Chronic Pain « Neck Solutions Blog

June 3, 2011

Physical Exercise, Body Mass Index, and Risk of Chronic Pain in the Low Back and Neck/Shoulders

Filed under: Back Pain,Chronic Pain,Neck Pain,Shoulder Pain — Administrator @ 3:57 am

Physical Exercise, Body Mass Index, and Risk of Chronic Pain in the Low Back and Neck/Shoulders: Longitudinal Data From the Nord-Trondelag Health Study

From: Am J Epidemiol. 2011 Jun 1. [Epub ahead of print]

Chronic musculoskeletal complaints are among the major health problems in Western society, and the most frequent cause of long-term sickness leave in Norway. Chronic musculoskeletal complaints is associated with several negative determinants of health, such as smoking, overweight, and low socio-economic status. Increased risk of cancer and higher mortality have also been reported among individuals with chronic widespread musculoskeletal complaints, which further emphasizes that this group of patients may constitute an important public health problem.

Physical inactivity is, like chronic musculoskeletal complaints, associated with e.g. more sick leave, overweight, low socio-economic status, increased risk of cancer, and increased mortality.

It is well established that regular physical exercise has a primary preventive effect on several chronic diseases, such as cardiovascular diseases, hypertension, and
type 2 diabetes mellitus. For localized musculoskeletal disorders, prospective studies have provided evidence that regular physical exercise can prevent the development of symptoms in the neck/shoulder and low back. Moreover, longitudinal studies have shown that physical exercise is associated with less musculoskeletal pain and stiff or painful joints among aging women.

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May 24, 2011

Suppression of anger and subsequent pain intensity and behavior among chronic low back pain patients: the role of symptom-specific physiological reactivity

Filed under: Back Pain,Chronic Pain — Administrator @ 9:15 am

Suppression of anger and subsequent pain intensity and behavior among chronic low back pain patients: the role of symptom-specific physiological reactivity

From: J Behav Med. 2011 May 20. [Epub ahead of print]

Anger is related to both acute and chronic pain intensity. Findings suggest that the manner in which anger is regulated—either inhibition (anger-in) or expression (anger-out) of angry feelings—is a particularly reliable determinant of chronic pain severity.

Anger, hostility, and anger management style are related to physiological reactivity to stress (8–10). Although much research has focused on the cardiovascular components of sympathetic and parasympathetic nervous system reactivity, anger variables may also be related to activation of the skeletal muscles.

Suppression of anger may be linked to heightened pain report and pain behavior during a subsequent painful event among chronic low back patients, but it is not clear whether these effects are partly accounted for by increased physiological reactivity during suppression.

In this study, chronic low back pain patients (N = 58) were assigned to Suppression or No Suppression conditions for a “cooperative” computer maze task during which a confederate harassed them. During baseline and maze task, patients’ lower paraspinal and trapezius muscle tension, blood pressure and heart rate were recorded. After the maze task, patients underwent a structured pain behavior task (behaviors were videotaped and coded).

Results showed that: (a) Suppression condition patients revealed greater lower paraspinal muscle tension and systolic blood pressure increases during maze task than No Suppression patients (previously published results showed that Suppression condition patients exhibited more pain behaviors than No Suppression patients); (b) residualized lower paraspinal and systolic blood pressure change scores were related significantly to pain behaviors; (c) both lower paraspinal and systolic blood pressure reactivity significantly mediated the relationship between Condition and frequency of pain behaviors.

Results suggest that suppression-induced lower paraspinal muscle tension and systolic blood pressure increases may link the actual suppression of anger during provocation to signs of clinically relevant pain among chronic low back pain patients.

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May 20, 2011

Effective treatment of chronic low back pain in humans reverses abnormal brain anatomy and function

Filed under: Back Pain,Chronic Pain — Administrator @ 1:21 pm

Effective treatment of chronic low back pain in humans reverses abnormal brain anatomy and function

From: J Neurosci. 2011 May 18;31(20):7540-50.

Chronic pain is associated with reduced brain gray matter and impaired cognitive ability. In this longitudinal study, the authors assessed whether neuroanatomical and functional abnormalities were reversible and dependent on treatment outcomes.

MRI scans were acquired from chronic low back pain patients before (n = 18) and 6 months after (spine surgery or facet joint injections; n = 14) treatment. In addition, 16 healthy controls were scanned, 10 of which returned 6 months after the first visit. Cortical thickness analysis on structural MRI scans were performed, and subjects performed a cognitive task during the functional MRI. Patients and controls, as well as patients before versus after treatment were compared.

After treatment, patients had increased cortical thickness in the left dorsolateral prefrontal cortex, which was thinner before treatment compared with controls. Increased dorsolateral prefrontal cortex thickness correlated with the reduction of both pain and physical disability. Additionally, increased thickness in primary motor cortex was associated specifically with reduced physical disability, and right anterior insula was associated specifically with reduced pain. Left dorsolateral prefrontal cortex activity during an attention-demanding cognitive task was abnormal before treatment, but normalized following treatment.

These data indicate that functional and structural brain abnormalities, specifically in the left dorsolateral prefrontal cortex are reversible, suggesting that treating chronic pain can restore normal brain function in humans.

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May 5, 2011

Persistent Musculoskeletal Inflammation in Chronic Whiplash Associated Disorder

Filed under: Chronic Pain,Neck Pain,Whiplash — Administrator @ 3:24 am

Elevated [11C]-D-Deprenyl Uptake in Chronic Whiplash Associated Disorder Suggests Persistent Musculoskeletal Inflammation

From: PLoS One. 2011 Apr 19;6(4):e19182

Chronic musculoskeletal pain syndromes are common, cause extensive individual suffering and place a large burden on health care in society. Yet, pain remains notoriously difficult to visualize and diagnose objectively. Furthermore the pathophysiology of persistent pain is elusive and there is a great need for ways to visualize and quantify pain mechanisms. One common chronic pain syndrome is whiplash associated disorder, where the onset is a soft tissue sprain of the neck caused by a rear end motor vehicle collision or a similar trauma. The injury is usually benign and resolves within a couple of months, but in a sub-portion of the population, whiplash injuries proceed to chronic debilitating pain. Generally accepted diagnostic criteria for whiplash associated disorder exist, but the etiology of chronic symptoms is not known, and there is a lack of an objective biomarker for chronic whiplash associated disorder.

Recent magnetic resonance imaging (MRI) studies of the neck in whiplash associated disorder have indicated structural abnormalities in the deep cervical muscles and ligaments, typically around the uppermost vertebras. However, such findings can also be present in healthy subjects, and thus largely fail to distinguish between whiplash associated disorder and normal, pain-free natural variations. Furthermore, structural imaging does not capture on-going biological processes; where as molecular imaging with positron emission tomography has the potential to visualize such mechanisms.

The present study explores if D-deprenyl retention is elevated in the neck region in chronic whiplash associated disorder patients as compared to pain free controls. The authors hypothesized that whiplash associated disorder patients would have an elevated D-deprenyl retention in deep neck muscle regions.

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May 1, 2011

Changes in Regional Gray and White Matter Volume in Patients with Myofascial-type Temporomandibular Disorders: A Voxel-based Morphometry Study

Filed under: Chronic Pain,TMJ Pain — Administrator @ 6:14 am

Changes in Regional Gray and White Matter Volume in Patients with Myofascial-type Temporomandibular Disorders: A Voxel-based Morphometry Study

From: J Orofac Pain. 2011 Spring;25(2):99-106

The aim of this study was to use magnetic resonance imaging and voxel-based morphometry to search for evidence of altered brain morphology in patients with temporomandibular disorders using voxel-based morphometry, regional gray and white matter volume was investigated in nine temporomandibular disorder patients and nine carefully matched healthy controls.

A decrease in gray matter volume occurred in the left anterior cingulate gyrus, in the right posterior cingulate gyrus, the right anterior insular cortex, left inferior frontal gyrus, as well as the superior temporal gyrus bilaterally in the temporomandibular disorders patients. Also, white matter analyses revealed decreases in regional white matter volume in the medial prefrontal cortex bilaterally in temporomandibular disorder patients.

These data support previous findings by showing that temporomandibular disorders, like other chronic pain states, is associated with changes in brain morphology in brain regions known to be part of the central pain system.

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April 28, 2011

Using a psychosocial subgroup assignment to predict sickness absence in a working population with neck and back pain

Filed under: Back Pain,Chronic Pain,Neck Pain — Administrator @ 3:39 am

Using a psychosocial subgroup assignment to predict sickness absence in a working population with neck and back pain.

From: BMC Musculoskelet Disord. 2011 Apr 26;12(1):81. [Epub ahead of print]

Neck and low back pain is a common cause of long term sickness absence as well as exclusion from the labor market, both in Sweden and internationally. In Sweden alone, the cost of neck and low back pain has been estimated to 1.3% of GNP. Thus, the prevention of chronicity has become important, in order to reduce costs and to lessen the suffering for individuals with neck pain and low back pain. It has been suggested that early preventive interventions may reduce future problems as well as selection criteria are of outmost importance for the outcome.

Psychological factors have long been associated with chronic pain and they also seem to exacerbate the clinical component of pain. In fact, psychosocial factors have shown not only to be pivotal in the transition from acute and subacute neck pain and low back pain to chronicity but also have a strong influence on the onset of pain. Furthermore, coping or elements of coping have been shown to be a strong to moderate predictor for future low back pain.

Attempts have been made to classify patients into subgroups to better understand which subtypes of patients would benefit from what particular treatment. The Multidimensional Pain Inventory was originally developed for chronic pain patients and is widely used to derive subgroups of patients. Three different subgroups derived empirically from the Multidimensional Pain Inventory have been labeled: dysfunctional, interpersonally distressed and adaptive copers. The dysfunctional subgroup are characterized by high pain severity, disability and affective distress, and interpersonally distressed individuals are characterized by low levels of social support, while the adaptive copers subgroup report a more successful adjustment to chronic pain.

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April 27, 2011

Catechol O-methyltransferase haplotype predicts immediate musculoskeletal neck pain and psychological symptoms after motor vehicle collision

Filed under: Chronic Pain,Neck Pain,TMJ Pain,Whiplash — Administrator @ 3:29 am

Catechol O-methyltransferase haplotype predicts immediate musculoskeletal neck pain and psychological symptoms after motor vehicle collision.

From: J Pain. 2011 Jan;12(1):101-7.

Pain sensitivity varies substantially among humans. A significant part of the human population develops chronic pain conditions that are characterized by heightened pain sensitivity. The association of COMT polymorphism with human pain perception and persistent pain conditions is of considerable importance. One of the genes in which variability is believed to contribute to differences in pain sensitivity and response to analgesics is the catechol-O-methyltransferase (COMT) gene. The COMT enzyme metabolises catecholamines such as dopamine, noradrenaline and adrenaline. Genetic variation contributes to differences in pain sensitivity and response to different analgesics. Catecholamines are involved in the modulation of pain and are partly metabolized by the catechol-O-methyltransferase (COMT) enzyme. It is shown that a polymorphism in the COMT gene, influence pain sensitivity in human experimental pain and the efficacy for morphine in cancer pain treatment.

A pathological pain condition that appears to be associated with COMT activity is myogenous temporomandibular joint disorder. This condition is characterized by persistent facial pain, impaired oral function and heightened sensitivity to pain-evoking stimuli (e.g. mechanical, thermal and ischemic) at numerous body sites. Myogenous temporomandibular joint disorder impacts 5–15% of the adult population and incurs billions of dollars in health care costs. In 1976, Marbach and Levitt reported that patients with facial pain conditions comparable to myogenous temporomandibular joint disorder show increased urinary levels of catecholamine metabolites and express diminished erythrocytic COMT activity, suggesting a role for COMT in this persistent pain condition. There is a relationship between COMT polymorphism, pain sensitivity and the risk of TMD development.

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April 14, 2011

Similarities between severe tinnitus and chronic pain

Filed under: Chronic Pain,Tinnitus — Administrator @ 3:14 am

Similarities between severe tinnitus and chronic pain

From: J Am Acad Audiol. 2000 Mar;11(3):115-24

The symptoms and signs of severe tinnitus and chronic pain have many similarities and similar hypotheses have been presented regarding how the symptoms are generated. Pain and tinnitus have many different forms. The severity of the symptoms of both varies within wide limits, and it is not likely that all forms have the same pathology. Some individuals with severe tinnitus perceive sounds to be unpleasant or painful. This may be similar to what is known as allodynia, which is a painful sensation of normally innocuous stimulation of the skin. Many individuals with chronic pain experience a worsening of their pain from repeated stimulation (the “wind-up” phenomenon). This is similar to the increasingly unpleasant feeling from sounds that are repeated that many individuals with severe tinnitus experience. There are also similarities in the hypotheses about the generation of pain and tinnitus. Although less severe tinnitus may be generated in the ear, it is believed that severe tinnitus in many cases is caused by changes in the nervous system that occur as a result of neural plasticity. Acute pain caused by tissue injury is generated at the site of injury but chronic pain is often generated in the central nervous system, yet another similarity between chronic pain and severe tinnitus. The changes in the nervous system consist of altered synaptic efficacy including opening of dormant synapses. For pain, this is believed to occur in the wide dynamic range neurons of the spinal cord and brain stem. Less is known about the anatomic location of the changes that cause severe tinnitus but there are indications that it may be the inferior colliculus. It is also possible that other auditory systems than the classical ascending pathways may be involved in severe tinnitus.

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March 31, 2011

An examination of coping styles and expectations for whiplash injury in Germany: comparison with Canadian data

Filed under: Chronic Pain,Neck Pain,Whiplash — Administrator @ 3:09 am

An examination of coping styles and expectations for whiplash injury in Germany: comparison with Canadian data

From: Clin Rheumatol. 2011 Mar 30. [Epub ahead of print]

This study examined concurrent expectations and coping style for whiplash injury in injury naive subjects in Germany. Studies suggest the recovery rate from whiplash injury may be faster in Germany than in Canada. Canadians have a high expectation for chronic pain following whiplash injury and Germans do not. Expectation of recovery not only predicts recovery in whiplash victims but is also known to correlate with coping style.

The Vanderbilt Pain Management Inventory was administered to university students and staff in Germany. Subjects who had not yet experienced whiplash injury were given a vignette concerning a neck sprain (whiplash injury) in a motor vehicle collision and were asked to indicate how likely they were to have thoughts or behaviours indicated in the coping style questionnaire. Subjects also completed expectation questionnaires regarding whiplash injury. Sixteen percent of subjects held an expectation of chronic neck or back pain after whiplash injury. The mean active coping style score was 27.4 ± 3.6 (40 is the maximum score for active coping). The mean passive coping style score was 27.0 ± 6.3 (50 is the maximum score for passive coping).

Coping style scores and patterns were not different from those previously observed in Canadian studies, but there was no correlation between expectations and coping style among German subjects, a finding that differs from Canadian studies. Although expectations and coping styles may interact or be co-modifiers in the outcomes of whiplash injury in Canadian whiplash victims, in Germany, despite having similar coping styles to Canadians, the lack of expectation for chronic pain may be protective from the effect of passive coping styles. Further studies of coping style as an aetiologic factor in the chronic whiplash syndrome are needed.

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March 24, 2011

Intraindividual Variability in Daily Sleep and Pain Ratings Among Chronic Pain Patients

Filed under: Chronic Pain — Administrator @ 3:07 am

Intraindividual Variability in Daily Sleep and Pain Ratings Among Chronic Pain Patients: Bidirectional Association and the Role of Negative Mood

From: Clin J Pain. 2011 Mar 16. [Epub ahead of print]

Sleep disturbance is a common problem among chronic pain patients. Cross-sectional data from clinical populations and experimental studies have shown an association between sleep disturbance and pain. However, there has been little prospective research into the relationship between daily variability between sleep and pain among chronic pain patients.

In this study, twenty-two women with chronic pain (back pain, facial pain, fibromyalgia) completed a sleep diary and wore an actigraph for a 2-week period. Self-report measures of pain, mood, and sleep were also completed at baseline. Hierarchical linear modeling was used to examine intraindividual variability in sleep and pain ratings among these women. The impact of mood and baseline pain ratings was also examined as potential moderators.

Hierarchical linear modeling analyses supported a bidirectional relationship between sleep and pain, such that a night of poor sleep was followed by increased pain ratings the following day and a day of increased pain was followed by a night of poor sleep. Depression scores further influenced these relationships.

Prospective examination supported a bidirectional relationship between sleep and pain among a group of women with chronic pain. Depressive symptoms had a moderating impact on these relationships. These findings suggest that addressing sleep is important in the treatment of individuals with chronic pain.

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