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1

Effects of stress on pain threshold and tolerance in children with recurrent abdominal pain  

Microsoft Academic Search

Models of stress-induced hyperalgesia state that exposure to stress can exaggerate subsequent pain experiences. Studies using both animal and human subjects have shown evidence for hyperalgesia as a function of stress [e.g., Jorum E. Analgesia or hyperalgesia following stress correlates with emotional behavior in rats. Pain 1988;32:341–48; Peckerman A, Hurwitz BE, Saab PG, Llabre MM, McCabe PM, Schneiderman N. Stimulus

Lynette M. Dufton; Brian Konik; Richard Colletti; Catherine Stanger; Margaret Boyer; Sara Morrow; Bruce E. Compas

2008-01-01

2

Effect of GaAs Laser at 904 nm in the Pain Threshold in Tibia and Tolerance in Deltoid Evaluated by Pressure Algometry  

NASA Astrophysics Data System (ADS)

The use of LLLT in pain relief is a controversial issue in Physiotherapy, with the efficacy of LLLT associated to pain relief still requiring significant study. Objective. This work focuses on the evaluation of the effect of low power GaAs laser at 904 nm in pressure pain threshold and tolerance in tibia and deltoid muscle, respectively. A total of 17 subjects were divided in two groups: active and sham laser. Measurements were taken before and after laser irradiation in healthy individuals using a pressure algometry, first verifying the viability of algometry to evaluate the pain threshold and tolerance inter individuals and comparing the differences of right and left sides in the same patients, and finally evaluating the pain threshold and tolerance before and after a single laser application. Laser energy density was of 4.0 J/cm2 with power density of 137 mW/cm2. Comparing algometry values of active laser group and the sham group, the pain tolerance in the deltoid muscle did not change among groups after laser irradiation, while it was also encountered a statistically significant difference in the pain threshold in tibia when comparing the laser active and sham laser (p<0.05). It was found that the active laser was effective in maintaining the pain threshold in tibia. The effective laser action in raising the pain threshold in tibia upon healthy individuals can suggest that the laser could be applied not only as curative but also with preventive purpose.

Soares, Luiz G. P.; Sato, Sidney K.; Silveira, Landulfo; Aimbire, Flávio; Moreira, Leonardo M.; Pinheiro, Antônio L. B.

2011-08-01

3

Assessment of pain threshold in haemophilic patients.  

PubMed

Many patients with haemophilia (PWH) live with persistent end-stage arthritis, as a result of multiple joint haemarthrosis, and experience daily pain. For these people, pain becomes a central aspect of life. The aim of this study was to use mechanical pain thresholds (MPT) to characterize pain perception in different PWH groups. The groups tested were characterized by age, previous bleeding into joints, Hemophilia Joint Health Score (HJHS) and PAIN perception score in the HJHS scoring. A total of 23 PWH (haemophilia A) were included in this study (10 children, 13 adults). A total of 12 PWH suffered from repeated bleeding into some of the tested joints. Data were compared to those collected from 15 age-matched control subjects. The most significant differences in MPTs were found when the PWH were compared to the controls, based on the differences in PAIN score (PAIN score 1 and 2) in all the tested joints, except for the right knee. Similarly, the difference in MPT in ankle joints was confirmed when PWH with and without bleeding were compared to controls. Summarizing the outcomes, we can emphasize the potential usefulness of MPT as an objective tool in evaluating the pain of PWH. PMID:24533950

Teyssler, P; Kolostova, K; Bobek, V

2014-03-01

4

Tactile threshold and pressure pain threshold during treatment of orofacial pain: an explorative study.  

PubMed

The aim of the present study was to evaluate the pressure pain threshold (PPT), tactile threshold (TT) and pain intensity as measured on a Visual Analogue Scale (VAS) in patients with pain in the orofacial region. Twenty-six patients with myogenous pain (7 ss), myogenous and capsular pain (11 ss) or neuropathic pain (8 ss) participated in the study. At baseline, the PPT was evaluated using an algometer and the TT using von Frey hairs. In addition, the pain intensity was rated on a VAS scale and the psychological profile made using the SCL-90 questionnaire. In some of the patients, the measurement procedure was conducted I week later, immediately before active treatment started. As active treatment, patients with myogenous or capsular pain received physical therapy in addition to conscious relaxation of the masticatory system, while patients with neuropathic pain were treated using tricyclic antidepressant medication. After 4 to 6 weeks, the measurements were repeated. Statistical evaluation using a linear mixed model revealed no significant changes in TT. In patients with myogenous and capsular pain, as well as in patients with neuropathic pain, the PPT increased after active treatment, while it decreased in the group with pure myogenous pain. The VAS score decreased in all groups. Regarding psychological profiles, a variety of characteristics were observed and the scale for sleeping problems was especially elevated in a majority of the patients. PMID:11642564

Drobek, W; De Laat, A; Schoenaers, J

2001-09-01

5

Pain pressure threshold values in ankylosing spondylitis.  

PubMed

Rheumatic patients experience persistent and disabling pain. We aimed to investigate the pain pressure threshold (PPT) values in ankylosing spondylitis (AS) patients compared to rheumatoid arthritis (RA) patients and healthy subjects. The relationship between lumbar and thoracal Schober, chin-to-chest distance, occiput-to-wall distance, finger-to-floor distance, chest expansion, and pain scores were also evaluated in an AS group. Our study group consisted of 17 AS patients, 20 RA patients, and 21 healthy volunteers. Eighteen tender points accepted by the American College of Rheumatism (ACR) for fibromyalgia syndrome evaluation in 1990 and three control points were evaluated with Fischer's tissue compliance meter, which can also be used as an algometer. Fourteen paravertebral points were evaluated, and mean values of paravertebral myalgic scores were recorded in the AS group. Our data indicate that AS patients do not have lower PPT with respect to healthy individuals, whereas RA patients have significantly lower PPT. A significant correlation was obtained between finger-to-floor distance and paravertebral myalgic score for AS. We conclude that AS does not have a widespread pain nature as RA. PMID:12172953

Incel, Nurgül Arinci; Erdem, H Rana; Ozgocmen, Salih; Catal, Sema Atalay; Yorgancioglu, Z Rezan

2002-08-01

6

Lack of effect of chronic dextromethorphan on experimental pain tolerance in methadone-maintained patients  

PubMed Central

Good evidence exists to suggest that individuals on opioid maintenance for the treatment of addiction (i.e. methadone) are less tolerant of experimental pain than are matched controls or ex-opioid addicts, a phenomenon theorized to reflect opioid-induced hyperalgesia (OIH). Agonist activity at the excitatory ionotropic N-methyl-D-aspartate (NMDA) receptor on dorsal horn neurons has been implicated in the development of both OIH and its putative expression at the clinical level—opioid tolerance. The aim of this study was to evaluate the potential utility of the NMDA-receptor antagonist, dextromethorphan (DEX), to reverse or treat OIH in methadone-maintenance (MM) patients. Utilizing a clinical trial design and double-blind conditions, changes in pain threshold and tolerance [cold pressor (CP) and electrical stimulation (ES)] following a 5-week trial of DEX (titrated to 480 mg/day) in comparison with placebo was evaluated in a well-characterized sample of MM patients. The sample (n = 40) was 53% male and ethnically diverse (53% Latino, 28% African American, 10% White, 9% other), with a mean age of 48.0 years (SD = 6.97). Based on t-test analyses, no difference was found between groups on CP pain threshold, CP pain tolerance, ES pain threshold or ES pain tolerance, both pre- and postmedication. Notably, DEX-related changes significantly differed by gender, with women tending to show diminished tolerance for pain with DEX therapy. These results support that chronic high-dose NMDA antagonism does not improve tolerance for pain in MM patients, although a gender effect on DEX response is suggested. PMID:18507735

Compton, Peggy A.; Ling, Walter; Torrington, Matt A.

2014-01-01

7

Pain-pressure threshold in painful jaw muscles following trigger point injection.  

PubMed

Pain and tenderness at trigger points and referral sites may be modified in subjects with myofascial pain in the head and neck region by injecting local anesthetic into active trigger points, but the effect of injection on jaw muscle pain-pressure thresholds has not been measured. The mechanism by which trigger-point injection affects muscle tenderness is also unclear and may be related to the "hyper-stimulation analgesia" induced by stimulation of an acupuncture point. A pressure algometer was used before and after an active trigger point injection in the masseter to measure the pain-pressure threshold in the masseter and temporal muscles of 10 subjects with jaw muscle pain of myogenous origin. The pain-pressure threshold in the masseter and temporal muscles was also measured in a matched control group before and after an acupuncture-point injection in the masseter. The pain-pressure threshold was significantly lower in myofascial pain subjects than in control subjects at all recording sites. Pain-pressure thresholds increased minimally in the masseter after trigger-point injection, whereas the temporal region was relatively unaffected. In the control group, the pain-pressure threshold increased significantly at all recording sites in the masseter after acupuncture-point injection. Although local anesthetic injection acts peripherally at the painful site and centrally where pain is sustained, pain-pressure thresholds were not dramatically increased in myofascial pain subjects, in contrast to controls. This suggests that in subjects with myofascial pain, there was continued excitability in peripheral tissues and/or central neural areas which may have contributed to the persistence of jaw muscle tenderness. PMID:7670426

McMillan, A S; Blasberg, B

1994-01-01

8

Fault-Tolerant Thresholds for Encoded Ancillae with Homogeneous Errors  

E-print Network

I describe a procedure for calculating thresholds for quantum computation as a function of error model given the availability of ancillae prepared in logical states with independent, identically distributed errors. The thresholds are determined via a simple counting argument performed on a single qubit of an infinitely large CSS code. I give concrete examples of thresholds thus achievable for both Steane and Knill style fault-tolerant implementations and investigate their relation to threshold estimates in the literature.

Bryan Eastin

2006-11-14

9

Pressure pain thresholds and musculoskeletal morbidity in automobile manufacturing workers  

Microsoft Academic Search

Objectives: Reduced pressure pain thresholds (PPTs) have been reported in occupational groups with symptoms of upper extremity musculoskeletal\\u000a disorders (UEMSDs). The purpose of this study was to determine whether automobile manufacturing workers (n=460) with signs and symptoms of UEMSDs had reduced PPTs (greater sensitivity to pain through pressure applied to the skin)\\u000a when compared with unaffected members of the cohort,

Judith E. Gold; Laura Punnett; Jeffrey N. Katz

2006-01-01

10

Reduced Cold Pain Tolerance in Chronic Pain Patients Following Opioid Detoxification  

PubMed Central

Objective One potential consequence of chronic opioid analgesic administration is a paradoxical increase of pain sensitivity over time. Little scientific attention has been given to how cessation of opioid medication affects the hyperalgesic state. In this study, we examined the effects of opioid tapering on pain sensitivity in chronic pain patients. Design Twelve chronic pain patients on long-term opioid analgesic treatment were observed in a 7- to 14-day inpatient pain rehabilitation program, with cold pain tolerance assessed at admission and discharge. The majority of participants were completely withdrawn from their opioids during their stay. Outcome Measures We hypothesized that those patients with the greatest reduction in daily opioid use would show the greatest increases in pain tolerance, as assessed by a cold pressor task. Results A linear regression revealed that the amount of opioid medication withdrawn was a significant predictor of pain tolerance changes, but not in the direction hypothesized. Greater opioid reduction was associated with decreased pain tolerance. This reduction of pain tolerance was not associated with opioid withdrawal symptoms or changes in general pain. Conclusions These findings suggest that the withdrawal of opioids in a chronic pain sample leads to an acute increase in pain sensitivity. PMID:18564998

Younger, Jarred; Barelka, Peter; Carroll, Ian; Kaplan, Kim; Chu, Larry; Prasad, Ravi; Gaeta, Ray; Mackey, Sean

2009-01-01

11

Pressure pain thresholds, clinical assessment, and differential diagnosis: reliability and validity in patients with myogenic pain.  

PubMed

Four studies are presented testing the validity and reliability of pressure pain thresholds (PPTs) and of examination parameters believed to be important in the clinical assessment of sites commonly used for such measures in patient samples. Forty-five patients with a myogenous temporomandibular disorder were examined clinically prior to PPT measures. Criteria for history and examination included functional aspects of the pain, tissue quality of the pain site, and the type of pain elicited from palpation. Control sites within the same muscle and in the contralateral muscle were also examined. PPTs were measured as an index of tenderness using a strain gauge algometer at these sites. The data from the 5 male subjects were excluded from subsequent analyses due to the higher PPT in the males and to their unequal distribution among the various factorial conditions. The first study demonstrated strong validity in PPT measures between patients (using pain sites replicating the patients' pain) and matched controls (n = 11). The PPT was not significantly different between the primary pain site (referred pain and non-referred pain collapsed) and the no-pain control site in the same muscle (n = 16). The PPT was significantly lower at the pain site compared to the no-pain control site in the contralateral muscle (n = 13). The second study indicated adequate reliability in patient samples of the PPT measures. In the third study, the PPT was significantly lower at sites producing referred pain on palpation compared to sites producing localized pain on palpation. The PPT findings from the control sites were inconsistent on this factor. The fourth study presented preliminary evidence that palpable bands and nodular areas in muscle were most commonly associated with muscle regions that produce pain; such muscle findings were not specific, however, for regions that produce pain. Further, the intraexaminer reliability in reassessing these pain sites qualitatively was only fair. Referred pain had a poor association with the pain pattern and physical findings, which may suggest a need to reevaluate part of the theory regarding referred muscle pain. The reliability of PPT measures was better overall than the reliability of the signs and site-specific symptoms, suggesting that pressure pain thresholds may be an important tool in clinical studies of pain. PPT measures demonstrate a high within-subject variability in pain patient subjects as well as non-pain subjects.(ABSTRACT TRUNCATED AT 400 WORDS) PMID:2594394

Ohrbach, R; Gale, E N

1989-11-01

12

Handling Ibuprofen Increases Pain Tolerance and Decreases Perceived Pain Intensity in a Cold Pressor Test  

PubMed Central

Pain contributes to health care costs, missed work and school, and lower quality of life. Extant research on psychological interventions for pain has focused primarily on developing skills that individuals can apply to manage their pain. Rather than examining internal factors that influence pain tolerance (e.g., pain management skills), the current work examines factors external to an individual that can increase pain tolerance. Specifically, the current study examined the nonconscious influence of exposure to meaningful objects on the perception of pain. Participants (N?=?54) completed a cold pressor test, examined either ibuprofen or a control object, then completed another cold pressor test. In the second test, participants who previously examined ibuprofen reported experiencing less intense pain and tolerated immersion longer (relative to baseline) than those who examined the control object. Theoretical and applied implications of these findings are discussed. PMID:23469170

Rutchick, Abraham M.; Slepian, Michael L.

2013-01-01

13

Pressure-Pain Thresholds and MRI Effusions in TMJ Arthralgia  

Microsoft Academic Search

It has been suggested that MRI-depicted effusions identify patients with TMJ arthralgia. The Research Diagnostic Criteria (RDC) propose a pressure-pain threshold (PPT) of 1 pound for the identification of TMJ arthralgia. The hypotheses in this study were that: (1) there is no association between MRI-depicted effusions and TMJ arthralgia, and (2) a PPT of 1 pound does not discriminate between

J. R. Shaefer; D. L. Jackson; E. L. Schiffman; Q. N. Anderson

2001-01-01

14

The effect of an electronic analgesia device on dental pain thresholds.  

PubMed

The effect of UltraCalm, an electronic dental analgesia (EDA) device, on dental pain thresholds was studied in 32 volunteers. For each subject, two initial baseline measurements of dental pain thresholds were made using an electric pulp tester. Pain thresholds were then measured during EDA with either UltraCalm or an inactive (placebo) device. No significant differences were found between the first and second baseline threshold measurements nor between the pain thresholds measured during the application of the UltraCalm and placebo devices. The mean baseline pain threshold was significantly lower than the threshold measured during application of the placebo device, but was not significantly different from the threshold during application of UltraCalm. it is concluded that UltraCalm has no consistent effect in altering dental pain thresholds. PMID:8142783

Cameron, W A; Pairman, J S; Orchardson, R

1993-01-01

15

Does Pain Catastrophizing Moderate the Relationship Between Spinal Nociceptive Processes and Pain Sensitivity?  

Microsoft Academic Search

Existing evidence indicates that pain catastrophizing is associated with enhanced pain reports and lower pain threshold\\/tolerance levels, but is not significantly related to nociceptive flexion reflex (NFR) threshold in healthy and clinical pain samples. This suggests pain catastrophizing may modulate pain threshold at a supraspinal level without influencing descending modulation of spinal nociceptive inputs. To examine this issue further, the

Jamie L. Rhudy; Christopher R. France; Emily J. Bartley; Amy E. Williams; Klanci M. McCabe; Jennifer L. Russell

2009-01-01

16

Substance P-associated increase of intra-articular temperature and pain threshold in the arthritic TMJ.  

PubMed

Neuropeptides are considered mediators and modulators of inflammatory joint disease. Substance P (SP) has been proposed as a mediator of pain, and its vasoactive properties are well documented. In this study, the presence of SP-like immunoreactivity in the synovial fluid was correlated to intra-articular temperature (IAT) and pain from the arthritic temporomandibular joint (TMJ) 3 to 5 weeks after one intra-articular injection of glucocorticosteroids. Eighteen TMJs were investigated for IAT and the presence of SP-like immunoreactivity in the synovial fluid in 12 patients with systemic inflammatory joint disease. After arthrocentesis, the aspirates were analyzed for SP-like immunoreactivity by means of competitive radio immunoassay. A visual analogue scale and an algometer determining the pressure pain threshold and tolerance level assessed arthritic pain and hyperalgesia in the TMJ. Our results indicate that SP-like immunoreactivity is associated with IAT and that increased concentrations of joint fluid SP-like immunoreactivity correspond to increased pain threshold and tolerance and a concomitantly decreased visual analogue scale. These findings suggest that SP is implicated in the vascular and nociceptive response of the arthritic joint and that SP, possibly assisted by the antinociceptive effect of local corticosteroids, has a modulatory role in arthritic pain and hyperalgesia. PMID:9656887

Appelgren, A; Appelgren, B; Kopp, S; Lundeberg, T; Theodorsson, E

1998-01-01

17

The impact of stress and anxiety on the pressure pain threshold of myofascial pain patients.  

PubMed

The purpose of this study was to evaluate the influence of stress and anxiety on the pressure pain threshold (PPT) of masticatory muscles and on the subjective pain report. Forty-five women, students, with mean age of 19.75 years, were divided into two groups: group 1:29 presenting with masticatory myofascial pain (MFP), according to the Research Diagnostic Criteria for Temporomandibular Disorders and group 2: 16 asymptomatic controls. An electronic algometer registered the pain thresholds on four different occasions throughout the academic year. To measure levels of stress, anxiety and pain, the Beck Anxiety Inventory, Lipp Stress Symptoms Inventory and Visual Analog Scale (VAS) were used. Three-way anova and Tukey's tests were used to verify differences in PPT between groups, times and sites. Levels of anxiety and VAS were compared using Mann-Whitney test, while Friedman's test was used for the within-groups comparison at different times (T1 to T4). The chi-squared and Cochran tests were performed to compare groups for the proportion of subjects with stress (alpha = 0.05). Differences in PPT recordings between time (P = 0.001) and sites (P < 0.001) were detected. Higher levels of anxiety and lower PPT figures were detected at T2 (academic examination) (P = 0.001). There was no difference between groups for anxiety and stress at any time (P > 0.05). The MFP group also has shown significant increase of VAS at the time of academic examination (P < 0.001). External stressors such as academic examinations have a potential impact on masticatory muscle tenderness, regardless of the presence of a previous condition such as masticatory myofascial pain. PMID:19210679

Vedolin, G M; Lobato, V V; Conti, P C R; Lauris, J R P

2009-05-01

18

Pain and pressure pain thresholds in adolescents with chronic fatigue syndrome and healthy controls: a cross-sectional study  

PubMed Central

Objectives Although pain is a significant symptom in chronic fatigue syndrome (CFS), pain is poorly understood in adolescents with CFS. The aim of this study was to explore pain distribution and prevalence, pain intensity and its functional interference in everyday life, as well as pressure pain thresholds (PPT) in adolescents with CFS and compare this with a control group of healthy adolescents (HC). Methods This is a case–control, cross-sectional study on pain including 120 adolescents with CFS and 39 HCs, aged 12–18?years. We measured pain frequency, pain severity and pain interference using self-reporting questionnaires. PPT was measured using pressure algometry. Data were collected from March 2010 until October 2012 as part of the Norwegian Study of Chronic Fatigue Syndrome in Adolescents: Pathophysiology and Intervention Trial. Results Adolescents with CFS had significantly lower PPTs compared with HCs (p<0.001). The Pain Severity Score and the Pain Interference Score were significantly higher in adolescents with CFS compared with HCs (p<0.001). Almost all adolescents with CFS experienced headache, abdominal pain and/or pain in muscles and joints. Moreover, in all sites, the pain intensity levels were significantly higher than in HCs (p<0.001). Conclusions We found a higher prevalence of severe pain among adolescents with CFS and lowered pain thresholds compared with HCs. The mechanisms, however, are still obscure. Large longitudinal population surveys are warranted measuring pain thresholds prior to the onset of CFS. Trial registration number Clinical Trials, NCT01040429; The Norwegian Study of Chronic Fatigue Syndrome in Adolescents: Pathophysiology and Intervention Trial (NorCAPITAL) http://www.clinicaltrials.gov. PMID:25287104

Winger, Anette; Kvarstein, Gunnvald; Wyller, Vegard Bruun; Sulheim, Dag; Fagermoen, Even; Småstuen, Milada Cvancarova; Helseth, Sølvi

2014-01-01

19

Correlations between Brain Cortical Thickness and Cutaneous Pain Thresholds Are Atypical in Adults with Migraine  

PubMed Central

Background/Objective Migraineurs have atypical pain processing, increased expectations for pain, and hypervigilance for pain. Recent studies identified correlations between brain structure and pain sensation in healthy adults. The objective of this study was to compare cortical thickness-to-pain threshold correlations in migraineurs to healthy controls. We hypothesized that migraineurs would have aberrant relationships between the anatomical neurocorrelates of pain processing and pain thresholds. Methods Pain thresholds to cutaneously applied heat were determined for 31 adult migraineurs and 32 healthy controls. Cortical thickness was determined from magnetic resonance imaging T1-weighted sequences. Regional cortical thickness-to-pain threshold correlations were determined for migraineurs and controls separately using a general linear model whole brain vertex-wise analysis. A pain threshold-by-group interaction analysis was then conducted to estimate regions where migraineurs show alterations in the pain threshold-to-cortical thickness correlations relative to healthy controls. Results Controls had negative correlations (p<0.01 uncorrected) between pain thresholds and cortical thickness in left posterior cingulate/precuneus, right superior temporal, right inferior parietal, and left inferior temporal regions, and a negative correlation (p<0.01 Monte Carlo corrected) with a left superior temporal/inferior parietal region. Migraineurs had positive correlations (p<0.01 uncorrected) between pain thresholds and cortical thickness in left superior temporal/inferior parietal, right precuneus, right superior temporal/inferior parietal, and left inferior parietal regions. Cortical thickness-to-pain threshold correlations differed between migraine and control groups (p<0.01 uncorrected) for right superior temporal/inferior parietal, right precentral, left posterior cingulate/precuneus, and right inferior parietal regions and (p<0.01 Monte Carlo corrected) for a left superior temporal/inferior parietal region. Conclusions Unlike healthy control subjects who have a significant negative correlation between cortical thickness in a superior temporal/inferior parietal region with pain thresholds, migraineurs have a non-significant positive correlation between cortical thickness in a superior temporal/inferior parietal region with pain thresholds. Since this region participates in orienting and attention to painful stimuli, absence of the normal correlation might represent a migraineurs inability to inhibit pain sensation via shifting attention away from the painful stimulus. PMID:24932546

Schwedt, Todd J.; Chong, Catherine D.

2014-01-01

20

Effects of Sensory Behavioral Tasks on Pain Threshold and Cortical Excitability  

PubMed Central

Background/Objective Transcutaneous electrical stimulation has been proven to modulate nervous system activity, leading to changes in pain perception, via the peripheral sensory system, in a bottom up approach. We tested whether different sensory behavioral tasks induce significant effects in pain processing and whether these changes correlate with cortical plasticity. Methodology/Principal Findings This randomized parallel designed experiment included forty healthy right-handed males. Three different somatosensory tasks, including learning tasks with and without visual feedback and simple somatosensory input, were tested on pressure pain threshold and motor cortex excitability using transcranial magnetic stimulation (TMS). Sensory tasks induced hand-specific pain modulation effects. They increased pain thresholds of the left hand (which was the target to the sensory tasks) and decreased them in the right hand. TMS showed that somatosensory input decreased cortical excitability, as indexed by reduced MEP amplitudes and increased SICI. Although somatosensory tasks similarly altered pain thresholds and cortical excitability, there was no significant correlation between these variables and only the visual feedback task showed significant somatosensory learning. Conclusions/Significance Lack of correlation between cortical excitability and pain thresholds and lack of differential effects across tasks, but significant changes in pain thresholds suggest that analgesic effects of somatosensory tasks are not primarily associated with motor cortical neural mechanisms, thus, suggesting that subcortical neural circuits and/or spinal cord are involved with the observed effects. Identifying the neural mechanisms of somatosensory stimulation on pain may open novel possibilities for combining different targeted therapies for pain control. PMID:23301010

Volz, Magdalena Sarah; Pinheiro, Fernando Santos; Merabet, Lotfi B.; Fregni, Felipe

2013-01-01

21

A Phase II, Randomized, Double-Blind, Placebo Controlled, Dose-Response Trial of the Melatonin Effect on the Pain Threshold of Healthy Subjects  

PubMed Central

Background Previous studies have suggested that melatonin may produce antinociception through peripheral and central mechanisms. Based on the preliminary encouraging results of studies of the effects of melatonin on pain modulation, the important question has been raised of whether there is a dose relationship in humans of melatonin on pain modulation. Objective The objective was to evaluate the analgesic dose response of the effects of melatonin on pressure and heat pain threshold and tolerance and the sedative effects. Methods Sixty-one healthy subjects aged 19 to 47 y were randomized into one of four groups: placebo, 0.05 mg/kg sublingual melatonin, 0.15 mg/kg sublingual melatonin or 0.25 mg/kg sublingual melatonin. We determine the pressure pain threshold (PPT) and the pressure pain tolerance (PPTo). Quantitative sensory testing (QST) was used to measure the heat pain threshold (HPT) and the heat pain tolerance (HPTo). Sedation was assessed with a visual analogue scale and bispectral analysis. Results Serum plasma melatonin levels were directly proportional to the melatonin doses given to each subject. We observed a significant effect associated with dose group. Post hoc analysis indicated significant differences between the placebo vs. the intermediate (0.15 mg/kg) and the highest (0.25 mg/kg) melatonin doses for all pain threshold and sedation level tests. A linear regression model indicated a significant association between the serum melatonin concentrations and changes in pain threshold and pain tolerance (R2?=?0.492 for HPT, R2?=?0.538 for PPT, R2?=?0.558 for HPTo and R2?=?0.584 for PPTo). Conclusions The present data indicate that sublingual melatonin exerts well-defined dose-dependent antinociceptive activity. There is a correlation between the plasma melatonin drug concentration and acute changes in the pain threshold. These results provide additional support for the investigation of melatonin as an analgesic agent. Brazilian Clinical Trials Registry (ReBec): (U1111-1123-5109). IRB: Research Ethics Committee at the Hospital de Clínicas de Porto Alegre.

Stefani, Luciana Cadore; Muller, Suzana; Torres, Iraci L. S.; Razzolini, Bruna; Rozisky, Joanna R.; Fregni, Felipe; Markus, Regina; Caumo, Wolnei

2013-01-01

22

The Effects of Focus of Meditation on Pain Tolerance, Compassion, and Anxiety Levels  

E-print Network

Sixty-one individuals participated in a study to examine whether practicing a meditation with a spiritual focus would demonstrate higher pain tolerance and faster pain awareness (cold-pressor task), increased implicit compassion (lexical decision...

Kluck, Benjamin Joseph

2008-01-01

23

Tactile sensory and pain thresholds in the face and tongue of subjects asymptomatic for oro-facial pain and headache.  

PubMed

The aim of this study was to examine the tactile sensory and pain thresholds in the face, tongue, hand and finger of subjects asymptomatic for pain. Sixteen healthy volunteers (eight men and eight women, mean age 35·7 years, range 27-41) participated. Using Semmes-Weinstein monofilaments, the tactile detection threshold (TDT) and the filament-prick pain detection threshold (FPT) were measured at five sites: on the cheek skin (CS), tongue tip (TT), palm side of the thenar skin (TS), dorsum of the hand (DH) and the finger tip (FT). The difference between the tactile sensory and pain threshold (FPT-TDT) was also calculated. Both for the TDT and FPT, TT and DH had the lowest and highest values, respectively. As for the FPT-TDT, there were no significant differences among the measurement sites. As the difference between FPT and TDT (FPT-TDT) is known to be an important consideration in interpreting QST (quantitative sensory testing) data and can be altered by neuropathology, taking the FPT-TDT as a new parameter in addition to the TDT and FPT separately would be useful for case-control studies on oro-facial pain patients with trigeminal neuralgia, atypical facial pain/atypical odontalgia and burning mouth syndrome/glossodynia. PMID:25041286

Okayasu, I; Komiyama, O; Ayuse, T; De Laat, A

2014-12-01

24

Gender role expectations of pain: relationship to experimental pain perception  

Microsoft Academic Search

The primary purpose of this study was to investigate the influence of an individual's Gender Role Expectations of Pain (GREP) on experimental pain report. One hundred and forty-eight subjects (87 females and 61 males) subjects underwent thermal testing and were asked to report pain threshold, pain tolerance, VAS ratings of pain intensity and unpleasantness, and a computerized visual analogue scales

Emily A Wise; Donald D Price; Cynthia D Myers; Marc W Heft; Michael E Robinson

2002-01-01

25

Pubertal status moderates the association between mother and child laboratory pain tolerance  

PubMed Central

BACKGROUND: There is limited information regarding the relationship between parent and child responses to laboratory pain induction in the absence of experimental manipulation. OBJECTIVES: To assess the association between responses to cold and pressure pain tasks in 133 nonclinical mothers and children (mean age 13.0 years; 70 girls), and the moderating effects of child sex and pubertal status on these mother-child relationships. METHODS: Mothers and children independently completed the cold and pressure pain tasks. Multiple linear regression analyses examined the association between mothers’ and children’s laboratory pain responses. The moderating effects of child sex and pubertal status were tested in the linear models by examining the interaction among mother laboratory pain responses, and child sex and pubertal status. RESULTS: Mothers’ cold pain anticipatory anxiety and pressure pain intensity were associated with children’s pressure pain anticipatory anxiety. Mothers’ pressure pain tolerance was associated with children’s pain tolerance for both the cold and pressure pain tasks. Mothers’ cold pain tolerance was associated with children’s pressure pain tolerance. Pubertal status moderated two of the three significant mother-child pain tolerance relationships, such that the associations held for early pubertal but not for late pubertal children. Sex did not moderate mother-child pain associations. CONCLUSIONS: The results indicate that mother-child pain relationships are centred primarily on pain avoidance behaviour, particularly among prepubertal children. These findings may inform interventions focused on pain behaviours, with a particular emphasis on mothers of prepubertal children, to reduce acute pain responses in their children. PMID:24367794

Tsao, Jennie CI; Li, Ning; Parker, Delana; Seidman, Laura C; Zeltzer, Lonnie K

2014-01-01

26

Intra- and interrater agreement of pressure pain thresholds in children with orthopedic disorders  

Microsoft Academic Search

Purpose  Pressure algometry is widely used to obtain measures of mechanical pain sensitivity in adults, both in experimental and clinical\\u000a pain conditions. Only very few studies describe the use of pressure algometry in children. The purpose of this study was to\\u000a produce reference values of pressure pain thresholds and to determine the intra- and interrater agreement, in order to introduce\\u000a pressure

Lone NikolajsenAnders; Anders D. Kristensen; Line K. Pedersen; Ole Rahbek; Troels S. Jensen; Bjarne Møller-Madsen

2011-01-01

27

Clinical Pressure Pain Threshold Testing in Neck Pain: Comparing Protocols, Responsiveness, and Association With Psychological Variables  

PubMed Central

Background Quantitative sensory testing, including pressure pain threshold (PPT), is seeing increased use in clinical practice. In order to facilitate clinical utility, knowledge of the properties of the tool and interpretation of results are required. Objectives This observational study used a clinical sample of people with mechanical neck pain to determine: (1) the influence of number of testing repetitions on measurement properties, (2) reliability and minimum clinically important difference, and (3) associations between PPT and key psychological constructs. Design This study was observational with both cross-sectional and prospective elements. Methods Experienced clinicians measured PPT in patients with mechanical neck pain following a standardized protocol. Subcohorts also provided repeated measures and completed scales of key psychological constructs. Results The total sample was 206 participants, but not all participants provided data for all analyses. Interrater and 1-week test-retest reliability were excellent (intraclass correlation coefficients [2,1]=.75–.95). Potentially important differences in reliability and PPT scores were found when using only 1 or 2 repeated measures compared with all 3. The PPT over a distal location (tibialis anterior muscle) was not adequately responsive in this sample, but the local site (upper trapezius muscle) was responsive and may be useful as part of a protocol to evaluate clinical change. Sensitivity values (range=0.08–0.50) and specificity values (range=0.82–0.97) for a range of change scores are presented. Depression, catastrophizing, and kinesiophobia were able to explain small but statistically significant variance in local PPT (3.9%–5.9%), but only catastrophizing and kinesiophobia explained significant variance in the distal PPT (3.6% and 2.9%, respectively). Limitations Limitations of the study include multiple raters, unknown recruitment rates, and unknown measurement properties at sites other than those tested here. Conclusions The results suggest that PPT is adequately reliable and that 3 measurements should be taken to maximize measurement properties. The variance explained by the psychological variables was small but significant for 3 constructs related to catastrophizing, depression, and fear of movement. Clinical implications for application and interpretation of PPT are discussed. PMID:24557645

Levesque, Lenerdene; Payne, Martin; Schick, Julie

2014-01-01

28

Fault-tolerant quantum computation with high threshold in two dimensions  

E-print Network

We present a scheme of fault-tolerant quantum computation for a local architecture in two spatial dimensions. The error threshold is 0.75% for each source in an error model with preparation, gate, storage and measurement errors.

Robert Raussendorf; Jim Harrington

2007-05-14

29

An accurate analytical framework for computing fault-tolerance thresholds using the [[7,1,3  

E-print Network

In studies of the threshold for fault-tolerant quantum error-correction, it is generally assumed that the noise channel at all levels of error-correction is the depolarizing channel. The effects of this assumption on the ...

Morten, Andrew J

2005-01-01

30

Deriving a Fault-Tolerant Threshold for a Global Control Scheme  

E-print Network

In this paper, adapted from the author's PhD thesis, we present otherwise unpublished results relating to global control schemes, culminating in the calculation of a fault-tolerant threshold for one such scheme. As with early fault-tolerant threshold results, the aim is to calculate a positive number, not to optimise it. We also discuss how the results might affect other related schemes, such as those based on cellular automata.

Alastair Kay

2007-03-07

31

The Fine Tuning of Pain Thresholds: A Sophisticated Double Alarm System  

PubMed Central

Two distinctive features characterize the way in which sensations including pain, are evoked by heat: (1) a thermal stimulus is always progressive; (2) a painful stimulus activates two different types of nociceptors, connected to peripheral afferent fibers with medium and slow conduction velocities, namely A?- and C-fibers. In the light of a recent study in the rat, our objective was to develop an experimental paradigm in humans, based on the joint analysis of the stimulus and the response of the subject, to measure the thermal thresholds and latencies of pain elicited by A?- and C-fibers. For comparison, the same approach was applied to the sensation of warmth elicited by thermoreceptors. A CO2 laser beam raised the temperature of the skin filmed by an infrared camera. The subject stopped the beam when he/she perceived pain. The thermal images were analyzed to provide four variables: true thresholds and latencies of pain triggered by heat via A?- and C-fibers. The psychophysical threshold of pain triggered by A?-fibers was always higher (2.5–3°C) than that triggered by C-fibers. The initial skin temperature did not influence these thresholds. The mean conduction velocities of the corresponding fibers were 13 and 0.8 m/s, respectively. The triggering of pain either by C- or by A?-fibers was piloted by several factors including the low/high rate of stimulation, the low/high base temperature of the skin, the short/long peripheral nerve path and some pharmacological manipulations (e.g. Capsaicin). Warming a large skin area increased the pain thresholds. Considering the warmth detection gave a different picture: the threshold was strongly influenced by the initial skin temperature and the subjects detected an average variation of 2.7°C, whatever the initial temperature. This is the first time that thresholds and latencies for pain elicited by both A?- and C-fibers from a given body region have been measured in the same experimental run. Such an approach illustrates the role of nociception as a “double level” and “double release” alarm system based on level detectors. By contrast, warmth detection was found to be based on difference detectors. It is hypothesized that pain results from a CNS build-up process resulting from population coding and strongly influenced by the background temperatures surrounding at large the stimulation site. We propose an alternative solution to the conventional methods that only measure a single “threshold of pain”, without knowing which of the two systems is involved. PMID:20428245

Plaghki, Léon; Decruynaere, Céline; Van Dooren, Paul; Le Bars, Daniel

2010-01-01

32

Fault-Tolerant Postselected Quantum Computation: Threshold Analysis  

E-print Network

The schemes for fault-tolerant postselected quantum computation given in [Knill, Fault-Tolerant Postselected Quantum Computation: Schemes, http://arxiv.org/abs/quant-ph/0402171] are analyzed to determine their error-tolerance. The analysis is based on computer-assisted heuristics. It indicates that if classical and quantum communication delays are negligible, then scalable qubit-based quantum computation is possible with errors above 1% per elementary quantum gate.

E. Knill

2004-04-19

33

Coping Predictors of Children’s Laboratory-Induced Pain Tolerance, Intensity, and Unpleasantness  

Microsoft Academic Search

This study examined coping predictors of laboratory-induced pain tolerance, intensity, and unpleasantness among 244 healthy children and adolescents (50.8% female; mean age, 12.73 ± 2.98 years; range, 8–18 years). Participants were exposed to separate 4-trial blocks of pressure and thermal (heat) pain stimuli, as well as 1 trial of cold pain stimuli. Strategies for coping with pain were measured using

Qian Lu; Jennie C. I. Tsao; Cynthia D. Myers; Su C. Kim; Lonnie K. Zeltzer

2007-01-01

34

Differential tolerance to morphine antinociception in assays of pain-stimulated vs. pain-depressed behavior in rats.  

PubMed

In preclinical research on pain and analgesia, noxious stimuli can stimulate expression of some behaviors (e.g. withdrawal reflexes) and depress others (e.g. feeding, locomotion, and positively reinforced operant responding). Tolerance to morphine antinociception is a robust and reliable phenomenon in preclinical assays of pain-stimulated behavior, but development of morphine tolerance in assays of pain-depressed behavior has not been studied. This study compared morphine antinociceptive tolerance in parallel assays of pain-stimulated and pain-depressed behavior in male Sprague-Dawley rats. Intraperitoneal injection of dilute lactic acid served as a noxious stimulus to stimulate a stretching response in one group of rats and to depress operant responding for electrical brain stimulation (intracranial self-stimulation; ICSS) in another group of rats. Antinociception produced by morphine (1.0mg/kg) was determined after a regimen of chronic treatment with either saline or morphine in separate subgroups of rats in each procedure. In rats receiving chronic saline, acid alone stimulated a stretching response and depressed ICSS, and both acid effects were blocked by 1.0mg/kg morphine. Rats receiving chronic morphine displayed hyperalgesic responses to the acid noxious stimulus in both procedures. Complete tolerance developed to morphine antinociception in the assay of acid-stimulated stretching, but morphine retained full antinociceptive effectiveness in the assay of acid-depressed ICSS. These results suggest that morphine antinociception in an assay of pain-depressed behavior is relatively resistant to tolerance. More broadly, these results suggest that antinociceptive tolerance can develop at different rates or to different degrees for different measures of antinociception. PMID:25530266

Altarifi, Ahmad A; Stevens Negus, S

2015-02-01

35

D-Aspartate Modulates Nociceptive-Specific Neuron Activity and Pain Threshold in Inflammatory and Neuropathic Pain Condition in Mice  

PubMed Central

D-Aspartate (D-Asp) is a free D-amino acid found in the mammalian brain with a temporal-dependent concentration based on the postnatal expression of its metabolizing enzyme D-aspartate oxidase (DDO). D-Asp acts as an agonist on NMDA receptors (NMDARs). Accordingly, high levels of D-Asp in knockout mice for Ddo gene (Ddo?/?) or in mice treated with D-Asp increase NMDAR-dependent processes. We have here evaluated in Ddo?/? mice the effect of high levels of free D-Asp on the long-term plastic changes along the nociceptive pathway occurring in chronic and acute pain condition. We found that Ddo?/? mice show an increased evoked activity of the nociceptive specific (NS) neurons of the dorsal horn of the spinal cord (L4–L6) and a significant decrease of mechanical and thermal thresholds, as compared to control mice. Moreover, Ddo gene deletion exacerbated the nocifensive responses in the formalin test and slightly reduced pain thresholds in neuropathic mice up to 7 days after chronic constriction injury. These findings suggest that the NMDAR agonist, D-Asp, may play a role in the regulation of NS neuron electrophysiological activity and behavioral responses in physiological and pathological pain conditions. PMID:25629055

Boccella, Serena; Vacca, Valentina; Errico, Francesco; Marinelli, Sara; Squillace, Marta; Di Maio, Anna; Vitucci, Daniela; Palazzo, Enza; De Novellis, Vito; Maione, Sabatino; Pavone, Flaminia; Usiello, Alessandro

2015-01-01

36

Decreased pain threshold and enhanced synaptic transmission in the anterior cingulate cortex of experimental hypothyroidism mice  

PubMed Central

Background Thyroid hormones are essential for the maturation and functions of the central nervous system. Pain sensitivity is related to the thyroid status. However, information on how thyroid hormones affect pain processing and synaptic transmission in the anterior cingulate cortex (ACC) is limited. Nociceptive threshold and synaptic transmission in the ACC were detected in the experimental hypothyroidism (HT) mice. Results HT was induced by methimazole and potassium perchlorate in distilled drinking water for 4 weeks. The threshold of pain perception to hot insults, but not mechanical ones, decreased in hypothyroid mice. After treatment with tri-iodothyronine (T3) or thyroxine (T4) for 2 weeks, thermal pain threshold recovered. Electrophysiological recordings revealed enhanced glutamatergic synaptic transmission and reduced GABAergic synaptic transmission in the ACC. Supplementation with T3 or T4 significantly rescued this synaptic transmission imbalance. In the same model, HT caused the up-regulation of the GluR1 subunit of the ?-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor and NR2B-containing N-methyl-D-aspartate receptors, but it down-regulated ?-aminobutyric acid A receptors in the ACC. Supplementation with T3 or T4 notably recovered the levels of above proteins. Conclusions These results suggest that HT promotes hypersensitivity to noxious thermal, and that supplementation with T3 or T4 rescues the imbalance between excitatory and inhibitory transmission in the ACC. PMID:24943008

2014-01-01

37

Effect of cognitive strategy content and length of instructions on cold pressor pain tolerance.  

PubMed

This experiment assessed a recent contention that cognitive pain-control strategies are effective because length of training produces demands irrespective of content of training. Participants held the dominant hand in ice water for 5 sec. They then estimated how long they expected to tolerate ice water using one of four cognitive pain-control strategies. People who used multiple cognitive strategies previously found to be effective experienced mean tolerance equal to that of subjects who used multiple cognitive strategies previously found to be ineffective. Participants then used the instructions while their hands were immersed in ice water. People tolerated the pain longer when using effective rather than ineffective strategies. The experiment demonstrated that the efficacy of cognitive pain-control strategies cannot be accounted for by length of instructions alone. PMID:7167307

Worthington, E L

1982-12-01

38

Magnitude estimates of cold pressor pain: effects of suggestions, cognitive strategy, and tolerance.  

PubMed

Pain magnitude when subjects immersed an arm in ice water was assessed by means of a magnitude estimation procedure during baseline and posttest sessions. Before the posttest session, subjects either received or did not receive an analgesic suggestion. Best-fit functions were linear, though power fits were also good. Analgesic suggestions had no effect on the rate of change in pain intensity. When subjects were classified as copers or catastrophizers on the basis of written testimony, pain intensity increased more rapidly for catastrophizers than for copers during the posttest session but not during the baseline session. Subjects who kept their arm immersed for more than 240 s were classified as high in tolerance. High-tolerance subjects experienced a slower rate of growth in pain intensity than low-tolerance subjects. Theoretical implications of the results are discussed. PMID:6669462

Spanos, N P; Jones, B; Brown, J M; Horner, D

1983-01-01

39

Prediction of threshold pain skin temperature from thermal properties of materials in contact.  

PubMed

Aerospace design engineers have long sought concrete data with respect to the thermal safety of materials in contact with human skin. A series of studies on this subject has been completed and some of the results have been reported earlier. In these studies over 2,000 observations were made of pain threshold during contact with materials at elevated temperatures. Six materials were used representing the full range of thermal properties from good conductors to good insulators. Previous reports gave methods for determining the maximum permissible temperatures for any material in safe contact with bare skin for 1-5 s solely from a knowledge of its thermal properties. This report presents the comparison of the theoretical and experimental contact temperatures at pain threshold and provides a method for deriving the skin temperature productive of threshold pain from the thermal properties of any material within the range of those studies. Ratios reflecting the heat transfer coefficient associated with the materials in contact are related to their thermal properties so that the skin temperature at pain threshold may be determined from that calculated from heat transfer theory. Tabular and graphical representation of these data permits interpolation within the range of properties so that any material of known thermal conductivity, density and specific heat may be assessed with respect to its effect on the skin temperature during contact to the end point of pain. These data, in conjunction with those already reported, constitute a system for the complete assessment of the thermal aspects of practically any material suitable for construction and manufacturing applications with respect to safe contact with human skin. PMID:7159344

Stoll, A M; Chianta, M A; Piergallini, J R

1982-12-01

40

A complete component analysis of Stress Inoculation for pain tolerance  

Microsoft Academic Search

This study involved a complete component analysis of Stress Inoculation Training (SIT) for the reduction of cold pressor pain. SIT consists of an Education, Skills Acquisition, and Application phase. Each of these three phases alone, all possible pairs of phases, the complete protocol, and a pseudotreatment control were presented to groups of university women. While the complete protocol increased pain

T. Michael Vallis

1984-01-01

41

Tonic Descending Facilitation from the Rostral Ventromedial Medulla Mediates Opioid-Induced Abnormal Pain and Antinociceptive Tolerance  

Microsoft Academic Search

Many clinical case reports have suggested that sustained opi- oid exposure can elicit unexpected, paradoxical pain. Here, we explore the possibility that (1) opioid-induced pain results from tonic activation of descending pain facilitation arising in the rostral ventromedial medulla (RVM) and (2) the presence of such pain manifests behaviorally as antinociceptive tolerance. Rats implanted subcutaneously with pellets or osmotic minipumps

Todd W. Vanderah; Nova M. H. Suenaga; Michael H. Ossipov; T. Philip; Josephine Lai

2001-01-01

42

Gender differences in low and high pain palpation thresholds in the TMJ and neck areas.  

PubMed

The null hypothesis was that pain pressure thresholds are the same for young healthy males and females and do not differ between the temporomandibular joint (TMJ) and muscle sites. The aim of the current study was to compare pain pressure threshold levels using an algometer with a convex-formed contact piece and pressure increase rates similar to those in conventional finger palpation, making the conditions more like clinical examination of painful spots with commonly used physiotherapeutic methods. Healthy subjects, 12 male, mean age 22.5 +/- 1.62 (SD), and 12 female, 22.4 +/- 2.19 (SD), were enrolled. A transducer with a calibrated load range, 0 to 25 pounds, was used to measure pressure threshold levels for low (T1), VAS to approximately 2, and high (T2), VAS to approximately 8, pain levels bilaterally in the occipital (OC), sternocleidomastoid (SCM), upper trapezius (TU), transverse process of first vertebra (C1), and lateral temporomandibular joint (TMJ) areas. The null hypothesis was rejected. Levels T1 and T2 were significantly lower in the females in all tested areas. The range of the mean for T1 levels was 4.9-8.0 pounds for males and 3.2-5.1 pounds for females. For T2 levels, the range was 8.9-15.6 pounds for males and 6.2-10.3 pounds for females. Significant differences were found between muscle sites. These results support the use of different threshold levels: a) for males and females; and b) for different muscle areas. PMID:23795398

Widmalm, Sven E; McKay, Duane C; Radke, John C; Zhang, Yuan; Wang, Xiaorui; Wang, Meiqing

2013-04-01

43

Fault-tolerant ancilla preparation and noise threshold lower bounds for the 23-qubit Golay code  

E-print Network

In fault-tolerant quantum computing schemes, the overhead is often dominated by the cost of preparing codewords reliably. This cost generally increases quadratically with the block size of the underlying quantum error-correcting code. In consequence, large codes that are otherwise very efficient have found limited fault-tolerance applications. Fault-tolerant preparation circuits therefore are an important target for optimization. We study the Golay code, a 23-qubit quantum error-correcting code that protects the logical qubit to a distance of seven. In simulations, even using a naive ancilla preparation procedure, the Golay code is competitive with other codes both in terms of overhead and the tolerable noise threshold. We provide two simplified circuits for fault-tolerant preparation of Golay code-encoded ancillas. The new circuits minimize error propagation, reducing the overhead by roughly a factor of four compared to standard encoding circuits. By adapting the malignant set counting technique to depolarizing noise, we further prove a threshold above 1.32 x 10^{-3} noise per gate.

Adam Paetznick; Ben W. Reichardt

2011-06-11

44

What Color is My Arm? Changes in Skin Color of an Embodied Virtual Arm Modulates Pain Threshold  

PubMed Central

It has been demonstrated that visual inputs can modulate pain. However, the influence of skin color on pain perception is unknown. Red skin is associated to inflamed, hot and more sensitive skin, while blue is associated to cyanotic, cold skin. We aimed to test whether the color of the skin would alter the heat pain threshold. To this end, we used an immersive virtual environment where we induced embodiment of a virtual arm that was co-located with the real one and seen from a first-person perspective. Virtual reality allowed us to dynamically modify the color of the skin of the virtual arm. In order to test pain threshold, increasing ramps of heat stimulation applied on the participants’ arm were delivered concomitantly with the gradual intensification of different colors on the embodied avatar’s arm. We found that a reddened arm significantly decreased the pain threshold compared with normal and bluish skin. This effect was specific when red was seen on the arm, while seeing red in a spot outside the arm did not decrease pain threshold. These results demonstrate an influence of skin color on pain perception. This top-down modulation of pain through visual input suggests a potential use of embodied virtual bodies for pain therapy. PMID:23914172

Martini, Matteo; Perez-Marcos, D.; Sanchez-Vives, M. V.

2013-01-01

45

Lack of impact of intravenous lidocaine on analgesia, functional recovery, and nociceptive pain threshold after total hip arthroplasty  

E-print Network

and does not modify pressure and punctuate pain thresholds and peri-incisionnal hyperalgesia. * Anaesthesia Fellow, Anaesthesia Resident, ** Professor of Anaesthesia, Service d'anesthésie, Assistance Publique

Paris-Sud XI, Université de

46

Virtual-reality distraction and cold-pressor pain tolerance: does avatar point of view matter?  

PubMed

This study tested the effects of distraction using virtual-reality (VR) technology on acute pain tolerance in young adults. Forty-one undergraduate students, aged 18-23 years, used a VR head-mounted display helmet, steering wheel, and foot pedal to play an auto racing video game while undergoing exposure to very cold water (cold pressor set at 1 °C). Two different game views were tested that were hypothesized to affect the degree to which participants felt "present" in the virtual environment: a first-person view, in which the participant saw the virtual environment through the eyes of the game character being manipulated; and a third-person view, in which the participant viewed the game character from a distance. The length of time participants tolerated the cold-water exposure (pain tolerance) under each distraction condition was compared to a baseline (no distraction) trial. Subjects also rated the degree to which they felt "present" in the virtual environment after each distraction trial. Results demonstrated that participants had significantly higher pain tolerance during both VR-distraction conditions relative to baseline (no distraction) trials. Although participants reported a greater sense of presence during the first-person condition than the third-person condition, pain-tolerance scores associated with the two distraction conditions did not differ. The types of VR applications in which presence may be more or less important are discussed. PMID:20950186

Dahlquist, Lynnda M; Herbert, Linda J; Weiss, Karen E; Jimeno, Monica

2010-10-01

47

Knee Extensor Strength Is Associated with Pressure Pain Thresholds in Adults with Fibromyalgia  

PubMed Central

Objective Individuals with fibromyalgia (FM) have lower muscle strength and lower pressure pain thresholds (PPT). The primary aim of this study was to determine the associations between muscle strength and PPT in adults with FM to test the hypothesis that greater measures of muscle strength would be associated with greater values of PPT. Secondary aims included determining the effects of pain severity and the peak uptake of oxygen (Vo2) on the associations between muscle strength and PPT. Methods Knee extensor and flexor strength (N?=?69) was measured in the dominant leg using a dynamometer, and PPT was assessed using an electronic algometer. Pain severity was determined using the Multidimensional Pain Inventory, and peak Vo2 uptake was quantified using an electronically braked cycle ergometer. Results Univariable linear regression analysis demonstrated a significant association between PPT (dependent variable) and isometric knee extensor (P<.001), isokinetic (60°/s) knee extensor (P?=?.002), and isokinetic (60°/s) knee flexor strength (P?=?.043). In a multiple variable linear regression analysis adjusted for age, sex, pain severity, body mass index and peak Vo2 uptake, a significant association was found between PPT and isometric knee extensor strength (P?=?.008). In a similar multiple variable analysis, a significant association was found between PPT and isokinetic knee extensor strength (P?=?.044). Conclusion Greater measures of isometric and isokinetic knee extensor strength were significantly associated with greater values of PPT in both univariable and multiple variable linear regression models. Trial Registration ClinicalTrials.gov NCT01253395 PMID:23565175

Hooten, W. Michael; Rosenberg, Casandra J.; Eldrige, Jason S.; Qu, Wenchun

2013-01-01

48

Shared Mechanisms for Opioid Tolerance and a Transition to Chronic Pain  

PubMed Central

Clinical pain conditions may remain responsive to opiate analgesics for extended periods, but such persistent acute pain can undergo a transition to an opiate-resistant chronic pain state that becomes a much more serious clinical problem. To test the hypothesis that cellular mechanisms of chronic pain in the primary afferent also contribute to the development of opiate resistance, we employed a recently developed model of the transition of from acute to chronic pain, hyperalgesic priming. Repeated intradermal administration of the potent and highly selective ?-opioid agonist, DAMGO, to produce tolerance for its inhibition of prostaglandin E2 (PGE2) hyperalgesia, simultaneously produced hyperalgesic priming. Conversely, injection of an inflammogen, carrageenan, used to produce priming produced DAMGO tolerance. Both effects were prevented by inhibition of protein kinase C? (PKC?). Carrageenan also induced opioid dependence, manifest as ?-opioid receptor antagonist (CTOP)-induced hyperalgesia that, like priming, was PKC?- and Gi-dependent. These findings suggest that the transition from acute to chronic pain, and development of ?-opioid receptor tolerance and dependence may be linked by common cellular mechanisms in the primary afferent. PMID:20357116

Joseph, Elizabeth K.; Reichling, David B.; Levine, Jon D.

2010-01-01

49

A preliminary report on adjuvant analgesic efficacy of HANS in opioid tolerant patients with cancer pain  

PubMed Central

Objective To observe the adjuvant analgesic efficacy of Han’s Acupoint Nerve Stimulator (HANS) in opioid tolerant patients with cancer pain. Methods A prospective non-controlled study was conducted. Opioid tolerant patients with cancer pain were enrolled and treated with both routinely analgesics and adjuvant HANS (2/100 Hz for 30 min/d, 5 d on and 2 d off for two weeks). Cancer pain, quality of life (QOL), anxiety and depression were assessed before enrollment and on d 8 and d 15 with the BPI-C, EORTC QLQ-C30, and self-rating anxiety scale (SAS)/self-rating depression scale (SDS), respectively; the therapeutic frequency of breakthrough pain (BP) and daily opioid dose were also recorded. Results Totally 47 patients meeting the inclusion criteria participated in this study; 43 patients completed the two-week treatment and assessment. The mean scores of patient’s “worst” and “least” pain intensity assessed with BPI-C decreased significantly on d 8 and d 15; the therapeutic frequency of BP also significantly decreased; but the average daily dose of opioids did not change significantly. For the nine symptoms in EORTC QLQ-C30 assessment, the mean scores of pain, fatigue, constipation and insomnia were significantly lower on d 8 and d 15 compared with baseline; the mean scores of the overall health status, nausea/vomiting and the incidence rates of both anxiety and depression also decreased significantly on d 15. Conclusions To opioid tolerant patients with cancer pain, adjuvant treatment with HANS could improve pain release and patients’ QOL by decreasing the severity of pain, fatigue, constipation, insomnia and other concomitant symptoms; it could also decrease the incidence rates of anxiety and depression. PMID:24826058

Li, Xiaomei; Zhu, Jianhua; Li, Pingping; Zhu, Guangqing; Wu, Xiaoming; Chen, Huoming; Zhao, Huixia; Wang, Wei; Zhang, Ying; Liu, Duanqi

2014-01-01

50

Tolerance of Pain by Cancer Patients in Hyperthermia Treatment  

Microsoft Academic Search

Hyperthermia-the artificial inducement of abnormally high blood temperature-is designed to cause tumor tissue to retain heat and has additive or synergistic effects with radiation and chemotherapy. Because of the clinically administered high temperature, cancer patients often experience pain and discomfort. In the study described in this article, 30 cancer patients undergoing hyperthermia treatment as part of their overall cancer care

Ronald H. Rozensky; Laurie Feldman Honor; Steve M. Tovian; Gordon Herz; Margaret Holland

1985-01-01

51

Decreased pain tolerance and mood in recreational users of MDMA  

Microsoft Academic Search

Rationale3,4-Methylenedioxymethamphetamine (MDMA) is known to affect brain serotonin (5-HT) neurons in experimental animals. However, its effects on humans are more difficult to infer. Serotonin is implicated in the body’s ability to modulate the effects of pain and to regulate mood.ObjectiveThe aim of this research is to test nociceptive responses and mood in MDMA users as an index of central 5-HT

MargaretClaire O’Regan; Angela Clow

2004-01-01

52

Chronic morphine use does not induce peripheral tolerance in a rat model of inflammatory pain  

PubMed Central

Although opioids are highly effective analgesics, they are also known to induce cellular adaptations resulting in tolerance. Experimental studies are often performed in the absence of painful tissue injury, which precludes extrapolation to the clinical situation. Here we show that rats with chronic morphine treatment do not develop signs of tolerance at peripheral ?-opioid receptors (?-receptors) in the presence of painful CFA-induced paw inflammation. In sensory neurons of these animals, internalization of ?-receptors was significantly increased and G protein coupling of ?-receptors as well as inhibition of cAMP accumulation were preserved. Opioid receptor trafficking and signaling were reduced, and tolerance was restored when endogenous opioid peptides in inflamed tissue were removed by antibodies or by depleting opioid-producing granulocytes, monocytes, and lymphocytes with cyclophosphamide (CTX). Our data indicate that the continuous availability of endogenous opioids in inflamed tissue increases recycling and preserves signaling of ?-receptors in sensory neurons, thereby counteracting the development of peripheral opioid tolerance. These findings infer that the use of peripherally acting opioids for the prolonged treatment of inflammatory pain associated with diseases such as chronic arthritis, inflammatory neuropathy, or cancer, is not necessarily accompanied by opioid tolerance. PMID:18246198

Zöllner, Christian; Mousa, Shaaban A.; Fischer, Oliver; Rittner, Heike L.; Shaqura, Mohammed; Brack, Alexander; Shakibaei, Mehdi; Binder, Waltraud; Urban, Florian; Stein, Christoph; Schäfer, Michael

2008-01-01

53

Reliability and validity of the pressure pain thresholds (PPT) in the TMJ capsules by electronic algometer.  

PubMed

Pressure pain thresholds (PPT) of 39 normal subjects (20 males and 19 females) and 30 female patients with temporomandibular joint (TMJ) capsulitis (21 lateral and 25 posterior capsulitis) were examined by an electronic algometer. In normal subjects, statistically significant correlation coefficients were obtained from the values of intra-examiners and inter-examiners in both lateral and posterior TMJ capsules (p < 0.01). A comparison with data obtained from contralateral sides failed to demonstrate significant differences. Statistically significant differences were found between the PPT of normal female subjects and female patients with capsulitis in both lateral and posterior TMJ capsules (p < 0.01). PMID:8242778

Chung, S C; Kim, J H; Kim, H S

1993-07-01

54

Feasibility and reliability of pain pressure threshold measurements in patellar tendinopathy.  

PubMed

Patellar tendinopathy is a common and often difficult to treat overuse injury which is characterized by activity-related anterior knee and focal palpation tenderness of the patellar tendon. The clinical diagnosis is mainly based on clinical examination, in which the yardstick is a non-standardized manual palpation. To standardize this palpation procedure the use of an algometer seems applicable. The purpose of this study was to investigate the feasibility and reliability of the algometer in patellar tendinopathy. A cross sectional study was carried out.The algometer was applied to the patellar tendon in 20 asymptomatic volleyball players to measure the 'normal' pressure pain threshold. The inter-rater reliability was analyzed in 54 athletes with symptomatic patellar tendinopathy, the intra-rater reliability was analyzed in 48 athletes with symptomatic patellar tendinopathy. During the procedure difficulties were described, the SEM, intra class correlations and limits of agreement were determined using the Bland and Altman method. The feasibility of the algometer is adequate. The PPT of asymptomatic athletes differs significantly (p<.001) from athletes with a diagnosis of patellar tendinopathy. The inter-rater (ICC 0.93) and intra-rater (ICC 0.60) reliability of the pain pressure threshold are adequate to moderate. Although further research is warranted PPT algometry seems to be a feasible, reliable and useful tool in the diagnosis and treatment evaluation of athletes with patellar tendinopathy. PMID:21669552

van Wilgen, Paul; van der Noord, Robert; Zwerver, Johannes

2011-11-01

55

Threshold of Musculoskeletal Pain Intensity for Increased Risk of Long-Term Sickness Absence among Female Healthcare Workers in Eldercare  

PubMed Central

Purpose Musculoskeletal disorders increase the risk for absenteeism and work disability. However, the threshold when musculoskeletal pain intensity significantly increases the risk of sickness absence among different occupations is unknown. This study estimates the risk for long-term sickness absence (LTSA) from different pain intensities in the low back, neck/shoulder and knees among female healthcare workers in eldercare. Methods Prospective cohort study among 8,732 Danish female healthcare workers responding to a questionnaire in 2004–2005, and subsequently followed for one year in a national register of social transfer payments (DREAM). Using Cox regression hazard ratio (HR) analysis we modeled risk estimates of pain intensities on a scale from 0–9 (reference 0, where 0 is no pain and 9 is worst imaginable pain) in the low back, neck/shoulders and knees during the last three months for onset of LTSA (receiving sickness absence compensation for at least eight consecutive weeks) during one-year follow-up. Results During follow-up, the 12-month prevalence of LTSA was 6.3%. With adjustment for age, BMI, smoking and leisure physical activity, the thresholds of pain intensities significantly increasing risk of LTSA for the low back (HR 1.44 [95%CI 1.07–1.93]), neck/shoulders (HR 1.47 [95%CI 1.10–1.96]) and knees (HR 1.43 [95%CI 1.06–1.93]) were 5, 4 and 3 (scale 0–9), respectively, referencing pain intensity of 0. Conclusion The threshold of pain intensity significantly increasing the risk for LTSA among female healthcare workers varies across body regions, with knee pain having the lowest threshold. This knowledge may be used in the prevention of LTSA among health care workers. PMID:22911772

Andersen, Lars L.; Clausen, Thomas; Burr, Hermann; Holtermann, Andreas

2012-01-01

56

Transrectal ultrasound-guided prostate biopsy, periprostatic local anesthesia and pain tolerance.  

PubMed

We have evaluated objectively pain tolerance in transrectal ultrasound-guided prostate biopsy (TRUS) using local periprostatic per rectal anesthesia as compared to the conventional method. From November 2008 to May 2009, 90 patients underwent transrectal ultrasound-guided prostate biopsy at Department of Urology, Clinical Center University Sarajevo. 90 patients who fulfilled the inclusion criteria were randomized into 3 groups of 30 patients each. Group 1 received periprostatic local anesthesia with 2% lidocaine, group 2 received Voltaren supp placed in rectum an hour before biopsy while group 3 received no local anesthesia. Pain scale responses were analyzed for each aspect of the biopsy procedure with a visual analog scale of 0-none to 10-maximal. There was no difference between the 3 groups in pain scores during digital rectal examination, intrarectal injection and probe insertion. The mean pain scores during needle insertion in group 1 receiving periprostatic nerve block and in group 2 receiving Voltaren supp were 3,10 +/- 2,32 and 5,15 +/- 2,01 respectively. In group 3 (no local anesthesia), mean pain scores were 6,06 +/- 2,95 which was found to be significantly different (p < 0,001). However, morbidity after the biopsy was not statistically different between all 3 groups. TRUS-guided prostate biopsy is a traumatic and painful experience, but the periprostatic blockage use is clearly associated with more tolerance and patient comfort during the exam. It is an easy, safe, acceptable and reproducible technique and should be considered for all patients undergoing TRUS biopsy regardless of age or number of biopsies. PMID:20192935

Hiros, Mustafa; Selimovic, Mirsad; Spahovic, Hajrudin; Sadovic, Sabina; Spuzic-Celic, Ediba

2010-02-01

57

The effects of aerobic exercise and strengthening exercise on pain pressure thresholds.  

PubMed

[Purpose] We assessed the effects of aerobic exercise and strengthening exercise on pain pressure thresholds (PPTs) over time. [Subjects and Methods] Fifteen healthy participants were recruited and randomly divided into 3 groups: aerobic exercise, strengthening exercise, and control. The subjects in the aerobic group walked on a treadmill for 40?min at 6.5?km/h. The subjects in the strength group performed circuit training that included bench press, lat pull down, biceps curl, triceps extension, and shoulder press based on the perceived exertion for 40?min. The subjects in the control group rested without any exercise in a quiet room for 40?min. The PPTs of 5 potential muscle trigger points before exercise, and immediately after 10 and 40?min of exercise or rest were measured using an electronic algometer (JTECH Medical, USA). The Friedman's, Kruskal-Wallis, and Mann-Whitney tests were performed using SPSS 18.0 (IBM, Korea). [Results] The PPTs of all subjects decreased after 10?min of exercise, but the difference was not statistically significant. The PPTs of the control group decreased after 40?min. Furthermore, the PPTs of 3 muscles increased after 40?min of aerobic exercise and of 6 muscles after 40?min of strengthening exercise. No significant difference in PPTs was noted among the groups. [Conclusion] The results show that 40?min is a more appropriate exercise time, although the efficacy of controlling pain did not differ between strengthening exercise and aerobic exercise. PMID:25140106

Lee, Han Suk

2014-07-01

58

Pressure Pain Thresholds Increase after Preconditioning 1 Hz Repetitive Transcranial Magnetic Stimulation with Transcranial Direct Current Stimulation  

PubMed Central

Background The primary motor cortex (M1) is an effective target of non-invasive cortical stimulation (NICS) for pain threshold modulation. It has been suggested that the initial level of cortical excitability of M1 plays a key role in the plastic effects of NICS. Objective Here we investigate whether transcranial direct current stimulation (tDCS) primed 1 Hz repetitive transcranial magnetic stimulation (rTMS) modulates experimental pressure pain thresholds and if this is related to observed alterations in cortical excitability. Method 15 healthy, male participants received 10 min 1 mA anodal, cathodal and sham tDCS to the left M1 before 15 min 1 Hz rTMS in separate sessions over a period of 3 weeks. Motor cortical excitability was recorded at baseline, post-tDCS priming and post-rTMS through recording motor evoked potentials (MEPs) from right FDI muscle. Pressure pain thresholds were determined by quantitative sensory testing (QST) through a computerized algometer, on the palmar thenar of the right hand pre- and post-stimulation. Results Cathodal tDCS-primed 1 Hz-rTMS was found to reverse the expected suppressive effect of 1 Hz rTMS on cortical excitability; leading to an overall increase in activity (p<0.001) with a parallel increase in pressure pain thresholds (p<0.01). In contrast, anodal tDCS-primed 1 Hz-rTMS resulted in a corresponding decrease in cortical excitability (p<0.05), with no significant effect on pressure pain. Conclusion This study demonstrates that priming the M1 before stimulation of 1 Hz-rTMS modulates experimental pressure pain thresholds in a safe and controlled manner, producing a form of analgesia. PMID:24658333

Moloney, Tonya M.; Witney, Alice G.

2014-01-01

59

Evaluation of sensitivity, motor and pain thresholds across the menstrual cycle through medium-frequency transcutaneous electrical nerve stimulation  

PubMed Central

OBJECTIVES: The aim of this study was to identify variations in nervous thresholds in different phases of the menstrual cycle in eumenorrheic women and users of oral contraceptives. METHOD: An observational study was performed including 56 volunteers, consisting of 30 eumenorrheic women who were non-users of oral contraceptives and 26 users of oral contraceptives. An electrical stimulator was employed to assess their nervous thresholds, with pulses applied at a fixed frequency of 2,500 Hz, modulated at 50 Hz, with phase variances of 20 ?s, 50 ?s and 100 ?s. Sensitivity, motor and pain thresholds were evaluated during five menstrual cycle phases: phase 1 - menstrual, phase 2 - follicular, phase 3 - ovulatory, phase 4 - luteal and phase 5 - premenstrual. RESULTS: The results indicated low sensitivity thresholds of 100 ?s for non-users of oral contraceptives and 50 ?s for oral contraceptive users in phase 5. Low motor thresholds of 20 ?s, 50 ?s and 100 ?s were observed for non-users of oral contraceptives in phase 5, while that of oral contraceptive users was 100 ?s. Finally, a low pain threshold of 100 ?s was observed in phase 5, but only in the oral contraceptive group. CONCLUSION: Nervous thresholds vary systematically across the phases of the menstrual cycle, with or without the use of oral contraceptives. These variations should be taken into account during research performed in women. PMID:23917651

de Brito Barbosa, Mariana; de Oliveira Guirro, Elaine Caldeira; Nunes, Fabiana Roberta

2013-01-01

60

Long-term fluctuations of pressure pain thresholds in healthy men, normally menstruating women and oral contraceptive users  

Microsoft Academic Search

The aim of this investigation was to evaluate whether the pressure pain threshold (PPT) in masticatory muscles of symptom-free subjects was influenced by fluctuations of the sex hormones. The PPT was measured with an electronic algometer for at least 10 consecutive menstrual cycles in 10 women using oral contraceptives and 10 women not using oral contraceptives, with a regular menstrual

Hans Isselée; Antoon De Laat; Kris Bogaerts; Roeland Lysens

2001-01-01

61

Human body impedance and threshold currents for perception and pain for contact hazard analysis in the VLF-MF band  

Microsoft Academic Search

The body impedance and threshold currents needed to produce sensations of perception and pain have been measured for 367 human subjects for the frequency range 10 kHz to 3 MHz. A sufficient number of subjects (197 male and 170 female subjects of ages between 18 and 70 years) were utilized in the study to make valid statistical predictions for the

Indira Chatterjee; Ding Wu; Om P. Gandhi

1986-01-01

62

Threshold temperatures mediate the impact of reduced snow cover on overwintering freeze-tolerant caterpillars  

NASA Astrophysics Data System (ADS)

Decreases in snow cover due to climate change could alter the energetics and physiology of ectothermic animals that overwinter beneath snow, yet how snow cover interacts with physiological thresholds is unknown. We applied numerical simulation of overwintering metabolic rates coupled with field validation to determine the importance of snow cover and freezing to the overwintering lipid consumption of the freeze-tolerant Arctiid caterpillar Pyrrharctia isabella. Caterpillars that overwintered above the snow experienced mean temperatures 1.3°C lower than those below snow and consumed 18.36 mg less lipid of a total 68.97-mg reserve. Simulations showed that linear temperature effects on metabolic rate accounted for only 30% of the difference in lipid consumption. When metabolic suppression by freezing was included, 93% of the difference between animals that overwintered above and below snow was explained. Our results were robust to differences in temperature sensitivity of metabolic rate, changes in freezing point, and the magnitude of metabolic suppression by freezing. The majority of the energy savings was caused by the non-continuous reduction in metabolic rate due to freezing, the first example of the importance of temperature thresholds in the lipid use of overwintering insects.

Marshall, Katie E.; Sinclair, Brent J.

2012-01-01

63

Study of experimental pain measures and nociceptive reflex in chronic pain patients and normal subjects.  

PubMed

This study evaluates (i) the effect of heterotopic chronic pain on various experimental pain measures, (ii) the relationship between experimental pain measures and chronic pain symptomatology assessment, and (iii) the influence of the various pain aetiologies on experimental pain measures. Fifty-three chronic pain patients were compared to 17 pain-free subjects with the following psychophysical and physiological indices: pain threshold (PTh), pain tolerance (PTol), verbal estimation of intensity and unpleasantness (intensity scale, IS; unpleasantness scale, US), threshold for intensity and unpleasantness (ITh and UTh), lower limb RIII nociceptive reflex (RIIITh and RIII frequency of occurrence). Chronic pain syndromes included neuropathic pain (n = 12), iodopathic pain (n = 12), myofascial syndromes (n = 9), headache (n = 9), and miscellaneous pain (n = 11). Chronic pain symptomatology was assessed with a visual analogue scale (VAS), a French MPQ adaptation (QDSA), Beck Depression Inventory (BDI), Spielberger State Trait Inventory (STAI) and Eysenck Personality Inventory (EPI). No significant difference was observed between chronic pain patients and pain-free control groups and between patient subgroups for PTh, PTol and RIIITh. No significant correlation was found between experimental pain measures and clinical pain, anxiety or depression scores. However, the chronic pain patients had a higher threshold for unpleasantness and judged the suprathreshold stimuli significantly less intense and less unpleasant than the control group. These results are discussed in relation to diffuse noxious inhibitory controls and the adaptation level theory of chronic pain experience. PMID:2052379

Boureau, F; Luu, M; Doubrère, J F

1991-02-01

64

Dynamic Compression Enhances Pressure-to-Pain Threshold in Elite Athlete Recovery: Exploratory Study.  

PubMed

Athlete recovery-adaptation is crucial to the progress and performance of highly trained athletes. The purpose of this study was to assess peristaltic pulse dynamic compression (PPDC) in reducing short-term pressure-to-pain threshold (PPT) among Olympic Training Center athletes following morning training. Muscular tenderness and stiffness are common symptoms of fatigue and exercise-induced muscle micro-trauma and edema. Twenty-four highly trained athletes (male = 12, female = 12) volunteered to participate in this study. The athletes were randomly assigned to experimental (n = 12) and control (n = 12) groups. PPT measurements were conducted with a manual algometer on three lower extremity muscles. Experimental group athletes underwent PPDC on both legs via computer-controlled circumferential inflated leggings that used a peristaltic-like pressure pattern from feet to groin. Pressures in each cell were set to factory defaults. Treatment time was 15 minutes. The control group performed the same procedures except that the inflation pump to the leggings was off. The experimental timeline included a morning training session, followed by a PPT pre-test, treatment application (PPDC or control), an immediate post-test (PPT), and a delayed post-test (PPT) following the afternoon practice session. Difference score results showed that the experimental group's PPT threshold improved following PPDC treatment immediately and persisted the remainder of the day following afternoon practice. The control group showed no statistical change. We conclude that PPDC is a promising means of accelerating and enhancing recovery following the normal aggressive training that occurs in Olympic and aspiring Olympic athletes. PMID:24531439

Sands, William A; McNeal, Jeni R; Murray, Steven Ross; Stone, Michael H

2014-02-12

65

Answer to comment on “sleep quality, arousal and pain thresholds in migraineurs: a blinded controlled polysomnographic study”  

PubMed Central

We discuss the comments on our article “Sleep quality, arousal and pain thresholds in migraineurs. A blinded controlled polysomnographic study” published in JHP 2013 Feb 14;14(1):12. We hypothesize that migraineurs need more sleep than healthy controls and more sleep than they manage to achieve. Some migraineurs probably have a decreased ability to process incoming stimuli. Increased spontaneous pain may follow either sleep restriction or sleep disturbance. A comparison of migraineurs with attack onset related to sleep, migraineurs with attack onset not related to sleep and controls will be reported in another paper. PMID:23815607

2013-01-01

66

Chronic inflammatory pain prevents tolerance to the antinociceptive effect of morphine microinjected into the ventrolateral periaqueductal gray of the rat  

PubMed Central

The ventrolateral periaqueductal gray (vlPAG) contributes to morphine antinociception and tolerance. Chronic inflammatory pain causes changes within the PAG that are expected to enhance morphine tolerance. This hypothesis was tested by assessing antinociception and tolerance following repeated microinjections of morphine into the vlPAG of rats with chronic inflammatory pain. Microinjection of morphine into the vlPAG reversed the allodynia caused by intraplantar administration of Complete Freund's Adjuvant (CFA), and produced antinociception on the hot plate test. Although there was a gradual decrease in morphine antinociception with repeated testing, there was no evidence of tolerance when morphine and saline treated rats with hind paw inflammation were tested with cumulative doses of morphine. In contrast, repeated morphine injections into the vlPAG caused a rightward shift in the morphine dose-response curve in rats without hind paw inflammation, as would be expected with the development of tolerance. The lack of tolerance in CFA treated rats was evident whether rats were exposed to repeated behavioral testing or not (Experiment 2) and whether they were treated with 4 or 8 prior microinjections of morphine into the vlPAG (Experiment 3). These data demonstrate that chronic inflammatory pain does not disrupt the antinociceptive effect of microinjecting morphine into the vlPAG, but it does disrupt the development of tolerance. PMID:24161274

Mehalick, Melissa L.; Ingram, Susan L.; Aicher, Sue; Morgan, Michael M

2013-01-01

67

Efficacy and gastrointestinal tolerability of oral oxycodone/naloxone combination for chronic pain in outpatients with cancer: an observational study.  

PubMed

Combination opioid agonist/antagonist therapy has been shown to preserve bowel function in patients with chronic cancer pain. This retrospective study evaluated the efficacy and tolerability of prolonged-released fixed-dose oxycodone-naloxone (PR OXN) in consecutive outpatients with chronic cancer pain. Of 206 patients prescribed PR OXN (mean age 61.3 ± 12.9 years; 52.9% female), 31.5% were opioid naïve. PR OXN was associated with a significant decrease in pain score measured on a visual analogue scale over 28 days (P < .0001), without adverse effects on bowel function, nor change in laxative use. PR OXN efficacy and tolerability were similar in opioid-naïve and -experienced patients, and among age-stratified subgroups. No severe side effects occurred. In a real-life outpatient setting, PR OXN provided analgesia without bowel dysfunction in patients with chronic cancer pain. PMID:24249829

Cuomo, Arturo; Russo, Gennaro; Esposito, Gennaro; Forte, Cira Antonietta; Connola, Marianna; Marcassa, Claudio

2014-12-01

68

Neuropathic Pain Activates the Endogenous ? Opioid System in Mouse Spinal Cord and Induces Opioid Receptor Tolerance  

PubMed Central

Release of endogenous dynorphin opioids within the spinal cord after partial sciatic nerve ligation (pSNL) is known to contribute to the neuropathic pain processes. Using a phosphoselective antibody [? opioid receptor (KOR-P)] able to detect the serine 369 phosphorylated form of the KOR, we determined possible sites of dynorphin action within the spinal cord after pSNL. KOR-P immunoreactivity (IR) was markedly increased in the L4 –L5 spinal dorsal horn of wild-type C57BL/6 mice (7–21 d) after lesion, but not in mice pretreated with the KOR antagonist nor-binaltorphimine (norBNI). In addition, knock-out mice lacking prodynorphin, KOR, or G-protein receptor kinase 3 (GRK3) did not show significant increases in KOR-P IR after pSNL. KOR-P IR was colocalized in both GABAergic neurons and GFAP-positive astrocytes in both ipsilateral and contralateral spinal dorsal horn. Consistent with sustained opioid release, KOR knock-out mice developed significantly increased tactile allodynia and thermal hyperalgesia in both the early (first week) and late (third week) interval after lesion. Similarly, mice pretreated with norBNI showed enhanced hyperalgesia and allodynia during the 3 weeks after pSNL. Because sustained activation of opioid receptors might induce tolerance, we measured the antinociceptive effect of the ? agonist U50,488 using radiant heat applied to the ipsilateral hindpaw, and we found that agonist potency was significantly decreased 7 d after pSNL. In contrast, neither prodynorphin nor GRK3 knock-out mice showed U50,488 tolerance after pSNL. These findings suggest that pSNL induced a sustained release of endogenous prodynorphin-derived opioid peptides that activated an anti-nociceptive KOR system in mouse spinal cord. Thus, endogenous dynorphin had both pronociceptive and antinociceptive actions after nerve injury and induced GRK3-mediated opioid tolerance. PMID:15140929

Xu, Mei; Petraschka, Michael; McLaughlin, Jay P.; Westenbroek, Ruth E.; Caron, Marc G.; Lefkowitz, Robert J.; Czyzyk, Traci A.; Pintar, John E.; Terman, Gregory W.; Chavkin, Charles

2008-01-01

69

Do Diabetic Patients with Acute Coronary Syndromes Have a Higher Threshold for Ischemic Pain?  

PubMed Central

Background: Data from over 4 decades have reported a higher incidence of silent infarction among patients with diabetes mellitus (DM), but recent publications have shown conflicting results regarding the correlation between DM and presence of pain in patients with acute coronary syndromes (ACS). Objective: Our primary objective was to analyze the association between DM and precordial pain at hospital arrival. Secondary analyses evaluated the association between hyperglycemia and precordial pain at presentation, and the subgroup of patients presenting within 6 hours of symptom onset. Methods: We analyzed a prospectively designed registry of 3,544 patients with ACS admitted to a Coronary Care Unit of a tertiary hospital. We developed multivariable models to adjust for potential confounders. Results: Patients with precordial pain were less likely to have DM (30.3%) than those without pain (34.0%; unadjusted p = 0.029), but this difference was not significant after multivariable adjustment, for the global population (p = 0.84), and for subset of patients that presented within 6 hours from symptom onset (p = 0.51). In contrast, precordial pain was more likely among patients with hyperglycemia (41.2% vs 37.0% without hyperglycemia, p = 0.035) in the overall population and also among those who presented within 6 hours (41.6% vs. 32.3%, p = 0.001). Adjusted models showed an independent association between hyperglycemia and pain at presentation, especially among patients who presented within 6 hours (OR = 1.41, p = 0.008). Conclusion: In this non-selected ACS population, there was no correlation between DM and hospital presentation without precordial pain. Moreover, hyperglycemia correlated significantly with pain at presentation, especially in the population that arrived within 6 hours from symptom onset. PMID:25076180

Nicolau, José Carlos; Barbosa, Carlos José Dornas Gonçalves; Franci, André; Baracioli, Luciano Moreira; Franken, Marcelo; Lima, Felipe Gallego; Giraldez, Roberto Rocha; Kalil Filho, Roberto; Ramires, José Antônio Franchini; Giugliano, Robert P.

2014-01-01

70

Migraine, arousal and sleep deprivation: comment on: “sleep quality, arousal and pain thresholds in migraineurs: a blinded controlled polysomnographic study”  

PubMed Central

We discuss the hypothesis proposed by Engstrom and coworkers that Migraineurs have a relative sleep deprivation, which lowers the pain threshold and predispose to attacks. Previous data indicate that Migraineurs have a reduction of Cyclic Alternating Pattern (CAP), an essential mechanism of NREM sleep regulation which allows to dump the effect of incoming disruptive stimuli, and to protect sleep. The modifications of CAP observed in Migraineurs are similar to those observed in patients with impaired arousal (narcolepsy) and after sleep deprivation. The impairment of this mechanism makes Migraineurs more vulnerable to stimuli triggering attacks during sleep, and represents part of a more general vulnerability to incoming stimuli. PMID:23758606

2013-01-01

71

Soil-Water Threshold Range of Chemical Signals and Drought Tolerance Was Mediated by ROS Homeostasis in Winter Wheat During Progressive Soil Drying  

Microsoft Academic Search

The soil-water threshold range of chemical signals and reactive oxygen species (ROS) homeostasis could have a profound impact\\u000a on drought tolerance in wheat. A pot experiment was used to investigate the homeostasis between ROS and antioxidant defense\\u000a at five harvest dates, and its role in the correlation between soil-water threshold range of chemical signals and drought\\u000a tolerance in three wheat

Zhen-Yu Wang; Feng-Min Li; You-Cai Xiong; Bing-Cheng Xu

2008-01-01

72

Determination of a pressure pain threshold cut-off value for the diagnosis of temporomandibular joint arthralgia.  

PubMed

Temporomandibular joint (TMJ) disorders are divided by the American Academy of Orofacial Pain into five categories. The most common ones are joint pain, as arthralgia and joint disorders, as disc displacements. An important clinical presentation of arthralgia is the painful tenderness to manual palpation or decreased pressure pain threshold (PPT). The authors conducted a study to determine the appropriate PPT value to discriminate asymptomatic TMJ individuals from those with moderate to severe arthralgia. Forty-nine individuals was evaluated and divided into groups: TMJ arthralgia, asymptomatic disc displacement and control group. Magnetic resonance images were obtained for all the groups, and algometry was performed on the TMJ lateral pole. Patients with arthralgia filled out a visual analogue scale (VAS). anova test with 1% of significance analysed the data. Specificity, sensitivity and ROC curve were also determined. Arthralgia group had significant lower PPT (mean of 1.07 kgf cm(-2) ) than the others. Asymptomatic disc displacement group (mean of 1.64 kgf cm(-2) ) has shown significant lower PPT than the control (mean of 2.35 kgf cm(-2) ). 89.66% of specificity and 70% of sensitivity were obtained when 1.36 kgf cm(-2) was applied to the TMJ (ROC area = 0.90). This value was considered to be the most appropriate to detected moderate to severe TMJ arthralgia. Indeed, the presence of disc displacement seems to significantly decrease PPT levels in asymptomatic subjects. The PPT value of 1.36 kgf cm(-2) can be used in the calibration procedures of the professionals involved with temporomandibular disorders and orofacial pain. PMID:24612404

Cunha, C O; Pinto-Fiamengui, L M S; Castro, A C P C; Lauris, J R P; Conti, P C R

2014-05-01

73

Practical Guide to the Management of Acute and Chronic Pain in the Presence of Drug Tolerance for the Healthcare Practitioner  

PubMed Central

Background Drug tolerance has been on the rise in recent years worldwide, and consequently, pain management in our population has become challenging. Methods Discussed in this review are commonly abused drugs and considerations for treating acute and chronic pain states in patients with substance disorders. Results After marijuana, alcohol, and tobacco, the most widely abused substances are oxycodone (Oxycontin), diazepam (Valium), and methylphenidate (Ritalin). Urine testing can detect metabolites of drugs used by patients and is useful for assessing drug abuse, medication diversion, and drug interactions. The comprehensive treatment of pain in a patient with addictive disorder or tolerance must address 3 issues: the patient's addiction, any associated psychiatric conditions, and the patient's pain. Eliciting a detailed history of drug abuse—illicit drugs as well as prescription drugs—and ascertaining if the patient is currently enrolled in a methadone maintenance program for the treatment of drug addiction is vital. Conclusion Medical observation, supportive care, multidisciplinary pain management, and timely interventions as necessary are the keys to safe outcomes in these patients. PMID:25249810

Vadivelu, Nalini; Singh-Gill, Harman; Kodumudi, Gopal; Kaye, Aaron Joshua; Urman, Richard D.; Kaye, Alan David

2014-01-01

74

Effects of a combination of oral naproxen sodium and codeine on experimentally induced pain  

Microsoft Academic Search

The effect of an orally administered combination of naproxen sodium 550 mg and codeine phosphate 60 mg on threshold and tolerance to electrically induced pain, and on the threshold to thermally induced pain, was compared with the effects of naproxen sodium 550 mg alone, codeine phosphate 60 mg alone, and placebo. 16 female and 16 male, healthy young subjects, took

G. Stacher; P. Bauer; C. Schneider; S. Winklehner; G. Schmierer

1982-01-01

75

Correlation between the levels of non-specific physical symptoms and pressure pain thresholds measured by algometry in patients with temporomandibular disorders.  

PubMed

Recent studies showed that patients with chronic TMD pain also feature increased sensitivity in other craniofacial regions, and even in remote peripheral areas, suggesting that nociceptive processing is centrally facilitated in this patient population. The aim of this study was to investigate the existence of a negative correlation between the levels of non-specific physical symptoms and pressure pain thresholds measured by algometry at sites distant from the chief complaint of oro-facial pain in patients with TMD. A total of 20 female patients were evaluated comprising 11 patients diagnosed with myofascial pain (Group I of RDC/TMD) and 9 patients with arthralgia (Group III of RDC/TMD), with both reporting chronic TMD pain for at least 3 months. Patients were tested by the pressure algometry technique, and, in the same visit, clinical diagnosis and levels of non-specific physical symptoms, including pain-related issues or not, were obtained. The raw scores were then standardised into a T-score. The possible correlation between the dependent variable levels of non-specific physical symptoms and pressure pain thresholds measured by algometry at sites distant from the chief complaint of oro-facial pain was assessed with Spearman's correlation coefficient. Results were considered statistically significant, which stood a lower than 5% probability of occurring by chance (P < 0·05). A statistically significant (P = 0·02) negative correlation (-0·51) was found to exist between the levels of non-specific physical symptoms, only if including issues involving pain-related symptoms, and experimental pressure pain thresholds in patients with painful TMD. PMID:25293389

Ramalho, D; Macedo, L; Goffredo Filho, G; Goes, C; Tesch, R

2015-02-01

76

Subgroups based on thermal and pressure pain thresholds in women with chronic whiplash display differences in clinical presentation – an explorative study  

PubMed Central

Purpose To investigate the presence of subgroups in chronic whiplash-associated disorders (WAD) based on pain thresholds for pressure (PPT), cold (CPT), and heat (HPT) and to compare these subgroups with respect to symptomatology, disability, and health aspects. Methods Two groups of female subjects – patients with chronic WAD (n = 28) and healthy controls (CON; n = 29) – were investigated. Quantitative sensory testing (QST) for thermal thresholds and algometry for PPT at four sites in the body (over the trapezius and tibialis anterior bilaterally) were determined. Habitual pain intensities, psychological strain, disability, and health aspects were registered using a questionnaire. Results A cluster analysis based on PPT, CPT, and HPT identified two subgroups of chronic WAD: one sensitive subgroup (s-WAD; n = 21), and one less sensitive subgroup (ls-WAD; n = 6). S-WAD displayed widespread hyperalgesia, whereas ls-WAD had localized hyperalgesia in the neck area, with tendencies to supernormal values in remote areas of the body. Generally, s-WAD had a significantly worse situation than the CON with respect to symptomatology, disability, and health aspects. The ls-WAD group was intermediary between s-WAD and CON in these aspects. Conclusion Different explanations, eg, severity of the pain condition per se, etiological factors, and pre-trauma differences in pain sensitivity, may exist for the differences in pain thresholds between the two subgroups. Future research should investigate the role of pain thresholds in the chronic stage to determine the efficacy of treatment interventions. PMID:23166449

Börsbo, Björn; Liedberg, Gunilla M; Wallin, Mia; Gerdle, Björn

2012-01-01

77

Conditioned pain modulation in temporomandibular disorders (TMD) pain patients.  

PubMed

The aims were to investigate (1) if temporomandibular disorders (TMD) patients with temporomandibular joint (TMJ) pain had different conditioned pain modulation (CPM) compared with healthy subjects and, (2) if clinical pain characteristics influenced CPM. Sixteen TMD pain patients and 16 age-matched healthy subjects were participated. A mechanical conditioning stimulus (CS) was applied to pericranial muscles provoking a pain intensity of 5/10 on a visual analogue scale. Pressure pain thresholds (PPT) and pressure pain tolerance thresholds (PPTol) were assessed at masseter, forearm and painful TMJ (only PPT) before, during, and 20 min after CS. Data were analyzed with ANOVAs. The correlations between CPM effect and ratings of TMD pain intensity on a numerical rating scale (NRS) or the pain duration were calculated (correlation coefficient; R). The relative PPT and PPTol increases (mean for the three assessment sites) during CS were significantly higher than baseline in healthy subjects (43.0 ± 3.6, 33.0 ± 4.0 %; P < 0.001, P < 0.001) but not in the TMD pain patients (4.9 ± 2.7, -1.4 ± 4.1 %; P = 0.492, P = 1.000) with significant differences between groups (P < 0.001). In the patients, the relative PPT changes during CS were not significantly higher than baseline at TMJ (5.3 ± 3.8 %, P = 0.981) and masseter (-2.8 ± 4.8 %, P = 1.000) but significantly higher at forearm (12.3 ± 4.7 %, P = 0.039). No correlation was detected between TMD pain intensity and CPM effect (R = -0.261; P = 0.337) or between pain duration and CPM effect (R = -0.423; P = 0.103) at painful TMJ. These findings indicate that CPM is impaired in TMD pain patients especially at sites with chronic pain but not at pain-free sites and that the clinical pain characteristics do not influence CPM. PMID:24897946

Oono, Yuka; Wang, Kelun; Baad-Hansen, Lene; Futarmal, Simple; Kohase, Hikaru; Svensson, Peter; Arendt-Nielsen, Lars

2014-10-01

78

A Novel Magnetic Stimulator Increases Experimental Pain Tolerance in Healthy Volunteers - A Double-Blind Sham-Controlled Crossover Study  

PubMed Central

The ‘complex neural pulse’TM (CNP) is a neuromodulation protocol employing weak pulsed electromagnetic fields (PEMF). A pioneering paper reported an analgesic effect in healthy humans after 30 minutes of CNP-stimulation using three nested whole head coils. We aimed to devise and validate a stimulator with a novel design entailing a multitude of small coils at known anatomical positions on a head cap, to improve applicability. The main hypothesis was that CNP delivery with this novel device would also increase heat pain thresholds. Twenty healthy volunteers were enrolled in this double-blind, sham-controlled, crossover study. Thirty minutes of PEMF (CNP) or sham was applied to the head. After one week the other treatment was given. Before and after each treatment, primary and secondary outcomes were measured. Primary outcome was heat pain threshold (HPT) measured with thermal quantitative sensory testing. Other outcomes were warmth detection threshold, and aspects of cognition, emotion and motor performance. As hypothesized heat pain threshold was significantly increased after the PEMF stimulation. All other outcomes were unaltered by the PEMF but there was a trend level reduction of cognitive performance after PEMF stimulation as measured by the digit-symbol substitution task. Results from this pilot study suggest that our device is able to stimulate the brain and to modulate its function. This is in agreement with previous studies that used similar magnetic field strengths to stimulate the brain. Specifically, pain control may be achieved with PEMF and for this analgesic effect, coil design does not appear to play a dominant role. In addition, the flexible configuration with small coils on a head cap improves clinical applicability. Trial Registration Dutch Cochrane Centre NTR1093 PMID:23620795

Kortekaas, Rudie; Konopka, Karl-Heinz; Harbers, Marten; van der Hoeven, Johannes H.; van Wijhe, Marten; Aleman, André; Maurits, Natasha M.

2013-01-01

79

Habitat selection and ranges of tolerance: how do species differ beyond critical thresholds?  

PubMed

Sensitivity to habitat fragmentation often has been examined in terms of thresholds in landscape composition at which a species is likely to occur. Observed thresholds often have been low or absent, however, leaving much unexplained about habitat selection beyond initial thresholds of occurrence, even for species with strong habitat preferences. We examined responses to varying amounts of tree cover, a widely influential measure of habitat loss, for 40 woodland bird species in a mixed woodland/grassland landscape in eastern North Dakota, USA. We used LOESS smoothing to describe incidence for each species at three scales: within 200, 400, and 1200 m around sample locations. For the 200-m scale, we also calculated the most-preferred range of tree cover (within which at least half of observations were predicted to occur) for each species. Only 10 of 40 species had occurrence thresholds greater than about 10% tree cover. After initial occurrence, species showed three general patterns: some increased monotonically with tree cover; some increased up to an asymptote; some peaked at intermediate amounts of tree cover and then declined. These patterns approximate selection for interior woodlands and for edge-rich environments, but incidence plots provide greater detail in landscape-scale selection than do those categories. For most species, patterns persisted at larger scales, but for some, larger scales had distinctly different patterns than local scales. Preferred ranges of tree cover varied from <20% tree cover (common grackle, Quiscalus quiscula) to >60% (veery, Catharus fuscescens). We conclude that incidence patterns provide more information on habitat selection than do threshold measures for most species: in particular, they differentiate species preferring concentrated woodlands from those preferring mixed landscapes, and they show contrasting degrees of selectiveness. [Correction added on 16 October 2012, after first online publication: the Abstract section has been reworded]. PMID:23170216

Cunningham, Mary Ann; Johnson, Douglas H

2012-11-01

80

Habitat selection and ranges of tolerance: how do species differ beyond critical thresholds?  

PubMed Central

Sensitivity to habitat fragmentation often has been examined in terms of thresholds in landscape composition at which a species is likely to occur. Observed thresholds often have been low or absent, however, leaving much unexplained about habitat selection beyond initial thresholds of occurrence, even for species with strong habitat preferences. We examined responses to varying amounts of tree cover, a widely influential measure of habitat loss, for 40 woodland bird species in a mixed woodland/grassland landscape in eastern North Dakota, USA. We used LOESS smoothing to describe incidence for each species at three scales: within 200, 400, and 1200 m around sample locations. For the 200-m scale, we also calculated the most-preferred range of tree cover (within which at least half of observations were predicted to occur) for each species. Only 10 of 40 species had occurrence thresholds greater than about 10% tree cover. After initial occurrence, species showed three general patterns: some increased monotonically with tree cover; some increased up to an asymptote; some peaked at intermediate amounts of tree cover and then declined. These patterns approximate selection for interior woodlands and for edge-rich environments, but incidence plots provide greater detail in landscape-scale selection than do those categories. For most species, patterns persisted at larger scales, but for some, larger scales had distinctly different patterns than local scales. Preferred ranges of tree cover varied from <20% tree cover (common grackle, Quiscalus quiscula) to >60% (veery, Catharus fuscescens). We conclude that incidence patterns provide more information on habitat selection than do threshold measures for most species: in particular, they differentiate species preferring concentrated woodlands from those preferring mixed landscapes, and they show contrasting degrees of selectiveness. [Correction added on 16 October 2012, after first online publication: the Abstract section has been reworded]. PMID:23170216

Cunningham, Mary Ann; Johnson, Douglas H

2012-01-01

81

Tapentadol prolonged release for severe chronic cancer-related pain: effectiveness, tolerability, and influence on quality of life of the patients  

PubMed Central

Background Clinical trials have shown the efficacy and good tolerability of tapentadol prolonged release (PR) for severe chronic pain of different etiologies. This study investigated the influence of tapentadol PR on pain control and quality of life of patients with severe chronic cancer-related pain in routine clinical practice in Germany. Patients and methods During a 3-month observation period, 45 physicians (mainly palliative care specialists) documented dosage and tolerability of tapentadol PR, previous and concomitant analgesic treatment, pain intensity, pain-related restrictions of daily activities and quality of life, and general state of health of 123 patients with chronic cancer-related pain in the context of a prospective noninterventional study. Results All patients (mean age 63.9±13.2 years, 93.5% in constant pain) had received analgesic long-term treatment (42.3% strong opioids) prior to the start of tapentadol PR treatment. During the observation period, tapentadol PR significantly reduced the average pain intensity by 2.4 points (from a mean 6.1±1.7 to 3.7±2.0, P<0.001); half of the patients (52%) achieved a pain score ?3 at the end of observation. At the same time, mental and emotional well-being, pain-related impairments of daily activities, sleep quality, and quality of life improved, while the overall intake of analgesic concomitant medication could be reduced. Improvements in general state of health were significant (P<0.001). Overall, tapentadol PR was well tolerated. Conclusion Good pain control with tapentadol PR was accompanied by markedly reduced pain-related mental and physical burden and quality of life improved. Overall, the general state of health of these patients with chronic cancer-related pain improved significantly despite the underlying illness.

Schikowski, Artur; Krings, Doris; Schwenke, Karla

2015-01-01

82

Heat-Related Deaths in Hot Cities: Estimates of Human Tolerance to High Temperature Thresholds  

PubMed Central

In this study we characterized the relationship between temperature and mortality in central Arizona desert cities that have an extremely hot climate. Relationships between daily maximum apparent temperature (ATmax) and mortality for eight condition-specific causes and all-cause deaths were modeled for all residents and separately for males and females ages <65 and ?65 during the months May–October for years 2000–2008. The most robust relationship was between ATmax on day of death and mortality from direct exposure to high environmental heat. For this condition-specific cause of death, the heat thresholds in all gender and age groups (ATmax = 90–97 °F; 32.2?36.1 °C) were below local median seasonal temperatures in the study period (ATmax = 99.5 °F; 37.5 °C). Heat threshold was defined as ATmax at which the mortality ratio begins an exponential upward trend. Thresholds were identified in younger and older females for cardiac disease/stroke mortality (ATmax = 106 and 108 °F; 41.1 and 42.2 °C) with a one-day lag. Thresholds were also identified for mortality from respiratory diseases in older people (ATmax = 109 °F; 42.8 °C) and for all-cause mortality in females (ATmax = 107 °F; 41.7 °C) and males <65 years (ATmax = 102 °F; 38.9 °C). Heat-related mortality in a region that has already made some adaptations to predictable periods of extremely high temperatures suggests that more extensive and targeted heat-adaptation plans for climate change are needed in cities worldwide. PMID:24658410

Harlan, Sharon L.; Chowell, Gerardo; Yang, Shuo; Petitti, Diana B.; Morales Butler, Emmanuel J.; Ruddell, Benjamin L.; Ruddell, Darren M.

2014-01-01

83

Efficacy and tolerability of carbamazepine for the treatment of painful diabetic neuropathy in adults: a 12-week, open-label, multicenter study  

PubMed Central

Objective Anticonvulsants are increasingly being used in the symptomatic management of several neuropathic pain disorders. The present observational study was designed to evaluate the efficacy, tolerability, and quality of life (QoL) of carbamazepine use for 12 weeks in patients with painful diabetic neuropathy, in Pakistan. Methods This was a 12-week, multicenter, open-label, uncontrolled trial in adult type 2 diabetic patients (aged 18–65 years) suffering from clinically confirmed neuropathic pain (Douleur Neuropathique en 4 [DN4] score ?4). Change in neuropathic pain at week 12 compared with baseline was assessed using the Brief Pain Inventory Scale–Short Form (pain severity score and pain interference score). QoL was determined by the American Chronic Pain Association QoL scale. Safety was assessed based on patient reported adverse events (AEs) and serious AEs. Results Of the total 500 screened patients, 452 enrolled and completed the study. The mean (± standard deviation [SD]) pain interference score decreased from 4.5±2.0 at baseline to 3.1±1.9 at week 12 (P<0.001). The mean (± SD) pain severity score decreased from 5.8±2.0 at baseline to 3.6±2.2 at week 12 (P<0.001). There was a decrease of ?30% in the pain severity score between visits. The mean (± SD) QoL scale score improved from 5.9±1.6 at baseline to 8.0±1.7 at week 12. A total of ten (2.2%) patients reported AEs during the study period. No patient discontinued the study due to AEs. Conclusion In this real-life experience study, carbamazepine, when prescribed for 12 weeks to adult diabetic patients suffering from neuropathic pain, showed pain-relief effect, with reduced mean pain severity and mean pain interference scores and with improved QoL and good tolerability profile. PMID:25061334

Saeed, Tariq; Nasrullah, Muhammad; Ghafoor, Adnan; Shahid, Riaz; Islam, Nadeem; Khattak, Mohammad Usman; Maheshwary, Neeta; Siddiqi, Ahson; Khan, Muhammad Athar

2014-01-01

84

Reduction of pain thresholds in fibromyalgia after very low-intensity magnetic stimulation: A double-blinded, randomized placebo-controlled clinical trial  

PubMed Central

BACKGROUND: Exposure to electromagnetic fields has been reported to have analgesic and antinociceptive effects in several organisms. OBJECTIVE: To test the effect of very low-intensity transcranial magnetic stimulation on symptoms associated with fibromyalgia syndrome. METHODS: A double-blinded, placebo-controlled clinical trial was performed in the Sagrado Corazón Hospital, Seville, Spain. Female fibromyalgia patients (22 to 50 years of age) were randomly assigned to either a stimulation group or a sham group. The stimulation group (n=28) was stimulated using 8 Hz pulsed magnetic fields of very low intensity, while the sham group (n=26) underwent the same protocol without stimulation. Pressure pain thresholds before and after stimulation were determined using an algometer during the eight consecutive weekly sessions of the trial. In addition, blood serotonin levels were measured and patients completed questionnaires to monitor symptom evolution. RESULTS: A repeated-measures ANOVA indicated statistically significant improvement in the stimulation group compared with the control group with respect to somatosensory pain thresholds, ability to perform daily activities, perceived chronic pain and sleep quality. While improvement in pain thresholds was apparent after the first stimulation session, improvement in the other three measures occurred after the sixth week. No significant between-group differences were observed in scores of depression, fatigue, severity of headaches or serotonin levels. No adverse side effects were reported in any of the patients. CONCLUSIONS: Very low-intensity magnetic stimulation may represent a safe and effective treatment for chronic pain and other symptoms associated with fibromyalgia. PMID:24308025

Maestú, Ceferino; Blanco, Manuel; Nevado, Angel; Romero, Julia; Rodríguez-Rubio, Patricia; Galindo, Javier; Lorite, Juan Bautista; de las Morenas, Francisco; Fernández-Argüelles, Pedro

2013-01-01

85

Threshold analysis with fault-tolerant operations for nonbinary quantum error correcting codes  

E-print Network

WITH FAULT-TOLERANT QUAN- TUM COMPUTATION ....................... 25 A.Background .......................... 25 1. Assumptions ....................... 25 2. SyndromeCalculation.................. 27 vii CHAPTER Page 3. ErrorModel ....................... 29 B... vector a l , we need to sum summationtext l h i,l a l .Wethusaddh i,l a l to the l prime th coordinate of the ancillary state. If the parity of the ancilla state after such operation is non-zero, then we conclude that i prime th bit of the syndrome...

Kanungo, Aparna

2005-11-01

86

Opiate tolerance to daily heroin administration: an apparent phenomenon associated with enhanced pain sensitivity  

Microsoft Academic Search

From a classical viewpoint, tolerance to analgesic effects of opiates refers to the decreased effectiveness of a given opiate following its repeated use.[11]Despite much research, it has not been conclusively demonstrated in vivo that functional changes observed at the opioid receptor level in the responsiveness to opiates account for development of tolerance.[2, 9, 10, 36]An alternative hypothesis is that opioid

J. P Laulin; E Célèrier; A Larcher; M Le Moal; G Simonnet

1999-01-01

87

Pain.  

PubMed

Invasive stimulation of the motor (precentral) cortex using surgically implanted epidural electrodes is indicated for the treatment of neuropathic pain that is refractory to medical treatment. Controlled trials have demonstrated the efficacy of epidural motor cortex stimulation (MCS), but MCS outcome remains variable and validated criteria for selecting good candidates for implantation are lacking. Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive approach that could be used as a preoperative tool to predict MCS outcome and also could serve as a therapeutic procedure in itself to treat pain disorders. This requires repeated rTMS sessions and a maintenance protocol. Other studies have also demonstrated the efficacy of transcranial direct current stimulation (tDCS) in relieving chronic pain syndromes. The most studied target is the precentral cortex, but other targets, such as the prefrontal and parietal cortices, could be of interest. The analgesic effects of cortical stimulation relate to the activation of various circuits modulating neural activities in remote structures, such as the thalamus, limbic cortex, insula, or descending inhibitory controls. In addition to the treatment of refractory neuropathic pain by epidural MCS, new developments of this type of strategy are ongoing, for other types of pain syndrome and stimulation techniques. PMID:24112914

Lefaucheur, Jean-Pascal

2013-01-01

88

Study of the trapezius muscle region pressure pain threshold and latency time in young people with and without depressed scapula.  

PubMed

The scapula is stabilized in or moved to a certain position to coordinate shoulder function and achieve shoulder and arm movement during the athletic and daily activities. An alteration in the scapular position both at rest and during arm movements is commonly associated with shoulder injury or dysfunction. The purpose of this study was to assess the influence of the depressed scapular position using pressure pain threshold (PPT) and delayed muscle activation of the upper and middle trapezius muscles. The study included 20 subjects who were divided into normal shoulder (n = 12) and depressed shoulder (n = 8) group. PPT was measured in a relaxed position. Muscle activity was recorded using surface electromyography and by calculating each shrug's muscle latency time (MLT). The results revealed that the healthy young subjects with depressed scapular position had signi?cantly lower PPT levels than those with normal scapular position both in the upper and middle trapezius muscle (P < 0.05). MLT of the upper trapezius was significantly delayed in both sides during the shoulder shrugs (P < 0.05). PMID:25130137

Lee, Kuan-Ting; Chuang, Chiung-Cheng; Lai, Chien-Hung; Ye, Jing-Jhao; Wu, Chien-Lung

2015-02-01

89

Influence of Geometry, Porosity and Surface Characteristics of Silica Nanoparticles on Acute Toxicity: Their Vasculature Effect and Tolerance Threshold  

PubMed Central

Silica nanoparticles (SiO2) are widely used in biomedical applications such as drug delivery, cell tracking and gene transfection. The capability to control the geometry, porosity, and surface characteristics of SiO2 further provides new opportunities for their applications in nanomedicine. Concerns however remain about the potential toxic effects of SiO2 upon exposure to biological systems. In the present study, the acute toxicity of SiO2 of systematically varied geometry, porosity and surface characteristics was evaluated in immune-competent mice when administered intravenously. Results suggest that in vivo toxicity of SiO2 was mainly influenced by nanoparticle porosity and surface characteristics. The maximum tolerated dose (MTD) increased in the following order: Mesoporous SiO2 (aspect ratio 1, 2, 8) at 30 – 65 mg/kg < amine-modified mesoporous SiO2 (aspect ratio 1, 2, 8) at 100 – 150 mg/kg < unmodified or amine-modified nonporous SiO2 at 450 mg/kg. The adverse reactions above MTDs were primarily caused by the mechanical obstruction of SiO2 in the vasculature that led to congestion in multiple vital organs and subsequent organ failure. It was revealed that hydrodynamic sizes of SiO2 post protein exposure had an important implication in relating SiO2 physicochemical properties with their vasculature impact and resultant tolerance threshold, as the larger the hydrodynamic size in the presence of serum protein, the lower the MTD. This study sheds light on the rational design of SiO2 to minimize in vivo toxicity and provides a critical guideline in selecting SiO2 as the appropriate system for nanomedicine applications. PMID:22364198

Yu, Tian; Greish, Khaled; McGill, Lawrence D.; Ray, Abhijit; Ghandehari, Hamidreza

2012-01-01

90

Possible involvement of prolonging spinal µ-opioid receptor desensitization in the development of antihyperalgesic tolerance to µ-opioids under a neuropathic pain-like state.  

PubMed

In the present study, we investigated the possible development of tolerance to the antihyperalgesic effect of µ-opioid receptor (MOR) agonists under a neuropathic pain-like state. Repeated treatment with fentanyl, but not morphine or oxycodone, produced a rapid development of tolerance to its antihyperalgesic effect in mice with sciatic nerve ligation. Like the behavioral study, G-protein activation induced by fentanyl was significantly reduced in membranes obtained from the spinal cord of nerve-ligated mice with in vivo repeated injection of fentanyl. In ?-endorphin-knockout mice with nerve ligation, developed tolerance to the antihyperalgesic effect of fentanyl was abolished, and reduced G-protein activation by fentanyl after nerve ligation with fentanyl was reversed to the normal level. The present findings indicate that released ?-endorphin within the spinal cord may be implicated in the rapid development of tolerance to fentanyl under a neuropathic pain-like state. PMID:21812868

Narita, Minoru; Imai, Satoshi; Nakamura, Atsushi; Ozeki, Ayumi; Asato, Megumi; Rahmadi, Mahardian; Sudo, Yuka; Hojo, Minoru; Uezono, Yasuhito; Devi, Lakshmi A; Kuzumaki, Naoko; Suzuki, Tsutomu

2013-07-01

91

The development of tolerance to intrathecal morphine in rat models of visceral and cutaneous pain.  

PubMed

The development of tolerance to intrathecal morphine was studied in rats chronically implanted with intrathecal catheters connected to osmotic minipumps. Measures of cutaneous nociception were the hot plate (HP) and tail flick (TF) tests. Measures of visceral nociception were visceromotor (VM) responses to ramped colorectal distension (CRD) and cardiovascular (CV) responses to phasic colorectal distension. Tolerance to a continuous infusion of 6 or 20 nmol/h of morphine sulfate developed over 6 days. A significant reduction in the dose-dependent effects of intrathecal morphine in the TF and HP tests and VM and CV responses to CRD occurred in rats receiving continuous infusions of morphine. The development of tolerance to intrathecal morphine was similar in both cutaneous and visceral models. PMID:9665657

Ness, T J; Follett, K A

1998-05-22

92

Higher serum S100B and BDNF levels are correlated with a lower pressure-pain threshold in fibromyalgia  

PubMed Central

Background Fibromyalgia (FM) is conceptualized as a central sensitization (CS) condition, that presents high serum brain-derived neurotrophic factor (BDNF) and neuroglia activation. Although the S100B protein regulates neuroglia functions, it has been traditionally used as a proxy of central nervous system damage. However, neither BDNF nor S100B association with the clinical picture of FM has been elucidated. To explore their association with the pressure-pain threshold (PPT) in FM, we performed a cross-sectional study, including 56 females with confirmed FM aged 18–65 years. Linear regression models were used to adjust for potential confounding factors between serum BDNF, S100B and PPT. Results Serum BDNF and S100B were correlated (Spearman’s Rho?=?0.29). Serum BDNF (log) and S100B (log) were correlated with the PPT (log) (Partial ?2?=?0.129, P?=?0.012 for the BDNF (log), and Partial ?2?=?0.105, P?=?0.025 for the S100B (log)). Serum BDNF (log) was inversely associated with PPT (log) (??=?-1.01, SE?=?0.41), age (??=?-0.02, SE?=?0.15) and obsessive compulsive disorder (??=?-0.36, SE?=?0.15), while serum S100B (log) was inversely associated with PPT (log) (??=?-1.38, SE?=?0.50), only. Conclusions Both neuroglia key mediators in the CS process were inversely correlated with the PPT. Serum assessment of BDNF and S100B deserve further study to determine its potential as a proxy for the CS spectrum in FM. PMID:25005881

2014-01-01

93

The role of sleep problems in central pain processing in rheumatoid arthritis  

PubMed Central

Objective Among rheumatoid arthritis (RA) patients, pain may exist out of proportion to peripheral inflammation. This observation suggests that central nervous system pain amplification mechanisms, such as diminished conditioned pain modulation (CPM), may play a role in enhancing pain perception among some RA patients. We examined CPM, pressure pain threshold and pressure pain tolerance among RA patients compared to controls. Methods Fifty-eight female RA patients and 54 age-matched controls without chronic pain underwent quantitative sensory testing (QST) to assess CPM, pressure pain threshold and pressure pain tolerance. CPM was induced using a cold water bath, and pain threshold (when patients first felt pain) and tolerance (when pain was too much to bear) were assessed with an algometer. Associations between RA and QST measures were analyzed using linear regression. Sleep problems, mental health and inflammation were assessed as mediators of the relationship between RA and QST measures. Results Median CPM levels were 0.5 kg/cm2 (interquartile range (IQR) ?0.1, 1.6) among RA patients compared to 1.5 kg/cm2 (IQR ?0.1, 2.5) among controls (P = 0.04). Relative to controls, RA patients had lower pain threshold and tolerance at the wrists (P ? 0.05). Compared to controls, RA patients had greater problems with sleep, catastrophizing, depression and anxiety (P < 0.0001). Mediation analyses suggested that low CPM levels may be partially attributable to sleep disturbance (P = 0.04). Conclusion RA patients have impaired CPM relative to pain-free controls. Sleep problems may mediate the association between RA and attenuated CPM. PMID:23124650

Lee, Yvonne C.; Lu, Bing; Edwards, Robert R.; Wasan, Ajay D.; Nassikas, Nicholas J.; Clauw, Daniel J.; Solomon, Daniel H.; Karlson, Elizabeth W.

2012-01-01

94

Efficacy and Tolerability of Nonprescription Ibuprofen versus Celecoxib for Dental Pain  

Microsoft Academic Search

Many clinicians appear confused about the purported clinical advantages of the new generation COX-2 inhibitors compared to both over-the-counter and prescription nonsteroidal anti-inflammatory analgesic agents (NSAIDs). In fact, there is a paucity of published information comparing the safety and efficacy of these two classes of drugs when used to treat acute pain. This study was designed to compare the safety

Geraldine Doyle; Shyamalie Jayawardena; Elizabeth Ashraf; Stephen A. Cooper

2002-01-01

95

An open-label, long-term study examining the safety and tolerability of pregabalin in Japanese patients with central neuropathic pain  

PubMed Central

Purpose Studies of pregabalin for the treatment of central neuropathic pain have been limited to double-blind trials of 4–17 weeks in duration. The purpose of this study was to assess the long-term safety and tolerability of pregabalin in Japanese patients with central neuropathic pain. The efficacy of pregabalin was also assessed as a secondary measure. Patients and methods This was a 53-week, multicenter, open-label trial of pregabalin (150–600 mg/day) in Japanese patients with central neuropathic pain due to spinal cord injury, multiple sclerosis, or cerebral stroke. Results A total of 103 patients received pregabalin (post-stroke =60; spinal cord injury =38; and multiple sclerosis =5). A majority of patients (87.4%) experienced one or more treatment-related adverse events, most commonly somnolence, weight gain, dizziness, or peripheral edema. The adverse event profile was similar to that seen in other indications of pregabalin. Most treatment-related adverse events were mild (89.1%) or moderate (9.2%) in intensity. Pregabalin treatment improved total score, sensory pain, affective pain, visual analog scale (VAS), and present pain intensity scores on the Short-Form McGill Pain Questionnaire (SF-MPQ) and ten-item modified Brief Pain Inventory (mBPI-10) total score at endpoint compared with baseline. Improvements in SF-MPQ VAS and mBPI-10 total scores were evident in all patient subpopulations. Mean changes from baseline in SF-MPQ VAS and mBPI-10 scores at endpoint were ?20.1 and ?1.4, respectively. Conclusion These findings demonstrate that pregabalin is generally well tolerated and provides sustained efficacy over a 53-week treatment period in patients with chronic central neuropathic pain. PMID:25114584

Onouchi, Kenji; Koga, Hiroaki; Yokoyama, Kazumasa; Yoshiyama, Tamotsu

2014-01-01

96

Sex Differences in Experimental and Clinical Pain Sensitivity for Patients with Shoulder Pain  

PubMed Central

Previous research demonstrates that men and women differ in the way that they perceive and process pain. Much of this work has been done in healthy adults with a lack of consensus in clinical pain populations. The purpose of this study was to investigate how men and women with shoulder pain differ in their experience of experimental and clinical pain and whether psychological processes differentially affect these responses. Fifty nine consecutive subjects (24 women, 35 men) seeking operative treatment for shoulder pain were enrolled in this study. Subjects completed self report questionnaires to assess clinical pain, catastrophizing, anxiety and depression and underwent a series of experimental pain tests consisting of pressure pain, thermal pain (threshold and tolerance), and thermal temporal summation. Results indicated that women experienced greater clinical pain and enhanced sensitivity to pressure pain. Age did not affect the observed sex differences. There were no sex differences in psychological association with experimental and clinical pain in this cohort. The relationship between clinical and experimental pressure pain was stronger in women as compared to men. These findings offer insight into the interactions between biological and psychosocial influences of pain and how these interactions vary by sex. PMID:20598598

Kindler, Lindsay L.; Valencia, Carolina; Fillingim, Roger B.; George, Steven Z.

2010-01-01

97

Pain Sensitivity Subgroups in Individuals With Spine Pain: Potential Relevance to Short-Term Clinical Outcome  

PubMed Central

Background Cluster analysis can be used to identify individuals similar in profile based on response to multiple pain sensitivity measures. There are limited investigations into how empirically derived pain sensitivity subgroups influence clinical outcomes for individuals with spine pain. Objective The purposes of this study were: (1) to investigate empirically derived subgroups based on pressure and thermal pain sensitivity in individuals with spine pain and (2) to examine subgroup influence on 2-week clinical pain intensity and disability outcomes. Design A secondary analysis of data from 2 randomized trials was conducted. Methods Baseline and 2-week outcome data from 157 participants with low back pain (n=110) and neck pain (n=47) were examined. Participants completed demographic, psychological, and clinical information and were assessed using pain sensitivity protocols, including pressure (suprathreshold pressure pain) and thermal pain sensitivity (thermal heat threshold and tolerance, suprathreshold heat pain, temporal summation). A hierarchical agglomerative cluster analysis was used to create subgroups based on pain sensitivity responses. Differences in data for baseline variables, clinical pain intensity, and disability were examined. Results Three pain sensitivity cluster groups were derived: low pain sensitivity, high thermal static sensitivity, and high pressure and thermal dynamic sensitivity. There were differences in the proportion of individuals meeting a 30% change in pain intensity, where fewer individuals within the high pressure and thermal dynamic sensitivity group (adjusted odds ratio=0.3; 95% confidence interval=0.1, 0.8) achieved successful outcomes. Limitations Only 2-week outcomes are reported. Conclusions Distinct pain sensitivity cluster groups for individuals with spine pain were identified, with the high pressure and thermal dynamic sensitivity group showing worse clinical outcome for pain intensity. Future studies should aim to confirm these findings. PMID:24764070

Bialosky, Joel E.; Robinson, Michael E.

2014-01-01

98

Tolerability of the capsaicin 8% patch following pretreatment with lidocaine or tramadol in patients with peripheral neuropathic pain: A multicentre, randomized, assessor-blinded study  

PubMed Central

Background Application of the capsaicin 8% patch is associated with treatment-related discomfort. Consequently, pretreatment for 60?min with anaesthetic cream is recommended; however, this may be uncomfortable and time consuming. Methods We conducted a multicentre, randomized (1:1), assessor-blinded study in patients with peripheral neuropathic pain to assess tolerability of the capsaicin patch following topical lidocaine (4%) or oral tramadol (50?mg) pretreatment. The primary endpoint was the proportion of patients tolerating capsaicin patch application (ability to receive ?90% of a 60-min application). Numeric Pain Rating Scale (NPRS) scores were assessed before, during and after treatment. Results Overall, 122 patients were included (61 per arm). The capsaicin patch was tolerated by 121 patients. Tolerability of the capsaicin patch was similar following pretreatment with lidocaine and tramadol. Following patch application, pain levels increased up to 55?min (change from baseline of 1.3 for lidocaine and 1.4 for tramadol). After patch removal, tramadol-treated patients experienced greater pain relief up to the end of day 1; in the evening, mean changes in NPRS scores from baseline were 0 for lidocaine and ?1 for tramadol. Proportions of patients reporting increases of ?2 NPRS points or >33% from baseline at one or more time point(s) on the day of treatment were similar between arms. Adverse event incidence was comparable between arms. Conclusions Capsaicin 8% patch tolerability was similar in the two arms, with comparable results for most secondary endpoints. Tramadol given 30?min before patch application should be considered as an alternative pretreatment option in patients receiving capsaicin patch treatment. What's already known about this topic? Application of topical capsaicin, a treatment for peripheral neuropathic pain conditions associated with allodynia, can cause painful discomfort. Therefore, a 60-min application of local anaesthetic cream before capsaicin 8% patch treatment was originally recommended. What does this study add? Oral analgesic pretreatment may reduce overall capsaicin patch treatment time and potential unpleasantness associated with applying a topical agent to an allodynic area. Based on LIFT data showing similar tolerability to capsaicin patch regardless of pretreatment method, the European Medicines Agency has issued a type II variation stating: treatment area may be pretreated with a topical anaesthetic or an oral analgesic may be given prior to patch application. PMID:24664539

Jensen, TS; Høye, K; Fricová, J; Vanelderen, P; Ernault, E; Siciliano, T; Marques, S

2014-01-01

99

Agreeable Smellers and Sensitive Neurotics – Correlations among Personality Traits and Sensory Thresholds  

PubMed Central

Correlations between personality traits and a wide range of sensory thresholds were examined. Participants (N?=?124) completed a personality inventory (NEO-FFI) and underwent assessment of olfactory, trigeminal, tactile and gustatory detection thresholds, as well as examination of trigeminal and tactile pain thresholds. Significantly enhanced odor sensitivity in socially agreeable people, significantly enhanced trigeminal sensitivity in neurotic subjects, and a tendency for enhanced pain tolerance in highly conscientious participants was revealed. It is postulated that varied sensory processing may influence an individual's perception of the environment; particularly their perception of socially relevant or potentially dangerous stimuli and thus, varied with personality. PMID:21556139

Croy, Ilona; Springborn, Maria; Lötsch, Jörn; Johnston, Amy N. B.; Hummel, Thomas

2011-01-01

100

Pain Sensitivity Risk Factors for Chronic TMD: Descriptive Data and Empirically Identified Domains from the OPPERA Case Control Study  

PubMed Central

Many studies report that people with temporomandibular disorders (TMD) are more sensitive to experimental pain stimuli than TMD-free controls. Such differences in sensitivity are observed in remote body sites as well as in the orofacial region, suggesting a generalized upregulation of nociceptive processing in TMD cases. This large case-control study of 185 adults with TMD and 1,633 TMD-free controls measured sensitivity to painful pressure, mechanical cutaneous, and heat stimuli, using multiple testing protocols. Based on an unprecedented 36 experimental pain measures, 28 showed statistically significantly greater pain sensitivity in TMD cases than controls. The largest effects were seen for pressure pain thresholds at multiple body sites and cutaneous mechanical pain threshold. The other mechanical cutaneous pain measures and many of the heat pain measures showed significant differences, but with lesser effect sizes. Principal component analysis (PCA) of the pain measures derived from 1,633 controls identified five components labeled: (1) heat pain ratings, (2) heat pain aftersensations and tolerance, (3) mechanical cutaneous pain sensitivity, (4) pressure pain thresholds, and (5) heat pain temporal summation. These results demonstrate that, compared to TMD-free controls, chronic TMD cases are more sensitive to many experimental noxious stimuli at extra-cranial body sites, and provides for the first time the ability to directly compare the case-control effect sizes of a wide range of pain sensitivity measures. PMID:22074753

Greenspan, Joel D.; Slade, Gary D.; Bair, Eric; Dubner, Ronald; Fillingim, Roger B.; Ohrbach, Richard; Knott, Charlie; Mulkey, Flora; Rothwell, Rebecca; Maixner, William

2011-01-01

101

Efficacy and tolerability of low-dose oral prolonged-release oxycodone/naloxone for chronic nononcological pain in older patients  

PubMed Central

Purpose Chronic pain is highly prevalent in older adults. Increasing evidence indicates strong opioids as a valid option for chronic pain management in geriatrics. The aim of this study was to evaluate efficacy and safety of low-dose oral prolonged-release oxycodone–naloxone (OXN-PR) in patients aged ?70 years. Methods This open-label prospective study assessed older patients naïve to strong opioids presenting with moderate-to-severe chronic pain. Patients were prescribed OXN-PR at an initial dose of 10/5 mg/day for 28 days. In case of insufficient analgesia, the initial daily dose could be increased gradually. The primary efficacy measure was change in pain intensity from baseline, assessed by a ten-point Numeric Rating Scale (NRS) at day 28 (T28). Changes in cognitive state, daily functioning, quality of life, constipation, and other adverse events were assessed. Results Of 53 patients enrolled (mean 81.7±6.2 years [range 70–92 years]), 52 (98.1%) completed the 28-day observation. At T28, the primary end point (?30% reduction in mean pain from baseline in the absence of bowel function deterioration) was achieved in 38 patients (71.7%). OXN-PR significantly relieved pain (NRS score –3.26; P<0.0001), as well as daily need for rescue paracetamol (from 86.8% at baseline to 40.4% at T28; P<0.001), and reduced impact of pain on daily activities (Brief Pain Inventory Short Form from 6.2±1.5 to 3.4±2.1; P<0.0001). OXN-PR was also associated with significant improvement in daily functioning (Barthel Index from 53.3±14.1 to 61.3±14.3; P<0.01). No changes were observed in cognitive status and bowel function. OXN-PR was well tolerated; only one patient (1.9%) prematurely withdrew from treatment, due to drowsiness. Conclusion Findings from this open-label prospective study suggest that low-dose OXN-PR may be effective and well tolerated for treatment of moderate-to-severe chronic pain in older patients. Besides its effectiveness, these data indicate that low-dose OXN-PR may be considered a safe analgesic option in this fragile population and warrants further investigation in randomized controlled studies.

Guerriero, Fabio; Sgarlata, Carmelo; Marcassa, Claudio; Ricevuti, Giovanni; Rollone, Marco

2015-01-01

102

Structural damage alarming using auto-associative neural network technique: Exploration of environment-tolerant capacity and setup of alarming threshold  

NASA Astrophysics Data System (ADS)

With the intention of avoiding false-positive and false-negative alarms in structural damage alarming using the auto-associative neural network (AANN) technique, two issues pertaining to this technique are addressed in this study. The first issue explored is the environment-tolerant capacity of the AANN. Efforts have been made to seek a generalization technique to enhance the environment-tolerant capacity. First, a baseline AANN model is formulated using the conventional training algorithm. Generalization techniques including AIC and FPE, early stopping, and Bayesian regularization are then investigated, resulting in three new AANN models. Their environment-tolerant capacity is evaluated as per their capability to avoid false-positive and false-negative alarms. The other issue addressed is the setup of alarming threshold, with intent to reduce the uncertainty in AANN-based structural damage alarming. A procedure based on the probability analysis of the novelty index is proposed for this purpose. First, the novelty index characterizing the intact structure is analyzed by the Kolmogorov-Smirnov goodness-of-fit test to obtain its best-fit continuous probability distribution. A confidence interval is then defined in consideration of the compromise between type I and type II errors. The alarming threshold of the novelty index is consequently set at the upper limit of the confidence interval. The above explorations are examined by using the long-term monitoring data on modal properties of the cable-stayed Ting Kau Bridge. The capability to eliminate false-positive alarm is verified by using unseen testing data which were not used in formulating the AANN models, while the capability to alleviate false-negative alarm is examined by using simulated data from the 'damaged' bridge with the help of a precise finite element model. The study indicates that the early stopping technique performs best in improving the environment-tolerant capacity of the AANN, and the alarming threshold set by the proposed procedure helps to reduce the uncertainty in AANN-based structural damage alarming.

Zhou, H. F.; Ni, Y. Q.; Ko, J. M.

2011-07-01

103

Variation in Tolerance and Resistance to the Leafhopper Empoasca fabae (Hemiptera: Cicadellidae) Among Potato Cultivars: Implications for Action Thresholds  

Microsoft Academic Search

The potato leafhopper, Empoasca fabae (Harris) (Hemiptera: Cicadellidae), is an emerging pest of potato and insecticide applications to control this insect have increased in recent years. Based on Þeld observations of leafhopperÐ crop dynamics, however, currently recommended action thresholds seem to be overly conservative. As a result, we initiated two experiments designed to quantify the impact of leafhoppers on potato

I. Kaplan; G. P. Dively; R. F. Denno

2008-01-01

104

[Combined action of mexidol and non-narcotic analgesics on pain thresholds and emotional stress behavior in animals].  

PubMed

The influence of non-narcotic analgesics analgin and pentalgin in the basic pharmacological effects of diazepam and mexidol has been studied in outbred male albino rats. It is established that both analgesics do not influence the activity of diazepam. At the same time, they potentiate the analgesic action of mexidol without influencing its antistress action and not inducing any side effects. The strengthening influence of pentalgin was more pronounced. It is concluded that mexidol can be administered in combination with non-narcotic analgesics, in particular with pentalgin, for relieving painful syndrome on the background of stress. PMID:17523444

Molodavkin, G M; Voronina, T A; Larentsova, L I; Pchelkina, M I; Meletova, O K

2007-01-01

105

Activation thresholds determine susceptibility to peptide-induced tolerance in a heterogeneous myelin-reactive T cell repertoire  

Microsoft Academic Search

Altered peptide ligands (APL) with increased MHC-binding properties are highly effective at inducing T cell tolerance after systemic administration in soluble form, preventing experimental autoimmune encephalomyelitis (EAE) induced with the myelin basic protein (MBP) Ac1-9 peptide. We have previously described a diverse Ac1-9-reactive T cell repertoire with differing TCR affinities. A remaining question is what proportion of this repertoire is

David McCue; Kelli R. Ryan; David C. Wraith; Stephen M. Anderton

2004-01-01

106

Experimental Pain Responses Support Peripheral and Central Sensitization in Patients with Unilateral Shoulder Pain  

PubMed Central

Objective The aims of this study were to 1) examine the pattern of experimental pain responses in the affected and non-affected extremities in patients with shoulder pain and 2) explore the intra-individual association between sensitization states derived from experimental pain testing. Methods Experimental pain responses from 58 patients with shoulder pain (17 females, ages 18 to 52) were compared to those from 56 age- and sex-matched healthy volunteers (16 females, ages 21 to 58). Experimental pain responses included pressure pain threshold (PPT), thermal pain threshold and tolerance, and suprathreshold heat pain response (SHPR). Comparisons were made between the affected and non-affected extremity of clinical participants and the average response of extremities in healthy participants. Peripheral and central sensitization indexes were computed for clinical participants using standardized scores and percentile cut-offs based on the data from the healthy control sample. Experimental pain responses in clinical participants observed beyond the 25th and 75th percentile of healthy control sample responses were used for investigation of intra-individual association of sensitization states. Results PPT on the affected side acromion and masseter of clinical participants were diminished compared to their non-affected side (p < 0.015). Bilateral sensitivity in clinical participants was noted for PPT at the acromion and SHPR (p < 0.015). Peripheral and central sensitization indexes demonstrated that individuals with shoulder pain present with variable patterns of peripheral and central sensitization. Conclusions Collectively, experimental pain responses supported peripheral and central sensitization in response to pressure and thermal stimuli. No clear association was made between individuals exhibiting peripheral or central sensitization and suggests heterogeneity in pain processing in this clinical population. PMID:23619203

Coronado, Rogelio A.; Simon, Corey B.; Valencia, Carolina; George, Steven Z.

2013-01-01

107

Glutamate-evoked jaw muscle pain as a model of persistent myofascial TMD pain?  

PubMed Central

Objective Compare pain-related measures and psychosocial variables between glutamate-evoked jaw muscle pain in healthy subjects (HS) and patients with persistent myofascial temporomandibular disorder (TMD) pain. Design 47 female HS and 10 female patients with persistent myofascial TMD pain participated. The HS received an injection of glutamate into the masseter muscle to model persistent myofascial TMD pain. Participants filled out a coping strategies questionnaire (CSQ), the symptom checklist 90 (SCL-90) and McGill Pain Questionnaire (MPQ). Pain intensity was assessed on an electronic visual analog scale (VAS). Pain-drawing areas, Numerical Rating Scale (NRS) scores of unpleasantness, pressure pain thresholds (PPT) and tolerance (PPTOL) were measured. Unpaired t-tests and correlation tests were used for analyses. Results The groups were significantly different when comparing the CSQ scores of control, decrease, diverting attention, increase of behavioral activities and somatization. The peak VAS pain, NRS of unpleasantness and MPQ scores were not significantly different between groups, but PPT and PPTOL were significantly lower in the TMD patients. Significant positive correlations were found in the TMD patients between peak VAS pain and CSQ catastrophizing score and SCL-90 somatization. The scores of PPTs and PPTOLs, in patients showed positive correlations with CSQ reinterpreting pain sensations scores and PPTs correlated with CSQ praying/hoping scores. Conclusions Glutamate-evoked pain responses in HS and persistent myofascial TMD pain have similar sensory-discriminative and affective-unpleasantness components but differ in psycho-social features. This study suggests that experimental designs based on glutamate injection into muscle can provide an appropriate model for elucidating persistent myofascial pain conditions. PMID:18313028

Castrillon, Eduardo E.; Cairns, Brian E.; Ernberg, Malin; Wang, Kelun; Sessle, Barry; Arendt-Nielsen, Lars; Svensson, Peter

2008-01-01

108

C-Reactive Protein and Pain Sensitivity: Findings from Female Twins  

PubMed Central

Background Systemic inflammation and pain sensitivity may contribute to the development and maintenance of chronic pain conditions. Purpose We examined the relationship between systemic inflammation as measured by C-reactive protein (CRP), and cold pain sensitivity in 198 female twins from the University of Washington Twin Registry. We also explored the potential role of familial factors in this relationship. Methods Linear regression modeling with generalized estimating equations examined the overall and within-pair associations. Results Higher levels of CRP were associated with higher pain sensitivity ratings at pain threshold (p = 0.02) and tolerance (p = 0.03) after adjusting for age, body mass index, time to reach pain threshold or tolerance, and clinical pain status. The magnitude of the associations remained the same in within-pair analyses controlling for familial factors. Conclusions The link between CRP and pain sensitivity may be due to non-shared environmental factors. CRP and pain sensitivity can be examined as potential biomarkers for chronic pain and other inflammatory conditions. PMID:21785898

Afari, Niloofar; Mostoufi, Sheeva; Noonan, Carolyn; Poeschla, Brian; Succop, Annemarie; Chopko, Laura; Strachan, Eric

2011-01-01

109

Comparison of analgesic effects and patient tolerability of nabilone and dihydrocodeine for chronic neuropathic pain: randomised, crossover, double blind study  

Microsoft Academic Search

Objective To compare the analgesic efficacy and side effects of the synthetic cannabinoid nabilone with those of the weak opioid dihydrocodeine for chronic neuropathic pain. Design Randomised, double blind, crossover trial of 14 weeks’ duration comparing dihydrocodeine and nabilone.Setting Outpatient units of three hospitals in the United Kingdom.Participants 96 patients with chronic neuropathic pain, aged 23-84 years. Main outcome measures

B Frank; M G Serpell; J Hughes; J N S Matthews; D Kapur

2008-01-01

110

The Role of Ketamine in Preventing Fentanyl-Induced Hyperalgesia and Subsequent Acute Morphine Tolerance  

Microsoft Academic Search

Perioperative opioids increase postoperative pain and morphine requirement, suggesting acute opioid toler- ance. Furthermore, opioids elicit N-methyl-d-aspartate (NMDA)-dependent pain hypersensitivity. We investi- gated postfentanyl morphine analgesic effects and the consequences of NMDA-receptor antagonist (ket- amine) pretreatment. The rat nociceptive threshold was measured by the paw-pressure vocalization test. Four fentanyl boluses (every 15 min) elicited a dose- dependent (a) increase followed

Jean-Paul Laulin; Pierre Maurette; Cyril Rivat; Marcel Chauvin; Guy Simonnet

2002-01-01

111

Gender expression, sexual orientation and pain sensitivity in women  

PubMed Central

BACKGROUND: Despite a growing body of literature investigating sex differences with regard to pain, surprisingly little research has been conducted on the influence of various aspects of self-identity, including gender expression and sexual orientation, on pain sensitivity within each sex, particularly among women. In men, dispositional femininity is linked to greater clinical pain and trait masculinity is associated with higher pain thresholds. OBJECTIVES: To examine whether gender expression and sexual orientation are associated with within-sex differences in ischemic pain sensitivity in healthy young women. METHODS: A convenience sample of 172 females (mean age 21.4 years; range 18 to 30 years of age; 56.0% white, 89% heterosexual) performed an ischemic pain task in counterbalanced order. Desired levels of dispositional femininity for a preferred romantic partner and self-described levels of personal dispositional femininity were measured. RESULTS: Compared with heterosexual women, lesbian and bisexual women reported lower pain intensity ratings early in the discomfort task. Irrespective of sexual orientation, attraction to more feminine romantic partners and dispositional masculinity were correlated with lower pain intensity, and with higher pain thresholds and tolerance levels. DISCUSSION: These preliminary findings suggest that within-sex differences in sexual orientation and other aspects of identity, irrespective of biological sex, may be important to consider when examining experimental pain performance and clinical pain experiences. CONCLUSION: Larger investigations of the psychophysiological relationships among sexual orientation, gender expression and pain sensitivity are warranted. These findings may have implications for differences in clinical pain sensitivity of lesbian and bisexual women compared with heterosexual women. PMID:24575419

Vigil, Jacob M; Rowell, Lauren N; Lutz, Charlotte

2014-01-01

112

Interaction of a Cannabinoid-2 Agonist With Tramadol on Nociceptive Thresholds and Immune Responses in a Rat Model of Incisional Pain.  

PubMed

The aim of this study was to elucidate the antinociceptive interaction between cannabinoids and tramadol and their impact on proinflammatory response, in terms of serum intereleukin-6 (IL-6) and interleukin-2 (IL-2) release, in a rat model of incisional pain. Prospective randomized trial assessing the individual or combined application of intraperitoneal tramadol (10 mg/kg) and the selective cannabinoid-2 (CB-2) agonist (R,S)-AM1241 (1 mg/kg) applied postsurgical stress stimulus. Pharmacological specificity was established by antagonizing tramadol with naloxone (0.3 mg/kg) and (R,S)-AM1241 with SR144528 (1 mg/kg). Thermal allodynia was assessed by hot plate test 30 (T30), 60 (T60), and 120 (T120) minutes after incision. Blood samples for plasma IL-6 and IL-2 level determination were obtained 2 hours after incision. Data from 42 rats were included in the final analyses. Significant augmentation of thermal threshold was observed at all time points, after administration of either tramadol or (R,S)-AM1241 compared with the control group (P = 0.004 and P = 0.015, respectively). The combination of (R,S)-AM1241 plus tramadol promoted the induced antinociception in an important manner compared with control (P = 0.002) and (R,S)-AM1241 (P = 0.022) groups. Although the antiallodynic effect produced by tramadol was partially reversed by naloxone 30 and 60 minutes after incision (P = 0.028 and P = 0.016, respectively), SR144528 blocked the effects of (R,S)-AM1241 administration in a significant manner (P = 0.001) at all time points. Similarly, naloxone plus SR144528 also blocked the effects of the combination of (R,S)-AM1241 with tramadol at all time points (P = 0.000). IL-6 level in (R,S)-AM1241 plus tramadol group was significantly attenuated compared with control group (P = 0.000). Nevertheless, IL-2 levels remained unchanged in all experimental groups. It seems that the concomitant administration of a selective CB-2 agonist with tramadol in incisional pain model may improve antinociceptive effects and immune responses of cannabinoids, but this effect does not seem to be superior to that of tramadol alone. PMID:25370921

Stachtari, Chrysoula C; Thomareis, Olympia N; Tsaousi, Georgia G; Karakoulas, Konstantinos A; Chatzimanoli, Foteini I; Chatzopoulos, Stavros A; Vasilakos, Dimitrios G

2014-11-01

113

A Quantitative Review of Ethnic Group Differences in Experimental Pain Response: Do Biology, Psychology and Culture Matter?  

PubMed Central

Objective Pain is a subjectively complex and universal experience. We examine research investigating ethnic group differences in experimental pain response, and factors contributing to group differences. Method We conducted a systematic literature review and analysis of studies using experimental pain stimuli to assess pain sensitivity across multiple ethnic groups. Our search covered the period from 1944-2011, and utilized the PUBMED bibliographic database; a reference source containing over 17 million citations. We calculated effect sizes, identified ethnic/racial group categories, pain stimuli and measures, and examined findings regarding biopsychosociocultural factors contributing to ethnic/racial group differences. Results We found 472 studies investigating ethnic group differences and pain. Twenty-six of these met our review inclusion criteria of investigating ethnic group differences in experimental pain. The majority of studies included comparisons between African Americans (AA) and non-Hispanic Whites (NHW). There were consistently moderate to large effect sizes for pain tolerance across multiple stimulus modalities; African Americans demonstrated lower pain tolerance. For pain threshold, findings were generally in the same direction, but effect sizes were small to moderate across ethnic groups. Limited data were available for suprathreshold pain ratings. A subset of studies comparing NHW and other ethnic groups showed a variable range of effect sizes for pain threshold and tolerance. Conclusion There are potentially important ethnic/racial group differences in experimental pain perception. Elucidating ethnic group differences, has translational merit for culturally-competent clinical care and for addressing and reducing pain treatment disparities among ethnically/racially diverse groups. PMID:22390201

Riley, Joseph L.; Williams, Ameenah K.K.; Fillingim, Roger B.

2012-01-01

114

Evaluation of a low-threshold/high-tolerance methadone maintenance treatment clinic in saint john, new brunswick, Canada: one year retention rate and illicit drug use.  

PubMed

Objective. To report the one-year retention rate and the prevalence of illicit opioid use and cocaine use in the Low-Threshold/High-Tolerance (LTHT) methadone maintenance treatment (MMT) clinic located in Saint John, New Brunswick, Canada. Methods. A description of the LTHT MMT clinic is provided. The one-year retention rate was determined by collecting data on patients who enrolled in the LTHT MMT clinic between August 04, 2009 and August 04, 2010. The prevalence of illicit drug use was determined using a randomly selected retrospective cohort of 84 participants. For each participant the results of six consecutive urine tests for the most recent three months were compared to the results of the first six consecutive urine tests after program entry. Results. The one-year retention rate was 95%, 67% of the cohort achieved abstinence from illicit opioids and an additional 13% abstained from cocaine use. Conclusion. The novel feature of the LTHT MMT clinic is that patients are not denied methadone because of lack of ancillary services. Traditional comprehensive MMT programs invest the majority of financial resources in ancillary services that support the biopsychosocial model, whereas the LTHT approach utilizes a medical model and directs resources at medical management. PMID:24860685

Christie, Timothy K S; Murugesan, Alli; Manzer, Dana; O'Shaughnessey, Michael V; Webster, Duncan

2013-01-01

115

A New Real-time Method for Detecting the Effect of Fentanyl Using the Preoperative Pressure Pain Threshold and Narcotrend Index: A Randomized Study in Female Surgery Patients.  

PubMed

Individual variability in the effects of opioid analgesics such as fentanyl remains a major challenge for tailored pharmacological treatment including postoperative analgesia. This study aimed to establish a new real-time method for detecting the effects of fentanyl and their individual differences in the preoperative period, using the pressure pain threshold (PPT) and Narcotrend index (NTI) test.Eighty women undergoing elective surgery under general anesthesia were enrolled in this randomized, double-blinded, placebo-controlled study to receive either intravenous fentanyl (Group F) or saline (Group S). Before (T1) and 5 (T2) and 10?min (T3) after intravenous injection, the PPT, NTI, respiratory rate, heart rate, blood pressure, and pulse oxygen saturation were measured. The initial time at which the Narcotrend index showed a decline was also recorded.In total, 40 patients in Group S and 38 patients in Group F were included in the final analysis. At 5?min and 10?min after intravenous fentanyl administration, the analgesic effect was determined by measuring the PPT, which was significantly increased (P?

Duan, Guangyou; Guo, Shanna; Zhan, Huiming; Qi, Dongmei; Zhang, Yuhao; Zhang, Xianwei

2015-01-01

116

Safety, tolerability, pharmacokinetics, and effects on human experimental pain of the selective ionotropic glutamate receptor 5 (iGluR5) antagonist LY545694 in healthy volunteers.  

PubMed

The objective of this study was to establish in healthy volunteers the maximally tolerated multiple dose (MTMD) of the ionotropic glutamate receptor 5 antagonist LY545694 (part A), and to investigate whether that dose had analgesic or antihyperalgesic effects in the brief thermal stimulation (BTS) pain model (Part B). Part A was a double-blind, placebo-controlled study in 3 groups of 10 healthy men. To simulate an extended-release formulation, study drug was administered orally over 6hours (12 equally divided aliquots at 30-minute intervals). Part B was a double-blind, placebo-controlled, double-dummy, 3-way crossover study in 27 healthy men. At each of the 3 study periods, subjects received either LY545694 (MTMD; as determined during part A) as a simulated, twice daily extended-release formulation for 4 doses over 3days, gabapentin (600mg 8hours apart; 6 doses over 3days; positive control), or matching placebo. The BTS model was induced twice with a 1-hour interval on each of the 2 study days, before drug administration and at the time of expected peak analgesia of LY545694. Plasma exposure for LY545694 was approximately linear over the 25- to 75-mg dose range. The MTMD of LY545694 was 25mg twice daily. Areas of secondary hyperalgesia were significantly smaller after administration of LY545694 and gabapentin compared with placebo (P<.0001 and P=.0004, respectively), but there was no difference between areas after administration of gabapentin and LY545694 (P=.400). Neither gabapentin nor LY545694 reduced the painfulness of skin heating during BTS model induction. The most common treatment-emergent adverse event was dizziness. The results of this study suggest that LY545694 should be explored further as a potential treatment for chronic pain involving neuronal sensitization. PMID:24486883

Petersen, Karin L; Iyengar, Smriti; Chappell, Amy S; Lobo, Evelyn D; Reda, Haatem; Prucka, William R; Verfaille, Steven J

2014-05-01

117

Increased Sensitivity to Thermal Pain and Reduced Subcutaneous Lidocaine Efficacy in Redheads  

PubMed Central

Background: Anesthetic requirement in redheads is exaggerated, suggesting that redheads may be especially sensitive to pain. We therefore tested the hypotheses that women with natural red hair are more sensitive to pain, and that redheads are resistant to topical and subcutaneous lidocaine. Methods: We evaluated pain sensitivity in red-haired (n=30) or dark-haired (n=30) women by determining the electrical current perception threshold, pain perception, and maximum pain tolerance with a Neurometer CPT/C (Neurotron, Inc., Baltimore, MD). We evaluated the analogous warm and cold temperature thresholds with the TSA-II Neurosensory Analyzer (Medoc Ltd., Minneapolis, MN). Volunteers were tested with both devices at baseline and with the Neurometer after 1-hour exposure to 4% liposomal lidocaine and after subcutaneous injection of 1% lidocaine. Data are presented as medians [interquartile ranges]. Results: Current perception, pain perception, and pain tolerance thresholds were similar in the red-haired and dark-haired women at 2000, 250, and 5 Hz. In contrast, redheads were more sensitive to cold pain perception (22.6°C [15.1, 26.1] vs. 12.6°C [0, 20], P=0.004), cold pain tolerance (6.0°C [0, 9.7] vs. 0.0°C [0.0, 2.0], P=0.001), and heat pain (46.3°C [45.7, 47.5] vs. 47.7°C [46.6, 48.7], P=0.009). Subcutaneous, lidocaine was significantly less effective in redheads, e.g., pain tolerance threshold at 2000 Hz stimulation in redheads was 11.0 mA [8.5, 16.5] vs. >20.0 mA [14.5, >20] in others, P=0.005). Conclusion: Red hair is the phenotype for mutations of the melanocortin 1 receptor. Our results indicate that redheads are more sensitive to thermal pain and are resistant to the analgesic effects of subcutaneous lidocaine. Mutations of the melanocortin 1 receptor, or a consequence thereof, thus modulate pain sensitivity. PMID:15731586

Liem, Edwin B.; Joiner, Teresa V.; Tsueda, Kentaro; Sessler, Daniel I.

2005-01-01

118

Efficacy of long-term milnacipran treatment in patients meeting different thresholds of clinically relevant pain relief: subgroup analysis of a randomized, double-blind, placebo-controlled withdrawal study  

PubMed Central

Background Fibromyalgia patients from a long-term, open-label study of milnacipran (50–200 mg/day) were eligible to participate in a 12-week, randomized, placebo-controlled withdrawal study. The withdrawal study evaluated loss of therapeutic response in patients who achieved ?50% pain improvements after receiving up to 3.25 years of milnacipran. This post-hoc analysis investigated whether patients who met lower thresholds of pain improvement also experienced worsening of fibromyalgia symptoms upon treatment withdrawal. Method Among patients who received milnacipran ?100 mg/day during the long-term study, three subgroups were identified based on percentage of pain reduction at randomization: ?50% (protocol-defined “responders”; n=150); ?30% to <50% (patients with clinically meaningful pain improvement; n=61); and <30% (n=110). Efficacy assessments included the visual analog scale (VAS) for pain, Fibromyalgia Impact Questionnaire-Revised (FIQR), 36-Item Short-Form Health Survey Physical Component Summary (SF-36 PCS), and Beck Depression Inventory (BDI). Results In the ?30 to <50% subgroup, significant worsening in pain was detected after treatment withdrawal. The difference between placebo and milnacipran in mean VAS score changes for this subgroup (+9.0, P<0.05) was similar to the difference in protocol-defined responders (+9.4, P<0.05). In the <30% subgroup, no worsening in pain was observed in either treatment arm. However, patients in this subgroup experienced significant worsening in FIQR scores after treatment withdrawal (placebo, +6.9; milnacipran, ?2.8; P<0.001), as well as worsening in SF-36 PCS and BDI scores. Conclusion Patients who experienced ?30% to <50% pain reduction with long-term milnacipran had significant worsening of fibromyalgia symptoms after treatment withdrawal. These results suggest that the conventional ?30% pain responder cutoff may be adequate to demonstrate efficacy in randomized withdrawal studies of fibromyalgia. Patients in the <30% pain reduction subgroup had worsening scores on the FIQR and other multidimensional measures after treatment withdrawal, indicating the importance of identifying and managing the multiple symptoms of fibromyalgia. PMID:25473309

Mease, Philip J; Clauw, Daniel J; Trugman, Joel M; Palmer, Robert H; Wang, Yong

2014-01-01

119

The Relationship Between Neck Pain and Physical Activity  

PubMed Central

Neck pain is a significant societal burden due to its high prevalence and healthcare costs. While physical activity can help to manage other forms of chronic musculoskeletal pain, little data exists on the relationship between physical activity and neck pain. The purpose of this study was to compare physical activity levels between individuals with neck pain and healthy controls, and then to relate disability, fear of movement, and pain sensitivity measures to physical activity levels in each of the two participant groups. 21 participants were recruited for each of the two participant groups (n = 42). Data collection included the use of the Neck Disability Index, the Tampa Scale for Kinesiophobia, electrocutaneous (Neurometer® CPT) and pressure stimulation (JTech algometer) for quantitative sensory testing, and 5 days of subjective (Rapid Assessment of Physical Activity) and objective (BioTrainer II) measurements of physical activity. Analysis of Variance and Pearson’s Correlation were used to determine if differences and relationships exist between dependent variables both within and between groups. The results show that individuals with mild neck pain and healthy controls do not differ in subjectively and objectively measured physical activity. While participants with neck pain reported higher neck disability and fear of movement, these factors did not significantly relate to physical activity levels. Perceived activity level was related to pain threshold and tolerance at local neck muscles sites (C2 paraspinal muscle and upper trapezius muscle), whereas measured activity was related to generalized pain sensitivity, as measured at the tibialis anterior muscle site. PMID:24133553

Cheung, Janice; Kajaks, Tara; MacDermid, Joy C.

2013-01-01

120

A randomized, double blind, placebo controlled, cross over study to evaluate the analgesic activity of Boswellia serrata in healthy volunteers using mechanical pain model  

PubMed Central

Objective: Experimental pain models in human healthy volunteers are advantageous for early evaluation of analgesics. All efforts to develop nonsteroidal anti-inflammatory drugs (NSAIDs) which are devoid of gastrointestinal and cardiovascular system effects are still far from achieving a breakthrough. Hence we evaluated the analgesic activity of an ayurvedic drug, Boswellia serrata by using validated human pain models which has shown its analgesic activity both in-vitro and preclinical studies to evaluate the analgesic activity of single oral dose (125 mg, 2 capsules) of Boswellia serrata compared to placebo using mechanical pain model in healthy human subjects. Materials and Methods: After taking written informed consent, twelve healthy subjects were randomized (1:1) to receive single oral dose of Boswellia serrata (Shallaki®) 125 mg, 2 capsules or identical placebo in a crossover design. Mechanical pain was assessed using Ugo basile analgesymeter (by Randall Selitto test) at baseline and at 1 hr, 2 hrs and 3 hrs after test drug administration. Pain Threshold force and time and Pain Tolerance force and time were evaluated. Statistical analysis was done by paired t-test. Results: Twelve healthy volunteers have completed the study. Mean percentage change from baseline in Pain Threshold force and time with Boswellia serrata when compared to placebo had significantly increased [Force: 9.7 ± 11.0 vs 2.9 ± 3.4 (P = 0.05) and time: 9.7 ± 10.7 vs 2.8 ± 3.4 (P = 0.04)] at third hr. Mean Percentage change from baseline in Pain Tolerance force and time with Boswellia serrata when compared to placebo had significantly (P ? 0.01) increased at 1 hr, 2 hrs and 3 hrs. Conclusion: In the present study, Boswellia serrata significantly increased the Pain Threshold and Pain Tolerance force and time compared to placebo. Both study medications were well tolerated. Further multiple dose studies may be needed to establish the analgesic efficacy of the drug. PMID:25298573

Prabhavathi, K.; Chandra, U. Shobha Jagdish; Soanker, Radhika; Rani, P. Usha

2014-01-01

121

A multicentre, open-label, follow-on study to assess the long-term maintenance of effect, tolerance and safety of THC/CBD oromucosal spray in the management of neuropathic pain.  

PubMed

Peripheral neuropathic pain (PNP) poses a significant clinical challenge. The long-term efficacy of delta-9-tetrahydrocannabinol (THC)/cannabidiol (CBD) oromucosal spray was investigated in this 38-week open-label extension study. In total, 380 patients with PNP associated with diabetes or allodynia entered this study from two parent randomised, controlled trials. Patients received THC/CBD spray for a further 38 weeks in addition to their current analgesic therapy. Neuropathic pain severity was the primary efficacy measure using a pain 0-10 numerical rating scale (NRS). Additional efficacy, safety and tolerability outcomes were also investigated. In total, 234 patients completed the study (62 %). The pain NRS showed a decrease in score over time in patients from a mean of 6.9 points (baseline in the parent studies) to a mean of 4.2 points (end of open-label follow-up). The proportion of patients who reported at least a clinically relevant 30 % improvement in pain continued to increase with time (up to 9 months); at least half of all patients reported a 30 % improvement at all time points. Improvements were observed for all secondary efficacy outcomes, including sleep quality 0-10 NRS scores, neuropathic pain scale scores, subject global impression of change and EQ-5D questionnaire scores. THC/CBD spray was well tolerated for the study duration and patients did not seek to increase their dose with time, with no new safety concerns arising from long-term use. In this previously difficult to manage patient population, THC/CBD spray was beneficial for the majority of patients with PNP associated with diabetes or allodynia. PMID:25270679

Hoggart, B; Ratcliffe, S; Ehler, E; Simpson, K H; Hovorka, J; Lej?ko, J; Taylor, L; Lauder, H; Serpell, M

2015-01-01

122

The Effect of Pressure Pain Sensitivity and Patient Factors on Self-Reported Pain-Disability in Patients with Chronic Neck Pain  

PubMed Central

The study was conducted to estimate the extent to which pressure pain sensitivity (PPS) and patient factors predict pain-related disability in patients with neck pain (NP), and to determine if PPS differs by gender. Forty-four participants with a moderate level of chronic NP were recruited for this cross sectional study. All participants were asked to complete self-reported assessments of pain, disability and comorbidity and then underwent PPS testing at 4-selected body locations. Pearson`s r w was computed to explore relationships between the PPS measures and the self-reported assessments. Regression models were built to identify predictors of pain and disability. An independent sample t-test was done to identify gender-related differences in PPS, pain-disability and comorbidity. In this study, greater PPS (threshold and tolerance) was significantly correlated to lower pain-disability (r = -.30 to -.53, p?0.05). Age was not correlated with pain or disability but comorbidity was (r= 0.42-.43, p?0.01). PPS at the 4-selected body locations was able to explain neck disability (R2=25-28%). Comorbidity was the strongest predictor of neck disability (R2 =30%) and pain (R2=25%). Significant mean differences for gender were found in PPS, disability and comorbidity, but not in pain intensity or rating. This study suggests that PPS may play a role in outcome measures of pain and disability but between-subject comparisons should consider gender and comorbidity issues. PMID:25320651

Uddin, Zakir; MacDermid, Joy C.; Woodhouse, Linda J.; Triano, John J.; Galea, Victoria; Gross, Anita R.

2014-01-01

123

Effectiveness and tolerability of pharmacologic and combined interventions for reducing injection pain during routine childhood immunizations: Systematic review and meta-analyses  

Microsoft Academic Search

Background: Immunization is the most common cause of iatrogenic pain in childhood. Despite the availability of various analgesics to manage vaccine injection pain, they have not been incorporated into clinical practice. To date, no systematic review has been published on the effectiveness of pharmacologic and combined interventions for reducing injection pain.Objectives: The objectives of this article were to assess the

Vibhuti Shah; Anna Taddio; Michael J. Rieder

2009-01-01

124

The inhibition of the nitric oxide-cGMP-PKG-JNK signaling pathway avoids the development of tolerance to the local antiallodynic effects produced by morphine during neuropathic pain.  

PubMed

Tolerance to the local antiallodynic effects of morphine, DPDPE ([D-Pen(2),D-Pen(5)]-Enkephalin) or JWH-015 ((2-methyl-1-propyl-1H-indol-3-yl)-1-naphthalenylmethanone) after their repeated administration during neuropathic pain was evaluated. The role of the nitric oxide-cGMP-protein kinase G (PKG)-c-Jun N-terminal kinase (JNK) signaling pathway on the peripheral morphine-induced tolerance after the chronic constriction of sciatic nerve in mice was also assessed. The mechanical and thermal antiallodynic effects produced by a high dose of morphine, DPDPE or JWH-015 subplantarly administered daily from days 10 to 20 after nerve injury were estimated with the von Frey filaments and cold plate tests. The antiallodynic effects of the repeated administration of morphine combined with a sub-analgesic dose of a selective inducible nitric oxide synthase (NOS2) (L-N(6)-(1-iminoethyl)-lysine; L-NIL), L-guanylate cyclase (1H-[1,2,4]oxadiazolo[4,3-a]quinoxalin-1-one; ODQ), PKG ((Rp)-8-(para-chlorophenylthio)guanosine-3',5'-cyclic monophosphorothioate; Rp-8-pCPT-cGMPs) or JNK (anthra[1,9-cd]pyrazol-6(2H)-one; SP600125) inhibitor from days 10 to 20 after injury were also evaluated. The repeated administration of morphine, but not DPDPE or JWH-015, produced a rapid development of tolerance to its mechanical and thermal antiallodynic effects in sciatic nerve-injured mice. The co-administration of morphine with L-NIL, ODQ, Rp-8-pCPT-cGMPs or SP600125 avoided the development of morphine antiallodynic tolerance after nerve injury. These findings reveal that the repeated local administration of DPDPE or JWH-015 did not induce antinociceptive tolerance after sciatic nerve injury-induced neuropathic pain. Our data also indicate that the peripheral nitric oxide-cGMP-PKG-JNK signaling pathway participates in the development of morphine tolerance after nerve injury and propose the inactivation of this pathway as a promising strategy to avoid morphine tolerance during neuropathic pain. PMID:22546233

Hervera, Arnau; Leánez, Sergi; Pol, Olga

2012-06-15

125

Modulation of learning, pain thresholds, and thermoregulation in the rat by preparations of free purified alpha-linolenic and linoleic acids: determination of the optimal omega 3-to-omega 6 ratio.  

PubMed Central

Ingested polyunsaturated fatty acids are postulated to lead to changes in central nervous system activity, presumably by altering the lipid composition of neuronal membranes. In support of this hypothesis, we and other investigators have previously demonstrated cognitive effects in rats fed oils that contain both alpha-linolenic acid (18:3 omega 3) and linoleic acid (18:2 omega 6), with the relative content of alpha-linolenic acid being seen as the critical variable. The present study in rats examined the effects of preparations containing different ratios of highly purified free alpha-linolenic acid to linoleic acid (about 25 mg/kg of body weight daily) on learning performance (Morris water tank), pain thresholds (heated plate), and thermoregulatory control of d-amphetamine-induced hypothermia during 4 weeks of treatment. Preparations with omega 3-to-omega 6 ratios ranging from 1:3.5 to 1:5 (specifically a ratio of 1:4) produced significant favorable effects on all of these variables. Although the specific mode of action remains to be elucidated, these results suggest that such preparations of free fatty acids should be evaluated in the treatment of memory disorders and pain conditions. PMID:7901853

Yehuda, S; Carasso, R L

1993-01-01

126

Groin pain  

MedlinePLUS

Pain - groin; Lower abdominal pain; Genital pain; Perineal pain ... Common causes of groin pain include: Pulled muscle, tendon, or ligaments in the leg. This problem often occurs in people who play sports such as ...

127

Associations between polymorphisms in dopamine neurotransmitter pathway genes and pain response in healthy humans.  

PubMed

Although evidence shows that several dopamine neurotransmission pathway genes are associated with specific clinical pain syndromes, such as fibromyalgia, chronic headache, and postoperative pain, the exact role of dopamine in pain processing is not fully understood. The aim of this study was to explore the relationship between functional polymorphisms in dopaminergic candidate genes and sensitivity to pain in healthy subjects. Healthy subjects (n=192; 105 F, 87 M) were exposed to experimental tonic cold pain (1 degrees C) and phasic heat pain (47 degrees C) stimuli. DNA samples were obtained from both participants and their parents. The relationships between pain response (intensity in response to heat and cold; threshold and tolerance in response to cold only) and the functional Variable Number of Tandem Repeat (VNTR) polymorphisms of three dopamine-related genes were investigated using a Transmission Disequilibrium Test (TDT). Specifically, 30-bp repeat in the promoter region of the monoamine oxidase-A gene (MAO-A), 40-bp repeat in the 3'-untranslated region of the dopamine transporter gene (DAT-1), and 48-bp repeat in the exon 3 of the dopamine receptor 4 gene (DRD4) were examined. Significant associations between cold pain tolerance and DAT-1 (p=0.008) and MAO-A (p=0.024) polymorphisms were found. Specifically, tolerance was shorter for carriers of allele 10 and the rarer allele 11, as compared to homozygous for allele 9, and for carriers of allele 4 as compared to homozygous for allele 3, respectively. These results, together with the known function of the investigated candidate gene polymorphisms, suggest that low dopaminergic activity can be associated with high pain sensitivity and vice versa. PMID:19796878

Treister, Roi; Pud, Dorit; Ebstein, Richard P; Laiba, Efrat; Gershon, Edith; Haddad, May; Eisenberg, Elon

2009-12-15

128

Treatment of myofascial pain.  

PubMed

SUMMARY The objective of this article was to perform a narrative review regarding the treatment of myofascial pain syndrome and to provide clinicians with treatment recommendations. This paper reviews the efficacy of various myofascial pain syndrome treatment modalities, including pharmacological therapy, injection-based therapies and physical therapy interventions. Outcomes evaluated included pain (visual analog scale), pain pressure threshold and range of motion. The evidence found significant benefit with multiple treatments, including diclofenac patch, thiocolchicoside and lidocaine patches. Trigger point injections, ischemic compression therapy, transcutaneous electrical nerve stimulation, spray and stretch, and myofascial release were also efficacious. The authors recommend focusing on treating underlying pathologies, including spinal conditions, postural abnormalities and underlying behavioral issues. To achieve maximum pain reduction and improve function, we recommend physicians approach myofascial pain syndrome with a multimodal plan, which includes a combination of pharmacologic therapies, various physical therapeutic modalities and injection therapies. PMID:24645933

Desai, Mehul J; Bean, Matthew C; Heckman, Thomas W; Jayaseelan, Dhinu; Moats, Nick; Nava, Andrew

2013-01-01

129

Evidence for threshold effects of 25-hydroxyvitamin D on glucose tolerance and insulin resistance in black and white obese postmenopausal women.  

PubMed

We identified normal vs. abnormal 25-hydroxyvitamin D [25(OH)D] concentrations by examining the relation of 25(OH)D to non-bone-related measures (plasma glucose, insulin resistance, lipids, blood pressure, fitness, obesity, and regional adiposity) and asking whether there is a 25(OH)D concentration above and below which the relation between 25(OH)D and outcome changes. We examined the relation between 25(OH)D and outcome by race to see whether race-specific normal ranges are needed, and we examined the role of insulin-like growth factor-1 (IGF-1) in modulating the relation between 25(OH)D and outcome. In a cross-sectional study of 239 overweight and obese, sedentary postmenopausal women without diabetes (83 black, 156 white), outcome measures included plasma lipids, glucose, insulin, homeostasis model assessment of insulin resistance (HOMA-IR), IGF-1, parathyroid hormone (PTH), aerobic fitness, body composition, subcutaneous abdominal and visceral fat, and blood pressure. We identified threshold effects in the association between 25(OH)D and these variables using piecewise linear regressions. We found that 25(OH)D was inversely related to fasting glucose, fasting and 2-h insulin, HOMA-IR, visceral abdominal fat, percentage fat, PTH, and triglycerides. Evidence for a threshold effect of 25(OH)D was found for 2-h glucose, 2-h insulin, fasting insulin, and HOMA-IR. There was no evidence suggesting the need for race-specific normal 25(OH)D concentrations. IGF-1 modulated the relation between 25(OH)D and outcome but only below, and not above, a threshold 25(OH)D concentration. Our findings suggest a threshold effect of 25(OH)D on glucose-insulin metabolism such that 25(OH)D ? ?26 ?g/L (65.0 pmol/L) supports normal glucose homeostasis and that the same cut point defining normal 25(OH)D concentration can be used in black and white women. This study was registered at clinicaltrials.gov as NCT01798030. PMID:24717362

Sorkin, John D; Vasaitis, Tadas Sean; Streeten, Elizabeth; Ryan, Alice S; Goldberg, Andrew P

2014-05-01

130

Pain Sensitivity and Modulation in Primary Insomnia  

PubMed Central

Sleep of good quantity and quality is considered a biologically important resource necessary to maintain homeostasis of pain-regulatory processes. To assess the role of chronic sleep disturbances in pain processing, we conducted laboratory pain testing in subjects with primary insomnia. Seventeen participants with primary insomnia (mean±SEM 22.6±0.9 years, 11 women) were individually matched with 17 healthy participants. All participants completed daily sleep and pain diaries over a 2-week period. Laboratory pain testing was conducted in a controlled environment and included (1) warmth detection threshold testing, (2) pain sensitivity testing (threshold detection for heat and pressure pain), and (3) tests to access pain-modulatory mechanisms (temporal summation and pain inhibition). Primary insomnia subjects reported experiencing spontaneous pain on twice as many days as healthy controls during the at-home recording phase (p<0.05). During laboratory testing, primary insomnia subjects had lower pain thresholds than healthy controls (p<0.05 for heat pain detection threshold, p<0.08 for pressure pain detection threshold). Unexpectedly, pain facilitation, as assessed with temporal summation of pain responses, was reduced in primary insomnia compared to healthy controls (p<0.05). Pain inhibition, as assessed with the diffuse noxious inhibitory control paradigm (DNIC), was attenuated in insomnia subjects when compared to controls (p<0.05). Based on these findings, we hypothesize that pain-inhibitory circuits in patients with insomnia are in a state of constant activation to compensate for ongoing subclinical pain. This constant activation ultimately results in a ceiling effect of pain-inhibitory efforts, as indicated by the inability of the system to adequately function during challenge. PMID:22396081

Haack, Monika; Scott-Sutherland, Jennifer; Santangelo, Gabrielle; Simpson, Norah; Sethna, Navil; Mullington, Janet M.

2013-01-01

131

Abdominal pain  

MedlinePLUS

Stomach pain; Pain - abdomen; Belly ache; Abdominal cramps; Bellyache; Stomachache ... Almost everyone has pain in the abdomen at some point. Most of the time, it is not serious. How bad your pain is ...

132

Flank pain  

MedlinePLUS

Pain - side; Side pain ... Flank pain can be a sign of a kidney problem. However, since many organs are in this area, other causes are possible. If you have flank pain and fever , chills, blood in the urine, or ...

133

Capsicum pain plaster in chronic non-specific low back pain.  

PubMed

Topically applied capsaicin (CAS 404-86-4) induces the release of substance P, a neurotransmitter, from sensory C-fibres. In addition, there is a specific blockade of transport and de-novo synthesis of substance P. As a result, repeated applications of capsaicin bring about a long lasting desensitisation to pain (increase of pain threshold). The desensitising effect is fully reversible. The confirmed pharmacodynamic actions and a number of double-blind clinical studies indicate that local capsicum preparations are very suitable for the treatment of neuropathic pain or musculoskeletal disorders, with or without inflammatory components. In a double-blind, randomised parallel-group study a capsicum plaster was compared with a placebo for 3 weeks in 154 patients with non-specific back pain. Inclusion criteria were a history of back pain for a minimum period of 3 months and a degree of pain of 5 or more on an eleven grade visual analogue scale. The principal target variable consisted of the score of 3 combined pain scales. Secondary efficacy measures were tests of mobility, a disability index (in the context of Arhus low back rating scale) and global assessments by physicians and patients. For patients to be rated as responders their total pain score at the final examination after 3 weeks of treatment had to show a reduction by at least 30% of the baseline value. The study unequivocally achieved the target criterion with a rate of responders in the capsicum group of 60.8% against 42.1% in the placebo group (p = 0.0219). The sum of the 3 separate pain scales decreased more markedly in the capsicum group than in the placebo group (38.5% compared to 28.0%; p = 0.002). Relatively slight improvements of the impaired mobility and the functional status are explained by the characteristics of the disorder treated. The efficacy ratings by observers and patients was definitely in favour of capsicum. Adverse effects--mostly harmless and resolving spontaneously--were reported by 15 patients in the capsicum group and by 9 in the placebo group. The tolerance ratings by investigators and patients were superior to the placebo product. This, however, partly is due to the local pharmacological actions of the drug. As in comparably positive randomised studies with capsaicin cream in patients with osteoarthritis or fibromyalgia it was shown that a capsicum plaster preparation can also be used to advantage in chronic non-specific back pain. PMID:11765591

Keitel, W; Frerick, H; Kuhn, U; Schmidt, U; Kuhlmann, M; Bredehorst, A

2001-11-01

134

Assessment of opioid receptor ?1 gene A118G polymorphism and its association with pain intensity in patients with fibromyalgia.  

PubMed

Fibromyalgia may present with widespread pain and tenderness, fatigue, anxiety, and depression and is associated with a low pain threshold. The etiology of fibromyalgia is yet to be ascertained, although both genetic and environmental factors may play a role in the susceptibility of patients to fibromyalgia. Various genetic variations have been investigated to explain fibromyalgia susceptibility and differences in pain sensitivity, pain threshold, and tolerance. The A118G rs1799971 polymorphism in the opioid receptor ?1 gene (OPRM1) is one of the candidate genes. We hypothesized that the OPRM1 polymorphism may play a role in fibromyalgia susceptibility and impact the pain intensity and pain-related symptoms in fibromyalgia patients. This study comprised of 108 patients with fibromyalgia and 100 healthy controls. Overall, the 118G allele frequency was 16.3 % and was significantly lower in patients with fibromyalgia than in the control group (13.9 and 19 %, respectively). No difference was observed between fibromyalgia patients with and without the A118G allele with regard to the Beck Depression Inventory, widespread pain index, symptom severity, and Fibromyalgia Impact Questionnaire scores. All body parts of patients with fibromyalgia demonstrated lower pressure pain thresholds (PPT) compared to controls. The PPTs were higher in the 118 A/A genotype carrier fibromyalgia patients than in 118*/G carriers; however, the differences were not significant. As the A118G polymorphism frequency was lower in fibromyalgia patients, this polymorphism may exert a protective effect against fibromyalgia in Turkish women. However, the OPRM1 polymorphism does not have a significant effect on pressure pain and fibromyalgia severity. PMID:24671502

Solak, Özlem; Erdo?an, Müjgan Özdemir; Y?ld?z, Handan; Ula?l?, Alper Murat; Yaman, Fatima; Terzi, Evrim Suna Ar?kan; Ulu, Sena; Dündar, Ümit; Solak, Mustafa

2014-09-01

135

Positive Traits Linked to Less Pain through Lower Pain Catastrophizing  

PubMed Central

The present study examined the association between positive traits, pain catastrophizing, and pain perceptions. We hypothesized that pain catastrophizing would mediate the relationship between positive traits and pain. First, participants (n = 114) completed the Trait Hope Scale, the Life Orientation Test- Revised, and the Pain Catastrophizing Scale. Participants then completed the experimental pain stimulus, a cold pressor task, by submerging their hand in a circulating water bath (0º Celsius) for as long as tolerable. Immediately following the task, participants completed the Short-Form McGill Pain Questionnaire (MPQ-SF). Pearson correlation found associations between hope and pain catastrophizing (r = ?.41, p < .01) and MPQ-SF scores (r = ?.20, p < .05). Optimism was significantly associated with pain catastrophizing (r = ?.44, p < .01) and MPQ-SF scores (r = ?.19, p < .05). Bootstrapping, a non-parametric resampling procedure, tested for mediation and supported our hypothesis that pain catastrophizing mediated the relationship between positive traits and MPQ-SF pain report. To our knowledge, this investigation is the first to establish that the protective link between positive traits and experimental pain operates through lower pain catastrophizing. PMID:22199416

Hood, Anna; Pulvers, Kim; Carrillo, Janet; Merchant, Gina; Thomas, Marie

2011-01-01

136

Does acute intraoral pain alter cutaneous sensibility?  

PubMed Central

Cutaneous sensibility was tested in eight patients suffering from acute postoperative intraoral pain. Tactile-, cold-, warm-, and heat-pain thresholds as well as reaction time to cold pulses were unaffected by the presence of pain. However, reaction time to warm pulses was increased in the painful area on the day of pain compared to a non-painful state. The findings are discussed in relation to (1) functional convergence of different sensory fibres on central neurons (2) the phenomenon of diffuse noxious inhibitory controls and (3) secondary hyperalgesia. The observed effect of clinical pain on the warm pathway could be explained as an intrasegmental noxious inhibitory effect. PMID:3216205

Hansson, P; Ekblom, A; Lindblom, U; Marchettini, P

1988-01-01

137

Experimental muscle pain impairs descending inhibition  

PubMed Central

In chronic musculoskeletal pain conditions, the balance between supraspinal facilitation and inhibition of pain shifts towards an overall decrease in inhibition. Application of a tonic painful stimulus results in activation of diffuse noxious inhibitory controls (DNIC). The aims of the present experimental human study were (1) to compare DNIC, evoked separately, by hypertonic saline (6%)-induced muscle pain (tibialis anterior) or cold pressor pain; (2) to investigate DNIC evoked by concomitant experimental muscle pain and cold pressor pain, and (3) to analyze for gender differences. Ten males and 10 age matched females participated in two sessions. In the first session unilateral muscle pain or unilateral cold pressor pain were induced separately; in the second session unilateral muscle pain and unilateral cold pressor pain were induced concomitantly. Pressure pain thresholds (PPT) were measured around the knee joint before, during, and after DNIC induction. Cold pressor pain increased PPT in both males and females with greater increases in males. Hypertonic saline-evoked muscle pain significantly increased PPT in males but not in females. When cold pressor and muscle pain were applied concomitantly the PPT increases were smaller when compared to the individual sessions. This study showed for the first time that two concurrent conditioning tonic pain stimuli (muscle pain and cold pressor pain) cause less DNIC compared with either of the conditioning stimuli given alone; and males showed greater DNIC than females. This may explain why patients with chronic musculoskeletal pain have impaired DNIC. PMID:18977598

Arendt-Nielsen, Lars; Sluka, Kathleen A.; Nie, Hong Ling

2009-01-01

138

A Phase 3, Randomized, Double-Blind Comparison of Analgesic Efficacy and Tolerability of Q8003 vs Oxycodone or Morphine for Moderate-to-Severe Postoperative Pain Following Bunionectomy Surgery  

PubMed Central

Objective Compare the efficacy and tolerability of the dual-opioid, Q8003® (morphine/oxycodone combination) 12 mg/8 mg to morphine 12 mg or oxycodone 8 mg in subjects following bunionectomy surgery. Design This was a randomized, double-blind study. Setting Hospitalized patients. Patients Healthy men or women aged ?18 years with moderate or severe pain (score ?2 on a 4-point Likert scale) and ?4 on the 11-point numerical pain rating scale following surgery. Interventions Study medication was initiated after surgery and was given for 48 hours. Outcomes The primary efficacy variable was mean sum of the pain intensity difference (SPID) scores from the postsurgical baseline. Results Five hundred twenty-two subjects were randomized; 31 (5.9%) discontinued, including 19 (3.6%) for adverse events. The mean total morphine equivalent dose (MED) was 182.7 mg from Q8003 12 mg/8 mg, 92.4 mg for morphine 12 mg, and 92.1 mg for oxycodone 8 mg. SPID from baseline over 24 hours and SPID from baseline over 48 hours were significantly (P < 0.02) higher for Q8003 12 mg/8 mg vs morphine 12 mg or oxycodone 8 mg. Significantly (P < 0.015) fewer subjects in the Q8003 group required ibuprofen rescue medication, used lower doses of rescue medication, and had a longer median time to first use of rescue medication. Oxygen desaturation <90% occurred in 5.3% with Q8003, 2.8% with morphine 12 mg, and 2.3% with oxycodone 8 mg, and the cumulative median dose at first desaturation was twofold greater with Q8003. Conclusion Q8003 provided superior efficacy to its individual components at twice the MED with only a modest increase in the incidence of adverse events. PMID:23802706

Richards, Patricia; Riff, Dennis; Kelen, Robin; Stern, Warren

2013-01-01

139

Is the Deficit in Pain Inhibition in Fibromyalgia Influenced by Sleep Impairments?  

PubMed Central

It has been proposed that a deficit in inhibitory conditioned pain modulation (ICPM) underlies the pathophysiology of fibromyalgia (FM), but there is high variability in ICPM efficacy in this syndrome that remains poorly understood. Based on emerging data showing that age, anxiety, depression and sleep can modulate ICPM efficacy, the main objective of this study was to determine the clinical correlates of experimentally-induced pain perception in FM. Fifty FM patients and 39 healthy controls (HC) were tested. Anxiety, depression, sleep and FM symptoms were measured with questionnaires or interview-type scales. Experimental pain testing consisted of two tonic heat pain stimulations separated by a 2-minute cold pressor test (CPT). Thermal pain thresholds and tolerance were higher in HC compared to FM patients. Pain ratings during the CPT were lower in HC relative to FM patients. ICPM efficacy was stronger in HC compared to FM patients. Finally, sleep quality was the only factor significantly related to ICPM efficacy. To our knowledge, this is the first study to report this association in FM. Future studies will need to replicate this finding, to determine whether impaired sleep is primary or secondary to deficient pain inhibition, and to characterize the neurobiological mechanisms underlying this association. PMID:23091577

Paul-Savoie, Emilie; Marchand, Serge; Morin, Mélanie; Bourgault, Patricia; Brissette, Nathalie; Rattanavong, Vongmaly; Cloutier, Christian; Bissonnette, Alain; Potvin, Stéphane

2012-01-01

140

Habituation to Experimentally Induced Electrical Pain during Voluntary-Breathing Controlled Electrical Stimulation (BreEStim)  

PubMed Central

Objective Painful peripheral electrical stimulation to acupuncture points was found to cause sensitization if delivered randomly (EStim), but induced habituation if triggered by voluntary breathing (BreEStim). The objective was to systematically compare the effectiveness of BreEStim and EStim and to investigate the possible mechanisms mediating the habituation effect of BreEStim. Methods Eleven pain-free, healthy subjects (6 males, 5 females) participated in the study. Each subject received the BreEStim and EStim treatments in a random order at least three days apart. Both treatments consisted of 120 painful but tolerable stimuli to the ulnar nerve at the elbow on the dominant arm. BreEStim was triggered by voluntary breathing while EStim was delivered randomly. Electrical sensation threshold (EST) and electrical pain threshold (EPT) were measured from the thenar and hypothenar eminences on both hands at pre-intervention and 10-minutes post-intervention. Results There was no difference in the pre-intervention baseline measurement of EST and EPT between BreEStim and EStim. BreEStim increased EPT in all tested sites on both hands, while EStim increased EPT in the dominant hypothenar eminence distal to the stimulating site and had no effect on EPT in other sites. There was no difference in the intensity of electrical stimulation between EStim and BreEStim. Conclusion Our findings support the important role human voluntary breathing plays in the systemic habituation effect of BreEStim to peripheral painful electrical stimulation. PMID:25153077

Li, Shengai; Hu, Tracy; Beran, Maria A.; Li, Sheng

2014-01-01

141

Heel pain  

MedlinePLUS

Pain - heel ... Heel pain is most often the result of overuse. Rarely, it may be caused by an injury. Your heel ... on the heel Conditions that may cause heel pain include: When the tendon that connects the back ...

142

Wrist pain  

MedlinePLUS

Pain - wrist ... Carpal tunnel syndrome: A common cause of wrist pain is carpal tunnel syndrome . You may feel aching, ... become weak, making it difficult to grasp things. Pain may extend up to your elbow. Carpal tunnel ...

143

Ankle pain  

MedlinePLUS

Pain - ankle ... Ankle pain is often due to an ankle sprain. An ankle sprain is an injury to the ligaments, which ... the joint. In addition to ankle sprains, ankle pain can be caused by: Damage or swelling of ...

144

Elbow pain  

MedlinePLUS

Pain - elbow ... Elbow pain can be caused by a variety of problems. A common cause in adults is tendinitis , an inflammation ... a partial dislocation ). Other common causes of elbow pain are: Bursitis -- inflammation of a fluid-filled cushion ...

145

Foot pain  

MedlinePLUS

Pain - foot ... Foot pain may be due to: Aging Being on your feet for long periods of time Being overweight A ... other sports activity The following can cause foot pain: Arthritis and gout : Common in the big toe, ...

146

Neck Pain  

MedlinePLUS

... Pregnancy and Rheumatic Disease Sex and Arthritis Neck Pain PRINT Download PDF Description Saying, “It’s a pain ... requires expensive or uncomfortable tests. What is neck pain? Acute strain may occur after sleeping in an ...

147

Pain Relievers  

MedlinePLUS

Pain relievers are medicines that reduce or relieve headaches, sore muscles, arthritis, or other aches and pains. There ... also have a slightly different response to a pain reliever. Over-the-counter (OTC) medicines are good for ...

148

Depression, Pain, and Pain Behavior.  

ERIC Educational Resources Information Center

Examined the degree to which depression predicted pain and pain behavior. The Beck Depression Inventory was administered to 207 low back pain patients. Depression and physical findings were the most important predictors of pain and pain behavior. Depression proved significant even after controlling for important demographic and medical status…

Keefe, Francis J.; And Others

1986-01-01

149

Tolerating Zero Tolerance?  

ERIC Educational Resources Information Center

The concept of zero tolerance dates back to the mid-1990s when New Jersey was creating laws to address nuisance crimes in communities. The main goal of these neighborhood crime policies was to have zero tolerance for petty crime such as graffiti or littering so as to keep more serious crimes from occurring. Next came the war on drugs. In federal…

Moore, Brian N.

2010-01-01

150

Pelvic Pain  

MedlinePLUS

Pelvic pain occurs mostly in the lower abdomen area. The pain might be steady, or it might come and go. If the pain is severe, it might get in the way ... re a woman, you might feel a dull pain during your period. It could also happen during ...

151

Back Pain  

MedlinePLUS

NINDS Back Pain Information Page Condensed from Low Back Pain Fact Sheet Table of Contents (click to jump to sections) ... Trials Organizations Additional resources from MedlinePlus What is Back Pain? Acute or short-term low back pain generally ...

152

Fear of Severe Pain Mediates Sex Differences in Pain Sensitivity Responses to Thermal Stimuli  

PubMed Central

The purpose of this paper was to examine the relationship of sex and pain-related fear in pain intensity reports to thermal stimuli and whether sex differences in reported pain intensity were mediated by pain-related fear. 177 participants, 124 female (23.5 ± 4.5 years old), filled out a demographic and fear of pain questionnaire (FPQ-III). Experimental pain testing was performed using thermal stimuli applied to the lower extremity. Participants rated the intensity of pain using the numerical pain rating scale (NPRS). Independent t-tests, Sobel's test, and linear regression models were performed to examine the relationships between sex, fear of pain, and pain sensitivity. We found significant sex differences for thermal pain threshold temperatures (t = 2.04, ?P = 0.04) and suprathreshold pain ratings for 49°C (t = ?2.12, ?P = 0.04) and 51°C (t = ?2.36, ?P = 0.02). FPQ-severe score mediated the effect of suprathreshold pain ratings of 49° (t = 2.00, ?P = 0.05), 51° (t = 2.07, ?P = 0.04), and pain threshold temperatures (t = ?2.12, ?P = 0.03). There are differences in the pain sensitivity between sexes, but this difference may be mediated by baseline psychosocial factors such as fear of pain. PMID:24523963

Horn, Maggie E.; Alappattu, Meryl J.; Gay, Charles W.; Bishop, Mark

2014-01-01

153

Cancer Pain  

Microsoft Academic Search

Cancer pain remains undertreated. Pain occurs in over three-quarters of cancer patients and remains one of the most feared\\u000a aspects of this illness despite the excellent therapies that are available. Cancer pain commonly results from tumor compressing\\u000a or invading soft tissue, bone, or nerves or from diagnostic or therapeutic endeavors. Optimal pain management involves determining\\u000a pain intensity, evaluating the etiology

Suzanne A. Nesbit

154

Algometry with a clothes peg compared to an electronic pressure algometer: a randomized cross-sectional study in pain patients  

PubMed Central

Background Hypersensitivity of the central nervous system is widely present in pain patients and recognized as one of the determinants of chronic pain and disability. Electronic pressure algometry is often used to explore aspects of central hypersensitivity. We hypothesized that a simple pain provocation test with a clothes peg provides information on pain sensitivity that compares meaningfully to that obtained by a well-established electronic pressure algometer. "Clinically meaningful" was defined as a medium (r = 0.3-0.5) or high (r > 0.5) correlation coefficient according to Cohen's conventions. Methods We tested 157 in-patients with different pain types. A calibrated clothes peg was applied for 10 seconds and patients rated the pain intensity on a 0 to 10 numerical rating scale. Pressure pain detection threshold (PPdt) and pressure pain tolerance threshold (PPtt) were measured with a standard electronic algometer. Both methods were performed on both middle fingers and ear lobes. In a subgroup of 47 patients repeatability (test-retest reliability) was calculated. Results Clothes peg values correlated with PPdt values for finger testing with r = -0.54 and for earlobe testing with r = -0.55 (all p-values < 0.001). Clothes peg values also correlated with PPtt values for finger testing with r = -0.55 (p < 0.001). Test-retest reliability (repeatability) showed equally stable results for clothes peg algometry and the electronic algometer (all r-values > 0.89, all p-values < 0.001). Conclusions Information on pain sensitivity provided by a calibrated clothes peg and an established algometer correlate at a clinically meaningful level. PMID:21787399

2011-01-01

155

Central Hypersensitivity in Chronic Hemiplegic Shoulder Pain  

PubMed Central

Objective This study aimed to examine the association of hemiplegic shoulder pain with central hypersensitivity through pressure-pain thresholds (PPT) at healthy, distant tissues. Design This study is a cross-sectional study. A total of 40 patients (n=20 hemiplegic shoulder pain (HSP), n=20 stroke without HSP) were enrolled in this study. Pressure-pain thresholds were measured at the affected deltoid and contralateral deltoid and tibialis anterior using a handheld algometer. Differences in PPTs were analyzed by Wilcoxon Rank Sum test and with linear regression analysis controlling for gender, a known confounder of PPTs. Results Subjects with hemiplegic shoulder pain had lower local PPTs than stroke control subjects when comparing the painful to dominant shoulders and comparing the non-painful shoulder and tibialis anterior to the non-dominant side controls. Similarly, those with hemiplegic shoulder pain had lower PPTs when comparing to controls in contralesional-to-contralesional comparisons as well as ipsilesional-to-ipsilesional comparisons. Conclusions Subjects with hemiplegic shoulder pain have lower local and distal PPTs than subjects without hemiplegic shoulder pain. Our study suggests that chronic shoulder pain may be associated with widespread central hypersensitivity, which has been previously found to be associated with other chronic pain syndromes. This further understanding can then help develop better treatment options for those with this hemiplegic shoulder pain. PMID:23255268

Hoo, Jennifer Soo; Paul, Tracy; Chae, John; Wilson, Richard

2013-01-01

156

Etoricoxib for arthritis and pain management  

PubMed Central

Nonsteroidal antiinflammatory drugs (NSAIDs), including selective cyclooxygenase (COX)-2 inhibitors, have come to play an important role in the pharmacologic management of arthritis and pain. Clinical trials have established the efficacy of etoricoxib in osteoarthritis, rheumatoid arthritis, acute gouty arthritis, ankylosing spondylitis, low back pain, acute postoperative pain, and primary dysmenorrhea. Comparative studies indicate at least similar efficacy with etoricoxib versus traditional NSAIDs. Etoricoxib was generally well tolerated in these studies with no new safety findings during long-term administration. The gastrointestinal, renovascular, and cardiovascular tolerability profiles of etoricoxib have been evaluated in large patient datasets, and further insight into the cardiovascular tolerability of etoricoxib and diclofenac will be gained from a large ongoing cardiovascular outcomes program (MEDAL). The available data suggest that etoricoxib is an efficacious alternative in the management of arthritis and pain, with the potential advantages of convenient once-daily administration and superior gastrointestinal tolerability compared with traditional NSAIDs. PMID:18360581

Brooks, Peter; Kubler, Paul

2006-01-01

157

Pain sensitivity and tactile spatial acuity are altered in healthy musicians as in chronic pain patients  

PubMed Central

Extensive training of repetitive and highly skilled movements, as it occurs in professional classical musicians, may lead to changes in tactile sensitivity and corresponding cortical reorganization of somatosensory cortices. It is also known that professional musicians frequently experience musculoskeletal pain and pain-related symptoms during their careers. The present study aimed at understanding the complex interaction between chronic pain and music training with respect to somatosensory processing. For this purpose, tactile thresholds (mechanical detection, grating orientation, two-point discrimination) and subjective ratings to thermal and pressure pain stimuli were assessed in 17 professional musicians with chronic pain, 30 pain-free musicians, 20 non-musicians with chronic pain, and 18 pain-free non-musicians. We found that pain-free musicians displayed greater touch sensitivity (i.e., lower mechanical detection thresholds), lower tactile spatial acuity (i.e., higher grating orientation thresholds) and increased pain sensitivity to pressure and heat compared to pain-free non-musicians. Moreover, we also found that musicians and non-musicians with chronic pain presented lower tactile spatial acuity and increased pain sensitivity to pressure and heat compared to pain-free non-musicians. The significant increment of pain sensitivity together with decreased spatial discrimination in pain-free musicians and the similarity of results found in chronic pain patients, suggests that the extensive training of repetitive and highly skilled movements in classical musicians could be considered as a risk factor for developing chronic pain, probably due to use-dependent plastic changes elicited in somatosensory pathways. PMID:25610384

Zamorano, Anna M.; Riquelme, Inmaculada; Kleber, Boris; Altenmüller, Eckart; Hatem, Samar M.; Montoya, Pedro

2015-01-01

158

Low back pain - acute  

MedlinePLUS

Backache; Low back pain; Lumbar pain; Pain - back; Acute back pain; Back pain - new; Back pain - short-term; Back strain - new ... back supports most of your body's weight. Low back pain is the number two reason that Americans see ...

159

Ribcage pain  

MedlinePLUS

... not cause the pain in those who have pleurisy (swelling of the lining of the lungs) or ... Inflammation of cartilage near the breastbone ( costochondritis ) Osteoporosis Pleurisy (the pain is worse when breathing deeply)

160

Back Pain  

MedlinePLUS

... Oh, my aching back!", you are not alone. Back pain is one of the most common medical problems, ... 10 people at some point during their lives. Back pain can range from a dull, constant ache to ...

161

Back Pain  

MedlinePLUS

Back Pain The Centers for Disease Control and Prevention’s 2008 Health Report states that over 27% of the ... States population age 18 and older have active back pain. As many as 80-90% of Americans will ...

162

Synthesis and evaluation of fault-tolerant quantum computer architectures  

E-print Network

Fault-tolerance is the cornerstone of practical, large-scale quantum computing, pushed into its prominent position with heroic theoretical efforts. The fault-tolerance threshold, which is the component failure probability ...

Cross, Andrew W. (Andrew William), 1979-

2005-01-01

163

Neck pain  

MedlinePLUS

Pain - neck; Neck stiffness ... this as having a stiff neck. If neck pain involves nerves, you may feel numbness, tingling, or ... A common cause of neck pain is muscle strain or tension. Usually, ... Such activities include: Bending over a desk for hours Poor ...

164

Geriatric pain  

Microsoft Academic Search

Geriatric pain will be a significant health care problem in the next millennium. Pain can be acute due to trauma or surgery,\\u000a and chronic due to medical illnesses and their sequels. In this article, management of geriatric chronic pain is discussed.

Daniel Lynch

1999-01-01

165

Chronic Pain  

Microsoft Academic Search

The primary purposes of acute pain and the reason it is noxious are to interrupt ongoing activity in order to warn the sufferer of tissue damage, to discourage movement that might exacerbate injury or prevent healing, and to teach the organism to avoid the pain-producing circumstances. Therefore, it is no wonder that when pain persists to become chronic, many sufferers

Malcolm H. Johnson

166

PainVision Apparatus Is Effective for Assessing Low Back Pain  

PubMed Central

Study Design Case series. Purpose To determine the utility of "PainVision" apparatus for the assessment of low back pain. Overview of Literature A newly developed device, the PainVision PS-2100 (Nipro, Osaka, Japan), has been used to assess the perception of pain in a quantitative manner. In the current study, we aimed to evaluate the efficacy of PainVision for the assessment of low back pain. Methods We assessed 89 patients with low back pain. The numeric rating scale (NRS) score, McGill Pain Questionnaire (MPQ) score and the degree of pain calculated by PainVision were measured twice at 4-week intervals in each patient. An electrode was patched on the forearm surface of the patients and the degree of pain was automatically calculated (degree of pain=100×[current producing pain comparable with low back pain-current at perception threshold/current at perception threshold]). Correlations between NRS and MPQ scores and the degree of pain were determined using Spearman's rank correlation test. Results There was a strong correlation between the NRS and MPQ scores at each time point (rs=0.60, p<0.0001). The degree of pain also showed a moderate correlation with NRS and MPQ scores at each time point (rs=0.40, p<0.03). The change in the degree of pain over 4 weeks showed a moderate correlation with changes in the NRS and MPQ scores (rs=0.40, p<0.01). Conclusions PainVision as self-reported questionnaires is a useful tool to assess low back pain.

Kawaguchi, Hiroshi; Takebayashi, Tsuneo; Orita, Sumihisa; Inoue, Gen; Yamauchi, Kazuyo; Aoki, Yasuchika; Nakamura, Junichi; Ishikawa, Tetsuhiro; Miyagi, Masayuki; Kamoda, Hiroto; Suzuki, Miyako; Kubota, Gou; Sakuma, Yoshihiro; Oikawa, Yasuhiro; Inage, Kazuhide; Sainoh, Takeshi; Sato, Jun; Takahashi, Kazuhisa; Konno, Shinichi

2014-01-01

167

Management of breakthrough pain due to cancer  

PubMed Central

Breakthrough pain is defined as the transient exacerbation of pain occurring in a patient with otherwise stable, persistent pain. It is estimated to affect over 50% of patients, particularly those with moderate to severe background pain. Breakthrough pain is one of the most difficult pain syndromes to treat. There are several types of breakthrough cancer pain: incidental type involves flares of pain associated with movement or activity; idiopathic type is transitory pain unrelated to a specific activity; and in end-of-dose failure pain occurs when blood levels of medications fall below an analgesic threshold at the end of a dosing interval. Persistent and breakthrough pain are distinct components of cancer pain and require separate management. Successful management of breakthrough pain may require a combination of pharmacological and non-pharmacological treatment strategies. Supplemental analgesia, known as rescue medication, is a common pharmacological treatment option. Breakthrough pain is treated with supplemental short-acting opioid use, as needed, e.g. short-acting morphine, intranasal fentanyl and buccal tablets of fentanyl. PMID:23788935

2013-01-01

168

Preoperative widespread pain sensitization and chronic pain after hip and knee replacement: a cohort analysis  

PubMed Central

Abstract Chronic pain after joint replacement is common, affecting approximately 10% of patients after total hip replacement (THR) and 20% of patients after total knee replacement (TKR). Heightened generalized sensitivity to nociceptive input could be a risk factor for the development of this pain. The primary aim of this study was to investigate whether preoperative widespread pain sensitivity was associated with chronic pain after joint replacement. Data were analyzed from 254 patients receiving THR and 239 patients receiving TKR. Pain was assessed preoperatively and at 12 months after surgery using the Western Ontario and McMaster Universities Osteoarthritis Pain Scale. Preoperative widespread pain sensitivity was assessed through measurement of pressure pain thresholds (PPTs) at the forearm using an algometer. Statistical analysis was conducted using linear regression and linear mixed models, and adjustments were made for confounding variables. In both the THR and TKR cohort, lower PPTs (heightened widespread pain sensitivity) were significantly associated with higher preoperative pain severity. Lower PPTs were also significantly associated with higher pain severity at 12 months after surgery in the THR cohort. However, PPTs were not associated with the change in pain severity from preoperative to 12 months postoperative in either the TKR or THR cohort. These findings suggest that although preoperative widespread pressure pain sensitivity is associated with pain severity before and after joint replacement, it is not a predictor of the amount of pain relief that patients gain from joint replacement surgery, independent of preoperative pain severity.

Wylde, Vikki; Sayers, Adrian; Lenguerrand, Erik; Gooberman-Hill, Rachael; Pyke, Mark; Beswick, Andrew D.; Dieppe, Paul; Blom, Ashley W.

2015-01-01

169

Low back pain - chronic  

MedlinePLUS

Nonspecific back pain; Backache - chronic; Lumbar pain - chronic; Pain - back - chronic; Chronic back pain - low ... waist, leads to pain. Many people with chronic back pain have arthritis. Or they may have extra wear ...

170

Neuropathic Pain  

PubMed Central

Neuropathic pain is triggered by lesions to the somatosensory nervous system that alter its structure and function so that pain occurs spontaneously and responses to noxious and innocuous stimuli are pathologically amplified. The pain is an expression of maladaptive plasticity within the nociceptive system, a series of changes that constitute a neural disease state. Multiple alterations distributed widely across the nervous system contribute to complex pain phenotypes. These alterations include ectopic generation of action potentials, facilitation and disinhibition of synaptic transmission, loss of synaptic connectivity and formation of new synaptic circuits, and neuroimmune interactions. Although neural lesions are necessary, they are not sufficient to generate neuropathic pain; genetic polymorphisms, gender, and age all influence the risk of developing persistent pain. Treatment needs to move from merely suppressing symptoms to a disease-modifying strategy aimed at both preventing maladaptive plasticity and reducing intrinsic risk. PMID:19400724

Costigan, Michael; Scholz, Joachim; Woolf, Clifford J.

2009-01-01

171

Cancer Pain  

Microsoft Academic Search

The effectiveness of cancer pain therapy is influenced by the attitudes and knowledge of the treating physicians. As part of a quality improvement project in the management of cancer pain, a survey of 236 medical practitioners was conducted. One hundred seventy-six respondents (74.5%) completed the survey. Fifty-two percent treated patients with cancer pain several times a week or more. Whereas

Rama Sapir; Raphael Catane; Nurith Strauss-Liviatan; Nathan I. Cherny

1999-01-01

172

Simultaneous recording of late and ultra-late pain evoked potentials in fibromyalgia  

Microsoft Academic Search

Objective: To characterize laser evoked potentials (LEP), pain psychophysics and local tissue response in fibromyalgia patients.Methods: LEP were recorded in 14 women with fibromyalgia in response to bilateral stimulation of tender and control points in upper limbs by 4 blocks of 20 stimuli at each point. Subsequently, heat pain thresholds were measured and supra-threshold magnitude estimations of heat pain stimuli

M Granot; D Buskila; Y Granovsky; E Sprecher; L Neumann; D Yarnitsky

2001-01-01

173

The role of painful events and pain perception in blood-injection-injury fears  

PubMed Central

Background and objectives Research suggests that blood, injection, and injury (BII) fears are related to painful experiences; however the role of frequency, intensity, and perceived ability to handle such events remains unknown. The aim of this study was to examine the relationship between BII fears and the frequency and intensity of prior painful experiences with blood, injuries, and injections. The relation of BII fears with self-reported tolerance and avoidance of physical discomfort and pain was also examined. Methods In the context of an undergraduate student survey, 392 participants completed questions about whether they were fearful of blood, injection, and injuries. They also completed questions about experiences with blood and injuries, as well as injections, including pain intensity, frequency of painful experiences, perceived ability to tolerate physical discomfort and pain (pain perception), and avoidance of physical discomfort. Results Findings indicated that only pain intensity, but not frequency of painful experiences with blood, injuries, and injections, was related to BII fears. Furthermore, there was a significant association between BII fears and pain perception, such that higher levels of discomfort intolerance were related to greater odds of endorsing BII fears. Conclusions These findings provide preliminary evidence that BII fears are associated with experiences with injections of high pain intensity. Individuals with a lower perceived ability to handle physical pain and discomfort are more likely to endorse BII fears. Clinical considerations and future directions are discussed. PMID:22677208

Smith, Noelle B.; Meuret, Alicia E.

2013-01-01

174

Central pain.  

PubMed

Questions from patients about pain conditions and analgesic pharmacotherapy and responses from authors are presented to help educate patients and make them more effective self-advocates. The topic addressed in this issue is central pain, a neuropathic pain syndrome caused by a lesion in the brain or spinal cord that sensitizes one's perception of pain. It is a debilitating condition caused by various diseases such as multiple sclerosis, strokes, spinal cord injuries, or brain tumors. Varied symptoms and the use of pharmacological medicines and nonpharmacological therapies will be addressed. PMID:25295639

Singh, Supreet

2014-12-01

175

Pain in extracorporeal shock wave lithotripsy.  

PubMed

Pain tolerance has long been identified as a factor influencing successful treatment of renal calculi by shock wave lithotripsy (SWL). We aimed to clarify which factors directly influence pain tolerance to predict which patients are likely to undergo successful treatment. We analysed retrospectively 179 patients who received their first SWL for a solitary kidney stone. All patients were on a non-opioid analgesia protocol and were treated on an outpatient basis. The target was to deliver 4,000 shock waves at an energy level of 4. In total, 53% of patients could tolerate the targeted shock wave number and energy and were retrospectively allocated into group A. Those who required a reduction in either energy levels or shock wave number were allocated in group B. Multivariate and univariate analysis showed that female patients, who are young with thin body habitus, have lower pain tolerance to SWL. PMID:19183979

Berwin, James Theo; El-Husseiny, T; Papatsoris, A G; Hajdinjak, T; Masood, J; Buchholz, N

2009-04-01

176

PAIN SCALES (ATTACHMENT A)  

E-print Network

PAIN SCALES (ATTACHMENT A) 0-10 NUMERIC PAIN INTENSITY SCALE 0 1 2 3 4 5 6 7 8 9 10 NO PAIN MODERATE WORST PAIN PAIN #12;PAIN SCALES (ATTACHMENT A) FLACC PAIN SCALE The FLACC is a behavioral pain assessment scale for use in non-verbal patients unable to provide numeric reports of pain. SCORING Categories

Oliver, Douglas L.

177

Risk Tolerance  

Microsoft Academic Search

This chapter provides an overview of the important role financial risk tolerance plays in shaping consumer financial decisions.\\u000a A review of normative and descriptive models of risk tolerance is provided. Additional discussion regarding the measurement\\u000a of risk tolerance is also presented. The chapter includes the presentation of a conceptual model of the principal factors\\u000a affecting financial risk tolerance with recommendations

John E. Grable

178

Beyond pain  

Microsoft Academic Search

The purpose of the present article is to provide unification to a number of somewhat disparate themes in the chronic pain and phobia literature. First, we present a summary review of the early writings and current theoretical perspectives regarding the role of avoidance in the maintenance of chronic pain. Second, we present an integrative review of recent empirical investigations of

Gordon J. G Asmundson; Peter J Norton; G. Ron Norton

1999-01-01

179

Pain frequency moderates the relationship between pain catastrophizing and pain  

PubMed Central

Background: Pain frequency has been shown to influence sensitization, psychological distress, and pain modulation. The present study examined if pain frequency moderates the relationship between pain catastrophizing and pain. Method: A non-clinical (247 students) and a clinical (223 pain patients) sample completed the Danish versions of the Pain Catastrophizing Scale (PCS), Beck Depression Inventory, and the State Trait Anxiety Inventory and rated pain intensity, unpleasantness and frequency. Results: In both samples, high pain frequency was found to moderate the association between pain catastrophizing and pain intensity, whereas low pain frequency did not. The psychometric properties and the factor structure of the Danish version of the PCS were confirmed. Conclusions: This is the first study to validate the Danish version of the PCS and to show that pain frequency moderates the relationship between pain catastrophizing and reported pain in both non-clinical and clinical populations. PMID:25646089

Kjøgx, Heidi; Zachariae, Robert; Pfeiffer-Jensen, Mogens; Kasch, Helge; Svensson, Peter; Jensen, Troels S.; Vase, Lene

2014-01-01

180

High-frequency rTMS of the motor cortex does not influence the nociceptive flexion reflex but increases the unpleasantness of electrically induced pain  

Microsoft Academic Search

The aim of this study was to investigate whether a 10-Hz repetitive transcranial magnetic stimulation (rTMS) applied over the motor cortex, using a stimulus paradigm employed for pain control in chronic pain, affects acute electrically induced pain. We investigated whether rTMS modulates the nociceptive flexion reflex (NFR) in addition to subjective pain perception. Pain threshold, NFR threshold, supra-threshold NFR response,

Veit Mylius; Janine Reis; Anne Knaack; Anja Haag; Wolfgang H. Oertel; Felix Rosenow; Karsten Schepelmann

2007-01-01

181

Accuracy threshold for postselected quantum computation  

E-print Network

We prove an accuracy threshold theorem for fault-tolerant quantum computation based on error detection and postselection. Our proof provides a rigorous foundation for the scheme suggested by Knill, in which preparation circuits for ancilla states are protected by a concatenated error-detecting code and the preparation is aborted if an error is detected. The proof applies to independent stochastic noise but (in contrast to proofs of the quantum accuracy threshold theorem based on concatenated error-correcting codes) not to strongly-correlated adversarial noise. Our rigorously established lower bound on the accuracy threshold, 1.04 \\times 10^{-3}, is well below Knill's numerical estimates.

Panos Aliferis; Daniel Gottesman; John Preskill

2007-09-17

182

Globally controlled fault tolerant quantum computation  

E-print Network

We describe a method to execute globally controlled quantum information processing which admits a fault tolerant quantum error correction scheme. Our scheme nominally uses three species of addressable two-level systems which are arranged in a one dimensional array in a specific periodic arrangement. We show that the scheme possesses a fault tolerant error threshold.

J. Fitzsimons; J. Twamley

2007-07-08

183

Effects of threatening information on interpersonal responses to pain.  

PubMed

Emerging evidence indicates that meanings attributed to pain contribute to tolerance and coping among affected individuals. However, links between pain appraisals and coping responses have received little attention within a broader interpersonal context. In this experiment, effects of appraisal on pain tolerance and coping were examined in adult dyads. Eighty-six acquaintance/friend pairs were randomly assigned to the role of Participant in a cold pressor test (CPT) or observer-helper who assisted in coping. Before the task, pairs in the threat condition read about frostbite symptoms and consequences, while those in the reassurance condition read about the safety of the task. In a mixed condition, Participants and Observers read the reassurance and threat passage, respectively. Between-groups analyses revealed threat group participants had lower pain tolerance and reported less cognitive coping than did participants in other appraisal conditions. Threat group observers reported less attention diversion, coping self-statements and ignoring in helping their partner than did reassured observers. Pain language was also most prominent in transactions of threatened dyads. Finally, use of attention diversion by observers contributed to pain tolerance, independent of participant factors (reported pain, appraisal condition, reported coping) and pain language in conversations during immersions. The study highlights how appraisal contributes not only to pain tolerance and coping in the affected individual but also to care-giving efforts of others in their social environment. PMID:18602319

Jackson, Todd; Huang, Xiting; Chen, Hong; Phillips, Heath

2009-04-01

184

What a Pain! Kids and Growing Pains  

MedlinePLUS

... Main Page The Pink Locker Society What a Pain! Kids and Growing Pains KidsHealth > Kids > Illnesses & Injuries > Aches, Pains & Injuries > What ... something doctors call growing pains . What Are Growing Pains? Growing pains aren't a disease. You probably ...

185

Reproducibility of pain measurement and pain perception  

Microsoft Academic Search

The reproducibility of both the conscious experience of pain and the reproducibility of psychophysical assessments of pain remain critical, yet poorly characterized factors in pain research and treatment. To assess the reproducibility of both the pain experience and two methods of pain assessment, 15 subjects evaluated experimental heat pain during four weekly sessions. In each session, both brief (5s) and

Elisa M. Rosier; Michael J. Iadarola; Robert C. Coghill

2002-01-01

186

Efficacy and Tolerability of Conventional Nimesulide Versus Beta-Cyclodextrin Nimesulide in Patients with Pain After Surgical Dental Extraction: A Multicenter, Prospective, Randomized, Double-Blind, Double-Dummy Study  

Microsoft Academic Search

Background: Pain following extraction of an impacted third molar is widely used to assess analgesic efficacy, especially that of a single dose of a drug. The analgesic activity of conventional nimesulide (CN) has been documented in a variety of types of acute and chronic pain. Beta-cyclodextrin nimesulide (BN) is a new formulation in which nimesulide is included in a cyclodextrin

Mildred Bocanegra; Alberto Seijas; Maria González Yibir??n

2003-01-01

187

The relationship between disease activity, sleep, psychiatric distress and pain sensitivity in rheumatoid arthritis: a cross-sectional study  

PubMed Central

Introduction Despite recent advances in anti-inflammatory therapy, rheumatoid arthritis (RA) patients continue to rate pain as a priority. The etiology of RA pain is likely multifactorial, including both inflammatory and non-inflammatory components. In this study, we examine the association between disease activity, sleep, psychiatric distress and pain sensitivity in RA. Methods Fifty-nine female RA patients completed questionnaires and underwent pressure pain threshold testing to assess hyperalgesia/allodynia at joint and non-joint sites. Blood samples were taken to measure C-reactive protein (CRP). The association between disease activity, sleep problems, psychiatric distress and pain threshold was assessed using Pearson/Spearman correlations and multivariable linear regression. Disease activity levels, sleep problems and psychiatric distress were compared between RA patients with fibromyalgia and RA patients without fibromyalgia. Results In unadjusted analyses, CRP was not correlated with pain threshold, but tender joint count was inversely correlated with pain threshold at all sites (P ? 0.004). Sleep problems were associated with low pain threshold at all sites (P ? 0.0008). Psychiatric distress was associated with low pain threshold at the wrist and thumbnail (P ? 0.006). In multivariable linear regression models, CRP was inversely associated with wrist pain threshold (P = 0.003). Sleep problems were inversely associated with pain threshold at all sites (P ? 0.01), but psychiatric distress was not. Despite differences in pain threshold, CRP levels and sleep problems between RA patients with fibromyalgia and those without fibromyalgia, associations between these variables did not change when patients with fibromyalgia were excluded. Conclusions Multivariable models are essential in analyses of pain. Among RA patients, inflammation is associated with heightened pain sensitivity at joints. In contrast, poor sleep is associated with diffuse pain sensitivity, as noted in central pain conditions such as fibromyalgia. Future studies examining pain sensitivity at joint and non-joint sites may identify patients with different underlying pain mechanisms and suggest alternative approaches to treating RA pain. PMID:19874580

2009-01-01

188

Accuracy threshold for postselected quantum computation  

Microsoft Academic Search

We prove an accuracy threshold theorem for fault-tolerant quantum computation based on error detection and postselection. Our proof provides a rigorous foundation for the scheme suggested by Knill, in which preparation circuits for ancilla states are protected by a concatenated error-detecting code and the preparation is aborted if an error is detected. The proof applies to independent stochastic noise but

Panos Aliferis; Daniel Gottesman; John Preskill

2007-01-01

189

Development of mechanical and thermal nociceptive threshold testing devices in unrestrained birds (broiler chickens)  

Microsoft Academic Search

Behavioural signs of pain are difficult to quantify and interpret in animals. Nociceptive threshold testing is therefore a useful method for examining the perception and processing of noxious stimuli underlying pain states. Devices were developed to measure response thresholds to quantified, ramped mechanical and thermal nociceptive stimuli applied to the leg or keel of unrestrained birds. Up to 9N mechanical

B. Hothersall; G. Caplen; C. J. Nicol; P. M. Taylor; A. E. Waterman-Pearson; J. C. Murrell

2011-01-01

190

Breast pain  

MedlinePLUS

... breast pain. For example, hormone level changes from menstruation or pregnancy often cause breast tenderness. Some amount ... unless a woman is taking hormone replacement therapy) Menstruation and premenstrual syndrome (PMS) Pregnancy -- breast tenderness tends ...

191

Penis pain  

MedlinePLUS

Pain - penis; Priapism ... Bladder stone Bites, either human or insect Cancer of the penis Erection that does not go away (priapism) Genital herpes Infected hair follicles Infected prosthesis of the penis Infection under the ...

192

Intraoperative use of remifentanil and opioid induced hyperalgesia/acute opioid tolerance: systematic review  

PubMed Central

Introduction: The use of opioids has been increasing in operating room and intensive care unit to provide perioperative analgesia as well as stable hemodynamics. However, many authors have suggested that the use of opioids is associated with the expression of acute opioid tolerance (AOT) and opioid-induced hyperalgesia (OIH) in experimental studies and clinical observations in dose and/or time dependent exposure even when used within the clinically accepted doses. Recently, remifentanil has been used for pain management during anesthesia as well as in the intensive care units because of its rapid onset and offset. Objectives: Search of the available literature to assess remifentanil AOT and OIH based on available published data. Methods: We reviewed articles analyzing remifentanil AOT and OIH, and focused our literature search on evidence based information. Experimental and clinical studies were identified using electronic searches of Medline (PubMed, Ovid, Springer, and Elsevier, ClinicalKey). Results: Our results showed that the development of remifentanil AOT and OIH is a clinically significant phenomenon requiring further research. Discussions and Conclusions: AOT – defined as an increase in the required opioid dose to maintain adequate analgesia, and OIH – defined as decreased pain threshold after chronic opioid treatment, should be suspected with any unexplained pain report unassociated with the disease progression. The clinical significance of these findings was evaluated taking into account multiple methodological issues including the dose and duration of opioids administration, the different infusion mode, the co-administrated anesthetic drug’s effect, method assessing pain sensitivity, and the repetitive and potentially tissue damaging nature of the stimuli used to determine the threshold during opioid infusion. Future studies need to investigate the contribution of remifentanil induced hyperalgesia to chronic pain and the role of pharmacological modulation to reverse this process. PMID:24847273

Kim, Sang Hun; Stoicea, Nicoleta; Soghomonyan, Suren; Bergese, Sergio D.

2014-01-01

193

Multicenter, Double-Blind, Randomized, Placebo-Controlled, Parallel-Group Study of the Efficacy, Safety, and Tolerability of THC:CBD Extract and THC Extract in Patients with Intractable Cancer-Related Pain  

Microsoft Academic Search

This study compared the efficacy of a tetrahydrocannabinol:cannabidiol (THC:CBD) extract, a nonopioid analgesic endocannabinoid system modulator, and a THC extract, with placebo, in relieving pain in patients with advanced cancer. In total, 177 patients with cancer pain, who experienced inadequate analgesia despite chronic opioid dosing, entered a two-week, multicenter, double-blind, randomized, placebo-controlled, parallel-group trial. Patients were randomized to THC:CBD extract

Jeremy R. Johnson; Mary Burnell-Nugent; Dominique Lossignol; Elena Doina Ganae-Motan; Richard Potts; Marie T. Fallon

2010-01-01

194

Pain as a reward: changing the meaning of pain from negative to positive co-activates opioid and cannabinoid systems.  

PubMed

Pain is a negative emotional experience that is modulated by a variety of psychological factors through different inhibitory systems. For example, endogenous opioids and cannabinoids have been found to be involved in stress and placebo analgesia. Here we show that when the meaning of the pain experience is changed from negative to positive through verbal suggestions, the opioid and cannabinoid systems are co-activated and these, in turn, increase pain tolerance. We induced ischemic arm pain in healthy volunteers, who had to tolerate the pain as long as possible. One group was informed about the aversive nature of the task, as done in any pain study. Conversely, a second group was told that the ischemia would be beneficial to the muscles, thus emphasizing the usefulness of the pain endurance task. We found that in the second group pain tolerance was significantly higher compared to the first one, and that this effect was partially blocked by the opioid antagonist naltrexone alone and by the cannabinoid antagonist rimonabant alone. However, the combined administration of naltrexone and rimonabant antagonized the increased tolerance completely. Our results indicate that a positive approach to pain reduces the global pain experience through the co-activation of the opioid and cannabinoid systems. These findings may have a profound impact on clinical practice. For example, postoperative pain, which means healing, can be perceived as less unpleasant than cancer pain, which means death. Therefore, the behavioral and/or pharmacological manipulation of the meaning of pain can represent an effective approach to pain management. PMID:23265686

Benedetti, Fabrizio; Thoen, Wilma; Blanchard, Catherine; Vighetti, Sergio; Arduino, Claudia

2013-03-01

195

Effect of types and anatomical arrangement of painful stimuli on conditioned pain modulation.  

PubMed

Reduced pain perception during painful stimulation to another body region (conditioned pain modulation [CPM]) is considered important for pain modulation and development of pain disorders. The various methods used to study CPM limit comparison of findings. We investigated the influence of key methodological variations on CPM, and the properties of CPM when the back is used for the test (TS) or conditioning (CS) stimulus. Two different TS (pressure pain threshold [PPT] and pain response to suprathreshold heat [Pain-45]) were assessed before and during application of a noxious or non-noxious (sham) CS. Eight blocks of trials varied the anatomical location (back and forearms) and arrangement (body side) of the stimuli. PPT (as the TS) increased during application of noxious, but not non-noxious CS when stimuli were applied to opposite body sides or heterotopic sites on one body side. Inconsistent with pain-induced CPM, Pain-45 decreased during both noxious and non-noxious CS. These findings indicate; (i) PPT can be more confidently interpreted with respect to CPM evoked by a painful stimulus than Pain-45, (ii) the back and forearm are equally effective as sites for stimuli; and (iii) stimuli arrangement does not influence CPM, except for identical anatomical regions on the same body side. PMID:25464158

Klyne, David M; Schmid, Annina B; Moseley, Lorimer G; Sterling, Michele; Hodges, Paul W

2014-11-15

196

Acidic Buffer Induced Muscle Pain Evokes Referred Pain and Mechanical Hyperalgesia in Humans  

PubMed Central

While tissue acidosis causes local deep-tissue pain, its effect on referred pain and mechanical muscle hyperalgesia is unknown. The aim of this study was to investigate a human experimental acidic muscle pain model using a randomized, controlled, single-blinded study design. 72 subjects (36 female) participated in three visits, each involving one 15 min intramuscular infusion into the anterior tibialis muscle: acidic phosphate buffer (5.2 pH) at 40 ml/hr (N=69) or 20 ml/hr (N=54), normal phosphate buffer (7.3 pH) at 40 ml/hr (N=70), or isotonic saline at 40 ml/hr (N=19). Pain ratings and pressure sensitivity of superficial and deep tissues were assessed before, during, and 20 min after infusion. Acidic buffer produced light to moderate, rate-dependent, muscle pain (not sex-dependent) compared to the control infusions, that referred pain to the ankle in 80% of women and 40% of men. Pain did not vary across selfreported menstrual phases. Pressure pain thresholds (PPTs) were reduced over the infused muscle with acidic infusion, defined as primary mechanical hyperalgesia. PPTs decreased at the ankle in those with referred pain in response to acidic buffer, i.e. referred mechanical hyperalgesia, but not at the foot. No pain or changes in PPTs occurred in the contralateral leg. These results demonstrate muscle acidosis can lead to local and referred pain and hyperalgesia, with significant sex differences in development of referred pain. PMID:18835099

Laura A, Frey Law; Kathleen A, Sluka; Tara, McMullen; Jennifer, Lee; Lars, Arendt-Nielsen; Thomas, Graven-Nielsen

2008-01-01

197

Recent development in therapeutics for breakthrough pain.  

PubMed

Breakthrough pain is defined as transitory flares of pain. Breakthrough pain is caused by cancer, cancer complications, treatment or comorbidities. The usual onset to maximum breakthrough pain intensity time is 3 min and duration is 30 min; therefore, the assessment for response needs to be at short intervals. The rapid onset and offset of pain results in inadequate responses when oral opioids are used to manage pain flares. Several strategies have been used to manage breakthrough pain: titration of the chronic opioid, independent titration of rescue opioids and alternative routes. Buccal fentanyl has a rapid onset to analgesia and appears to be superior to oral morphine. Newer fentanyl preparations have been released to manage breakthrough pain in the opioid-tolerant individual. Other routes of administration that have a rapid onset to analgesia include intranasal hydrophilic and lipophilic opioids, inhaled opioids delivered by special delivery devices and parenteral morphine. In a small series of patients experiencing severe flares of pain with spinal opioids unrelieved by parenteral opioids, sublingual ketamine and bolus doses of intrathecal local anesthetics have been effective. Nonpharmacological approaches to managing activity-related pain include radiation therapy, surgical correction of impending fractures, kyphoplasty and radioisotopes. PMID:20420495

Davis, Mellar P

2010-05-01

198

Inflammatory Back Pain vs. Mechanical Back Pain  

MedlinePLUS Videos and Cool Tools

... cause. Specifically, is the back pain inflammatory in nature or mechanical? INFLAMMATORY VS MECHANICAL BACK PAIN VIDEO: ... determing if the back pain is inflammatory in nature and related to a disease such as ankylosing ...

199

Interpersonal Transactions and Responses to Cold Pressor Pain among Australian Women and Men  

Microsoft Academic Search

This study was designed to assess how interpersonal transactions affect responses to painful stimulation among Australian\\u000a women and men. Participants were 69 women and 49 men, randomly assigned to a No Transaction (NT) condition (coping alone)\\u000a or one of three experimenter-initiated transactions (Distraction, Pain-Monitoring, Re-interpretation). Significant sex?×?transaction\\u000a interactions for pain tolerance and reported pain revealed that pain responses of men

Todd Jackson

2007-01-01

200

Achilles Pain.  

ERIC Educational Resources Information Center

Five ailments which can cause pain in the achilles tendon area are: (1) muscular strain, involving the stretching or tearing of muscle or tendon fibers; (2) a contusion, inflammation or infection called tenosynovitis; (3) tendonitis, the inflammation of the tendon; (4) calcaneal bursitis, the inflammation of the bursa between the achilles tendon…

Connors, G. Patrick

201

The physical and psychological experience of pain: the effects of labeling and cold pressor temperature on three pain measures in college women  

Microsoft Academic Search

Using the cold pressor test, three experiments were conducted to investigate the effects of water temperature and labeling on three dependent measures in college women: behavioral pain tolerance (BPT), a sensory rating of the pain experience (SR) and a parallel affective rating of the experience (AR). Temperature of the cold pressor was varied as the physical factor; labels (discomfort, pain,

Michele S Hirsch; Robert M Liebert

1998-01-01

202

Central Pain Syndrome  

MedlinePLUS

NINDS Central Pain Syndrome Information Page Table of Contents (click to jump to sections) What is Central Pain Syndrome? Is there ... being done? Clinical Trials Organizations What is Central Pain Syndrome? Central pain syndrome is a neurological condition ...

203

Somatoform pain disorder  

MedlinePLUS

Pain disorder ... thought to be related to emotional stress. The pain was often said to be "all in their head." However, patients with somatoform pain disorder seem to experience painful sensations in a ...

204

Complex Regional Pain Syndrome  

MedlinePLUS

Complex regional pain syndrome (CRPS) is a chronic pain condition. It causes intense pain, usually in the arms, hands, legs, or feet. ... in skin temperature, color, or texture Intense burning pain Extreme skin sensitivity Swelling and stiffness in affected ...

205

Chronic Pain Medicines  

MedlinePLUS

MENU Return to Web version Chronic Pain | Chronic Pain Medicines How is chronic pain treated? Treatment of chronic ... or she tells you how to use your pain medicine. If you have questions about side effects or ...

206

Threshold quantum cryptography  

SciTech Connect

We present the concept of threshold collaborative unitary transformation or threshold quantum cryptography, which is a kind of quantum version of threshold cryptography. Threshold quantum cryptography states that classical shared secrets are distributed to several parties and a subset of them, whose number is greater than a threshold, collaborates to compute a quantum cryptographic function, while keeping each share secretly inside each party. The shared secrets are reusable if no cheating is detected. As a concrete example of this concept, we show a distributed protocol (with threshold) of conjugate coding.

Tokunaga, Yuuki [NTT Information Sharing Platform Laboratories, NTT Corporation, 1-1 Hikari-no-oka, Yokosuka, Kanagawa 239-0847 (Japan); Division of Materials Physics, Graduate School of Engineering Science, Osaka University, Toyonaka, Osaka 560-8531 (Japan); Okamoto, Tatsuaki [NTT Information Sharing Platform Laboratories, NTT Corporation, 1-1 Hikari-no-oka, Yokosuka, Kanagawa 239-0847 (Japan); Imoto, Nobuyuki [Division of Materials Physics, Graduate School of Engineering Science, Osaka University, Toyonaka, Osaka 560-8531 (Japan)

2005-01-01

207

Pain Sensitivity and Observer Perception of Pain in Individuals with Autistic Spectrum Disorder  

PubMed Central

The peer-reviewed literature investigating the relationship between pain expression and perception of pain in individuals with ASD is sparse. The aim of the present systematic PRIMSA review was twofold: first, to see what evidence there is for the widely held belief that individuals with ASD are insensitive to pain or have a high pain threshold in the peer-reviewed literature and, second, to examine whether individuals with ASD react or express pain differently. Fifteen studies investigating pain in individuals with ASD were identified. The case studies all reported pain insensitivity in individuals with ASD. However, the majority of the ten experimental studies reviewed indicate that the idea that individuals with ASD are pain insensitive needs to be challenged. The findings also highlight the strong possibility that not all children with ASD express their physical discomfort in the same way as a neurotypical child would (i.e., cry, moan, seek comfort, etc.) which may lead caregivers and the medical profession to interpret this as pain insensitivity or incorrectly lead them to believe that the child is in no pain. These results have important implications for the assessment and management of pain in children with ASD. PMID:23843740

Allely, C. S.

2013-01-01

208

Experimental Pain and Opioid Analgesia in Volunteers at High Risk for Obstructive Sleep Apnea  

PubMed Central

Background Obstructive sleep apnea (OSA) is characterized by recurrent nocturnal hypoxia and sleep disruption. Sleep fragmentation caused hyperalgesia in volunteers, while nocturnal hypoxemia enhanced morphine analgesic potency in children with OSA. This evidence directly relates to surgical OSA patients who are at risk for airway compromise due to postoperative use of opioids. Using accepted experimental pain models, we characterized pain processing and opioid analgesia in male volunteers recruited based on their risk for OSA. Methods After approval from the Intitutional Review Board and informed consent, we assessed heat and cold pain thresholds and tolerances in volunteers after overnight polysomnography (PSG). Three pro-inflammatory and 3 hypoxia markers were determined in the serum. Pain tests were performed at baseline, placebo, and two effect site concentrations of remifentanil (1 and 2 µg/ml), an ?-opioid agonist. Linear mixed effects regression models were employed to evaluate the association of 3 PSG descriptors [wake after sleep onset, number of sleep stage shifts, and lowest oxyhemoglobin saturation (SaO2) during sleep] and all serum markers with pain thresholds and tolerances at baseline, as well as their changes under remifentanil. Results Forty-three volunteers (12 normal and 31 with a PSG-based diagnosis of OSA) were included in the analysis. The lower nadir SaO2 and higher insulin growth factor binding protein-1 (IGFBP-1) were associated with higher analgesic sensitivity to remifentanil (SaO2, P?=?0.0440; IGFBP-1, P?=?0.0013). Other pro-inflammatory mediators like interleukin-1? and tumor necrosis factor-? (TNF-?) were associated with an enhanced sensitivity to the opioid analgesic effect (IL-1?, P?=?0.0218; TNF-?, P?=?0.0276). Conclusions Nocturnal hypoxemia in subjects at high risk for OSA was associated with an increased potency of opioid analgesia. A serum hypoxia marker (IGFBP-1) was associated with hypoalgesia and increased potency to opioid analgesia; other pro-inflammatory mediators also predicted an enhanced opioid potency. Trial Registration: ClinicalTrials.gov NCT00672737. PMID:23382975

Doufas, Anthony G.; Tian, Lu; Padrez, Kevin A.; Suwanprathes, Puntarica; Cardell, James A.; Maecker, Holden T.; Panousis, Periklis

2013-01-01

209

Mechanical pain sensitivity and the severity of chronic neck pain and disability are not modulated across the menstrual cycle  

PubMed Central

Despite the high prevalence of neck pain among women, menstrual effects on regional pain outcomes have not been investigated in this clinical population. This study evaluated menstrual effects on mechanical pain sensitivity (Pressure Pain Threshold; PPT), neck pain intensity (Numeric Pain Rating Scale; NPRS) and neck-related disability (Neck Disability Index; NDI) in 22 normally menstruating (NM) and 17 hormonal contraceptive (HC) users with chronic neck pain. Sex hormones, PPT, and NDI were measured during the early follicular (F1), late follicular (F2), and luteal (L) menstrual phases. Daily NPRS scores were recorded in an online symptom diary and averaged within each phase. Estradiol and progesterone increased only for NM women in F2 and L, respectively. Phase effects on PPT (?2=0.003), NDI (?2=0.003), and NPRS (?2=0.016) for NM women were small, and did not differ from the HC group (p?0.386). Averaged across the menstrual cycle, PPT scores explained 29% of the variance in NPRS scores for NM women, but were not associated with NDI scores in either group. Results indicate that that magnitude of menstrual effects on mechanical pain sensitivity, and the severity of neck pain and disability do not exceed thresholds of clinically detectable change in women with chronic neck pain. PERSPECTIVE Fluctuations in evoked and clinical pain outcomes across the menstrual cycle do not appear to be of sufficient magnitude to impact clinical decision-making for women with chronic neck pain. PMID:24021578

Balter, JE; Molner, JL; Kohrt, WM; Maluf, KS

2013-01-01

210

Interactions between Glutamate and Capsaicin in Inducing Muscle Pain and Sensitization in Humans  

PubMed Central

The aim of the study was to investigate the interaction between glutamate and capsaicin in inducing muscle pain and sensitization in humans. Fifteen male volunteers participated. Glutamate or capsaicin or isotonic saline, in a paired-sequence order, was injected randomly into the right or left masseter muscle. Two injections were given in a double-blinded design 25 minutes apart in 1 session/week over 4 weeks: saline (A1) followed by glutamate (A2), capsaicin (B1) followed by glutamate (B2), saline (C1) followed by capsaicin (C2), and glutamate (D1) followed by capsaicin (D2). The subjects drew the area of perceived pain and scored pain intensity on a 0–10 visual analogue scale (VAS). Pressure pain threshold (PPT) at the injection site, at a site 2-cm away, and on the contralateral side, as well as pressure pain tolerance (PPTol) at the injection site and contralateral site, were also measured before and after injection and subsequently at 5-minute intervals. Paired t-test analyses showed that the pain drawing area was significantly smaller in the B2 compared to the A2 condition (P = 0.028), and significantly larger in the D2 compared to the C2 condition (P = 0.027). It also revealed significantly lower VAS peak pain intensity (P = 0.008) and smaller VAS area under the curve (P=0.003) for the B2 compared to the A2 condition, and significantly higher VAS peak pain (P = 0.015) and larger VAS area under the curve (P = 0.037) for the D2 compared to the C2 condition. There was a significant PPT and PPTol decrease at the injection site after glutamate or capsaicin injection (ANOVA: P < 0.028). The percentage decrease in PPT or PPTol (at the injection site) was not significantly different for the B2 compared to the A2 condition (Paired t-test: P > 0.682) or for the D2 compared to the C2 condition (P > 0.133). Significant PPT changes were also observed at the site 2 cm away, but not on the contralateral side. In conclusion, these findings indicate that intramuscular administrations of glutamate and capsaicin interact and influence pain and sensitization of muscle nociceptors: glutamate causes a sensitization to subsequent administration of capsaicin whereas capsaicin is associated with a desensitization to subsequent injection of glutamate. These findings support previous animal data. PMID:18162423

Arendt-Nielsen, L; Svensson, P; Sessle, BJ; Cairns, BE; Wang, K

2008-01-01

211

Abdominal Pain following Gastric Bypass: Suspects & Solutions  

PubMed Central

Introduction Gastric bypass remains the mainstay of surgical therapy for obesity. Abdominal pain after gastric bypass is common, and accounts for up to half of all postoperative complaints and emergency room visits. This manuscript reviews the most important causes of abdominal pain specific to gastric bypass and discusses management considerations. Data Sources The current surgical literature was reviewed using PubMed, with a focus on abdominal pain after gastric bypass and the known pathologies that underlie its pathogenesis. Conclusions The differential diagnosis for abdominal pain after gastric bypass is large and includes benign and life-threatening entities. Its diverse causes require a broad evaluation that should be directed by history and clinical presentation. In the absence of a clear diagnosis, the threshold for surgical exploration in patients with abdominal pain after gastric bypass should be low. PMID:21333269

Greenstein, Alexander J.; O’Rourke, Robert W.

2010-01-01

212

Fentanyl nasal spray (Lazanda) for pain.  

PubMed

The FDA has approved a nasal spray formulation of fentanyl (Lazanda-Archimedes) for management of breakthrough pain in adult cancer patients who are already receiving and are tolerant to opioid therapy. Fentanyl is already available in the US for intravenous, intrathecal, epidural, transdermal and oral transmucosal use. PMID:22173454

2011-12-12

213

Transplantation tolerance.  

PubMed

Although transplantation has been a standard medical practice for decades, marked morbidity from the use of immunosuppressive drugs and poor long-term graft survival remain important limitations in the field. Since the first solid organ transplant between the Herrick twins in 1954, transplantation immunology has sought to move away from harmful, broad-spectrum immunosuppressive regimens that carry with them the long-term risk of potentially life-threatening opportunistic infections, cardiovascular disease, and malignancy, as well as graft toxicity and loss, towards tolerogenic strategies that promote long-term graft survival. Reports of "transplant tolerance" in kidney and liver allograft recipients whose immunosuppressive drugs were discontinued for medical or non-compliant reasons, together with results from experimental models of transplantation, provide the proof-of-principle that achieving tolerance in organ transplantation is fundamentally possible. However, translating the reconstitution of immune tolerance into the clinical setting is a daunting challenge fraught with the complexities of multiple interacting mechanisms overlaid on a background of variation in disease. In this article, we explore the basic science underlying mechanisms of tolerance and review the latest clinical advances in the quest for transplantation tolerance. PMID:24213880

Salisbury, Emma M; Game, David S; Lechler, Robert I

2014-12-01

214

Spinal cord stimulation normalizes abnormal cortical pain processing in patients with cardiac syndrome X.  

PubMed

Cardiac syndrome X (CSX) is characterized by effort angina, ST-segment depression during stress tests and normal coronary arteries. Abnormal nociception was suggested in these patients by studies showing a reduced cardiac pain threshold; furthermore, we recently found a lack of habituation to pain stimuli using recording of laser evoked potentials (LEPs). In CSX patients with severe angina, spinal cord stimulation (SCS) was shown to improve symptoms. In this study we investigated whether, in these patients, SCS has any effects on the excitability of the nociceptive system, assessed by LEPs recording. We studied 16 CSX patients (61.6+/-7 years; 4 men) who underwent SCS for refractory angina. Cortical LEPs were recorded during stimulation of the chest and right-hand during active SCS (SCS-ON) and in the absence of SCS (SCS-OFF), using a randomized cross-over design. Three sequences of painful stimuli were applied at each site during each test. During the first sequence of chest stimuli, the N2/P2 LEP amplitude was higher during the SCS-ON, compared to the SCS-OFF phase (18.2+/-7.8 vs. 11.5+/-4.4 microV, P=0.006). The N2/P2 amplitude did not change significantly across the three stimulation sequences during the SCS-OFF phase (P=0.22), whereas it decreased progressively during the second and third sequence (to 87.1+/-29.5% and 76.4+/-24.1%, respectively) compared with the first sequence, during the SCS-ON phase (P=0.014). Similar results were observed during right-hand stimulation. Our study shows that in CSX patients SCS is able to restore habituation to peripheral pain stimuli. This effect might contribute to restore the ability of CSX patients to better tolerate cardiac pain. PMID:18440702

Sestito, Alfonso; Lanza, Gaetano Antonio; Le Pera, Domenica; De Armas, Liala; Sgueglia, Gregory Angelo; Infusino, Fabio; Miliucci, Roberto; Tonali, Pietro Attilio; Crea, Filippo; Valeriani, Massimiliano

2008-09-30

215

Partners' Empathy Increases Pain Ratings: Effects of Perceived Empathy and Attachment Style on Pain Report and Display  

PubMed Central

Pain can be influenced by its social context. We aimed to examine under controlled experimental conditions how empathy from a partner and personal attachment style affect pain report, tolerance, and facial expressions of pain. Fifty-four participants, divided into secure, anxious, and avoidant attachment style groups, underwent a cold pressor task with their partners present. We manipulated how much empathy the participants perceived that their partners had for them. We observed a significant main effect of perceived empathy on pain report, with greater pain reported in the high perceived empathy condition. No such effects were found for pain tolerance or facial display. We also found a significant interaction of empathy with attachment style group, with the avoidant group reporting and displaying less pain than the secure and the anxious groups in the high perceived empathy condition. No such findings were observed in the low empathy condition. These results suggest that empathy from one's partner may influence pain report beyond behavioral reactions. In addition, the amount of pain report and expression that people show in high empathy conditions depends on their attachment style. Perspective Believing that one's partner feels high empathy for one's pain may lead individuals to rate the intensity of pain as higher. Individual differences in attachment style moderate this empathy effect. PMID:24953886

Hurter, Sarah; Paloyelis, Yannis; de C. Williams, Amanda C.; Fotopoulou, Aikaterini

2014-01-01

216

Paining Out: An Integrative Pain Therapy Model  

Microsoft Academic Search

This article describes and evaluates an integrative pain therapy model as a beneficial form of pain-management for chronic\\u000a pain. The author based his model on cognitive-behavioral modalities, progressive relaxation combined with art therapy, sensory\\u000a awareness combined with indirect clinical hypnosis, formal clinical hypnosis and self-hypnosis. Those techniques were applied\\u000a in small group settings to systematically alter pain perception, pain interpretations

Mirko Pavlek

2008-01-01

217

Risk Factor Assessment for Problematic Use of Opioids for Chronic Pain  

Microsoft Academic Search

Opioid analgesics provide effective treatment for noncancer pain, but many health providers have concerns about cognitive effects, tolerance, dependence, and addiction. Misuse of opioids is prominent in patients with chronic pain and early recognition of misuse risk could help providers offer adequate patient care while implementing appropriate levels of monitoring to reduce aberrant drug-related behaviors. Many persons with chronic pain

Robert N. Jamison; Robert R. Edwards

2012-01-01

218

Salt Tolerance  

PubMed Central

Studying salt stress is an important means to the understanding of plant ion homeostasis and osmo-balance. Salt stress research also benefits agriculture because soil salinity significantly limits plant productivity on agricultural lands. Decades of physiological and molecular studies have generated a large body of literature regarding potential salt tolerance determinants. Recent advances in applying molecular genetic analysis and genomics tools in the model plant Arabidopsis thaliana are shading light on the molecular nature of salt tolerance effectors and regulatory pathways. PMID:22303210

Xiong, Liming; Zhu, Jian-Kang

2002-01-01

219

Clinical Issues in Pain Management Clinical Issues in Pain Management  

E-print Network

Example: Chronic low back pain Recurrent acute pain Intermittent episodes of acute pain Chronic becausePain Clinical Issues in Pain Management #12;Clinical Issues in Pain Management: Acute Pain By definition, acute pain goes on for six months or less During acute pain, there is an urgent search for relief

Meagher, Mary

220

Stress-induced pain: a target for the development of novel therapeutics.  

PubMed

Although current therapeutics provide relief from acute pain, drugs used for treatment of chronic pain are typically less efficacious and limited by adverse side effects, including tolerance, addiction, and gastrointestinal upset. Thus, there is a significant need for novel therapies for the treatment of chronic pain. In concert with chronic pain, persistent stress facilitates pain perception and sensitizes pain pathways, leading to a feed-forward cycle promoting chronic pain disorders. Stress exacerbation of chronic pain suggests that centrally acting drugs targeting the pain- and stress-responsive brain regions represent a valid target for the development of novel therapeutics. This review provides an overview of how stress modulates spinal and central pain pathways, identifies key neurotransmitters and receptors within these pathways, and highlights their potential as novel targets for therapeutics to treat chronic pain. PMID:25194019

Johnson, Anthony C; Greenwood-Van Meerveld, Beverley

2014-11-01

221

A 2Week, multicenter, randomized, double-blind, double-dummy, add-on study of the effects of titration on tolerability of tramadol\\/acetaminophen combination tablet in Korean adults with knee osteoarthritis pain  

Microsoft Academic Search

Background: Combined tramadol\\/acetaminophen is used to treat pain related to osteoarthritis. However, adverse events (AEs) leading to discontinuation can occur. Dose titration may decrease the risk for AEs.Objective: The aim of this study was to assess the effect of tramadol\\/acetaminophen titration on the development of AEs leading to treatment discontinuation in patients with knee osteoarthritis.Methods: This 2-week, multicenter, randomized, double-blind,

Chan-Bum Choi; Jung Soo Song; Young Mo Kang; Chang Hee Suh; Jisoo Lee; Jung-Yoon Choe; Choong Ki Lee; Seung Cheol Shim; Won Tae Chung; Gwan Gyu Song; Hyun Ah Kim; Jong Dae Ji; Eon Jeong Nam; Sung-Hoon Park; Young Hoon Hong; Dong Hyuk Sheen; Mi Kyoung Lim; Young II Seo; Yoon-Kyoung Sung; Tae-Hwan Kim; Jong-Tae Lee; Sang-Cheol Bae

2007-01-01

222

Painful hypoadrenalism.  

PubMed

A 61-year-old man presented with diffuse myalgia and arthralgia. The physical examination showed diffuse musculoskeletal tenderness and joint stiffness without the presence of synovitis or arthritis. Nerve conduction study showed combined mild axonal degenerative and demyelinating change. Muscle biopsy analysis showed unspecific mild muscle atrophy with myopathic changes found on electromyography. A diagnosis of isolated adrenocorticotropic hormone deficiency was made on the basis of endocrinological evaluation. The widespread musculoskeletal pain resolved as a result of administration of physiological dose of hydrocortisone replacement. In a patient with unexplained rheumatic symptoms, adrenocortical insufficiency should be considered in the possible aetiology. PMID:22700071

Hoshino, Chisho; Satoh, Noriyuki; Narita, Masashi; Kikuchi, Akio; Inoue, Minoru

2011-01-01

223

Painful hypoadrenalism  

PubMed Central

A 61-year-old man presented with diffuse myalgia and arthralgia. The physical examination showed diffuse musculoskeletal tenderness and joint stiffness without the presence of synovitis or arthritis. Nerve conduction study showed combined mild axonal degenerative and demyelinating change. Muscle biopsy analysis showed unspecific mild muscle atrophy with myopathic changes found on electromyography. A diagnosis of isolated adrenocorticotropic hormone deficiency was made on the basis of endocrinological evaluation. The widespread musculoskeletal pain resolved as a result of administration of physiological dose of hydrocortisone replacement. In a patient with unexplained rheumatic symptoms, adrenocortical insufficiency should be considered in the possible aetiology. PMID:22700071

Hoshino, Chisho; Satoh, Noriyuki; Narita, Masashi; Kikuchi, Akio; Inoue, Minoru

2011-01-01

224

Pain in People with Learning Disabilities in Residential Settings--The Need for Change  

ERIC Educational Resources Information Center

This audit investigated residential staff beliefs around pain thresholds and strategies they adopt to recognise and manage pain in people with learning disabilities across Surrey. A structured interview was constructed to elicit information. Results demonstrated that pain is not being effectively recognised or managed by residential staff in…

Beacroft, Monica; Dodd, Karen

2010-01-01

225

Breast Cancer EDGE Task Force Outcomes: Clinical Measures of Pain  

PubMed Central

Background Pain is one of the most commonly reported impairments after breast cancer treatment affecting anywhere from 16-73% of breast cancer survivors Despite the high reported incidence of pain from cancer and its treatments, the ability to evaluate cancer pain continues to be difficult due to the complexity of the disease and the subjective experience of pain. The Oncology Section Breast Cancer EDGE Task Force was created to evaluate the evidence behind clinical outcome measures of pain in women diagnosed with breast cancer. Methods The authors systematically reviewed the literature for pain outcome measures published in the research involving women diagnosed with breast cancer. The goal was to examine the reported psychometric properties that are reported in the literature in order to determine clinical utility. Results Visual Analog Scale, Numeric Rating Scale, Pressure Pain Threshold, McGill Pain Questionnaire, McGill Pain Questionnaire – Short Form, Brief Pain Inventory and Brief Pain Inventory – Short Form were highly recommended by the Task Force. The Task Force was unable to recommend two measures for use in the breast cancer population at the present time. Conclusions A variety of outcome measures were used to measure pain in women diagnosed with breast cancer. When assessing pain in women with breast cancer, researchers and clinicians need to determine whether a unidimensional or multidimensional tool is most appropriate as well as whether the tool has strong psychometric properties. PMID:25346950

Harrington, Shana; Gilchrist, Laura; Sander, Antoinette

2014-01-01

226

Religious Tolerance.  

ERIC Educational Resources Information Center

This theme issue looks at three issues of religious tolerance. The first article examines a case recently decided by the United States Supreme Court on student-led prayers at school events. The second article explores the persecution suffered by members of the Mormon religion during the 19th century. The final article looks at Martin Luther and…

Martz, Carlton

2000-01-01

227

When Sex Is Painful  

MedlinePLUS

How common is painful sex? Pain during intercourse is very common—nearly 3 out of 4 women have pain during intercourse at some time during ... a long-term problem. What causes pain during sex? Pain during sex may be a sign of ...

228

Low Back Pain  

MedlinePLUS

MENU Return to Web version Low Back Pain Overview What is low back pain? Low back pain is a common problem for many people. It can be caused by many ... lift and exercise correctly. Symptoms When is low back pain serious? Call your family doctor if: Pain goes ...

229

Fault-Tolerant Exact State Transmission  

E-print Network

We show that a category of one-dimensional XY-type models may enable high-fidelity quantum state transmissions, regardless of details of coupling configurations. This observation leads to a fault- tolerant design of a state transmission setup. The setup is fault-tolerant, with specified thresholds, against engineering failures of coupling configurations, fabrication imperfections or defects, and even time-dependent noises. We propose the implementation of the fault-tolerant scheme using hard-core bosons in one-dimensional optical lattices.

Zhao-Ming Wang; Lian-Ao Wu; Michele Modugno; Wang Yao; Bin Shao

2012-05-02

230

Fault-tolerant almost exact state transmission  

PubMed Central

We show that a category of one-dimensional XY-type models may enable high-fidelity quantum state transmissions, regardless of details of coupling configurations. This observation leads to a fault-tolerant design of a state transmission setup. The setup is fault-tolerant, with specified thresholds, against engineering failures of coupling configurations, fabrication imperfections or defects, and even time-dependent noises. We propose an experimental implementation of the fault-tolerant scheme using hard-core bosons in one-dimensional optical lattices. PMID:24185259

Wang, Zhao-Ming; Wu, Lian-Ao; Modugno, Michele; Yao, Wang; Shao, Bin

2013-01-01

231

Chronic intraoral pain--assessment of diagnostic methods and prognosis.  

PubMed

The overall goal of this thesis was to broaden our knowledge of chronic intraoral pain. The research questions were: What methods can be used to differentiate inflammatory, odontogenic tooth pain from pain that presents as toothache but is non-odontogenic in origin? What is the prognosis of chronic tooth pain of non-odontogenic origin, and which factors affect the prognosis? Atypical odontalgia (AO) is a relatively rare but severe and chronic pain condition affecting the dentoalveolar region. Recent research indicates that the origin is peripheral nerve damage: neuropathic pain. The condition presents as tooth pain and is challenging to dentists because it is difficult to distinguish from ordinary toothache due to inflammation or infection. AO is of interest to the pain community because it shares many characteristics with other chronic pain conditions, and pain perpetuation mechanisms are likely to be similar. An AO diagnosis is made after a comprehensive examination and assessment of patients' self-reported characteristics: the pain history. Traditional dental diagnostic methods do not appear to suffice, since many patients report repeated care-seeking and numerous treatment efforts with little or no pain relief. Developing methods that are useful in the clinical setting is a prerequisite for a correct diagnosis and adequate treatment decisions. Quantitative sensory testing (QST) is used to assess sensory function on skin when nerve damage or disease is suspected. A variety of stimuli has been used to examine the perception of, for example, touch, temperature (painful and non-painful), vibration, pinprick pain, and pressure pain. To detect sensory abnormalities and nerve damage in the oral cavity, the same methods may be possible to use. Study I examined properties of thermal thresholds in and around the mouth in 30 pain-free subjects: the influence of measurement location and stimulation area size on threshold levels, and time variability of thresholds. Thresholds for cold, warmth and painful heat were measured in four intraoral and two extraoral sites. Measurements were repeated 3 times over 6 weeks, using four sizes of stimulation area (0.125-0.81 cm2). The threshold levels were highly dependent on location but less dependent on measuring probe size and time variability was small, and this knowledge is important for the interpretation of QST results. Study II applied a recently developed standardized QST examination protocol (intended for use on skin) inside the oral cavity. Two trained examiners evaluated 21 pain-free subjects on three occasions over 1-3 weeks, at four sites-three intraoral and one extraoral. Most tests had acceptable reliability and the original test instruments and techniques could be applied intraorally with only minor adjustments. Study III examined the value of cone-beam computed tomography (CBCT) in pain investigations. Twenty patients with AO and 5 with symptomatic apical periodontitis (inflammatory tooth pain) participated. The results indicate that when AO is suspected, addition of CBCT can improve the diagnostic certainty compared to sole use of periapical and panoramic radiographs, especially because of the superior ability of CBCT to exclude inflammation as the pain cause. Study IV assessed the long-term prognosis of AO, and analyzed potential outcome predictors. A comprehensive questionnaire including validated and reliable instruments was used to gather data on patient and pain characteristics and pain consequences from 37 patients in 2002 and 2009. Thirty-five percent of the patients reported substantial overall improvement at follow-up, but almost all still had pain of some degree after many years. The initial high level of emotional distress was unchanged. Low baseline pain intensity predicted improvement over time. PMID:22338784

Pigg, Maria

2011-01-01

232

Perioperative management of the opioid tolerant patient for orthopedic surgery.  

PubMed

The prevalence of opioid use in the North America and some countries of the European Union has resulted in an increase in the number of patients who may exhibit opioid tolerance when requiring postoperative pain management. The approach to postoperative pain control in these patients is different from the strategies used in opioid-naïve patients. Better understanding of the cellular mechanisms of opioid tolerance in animals has resulted in the transfer of these concepts from the basic research to the clinical arena. This article presents new developments in opioid tolerance and how this knowledge can be applied to clinical practice. PMID:25453671

Mahathanaruk, Marchyarn; Hitt, James; de LeonCasasola, Oscar A

2014-12-01

233

Intracerebroventricular opioids for intractable pain  

PubMed Central

When pain is refractory to systemic opioid and non-opioid analgesic therapy and palliative chemoradiation or ablative or stimulant neurosurgical procedures are not possible, palliative treatment becomes limited, particularly if the patient wishes to be at home at the end of life. Intracerebroventricular (ICV) infusion of morphine in the home setting might be presented as an option. The present article reviews the basic and clinical evidence of the efficacy and safety of ICV administration of opioids. Information was gathered from various bibliographic sources, including PubMed and others, and summarized and evaluated to assess the efficacy and safety of ICV opioids for pain relief. Results from ICV infusion of morphine into terminally ill patients refractory to other pain treatments have been reported since the early 1980s. Good efficacy has been achieved for the vast majority of patients, without serious development of analgesic tolerance. There have also been a low incidence of adverse effects, such as constipation and respiratory depression, and a significant retention of alertness associated with this route of administration. Intracerebroventricular infusion of opioid analgesics thus appears to be a safe and effective therapy for the palliative treatment of refractory pain. PMID:22295988

Raffa, Robert B; Pergolizzi, Joseph V

2012-01-01

234

Bone pain or tenderness  

MedlinePLUS

... cause of the pain, your doctor may prescribe: Antibiotics Anti-inflammatory medicines Hormones Laxatives (if you develop constipation during prolonged bed rest) Pain relievers If pain is related to thinning bones, you may need treatment for osteoporosis .

235

What Is Back Pain?  

MedlinePLUS

... some types of treatments for chronic back pain. Hot or Cold Packs (or Both) Hot or cold packs can soothe sore, stiff backs. ... helps reduce swelling and numbs deep pain. Using hot or cold packs may relieve pain, but this ...

236

Prevent Back Pain  

MedlinePLUS

... Everyday Healthy Living > Safety > Prevent Back Pain Prevent Back Pain The Basics Take Action! Ver en español Content ... Basics One of the best ways to prevent back pain is to keep your back muscles strong. Follow ...

237

Medications for back pain  

MedlinePLUS

Your back pain may not go away completely, or it may get more painful at times. Learning to take care ... home and how to prevent repeat episodes of back pain may help you avoid surgery. Different medications can ...

238

Somatosensory Abnormalities for Painful and Innocuous Stimuli at the Back and at a Site Distinct from the Region of Pain in Chronic Back Pain Patients  

PubMed Central

Chronic low back pain (CLBP) was shown to be associated with pathophysiological changes at several levels of the sensorimotor system. Changes in sensory thresholds have been reported but complete profiles of Quantitative Sensory Testing (QST) were only rarely obtained in CLBP patients. The aim of the present study was to investigate comprehensive QST profiles in CLBP at the painful site (back) and at a site distinct from their painful region (hand) and to compare these data with similar data in healthy controls. We found increased detection thresholds in CLBP patients compared to healthy controls for all innocuous stimuli at the back and extraterritorial to the painful region at the hand. Additionally, CLBP patients showed decreased pain thresholds at both sites. Importantly, there was no interaction between the investigated site and group, i.e. thresholds were changed both at the affected body site and for the site distinct from the painful region (hand). Our results demonstrate severe, widespread changes in somatosensory sensitivity in CLBP patients. These widespread changes point to alterations at higher levels of the neuraxis or/and to a vulnerability to nociceptive plasticity in CLBP patients. PMID:23554950

Puta, Christian; Schulz, Birgit; Schoeler, Saskia; Magerl, Walter; Gabriel, Brunhild; Gabriel, Holger H. W.; Miltner, Wolfgang H. R.; Weiss, Thomas

2013-01-01

239

Children's selective attention to pain and avoidance behaviour: the role of child and parental catastrophizing about pain.  

PubMed

The present study investigated selective attention to pain in children, its implications for child avoidance behaviour, and the moderating role of dimensions comprising child and parental catastrophizing about pain (ie, rumination, magnification, and helplessness). Participants were 59 children (31 boys) aged 10-16 years and one of their parents (41 mothers). Children performed a dot-probe task in which child facial pain displays of varying pain expressiveness were presented. Child avoidance behaviour was indexed by child pain tolerance during a cold-pressor task. Children and parents completed measures of child and parent pain catastrophizing, respectively. Findings indicated that both the nature of child selective attention to pain and the impact of selective attention upon child avoidance behaviour were differentially sensitive to specific dimensions of child and parental catastrophizing. Specifically, findings showed greater tendency to shift attention away from pain faces (i.e.,, attentional avoidance) among children reporting greater pain magnification. A similar pattern was observed in terms of parental characteristics, such that children increasingly shifted attention away from pain with increasing levels of parental rumination and helplessness. Furthermore, child attentional avoidance was associated with greater avoidance behaviour (i.e., lower pain tolerance) among children reporting high levels of pain magnification and those whose parents reported greater rumination about pain. The current findings corroborate catastrophizing as a multidimensional construct that may differentially impact outcomes and attest to the importance of assessing both child and parental characteristics in relation to child pain-related attention and avoidance behaviour. Further research directions are discussed. PMID:23792243

Vervoort, Tine; Trost, Zina; Van Ryckeghem, Dimitri M L

2013-10-01

240

Complex Regional Pain Syndrome  

MedlinePLUS

... any treatment? Because there is no cure for CRPS, treatment is aimed at relieving painful symptoms. Doctors may prescribe topical analgesics, antidepressants, corticosteroids, and opioids to relieve pain. ...

241

Responses to pain in school-aged children with experience in a neonatal intensive care unit: Cognitive aspects and maternal influences  

Microsoft Academic Search

Previously, it was shown that school-aged (9–14yr) preterm and fullterm children with neonatal pain exposure exhibit elevated heat pain thresholds and heightened perceptual sensitization to tonic painful heat when tested under standard conditions [Hermann C, Hohmeister J, Demirakca S, Zohsel K, Flor H. Long-term alteration of pain sensitivity in school-aged children with early pain experiences. Pain 2006;125:278–85]. Here, changes in

Johanna Hohmeister; Süha Demirakça; Katrin Zohsel; Herta Flor; Christiane Hermann

2009-01-01

242

Bayesian Threshold Estimation  

ERIC Educational Resources Information Center

Bayesian estimation of a threshold time (hereafter simply threshold) for the receipt of impulse signals is accomplished given the following: 1) data, consisting of the number of impulses received in a time interval from zero to one and the time of the largest time impulse; 2) a model, consisting of a uniform probability density of impulse time…

Gustafson, S. C.; Costello, C. S.; Like, E. C.; Pierce, S. J.; Shenoy, K. N.

2009-01-01

243

Ecological thresholds: a survey  

Microsoft Academic Search

The existence of ecological discontinuities and thresholds has been recognised by ecological economics as a key feature to take into account in the study of environment–economy interactions. This paper reviews some theoretical developments and empirical studies dealing with ecological phenomena involving non-linear dynamics. The literature about this issue reveals that there is abundant evidence of discontinuities and threshold effects as

Roldan Muradian

2001-01-01

244

Peripheral Pain Mechanisms in Chronic Widespread Pain  

PubMed Central

Clinical symptoms of chronic widespread pain (CWP) conditions including fibromyalgia (FM), include pain, stiffness, subjective weakness, and muscle fatigue. Muscle pain in CWP is usually described as fluctuating and often associated with local or generalized tenderness (hyperalgesia and/or allodynia). This tenderness related to muscle pain depends on increased peripheral and/or central nervous system responsiveness to peripheral stimuli which can be either noxious (hyperalgesia) or non-noxious (allodynia). For example, patients with muscle hyperalgesia will rate painful muscle stimuli higher than normal controls, whereas patients with allodynia may perceive light touch as painful, something that a “normal” individual will never describe as painful. The pathogenesis of such peripheral and/or central nervous system changes in CWP is unclear, but peripheral soft tissue changes have been implicated. Indirect evidence from interventions that attenuate tonic peripheral nociceptive impulses in patients with CWP syndromes like FM suggest that overall FM pain is dependent on peripheral input. More importantly, allodynia and hyperalgesia can be improved or abolished by removal of peripheral impulse input. Another potential mechanism for CWP pain is central disinhibition. However, this pain mechanism also depends on tonic impulse input, even if only inadequately inhibited. Thus a promising approach to understanding CWP is to determine whether abnormal activity of receptors in deep tissues is fundamental to the development and maintenance of this chronic pain disorder. Conclusions Most CWP patients present with focal tissue abnormalities including myofascial trigger points, ligamentous trigger points, or osteoarthritis of the joints and spine. While not predictive for the development of CWP these changes nevertheless represent important pain generators that may initiate or perpetuate chronic pain. Local chemical mediators, including lactic acid, ATP, and cytokines seem to play an important role in sensitizing deep tissue nociceptors of CWP patients. Thus the combination of peripheral impulse input and increased central pain sensitivity may be responsible for wide-spread chronic pain disorders including FM. PMID:22094192

Staud, Roland

2011-01-01

245

Make a CHANGE: optimising communication and pain management decisions.  

PubMed

The major objectives of the CHANGE PAIN International Advisory Board are to enhance understanding of chronic pain and to develop strategies for improving pain management. At its second meeting, in November 2009, evidence was presented that around one person in five in Europe and the USA experiences chronic pain, and the delay before referral to a pain specialist is often several years. Moreover, physicians' pharmacological approach to chronic pain is inconsistent, as evidenced by the huge variation in treatment between different European countries. It was agreed that efficient communication between physician and patient is essential for effective pain management, and that efficacy/side-effect balance is a key factor in choosing an analgesic agent. The multifactorial nature of chronic pain produces various physical and psychological symptoms, so the management of chronic pain should be tailored to the individual. Pharmacological therapy must be matched to the causative mechanisms responsible, or it is likely to prove ineffective and risk the development of a 'vicious circle'; doses are increased because of inadequate pain relief, but this increases side-effects so doses are reduced, pain relief is then inadequate, so doses are increased, and so on. Pain management decisions should not therefore be based solely on the severity of pain. Based on the concept of individual treatment targets (ITT), the CHANGE PAIN Scale was adopted - a simple, user-friendly assessment tool to improve communication between physician and patient. The 11-point NRS enables the patient to rate the current pain intensity and to set a realistic individual target level. On the reverse are six key parameters affecting the patient's quality of life; clinicians simply need to agree with patients whether improvement is needed in each one. Regular use can establish the efficacy and tolerability of pain management, and the rate of progress towards individual treatment targets. PMID:21194393

Müller-Schwefe, Gerhard; Jaksch, Wolfgang; Morlion, Bart; Kalso, Eija; Schäfer, Michael; Coluzzi, Flaminia; Huygen, Frank; Kocot-Kepska, Magdalena; Mangas, Ana Cristina; Margarit, Cesar; Ahlbeck, Karsten; Mavrocordatos, Philippe; Alon, Eli; Collett, Beverly; Aldington, Dominic; Nicolaou, Andrew; Pergolizzi, Joseph; Varrassi, Giustino

2011-02-01

246

Maladaptive dendritic spine remodeling contributes to diabetic neuropathic pain.  

PubMed

Diabetic neuropathic pain imposes a huge burden on individuals and society, and represents a major public health problem. Despite aggressive efforts, diabetic neuropathic pain is generally refractory to available clinical treatments. A structure-function link between maladaptive dendritic spine plasticity and pain has been demonstrated previously in CNS and PNS injury models of neuropathic pain. Here, we reasoned that if dendritic spine remodeling contributes to diabetic neuropathic pain, then (1) the presence of malformed spines should coincide with the development of pain, and (2) disrupting maladaptive spine structure should reduce chronic pain. To determine whether dendritic spine remodeling contributes to neuropathic pain in streptozotocin (STZ)-induced diabetic rats, we analyzed dendritic spine morphology and electrophysiological and behavioral signs of neuropathic pain. Our results show changes in dendritic spine shape, distribution, and shape on wide-dynamic-range (WDR) neurons within lamina IV-V of the dorsal horn in diabetes. These diabetes-induced changes were accompanied by WDR neuron hyperexcitability and decreased pain thresholds at 4 weeks. Treatment with NSC23766 (N(6)-[2-[[4-(diethylamino)-1-methylbutyl]amino]-6-methyl-4-pyrimidinyl]-2-methyl-4,6-quinolinediamine trihydrochloride), a Rac1-specific inhibitor known to interfere with spine plasticity, decreased the presence of malformed spines in diabetes, attenuated neuronal hyperresponsiveness to peripheral stimuli, reduced spontaneous firing activity from WDR neurons, and improved nociceptive mechanical pain thresholds. At 1 week after STZ injection, animals with hyperglycemia with no evidence of pain had few or no changes in spine morphology. These results demonstrate that diabetes-induced maladaptive dendritic spine remodeling has a mechanistic role in neuropathic pain. Molecular pathways that control spine morphogenesis and plasticity may be promising future targets for treatment. PMID:22593049

Tan, Andrew M; Samad, Omar A; Fischer, Tanya Z; Zhao, Peng; Persson, Anna-Karin; Waxman, Stephen G

2012-05-16

247

Imipramine decreases oesophageal pain perception in human male volunteers  

PubMed Central

Background—Visceral hyperalgesia is a hallmark of functional gastrointestinal disorders. Antidepressants improve symptoms in these patients, although their mode of action is unclear. Antidepressant, anticholinergic, and analgesic mechanisms have been proposed. ?Aims—To investigate whether imipramine, which has a visceral analgesic effect, increases pain thresholds to experimental visceral pain. ?Methods—Visceral perception for first sensation and pain was measured with intraoesophageal balloon distension in 15 male volunteers. The effect of imipramine was studied in a double blind, placebo controlled, crossover study. Imipramine was given in ascending doses for 12 days (25 mg days 1-3, 50 mg days 4-6, 75 mg days 7-12), with oesophageal perception studied on day 13. ?Results—Inflation volumes and intraballoon pressures at first sensation were not different between placebo and imipramine. Balloon inflation volume at pain threshold was higher on imipramine (p=0.015). Median intraballoon pressures were not different at pain threshold for placebo and imipramine. Oesophageal wall compliance was not affected by imipramine. ?Conclusion—Increased pain thresholds on imipramine in this group of normal male volunteers in the absence of changes in oesophageal tone imply the presence of a visceral analgesic effect. ?? Keywords: antidepressants; imipramine; visceral hyperalgesia; oesophageal balloon; distension; functional bowel syndromes PMID:9691919

Peghini, P; Katz, P; Castell, D

1998-01-01

248

Somatosensory findings in patients with spinal cord injury and central dysaesthesia pain.  

PubMed Central

OBJECTIVE: To determine whether central pain in patients with spinal cord injury is only dependent on the lesioning of spinothalamic pathways. METHODS: In sixteen patients with spinal cord injury and central dysaesthesia pain, somatosensory abnormalities in painful denervated skin areas were compared with somatosensory findings in normal skin areas as well as in non-painful denervated skin areas. RESULTS: The threshold values for detection of thermal (heat, cold, heat pain, or cold pain) and tactile stimulation were significantly changed in denervated skin areas although there were no significant differences in the threshold values between painful and non-painful denervated skin areas. The reductions of sensations of touch, vibration, joint position, and two point discrimination in painful and non-painful denervated skin areas were not significantly different. Allodynia (pain caused by non-noxious stimulation) and wind up-like pain (pain caused by repeatedly pricking the skin) were significantly more common in painful than non-painful denervated skin areas. CONCLUSIONS: Because pain and thermal sensory perception are primarily mediated to the brain via spinothalamic pathways, whereas the sensations of touch, vibration and joint position are primarily mediated by dorsal column-medial lemniscal pathways, the results indicate that central pain is not only dependent on the lesioning of either dorsal column-medial lemniscal pathways or spinothalamic pathways. The findings of abnormal evoked pain (allodynia and wind up-like pain) may be consistent with the experimental findings of hyperexcitability in nociceptive spinothalamic tract neurons, that may be involved in the pathogenesis of central pain. Images PMID:8774406

Eide, P K; Jørum, E; Stenehjem, A E

1996-01-01

249

Teaching tolerance  

PubMed Central

Babies born with Pompe disease require life-long treatment with enzyme-replacement therapy (ERT). Despite the human origin of the therapy, recombinant human lysosomal acid ? glucosidase (GAA, rhGAA), ERT unfortunately leads to the development of high titers of anti-rhGAA antibody, decreased effectiveness of ERT, and a fatal outcome for a significant number of children who have Pompe disease. The severity of disease, anti-drug antibody (ADA) development, and the consequences thereof are directly related to the degree of the enzyme deficiency. Babies born with a complete deficiency GAA are said to have cross-reactive immunologic material (CRIM)–negative Pompe disease and are highly likely to develop GAA ADA. Less frequently, GAA ADA develop in CRIM-positive individuals. Currently, GAA-ADA sero-positive babies are treated with a combination of immunosuppressive drugs to induce immunological tolerance to ERT, but the long-term effect of these regimens is unknown. Alternative approaches that might redirect the immune response toward antigen-specific tolerance without immunosuppressive agents are needed. Methods leading to the induction of antigen-specific regulatory T cells (Tregs), using peptides such as Tregitopes (T regulatory cell epitopes) are under consideration for the future treatment of CRIM-negative Pompe disease. Tregitopes are natural T cell epitopes derived from immunoglobulin G (IgG) that cause the expansion and activation of regulatory T cells (Treg). Teaching the immune system to tolerate GAA by co-delivering GAA with Tregitope peptides might dramatically improve the lives of CRIM-negative babies and could be applied to other enzyme replacement therapies to which ADA have been induced. PMID:23095864

Cousens, Leslie P.; Mingozzi, Federico; van der Marel, Sander; Su, Yan; Garman, Richard; Ferreira, Valerie; Martin, William; Scott, David W.; De Groot, Anne S.

2012-01-01

250

Pregabalin in severe burn injury pain: a double-blind, randomised placebo-controlled trial.  

PubMed

This randomised, double-blind, placebo-controlled trial assessed the efficacy and tolerability of pregabalin to alleviate the neuropathic component of moderate to severe burn pain. Patients aged 18 to 65 years admitted to a burns unit with a 5% or greater total body surface area burn injury were screened to participate in the trial. Using the Neuropathic Pain Scale (NPS), patients scoring 4 or higher on 'hot' pain or 'sharp' pain were invited to participate. Consenting patients were randomly assigned to receive pregabalin or placebo for 28 days with individual dose titration commencing at 75 mg twice daily to a maximum pregabalin dose of 300 mg twice daily. The primary outcome measure was the patients' daily response to the sharp and hot pain of the NPS. Secondary outcome measures included the remaining elements of the NPS, daily opioid requirement, length of hospital stay, pain at 6 months, and side effects of nausea, vomiting, drowsiness and giddiness. For patients administered pregabalin, the primary outcome measures hot (P = .01) and sharp (P = .04) pain were significantly reduced compared with those in patients administered placebo. Secondary outcome measures of itch, unpleasantness, surface pain, and procedural pain were significantly lower (P < .05) in the pregabalin group. Adverse effects were uncommon, with no difference between the treatment groups. There was no significant difference between the pregabalin and placebo treatment groups with respect to opioid consumption, duration of hospital stay, or pain at 6 months. Pregabalin was efficacious and well tolerated in patients after severe burn injury and whose pain was characterised by features of acute neuropathic pain. In this study, pregabalin was well tolerated and significantly reduced several elements of the neuropathic pain scale including hot pain, unpleasantness of the pain, surface pain, and itch, and also significantly reduced procedural pain. PMID:21398038

Gray, Paul; Kirby, Julie; Smith, Maree T; Cabot, Peter J; Williams, Bronwyn; Doecke, James; Cramond, Tess

2011-06-01

251

A Systematic Comparison Between Subjects with No Pain and Pain Associated with Active Myofascial Trigger Points  

PubMed Central

Objective To determine whether standard evaluations of pain distinguish subjects with no pain from those with myofascial pain syndromes (MPS) and active trigger points (MTrPs); and to assess whether self-reports of mood, function and health-related quality of life differ between these groups. Design Prospective, descriptive study. Setting University Patients Adults with and without neck pain Methods We evaluated adults with MPS and active (painful) MTrPs and those without pain. Subjects in the “Active” (‘A’) group had at least one active MTrP with spontaneous pain which was persistent, lasted more than 3 months and had characteristic pain on palpation. Subjects in the “No pain” (‘Np’) group had no spontaneous pain. However, some had discomfort on MTrP palpation (latent MTrP) while others in the Np group had no discomfort on palpation of nodules or had no nodules. Outcome Measures Each participant underwent range of motion (ROM) measurement, 10-point manual muscle test, and manual and algometric palpation. The latter determined the pain/pressure threshold using an algometer of 4 pre-determined anatomical sites along the upper trapezius. Participants rated pain using a verbal analogue scale (0–10); completed the Brief Pain Inventory and Oswestry Disability Scale (ODS), which included a sleep sub-scale; Short Form 36(SF36) and the Profile of Mood States (POMS). Results here were 24 in the ‘A’ group (mean 36 yrs, 16 women) and 26 in the ‘Np’ group (mean 26 yrs, 12 women). Subjects in group ‘A’ differed from ‘Np’ in number of latent MTrPs (p=.0062); asymmetrical cervical ROM (p=.01 side bending and p=.002 rotation); in all pain reports (p<.0001); algometry (p<.03); POMS (p<.038); SF36 (p<.01) and ODS (p<.0001). Conclusion A systematic musculoskeletal evaluation of people with MPS reliably distinguishes them from subjects with no pain. The two groups are significantly different in their physical findings and self-reports of pain, sleep disturbance, disability, health status and mood. These findings support the view that a “local” pain syndrome has significant associations with mood, health-related quality of life and function.. PMID:23810811

Gerber, Lynn H.; Sikdar, Siddhartha; Armstrong, Katee; Diao, Guoqing; Heimur, Juliana; Kopecky, John; Turo, Diego; Otto, Paul; Gebreab, Tadesse; Shah, Jay

2013-01-01

252

Chronic Pain and Fatigue  

E-print Network

Chronic Pain and Fatigue Research Center Department of Anesthesiology 24 Frank Lloyd Wright Dr, information regarding this condition The UMHS Chronic Pain and Fatigue Research Center (CPFRC) offers of other pain syndromes such as irritable bowel, pelvic pain, and headaches. The FM Workshop is conducted

Shyy, Wei

253

PAIN MEDICINE POSITION PAPER  

Microsoft Academic Search

Current Status Since the 1950s, significant advances in the treatment of pain have resulted in greater relief for an increasing number of patients. However, the quality of pain care delivery in the United States continues to fall remarkably short of the current potential for optimal care. Pain medicine remains fragmented, and the absence of a unified organizational model of pain

Michel Y. Dubois; Rollin M. Gallagher; Philipp M. Lippe

2009-01-01

254

Chronic pelvic pain.  

PubMed

Chronic pelvic pain is pain lasting longer than 6 months and is estimated to occur in 15% of women. Causes of pelvic pain include disorders of gynecologic, urologic, gastroenterologic, and musculoskeletal systems. The multidisciplinary nature of chronic pelvic pain may complicate diagnosis and treatment. Treatments vary by cause but may include medicinal, neuroablative, and surgical treatments. PMID:24280400

Stein, Sharon L

2013-12-01

255

[Transdermal fentanyl patch for the treatment of chronic intractable pain].  

PubMed

The purpose of the treatment of chronic non-cancer pain is the improvement of the patient's quality of life, not the complete alleviation of pain. In Japan transdermal fentanyl patch can be used for the treatment of chronic intractable pain including cancer pain and chronic non-cancer pain. In prescribing transdermal fentanyl patch for patients with chronic non-cancer pain, cares should be focused on the selection of the patients and the periodic and continuous observation of analgesic effect and side effects. Patients with mental disorders need the consultation with specialists. In most cases side effects such as nausea, vomiting, constipation and sedation can be well tolerated. However, respiratory suppression or over sedation would also occur and such side effects can sometimes be fatal. Furthermore, long term effects on endocrine and immune systems have not been clarified yet. Proper prescription of opioids during a limited period of time is definitely the primary concern of medical professionals. PMID:23905400

Ibuki, Takae

2013-07-01

256

Cortical thickness correlates of pain and temperature sensitivity.  

PubMed

It is well established that there is individual variability in pain and temperature sensitivity. Functional brain imaging studies have found that interindividual heat pain variability correlates with brain activity in sensory and pain modulation areas. Thus, it is possible that these individual differences are associated with variability in gray matter thickness of cortical regions involved in thermoreception and pain. To test this, we investigated the relationship between thermal thresholds and cortical thickness in 80 healthy subjects. Subjects underwent a psychophysical session to determine their cool detection (CD), warm detection (WD), cold pain (CP), and heat pain (HP) threshold. A high-resolution structural magnetic resonance imaging scan was acquired for each subject. We correlated each threshold measure to cortical thickness of regions associated with thermoreception and pain. The mean (± SD) thresholds were 30.7 °C (± 0.8) for CD, 33.8 °C (± 0.7) for WD, 11.7 °C (± 9.7) for CP, and 45.3 °C (± 2.8) for HP. The brain gray matter analysis revealed a strong correlation between greater thermal and pain sensitivity and cortical thickening of the primary somatosensory cortex. Additionally, greater sensitivity to cool stimuli correlated with cortical thickening in the paracentral lobule, and greater WD correlated with cortical thinning in the anterior midcingulate cortex. We also found that greater HP sensitivity correlated with thickening in the posterior midcingulate cortex and the orbitofrontal cortex. These cortical gray matter correlates of thermal and pain sensitivity provide a neural basis for individual differences in thermal sensitivity. PMID:22516588

Erpelding, Nathalie; Moayedi, Massieh; Davis, Karen D

2012-08-01

257

Opioids for neuropathic pain  

Microsoft Academic Search

Whether opioids are effective for neuropathic pain has been a matter of controversy for decades. Within limits, it is clear\\u000a that opioids in general are effective for neuropathic pain. Furthermore, there is no evidence that opioids are any less effective\\u000a for neuropathic pain than for non-neuropathic pain, no evidence that opioids are less effective for neuropathic pain than\\u000a are other

Nathaniel Katz; Christine Benoit

2005-01-01

258

Growing pains in children  

PubMed Central

We review the clinical manifestations of "growing pains", the most common form of episodic childhood musculoskeletal pain. Physicians should be careful to adhere to clear clinical criteria as described in this review before diagnosing a child with growing pain. We expand on current theories on possible causes of growing pains and describe the management of these pains and the generally good outcome in nearly all children. PMID:17550631

Uziel, Yosef; Hashkes, Philip J

2007-01-01

259

Sex, gender, coping, and self-efficacy: Mediation of sex differences in pain perception in children and adolescents  

Microsoft Academic Search

Sex differences in pain perception have been reported in an expanding literature based on adult samples in epidemiological as well as laboratory studies. Especially with respect to the latter, studies with children and adolescents do not consistently show that females report higher pain ratings and display lower pain tolerance than males. The first aim of the presented studies is to

Marc Vierhaus; Arnold Lohaus; Anne-Katharina Schmitz

2011-01-01

260

Breakthrough pain: characteristics and impact in patients with cancer pain  

Microsoft Academic Search

Few surveys have been performed to define the characteristics and impact of breakthrough pain in the cancer population. In this cross-sectional survey of inpatients with cancer, patients responded to a structured interview (the Breakthrough Pain Questionnaire) designed to characterize breakthrough pain, and also completed measures of pain and mood (Memorial Pain Assessment Card (MPAC)), pain-related interference in function (Brief Pain

Russell K Portenoy; David Payne; Paul Jacobsen

1999-01-01

261

Pain and Associated Substance Use among Opioid Dependent Individuals Seeking Office-Based Treatment with Buprenorphine-Naloxone: A Needs Assessment Study  

PubMed Central

Background and Objectives A paucity of studies has examined the pain experiences of opioid dependent individuals seeking office-based buprenorphine-naloxone treatment (BNT). We set out to examine, among those seeking BNT: (a) the prevalence of pain types (i.e., recent pain, chronic pain), (b) the characteristics of pain (intensity, frequency, duration, interference, location, and genesis), and (c) substance use to alleviate pain. Methods We surveyed 244 consecutive individuals seeking office-based buprenorphine-naloxone treatment (BNT) for opioid dependence about physical pain and associated substance use. Results Thirty-six percent of respondents reported chronic pain (CP) (i.e., pain lasting at least 3 months) and 36% reported “some pain” (SP) (i.e., past week pain not meeting the threshold for CP). In comparison to SP respondents, those with CP were, on average, older; reported greater current pain intensity, pain frequency, typical pain duration, typical pain intensity, and typical pain interference; were more likely to report shoulder or pelvis and less likely to report stomach or arms as their most bothersome pain location; and were more likely to report accident or nerve damage and less likely to report opioid withdrawal as the genesis of their pain. Both pain subgroups reported similarly high rates of past-week substance use to alleviate pain. Conclusions and Scientific Significance The high rates of pain and self-reported substance use to manage pain suggest the importance of assessing and addressing pain in BNT patients. PMID:23617861

Barry, Declan T.; Savant, Jonathan D.; Beitel, Mark; Cutter, Christopher J.; Moore, Brent A.; Schottenfeld, Richard S.; Fiellin, David A.

2012-01-01

262

A human experimental model of episodic pain.  

PubMed

An experimental model of daily episodic pain was developed to investigate peripheral sensitization and cortical reorganization in healthy individuals. Two experiments (A and B) were conducted. Experiments A and B consisted of one and five consecutive days, respectively, in which the participants were subjected to 45 min of intense painful cutaneous electrical stimulation (episodic pain session), using a stimulus paradigm that in animals has been shown to induce long-term potentiation. These electrical stimulations produced a verbal pain rating of approximately 85 on a 0-100 verbal rating scale (VRS). Physiological (blood flow and axon flare reflex), psychophysical (perception threshold and verbal pain ratings) and electrophysiological (128 channels recorded somatosensory evoked potential (SEP)) measurements were recorded. The stimulation evoked a visible axon flare reflex and caused significantly increased cutaneous blood flow around the site of the stimulation. Axon flare reflex and blood flow reached a plateau on day one in all the subjects and no significant changes between the days were observed. The results showed that the effect of the electrical stimulations changed over the five days; pain potentiation was induced on the first day (significant increase in the verbal pain ratings during the 45 min stimulation) but not on any of the subsequent days. After five days of subsequent pain induction, the global field power showed a significant reduction in P2 amplitude in the late stage (200-370 ms, in the central-parietal area). In conclusion, the results suggest that in healthy individuals this model of episodic pain produces a rapid adaptation after day one and that generates significant SEP changes at day five. PMID:25128903

Petrini, Laura; Hennings, Kristian; Li, Xi; Negro, Francesco; Arendt-Nielsen, Lars

2014-12-01

263

Resilient Quantum Computation: Error Models and Thresholds  

E-print Network

Recent research has demonstrated that quantum computers can solve certain types of problems substantially faster than the known classical algorithms. These problems include factoring integers and certain physics simulations. Practical quantum computation requires overcoming the problems of environmental noise and operational errors, problems which appear to be much more severe than in classical computation due to the inherent fragility of quantum superpositions involving many degrees of freedom. Here we show that arbitrarily accurate quantum computations are possible provided that the error per operation is below a threshold value. The result is obtained by combining quantum error-correction, fault tolerant state recovery, fault tolerant encoding of operations and concatenation. It holds under physically realistic assumptions on the errors.

Emanuel Knill; Raymond Laflamme; Wojciech H. Zurek

1997-02-26

264

Evidence of Increased Non-Verbal Behavioral Signs of Pain in Adults with Neurodevelopmental Disorders and Chronic Self-Injury  

ERIC Educational Resources Information Center

The role of pain in relation to self-injurious behavior (SIB) among individuals with intellectual disabilities is not well understood. Some models of SIB are based on altered endogenous opioid system activity which could result in elevated pain thresholds. In this study, non-verbal behavioral signs indicative of pain as measured by the…

Symons, Frank J.; Harper, Vicki N.; McGrath, Patrick J.; Breau, Lynn M.; Bodfish, James W.

2009-01-01

265

Lower-Order Pain-Related Constructs are More Predictive of Cold Pressor Pain Ratings than Higher-Order Personality Traits  

PubMed Central

Pain is a debilitating condition affecting millions each year, yet what predisposes certain individuals to be more sensitive to pain remains relatively unknown. Several psychological factors have been associated with pain perception, but the structural relations between multiple higher- and lower-order constructs and pain are not well understood. Thus, we aimed to examine the associations between pain perception using the cold pressor task (CPT), higher-order personality traits (neuroticism, negative affectivity, trait anxiety, extraversion, positive affectivity, psychoticism), and lower-order pain-related psychological constructs (pain catastrophizing [pre- and post], fear of pain, anxiety sensitivity, somatosensory amplification, hypochondriasis) in 66 pain-free adults. Factor analysis revealed three latent psychological variables: pain- or body-sensitivity, negative affect/neuroticism, and positive affect/extraversion. Similarly, pain responses factored into three domains: intensity, quality, and tolerance. Regression and correlation analyses demonstrated 1) all the lower-order pain constructs (fear, catastrophizing, and hypochondriasis) are related through a single underlying latent factor, that is partially related to the higher-order negative-valence personality traits; 2) pain- or body-sensitivity was more strongly predictive of pain quality than higher-order traits; and 3) the form of pain assessment is important – only qualitative pain ratings were significantly predicted by the psychological factors. Perspective: Consistent with the biopsychosocial model, these results suggest multiple pain-related psychological measures likely assess a common underlying factor, which is more predictive of qualitative than intensity pain ratings. This information may be useful for the development and advancement of pain assessments and treatments while considering the multidimensional nature of pain. PMID:20356801

Lee, Jennifer E; Watson, David; Frey Law, Laura A

2010-01-01

266

An Introduction Significance of Pain  

E-print Network

Inflammation or nerve damage !!65 -90 million in US !!Arthritis !!Neuropathic pain !!Back pain !!MigraineAn Introduction to: Pain #12;Significance of Pain !!Pain is adaptive !!Alerts us to danger !!Motivates escape and avoidance learning !!Motivates recuperation !!Congenital insensitivity to pain !!Pain

Meagher, Mary

267

Facilitation of pain in the human spinal cord by nocebo treatment.  

PubMed

Nocebo hyperalgesia is an increase in subjective pain perception after a patient or subject underwent an inert treatment without any active ingredient. For example, verbal suggestion of increased pain can enhance both pain experience and responses in pain-related cortical brain areas. However, changes in cortical pain responses may be secondary to earlier amplification of incoming pain signals within the spinal cord. To test for a potential early enhancement of pain signals in the dorsal horn of the spinal cord, we combined a nocebo heat pain paradigm with spinal functional magnetic resonance imaging in healthy volunteers. We found that local application of an inert nocebo cream on the forearm increased pain ratings compared with a control cream, and also reduced pain thresholds on the nocebo-treated skin patch. On the neurobiological level, pain stimulation induced a strong activation in the spinal cord at the level of the stimulated dermatomes C5/C6. Comparing pain stimulation under nocebo to a control pain stimulation of the same physical intensity revealed enhanced pain-related activity in the ipsilateral dorsal horn of the spinal cord. Importantly, the activation of the main effect of pain and the nocebo effect spatially overlapped. The current study thus provides direct evidence for a pain-facilitating mechanism in the human spinal cord before cortical processing, which can be activated by cognitive manipulations such as nocebo treatments. PMID:23966699

Geuter, Stephan; Büchel, Christian

2013-08-21

268

Central modulation of pain  

PubMed Central

It has long been appreciated that the experience of pain is highly variable between individuals. Pain results from activation of sensory receptors specialized to detect actual or impending tissue damage (i.e., nociceptors). However, a direct correlation between activation of nociceptors and the sensory experience of pain is not always apparent. Even in cases in which the severity of injury appears similar, individual pain experiences may vary dramatically. Emotional state, degree of anxiety, attention and distraction, past experiences, memories, and many other factors can either enhance or diminish the pain experience. Here, we review evidence for “top-down” modulatory circuits that profoundly change the sensory experience of pain. PMID:21041960

Ossipov, Michael H.; Dussor, Gregory O.; Porreca, Frank

2010-01-01

269

Pediatric pain management.  

PubMed

It is now recognized that from the newborn period onwards, children are capable of experiencing pain. This includes the premature infant. The challenge for healthcare providers is to incorporate methods of pain assessment and treatment into their daily practices. The child's understanding of pain closely follows the cognitive and behavioral model developed by Jean Piaget. Based on these developmental stages, pain assessment measures have been developed. Pharmacologic advances have accompanied this improved understanding of infant, child, and adolescent psychology. While acute pain accounts for the majority of children's experiences, recurrent/chronic pain states do occur (e.g. sickle cell related and neuropathic) and can be effectively treated. PMID:9037997

Lederhaas, G

1997-01-01

270

Loin pain hematuria syndrome.  

PubMed

Loin pain hematuria syndrome is a rare disease with a prevalence of ?0.012%. The most prominent clinical features include periods of severe intermittent or persistent unilateral or bilateral loin pain accompanied by either microscopic or gross hematuria. Patients with loin pain hematuria syndrome initially present with hematuria, flank pain, or most often both hematuria and flank pain. Kidney biopsies from patients with loin pain hematuria typically reveal only minor pathologic abnormalities. Further, loin pain hematuria syndrome is not associated with loss of kidney function or urinary tract infections. Loin pain hematuria syndrome-associated hematuria and pain are postulated to be linked to vascular disease of the kidney, coagulopathy, renal vasospasm with microinfarction, hypersensitivity, complement activation on arterioles, venocalyceal fistula, abnormal ureteral peristalsis, and intratubular deposition of calcium or uric acid microcrystals. Many patients with loin pain hematuria syndrome also meet criteria for a somatoform disorder, and analgesic medications, including narcotics, commonly are used to treat loin pain hematuria syndrome-associated pain. Interventional treatments include renal denervation, kidney autotransplantation, and nephrectomy; however, these methods should be used only as a last resort when less invasive measures have been tried unsuccessfully. In this review article, we discuss and critique current clinical practices related to loin pain hematuria syndrome pathophysiology, diagnosis, treatment, and prognosis. PMID:24725981

Taba Taba Vakili, Sahar; Alam, Tausif; Sollinger, Hans

2014-09-01

271

Pain modulation during drives through cold and hot virtual environments.  

PubMed

Evidence exists that virtual worlds reduce pain perception by providing distraction. However, there is no experimental study to show that the type of world used in virtual reality (VR) distraction influences pain perception. Therefore, we investigated whether pain triggered by heat or cold stimuli is modulated by "warm "or "cold " virtual environments and whether virtual worlds reduce pain perception more than does static picture presentation. We expected that cold worlds would reduce pain perception from heat stimuli, while warm environments would reduce pain perception from cold stimuli. Additionally, both virtual worlds should reduce pain perception in general. Heat and cold pain stimuli thresholds were assessed outside VR in 48 volunteers in a balanced crossover design. Participants completed three 4-minute assessment periods: virtual "walks " through (1) a winter and (2) an autumn landscape and static exposure to (3) a neutral landscape. During each period, five heat stimuli or three cold stimuli were delivered via a thermode on the participant's arm, and affective and sensory pain perceptions were rated. Then the thermode was changed to the other arm, and the procedure was repeated with the opposite pain stimuli (heat or cold). We found that both warm and cold virtual environments reduced pain intensity and unpleasantness for heat and cold pain stimuli when compared to the control condition. Since participants wore a head-mounted display (HMD) in both the control condition and VR, we concluded that the distracting value of virtual environments is not explained solely by excluding perception of the real world. Although VR reduced pain unpleasantness, we found no difference in efficacy between the types of virtual world used for each pain stimulus. PMID:17711359

Mühlberger, Andreas; Wieser, Matthias J; Kenntner-Mabiala, Ramona; Pauli, Paul; Wiederhold, Brenda K

2007-08-01

272

Pain in Parkinson's Disease  

MedlinePLUS

... for increased overall health care costs. A person’s perception of pain can be affected by emotional factors. ... medications such as levodopa can affect a person’s perception of pain. People with Parkinson’s who are in ...

273

Magnets for Pain Relief  

MedlinePLUS

... our disclaimer about external links Menu Magnets for Pain Relief On this page: Introduction Key Points About ... Top What the Science Says About Magnets for Pain Scientific evidence does not support the use of ...

274

Sacroiliac joint pain.  

PubMed

The sacroiliac joint is a source of pain in the lower back and buttocks in approximately 15% of the population. Diagnosing sacroiliac joint-mediated pain is difficult because the presenting complaints are similar to those of other causes of back pain. Patients with sacroiliac joint-mediated pain rarely report pain above L5; most localize their pain to the area around the posterior superior iliac spine. Radiographic and laboratory tests primarily help exclude other sources of low back pain. Magnetic resonance imaging, computed tomography, and bone scans of the sacroiliac joint cannot reliably determine whether the joint is the source of the pain. Controlled analgesic injections of the sacroiliac joint are the most important tool in the diagnosis. Treatment modalities include medications, physical therapy, bracing, manual therapy, injections, radiofrequency denervation, and arthrodesis; however, no published prospective data compare the efficacy of these modalities. PMID:15473677

Dreyfuss, Paul; Dreyer, Susan J; Cole, Andrew; Mayo, Keith

2004-01-01

275

Communicating about Cancer Pain  

Cancer.gov

Patients with cancer may be reluctant to discuss their pain with their doctors for a variety of reasons. NCI sponsors research that examines the barriers that prevent patients from talking about pain.

276

Diabetic neuropathic pain: a role for testosterone metabolites.  

PubMed

Diabetic neuropathy is associated with neuropathic pain in about 50% of diabetic subjects. Clinical management of neuropathic pain is complex and so far unsatisfactory. In this study, we analyzed the effects of the testosterone metabolites, dihydrotestosterone (DHT), and 3?-diol, on nociceptive and allodynia thresholds and on molecular and functional parameters related to pain modulation in the dorsal horns of the spinal cord and in the dorsal root ganglia of rats rendered diabetic by streptozotocin injection. Furthermore, the levels of DHT and 3?-diol were analyzed in the spinal cord. Diabetes resulted in a significant decrease in DHT levels in the spinal cord that was reverted by DHT or 3?-diol treatments. In addition, 3?-diol treatment resulted in a significant increase in 3?-diol in the spinal cord compared with control values. Both steroids showed analgesic properties on diabetic neuropathic pain, affecting different pain parameters and possibly by different mechanisms of action. Indeed, DHT counteracted the effect of diabetes on the mechanical nociceptive threshold, pre- and post-synaptic components, glutamate release, astrocyte immunoreactivity, and expression of interleukin-1? (IL1?), while 3?-diol was effective on tactile allodynia threshold, glutamate release, astrocyte immunoreactivity and the expression of substance P, toll-like receptor 4, tumor necrosis factor-?, transforming growth factor ?-1, IL1?, and translocator protein. These results indicate that testosterone metabolites are potential agents for the treatment of diabetic neuropathic pain. PMID:24424289

Calabrese, Donato; Giatti, Silvia; Romano, Simone; Porretta-Serapiglia, Carla; Bianchi, Roberto; Milanese, Marco; Bonanno, Giambattista; Caruso, Donatella; Viviani, Barbara; Gardoni, Fabrizio; Garcia-Segura, Luis Miguel; Melcangi, Roberto Cosimo

2014-04-01

277

Age-of-onset of menopause is associated with enhanced painful and non-painful sensitivity in fibromyalgia.  

PubMed

Fibromyalgia (FM) is a chronic pain condition characterized by high prevalence in women. In particular, estrogen deficit has been considered as a potentially promoting factor of FM symptoms. This study was aimed to examine the relationship between age-of-onset of menopause and pain sensitivity in FM. For this purpose, pain sensitivity was assessed in 74 FM and 32 pain-free control women. All participants were postmenopausal and underwent a detailed semi-structured clinical interview, including data about menopause transition, previous history of hysterectomy or ovariectomy, and menses time. Participants were divided into two groups depending on age-of-onset of menopause: early menopause [?49 years] vs. late menopause [>49 years]. Pain and non-pain thresholds were assessed by using cold, heat, mechanical, and electrical stimulation. FM women showed higher overall pain sensitivity as compared with healthy subjects. FM women with early age-of-onset of menopause displayed greater pain and non-pain sensitivity than FM women with late age-of-onset of menopause, whereas no differences were observed in healthy women due to age-of-onset of menopause. These results suggest that an early transition to menopause (shortening the time of exposure to estrogens) may influence pain hypersensitivity and could be related to aggravation of FM symptoms. PMID:23417348

Martínez-Jauand, M; Sitges, C; Femenia, J; Cifre, I; González, S; Chialvo, D; Montoya, P

2013-07-01

278

Associations between serotonin transporter gene polymorphisms and heat pain perception in adults with chronic pain  

PubMed Central

Background The triallelic serotonin transporter gene linked polymorphic region (5-HTTLPR) has been associated with alterations in thermal pain perception. The primary aim of this study was to investigate the associations between heat pain (HP) perception and the triallelic 5-HTTLPR in a large cohort of adults with chronic pain. Methods The cohort included 277 adults with chronic pain who met inclusion criteria, and were consecutively admitted to an outpatient pain rehabilitation program from March 2009 through March 2010. Individuals were genotyped for the triallelic 5-HTTLPR (including rs25531) and categorized as high, intermediate, or low expressors of the serotonin transporter. Standardized measures of HP perception were obtained using a validated quantitative sensory test method of levels. Results The distribution of the high, intermediate, and low expressing genotypes was 61 (22%), 149 (54%) and 67 (24%), respectively. The Hardy-Weinberg P-value was 0.204 which indicated no departure from equilibrium. A significant effect of genotype was observed for values of HP threshold (P?=?0.029). Individual group comparisons showed that values of HP threshold were significantly greater in the intermediate compared to the high expressing group (P?=?0.009) but not the low expressing group (P?>?0.1). In a multiple variable linear regression model, the intermediate group (P?=?0.034) and male sex (P?=?0.021) were associated with significantly greater values of HP 0.5, but no significant genotype-by-sex interaction effect was observed. Conclusions In this study that involved adults with chronic pain, the intermediate triallelic 5-HTTLPR expressing group, but not the low expressing group, was associated with greater HP thresholds compared to the high expressing group. PMID:23895108

2013-01-01

279

Posttonsillectomy pain in children.  

PubMed

Tonsillectomy, used to treat a variety of pediatric disorders, including obstructive sleep apnea, peritonsillar cellulitis or abscesses, and very frequent throat infection, is known to produce nausea, vomiting, and prolonged, moderate-to-severe pain. The authors review the causes of posttonsillectomy pain, current findings on the efficacy of various pharmacologic and nonpharmacologic interventions in pain management, recommendations for patient and family teaching regarding pain management, and best practices for improving medication adherence. PMID:24445532

Sutters, Kimberly A; Isaacson, Glenn

2014-02-01

280

Molecular pain, a new era of pain research and medicine  

Microsoft Academic Search

Molecular pain is a relatively new and rapidly expanding research field that represents an advanced step from conventional pain research. Molecular pain research addresses physiological and pathological pain at the cellular, subcellular and molecular levels. These studies integrate pain research with molecular biology, genomics, proteomics, modern electrophysiology and neurobiology. The field of molecular pain research has been rapidly expanding in

Jianguo Gu; Min Zhuo; Michael Caterina; Amy B MacDermott; Annika Malmberg; Volker Neugebauer; Megumu Yoshimura

2005-01-01

281

Definitions and Types of Pain  

MedlinePLUS

... Types of Pain Defining Pain Pain is a perception that signals the individual that tissue damage has ... in the body that are involved in the perception of pain are called "nociception." Basic and clinical ...

282

Pediatric Procedural Pain  

ERIC Educational Resources Information Center

This article reviews the various settings in which infants, children, and adolescents experience pain during acute medical procedures and issues related to referral of children to pain management teams. In addition, self-report, reports by others, physiological monitoring, and direct observation methods of assessment of pain and related constructs…

Blount, Ronald L.; Piira, Tiina; Cohen, Lindsey L.; Cheng, Patricia S.

2006-01-01

283

Chest pain in children.  

PubMed Central

Chest pain is usually a benign symptom in children. The most common identifiable causes are musculoskeletal. Often, no cause can be identified. Cardiac disorders are uncommon causes of chest pain children. Most causes can be diagnosed from history and physical examination. Treatment should be directed at the underlying cause. For idiopathic chest pain, reassurance and regular follow-up examinations are important. PMID:8704491

Leung, A. K.; Robson, W. L.; Cho, H.

1996-01-01

284

Complex Regional Pain Syndrome  

MedlinePLUS

... pain reliever) into certain nerves to block the pain signals. If the injection works, it may be repeated. Physical therapy and psychological counseling are also helpful. However, a treatment that works for ... pain syndrome from getting worse. Sometimes the condition improves. ...

285

Paine Appointed Administrator  

NASA Technical Reports Server (NTRS)

President Richard M. Nixon announcing the appointment of Dr. Thomas O. Paine as Administrator for the National Aeronautics and Space Administration. The ceremony was held at the White House. Paine had been serving as acting administrator. From left to right: President Richard M. Nixon NASA Administrator Dr. Thomas O. Paine Vice President Spiro T. Agnew

1969-01-01

286

Forebrain Pain Mechanisms  

PubMed Central

Emotional-affective and cognitive dimensions of pain are less well understood than nociceptive and nocifensive components, but the forebrain is believed to play an important role. Recent evidence suggests subcortical and cortical brain areas outside the traditional pain processing network contribute critically to emotional-affective responses and cognitive deficits related to pain. These brain areas include different nuclei of the amygdala and certain prefrontal cortical areas. Their roles in various aspects of pain will be discussed. Biomarkers of cortical dysfunction are being identified that may evolve into therapeutic targets to modulate pain experience and improve pain-related cognitive impairment. Supporting data from preclinical studies in neuropathic pain models will be presented. Neuroimaging analysis provides evidence for plastic changes in the pain processing brain network. Results of clinical studies in neuropathic pain patients suggest that neuroimaging may help determine mechanisms of altered brain functions in pain as well as monitor the effects of pharmacologic interventions to optimize treatment in individual patients. Recent progress in the analysis of higher brain functions emphasizes the concept of pain as a multidimensional experience and the need for integrative approaches to determine the full spectrum of harmful or protective neurobiological changes in pain. PMID:19162070

Neugebauer, Volker; Galhardo, Vasco; Maione, Sabatino; Mackey, Sean C.

2009-01-01

287

Cannabinoids in cancer pain  

Microsoft Academic Search

This article of the month presents results of a clinical study conducted in the UK and Romania, which evaluated the efficacy of a THC:CBD cannabis extract (Sativex®) and a THC cannabis ex- tract in the treatment of 177 patients with cancer pain, who experienced inadequate pain reduction despite intake of opioids (Johnson et al. J Pain Symptom Manage, 2010, in

Franjo Grotenhermen

2010-01-01

288

Music can effectively reduce pain perception in women rather than men  

PubMed Central

Objective: Nowadays music is used to decrease pain and increase relaxation in clinical settings. It is hypothesized that music can affect women more easily than men. We assessed the effect of two types of music (Iranian folkloric and preferred music) on pain tolerance and pain rating in cold pressor test. Methodology: A consecutive sample of 50 healthy Iranian medical students was enrolled. They reported pain tolerance and pain rating in cold pressor test in three different musical conditions served as the outcome measures. The results were analyzed with repeated measurement analysis of variance. Result: Mean tolerance time was significantly higher in preferred music compared to Iranian folkloric music (F (1,48) =25.44, p=0.0001) and no music (F(1,48)=3.51, p=0.0001) conditions. There was a significant interaction when tolerance time in no music condition was compared to preferred music condition, regarding sex; Tolerance time increased more in females (F(1,48)=5.53, p=0.023). The results also indicated that pain ratings, regardless of sex, were different in three musical conditions (F(1.7,81.34)=15.37, p=0.0001). Conclusion: Music distracted attention from pain and Women can be impressed and distracted more easily by music. PMID:24353523

Ghaffaripour, Sina; Mahmoudi, Hilda; Sahmeddini, Mohammad Ali; Alipour, Abbas; Chohedri, Abdolhamid

2013-01-01

289

Horizontal Body Position Reduces Cortical Pain-Related Processing: Evidence from Late ERPs  

PubMed Central

The present study investigated the influence of short-term horizontal body position on pain-related somatosensory processing, by measuring subjective and cortical responses to electrical pain stimulation. Twenty-eight healthy women were randomly assigned to either the experimental horizontal group (Bed Rest, BR) or to the sitting control group (Sitting Control, SC). After 90 minutes in either horizontal or sitting position, the individual pain thresholds were assessed and EEG/self-evaluations recorded during the administration of 180 stimuli delivered to the left forearm. Electrical pain stimuli, calibrated to subjects’ individual pain thresholds, consisted of two different intensity levels: no pain (40% below pain threshold) and pain (40% above pain threshold). Compared with control, BR condition significantly inhibited subjective sensitivity to painless stimuli, whereas electrophysiological results pointed to a reduced slow cortical wave (interval: 300-600 ms) at all stimulus intensities, and smaller amplitude in BR’s right vs. left prefrontal sites. sLORETA analysis revealed that cortical responses were associated with a decreased activation of superior frontal gyrus and anterior cingulate cortex (BA 6/24). Interestingly, BR group only showed significant negative correlations between self-evaluation of painful intensities and frontal cortical negativity, revealing increasingly differentiated responses in bed rest: indeed those BR participants who reported lower pain ratings, displayed reduced negativity within anterior regions. Taken together, results indicate that short-term horizontal position is able to inhibit a fronto-parietal pain network, particularly at the level of central prefrontal regions typically involved in cognitive, affective and motor aspects of pain processing. PMID:24278467

Fardo, Francesca; Spironelli, Chiara; Angrilli, Alessandro

2013-01-01

290

Plant salt tolerance  

Microsoft Academic Search

Soil salinity is a major abiotic stress in plant agriculture worldwide. This has led to research into salt tolerance with the aim of improving crop plants. However, salt tolerance might have much wider implications because transgenic salt-tolerant plants often also tolerate other stresses including chilling, freezing, heat and drought. Unfortunately, suitable genetic model systems have been hard to find. A

Jian-Kang Zhu

2001-01-01

291

Salinity thresholds of Acropora spp. on the Great Barrier Reef  

NASA Astrophysics Data System (ADS)

Salinity tolerances of reef corals have been experimentally investigated since the early twentieth century. Yet, nearly 100 years later, we are no closer to having a threshold that can be applied in studies of the impacts of freshwater runoff on coral communities. We present an empirically derived salinity threshold for sensitive Acropora species from the Keppel Islands in the southern inshore Great Barrier Reef (GBR), based on in situ salinity exposure and coral responses during a major flood event in 2010-2011. This threshold is presented as a dose-time response for a salinity-sensitive range of 22-28 PSU and an exposure time of 3-16 days at the lowest and highest salinities, respectively. The robustness of the salinity threshold was confirmed by comparison with responses of corals to low salinity ~600 km north in the central GBR, which were exposed to substantially different turbidity and chlorophyll levels during the period of hypo-salinity.

Berkelmans, R.; Jones, A. M.; Schaffelke, B.

2012-12-01

292

Efficacy and safety of cimicoxib in the control of perioperative pain in dogs  

PubMed Central

Objectives To determine the efficacy and safety of cimicoxib (Cimalgex®; Vétoquinol SA) for the control of perioperative pain in dogs. Methods A double-blind, randomized, controlled multi-centre field study was conducted in 237 dogs undergoing orthopaedic or soft tissue surgery. Pain was monitored by the attending veterinarian over the 7 days following the surgical procedure using two pain-scoring systems and a visual analogue scale. An enhanced monitoring protocol for postoperative pain was utilized during the first 24 hours after surgery. The dog owner's assessment of perceived analgesia during this time period was also recorded. Results Cimicoxib demonstrated statistically significant non-inferiority compared to carprofen. These findings were confirmed by owners’ assessments and by the evolution of the pain scores. Both drugs were well tolerated throughout the study. Clinical Significance Cimicoxib had non-inferior efficacy and tolerability when compared to carprofen for the control of perioperative pain in dogs undergoing orthopaedic or soft tissue surgery. PMID:23710692

Grandemange, E; Fournel, S; Woehrlé, F

2013-01-01

293

The influence of children's pain memories on subsequent pain experience.  

PubMed

Healthy children are often required to repeatedly undergo painful medical procedures (eg, immunizations). Although memory is often implicated in children's reactions to future pain, there is a dearth of research directly examining the relationship between the 2. The current study investigated the influence of children's memories for a novel pain stimulus on their subsequent pain experience. One hundred ten healthy children (60 boys) between the ages of 8 and 12 years completed a laboratory pain task and provided pain ratings. Two weeks later, children provided pain ratings based on their memories as well as their expectancies about future pain. One month following the initial laboratory visit, children again completed the pain task and provided pain ratings. Results showed that children's memory of pain intensity was a better predictor of subsequent pain reporting than their actual initial reporting of pain intensity, and mediated the relationship between initial and subsequent pain reporting. Children who had negatively estimated pain memories developed expectations of greater pain prior to a subsequent pain experience and showed greater increases in pain ratings over time than children who had accurate or positively estimated pain memories. These findings highlight the influence of pain memories on healthy children's expectations of future pain and subsequent pain experiences and extend predictive models of subsequent pain reporting. PMID:22560288

Noel, Melanie; Chambers, Christine T; McGrath, Patrick J; Klein, Raymond M; Stewart, Sherry H

2012-08-01

294

Dancing in pain: pain appraisal and coping in dancers.  

PubMed

This study investigated the relationships between the type of pain experienced (performance pain and injury pain), the cognitive appraisal of pain and pain coping styles in dancers. Fifty-one professional ballet and contemporary dancers (17 males and 34 females), with the mean age of 25.9 years, completed a general pain questionnaire, the Pain Appraisal Inventory, the Survey of Pain Attitudes Control Subscale, and the Sports Inventory for Pain. Multivariate analyses of variance indicated that both the cognitive appraisal of the pain and pain coping styles did not differ according to the type of pain experienced or the pain severity. However, it was found that dancers with performance pain of either low or high severity were more likely to dance in pain than dancers experiencing injury pain. Multiple regression analyses indicated that the appraisal of pain as threatening was predictive of the use of avoidance and catastrophizing pain coping styles. Overall, results indicated that dancers may not differentiate between performance pain and injury pain, or modify their appraisal and coping strategies according to the characteristics of the pain experienced. The study highlighted an opportunity for increased education for dancers in recognizing the difference between pain considered to be a routine aspect of training and pain which is a signal of serious injury. PMID:19618573

Anderson, Ruth; Hanrahan, Stephanie J

2008-01-01

295

Citalopram Treatment of Pediatric Recurrent Abdominal Pain and Comorbid Internalizing Disorders: An Exploratory Study  

ERIC Educational Resources Information Center

Objective: To assess the potential efficacy, tolerability, and safety of citalopram in the treatment of functional pediatric recurrent abdominal pain and comorbid internalizing disorders. Method: Twenty-five clinically referred children and adolescents with recurrent abdominal pain aged 7 to 18 years, inclusive, participated in a 12-week,…

Campo, John V.; Perel, James; Lucas, Amanda; Bridge, Jeff; Ehmann, Mary; Kalas, Catherine; Monk, Kelly; Axelson, David; Birmaher, Boris; Ryan, Neal; Di Lorenzo, Carlo; Brent, David A.

2004-01-01

296

Cannabinoids for neuropathic pain.  

PubMed

Treatment options for neuropathic pain have limited efficacy and use is fraught with dose-limiting adverse effects. The endocannabinoid system has been elucidated over the last several years, demonstrating a significant interface with pain homeostasis. Exogenous cannabinoids have been demonstrated to be effective in a range of experimental neuropathic pain models, and there is mounting evidence for therapeutic use in human neuropathic pain conditions. This article reviews the history, pharmacologic development, clinical trials results, and the future potential of nonsmoked, orally bioavailable, nonpsychoactive cannabinoids in the management of neuropathic pain. PMID:25160710

Fine, Perry G; Rosenfeld, Mark J

2014-10-01

297

Immune mediators of chronic pelvic pain syndrome.  

PubMed

The cause of chronic pelvic pain syndrome (CPPS) has yet to be established. Since the late 1980s, cytokine, chemokine, and immunological classification studies using human samples have focused on identifying biomarkers for CPPS, but no diagnostically beneficial biomarkers have been identified, and these studies have done little to deepen our understanding of the mechanisms underlying chronic prostatic pain. Given the large number of men thought to be affected by this condition and the ineffective nature of current treatments, there is a pressing need to elucidate these mechanisms. Prostatitis types IIIa and IIIb are classified according to the presence of pain without concurrent presence of bacteria; however, it is becoming more evident that, although levels of bacteria are not directly associated with levels of pain, the presence of bacteria might act as the initiating factor that drives primary activation of mast-cell-mediated inflammation in the prostate. Mast cell activation is also known to suppress regulatory T cell (Treg) control of self-tolerance and also activate neural sensitization. This combination of established autoimmunity coupled with peripheral and central neural sensitization can result in the development of multiple symptoms, including pelvic pain and bladder irritation. Identifying these mechanisms as central mediators in CPPS offers new insight into the prospective treatment of the disease. PMID:24686526

Murphy, Stephen F; Schaeffer, Anthony J; Thumbikat, Praveen

2014-05-01

298

Testing of a new pneumatic device to cause pain in humans  

Microsoft Academic Search

anterior tibia. The reproducibility of the pain was tested by rating the pressure that caused pain rated 4-5 on a visual analogue scale (VAS) on days 0, 7, and 24 in 10 volunteers. The effect of remifentanil (0.025, 0.05, 0.075, and 0.1 m gk g -1 min-1) on pain tolerance in another set of volunteers (n=11) was used as an

H. M. Schubert; I. H. Lorenz; F. Zschiegner; C. Kremser; M. Hohlrieder; M. Biebl; C. Kolbitsch; P. L. Moser

2004-01-01

299

An equine pain face  

PubMed Central

Objective The objective of this study was to investigate the existence of an equine pain face and to describe this in detail. Study design Semi-randomized, controlled, crossover trial. Animals Six adult horses. Methods Pain was induced with two noxious stimuli, a tourniquet on the antebrachium and topical application of capsaicin. All horses participated in two control trials and received both noxious stimuli twice, once with and once without an observer present. During all sessions their pain state was scored. The horses were filmed and the close-up video recordings of the faces were analysed for alterations in behaviour and facial expressions. Still images from the trials were evaluated for the presence of each of the specific pain face features identified from the video analysis. Results Both noxious challenges were effective in producing a pain response resulting in significantly increased pain scores. Alterations in facial expressions were observed in all horses during all noxious stimulations. The number of pain face features present on the still images from the noxious challenges were significantly higher than for the control trial (p = 0.0001). Facial expressions representative for control and pain trials were condensed into explanatory illustrations. During pain sessions with an observer present, the horses increased their contact-seeking behavior. Conclusions and clinical relevance An equine pain face comprising ‘low’ and/or ‘asymmetrical’ ears, an angled appearance of the eyes, a withdrawn and/or tense stare, mediolaterally dilated nostrils and tension of the lips, chin and certain facial muscles can be recognized in horses during induced acute pain. This description of an equine pain face may be useful for improving tools for pain recognition in horses with mild to moderate pain. PMID:25082060

Gleerup, Karina B; Forkman, Björn; Lindegaard, Casper; Andersen, Pia H

2015-01-01

300

Hypersensitivity Due to Stress  

PubMed Central

Basal, preoperative and postoperative perception thresholds and pain tolerance thresholds were studied in 32 patients undergoing minor oral surgery using monopolar stimulation of a vital anterior tooth. Significant differences were found between the perception and pain tolerance thresholds, the basal and preoperative perception and pain tolerance thresholds being higher than the postoperative thresholds. Decreased postoperative pain tolerance thresholds were found in patients with increased anxiety. The effect of premedication on the thresholds was also studied. Premedication with diazepam and pethidine caused an increase in the preoperative perception and pain tolerance thresholds but did not prevent a decrease in the postoperative perception and pain tolerance thresholds. The increase in the preoperative perception and pain tolerance thresholds caused by the premedication was equal in magnitude to the decrease in the thresholds measured immediately after surgery. PMID:2490058

Hampf, Göran

1989-01-01

301

Persistent Peripheral Inflammation Attenuates Morphine-induced Periaqueductal Gray Glial Cell Activation and Analgesic Tolerance in the Male Rat  

PubMed Central

Morphine is among the most prevalent analgesics prescribed for chronic pain. However, prolonged morphine treatment results in the development of analgesic tolerance. An abundance of evidence has accumulated indicating that CNS glial cell activity facilitates pain transmission and opposes morphine analgesia. While the midbrain ventrolateral periaqueductal gray (vlPAG) is an important neural substrate mediating pain modulation and the development of morphine tolerance, no studies have directly assessed the role of PAG-glia. Here we test the hypothesis that morphine-induced increases in vlPAG glial cell activity contribute to the development of morphine tolerance. As morphine is primarily consumed for the alleviation of severe pain, the influence of persistent inflammatory pain was also assessed. Administration of morphine, in the absence of persistent inflammatory pain, resulted in the rapid development of morphine tolerance and was accompanied by a significant increase in vlPAG glial activation. In contrast, persistent inflammatory hyperalgesia, induced by intraplantar administration of Complete Freund’s Adjuvant (CFA), significantly attenuated the development of morphine tolerance. No significant differences were noted in vlPAG glial cell activation for CFA-treated animals versus controls. These results indicate that vlPAG glia are modulated by a persistent pain state, and implicate vlPAG glial cells as possible regulators of morphine tolerance. Perspective The development of morphine tolerance represents a significant impediment to its use in the management of chronic pain. We report that morphine tolerance is accompanied by increased glial cell activation within the vlPAG, and that the presence of a persistent pain state prevented vlPAG glial activation and attenuated morphine tolerance. PMID:23395474

Eidson, Lori N.; Murphy, Anne Z.

2014-01-01

302

Deficient conditioned pain modulation after spinal cord injury correlates with clinical spontaneous pain measures.  

PubMed

The contribution of endogenous pain modulation dysfunction to clinical and sensory measures of neuropathic pain (NP) has not been fully explored. Habituation, temporal summation, and heterotopic noxious conditioning stimulus-induced modulation of tonic heat pain intensity were examined in healthy noninjured subjects (n = 10), and above the level of spinal cord injury (SCI) in individuals without (SCI-noNP, n = 10) and with NP (SCI-NP, n = 10). Thermoalgesic thresholds, Cz/AFz contact heat evoked potentials (CHEPs), and phasic or tonic (30 seconds) heat pain intensity were assessed within the C6 dermatome. Although habituation to tonic heat pain intensity (0-10) was reported by the noninjured (10 s: 3.5 ± 0.3 vs 30 s: 2.2 ± 0.5 numerical rating scale; P = 0.003), loss of habituation was identified in both the SCI-noNP (3.8 ± 0.3 vs 3.6 ± 0.5) and SCI-NP group (4.2 ± 0.4 vs 4.9 ± 0.8). Significant temporal summation of tonic heat pain intensity was not observed in the 3 groups. Inhibition of tonic heat pain intensity induced by heterotopic noxious conditioning stimulus was identified in the noninjured (-29.7% ± 9.7%) and SCI-noNP groups (-19.6% ± 7.0%), but not in subjects with SCI-NP (+1.1% ± 8.0%; P < 0.05). Additionally, the mean conditioned pain modulation response correlated positively with Cz/AFz CHEP amplitude (? = 0.8; P = 0.015) and evoked heat pain intensity (? = 0.8; P = 0.007) in the SCI-NP group. Stepwise regression analysis revealed that the mean conditioned pain modulation (R = 0.72) correlated with pain severity and pressing spontaneous pain in the SCI-NP group. Comprehensive assessment of sensory dysfunction above the level of injury with tonic thermal test and conditioning stimuli revealed less-efficient endogenous pain modulation in subjects with SCI-NP. PMID:25599447

Albu, Sergiu; Gómez-Soriano, Julio; Avila-Martin, Gerardo; Taylor, Julian

2015-02-01

303

Associative tolerance to nicotine analgesia in the rat: tail-flick and hot-plate assays  

E-print Network

dose-dependent elevation of pain tolerance. Pomerleau (1986) found that high-nicotine cigarettes and tobacco snuff increased the endurance to ice-water pain in the cold-presser paradigm as compared with control subjects. Perkins and colleagues (1994...

Reynoso, Jose T.

2012-06-07

304

Network problem threshold  

NASA Technical Reports Server (NTRS)

Network transmission errors such as collisions, CRC errors, misalignment, etc. are statistical in nature. Although errors can vary randomly, a high level of errors does indicate specific network problems, e.g. equipment failure. In this project, we have studied the random nature of collisions theoretically as well as by gathering statistics, and established a numerical threshold above which a network problem is indicated with high probability.

Gejji, Raghvendra, R.

1992-01-01

305

Neurological diseases and pain  

PubMed Central

Chronic pain is a frequent component of many neurological disorders, affecting 20–40% of patients for many primary neurological diseases. These diseases result from a wide range of pathophysiologies including traumatic injury to the central nervous system, neurodegeneration and neuroinflammation, and exploring the aetiology of pain in these disorders is an opportunity to achieve new insight into pain processing. Whether pain originates in the central or peripheral nervous system, it frequently becomes centralized through maladaptive responses within the central nervous system that can profoundly alter brain systems and thereby behaviour (e.g. depression). Chronic pain should thus be considered a brain disease in which alterations in neural networks affect multiple aspects of brain function, structure and chemistry. The study and treatment of this disease is greatly complicated by the lack of objective measures for either the symptoms or the underlying mechanisms of chronic pain. In pain associated with neurological disease, it is sometimes difficult to obtain even a subjective evaluation of pain, as is the case for patients in a vegetative state or end-stage Alzheimer's disease. It is critical that neurologists become more involved in chronic pain treatment and research (already significant in the fields of migraine and peripheral neuropathies). To achieve this goal, greater efforts are needed to enhance training for neurologists in pain treatment and promote greater interest in the field. This review describes examples of pain in different neurological diseases including primary neurological pain conditions, discusses the therapeutic potential of brain-targeted therapies and highlights the need for objective measures of pain. PMID:22067541

2012-01-01

306

Pain after earthquake  

PubMed Central

Introduction On 6 April 2009, at 03:32 local time, an Mw 6.3 earthquake hit the Abruzzi region of central Italy causing widespread damage in the City of L Aquila and its nearby villages. The earthquake caused 308 casualties and over 1,500 injuries, displaced more than 25,000 people and induced significant damage to more than 10,000 buildings in the L'Aquila region. Objectives This observational retrospective study evaluated the prevalence and drug treatment of pain in the five weeks following the L'Aquila earthquake (April 6, 2009). Methods 958 triage documents were analysed for patients pain severity, pain type, and treatment efficacy. Results A third of pain patients reported pain with a prevalence of 34.6%. More than half of pain patients reported severe pain (58.8%). Analgesic agents were limited to available drugs: anti-inflammatory agents, paracetamol, and weak opioids. Reduction in verbal numerical pain scores within the first 24 hours after treatment was achieved with the medications at hand. Pain prevalence and characterization exhibited a biphasic pattern with acute pain syndromes owing to trauma occurring in the first 15 days after the earthquake; traumatic pain then decreased and re-surged at around week five, owing to rebuilding efforts. In the second through fourth week, reports of pain occurred mainly owing to relapses of chronic conditions. Conclusions This study indicates that pain is prevalent during natural disasters, may exhibit a discernible pattern over the weeks following the event, and current drug treatments in this region may be adequate for emergency situations. PMID:22747796

2012-01-01

307

Prescription Pain Reliever Abuse and Dependence among Adolescents: A Nationally Representative Study  

ERIC Educational Resources Information Center

The study investigates the prevalence, patterns, and correlates of adolescents' abuse, sub-threshold dependence, and dependence on prescription pain relievers (PPRs) in a nationally representative sample. Results show dependence on PPRs can take place without abuse and that sub-threshold dependence could have implications for major diagnostic…

Wu, Li-Tzy; Ringwalt, Christopher L.; Mannelli, Paolo; Patkar, Ashwin A.

2008-01-01

308

Can widespread hypersensitivity in carpal tunnel syndrome be substantiated if neck and arm pain are absent?  

PubMed

Recent studies demonstrated that patients with carpal tunnel syndrome (CTS) have signs of thermal and mechanical hyperalgesia in extra-median territories suggesting an involvement of central pain mechanisms. As previous studies included patients with shoulder/arm symptoms or neck pain, a potential influence of these coexisting disorders cannot be excluded. This study therefore evaluated whether widespread sensory changes (hypoesthesia or hyperalgesia) are present in patients with unilateral CTS in the absence of coexisting disorders. Twenty-six patients with unilateral CTS with symptoms localised to their hand and 26 healthy controls participated in the study. A comprehensive quantitative sensory testing (QST) protocol including thermal and mechanical detection and pain thresholds was performed over the hands (median, ulnar and radial innervation area), lateral elbows, neck and tibialis anterior muscle. Patients with CTS demonstrated thermal and mechanical hypoesthesia in the hand but not at distant sites. Thermal or mechanical hyperalgesia was not identified at any location with traditional QST threshold testing. However, patients with CTS rated the pain during thermal pain testing significantly higher than healthy participants. This was especially apparent for heat pain ratings which were elevated not only in the affected hand but also in the neck and tibialis anterior muscle. In conclusion, CTS alone in the absence of coexisting neck and arm pain does not account for sensory changes outside the affected hand as determined by traditional QST threshold testing. Elevated pain ratings may however be an early indication of central pain mechanisms. PMID:22323374

Schmid, A B; Soon, B T C; Wasner, G; Coppieters, M W

2012-02-01

309

Inhibitory effect of bisphosphonate on osteoclast function contributes to improved skeletal pain in ovariectomized mice.  

PubMed

The aim of this study was to evaluate skeletal pain associated with osteoporosis and to examine the inhibitory effect of bisphosphonate (BP) on pain in an ovariectomized (OVX) mouse model. We evaluated skeletal pain in OVX mice through an examination of pain-like behavior as well as immunohistochemical findings. In addition, we assessed the effects of alendronate (ALN), a potent osteoclast inhibitor, on those parameters. The OVX mice showed a decrease in the pain threshold value, and an increase in the number of c-Fos immunoreactive neurons in laminae I-II of the dorsal horn of the spinal cord. Alendronate caused an increase in the pain threshold value and inhibited c-Fos expression. The serum level of tartrate-resistant acid phosphatase 5b, a marker of osteoclast activity, was significantly negatively correlated with the pain threshold value. Furthermore, we found that an antagonist of the transient receptor potential channel vanilloid subfamily member 1, which is an acid-sensing nociceptor, improved pain-like behavior in OVX mice. These results indicated that the inhibitory effect of BP on osteoclast function might contribute to an improvement in skeletal pain in osteoporosis patients. PMID:24633536

Abe, Yasuhisa; Iba, Kousuke; Sasaki, Koichi; Chiba, Hironori; Kanaya, Kumiko; Kawamata, Tomoyuki; Oda, Kimimitsu; Amizuka, Norio; Sasaki, Muneteru; Yamashita, Toshihiko

2014-03-16

310

Making Diagnostic Thresholds Less Arbitrary  

E-print Network

The application of diagnostic thresholds plays an important role in the classification of mental disorders. Despite their importance, many diagnostic thresholds are set arbitrarily, without much empirical support. This paper seeks to introduce...

Unger, Alexis Ariana

2012-07-16

311

Perioperative pain therapy in opioid abuse.  

PubMed

Opioid addiction represents an exaggerated organic and psychological comorbidity and should be regarded as a high-risk problem. Particular features seen perioperatively are tolerance, hyperalgesia and higher analgesic requirement together with physical and psychological withdrawal symptoms. Adequate pain management should have a high priority even for these patients.This review deals with the specific problems of addiction or opioid tolerance in this vulnerable patient group in the perioperative period. In this group are opioid-tolerant chronic pain patients on long-term therapy, addicts with long-term substitution therapy, those currently addicted and those with a previous history of addiction, mainly to heroin. This article intends to simplify the management of drug-dependent patients and offers strategies for perioperative analgesia that include stabilisation of physical dependency by substitution with methadone or ?-agonists; avoidance of stress; use of regional techniques in combination with non-opioids or opioids with higher doses than those used in non-addicts; avoidance of inadequate analgesic dosing; effective use of the opioid-sparing effect of different co-analgesics; and psychological support wherever appropriate.Those caring for abstinent patients should note that an inadequate dosage of analgesics can potentially reactivate addiction. After successful withdrawal of opioids and prolonged abstinence, opioid therapy can result in an exaggerated response. PMID:23241915

Stromer, Waltraud; Michaeli, Kristina; Sandner-Kiesling, Andreas

2013-02-01

312

Abdominal pain - children under age 12  

MedlinePLUS

Stomach pain in children; Pain - abdomen - children; Abdominal cramps in children; Belly ache in children ... When your child complains of abdominal pain, see if they can ... kinds of pain: Generalized pain or pain over more than half ...

313

Pain Management in Newborns.  

PubMed

As a standard of care for preterm/term newborns effective pain management may improve their clinical and neurodevelopmental outcomes. Neonatal pain is assessed using context-specific, validated, and objective pain methods, despite the limitations of currently available tools. Therapeutic approaches reducing invasive procedures and using pharmacologic, behavioral, or environmental measures are used to manage neonatal pain. Nonpharmacologic approaches like kangaroo care, facilitated tucking, non-nutritive sucking, sucrose, and others can be used for procedural pain or adjunctive therapy. Local/topical anesthetics, opioids, NSAIDs/acetaminophen and other sedative/anesthetic agents can be incorporated into NICU protocols for managing moderate/severe pain or distress in all newborns. PMID:25459780

Hall, Richard W; Anand, Kanwaljeet J S

2014-12-01

314

Pain and functional imaging.  

PubMed Central

Functional neuroimaging has fundamentally changed our knowledge about the cerebral representation of pain. For the first time it has been possible to delineate the functional anatomy of different aspects of pain in the medial and lateral pain systems in the brain. The rapid developments in imaging methods over the past years have led to a consensus in the description of the central pain responses between different studies and also to a definition of a central pain matrix with specialized subfunctions in man. In the near future we will see studies where a systems perspective allows for a better understanding of the regulatory mechanisms in the higher-order frontal and parietal cortices. Also, pending the development of experimental paradigms, the functional anatomy of the emotional aspects of pain will become better known. PMID:10466155

Ingvar, M

1999-01-01

315

Neonatal pain management  

PubMed Central

The past 2-3 decades have seen dramatic changes in the approach to pain management in the neonate. These practices started with refuting previously held misconceptions regarding nociception in preterm infants. Although neonates were initially thought to have limited response to painful stimuli, it was demonstrated that the developmental immaturity of the central nervous system makes the neonate more likely to feel pain. It was further demonstrated that untreated pain can have long-lasting physiologic and neurodevelopmental consequences. These concerns have resulted in a significant emphasis on improving and optimizing the techniques of analgesia for neonates and infants. The following article will review techniques for pain assessment, prevention, and treatment in this population with a specific focus on acute pain related to medical and surgical conditions.

Bhalla, Tarun; Shepherd, Ed; Tobias, Joseph D.

2014-01-01

316

Sleep Disorders and their Association with Laboratory Pain Sensitivity in Temporomandibular Joint Disorder  

PubMed Central

Study Objectives: We characterized sleep disorder rates in temporomandibular joint disorder (TMD) and evaluated possible associations between sleep disorders and laboratory measures of pain sensitivity. Design: Research diagnostic examinations were conducted, followed by two consecutive overnight polysomnographic studies with morning and evening assessments of pain threshold. Setting: Orofacial pain clinic and inpatient sleep research facility Participants: Fifty-three patients meeting research diagnostic criteria for myofascial TMD. Interventions: N/A Measurements and Results: We determined sleep disorder diagnostic rates and conducted algometric measures of pressure pain threshold on the masseter and forearm. Heat pain threshold was measured on the forearm; 75% met self-report criteria for sleep bruxism, but only 17% met PSG criteria for active sleep bruxism. Two or more sleep disorders were diagnosed in 43% of patients. Insomnia disorder (36%) and sleep apnea (28.4%) demonstrated the highest frequencies. Primary insomnia (PI) (26%) comprised the largest subcategory of insomnia. Even after controlling for multiple potential confounds, PI was associated with reduced mechanical and thermal pain thresholds at all sites (P < 0.05). Conversely, the respiratory disturbance index was associated with increased mechanical pain thresholds on the forearm (P < 0.05). Conclusions: High rates of PI and sleep apnea highlight the need to refer TMD patients complaining of sleep disturbance for polysomnographic evaluation. The association of PI and hyperalgesia at a non-orofacial site suggests that PI may be linked with central sensitivity and could play an etiologic role in idiopathic pain disorders. The association between sleep disordered breathing and hypoalgesia requires further study and may provide novel insight into the complex interactions between sleep and pain-regulatory processes. Citation: Smith MT; Wickwire EM; Grace EG; Edwards RR; Buenaver LF; Peterson S; Klick B; Haythornthwaite JA. Sleep disorders and their association with laboratory pain sensitivity in temporomandibular joint disorder. SLEEP 2009;32(6):779–790. PMID:19544755

Smith, Michael T.; Wickwire, Emerson M.; Grace, Edward G.; Edwards, Robert R.; Buenaver, Luis F.; Peterson, Stephen; Klick, Brendan; Haythornthwaite, Jennifer A.

2009-01-01

317

Loin pain haematuria syndrome: distress resolved by pain relief  

Microsoft Academic Search

Loin pain haematuria syndrome (LPHS) is a syndrome of severe chronic pain of unknown aetiology. This study assessed pain, mood variables and psychiatric status in patients (n=26) with LPHS. Patients were assessed before and after treatment with capsaicin. Assessment inventories used were the McGill Pain Questionnaire, the Pain Discomfort Scale, the General Health Questionnaire and the Hospital Anxiety and Depression

Matthew Bultitude; John Young; Michael Bultitude; James Allan

1998-01-01

318

Comparative Pain Scale 0 No pain. Feeling perfectly normal.  

E-print Network

pain, such as a sprained ankle when you stand on it wrong or mild back pain. Not only do you notice-migraine headache combined with several bee stings, or a bad back pain. Severe Unable to engage in normal activitiesComparative Pain Scale 0 No pain. Feeling perfectly normal. Minor Does not interfere with most

Kay, Mark A.

319

Complex regional pain syndrome.  

PubMed

Complex regional pain syndrome is a chronic pain syndrome that is often instigated by postoperative or post-traumatic events. The disease process can progress through three stages, the first of which tends to respond best to treatment. A review of the literature is presented, followed by a report of a patient who developed symptoms of complex regional pain syndrome following a water-skiing accident. PMID:10546427

Hernandez, W; Raja, A; Capuano, C

1999-10-01

320

Esophageal Chest Pain  

Microsoft Academic Search

\\u000a Esophageal chest pain has come under critical scrutiny recently [1]. Motility disorders in particular have fallen out of favor as a cause of chest pain [1–3], to the extent that chest pain of uncertain origin has now become a rare indication for esophageal manometry in the United\\u000a States [4]. The reasons for this include changing perceptions about the relevance of

John S de Caestecker

321

Painful Peripheral Neuropathies  

PubMed Central

Peripheral neuropathies are a heterogeneous group of diseases affecting peripheral nerves. The causes are multiple: hereditary, metabolic, infectious, inflammatory, toxic, traumatic. The temporal profile includes acute, subacute and chronic conditions. The majority of peripheral neuropathies cause mainly muscle weakness and sensory loss, positive sensory symptoms and sometimes pain. When pain is present, however, it is usually extremely intense and among the most disabling symptoms for the patients. In addition, the neurological origin of the pain is often missed and patients receive inadequate or delayed specific treatment. Independently of the disease causing the peripheral nerve injury, pain originating from axonal pathology or ganglionopathy privileges neuropathies affecting smaller fibres, a clinical observation that points towards abnormal activity within nociceptive afferents as a main generator of pain. Natural activation of blood vessels or perineurial nociceptive network by pathology also causes intense pain. Pain of this kind, i.e. nerve trunk pain, is among the heralding symptoms of inflammatory or ischemic mononeuropathy and for its intensity represents itself a medical emergency. Neuropathic pain quality rekindles the psychophysical experience of peripheral nerves intraneural microstimulation i.e. a combination of large and small fibres sensation temporally distorted compared to physiological perception evoked by natural stimuli. Pins and needles, burning, cramping mixed with numbness, and tingling are the wording most used by patients. Nociceptive pain instead is most often described as aching, deep and dull. Good command of peripheral nerve anatomy and pathophysiology allows timely recognition of the different pain components and targeted treatment, selected according to intensity, type and temporal profile of the pain. PMID:18615140

Marchettini, P; Lacerenza, M; Mauri, E; Marangoni, C

2006-01-01

322

[Pain suppression in the trigeminal region by means of transcutaneous nerve stimulation].  

PubMed

On the basis of the gate control theory, an attempt was made to influence acute pain by transcutaneous nerve stimulation (TNS) in the region of the trigeminal nerve. After favorable first results in clinical application, we determined sensation and pain treshold values of teeth in two groups of patients by exactly defined electric stimuli of different degrees. After transcutaneous electro-stimulation of the pertinent ramus of the trigeminal nerve with rectangular stimulating currents, the threshold measurements were repeated. The thresholds were raised by an average 79% as far as sensation was concerned, and by an average 69% as far as pain was concerned. PMID:1082811

Reuter, E; Krekeler, G; Krainick, J U; Thoden, U; Doerr, M

1976-03-01

323

Sex differences in brain response to anticipated and experienced visceral pain in healthy subjects  

PubMed Central

Women demonstrate higher pain sensitivity and prevalence of chronic visceral pain conditions such as functional gastrointestinal disorders than men. The role of sex differences in the brain processing of visceral pain is still unclear. In 16 male and 16 female healthy subjects we compared personality, anxiety levels, skin conductance response (SCR), and brain processing using functional MRI during anticipation and pain induced by esophageal distension at pain toleration level. There was no significant difference in personality scores, anxiety levels, SCR, and subjective ratings of pain between sexes. In group analysis, both men and women demonstrated a similar pattern of brain activation and deactivation during anticipation and pain consistent with previous reports. However, during anticipation women showed significantly greater activation in the cuneus, precuneus, and supplementary motor area (SMA) and stronger deactivation in the right amygdala and left parahippocampal gyrus, whereas men demonstrated greater activation in the cerebellum. During pain, women demonstrated greater activation in the midcingulate cortex, anterior insula, premotor cortex, and cerebellum and stronger deactivation in the caudate, whereas men showed increased activity in the SMA. The pattern of brain activity suggests that, during anticipation, women may demonstrate stronger limbic inhibition, which is considered to be a cognitive modulation strategy for impending painful stimulation. During pain, women significantly activate brain areas associated with the affective and motivation components of pain. These responses may underlie the sex differences that exist in pain conditions, whereby women may attribute more emotional importance to painful stimuli compared with men. PMID:23392235

Kano, Michiko; Farmer, Adam D.; Aziz, Qasim; Giampietro, Vincent P.; Brammer, Michael J.; Williams, Steven C. R.; Fukudo, Shin

2013-01-01

324

Opioid tolerance development: a pharmacokinetic/pharmacodynamic perspective.  

PubMed

The opioids are commonly used to treat acute and severe pain. Long-term opioid administration eventually reaches a dose ceiling that is attributable to the rapid onset of analgesic tolerance coupled with the slow development of tolerance to the untoward side effects of respiratory depression, nausea and decreased gastrointestinal motility. The need for effective-long term analgesia remains. In order to develop new therapeutics and novel strategies for use of current analgesics, the processes that mediate tolerance must be understood. This review highlights potential pharmacokinetic (changes in metabolite production, metabolizing enzyme expression, and transporter function) and pharmacodynamic (receptor type, location and functionality; alterations in signaling pathways and cross-tolerance) aspects of opioid tolerance development, and presents several pharmacodynamic modeling strategies that have been used to characterize time-dependent attenuation of opioid analgesia. PMID:18989788

Dumas, Emily O; Pollack, Gary M

2008-12-01

325

Ketamine in pain management.  

PubMed

For ketamine's fiftieth birthday, a narrative review of this unique drug in pain management is presented. Its history is traced from its conception, and its heritage, as a phencyclidine offspring, delineated. The earliest roots of the conceptions concerning the mechanisms of action are sought, and then followed in preclinical as well as clinical research. The major proposed mechanisms in the literature are commented on and evaluated. The growth of the clinical evidence for perioperative pain, acute pain, and chronic pain is followed from early attempts to systematic reviews. Finally, an attempt is made to foresee what the next 50 years might hold in store for our 50 years old. PMID:23663314

Persson, Jan

2013-06-01

326

Personalized treatment of pain.  

PubMed

Despite advances made in its understanding and treatment, chronic pain remains an unsolved and all too common problem. One of the main obstacles to successful management of pain is the high variability of many patients regarding both response to treatment and susceptibility to adverse effects, which curtails the utility of therapeutic intervention. Understanding the causes of this variability is an important challenge which may lead to a new era in rational pain management. As described in this review, however, there currently seems to be more than one possible explanation of this variability. Rational personalized pain management must take into consideration both ever-increasing knowledge of pharmacogenetics and pharmacokinetics and a broad, clinically based attitude incorporating co-morbidities, both physical and psychiatric, and concomitant medications. Novel models for testing in-vivo pain processing, for example assessment of conditioned pain modulation (CPM), are also promising approaches to use of rational data for empirical treatment of pain. Last, listening to the patient and understanding the context in which pain has affected his or her life is an important part of maintaining the personal nature of therapeutic interaction with patients suffering from pain. PMID:23292814

Ablin, Jacob N; Buskila, Dan

2013-01-01

327

Tinnitus and pain.  

PubMed

Tinnitus has many similarities with the symptoms of neurological disorders such as paresthesia and central neuropathic pain. There is considerable evidence that the symptoms and signs of some forms of tinnitus and central neuropathic pain are caused by functional changes in specific parts of the central nervous system and that these changes are caused by expression of neural plasticity. The changes in the auditory nervous system that cause tinnitus and the changes in the somatosensory systems that cause central neuropathic pain may have been initiated from the periphery, i.e. the ear or the auditory nerve for tinnitus and receptors and peripheral nerves in the body for pain. In the chronic condition of tinnitus and pain, abnormalities in the periphery may no longer play a role in the pathology, but the tinnitus is still referred to the ear and central neuropathic pain is still referred to the location on the body of the original pathology. In this chapter we will discuss specific similarities between tinnitus and pain, and compare tinnitus with other phantom disorders. Since much more is known about pain than about tinnitus, it is valuable to take advantage of the knowledge about pain in efforts to understand the pathophysiology of tinnitus and find treatments for tinnitus. PMID:17956770

Møller, A R

2007-01-01

328

Cannabinoids in the management of difficult to treat pain  

PubMed Central

This article reviews recent research on cannabinoid analgesia via the endocannabinoid system and non-receptor mechanisms, as well as randomized clinical trials employing cannabinoids in pain treatment. Tetrahydrocannabinol (THC, Marinol®) and nabilone (Cesamet®) are currently approved in the United States and other countries, but not for pain indications. Other synthetic cannabinoids, such as ajulemic acid, are in development. Crude herbal cannabis remains illegal in most jurisdictions but is also under investigation. Sativex®, a cannabis derived oromucosal spray containing equal proportions of THC (partial CB1 receptor agonist ) and cannabidiol (CBD, a non-euphoriant, anti-inflammatory analgesic with CB1 receptor antagonist and endocannabinoid modulating effects) was approved in Canada in 2005 for treatment of central neuropathic pain in multiple sclerosis, and in 2007 for intractable cancer pain. Numerous randomized clinical trials have demonstrated safety and efficacy for Sativex in central and peripheral neuropathic pain, rheumatoid arthritis and cancer pain. An Investigational New Drug application to conduct advanced clinical trials for cancer pain was approved by the US FDA in January 2006. Cannabinoid analgesics have generally been well tolerated in clinical trials with acceptable adverse event profiles. Their adjunctive addition to the pharmacological armamentarium for treatment of pain shows great promise. PMID:18728714

Russo, Ethan B

2008-01-01

329

Coping Styles, Pain Expressiveness, and Implicit Theories of Chronic Pain.  

PubMed

ABSTRACT Whereas some individuals use active coping strategies and are able to adaptively cope with their pain, others use passive strategies and catastrophic appraisals, which are often associated with increased displays of pain behavior and negative pain-related outcomes. To investigate attribution-based implicit theories as a potential underlying mechanism that might affect coping success, we hypothesized that pain patients with an incremental implicit theory of pain (i.e., view pain as malleable) would have more active coping strategies, lower levels of pain expressiveness, and better pain-related outcomes than those with an entity implicit theory of pain (i.e., view pain as nonmalleable). Patients with chronic back pain undergoing a functional assessment completed a variety of self-report measures and participated in a pain-inducing physiotherapy procedure. The results revealed those with an incremental theory of pain used more active coping strategies, displayed less pain behavior, and reported better pain-related outcomes (e.g., lower levels of depression) than individuals with an entity theory of pain. The findings suggest implicit theories of pain may represent an underlying social-cognitive mechanism linked to important coping, emotional, and expressive reactions to chronic pain. Identifying such a mechanism may provide valuable information for the assessment and treatment of chronic pain. PMID:25396698

Higgins, N C; Bailey, S Jeffrey; LaChapelle, Diane L; Harman, Katherine; Hadjistavropoulos, Thomas

2014-11-14

330

Oxytocin in the rat caudate nucleus influences pain modulation.  

PubMed

Our previous studies have demonstrated that oxytocin (OXT) in the central nervous system plays a role in pain modulation. Many studies have found that caudate nucleus (CdN) enriches OXT and OXT receptors by the methods of historadioautograph and gene expression. The communication was designed to investigate OXT effect in the rat CdN on pain modulation. The results showed that (1) intra-CdN microinjection of OXT receptor antagonist, desGly-NH(2), d(CH(2))(5)[D-Tyr(2), Thr-sup-4]OVT decreased the pain threshold, whereas the local administration of OXT increased the pain threshold in a dose-dependent manner; (2) OXT receptor antagonist can attenuate the analgesic role induced intra-CdN administration of OXT; and (3) pain stimulation could increase OXT concentration in the CdN perfusion liquid. The data suggested that OXT in the CdN was involved in this pain process via OXT receptors. PMID:21903147

Yang, Jun; Pan, Yan-Juan; Zhao, Ying; Qiu, Pei-Yong; Lu, Lu; Li, Peng; Chen, Feng; Yan, Xi-Qing; Wang, Da-Xin

2011-10-01

331

Grossman's Missing Health Threshold?  

PubMed Central

We present a generalized solution to Grossman's model of health capital (1972), relaxing the widely used assumption that individuals can adjust their health stock instantaneously to an “optimal” level without adjustment costs. The Grossman model then predicts the existence of a health threshold above which individuals do not demand medical care. Our generalized solution addresses a significant criticism: the model's prediction that health and medical care are positively related is consistently rejected by the data. We suggest structural- and reduced-form equations to test our generalized solution and contrast the predictions of the model with the empirical literature. PMID:21775003

Galama, Titus; Kapteyn, Arie

2011-01-01

332

Molecular pain, a new era of pain research and medicine.  

PubMed

Molecular pain is a relatively new and rapidly expanding research field that represents an advanced step from conventional pain research. Molecular pain research addresses physiological and pathological pain at the cellular, subcellular and molecular levels. These studies integrate pain research with molecular biology, genomics, proteomics, modern electrophysiology and neurobiology. The field of molecular pain research has been rapidly expanding in the recent years, and has great promise for the identification of highly specific and effective targets for the treatment of intractable pain. Although several existing journals publish articles on classical pain research, none are specifically dedicated to molecular pain research. Therefore, a new journal focused on molecular pain research is needed. Molecular Pain, an Open Access, peer-reviewed, online journal, will provide a forum for molecular pain scientists to communicate their research findings in a targeted manner to others in this important and growing field. PMID:15813987

Gu, Jianguo; Zhuo, Min; Caterina, Michael; MacDermott, Amy B; Malmberg, Annika; Neugebauer, Volker; Yoshimura, Megumu

2005-01-01

333

Factors associated with the modulation of pain by visual distortion of body size  

PubMed Central

Modulation of pain using visual distortion of body size (VDBS) has been the subject of various reports. However, the mechanism underlying the effect of VDBS on pain has been less often studied. In the present study, factors associated with modulation of pain threshold by VDBS were investigated. Visual feedback in the form of a magnified image of the hand was provided to 44 healthy adults to examine changes in pain. In participants with a higher pain threshold when visual feedback of a magnified image of the hand was provided, the two-point discrimination threshold decreased. In contrast, participants with a lower pain threshold with visual feedback of a magnified image of the hand experienced unpleasant emotions toward the magnified image of the hand. Interestingly, this emotional reaction was strongly associated with negative body consciousness in several subjects. These data suggested an analgesic effect of visual feedback in the form of a magnified image of the hand is only when tactile perception is vivid and the emotional reaction toward the magnified image is moderate. The results also suggested that negative body consciousness is important for the modulation of pain using VDBS. PMID:24688463

Osumi, Michihiro; Imai, Ryota; Ueta, Kozo; Nakano, Hideki; Nobusako, Satoshi; Morioka, Shu

2014-01-01

334

Pronociceptive actions of dynorphin maintain chronic neuropathic pain.  

PubMed

Whereas tissue injury increases spinal dynorphin expression, the functional relevance of this upregulation to persistent pain is unknown. Here, mice lacking the prodynorphin gene were studied for sensitivity to non-noxious and noxious stimuli, before and after induction of experimental neuropathic pain. Prodynorphin knock-out (KO) mice had normal responses to acute non-noxious stimuli and a mild increased sensitivity to some noxious stimuli. After spinal nerve ligation (SNL), both wild-type (WT) and KO mice demonstrated decreased thresholds to innocuous mechanical and to noxious thermal stimuli, indicating that dynorphin is not required for initiation of neuropathic pain. However, whereas neuropathic pain was sustained in WT mice, KO mice showed a return to baselines by post-SNL day 10. In WT mice, SNL upregulated lumbar dynorphin content on day 10, but not day 2, after injury. Intrathecal dynorphin antiserum reversed neuropathic pain in WT mice at post-SNL day 10 (when dynorphin was upregulated) but not on post-SNL day 2; intrathecal MK-801 reversed SNL-pain at both times. Opioid (mu, delta, and kappa) receptor density and G-protein activation were not different between WT and KO mice and were unchanged by SNL injury. The observations suggest (1) an early, dynorphin-independent phase of neuropathic pain and a later dynorphin-dependent stage, (2) that upregulated spinal dynorphin is pronociceptive and required for the maintenance of persistent neuropathic pain, and (3) that processes required for the initiation and the maintenance of the neuropathic pain state are distinct. Identification of mechanisms that maintain neuropathic pain appears important for strategies to treat neuropathic pain. PMID:11222667

Wang, Z; Gardell, L R; Ossipov, M H; Vanderah, T W; Brennan, M B; Hochgeschwender, U; Hruby, V J; Malan, T P; Lai, J; Porreca, F

2001-03-01

335

Characteristics of aversive thresholds measured by a titration schedule1  

PubMed Central

Three variables were studied for their single and joint effects on aversive thresholds obtained by a titration schedule with electric shock as the aversive stimulus. One variable was the interval between the periodic increments in shock amplitude. Another was the size of this increment. The third was the size of the decrement produced when the subject responded. Both monkeys and humans tolerated more shock at the shorter increment-to-increment intervals than at the longer ones, confirming rat data previously obtained. Reducing the decremental step size also led to an increase in the amount of shock tolerated by monkeys. In addition, simply reducing both incremental and decremental step size without changing the interval between increments led monkeys to tolerate more shock. The attempt to explain these data was based on the changes that such manipulations might produce in the amount of avoidance behavior elicited. PMID:14055954

Weiss, Bernard; Laties, Victor G.

1963-01-01

336

Hypnosis and Clinical Pain  

Microsoft Academic Search

Hypnosis has been demonstrated to reduce analogue pain, and studies on the mechanisms of laboratory pain reduction have provided useful applications to clinical populations. Studies showing central nervous system activity during hypnotic procedures offer preliminary information concerning possible physiological mechanisms of hypnotic analgesia. Randomized controlled studies with clinical populations indicate that hypnosis has a reliable and significant impact on acute

David R. Patterson; Mark P. Jensen

2003-01-01

337

Shoulder Pain COMMON CAUSES  

E-print Network

-injury. Once initial pain has eased a rehabilitation program of shoulder strengthening exercises and stretching strain. Muscle spasms may develop as strained muscles swell after injury. Rest and gentle stretching Pain See Your Healthcare Provider If Rehabilitation Exercises Patient Information: If you suspect

Virginia Tech

338

Chemical Interventions for Pain.  

ERIC Educational Resources Information Center

Reviews properties and pharmacological effects of medications for pain, including peripherally acting analgesics, centrally acting narcotics, and adjuvant analgesics including antidepressants. Discusses the role of the endogenous opioid system in pain and depression. Explores clinical management issues in both inpatient and outpatient settings,…

Aronoff, Gerald M.; And Others

1986-01-01

339

Sacroiliac joint pain - aftercare  

MedlinePLUS

... Trauma from impact, such as landing hard on buttocks Although, SIJ pain can be caused by trauma, this type of ... doctor may order: An injection to help with pain and inflammation. These injections can be repeated over time if necessary. Medicines ...

340

The pain of altruism.  

PubMed

Sociality and cooperation are benefits to human cultures but may carry unexpected costs. We suggest that both the human experience of pain and the expression of distress may result from many causes not experienced as painful in our close primate relatives, because human ancestors motivated to ask for help survived in greater numbers than either the thick-skinned or the stoic. PMID:25200380

Finlay, Barbara L; Syal, Supriya

2014-12-01

341

Diclofenac Topical (osteoarthritis pain)  

MedlinePLUS

... Diclofenac topical liquid (Pennsaid) is used to relieve osteoarthritis pain in the knees. Diclofenac is in a class of medications called ... area four times a day to treat arthritis pain. Topical diclofenac for ... apply to the knee four times a day. Topical diclofenac for osteoarthritis ...

342

Advances in Cancer Pain  

Microsoft Academic Search

dvances in cancer pain research and management are an example of the advances that have occurred within the field of neuro-oncology, the medical discipline that includes the diagnosis and treatment of primary central nervous system neoplasms, metastatic and nonmetastatic neurological complications of cancer originating outside the ner- vous system, and pain associated with cancer. Progress in the diagnosis and treatment

Kathleen M. Foley

1999-01-01

343

Lower Back Pain  

MedlinePLUS

... If your pain is severe, if you have lost feeling or movement, or if you have lost control of your bladder or bowels, see your ... If your pain is severe, if you have lost feeling or movement, or if you have lost ...

344

Early visceral pain predicts chronic pain after laparoscopic cholecystectomy.  

PubMed

Chronic pain after laparoscopic cholecystectomy is related to postoperative pain during the first postoperative week, but it is unknown which components of the early pain response is important. In this prospective study, 100 consecutive patients were examined preoperatively, 1week postoperatively, and 3, 6, and 12months postoperatively for pain, psychological factors, and signs of hypersensitivity. Overall pain, incisional pain (somatic pain component), deep abdominal pain (visceral pain component), and shoulder pain (referred pain component) were registered on a 100-mm visual analogue scale during the first postoperative week. Nine patients developed chronic unexplained pain 12months postoperatively. In a multivariate analysis model, cumulated visceral pain during the first week and number of preoperative biliary pain attacks were identified as independent risk factors for unexplained chronic pain 12months postoperatively. There were no consistent signs of hypersensitivity in the referred pain area either pre- or postoperatively. There were no significant associations to any other variables examined. The risk of chronic pain after laparoscopic cholecystectomy is relatively low, but significantly related to the visceral pain response during the first postoperative week. PMID:25250720

Blichfeldt-Eckhardt, Morten Rune; Ording, Helle; Andersen, Claus; Licht, Peter B; Toft, Palle

2014-11-01

345

Cutaneous pain effects induced by Nd:YAG and CO2 laser stimuli  

NASA Astrophysics Data System (ADS)

The near infrared laser technique can activate cutaneous nociceptors with high specificity and reproducibility and be used in anti-riot equipment. This study aimed to explore cutaneous pain effect and determine the threshold induced by Nd:YAG and CO2 laser stimuli. The corresponding wavelength was 1.32?m and 10.6?m. The pain effect was assessed in three healthy subjects (1 woman and 2 men) on the skin of dorsum of both hands. The energy of each pulse and whether the subjects felt a painful sensation after each stimulus were recorded. A simplified Bliss Method was used to calculate the pain threshold which were determined under three pulse durations for Nd:YAG laser and one pulse duration for CO2 laser. As a result the pain thresholds were determined to be 5.6J/cm2, 5.4J/cm2 and 5.0J/cm2 respectively when using Nd:YAG laser, 4.0mm beam diameter, 8ms, 0.1s and 1s pulse duration. The pain threshold was 1.0J/cm2 when using CO2 laser, 4.0mm beam diameter and 0.1s pulse duration. We concluded that the threshold of cutaneous pain elicited by 1.32?m laser was independent upon the pulse duration when the exposure time ranged from 8ms to 1s. Under the same exposure condition, the threshold of cutaneous pain elicited by 1.32?m laser was higher than that elicited by 10.6?m laser.

Wang, Jia-Rui; Yu, Guang-Yuan; Yang, Zai-Fu; Chen, Hong-Xia; Hu, Dong-Dong; Zou, Xian-Biao

2012-12-01

346

Increased thermal and mechanical nociceptive thresholds in rats with depressive-like behaviors  

PubMed Central

Clinical observations suggest that depressed patients were less sensitive to experimental pain than healthy subjects. However, few animal studies are reported concerning the association of depression and pain. The purpose of this study was to investigate the effects of unpredictable chronic mild stress (UCMS) induced depression on the perceived intensity of painful stimulation in rats. We measured the thermal and mechanical paw withdrawal thresholds (PWT) of normal and spinal nerve ligated (SNL) rats using hot plate test and von Frey test, respectively. The results showed that rats exposed to UCMS exhibited significantly higher thermal and mechanical pain thresholds in comparison to the non-depressed controls. In particular, the PWT of the SNL group was restored to nearly normal level after three weeks of UCMS, and even comparable to that of the control group. These results strongly suggest that the depressed subjects have decreased sensitivity to externally applied noxious stimulation, which is consistent with our previous findings. Research Highlight ? Unpredictable chronic mild stress (UCMS) induces depressive behaviors in rats ? UCMS elevates contact heat paw withdrawal threshold in normal rats ? UCMS elevates mechanical paw withdrawal threshold in normal rats ? UCMS elevates mechanical paw withdrawal threshold in SNL rats PMID:20637742

Shi, Miao; Qi, Wei-Jing; Gao, Ge; Wang, Jin-Yan; Luo, Fei

2010-01-01

347

Spinal dural AV fistula: an unusual cause of chest pain.  

PubMed

A 22 -year-old man presented with 6 months of sudden onset, incapacitating, left-sided chest pain occurring 1-2 times a week. The severity of the pain caused loss of consciousness several times leading to multiple fractures. Investigation with echocardiogram, exercise tolerance test, Holter monitor, chest X-ray and V/Q scan revealed no abnormality as did EEG and 48 h video telemetry. MRI of the thoracic and lumbar spine showed a spinal dural arteriovenous fistula (SDAVF) at the level of T6, confirmed on angiogram. The patient underwent division of the left T6 AV fistula. Following the operation, the patient has been completely pain free. Our patient, presenting in his early 20s does not fit the usual age demographic for SDAVF. A second atypical feature is his presentation with chest pain alone and no neurological symptoms. This case represents a rare presentation of SDAVF. PMID:24532234

Bioh, Gabriel; Bogle, Richard

2014-01-01

348

Improving pain management in orthopedic surgical patients with opioid tolerance.  

PubMed

As increasing numbers of the baby boomer generation seek health care, nursing staff educated in the evidence-based practice process can make significant contributions to successful patient outcomes. Health care providers who anticipate the approaching perfect storm in health care and thoughtfully plan, collaborate, and incorporate evidence-based practice methods will be well prepared to improve the quality of care, realize cost savings, and meet the challenges ahead. PMID:25155539

Doi, Kathleen; Shimoda, Rosanne; Gibbons, Gregory

2014-09-01

349

Back Pain and Emotional Distress  

MedlinePLUS

North American Spine Society Public Education Series Back Pain and Emotional Distress Common Reactions to Back Pain Four out of five adults will experience an episode of significant back pain sometime during ...

350

Taking narcotics for back pain  

MedlinePLUS

Narcotics are strong drugs that are sometimes used to treat pain. They are also called opioids. You ... types of pain medicine do not relieve pain. Narcotics can provide short-term relief of severe back ...

351

Easing Back Pain During Pregnancy  

MedlinePLUS

What causes back pain during pregnancy? The following changes during pregnancy can lead to back pain: • Strain on your back muscles • Abdominal ... you exercise. How can pregnancy hormones contribute to back pain? To prepare for the passage of the baby ...

352

Fibonacci scheme for fault-tolerant quantum computation Panos Aliferis1  

E-print Network

Fibonacci scheme for fault-tolerant quantum computation Panos Aliferis1 and John Preskill2 1 IBM; published 30 January 2009 We rigorously analyze Knill's Fibonacci scheme for fault-tolerant quantum proved accuracy thresholds, the Fibonacci scheme has a significantly reduced overhead cost because

Preskill, John

353

[Genetics, pain and analgesia].  

PubMed

Genomic variations influencing nociceptive sensitivity and susceptibility to pain conditions, as well as responses to pharmacotherapy of pain are currently under investigation. Candidate genes involved in pain perception, pain processing and pain management such as (opioid) receptors, transporters and other targets of pharmacotherapy are discussed. Drug metabolizing enzymes represent a further major target of ongoing research in order to identify associations between an individual's genetic profile and drug response (pharmacogenetics). Polymorphisms of the cytochrome P 450 enzymes influence analgesic efficacy of codeine, tramadol and tricyclic antidepressants (CYP2D6). Blood levels of some non-steroidal anti-inflammatory drugs (NSAIDs) are dependent on CYP2C9 activity, whereas opioid receptor polymorphisms are discussed with respect to differences in opioid-mediated analgesia and side-effects. Pharmacogenetics is seen as a potential diagnostic tool for improving patient therapy and care and will contribute to a more individualized drug treatment in the future. PMID:16625360

Stamer, U; Bayerer, B; Stüber, F

2006-07-01

354

An archaeology of pain  

NASA Astrophysics Data System (ADS)

Pain is a discursive construct of science and medicine. Through the discourses of biopower and technoscience pain is used to construct and maintain the social body. Biopower and technoscience are discursive practices that are enveloped within the disciplines of Western society. Specifically, the disciplines of education, science, and medicine use biopower and technoscience to normalize the body and construct binaries which create the abnormal. The cyborg is a discursive practice used to implode the binaries of the disciplines which maintain the social body. Through the implosion of binaries, the binary of mind/body is no longer plausible in the explanation of pain. Neuropathic chronic pain and phantom limb pain become cyborg discourses which operate to deconstruct the pedagogies of science and medicine.

Gruber, Dennis Michael

355

Musculoskeletal chest wall pain  

PubMed Central

The musculoskeletal structures of the thoracic wall and the neck are a relatively common source of chest pain. Pain arising from these structures is often mistaken for angina pectoris, pleurisy or other serious disorders. In this article the clinical features, pathogenesis and management of the various musculoskeletal chest wall disorders are discussed. The more common causes are costochondritis, traumatic muscle pain, trauma to the chest wall, “fibrositis” syndrome, referred pain, psychogenic regional pain syndrome, and arthritis involving articulations of the sternum, ribs and thoracic spine. Careful analysis of the history, physical findings and results of investigation is essential for precise diagnosis and effective treatment. ImagesFig. 3Fig. 4Fig. 5 PMID:4027804

Fam, Adel G.; Smythe, Hugh A.

1985-01-01

356

Quantum accuracy threshold for concatenated distance-3 codes  

E-print Network

We prove a new version of the quantum threshold theorem that applies to concatenation of a quantum code that corrects only one error, and we use this theorem to derive a rigorous lower bound on the quantum accuracy threshold epsilon_0. Our proof also applies to concatenation of higher-distance codes, and to noise models that allow faults to be correlated in space and in time. The proof uses new criteria for assessing the accuracy of fault-tolerant circuits, which are particularly conducive to the inductive analysis of recursive simulations. Our lower bound on the threshold, epsilon_0 > 2.73 \\times 10^{-5} for an adversarial independent stochastic noise model, is derived from a computer-assisted combinatorial analysis; it is the best lower bound that has been rigorously proven so far.

Panos Aliferis; Daniel Gottesman; John Preskill

2005-10-21

357

Optimising threshold levels for information transmission in binary threshold networks: Independent multiplicative noise on each threshold  

NASA Astrophysics Data System (ADS)

The problem of optimising the threshold levels in multilevel threshold system subject to multiplicative Gaussian and uniform noise is considered. Similar to previous results for additive noise, we find a bifurcation phenomenon in the optimal threshold values, as the noise intensity changes. This occurs when the number of threshold units is greater than one. We also study the optimal thresholds for combined additive and multiplicative Gaussian noise, and find that all threshold levels need to be identical to optimise the system when the additive noise intensity is a constant. However, this identical value is not equal to the signal mean, unlike the case of additive noise. When the multiplicative noise intensity is instead held constant, the optimal threshold levels are not all identical for small additive noise intensity but are all equal to zero for large additive noise intensity. The model and our results are potentially relevant for sensor network design and understanding neurobiological sensory neurons such as in the peripheral auditory system.

Zhou, Bingchang; McDonnell, Mark D.

2015-02-01

358

Development of mechanical and thermal nociceptive threshold testing devices in unrestrained birds (broiler chickens).  

PubMed

Behavioural signs of pain are difficult to quantify and interpret in animals. Nociceptive threshold testing is therefore a useful method for examining the perception and processing of noxious stimuli underlying pain states. Devices were developed to measure response thresholds to quantified, ramped mechanical and thermal nociceptive stimuli applied to the leg or keel of unrestrained birds. Up to 9N mechanical force was delivered via a single round-ended 2mm pin using a pneumatic actuator at 0.4Ns(-1). Heat was applied through a small copper element at 0.8°Cs(-1) to a maximum of 50°C. The repeatability and reliability of threshold measures were validated using 10-12 broiler chickens (aged 49-66 days) per site and modality. Mechanical threshold, or skin and threshold temperature, were recorded over three sessions across a 36h period. Both stimulus types elicited clear, reproducible behavioural responses. Mechanical threshold means and 95% confidence intervals were 3.0 (2.8-3.2)N for keel and 2.0 (1.8-2.1)N for leg sites. Keel thermal tests gave a mean skin temperature of 39.3 (39.1-39.5)°C, and threshold of 46.8 (46.6-47.1)°C. Leg skin temperature was 35.7 (35.6-35.9)°C and threshold 42.5 (42.2-42.8)°C. Threshold measures were consistent within and across sessions and birds showed individual repeatability across tests within sessions. Individual birds' mechanical keel thresholds were also repeatable across sessions. The apparatus gave reliable, reproducible measurements of thresholds to noxious mechanical and thermal stimuli. The range recorded was comparable with previously published nociceptor thresholds in dissected chicken nerve filament fibres, and the method appears suitable for studying nociceptive processes in broiler chickens. PMID:21843551

Hothersall, B; Caplen, G; Nicol, C J; Taylor, P M; Waterman-Pearson, A E; Weeks, C A; Murrell, J C

2011-09-30

359

Factors influencing time course of pain after depot oil intramuscular injection of testosterone undecanoate.  

PubMed

Pain following depot intramuscular (IM) injection of oil vehicle-based drugs has been little studied. This study aimed to determine prospectively the prevalence, determinants, severity and functional consequences of pain during the week after IM injection of 1 000 mg testosterone undecanoate (TU) in a 4-mL castor oil vehicle. Androgen-deficient men receiving regular T replacement therapy at an academic andrology clinic were recruited to report pain scores using a coloured visual linear analogue scale at seven times over the first day and daily for a week after a deep IM gluteal injection. The time course and covariables influencing pain scores were analysed by mixed model analysis of variance (ANOVA). Following 168 injections in 125 men, pain was reported by 80% of men, peaking immediately after injection, reaching only moderate severity, lasting 1-2 days and returning to baseline by day 4. The pain required little analgesic use and produced minimal interference in daily activities. The time course of pain scores was reproducible in the 43 men who underwent two consecutive injections. Pain was more severe in men who had an earlier painful injection, but less severe in older and more obese men. There were negligible differences in post-injection pain experience between experienced nurses administering injections. Deep IM gluteal injection of depot TU in 4-mL castor oil is well tolerated and post-injection pain is influenced by earlier painful injection experience, as well as age and obesity. PMID:20118950

Sartorius, Gideon; Fennell, Carolyn; Spasevska, Sasa; Turner, Leo; Conway, Ann J; Handelsman, David J

2010-03-01

360

Factors influencing time course of pain after depot oil intramuscular injection of testosterone undecanoate  

PubMed Central

Pain following depot intramuscular (IM) injection of oil vehicle-based drugs has been little studied. This study aimed to determine prospectively the prevalence, determinants, severity and functional consequences of pain during the week after IM injection of 1 000 mg testosterone undecanoate (TU) in a 4-mL castor oil vehicle. Androgen-deficient men receiving regular T replacement therapy at an academic andrology clinic were recruited to report pain scores using a coloured visual linear analogue scale at seven times over the first day and daily for a week after a deep IM gluteal injection. The time course and covariables influencing pain scores were analysed by mixed model analysis of variance (ANOVA). Following 168 injections in 125 men, pain was reported by 80% of men, peaking immediately after injection, reaching only moderate severity, lasting 1–2 days and returning to baseline by day 4. The pain required little analgesic use and produced minimal interference in daily activities. The time course of pain scores was reproducible in the 43 men who underwent two consecutive injections. Pain was more severe in men who had an earlier painful injection, but less severe in older and more obese men. There were negligible differences in post-injection pain experience between experienced nurses administering injections. Deep IM gluteal injection of depot TU in 4-mL castor oil is well tolerated and post-injection pain is influenced by earlier painful injection experience, as well as age and obesity. PMID:20118950

Sartorius, Gideon; Fennell, Carolyn; Spasevska, Sasa; Turner, Leo; Conway, Ann J.; Handelsman, David J.

2010-01-01

361

Basic aspects of musculoskeletal pain: from acute to chronic pain  

PubMed Central

The transition from acute to chronic musculoskeletal pain is not well understood. To understand this transition, it is important to know how peripheral and central sensitization are manifested and how they can be assessed. A variety of human pain biomarkers have been developed to quantify localized and widespread musculoskeletal pain. In addition, human surrogate models may be used to induce sensitization in otherwise healthy volunteers. Pain can arise from different musculoskeletal structures (e.g. muscles, joints, ligaments, or tendons), and differentiating the origin of pain from those different structures is a challenge. Tissue specific pain biomarkers can be used to tease these different aspects. Chronic musculoskeletal pain patients in general show signs of local/central sensitization and spread of pain to degrees which correlate to pain intensity and duration. From a management perspective, it is therefore highly important to reduce pain intensity and try to minimize the duration of pain. PMID:23115471

Arendt-Nielsen, Lars; Fernández-de-las-Peñas, César; Graven-Nielsen, Thomas

2011-01-01

362

Oscillatory Threshold Logic  

PubMed Central

In the 1940s, the first generation of modern computers used vacuum tube oscillators as their principle components, however, with the development of the transistor, such oscillator based computers quickly became obsolete. As the demand for faster and lower power computers continues, transistors are themselves approaching their theoretical limit and emerging technologies must eventually supersede them. With the development of optical oscillators and Josephson junction technology, we are again presented with the possibility of using oscillators as the basic components of computers, and it is possible that the next generation of computers will be composed almost entirely of oscillatory devices. Here, we demonstrate how coupled threshold oscillators may be used to perform binary logic in a manner entirely consistent with modern computer architectures. We describe a variety of computational circuitry and demonstrate working oscillator models of both computation and memory. PMID:23173034

Borresen, Jon; Lynch, Stephen

2012-01-01

363

[Multimodal pain therapy].  

PubMed

Chronic pain has both high prevalence and a significant economic impact in Germany. The most common chronic pain types are low back pain and headache. On the one hand, the management of chronic pain patients is incomplete, yet it is often overtreated in orthopaedic surgical settings with interventional procedures. The reason for this is the structure of outpatient management and the way it is paid for in Germany. Pain management of patients with private insurance cover is no better because of "doctor shopping". Medical guidelines could be of some help in improving the situation, but they are widely unknown, and have still to demonstrate whether they have any impact on GP treatment pathways. The "gold standard" multimodal pain therapy shows significant improvement in many studies compared to monomodal therapy regimes and interventional regimes, but is too rarely recommended by the patients' physicians, whether GPs or specialists. Because of the huge number of institutions nowadays that, for the sake of form, offer such multimodal therapies, these need to be differentiated in terms of their structural and process quality. A first step is the "k edoq" project. It is essential to improve knowledge of the principles of modern pain management. This includes better networking and communication between doctors, physiotherapists and psychologists, and at the grassroots level, providing the public with more detailed and better information. PMID:25000627

Böger, A

2014-06-01

364

Breast cancer pain management - A review of current & novel therapies  

PubMed Central

Breast cancer is one of the most prevalent cancers amongst women in the world. Unfortunately, even after adequate treatment, some patients experience severe pain either due to disease progression or due to treatment related side effects. The persistent pain causes a negative physical and psychosocial impact on patients’ lives. Current rational pain management is patient-centred and requires a thorough psychological assessment. Usually adequate analgesia is achieved by adopting the WHO's three step analgesic ladder. As the disease progresses, the pain experienced by the patient also increases. This necessitates the administration of opioids and adjuvant analgesics to the breast cancer patients experiencing severe pain. However, opioid use is associated with intolerable side effects like constipation, nausea, vomiting, fear of dependence, and tolerance. Concomitant medications are required to combat these unacceptable side effects. Adjuvant analgesics need to be added to provide adequate and satisfactory analgesia. These factors worsen the psychological state of patients and deteriorate their quality of life. Hence, there is a need to develop therapeutic modalities to provide adequate analgesia with minimum side effects. This review article focuses on the current treatments available for cancer pain management, their limitations, and novel targets and non-pharmacological measures under investigation which have the potential to produce a radical change in pain management measures for the breast cancer patients. PMID:24718395

Satija, Aanchal; Ahmed, Syed Mehmood; Gupta, Rahul; Ahmed, Arif; Rana, Shiv Pratap Singh; Singh, Suraj Pal; Mishra, Seema; Bhatnagar, Sushma

2014-01-01

365

Breast cancer pain management - a review of current & novel therapies.  

PubMed

Breast cancer is one of the most prevalent cancers amongst women in the world. Unfortunately, even after adequate treatment, some patients experience severe pain either due to disease progression or due to treatment related side effects. The persistent pain causes a negative physical and psychosocial impact on patients' lives. Current rational pain management is patient-centred and requires a thorough psychological assessment. Usually adequate analgesia is achieved by adopting the WHO's three step analgesic ladder. As the disease progresses, the pain experienced by the patient also increases. This necessitates the administration of opioids and adjuvant analgesics to the breast cancer patients experiencing severe pain. However, opioid use is associated with intolerable side effects like constipation, nausea, vomiting, fear of dependence, and tolerance. Concomitant medications are required to combat these unacceptable side effects. Adjuvant analgesics need to be added to provide adequate and satisfactory analgesia. These factors worsen the psychological state of patients and deteriorate their quality of life. Hence, there is a need to develop therapeutic modalities to provide adequate analgesia with minimum side effects. This review article focuses on the current treatments available for cancer pain management, their limitations, and novel targets and non-pharmacological measures under investigation which have the potential to produce a radical change in pain management measures for the breast cancer patients. PMID:24718395

Satija, Aanchal; Ahmed, Syed Mehmood; Gupta, Rahul; Ahmed, Arif; Rana, Shiv Pratap Singh; Singh, Suraj Pal; Mishra, Seema; Bhatnagar, Sushma

2014-02-01

366

Radiofrequency ablation of osseous metastases for the palliation of pain  

PubMed Central

A number of different methods have been proposed for pain relief in cancer patients with bone metastases, each with different indications, contraindications and complications (systemic analgesics, bisphosphonates, antitumor chemotherapy, radiotherapy, systemic radio-isotopes, local surgery and vertebroplasty). The ideal treatment has to be fast, safe, effective and tolerable for the patient. CT-guided radiofrequency (RF) ablation may fulfill these criteria. Our experience in the treatment of 30 patients (34 lesions) with painful bone metastases using RF ablation was assessed. There was a significant decrease in the mean past-24-h Brief Pain Inventory (BPI) score for worst pain, for average pain and for pain interference during daily life (4.7, 4.8 and 5.3 units respectively) 4 and 8 weeks after treatment. There was a marked decrease (3 out of 30 patients 4 and 8 weeks after treatment) in the use of analgesics. CT-guided RF ablation appears to be effective for treatment of painful bone metastases. PMID:18030464

Mylona, S.; Galani, P.; Tzavoulis, D.; Kalioras, V.; Tanteles, S.; Pomoni, M.

2007-01-01

367

Learning foraging thresholds for lizards  

SciTech Connect

This work gives a proof of convergence for a randomized learning algorithm that describes how anoles (lizards found in the Carribean) learn a foraging threshold distance. This model assumes that an anole will pursue a prey if and only if it is within this threshold of the anole`s perch. This learning algorithm was proposed by the biologist Roughgarden and his colleagues. They experimentally confirmed that this algorithm quickly converges to the foraging threshold that is predicted by optimal foraging theory our analysis provides an analytic confirmation that the learning algorithm converses to this optimal foraging threshold with high probability.

Goldberg, L.A. [Univ. of Warwick, Coventry (United Kingdom). Dept. of Computer Science; Hart, W.E. [Sandia National Labs., Albuquerque, NM (United States); Wilson, D.B. [Massachusetts Inst. of Tech., Cambridge, MA (United States)

1996-01-12

368

Nonspecific Arm Pain  

PubMed Central

Nonspecific activity-related arm pain is characterized by an absence of objective physical findings and symptoms that do not correspond with objective pathophysiology. Arm pain without strict diagnosis is often related to activity, work-related activity in particular, and is often seen in patients with physically demanding work. Psychological factors such as catastrophic thinking, symptoms of depression, and heightened illness concern determine a substantial percentage of the disability associated with puzzling hand and arm pains. Ergonomic modifications can help to control symptoms, but optimal health may require collaborative management incorporating psychosocial and psychological elements of illness. PMID:25207288

Moradi, Ali; Ebrahimzadeh, Mohammad H; Ring, David

2013-01-01

369

Fault-Tolerant Measurement-Based Quantum Computing with Continuous-Variable Cluster States  

E-print Network

A long-standing open question about Gaussian continuous-variable cluster states is whether they enable fault-tolerant measurement-based quantum computation. The answer is yes. Initial squeezing in the cluster above a threshold value of 20.5 dB ensures that errors from finite squeezing acting on encoded qubits are below the fault-tolerance threshold of known qubit-based error-correcting codes. By concatenating with one of these codes and using ancilla-based error correction, fault-tolerant measurement-based quantum computation of theoretically indefinite length is possible with finitely squeezed cluster states.

Nicolas C. Menicucci

2014-04-03

370

Thresholds for correcting errors, erasures, and faulty syndrome measurements in degenerate quantum codes  

E-print Network

We suggest a technique for constructing lower (existence) bounds for the fault-tolerant threshold to scalable quantum computation applicable to degenerate quantum codes with sublinear distance scaling. We give explicit analytic expressions combining probabilities of erasures, depolarizing errors, and phenomenological syndrome measurement errors for quantum LDPC codes with logarithmic or larger distances. These threshold estimates are parametrically better than the existing analytical bound based on percolation.

Ilya Dumer; Alexey A. Kovalev; Leonid P. Pryadko

2014-12-18

371

Low Pain vs No Pain Multi-core Haskells  

E-print Network

Chapter 1 Low Pain vs No Pain Multi-core Haskells M. KH. Aswad , P. W. Trinder, A. D. Al Zain, G. J uses 15 'typical' programs to compare a 'no pain', i.e. entirely implicit, parallel language with three 'low pain', i.e. semi-explicit languages. The parallel Haskell implementations use different versions

Trinder, Phil

372

PAIN MEDICINE Neural Correlates of Chronic Low Back Pain Measured  

E-print Network

PAIN MEDICINE Neural Correlates of Chronic Low Back Pain Measured by Arterial Spin Labeling Ajay D of the CP exacerba- tions for each back pain subject. Results: The clinically significant worsening.D., Randy L. Gollub, M.D., Ph.D.# ABSTRACT Background: The varying nature of chronic pain (CP) is difficult

Napadow, Vitaly

373

Influence of anatomic location of lidocaine patch 5% on effectiveness and tolerability for postherpetic neuralgia  

PubMed Central

Purpose Lidocaine patch 5% is recommended as a first-line therapy for postherpetic neuralgia pain in neuropathic pain guidelines. Postherpetic neuralgia can occur anywhere on the body but often follows acute herpes zoster occurring in trigeminal and brachial plexus dermatomes. An analysis was conducted to determine whether the anatomic location of lidocaine patch 5% is associated with variations in effectiveness or tolerability in patients with postherpetic neuralgia. Methods This was a post hoc analysis by anatomic site of patch placement (head [including neck], trunk [chest, abdomen, back, hips], and extremities [arm, leg]) of a 4-week, multicenter, open-label study that enrolled patients with persistent pain following herpes zoster infection. Effectiveness was measured by Brief Pain Inventory (BPI) average pain intensity (0 [no pain] to 10 [worst imaginable pain]) and the BPI subscale for pain relief (0% [no relief] to 100% [complete relief]). Tolerability was assessed on the basis of patient-reported adverse events. Results Of 332 enrolled patients (59.6% women [n = 198]; 92.5% white [n = 307]; mean [standard deviation] age, 71.2 [13.9] years), those (n = 203) who applied lidocaine patch 5% to a single anatomic site only and had baseline and postbaseline pain score data were analyzed (trunk, n = 130; head, n = 41; extremities, n = 32). The frequency of adverse events differed significantly by anatomic location, with significantly more adverse events reported with patch placement on the head versus the extremities (P = 0.006) or trunk (P = 0.02). BPI average pain improved significantly from baseline in each of the three anatomic areas (mean score decrease, 1.50–2.04; P ? 0.002), with no significant difference in effectiveness by patch location. Conclusion Lidocaine 5% patch was effective and generally well tolerated for each anatomic area evaluated, although application to the head was tolerated less well compared with the trunk and extremities. PMID:23814464

Nalamachu, Srinivas; Wieman, Matthew; Bednarek, Leah; Chitra, Surya

2013-01-01

374

The effect of experimentally-induced subacromial pain on proprioception.  

PubMed

Shoulder injuries may be associated with proprioceptive deficits, however, it is unknown whether these changes are due to the experience of pain, tissue damage, or a combination of these. The aim of this study was to investigate the effect of experimentally-induced sub-acromial pain on proprioceptive variables. Sub-acromial pain was induced via hypertonic saline injection in 20 healthy participants. Passive joint replication (PJR) and threshold to detection of movement direction (TTDMD) were assessed with a Biodex System 3 Pro isokinetic dynamometer for baseline control, experimental pain and recovery control conditions with a starting position of 60° shoulder abduction. The target angle for PJR was 60° external rotation, starting from 40°. TTDMD was tested from a position of 20° external rotation. Repeated measures ANOVAs were used to determine differences between PJR absolute and variable errors and TTDMD for the control and experimental conditions. Pain was elicited with a median 7 on the Numeric Pain Rating Scale. TTDMD was significantly decreased for the experimental pain condition compared to baseline and recovery conditions (?30%, P = 0.003). No significant differences were found for absolute (P = 0.152) and variable (P = 0.514) error for PJR. Movement sense was enhanced for the experimental sub-acromial pain condition, which may reflect protective effects of the central nervous system in response to the pain. Where decreased passive proprioception is observed in shoulders with injuries, these may be due to a combination of peripheral tissue injury and neural adaptations that differ from those due to acute pain. PMID:25261091

Sole, Gisela; Osborne, Hamish; Wassinger, Craig

2015-02-01

375

Pain Control: Support for People with Cancer  

MedlinePLUS

Español Pain Control: Support for People With Cancer Pain Control is for people who have pain from cancer or from its ... health care team How to make your pain control plan work for you Pain control medicines and ...

376

Tolerance.org  

NSDL National Science Digital Library

While some groups only give lip service to spreading the good word about the importance of tolerance, the Southern Poverty Law Center has created this fine website to disseminate valuable materials for people interested in dismantling bigotry and creating communities that welcome and value diversity. The site has much to offer, including daily news updates about groups and individuals working for tolerance and fighting hate, guidebooks for adult and youth activists, and educational games for young children. The site is thematically divided into areas for teachers, teens, children, and parents. The parents section has some great resources, including a feature titled "10 Ways to Nurture Tolerance" and a list of helpful books on the theme of tolerance for parents that is quite handy. Educators will find the "Teaching Tolerance" area a welcome find, as it contains a number of classroom activities and the current edition (along with an archive) of their Teaching Tolerance magazine.

377

Acid tolerance in amphibians  

SciTech Connect

Studies of amphibian acid tolerance provide information about the potential effects of acid deposition on amphibian communities. Amphibians as a group appear to be relatively acid tolerant, with many species suffering increased mortality only below pH 4. However, amphibians exhibit much intraspecific variation in acid tolerance, and some species are sensitive to even low levels of acidity. Furthermore, nonlethal effects, including depression of growth rates and increases in developmental abnormalities, can occur at higher pH.

Pierce, B.A.

1985-04-01

378

Managing Cancer Pain  

PubMed Central

Despite the existence of effective analgesic drugs, many cancer patients live and die with ineffective pain control. The control of cancer pain is largely achievable with the appropriate use of available analgesics and co-analgesics. It requires attention to detail by a sympathetic physician who will treat the patient as a whole person. The support of knowledgeable nursing, social work, and chaplaincy staff in hospital and at home is essential to the on-going care of these patients. The major obstacles to the control of cancer pain are the physician's lack of detailed inquiry and attention, combined with the inappropriate and inadequate use of analgesics. The misinformation, prejudice and fear surrounding narcotic analgesics are largely unfounded in treating this group of patients. This article addresses issues of management and details a logical approach to analgesic use in patients with cancer pain. PMID:21279022

Latimer, Elizabeth

1984-01-01

379

Magnets for Pain Relief  

MedlinePLUS

Magnets for Pain Relief On this page: Introduction Key Points About Magnets Safety and Side Effects What ... help ensure coordinated and safe care. Top About Magnets A magnet produces a measurable force called a ...

380

Pain Management Programs  

MedlinePLUS

... care providers working directly with the person with pain with a variety of measurement, interventions, and strategies for self-management designed to offer a complete program from assessment, ...

381

Pain medications - narcotics  

MedlinePLUS

... than 3 to 4 months. NAMES OF NARCOTICS Codeine Fentanyl (Duragesic) -- available as a patch Hydrocodone ( Vicodin) ... specialist to help you manage long-term pain. SIDE EFFECTS OF NARCOTICS Drowsiness and impaired judgment often occur ...

382

Palliative care - managing pain  

MedlinePLUS

... Advil, Motrin), diclofenac Narcotics or opioids , such as codeine, morphine, oxycodone, or fentanyl Medicines that work on ... relieve your pain, a different one may help. Side effects, like drowsiness, may get better over time. Other ...

383

Pain management after craniotomy.  

PubMed

Fear of the side effects of analgesic drugs frequently leads to the under-treatment of post-craniotomy pain. Nevertheless, this pain continues to be commonly observed, is frequently severe, and, if unrelieved, may cause distress for the neurosurgical patient and serious complications for the operative brain. We review recent evidence-based data on pain therapy after intracranial surgery. Especially when performed at the end of surgery, local anaesthetic scalp infiltration provides adequate, short-term postoperative pain relief. Opioids, such as morphine or oxycodone, may be used in the early period after craniotomy. If titrated properly, opioids do not increase serious side effects as compared with codeine. The non-narcotics ketoprofen, tramadol, and paracetamol may be useful as supplemental, opioid-sparing drugs. There is a need for larger trials to delineate safety and efficacy of analgesic therapies with a focus on short- and long-term outcomes. PMID:18286837

Nemergut, Edward C; Durieux, Marcel E; Missaghi, Nizam B; Himmelseher, Sabine

2007-12-01

384

Patellofemoral Pain Syndrome  

MedlinePLUS

... on nonimpact elliptical trainers, which are popular at gyms. Because these machines support your body weight, they ... What kind of exercise should I do? Bibliography Management of Patellofemoral Pain Syndrome by S Dixit, M.D., ...

385

Pain: Hope through Research  

MedlinePLUS

... and tumors associated with neurofibromatosis , a neurogenetic disorder. Sports injuries are common. Sprains, strains, bruises, dislocations, and ... all well-known words in the language of sports. Pain is another. In extreme cases, sports injuries ...

386

Complex Regional Pain Syndrome  

MedlinePLUS

... aspartate (NMDA) receptor antagonists such as dextromethorphan and ketamine nasal calcitonin, especially for deep bone pain, and ... involving individuals with acute-phase CRPS is planned. Ketamine . Investigators are using low doses of ketamine—a ...

387

Mechanisms of Neuropathic Pain  

PubMed Central

Neuropathic pain refers to pain that originates from pathology of the nervous system. Diabetes, infection (herpes zoster),nerve compression, nerve trauma, “channelopathies,” and autoimmune disease are examples of diseases that maycause neuropathic pain. The development ofbothanimal models and newer pharmacological strategies has led to an explosion of interest in the underlying mechanisms. Neuropathic pain reflects both peripheral and central sensitization mechanisms. Abnormal signals arise not only from injured axons but also from the intact nociceptors that share the innervation territory of the injured nerve. This review focuses on how both human studies and animal models are helping to elucidate the mechanisms underlying these surprisingly common disorders. The rapid gain in knowledge about abnormal signaling promises breakthroughs in the treatment of these often debilitating disorders. PMID:17015228

Campbell, James N.; Meyer, Richard A.

2007-01-01

388

American Pain Society  

MedlinePLUS

... Interest Policy Code of Ethics Awards and Grants Annual Reports Press Room Membership Member Benefits/Join APS Join/ ... Bulletin Archives APS E-News Clinical Practice Guidelines Annual Reports Online Store Advocacy Pain Care Coalition Washington Wire ...

389

Greater trochanteric pain syndrome.  

PubMed

Pain around the greater trochanter is still a common clinical problem that may be secondary to a variety of either intra-articular or periarticular pathologies. Gluteal tendon pathologies are one of the primary causes of greater trochanteric pain, with attrition of the fasciae latae against the gluteus medius and minimus tendons, and the trochanteric bursa being possible causes. Key sonographic findings of gluteal tendinopathy, bursitis, and differential diagnosis are described in this overview. Clinical diagnosis and treatment of greater trochanteric pain syndrome is still challenging; therefore ultrasound is helpful to localize the origin of pain, determine underlying pathology, and, based on these findings, to guide local aspiration and/or injection in cases of tendinopathy and/or bursitis. PMID:23487333

Klauser, Andrea S; Martinoli, Carlo; Tagliafico, Alberto; Bellmann-Weiler, Rosa; Feuchtner, Gudrun M; Wick, Marius; Jaschke, Werner R

2013-02-01

390

Mechanism of transmission and modulation of renal pain in cats; effects of transcutaneous electrical nerve stimulation on renal pain.  

PubMed

Transcutaneous electrical nerve stimulation (TENS) has widely been employed as a method of obtaining analgesia in medical practice. The mechanisms of pain relief by TENS are known to be associated with the spinal gate control mechanism or descending pain inhibitory system. However, most of the studies concerning the analgesic effects and their mechanisms for TENS have dealt with somatic pain. Thus, in this experiment, we investigated the analgesic effects of TENS on renal pain as a model of visceral pain, and the characteristics of the dorsal horn cells with renal inputs. The renal pain was induced by acute occlusion of the ureter or renal artery. The main results are summarized as follows: 1) The renal nerve was composed of A beta, A delta and C fiber groups; the thresholds for each group were 400-800 mV, 1.1-1.5 V, and 2.1-5.8 V, respectively. 2) The dorsal horn cells tested received A and/or C afferent fibers from the kidney, and the more C inputs the dorsal horn cells had, the greater was the response to the stimuli that elicited the renal pain. 3) 94.9% of cells with renal input had the concomitant somatic receptive fields on the skin; the high threshold (HT) and wide dynamic range (WDR) cells exhibited a greater responses than low threshold (LT) cells to the renal pain-producing stimuli. 4) TENS reduced the C-responses of dorsal horn cells to 38.9 +/- 8.4% of the control value and the effect lasted for 10 min after the cessation of TENS. 5) By TENS, the responses evoked by acute occlusion of the ureter or renal artery were reduced to 37.5 +/- 9.7% and 46.3 +/- 8.9% of the control value, respectively. This analgesic effects lasted 10 min after TENS. 6) The responses elicited by squeezing the receptive fields of the skin were reduced to 40.7 +/- 7.9% of the control value and the effects lasted 15 min after TENS. These results suggest that most of dorsal horn cells with renal inputs have the concomitant somatic inputs and TENS can alleviate the renal pain as well as somatic pain. PMID:7618365

Nam, T S; Baik, E J; Shin, Y U; Jeong, Y; Paik, K S

1995-05-01

391

Evaluation of exercise and potassium chloride supplementation on blood pressure and nociceptive threshold in hypertensive rats.  

PubMed

Hypertensive subjects present an increased nociceptive threshold, and the lack or delay of pain perception may impede detection of angina and myocardial infarction. Nutritional interventions, like potassium chloride (KCl) diet supplementation, and exercises are common nonpharmacological indications for treating hypertension. Spontaneous hypertensive rats (SHR) and normotensive male Wistar rats were submitted to a combination of exercise and KCl diet supplementation. Exercise reduced the nociceptive threshold in SHR; however, this effect was inhibited by KCl supplementation. Exercise and KCl supplementation did not alter systolic blood pressure. Reduction of the nociceptive threshold by exercise may be important for the detection of angina and myocardial infarction in hypertensive individuals. PMID:20383229

Galdino, Giovane S; Lopes, Airton M C; Franca, Valéria M; Duarte, Igor D G; Perez, Andrea C

2010-04-01

392

Sulfur tolerant anode materials  

SciTech Connect

The goal of this program is the development of a molten carbonate fuel cell (MCFC) anode which is more tolerant of sulfur contaminants in the fuel than the current state-of-the-art nickel-based anode structures. This program addresses two different but related aspects of the sulfur contamination problem. The primary aspect is concerned with the development of a sulfur tolerant electrocatalyst for the fuel oxidation reaction. A secondary issue is the development of a sulfur tolerant water-gas-shift reaction catalyst and an investigation of potential steam reforming catalysts which also have some sulfur tolerant capabilities. These two aspects are being addressed as two separate tasks.

Not Available

1987-02-01

393

Sulfur tolerant anode materials  

SciTech Connect

The goal of this program is the development of a molten carbonate fuel cell (MCFC) anode which is more tolerant of sulfur contaminants in the fuel than the current state-of-the-art nickel-based anode structures. This program addresses two different but related aspects of the sulfur contamination problem. The primary aspect is concerned with the development of a sulfur tolerant electrocatalyst for the fuel oxidation reaction. A secondary issue is the development of a sulfur tolerant water-gas-shift reaction catalyst and an investigation of potential steam reforming catalysts which also have some sulfur tolerant capabilities. These two aspects are being addressed as two separate tasks.

Not Available

1988-05-01

394

Cognitive Hypnotherapy for Pain Management  

Microsoft Academic Search

Pain is a serious health care problem and there is growing evidence to support the use of hypnosis and cognitive-behavioral interventions for pain management. This article reviews clinical techniques and methods of cognitive hypnotherapy for pain management. Current research with emphasis given to randomized, controlled trials is presented and the efficacy of hypnotherapy for pain management is discussed. Evidence for

Gary Elkins; Aimee Johnson; William Fisher

2012-01-01

395

Low Back Pain COMMON CAUSES  

E-print Network

Low Back Pain COMMON CAUSES: Low back pain may be triggered by a specific event, such improper are known to increase risk for potential injury, but often back pain occurs after a seemingly innocent task, like bending over to pick up something from the floor. Sufferers frequently complain that back pain

Virginia Tech

396

MRI and low back pain  

MedlinePLUS

Back pain and sciatica are common health complaints. Almost everyone has back pain at some time in their life. Most of ... DANGER SIGNS AND BACK PAIN Both you and your doctor may be worried that something serious is causing your low back pain. Could your ...

397

Back Pain - How to Prevent  

MedlinePLUS

How to Prevent Back Pain Introduction Back pain is one of the most common medical problems people have. It affects most people at least ... doctor or healthcare professional or a Causes of Back Pain The most common cause of back pain is ...

398

Upper Back Pain COMMON CAUSES  

E-print Network

Upper Back Pain COMMON CAUSES: Upper back pain may be triggered by a specific event of the computer can innocently strain muscles of the upper back. Long term back problems are more likely when pain develops gradually or discomfort is recurrent over a period of time. Chronic back pain is often triggered

Virginia Tech

399

What's wrong with pain?  

E-print Network

seriously we should take instances of pain in these animals from an ethical perspective. Though I do not have the space to adequately consider other marginal cases, the analysis in this thesis will provide some useful new guideposts to look for when... considering these other cases. Along the way of analyzing whether nonhuman pains should be considered morally relevant, difficult ethical questions will arise. In particular, any argument for taking others? interests seriously will have to provide some...

Shriver, Adam Joseph

2006-10-30

400

Post Vasectomy Pain Syndrome  

Microsoft Academic Search

Although the prevalence of post vasectomy pain syndrome is unknown, it is certain that the incidence of this uncommon complication\\u000a will increase because of the continued popularity of vasectomy as a highly effective and economic means of contraception.\\u000a This chapter covers the evaluation of and treatment options available for the sequelae of symptoms associated with post vasectomy\\u000a pain syndrome and

Jeannette M. Potts

401

Functional Abdominal Pain  

Microsoft Academic Search

Functional abdominal pain syndrome (FAPS) is a relatively less common functional gastrointestinal (GI) disorder defined by\\u000a the presence of constant or frequently recurring abdominal pain that is not associated with eating, change in bowel habits,\\u000a or menstrual periods (Drossman Gastroenterology 130:1377–1390, 2006), which points to a more centrally targeted (spinal and supraspinal) basis for the symptoms. However, FAPS is frequently

Madhusudan Grover; Douglas A. Drossman

2010-01-01

402

Sodium channelopathies and pain  

Microsoft Academic Search

Chronic pain often represents a severe, debilitating condition. Up to 10% of the worldwide population are affected, and many\\u000a patients are poorly responsive to current treatment strategies. Nociceptors detect noxious conditions to produce the sensation\\u000a of pain, and this signal is conveyed to the CNS by means of action potentials. The fast upstroke of action potentials is mediated\\u000a by voltage-gated

Angelika Lampert; Andrias O. O’Reilly; Peter Reeh; Andreas Leffler

2010-01-01

403

Management of Foot Pain  

PubMed Central

This paper deals chiefly with the young adult foot, the older adult foot, and pain of mechanical origin. It does not discuss treatment by surgical methods, but rather by the use of exercises, foot supports and shoe corrections. Foot pain resulting from mechanical disorders can be treated effectively by determination of the biomechanical causative factors, usually by simple physical examination. Relief can often be gained with simple mechanical devices, provided at low cost. ImagesFigure 1Figure 2Figure 4 PMID:21263862

Godfrey, Charles M.

1987-01-01

404

Low Back Pain  

PubMed Central

Low back pain is one of the most common and costly afflictions of our Society. The majority of adults will have at least one episode of acute low back pain that will likely resolve regardless of treatment. Lumbar spine radiographs are overused and there is little scientific support for many of the therapeutic interventions advocated. Even for those patients with symptomatic herniated disc, only a small fraction will ultimately require surgical intervention. PMID:2930949

Reuler, James B.

1985-01-01

405

Probabilistic Threshold Criterion  

SciTech Connect

The Probabilistic Shock Threshold Criterion (PSTC) Project at LLNL develops phenomenological criteria for estimating safety or performance margin on high explosive (HE) initiation in the shock initiation regime, creating tools for safety assessment and design of initiation systems and HE trains in general. Until recently, there has been little foundation for probabilistic assessment of HE initiation scenarios. This work attempts to use probabilistic information that is available from both historic and ongoing tests to develop a basis for such assessment. Current PSTC approaches start with the functional form of the James Initiation Criterion as a backbone, and generalize to include varying areas of initiation and provide a probabilistic response based on test data for 1.8 g/cc (Ultrafine) 1,3,5-triamino-2,4,6-trinitrobenzene (TATB) and LX-17 (92.5% TATB, 7.5% Kel-F 800 binder). Application of the PSTC methodology is presented investigating the safety and performance of a flying plate detonator and the margin of an Ultrafine TATB booster initiating LX-17.

Gresshoff, M; Hrousis, C A

2010-03-09

406

Mechanisms of Myofascial Pain  

PubMed Central

Myofascial pain syndrome is an important health problem. It affects a majority of the general population, impairs mobility, causes pain, and reduces the overall sense of well-being. Underlying this syndrome is the existence of painful taut bands of muscle that contain discrete, hypersensitive foci called myofascial trigger points. In spite of the significant impact on public health, a clear mechanistic understanding of the disorder does not exist. This is likely due to the complex nature of the disorder which involves the integration of cellular signaling, excitation-contraction coupling, neuromuscular inputs, local circulation, and energy metabolism. The difficulties are further exacerbated by the lack of an animal model for myofascial pain to test mechanistic hypothesis. In this review, current theories for myofascial pain are presented and their relative strengths and weaknesses are discussed. Based on new findings linking mechanoactivation of reactive oxygen species signaling to destabilized calcium signaling, we put forth a novel mechanistic hypothesis for the initiation and maintenance of myofascial trigger points. It is hoped that this lays a new foundation for understanding myofascial pain syndrome and how current therapies work, and gives key insights that will lead to the improvement of therapies for its treatment.

Jafri, M. Saleet

2014-01-01

407

Pain management in the elderly.  

PubMed

Assessment and management of pain are among the skills that perianesthesia nurses need to deliver safe and effective care. The principles of pain management remain fairly consistent across all age groups. However, managing the pain of elderly surgical patients presents unique challenges. Many elderly people have painful chronic conditions. Consequently, during the perioperative period, the nurse must manage both the patient's chronic and acute pain. As a group, the elderly are more vulnerable to inadequate pain assessment and treatment and are more likely to have serious side effects of analgesic therapy. Therefore, this report highlights the unique aspects of pain management in elderly patients. PMID:10839075

Gordon, D B

1999-12-01

408

Threshold Concepts and Information Literacy  

ERIC Educational Resources Information Center

What do we teach when we teach information literacy in higher education? This paper describes a pedagogical approach to information literacy that helps instructors focus content around transformative learning thresholds. The threshold concept framework holds promise for librarians because it grounds the instructor in the big ideas and underlying…

Townsend, Lori; Brunetti, Korey; Hofer, Amy R.

2011-01-01

409

The Nature of Psychological Thresholds  

ERIC Educational Resources Information Center

Following G. T. Fechner (1966), thresholds have been conceptualized as the amount of intensity needed to transition between mental states, such as between a states of unconsciousness and consciousness. With the advent of the theory of signal detection, however, discrete-state theory and the corresponding notion of threshold have been discounted.…

Rouder, Jeffrey N.; Morey, Richard D.

2009-01-01

410

Synchronisation of Resonances with Thresholds  

Microsoft Academic Search

The mechanism by which a resonance may be attracted to a sharp threshold is described with several examples. It involves a threshold cusp interfering constructively with either or both (i) a resonance produced via confinement, (ii) attractive t- and u-channel exchanges. More generally, it is suggested that resonances are eigenstates generated by mixing between confined states and long-range meson and

David V. Bugg

2009-01-01

411

Threshold Hypothesis: Fact or Artifact?  

ERIC Educational Resources Information Center

The threshold hypothesis (TH) assumes the existence of complex relations between creative abilities and intelligence: linear associations below 120 points of IQ and weaker or lack of associations above the threshold. However, diverse results have been obtained over the last six decades--some confirmed the hypothesis and some rejected it. In this…

Karwowski, Maciej; Gralewski, Jacek

2013-01-01

412

Pacemaker neurons within newborn spinal pain circuits  

PubMed Central

Spontaneous activity driven by “pacemaker” neurons, defined by their intrinsic ability to generate rhythmic burst-firing, contributes to the development of sensory circuits in many regions of the immature CNS. However, it is unknown if pacemaker-like neurons are present within central pain pathways in the neonate. Here we provide evidence that a subpopulation of glutamatergic interneurons within lamina I of the rat spinal cord exhibits oscillatory burst-firing during early life, which occurs independently of fast synaptic transmission. Pacemaker neurons were distinguished by a higher ratio of persistent, voltage-gated Na+ conductance to leak membrane conductance (gNa,P / gleak) compared to adjacent, non-bursting lamina I neurons. The activation of high-threshold (N-type and L-type) voltage-gated Ca2+ channels also facilitated rhythmic burst-firing by triggering intracellular Ca2+ signaling. Bursting neurons received direct projections from high-threshold sensory afferents, but transmitted nociceptive signals with poor fidelity while in the bursting mode. The observation that pacemaker neurons send axon collaterals throughout the neonatal spinal cord raises the possibility that intrinsic burst-firing could provide an endogenous drive to the developing sensorimotor networks which mediate spinal pain reflexes. PMID:21677184

Li, Jie; Baccei, Mark L.

2011-01-01

413

Opioid receptor–triggered spinal mTORC1 activation contributes to morphine tolerance and hyperalgesia  

PubMed Central

The development of opioid-induced analgesic tolerance and hyperalgesia is a clinical challenge for managing chronic pain. Adaptive changes in protein translation in the nervous system are thought to promote opioid tolerance and hyperalgesia; however, how opioids drive such changes remains elusive. Here, we report that mammalian target of rapamycin (mTOR), which governs most protein translation, was activated in rat spinal dorsal horn neurons after repeated intrathecal morphine injections. Activation was triggered through ? opioid receptor and mediated by intracellular PI3K/Akt. Spinal mTOR inhibition blocked both induction and maintenance of morphine tolerance and hyperalgesia, without affecting basal pain perception or locomotor functions. These effects were attributed to the attenuation of morphine-induced increases in translation initiation activity, nascent protein synthesis, and expression of some known key tolerance-associated proteins, including neuronal NOS (nNOS), in dorsal horn. Moreover, elevating spinal mTOR activity by knocking down the mTOR-negative regulator TSC2 reduced morphine analgesia, produced pain hypersensitivity, and increased spinal nNOS expression. Our findings implicate the ? opioid receptor–triggered PI3K/Akt/mTOR pathway in promoting morphine-induced spinal protein translation changes and associated morphine tolerance and hyperalgesia. These data suggest that mTOR inhibitors could be explored for prevention and/or reduction of opioid tolerance in chronic pain management. PMID:24382350

Xu, Ji-Tian; Zhao, Jian-Yuan; Zhao, Xiuli; Ligons, Davinna; Tiwari, Vinod; Atianjoh, Fidelis E.; Lee, Chun-Yi; Liang, Lingli; Zang, Weidong; Njoku, Dolores; Raja, Srinivasa N.; Yaster, Myron; Tao, Yuan-Xiang

2014-01-01

414

The Effects of Laughter on Discomfort Thresholds: Does Expectation Become Reality?  

Microsoft Academic Search

Distraction and relaxation have been controlled in previous studies as possible mechanisms for the effectiveness of mirthful laughter in coping with pain and discomfort. The purpose of this study is to control expectation of benefit from laughter. Discomfort thresholds for a blood pressure cuff at the upper dominant arm were recorded immediately before and after exposure to either a humorous

Diana L. Mahony; W. Jeffrey Burroughs; Arron C. Hieatt

2001-01-01

415

Impaired behavioural pain responses in hph-1 mice with inherited deficiency in GTP cyclohydrolase 1 in models of inflammatory pain  

PubMed Central

Background GTP cyclohydrolase 1 (GTP-CH1), the rate-limiting enzyme in the synthesis of tetrahydrobiopterin (BH4), encoded by the GCH1 gene, has been implicated in the development and maintenance of inflammatory pain in rats. In humans, homozygous carriers of a “pain-protective” (PP) haplotype of the GCH1 gene have been identified exhibiting lower pain sensitivity, but only following pain sensitisation. Ex vivo, the PP GCH1 haplotype is associated with decreased induction of GCH1 after stimulation, whereas the baseline BH4 production is not affected. Contrary, loss of function mutations in the GCH1 gene results in decreased basal GCH1 expression, and is associated with DOPA-responsive dystonia (DRD). So far it is unknown if such mutations affect acute and inflammatory pain. Results In the current study, we examined the involvement of the GCH1 gene in pain models using the hyperphenylalaninemia 1 (hph-1) mouse, a genetic model for DRD, with only 10% basal GTP-CH1 activity compared to wild type mice. The study included assays for determination of acute nociception as well as models for pain after sensitisation. Pain behavioural analysis of the hph-1 mice showed reduced pain-like responses following intraplantar injection of CFA, formalin and capsaicin; whereas decreased basal level of GTP-CH1 activity had no influence in naïve hph-1 mice on acute mechanical and heat pain thresholds. Moreover, the hph-1 mice showed no signs of motor impairment or dystonia-like symptoms. Conclusions In this study, we demonstrate novel evidence that genetic mutations in the GCH1 gene modulate pain-like hypersensitivity. Together, the present data suggest that BH4 is not important for basal heat and mechanical pain, but they support the hypothesis that BH4 plays a role in inflammation-induced hypersensitivity. Our studies suggest that the BH4 pathway could be a therapeutic target for the treatment of inflammatory pain conditions. Moreover, the hph-1 mice provide a valid model to study the consequence of congenital deficiency of GCH1 in painful conditions. PMID:23421753

2013-01-01

416

Smoking is Associated with Reduced Leptin and Neuropeptide Y Levels and Higher Pain Experience in Patients with Fibromyalgia  

PubMed Central

Smoking deregulates neuroendocrine responses to pain supporting production of neuropeptide Y (NpY) by direct stimulation of nicotinic receptors or by inhibiting adipokine leptin. Present study addressed the effect of cigarette smoking on adipokines and pain parameters, in 62 women with fibromyalgia (FM) pain syndrome with unknown etiology. Pain was characterized by a visual analogue scale, tender point (TP) counts, pressure pain threshold, and neuroendocrine markers NpY and substance P (sP). Levels of IGF-1, leptin, resistin, visfatin, and adiponectin were measured in blood and cerebrospinal fluid. Current smokers (n = 18) had lower levels of leptin compared to ex-smokers (n = 25, P = 0.002), while the expected NpY increase was absent in FM patients. In smokers, this was transcribed in higher VAS-pain (P = 0.04) and TP count (P = 0.03), lower pain threshold (P = 0.01), since NpY levels were directly related to the pain threshold (rho = 0.414) and inversely related to TP counts (rho = ?0.375). This study shows that patients with FM have no increase of NpY levels in response to smoking despite the low levels of leptin. Deregulation of the balance between leptin and neuropeptide Y may be one of the essential mechanisms of chronic pain in FM. PMID:25197167

Bokarewa, Maria I.; Erlandsson, Malin C.; Mannerkorpi, Kaisa

2014-01-01

417

Differential alternation of the antinociceptive effect of narcotic analgesics on the inflammatory pain state.  

PubMed

Antinociceptive effect of narcotic analgesics, fentanyl, oxycodone and methadone in inflammatory pain state was described in the von Frey filament test using the complete Freund's adjuvant (CFA)-induced mouse inflammatory pain model. After the i.pl. injection of CFA, mechanical allodynia (decrease of mechanical threshold) was observed in ipsilateral paw. The antinociceptive effect of fentanyl and oxycodone injected s.c. against mechanical allodynia in inflammatory pain state was reduced bilaterally at 1 day after CFA pretreatment. However, the antinociceptive effect of methadone injected s.c. against mechanical allodynia in inflammatory pain state was reduced unilaterally at 1 day after CFA pretreatment. Moreover, the reduction of the antinociceptive effect of methadone in ipsilateral paw on inflammatory pain state was smaller than those of fentanyl or oxycodone. In conclusion, the alternation of the antinociceptive effect of narcotic analgesics in inflammatory pain state is variable among the narcotic analgesics used. PMID:24361775

Aoki, Yuta; Mizoguchi, Hirokazu; Watanabe, Chizuko; Sakurada, Tsukasa; Sakurada, Shinobu

2014-02-01

418

Pain as social glue: shared pain increases cooperation.  

PubMed

Even though painful experiences are employed within social rituals across the world, little is known about the social effects of pain. We examined the possibility that painful experiences can promote cooperation within social groups. In Experiments 1 and 2, we induced pain by asking some participants to insert their hands in ice water and to perform leg squats. In Experiment 3, we induced pain by asking some participants to eat a hot chili pepper. Participants performed these tasks in small groups. We found evidence for a causal link: Sharing painful experiences with other people, compared with a no-pain control treatment, promoted trusting interpersonal relationships by increasing perceived bonding among strangers (Experiment 1) and increased cooperation in an economic game (Experiments 2 and 3). Our findings shed light on the social effects of pain, demonstrating that shared pain may be an important trigger for group formation. PMID:25193943

Bastian, Brock; Jetten, Jolanda; Ferris, Laura J

2014-11-01

419

Are Phytochelatins Involved in Differential Metal Tolerance or Do They Merely Reflect Metal-Imposed Strain?  

PubMed Central

Plants from nontolerant and copper-tolerant populations of Silene vulgaris both produce phytochelatins upon exposure to copper. The threshold copper concentration for induction of phytochelatin and the copper concentration at which maximum phytochelatin contents occurs increase proportionally with the level of tolerance to copper. When exposed to their own highest no-effect concentration or 50%-effect concentration of copper for root growth, tolerant and nontolerant plants exhibit equal phytochelatin contents in the root apex, which is the primary copper target. This also holds for distinctly tolerant nonsegregating F3 families, derived from a single cross of a nontolerant plant to a tolerant one. Therefore, the phytochelatin content of the root apex can be used as a quantitative tolerance-independent measure of the degree of toxicity experienced by the plant. Differential copper tolerance in S. vulgaris does not appear to rely on differential phytochelatin production. PMID:16669061

Schat, Henk; Kalff, Mechteld M. A.

1992-01-01

420

SFT: scalable fault tolerance  

Microsoft Academic Search

In this paper we will present a new technology that we are currently developing within the SFT: Scalable Fault Tolerance FastOS project which seeks to implement fault tolerance at the operating system level. Major design goals include dynamic reallocation of resources to allow continuing execution in the presence of hardware failures, very high scalability, high efficiency (low overhead), and transparency---requiring

Fabrizio Petrini; Jarek Nieplocha; Vinod Tipparaju

2006-01-01

421

Practical Byzantine Fault Tolerance  

Microsoft Academic Search

This paper describes a new replication algorithm that is able to tolerate Byzantine faults. We believe that Byzantine- fault-tolerant algorithms will be increasingly important in the future because malicious attacks and software errors are increasingly common and can cause faulty nodes to exhibit arbitrary behavior. Whereas previous algorithms assumed a synchronous system or were too slow to be used in

Miguel Castro; Barbara Liskov

1999-01-01

422

Approaching Tolerance in Transplantation  

Microsoft Academic Search

Basic research has provided substantial encouragement that tolerance processes may be harnessed to the benefit of organ transplants. The goal of achieving mixed chimerism to ensure a robust tolerance, however elegant, may yet prove to be too complex and, consequently, risky as a procedure to compensate for the breadth of genetic differences, and prior immunological experiences of donor and host.

Herman Waldmann; Stephen Cobbold

2001-01-01