The Journal of Pain RSS feed: Articles in Press. The Journal of Pain publishes original articles related to all aspects of pain, including clinical and basic research, patient care, education, and health policy. Articles selected for publication in the Journal are most commonly reports of original clinical research or reports of original basic research. In addtion, invited critical reviews, including meta analyses of drugs for pain management, invited commentaries on reviews, and exceptional case studies are published in the Journal . The mission of the Journal is to improve the care of patients in pain by providing a forum for clinical researchers, basic scientists, clinicians, and other health professionals to publish original research. The Journal of Pain has an Impact factor of 4.851 in the 2011 Journal Citation Reports®, published by Thomson Reuters. http://www.jpain.org//inpress?rss=yesElsevier Inc.en © 2012 American Pain Society. Published by Elsevier Inc. All rights reserved. The Journal of Pain1526-59002012-01-30 © 2012 American Pain Society. Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.jpain.org/article/PIIS1526590011008868/abstract?rss=yesAbstract: Taking opioids with other central nervous system (CNS) depressants can increase risk of oversedation and respiratory depression. We used telephone survey and electronic health care data to assess the prevalence of, and risk factors for, concurrent use of alcohol and/or sedatives among 1,848 integrated care plan members who were prescribed chronic opioid therapy (COT) for chronic noncancer pain. Concurrent sedative use was defined by receiving sedatives for 45+ days of the 90 days preceding the interview; concurrent alcohol use was defined by consuming 2+ drinks within 2 hours of taking an opioid in the prior 2 weeks. Some analyses were stratified by substance use disorder (SUD) history (alcohol or drug). Among subjects with no SUD history, 29% concurrently used sedatives versus 39% of those with an SUD history. Rates of concurrent alcohol use were similar (12 to 13%) in the 2 substance use disorder strata. Predictors of concurrent sedative use included SUD history, female gender, depression, and taking opioids at higher doses and for more than 1 pain condition. Male gender was the only predictor of concurrent alcohol use. Concurrent use of CNS depressants was common among this sample of COT users regardless of substance use disorder status.Perspective: Risks associated with concurrent use of CNS depressants are not restricted to COT users who abuse those substances. And, the increased risk of concurrently using CNS depressants is not restricted to opioid users with a prior SUD history. COT requires close monitoring, regardless of substance use disorder history.Concurrent Use of Alcohol and Sedatives Among Persons Prescribed Chronic Opioid Therapy: Prevalence and Risk Factors - Corrected ProofKathleen W. Saunders, Michael Von Korff, Cynthia I. Campbell, Caleb J. Banta-Green, Mark D. Sullivan, Joseph O. Merrill, Constance Weisner10.1016/j.jpain.2011.11.004The Journal of Pain (2012)2012-01-30The Journal of Pain2012-01-30ORIGINAL REPORThttp://www.jpain.org/article/PIIS152659001100887X/abstract?rss=yesAbstract: This study compared the efficacy of 2 psychological treatments for fibromyalgia with each other and with standard care. Ninety-three patients with fibromyalgia (FM) were randomly assigned to 1 of the 3 experimental conditions: 1) multicomponent cognitive-behavioral therapy (CBT); 2) multicomponent CBT with hypnosis; and 3) pharmacological treatment (standard care control group). The outcome measures of pain intensity, catastrophizing, psychological distress, functionality, and sleep disturbances were assessed before treatment, immediately after treatment, and at 3- and 6-month follow-up visits. CBT and CBT with hypnosis participants received the standard pharmacological management plus 14 weekly, 120-minute-long sessions of psychological treatment. All but 1 session followed a group format; the remaining session was individual. The analyses indicated that: 1) patients with FM who received multicomponent CBT alone or multicomponent CBT with hypnosis showed greater improvements than patients who received only standard care; and 2) adding hypnosis enhanced the effectiveness of multicomponent CBT. This study presents new evidence about the efficacy of multicomponent CBT for FM and about the additional effects of hypnosis as a complement to CBT. The relevance and implications of the obtained results are discussed.Perspective: This article highlights the beneficial effects of adding hypnosis in a multicomponent cognitive-behavioral group treatment of fibromyalgia patients. Also, this research showed that by adding hypnosis the length of treatment did not increase.Multicomponent Cognitive-Behavioral Group Therapy With Hypnosis for the Treatment of Fibromyalgia: Long-Term Outcome - Corrected ProofAntoni Castel, Rosalia Cascón, Anna Padrol, José Sala, Maria Rull10.1016/j.jpain.2011.11.005The Journal of Pain (2012)2012-01-30The Journal of Pain2012-01-30ORIGINAL REPORThttp://www.jpain.org/article/PIIS1526590011008893/abstract?rss=yesAbstract: We demonstrate and evaluate a method for modeling acute pain resolution in individual patients over 6 days following an emergency department visit for an acutely painful condition. Five hundred and thirteen patients presenting with acutely painful conditions provided 11-point numerical ratings of pain intensity at discharge from an emergency department and daily thereafter for a total of 6 days. Latent growth curve modeling with a linear fit yielded measures of initial pain intensity (intercept) and rate of pain resolution (slope) for each individual patient. The linear fits provided good approximations of individual pain trajectories. The average patient had intercept of 6.57 with a slope of −.61. On Day 4, 54.6% of patients reported a pain level equal to or greater than 4. Classification of individual patients by slope revealed that 79% of the sample had the expected negative slope for acute pain resolution while 21% had flat or positive slopes, indicating lack of pain resolution or worsening of pain over time following discharge. The standard errors of measurement for the acute pain trajectories were markedly smaller than those for conventional pain ratings, indicating that the trajectory approach to pain measurement improves measurement precision.Perspective: The acute pain trajectory provides more information than conventional pain measurement and increases measurement precision. It provides a means of determining the efficacy of acute pain management in the emergency department. The rate of pain resolution is a potentially valuable outcome measure for controlled clinical trials.Resolution of Acute Pain Following Discharge From the Emergency Department: The Acute Pain Trajectory - Corrected ProofC. Richard Chapman, David Fosnocht, Gary W. Donaldson10.1016/j.jpain.2011.11.007The Journal of Pain (2012)2012-01-30The Journal of Pain2012-01-30ORIGINAL REPORThttp://www.jpain.org/article/PIIS1526590011009333/abstract?rss=yesAbstract: Paclitaxel often induces persistent painful neuropathy as its most common treatment-limiting side effect. Little is known concerning the underlying mechanisms. Given the prominent role of glial cells in many types of neuropathic pain, we investigated here the morphological and functional changes of spinal astrocytes and microglia in a rat model of paclitaxel-induced neuropathy. Immunohistochemistry, western blotting, and real-time polymerase chain reaction were performed with samples from 109 rats up to 28 days after paclitaxel treatment. Paclitaxel (2 mg/kg, i.p.) induced a rapid and persistent activation of spinal astrocytes assessed using glial fibrillary acidic protein, but not apparent activation of microglia assessed using OX42, Iba-1, and phosphorylated p38. In the context of astocyte activation, there was a significant downregulation of glial glutamate transporters GLAST and GLT-1 in spinal dorsal horn. The activation of spinal astrocytes by paclitaxel was not associated with expression of pro-inflammatory cytokines including tumor necrosis factor-α, interleukin-1β, or interleukin-6 in spinal dorsal horn. Systemic treatment with minocycline (50 mg/kg, i.p.) prevented activation of astrocytes and downregulation of glial glutamate transporters in spinal dorsal horn induced by paclitaxel. These data suggest the involvement of spinal astrocytes but not microglia in the pathogenesis of paclitaxel-induced neuropathy.Perspective: Spinal astrocytes and/or glial glutamate transporters could be new therapeutic targets for paclitaxel-induced painful neuropathy.Evidence That Spinal Astrocytes but Not Microglia Contribute to the Pathogenesis of Paclitaxel-Induced Painful Neuropathy - Corrected ProofHaijun Zhang, Seo-Yeon Yoon, Hongmei Zhang, Patrick M. Dougherty10.1016/j.jpain.2011.12.002The Journal of Pain (2012)2012-01-30The Journal of Pain2012-01-30ORIGINAL REPORThttp://www.jpain.org/article/PIIS1526590011008881/abstract?rss=yesAbstract: A controlled experimental study was performed to examine the efficacy of the endogenous pain inhibitory systems and whether this (mal)functioning is associated with symptom increases following exercise in patients with chronic whiplash-associated disorders (WAD). In addition, 2 types of exercise were compared. Twenty-two women with chronic WAD and 22 healthy controls performed a submaximal and a self-paced, physiologically limited exercise test on a cycle ergometer with cardiorespiratory monitoring on 2 separate occasions. Pain pressure thresholds (PPT), health status, and activity levels were assessed in response to the 2 exercise bouts. In chronic WAD, PPT decreased following submaximal exercise, whereas they increased in healthy subjects. The same effect was established in response to the self-paced, physiologically limited exercise, with exception of the PPT at the calf which increased. A worsening of the chronic WAD symptom complex was reported post-exercise. Fewer symptoms were reported in response to the self-paced, physiologically limited exercise. These observations suggest abnormal central pain processing during exercise in patients with chronic WAD. Submaximal exercise triggers post-exertional malaise, while a self-paced and physiologically limited exercise will trigger less severe symptoms, and therefore seems more appropriate for chronic WAD patients.Perspective: The results from this exercise study suggest impaired endogenous pain inhibition during exercise in people with chronic WAD. This finding highlights the fact that one should be cautious when evaluating and recommending exercise in people with chronic WAD, and that the use of more individual, targeted exercise therapies is recommended.Lack of Endogenous Pain Inhibition During Exercise in People With Chronic Whiplash Associated Disorders: An Experimental Study - Corrected ProofJessica Van Oosterwijck, Jo Nijs, Mira Meeus, Michel Van Loo, Lorna Paul10.1016/j.jpain.2011.11.006The Journal of Pain (2012)2012-01-27The Journal of Pain2012-01-27ORIGINAL REPORThttp://www.jpain.org/article/PIIS1526590011008728/abstract?rss=yesAbstract: Clinically recorded pain scores are abundant in patient health records but are rarely used in research. The use of this information could help improve clinical outcomes. For example, a recent report by the Institute of Medicine stated that ineffective use of clinical information contributes to undertreatment of patient subpopulations—especially women. This study used diagnosis-associated pain scores from a large hospital database to document sex differences in reported pain. We used de-identified electronic medical records from Stanford Hospital and Clinics for more than 72,000 patients. Each record contained at least 1 disease-associated pain score. We found over 160,000 pain scores in more than 250 primary diagnoses, and analyzed differences in disease-specific pain reported by men and women. After filtering for diagnoses with minimum encounter numbers, we found diagnosis-specific sex differences in reported pain. The most significant differences occurred in patients with disorders of the musculoskeletal, circulatory, respiratory and digestive systems, followed by infectious diseases, and injury and poisoning. We also discovered sex-specific differences in pain intensity in previously unreported diseases, including disorders of the cervical region, and acute sinusitis (P = .01, .017, respectively). Pain scores were collected during hospital encounters. No information about the use of pre-encounter over-the-counter medications was available. To our knowledge, this is the largest data-driven study documenting sex differences of disease-associated pain. It highlights the utility of electronic medical record data to corroborate and expand on results of smaller clinical studies. Our findings emphasize the need for future research examining the mechanisms underlying differences in pain.Perspective: This article highlights the potential of electronic medical records to conduct large-scale pain studies. Our results are consistent with previous studies reporting pain differences between sexes and also suggest that clinicians should pay increased attention to this idea.Sex Differences in Reported Pain Across 11,000 Patients Captured in Electronic Medical Records - Corrected ProofDavid Ruau, Linda Y. Liu, J. David Clark, Martin S. Angst, Atul J. Butte10.1016/j.jpain.2011.11.002The Journal of Pain (2012)2012-01-16The Journal of Pain2012-01-16ORIGINAL REPORThttp://www.jpain.org/article/PIIS1526590011008856/abstract?rss=yesAbstract: Evoked potentials (EPs) to radiant or contact heat pain stimuli reflect the synchronization of brain activity to noxious inputs. However, we do not know how they relate to conscious awareness (AW) of a sensation. In healthy volunteers, we determined the time of AW for thermal noxious and non-noxious sensory inputs and examined its correlation to parametric measures of vertex EPs. Subjects had to report the position of the hand of a Libet’s clock at the moment they perceived either a laser or a thermode stimulus. AW was determined after subtracting the position of the clock hand at the moment of stimulus delivery from the one reported by the subject, in ms. Subjects estimated AW in all single trials, including those in which no EPs could be identified. Mean AW was estimated earlier than the corresponding EP latency for both types and intensities of stimuli. There was a weak but significant negative correlation of AW to EPs amplitude, which was higher than the correlation of AW to EPs latency. Our results indicate that the timing of AW is influenced by the subjective relevance of sensory inputs. This feature could be used for the analysis of cognitive aspects of pain processing.Perspective: This article presents a way to measure the subjective awareness of the sensation induced by a noxious heat stimulus, either radiant or contact, in healthy human subjects. This method could be used for the analysis of cognitive aspects of pain processing.Awareness of Temperature and Pain Sensation - Corrected ProofJosep Valls-Solé, Juan M. Castellote, Markus Kofler, Jordi Casanova-Molla, Hatice Kumru, Pedro Schestatsky10.1016/j.jpain.2011.11.003The Journal of Pain (2012)2012-01-16The Journal of Pain2012-01-16ORIGINAL REPORThttp://www.jpain.org/article/PIIS152659001100873X/abstract?rss=yesAbstract: Sex, race/ethnic, and age differences in pain have been reported in clinical and experimental research. Gender role expectations have partly explained the variability in sex differences in pain, and the Gender Role Expectations of Pain questionnaire (GREP) was developed to measure sex-related stereotypic attributions about pain. It is hypothesized that similar expectations exist for age- and race-related pain decisions. This study investigated new measures of race/ethnic- and age-related stereotypic attributions of pain sensitivity and willingness to report pain, and examined the psychometric properties of a modified GREP. Participants completed the Race/Ethnicity Expectations of Pain questionnaire, Age Expectations of Pain questionnaire, and modified GREP. Results revealed a 3-factor solution to the race/ethnicity questionnaire and a 2-factor solution to the age questionnaire, consistent with theoretical construction of the items. Results revealed a 4-factor solution to the modified GREP that differed from the original GREP and theoretical construction of the items. Participants’ pain-related stereotypic attributions differed across racial/ethnic, age, and gender groups. These findings provide psychometric support for the measures examined herein and suggest that stereotypic attributions of pain in others differ across demographic categories. Future work can refine the measures and examine whether select demographic variables influence pain perception, assessment, and/or treatment.Perspective: The findings suggest that one’s expectations of the pain experience of another person are influenced by the stereotypes one has about different genders, races, and ages. The 3 pain expectation measures investigated in the current study could be used in future work examining biases in pain assessment and treatment.The Perception of Pain in Others: How Gender, Race, and Age Influence Pain Expectations - Corrected ProofLaura D. Wandner, Cindy D. Scipio, Adam T. Hirsh, Calia A. Torres, Michael E. Robinson10.1016/j.jpain.2011.10.014The Journal of Pain (2012)2012-01-09The Journal of Pain2012-01-09ORIGINAL REPORT