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Defeating the stigma of chronic pain

Amanda C. de C Williams
2016 Pain  
De Ruddere and Craig, in their Topical Review [6], describe the stigma applied to and felt by people with chronic pain in a psychosocial context: as deviance from expected behaviour, both in medical settings  ...  A C C E P T E D unchanged. Using clinicians' report of gaps in understanding and in treatment options, De Ruddere and Craig make a good argument for better pain education.  ...  A C C E P T E D  ... 
doi:10.1097/j.pain.0000000000000530 pmid:26934511 fatcat:gdrcncgtyfh5dehd7y5vpstxpa

Updating the definition of pain

Amanda C. de C. Williams, Kenneth D. Craig
2016 Pain  
A C C E P T E D it is both a sensation and an emotional experience.  ...  A C C E P T E D importance of attending to pain in people unable to make self-report [14] .  ... 
doi:10.1097/j.pain.0000000000000613 pmid:27200490 fatcat:yg4k4ltzmfbnfji55ua23q7uta

"Well, I wouldn't start from here"

Stephen Morley, Amanda C de C Williams
2015 Pain  
doi:10.1097/j.pain.0000000000000183 pmid:25851459 fatcat:lj3fyrnryfahxe2qa5gtzqzuha

Pain from torture

Kirstine Amris, Lester E. Jones, Amanda C de C. Williams
2019 PAIN Reports  
Survivors of torture are for many reasons at particularly high risk for inadequate assessment and management of pain. Among the many health problems associated with torture, persistent pain is frequent, particularly pain in the musculoskeletal system. The pathophysiology underlying post-torture pain is largely unknown, but pain inflicted in torture may have profound effects on neurophysiology and pain processing. A narrative review of assessment and treatment studies, informed by clinical
more » ... ence, was undertaken. The clinical presentation in survivors of torture shares characteristics with other chronic primary pain syndromes, including chronic widespread pain. Unfortunately, such pain is often misunderstood and dismissed as a manifestation of psychological distress, both in specialist psychosocially oriented torture services and in mainstream health care. This means that pain is at risk of not being recognized, assessed, or managed as a problem in its own right. The available research literature on rehabilitation for torture survivors is predominantly targeted at mental health problems, and studies of effectiveness of pain management in torture survivors are lacking. Rehabilitation is identified as a right in the UN Convention on Torture, aiming to restore as far as possible torture survivors' health and capacity for full participation in society. It is therefore important that pain and its consequences are adequately addressed in rehabilitative efforts. This article summarizes the current status on assessment and management of pain problems in the torture survivor.
doi:10.1097/pr9.0000000000000794 pmid:31984299 pmcid:PMC6903341 fatcat:ahpzyj6yvba5vnu7o6m5ir4kbu

What can evolutionary theory tell us about chronic pain?

Amanda C. de C Williams
2016 Pain  
It is 150 years since Darwin published On the Origin of Species, but his insights and the others that followed are underused in the study of pain. An understanding of evolutionary processes could help us frame questions and interpret data more coherently, and could provide a translational framework across research endeavors. Common misconceptions about how natural selection operates are widespread; conditions that cause suffering-often painful diseases-are presented as unanswerable challenges
more » ... evolutionary theory but genes spread when they confer reproductive advantages, or confer survival advantages, or both, not because they guarantee health and happiness. 6 Some of those advantages applied in our ancestral environment but not in our current environment; some came with disadvantages which did not outweigh the advantages (in the ancestral environment). In the field of pain, an explicitly evolutionary framework is rare in developing models or investigating behavior, with some notable exceptions. 21,31,32 Pain research (and medical research in general 25 ) largely targets questions concerning mechanisms rather than those concerning function, in contrast, for instance, to research on social behaviors such as empathy and altruism. 26 Over evolutionary time, injuries from predatory attacks, intraspecies conflict and environmental hazards represent a threat to survival and thus lie at the cutting edge of selection pressures. How can we account for our behavior in relation to injury and pain, and the behavior of animals that we use in pain research? The emotional dimension of pain, established in the IASP definition 13 and given prominence in some models of pain 5,32 and in some clinical settings, is often neglected in nonhuman animal research, despite striking commonalities of behavior. 4,19,21 Emotions, not least negative ones, can be conceptualized as serving to organize and guide goal-directed action, particularly when goals conflict. 24 The relative neglect of motivation in animals obscures possible continuities in behavior, yet across studies of pain in nonhuman animals (albeit very unevenly covered), such as cephalopods, crustaceans, fish, and particularly in farmed animals and laboratory rodents among mammals, 1,28,32 patterns of behavior are described post-injury. The behaviors are: reduced foraging and exploratory activity, sparing or guarding the injured area or limb, and memory for and avoidance of cues associated with the injury. 32 Those working with invertebrate models in particular, such as Aplysia eg, Walters and Moroz 33 or crustaceans eg, Dyuizen et al. 9 , emphasize evolutionarily conserved mechanisms and genes across phyla. Behavior is very hard to reconstruct from fossil evidence, yet natural selection often acts directly on behavior, which in turn arises from the physiological, cognitive, and emotional phenotype of the animal in question and ultimately from its genotype. The parsimonious assumption must be that not only anatomy and physiology are the result of natural selection but behavior also. 29
doi:10.1097/j.pain.0000000000000464 pmid:26683235 fatcat:xdp6ebi3nrg4vhbizgxlluwweu

Facial expression of pain: An evolutionary account

Amanda C. de C. Williams
2002 Behavioral and Brain Sciences  
C.  ...  Amanda Williams has shared a wide-ranging evolutionary perspective on the sources of facial expressions that commonly accompany pain, and the associated psychological-communicative processes that, she  ... 
doi:10.1017/s0140525x02000080 fatcat:7fma26fbqfaalfcdlg64i5lbbu

The psychological impact of torture

Amanda C de C Williams, Jannie van der Merwe
2013 British Journal of Pain  
Many refugees in the developed world are survivors of torture and present with health needs without their traumatic experience being disclosed or identified. Chronic pain is a common problem, as are symptoms of post-traumatic stress disorder (PTSD), anxiety, depression, and other distress. Current circumstances, particularly poverty, uncertainty about asylum, separation from or loss of family and roles, and difficulties settling in the host country, all contribute to current psychological
more » ... ms and exacerbate existing ones. Psychological treatment studies tend to be focused either on PTSD diagnosis and use protocoldriven treatment, usually in the developed world, or on multiple problems using multimodal treatment including advocacy and welfare interventions, usually in the developing world. Reviews of both of these, and some of the major criticisms, are described. Psychological interventions tend to produce mediumsized changes in targeted measures of distress, when compared with waiting lists or standard treatment, but these may fall well short of enabling recovery, and long-term follow-up is rare. A human rights context, with reference to cultural difference in expressing distress and seeking help, and with reference to the personal meaning of torture, is essential as a basis for formulating treatment initiatives based on the evidence reviewed. Summary points • Refugees with a history of torture may have a wide range of psychological and social difficulties which do not easily fit within diagnostic categories. • Torture and its sequelae can have multiple meanings and, in the clinical context, it is the interpretation of the torture survivor that matters. • There are doubts about applying the concept and measures of post-traumatic stress disorder: symptoms should be assessed separately. • Current circumstances can be as important as trauma history in understanding the psychological state of a torture survivor. • Cognitive behavioural therapy and narrative exposure therapy seem equally effective in reducing trauma symptoms, and to a lesser extent, depression.
doi:10.1177/2049463713483596 pmid:26516507 pmcid:PMC4590125 fatcat:pp6zbrgdjjfflfe5456hlzlake

The relationship between guarding, pain, and emotion

Temitayo Olugbade, Nadia Bianchi-Berthouze, Amanda C de C. Williams
2019 PAIN Reports  
Pain-related behavior in people with chronic pain is often overlooked in a focus on increasing the amount of activity, yet it may limit activity and maintain pain and disability. Targeting it in treatment requires better understanding of the role of beliefs, emotion, and pain in pain behavior. This study aimed to clarify the interrelationships between guarding, pain, anxiety, and confidence in movement in people with chronic pain in everyday movements. Physiotherapists rated extent of guarding
more » ... n videos of people with chronic pain and healthy controls making specific movements. Bayesian modelling was used to determine how guarding was related to self-reported pain intensity, anxiety, and emotional distress, and observer-rated confidence in movement. The absence of guarding was associated with low levels of pain, anxiety, distress, and higher movement self-efficacy, but guarding behavior occurred at high and low levels of each of those variables. Guarding was not directly dependent on pain but on anxiety; the relationship between pain and guarding was mediated by anxiety, with a high probability. Nor was guarding directly related to the broader distress score, but to self-efficacy for movement, again with a high probability. Pain-related guarding is more likely to be effectively addressed by intervention to reduce anxiety rather than pain (such as analgesia); more attention to how people move with chronic pain, rather than only how much they move, is likely to help to extend activity.
doi:10.1097/pr9.0000000000000770 pmid:31579861 pmcid:PMC6728010 fatcat:jlc3f27pzja2vizfwgbfn34nii

Civil discourse in scholarly communications

Kenneth D. Craig, Amanda C de C Williams, Kanwaljeet J.S. Anand
2020 PAIN Reports  
Although the task force has not provided a rationale, its revision of the IASP definition is consistent with the Williams and Craig 5 observation that methods for assessing pain need not be specified in  ...  By contrast, Williams and Craig 5 noted that a substantial research literature now demands recognition of cognitive and social features that constitute defining qualities of all pain experiences, not only  ... 
doi:10.1097/pr9.0000000000000811 pmid:32441703 pmcid:PMC7209819 fatcat:4jy3py5ti5eojbjq6k6ndg5ube

Social interaction in pain: Reinforcing pain behaviors or building intimacy?

Annmarie Cano, Amanda C. de C. Williams
2010 Pain  
Cano and de C. Williams | 2010 4 However, the potential range of verbal communications is broad.  ...  Cano and de C. Williams | 2010 8 In pursuing this work, researchers must continue to consider the context of interaction.  ... 
doi:10.1016/j.pain.2009.10.010 pmid:19892466 pmcid:PMC2834842 fatcat:2zv4p2gprnaknkf7lmnqrhsglu

Health care providers' judgments in chronic pain

Gráinne Schäfer, Kenneth M. Prkachin, Kimberley A. Kaseweter, Amanda C. de C Williams
2016 Pain  
A C C E P T E D A C C E P T E D A C C E P T E D A C C E P T E D A C C E P T E D A C C E P T E D (see supplemental file 1 for details, available online as Supplemental Digital Content at http:  ...  A C C E P T E D A C C E P T E D Discussion This study investigated the effects of five variables on pain estimates, judgements about pain expression, and treatment decisions, of medical students and  ... 
doi:10.1097/j.pain.0000000000000536 pmid:26934512 fatcat:vwvmho7ksra4tcwvus7pn5ufha

Persistent pain: not a medically unexplained symptom

Amanda C de C Williams, Martin Johnson
2011 British Journal of General Practice  
Williams and Johnson acknowledge that even in the pain management field, better understanding of underlying mechanisms has not yet led to the introduction of an array of effective treatments.  ...  INTRODUCTION Williams and Johnson present a strong argument against seeing chronic pain as an example of somatisation or as a medically unexplained symptom. 1 They are concerned that such perspectives  ... 
doi:10.3399/bjgp11x601479 pmid:22152842 pmcid:PMC3177126 fatcat:pr5mwjgsgjbpjbbcjdc6hsz7cq

Pain expressiveness and altruistic behavior

Amanda C. de C Williams, Elizabeth Gallagher, Antonio R. Fidalgo, Peter J. Bentley
2016 Pain  
The 5 cost and benefit parameters, cost of expression c exp , cost of altruistic behavior c alt , cost to connectedness of nonaltruistic behavior c self , benefit of altruistic behavior b alt , and time  ...  Key: b alt , energy benefit of being helped when injured, 0 to 1, default 0.5; c alt , energy cost of helping (altruism), 0 to 20; c exp , energy cost of expressing pain, 0 to 20; c self , cost to connectedness  ... 
doi:10.1097/j.pain.0000000000000443 pmid:26655734 pmcid:PMC4751745 fatcat:swvfcxmlhjfm7kixmmn2ke5q5m

How do people understand their neuropathic pain? A Q-study

Sally Martin, Clare Daniel, Amanda C. de C. Williams
2014 Pain  
Neuropathic pain (NP) is not easy to understand for those with the diagnosis. Even in specialist medical services, explanation may not be given or may not be integrated with patients' existing beliefs about their conditions. We were curious about how people with NP conceptualised the problem. Web sites relevant to NP were used to recruit 79 people with NP. They were sampled using Q-methodology, which requires sorting according to degree of agreement or disagreement with diverse statements about
more » ... NP, derived from the widest possible range of sources. The sets of sorted statements are analysed for factors which represent shared constructions. The four factors that we found differed in important ways: (1) identification of nerve damage as cause; (2) the necessity of identifying cause; (3) the acceptability of symptomatic treatment; (4) the existence or not of psychological influences; and (5) the usefulness of psychological treatment. The meaning of these factors was extended by participants' free comments: certain viewpoints showed associations with their medical and treatment histories and with the interference of pain with daily life. Overall, a biopsychosocial model of pain was only weakly represented, and no integrated model of pain emerged across the four different accounts. There was little reference to NP having been explained when the diagnosis was made. This study highlights the need for more accessible explanations of NP within and outside medical services if people with NP are to use their understanding of NP to help them manage their pain and reduce its impact on their lives.
doi:10.1016/j.pain.2013.10.021 pmid:24161663 fatcat:yr5xzlwn3re53k7wea6bvgtl7u

Facial expression of pain: an evolutionary account

Amanda C de C Williams
2002 Behavioral and Brain Sciences  
C.  ...  Amanda Williams has shared a wide-ranging evolutionary perspective on the sources of facial expressions that commonly accompany pain, and the associated psychological-communicative processes that, she  ... 
pmid:12879700 fatcat:ilm5p2wlfffczcfamsdjsfrjgq
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