Year: 2005-06 (current)

Summary: Recent evidence from cross-sectional studies suggests that the observed age-related increase in the prevalence of persistent pain does not go beyond the seventh decade of life, but longitudinal studies are needed to disentangle the influence of cohort effects from that due to ageing. The present study examined the frequency and severity of pain complaints in a sample of community-dwelling adults aged over 65 years over a 6-year period A total of 796 older people were assessed for pain on three separate occasions over six years. Findings show that at baseline, 34 per cent of participants reported experiencing a persistent pain complaint at least once or twice in the preceding year. However, during the study 21 per cent remained pain free, 33 per cent reported an increase in pain frequency and only 11 per cent reported less pain.

These findings suggest that the prevalence of pain increases over time, becoming 1.3 times more frequent and intense per decade. The greatest rate of change was evident in older participants and those having an initial low level of pain.

Year: 2005-06 (current)

Summary: TPhantom limbs are perceived sensations in the part of a limb that has either failed to develop (congenital limb deficiency) or has been amputated (acquired limb loss). Phantom sensations are unique for each person and differ in the perceived size, shape, position and posture (kinaesthetic properties); the ability to move the phantom (kinetic); and the ‘external’ feelings of pressure, touch, temperature, itch and vibration (exteroceptive). Many amputees also perceive their phantom limb to be painful. For example, it may feel to be burning, cramped or have stabbing pains.

We recently showed that high levels of depression and anxiety at the time of amputation could influence the onset and maintenance of phantom pain sensations over a six-month follow-up period. However, we still lack a consistent understanding of how and why phantom limb experiences (including pain) differ widely in people. The present study aims to extend our previous work by examining the potential reasons for the high variability in:
. The incidence, duration, intensity and frequency of phantom limb sensations (painful and non-painful);
. The kinaesthetic, kinetic and exteroceptive qualities of phantom limb sensations, and
. The mood, coping and level of disability experienced in association with phantom limb sensations.

Summary: There is a well-documented association between mood state, particularly levels of anxiety, and the reported severity of clinical pain. The present study is using a learning-conditioning paradigm to systematically manipulate psychological factors, including beliefs and levels of anxiety. We have shown that an experimentally induced increase in anxiety is accompanied by higher subjective ratings of painful stimuli with a more rapid nociceptor response in the presence of anxiety. This may suggest a descending modulatory influence of anxiety on nociceptive processing that extends into the periphery. These experiments provide important new insight into the way in which psychological factors might modify pain transmission.

Summary: This project will explore the levels of self-reported pain, mood, activity and coping strategy use in older patients with differing levels of medical co-morbidity. The effect of medical co-morbidity on patient outcome after attendance at the NARI/MECRS multidisciplinary pain management service will also be investigated.