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      Mania reduces perceived pain intensity in patients with chronic pain: preliminary evidence from retrospective archival data

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          Bipolar disorder is associated with poor pain outcomes, but the extant literature has not taken into account how mania or hypomania – a central feature of bipolar disorders – influences pain intensity. The objective of this study was to describe whether patients recalled experiencing reduced pain intensity during manic or hypomanic episodes.

          Design and setting

          This study used a retrospective design using archival data from patient’s medical records.


          A total of 201 patients with chronic pain with bipolar I (39.6%) or bipolar II (60.4%) disorder who were undergoing a psychological evaluation for an interventional pain procedure were included in this study.


          Patients underwent a semistructured interview where they were asked if they recalled reductions in pain intensity during their most recent manic or hypomanic episode. The proportion of patients who responded “yes” versus “no” to this question was the primary outcome variable.


          Results reveal that 64.2% of patients recalled experiencing a reduction in pain intensity during their most recent manic or hypomanic episode.


          Perceptions of reduced pain intensity during mania or hypomania may contribute to a cycle of increased activity during manic episodes, which may increase pain over time. It may also lead to false-positive findings on spinal cord stimulator trials and diagnostic pain blocks, among other interventional pain procedures. The preliminary findings of this study highlight the clinical importance of assessing for bipolar disorders in patients with chronic pain.

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          Most cited references 23

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          A longitudinal study to explain the pain-depression link in older adults with osteoarthritis.

          To evaluate whether osteoarthritis (OA) pain determines depressed mood, taking into consideration fatigue and disability and controlling for other factors. In a community cohort with hip/knee OA, telephone interviews assessed OA pain and disability (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC]), fatigue (Multidimensional Fatigue Symptom Inventory), depressed mood (Center for Epidemiologic Studies Depression Scale), and covariates (demographics, self-rated health, comorbidity, pain coping, pain catastrophizing, and social support) at 3 time points over 2 years. Drawing on previous research, a path model was developed to test the interrelationships among the key concepts (pain, depression, fatigue, disability) over time, controlling for covariates. The baseline mean age was 75.4 years; 78.5% of the subjects were women, 37.2% were living alone, and 15.5% had ≥3 comorbid conditions. WOMAC scores indicated moderate OA symptoms and disability. From the final model with 529 subjects, adjusting for covariates, we found that current OA pain strongly predicted future fatigue and disability (both short and long term), that fatigue and disability in turn predicted future depressed mood, that depressed mood and fatigue were interrelated such that depressed mood exacerbated fatigue and vice versa, and that fatigue and disability, but not depressed mood, led to worsening of OA pain. Controlling for other factors, OA pain determined subsequent depressed mood through its effect on fatigue and disability. These effects led to worsening of pain and disability over time. These results support the need for improved pain management in OA to prevent or attenuate the downstream effects of pain on disability and mood. Copyright © 2011 by the American College of Rheumatology.
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            Examinations of chronic pain and affect relationships: applications of a dynamic model of affect.

            Two studies of the relationship between pain and negative affect are presented in this article: a study of weekly fluctuations in pain and negative affect among those with arthritis and a study of daily fluctuations in pain and negative affect for participants with fibromyalgia. The roles of positive affect and mood clarity (or the ability to distinguish between different emotions) in modifying the size of the relationship between pain and negative affect were examined in both studies as a means of testing the predictions of a dynamic model of affect regulation. In both studies, the presence of positive affect reduced the size of the relationship between pain and negative affect. Also, for arthritis participants with greater mood clarity, there was less overlap in ratings of negative and positive affective states.
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              Psychological resilience predicts decreases in pain catastrophizing through positive emotions.

              The study used a daily process design to examine the role of psychological resilience and positive emotions in the day-to-day experience of pain catastrophizing. A sample of 95 men and women with chronic pain completed initial assessments of neuroticism, psychological resilience, and demographic data, and then completed short diaries regarding pain intensity, pain catastrophizing, and positive and negative emotions every day for 14 consecutive days. Multilevel modeling analyses indicated that independent of level of neuroticism, negative emotions, pain intensity, income, and age, high-resilient individuals reported greater positive emotions and exhibited lower day-to-day pain catastrophizing compared with low-resilient individuals. Mediation analyses revealed that psychologically resilient individuals rebound from daily pain catastrophizing through experiences of positive emotion. Implications for research on psychological resilience, pain catastrophizing, and positive emotions are discussed. (c) 2010 APA, all rights reserved.

                Author and article information

                J Pain Res
                J Pain Res
                Journal of Pain Research
                Journal of Pain Research
                Dove Medical Press
                23 March 2016
                : 9
                : 147-152
                [1 ]Department of Psychology, University of Kentucky, Lexington, KY, USA
                [2 ]Bluegrass Health Psychology, Lexington, KY, USA
                Author notes
                Correspondence: Ian A Boggero, Department of Psychology, University of Kentucky, 171 Funkhouser Drive, Lexington, KY 40506, USA, Tel +1 859 257 2207, Fax +1 859 323 1979, Email ian.boggero@ 123456uky.edu
                © 2016 Boggero and Cole. This work is published and licensed by Dove Medical Press Limited

                The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

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