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The trigeminal nerve theory has been proposed as a pathophysiological mechanism of migraine; however, its association with the triggers of migraine remains unclear. Cervical disability such as neck pain and restricted cervical rotation, have been associated with not only cervicogenic headaches but also migraine. The presence of cervical disability could worsen of the migraine, and also the response to pharmacologic treatment may be reduced. The aim in this review is to highlight the involvement of cervical disability in migraine, considering contributing factors.
In recent years, evidence of neck pain complaints in migraine has been increasing. ALK assay In addition, there is some recent evidence of cervical musculoskeletal impairments in migraine, as detected by physical assessment. However, the main question of whether neck pain or an associated cervical disability can act as an initial factor leading to migraine attacks still remains. Daily life imposes heavy loads on cervical structures (i.e. muscles, joints and ligaments), for instance, in the forward head position. The repetitive nociceptive stimulation initiating those cervical skeletal muscle positions may amplify the susceptibility to central migraine and contribute to chronicity via the trigeminal cervical complex.
Further studies are needed to explain the association between cervical disability as a source of pain and the development of migraine. However, evidence suggests that cervical disability needs to be considered in the prevention and treatment of migraine.
Further studies are needed to explain the association between cervical disability as a source of pain and the development of migraine. However, evidence suggests that cervical disability needs to be considered in the prevention and treatment of migraine.
People with chronic pain often seek support from friends and family for everyday tasks. These individuals are termed informal caregivers. There remains uncertainty regarding the lived experiences of these people who care for individuals with chronic musculoskeletal pain. The aim of this article is to synthase the evidence on the lived experiences of informal caregivers providing care to people with chronic musculoskeletal pain.
A systematic literature review was undertaken of published and unpublished literature databases including EMBASE, MEDLINE, CINAHL, PubMed, the WHO International Clinical Trial Registry and ClinicalTrials.gov registry (to September 2019). Qualitative studies exploring the lived experiences of informal caregivers of people with chronic musculoskeletal pain were included. Data were synthesised using a meta-ethnography approach. Evidence was evaluated using the Critical Appraisal Skills Programme qualitative appraisal tool.
From 534 citations, 10 studies were eligible (360 participaneriences can be modified to improve a caregiving dyad's lived experience is now warranted.
Acceptance and commitment therapy (ACT), based in the psychological flexibility model, may benefit people with chronic abdominal pain. The current study preliminarily investigates associations between psychological flexibility processes and daily general, social and emotional functioning in chronic abdominal pain.
An online survey comprising measures of psychological flexibility processes and daily functioning was distributed through social media.
In total, 89 participants with chronic abdominal pain were included in the analyses.
All investigated psychological flexibility processes significantly correlated with pain interference, work and social adjustment, and depression, in the expected directions (|r| = .35-.68). Only pain acceptance significantly correlated with gastrointestinal (GI) symptoms, r = -.25. After adjusting for pain in the analyses, pain acceptance remained significantly associated with all outcomes, |β| = .28-.56, but depression. After adjusting for pain and pain acceptance, only cognitive fusion remained significantly associated with anxiety, β = -.27, and depression, β = .43. When contrasting GI-specific anxiety with psychological flexibility processes, pain acceptance was uniquely associated with pain-related interference and work and social adjustment, and cognitive fusion and committed action were uniquely associated with depression.
Psychological flexibility processes were positively associated with daily functioning in people with chronic abdominal pain. ACT may provide benefit for these people. Further studies with experimental designs are needed to examine the utility of ACT for people with abdominal pain.
Psychological flexibility processes were positively associated with daily functioning in people with chronic abdominal pain. ACT may provide benefit for these people. Further studies with experimental designs are needed to examine the utility of ACT for people with abdominal pain.
This article describes the development and initial evaluation of introducing a psychologist role within an adult inpatient pain service (IPS) in a large North West of England National Health Service (NHS) trust.
The role of a psychologist in the management of outpatient chronic pain has been well documented, but their role within the IPS is less well described and rarely evaluated. We describe the development of a psychologist role within the team and initial service evaluation outcomes.
Following an initial needs assessment, a band 8c psychologist joined the IPS one day per week offering brief one-to-one psychological interventions to people struggling with acute or chronic pain in hospital referred by inpatient pain team. The psychologist had an indirect role offering training, supervision and support to members of the inpatient pain team. Regarding direct patient work, following psychometric screening for pain-related disability and distress, a cognitive behavioural therapy (CBT) approach was appliedhe psychologist became a valuable member of the multi-disciplinary IPS team, offering brief direct and indirect psychological interventions. While a relatively small sample, our prospective service evaluation data suggest brief psychological intervention may contribute to reduced length of stay and hospital admissions for people experiencing pain-related distress in hospital.
Assessment of outcomes from health interventions are of increasing importance, primarily to identify effective and safe treatment, but also to justify funding decisions. The Bath Adolescent Pain Questionnaire (BAPQ) is a self-report questionnaire, validated in 11-18 year olds, assessing the impact of pain in multiple domains of adolescent life. The similarly validated Bath Adolescent Pain Questionnaire for Parents (BAPQ-P) uses the same domains as the BAPQ, assessing the functioning and development of the adolescent from the parents' perspective.
We conducted a prospective study, planning to routinely collect BAPQ/BAPQ-P data at initial assessment and 6 months later. All patients aged between 5 and 19 attending our chronic pain clinic for the first time between December 2009 and December 2014 were mailed BAPQ and BAPQ-P questionnaires before the first appointment and 6 months after the first appointment.
In total, 376 of 386 families returned questionnaires at time 0 and 96 after 6 months, 26% of those easurement proved useful tools to assess response to pain management input in adolescents over a 6-month period. Our experience and results suggest that these tools can, with appropriate administrative support, be used in routine clinical practice to assess patient outcomes. We also believe that BAPQ and BAPQ-P measurements have a utility to audit pain clinic activity and potentially a use in demonstrating beneficial outcomes to commissioners.
To explore the effects of a hypnotic communication (HC) training for paediatric nurses in decreasing patients' pain and distress during venipunctures.
A 4-day theoretical and practical HC training was offered to five paediatric oncology nurses. The effects of HC were tested with 22 young cancer patients (13 girls, 9 boys, 10 ± 4 years) over four time points, with 88 encounters being video-recorded and coded in stable professional-patient dyads. Patients' pain and distress were rated by patients and parents with visual analogue scales and coded from recordings using the Faces, Legs, Activity, Cry and Consolability (FLACC) scale.
We observed a significant decrease in pre-post distress reported by parents (
= 0.45,
= 0.046). Two out of five nurses with higher skills acquisition had larger reduction in patients' self-reported pain (
= 1.03,
= 0.028), parents perceived pain (
= 1.09,
= 0.042), distress (
= 1.05,
= 0.043) as well as observed pain (
= 1.22,
= 0.025). Favourable results on pain and distress did not maintain at follow-up.
Training nurses in HC may translate into improved pain and distress in patients, both self-rated and observed provided that skills are used in practice. HC training is a promising non-pharmacological intervention to address pain in paediatrics.
Training nurses in HC may translate into improved pain and distress in patients, both self-rated and observed provided that skills are used in practice. HC training is a promising non-pharmacological intervention to address pain in paediatrics.
Psychological variables contribute to pain- and injury-related outcomes. We examined the hypothesis that anatomical spread and intensity of persistent pain relate to anxiety-related variables generalised anxiety, fear of pain and pain catastrophising.
An online survey was used to gather data from 413 women with persistent pain (low back pain, n = 139; fibromyalgia syndrome, n = 95; neck pain, n = 55; whiplash, n = 41; rheumatoid arthritis, n = 37; migraine, n = 46). The spread and intensity of pain were assessed using the McGill pain chart and a Numerical Rating Scale. A Bayesian Structural Equation Model assessed if the intensity and spread of pain increased with anxiety-related variables. Men were also surveyed (n = 80), but the sample size was only sufficient for analysing if their data were consistent with the model for women.
Across subgroups of women, one standard deviation increase in catastrophising, generalised anxiety and fear corresponded to 27%, 7% and -1% additional pain areas and a 1.1, 0 ce the model did not consistently fit the men, we may conclude that the relationships are moderated by sex. Clinician attention to psychological variables as potential contributing factors can be justified; however, research is needed to understand the relationship and whether psychological treatment can reduce pain.
S1 root block is performed for pain in the lower limbs due to S1 nerve root inflammation at the L5/S1 disc level or compression in the lateral recess. We often note anterior or posterior spread of contrast away from the L5/S1 disc through an anatomically appropriate needle tip placement. We frequently encounter vascular spread when performing S1 root blocks, and the reported incidence varies between 10.4% and 27.8%. There is no clear strategy published to manage these challenges. In such clinical scenarios, we propose a double needle and/or a multilevel needle technique.
A 39-year-old male presented with radicular pain in the left S1 distribution which matched the magnetic resonance imaging (MRI) scan findings and thus he was listed for a left S1 root block. A 22G needle was placed at the S1 level and upon injecting the contrast, vascular spread and anterior and distal spread along the nerve root were noted and the contrast did not reach the site of the pathology, the L5/S1 disc. The contrast continued to spread anteriorly despite withdrawing the needle.
