Pain ForumPub Date : 1999-12-01DOI: 10.1016/S1082-3174(99)70006-1
Kenneth A. Follett
{"title":"The fallacy of using a solitary outcome measure as the standard for satisfactory pain treatment outcome","authors":"Kenneth A. Follett","doi":"10.1016/S1082-3174(99)70006-1","DOIUrl":"https://doi.org/10.1016/S1082-3174(99)70006-1","url":null,"abstract":"<div><p>‘Success” connotes that a goal has been achieved. For many pain therapies, pain reduction is selected as the goal, and 50% reduction of pain intensity is selected frequently as the threshold for declaring success. Assessment of pain treatment outcome with this solitary measure minimizes the multidimensional nature of pain, pain management, and outcomes. Although the 50% threshold for declaring success may be acceptable in some instances, in most cases it does not characterize adequately the global responses that should be expected with successful pain management. Goals for a given individual's pain therapy should be chosen according to the needs and concerns of the parties affected by the pain disorder and should be established prior to initiating a treatment program. Success should be judged according to whether the selected goals are met.</p></div>","PeriodicalId":101001,"journal":{"name":"Pain Forum","volume":"8 4","pages":"Pages 189-191"},"PeriodicalIF":0.0,"publicationDate":"1999-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1082-3174(99)70006-1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91684308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pain ForumPub Date : 1999-12-01DOI: 10.1016/S1082-3174(99)70005-X
Joel L. Seres
{"title":"The fallacy of using 50% pain relief as the standard for satisfactory pain treatment outcome","authors":"Joel L. Seres","doi":"10.1016/S1082-3174(99)70005-X","DOIUrl":"https://doi.org/10.1016/S1082-3174(99)70005-X","url":null,"abstract":"<div><p>Chronic pain treatment outcomes are difficult to standardize. Pain levels and improvement in pain often do not correlate with functional ability, need for medication, or suffering behaviors. The 50% threshold has become the standard for minimally adequate pain relief. In fact, there is little literature that supports such an outcome as meaningful. Because it is so easy to use, it has become in effect the “gold standard” of outcome. This review challenges its use as confusing and misleading and recommends its cessation. Current attempts at composite measures have promise.</p></div>","PeriodicalId":101001,"journal":{"name":"Pain Forum","volume":"8 4","pages":"Pages 183-188"},"PeriodicalIF":0.0,"publicationDate":"1999-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1082-3174(99)70005-X","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91684309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pain ForumPub Date : 1999-12-01DOI: 10.1016/S1082-3174(99)70010-3
George B. Stefano
{"title":"The Mu3 opiate receptor subtype","authors":"George B. Stefano","doi":"10.1016/S1082-3174(99)70010-3","DOIUrl":"https://doi.org/10.1016/S1082-3174(99)70010-3","url":null,"abstract":"<div><p>The mu<sub>3</sub> opiate receptor subtype has been characterized by various binding assays as opiate alkaloid selective (eg, morphine) and opioid peptide (eg, methionine enkephalin) insensitive. The binding is monophasic, saturable, and stereospecific, as well as naloxone reversible. This opiate receptor subtype has been found on human and invertebrate tissues, demonstrating that it has been conserved during evolution. Furthermore, in numerous reports, this receptor is coupled to constitutive nitric oxide release. In this regard, for example, morphine immune downregulating activities parallels those actions formerly attributed to nitric oxide. Thus, this opiate receptor represents an addition to mu receptor heterogeneity that offers an explanation for the difference in actions of opioid peptides and opiate alkaloids in physiological systems transcending analgesia.</p></div>","PeriodicalId":101001,"journal":{"name":"Pain Forum","volume":"8 4","pages":"Pages 206-209"},"PeriodicalIF":0.0,"publicationDate":"1999-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1082-3174(99)70010-3","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91684314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pain ForumPub Date : 1999-12-01DOI: 10.1016/S1082-3174(99)70009-7
John S. Morley
{"title":"New perspectives in our use of opioids","authors":"John S. Morley","doi":"10.1016/S1082-3174(99)70009-7","DOIUrl":"https://doi.org/10.1016/S1082-3174(99)70009-7","url":null,"abstract":"<div><p>Some opioids in common use (eg, methadone) differ from others (eg, morphine) in being<em>N</em>-methyl-<span>d</span>-aspartic acid receptor antagonists and inhibitors of monoamine transmitter reuptake. The nonopioid receptors mediating these effects have been shown to be involved in many pain states, and antagonists of these receptors act synergistically with mu opioid receptor agonists in promoting antinociception. This distinction emphasizes the need to reassess the basis of our use of opioids in the treatment of pain states that have previously been described as <em>opioidinsensitive or opioid poorly responsive</em>. In describing the activity of opioids, use of the term <em>narrow spectrum</em> or <em>broad spectrum</em> should reflect not only an assessment of actions mediated by opioid receptor classes (mu, delta, kappa, and subtypes), but also the actions mediated by nonopioid receptors. There are already indications that, in clinical situations, broad-spectrum opioids, such as methadone, are more effective than narrow spectrum opioids, such as morphine, in promoting pain relief in problematic situations such as neuropathic pain. Apart from this enlightenment in the treatment of pain, new opportunities for the use of opioids in the regulation of immune responses, and in the treatment of cancer disease, are also provided by the existence of opiate (morphine-related opioids)-specific binding sites in immunocytes and lung cancer cells. Further clinical trials with methadone, and more concerted laboratory work to identify other broad-spectrum opioids, and to characterize other nonopioid effects of opiates, are called for.</p></div>","PeriodicalId":101001,"journal":{"name":"Pain Forum","volume":"8 4","pages":"Pages 200-205"},"PeriodicalIF":0.0,"publicationDate":"1999-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1082-3174(99)70009-7","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91684312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pain ForumPub Date : 1999-12-01DOI: 10.1016/S1082-3174(99)70004-8
Francis J. Keefe, John C. Lefebvre, Suzanne J. Smith
{"title":"Catastrophizing research","authors":"Francis J. Keefe, John C. Lefebvre, Suzanne J. Smith","doi":"10.1016/S1082-3174(99)70004-8","DOIUrl":"https://doi.org/10.1016/S1082-3174(99)70004-8","url":null,"abstract":"<div><p>This Commentary addresses some common conceptual errors and methodological issues raised by the Focus article by Geisser, Robinson, and Riley. One conceptual error, the problem of confounding coping with outcome, is evident in their assertion that catastrophizing is not a form of coping, but rather a maladaptive pain belief. Catastrophizing clearly fits current definitions of coping, even though it may be associated with negative outcomes. A second conceptual error is the tendency to oversimplify the coping process that is evident in the tendency to divide coping strategies into dichotomous categories (eg, active vs passive, adaptive vs maladaptive). Methodological issues raised by this article include: (1) the need to recognize the strengths of existing pain coping instruments (eg, the Coping Strategies Questionnaire), and (2) the utility of new and alternative coping measures. This Commentary concludes with a discussion of important directions for future research on pain coping.</p></div>","PeriodicalId":101001,"journal":{"name":"Pain Forum","volume":"8 4","pages":"Pages 176-180"},"PeriodicalIF":0.0,"publicationDate":"1999-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1082-3174(99)70004-8","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91684307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pain ForumPub Date : 1999-12-01DOI: 10.1016/S1082-3174(99)70007-3
John D. Loeser
{"title":"Seres' fallacies","authors":"John D. Loeser","doi":"10.1016/S1082-3174(99)70007-3","DOIUrl":"https://doi.org/10.1016/S1082-3174(99)70007-3","url":null,"abstract":"<div><p>Accurate determination of treatment outcomes is critical in the development of new therapies and the evaluation of existing treatments. Valid measures and meaningful statistical inferences are required. We have an obligation to develop better outcome assessments in the management of pain.</p></div>","PeriodicalId":101001,"journal":{"name":"Pain Forum","volume":"8 4","pages":"Pages 192-194"},"PeriodicalIF":0.0,"publicationDate":"1999-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1082-3174(99)70007-3","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91684310","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pain ForumPub Date : 1999-12-01DOI: 10.1016/S1082-3174(99)70009-7
J. Morley
{"title":"New perspectives in our use of opioids","authors":"J. Morley","doi":"10.1016/S1082-3174(99)70009-7","DOIUrl":"https://doi.org/10.1016/S1082-3174(99)70009-7","url":null,"abstract":"","PeriodicalId":101001,"journal":{"name":"Pain Forum","volume":"1 1","pages":"200-205"},"PeriodicalIF":0.0,"publicationDate":"1999-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89673134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pain ForumPub Date : 1999-12-01DOI: 10.1016/S1082-3174(99)70001-2
Michael E. Geisser , Michael E. Robinson , Joseph L. Riley III
{"title":"Pain beliefs, coping, and adjustment to chronic pain","authors":"Michael E. Geisser , Michael E. Robinson , Joseph L. Riley III","doi":"10.1016/S1082-3174(99)70001-2","DOIUrl":"https://doi.org/10.1016/S1082-3174(99)70001-2","url":null,"abstract":"<div><p>Pain beliefs and coping are believed to be important determinants of adjustment to chronic pain. The majority of the studies in this area have focused on the potential benefits of adaptive pain coping strategies and beliefs to improve adjustment to pain. In this Focus article, we propose a model whereby maladaptive pain beliefs and coping strategies are considered primary determinants of chronic pain adjustment, and influence the likelihood of engaging in more adaptive coping through influencing mediating factors such as perceived self-efficacy to manage pain. We (1) review data to support this model; (2) discuss evidence for the influence of maladaptive and adaptive coping and beliefs on chronic pain adjustment within the context of methodological limitations of studies in this area; (3) discuss the difficulties in assessing adaptive pain coping and beliefs; and (4) examine the implications of our proposed model for cognitive/behavioral interventions for chronic pain. We conclude that future studies on chronic pain adjustment should place more emphasis on the examination of maladaptive pain beliefs and coping strategies, examine causal relationships between adaptive and maladaptive strategies, and employ more multivariate analyses when examining the relationship between pain beliefs, coping, and adaptation to chronic pain.</p></div>","PeriodicalId":101001,"journal":{"name":"Pain Forum","volume":"8 4","pages":"Pages 161-168"},"PeriodicalIF":0.0,"publicationDate":"1999-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1082-3174(99)70001-2","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91684305","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pain ForumPub Date : 1999-12-01DOI: 10.1016/S1082-3174(99)70002-4
B. Thorn, Martha Anne Rich, J. Boothby
{"title":"Pain beliefs and coping attempts","authors":"B. Thorn, Martha Anne Rich, J. Boothby","doi":"10.1016/S1082-3174(99)70002-4","DOIUrl":"https://doi.org/10.1016/S1082-3174(99)70002-4","url":null,"abstract":"","PeriodicalId":101001,"journal":{"name":"Pain Forum","volume":"108 1","pages":"169-171"},"PeriodicalIF":0.0,"publicationDate":"1999-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88130658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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