IL-7, IL-18, MCP-1, MIP1-β, and OPG as biomarkers for pain treatment response in patients with cancer. Predictors of pain outcomes in patients with chronic musculoskeletal pain co-morbid with depression: results from a randomized controlled trial. Inflammatory biomarkers and physical function in older, obese adults with knee pain and self-reported osteoarthritis after intensive weight-loss therapy. Central Modulation of Pain Evoked From Myofascial Trigger Point Individually tailored treatment targeting activity, motor behavior, and cognition reduces pain-related disability: a randomized controlled trial in patients with musculoskeletal pain. Non-pharmacological Intervention for Chronic Pain in Veterans: A Pilot Study of Heart Rate Variability Biofeedback The CONECSI trial: Results of a randomized controlled trial of a multidisciplinary cognitive behavioral program for coping with chronic neuropathic pain after spinal cord injury Horticultural therapy for patients with chronic musculoskeletal pain: results of a pilot study. Assessing chronic pain in general practice: Are guidelines relevant? A cluster randomized controlled trial Identifying biomarker patterns and predictors of inflammation and myocardial stress. Effect of Individually Tailored Biopsychosocial Workplace Interventions on Chronic Musculoskeletal Pain and Stress Among Laboratory Technicians: Randomized Controlled Trial. An in vivo microanalytical technique for measuring the local biochemical milieu of human skeletal muscle. Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale A pathway linking patient participation in cancer consultations to pain control. Genetic variation in the hypothalamic–pituitary–adrenal stress axis influences susceptibility to musculoskeletal pain: results from the EPIFUND study Does Teaching Physical Therapists to Deliver a Biopsychosocial Treatment Program Result in Better Patient Outcomes? A Randomized Controlled Trial Association Between Inflammatory Markers and Progression to Kidney Dysfunction: Examining Different Assessment Windows in Patients With Type 1 Diabetes
BACKGROUND Pain is one of the most common symptoms in patients suffering from advanced cancer and receiving palliative care and is often responsible for a poor quality of life . To date , there exists no published correlation between biological , measurable biomarkers and pain intensity . OBJECTIVES The primary objective was to search and identify pain-associated cytokines ( biomarkers ) correlating with changes in numeric rating scale ( NRS ) pain scores in patients with cancer before and after pain treatment .  The secondary objectives were to assess cytokine serum level differences between patients and healthy controls and to evaluate possible relationships between pain entities , pain intensity ( in NRS ) , gender , location of primary tumor , and the patients ' cytokine baseline concentrations . STUDY DESIGN Controlled , prospect i ve study . SETTING University medical center . METHODS Eligible patients with exacerbated cancer-related pain ( NRS = 5 ) and healthy controls with no pain were included . Serum level changes of 19 cytokines were analyzed before and during opioid treatment . RESULTS Of 19 analyzed biomarkers , 5 ( IL-7 , IL-18 , MCP-1 , MIP-1α , MIP-1β and OPG ) turned out to correlate significantly with pain relief . In healthy controls , all analyzed cytokines showed no significant differences . In the secondary analysis , only one significant correlation was detected between OPG and pain entities . Furthermore , IL-4 , IL-7 , IFN-γ and OPG appeared to account for the ability to predict a patient 's gender . LIMITATIONS Our findings should be considered as preliminary and need to be confirmed in further studies . CONCLUSION Our results provide preliminary evidence of a significant correlation of pain relief in patients with cancer and at least 5 cytokines . These biomarkers may serve as the basis for development of diagnostic tools for pain assessment and could serve as potential new targets for pain control OBJECTIVE The combination of chronic musculoskeletal pain and depression is associated with worse clinical outcomes than either condition alone . In this study , we report the predictors of pain intensity and activity interference in primary care patients with co-morbid pain and depression . METHODS This is a secondary data analysis of the 250 persons who participated in a r and omized clinical trial design ed to test the effectiveness of 12 weeks of optimized antidepressant therapy for both depression and pain . Using multivariate linear regression analysis , we assessed the predictive value of baseline  self-efficacy , fear of movement , pain  beliefs  , and demographic and clinical factors on 3-month Grade d Chronic Pain Scale pain intensity and activity interference outcomes . RESULTS In the full model , significant sociodemographic predictors of less activity interference included being non-white ( beta-5.8 , P = 0.04 ) and being employed ( beta-13.3 , P < 0.0001 ) . The latter was also predictive of less pain intensity ( beta-5.6 , P = 0.01 ) . As expected , the optimized antidepressant treatment arm was associated with improved outcomes ( pain intensity : beta-3.7 , P = 0.0005 and activity interference : beta-6.4 , P = 0.01 ) . Whereas stronger perceived pain control ( beta 3.6 , P = 0.01 ) was associated with greater activity interference , higher degree of fear of movement ( or fear avoidance ) predicted greater pain intensity ( beta 0.46 , P = 0.04 ) and activity interference ( beta 0.57 , P = 0.05 ) . Neither the location ( low back vs hip/knee ) nor duration of pain were predictive of pain intensity or interference outcomes . CONCLUSION The findings are consistent with a bio-psychosocial model , implicating the need to consider the impact of sociodemographic variables and pain-related beliefs and cognition on pain-related outcomes for patients with co-morbid musculoskeletal pain and depression OBJECTIVES To describe the relationships between proinflammatory biomarkers and self-reported and performance-based physical function and to examine the effect of weight loss on these markers of inflammation . DESIGN R and omized , longitudinal , clinical study comparing subjects eating an energy-restricted diet and participating in exercise training with a control group . SETTING Community-base participants for the Physical Activity , Inflammation and Body Composition Trial . PARTICIPANTS Eighty-seven obese ( body mass index ( BMI ) > 30.0 kg/m(2 ) ) adults aged 60 and older with knee pain and self-report of osteoarthritis . MEASUREMENTS Inflammatory biomarkers ( interleukin 6 ( IL-6 ) , tumor necrosis factor alpha ( TNFalpha ) , C-reactive protein , and soluble receptors for TNFalpha ( sTNFR1 and sTNFR2 ) ) and self-reported ( Western Ontario and McMaster University Osteoarthritis Index question naire ) and performance-based ( 6-minute walk distance and stair climb time ) measures of physical function at baseline and 6 months . RESULTS Mean ( st and ard error of the mean ) weight loss was 8.7 % ( 0.8 % ) in the intervention group , compared with 0.0 % ( 0.7 % ) in the control group . sTNFR1 was significantly less in the intervention group than in the control group at 6 months . sTNFR1 and sTNFR2 predicted stair climb time at baseline . Change across the 6-month intervention for sTNFR2 was an independent predictor for change in 6-minute walk distance . CONCLUSION These results indicate that an intensive weight-loss intervention in older obese adults with knee pain can help improve inflammatory biomarkers and that changes in these concentrations showed associations with physical function Objectives Low-intensity low-frequency electrostimulation delivered within a myofascial trigger point ( MTP ) has been used as intervention to deactivate MTPs . The therapeutic effect has been suggested to be due to peripheral mechanisms . However , nonpainful stimuli are also known to reduce simultaneous pain through central effects . The primary objective of the present study was to assess if central pain modulation occurs after intervention with low-intensity electrostimulation within an MTP . We hypothesized that intervention induces pain inhibition via the periaqueductal gray ( PAG ) . Methods Twenty-four patients with myofascial pain syndrome participated in the study . During functional magnetic resonance scanning , painful ( high-intensity ) intramuscular electrostimulation was delivered at r and om intervals ( mean interstimulus interval=10.2 s ) within an MTP of the upper left trapezius muscle . In-between scanning sessions , intervention ( intramuscular electrostimulation , low-intensity , interstimulus interval=0.5 s ) was applied to the same area . Patients were divided into responders and nonresponders according to their change in pressure pain thresholds relative to intervention . In addition to a whole brain search , a region of interest approach was also implemented to test the effect of intervention on PAG signal change . Results The main findings were : ( 1 ) intervention modulated PAG activity to painful stimuli more in responders than in nonresponders , ( 2 ) change in PAG activity from the whole patient population correlated with change in pressure pain threshold , and ( 3 ) a network known to regulate affective qualities of the pain experience was ( subsignificantly ) engaged more in responders than in nonresponders . Discussion The applied intervention most likely involves supraspinal pain control mechanisms related to both antinociception and regulation of pain affect UNLABELLED This study compares the outcomes of an individually tailored behavioral medicine intervention ( experimental ) with physical exercise therapy ( control ) . The experimental intervention was systematic ally individualized according to each participant 's behavioral treatment goals and functional behavioral analyses . One hundred twenty-two patients seeking care at 3 primary health care clinics because of musculoskeletal pain were r and omized . Ninety-seven completed the trial . Data were collected at baseline , immediately after treatment , and at a 3-month follow-up . Analyses of data from completers , as well as intention-to-treat analyses , showed that the experimental group experienced lower levels of disability ( P = .01 ) , lower maximum pain intensity ( P = .02 ) , higher levels of pain control ( P = .001 ) , and lower fear of movement ( P = .022 ) as a result of treatment condition . Self-efficacy ( P = .0001 ) and physical performance ( P = .0001 ) increased over time for both groups . Participants in the experimental group generally reported more positive effects after treatment . Treatment fidelity was maintained during the course of the study . Activity can be resumed and pain might be managed by the patients themselves if treatment incorporates the biopsychosocial explanatory model of pain and strategies are tailored according to individual 's priorities of everyday life activities and empirically derived determinants of pain-related disability . PERSPECTIVE This study shows that the biomedical and the psychosocial perspectives of the experiences and consequences of pain complement rather than contradict each other . Primary health care patients with persistent musculoskeletal pain benefit more from a systematic tailoring of treatments according to biopsychosocial factors than from a physically based exercise intervention Objective : Chronic pain is an emotionally and physically debilitating form of pain that activates the body 's stress response and over time can result in lowered heart rate variability ( HRV ) power , which is associated with reduced resiliency and lower self-regulatory capacity . This pilot project was intended to determine the effective-ness of HRV coherence biofeedback ( HRVCB ) as a pain and stress management intervention for veterans with chronic pain and to estimate the effect sizes . It was hypothesized that HRVCB will increase parasympathetic activity result ing in higher HRV coherence measured as power and decrease self-reported pain symptoms in chronic pain patients . Study design : Fourteen veterans receiving treatment for chronic pain were enrolled in the pre-post intervention study . They were r and omly assigned , with 8 subjects enrolled in the treatment group and 6 in the control group . The treatment group received biofeedback intervention plus st and ard care , and the other group received st and ard care only . The treatment group received four HRVCB training sessions as the intervention . Measures : Pre-post measurements of HRV amplitude , HRV power spectrum variables , cardiac coherence , and self-ratings of perceived pain , stress , negative emotions , and physical activity limitation were made for both treatment and control groups . Results : The mean pain severity for all subjects at baseline , using the self-scored Brief Pain Inventory ( BPI ) , was 26.71 ( SD=4.46 ; range=21—35 ) indicating a moderate to severe perceived pain level across the study subjects . There was no significant difference between the treatment and control groups at baseline on any of the measures . Post-HRVCB , the treatment group was significantly higher on coherence ( P=.01 ) and lower ( P=.02 ) on pain ratings than the control group . The treatment group showed marked and statistically significant ( 1-tailed ) increases over the baseline in coherence ratio ( 191 % , P=.04 ) and marked , significant ( 1-tailed ) reduction in pain ratings ( 36 % , P<.001 ) , stress perception ( 16 % , P=.02 ) , negative emotions ( 49 % , P<.001 ) , and physical activity limitation ( 42 % , P<.001 ) . Significant between-group effects on all measures were found when pre-training values were used as covariates . Conclusions : HRVCB intervention was effective in increasing HRV coherence measured as power in the upper range of the LF b and and reduced perceived pain , stress , negative emotions , and physical activity limitation in veterans suffering from chronic pain . HRVCB shows promise as an effective non-pharmacological intervention to support st and ard treatments for chronic pain Summary A multidisciplinary cognitive behavioral program might have beneficial effects on people with chronic neuropathic spinal cord injury pain . ABSTRACT Many people with spinal cord injury ( SCI ) rate chronic neuropathic pain as one of the most difficult problems to manage . The aim of the CONECSI ( COping with NEuropathiC Spinal cord Injury pain ) trial was to evaluate a multidisciplinary cognitive behavioral treatment program for persons with chronic neuropathic pain after SCI . The intervention consisted of educational , cognitive , and behavioral elements .  A total of 61 people were r and omized to either the intervention group or the waiting list control group in 4 Dutch rehabilitation centers . Primary outcomes were pain intensity and pain‐related disability ( Chronic Pain Grade question naire ) , and secondary outcomes were mood ( Hospital Anxiety and Depression Scale ) , participation in activities ( Utrecht Activities List ) , and life satisfaction ( Life Satisfaction Question naire ) . Measurements were performed at baseline , and at 3 , and 6 months follow‐up . The primary statistical technique was r and om coefficient analysis . The analyses showed significant changes over time on both primary ( t1–t2 ) , and 2 out of 4 secondary outcomes ( both t1–t2 and t1–t3 ) . Significant intervention effects ( Time * Group interactions ) were found for anxiety and participation in activities , but not for the primary outcomes . Subsequent paired t tests showed significant changes in the intervention group that were not seen in the control group : decrease of pain intensity , pain‐related disability , anxiety , and increase of participation in activities . This study implies that a multidisciplinary cognitive behavioral program might have beneficial effects on people with chronic neuropathic SCI pain CONTEXT Therapists can use horticultural therapy as an adjuvant therapy in a non threatening context , with the intent of bringing about positive effects in physical health , mental health , and social interaction . Very few experimental studies exist that test its clinical effectiveness . OBJECTIVE To determine whether the addition of horticultural therapy to a pain-management program improved physical function , mental health , and ability to cope with pain . DESIGN The research team design ed a prospect i ve , nonr and omized , controlled cohort study , enrolling all patients consecutively referred to the Zurzach Interdisciplinary Pain Program ( ZISP ) who met the study s criteria . The team divided them into two cohorts based on when medical professionals referred them : before ( control group ) or after ( intervention group ) introduction of a horticultural therapy program . SETTING The setting was the rehabilitation clinic ( RehaClinic ) in Bad Zurzach , Switzerl and . PARTICIPANTS Seventy-nine patients with chronic musculoskeletal pain ( fibromyalgia or chronic , nonspecific back pain ) participated in the study . INTERVENTIONS The research team compared a 4-week , inpatient , interdisciplinary pain-management program with horticultural therapy ( intervention , n = 37 ) with a pain-management program without horticultural therapy ( control , n = 42 ) . The horticultural therapy program consisted of seven sessions of group therapy , each of 1-hour duration . OUTCOME MEASURES The research team assessed the outcome using the Medical Outcome Study Short Form-36 ( SF-36 ) , the West Haven-Yale Multidimensional Pain Inventory ( MPI ) , the Hospital Anxiety and Depression Scale ( HADS ) , the Coping Strategies Question naire ( CSQ ) , and two functional performance tests . The team tested participants on entry to and discharge from the 4-week pain-management program . RESULTS Between-group differences in sociodemographic and outcome variables were not significant on participants entry to the pain-management program . On discharge , the research team measured small to moderate outcome effects ( effect size [ ES ] up to 0.71 ) within both groups . The study found significantly larger improvements for the horticultural therapy group vs the control group in SF-36 role physical ( ES = 0.71 vs 0.22 ; P = .018 ) ; SF-36 mental health ( ES = 0.46 vs 0.16 ; P = .027 ) ; HADS anxiety ( ES = 0.26 vs 0.03 ; P = .043 ) ; and CSQ pain behavior ( ES = 0.30 vs -0.05 ; P = .032 ) . CONCLUSION The addition of horticultural therapy to a pain management program improved participants ' physical and mental health and their coping ability with respect to chronic musculoskeletal pain Objectives : To evaluate the impact of using pain assessment scales on the management of musculoskeletal chronic pain . Methods : Cluster-r and omized controlled multicentre trial in French general practice setting s. Practice s were r and omized by region before patient recruitment . The inclusion concerned patients suffering from musculoskeletal chronic pain . General practitioners assigned to the scale group used two vali date d assessment instruments ; those assigned to the control group cared for their patients according to their usual practice . The primary end-point was the level of relief obtained and the secondary changes in prescription of painkilling modalities . Results : A total of 155 general practitioners included 772 successive patients suffering from musculoskeletal chronic pain . The control group reported a mean level of relief of 50.7 % compared with one of 41.1 % in the scale group ( p<0.0001 ) . In the intervention group , physicians decreased significantly their prescription of  level two painkillers .  Conclusions . In general practice , the use of pain assessment scales is not associated with greater pain relief . The lesser level of pain relief obtained in the scale group does provide evidence that using pain assessment scales does not enhance the relief of chronic pain in patients in primary care . Guidelines which recommend the systematic use of scales for the assessment and monitoring of chronic pain are not tailored to either the context or the patients encountered in the primary care setting BACKGROUND Regular exercise is recommended to improve outcomes in patients with heart failure .  Exercise is known to decrease inflammation and thought to decrease myocardial stress ; however , studies of exercise in heart failure have had mixed results on levels of N-terminal pro-B-type natriuretic peptide ( NT-proBNP ) and high-sensitivity C-reactive protein ( hsCRP ) . A multimarker analysis may help to identify distinct subgroups of patients who respond to exercise . Our primary study objective was to identify common and distinct patterns of change in hsCRP and NT-proBNP and to quantify the influence of exercise therapy on the observed patterns of change . METHODS AND RESULTS NT-proBNP and hsCRP were assessed in a r and om sample of 320 participants from the biomarker sub study of HF-ACTION , a r and omized clinical trial of  exercise training versus usual care  in patients with stable and chronic heart failure . Growth mixture modeling was used to identify unique biomarker patterns over 12 months . Three statistically independent and clinical ly meaningful biomarker patterns of NT-proBNP and hsCRP were identified . Two patterns were combined and compared with the " low/stable " pattern , which was characterized by the lowest levels of NT-proBNP and hsCRP over time . Participants who were taking a loop diuretic and had hypertension or ischemic etiology were ∼2 times as likely to be in the " elevated/worsening " biomarker pattern . Participants r and omized to the exercise intervention were less likely to be in the elevated/worsening pattern of NT-proBNP and hsCRP ( relative risk ratio 0.56 , 95 % confidence interval 0.32 - 0.98 ; P = .04 ) . CONCLUSIONS Exercise therapy was protective for reducing the frequency of membership in the elevated/worsening biomarker pattern , indicating that exercise may be helpful in delaying the progression of heart failure BACKGROUND Chronic musculoskeletal pain is prevalent among laboratory technicians and work-related stress may aggravate the problem . OBJECTIVES This study investigated the effect of a multifaceted worksite intervention on pain and stress among laboratory technicians with chronic musculoskeletal pain using individually tailored physical and cognitive elements . STUDY DESIGN This trial uses a single-blind r and omized controlled design with allocation concealment in a 2-armed parallel group format among laboratory technicians . The trial " Implementation of physical exercise at the Workplace (IRMA09)--Laboratory technicians " was registered at Clinical Trials.gov prior to participant enrolment . SETTING The study was conducted at the head division of a large private pharmaceutical company 's research and development department in Denmark . The study duration was March 2014 ( baseline ) to July 2014 ( follow-up ) . METHODS Participants ( n = 112 ) were allocated to receive either physical , cognitive , and mindfulness group-based training ( PCMT group ) or a reference group ( REF ) for 10 weeks at the worksite . PCMT consisted of 4 major elements : 1 ) resistance training individually tailored to the pain affected area , 2 ) motor control training , 3 ) mindfulness , and 4 ) cognitive and behavioral therapy/education . Participants of the REF group were encouraged to follow ongoing company health initiatives . The predefined primary outcome measure was pain intensity ( VAS scale 0 - 10 ) in average of the regions : neck , shoulder , lower and upper back , elbow , and h and at 10 week follow-up . The secondary outcome measure was stress assessed by Cohen´s perceived stress question naire . In addition , an explorative dose-response analysis was performed on the adherence to PCMT with pain and stress , respectively , as outcome measures . RESULTS A significant ( P < 0.0001 ) treatment by time interaction in pain intensity was observed with a between-group difference at follow-up of -1.0 ( 95%CI : -1.4 to -0.6 ) . No significant effect on stress was observed ( treatment by time P = 0.16 ) . Exploratory analyses for each body region separately showed significant pain reductions of the neck , shoulders , upper back and lower back , as well as a tendency for h and pain . Within the PCMT group , general linear models adjusted for age , baseline pain , and stress levels showed significant associations for the change in pain with the number of physical-cognitive training sessions per week ( -0.60 [ 95%CI -0.95 to -0.25 ] ) and the number of mindfulness sessions ( 0.15 [ 95%CI 0.02 to 0.18 ] ) . No such associations were found with the change in stress as outcome . LIMITATIONS Limitations of behavioral interventions include the inability to blind participants to which intervention they receive . Self-reported outcomes are a limitation as they may be influenced by placebo effects and outcome expectations . CONCLUSIONS We observed significant reductions in chronic musculoskeletal pain following a 10-week individually adjusted multifaceted intervention with physical training emphasizing dynamic joint mobility and mindfulness coupled with fear-avoidance and de-catastrophizing behavioral therapy compared to a reference group encouraged to follow on-going company health initiatives . A higher dose of physical-cognitive training appears to facilitate pain reduction , whereas a higher dose of mindfulness appears to increase pain . Hence , combining physical training with mindfulness may not be an optimal strategy for pain reduction . TRIAL REGISTRATION NCT02047669 Myofascial pain associated with myofascial trigger points ( MTrPs ) is a common cause of nonarticular musculoskeletal pain . Although the presence of MTrPs can be determined by soft tissue palpation , little is known about the mechanisms and biochemical milieu associated with persistent muscle pain . A microanalytical system was developed to measure the in vivo biochemical milieu of muscle in near real time at the subnanogram level of concentration . The system includes a microdialysis needle capable of continuously collecting extremely small sample s ( approximately 0.5 microl ) of physiological saline after exposure to the internal tissue milieu across a 105-microm-thick semi-permeable membrane . This membrane is positioned 200 microm from the tip of the needle and permits solutes of < 75 kDa to diffuse across it . Three subjects were selected from each of three groups ( total 9 subjects ) : normal ( no neck pain , no MTrP ) ; latent ( no neck pain , MTrP present ) ; active ( neck pain , MTrP present ) . The microdialysis needle was inserted in a st and ardized location in the upper trapezius muscle . Due to the extremely small sample size collected by the microdialysis system , an established microanalytical laboratory , employing immunoaffinity capillary electrophoresis and capillary electrochromatography , performed analysis of selected analytes . Concentrations of protons , bradykinin , calcitonin gene-related peptide , substance P , tumor necrosis factor-alpha , interleukin-1beta , serotonin , and norepinephrine were found to be significantly higher in the active group than either of the other two groups ( P < 0.01 ) . pH was significantly lower in the active group than the other two groups ( P < 0.03 ) . In conclusion , the described microanalytical technique enables continuous sampling of extremely small quantities of substances directly from soft tissue , with minimal system perturbation and without harmful effects on subjects . The measured levels of analytes can be used to distinguish clinical ly distinct groups & NA ;  Pain intensity is frequently measured on an 11‐point pain intensity numerical rating scale ( PI‐NRS ) , where 0=no pain and 10=worst possible pain . However , it is difficult to interpret the clinical importance of changes from baseline on this scale ( such as a 1‐ or 2‐point change ) . To date , there are no data driven estimates for clinical ly important differences in pain intensity scales used for chronic pain studies . We have estimated a clinical ly important difference on this scale by relating it to global assessment s of change in multiple studies of chronic pain . Data on 2724 subjects from 10 recently completed placebo‐controlled clinical trials of pregabalin in diabetic neuropathy , postherpetic neuralgia , chronic low back pain , fibromyalgia , and osteoarthritis were used . The studies had similar design s and measurement instruments , including the PI‐NRS , collected in a daily diary , and the st and ard seven‐point patient global impression of change ( PGIC ) , collected at the endpoint . The changes in the PI‐NRS from baseline to the endpoint were compared to the PGIC for each subject . Categories of ‘ much improved ’ and ‘ very much improved ’ were used as determinants of a clinical ly important difference and the relationship to the PI‐NRS was explored using graphs , box plots , and sensitivity/specificity analyses . A consistent relationship between the change in PI‐NRS and the PGIC was demonstrated regardless of study , disease type , age , sex , study result , or treatment group . On average , a reduction of approximately two points or a reduction of approximately 30 % in the PI‐NRS represented a clinical ly important difference . The relationship between percent change and the PGIC was also consistent regardless of baseline pain , while higher baseline scores required larger raw changes to represent a clinical ly important difference . The application of these results to future studies may provide a st and ard definition of clinical ly important improvement in clinical trials of chronic pain therapies . Use of a st and ard outcome across chronic pain studies would greatly enhance the comparability , validity , and clinical applicability of these studies OBJECTIVE To test a pathway through which a tailored , pain management education-coaching intervention could contribute to better  cancer pain control through the effects of patients ' communication about pain on physician prescribing of pain medication . METHODS Secondary analysis of data from a r and omized controlled trial that tested the effects of a tailored education-coaching intervention on pain control for patients with advanced cancer . The current analysis focused on a subset of the patients ( n = 135 ) who agreed to have their consultations audio-recorded . Patients ' active communication about pain ( e.g. , expressing questions , concerns , and preferences about pain-related issues ) was coded from audio-recordings . Change in pain medication was measured by patient self-report . Improvement in pain control was scored as the difference between baseline pain score and pain reported at 6 weeks . RESULTS Patients ' pain-related communication was a significant predictor of patient-reported changes in physician prescribing of pain medication ( p < .0001 ) and mediated the effect of baseline pain on medication change . Other predictors of change in pain medication were age ( younger ) and having participated in the intervention ( as opposed to usual care ) . Of the patients reporting adjustment in pain medications , 49 % experienced better pain control compared with only 27 % of patients reporting no change in pain management ( p < .02 ) . CONCLUSIONS Cancer patients who ask questions , express concerns , and state preferences about pain-related matters can prompt physicians to change their pain management regimen , which in turn may lead to better pain control . Future research should model pathways through which clinician-patient communication can lead to better cancer outcomes Objectives To determine if genetic variation in genes in the hypothalamic – pituitary – adrenal ( HPA ) axis , the primary stress response system , influences susceptibility to developing musculoskeletal pain . Methods Pain and comorbidity data was collected at three time points in a prospect i ve population -based cohort study . Pairwise tagging single nucleotide polymorphisms ( SNPs ) were selected and genotyped for seven genes . Genetic association analysis was carried out using zero-inflated negative binomial regression to test for association between SNPs and the maximum number of pain sites across the three time points in participants reporting pain , reported as proportional changes with 95 % CIs . SNPs were also tested for association with chronic widespread pain ( CWP ) using logistic regression reporting odds ratios and 95 % CI . Results A total of 75 SNPs were successfully genotyped in 994 participants including 164 cases with persistent CWP and 172 pain-free controls . Multiple SNPs in SERPINA6 were associated with the maximum number of pain sites ; for example , each copy of the T allele of rs941601 was associated with having 16 % ( proportional change=1.16 , 95 % CI 1.04 to 1.28 , p=0.006 ) more pain sites compared to participants with the CC genotype . SERPINA6 gene SNPs were also associated with CWP . Significant associations between the maximum number of pain sites and SNPs in the CRHBP and POMC genes were also observed and a SNP in MC2R was also associated with CWP . Associations between SNPs and comorbidity of poor sleep quality and depression explained some of the associations observed . Conclusions Genetic variation in HPA axis genes was associated with musculoskeletal pain ; however , some of the associations were explained by comorbidities . Replication of these findings is required in independent cohorts Background Psychosocial prognostic factors are important in the development of chronic pain , but treatment providers often lack knowledge and skills to assess and address these risk factors . Objective The aim of this study was to examine the effects on outcomes ( pain and disability ) in patients of a course about psychosocial prognostic factors for physical therapists . Design This study was a r and omized , controlled trial . Setting The setting was primary care practice . Participants Forty-two primary care physical therapists attended an 8-day university course ( over 8 weeks ) aim ed at identifying and addressing psychosocial risk factors . Intervention The physical therapists were r and omly assigned to either the course or a waiting list . They treated consecutive patients with acute and subacute musculoskeletal pain both before and after the course . Measurements We measured physical therapists ' attitudes and beliefs about psychosocial factors , knowledge , and skills before and after the course . We measured patients ' pain , disability , catastrophizing , and mood at the start of treatment and at a 6-month follow-up . Methods The physical therapists were r and omly assigned to either the course or a waiting list . They treated consecutive patients with acute and subacute musculoskeletal pain both before and after the course . Results Pain and disability outcomes in all patients of physical therapists who had participated in the course or in patients at risk of developing long-term disability who had higher levels of catastrophizing or depression were not significantly different from those outcomes in patients of physical therapists who had not participated in the course . Pain and disability outcomes in patients with a low risk of developing long-term disability— and pain outcomes in patients with a high risk of developing long-term disability — were not dependent upon whether the attitudes and beliefs of their physical therapists changed during the course . However , disability outcomes in patients with a high risk of developing long-term disability may have been influenced by whether the attitudes and beliefs of their physical therapists changed . Limitations A limitation of this study was that actual practice behavior was not measured . Conclusions An 8-day university course for physical therapists did not improve outcomes in a group of patients as a whole or in patients with a risk of developing long-term disability . However , patients who had a risk of developing long-term disability and had higher levels of catastrophizing or depression may have shown greater reductions in disability if the attitudes and beliefs of their physical therapists changed during the course OBJECTIVE To determine whether biomarkers of inflammation and endothelial dysfunction are associated with the development of  kidney dysfunction  and the time frame of their association . RESEARCH DESIGN AND METHODS Biomarkers were measured at four time points during 28 years of treatment and follow-up in patients with type 1 diabetes in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications ( DCCT/EDIC ) cohort . In addition to traditional biomarkers of inflammation ( C-reactive protein and fibrinogen ) , we measured  interleukin-6 ( IL-6 ) and soluble tumor necrosis factor receptors 1 and 2 ( sTNFR-1/2 ) , markers of endothelial dysfunction ( soluble intracellular adhesion molecule-1 , vascular cell adhesion molecule-1 , and E-selectin [ sE-selectin ] ) , and fibrinolysis ( total and active plasminogen activator inhibitor-1 [ PAI-1 ] ) . Renal outcomes were defined as progression to incident chronic kidney disease ( stage 3 or more severe ) or macroalbuminuria ( albumin excretion rate ≥300 mg/24 h ) . Prospect i ve multivariate event-time analyses were used to determine the association of each biomarker with each subsequent event within prespecified intervals ( 3-year and 10-year windows ) . RESULTS Multivariate event-time models indicated that several markers of inflammation ( sTNFR-1/2 ) , endothelial dysfunction ( sE-selectin ) , and clotting/fibrinolysis ( fibrinogen and PAI-1 ) are significantly associated with subsequent development of kidney dysfunction . Although some markers showed variations in the associations between the follow-up windows examined , the results indicate that biomarkers ( sTNFR-1/2 , sE-selectin , PAI-1 , and fibrinogen ) are associated with progression to chronic kidney disease in both the 3-year and the 10-year windows . CONCLUSIONS Plasma markers of inflammation , endothelial dysfunction , and clotting/fibrinolysis are associated with progression to kidney dysfunction in type 1 diabetes during both short-term and long-term follow-up
Inflammatory markers were most commonly measured followed by neurotransmitter-related genes and metabolite-detecting genes .
After exercise interventions , changes in biomarkers involved in neurotransmission and inflammation suggest a hypoalgesic exercise effect .
Significant biomarker associations were found with pain intensity , fatigue , depression , anxiety , and quality of life .
Discussion : It remains a question whether biomarkers can be used as objective measures for risk assessment , diagnosis , or evaluation or as surrogate endpoints in chronic pain .
Regardless , the potential translational value of biomarkers in chronic pain is evident .
Background : Chronic pain is highly prevalent .
Current management is challenged by lack of vali date d objective measures like biological markers .
Clinical pain studies employing exercise interventions have evaluated biomarkers ; however , it is unclear how exercise impacts biomarkers involved in pain pathways and whether these markers are associated with relevant pain-related outcomes .
This systematic review evaluates data from clinical studies employing exercise interventions in chronic musculoskeletal nonmalignant pain conditions in which biomarkers in pain pathways were measured .