustment to Cancer Pain 135
Intervention Studies 137
Future Directions for Clinical and Research Efforts in Disease Related Pain 139
Focus on Partner’s Experience 139
Individual Differences in Response to Couples Interventions 140
Disease-Specific Couples Interventions 140
Couple Based Interventions 141
Depression in Chronic Pain 141
Family Intervention 142
Pain Patients Without an Intimate Partner 142
More Behavioral Intervention 143
Positive Emotions 143
Physiological Mechanisms 143
Acceptability of Psychosocial Pain Treatment 144
Delivery Methods of Partner-Based Interventions 144
Longitudinal Studies 145
Increasing Diversity 145
Conclusions 146
References 146
Sex Differences in Pain 152
Introduction 152
Evidence for Sex Differences in Pain and Analgesia 152
Sex Differences in Prevalence of Pain Experience 152
Sex Differences in Health Care Utilization, Analgesic Use and Analgesic Effectiveness 154
Sex Difference in Pain Sensitivity to Experimental Stimuli 155
Sex Differences in Non-pharmacological Treatment 156
Explanations for Sex Differences in Pain 158
Emotions and Pain: The Role of Depression, Anxiety and Anger 158
Health Cognitions, Beliefs and Expectations 160
Coping Behaviors 162
Interpersonal Interactions 163
Biological Factors 164
Summary and Conclusions 166
References 167
Pain in Children 176
Neurobiology of Pain Pathways in Children 177
What Is a Child: Towards a Definition 178
Epidemiology 178
Neonates 179
Acute Pain in Children 179
Chronic Pain in Children 179
Headache 180
Chronic Tension-Type Headache 180
Chronic Post-Traumatic Headache 181
Complex Regional Pain Syndrome 181
Abdominal Pain 182
Diagnosing and Measuring Pain in Children 184
Taking a Pain History 184
Acute Pain 185
Chronic Pain 185
Acute Pain Assessment 186
Self Report 186
Physiologic 186
Behavioral Observation 187
Chronic Pain Assessment 189
Medications: Evidence-Based Best Practices 192
Acute Pain 192
Opioids 192
Non-steroidal Anti-inflammatory Drugs (NSAIDS) 194
Acute Pain: Regional Anesthesia 194
Chronic Pain 195
Chronic Pain and Development 196
Chronic Pain Management 197
The Process 198
Cancer Pain 198
Pharmacological 198
Opioids 198
Methadone 199
Fentanyl 199
Implanted Infusion Pumps 200
Headache 200
Migraine 201
Tension-Type Headache 203
Post-Traumatic Headache 203
Cervicogenic Headache 203
Neuropathic Pain 204
Peripheral and Trigeminal Neuropathy 204
Tricyclic Antidepressants 205
Anticonvulsants 205
Opioids 206
Complex Regional Pain Syndrome 206
Abdominal Pain 207
Conclusion 207
Future Perspectives 208
References 210
Pain in the Older Person 222
Introduction 222
Neurophysiology of Aging 223
Assessing and Measuring Pain in Older People 224
Assessing and Measuring Pain in Cognitively Intact Patients 225
Assessing and Measuring Pain in Cognitively Impaired Patients 225
Psychosocial Issues Associated with Pain in the Older Person 226
Depression 226
Symptoms Associated with Depression 227
Fatigue 227
Treating Older People with Pain Based Upon Pathophysiology 228
Evidence Based Interventions 229
Medications 230
Complementary and Alternative Medicine (CAM) 230
Pain Management in Long-Term Care Facilities 231
Barriers 232
Medications for Pain 232
Pain at the End of Life 233
Hospice Versus Palliative Care 235
Providing the Best Care at the End of Life 236
Conclusions 236
Future Directions 237
References 238
Healthcare Economic Evaluation of Chronic Pain: Measuring the Economic, Social and Personal Impact of Chronic Pain and its Management 246
Introduction 246
The Definition and Prevalence of Chronic Pain 246
The Implications of Chronic Pain 247
The Potential Role of Economic Evaluation in Chronic Pain 247
An Overview of Healthcare Economic Evaluation 248
The Dimensions of a Healthcare Economic Evaluation 249
The Types of Analysis in a Healthcare Economic Evaluation 250
The Categories of Costs in a Healthcare Economic Evaluations 253
Delineating Healthcare Costs 253
The Point of View or Perspective of a Healthcare Economic Evaluation 255
A Framework for Assessing Healthcare Economic Analyses 256
Chronic Low Back Pain 256
The Definition and Prevalence of Chronic Low Back Pain 256
The Treatment of Chronic Low Back Pain 257
The Burden of Chronic Low Back Pain 258
Economic Evaluation of the Treatment of Chronic Lower Back Pain 260
Fibromyalgia 262
The Definition and Prevalence of Fibromyalgia 262
The Treatment of Fibromyalgia 263
The Burden of Fibromyalgia 265
Economic Analyses of the Treatment of Fibromyalgia 268
Implications for the Clinical Application of Healthcare Economic Evaluations of Chronic Pain Management 270
Can Cost-Effectiveness Analysis Be Performed Simultaneously With an Efficacy Study of Chronic Pain Treatment? 270
When Designing an Economic Evaluation to Be Conducted Alongside a Clinical Trial, Upon Which Endpoint Should the Overall Study Sample Size Be Based? 271
Costs per Country Be Pooled or Remain Separate in Multinational Studies of Chronic Pain? 272
Conclusions 273
References 275
Chemotherapy Induced Peripheral Neuropathies (CIPNs): A Biobehavioral Approach 286
Introduction 286
Epidemiology 287
Symptoms Associated with CIPNs 288
Barriers 289
A Biobehavioral Approach to Understanding CIPNs 291
Healthy Peripheral Nerves 292
The Danger Model 292
Cancer as a Context 293
Peripheral Nerve Injury and Peripheral Sensitization 293
Peripheral Nerve Injury and Glial Activation of the Spinal Cord 294
Immune to Brain Communication 295
Sickness Responses and Sickness Behaviors 296
Conclusions 297
References 299
Pain and Use of Health Services Among Persons Living with HIV 312
Introduction 313
Prevalence of Pain in the General Population of Adults 313
Prevalence of Pain Among the General Population of Children 315
Prevalence of Pain in Adults and Children Living with HIV 316
Pain and Health Status 317
Types of Pain 317
Undertreatment of Pain 318
Pain and Functional Impairment 319
Psychological Distress and Pain 320
Pain and Access to Health Services 323
Access to Health Services 323
HIV and the Healthcare System 324
Funding for HIV-Related Services 325
Barriers to Accessing Health Care Among Persons Living with HIV 326
Pain and the Healthcare System 328
Chronic Pain and the Use of Conventional Health Services 328
Chronic Pain and the Use of Complementary and Alternative Therapies 331
Psychological Distress, Pain, and Use of Health Services 333
Chronic Pain and the Use of Conventional Health Services and Complementary and Alternative Therapies Among Persons Living with HIV 334
Conclusion 337
Future Directions 338
References 339
Pain Measurement 347
Introduction 347
Measuring Pain 348
Assessment Instruments 349
Assessing Pain in Non-Verbal Populations 351
Measuring Pain in Children 352
Other Instruments 353
Quality Measures 353
Improving Pain Management 355
Quality Improvement 355
Interventions Targeting Health Care Professionals 356
Assessment, Educational, and Psychosocial Interventions Targeting Patients 357
Conclusion 358
References 359
Phantom Pain 362
Introduction 362
Describing Phantom Limb Pain and Phantom Sensations 364
Epidemiology 365
Risk Factors 366
Etiology 367
Phantom Pain as a Psychiatric Problem 367
Neuromata 368
Neurons of the Spinal Cord 368
Reorganization (Remapping) 368
Treatments 371
Surgical treatments 373
Pharmacological treatments 374
Salmon Calcitonin 374
Oral Dextromethorphan 375
Gabapentin 375
Amitryptiline 376
Ketamine 376
Psychological treatments 377
Supportive treatments 378
Prosthetic Management 378
Transcutaneous Electrical Nerve Stimulation (TENS) 378
Farabloc 379
Mirror Treatments 379
Self Management 380
Conclusion 380
References 381
Pain: Substance Abuse Issues in the Treatment of Pain 387
A Brief History of Drug Regulation in the United States 388
Risk versus Benefit 389
A Continuum of Pain and Opioid Addiction 390
Definitions 390
Pseudoaddiction 391
Pseudotolerance 391
Multiple Types of Tolerance 392
Iatrogenic Addiction 392
Universal Precautions in Pain Medicine 394
Group I - Primary Care Management Patients 394
Group II - Primary Care Patients with Specialist Support 395
Group III - Specialty Pain Management 395
Urine Drug Testing in Pain or Addiction Medicine 396
Specimen Choice 397
Whom to Test 397
Testing Strategies 397
Opioid Agreements 400
Reality and Responsibility: The Treatment of Pain and Suffering in Our Society 401
References 402
The Use of Complementary and Alternative Medicine for Pain 405
Manipulative and Body-Based CAM Therapies for Pain 407
Massage 407
Mind-Body Medicine CAM Therapies for Pain 408
Hypnosis and Imagery 408
Yoga 410
Meditation 412
Tai-Chi and Qi Gong 412
Energy Medicine 414
Reiki 414
Acupuncture 415
Methodological Issues 419
Control Groups 419
Mechanisms of Action & Placebo
Masking & Dose-Ranging
Effects of Age 424
Standardized Treatments 425
Limitations and Directions 425
References 426
Imaging Modalities for Pain 433
Introduction 433
Background/Historical Overview 433
Imaging Methodology 435
Magnetoencephalography (MEG) 435
The Principles of MEG 435
Temporal and Spatial Resolution 437
Positron Emission Tomography (PET) 437
The Principles of PET 437
Radiotracers and Receptor Binding 438
Experimental Design and Statistical Analysis 438
Functional Magnetic Resonance Imaging (fMRI) 439
The BOLD Response 439
Data Acquisition 439
Experimental Design 440
Statistical Analysis 440
Functional Connectivity 441
Pharmacological fMRI 441
Imaging Pain 442
The Pain Matrix 442
Sensory-Discriminative Aspect of Pain 443
Affective-Motivational Aspect of Pain 445
Pain Modulation 447
Impact of Attention and Distraction 448
Impact of Expectation and Emotion 451
Pain Imaging in Patients 456
Future Perspectives 458
References 460
Pain, Transportation Issues and Whiplash 471
The Whiplash Injury 472
Symptoms 473
Physical Characteristics of the Whiplash Condition 474
Motor and Sensori-Motor Dysfunction 474
Evidence for Augmented Central Pain Processes in WAD 475
Psychological Features of the Whiplash Condition 478
Posttraumatic Stress Symptoms - An Important Factor in Whiplash? 480
Relationships Between Physical and Psychological Factors 482
The Prediction of Outcome Following Whiplash Injury 485
Implications for Assessment and Management of Whiplash 486
Summary 488
References 489
Gene Therapy for Chronic Pain 496
Introduction 496
Methods of Gene Therapy 497
Liposomes and Naked Plasmid DNA 497
Viral Vectors 498
Adenoviral Vectors 498
Adeno-Associated Virus and Lentivirus Vectors 499
Herpes Simplex Virus (HSV)-1 499
Preclinical Studies of Gene Therapy 500
Basal Nociceptive and Mechanical Sensitivity 500
Inflammatory Nociception and Hypersensitivity 506
Neuropathic Pain Models of Allodynia and Hyperalgesia 507
Cancer Pain Models 507
Specificity of Effects of Preclinical Studies 507
Human Clinical Trials 508
Conclusions 510
References 511
Palliative Care and Pain Management in the United States 515
Introduction 515
The Cultural Evolution of the Modern Palliative Care Movement: A Brief History 515
The Clinical Worlds of ‘‘Palliative Care’’ and ‘‘Pain Management’’ 516
Pain Management and Hospice 516
Total Pain 517
Saunders’ Total Pain, Engels’ Biopsychosocial Model, and Bonica’s Multidisciplinary Pain Centers 519
Hospice Care Comes to the United States 520
The Growth of Palliative Care Services in the United States 522
Palliative Care Post - SUPPORT 524
Palliative Care and Pain Management 524
Evidence Based Pain Management and Palliative Care 525
System Change and Advocacy 527
Palliative Care and Pain Management - Still Worlds Apart 529
An Eye to the Future 530
References 531
Pain in Society: Ethical Issues and Public Policy Concerns 536
Introduction 536
Ethical Dimensions of Pain and Its Relief 537
Barriers to Effective Pain Relief 538
Regulation of Opioid Analgesics 541
Litigating the Right to Pain Relief 544
Public Policy Responses to the Phenomenon of Undertreated Pain 545
Conclusion 546
References 547
Index 550