Home Medicine Chronic pain disrupts ability to work by interfering with social function: A cross-sectional study
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Chronic pain disrupts ability to work by interfering with social function: A cross-sectional study

  • Elizabeth Hengstebeck EMAIL logo , Steven Roskos , Karen Breejen , Bengt Arnetz and Judy Arnetz
Published/Copyright: October 1, 2017
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Scandinavian Journal of Pain
From the journal Scandinavian Journal of Pain Volume 17 Issue 1

Abstract

Background and aims

Some 100 million adults in the United States suffer from chronic pain. While research to date has focused primarily on pain interference with physical and psychological function and its effects on employment, few studies have examined the impact of pain interference on social functioning and its effects on employment. The aims of our study were to (1) evaluate the association between pain interference with ability to work and actual employment status among working age adults with chronic pain; and (2) evaluate pain interference with four types of functioning - cognitive, physical, psychological, and social - as possible mediators of pain interference with the ability to work.

Methods

Data were collected via a self-selected sample of individuals visiting the American Chronic Pain Association (ACPA) website. The final dataset included 966 respondents. We examined the association between pain interference with the ability to work and employment in a population with chronic pain. We then analyzed pain interference with four types of functioning, physical, psychological, cognitive, and social, for their impact on the ability to work.

Results

Pain interference with ability to work was significantly inversely associated with employment status, i.e., the less that pain interfered with one’s ability to work, the greater the likelihood of being employed. Moreover, pain interference with ability to work was a stronger predictor of employment status than an individual’s rating of their pain intensity. Pain interference with social functioning partially mediated the effects of pain interference with cognitive and physical functioning and fully mediated the effects of pain intensity and pain interference with psychological functioning on pain interference with the ability to work. Results suggest that pain interference with social function may be a significant contributor to pain interference with ability to work in working age adults with chronic pain.?

Conclusions

In the development of effective solutions to address the economic and societal burden of chronic pain, this paper highlights the role of social function as an important, yet frequently overlooked, contributor to chronic pain’s effect on the ability to work. Our findings underscore the importance of an integrated biopsychosocial approach to managing chronic pain, especially when addressing ability to work. From a clinical standpoint, assessing and managing pain intensity is necessary but not sufficient in addressing the far-reaching negative consequences of chronic pain.

Implications

The development of interventions that improve social function may improve the ability to work in adults with chronic pain. Likewise, sick leave should be prescribed restrictivelyin the management of chronic pain since it may further interfere with social functioning.

Perspective

This study highlights the importance of the assessment of pain interference with social function as a part of a comprehensive biopsychosocial approach to the evaluation and management of patients with chronic pain. Interventions that improve social function may improve the ability to work in this population. In addition, sick leave should be prescribed restrictively in the management of chronic pain since it by itself interferes with social functioning.

Keywords: Chronic pain; Pain interference; Social function; Work; Employment

1 Introduction

Chronic pain is recognized as a critical public health challenge [1,2]. The treatment of chronic pain is complex, and is further complicated by the risks associated with opioids, which are one of the most commonly prescribed pharmacologic interventions for pain [3]. The burgeoning epidemic of opioid abuse and overdose in the United States and the push for federal legislation to appropriate new funding to address these problems [4] underscores the importance of understanding this public health challenge. Yet effective solutions to the enormous economic and societal burden that is created by chronic pain continue to be elusive. Some 100 million adults in the United States suffer from chronic pain due to common medical illnesses [1], and chronic pain has a deleterious impact on many areas of personal and professional functioning, including the ability to work [2,5,6].

The ability to work is not only influenced by physical function, but also psychological, cognitive, and social functioning, all of which are affected by pain [7]. This effect of pain on function, or “pain interference”, has gained increasing interest recently, and measuring aspects of both pain intensity and pain interference may provide a more comprehensive view of the overall “pain experience” [8]. However, research to date has focused primarily on pain interference with physical and psychological function and resulting effects on employment, while few studies have examined the impact of pain interference on social functioning and employment [2,6]. Pain interference with social function has been measured utilizing patient-reported outcomes that assess both the ability of an individual to participate in everyday relationships and activities as well as the degree of satisfaction with the level of participation [6, 2].

While chronic pain is caused by a complex interplay of biopsychosocial factors, social factors are now increasingly recognized to play a more important role than previously understood [9]. Social factors appear to impact an individual’s experience of chronic pain. For instance, in patients with low back pain, social factors were found to be important contributors to the overall level of distress experienced [10,11]. Additionally, neuroscience has provided some insights into the possible role of shared neural pathways for both physical and social pain by examining pain pathways associated with social loss [12,13]. Based on these links between pain and social factors, the impact of pain interference on employment may be significantly mediated by altered social function associated with pain. Our principal goal was to explore this connection between social function and pain interference with employment further.

We examined pain interference with four types of functioning - physical, psychological, cognitive, and social - and their impact on the ability to work in a population with chronic pain. The aims of this study were to (1) evaluate the association between pain interference with ability to work and actual employment among working age adults with chronic pain; and (2) evaluate pain interference with four types of functioning - cognitive, physical, psychological, and social - as possible mediators of pain interference with the ability to work. We hypothesized that pain intensity and duration of pain would be major determinants of employment. We also hypothesized that pain interference with all four types of functioning - physical, psychological, cognitive, and social - would correlate with the individual’s self-rated ability to work. Furthermore, we predicted that pain interference with social functioning would be the strongest predictor of pain’s interference with ability to work.

2 Methods

This study is based on secondary data analysis of a publicly available dataset [14]. Data were collected via a self-selected sample of individuals visiting the American Chronic Pain Association (ACPA) website. Between August 2007 and February 2008, participants responded to the website-based survey that included items eliciting demographic information and chronic pain history [14]. Eligibility criteria stipulated that the respondents must be 21 years of age or older with at least one chronic pain condition for a duration of at least three months prior to taking the survey. Those who met these criteria completed an online informed consent form prior to beginning the survey. The Michigan State University Office of Regulatory Affairs and Human Research Protection Programs has determined this project to be IRB exempt.

Chronic pain. Respondents were asked to report how long they had experienced chronic pain, how long they had been treated by a physician for their chronic pain, and the type of chronic pain conditions they currently had (migraine, rheumatoid arthritis, osteoarthritis, cancer pain, low back pain, neck pain, fibromyalgia, other neurological pain, and other pain). They were also asked to rate their pain level by selecting the one number that best described their pain on average (0 = no pain to 10 = the worst pain).

Pain interference. The Patient-Reported Outcomes Measurement Information System (PROMIS) pain interference scale consists of 47 questions with a one (not at all/never) to five (very much/always) response scale. The questions focus on the extent to which pain interfered with various thoughts and activities in the past 7 days [15]. Items were submitted to a principal components factor analysis with varimax rotation. After examining factor loadings, items that did not cross-load and had a factor loading of greater than .60 were retained and configured into subscales [16]. Pain Interference with Physical Functioning resulted in 3 separate subscales, sitting, standing, and day to day activities. Only the “sitting” subscale was selected to represent Pain Interference with Physical Functioning in the following analyses, as it represented the most severe impairment. This subscale consists of 3 items (i.e., sitting for more than 1 h; sitting for more than 30 min; sitting for more than 10 min; Cronbach’s α = .890). Pain Interference with Cognitive Functioning consisted of 3 items (i.e., ability to remember things; ability to take in new information; ability to concentrate; Cronbach’s α = .855). Pain Interference with Psychological Functioning consisted of 8 items (i.e., make you feel depressed; make you feel discouraged; worry about pain; distressing; emotionally tense; feel anxious; irritable; feel like a burden to you; Cronbach’s α = .895). Pain Interference with Social Functioning consisted of 7 items (difficult for you to plan social activities; ability to participate in social activities; your enjoyment of social activities; keep you from socializing with others; hard to plan social activities; restrict your social life to your home; avoid social activities; Cronbach’s α = .937). Scales were created by summing the raw score, multiplying by the number of items, and dividing by the number of items that were actually answered. The raw scale scores were then standardized by conversion into t-scores [16].

Employment. Respondents were classified as unemployed ifthey reported that they currently were unemployed, disabled, retired, or on a leave of absence. Those who reported that they were students, part-time employed, or full-time employed were classified as employed. Additionally, a single item from the PROMIS Pain Interference scale (0 = not at all; 5 = very much) was used to assess the extent to which pain interfered with the respondents’ ability to work: “In the past 7 days, how much did pain interfere with your ability to work (include work at home)?”

3 Data analysis

A series ofunivariate analyses ofvariance tests were performed to examine differences in chronic pain characteristics between respondents based on demographics (Gender: male, female; Marital Status: not married, married; Education: high school or less, some college, college or greater; Occupation: unemployed, employed).

Aim 1: An ordered logistic regression was employed as a method of testing the extent to which variation in pain interference with ability to work accounted for the variation in employment above and beyond respondents’ pain rating. In the first step, age, length of time experiencing pain, length of time in treatment, and the number of pain conditions reported were entered into the model. In the second step, pain rating was entered. In the third and final step, pain interference with ability to work was entered.

Aim 2: A hierarchical linear regression was performed to determine the extent to which the different types of pain interference predicted the relationship between pain rating and ability to work. In the first step, age, length of time experiencing pain, length of time in treatment, and the number of pain conditions reported were entered into the model. In the second step, pain rating was entered. In the third step, pain interference with cognitive functioning, physical functioning, and psychological functioning were entered into the model. In the fourth and final step, pain interference with social functioning was entered. This last independent variable was entered separately because we hypothesized that it would be the strongest predictor of pain interference with work among all the function variables.

The p-value for significant findings was set at a two-sided p ≤ .05. All analyses were conducted using SPSS 23 (IBM Corp., Armonk, NY).

4 Results

Subjects: The full dataset included 966 respondents between the ages of 21-96 (Mean [M] = 48.19, Standard Deviation [SD] = 11.06). Considering our interest in working age adults, only those who were younger than 62 years of age who had provided complete data were included. The final study sample consisted of 598 respondents between the ages of 22-61 (M = 46.03, SD = 9.08). Table 1 summarizes characteristics of the study populations.

Table 1

Demographics and description of the sample (n = 598).

Variable Number (n) (%) M (SD)
Gender
 Male 103 (17.3)
 Female 492 (82.7)
Race/Ethnicity
 Non-Hispanic 573 (97.3)
 White 554 (92.6)
 Black 10 (1.7)
 Asian 4 (0.7)
 Native American 5 (0.8)
 Hispanic/Latino 24 (4.0)
 Other/No Response 1 (0.2)
Education
 High School or less 108 (18.1)
 Some college 296 (49.5)
 College or greater 194 (32.4)
Relationship Status
 Not married 242 (40.5)
 Married 354 (59.2)
Occupation
 Not employed 288 (48.2)
 Unemployed 44 (7.4)
 Disabled 244 (40.8)
 Employed 310 (51.8)
 Student 17 (2.8)
 Employed part-time 53 (8.9)
 Employed full-time 240 (40.1)
Chronic Pain Condition
 Migraine 143 (23.9)
 Rheumatoid arthritis 34 (5.7)
 Osteoarthritis 104 (17.4)
 Cancer pain 2 (0.3)
 Low back pain 330 (55.2)
 Neck pain 281 (47.0)
 Fibromyalgia 233 (39.0)
 Other neurological pain 222 (37.1)
 Other pain 185 (30.9)
# of Conditions 2.57(0.91)
Age 46.03 (9.08)
Pain Time (years) 7.18(6.35)
Treatment Time (years) 6.61 (1.51)

The majority identified as female (82.3%) and non-Hispanic white (92.6%;). The most frequently identified pain conditions were low back pain (55.2%), neck pain (47%), and fibromyalgia (37.1%). On average, respondents reported 2.57 pain conditions. Slightly more than half (51.8%) of respondents were employed. There were no significant differences in number of chronic conditions, length of time (years) experiencing pain, or length of time (years) in treatment stratified by gender, marital status, or education. However, respondents who were unemployed (M = 2.71, Standard Error [SE] = 0.07) reported significantly more pain conditions than those who were employed (M = 2.33, SE = 0.11; F (Fstatistic)(1,596) = 9.06, p = .003). Unemployed respondents (M = 10.39 years, SE = 0.62) had also experienced pain for a longer time than employed respondents (M = 7.88 years, SE = 0.93; F (1,596) = 5.00, p = .026).The length of time in treatment was also significantly higher among unemployed respondents (M = 8.01 years, SE = 0.49) than those who were employed (M = 5.67 years, SE = 0.74; F (1, 596) = 7.03, p = .008).

Aim 1: Table 2 summarizes the results of the logistic regression detailing factors associated with employment.

Table 2

Summary of ordered logistic regression analysis for variables associated with employment (n = 598).

Variable Step 1 Step 2 Step 3
B [a] SE B[b] OR[c] B SE B OR B SE B OR
Age -.036[***] .010 .964 -.035[***] .010 .966 -.038[***] .011 .963
Pain Time .012 .015 1.012 .016 .016 1.016 .029 .017 1.029
Treatment Time -.042[*] .020 .959 -.046[*] .020 .955 -.060[**] .022 .942
# of Conditions -329[***] .098 .720 -324[***] .099 .723 -.251[*] .112 .778
Pain Rating -.202[***] .058 .817 -.004 .068 .996
Pain Interference w/ Ability to Work -1.482[***] .146 .227
Nagelkerke R2 .088 .113 387
χ 2 for step 18.47[*] 12.46[***] 152.10[***]

In all three steps, age (B [unstandardized Beta] = -.036, p < .001), length of time in pain treatment (B = -.042, p = .034), and number of pain conditions (B = -.329, p = .001) were each significantly inversely associated with employment. Pain rating, entered in the second step, was also significantly inversely associated with employment (B = -.202, p = .001) in that the lower the pain rating the more likely the respondent would be employed. In the third and final step, pain interference with ability to work was significantly inversely associated with employment (B = -1.48, p < .001), i.e., the less that pain interfered with the respondent’s ability to work, the greater the likelihood of being employed. Of note, pain rating was no longer significant in the final step, indicating that pain interference with one’s ability to work fully mediated the effects of the respondents’ pain rating on employment. Based on Nagelkerke R2, the final step explained approximately 39% of the overall variance in employment status, compared to 11% explained by step 2.

Aim 2: Results of the linear regression analysis examining predictors of pain interference with ability to work are summarized in Table 3.

Table 3

Summary of hierarchical linear regression analysis for variables predicting extent pain interferes with ability to work (n = 598).

Variable Step 1 Step 2 Step 3 Step 4
B [a] SE B[c] β [b] B [a] SE B β [b] B [a] SE B β [b] B [a] SE B β [b]
Age .005 .004 .048 .003 .004 .033 .004 .004 .037 .004 .004 .036
Pain Time .011 .007 .094 .008 .007 .069 .007 .006 .062 .009 .006 .073
Treatment Time -.007 .009 -.046 -.005 .009 -.032 .002 .008 .012 -.003 .007 -.021
# of Conditions .136 .044 .129[**] .124 .042 .119[**] .024 .039 .023 .014 .036 .014
Pain Rating .174 .025 .278[***] .056 .024 .089[*] .024 .023 .039
Pain Interference w/ Cog. Functioning .028 .004 .292[***] .016 .004 .164[***]
Pain Interference w/Phys. Functioning .016 .004 .169[***] .007 .004 .078
Pain Interference w/Psych. Functioning .013 .004 .137[**] .000 .004 .000
Pain Interference w/ Social Functioning .044 .004 .444[***]
R 2 .028 .104 .278 381
F for change in R2 4.214[**] 50.456[***] 50.705[***] 98.637[***]

The number of pain conditions reported was a significant predictor of pain interference with work in step 1 and remained significant in step 2, along with pain rating. In the third step, all three pain interference scales were significant in that the greater the pain interference with cognitive functioning, physical functioning, and psychological functioning, the greaterthe pain interference with ability to work. Pain rating remained a significant predictor, however, the number of pain conditions reported was no longer significant in step 3. In the final step, the only significant predictors of ability to work were pain interference with cognitive, physical, and social functioning. Pain rating did not remain a significant predictor when the functioning variables were entered into the model, and pain interference with psychological functioning was no longer significant in the final step. The greater the pain interference with social functioning (β [standardized Beta] = .444, p < .001), the greater the pain interference with ability to work. Pain interference with social functioning partially mediated the effects of pain interference with cognitive and physical functioning and fully mediated the effects of pain rating and pain interference with psychological functioning on pain interference with the ability to work. The final step explained approximately 38% of the overall variance in pain interference with ability to work, compared to 28% explained by step 3 and 10% explained by step 2.

5 Discussion

The primary aim of this study was to evaluate the association between pain interference with the ability to work and actual employment among working age adults with chronic pain. A secondary aim was to assess pain interference with four types of functioning - cognitive, physical, psychological, and social - as possible predictors of pain interference with the ability to work. For the primary aim, our hypothesis was that pain rating and duration of pain would be the factors most strongly associated with employment. Results partially supported that hypothesis, with shorter treatment time significantly associated with likelihood of being employed. The number of pain conditions was also inversely associated with employment, i.e. persons with fewer pain conditions were more likely to be employed. However, pain rating - a measure of pain intensity - while initially significant in our model, was no longer significant when pain interference with ability to work was added to the model. These results informed our secondary aim focusing on studying specific aspects of pain interference with the ability to work. Results supported our hypothesis, that pain interference with social functioning was the strongest predictor of pain’s effect on the ability to work.

Pain interference with social function is thus a significant factor in an individuals’ ability to work. Although the manner in which this occurs is most likely multifactorial, a number of specific reasons are proposed. First, the loss of employment often results in a loss of social identity for many individuals [7,17]. Work may be one of the most important activities in the lives of many employed individuals [17]. Since work may give meaning both personally and professionally, the loss of employment inevitably involves the loss of social relationships and support [7,17]. In addition, chronic pain itself further negatively impacts social functioning by limiting physical ability to participate in normal daily activities [2]. This overall decline in functioning due to a loss of the ability to engage in daily activities including social functioning directly affects the health-related quality of life for individuals with chronic pain [2].

We did not have data on how patients had been treated for their pain or the proportion of study participants using opioids. However, the widespread use of opioids in the management of chronic pain may likewise play a deleterious role in social functioning. The role of the μ opioid receptor in animal social behaviors has been demonstrated in a number of studies [18]. A link between impaired social behaviors in animals and the level of endogenous opioids is elucidated by the Brain Opioid Theory of Social Attachment (BOTSA) [18]. The underlying premise of BOTSA is supported by the observed decrease in opioid receptor tone when social attachments are removed resulting in an increase in the level of experienced distress [18]. Although these animal studies demonstrate an increase in animal social behaviors with the use of low dose opioids in an acute setting, the use of moderate to high dose μ opioid receptor agonists in the same setting have demonstrated a decrease in social behaviors [18]. Similarly, animals that were chronically administered low dose μ opioid receptor agonists showed a similar decrease in social behaviors [18]. Analogous observations have been observed in humans who are enrolled in opioid maintenance clinics [18]. The long term administration of low dose opioid agonists, as seen in opioid maintenance clinics, appears to produce a similar loss of social attachment [18]. This may provide additional insight into the loss of social function in chronic pain patients particularly when the ongoing use of opioids is a key part of the management.

Our findings underscore the importance of an integrated biopsychosocial approach to managing chronic pain, especially when addressing ability to work. It is well established that pain is not merely a biological phenomenon, and that biomedical approaches alone are ineffective when addressing chronic pain [1]. Our findings show that focusing on assessing and managing pain intensity is necessary, but not sufficient, to appropriately address the negative consequences of chronic pain.

All of the study participants reported substantial time in treatment for their pain: a mean of over 5 years for those who were employed and a mean of 8 years for those unemployed. This speaks to the chronic nature of their pain conditions. When evaluating patients with chronic pain, more attention on the assessment of pain interference with social function may be valuable. Moreover, interventions that improve social function may improve the ability to work. This approach is supported by the reported effectiveness of applying cognitive behavior therapy, acceptance and commitment therapy, and multimodal therapy in addressing recalcitrant pain and return to work [19]. Moreover, one of the few prospective randomized studies of early return-to-work interventions in employees with chronic pain supports the focus on addressing pain interference with social, cognitive, and physical functioning, rather than pain only [20].

One of the limitations of our study is that the population evaluated was primarily female and white. In addition, the study participants represented self-selected individuals that accessed the American Chronic Pain Association website. Although our data may not be representative of all people with chronic pain, the pain conditions represented by participants match the most common pain conditions in the American population. We also did not measure progress over time. Although the survey data was collected in 2007 and 2008, there is little reason to believe findings would differ from more recently collected data. Furthermore, to the best of our knowledge, there has been no prior work applying our multimodal approach to study chronic pain and its interference with the ability to work and actual employment.

Areas for further research might include evaluating objective measure of ability to work, such as functional capacity evaluations, in addition to patients’ self-reported or actual employment status. Research evaluating patients’ progress over time would also help to better understand the mechanisms by which social factors interfere with the ability to work. Ultimately, a greater understanding may lead to the development of interventions targeting social interference and its impact on the ability to work, and, ultimately, employment.

6 Conclusion

This study demonstrates that pain interference with social function is a significant contributor to pain interference with ability to work in working age patients with chronic pain. In this particular population of adults with chronic pain, pain interference with social function impacted the ability to work more than pain interference with cognitive or physical function. Interestingly, pain rating, which is routinely assessed in the management of chronic pain, did not significantly impact patients’ ability to work once pain interference with function was added to the model in our study. In the development of effective solutions to address the economic and societal burden of chronic pain, this paper highlights the role of social function as an important, yet frequently overlooked, contributor to chronic pain’s effect on the ability to work. Health care providers should also carefully consider the utility of prescribing sick leave to patients with chronic pain conditions since it may interfere with social functioning, and thus might exacerbate the effects on perceived ability to work and actual employment [20].

It is becoming increasingly clear that pain interference with social function is an important area for all health care providers to routinely assess in their patients with chronic pain. Health care providers who manage chronic pain are well-positioned to collaborate with their patients in the development of a comprehensive approach to the management of chronic pain which addresses all aspects of the biopsychosocial model, and focusing on social factors may be an effective starting point.

7 Highlights

  • Social factors are now recognized to play an important role in chronic pain.

  • In a chronic pain survey, interference with social function affected work ability.

  • Social function was more significant than pain intensity rating in ability to work.

  • Pain interventions targeting social function may improve the ability to work.

  1. Ethical issues: The Michigan State University Office of Regulatory Affairs and Human Research Protection Programs has determined this project to be IRB exempt. Informed consent, Ethics Board approval, and study protocol registration was not required or obtained.

  2. Conflicts of interest: The authors have no relevant financial disclosures or conflicts of interest.

Acknowledgement

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Received: 2017-06-05
Revised: 2017-09-26
Accepted: 2017-09-27
Published Online: 2017-10-01
Published in Print: 2017-10-01

© 2017 Scandinavian Association for the Study of Pain

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  42. Quantitative sensory tests (QST) are promising tests for clinical relevance of anti–nociceptive effects of new analgesic treatments
  43. Educational case report
  44. Pregabalin as adjunct in a multimodal pain therapy after traumatic foot amputation — A case report of a 4-year-old girl
  45. Editorial comment
  46. Severe side effects from intrathecal morphine for chronic pain after repeated failed spinal operations
  47. Editorial comment
  48. Opioids in chronic pain – Primum non nocere
  49. Editorial comment
  50. Finally a promising analgesic signal in a long-awaited new class of drugs: TRPV1 antagonist mavatrep in patients with osteoarthritis (OA)
  51. Observational study
  52. The relationship between chronic musculoskeletal pain, anxiety and mindfulness: Adjustments to the Fear-Avoidance Model of Chronic Pain
  53. Clinical pain research
  54. Opioid tapering in patients with prescription opioid use disorder: A retrospective study
  55. Editorial comment
  56. Sleep, widespread pain and restless legs — What is the connection?
  57. Editorial comment
  58. Broadening the fear-avoidance model of chronic pain?
  59. Observational study
  60. Identifying characteristics of the most severely impaired chronic pain patients treated at a specialized inpatient pain clinic
  61. Editorial comment
  62. The burden of central anticholinergic drugs increases pain and cognitive dysfunction. More knowledge about drug-interactions needed
  63. Editorial comment
  64. A case-history illustrates importance of knowledge of drug-interactions when pain-patients are prescribed non-pain drugs for co-morbidities
  65. Editorial comment
  66. Why can multimodal, multidisciplinary pain clinics not help all chronic pain patients?
  67. Topical review
  68. Individual variability in clinical effect and tolerability of opioid analgesics – Importance of drug interactions and pharmacogenetics
  69. Editorial comment
  70. A new treatable chronic pain diagnosis? Flank pain caused by entrapment of posterior cutaneous branch of intercostal nerves, lateral ACNES coined LACNES
  71. Clinical pain research
  72. PhKv a toxin isolated from the spider venom induces antinociception by inhibition of cholinesterase activating cholinergic system
  73. Clinical pain research
  74. Lateral Cutaneous Nerve Entrapment Syndrome (LACNES): A previously unrecognized cause of intractable flank pain
  75. Editorial comment
  76. Towards a structured examination of contextual flexibility in persistent pain
  77. Clinical pain research
  78. Context sensitive regulation of pain and emotion: Development and initial validation of a scale for context insensitive avoidance
  79. Editorial comment
  80. Is the search for a “pain personality” of added value to the Fear-Avoidance-Model (FAM) of chronic pain?
  81. Editorial comment
  82. Importance for patients of feeling accepted and understood by physicians before and after multimodal pain rehabilitation
  83. Editorial comment
  84. A glimpse into a neglected population – Emerging adults
  85. Observational study
  86. Assessment and treatment at a pain clinic: A one-year follow-up of patients with chronic pain
  87. Clinical pain research
  88. Randomized, double-blind, placebo-controlled, dose-escalation study: Investigation of the safety, pharmacokinetics, and antihyperalgesic activity of L-4-chlorokynurenine in healthy volunteers
  89. Clinical pain research
  90. Prevalence and characteristics of chronic pain: Experience of Niger
  91. Observational study
  92. The use of rapid onset fentanyl in children and young people for breakthrough cancer pain
  93. Original experimental
  94. Acid-induced experimental muscle pain and hyperalgesia with single and repeated infusion in human forearm
  95. Original experimental
  96. Swearing as a response to pain: A cross-cultural comparison of British and Japanese participants
  97. Clinical pain research
  98. The cognitive impact of chronic low back pain: Positive effect of multidisciplinary pain therapy
  99. Clinical pain research
  100. Central sensitization associated with low fetal hemoglobin levels in adults with sickle cell anemia
  101. Topical review
  102. Targeting cytokines for treatment of neuropathic pain
  103. Original experimental
  104. What constitutes back pain flare? A cross sectional survey of individuals with low back pain
  105. Original experimental
  106. Coping with pain in intimate situations: Applying the avoidance-endurance model to women with vulvovaginal pain
  107. Clinical pain research
  108. Chronic low back pain and the transdiagnostic process: How do cognitive and emotional dysregulations contribute to the intensity of risk factors and pain?
  109. Original experimental
  110. The impact of the Standard American Diet in rats: Effects on behavior, physiology and recovery from inflammatory injury
  111. Educational case report
  112. Erector spinae plane (ESP) block in the management of post thoracotomy pain syndrome: A case series
  113. Original experimental
  114. Hyperbaric oxygenation alleviates chronic constriction injury (CCI)-induced neuropathic pain and inhibits GABAergic neuron apoptosis in the spinal cord
  115. Observational study
  116. Predictors of chronic neuropathic pain after scoliosis surgery in children
  117. Clinical pain research
  118. Hospitalization due to acute exacerbation of chronic pain: An intervention study in a university hospital
  119. Clinical pain research
  120. A novel miniature, wireless neurostimulator in the management of chronic craniofacial pain: Preliminary results from a prospective pilot study
  121. Clinical pain research
  122. Implicit evaluations and physiological threat responses in people with persistent low back pain and fear of bending
  123. Original experimental
  124. Unpredictable pain timings lead to greater pain when people are highly intolerant of uncertainty
  125. Original experimental
  126. Initial validation of the exercise chronic pain acceptance questionnaire
  127. Clinical pain research
  128. Exploring patient experiences of a pain management centre: A qualitative study
  129. Clinical pain research
  130. Narratives of life with long-term low back pain: A follow up interview study
  131. Observational study
  132. Pain catastrophizing, perceived injustice, and pain intensity impair life satisfaction through differential patterns of physical and psychological disruption
  133. Clinical pain research
  134. Chronic pain disrupts ability to work by interfering with social function: A cross-sectional study
  135. Original experimental
  136. Evaluation of external vibratory stimulation as a treatment for chronic scrotal pain in adult men: A single center open label pilot study
  137. Observational study
  138. Impact of analgesics on executive function and memory in the Alzheimer’s Disease Neuroimaging Initiative Database
  139. Clinical pain research
  140. Visualization of painful inflammation in patients with pain after traumatic ankle sprain using [11C]-D-deprenyl PET/CT
  141. Original experimental
  142. Developing a model for measuring fear of pain in Norwegian samples: The Fear of Pain Questionnaire Norway
  143. Topical review
  144. Psychoneuroimmunological approach to gastrointestinal related pain
  145. Letter to the Editor
  146. Do we need an updated definition of pain?
  147. Narrative review
  148. Is acetaminophen safe in pregnancy?
  149. Book Review
  150. Physical Diagnosis of Pain
  151. Book Review
  152. Advances in Anesthesia
  153. Book Review
  154. Atlas of Pain Management Injection Techniques
  155. Book Review
  156. Sedation: A Guide to Patient Management
  157. Book Review
  158. Basics of Anesthesia
https://doi.org/10.1016/j.sjpain.2017.09.021
Keywords for this article
Chronic pain; Pain interference; Social function; Work; Employment

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  1. Observational study
  2. Perceived sleep deficit is a strong predictor of RLS in multisite pain – A population based study in middle aged females
  3. Clinical pain research
  4. Prospective, double blind, randomized, controlled trial comparing vapocoolant spray versus placebo spray in adults undergoing intravenous cannulation
  5. Clinical pain research
  6. The Functional Barometer — An analysis of a self-assessment questionnaire with ICF-coding regarding functional/activity limitations and quality of life due to pain — Differences in age gender and origin of pain
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  8. Clinical outcome following anterior arthrodesis in patients with presumed sacroiliac joint pain
  9. Observational study
  10. Chronic disruptive pain in emerging adults with and without chronic health conditions and the moderating role of psychiatric disorders: Evidence from a population-based cross-sectional survey in Canada
  11. Educational case report
  12. Management of patients with pain and severe side effects while on intrathecal morphine therapy: A case study
  13. Clinical pain research
  14. Behavioral inhibition, maladaptive pain cognitions, and function in patients with chronic pain
  15. Observational study
  16. Comparison of patients diagnosed with “complex pain” and “somatoform pain”
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  18. Patient perspectives on wait times and the impact on their life: A waiting room survey in a chronic pain clinic
  19. Topical review
  20. New evidence for a pain personality? A critical review of the last 120 years of pain and personality
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  23. Clinical pain research
  24. Pain patients’ experiences of validation and invalidation from physicians before and after multimodal pain rehabilitation: Associations with pain, negative affectivity, and treatment outcome
  25. Observational study
  26. Long-term treatment in chronic noncancer pain: Results of an observational study comparing opioid and nonopioid therapy
  27. Clinical pain research
  28. COMBAT study – Computer based assessment and treatment – A clinical trial evaluating impact of a computerized clinical decision support tool on pain in cancer patients
  29. Original experimental
  30. Quantitative sensory tests fairly reflect immediate effects of oxycodone in chronic low-back pain
  31. Editorial comment
  32. Spatial summation of pain and its meaning to patients
  33. Original experimental
  34. Effects of validating communication on recall during a pain-task in healthy participants
  35. Original experimental
  36. Comparison of spatial summation properties at different body sites
  37. Editorial comment
  38. Behavioural inhibition in the context of pain: Measurement and conceptual issues
  39. Clinical pain research
  40. A randomized study to evaluate the analgesic efficacy of a single dose of the TRPV1 antagonist mavatrep in patients with osteoarthritis
  41. Editorial comment
  42. Quantitative sensory tests (QST) are promising tests for clinical relevance of anti–nociceptive effects of new analgesic treatments
  43. Educational case report
  44. Pregabalin as adjunct in a multimodal pain therapy after traumatic foot amputation — A case report of a 4-year-old girl
  45. Editorial comment
  46. Severe side effects from intrathecal morphine for chronic pain after repeated failed spinal operations
  47. Editorial comment
  48. Opioids in chronic pain – Primum non nocere
  49. Editorial comment
  50. Finally a promising analgesic signal in a long-awaited new class of drugs: TRPV1 antagonist mavatrep in patients with osteoarthritis (OA)
  51. Observational study
  52. The relationship between chronic musculoskeletal pain, anxiety and mindfulness: Adjustments to the Fear-Avoidance Model of Chronic Pain
  53. Clinical pain research
  54. Opioid tapering in patients with prescription opioid use disorder: A retrospective study
  55. Editorial comment
  56. Sleep, widespread pain and restless legs — What is the connection?
  57. Editorial comment
  58. Broadening the fear-avoidance model of chronic pain?
  59. Observational study
  60. Identifying characteristics of the most severely impaired chronic pain patients treated at a specialized inpatient pain clinic
  61. Editorial comment
  62. The burden of central anticholinergic drugs increases pain and cognitive dysfunction. More knowledge about drug-interactions needed
  63. Editorial comment
  64. A case-history illustrates importance of knowledge of drug-interactions when pain-patients are prescribed non-pain drugs for co-morbidities
  65. Editorial comment
  66. Why can multimodal, multidisciplinary pain clinics not help all chronic pain patients?
  67. Topical review
  68. Individual variability in clinical effect and tolerability of opioid analgesics – Importance of drug interactions and pharmacogenetics
  69. Editorial comment
  70. A new treatable chronic pain diagnosis? Flank pain caused by entrapment of posterior cutaneous branch of intercostal nerves, lateral ACNES coined LACNES
  71. Clinical pain research
  72. PhKv a toxin isolated from the spider venom induces antinociception by inhibition of cholinesterase activating cholinergic system
  73. Clinical pain research
  74. Lateral Cutaneous Nerve Entrapment Syndrome (LACNES): A previously unrecognized cause of intractable flank pain
  75. Editorial comment
  76. Towards a structured examination of contextual flexibility in persistent pain
  77. Clinical pain research
  78. Context sensitive regulation of pain and emotion: Development and initial validation of a scale for context insensitive avoidance
  79. Editorial comment
  80. Is the search for a “pain personality” of added value to the Fear-Avoidance-Model (FAM) of chronic pain?
  81. Editorial comment
  82. Importance for patients of feeling accepted and understood by physicians before and after multimodal pain rehabilitation
  83. Editorial comment
  84. A glimpse into a neglected population – Emerging adults
  85. Observational study
  86. Assessment and treatment at a pain clinic: A one-year follow-up of patients with chronic pain
  87. Clinical pain research
  88. Randomized, double-blind, placebo-controlled, dose-escalation study: Investigation of the safety, pharmacokinetics, and antihyperalgesic activity of L-4-chlorokynurenine in healthy volunteers
  89. Clinical pain research
  90. Prevalence and characteristics of chronic pain: Experience of Niger
  91. Observational study
  92. The use of rapid onset fentanyl in children and young people for breakthrough cancer pain
  93. Original experimental
  94. Acid-induced experimental muscle pain and hyperalgesia with single and repeated infusion in human forearm
  95. Original experimental
  96. Swearing as a response to pain: A cross-cultural comparison of British and Japanese participants
  97. Clinical pain research
  98. The cognitive impact of chronic low back pain: Positive effect of multidisciplinary pain therapy
  99. Clinical pain research
  100. Central sensitization associated with low fetal hemoglobin levels in adults with sickle cell anemia
  101. Topical review
  102. Targeting cytokines for treatment of neuropathic pain
  103. Original experimental
  104. What constitutes back pain flare? A cross sectional survey of individuals with low back pain
  105. Original experimental
  106. Coping with pain in intimate situations: Applying the avoidance-endurance model to women with vulvovaginal pain
  107. Clinical pain research
  108. Chronic low back pain and the transdiagnostic process: How do cognitive and emotional dysregulations contribute to the intensity of risk factors and pain?
  109. Original experimental
  110. The impact of the Standard American Diet in rats: Effects on behavior, physiology and recovery from inflammatory injury
  111. Educational case report
  112. Erector spinae plane (ESP) block in the management of post thoracotomy pain syndrome: A case series
  113. Original experimental
  114. Hyperbaric oxygenation alleviates chronic constriction injury (CCI)-induced neuropathic pain and inhibits GABAergic neuron apoptosis in the spinal cord
  115. Observational study
  116. Predictors of chronic neuropathic pain after scoliosis surgery in children
  117. Clinical pain research
  118. Hospitalization due to acute exacerbation of chronic pain: An intervention study in a university hospital
  119. Clinical pain research
  120. A novel miniature, wireless neurostimulator in the management of chronic craniofacial pain: Preliminary results from a prospective pilot study
  121. Clinical pain research
  122. Implicit evaluations and physiological threat responses in people with persistent low back pain and fear of bending
  123. Original experimental
  124. Unpredictable pain timings lead to greater pain when people are highly intolerant of uncertainty
  125. Original experimental
  126. Initial validation of the exercise chronic pain acceptance questionnaire
  127. Clinical pain research
  128. Exploring patient experiences of a pain management centre: A qualitative study
  129. Clinical pain research
  130. Narratives of life with long-term low back pain: A follow up interview study
  131. Observational study
  132. Pain catastrophizing, perceived injustice, and pain intensity impair life satisfaction through differential patterns of physical and psychological disruption
  133. Clinical pain research
  134. Chronic pain disrupts ability to work by interfering with social function: A cross-sectional study
  135. Original experimental
  136. Evaluation of external vibratory stimulation as a treatment for chronic scrotal pain in adult men: A single center open label pilot study
  137. Observational study
  138. Impact of analgesics on executive function and memory in the Alzheimer’s Disease Neuroimaging Initiative Database
  139. Clinical pain research
  140. Visualization of painful inflammation in patients with pain after traumatic ankle sprain using [11C]-D-deprenyl PET/CT
  141. Original experimental
  142. Developing a model for measuring fear of pain in Norwegian samples: The Fear of Pain Questionnaire Norway
  143. Topical review
  144. Psychoneuroimmunological approach to gastrointestinal related pain
  145. Letter to the Editor
  146. Do we need an updated definition of pain?
  147. Narrative review
  148. Is acetaminophen safe in pregnancy?
  149. Book Review
  150. Physical Diagnosis of Pain
  151. Book Review
  152. Advances in Anesthesia
  153. Book Review
  154. Atlas of Pain Management Injection Techniques
  155. Book Review
  156. Sedation: A Guide to Patient Management
  157. Book Review
  158. Basics of Anesthesia
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