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Resistance to anthracyclines and other chemotherapeutics due to P-glycoprotein (pgp)-mediated export is a frequent problem in cancer treatment. Here, we report that iron oxide–titanium dioxide core-shell nanocomposites can serve as efficient carriers for doxorubicin to overcome this common mechanism of drug resistance in cancer cells. Doxorubicin nanocarriers (DNC) increased effective drug uptake in drug-resistant ovarian cells. Mechanistically, doxorubicin bound to the TiO2 surface by a labile bond that was severed upon acidification within cell endosomes. Upon its release, doxorubicin traversed the intracellular milieu and entered the cell nucleus by a route that evaded pgp-mediated drug export. Confocal and X-ray fluorescence microscopy and flow cytometry were used to show the ability of DNCs to modulate transferrin uptake and distribution in cells. Increased transferrin uptake occurred through clathrin-mediated endocytosis, indicating that nanocomposites and DNCs may both interfere with removal of transferrin from cells. Together, our findings show that DNCs not only provide an alternative route of delivery of doxorubicin to pgp-overexpressing cancer cells but also may boost the uptake of transferrin-tagged therapeutic agents. Cancer Res; 72(3); 769–78. ©2011 AACR.

The extraction of trivalent lanthanides from an aqueous phase containing 1 M NaClO4 into the room temperature ionic liquid 1-butyl-3-methylimidazolium nonafluoro-1-butanesulfonate by the β-diketone extractant 2-thenoyltrifluoroacetone (Htta) was studied. Radiotracer distribution, absorption spectroscopy, time-resolved laser-induced fluorescence spectroscopy, and X-ray absorption fine structure measurements point to the extraction of multiple lanthanide species. At low extractant concentrations, fully hydrated aqua cations of the lanthanides are present in the ionic liquid phase. As the extractant concentration is increased 1:2 and 1:3 lanthanide:tta species are observed. In contrast, 1:4 Ln:tta complexes were observed in the extraction of lanthanides by Htta into 1-butyl-3-methylimidazolium bis(trifluoromethanesulfonyl)imide.

Chronic pain is a significant health problem which interferes with patients daily functioning and quality of life. Valid and reliable measures of pain-related interference are needed to provide adequate care to patients and monitor changes in pain and functioning over time. This study sought to evaluate the reliability and validity of a Portuguese version of the Brief Pain Inventory (P-BPI) interference scale. Two hundred and fourteen patients with chronic musculoskeletal pain completed the P-BPI, 0-10 NRS of pain intensity, Short Form-12 Health Status Questionnaire (SF-12), Hospital Anxiety and Depression Scale (HADS). The P-BPI demonstrated excellent internal consistency (Cronbach’s alpha = .91) and showed moderate associations with the criterion measures (all rs .30 or larger), supporting its construct validity. Confirmatory factor analysis of the P-BPI items yielded a single factor, further supporting its construct validity. The results provide strong support for the reliability and validity of the P-BPI interference scale. Resumen: El dolor crónico es un importante problema de salud que afecta al funcionamiento diario de la persona con dolor, a su bienestar psicológico y a la calidad de vida. Con el fin de prestar cuidados sanitarios adecuados, a monitorear los cambios en el dolor y en el funcionamiento y en vista a la investigación transcultural, se necessitan instrumentos válidos y fiables de evaluación de la interferencia del dolor. El objetivo de este estudio es evaluar la fiabilidad y validez de la versión portuguesa de la Escala de Interferencia de lo Brief Pain Inventory (P-BPI). Doscientos catorze participantes con dolor crónico músculoesquelético respondieron al P-BPI, al 0-10 NRS, al Short Form-12 Health Status Questionnaire (SF-12) y al Hospital Anxiety and Depression Scale (HADS). El P-BPI mostró una excelente consistencia interna (alfa de Cronbach = 0.91) y correlaciones moderadas con las medidas de critério (rs ≥ 0.30). El análisis factorial confirmatorio apoyó la solución de un factor. Los resultados apoyan la fiabilidad y validez de construto de la Escala de Interferencia del P-BPI. Es necesario que futuras investigaciónes evaluen la responsividad de la escala a los cambios en la interferencia del dolor a lo largo del tiempo.

This case series evaluated the use of virtual reality hypnosis (VRH) for the treatment of pain associated with multiple fractures from traumatic injuries. VRH treatment was administered on 2 consecutive days, and pain and anxiety were assessed each day before and after VRH treatment as well as on Day 3, which was 24 hours after the second treatment session. Pain reduction from baseline to Day 3 was from 70% to 30%, despite opioid analgesic use remaining stable. The subjective pain reduction reported by patients was encouraging, and the results of this case series suggest the importance of further study of VRH with larger samples using randomized controlled trials.

Population aging, caused by reductions in fertility and increasing longevity, varies by country and is anticipated to continue and to reach global proportions during the 21st century. Although the effects of population aging have been well documented for decades, the impact of aging on people with spinal cord injury (SCI) has not received similar attention. It is reasonable to expect that population aging features such as the increasing mean age of the population, share of the population in the oldest age groups, and life expectancy would be reflected in SCI population demographics. Although the mean age and share of the SCI population older than 65 yrs are increasing, data from the National Spinal Cord Injury Statistical Center suggest that life expectancy increases in the SCI population have not kept the same pace as those without SCI in the last 15 yrs. The reasons for this disparity are likely multifactorial and include the changing demographics of the SCI population with more older people being injured; susceptibility of people with SCI to numerous medical conditions that impart a health hazard; risky behaviors leading to a disproportionate percentage of deaths as a result of preventable causes, including septicemia; changes in the delivery of health services during the first year after injury when the greatest resources are available; and other unknown factors. The purposes of this paper are (1) to define and differentiate general population aging and aging in people with SCI, (2) to briefly present the state of the science on health conditions in those aging with SCI, and finally, (3) to present recommendations for future research in the area of aging with SCI.

A composite responder index for chronic low-back pain (CLBP) has recently been proposed to evaluate the efficacy of CLBP treatments in clinical trials. We compared the responsiveness of this composite measure with a number of single-item responder definitions.We pooled data from 2 placebo-controlled studies of etoricoxib in CLBP to evaluate 5 response criteria: 30% pain intensity (PI) reduction; 50% PI reduction; 20 mm absolute reduction (100 mm PI visual analog scale); patient global assessment of response to therapy (PGART); and the composite criteria of 30% reduction in PI+30% improvement in PGART of disease status+no worsening in function. We used bootstrap analysis and logistic regression to assess the ability to differentiate etoricoxib and placebo, and the κ coefficient to assess agreement among the responder criteria.The criterion of a 20 mm improvement in PI resulted in the greatest proportion (71.5%) of patients being classified as responders and all criteria separated etoricoxib from placebo (P≤0.0001). PGART had the highest discriminant ability (odds ratio 5.90), and was significantly (P0.05) more discriminant than the 20 mm and ≥30% improvements and the composite criteria. After adjusting for all other measures, only PGART continued to show a significant treatment effect for etoricoxib versus placebo (P=0.0003). Kappa values contrasting the composite criteria and the single-item measures ranged from 0.59 to 0.85.These findings do not support the superiority of a composite index over single-item ratings of PI and PGART ratings, but do suggest that PGART ratings may be more responsive to treatment, perhaps because they measure something in addition to change in PI.

OBJECTIVES: The objective of this study was to develop the International Spinal Cord Injury Pain Extended Data Set (ISCIPEDS) with the purpose of guiding the assessment and treatment of pain after spinal cord injury (SCI).SETTING: International.METHODS: The ISCIPEDS was reviewed by members of the International SCI Data Sets Committee, the International Spinal Cord Society Executive and Scientific Committees, American Spinal Injury Association and American Pain Society Boards, and the Neuropathic Pain Special Interest Group of the International Association for the Study of Pain, individual reviewers and societies.RESULTS: The working group recommended four assessment domains for the ISCIPEDS: (i) Pain symptoms including variables related to pain type, temporal course, severity, unpleasantness, tolerability of pain and questionnaires assessing pain type and symptom severity; (ii) Sensory signs to detect and quantify sensory abnormalities commonly associated with neuropathic pain, including dynamic mechanical and thermal allodynia, and hyperalgesia; (iii) Treatments (ongoing and past 12 months); and (iv) Psychosocial factors and comorbid conditions.CONCLUSION: The ISCIPEDS was designed to be used together with the International SCI Pain Basic Data Set and provide a brief yet thorough assessment of domains related to chronic pain in individuals with SCI. The data set includes pain-relevant self-reported assessments, questionnaires and sensory examinations. The recommendations were based on (i) their relevance to individuals with SCI and chronic pain, (ii) the existence of published findings supporting the utility of the selected measures for use in individuals with SCI, and to the greatest extent possible (iii) their availability in the public domain free of charge.Spinal Cord advance online publication, 12 April 2016; doi:10.1038/sc.2016.51.

The Pittsburgh Sleep Quality Index (PSQI) is a widely used measure of sleep quality in adolescents, but information regarding its psychometric strengths and weaknesses in this population is limited. In particular, questions remain regarding whether it measures one or two sleep quality domains. The aims of the present study were to (a) adapt the PSQI for use in adolescents and young adults, and (b) evaluate the psychometric properties of the adapted measure in this population. The PSQI was slightly modified to make it more appropriate for use in youth populations and was translated into Spanish for administration to the sample population available to the study investigators. It was then administered with validity criterion measures to a community-based sample of Spanish adolescents and young adults (AYA) between 14 and 24 years old (N = 216). The results indicated that the questionnaire (AYA-PSQI-S) assesses a single factor. The total score evidenced good convergent and divergent validity and moderate reliability (Cronbach's alpha = .72). The AYA-PSQI-S demonstrates adequate psychometric properties for use in clinical trials involving adolescents and young adults. Additional research to further evaluate the reliability and validity of the measure for use in clinical settings is warranted.

Literature review. Utilizing individuals with spinal cord injury (SCI) as a representative population for physical disability, this paper: (1) reviews the history of the concept of secondary conditions as it applies to the health of individuals aging with long-term disabilities; (2) proposes a definition of secondary health conditions (SHCs) and a conceptual model for understanding the factors that are related to SHCs as individuals age with a disability; and (3) discusses the implications of the model for the assessment of SHCs and for developing interventions that minimize their frequency, severity and negative effects on the quality of life of individuals aging with SCI and other disabilities. Key findings from research articles, reviews and book chapters addressing the concept of SHCs in individuals with SCI and other disabilities were summarized to inform the development of a conceptual approach for measuring SCI-related SHCs. Terms used to describe health conditions secondary to SCI and other physical disabilities are used inconsistently throughout the literature. This inconsistency represents a barrier to improvement, measurement and for the development of effective interventions to reduce or prevent these health conditions and mitigate their effects on participation and quality of life. A working definition of the term SHCs is proposed for use in research with individuals aging with SCI, with the goal of facilitating stronger evidence and increased knowledge upon which policy and practice can improve the health and well-being of individuals aging with a disability.

Aims and objectives. To examine the associations between pain-related psychological and social factors and pregnancy-related lumbopelvic pain intensity and interference after controlling biological factors. Background. Pregnancy-related lumbopelvic pain is prevalent and has been shown to interfere with women’s quality of life. Although pain is a multidimensional phenomenon known to be influenced by psychosocial factors, the majority of previous research on this pregnancy-related lumbopelvic pain has focused on biological factors. Design. Cross-sectional correlational research. Method. A sample of 183 pregnant women with lumbopelvic pain was recruited from a medical center in northern Taiwan. Study participants provided demographic information and were administered the Brief Pain Inventory and a modified Catastrophising subscale of the Coping Strategies Questionnaire. Multiple regressions were used to examine the associations among the study variables. Results. Analyses indicated that lower education level was associated with higher pain intensity. Higher pain intensity during pregnancy and catastrophising cognitions were associated significantly with higher pain interference. Moreover, age moderated the strength of the association between pain intensity and pain interference. This association was stronger for older than for younger women. Conclusions. This study identified the psychosocial factors associated with pregnancy-related lumbopelvic pain intensity (educational level) and interference (pain intensity and catastrophising) and also a variable (age) that moderated the association between pain intensity and pain interference. The findings support a biopsychosocial approach in understanding the experience and impact of pregnancy-related lumbopelvic pain. Relevance to clinical practice. Nurses should assess pregnant clients’ age, educational level, pain intensity and pain catastrophising thoughts to help identify women who are more at risk for higher lumbopelvic pain intensity or interference. Women endorsing catastrophising cognitions should be referred to or provided with treatment to reduce the frequency of these cognitions that are known to have a negative impact on quality of life in other pain populations.

The Visual Analogue Scale (VAS), Numerical Rating Scale (NRS), Verbal Rating Scale (VRS), and the Faces Pain Scale-Revised (FPS-R) are among the most commonly used measures of pain intensity in clinical and research settings. Although evidence supports their validity as measures of pain intensity, few studies have compared them with respect to the critical validity criteria of responsivity, and no experiment has directly compared all 4 measures in the same study. The current study compared the relative validity of VAS, NRS, VRS, and FPS-R for detecting differences in painful stimulus intensity and differences between men and women in response to experimentally induced pain. One hundred twenty-seven subjects underwent four 20-second cold pressor trials with temperature order counterbalanced across 1 degrees C, 3 degrees C, 5 degrees C, and 7 degrees C and rated pain intensity using all 4 scales. Results showed statistically significant differences in pain intensity between temperatures for each scale, with lower temperatures resulting in higher pain intensity. The order of responsivity was as follows: NRS, VAS, VRS, and FPS-R. However, there were relatively small differences in the responsivity between scales. A statistically significant sex main effect was also found for the NRS, VRS, and FPS-R. The findings are consistent with previous studies supporting the validity of each scale. The most support emerged for the NRS as being both (1) most responsive and (2) able to detect sex differences in pain intensity. The results also provide support for the validity of the scales for use in Portuguese samples.

Chronic pain is a significant problem for many individuals with disabilities, such as spinal cord injury (SCI) and multiple sclerosis (MS).1–4 Moreover, recent research indicates that a number of psychosocial factors that have been shown to contribute to the experience of pain, distress, and disability in individuals who present with chronic pain as a primary problem are also associated with measures of patient functioning in individuals with disabilities and chronic pain.5–10 Pain catastrophizing, in particular, has been consistently shown to predict patient functioning across most, if not all, populations of individuals with chronic pain.10–12 Pain catastrophizing refers to a propensity to focus on and magnify pain sensations, and to negatively evaluate one’s ability to cope with pain.12 Research has shown that individuals with chronic pain who catastrophize report higher levels of pain intensity, psychological distress, and disability, and also report higher rates of healthcare usage, longer hospitalizations, and greater use of pain medication than those who do not catastrophize.12 Longitudinal research has also shown that catastrophizing can lead to greater pain intensity, functional impairment, and depression.11 These findings have generally been replicated in samples of individuals with physical disabilities and chronic pain. For example, castrophizing has been shown to be positively associated with measures of distress and disability in individuals with SCI,10,13 and with pain intensity and disability in individuals with phantom limb pain.14 Catastrophizing has also been shown to be significantly associated with greater pain intensity, increased pain interference, and poorer psychological functioning in patients with MS.15 Research in individuals who present with pain as a primary problem (e.g., chronic low back pain) suggests that women tend to catastrophize more than men.16 Moreover, when catastrophizing cognitions are controlled, statistically significant sex differences in pain intensity and distress that are often observed (women reporting higher levels of both17,18) disappear.11,19 These findings suggest that catastrophizing may play an important role in the differences that are sometimes observed between men and women in pain and distress. However, because previous studies have focused on individuals with primary chronic pain problems, it is not clear whether such sex differences extend to individuals with chronic pain that is secondary to a disability. Sex may also moderate the relationship between catastrophizing and measures of pain and dysfunction, although this possibility has only been examined in very few studies. In one such study, Hirsh and colleagues20 found a stronger association between pain, mood and disability in women compared to men in individuals with low back, myofascial, neck, arthritis, and fibromyalgia pain. While this paper did not directly examine catastrophizing, it did suggest the possibility that men and women may differ in how psychosocial variables are related to pain and other important pain-related variables; such differences could potentially extend to catastrophizing. In other words, among women, the association between pain and disability may be mediated by negative mood and psychological functioning, while psychosocial factors may play less of a role in these associations for men.20 Along these lines, Sullivan and colleagues19 reported that women differ from men in their behavioral responses to pain. These investigators cited several studies demonstrating that women (a) report more health care utilization than men, (b) take more sick days than men in response to pain, and (c) are more likely to go on short-term disability following a pain-related condition compared to men. Despite these previous findings suggesting differences between men and women in the associations among pain-related variables (including psychosocial variables), no study has yet examined the relationship between sex, catastrophizing, pain, and dysfunction in individuals with a disability and chronic pain. Knowledge concerning these relationships is important because, if sex differences are found, this raises the possibility that men and women may benefit from different treatment interventions or approaches. Determining the extent to which such sex differences are found in individuals with a disability and chronic pain is also important because the rates of many disabling conditions vary between men and women. For example, and of most relevance to the current study, approximately 80% of spinal cord injuries occur in men,21 whereas MS is twice as common in women.22 The analyses performed in this study were designed to help advance our understanding of the role that sex may play in the associations among psychosocial factors and physical functioning, and how certain psychological variables, such as catastrophizing, may be associated with pain and dysfunction in two distinct disabilities (MS and SCI). Specifically, the purposes of this study were to: (1) determine if the sex differences in catastrophizing that have previously been found in other pain groups replicate in a sample of patients with chronic pain that is secondary to a disability (MS or SCI); (2) examine, for the first time, the possible moderating effects of sex on the associations between catastrophizing and measures of pain and functioning in individuals with MS and SCI; and (3) explore possible differences in catastrophizing between MS and SCI groups, and whether the associations between catastrophizing and measures of pain and functioning vary as a function of disability group. Based on the results of previous, relevant research, we hypothesized that women will report greater catastrophizing than men across both disability groups studied. We also anticipated that the association between catastrophizing and critical outcome variables will be stronger for women than for men. Given the lack of previous research examining differences in psychosocial variables between disability groups, we did not have specific hypotheses concerning possible similarities and differences in the associations between catastrophizing and measures of pain and functioning between patients with MS and SCI; therefore, the analyses for the third study purpose were considered exploratory.

Pain beliefs as indexed by the Survey of Pain Attitudes (SOPA) have been consistently shown to predict pain adjustment outcomes in Western populations. However, its utility in non-Western populations is unclear.We evaluated the construct and predictive validity of the Chinese version of the 14-item SOPA (ChSOPA-14) in a sample of Chinese patients with chronic pain.A total of 208 Chinese patients with chronic musculoskeletal pain completed the ChSOPA-14, the Chronic Pain Grade questionnaire, the Pain Catastrophizing Scale, the Center for Epidemiological Studies-Depression Scale, and measures of sociodemographic characteristics.Except Medical Cure, all ChSOPA-14 scales were significantly correlated with validity criterion measures (all P0.05) in expected directions. The present Chinese sample scored the highest on the Medical Cure scale (mean=2.98, standard deviation [SD]=1.05) but the lowest on the Disability scale (mean=1.75, SD=1.67). Results of hierarchical multiple regression analyses showed that the ChSOPA-14 scales predicted concurrent depression (F(7,177)=14.51, P0.001) and pain disability (F(7,180)=8.77, P0.001). Pain Control (stdβ [standardized beta coefficient]=-0.13; 95% confidence interval [CI]: -3.41, -0.13; P0.05) and Emotion (stdβ=29; 95% CI: 1.76, 5.02; P0.001) emerged as significant independent predictors of concurrent depression whereas Disability (stdβ=0.19; 95% CI: 1.33, 7.88; P0.01), Emotion (stdβ=16; 95% CI: 0.08, 7.59; P0.05), and Solicitude (stdβ=-0.14; 95% CI: -7.05, -0.04; P0.05) significantly associated with concurrent disability.The findings offer preliminary evidence for the construct and concurrent predictive validity of the ChSOPA-14. This makes available a suitable instrument for chronic pain in the Chinese population and will facilitate future cross-cultural research on pain beliefs.

OBJECTIVES There is emerging evidence that transcranial magnetic stimulation (TMS) can produce analgesic effects in clinical samples and in healthy adults undergoing experimentally induced pain; and the field of minimally invasive brain stimulation for the management of pain is expanding rapidly. Although motor cortex is the most widely used cortical target for TMS in the management of neuropathic pain, few studies have systematically investigated the analgesic effects of a full range of device parameters to provide initial hints about what stimulation intensities and frequencies are most helpful (or even potentially harmful) to patients. Further, there is considerable inconsistency between studies with respect to laboratory pain measurement procedures, TMS treatment parameters, sophistication of the sham methods, and sample sizes. METHODS This study used a sham-controlled, within-subject, cross-over design to examine the effects of 5 different TMS treatment parameters across several quantitative sensory measures in a sample of healthy adult volunteers. Sixty-five participants underwent quantitative sensory testing procedures pre and post-40-minutes of real and sham motor cortex TMS. TMS was delivered at 1 Hz 80% resting motor threshold (rMT), 1 Hz 100% rMT, 10 Hz 80% rMT, 10 Hz 100% rMT, or 50 Hz triplets at 90% of active motor threshold (intermittent theta-burst). RESULTS The mean painfulness rating of real TMS stimulation itself was 3.0 (SE=0.36) out of 10 and was significantly greater than zero [t(64)=8.17, P

Objectives. 1) To replicate and extend previous research on the prevalence and characteristics of pregnancy-related lumbopelvic pain, and 2) to examine the associations between pain intensity, pain interference, and pain coping strategies in a sample of women with pregnancy-related lumbopelvic pain. Design. Cross-sectional design. Setting. An academic public and urban medical center in Taiwan. Patients. Pregnant women without gestational or psychiatric diseases in the 35th to 41st gestational week. Interventions. N/A. Outcome Measures. Questionnaires were used to collect data on demographics, pain intensity, pain interference, and pain coping responses. Results. Of 230 consecutive cases scheduled for an outpatient obstetrics-gynecology clinic appointment, 187 agreed to participate in this study. One hundred and forty (74.9%) of these reported pregnancy-related lumbopelvic pain. Most participants with pain reported it as mild to moderate in severity and that the pain interfered with a number of daily activities. The coping responses used most often for pain management included rest (94.3%), task persistence (87.9%), and asking for assistance (87.1%). Conclusion. The results confirmed that pregnancy-related lumbopelvic pain is a common problem that interferes with important activities. Pregnant women use a number of coping strategies to manage lumbopelvic pain. A common use of passive coping responses such as rest and asking for assistance suggest the possibility of a helplessness phenomenon in response to pain among some of the study participants. Education and interventions targeting this may be warranted to minimize the chances that the lumbopelvic pain experienced during pregnancy will develop into a chronic pain problem over time.

Chronic pain is a significant problem for many individuals following spinal cord injury (SCI). Unfortunately, SCI-related neuropathic pain has proven to be largely refractory to analgesic medications and other available treatments. Cranial electrotherapy stimulation (CES) has been effective in managing some types of pain. It involves the application of a small amount of current through the head via ear clip electrodes.Explore the effectiveness of CES for neuropathic pain in persons with SCI and chronic pain.Multi-site, double-blind, sham-controlled study.Adults with SCI and chronic neuropathic pain at or below the level of injury were randomized to receive active or sham CES.Application of active CES or sham CES 1 hour daily for 21 days. Six-month open-label phase to assess 'as-needed' CES use.Change in pre- to post-session pain ratings as well as change in pain intensity, pain interference, pain quality, pain beliefs and coping strategies, general physical and mental health status, depressive symptomatology, perceived stress, and anxiety pre- to post-treatment.The active group reported a significantly greater average decrease in pain during daily treatments than the sham group (Kruskal-Wallis chi-square = 4.70, P0.05). During the 21-day trial, there was a significant group × time interaction for only one outcome variable; the active group showed larger pre- to post-treatment decreases in pain interference than the sham group did (F = 8.50, P0.01, d = 0.59).On average, CES appears to have provided a small but statistically significant improvement in pain intensity and pain interference with few troublesome side effects. Individual results varied from no pain relief to a great deal of relief.

Global ratings of treatment satisfaction and improvement can provide an opportunity for patients to aggregate multiple aspects of their treatment into a single measure of its perceived benefits and disadvantages. Although such measures have been recommended for chronic pain clinical trials, only limited data are available that address the hypothesis that they reflect multiple aspects of patients’ treatment experience. Our objective was to identify the factors that make independent contributions to ratings of treatment satisfaction. We analyzed data from 5 open-label clinical trials of lidocaine patch 5% in osteoarthritis knee pain and chronic low back pain that were 2 to 12 weeks in duration. A total of 383 patients completed the Patient Global Assessment of Treatment Satisfaction scale and measures of pain, interference with physical and emotional functioning, sleep interference, and adverse events. The results of multivariate analyses indicated that improvements in measures of pain intensity, pain relief, and interference with physical functioning each made independent contributions to treatment satisfaction in both groups of patients. Improvements in interference with emotional functioning and sleep and the presence and severity of adverse events were not associated with satisfaction. Perspective Measures of treatment satisfaction can reflect different aspects of the patient’s treatment response, including improvements in pain and physical functioning. Increased understanding of such global measures may facilitate development of clinical trial outcomes that allow patients to evaluate with minimal burden those aspects of the treatment experience they consider personally meaningful.

Many different psychosocial treatments for pain have been described in the literature. All of these treatments have at least some evidence supporting their efficacy. However, each treatment is based on a theory or model that is most useful only for that particular intervention. An overarching model or framework that includes all of the factors hypothesized to play a role in the effects of these treatments would be useful for (1) understanding the similarities and differences between existing and future psychosocial pain treatments, (2) guiding the psychosocial evaluation of patients with chronic pain, and (3) giving clinicians greater flexibility for including psychosocial interventions that have proven efficacy, but that may not be explained by their preferred (but perhaps limited) model. This article proposes an initial version of such a framework, with the hope that it will increase our understanding of the role that psychosocial factors play in the experience of pain and its negative effects on functioning, and informs future research seeking to identify the common and specific factors associated with psychosocial pain treatments.

Fifteen adults with multiple sclerosis were given 16 sessions of treatment for chronic pain that included 4 sessions each of 4 different treatment modules: (a) an education control intervention; (b) self-hypnosis training (HYP); (c) cognitive restructuring (CR); and (d) a combined hypnosis-cognitive restructuring intervention (CR–HYP). The findings supported the greater beneficial effects of HYP, relative to CR, on average pain intensity. The CR–HYP treatment appeared to have beneficial effects greater than the effects of CR and HYP alone. Future research examining the efficacy of an intervention that combines CR and HYP is warranted.

Objective A recently published instrument (PRECIS) was designed to assist investigative teams in understanding the various design decisions that need to be made regarding pragmatic vs. explanatory trials. Our team used this instrument during an investigators' meeting to organize our discussion regarding the design of a planned trial and to determine the extent of consensus among the study investigators. Study Design and Setting The study was descriptive in nature and occurred during an investigator meeting. After reading and reviewing the 10 PRECIS criteria, the team made quantitative judgments of the planned study regarding each PRECIS criteria to reflect initial, ideal, and final study design perceptions. Results Data indicated that the final study design was more explanatory in nature than the preliminary plan. Evidence of consensus was obtained. Conclusion The investigative team found that applying PRECIS principles were useful for (1) detailing points of discussion related to trial design, (2) making revisions to the design to be consistent with the project goals, and (3) achieving consensus. We believe our experiences with PRECIS may prove valuable for trial researchers in much the same way that case reports can provide valuable insights for clinicians.

The potential benefits of combining pain education (PE) with clinical hypnosis (CH) has not yet been investigated in individuals with chronic pain. A total of 100 patients with chronic nonspecific low back pain were randomized to receive either: 1) PE alone, or 2) PE with CH. Outcomes were collected by a blinded assessor at 2 weeks and 3 months after randomization. The primary outcomes were average pain intensity, worst pain intensity (both assessed with 11-point numeric rating scales), and disability (24-item Roland Morris Disability Questionnaire) at 2 weeks. At 2 weeks, participants who received PE with CH reported lower worst pain intensity (mean difference = 1.35 points, 95% confidence interval [CI] = .32–2.37) and disability (mean difference = 2.34 points, 95% CI = .06–4.61), but not average pain intensity (mean difference = .67 point, 95% CI = −.27 to 1.62), relative to participants who received PE alone. PE with CH participants also reported more global perceived benefits at 2 weeks (mean difference = −1.98 points, 95% CI = −3.21 to −.75). At 3 months, participants who received PE with CH reported lower worst pain intensity (mean difference = 1.32 points, 95% CI = .29–2.34) and catastrophizing (mean difference = 5.30 points, 95% CI = 1.20–9.41). No adverse effects in either treatment condition were reported. To our knowledge, this is the first trial showing that additional use of hypnosis with PE results in improved outcomes over PE alone in patients with chronic nonspecific low back pain. Perspective This study provides evidence supporting the efficacy of another treatment option for teaching patients to self-manage chronic low back pain that has a relatively low cost and that can be offered in groups.

This article describes how psychological services for Veterans being seen in an interdisciplinary pain management program were expanded to include Complementary and Alternative Medicine (CAM) approaches. The benefits observed following the introduction of CAM therapies included: improved attendance and Veterans' involve- ment in group-based therapies, reductions in self-reported pain and anxiety, improved sleep, and an increased sense of emotional well being in the participants. The data also show that CAM therapies, when offered as a treatment option in the format of a drop-in group clinic, were associated with a modest but significant average pain reduction of 1.02 units on a 0-10 Numerical Rating scale. The CAM therapies described in this program are relatively inexpensive and portable, and can appear to the patient as conventional Western or "real" medical treatment (and perhaps, therefore, have less stigma than psychotherapy) for pain and associated distress. They also require minimal training to use and, therefore, can be used as a self-treatment at home. If proven to be effective in future controlled trials, their use could improve access to effective pain care, particularly for Veterans residing in the rural settings.

This paper describes the psychometric properties of the PROMIS Pain Interference (PROMIS-PI) bank. An initial candidate item pool (n=644) was developed and evaluated based on review of existing instruments, interviews with patients, and consultation with pain experts. From this pool, a candidate item bank of 56 items was selected and responses to the items were collected from large community and clinical samples. A total of 14,848 participants responded to all or a subset of candidate items. The responses were calibrated using an item response theory (IRT) model. A final 41-item bank was evaluated with respect to IRT assumptions, model fit, differential item function (DIF), precision, and construct and concurrent validity. Items of the revised bank had good fit to the IRT model (CFI and NNFI/TLI ranged from 0.974 to 0.997), and the data were strongly unidimensional (e.g., ratio of first and second eigenvalue = 35). Nine items exhibited statistically significant DIF. However, adjusting for DIF had little practical impact on score estimates and the items were retained without modifying scoring. Scores provided substantial information across levels of pain; for scores in the T-score range 50-80, the reliability was equivalent to 0.96 to 0.99. Patterns of correlations with other health outcomes supported the construct validity of the item bank. The scores discriminated among persons with different numbers of chronic conditions, disabling conditions, levels of self-reported health, and pain intensity (p< 0.0001). The results indicated that the PROMIS-PI items constitute a psychometrically sound bank. Computerized adaptive testing and short forms are available.

Objective. To better understand the severity and impact of pain in women who are breast cancer survivors. Design. Cross-sectional survey. Setting. Cancer wellness clinic. Patients. Two hundred fifty-three women with a history of early-stage breast cancer who had completed therapy and were without evidence of disease. Interventions. None. Outcome Measures. A survey that included questions about cancer history, pain, sleep problems, and physical and psychological functioning. Results. About half of the participants (117 or 46%) reported some pain, although most rated its intensity as mild. Both average and worst pain ratings showed significant associations with physical functioning ( r s, −0.48 and −0.43, respectively), severity of sleep problems ( r s, 0.31 and 0.30), and psychological functioning ( r s, −0.27 and −0.24). Age (with younger participants slightly more likely to report pain) and history of antiestrogen therapy showed nonsignificant trends to predict the presence of pain. Conclusions. The study findings provide new and important knowledge regarding the severity and impact of pain in female breast cancer survivors. The results indicate that clinicians should assess pain regularly in breast cancer survivors and treat this pain when indicated. The findings also support the need for research to determine whether improved pain management would result in improved quality of life for women with a history of breast cancer.

Pain following traumatic injuries is common, can impair injury recovery and is often inadequately treated. In particular, the role of adjunctive nonpharmacologic analgesic techniques is unclear. The authors report a randomized, controlled study of 21 hospitalized trauma patients to assess the analgesic efficacy of virtual reality hypnosis (VRH)—hypnotic induction and analgesic suggestion delivered by customized virtual reality (VR) hardware/software. Subjective pain ratings were obtained immediately and 8 hours after VRH (used as an adjunct to standard analgesic care) and compared to both adjunctive VR without hypnosis and standard care alone. VRH patients reported less pain intensity and less pain unpleasantness compared to control groups. These preliminary findings suggest that VRH analgesia is a novel technology worthy of further study, both to improve pain management and to increase availability of hypnotic analgesia to populations without access to therapist-provided hypnosis and suggestion.

Research generally indicates that providers demonstrate modest insight into their clinical decision processes. In a previous study utilizing virtual human (VH) technology, we found that patient demographic characteristics and facial expressions of pain were statistically significant predictors of many nurses' pain-related decisions. The current study examined the correspondence between the statistically identified and self-reported influences of contextual information on pain-related decisions. Fifty-four nurses viewed vignettes containing a video of a VH patient and text describing a postsurgical context. VH sex, race, age, and facial expression varied across vignettes. Participants made pain-assessment and treatment decisions on visual analogue scales. Participants subsequently indicated the information they relied on when making decisions. None of the participants reported using VH sex, race, or age in their decision process. Statistical modeling indicated that 28 to 54% of participants (depending on the decision) used VH demographic cues. 76% of participants demonstrated concordance between their reported and actual use of the VH facial expression cue. Vital signs, text-based clinical summary, and VH movement were also reported as influential factors. These data suggest that biases may be prominent in practitioner decision-making about pain, but that providers have minimal awareness of and/or a lack of willingness to acknowledge this bias. Perspective The current study highlights the complexity of provider decision-making about pain management. The VH technology could be used in future research and education applications aimed at improving the care of all persons in pain.

Understanding the complex trajectories of disability and aging requires a biopsychosocial approach that considers disability in the broader context of later adulthood. Although disability service researchers and gerontologists have many shared interests and a similar mission, the fields are relatively new to one another and have had little historical interaction. The purpose of this article is to increase and improve collaboration among investigators in these fields by providing some background in social gerontology to the disability researcher, and by applying key theories in aging to the issue of growing older with physical disability. The article discusses particular problem areas for older adults, including social support, and also discusses the parallel paradoxes of aging and disability.

The aqueous speciation of trivalent lanthanide and actinide cations in solutions containing DTPA (diethylenetriamine-N,N,N′,N′,N′′-pentaacetic acid) and lactic acid were studied under conditions representative of the TALSPEAK process. Spectrophotometric titrations, fluorescence spectroscopy, and thermometric titrations were used to search for indications of ternary metal-DTPA-lactate complexes. The addition of lactate anions to metal-DTPA complexes was undetectable by any of these techniques, even at free lactate concentrations of 0.75 M. Although lactic acid is necessary for the optimal performance of the TALSPEAK process, we find that the fractions of aqueous ternary Ln3+/An3+-DTPA-lactate complexes are far too low to account for the observed acid dependence of TALSPEAK metal extraction.

Item Response Theory (IRT) is being increasingly used to develop and evaluate outcome measures. However, many pain measures, including those that assess pain quality, have yet to be evaluated from the IRT perspective. The current study evaluated the scales of a commonly used measure of pain quality (the Pain Quality Assessment Scale, or PQAS) using IRT analyses in 3 samples of patients with chronic pain. The findings indicated variability in the precision of the scales, suggesting that all 3 of the PQAS scales are precise when pain is severe and that the Paroxysmal and Deep scales but not necessarily the Surface scale are precise when pain is of moderate or lower severity. In addition, 2 potential problems with the 11 (ie, 0 to 10) response levels used for the PQAS items were identified: (1) a high degree of overlap between adjacent response levels and (2) a lack of interval scaling. Research is needed to determine the extent to which these problems do, or do not, threaten the validity of the PQAS items and scales as outcome measures in pain clinical trials. Perspective IRT analyses provide important information about the psychometric and practical qualities of pain measures that is not provided by standard (classical test theory) analyses. IRT analyses of the PQAS subscales indicate that some of the scales are more precise than others at different levels of pain severity and provide important directions for further research to better understand the PQAS. IRT analyses would probably similarly provide important information concerning the utility of other measures commonly used in pain research.

Postpoliomyelitis syndrome (PPS) is a disorder that is characterized by a collection of neurologic and non-neurologic symptoms that manifests many years after recovery from the initial poliovirus infection. Diagnostic criteria, as set forth by the Post-Polio Task Force, include (1) a previous episode of paralytic poliomyelitis with residual motor neuron loss, which can be confirmed through patient history, a neurologic examination, and, if needed, an electrodiagnostic examination; (2) a period of neurologic recovery followed by an interval (usually 15 yrs or more) of neurologic and functional stability; (3) a gradual or abrupt onset of new weakness or abnormal muscle fatigability (decreased endurance) or both, with or without generalized fatigue, muscle atrophy, or pain; and (4) exclusion of medical, orthopedic, or neurologic conditions that may be causing the symptoms noted earlier.1,2 Attrition of motor neurons, immunologic processes, muscle overuse and disuse, and normal aging have been implicated in the development of PPS.2 Estimates of the occurrence of PPS in polio survivors range from 29% to 64%, and up to 640,000 residents of the United States may be experiencing related symptoms.3 Pain is common in individuals with PPS. Prevalence rates range from 42% to 80% for joint pain and 38%–86% for muscle pain.2 The results from a recent study by our group found that 91% of participants who responded to a community-based survey reported experiencing pain currently or within the past 3mos.4 Evidence indicating that individuals with PPS can have significant pain problems also comes from research showing that persons with PPS report higher levels of pain severity than comparison samples of healthy individuals5 as well as those diagnosed with other potentially disabling conditions such as multiple sclerosis6 and other forms of neuromuscular disease.7 The sites and causes of pain in PPS vary and can include joint pain resulting from abnormal biomechanics secondary to muscle imbalance.1 In addition, individuals with PPS can experience significant muscle pain and cramping because of overuse as well as fasciculations presumably because of motor neuron irritability.1 Biopsychosocial conceptualizations of chronic pain have received increasing support in the broader pain literature. Biopsychosocial models acknowledge the biological bases that underlie most pain conditions but also note that psychosocial factors may contribute to the experience and impact of pain. In support of these models in populations of individuals with disabilities, factors such as pain-related cognitions or attributions, coping, and social support have been shown to be associated with pain and functioning in individuals with multiple sclerosis,8 spinal cord injury,9 acquired limb loss,10 and muscular dystrophy.11 However, as Ehde et al.12 noted, these psychosocial factors have received little empirical attention in the context of pain in persons with PPS. A few studies have examined the general quality of life among persons with PPS. For example, in an early study, Conrady et al.13 found high levels of “psychological distress” in a sample recruited from a PPS clinic and support group. More recently, Vasiliadis et al.14 found that mental health variables assessed by the MOS 36-item Short-Form Health Survey (SF-36) were associated with pain in a sample of 126 individuals with PPS. In a study with a relatively small sample (n = 32), Willen and Grimby15 also found pain to be significantly correlated with a broad psychological measure, the Emotional Reaction Scale of the Nottingham Health Profile.16 However, we are not aware of any research that has examined the influence of specific psychosocial variables (e.g., pain beliefs) on the severity and impact of pain in PPS. This is an important avenue of research because increased understanding of these relationships is likely to have important treatment implications that could potentially improve the quality of life of persons living with this condition. The purpose of the current study was to examine the associations among measures of psychosocial factors, pain, and adjustment in a sample of individuals with PPS. We hypothesized that a set of psychosocial variables—specifically, pain catastrophizing, pain beliefs, pain coping strategies, and social support—would be significantly and uniquely related to pain intensity, pain interference, and general psychological functioning in a sample of individuals with PPS, even after controlling for relevant demographic and clinical variables.

Data from 26 participants in a case series of hypnotic analgesia for chronic pain were examined to determine the long-term effects of hypnosis treatment. Statistically significant decreases in average daily pain intensity, relative to pre-treatment values, were observed at post-treatment and at 3 and 9 months follow- up but not at 6 or 12 months follow-up. The percent of participants who reported clinically meaningful decreases in pain were 27%, 19%, 19%, and 23%, at 3, 6, 9, and 12 months follow-up points, respectively. Moreover, at 12 months post-treatment, 81% of the sample reported that still used the self-hypnosis skills learned in treatment. Overall the results indicate that about 20% of the sample obtained substantial and lasting long-term reductions in average daily pain following hypnosis treatment and that many more continue to use self-hypnosis up to 12 months following treatment.

Two lines of evidence provide preliminary support for the role that brain state, measured via electroencephalogram (EEG), may play in chronic pain. First, research has identified a link between brain EEG activity and the experience of pain. Second, there are a number of published studies documenting the beneficial effects of interventions that impact the cortical activity associated with chronic pain. These interventions include neurobehavioral treatments such as neurofeedback and hypnosis as well as invasive and non-invasive brain stimulation. Preliminary data showing the efficacy of neuromodulatory strategies for treating pain provides compelling reason to examine how cortical activity (as measured by EEG) may underlie the experience of pain. Existing data already suggest specific approaches that neurofeedback clinicians might consider when treating patients with chronic pain. Reciprocally, observations by neurofeedback practitioners could provide important case data that could foster the desig...

Dysvascular and diabetic patients are faced with high rates of chronic pain as a consequence of numerous secondary sequelae, including diabetic neuropathy and limb loss. Researchers and scientists have put forth a tremendous amount of effort to understand the complex nature of pain in this population of individuals, as well as others with chronic pain secondary to illness and injury. The emergent understanding of anatomy and sensory physiology within the past century has fueled an initial focus of understanding pain from a purely neurologic and biochemical perspective. Over the past few decades, the field has moved toward an understanding of pain as a process involving the dynamic interaction of biologic, psychological, behavioral, and social variables. This article provides a brief overview of several psychosocial processes, cognitive, affective, and behavioral, that have emerged as influential to the experience, impact, and treatment of pain.

Objective:To evaluate the psychometric properties of a subset of International Spinal Cord Injury Basic Pain Data Set (ISCIBPDS) items that could be used as self-report measures in surveys, longitudinal studies and clinical trials.Setting:Community.Methods:A subset of the ISCIBPDS items and measures of two validity criteria were administered in a postal survey to 184 individuals with spinal cord injury (SCI) and pain. The responses of the participants were evaluated to determine: (1) item response rates (as an estimate of ease of item completion); (2) internal consistency (as an estimate of the reliability of the multiple-item measures); and (3) concurrent validity.Results:The results support the utility and validity of the ISCIBPDS items and scales that measure pain interference, intensity, site(s), frequency, duration and timing (time of day of worst pain) in individuals with SCI and chronic pain. The results also provide psychometric information that can be used to select from among the ISCIBPDS items in settings that require even fewer items than are in the basic data set.Spinal Cord advance online publication, 29 September 2009; doi:10.1038/sc.2009.112.

Chronic pain is a common secondary condition affecting many individuals with limb loss. In addition to other challenges posed by amputation, pain can have serious consequences for health and functioning, including reduced likelihood of employment and participation in social activities1,2 and interference in prosthetic training.3 Chronic pain associated with amputation has been associated with higher affective distress4 and disability5 as well as lower health-related quality-of-life6 when compared with persons with amputation who do not report pain. The majority of the amputation literature has focused on lower-limb loss, possibly because of the greater incidence of lower-limb amputation. However, the number of individuals with upper-limb loss in the community may be greater than suggested by incidence data, given the younger average age of upper-limb loss and the higher mortality rate of individuals with lower-limb loss.7 Individuals with upper-limb loss tend to live and work with an amputation for more of their lifespan than those with lower-limb loss. Therefore, the impact of pain on functioning may be especially important for this group and requires further study. The few studies on pain after upper-limb loss have focused mainly on the characteristics and impact of phantom limb pain (PLP), and to an even lesser degree, residual-limb pain (RLP). Chronic PLP is common after upper-limb loss, occurring in anywhere from 41%8 to 69%9 of individuals with upper-limb loss. Chronic RLP is also common in persons with upper-limb loss, ranging from 49%10 to 66%11 of community samples. However, pain may occur in sites other than the phantom or residual limb. A handful of studies have examined other types of pain associated with upper-limb loss and have reported significant rates of pain ranging from 33% to 64% in the back,7,11 nonamputated arm,7,11 and neck.7 However, only one study, to our knowledge, included all of these pain locations,7 and none has examined quality-of-life or the relative levels of pain interference and disability associated with each pain type or site. The purpose of this study was to examine the prevalence, characteristics, and associations with functioning of a number of pain problems in persons with upper-limb loss, including PLP, RLP, neck pain, back pain, and nonamputated-limb pain. Based on previous research, we hypothesized that PLP and RLP would be the most common types of amputation-related pain. However, we also hypothesized that the other types of pain examined would be common and associated with significant disability for a subset of the sample.

To assess the role of biopsychosocial factors in patients with type 1 myotonic and facioscapulohumeral muscular dystrophy (MMD1/FSHD) with chronic pain. Associations between psychosocial factors were found to be important in other samples of persons with pain and both psychological functioning and pain interference in a sample of patients suffering from MMD/FSHD. Prospective, multiple group, survey study of 182 patients with confirmed MMD1 and FSHD. Participants completed surveys assessing pain interference and psychological functioning, as well as psychosocial, demographic, and injury-related variables. Analyses indicated that greater catastrophizing was associated with increased pain interference and poorer psychological functioning, pain attitudes were significantly related to both pain interference and psychological functioning, and coping responses were significantly related only to pain interference. In addition, greater perceived social support was associated with better psychological functioning. The results support the use of studying pain in persons with MMD/FSHD from a biopsychosocial perspective, and the importance of identifying psychosocial factors that may play a role in the adjustment to and response to pain secondary to MMD/FSHD.

Twenty-two patients with multiple sclerosis (MS) and chronic pain we recruited into a quasi-experimental trial comparing the effects of self-hypnosis training (HYP) with progressive muscle relaxation (PMR) on pain intensity and pain interference; 8 received HYP and the remaining 14 participants were randomly assigned to receive either HYP or PMR. HYP-condition participants reported significantly greater pre- to postsession as well as pre- to posttreatment decreases in pain and pain interference than PMR-condition participants, and gains were maintained at 3-month follow-up. Most of the participants in both conditions reported that they continued to use the skills they learned in treatment and experienced pain relief when they did so. General hypnotizability was not significantly related to treatment outcome, but treatment-outcome expectancy assessed before and after the first session was. The results support the efficacy of self-hypnosis training for the management of chronic pain in persons with MS.

A U.S. Army soldier stationed in Iraq developed myriad pain problems after sustaining a high-level spinal cord injury (SCI) from a gunshot wound. These problems were negatively impacting his ability to participate fully in his physical rehabilitation and care. Ten sessions of self-hypnosis training were administered to the patient over a 5-week period to help him address these problems. Both the patient and his occupational therapist reported a substantial reduction in pain over the course of treatment, which allowed the patient to actively engage in his therapies. Six months post treatment, the patient reported continued use of the hypnosis strategies taught, which effectively reduced his experience of pain. This case study demonstrates the efficacy of hypnotic analgesia treatment for U.S. military veterans who are experiencing pain problems due to traumatic or combat-related SCIs.

The pain associated with burn injuries is intense, unremitting and often exacerbated by anxiety, depression and other complicating patient factors. On top of this, modern burn care involves the repetitive performance – often on a daily basis for weeks to months – of painful and anxiety-provoking procedures that create additional treatment-related pain, such as wound care, dressing changes and rehabilitation activities. Pain management in burn patients is primarily achieved by potent pharmacologic analgesics (e.g., opioids), but is necessarily complemented by nonpharmacologic techniques, including distraction or hypnosis. Immersive virtual reality provides a particularly intense form of cognitive distraction during such brief, painful procedures, and has undergone preliminary study by several research groups treating burn patients over the past decade. Initial reports from these groups are consistent in suggesting that immersive virtual reality is logistically feasible, safe and effective in ameliorating the pain and anxiety experienced in various settings of post-burn pain. Furthermore, the technique appears applicable to a wide age range of patients and may be particularly well-adapted for use in children, one of the most challenging populations of burn victims to treat. However, confirmation and extension of these results in larger numbers of patients in various types of burn-related pain is necessary to more clearly define the specific benefits and limitations of virtual reality analgesia in the burn care setting.

Primary: to examine the association between perceived spouse responses to patient well behaviors and important patient variables (pain behavior, pain intensity, pain interference, and depressive symptoms). Secondary: to examine whether perceived spouse responses to patient pain behaviors are associated with important pain-related variables.Sixty-four patients with headache and their spouses completed self-report questionnaire packets that included measures of pain intensity, pain behaviors, depression, marital satisfaction, and perceived spouse responses to pain and well behaviors. Separate regression models were used to predict each dependent variable.Patient reports of spouse negative responses to well behaviors were significantly associated with greater patient reported pain behavior and pain intensity, whereas perceptions of facilitative responses to well behaviors were not significantly related to any dependent variable. Patient reports of spouse solicitous responses to patient pain behaviors were associated with higher levels of pain behavior, depressive symptoms, pain intensity, and pain interference.Perceptions of spouse responses to patient well behaviors seem to have important associations with patient functioning, yet have received insufficient research attention. The Spouse Response Inventory (SRI) thus represents a valuable addition to available research instruments because it assesses spouse responses to well behaviors.

Stoelb BL, Carter GT, Abresch RT, Purekal S, McDonald CM, Jensen MP. Pain in persons with postpolio syndrome: frequency, intensity, and impact. Objective To describe the frequency, intensity, and impact of pain in persons with postpoliomyelitis syndrome (PPS). Design Retrospective, cross-sectional survey. Setting Community-based survey. Participants Convenience sample of people with PPS. Interventions Not applicable. Main Outcome Measures Overall intensity and duration of pain, pain sites, pain interference, pain treatments, and relief provided by pain treatments. Results A total of 91% (n=57) of the study participants (N=63) reported pain. The most frequently reported pain sites were the shoulders, lower back, legs, and hips. Participants reported pain intensity to be the greatest in the knees, legs, wrists, lower back, and head. Pain interfered most with sleep and with activities requiring a high level of musculoskeletal involvement. Respondents also reported pain problems that were more severe than those of the general population and than those of a sample of people with multiple sclerosis. Many treatments had been tried previously for pain, but continued use of treatments was reported by relatively few participants at the time of the survey. Conclusions The findings indicate that pain is a persistent and common problem in persons with PPS, highlighting the need for effective and accessible pain treatments for this population.

This case report evaluates virtual reality hypnosis (VRH) in treating chronic neuropathic pain in a patient with a 5-year history of failed treatments. The patient participated in a 6-month trial of VRH, and her pain ratings of intensity and unpleasantness dropped on average 36% and 33%, respectively, over the course of 33 sessions. In addition, she reported both no pain and a reduction of pain for an average of 3.86 and 12.21 hours, respectively, after treatment sessions throughout the course of the VRH treatment. These reductions and the duration of treatment effects following VRH treatment were superior to those following a trial of standard hypnosis (non-VR) treatment. However, the pain reductions with VRH did not persist over long periods of time. The findings support the potential of VRH treatment for helping individuals with refractory chronic pain conditions.

Ambient-temperature environments in which dissolved silica and U(VI) are present may lack the conditions necessary to readily form crystalline uranyl-silicate phases; however amorphous phases, as defined by the absence of well-defined Bragg reflections in powder X-ray diffraction patterns, are kinetically favored when solution saturation levels are appropriate. Such amorphous uranyl-silicates may be related to the crystalline phases predicted to be thermodynamically stable and influence the mobility of U in the environment. To investigate amorphous uranyl-silicates and their relation to crystalline phases we precipitated solids from solutions containing 0.05 M UO 2 (ClO 4 ) 2 and 0.1 M Na 2 SiO 3 adjusted to pH values from 2.2 to 9 and allowed the precipitates to age in their mother liquors for approximately 6 weeks at 22 °C. We compared the chemical composition, X-ray diffraction patterns, and Fourier transform infrared spectra of the precipitates to those of the crystalline phases predicted by thermodynamic modeling. The precipitates were amorphous with U:Si ratios of 0.8 ± 0.1. Their FTIR spectra revealed changes in the UO 2 2+ and SiO 4 4− vibrations as a function of pH that are consistent with a shift in mid-range structural linkages from those similar to soddyite to those more like Na-boltwoodite. Structural H 2 O, OH, and SiO 3 OH 3− vibrations do not change as a function of pH and are consistent with a mixture of soddyite-like and Na-boltwoodite-like features. Six weeks of aging at ambient temperature is enough time for the precipitate structures to rearrange and adopt mid-range structural linkages characteristic of crystalline phases predicted by thermodynamic modeling.

Objective: To provide a better empirical understanding of the dimensionality of neuropathic and non-neuropathic pain quality. Method: An exploratory factor analysis (FA) was performed with baseline pain quality data [assessed using the Pain Quality Assessment Scale (PQAS)] from patients with osteoarthritis of the knee (n = 368) and low back pain (n = 455) who had participated in a series of analgesic clinical trials. The results of the FA were then confirmed in a sample of patients with neuropathic pain secondary to carpal tunnel syndrome (n = 138). Comparisons between the diagnostic groups on scale scores derived from the FA results were also made using t tests. Results: Three clear pain quality factors emerged that seemed to represent (1) paroxysmal pain sensations (PQAS descriptors: shooting, sharp, electric, hot, and radiating), (2) superficial pain (itchy, cold, numb, sensitive, and tingling), and (3) deep pain (aching, heavy, dull, cramping, and throbbing). The PQAS tender pain item did not load strongly on any of the 3 factors. Discussion: The findings support the hypothesis that pain qualities cluster into distinct groups. If replicated in additional samples, the pain quality domains identified may provide clinicians and researchers with a useful way to summarize data from pain quality measures, and may also provide meaningful end points that would allow for treatment differentiation between various pharmacologic entities.

Small‐angle neutron scattering (SANS) data for n‐octane solutions of TBP loaded with progressively larger amounts of HNO3, HClO4, H2SO4, and H3PO4 up to and beyond the LOC (limiting organic concentration of acid) condition, were interpreted using the Baxter model for hard spheres with surface adhesion. The coherent picture of the behavior of the TBP solutions derived from the SANS investigation discussed in this paper confirmed our recently developed model for third phase formation. This model analyses the features of the scattering data in the low Q region as arising from van der Waals interactions between the polar cores of reverse micelles. Our SANS data indicated that the TBP micelles swell when acid and water are extracted into their polar core. The swollen micelles have critical diameters ranging from 15 to 22 A, and polar core diameters between 10 and 15 A, depending on the specific system. At the respective LOC conditions, the TBP weight‐average aggregation numbers are ∼4 for HClO4, ∼6 for H2SO4, ...

This study describes further development of the Multidimensional Pain Readiness to Change Questionnaire (MPRCQ2), a measure of readiness to adopt a variety of pain management and coping strategies commonly taught in multidisciplinary treatment programs. Clinical samples were recruited from a Fibromyalgia Day Program (n = 139) and an Arthritis Day Program (n = 51) as well as 2 survey samples with pain resulting from either a spinal cord injury (n = 127) or an amputation (n = 120). The results indicate preliminary support for the reliability and validity of the MPRCQ2. The MPRCQ2 may be helpful in future research investigating the relationship between readiness to change pain-related coping and adoption of coping behaviors and adjustment to chronic pain. Perspective This study describes the development of a revised version of the MPRCQ, the MPRCQ2, in 4 patient samples. The results support the reliability and validity of the MPRCQ2 in individuals with fibromyalgia syndrome, arthritis, acquired amputation, and spinal cord injury and improve on some aspects of the instrument.