%0 Journal Article
%A Hush, JM
%A Nicholas, Michael
%T Cognitive behavioral treatment for low back pain: Case study and commentary
%B Journal of Clinical Outcomes Management
%D 2011
%C United States
%I Turner White Communications, Inc.
%V 18
%N 2
%P 48-61
%@ 1079-6533
%X 
%Z FOR Codes: 110321 110319



%0 Journal Article
%~ Pubmed
%A Blyth, F M
%A Cumming, R G
%A Nicholas, M K
%A Creasey, H
%A Handelsman, D J
%A Le Couteur, D G
%A Naganathan, V
%A Sambrook, P N
%A Seibel, M J
%A Waite, L M
%T Intrusive pain and worry about health in older men: the CHAMP study.
%B Pain
%D 2011
%V 152
%N 2
%P 447-52
%@ 1872-6623
%X The role of anxiety in pain is less well understood than the role of depression. Based on recent conceptual thinking about worry and pain, we explored the relationship between pain status and worry about health and anxiety in 1217 community-dwelling men aged 70 years or older who participated in the baseline phase of the Concord Health and Ageing in Men Project study, a large population-based epidemiological study of healthy ageing based in Sydney, Australia. We hypothesised that worry about health would be associated with having persistent pain, and that the association would be stronger in the presence of co-existing pain-related interference with activities (intrusive pain). Of men in the study, 12.5% had persistent and intrusive pain, 22.4% were worried about their health, and 6.3% had anxiety. We found a strong association between worry about health and pain that was both persistent and intrusive, and that remained after accounting for age, number of comorbidities, depression, self-rated health status, arthritis, and gait speed (adjusted odds ratio 2.9; 95% confidence interval 1.8-4.7), P<0.0001). The corresponding adjusted odds ratio for the association between anxiety and pain was 2.3 (95% confidence interval 1.0-4.8; P=0.0363). These findings suggest that at a population level, subthreshold anxiety and pain are strongly related, and worry about health occurs much more commonly than anxiety itself. To our knowledge, this is the first study to explore, specifically, the relationship between pain status and worry about health in older men. In older community-dwelling men, pain was robustly associated with worry about health, highlighting the potential importance of subthreshold anxiety-related psychological factors.
%Z FOR Codes: 111706 170106



%0 Journal Article
%~ Pubmed
%A Perry, K Nicholson
%A Nicholas, Michael K
%A Middleton, James
%T Multidisciplinary cognitive behavioural pain management programmes for people with a spinal cord injury: design and implementation.
%B Disability and rehabilitation
%D 2011
%V 33
%N 13-14
%P 1272-80
%@ 1464-5165
%X This article seeks to outline the design and implementation of cognitive behavioural pain management programmes (PMPs) for people with spinal cord injury (SCI), illustrated by the experiences in a recently evaluated programme (SpinalADAPT). It is hoped that this will provide an easily accessible account of the relevant design and implementation issues for those who seek to deliver such programmes to persons with a SCI.
%Z FOR Codes: 1701



%0 Journal Article
%~ Pubmed
%A Linton, Steven J
%A Nicholas, Michael K
%A Macdonald, Shane
%A Boersma, Katja
%A Bergbom, Sofia
%A Maher, Chris
%A Refshauge, Kathy
%T The role of depression and catastrophizing in musculoskeletal pain.
%B European journal of pain (London, England)
%D 2011
%V 15
%N 4
%P 416-22
%@ 1532-2149
%X Many patients with musculoskeletal pain also suffer from a depressed mood. Catastrophizing is one process that may link depression and pain since it is a key concept in models of both problems. Earlier research has suggested that catastrophizing measures something above and beyond depression. This study tests the idea that if depressed mood and catastrophizing are separate entities then when one is absent the other should still contribute to poor outcome, and, when both are present there should be an additional adverse effect. To this end, a prospective design, with a built-in replication from two clinical samples of patients with sub-acute pain (one from Sweden, N=373; one from Australasia, N=259), was employed. Participants were classified as to having high/low scores on measures of depression and catastrophizing. Subsequently, these classifications were studied in relation to outcome variables cross-sectionally and at follow-up. Results showed a small to moderate correlation between catastrophizing and depression and that there are individuals with one, but not the other problem. Further, having one or the other of the entities was associated with current pain problems and outcome, while having both increased the associations substantially. The replication showed very similar results Our data demonstrate that pain catastrophizing and heightened depressed mood have an additive and adverse effect on the impact of pain, relative to either alone. It suggests that each should be assessed in the clinic and that future research should focus on treatments specifically designed to tackle both depressed mood and catastrophizing.
%Z FOR Codes: 110399



%0 Journal Article
%~ Pubmed
%A Linton, Steven J
%A Nicholas, Michael
%A Macdonald, Shane
%T Development of a short form of the ??rebro Musculoskeletal Pain Screening Questionnaire.
%B 
%D 2011
%V 36
%N 22
%P 1891-5
%@ 1528-1159
%X A longitudinal design where the questionnaire was completed at a pretest and predictive ability evaluated with a 1-year follow-up. A second sample was employed to provide a replication.
%Z FOR Codes: 170106



%0 Journal Article
%~ Pubmed
%A Hall, Amanda M
%A Kamper, Steven J
%A Maher, Chris G
%A Latimer, Jane
%A Ferreira, Manuela L
%A Nicholas, Michael K
%T Symptoms of depression and stress mediate the effect of pain on disability.
%B Pain
%D 2011
%V 152
%N 5
%P 1044-51
%@ 1872-6623
%X The mechanism or mechanisms involved in the development of pain-related disability in people with low back pain is unclear. Psychological distress has been identified as one potential pathway by which an episode of pain influences the development of persistent disabling symptoms; however, the relationship has not been formally investigated. This study investigated the causal relationship between pain and disability via psychological distress (and its components depression, stress, and anxiety) by using mediation path analysis. The study sample included 231 participants with subacute low back pain (6 to 12 weeks' pain duration) who had been recruited for an exercise-based randomised, controlled trial. All participants completed self-report assessments of pain (0-10 numerical rating scale), disability (Roland Morris Disability Questionnaire), and psychological distress (Depression Anxiety and Stress Scale) at baseline and again at 2 follow-up time points (6 and 12 weeks after baseline). The results of the mediation analysis suggest that approximately 30% of the relationship between subacute pain and later disability is dependent on the level of patients' psychological distress. The finding that psychological distress only partially (30%) mediated the pain-disability relationship indicates that other factors should also be explored. Further analysis into the components of psychological distress revealed that the symptoms of depression and stress, but not anxiety, are responsible for mediation of the pain-disability relationship. These findings provide an opportunity to decrease the risk of long-term disability through early identification and management of depressive and stress symptoms. Psychological distress symptoms at 6 weeks in patients with low back pain influences future disability. Symptoms of depression and stress, but not anxiety, are responsible for mediation of the pain-disability relationship.
%Z FOR Codes: 110399



%0 Journal Article
%~ Pubmed
%A Nicholas, Michael K
%A George, Steven Z
%T Psychologically informed interventions for low back pain: an update for physical therapists.
%B Physical therapy
%D 2011
%V 91
%N 5
%P 765-76
%@ 1538-6724
%X A central theme of current evidence-based guidelines for managing low back pain is endorsement of the resumption of activities despite the presence of pain. This task can be challenging for both therapists and patients, and there are many essentially psychological obstacles to implementing the guidelines. These obstacles can be overcome by knowing how to recognize potential psychological obstacles and understanding the options for managing psychological obstacles in combination with activity-based interventions. This article is intended to address these tasks by explaining and describing the application of empirically based psychological principles and strategic clinical reasoning. Importantly, the roles of skills in assessment, treatment planning, and communication with patients are identified as essential but feasible skills for physical therapists to acquire with appropriate training.
%Z FOR Codes: 110317 110319



%0 Journal Article
%~ Pubmed
%A Nicholas, Michael K
%A Linton, Steven J
%A Watson, Paul J
%A Main, Chris J
%A , the "Decade of the Flags" Working Group
%T Early identification and management of psychological risk factors ("yellow flags") in patients with low back pain: a reappraisal.
%B Physical therapy
%D 2011
%V 91
%N 5
%P 737-53
%@ 1538-6724
%X Originally the term "yellow flags" was used to describe psychosocial prognostic factors for the development of disability following the onset of musculoskeletal pain. The identification of yellow flags through early screening was expected to prompt the application of intervention guidelines to achieve secondary prevention. In recent conceptualizations of yellow flags, it has been suggested that their range of applicability should be confined primarily to psychological risk factors to differentiate them from other risk factors, such as social and environmental variables. This article addresses 2 specific questions that arise from this development: (1) Can yellow flags influence outcomes in people with acute or subacute low back pain? and (2) Can yellow flags be targeted in interventions to produce better outcomes? Consistent evidence has been found to support the role of various psychological factors in prognosis, although questions remain about which factors are the most important, both individually and in combination, and how they affect outcomes. Published early interventions have reported mixed results, but, overall, the evidence suggests that targeting yellow flags, particularly when they are at high levels, does seem to lead to more consistently positive results than either ignoring them or providing omnibus interventions to people regardless of psychological risk factors. Psychological risk factors for poor prognosis can be identified clinically and addressed within interventions, but questions remain in relation to issues such as timing, necessary skills, content of treatments, and context. In addition, there is still a need to elucidate mechanisms of change and better integrate this understanding into the broader context of secondary prevention of chronic pain and disability.
%Z FOR Codes: 110319 110317



%0 Journal Article
%~ Pubmed
%A Dominick, Clare
%A Blyth, Fiona
%A Nicholas, Michael
%T Patterns of chronic pain in the New Zealand population.
%B The New Zealand medical journal
%D 2011
%V 124
%N 1337
%P 63-76
%@ 1175-8716
%X This study describes the prevalence and impact of chronic and recent pain in the New Zealand population and the groups most likely to report and use treatment for their chronic pain. Results are compared with international estimates.
%Z FOR Codes: 111706



%0 Journal Article
%~ Pubmed
%A Brandini, Daniela A
%A Benson, Janet
%A Nicholas, Michael K
%A Murray, Greg M
%A Peck, Christopher C
%T Chewing in temporomandibular disorder patients: an exploratory study of an association with some psychological variables.
%B Journal of orofacial pain
%D 2011
%V 25
%N 1
%P 56-67
%@ 1064-6655
%X To compare kinematic parameters (ie, amplitude, velocity, cycle frequency) of chewing and pain characteristics in a group of female myofascial temporomandibular disorder (TMD) patients with an age-matched control female group, and to study correlations between psychological variables and kinematic variables of chewing.
%Z FOR Codes: 110506



%0 Journal Article
%~ Pubmed
%A Dear, Blake F
%A Sharpe, Louise
%A Nicholas, Michael K
%A Refshauge, Kathryn
%T Pain-related attentional biases: the importance of the personal relevance and ecological validity of stimuli.
%B The journal of pain : official journal of the American Pain Society
%D 2011
%V 12
%N 6
%P 625-32
%@ 1528-8447
%X The literature regarding pain-related attentional biases is currently marked by considerable inconsistency. The primary aim of the present study was to examine whether 2 stimulus-related factors may be important to the detection of pain-related attentional biases: 1) the personal relevance of stimuli; and 2) their ecological validity. To do this, the present research compared the ability of a word-based dot-probe task (ie, lower ecological validity) and picture-based dot-probe task (ie, higher ecological validity) to detect attentional biases using generally selected (ie, lower personal relevance) and idiosyncratically selected stimuli (ie, higher personal relevance). To do this, the present study used a large sample of chronic pain patients and matched pain-free individuals. Attentional biases were found among both chronic pain patients and pain-free individuals for idiosyncratically selected pictorial stimuli (ie, highest ecological validity and personal relevance) but not for generally selected pictorial stimuli or for pain-related word stimuli, irrespective of whether they were idiosyncratically or generally selected. These biases were found to stem from vigilance for pain-related stimuli. Overall, the findings of the present study suggest that similar pain-related attentional biases can be found among both pain-free individuals and chronic pain patients and that stimulus-related factors may be important to the detection of those biases. PERSPECTIVE: To date, research examining pain-related attentional biases has yielded inconsistent results. The present study sought to examine 2 stimulus-related factors often identified for their potential to influence the consistency of findings. The findings of this study highlight the importance of considering stimulus-related factors when designing and interpreting pain-related dot-probe research.
%Z FOR Codes: 110317 170110



%0 Journal Article
%~ Pubmed
%A Dear, Blake F
%A Sharpe, Louise
%A Nicholas, Michael K
%A Refshauge, Kathryn
%T The psychometric properties of the dot-probe paradigm when used in pain-related attentional bias research.
%B The journal of pain : official journal of the American Pain Society
%D 2011
%V 12
%N 12
%P 1247-54
%@ 1528-8447
%X In recent years, there has been increasing acknowledgment of the need for psychometric data regarding the dot-probe paradigm. The aim of the present study was to provide some data on the psychometric properties of the dot-probe paradigm in the context of pain-related research. Using the data of a large pain-free sample and a large chronic pain sample, the present study examined the psychometric properties of a picture- and word-based dot-probe task. It also examined the data of idiosyncratically selected stimuli designed to be relevant to each participant and compared this with the data of neutral stimuli and nonsalient pain-related stimuli. Poor levels of internal consistency (?? range: -.44 to .28; split-half r range: -.35 to .11) and test-retest reliability (r range: -.14 to .13) were found among the pain-free sample, irrespective of the task used or the stimuli used. There was limited evidence of comparability between the 2 tasks among the chronic pain sample (r range: -.08 to .26) and similarly poor levels of internal-consistency (?? range: -.56 to .17; split-half r range: -.20 to .25). The findings of the present study therefore suggest that psychometric issues may be important to pain-related attentional bias research. More research is, however, undoubtedly needed. PERSPECTIVE: The aim of the present study was to provide data regarding the psychometric properties of the dot-probe paradigm within the specific context of pain-related attentional bias research. The findings of this study suggest that psychometric issues may be an important consideration in pain-related attentional biases research.
%Z FOR Codes: 110317 170110



%0 Journal Article
%~ Pubmed
%A Dominick, Clare H
%A Blyth, Fiona M
%A Nicholas, Michael K
%T Unpacking the burden: Understanding the relationships between chronic pain and comorbidity in the general population.
%B Pain
%D 2011
%V 
%N 
%P 
%@ 1872-6623
%X We investigated the association of chronic pain with physical and mental comorbidity in the New Zealand population by measuring chronic pain status separate from comorbid conditions. Models of allostatic load provided a conceptual basis for considering multi-morbidity as accumulated comorbid load and for using both discrete conditions and cumulative measures in analyses. The nationally representative cross-sectional survey data included self-reported doctor-diagnosed chronic physical and mental health conditions, Kessler 10-item scale scores, an independent measure of chronic pain, and sociodemographic characteristics. The population prevalence of chronic pain is 16.9%, and a quarter (26%) of the population report 2 or more comorbid physical conditions statistically associated with chronic pain (unadjusted P<0.01). Results indicate that accumulated comorbid load is independently associated with chronic pain. Six physical conditions independently associated with chronic pain (adjusted odds range from 1.4 to 3.9) increase the risk of chronic pain in an additive manner, and residual accumulated load further increases risk for 2 or more conditions (adjusted odds 1.6). Anxiety/depression interacts synergistically with arthritis and neck/back disorders to increase the odds of reporting chronic pain beyond an additive model. This synergistic effect is not apparent for other conditions or for additional comorbid load. Results imply that measurement of chronic pain independent of comorbid conditions and adjustment for comorbid conditions is important for more accurate prevalence estimates and understanding relationships between conditions. Future epidemiological research might usefully incorporate independent measurement of chronic pain alongside adjustment for specific physical and mental health conditions as well as accumulated comorbid load.
%Z FOR Codes: 111706



%0 Journal Article
%~ Pubmed
%A Nicholas, Michael K
%A Asghari, Ali
%A Corbett, Mandy
%A Smeets, Rob J E M
%A Wood, Bradley M
%A Overton, Sarah
%A Perry, Carolyn
%A Tonkin, Lois E
%A Beeston, Lee
%T Is adherence to pain self-management strategies associated with improved pain, depression and disability in those with disabling chronic pain?
%B European journal of pain (London, England)
%D 2011
%V 
%N 
%P 
%@ 1532-2149
%X There is generally good evidence that pain management interventions that include self-management strategies can substantially reduce disability and improve psychological well-being in patients with chronic pain. Reductions in unhelpful responses, especially catastrophising and fear-avoidance beliefs, have been established as key contributors to these gains. In contrast, there is surprisingly little evidence that adherence to self-management strategies contributes to achieving these outcomes. Difficulties in defining and measuring the use of pain self-management strategies have been obstacles for this research. Using a pragmatic way of assessing the practice of specific strategies this study investigated their ability to account for changes in pain, disability and depressive symptoms after a 3-week cognitive-behavioural pain management program. The post-treatment outcomes on these dimensions were found to be statistically and, for many, clinically significant. Consistent with previous research, reductions in catastrophising and fear-avoidance beliefs, and increased pain self-efficacy beliefs, were also associated with these gains. But the key new finding was that there was a clear gradient between adherence to specific self-management strategies and reductions in pain, disability and depressive symptoms. Furthermore, adherence to the self-management strategies was predictive of better outcomes even after controlling for the moderating effects of initial catastrophising, fear-avoidance and pain self-efficacy beliefs.
%Z FOR Codes: 111706



%0 Journal Article
%~ Pubmed
%A Nicholas, Michael K
%T Obstacles to recovery after an episode of low back pain; the 'usual suspects' are not always guilty.
%B Pain
%D 2010
%V 148
%N 3
%P 363-4
%@ 1872-6623
%X 
%Z FOR Codes: 170106



%0 Journal Article
%~ Pubmed
%A Wood, Bradley M
%A Nicholas, Michael K
%A Blyth, Fiona
%A Asghari, Ali
%A Gibson, Stephen
%T The Utility of the Short Version of the Depression Anxiety Stress Scales (DASS-21) in Elderly Patients with Persistent Pain: Does Age Make a Difference?
%B Pain medicine (Malden, Mass.)
%D 2010
%V 11
%N 12
%P 1780-1790
%@ 1526-4637
%X Objective.??? This study examined the assessment of the negative emotional constructs of depression, anxiety and stress with the short version (21 items) of the Depression Anxiety Stress Scales (DASS-21) in elderly patients (age > 60 years) with persistent pain. Design.??? A convenience sample of 2,045 patients attending a tertiary referral pain centre were categorized by age and included a group aged 60 years and under (n???=???1,245) for assessment of age differences. Elderly patients (n???=???800) were divided into 3 groups: 61-70 years (n???=???366), 71-80 years (n???=???308) and 81 years and over (n???=???126). Patients completed the DASS-21 as part of an initial clinical assessment process. Results.??? The failure rate for scale completion increased across age groups and was significantly higher in the oldest group compared to the youngest group. All scales demonstrated reasonable convergent and divergent validity. Confirmatory factor analysis confirmed a three-factor structure and is consistent with previous studies. Age differences in depression, anxiety and stress scores were also assessed. Interestingly, patients aged 60 years and under had significantly higher Depression and Stress scores compared to all other age groups. This group also had significantly higher Anxiety scores compared to patients aged 61-70 years. Conclusions.??? Overall, the DASS-21 is a reliable and valid measure of depression, anxiety and stress in elderly patients with persistent pain. There are some age differences in the normative values for the reporting of mood symptoms and these need to be taken into account when assessing pain-related mood disturbance in older populations.
%Z FOR Codes: 170107



%0 Journal Article
%~ Pubmed
%A Sharpe, L
%A Nicholson Perry, K
%A Rogers, P
%A Dear, B F
%A Nicholas, M K
%A Refshauge, K
%T A comparison of the effect of attention training and relaxation on responses to pain.
%B Pain
%D 2010
%V 150
%N 3
%P 469-76
%@ 1872-6623
%X This study aimed to investigate the efficacy of an attention training technique (ATT) on pain ratings, threshold and tolerance during the cold pressor task. One hundred and three undergraduate students were randomly assigned to receive either threat-alleviating or threat-inducing information about the task. Participants were then re-randomized to receive either ATT or progressive muscle relaxation (PMR). Hence, the present study had a 2 (threat expectancy: high vs. low)x2 (training: ATT vs. PMR) design. Analyses confirmed that the threat manipulation was effective in increasing the harm associated with the task. ATT resulted in a relative reduction in hypervigilance to sensory pain words compared to PMR. ATT was also associated with a lower degree of focus on internal sensations, but not mindfulness or difficulty disengaging from pain words. Results showed that, relative to relaxation training, those receiving ATT reported pain less quickly than those receiving relaxation, although there were no differences between the training groups for tolerance or pain ratings. These results show that ATT changes the cognitive processes of internal/external focus and hypervigilance towards sensory pain words, but not difficulty disengaging or mindfulness. Although ATT changed threshold, the fact that neither pain ratings nor tolerance was affected suggests that a single, brief session of ATT may not be sufficient to affect broader change. Nonetheless, this study shows that ATT can change cognitive processes thought to be associated with heightened perception of pain and that this changes how quickly pain is registered and is therefore worthy of further investigation.
%Z FOR Codes: 1701



%0 Journal Article
%~ Pubmed
%A Dehghani, Mohsen
%A Sharpe, Louise
%A Nicholas, Michael K
%T Structural evaluation of the contemporary psychological models of chronic pain: does fear of pain work for all?
%B Cognitive behaviour therapy
%D 2010
%V 39
%N 3
%P 214-24
%@ 1651-2316
%X The aim of the present study was to test Turk and Okifuji's (2002) model of chronic pain and in particular the moderating role of self-efficacy. We assessed 207 consecutive chronic pain patients (53.1% female) on a range of relevant measures and tested the model using structured equation modelling. The model was supported. These results support Turk and Okifuji's model of chronic pain and suggest that it can account for the relationships between variables in chronic pain patients. In particular, the results support the central role of fear-based avoidance and self-efficacy in chronic pain. Future research should be aimed at testing the alternative contemporary models of chronic pain at different stages of the development and maintenance of chronic pain and over time.
%Z FOR Codes: 170106



%0 Journal Article
%~ Pubmed
%A Haggman, Sonia P
%A Sharpe, Louise A
%A Nicholas, Michael K
%A Refshauge, Kathryn M
%T Attentional biases toward sensory pain words in acute and chronic pain patients.
%B The journal of pain : official journal of the American Pain Society
%D 2010
%V 11
%N 11
%P 1136-45
%@ 1528-8447
%X Attentional biases towards pain-related words of chronic and acute low back pain (LBP) patients were compared with healthy pain-free controls. Specifically, the aims were to determine: 1)??whether chronic LBP patients demonstrate attentional biases compared to pain-free controls; 2)??whether observed biases are also present in those with acute LBP; and 3) whether observed biases are associated with pain-related fear among the pain groups. Four groups were recruited: 1) acute LBP patients; 2) chronic LBP patients from physiotherapy practices; 3) chronic LBP patients from a tertiary referral pain-management center; and 4) healthy pain-free controls. Participants were assessed on the dot-probe computer task for attentional bias to pain-related words. All 3 pain groups demonstrated biases compared to controls on sensory but not on affective, disability, or threat words. Among the pain groups, those with low and moderate levels of fear of (re)injury demonstrated biases towards sensory pain words that were absent in those with high levels of fear, which is counterintuitive to what the fear of (re)injury model suggests. These results suggest that the experience of pain, rather than duration, is the primary indicator of the presence of pain-related biases. PERSPECTIVE: Attentional biases are present in chronic and acute pain. Biases towards sensory-pain stimuli were demonstrated regardless of pain duration; however, they were present in those with low and moderate levels of fear of (re)injury only and not those high in fear. These findings are not consistent with the fear of (re)injury model.
%Z FOR Codes: 170106



%0 Journal Article
%~ Pubmed
%A Tveito, Torill Helene
%A Shaw, William S
%A Huang, Yueng-Hsiang
%A Nicholas, Michael
%A Wagner, Gregory
%T Managing pain in the workplace: a focus group study of challenges, strategies and what matters most to workers with low back pain.
%B Disability and rehabilitation
%D 2010
%V 32
%N 24
%P 2035-45
%@ 1464-5165
%X Most working adults with low back pain (LBP) continue to work despite pain, but few studies have assessed self-management strategies in this at-work population. The purpose of this study was to identify workplace challenges and self-management strategies reported by workers remaining at work despite recurrent or persistent LBP, to be used as a framework for the development of a workplace group intervention to prevent back disability.
%Z FOR Codes: 110321



%0 Journal Article
%~ Pubmed
%A Perry, Kathryn Nicholson
%A Nicholas, Michael K
%A Middleton, James W
%T Comparison of a pain management program with usual care in a pain management center for people with spinal cord injury-related chronic pain.
%B The Clinical journal of pain
%D 2010
%V 26
%N 3
%P 206-16
%@ 1536-5409
%X OBJECTIVE: To evaluate the effectiveness of a specifically modified group-based, multidisciplinary cognitive-behavioral pain management program (PMP) in comparison to usual care in a clinical sample of people with spinal cord injury (SCI)-related chronic pain. METHOD: Changes over time on a range of measures, including usual pain intensity, pain catastrophizing and self-efficacy, mood, SCI acceptance and self-efficacy, and interference due to pain were examined in 2 groups with SCI-related chronic pain after a multidisciplinary pain assessment. One group (n=19) attended the PMP, and the other (n=17) received standard care on an individualized basis in a pain management center. RESULTS: The groups were significantly different at baseline, with the PMP group scoring more negatively on a number of the measures, including usual pain intensity. The PMP group showed an overall improvement in mood and life interference due to pain at the end of the PMP when compared with the usual care group. Within the PMP group, there was a significant improvement over time in anxiety and pain catastrophizing. No changes in SCI-related psychologic variables (acceptance and self-efficacy) were observed in either group. DISCUSSION: This study demonstrates that a PMP may offer benefits to clinical populations with SCI-related chronic pain in a pain management center. The reported improvements were of a magnitude to be clinically significant. However, some of the initial benefits reported were not maintained at the nine month follow-up. The interventions may need to be augmented to address the effects of SCI-related psychologic variables that may impact upon the individual's ability to benefit from a PMP.
%Z FOR Codes: 1701



%0 Journal Article
%~ Pubmed
%A Wood, Bradley M
%A Nicholas, Michael K
%A Blyth, Fiona
%A Asghari, Ali
%A Gibson, Stephen
%T Assessing pain in older people with persistent pain: the NRS is valid but only provides part of the picture.
%B The journal of pain : official journal of the American Pain Society
%D 2010
%V 11
%N 12
%P 1259-66
%@ 1528-8447
%X This study examined the assessment of pain intensity and pain distress with the Numerical Rating Scale (NRS) in elderly patients (age > 60 years) with persistent pain. A consecutive sample of 800 elderly patients were categorized by age into 3 groups: 61 to 70 years (n = 366), 71 to 80 years (n = 308), and 81 years and over (n = 126). Participants completed 3 Numerical Rating Scales assessing current pain intensity, and both the usual level of pain and average pain distress in the preceding week. The failure rate for scale completion was low for all scales for all age groups, but was significantly higher in the oldest group compared to the youngest group for the scales assessing current pain intensity and average pain distress in the preceding week. The NRS was shown to be a reliable and valid measure of pain intensity and pain distress in all these age groups. Distress related to pain appeared to be specific to the pain experience and was only weakly related to more generalized affective distress. These findings confirm that measures of pain intensity and pain distress, like the NRS, capture only part of the pain experience in older patients and should be supplemented by other measures in the assessment process. PERSPECTIVE: This article confirms the utility of the Numerical Rating Scale (NRS) as a measure of pain intensity and pain distress in elderly patients with persistent pain. The use of a large sample increases confidence in the psychometric soundness of the NRS with this population.
%Z FOR Codes: 110399 119999 111706



%0 Journal Article
%~ Pubmed
%A McGowan, Naomi
%A Sharpe, L
%A Refshauge, K
%A Nicholas, M K
%T The effect of attentional re-training and threat expectancy in response to acute pain.
%B Pain
%D 2009
%V 142
%N 1-2
%P 101-7
%@ 1872-6623
%X This study aimed to investigate the efficacy of implicit attention re-training (AR) on pain ratings, threshold and tolerance during the cold-pressor task and to determine whether the effectiveness of AR was affected by threat expectancy. One hundred and four undergraduate psychology students were randomly assigned to receive either threat-alleviating or threat-inducing information about the task. Participants were then re-randomized to receive an AR that either trained them to implicitly attend to neutral and ignore pain-related stimuli (neutral training) or to attend towards pain-related stimuli (pain training). Hence, the present study had a 2 (threat expectancy: high vs low) x 2 (AR: pain vs neutral) design. Manipulation checks confirmed that the threat manipulation was effective in increasing threat expectancy and the training paradigm shifted attentional biases in predicted directions. Results showed that, relative to neutral re-training, those in the pain re-training group reported higher levels of pain 30s into the cold pressor task and registered pain more quickly. There was no difference in tolerance between the groups, nor pain at tolerance. This was the same pattern of results found for the threat induction. For initial pain ratings, there was an interaction that closely approached significance (p=0.053). These results show that AR affects individual's perceptions of and their responses to pain during an experimental task in a similar way to increasing the threat expectancy of the task. Future research should trial AR in real-life settings to determine whether these results can be generalized.
%Z FOR Codes: 170106



%0 Journal Article
%~ Pubmed
%A Law, Roberta Y W
%A Harvey, Lisa A
%A Nicholas, Michael K
%A Tonkin, Lois
%A De Sousa, Maria
%A Finniss, Damien G
%T Stretch exercises increase tolerance to stretch in patients with chronic musculoskeletal pain: a randomized controlled trial.
%B Physical therapy
%D 2009
%V 89
%N 10
%P 1016-26
%@ 1538-6724
%X BACKGROUND: Stretch is commonly prescribed as part of physical rehabilitation in pain management programs, yet little is known about its effectiveness. OBJECTIVE: A randomized controlled trial was conducted to investigate the effects of a 3-week stretch program on muscle extensibility and stretch tolerance in patients with chronic musculoskeletal pain. DESIGN: A within-subject design was used, with one leg of each participant randomly allocated to an experimental (stretch) condition and the other leg randomly allocated to a control (no-stretch) condition. PATIENTS AND SETTING: Thirty adults with pain of musculoskeletal origin persisting for at least 3 months were recruited from patients enrolled in a multidisciplinary pain management program at a hospital in Sydney, Australia. INTERVENTION: The hamstring muscles of the experimental leg were stretched daily for 1 minute over 3 weeks; the control leg was not stretched. This intervention was embedded within a pain management program and supervised by physical therapists. MEASUREMENTS: Primary outcomes were muscle extensibility and stretch tolerance, which were reflected by passive hip flexion angles measured with standardized and nonstandardized torques, respectively. Initial measurements were taken before the first stretch on day 1, and final measurements were taken 1 to 2 days after the last stretch. A blinded assessor was used for testing. RESULTS: Stretch did not increase muscle extensibility (mean between-group difference in hip flexion was 1 degrees , 95% confidence interval=-2 degrees to 4 degrees ), but it did improve stretch tolerance (mean between-group difference in hip flexion was 8 degrees , 95% confidence interval=5 degrees to 10 degrees ). CONCLUSION: Three weeks of stretch increases tolerance to the discomfort associated with stretch but does not change muscle extensibility in patients with chronic musculoskeletal pain.
%Z FOR Codes: 110602 110317 111603



%0 Journal Article
%~ Pubmed
%A Nicholas, Michael K
%T First things first: reductions in catastrophising before fear of movement.
%B Pain
%D 2009
%V 145
%N 1-2
%P 6-7
%@ 1872-6623
%X 
%Z FOR Codes: 170199 170199



%0 Journal Article
%~ Isi
%A Asghari, A.
%A Nicholas, M. K.
%T An Investigation of Pain Self-Efficacy Beliefs in Iranian Chronic Pain Patients: A Preliminary Validation of a Translated English-Language Scale
%B Pain Medicine
%D 2009
%C United States
%I Wiley-Blackwell Publishing, Inc.
%V 10
%N 4
%P 619-632
%@ 1526-2375
%X 
%Z FOR Codes: 170106



%0 Journal Article
%~ Isi
%A Flink, I. K.
%A Nicholas, M. K.
%A Boersma, K.
%A Linton, S. J.
%T Reducing the threat value of chronic pain: A preliminary replicated single-case study of interoceptive exposure versus distraction in six individuals with chronic back pain
%B Behaviour Research and Therapy
%D 2009
%C United Kingdom
%I Elsevier Ltd
%V 47
%N 8
%P 721-728
%@ 0005-7967
%X 
%Z FOR Codes: 1701



%0 Journal Article
%~ Pubmed
%A Nicholas, Michael K
%A Coulston, Carissa M
%A Asghari, Ali
%A Malhi, Gin Singh
%T Depressive symptoms in patients with chronic pain.
%B Medical Journal of Australia
%D 2009
%V 190
%N 7 Suppl
%P S66-70
%@ 0025-729X
%X OBJECTIVE: To determine the nature of depressive symptoms in a sample of patients with chronic pain, and to examine the relationship between depressive symptoms and physical disability due to pain. DESIGN, PARTICIPANTS AND SETTING: Cross-sectional study of 812 patients with complete datasets from a total of 2419 patients with pain who were referred to the Pain Management Research Institute at Royal North Shore Hospital, Sydney, between January 2000 and December 2007. MAIN OUTCOME MEASURES: Pain severity and distress, physical disability, depressive symptoms, pain self-efficacy, catastrophising, fear of movement/(re)injury, use of unhelpful self-management strategies, sense of control over life, and perceived support from significant others, assessed by the West Haven-Yale Multidimensional Pain Inventory, modified version of the Roland Morris Disability Questionnaire, the depression subscale of the Depression Anxiety Stress Scales, Pain Self-Efficacy Questionnaire, Pain-Related Self-Statements Scale, Tampa Scale of Kinesiophobia, and Pain Self-Management Checklist. RESULTS: After controlling for the effects of age, sex and duration of pain, depressive symptoms were most strongly correlated with a combination of catastrophising, sense of control over life, physical disability, pain self-efficacy beliefs, higher use of unhelpful self-management strategies and lower perceived social support. Depressive symptoms also correlated with physical disability, but to a lesser extent than other variables, including fear of re-injury, low self-efficacy for activity and pain severity. The depressive symptoms that were rated as most frequently experienced reflected sadness, lack of initiative and lack of ability to experience pleasure. CONCLUSIONS: In patients with chronic pain, depressive symptoms are correlated more strongly with cognitive variables than pain severity and pain distress, while physical disability is correlated more strongly with cognitive, behavioural and pain variables than depressive symptoms. Furthermore, depressive symptoms are characterised predominantly by mood-related symptoms, which suggests differences in the experience of depression in patients with chronic pain compared with those presenting with mental disorders.
%Z FOR Codes: 110319



%0 Journal Article
%~ Pubmed
%A Nicholson Perry, Kathryn
%A Nicholas, Michael K
%A Middleton, James
%A Siddall, Philip
%T Psychological characteristics of people with spinal cord injury-related persisting pain referred to a tertiary pain management center.
%B Journal of rehabilitation research and development
%D 2009
%V 46
%N 1
%P 57-67
%@ 1938-1352
%X This study examines the psychological characteristics of a cohort of individuals with spinal cord injury (SCI) and persisting pain referred to a tertiary pain management center. Forty-five individuals completed measures of pain, mood, disability, and both pain- and SCI-related psychological variables such as self-efficacy and catastrophizing. Compared with a general pain clinic population attending the same tertiary pain management center (n = 5,941), the sample was found to have lower pain intensity, comparable pain catastrophizing levels, and less activity interference due to pain. In contrast, those with SCI pain reported poorer mood. Pain catastrophizing was associated with anxiety, depression, and activity interference due to pain; pain self-efficacy was close to being significantly associated with these variables also. SCI acceptance and self-efficacy were also associated with some of these variables. These findings suggest that the biopsychosocial model of pain is applicable in this sample and that further treatment benefits could be obtained through use of interventions targeting psychological and social variables within this model.
%Z FOR Codes: 110399 170106



%0 Journal Article
%~ Pubmed
%A Nicholson Perry, Kathryn
%A Nicholas, Michael K
%A Middleton, James
%T Spinal cord injury-related pain in rehabilitation: a cross-sectional study of relationships with cognitions, mood and physical function.
%B European journal of pain (London, England)
%D 2009
%V 13
%N 5
%P 511-7
%@ 1532-2149
%X Although psychological aspects of SCI-related pain have been investigated in those with chronic pain, little data is available regarding these factors in those early in the course of the injury. Using a sample admitted for SCI rehabilitation, this paper describes the relationships between usual pain intensity, mood, disability and both pain and SCI-related psychological factors. The sample were largely similar to other samples of individuals with SCI-related chronic pain in terms of mood, but were noted to be less catastrophic in their thinking about pain than a comparative pain clinic sample. They also reported SCI self-efficacy and acceptance scores consistent with other SCI samples. Compared with other SCI populations there were mixed findings in relation to physical disability. Consistent with previous findings in chronic pain SCI samples, usual pain intensity was found to have a strong relationship with symptoms of anxiety and depression, and pain-related life interference. SCI acceptance was significantly negatively associated with depression scores, pain catastrophizing was significantly positively associated with both anxiety and depression scores, and SCI self-efficacy was significantly negatively associated with both anxiety and depression scores. SCI self-efficacy was also significantly positively associated with physical function scores. These findings suggest that pain-related psychological factors may have importance even early in the clinical course following SCI, but that it is important, however, to consider more general SCI-related psychological factors alongside them. In addition, these findings suggest the possibility that early interventions based upon the cognitive behavioural treatment of pain may be integrated into SCI rehabilitation programmes.
%Z FOR Codes: 119999



%0 Journal Article
%~ Pubmed
%A Sard?, Jamir
%A Nicholas, Michael K
%A Asghari, Ali
%A Pimenta, Cibele A M
%T The contribution of self-efficacy and depression to disability and work status in chronic pain patients: a comparison between Australian and Brazilian samples.
%B European journal of pain (London, England)
%D 2009
%V 13
%N 2
%P 189-95
%@ 1532-2149
%X There is evidence that cognitions (beliefs) and mood contribute to physical disability and work status in people with chronic pain. However, most of the current evidence comes from North America and Europe. This study examined the contribution of demographic, pain and psychosocial factors to disability and work status in chronic pain patients in two matched samples from quite different countries (Australia and Brazil). Data were collected from 311 chronic pain patients in each country. The results suggest that although demographic and pain variables (especially pain levels) contribute to disability, self-efficacy beliefs made a significant contribution to disability in both samples. Age and educational level also contributed to unemployment in both samples. But there were some differences, with self-efficacy and physical disability contributing to work status only in the Brazilian sample. In contrast, depression was the only psychological risk factor for unemployment in the Australian sample. Catastrophising and pain acceptance did not contribute to disability or unemployment in either sample. These findings confirm key aspects of biopsychosocial models of pain in two culturally and linguistically different chronic pain samples from different countries. They suggest that different chronic pain populations may share more similarities than differences.
%Z FOR Codes: 119999



%0 Journal Article
%A Finniss, Damien
%A Nicholas, Michael
%A Benedetti, Fabrizio
%T Placebo analgesia - understanding the mechanisms and implications for clinical practice
%B Reviews in Pain
%D 2009
%C United Kingdom
%I British Pain Society
%V 3
%N 2
%P 15-19
%@ 2042-1249
%X 
%Z FOR Codes: 110999



%0 Journal Article
%~ Pubmed
%A Smeets, Rob J E M
%A Maher, Chris G
%A Nicholas, Michael K
%A Refshauge, Kathy M
%A Herbert, Robert D
%T Do psychological characteristics predict response to exercise and advice for subacute low back pain?
%B Arthritis & Rheumatism
%D 2009
%V 61
%N 9
%P 1202-9
%@ 0004-3591
%X OBJECTIVE: To determine whether psychological characteristics predict outcome and/or response to physiotherapist-directed exercise- or advice-based treatment of subacute low back pain. METHODS: We conducted a secondary analysis of a factorial, placebo-controlled trial (n = 259). The psychological characteristics were catastrophizing, coping, pain self-efficacy, fear of injury/movement, depression, anxiety, and stress. We used mixed models to predict pain and function outcomes (both scored on a 0-10 scale). The models include a term for treatment group, a term for the psychological characteristic (which tested prediction of outcome), and an interaction term between the treatment group and psychological characteristic (which tested treatment effect modification). To aid the interpretation of the magnitude of the effect modification, we calculated the change in outcome for a 1 SD increase of the baseline score of the putative effect modifier. A >/=1.5-point change of the outcome of interest per 1 SD change of putative effect modifier was regarded as clinically important. RESULTS: All of the psychological characteristics except coping predicted outcome, but none appeared to be important treatment effect modifiers. Only 5 of the 56 tests of treatment modification were statistically significant, and none of the 95% confidence intervals (95% CIs) for the interactions included clinically important effects. For example, a 1 SD higher baseline level of anxiety was associated with a 0.62 (95% CI 0.10, 1.15) additional effect of exercise on function at 52 weeks. CONCLUSION: Most of the psychological characteristics we tested predicted outcome, but none predicted response to physiotherapist-guided exercise and/or advice.
%Z FOR Codes: 110399



%0 Journal Article
%~ Pubmed
%A Macedo, Luciana G
%A Latimer, Jane
%A Maher, Chris G
%A Hodges, Paul W
%A Nicholas, Michael
%A Tonkin, Lois
%A McAuley, James H
%A Stafford, Ryan
%T Motor control or graded activity exercises for chronic low back pain? A randomised controlled trial.
%B BMC musculoskeletal disorders [electronic resource]
%D 2008
%V 9
%N 
%P 65
%@ 1471-2474
%X BACKGROUND: Chronic low back pain remains a major health problem in Australia and around the world. Unfortunately the majority of treatments for this condition produce small effects because not all patients respond to each treatment. It appears that only 25-50% of patients respond to exercise. The two most popular types of exercise for low back pain are graded activity and motor control exercises. At present however, there are no guidelines to help clinicians select the best treatment for a patient. As a result, time and money are wasted on treatments which ultimately fail to help the patient. METHODS: This paper describes the protocol of a randomised clinical trial comparing the effects of motor control exercises with a graded activity program in the treatment of chronic non specific low back pain. Further analysis will identify clinical features that may predict a patient's response to each treatment. One hundred and seventy two participants will be randomly allocated to receive either a program of motor control exercises or graded activity. Measures of outcome will be obtained at 2, 6 and 12 months after randomisation. The primary outcomes are: pain (average pain intensity over the last week) and function (patient-specific functional scale) at 2 and 6 months. Potential treatment effect modifiers will be measured at baseline. DISCUSSION: This trial will not only evaluate which exercise approach is more effective in general for patients will chronic low back pain, but will also determine which exercise approach is best for an individual patient. TRIAL REGISTRATION NUMBER: ACTRN12607000432415.
%Z FOR Codes: 110317



%0 Journal Article
%~ Pubmed
%A Nicholas, Michael K
%T On adherence to self-management strategies.
%B European journal of pain (London, England)
%D 2008
%V 13
%N 2
%P 113-4
%@ 1532-2149
%X 
%Z FOR Codes: 1199



%0 Journal Article
%~ Isi
%A Sarda, J.
%A Nicholas, M. K.
%A Pimenta, C. A. M.
%A Asghari, A.
%T Psychometric properties of the DASS-Depression scale among a Brazilian population with chronic pain
%B Journal of Psychosomatic Research
%D 2008
%C United States
%I Elsevier Inc.
%V 64
%N 1
%P 25-31
%@ 0022-3999
%X 
%Z FOR Codes: 110319



%0 Journal Article
%~ Pubmed
%A Stewart, Mark J
%A Maher, Chris G
%A Refshauge, Kathryn M
%A Herbert, Rob D
%A Nicholas, Michael K
%T Patient and clinician treatment preferences do not moderate the effect of exercise treatment in chronic whiplash-associated disorders.
%B European journal of pain (London, England)
%D 2008
%V 12
%N 7
%P 879-85
%@ 1532-2149
%X An issue that arises when selecting therapy is whether patient or clinician preferences for treatment moderate the effect of treatment. To evaluate this question we conducted a secondary analysis of the results of a randomized controlled trial of exercise treatment of chronic whiplash. Immediately prior to randomization, treatment preference ratings were collected from each patient and from the physiotherapist who assessed each patient. Patients were then randomized to receive advice alone or exercise and advice with the primary treatment outcomes of pain and function measured immediately after conclusion of treatment. Treatment effect modification was evaluated with a treatment group by preference interaction term in the regression analyses. The analysis revealed that neither patient nor therapist treatment preferences moderated the effect of exercise treatment for chronic whiplash. The interaction effect of treatment group by patient preference was 0.1 (-0.3 to 0.5, p=0.68) on the 0-10 pain intensity scale and -0.1 (-0.5 to 0.3, p=0.64) on the 0-10 function scale. The interaction effect of treatment group by therapist preference was 0.0 (-0.3 to 0.4, p=0.786) on the 0-10 pain intensity scale and -0.2 (-0.4 to 0.1, p=0.296) on the 0-10 function scale. Our findings do not provide evidence that patient or therapist treatment preferences moderate the effect of exercise treatment for chronic whiplash.
%Z FOR Codes: 119999



%0 Journal Article
%~ Pubmed
%A Blyth, Fiona M
%A Macfarlane, Gary J
%A Nicholas, Michael K
%T Response to Ms. Nielsen's Letter to the Editor of Pain.
%B Pain
%D 2007
%V 
%N 
%P 
%@ 1872-6623
%X 
%Z FOR Codes: 111706



%0 Journal Article
%~ Pubmed
%A Stewart, Mark
%A Maher, Christopher G
%A Refshauge, Kathryn M
%A Bogduk, Nikolai
%A Nicholas, Michael
%T Responsiveness of pain and disability measures for chronic whiplash.
%B Spine
%D 2007
%V 32
%N 5
%P 580-5
%@ 1528-1159
%X STUDY DESIGN: Cohort study. OBJECTIVE: To evaluate the responsiveness of common pain and disability measures in a cohort of patients with chronic whiplash. SUMMARY OF BACKGROUND DATA: Pain and disability are routinely measured in clinical practice and clinical research. However, to date, a head-to-head comparison of competing measures for whiplash patients has not been performed. METHODS: Pain (pain intensity, bothersomeness, and SF-36 bodily pain score) and disability (Patient Specific Functional Scale, Neck Disability Index, Functional Rating Index, Copenhagen Scale, and SF-36 physical summary) measures were completed by 132 patients with chronic whiplash at baseline and then again after 6 weeks together with an 11-point global perceived effect scale. Internal responsiveness was evaluated by calculating effect sizes and standardized response means, and external responsiveness by correlating change scores with global perceived effect scores and by ROC curves. RESULTS: The ranking of responsiveness was consistent across the different analyses. Pain bothersomeness was more responsive than pain intensity, which was more responsive than the SF-36 pain measure. The Patient Specific Functional Scale was the most responsive disability measure, followed by the spine-specific measures, with the SF-36 physical summary measure the least responsive. CONCLUSION: Pain bothersomeness and the Patient Specific Functional Scale provide the most responsive measures of pain and disability, respectively, in patients with chronic whiplash.
%Z FOR Codes: 110317



%0 Journal Article
%~ Isi
%A Herbert, RD
%A Refshauge, KM
%A McNair, P
%A Maher, CG
%A Pengel, LHM
%A Nicholas, MK
%T Physiotherapist-directed exercise, advice, or both for subacute low back pain - A randomized trial
%B ANNALS OF INTERNAL MEDICINE
%D 2007
%C United States
%I American College of Physicians
%V 146
%N 11
%P 787-796
%@ 0003-4819
%X 



%0 Journal Article
%~ Pubmed
%A Nicholas, Michael K
%A Asghari, Ali
%A Blyth, Fiona M
%T What do the numbers mean? Normative data in chronic pain measures.
%B Pain
%D 2007
%V 134
%N 1-2
%P 158-73
%@ 1872-6623
%X Although self-reported measures play a central role in the assessment of pain and its treatment, it has long been recognized that interpretation of these measures is severely limited by the absence of normative data. Despite that, relatively few of the measures used in pain clinics or research studies have normative data for reference. Using a pain centre sample (n=6124), this paper describes the development of a normative dataset on a number of commonly used pain-related measures. The measures cover many of the key dimensions in pain assessment, including pain severity/quality, disability (physical functioning), and mood (emotional functioning). Measures of different cognitive and coping constructs are also included. Mean scores are reported for each measure according to age group, gender, pain site, as well as percentiles for different scores for patients with chronic low back pain. The potential uses for datasets of this type include the assessment and evaluation of individual cases, as well as the interpretation of published clinical trials. It is also argued that future systematic reviews of pain treatments should include consideration of such patient characteristics as pain levels, disability and mood in the studies reviewed rather than pain site and chronicity alone.
%Z FOR Codes: 110299



%0 Journal Article
%~ Pubmed
%A Blyth, Fiona M
%A Macfarlane, Gary J
%A Nicholas, Michael K
%T The contribution of psychosocial factors to the development of chronic pain: the key to better outcomes for patients?
%B Pain
%D 2007
%V 129
%N 1-2
%P 8-11
%@ 1872-6623
%X 
%Z FOR Codes: 111706



%0 Journal Article
%~ Pubmed
%A Finniss, Damien G
%A Murphy, Paul M
%A Brooker, Charles
%A Nicholas, Michael K
%A Cousins, Michael J
%T Complex regional pain syndrome in children and adolescents.
%B European journal of pain (London, England)
%D 2006
%V 10
%N 8
%P 767-70
%@ 1090-3801
%X Complex regional pain syndrome (CRPS) is a disorder characterised by pain, sensory and motor disturbances and represents a significant medical entity. This report discusses two cases of CRPS in children and adolescents, highlighting several critical issues for clinicians in the diagnosis and management of CRPS in these populations. Early diagnosis, referral and appropriate intervention are essential in decreasing pain, suffering and resorting function for children and adolescents with CRPS.
%Z FOR Codes: 110301



%0 Journal Article
%~ Pubmed
%A Nicholas, Michael K
%T The pain self-efficacy questionnaire: Taking pain into account.
%B European journal of pain (London, England)
%D 2006
%V 11
%N 2
%P 153-63
%@ 1090-3801
%X Self-efficacy beliefs in people with chronic pain have been assessed either by reference to confidence in ability to perform specific tasks or to confidence in performing more generalised constructs like coping with pain. Both approaches reflect aspects of the original conceptualisations of self-efficacy and both have proved useful, but it is noteworthy that confidence in performing activities in the context of pain is rarely addressed. An important element in the original formulations of self-efficacy referred to persistence in the face of obstacles and aversive experiences. In this context, self-efficacy beliefs for people experiencing chronic pain might be expected to incorporate not just the expectation that a person could perform a particular behaviour or task, but also their confidence in being able to do it despite their pain. This aspect of the self-efficacy construct has been included in a measure for people with chronic pain, the Pain Self-Efficacy Questionnaire (PSEQ). The accumulated evidence from a number of published studies and a confirmatory analysis with a large cohort of heterogeneous chronic pain patients attending a pain management program provide support for the PSEQ's original psychometric properties developed with a sample of chronic low back pain patients. The importance of taking the context of pain into account in the assessment of self-efficacy beliefs in pain populations and the ways in which this measure can be used to improve the assessment of people experiencing chronic pain, before and after treatment, are examined.



%0 Journal Article
%~ Pubmed
%A van Leeuwen, Marina T
%A Blyth, Fiona M
%A March, Lyn M
%A Nicholas, Michael K
%A Cousins, Michael J
%T Chronic pain and reduced work effectiveness: the hidden cost to Australian employers.
%B European journal of pain (London, England)
%D 2006
%V 10
%N 2
%P 161-6
%@ 1090-3801
%X Cost estimates of the impact of chronic pain on work have largely focussed on absenteeism, excluding the hidden contribution of reduced work effectiveness to lost productivity. This paper aims to estimate the cost of lost productivity due to chronic pain in Australia, not only in terms of absenteeism but also reduced work effectiveness. Data on chronic pain in Australia and its impact on work were obtained from the 1997 New South Wales Health Survey (n=17,543) and the Northern Sydney Area Pain Study (n=2,092), both of which were population-based and used random-digit dialing sampling methods. This was combined with relevant Australian population and labour force data obtained from the Australian Bureau of Statistics. From this we estimated annual lost productivity costs arising from both chronic pain-related days absent and 'reduced-effectiveness workdays'. There were estimated to be 9.9 million workdays absent due to chronic pain annually in Australia, equating to a cost of AUD 1.4 billion per annum. Under the assumption that reduced-effectiveness workdays affect productivity costs in the same way as lost work days, the total number of lost workday equivalents was 36.5 million, with the total annual cost of lost productivity due to chronic pain estimated as AUD 5.1 billion per annum. In conclusion, while the impact of reduced work effectiveness on days worked with pain on productivity is uncertain, it has the potential to account for the majority of lost productivity costs associated with chronic pain. Interventions which target working despite pain have the potential to significantly reduce lost productivity costs due to chronic pain.



%0 Journal Article
%~ Pubmed
%A Nicholas, Michael K
%A Molloy, Allan R
%A Brooker, Charles
%T Using opioids with persisting noncancer pain: a biopsychosocial perspective.
%B The Clinical journal of pain
%D 2006
%V 22
%N 2
%P 137-46
%@ 0749-8047
%X OBJECTIVE: Despite the growing use of opioids for persisting noncancer pain, evidence for their effectiveness is limited, especially in relation to functional outcomes. Guidelines have been developed for prescribers, but their utility is untested. This review examines the use of opioids in this population from a biopsychosocial perspective and makes a number of recommendations. DATA SOURCES: Published comparison studies and reviews of oral opioids in chronic noncancer pain, as well as 5 published guidelines for the prescription of opioids and systematic reviews of cognitive-behavioral pain management programs. METHODS: Outcomes of the opioid comparison studies were reviewed and compared to those achieved by pain management programs. CONCLUSIONS: The available evidence indicates that by themselves, oral opioids generally achieve only modest reductions in pain levels in patients with chronic noncancer pain. Functional outcomes are inconsistent across studies. There are questions about the timing of their use and patient selection. There are risks in trials of opioids only after other conservative interventions have been tried unsuccessfully. Also, in some patients, ongoing use of opioids risks repeated over-doing of pain-generating activities and reinforcing escape/avoidance responses that promote disability. These risks may be lessened by assessment of current use of pain self-management strategies among potential candidates for opioids. This offers advantages in promoting collaborative management of persisting pain as well as better pain and functional outcomes. In this view, opioids may be considered as one possible element of a management plan rather than the primary treatment.



%0 Journal Article
%~ Pubmed
%A Stewart, Mark J
%A Maher, Chris G
%A Refshauge, Kathryn M
%A Herbert, Rob D
%A Bogduk, Nikolai
%A Nicholas, Michael
%T Randomized controlled trial of exercise for chronic whiplash-associated disorders.
%B Pain
%D 2006
%V 128
%N 1-2
%P 59-68
%@ 1872-6623
%X Whiplash-associated disorders are common and incur considerable expense in social and economic terms. There are no known effective treatments for those people whose pain and disability persist beyond 3 months. We conducted a randomized, assessor-blinded, controlled trial at two centres in Australia. All participants received 3 advice sessions. In addition the experimental group participated in 12 exercise sessions over 6 weeks. Primary outcomes were pain intensity, pain bothersomeness and function measured at 6 weeks and 12 months. Exercise and advice was more effective than advice alone at 6 weeks for all primary outcomes but not at 12 months. The effect of exercise on the 0-10 pain intensity scale was -1.1 (95%CI -1.8 to -0.3, p=0.005) at 6 weeks and -0.2 (0.6 to -1.0, p=0.59) at 12 months; on the bothersomeness scale the effect was -1.0 (-1.9 to -0.2, p=0.003) at 6 weeks and 0.3 (-0.6 to 1.3, p=0.48) at 12 months. The effect on function was 0.9 (0.3 to 1.6, p=0.006) at 6 weeks and 0.6 (-0.1 to 1.4, p=0.10) at 12 months. High levels of baseline pain intensity were associated with greater treatment effects at 6 weeks and high levels of baseline disability were associated with greater treatment effects at 12 months. In the short-term exercise and advice is slightly more effective than advice alone for people with persisting pain and disability following whiplash. Exercise is more effective for subjects with higher baseline pain and disability.



%0 Journal Article
%~ Pubmed
%A Nicholas, Michael K
%A Asghari, Ali
%T Investigating acceptance in adjustment to chronic pain: is acceptance broader than we thought?
%B Pain
%D 2006
%V 124
%N 3
%P 269-79
%@ 1872-6623
%X Research on the role of acceptance in adjustment to persisting pain has been facilitated by the development of the Chronic Pain Acceptance Questionnaire (CPAQ). However, to date the CPAQ has been used to explore acceptance of pain without taking into account the likely contribution of other cognitive variables that have been shown to influence adjustment to persisting pain. This study examined the role of pain acceptance, as measured by the CPAQ, in accounting for adjustment to pain when controlling for the effects of other cognitive variables. The results indicated that while the Activity engagement subscale of the CPAQ was predictive of depression severity, neither of the CPAQ's two subscales was predictive of pain severity or physical disability. These findings differ from some reported previously and they suggest that the CPAQ, by itself, may not be sufficient to explain the processes of acceptance of pain and, hence, adjustment to pain. The findings also indicate that the Pain willingness subscale of the CPAQ is not robust and should be discarded. A broader approach to investigating acceptance of pain is proposed.



%0 Journal Article
%~ Isi
%A Asghari, A.
%A Nicholas, M. K.
%T Personality and pain-related beliefs/coping strategies: A prospective study.
%B Clinical Journal of Pain
%D 2006
%C United States
%I Lippincott Williams & Wilkins
%V 22
%N 1
%P 10-18
%@ 0749-8047
%X 



%0 Journal Article
%~ Pubmed
%A Molloy, Allan R
%A Nicholas, Michael K
%A Asghari, Ali
%A Beeston, Lee R
%A Dehghani, Mohsen
%A Cousins, Michael J
%A Brooker, Charles
%A Tonkin, Lois
%T Does a Combination of Intensive Cognitive-Behavioral Pain Management and a Spinal Implantable Device Confer any Advantage? A Preliminary Examination.
%B 
%D 2006
%V 6
%N 2
%P 96-103
%@ 1533-2500
%X Research suggests that a combination of a somatic and a psychosocial intervention for chronic noncancer pain should be associated with a better outcome than either alone. This study presents data on a series of 31 patients who underwent sequential treatment with an implantable device targeting pain relief and a cognitive-behavioral pain management program that targeted improved function. A combination of treatments was used as there was a suboptimal response to the initial treatment. There were improvements in a range of outcomes at a long-term follow-up. Significant improvements were found in disability, affective distress, self-efficacy, and catastrophizing, but not in average pain severity. Further analyses failed to demonstrate an order effect. These results support the view that combined somatic and psychosocial interventions can achieve better outcomes than either alone in selected chronic pain patients. This approach requires that psychological assessment is essential before the use of an implantable device. This may not only improve patient selection, but also identify psychosocial factors that may be modified to enhance the effectiveness of invasive interventions. In addition, consideration for an implantable device following a suboptimal response to treatment in a cognitive-behavioral pain management program should include a re-evaluation of the patients' beliefs and use of self-management (coping) strategies before deciding on further treatment options.



%0 Journal Article
%~ Pubmed
%A Nicholas, Michael
%A Asghari, Ali
%T Response to letter by McCracken et al. (2006).
%B Pain
%D 2006
%V 
%N 
%P 
%@ 1872-6623
%X 



%0 Journal Article
%~ Pubmed
%A Blyth, Fiona M
%A March, Lyn M
%A Nicholas, Michael K
%A Cousins, Michael J
%T Self-management of chronic pain: a population-based study.
%B Pain
%D 2005
%V 113
%N 3
%P 285-92
%@ 0304-3959
%X While effective self-management of chronic pain is important, clinic-based studies exclude the more typical pattern of self-management that occurs in the community, often without reference to health professionals. We examined specific hypotheses about the use of self-management strategies in a population-based study of chronic pain subjects. Data came from an Australian population-based random digit dialling computer-assisted telephone survey and included 474 adults aged 18 or over with chronic pain (response rate 73.4%). Passive strategies were more often reported than active ones: passive strategies such as taking medication (47%), resting (31.5%), and using hot/cold packs (23.4%) were most commonly reported, while the most commonly reported active strategy was exercising (25.8%). Only 33.5% of those who used active behavioural and/or cognitive strategies used them exclusively, while 67.7% of those who used passive behavioural and/or conventional medical strategies did so exclusively. Self-management strategies were associated with both pain-related disability and use of health services in multiple logistic regression models. Using passive strategies increased the likelihood of having high levels of pain-related disability (adjusted OR 2.59) and more pain-related health care visits (adjusted OR 2.9); using active strategies substantially reduced the likelihood of having high levels of pain-related disability (adjusted OR 0.2). In conclusion, we have shown in a population-based study that clinical findings regarding self-management strategies apply to the broader population and advocate that more attention be given to community-based strategies for improving awareness and uptake of active self-management strategies for chronic pain.



%0 Journal Article
%~ Pubmed
%A Franche, Ren?e-Louise
%A Baril, Raymond
%A Shaw, William
%A Nicholas, Michael
%A Loisel, Patrick
%T Workplace-based return-to-work interventions: optimizing the role of stakeholders in implementation and research.
%B Journal of occupational rehabilitation
%D 2005
%V 15
%N 4
%P 525-42
%@ 1053-0487
%X INTRODUCTION: The challenges of engaging and involving stakeholders in return-to-work (RTW) intervention and research have not been well documented. METHODS: This article contrasts the diverse paradigms of workers, employers, insurers, labor representatives, and healthcare providers when implementing and studying workplace-based RTW interventions. RESULTS: Analysis of RTW stakeholder interests suggests that friction is inevitable; however, it is possible to encourage stakeholders to tolerate paradigm dissonance while engaging in collaborative problem solving to meet common goals. We review how specific aspects of RTW interventions can be instrumental in resolving conflicts arising from differing paradigms: calibration of stakeholders' involvement, the role of supervisors and of insurance case managers, and procedural aspects of RTW interventions. The role of the researcher in engaging stakeholders, and ethical aspects associated with that process are discussed. CONCLUSIONS: Recommendations for future research include developing methods for engaging stakeholders, determining the optimal level and timing of stakeholder involvement, expanding RTW research to more diverse work settings, and developing RTW interventions reflecting all stakeholders' interests.



%0 Journal Article
%~ Isi
%A Taylor, R.
%A Lovibond, P. F.
%A Nicholas, M. K.
%A Cayley, C.
%A Wilson, P. H.
%T The utility of somatic items in the assessment of depression in patients with chronic pain - A comparison of the Zung Self-Rating Depression Scale and the Depression Anxiety Stress Scales in chronic pain and clinical and community samples.
%B Clinical Journal of Pain
%D 2005
%C USA
%I Lippincott Williams & Wilkins
%V 21
%N 1
%P 91-100
%@ 0749-8047
%X 



%0 Journal Article
%~ Pubmed
%A Moseley, G Lorimer
%A Nicholas, M K
%A Hodges, Paul W
%T Pain differs from non-painful attention-demanding or stressful tasks in its effect on postural control patterns of trunk muscles.
%B Experimental brain research. Experimentelle Hirnforschung. Experimentation cerebrale
%D 2004
%V 156
%N 1
%P 64-71
%@ 0014-4819
%X Pain changes postural activation of the trunk muscles. The cause of these changes is not known but one possibility relates to the information processing requirements and the stressful nature of pain. This study investigated this possibility by evaluating electromyographic activity (EMG) of the deep and superficial trunk muscles associated with voluntary rapid arm movement. Data were collected from control trials, trials during low back pain (LBP) elicited by injection of hypertonic saline into the back muscles, trials during a non-painful attention-demanding task, and during the same task that was also stressful. Pain did not change the reaction time (RT) of the movement, had variable effects on RT of the superficial trunk muscles, but consistently increased RT of the deepest abdominal muscle. The effect of the attention-demanding task was opposite: increased RT of the movement and the superficial trunk muscles but no effect on RT of the deep trunk muscles. Thus, activation of the deep trunk muscles occurred earlier relative to the movement. When the attention-demanding task was made stressful, the RT of the movement and superficial trunk muscles was unchanged but the RT of the deep trunk muscles was increased. Thus, the temporal relationship between deep trunk muscle activation and arm movement was restored. This means that although postural activation of the deep trunk muscles is not affected when central nervous system resources are limited, it is delayed when the individual is also under stress. However, a non-painful attention-demanding task does not replicate the effect of pain on postural control of the trunk muscles even when the task is stressful.



%0 Journal Article
%~ Pubmed
%A Asghari, Ali
%A Nicholas, Michael K
%T Pain during mammography: the role of coping strategies.
%B Pain
%D 2004
%V 108
%N 1-2
%P 170-9
%@ 0304-3959
%X This study examined the pain/discomfort ratings during mammography and their relationship to pain-coping strategies. Prior to their mammogram in order to assess how they cope with day-to-day pain experience 220 women completed an Iranian translation of the Coping Strategies Questionnaire (IR-CSQ). Immediately after mammography, all subjects completed a modified version of the IR-CSQ to assess their coping style with pain during mammography. Ratings of pain/discomfort during the mammogram were also collected, using a 100-mm Visual Analog Scale and a 6-point Pain/Discomfort Rating Scale (PRDS). Up to 92% of the women reported that the mammogram examination was painful. However, considerable variability in pain ratings was found, with some women reporting severe pain and others reporting little or no pain. While the ratings of coping effectiveness in facing day-to-day pain experience were not significantly related to mammography pain ratings, there was a significant association between the ratings of coping efficacy in facing mammography pain specifically and measures of mammography pain. Multiple hierarchical regression analyses revealed that while higher use of catastrophising and coping self-statements in facing mammography pain were predictors of more severe pain during mammography, higher use of ignoring pain sensations was predictive of less severe pain during mammography. The potential significance of these findings for identifying patients at risk of poor adjustment to chronic pain is discussed.



%0 Journal Article
%~ Pubmed
%A Moseley, G Lorimer
%A Nicholas, Michael K
%A Hodges, Paul W
%T A randomized controlled trial of intensive neurophysiology education in chronic low back pain.
%B The Clinical journal of pain
%D 2004
%V 20
%N 5
%P 324-30
%@ 0749-8047
%X Cognitive-behavioral pain management programs typically achieve improvements in pain cognitions, disability, and physical performance. However, it is not known whether the neurophysiology education component of such programs contributes to these outcomes. In chronic low back pain patients, we investigated the effect of neurophysiology education on cognitions, disability, and physical performance.



%0 Journal Article
%~ Pubmed
%A Jolliffe, Christopher D
%A Nicholas, Michael K
%T Verbally reinforcing pain reports: an experimental test of the operant model of chronic pain.
%B Pain
%D 2004
%V 107
%N 1-2
%P 167-75
%@ 0304-3959
%X Effective treatments for chronic pain have been based on the operant model for chronic pain, which holds that pain behaviours can be operantly controlled by various reinforcers. Support for the operant model comes primarily from treatment/outcome studies which report significant reductions in pain behaviours in chronic pain patients, but fail to demonstrate the underlying operant thesis that various reinforcers play a significant role in the establishment and maintenance of pain behaviours. In an experimental test of this hypothesis, the pain reports of forty-six healthy undergraduate students were measured over two sets of fifteen trials, in which the pressure from a blood-pressure cuff applied to their arm either remained stable or decreased over time. Half of the subjects received positive verbal reinforcement from the experimenter after each trial if their report of pain intensity exceeded that of the previous trial. Overall, the mean pain reports of reinforced subjects were significantly greater than those of the non-reinforced subjects both when the intensity of the cuff was stable over trials, and when it decreased, as expected. These results provide support for the operant model of chronic pain. The clinical and theoretical implications of these results for the operant model of chronic pain are discussed, and suggestions for future research are made.



%0 Journal Article
%~ Pubmed
%A Nicholas, Michael K
%T When to refer to a pain clinic.
%B Best practice & research. Clinical rheumatology
%D 2004
%V 18
%N 4
%P 613-29
%@ 1521-6942
%X This chapter addresses the questions of which patients might profitably be referred to pain clinics, as well as when this should happen for the optimum results. Since there are many different types of pain clinic, the question of to which pain clinic should a patient be referred is also examined. The development of multidisciplinary pain clinics and the types of services (assessment and treatments) they offer are reviewed as well as evidence for the effectiveness and cost-benefits of pain clinics. In order to make constructive use of pain clinics the potential misuse of pain clinics, by, for example, seeing them as 'last resorts' for hopeless cases or through inadequate preparation, is explored. Common criticisms of pain clinics, such as long-waiting lists and poor linkages to referrers and primary practitioners, and ways in which these are being addressed are also considered. A number of issues to be considered by the doctor when making a referral to a pain clinic are also identified.



%0 Journal Article
%~ Pubmed
%A Moseley, G Lorimer
%A Nicholas, Michael K
%A Hodges, Paul W
%T Does anticipation of back pain predispose to back trouble?
%B Brain; a journal of neurology
%D 2004
%V 127
%N Pt 10
%P 2339-47
%@ 1460-2156
%X Limb movement imparts a perturbation to the body. The impact of that perturbation is limited via anticipatory postural adjustments. The strategy by which the CNS controls anticipatory postural adjustments of the trunk muscles during limb movement is altered during acute back pain and in people with recurrent back pain, even when they are pain free. The altered postural strategy probably serves to protect the spine in the short term, but it is associated with a cost and is thought to predispose spinal structures to injury in the long term. It is not known why this protective strategy might occur even when people are pain free, but one possibility is that it is caused by the anticipation of back pain. In eight healthy subjects, recordings of intramuscular EMG were made from the trunk muscles during single and repetitive arm movements. Anticipation of experimental back pain and anticipation of experimental elbow pain were elicited by the threat of painful cutaneous stimulation. There was no effect of anticipated experimental elbow pain on postural adjustments. During anticipated experimental back pain, for single arm movements there was delayed activation of the deep trunk muscles and augmentation of at least one superficial trunk muscle. For repetitive arm movements, there was decreased activity and a shift from biphasic to monophasic activation of the deep trunk muscles and increased activity of superficial trunk muscles during anticipation of back pain. In both instances, the changes were consistent with adoption of an altered strategy for postural control and were similar to those observed in patients with recurrent back pain. We conclude that anticipation of experimental back pain evokes a protective postural strategy that stiffens the spine. This protective strategy is associated with compressive cost and is thought to predispose to spinal injury if maintained long term.



%0 Journal Article
%~ Pubmed
%A Dehghani, M
%A Sharpe, L
%A Nicholas, M K
%T Modification of attentional biases in chronic pain patients: a preliminary study.
%B European journal of pain (London, England)
%D 2004
%V 8
%N 6
%P 585-94
%@ 1090-3801
%X Research suggests that chronic pain patients demonstrate cognitive biases towards pain-related information and that such biases predict patient functioning. This study examined the degree to which a successful cognitive-behavioural program was able to reduce the observed attentional bias towards sensory pain words. Forty-two patients with chronic pain conditions for more than three months were recruited prior to commencing a cognitive-behavioural pain management program. Participants were assessed before the program, after the program and at one-month follow-up. Results confirmed that chronic pain patients exhibited biased attention towards sensory pain-related words at pre-treatment. These biases were still evident at post-treatment, but were no longer statistically significant at follow-up. Multiple regression analyses indicated that the changes in attentional bias towards sensory words between post-treatment and follow-up were predicted by pre- to post-treatment changes in fear of movement (Tampa Scale for Kinesiophobia) but not other relevant variables, such fear of pain or anxiety sensitivity. These results demonstrate that successful cognitive-behavioural treatments can reduce selective attention, thought to be indicative of hypervigilance towards pain. Moreover, these biases appear to be changed by reducing the fear associated with movement. Theoretically, these results provide support for the fear of (re)injury model of pain. Clinically, this study supports the contention that fear of (re)injury and movement is an appropriate target of pain management and that reducing these fears causes patients to attend less to pain-related stimuli.



%0 Journal Article
%A Nicholas, M
%A Molloy, A
%T Cognitive behavioural therapy for chronic pain patients
%B MedicineToday
%D 2003
%C Neutral Bay
%I Medicine Today PtyLtd
%V Supplement, August 2003
%N 
%P 12-17
%@ 1443-430X
%X 



%0 Journal Article
%A Stewart, M
%A Maher, CG
%A Refshauge, KM
%A Herbert, RD
%A Bogduk, N
%A Nicholas, M
%T Advice or exercise for chronic whiplash disorders? Design of a randomized controlled trial
%B Bmc Musculoskeletal Disorders
%D 2003
%C MIDDLESEX HOUSE, 34-42 CLEVELAND ST, LONDON, ENGLAND, W1T 4L
%I Biomed Central Ltd
%V Apr-18
%N 
%P 1-16
%@ 1471-2474
%X 



%0 Journal Article
%~ Pubmed
%A Dehghani, Mohsen
%A Sharpe, Louise
%A Nicholas, Michael K
%T Selective attention to pain-related information in chronic musculoskeletal pain patients.
%B Pain
%D 2003
%V 105
%N 1-2
%P 37-46
%@ 0304-3959
%X Cognitive-behavioural models of chronic pain contend that appraisals of harm affect the individual's response to pain. It has been suggested that fear of pain and/or anxiety sensitivity predispose individuals to chronicity. According to this view, pain is maintained through hypervigilance towards painful sensations and subsequent avoidance. The present study investigates the nature of cognitive biases in chronic pain patients. A sample of 169 consecutive patients referred to a specialist pain management centre participated in the study. Questionnaires measuring different aspects of pain and a computerised version of the Dot-Probe Task were administered. Four types of words related to different dimensions of pain and matched, neutral words were used as stimuli. Reaction times in response to the stimuli were recorded. A factorial design 3 x 4 x 2 x 2 and ANOVAs were employed to analyse the data. Chronic pain patients showed a cognitive bias to sensory pain words relative to affective, disability, and threat-related words. However, contrary to expectations, those high in fear of pain responded more slowly to stimuli than those less fearful of pain. These results suggest that patients with chronic pain problems selectively attend to sensory aspects of pain. However, selective attention appears to depend upon the nature of pain stimuli. For those who are highly fearful of pain they may not only selectively attend to pain-related information but have difficulty disengaging from that stimuli. Theoretical and clinical implications of the data are discussed.
%Z FOR Codes: 111799



%0 Journal Article
%~ Pubmed
%A Blyth, Fiona M
%A March, Lyn M
%A Nicholas, Michael K
%A Cousins, Michael J
%T Chronic pain, work performance and litigation.
%B Pain
%D 2003
%V 103
%N 1-2
%P 41-7
%@ 0304-3959
%X The overall population impact of chronic pain on work performance has been underestimated as it has often been described in terms of work-related absence, excluding more subtle effects that chronic pain may have on the ability to work effectively. Additionally, most studies have focussed on occupational and/or patient cohorts and treatment seeking, rather than sampling from the general population. We undertook a population-based random digit dialling computer-assisted telephone survey with participants randomly selected within households in order to measure the impact of chronic pain on work performance. In addition, we measured the association between pain-related disability and litigation. The study took place in Northern Sydney Health Area, a geographically defined urban area of New South Wales, Australia, and included 484 adults aged 18 or over with chronic pain. The response rate was 73.4%. Working with pain was more common (on an average 83.8 days in 6 months) than lost work days due to pain (4.5 days) among chronic pain participants in full-time or part-time employment. When both lost work days and reduced-effectiveness work days were summed, an average of 16.4 lost work day equivalents occurred in a 6-month period, approximately three times the average number of lost work days. In multiple logistic regression modelling with pain-related disability as the dependent variable, past or present pain-related litigation had the strongest association (odds ratio (OR)=3.59, P=0.001). In conclusion, chronic pain had a larger impact on work performance than has previously been recognised, related to reduced performance while working with pain. A significant proportion were able to work effectively with pain, suggesting that complete relief of pain may not be an essential therapeutic target. Litigation (principally work-related) for chronic pain was strongly associated with higher levels of pain-related disability, even after taking into account other factors associated with poor functional outcomes.



%0 Journal Article
%A Nicholas, M
%T Managed care policies and pain management programs
%B Anesthesia And Analgesia
%D 2003
%C 530 Walnut St, Philadelphia, Usa, Pa, 19106-362
%I Lippincott Williams & Wilkins
%V 97
%N 
%P 1-1
%@ 0003-2999
%X 



%0 Journal Article
%A Nicholas, MK
%A Molloy, AR
%T Chronic pain control integrating medical and psychosocial treatment options
%B New Ethics Journal
%D 2002
%C New Zealand
%I Adis International Ltd.
%V Dec-02
%N 
%P 33-40
%@ 11744502
%X 



%0 Book Section
%A Nicholas, MK
%A Molloy, AR
%T Reducing disability in injured workers: the importance of collaborative management
%B Pain Research and Clinical Management
%D 2002
%C Amsterdam
%I Elsevier
%V 
%N 
%P 33-46
%@ 0-444-50732-9
%X 



%0 Book Section
%A Nicholas, MK
%A Asghari, A
%T Pain self-efficacy and pain behaviour. A prospective study
%B Pain
%D 2001
%C Thousand Oaks, California USA
%I Sage Publications
%V 
%N 
%P 267-296
%@ 0-7619-1652-0
%X 



%0 Journal Article
%A Nicholas, MK
%A Wright, M
%T Management of acute and chronic pain
%B Psychology and Psychiatry: Integrating Medical Practice
%D 2001
%C 175 Fifth Ave, New York, Ny, 10010
%I Springer-Verlag
%V 17
%N 
%P 58-61
%@ 0179-0358
%X