Pain Forum RSS feed: Current Issue. http://www.journals.elsevierhealth.com/periodicals/ypfor/?rss=yesElsevier Inc.en © 1999 the American Pain Society. Published by Elsevier Inc. All rights reserved. Pain Forum1082-317484January 1999 © 1999 the American Pain Society. Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.journals.elsevierhealth.com/periodicals/ypfor/article/PIIS1082317499700012/abstract?rss=yesAbstract: Pain beliefs and coping are believed to be important determinants of adjustment to chronic pain. The majority of the studies in this area have focused on the potential benefits of adaptive pain coping strategies and beliefs to improve adjustment to pain. In this Focus article, we propose a model whereby maladaptive pain beliefs and coping strategies are considered primary determinants of chronic pain adjustment, and influence the likelihood of engaging in more adaptive coping through influencing mediating factors such as perceived self-efficacy to manage pain. We (1) review data to support this model; (2) discuss evidence for the influence of maladaptive and adaptive coping and beliefs on chronic pain adjustment within the context of methodological limitations of studies in this area; (3) discuss the difficulties in assessing adaptive pain coping and beliefs; and (4) examine the implications of our proposed model for cognitive/behavioral interventions for chronic pain. We conclude that future studies on chronic pain adjustment should place more emphasis on the examination of maladaptive pain beliefs and coping strategies, examine causal relationships between adaptive and maladaptive strategies, and employ more multivariate analyses when examining the relationship between pain beliefs, coping, and adaptation to chronic pain.Pain beliefs, coping, and adjustment to chronic pain: let's focus more on the negativeMichael E. Geisser*, Michael E. Robinson†, Joseph L. RileyPain Forum 8, 4 (1999)1999-01-01Pain Forum1999-01-0184S1082-3174(05)X7012-XFOCUS ARTICLE161161http://www.journals.elsevierhealth.com/periodicals/ypfor/article/PIIS1082317499700024/abstract?rss=yesAbstract: A reduction of maladaptive responses to pain is crucial in adjustment to chronic painful states. However, previous research has also demonstrated that adjustment to pain is predicted by interactions between coping attempts and characteristics of individuals. Therefore, we contend that examination of what patients should do, as well as what they should not do is necessary. We propose an alternate model of pain adjustment, within which the constructs of beliefs and coping are separated. Also, catastrophizing is conceptualized as a secondary appraisal, rather than a failed coping attempt. We discuss our assertions within the context of the appropriate distinction between mediator and moderator variables.Pain beliefs and coping attempts: conceptual model buildingBeverly E. Thorn, Martha Anne Rich, Jennifer L. BoothbyPain Forum 8, 4 (1999)1999-01-01Pain Forum1999-01-0184S1082-3174(05)X7012-XCommentaries169169http://www.journals.elsevierhealth.com/periodicals/ypfor/article/PIIS1082317499700036/abstract?rss=yesAbstract: Geisser, Robinson, and Riley present a stimulating conceptual model of coping with chronic pain in which the authors argue that maladaptive beliefs and coping are primary determinants of adjustment and influence adaptive beliefs and coping through their influence on perceptions of control. We discuss some aspects of the model that require further refinement. First, the assessments of beliefs, appraisals, and coping need to be independent of outcome, obviating the use of “adaptive” and “maladaptive” in conceptual models. Unqualified statements about the universal adaptiveness, or maladaptiveness, of appraisal and coping strategies are likely to be unusual, since some strategies may result in higher emotional adjustment but not physical adjustment or vice versa. Second, beliefs, appraisals, and coping are distinct conceptual dimensions. Conceptual models that delineate relevant dimensions of these constructs rather than unify these partially independent constructs will likely have greater utility. Third, broadening the conceptualization of pain appraisal to include the individual's interpretation of the meaning of the pain is likely to provide expanded understanding of the pain coping process. Fourth, factors active in the individual's environment, particularly social relationships, need to be integrated into any comprehensive model of coping with chronic pain. And fifth, the bidirectional relationships between beliefs, appraisals, and coping need to be integrated into conceptual models. These processes are interrelated and feed back to one another as the individual struggles to cope with the challenges and threat posed by pain. The inherent complexity of coping with pain requires conceptualizations that address its transactional nature and methodologies that capture this dynamic process. Our comments direct future investigators to address when coping works, in what way it works, and for whom it works.Coping with pain: what works, under what circumstances, and in what ways?Jennifer A. Haythornthwaite, Leslie J. HeinbergPain Forum 8, 4 (1999)1999-01-01Pain Forum1999-01-0184S1082-3174(05)X7012-XCommentaries172172http://www.journals.elsevierhealth.com/periodicals/ypfor/article/PIIS1082317499700048/abstract?rss=yesAbstract: This Commentary addresses some common conceptual errors and methodological issues raised by the Focus article by Geisser, Robinson, and Riley. One conceptual error, the problem of confounding coping with outcome, is evident in their assertion that catastrophizing is not a form of coping, but rather a maladaptive pain belief. Catastrophizing clearly fits current definitions of coping, even though it may be associated with negative outcomes. A second conceptual error is the tendency to oversimplify the coping process that is evident in the tendency to divide coping strategies into dichotomous categories (eg, active vs passive, adaptive vs maladaptive). Methodological issues raised by this article include: (1) the need to recognize the strengths of existing pain coping instruments (eg, the Coping Strategies Questionnaire), and (2) the utility of new and alternative coping measures. This Commentary concludes with a discussion of important directions for future research on pain coping.Catastrophizing research: avoiding conceptual errors and maintaining a balanced perspectiveFrancis J. Keefe, John C. Lefebvre, Suzanne J. SmithPain Forum 8, 4 (1999)1999-01-01Pain Forum1999-01-0184S1082-3174(05)X7012-XCommentaries176176http://www.journals.elsevierhealth.com/periodicals/ypfor/article/PIIS108231749970005X/abstract?rss=yesAbstract: Chronic pain treatment outcomes are difficult to standardize. Pain levels and improvement in pain often do not correlate with functional ability, need for medication, or suffering behaviors. The 50% threshold has become the standard for minimally adequate pain relief. In fact, there is little literature that supports such an outcome as meaningful. Because it is so easy to use, it has become in effect the “gold standard” of outcome. This review challenges its use as confusing and misleading and recommends its cessation. Current attempts at composite measures have promise.The fallacy of using 50% pain relief as the standard for satisfactory pain treatment outcomeJoel L. SeresPain Forum 8, 4 (1999)1999-01-01Pain Forum1999-01-0184S1082-3174(05)X7012-XFOCUS ARTICLE183183http://www.journals.elsevierhealth.com/periodicals/ypfor/article/PIIS1082317499700061/abstract?rss=yesAbstract: “Success” connotes that a goal has been achieved. For many pain therapies, pain reduction is selected as the goal, and 50% reduction of pain intensity is selected frequently as the threshold for declaring success. Assessment of pain treatment outcome with this solitary measure minimizes the multidimensional nature of pain, pain management, and outcomes. Although the 50% threshold for declaring success may be acceptable in some instances, in most cases it does not characterize adequately the global responses that should be expected with successful pain management. Goals for a given individual's pain therapy should be chosen according to the needs and concerns of the parties affected by the pain disorder and should be established prior to initiating a treatment program. Success should be judged according to whether the selected goals are met.The fallacy of using a solitary outcome measure as the standard for satisfactory pain treatment outcomeKenneth A. FollettPain Forum 8, 4 (1999)1999-01-01Pain Forum1999-01-0184S1082-3174(05)X7012-XCommentaries189189http://www.journals.elsevierhealth.com/periodicals/ypfor/article/PIIS1082317499700073/abstract?rss=yesAbstract: Accurate determination of treatment outcomes is critical in the development of new therapies and the evaluation of existing treatments. Valid measures and meaningful statistical inferences are required. We have an obligation to develop better outcome assessments in the management of pain.Seres' fallaciesJohn D. LoeserPain Forum 8, 4 (1999)1999-01-01Pain Forum1999-01-0184S1082-3174(05)X7012-XCommentaries192192http://www.journals.elsevierhealth.com/periodicals/ypfor/article/PIIS1082317499700085/abstract?rss=yesAbstract: The “modern” criterion of 50% pain relief has longstanding precedents in the “ancient” literature. We agree that other measures of outcome, which reflect pain relief indirectly, are important, and accordingly for over two decades have routinely reported activities of daily living, return to work, patient satisfaction, need for additional treatment, and medication requirements. Physician and patient may deceive themselves (L. fallax, deceit) by undue reliance on any single outcome criterion. Relief of pain per se, however, is most relevant to the patient's presenting complaint, and however we choose to quantitate it, it is a sine qua non.The glass is half fullRichard B. NorthPain Forum 8, 4 (1999)1999-01-01Pain Forum1999-01-0184S1082-3174(05)X7012-XCommentaries195195http://www.journals.elsevierhealth.com/periodicals/ypfor/article/PIIS1082317499700097/abstract?rss=yesAbstract: Some opioids in common use (eg, methadone) differ from others (eg, morphine) in being N-methyl-D-aspartic acid receptor antagonists and inhibitors of monoamine transmitter reuptake. The nonopioid receptors mediating these effects have been shown to be involved in many pain states, and antagonists of these receptors act synergistically with mu opioid receptor agonists in promoting antinociception. This distinction emphasizes the need to reassess the basis of our use of opioids in the treatment of pain states that have previously been described as opioid-insensitive or opioid poorly responsive. In describing the activity of opioids, use of the term narrow spectrum or broad spectrum should reflect not only an assessment of actions mediated by opioid receptor classes (mu, delta, kappa, and subtypes), but also the actions mediated by nonopioid receptors. There are already indications that, in clinical situations, broad-spectrum opioids, such as methadone, are more effective than narrow spectrum opioids, such as morphine, in promoting pain relief in problematic situations such as neuropathic pain. Apart from this enlightenment in the treatment of pain, new opportunities for the use of opioids in the regulation of immune responses, and in the treatment of cancer disease, are also provided by the existence of opiate (morphine-related opioids)-specific binding sites in immunocytes and lung cancer cells. Further clinical trials with methadone, and more concerted laboratory work to identify other broad-spectrum opioids, and to characterize other nonopioid effects of opiates, are called for.New perspectives in our use of opioidsJohn S. MorleyPain Forum 8, 4 (1999)1999-01-01Pain Forum1999-01-0184S1082-3174(05)X7012-XFOCUS ARTICLE200200http://www.journals.elsevierhealth.com/periodicals/ypfor/article/PIIS1082317499700103/abstract?rss=yesAbstract: The mu3 opiate receptor subtype has been characterized by various binding assays as opiate alkaloid selective (eg, morphine) and opioid peptide (eg, methionine enkephalin) insensitive. The binding is monophasic, saturable, and stereospecific, as well as naloxone reversible. This opiate receptor subtype has been found on human and invertebrate tissues, demonstrating that it has been conserved during evolution. Furthermore, in numerous reports, this receptor is coupled to constitutive nitric oxide release. In this regard, for example, morphine immune downregulating activities parallels those actions formerly attributed to nitric oxide. Thus, this opiate receptor represents an addition to mu receptor heterogeneity that offers an explanation for the difference in actions of opioid peptides and opiate alkaloids in physiological systems transcending analgesia.The mu3 opiate receptor subtypeGeorge B. StefanoPain Forum 8, 4 (1999)1999-01-01Pain Forum1999-01-0184S1082-3174(05)X7012-XCommentaries206206http://www.journals.elsevierhealth.com/periodicals/ypfor/article/PIIS1082317499700115/abstract?rss=yesAbstract: Many hyperalgesic states and the development of tolerance to morphine converge at the cellular level through the activation of the N-methyl-d-aspartic acid (NMDA) receptor and common signal transduction events including the activation of protein kinase C. Some commonly used opioids and their derivatives possess NMDA receptor antagonist activity. In preclinical models, the behavioral consequences of this activity, as illustrated by the dextro isomer of methadone, are antihyperalgesic effects and the attenuation of morphine tolerance. These observations suggest that the combination of an opioid plus NMDA receptor antagonist activity should be of particular value in pain states where the potency of the opioid has been reduced as a result of hyperalgesia and/or opioid tolerance. One strategy for the development of these observations includes evaluation of these established opioids and their derivatives in clinical studies directed at improving the therapeutic window of the opioid.Old dogs, new tricksCharles E. InturrisiPain Forum 8, 4 (1999)1999-01-01Pain Forum1999-01-0184S1082-3174(05)X7012-XCommentaries210210http://www.journals.elsevierhealth.com/periodicals/ypfor/article/PIIS1082317499700127/abstract?rss=yesAbstract: In addition to their use in pain management in terminal cancer patients, therapeutic opioids have been found to be potent inducers of apoptosis in several types of human cancer cells, resulting in the inhibition of tumor growth. However, these growth-inhibitory effects appear not to involve conventional opioid receptor types or signal transduction pathways that mediate their central nervous system (CNS) actions, suggesting the existence of multiple binding sites. This offers the potential of designing opioid drugs targeted toward tumor tissues. While these findings suggest a new therapeutic approach for the treatment of several cancers, they indicate a need for more research on the apoptotic effects of chronic opioid use in neuronal cells. A greater understanding of the comparative effects of opioid drugs in the CNS and peripheral tissues could result in the design of better treatment protocols for their use in the control of cancer pain and growth.Anticancer effects of therapeutic opioidsRhoda ManeckjeePain Forum 8, 4 (1999)1999-01-01Pain Forum1999-01-0184S1082-3174(05)X7012-XCommentaries213213