EMDR in the Treatment of Chronic Pain

2009 ◽  
Vol 3 (2) ◽  
pp. 66-79 ◽  
Author(s):  
Alexandra Mazzola ◽  
Marìa Lujàn Calcagno ◽  
Marìa Teresa Goicochea ◽  
Honorio Pueyrredòn ◽  
Jorge Leston ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Sleep Disturbances ◽  
Pain Perception ◽  
Psychological Treatment ◽  
Life Quality ◽  
Outcome Evaluation ◽  
Pain Modulation ◽  
Depression Level ◽  
Objective Outcome

Chronic pain can significantly diminish life quality, causing depression, anxiety, and sleep disturbances, and may lead to neuroplastic processes that influence pain modulation. The current study investigated eye movement desensitization and reprocessing (EMDR) treatment of 38 patients suffering from chronic pain with 12 weekly 90-minute sessions. A battery of self-reported questionnaires assessing quality of life, pain intensity, and depression level were administered pre- and posttreatment for objective outcome evaluation. The Structured Clinical Interview for DSM was administered at pretreatment to identify participants’ personality traits that may influence pain perception. Patients showed statistically significant improvement relative to baseline after 12 weeks of EMDR treatment. Our findings suggest that EMDR is an effective tool in the psychological treatment of chronic pain, resulting in decrease pain sensations, pain-related negative affect, and anxiety and depression levels. We examine possible theories about the mechanisms by which EMDR achieves these effects. Results were consistent with the underlying EMDR premise that posits the important effect of emotions on pain perception.

Role of Ethnicity on Pain Perception, Fatigue, and Quality of Life in a Pediatric Chronic Pain Population

2007 ◽  
Author(s):  
Jeffrey I. Gold ◽  
Trina Haselrig ◽  
D. Colette Nicolaou ◽  
Katharine A. Belmont
Keyword(s):  
Quality Of Life ◽  
Chronic Pain ◽  
Pain Perception ◽  
Pediatric Chronic Pain

Sleep disturbance in patients attending specialized chronic pain clinics in Denmark: a longitudinal study examining the relationship between sleep and pain outcomes

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Henrik Bjarke Vaegter ◽  
Mette Terp Høybye ◽  
Frederik Hjorth Bergen ◽  
Christine E. Parsons
Keyword(s):  
Quality Of Life ◽  
Chronic Pain ◽  
Sleep Quality ◽  
Pain Intensity ◽  
Sleep Disturbances ◽  
Pain Disability ◽  
Pain Clinics ◽  
Pain Outcomes

Abstract Objectives Sleep disturbances are highly prevalent in patients with chronic pain. However, the majority of studies to date examining sleep disturbances in patients with chronic pain have been population-based cross-sectional studies. The aims of this study were to 1) examine the frequency of sleep disturbances in patients referred to two interdisciplinary chronic pain clinics in Denmark, 2) explore associations between sleep disturbances and pain intensity, disability and quality of life at baseline and follow-up, and 3) explore whether changes in sleep quality mediated the relationships between pain outcomes at baseline and pain outcomes at follow-up. Methods We carried out a longitudinal observational study, examining patients enrolled in two chronic pain clinics assessed at baseline (n=2,531) and post-treatment follow-up (n=657). Patients reported on their sleep disturbances using the sleep quality subscale of the Karolinska Sleep Questionnaire (KSQ), their pain intensity using 0–10 numerical rating scales, their pain-related disability using the Pain Disability Index (PDI), and quality of life using the EuroQol-VAS scale. The average time between baseline and follow-up was 207 days (SD=154). Results At baseline, the majority of patients reported frequent sleep disturbances. We found a significant association at baseline between self-reported sleep disturbances and pain intensity, pain-related disability, and quality of life, where greater sleep disturbance was associated with poorer outcomes. At follow-up, patients reported significant improvements across all pain and sleep outcomes. In two mediation models, we showed that changes in sleep disturbances from baseline to follow-up were significantly associated with (i) pain intensity at follow-up, and (ii) pain disability at follow-up. However, baseline pain intensity and disability scores were not associated with changes in sleep disturbances and, we did not find evidence for significant mediation of either pain outcome by changes in sleep disturbances. Conclusions Self-reported sleep disturbances were associated with pain outcomes at baseline and follow-up, with greater sleep disturbances associated with poorer pain outcomes. Changes in sleep quality did not mediate the relationships between baseline and follow-up scores for pain intensity and disability. These findings contribute to a growing body of evidence confirming an association between sleep and chronic pain experience, particularly suggestive of a sleep to pain link. Our data following patients after interdisciplinary treatment suggests that improved sleep is a marker for a better outcome after treatment.

scholarly journals Characterization of New TRPM8 Modulators in Pain Perception

2019 ◽  
Vol 20 (22) ◽  
pp. 5544 ◽  
Author(s):  
Carmen De Caro ◽  
Claudia Cristiano ◽  
Carmen Avagliano ◽  
Alessia Bertamino ◽  
Carmine Ostacolo ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Pain Perception ◽  
Transient Receptor Potential ◽  
Pain Modulation ◽  
The Body ◽  
Sprague Dawley ◽  
Transient Receptor Potential Melastatin ◽  
Pain Models ◽  
Excessive Activation

Background: Transient Receptor Potential Melastatin-8 (TRPM8) is a non-selective cation channel activated by cold temperature and by cooling agents. Several studies have proved that this channel is involved in pain perception. Although some studies indicate that TRPM8 inhibition is necessary to reduce acute and chronic pain, it is also reported that TRPM8 activation produces analgesia. These conflicting results could be explained by extracellular Ca2+-dependent desensitization that is induced by an excessive activation. Likely, this effect is due to phosphatidylinositol 4,5-bisphosphate (PIP2) depletion that leads to modification of TRPM8 channel activity, shifting voltage dependence towards more positive potentials. This phenomenon needs further evaluation and confirmation that would allow us to understand better the role of this channel and to develop new therapeutic strategies for controlling pain. Experimental approach: To understand the role of TRPM8 in pain perception, we tested two specific TRPM8-modulating compounds, an antagonist (IGM-18) and an agonist (IGM-5), in either acute or chronic animal pain models using male Sprague-Dawley rats or CD1 mice, after systemic or topical routes of administration. Results: IGM-18 and IGM-5 were fully characterized in vivo. The wet-dog shake test and the body temperature measurements highlighted the antagonist activity of IGM-18 on TRPM8 channels. Moreover, IGM-18 exerted an analgesic effect on formalin-induced orofacial pain and chronic constriction injury-induced neuropathic pain, demonstrating the involvement of TRPM8 channels in these two pain models. Finally, the results were consistent with TRPM8 downregulation by agonist IGM-5, due to its excessive activation. Conclusions: TRPM8 channels are strongly involved in pain modulation, and their selective antagonist is able to reduce both acute and chronic pain.

scholarly journals Manganese-enhanced MRI depicts a reduction in brain responses to nociception upon mTOR inhibition in chronic pain rats

2020 ◽  
Vol 13 (1) ◽  
Author(s):  
Myeounghoon Cha ◽  
Songyeon Choi ◽  
Kyeongmin Kim ◽  
Bae Hwan Lee
Keyword(s):  
Chronic Pain ◽  
Nerve Injury ◽  
Pain Perception ◽  
Imaging Techniques ◽  
Insular Cortex ◽  
Pain Modulation ◽  
Anterior Cingulate ◽  
Related Area ◽  
Mtor Inhibition ◽  
The Brain

AbstractNeuropathic pain induced by a nerve injury can lead to chronic pain. Recent studies have reported hyperactive neural activities in the nociceptive-related area of the brain as a result of chronic pain. Although cerebral activities associated with hyperalgesia and allodynia in chronic pain models are difficult to represent with functional imaging techniques, advances in manganese (Mn)-enhanced magnetic resonance imaging (MEMRI) could facilitate the visualization of the activation of pain-specific neural responses in the cerebral cortex. In order to investigate the alleviation of pain nociception by mammalian target of rapamycin (mTOR) modulation, we observed cerebrocortical excitability changes and compared regional Mn2+ enhancement after mTOR inhibition. At day 7 after nerve injury, drugs were applied into the intracortical area, and drug (Vehicle, Torin1, and XL388) effects were compared within groups using MEMRI. Therein, signal intensities of the insular cortex (IC), primary somatosensory cortex of the hind limb region, motor cortex 1/2, and anterior cingulate cortex regions were significantly reduced after application of mTOR inhibitors (Torin1 and XL388). Furthermore, rostral-caudal analysis of the IC indicated that the rostral region of the IC was more strongly associated with pain perception than the caudal region. Our data suggest that MEMRI can depict pain-related signal changes in the brain and that mTOR inhibition is closely correlated with pain modulation in chronic pain rats.

It Was Not Safe to Feel Angry: Disrupted Early Attachment and the Development of Chronic Pain in Later Life

2017 ◽  
Vol 11 (3) ◽  
pp. 223-241 ◽  
Author(s):  
Frances Sommer Anderson
Keyword(s):  
Chronic Pain ◽  
Life Stress ◽  
Psychological Treatment ◽  
Early Life Stress ◽  
Later Life ◽  
Secure Attachment ◽  
Somatic Pain ◽  
Treatment Techniques ◽  
Mind And Body

Using detailed clinical material from her treatment of three patients referred by physiatrist John E. Sarno, for psychological treatment of chronic pain, Dr Anderson illustrates a relationship between dissociated/repressed affect and the development of chronic musculoskeletal back pain. Sarno, conversant with the fundamentals of psychoanalysis, theorised that the somatic pain, which he termed tension myoneural syndrome (TMS), served as a distraction from emotions that were unbearable. That is, the pain served as a psychological defense or survival tactic. In treatment, the adverse impact of overwhelming physical and emotional experiences on attachment and emotion regulation are identified and discussed. Detailed clinical process, which includes the use of trauma treatment techniques, illuminate how psychological treatment can be used to help patients identify and tolerate feelings associated with early life stress, leading to relief from the somatic pain. Anderson, informed by the psychosomatic theories of Krystal and McDougall and by contemporary attachment theorists, advances the position that the physician as diagnostician functions symbolically as the "parent" who links mind and body, thereby reducing the patient's fear of pain and creating a secure attachment bond. In this secure attachment relationship, the physician "authorises" the patient to experience emotions that were previously disavowed. In the relationship with an empathic relational psychoanalyst, the patient's pain resolves as s/he builds a capacity to identify and tolerate emotions and learns how to use emotions, particularly anger, to enhance relationships and improve their quality of life.

scholarly journals Neurobiology Underlying Fibromyalgia Symptoms

2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Marta Ceko ◽  
M. Catherine Bushnell ◽  
Richard H. Gracely
Keyword(s):  
Gray Matter ◽  
Sleep Disturbances ◽  
Pain Perception ◽  
Clinical Symptoms ◽  
Chronic Widespread Pain ◽  
Pain Modulation ◽  
Current Evidence ◽  
Sleep Regulation ◽  
Increased Sensitivity ◽  
Experimental Findings

Fibromyalgia is characterized by chronic widespread pain, clinical symptoms that include cognitive and sleep disturbances, and other abnormalities such as increased sensitivity to painful stimuli, increased sensitivity to multiple sensory modalities, and altered pain modulatory mechanisms. Here we relate experimental findings of fibromyalgia symptoms to anatomical and functional brain changes. Neuroimaging studies show augmented sensory processing in pain-related areas, which, together with gray matter decreases and neurochemical abnormalities in areas related to pain modulation, supports the psychophysical evidence of altered pain perception and inhibition. Gray matter decreases in areas related to emotional decision making and working memory suggest that cognitive disturbances could be related to brain alterations. Altered levels of neurotransmitters involved in sleep regulation link disordered sleep to neurochemical abnormalities. Thus, current evidence supports the view that at least some fibromyalgia symptoms are associated with brain dysfunctions or alterations, giving the long-held “it is all in your head” view of the disorder a new meaning.

scholarly journals Determinants of subjective quality of life among older married adults in Poland

2020 ◽  
Author(s):  
Milena Chełchowska
Keyword(s):  
Quality Of Life ◽  
Marital Satisfaction ◽  
Older People ◽  
Life Quality ◽  
Well Being ◽  
Subjective Well Being ◽  
Subjective Quality Of Life ◽  
Final Sample ◽  
Depression Level

In recent decades, the issue of life quality and its determinants has been increasingly discussed in the scientific literature. One of the key determinants of subjective well-being is the fact of being in a relationship (formal or not) as well as its quality. The results of analyzes for other countries show that people who have a partner have a higher subjective well-being than people who do not live with their spouse, while divorced people have the lowest (and the highest level of depression). In addition to being in a relationship, its quality is also important: people more satisfied with marriage declare greater well-being than those less satisfied. The aim of the study is to analyze quality of life (expressed in terms of well-being and depression) among older people in Poland, putting emphasis on their individual (e.g. age, sex, health status, level of education) and household (financial situation) characteristics. Importantly, the analysis takes into account the quality of the marriage approximated by the satisfaction with marriage declared by both spouses separately. For the purposes of this study I use data of ‘Social Diagnosis’ study carried out in 2015 in Poland. The final sample was limited to partnered older people aged 65+. Basic individual socio-demographic and economic as well as household characteristics were controlled for. The results show that older partnered men in Poland have higher subjective well-being than older partnered women. Also, older partnered men report significantly higher levels of marital satisfaction than older partnered women do. Moreover, it should be underlined that higher levels of marital satisfaction among older spouses may be beneficial for their own quality of life expressed by well-being and depression. Thus, better opinion about marriage may increase subjective well-being and decrease depression level. However, this relationship is different for older partnered men and women. Positive relationship between marital satisfaction and well-being is stronger for partnered women when subjective well-being is taken into account and for men when well-being is understood as depression level.

scholarly journals Manganese-enhanced MRI depicts a reduction in brain response to nociception upon mTOR inhibition in chronic pain rats

2020 ◽  
Author(s):  
Myeounghoon Cha ◽  
Songyeon Choi ◽  
Kyeongmin Kim ◽  
Bae Hwan Lee
Keyword(s):  
Chronic Pain ◽  
Nerve Injury ◽  
Pain Perception ◽  
Imaging Techniques ◽  
Pain Modulation ◽  
Anterior Cingulate ◽  
Brain Response ◽  
Related Area ◽  
Mtor Inhibition ◽  
The Brain

Abstract Neuropathic pain induced by a nerve injury can lead to chronic pain. Recent studies have reported hyperactive neural activities in the nociceptive-related area of the brain as a result of chronic pain. Although cerebral activities associated with hyperalgesia and allodynia in chronic pain models are difficult to represent with functional imaging techniques, advances in manganese (Mn)-enhanced magnetic resonance imaging (MEMRI) could facilitate the visualization of the activation of pain-specific neural responses in the cerebral cortex. In order to investigate the alleviation of pain nociception by mammalian target of rapamycin (mTOR) modulation, we observed cerebrocortical excitability changes and compared regional Mn 2+ enhancement after mTOR inhibition. At day 7 after nerve injury, drugs were applied into the intracortical area, and drug (Vehicle, Torin1, and XL388) effects were compared within groups using MEMRI. Therein, signal intensities of the insular cortex (IC), primary somatosensory cortex of the hind limb region, motor cortex 1/2, and anterior cingulate cortex regions were significantly reduced after application of mTOR inhibitors (Torin1 and XL388). Furthermore, rostral-caudal analysis of the IC indicated that the rostral region of the IC was more strongly associated with pain perception than the caudal region. Our data suggest that MEMRI can depict pain-related signal changes in the brain and that mTOR inhibition is closely correlated with pain modulation in chronic pain rats.

scholarly journals Role of Descending Dopaminergic Pathways in Pain Modulation

2019 ◽  
Vol 17 (12) ◽  
pp. 1176-1182 ◽  
Author(s):  
Changsheng Li ◽  
Sufang Liu ◽  
Xihua Lu ◽  
Feng Tao
Keyword(s):  
Chronic Pain ◽  
Well Being ◽  
Pain Modulation ◽  
Central Regulation ◽  
Dopaminergic Systems ◽  
Different Types ◽  
Dopaminergic Pathways ◽  
The Brain

Pain, especially when chronic, is a common reason patients seek medical care and it affects the quality of life and well-being of the patients. Unfortunately, currently available therapies for chronic pain are often inadequate because the neurobiological basis of such pain is still not fully understood. Although dopamine has been known as a neurotransmitter to mediate reward and motivation, accumulating evidence has shown that dopamine systems in the brain are also involved in the central regulation of chronic pain. Most importantly, descending dopaminergic pathways play an important role in pain modulation. In this review, we discuss dopamine receptors, dopaminergic systems in the brain, and the role of descending dopaminergic pathways in the modulation of different types of pain.

scholarly journals Phenotyping chronic tinnitus patients using self-report questionnaire data: cluster analysis and visual comparison

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Uli Niemann ◽  
Petra Brueggemann ◽  
Benjamin Boecking ◽  
Wilhelm Mebus ◽  
Matthias Rose ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cluster Analysis ◽  
Pain Perception ◽  
Psychological Treatment ◽  
Assessment Tools ◽  
Self Report ◽  
Chronic Tinnitus ◽  
Questionnaire Data ◽  
Patient Subgroups

Abstract Chronic tinnitus is a complex, multi-factorial symptom that requires careful assessment and management. Evidence-based therapeutic approaches involve audiological and psychological treatment components. However, not everyone benefits from treatment. The identification and characterisation of patient subgroups (or “phenotypes”) may provide clinically relevant information. Due to the large number of assessment tools, data-driven methods appear to be promising. The acceptance of these empirical results can be further strengthened by a comprehensive visualisation. In this study, we used cluster analysis to identify distinct tinnitus phenotypes based on self-report questionnaire data and implemented a visualisation tool to explore phenotype idiosyncrasies. 1228 patients with chronic tinnitus from the Charité Tinnitus Center in Berlin were included. At baseline, each participant completed 14 questionnaires measuring tinnitus distress, -loudness, frequency and location, depressivity, perceived stress, quality of life, physical and mental health, pain perception, somatic symptom expression and coping attitudes. Four distinct patient phenotypes emerged from clustering: avoidant group (56.8%), psychosomatic group (14.1%), somatic group (15.2%), and distress group (13.9%). Radial bar- and line charts allowed for visual inspection and juxtaposition of major phenotype characteristics. The phenotypes differed in terms of clinical information including psychological symptoms, quality of life, coping attitudes, stress, tinnitus-related distress and pain, as well as socio-demographics. Our findings suggest that identifiable patient subgroups and their visualisation may allow for stratified treatment strategies and research designs.

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