Fear of pain, not pain catastrophizing, predicts acute pain intensity, but neither factor predicts tolerance or blood pressure reactivity: An experimental investigation in pain-free individuals

140 normotensive chronic low back pain (LBP) sufferers received opioid blockade (8 mg naloxone IV) or placebo in randomized, counterbalanced order in separate sessions. During each, participants underwent a 1-min finger pressure pain task followed by an ischemic forearm pain task. Opioid blockade impaired post-pain BP recovery in controls but not LBP participants (ps <.001). In controls, low TRANG was associated with blockade-induced recovery impairments, with no blockade effect in high TRANG participants. In LBP participants, blockade did not alter recovery regardless of TRANG (interaction ps <.05). Results support dysfunctional opioid modulation of BP recovery in healthy high TRANG controls and further suggest chronic painrelated impairments in opioid-mediated cardiovascular recovery. Copyright ©2006 by Lawrence Erlbaum Associates, Inc. doi:10.1016/j.acpain.2006.08.020 Fear of pain, not pain catastrophizing, predicts acute pain intensity, but neither factor predicts tolerance or blood pressure reactivity: An experimental investigation in pain-free individuals George S.Z., Dannecker E.A., Robinson M.E. European Journal of Pain 2006;10(5):457-65 Previous studies of the Fear-Avoidance Model of Exaggerated Pain Perception have commonly included patients with chronic low back pain, making it difficult to determine which psychological factors led to the development of an ‘‘exaggerated pain perception’’. This study investigated the validity of the Fear-Avoidance Model of Exaggerated Pain Perception by considering the influence of fear of pain and pain catastrophizing on acute pain perception, after considering sex and anxiety. Thirty-two males and 34 females completed the State-Trait Anxiety Inventory, the Fear of Pain Questionnaire, and the Coping Strategies Questionnaire. Subjects underwent a cold pressor procedure and tolerance, pain intensity, and blood pressure reactivity were measured. Sex, anxiety, fear of pain, and pain catastrophizing were simultaneously entered into separate multiple regression models to predict different components of pain perception. Tolerance was not predicted by fear of pain, pain catastrophizing, or anxiety. Pain intensity at threshold and tolerance were significantly predicted by fear of pain, only. Blood pressure reactivity to pain was significantly predicted by anxiety, only. These results suggest that fear of pain may have a stronger influence on acute pain intensity when compared to pain catastrophizing, while neither of the factors

Abstracts predicted tolerance or blood pressure reactivity. ( 2005 European Federation of Chapters of the International Association for the Study of Pain. doi:10.1016/j.acpain.2006.08.021 PHARMACOLOGY OF ACUTE PAIN Intramuscular injection of diclofenac Forensic aspects of risk assessment and informed consent Graß H., Bertram C., Schuff A., Dettmeyer R. Rechtsmedizin 2006;16(3):161—4 The application of drugs by injection and especially by intramuscular application is a common treatment, e.g. in cases of acute pain. The non-steroidal anti-inflammatory drug diclofenac leads the ranking list of the most commonly used intramuscularly applied drugs. The risk of inducing a phlegmona diffusa or an abscess by such an injection, as described in the literature, by this kind of treatment will be illustrated by a case report and critically discussed. ©Springer Medizin Verlag 2006. doi:10.1016/j.acpain.2006.08.022 The COX-2 specific inhibitor valdecoxib versus tramadol in acute ankle sprain: A multicenter randomized, controlled trial Ekman E.F., Ruoff G., Kuehl K., Ralph L., Hormbrey P., Fiechtner J., Berger M.F. American Journal of Sports Medicine 2006; 34(6):945—55 Background: The cyclooxygenase-2 specific inhibitor valdecoxib has not been approved in the United States for treatment of acute pain. Hypothesis: Valdecoxib 20 mg twice daily or once daily (both with a 40 mg loading dose) is not clinically inferior to tramadol for treating the signs and symptoms of acute ankle pain. Study design: Randomized, controlled clinical trial; Level of evidence, 1. Methods: Patients (N = 829) with acute first- or second-degree ankle sprain received 7 days’ treatment with valdecoxib 20 mg either twice daily or once daily (both with 40 mg loading dose), tramadol 50 mg 4 times daily, or placebo. The primary end point was Patient’s Assessment of Ankle Pain visual analog scale on day 4; a test of noninferiority compared valdecoxib with tramadol. Results: On day 4, both valdecoxib doses were significantly better versus placebo and were comparable with tramadol in relieving ankle pain. On day 7, valdecoxib, but not tramadol, significantly