John P. Garofalo

Long-term effectiveness of a comprehensive pain management program: strengthening the case for interdisciplinary care

Chronic pain, a debilitating medical condition affecting approximately 15% of the US population, leads to individual suffering and costs to society in terms of health care dollars and lost productivity. To examine the effectiveness of a comprehensive pain management program, data from 108 program participants were evaluated. Preprogram, postprogram, and 6-month follow-up data were collected from 80 participants, and preprogram, postprogram, and 1-year data were collected from 46 participants. Outcomes data from several domains were assessed: pain severity, emotional distress, interference of pain on function, perceived control of pain, treatment helpfulness, and number of hours resting. Within-subject repeated-measure analyses of variance found statistically significant findings on the six outcome measures utilized in this study for both the 6-month and 1-year samples. Examination of 95% confidence intervals revealed no overlap in pretreatment scores with 6-month and 1-year outcomes in five of the six domains studied. Mean scores on emotional distress did not maintain statistical significance in the 6-month or 1-year review. Overall, this study strengthens the case for interdisciplinary care for chronic pain management and provides evidence for the long-term effectiveness of this therapy. Furthermore, this study lends support to the notion that interdisciplinary treatments are effective in targeting multiple domains affected by the pain condition.

The Role of Mood States Underlying Sex Differences in the Perception and Tolerance of Pain

Abstract:  While sex differences in pain reporting are frequently observed, the reasons underlying these differences remain unclear. The present study examined sex differences in self‐report and physiological measures of pain threshold and tolerance following the administration of two laboratory pain‐induction tasks. The primary study aim centered on determining whether repeated exposure to such tasks would yield sex differences in terms of pain threshold and tolerance. In addition, it was hypothesized that if such differences did exist, negative mood states might account for changes in pain ratings, threshold, and/or tolerance in subsequent exposure to noxious stimuli. Recruited from a convenience sample, 66 participants (44 female and 22 male) were exposed to both thermal and cold noxious stimuli at three separate times, while psychophysiological and self‐report data were collected. Because women outnumbered men 2:1, Fisher z transformations were performed to determine whether the observed associations between mood states and pain ratings differed. We found stronger associations between fatigue and thermal‐heat pain ratings for men at their first and third exposure to the pain task compared to women (z = 2.11, P < 0.05; z = 3.14, P < 0.001, respectively). Results indicated that women evidenced greater pain tolerance than men on both a behavioral and physiological level; however, they reported greater pain severity than men. Fatigue was also found to be particularly important to reports of pain severity in men and pain tolerance in response to noxious stimuli for women. Possible pathways in which mood states influenced these endpoints are discussed.

Look on the bright side: do the benefits of optimism depend on the social nature of the stressor?

Growing evidence suggests that a number of personality traits associated with physical disease risk tend to be social in nature and selectively responsive to social as opposed to non-social stimuli. The current aim was to examine dispositional optimism within this framework. In Study 1, optimism was projected into the Interpersonal Circumplex and Five Factor Model revealing significant interpersonal representation characterized by high control and affiliation. Study 2 demonstrated that higher dispositional optimism attenuated cardiovascular responses to a social (speech) but not non-social stressor (cold pressor) task. Optimism-related attenuation of reactivity to the social vs. non-social stressor contributes further evidence to an emerging picture of psychosocial risk as largely reflecting person × social environment interactions.

Assessment of the Psychological Comorbidity, Pathophysiological Mechanisms, and Treatment Implications in Patients with Chronic Orofacial Pain

Chronic orofacial pain is a multifaceted health problem that like many other forms ofchronic pain bears deleterious effects upon quality of life as well as psychological andphysiological well-being. Due to a poorly understood etiology, effective treatment strategies are lacking and tend to lack a guiding integrative conceptual framework toform the basis and development of intervention. This review seeks to provide an updatedreview of the comorbid psychological disorders and characteristics that are common among chronic orofacial pain patients, while also examining the pathophysiological mechanisms underlying orofacial pain. Rather than consider the emotional, cognitive, andneuroendocrine influences upon pain perception and severity individually, these factorsshould be viewed as working in concert with one another. It is this interplay amongst distinct psychological characteristics governing the patient along with physiologicalmechanisms that exacerbate the pain. Together, the goal is to identify unique characteristics surrounding orofacial pain and offer some plausible insights for effectivetreatment outcomes.

Outcome measures in prediction of occupational disability

Chronic pain is a costly and debilitating medical condition. In the United States, approximately 80% of visits to physicians are related to pain (1). Pain affects more than 50 million Americans and consumes more than

Examining Sympathetic Nerve Activity with Microneurography during Hypnosis: Untangling the Effects of Central Command

70 billion in health care costs and lost productivity (2). The complex nature of pain demands assessment and treatment of both the biological and the psychosocial factors that exacerbate and maintain its symptoms and dysfunctions.

Impact of a Breast Cancer Diagnosis on Adult Children's Cognitive and Emotional Coherence

Abstract Using microelectrode recordings of postganglionic sympatheticaction potentials, the authors studied the effects of hypnotic suggestion on sympathetic outflow targeted to skin during static handgrip exercise. All subjects performed sustained handgrip at 33% maximal voluntary contraction (MVC) for 2 minutes during 3 consecutive trials. Two subjects randomly assigned to a hypnosis condition received suggestions that the 2nd trial was more difficult and the last trial was less difficult than the first trial. Two subjects randomly assigned to the control condition received no hypnosis or suggestions about task difficulty. In the nonhypnosis condition, skin sympathetic nerve activity (SNA) increased by 6% from baseline during the 2nd trial and 13% from baseline during the 3rd trial. In the hypnosis condition, skin SNA increased by 25% during the 2nd trial (suggestion of increased difficulty) and returned to baseline during the 3rd condition (suggestion of decreased difficulty). Therefore, the impact of central command on skin SNA is suggested by these results.

An early screening and intervention model for acute and subacute low back pain

The current study examined whether adult children of recently diagnosed breast cancer patients experience heightened general and major stressor-related distress, and identified a potential mediator between these two forms of distress. Unique from other stress studies, the current study proposed a novel intrapsychic construct, the extent to which one understands and recognizes his or her thoughts and feelings related to a major stressor, for which we coined the term cognitive and emotional coherence. Albeit preliminary, findings supported study hypotheses and argue that this construct may represent an important mediator of distress as well as a pivotal target for psychosocial intervention.

Workers’ Compensation and Other Disability Insurance Systems Involved in Occupational Musculoskeletal Disorders

Low back pain (LBP) is one of the most common causes of disability. Volinn (1997) identified seven epidemiological investigations conducted in Belgium, Germany, Great Britain and Sweden that reported on the point prevalence of LBP. By weighting the percentages by the sample size, and then aggregating across studies, it was found that the rates of LBP in these countries averages approximately 34%. This is almost twice that reported in surveys conducted in less developed countries. Also, as Mayer and Gatchel (1988) had originally reviewed, it is the number one cause of disability of persons under age 45. Over this age, it is the third leading cause of disability, becoming progressively less of a factor during later years when function and productivity become of less concern than survival. It should also be noted that back-related disorders represent the most prevalent source of disability in the U.S. military (Feuerstein, Berkowitz & Peck, 1997). Indeed, in the U.S, of all the occupational musculoskeletal disorders, the most research attention to date has been dedicated to LBP disability, because this is the most expensive benign condition in industrialized countries (Volinn, 1997). It has been estimated that, in any one year, about 3-4% of the population in all industrialized countries has a temporarily disabling LBP episode, and that more than 1% of the working age population is “totally and permanently disabled” by this problem. From a financial point of view, it is one of the most costly problems in the North American workplace (Krause & Ragland, 1994). An even more startling trend is the disproportionate increase in LBP disability as measured against population growth. For example, Frymoyer and Cats-Baril (1991) had earlier reported LBP disability increasing at a rate 14 times the population-growth from1957 to 1976. This trend is continuing to this day.

Cardiovascular Disease and the Workplace

Over the last century, rights for injured workers and protections for employers have developed and evolved considerably. Furthermore, “social safety net” programs, such as Social Security Disability Insurance that developed as part of Franklin Roosevelt’s “New Deal,” continue to play a significant role for individuals with occupational musculoskeletal disorders. In 2010, approximately 57 million Americans between the ages of 21 and 64 were classified as disabled (U. S. Census Bureau, 2012). In addition, according to the Social Security Administration, an individual who is 20 years of age only has a 70 % chance of reaching full retirement without becoming disabled. Developing an understanding of the impact of these programs on patients with musculoskeletal disorders can improve the effectiveness of clinicians and systems involved in providing care to this growing population of patients. Moreover, along with federal programs, State workers’ compensation programs serve as a crucial social contract for Americans. Workers’ compensation insurance represents an agreement between employers and employees in which employees who are injured during the course of their work receive wages and health care for their job-related injury. In exchange for these benefits, employers are protected from certain lawsuits involving the work-related injury. This agreement is commonly referred to as “the compensation bargain.”