OBJECTIVE: Although there has been a link between certain types of pain, notably chest pain, and panic disorder, the relation between pain and panic disorder has not been systematically evaluated. In the present study, the relation between pain symptoms (headache, chest pain, stomach pain, joint pain) and the clinical presentation of patients with panic disorder was evaluated.HYPOTHESES: Pain was generally hypothesized to be related to increased symptoms of anxiety, panic-relevant cognitive domains and treatment outcome. In terms of specific pain domains, headache and chest pain were expected to be more closely related to anxiety-related symptoms.PARTICIPANTS AND METHODS: Patients (n=139) meeting the criteria of the Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition for panic disorder completed a set of standardized clinician-rated and self-reported measures. Moderator analyses were used in a subset of these patients completing a treatment outcome study.RESULTS: Approximately two-thirds of the participants endorsed at least one current pain symptom. The hypotheses were partially supported, with pain being associated with higher levels of anxiety and depression symptoms, as well as panic frequency. Pain was also related to several cognitive features, including anxiety sensitivity and panic appraisals. Headache and chest pain were more highly associated with anxiety symptoms than was joint pain. Cognitive measures did not mediate the relation between anxiety and pain, and pain did not significantly moderate outcome in response to cognitive-behavioural therapy.CONCLUSIONS: Co-occurring pain symptoms appear to be more highly related to phenomenology than to treatment response in patients with panic disorder.

Norman B Schmidt

Helen T Santiago

John H Trakowski

J Michael Kendren

Pain in Patients with Panic Disorder: Relation to Symptoms, Cognitive Characteristics and Treatment Outcome

Considerable research suggests that health anxiety (HA) influences the response of patients with chronic pain to pain and treatment. The present investigation extends the current understanding of HA and explores whether it affects how patients respond to a common therapeutic intervention, namely instructions to reduce pain behaviour. Sixty-five patients with chronic pain completed measures of pain, anxiety and cognition following an active occupational therapy session in which they were specifically instructed either to inhibit or reduce pain behaviour, or to carry out the session as they normally would. Regression analyses revealed that those with higher levels of HA experienced greater anxiety, somatic sensations and catastrophic cognitions during therapy than those with lower levels of HA. The regression analyses also revealed a consistent trend for an interaction between HA and instructional set; when those with higher HA reduced their pain behaviour, they subsequently reported greater anxiety, and more somatic sensations and catastrophic thoughts than when they carried out the session as they normally would. In contrast, only those with lower HA had a tendency to benefit from reducing pain behaviour, reporting lower state anxiety and fewer somatic sensations during the session than those who did not reduce their pain behaviour. The results suggest that HA should be taken into consideration during treatment.

Heather D Hadjistavropoulos

Gordon JG Asmundson

Diane L LaChapelle

Allisson Quine

The Role of Health Anxiety among Patients with Chronic Pain in Determining Response to Therapy

OBJECTIVES: To describe the pattern of perceived cognitive deficits in patients with whiplash injury, to examine the relation between perceived cognitive deficits and disability, and to examine the determinants of perceived cognitive deficits in patients with whiplash injury.PARTICIPANTS: A total of 81 individuals participated in the study. There were 29 patients (13 men, 16 women) with a diagnosis of whiplash, grade I or II. Patients with work-related soft-tissue injuries (n=24) and nonclinical controls (n=28) were included as comparison groups.METHODS: Participants completed measures of perceived cognitive deficits, pain severity, depression, anxiety and pain-related disability.RESULTS: Both patient groups scored significantly higher than the nonpatient control group on the measure of perceived cognitive deficits, but did not differ significantly from each other. Perceptions of cognitive deficits were significantly correlated with pain-related disability. A hierarchical regression examining the relative contribution of anxiety, depression and pain showed that only anxiety and depression contributed significant unique variance to the prediction of perceived cognitive deficits.DISCUSSION: The potential benefits of focusing interventions on the management of anxiety and depression in the rehabilitation of patients with whiplash injuries are discussed.

Michael JL Sullivan

Erin Hall

Rosita Bartolacci

Maureen E Sullivan

Heather Adams

Perceived Cognitive Deficits, Emotional Distress and Disability following Whiplash Injury

I was raised in North America - a culture and society in which the education emphasizes knowledge about science, its methods and its principles. The scientific method of understanding, coupled with the rudimentary knowledge that I was taught in high school biology, resulted in my conceptualization of pain as an objective truth. Pain, as I believed for a long time, was a bodily sensation with an expression that was more or less universal; to me, pain was simply the sensation that the brain experiences as a response to noxious stimuli. The pain sensation protects us from things that can hurt us; it is a warning sign that something in us is physically amiss. Thus, everybody physically reacts to the touch of a flame or experiences abdominal pain when there is appendicitis. Even now, in medical school, the pain education that I have received so far has only involved the physiology or mechanics of pain. Pain, as a physiological condition, operates independent of cultural context. However, in considering the experience of pain that my grandmother has endured, I realize that pain is much more than a mechanical bodily sensation effected by the nervous system in response to stimulus. Pain is a human experience, and as such, it is highly individualized and subjective. The proper diagnosis, care and treatment of pain necessitate a holistic understanding of pain, its physiology and its context (1).

David Ng

Pain: A Culturally Informed Experience

On January 1, 1995, Saskatchewan adopted a radical, no-fault system for motor vehicle accident insurance. Virtually no room was left for injured victims to sue for damages, whether for pain and suffering or for economic compensation. In fact, the no-fault system removed benefits for pain and suffering altogether. Apart from the concern that arose at the denial of justice in relation to economic matters and the blanket denial of pain, there was concern over the arrangements for medical care. Under the new Automobile Accident Insurance Act, injured persons were entitled to compensation and payment for treatment, as managed by their own doctors, chiropractors or physiotherapists for the first six weeks subsequent to an injury. Thereafter, they were required to be seen by insurance company-appointed doctors, chiropractors or physiotherapists if they wished the income replacement benefits to continue, treatment to be provided or both. They also were obliged to accept the recommendations of the insurance company doctors for the next 12 weeks, under what was called 'secondary rehabilitation'. If they claimed not to be well at the end of that period, further rehabilitation, described as 'tertiary rehabilitation' would be ordered. Two specific 'in-patient' centres were established for tertiary rehabilitation in different parts of the province (Regina and Saskatoon), and victims thought to be in need of tertiary rehabilitation had to travel if they did not live in either Regina (the provincial capital) or Saskatoon. The administration and treatment of individuals under these systems were so unacceptable to many individuals that a widespread resistance movement was generated and was established as the Coalition Against No-Fault Insurance on August 28, 1998, opening with simultaneous protests in Regina, Saskatoon, Prince Albert North Battleford and Estevan, each one organized by a local victim of the no-fault insurance scheme.

Lorie Terry

Insurance Research and Medical Ethics

BACKGROUND: Chronic pain is one of the most common reasons for therapeutic cannabis use.OBJECTIVES: To describe therapeutic cannabis use among patients with chronic pain.METHODS: Patients with chronic pain who voluntarily indicated that they used cannabis therapeutically completed a questionnaire about the type of cannabis used, the mode of administration, the amount used and the frequency of use, and their perception of the effectiveness of cannabis on a set of pain-associated symptoms and side effects. The study was approved by the McGill University Health Centre Research Ethics Board.RESULTS: Fifteen patients (10 male) were interviewed (median age 49.5 years, range 24 to 68 years). All patients smoked herbal cannabis for therapeutic reasons (median duration of use six years, range two weeks to 37 years). Seven patients only smoked at night-time (median dose eight puffs, range two to eight puffs), and eight patients used cannabis mainly during the day (median dose three puffs, range two to eight puffs); the median frequency of use was four times per day (range one to 16 times per day). Twelve patients reported improvement in pain and mood, while 11 reported improvement in sleep. Eight patients reported a 'high'; six denied a 'high'. Tolerance to cannabis was not reported.CONCLUSIONS: The results of this self-selected case series must be interpreted with caution. Small doses of smoked cannabis may improve pain, mood and sleep in some patients with chronic pain. Clinical trials are warranted to test these effects. Further prospective studies should examine the patterns and prevalence of cannabis use among chronic pain populations.

Mark A Ware

Ann Gamsa

Jan Persson

Mary-Ann Fitzcharles

Cannabis for Chronic Pain: Case Series and Implications for Clinicians

Clinicians often encounter patients who present with both chronic pain and elevated levels of anxiety. In some cases, the source of the anxiety is vague and diffuse. For others, there is an identifiable precipitating object, event or situation. For example, some patients with chronic pain are able to attribute their anxiety to the possibility of not regaining lost functional abilities, financial difficulties, feelings of social inadequacy, or uncertainty about the meaning and consequences of pain. The association between chronic pain and anxiety may not be particularly surprising when one considers that, in the acute phase, both pain and target-oriented anxiety (or fear) motivate actions that serve to minimize the threat and maximize the likelihood of successful escape. As well, their neurobiology, while distinct, interacts in the reticular system (1). Evaluations of the association between chronic pain and fear-relevant constructs were initiated in the 1960s and 1970s (2,3). It has only been of late, however, that theorists and researchers have begun to focus their attention on delineating the precise nature of the relationship and its specific implications for the assessment and management of pain.

Anxiety and Related Factors in Chronic Pain

About this journal

Pain Research and Management publishes research focusing on laboratory and clinical findings in the field of pain research and the prevention and management of pain.

Journal profile

Meet the editorial board

Chief Editor&nbsp;Professor Valeriani specialises in clinical neurophysiology with a particular interest in pain and headaches in children and adults, and is currently a neurologist who works at the Bambi Gesu Children’s Hospital in Rome.

Editor spotlight

Submit your proposal

Do you think there is an emerging area of research that really needs to be highlighted? Or an existing research area that has been overlooked or would benefit from deeper investigation? Raise the profile of a research area by leading a Special Issue.

Special Issues

Author guidelines

Editorial board

Databases and indexing

Pain Research and Management - Table of contents 2002

title

Pain Research and Management publishes research focusing on laboratory and clinical findings in the field of pain research and the prevention and management of pain.

Pain Research and Management