All data were analyzed in SPSS Version 22 (IBM Corpora- tion, Armonk, NY, USA). Tests for normality were performed by the Kolmogorov–Smirnov test. Due to violations of the assumptions of normally distributed data for pain, stress, and questionnaire data, we used nonparametric statistics for correlation analysis (Spearman correlations) and for the group by trial analysis (Friedman test). Pairwise Wilcoxon tests were used for comparisons of trials within groups. Mann–Whitney U-tests were employed to test the differ- ences between the groups at each trial. A P-value ,0.05 was considered significant for the analyses except the group comparisons in the repeated measures of pain and stress data where Bonferroni corrections were employed to correct for multiple comparisons (P,0.05/three trials [Pretest, Post- test 1, Posttest 2] = P,0.0167). To test the hypothesis that fear of pain produces increased levels of stress that in turn causes increased pain, we performed a mediation analysis. 29,30
and several other countries. However, one could realize that despite the difference of sample, we found similar results than those reported in the study of the author ’ s scale with subjects recruited at a tertiary pain clinic. 4,23 Fourth, mostly mothers completed the parent ’ s measures in this study, which might be a limitation of the current study, since extensive literature has shown differences between sex in pain perception and the emotional reac- tion to pain. 58 Thereby, we can consider that the response to confrontation of avoided activities due to pain and reengagement with activities of daily living change according to mothers ’ or fathers ’ perception. Fifth, the study is based on self-reported measures. Thus, the comprehension of the content of the assess- ment instruments may have implications for the internal validity of the survey as there may be an overlap in the constructs measured in the study. Finally, further long- itudinal studies are required with a more signi ﬁ cant number of clinical samples and their parents to examine how prior parent fears and avoidance behaviors in ﬂ u- ence subsequent child avoidant behaviors and outcomes. This survey provides evidence for the consistent psychometric properties of the BrP-FOPQ-A and BrP- FOPQ-P. It demonstrates good discriminative proper- ties, and the validity of BrP-FOPQ-A was con ﬁ rmed by its positive correlation with depressive symptoms, emotion and conducts problems, physical and psycho- social functioning due to their physical health and a biological marker of neuroplasticity (ie, BDNF). Therefore, these results suggest that both scales repre- sent valuable instruments for use in scienti ﬁ c studies and in the clinical setting involving early adolescents prone to develop chronic pain or institute therapeutic approaches to improve the negative feelings related to fear of pain.
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Several studies have postulated that the relationship between AS and fear of pain could be explained by attentional processes. Reiss, Peterson, Gursky, & McNally (1986) were the first to propose that high AS may be characterized by hypervigilant self-monitoring of internal physical sensations. Moreover, AS is related to cognitive biases toward physically threatening and pain-related stimuli (Keogh, Dillon, Georgiou, & Hunt, 2001; Stewart, Conrod, Gignac, & Pihl, 1998). Asmundson, Kuperos and Norton (1997) found that individuals with chronic pain and low AS were able to shift their attention away from stimuli related to pain, in contrast to the subjects with high AS. Keogh and Cochrane (2002) found that the tendency to negatively interpret ambiguous bodily sensations related to panic mediated the association between AS and emotional responses to cold pressor pain. Of note, AS was still related to affective pain scores when controlling for fear of pain.
the CPM protocol measured pain ratings for a test stimulus (5 seconds of pressure to the left thumbnail) when it was administered: alone (TS1); during a conditioning pain stimulus (30 seconds of cold water immersion of the right hand, TS2); 15 seconds after termination of the conditioning pain stimulus (TS3); and 50 seconds later (TS4). Pain rat- ings using the 0–10 NRS were made immediately following administration of each test stimulus. For the test stimulus, pressure stimuli were applied to the fixed thumbnail of the left hand using a 1 × 1 cm hard rubber probe. The rubber probe was attached to a hydraulic piston, which was con- trolled by a computer-activated pump to provide repeatable pressure-pain stimuli of rectangular waveform. 23 The amount
Somatic or psychiatric disorders and use of prescription-based medications or allergy medications led to exclusion from participation. Pregnant women were excluded. Participants were instructed to abstain from use of nicotine- and caffeine- containing substances 3 hours before participation. The participants had to speak Norwegian as Norwegian language was used in the questionnaires, instructions, consent and mea- surements of pain, stress and activation collected in the experi- ments. Data from seven different study samples were pooled. All participants filled in the FPQ-III and an informed consent form. The studies were approved by the Regional Committee for Medical Research Ethics North Norway (project numbers: 2013/966, 2012/1888, 2610.00001, 49/2005, 5.2006.2452; 20277, 17/2006).
FPQ-III is utilized to measure FOP in healthy individuals. The finding of less pronounced sex differences on the subscales with less serious outcomes, again raises the question if higher levels of anxiety in females than in males might influence the Severe Pain subscale. Sex differences in interpretations of possible consequences from the presented situations may explain this finding. Furthermore, specificity of some of the FPQ items could improve the ability to measure FOP equally in healthy males and females. Exchanging items where large sex differences are expressed, with other items describing situations where severe pain is involved, might improve the FPQ-III’s ability to measure FOP more equally in males and females. As previously mentioned, most healthy individuals have no experience with or relation to serious accidents or injuries, such as one may expect after a car accident or breaking the neck. It may be argued that the Severe Pain sub- scale does not present situations exclusively related to pain infliction. Inclusion of items presenting other pain involving situations may be more appropriate in relation to measure- ments of pain and FOP. A possible way of further developing the FPQ-III could be to exchange some of these items with other items that healthy participants more easily can relate to. This may be situations involving moderate-to-high levels of pain, such as postoperative pain, migraine, appendicitis, urinary infection, pyelitis, dislocation of a shoulder, elbow or knee, and tooth pain.
theory-driven hypotheses to better understand the mechanisms through which pain-related fac- tors operate, components of a risk-resilience model for adult chronic pain were tested in youth with chronic pain. This study specifically assessed sustainability as a resilience outcome since this construct is commonly examined in pediatric psychology research using validated measures. Furthermore, given the extensive literature assessing psychosocial risk factors predictive of mal- adaptive pain-related outcomes, it is essential to begin investigating positive psychological con- structs that promote resilience, such as dispositional optimism, particularly within the understud- ied field of pediatric chronic pain. As mentioned previously, it is also imperative to determine the predictive value of related vulnerability constructs by simultaneously assessing their unique variance in pain outcomes. Therefore, this study aimed to examine the applicability of prominent risk factors, including pain catastrophizing and fear of pain, as well as the resilience factor of dispositional optimism, on pain-related disability and quality of life in a sample of pediatric chronic pain patients. Findings will provide implications for methods of decreasing risk factors and enhancing resilient functioning through pain management interventions.
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Participants reported a range of avoidance behaviors, af- fecting the face, since the onset of TN. Fear of pain episodes prevented participants from engaging in aspects of personal care, which they had experienced as pain stimuli (ref 9 and 10). Other participants, however, expressed the attitude that they would continue trying to lead their lives as normal, even with the potentially disruptive nature of their illness (ref 11). Despite being determined to continue as normal, participants were forced to make adjustments in important areas of their lives. Eating presents a major problem in TN and participants’ reports highlighted a dilemma which placed them between needing to avoid chewing—in order to prevent pain—and patterns of disordered food and drink consumption, which put participants at risk of nutrient deficiency. While one par- ticipant relied on liquidized food, another adopted an extreme- ly restricted diet (ref 12). Other participants reported including alcohol in their diet, to self-medicate and to help them cope with the pain (ref 13). Participants’ difficulty eating, while in pain, was revealed as anxiety-provoking and as having impli- cations for wider social interaction (ref 14).
(66) = 730.32, p < 0.001) showing that the data was appropriate for the PCA. Items that loaded 0.3 or greater on each factor were retained within that factor. Both the scree test and eigenvalues of 5.11, 1.66, 1.50, and 1.45 indicated a four-factor solution and explained 50.2% of the total variance. The factors were labelled as follows with the explained variance in parentheses: 1 cognitive anxiety (26.60%), 2 fear of pain (7.29%), 3. escape/avoidance (7.72%), and 4. physiological anxiety (8.58%). Inspection of the Promax rotation showed that each factor was comprised of five items which were consistent with the theoretical con- structs of the original PASS-20 subscales. Additionally, initial item communalities (h 2 ) were moderate, ranging from 0.39 to 0.66  and at least half of the items of each factor had a factor loading of 0.60 or greater, which supported the factor stability of the Arabic PASS-20. However, item 10, BI try to avoid activities that cause pain,^ showed  h 2 of 0.17 and a loading of 0.25, but it was not excluded from the final Arabic PASS-20. The results of the CFA for the Arabic PASS-20 are shown in Table 3. The χ 2 /df, CFI, IFI, RMSA, and ECVI values indicated a better fit for the healthy group compared with the pain patients.
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al also proved that doing neck stabilization exercises and maximal isometric exercises increase the cross sectional area of deep neck muscles, reduces pain and disability. However, stabilization exercises were more effective when it comes to reducing pain and disability and increasing cross sectional area than the maximal isometric exercises (24) . We have also shown that stabilization exercises can reduce the pain, fear of pain and movement and increase range of motion of patients with chronic neck pain and in most cases, the variables under study are more effective than neuromuscular facilitation exercises. Aker also systematically reviewed the efficiency of conservative treatments for treating mechanical neck disorders. Many of the mechanical neck disorders treatment methods have not received the support they need by clinical trials (25). In a systematic review, Kay evaluated the efficiency of exercises in reducing pain and fear of pain and in improving disability and function in patients with mechanical neck disorders and showed that specific exercises might be effective in treating chronic and severe mechanical neck disorders (26). Bronfort, in a study, concluded that strength training exercises, along with manual treatment or separately, are more effective in improving pain and fear of pan in patients suffering from chronic neck pain than manual treatments alone (27).
Catastrophizing is associated to occurrence and maintenance of magnified pain threshold, pain is related to worry and fear which leads to inability in diverting attention away from pain due to which psychological distress are supposed to be high irrespective to any type of discomfort. Fear of pain is a characteristic feature which describes a maladaptive cognitive expression by sufferers with anxiety and depressive symptoms. Catastrophizing pain has been interpreted as an emotional variable as fear of pain and has been defined as highly negative expressive reaction to pain eliciting stimuli involving a high degree of mobilization for avoidance behavior which inversely reduces the quality of life. The Aim of the present study was to evaluate susceptibility of catastrophizing pain among male and female sufferers. Moreover, this paper discriminates between those who authentically perceive pain to that who catastrophize. Moreover, find out reasons behind that catastrophizes suffer heightened pain experiences and increased emotional distress and how do we conclude whether pain in the absence of peripheral pathology is ‘real’ or not. In a cross sectional study, 140 individuals have been enrolled from general population who have been suffering from any type of chronic pain with exception of Menopausal women, Cardiovascular diseases, Nephropathy and cancer, and acceptance of age between 18 to 50 years. For evaluation multistage random selection procedure have been performed by governing questionnaire to examine their pain duration, intensity, frequency, and degree of multi psychological feeling using pain catastrophizing scale of Michael JL Sullivan. The results indicated a manipulative behavior in expression of pain or discomfort more common among females than males. This might be due to many psychosocial constraints that in turn exaggerate the catastrophizing of pain reporting and emotional instability in females. By discriminating between true and fake point of view in pain it was concluded that Pain catastrophizing in most of the individual found to be pre-existing trait of mindset due to their daily practices on the other hand it was observed that small ratio of females who reported low worst pain intensity with less catastrophized comparatively some of the proportion of females reported high degree of worst pain with high catastrophizing the inverse factors between them was emotional frustration, which was low in fake pain preceptors this is because people may not undergo emotional frustration after exploring exaggerated pain behavior to seek attention.
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when compared to psychopaths. Considering every individual possesses psychopathic traits to different degrees, and that psychopaths are at the far end of the continuum of psychopathic traits, a pilot study in a healthy sample may be sufficient to provide preliminary results regarding the correlation between higher psychopathic traits and response towards fear of pain variables (Berg et al., 2013). Hence, the purpose of this pilot study is to establish a paradigm for a future study assessing how psychopathic individuals react towards pain in terms of fear- related constructs, such as anxiety, pain catastrophizing, and threat. Furthermore, the design of the current study should take fear conditioning of psychopaths into consideration. Based on previous work (Hare, 1966), participants were given the choice to start a pain stimulus immediately or after a 10 second countdown over the course of 20 trials. After every 5 trials, participants' perception of fear-related variables such as fear of pain, pain intensity, and threat of pain was assessed. The temperature was set to increase after every trial in order to reduce habituation and to increase fear of pain.
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Back pain is the most common reason for people in Denmark visiting general practitioners (GPs)  and it is responsible for more years lived with disability worldwide than any other condition [16, 17]. The societal, health care and economic burden associated with back pain is high and comparable to conditions such as cardiovascular dis- ease, cancer, mental health, and autoimmune diseases . In Denmark, every tenth visit to a GP and every third visit to a chiropractor or physiotherapist is due to back pain . Almost one in five patients consulting a Danish GP for back pain has severe persistent pain . Single episodes of back pain usually resolve quickly but recurrent episodes are very common [20–23]. Patients with persist- ent back pain describe the condition as negatively affect- ing their lives, leaving them disempowered, and that the outcomes of consultations with health care professionals are often inadequate . Further, half of the patients attending a GP due to back pain believe that they need imaging . There is an obvious need to reduce the burden of back pain both in terms of the disability and poor quality of life experienced by people who live with severe back pain and in terms of the substantial costs to society.
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Objectives To identify relevant change mechanisms, meaning changes in process variables through treatment predicting outcome in the treatment and prevention of chronic low back pain. There are effective interventions for the treatment and secondary prevention of chronic low back pain. However there is a lack of knowledge concerning the interrelationship between changes in treatment process variables and changes in outcome. It would be essential to know which components are clearly associated with a positive outcome. Knowing which variables influence treatment outcome would help refining treatments, so that they become more effective and economic. Part 1 is a systematic review that evaluates, which changes in treatment process variables predict outcome of exercise, behavioural and multimodal treatment of chronic low back pain. Part 2 analyses relevant treatment processes in an exercise versus a multidisciplinary secondary prevention program for low back pain, in order to identify prognostic factors for a successful intervention.
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Jessica was a 15-year-old girl. She was described as an anxious child. She had been shy and a quiet girl in kindergarten, but blended well with her classmates in grade 7 and also started making friends and succeeding academically. She experienced severe abdominal pain several times that was worst in the morning and not present in the night. Because of which she had to miss her school many times during the previous year. She would also complain about muscle pain and fatigue. She would avoid school trips fearing the bus would crash. She also had sleeping issues and asked her parents about their reassurance multiple times.
Lack of knowledge about MHM was a source of anx- iety among the girls in this study, and this can lead to inadequate menstrual hygiene management (e.g. to pre- dict onset of next period) [19, 27, 28]. Confidence in managing menstruation was undermined by disengage- ment of guardians, and lack of access to adequate pro- tection methods, due mainly to poverty. Further work should explore whether improved puberty education and the use of a diary decreases leaking by improving predic- tion of the next due date. The role of the parents was clear from both qualitative and quantitative studies with mothers being the primary source of information on menstruation, and higher rates of menstruation-related absenteeism among maternal orphans. This, together with the stigma and fear of teasing from boys, teachers and other school staff highlights the importance of im- proving knowledge and discussion of puberty and men- struation in the schools, families and community. Few
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Results: One hundred sixteen potentially useful instruments were initially identified in the review, measuring pain severity, psychological distress, functional capacity, quality of life or multidimensional constructs of persistent pain. Following a series of steps, 45 instruments were shortlisted, with sound clinical utility and strong psychometric properties. Of these, 16 instruments were appropriate to primary health care settings because of simple wording, brief items, short administration time, and ease of scoring.
control while the current study investigated position control. Force control differs from position control in several important parameters such as muscle coactiva- tion , reflex responsiveness to afferent feedback , recruitment pattern of the motor unit pool , and joint stiffness . Hence, the results of force control studies cannot directly be compared with our results, but are rather used as an indication of system stability in chronic pain conditions. It should also be noted that various chronic pain conditions may differ in terms of the possible effects on motor control characteristics, making generalization of findings across conditions diffi- cult. Nevertheless, both our and the previous studies re- ferred to above indicate that isometric limb stability is only mildly influenced by FM or other chronic musculo- skeletal pain conditions.
Abstract: Contemporary societies are currently subjected to very rapid and radical social changes and, as a consequence, struggle with their outcomes. The results range from the unforeseen repercussions of globally shifting political powers, through rising nationalisms, to prolonged economic, environmental, political and humanitarian crises. Critical analysis of the theories focused on the phenomena of authoritarianism, escapism, political myth, and conformity allows for outlining a comprehensive picture of the universally recognized opposition between freedom and security. From the distinction between the positive and negative freedom to the ambiguity surrounding the concept of “freedom from fear”, the fundamental dilemma is viewed from a historical perspective and illustrated with modern examples, emphasizing its current validity, insightfulness and potential in analyzing con- temporary global problems. This approach allows for in-depth analyses of diversified social and political issues, such as the North African-European refugee crisis, rising nationalisms in the Western world, or a marked shift in political and social perspectives worldwide, from modern escapism to the birth of new myths of state.
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We performed a systematic search using relevant data- bases including Medline (PubMed 1980–2012), Psy- cINFO (EBSCO 1980–2012), and CINAHL (EBSCO 1981–2012). We manually searched related reviews and studies’ reference lists. We used a wide range of key- words to ensure including most of the studies that per- tained to our aim. In our search, we combined keywords related to back pain and/or sciatica, disc herniation, surgery to remove herniation, and FAM factors with “AND” search query (detailed search’s keywords is dis- played below). We included studies that fit our inclusion criteria (Table 1).