Sample records for pain tolerance threshold

  1. 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)

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

    2011-08-01

    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.

  2. Ceruletide increases dose dependently both jejunal motor activity and threshold and tolerance to experimentally induced pain in healthy man.

    PubMed Central

    Stacher, G; Steinringer, H; Schmierer, G; Schneider, C; Winklehner, S; Mittelbach, G; De Paolis, C; Praga, C

    1984-01-01

    The effects of ceruletide on jejunal motility and experimentally induced pain were studied in 16 healthy men, who participated each in four experiments and received in random double blind fashion 5, 10, or 20 micrograms ceruletide intramuscularly or placebo. Jejunal pressures were recorded by three perfused catheters with orifices between 10 and 20 cm aboral of the ligament of Treitz. Ceruletide dose dependently diminished phase I and increased phase II type activity and tended to reduce the number, but not the duration, of activity fronts. The number and amplitude of contractions as well as the area under the curve increased significantly and dose dependently as did threshold and tolerance to electrically and threshold to thermally induced pain. Only mild sedative and other side effects occurred. PMID:6714795

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

    Microsoft Academic Search

    Wojciech Drobek; Antoon De Laat; Joseph Schoenaers

    2001-01-01

    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,

  4. Computer-Delivered Social Norm Message Increases Pain Tolerance

    PubMed Central

    Pulvers, Kim; Schroeder, Jacquelyn; Limas, Eleuterio F.; Zhu, Shu-Hong

    2013-01-01

    Background Few experimental studies have been conducted on social determinants of pain tolerance. Purpose This study tests a brief, computer-delivered social norm message for increasing pain tolerance. Methods Healthy young adults (N=260; 44 % Caucasian; 27 % Hispanic) were randomly assigned into a 2 (social norm)×2 (challenge) cold pressor study, stratified by gender. They received standard instructions or standard instructions plus a message that contained artifically elevated information about typical performance of others. Results Those receiving a social norm message displayed significantly higher pain tolerance, F(1, 255)=26.95, p<.001, ?p2=.10 and pain threshold F(1, 244)=9.81, p=.002, ?p2=.04, but comparable pain intensity, p>.05. There were no interactions between condition and gender on any outcome variables, p>.05. Conclusions Social norms can significantly increase pain tolerance, even with a brief verbal message delivered by a video. PMID:24146086

  5. Personality Correlates of Pain Perception and Tolerance.

    ERIC Educational Resources Information Center

    Lukin, Penny R.; Ray, A. Bartow

    1982-01-01

    Explored personality correlates of pain perception and tolerance in a nonmedical sample and setting. Results showed no significant correlations with personality measures and cold-pressor scores, but a significant relationship between pain tolerance and cognitive focus; those who focused on the experimental situation had much shorter tolerance

  6. Striatal ?-opioid receptor availability predicts cold pressor pain threshold in healthy human subjects.

    PubMed

    Hagelberg, Nora; Aalto, Sargo; Tuominen, Lauri; Pesonen, Ullamari; Någren, Kjell; Hietala, Jarmo; Scheinin, Harry; Pertovaara, Antti; Martikainen, Ilkka K

    2012-07-11

    Previous PET studies in healthy humans have shown that brain ?-opioid receptor activation during experimental pain is associated with reductions in the sensory and affective ratings of the individual pain experience. The aim of this study was to find out whether brain ?-opioid receptor binding at the resting state, in absence of painful stimulation, can be a long-term predictor of experimental pain sensitivity. We measured ?-opioid receptor binding potential (BP(ND)) with ?-opioid receptor selective radiotracer [(11)C]carfentanil and positron emission tomography (PET) in 12 healthy male subjects. Later, we recruited these subjects to participate in a separate psychophysical testing session to measure cold pressor pain threshold, cold pressor pain tolerance and tactile sensitivity with von Frey monofilaments. We used both voxel-by-voxel and region-of-interest image analyses to examine the potential associations between ?-opioid receptor BP(ND) and psychophysical measures. The results show that striatal ?-opioid receptor BP(ND) predicts cold pressor pain threshold, but not cold pressor pain tolerance or tactile sensitivity. This finding suggests that striatal ?-opioid receptor density is involved in setting individual pain threshold. PMID:22622175

  7. Increased Cold-Pain Thresholds in Major Depression

    Microsoft Academic Search

    Christiane Schwier; Anna Kliem; Michael Karl Boettger; Karl-Jürgen Bär

    2010-01-01

    Most previous studies indicated that patients suffering from major depressive disorder (MDD) showed a decreased sensitivity for external or skin surface pain, eg, for heat or electrical stimuli, as compared to healthy controls. Here, we investigated cold-pain thresholds in 20 unmedicated patients suffering from MDD and 20 matched controls. We applied the ascending method of limits which has previously been

  8. Fault-tolerant thresholds for encoded ancillae with homogeneous errors

    SciTech Connect

    Eastin, Bryan [Department of Physics and Astronomy, University of New Mexico, Albuquerque, New Mexico 87131-1156 (United States)

    2007-02-15

    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 Calderbank-Shor-Steane 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.

  9. Fault-Tolerant Thresholds for Encoded Ancillae with Homogeneous Errors

    E-print Network

    Bryan Eastin

    2006-11-14

    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.

  10. Trust-Threshold Based Routing in Delay Tolerant Networks

    Microsoft Academic Search

    MoonJeong Chang; Ing-Ray Chen; Fenye Bao; Jin-Hee Cho

    \\u000a We propose a trust-threshold based routing protocol for delay tolerant networks, leveraging two trust thresholds for accepting\\u000a recommendations and for selecting the next message carrier for message forwarding. We show that there exist optimal trust\\u000a threshold values under which trust-threshold based routing performs the best in terms of message delivery ratio, message delay\\u000a and message overhead. By means of a

  11. Dynorphin Promotes Abnormal Pain and Spinal Opioid Antinociceptive Tolerance

    Microsoft Academic Search

    Todd W. Vanderah; Luis R. Gardell; Shannon E. Burgess; Mohab Ibrahim; Ahmet Dogrul; Cheng-Min Zhong; En-Tan Zhang; T. Philip; Michael H. Ossipov; Josephine Lai; Frank Porreca

    2000-01-01

    The nonopioid actions of spinal dynorphin may promote aspects of abnormal pain after nerve injury. Mechanistic similarities have been suggested between opioid tolerance and neuropathic pain. Here, the hypothesis that spinal dynorphin might mediate effects of sustained spinal opioids was explored. Possible abnormal pain and spinal antinociceptive tolerance were evaluated after intrathecal administration of (D-Ala 2, N-Me-Phe 4, Gly-ol 5)enke

  12. Pain threshold correlates with functional scores in osteoarthritis patients

    PubMed Central

    Kuni, Benita; Wang, Haili; Rickert, Markus; Ewerbeck, Volker; Schiltenwolf, Marcus

    2015-01-01

    Background and purpose Pain sensitization may be one of the reasons for persistent pain after technically successful joint replacement. We analyzed how pain sensitization, as measured by quantitative sensory testing, relates preoperatively to joint function in patients with osteoarthritis (OA) scheduled for joint replacement. Patients and methods We included 50 patients with knee OA and 49 with hip OA who were scheduled for joint replacement, and 15 control participants. Hip/knee scores, thermal and pressure detection, and pain thresholds were examined. Results Median pressure pain thresholds were lower in patients than in control subjects: 4.0 (range: 0–10) vs. 7.8 (4–10) (p = 0.003) for the affected knee; 4.5 (2–10) vs. 6.8 (4–10) (p = 0.03) for the affected hip. Lower pressure pain threshold values were found at the affected joint in 26 of the 50 patients with knee OA and in 17 of the 49 patients with hip OA. The American Knee Society score 1 and 2, the Oxford knee score, and functional questionnaire of Hannover for osteoarthritis score correlated with the pressure pain thresholds in patients with knee OA. Also, Harris hip score and the functional questionnaire of Hannover for osteoarthritis score correlated with the cold detection threshold in patients with hip OA. Interpretation Quantitative sensory testing appeared to identify patients with sensory changes indicative of mechanisms of central sensitization. These patients may require additional pain treatment in order to profit fully from surgery. There were correlations between the clinical scores and the level of sensitization. PMID:25323797

  13. Chronic pain and genetic background interact and influence opioid analgesia, tolerance, and physical dependence.

    PubMed

    Liang, De-Yong; Guo, TianZi; Liao, Guochun; Kingery, Wade S; Peltz, Gary; Clark, J David

    2006-04-01

    Opioids are commonly used in the treatment of moderate to severe pain. However, their chronic use is limited by analgesic tolerance and physical dependence. Few studies have examined how chronic pain affects the development of tolerance or dependence, and essentially no studies have looked at the role of both genetics and pain together. For these studies we used 12 strains of inbred mice. Groups of mice from each strain were tested at baseline for morphine analgesic sensitivity, mechanical nociceptive threshold, and thermal nociceptive threshold. Mice were then given morphine in a 4-day escalating morphine administration paradigm followed by reassessment of the morphine dose-response relationship. Finally, physical dependence was measured by administering naloxone. Parallel groups of mice underwent hind paw injection of complete Freund's adjuvant (CFA) to induce chronic hind paw inflammation 7 days prior to the beginning of testing. The data showed that CFA treatment tended to lower baseline ED(50) values for morphine and enhanced the degree of analgesic tolerance observed after 4 days of morphine treatment. In addition, the degree of jumping behavior indicative of physical dependence was often altered if mice had been treated with CFA. The influence of background strain was substantial for all traits measured. In silico haplotypic mapping of the tolerance and physical dependence data demonstrated that CFA pretreatment altered the pattern of the predicted associations and greatly reduced their statistical significance. We conclude that chronic inflammatory pain and genetics interact to modulate the analgesic potency of morphine, tolerance, and physical dependence. PMID:16516386

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

    PubMed Central

    Rutchick, Abraham M.; Slepian, Michael L.

    2013-01-01

    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

  15. Silica Nanoconstruct Cellular Toleration Threshold In Vitro

    PubMed Central

    Herd, Heather L.; Malugin, Alexander; Ghandehari, Hamidreza

    2011-01-01

    The influence of geometry of silica nanomaterials on cellular uptake and toxicity on epithelial and phagocytic cells was studied. Three types of amine-terminated silica nanomaterials were prepared and characterized via the modified Stober method, namely spheres (178±27 nm), worms (232±22 nm × 1348±314 nm) and cylinders (214±29 nm × 428±66 nm). The findings of the study suggest that in this size range and for the cell types studied, geometry does not play a dominant role in the modes of toxicity and uptake of these particles. Rather, a concentration threshold and cell type dependent toxicity of all particle types was observed. This correlated with confocal microscopy observations, as all nanomaterials were observed to be taken up in both cell types, with a greater extent in phagocytic cells. It must be noted that there appears to be a concentration threshold at ~100 µg/mL, below which there is limited to no impact of the nanoparticles on membrane integrity, mitochondrial function, phagocytosis or cell death. Analysis of cell morphology by transmission electron microscopy, colocalization experiments with intracellular markers and Western Blot results provide evidence of potential involvement of lysosomal escape, autophagic like activity, compartmental fusion and recycling in response to intracellular nanoparticle accumulation. These processes could be involved in cellular coping or defense mechanisms. The manipulation of physicochemical properties to enhance or reduce toxicity paves the way for the safe design of silica-based nanoparticles for use in nanomedicine. PMID:21342660

  16. Efficacy and Tolerability of Lornoxicam versus Tramadol in Postoperative Pain

    Microsoft Academic Search

    Henrik Staunstrup; Janne Ovesen; Ulf Thyge Larsen; Karsten Elbæk; Ulla Larsen; Karsten Krøner

    1999-01-01

    This randomized double-blind study compared the analgesic efficacy and tolerability of intramuscular lornoxicam and tramadol in 76 patients with moderate to unbearable pain following arthroscopic reconstruction of the anterior cruciate ligament using the patella bone-tendon-bone technique. Patients receiving a single dose of lornoxicam 16 mg experienced significantly greater total pain relief than patients receiving tramadol 100 mg over the following

  17. Insular cortex mediates increased pain tolerance in yoga practitioners.

    PubMed

    Villemure, Chantal; Ceko, Marta; Cotton, Valerie A; Bushnell, M Catherine

    2014-10-01

    Yoga, an increasingly popular discipline among Westerners, is frequently used to improve painful conditions. We investigated possible neuroanatomical underpinnings of the beneficial effects of yoga using sensory testing and magnetic resonance imaging techniques. North American yogis tolerated pain more than twice as long as individually matched controls and had more gray matter (GM) in multiple brain regions. Across subjects, insular GM uniquely correlated with pain tolerance. Insular GM volume in yogis positively correlated with yoga experience, suggesting a causal relationship between yoga and insular size. Yogis also had increased left intrainsular white matter integrity, consistent with a strengthened insular integration of nociceptive input and parasympathetic autonomic regulation. Yogis, as opposed to controls, used cognitive strategies involving parasympathetic activation and interoceptive awareness to tolerate pain, which could have led to use-dependent hypertrophy of insular cortex. Together, these findings suggest that regular and long-term yoga practice improves pain tolerance in typical North Americans by teaching different ways to deal with sensory inputs and the potential emotional reactions attached to those inputs leading to a change in insular brain anatomy and connectivity. PMID:23696275

  18. Affective pictures processing, attention, and pain tolerance

    Microsoft Academic Search

    Minet de Wied; Marinus N Verbaten

    2001-01-01

    Two experiments were conducted to determine whether attention mediates the effects of affective distractors on cold pressor pain, or whether the cognitive processes of priming and appraisal best account for the effects. In Experiment I, 65 male respondents were exposed to either pleasant, neutral or unpleasant pictures selected from the International Affective Pictures System (IAPS). The cold-pressor test was administered

  19. Variability of argon laser-induced sensory and pain thresholds on human oral mucosa and skin.

    PubMed Central

    Svensson, P.; Bjerring, P.; Arendt-Nielsen, L.; Kaaber, S.

    1991-01-01

    The variability of laser-induced pain perception on human oral mucosa and hairy skin was investigated in order to establish a new method for evaluation of pain in the orofacial region. A high-energy argon laser was used for experimental pain stimulation, and sensory and pain thresholds were determined. The intra-individual coefficients of variation for oral thresholds were comparable to cutaneous thresholds. However, inter-individual variation was smaller for oral thresholds, which could be due to larger variation in cutaneous optical properties. The short-term and 24-hr changes in thresholds on both surfaces were less than 9%. The results indicate that habituation to laser thresholds may account for part of the intra-individual variation observed. However, the subjective ratings of the intensity of the laser stimuli were constant. Thus, oral thresholds may, like cutaneous thresholds, be used for assessment and quantification of analgesic efficacies and to investigate various pain conditions. PMID:1814248

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

    PubMed Central

    Schwedt, Todd J.; Chong, Catherine D.

    2014-01-01

    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

  1. Chronic pain and genetic background interact and influence opioid analgesia, tolerance, and physical dependence

    Microsoft Academic Search

    De-Yong Liang; TianZi Guo; Guochun Liao; Wade S. Kingery; Gary Peltz; J. David Clark

    2006-01-01

    Opioids are commonly used in the treatment of moderate to severe pain. However, their chronic use is limited by analgesic tolerance and physical dependence. Few studies have examined how chronic pain affects the development of tolerance or dependence, and essentially no studies have looked at the role of both genetics and pain together. For these studies we used 12 strains

  2. Efficacy and tolerability of lornoxicam versus tramadol in postoperative pain.

    PubMed

    Staunstrup, H; Ovesen, J; Larsen, U T; Elbaek, K; Larsen, U; Krøner, K

    1999-08-01

    This randomized double-blind study compared the analgesic efficacy and tolerability of intramuscular lornoxicam and tramadol in 76 patients with moderate to unbearable pain following arthroscopic reconstruction of the anterior cruciate ligament using the patella bone-tendon-bone technique. Patients receiving a single dose of lornoxicam 16 mg experienced significantly greater total pain relief than patients receiving tramadol 100 mg over the following 8 hours. Lornoxicam had greater analgesic efficacy than tramadol in patients with moderate baseline pain but was of equivalent efficacy in those with severe/unbearable baseline pain. Fewer patients in the lornoxicam group required rescue medication (58% vs. 77%, respectively). Patients' global impression of efficacy showed lornoxicam to be superior to tramadol with 82% and 49% of patients, respectively, rating treatment as good, very good, or excellent. Following multiple-dose administration of lornoxicam (8 mg tid) or tramadol (100 mg tid) for 3 days, efficacy profiles similar to those following a single dose were obtained. Thus, slightly fewer patients in the lornoxicam group required rescue medication, and patients' global impression of efficacy again favored lornoxicam. Adverse events were reported by 38 of the 76 patients and were mainly mild to moderate in severity. Significantly fewer patients reported one or more adverse events with lornoxicam than with tramadol (14 vs. 24, respectively). Thus, intramuscular lornoxicam offers a useful alternative to tramadol for the treatment of moderate to severe postoperative pain. PMID:10434236

  3. Reduced heat pain thresholds after sad-mood induction are associated with changes in thalamic activity

    Microsoft Academic Search

    Gerd Wagner; Mandy Koschke; Tanja Leuf; Ralf Schlösser; Karl-Jürgen Bär

    2009-01-01

    Negative affective states influence pain processing in healthy subjects in terms of augmented pain experience. Furthermore, our previous studies revealed that patients with major depressive disorder showed increased heat pain thresholds on the skin. Potential neurofunctional correlates of this finding were located within the fronto-thalamic network. The aim of the present study was to investigate the neurofunctional underpinnings of the

  4. Thermal Thresholds and Catastrophizing in Individuals with Chronic Pain after Whiplash Injury

    Microsoft Academic Search

    Ragnhild Raak; Mia Wallin

    2006-01-01

    Thermal sensitivity, thermal pain thresholds, and catastrophizing were examined in individuals with whiplash associated disorders (WAD) and in healthy pain-free participants. Quantitative sensory testing (QST) was used to measure skin sensitivity to cold and warmth and cold and heat pain thresholds over both the thenar eminence and the trapezius muscle (TrM) in 17 participants with WAD (age 50.8± 11.3 years)

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

    E-print Network

    Kluck, Benjamin Joseph

    2008-01-01

    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...

  6. Levodopa raises objective pain threshold in Parkinson's disease: a RIII reflex study

    PubMed Central

    Gerdelat?Mas, A; Simonetta?Moreau, M; Thalamas, C; Ory?Magne, F; Slaoui, T; Rascol, O; Brefel?Courbon, C

    2007-01-01

    Background Patients suffering from Parkinson's disease (PD) describe painful sensations that could be related to neuropathic pain. Experimental data have indicated the involvement of basal ganglia and dopaminergic pathways in central nociceptive processing. Aim The objective of this study was to assess and compare the effect of levodopa on the objective pain threshold in patients with PD and healthy subjects. Methods The objective pain threshold was assessed by the nociceptive flexion reflex (RIII) in 13 PD patients and 10 healthy subjects. Patients and healthy subjects were evaluated under two randomised conditions: with levodopa (ON) and without (OFF). Results Levodopa significantly increased the RIII threshold of PD patients (6.9 (1.2)?mA in the OFF condition vs 8 (1.1)?mA in the ON position; p?=?0.02). RIII threshold was significantly lower in PD patients than in healthy subjects in the OFF condition (6.9 (1.2)?mA vs 9.7 (3.4)?mA; p?=?0.02). RIII threshold did not change after levodopa administration in healthy subjects. Conclusion These results provide evidence of a dopaminergic modulation of objective pain threshold in PD patients. In addition, the decrease in RIII threshold in PD patients, in the OFF condition, compared with controls, confirms the existence of an objective pain perception disturbance in PD. PMID:17504881

  7. Laboratory pain perception and clinical pain in post-menopausal women and age-matched men with osteoarthritis: relationship to pain coping and hormonal status

    Microsoft Academic Search

    Christopher R. France; Francis J. Keefe; Charles F. Emery; Glenn Affleck; Janis L. France; Sandra Waters; David S. Caldwell; David Stainbrook; Kevin V. Hackshaw; Christopher Edwards

    2004-01-01

    The present study examined relationships between pain coping, hormone replacement therapy, and laboratory and clinical pain reports in post-menopausal women and age-matched men with osteoarthritis. Assessment of nociceptive flexion reflex threshold was followed by an assessment of electrocutaneous pain threshold and tolerance. Participants rated their arthritis pain using the Arthritis Impact Measurement Scales. To assess pain coping, participants completed measures

  8. Pain threshold and intensity in rheumatic patients: correlations with the Hamilton Depression Rating scale.

    PubMed

    Bagnato, Gianluca; De Andres, Ilenia; Sorbara, Stefania; Verduci, Elisa; Corallo, Giorgio; Ferrera, Antonino; Morgante, Salvatore; Roberts, William Neal; Bagnato, Gianfilippo

    2015-03-01

    Individuals suffering from chronic pain are frequently affected by depression, which in turn increases the risk of developing chronic pain over time. This study aims to investigate the relationship between depression and pain intensity and threshold in a group of rheumatic patients compared to healthy subjects. One hundred twenty-four individuals of whom 50 were affected by rheumatoid arthritis (RA), 23 by psoriatic arthritis (PsA), 23 by ankylosing spondylitis (AS), and 28 age-matched controls without chronic pain underwent quantitative sensory testing to assess pressure pain threshold with pressure algometry. Pain intensity was evaluated through the visual analogue scale (VAS) and depression through the Hamilton Depression Rating scale (HAMD). A significant inverse correlation between HAMD values and pressure pain thresholds was found in the entire group of patients (p?pain thresholds and VAS. We found lower pain thresholds in RA and PsA patients while no difference has been evidenced in AS patients compared to healthy controls. HAMD scores were also significantly higher in rheumatic patients than in controls. The use of pressure algometry in the evaluation of chronic pain in patients affected by rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis that display comorbid depression could represent an additional and integrative method to improve pain/depression overlap management or research. PMID:24407907

  9. Determinants of pressure pain threshold in adult twins: evidence that shared environmental influences predominate

    Microsoft Academic Search

    Alexander J. MacGregor; Gareth O. Griffiths; Juliet Baker; Timothy D. Spector

    1997-01-01

    The objective of this study was to examine the relative contribution of genetic and environmental factors in determining pain perception in a classical twin study. Dolorimeter measurements of pressure pain threshold (PPT) were recorded in 609 healthy female-female twin pairs of whom 269 pairs were monozygotic (MZ) and 340 were dizygotic (DZ). There was a strong correlation (R) in PPT

  10. Fault-tolerant quantum computation with high threshold in two dimensions

    E-print Network

    Robert Raussendorf; Jim Harrington

    2007-05-14

    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.

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

    E-print Network

    Morten, Andrew J

    2005-01-01

    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 ...

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

    Microsoft Academic Search

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

    2007-01-01

    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

  13. Deriving a Fault-Tolerant Threshold for a Global Control Scheme

    E-print Network

    Alastair Kay

    2007-03-07

    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.

  14. Fault-Tolerant Postselected Quantum Computation: Threshold Analysis

    E-print Network

    E. Knill

    2004-04-19

    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.

  15. Vestibular tactile and pain thresholds in women with vulvar vestibulitis syndrome

    Microsoft Academic Search

    Caroline F Pukall; Yitzchak M Binik; Samir Khalifé; Rhonda Amsel; Frances V Abbott

    2002-01-01

    Vulvar vestibulitis syndrome (VVS) is a common cause of dyspareunia in pre-menopausal women. Little is known about sensory function in the vulvar vestibule, despite Kinsey's assertion that it is important for sexual sensation. We examined punctate tactile and pain thresholds to modified von Frey filaments in the genital region of women with VVS and age- and contraceptive-matched pain-free controls. Women

  16. Vestibular tactile and pain thresholds in women with vulvar vestibulitis syndromeq

    Microsoft Academic Search

    Caroline F. Pukall; Yitzchak M. Binik; Samir Khalife; Rhonda Amsel; Frances V. Abbotte

    Vulvar vestibulitis syndrome (VVS) is a common cause of dyspareunia in pre-menopausal women. Little is known about sensory function in the vulvar vestibule, despite Kinsey's assertion that it is important for sexual sensation. We examined punctate tactile and pain thresholds to modified von Frey filaments in the genital region of women with VVS and age- and contraceptive-matched pain-free controls. Women

  17. Altered esophageal pain threshold in irritable bowel syndrome

    Microsoft Academic Search

    Mario Costantini; Giacomo Carlo Sturniolo; Giovanni Zaninotto; Renata D'Incà; Rita Polo; Remo Naccarato; Ermanno Ancona

    1993-01-01

    Gut motility disorders and altered pain perception were reported in patients with irritable bowel syndrome (IBS). To verify foregut involvement in IBS, we studied 30 patients using esophageal manometry and 24-hr pH monitoring of the distal esophagus. Two subgroups of patients underwent esophageal provocative tests (bethanechol 50 µg\\/kg subcutaneously and esophageal balloon distension test). Twelve healthy volunteers formed a control

  18. Chronic Morphine Induces Downregulation of Spinal Glutamate Transporters: Implications in Morphine Tolerance and Abnormal Pain Sensitivity

    Microsoft Academic Search

    Jianren Mao; Backil Sung; Ru-Rong Ji; Grewo Lim

    2002-01-01

    Tolerance to the analgesic effects of an opioid occurs after its chronic administration, a pharmacological phenomenon that has been associated with the development of abnormal pain sensitivity such as hyperalgesia. In the present study, we ex- amined the role of spinal glutamate transporters (GTs) in the development of both morphine tolerance and associated ther- mal hyperalgesia. Chronic morphine administered through

  19. The relationship between fibromyalgia and pressure pain threshold in patients with dyspareunia

    PubMed Central

    Terzi, Hasan; Terzi, Rabia; Kale, Ahmet

    2015-01-01

    OBJECTIVE: To evaluate the number of tender points, pressure pain threshold and presence of fibromyalgia among women with or without dyspareunia. METHODS: The present cross-sectional study included 40 patients with dyspareunia and 30 healthy controls. The participants were asked if they had engaged in sexual intercourse during the previous four weeks, and dyspareunia was rated from 0 to 3 based on the Marinoff Dyspareunia Scale. A pressure algometer (dolorimeter) was used to measure the pressure pain threshold. Fibromyalgia was diagnosed based on the 1990 American College of Rheumatology criteria. The depression status of the participants was assessed using the Beck Depression Inventory. RESULTS: No statistically significant difference was found with regard to age, body mass index, habits (alcohol use and smoking), educational status and occupational status between the two groups. Total myalgic score, total control score and tender point mean pain threshold were significantly lower in the group with dyspareunia. The number of tender points was significantly higher in patients with dyspareunia. The mean Beck Depression Inventory score was 14.7±8.4 in the dyspareunia group compared with 11.2±7.1 in the control group. Five (12.5%) of the patients with dyspareunia were diagnosed with fibromyalgia, whereas no patients in the control group were diagnosed with fibromyalgia. There was no significant difference between the two groups with regard to the presence of fibromyalgia. CONCLUSION: The finding of lower pressure pain thresholds and a higher number of tender points among patients with dyspareunia suggests that these patients may have increased generalized pain thresholds. Additional studies involving a larger number of patients are required to investigate the presence of central mechanisms in the pathogenesis of dyspareunia. PMID:25996766

  20. Pain tolerance, pain sensitivity, and accessibility of aggression-related schemata in parents at-risk for child physical abuse.

    PubMed

    Hiraoka, Regina; Crouch, Julie L; Reo, Gim; Wagner, Michael; Milner, Joel S; Skowronski, John J

    2014-11-01

    This study examined whether parents with varying degrees of child physical abuse (CPA) risk differed in pain tolerance, pain sensitivity, and accessibility of aggression-related schemata. Participants included 91 (51 low CPA risk and 40 high CPA risk) general population parents. Participants were randomly assigned to complete either an easy or a difficult anagram task. Pain tolerance and pain sensitivity were assessed using a cold pressor task. Accessibility of aggression-related schemata was assessed at the outset of the data collection session and at the end of the session using a word completion task. Parents' self-reported negative affect was assessed three times over the course of the study: baseline, after the anagram task, and after the cold pressor task. As expected, high-risk (compared to low-risk) parents reported higher levels of negative affect at each time point. Moreover, after completing the difficult anagram task, high-risk (compared to low-risk) parents exhibited higher pain sensitivity during the cold pressor task. Following completion of the cold pressor task, high-risk (compared to low-risk) parents exhibited greater accessibility of aggression-related schemata. Collectively, these findings indicate that under certain conditions, high-risk parents experience a confluence of aggression-related risk factors (i.e., negative affect, pain sensitivity, and aggression-related information processes) that may predispose them to aggressive behavior. PMID:25073732

  1. Toward anonymity in Delay Tolerant Networks: Threshold Pivot Scheme

    Microsoft Academic Search

    Rob Jansen; Robert Beverly

    2010-01-01

    Delay Tolerant Networks (DTNs) remove traditional assumptions of end-to-end connectivity, extending network communication to intermittently connected mobile, ad-hoc, and vehicular environments. This work considers anonymity as a vital security primitive for viable military and civilian DTNs. DTNs present new and unique anonymity challenges since we must protect physical location information as mobile nodes with limited topology knowledge naturally mix. We

  2. Reliability and responsiveness of algometry for measuring pressure pain threshold in patients with knee osteoarthritis

    PubMed Central

    Mutlu, Ebru Kaya; Ozdincler, Arzu Razak

    2015-01-01

    [Purpose] This study aimed to establish the intrarater reliability and responsiveness of a clinically available algometer in patients with knee osteoarthritis as well as to determine the minimum-detectable-change and standard error of measurement of testing to facilitate clinical interpretation of temporal changes. [Subjects] Seventy-three patients with knee osteoarthritis were included. [Methods] Pressure pain threshold measured by algometry was evaluated 3 times at 2-min intervals over 2 clinically relevant sites—mediolateral to the medial femoral tubercle (distal) and lateral to the medial malleolus (local)—on the same day. Intrarater reliability was estimated by intraclass correlation coefficients. The minimum-detectable-change and standard error of measurement were calculated. As a measure of responsiveness, the effect size was calculated for the results at baseline and after treatment. [Results] The intrarater reliability was almost perfect (intraclass correlation coefficient = 0.93–0.97). The standard error of measurement and minimum-detectable-change were 0.70–0.66 and 1.62–1.53, respectively. The pressure pain threshold over the distal site was inadequately responsive in knee osteoarthritis, but the local site was responsive. The effect size was 0.70. [Conclusion] Algometry is reliable and responsive to assess measures of pressure pain threshold for evaluating pain patients with knee osteoarthritis. PMID:26180358

  3. Effect of buspirone on thermal sensory and pain thresholds in human volunteers

    PubMed Central

    Pavlakovi?, Goran; Tigges, Julija; Crozier, Thomas A

    2009-01-01

    Background Buspirone is a partial 5-HT1A receptor agonist. Animal studies have shown that modulation of serotoninergic transmission at the 5-HT1A receptor can induce analgesia in acute pain models. However, no studies have been published so far on the effects of serotonin receptor agonists on pain perception in humans. Methods The effects of buspirone (30 mg p.o.) on thermal sensory and pain thresholds were investigated in twelve female volunteers (26 ± 2 yrs) in a prospective, randomized, double-blind, double-dummy, placebo-controlled study with morphine (10 mg i.v.) as positive control. Results Morphine significantly increased the heat pain detection threshold (?T: placebo 1.0°C and 1.3°C, p < 0.05) at 60 minutes. Buspirone caused mild sedation in six participants at 60 minutes, but was without effect on any of the measured parameters. Conclusion Buspirone in the maximal recommended dose was without significant effect on thermal pain. However, as it is only a partial agonist at the 5-HT1A receptor and also acts on other receptor types, the negative results of the present study do not rule out a possible analgesic effect of more specific 5-HT1A receptor agonists. PMID:19480657

  4. Human exposure to a specific pulsed magnetic field: effects on thermal sensory and pain thresholds

    Microsoft Academic Search

    Naomi M Shupak; Frank S Prato; Alex W Thomas

    2004-01-01

    Exposure to pulsed magnetic fields (MF) has been shown to have a therapeutic benefit in both animals (e.g. mice, snails) and humans. The current study investigated the potential analgesic benefit of MF exposure on sensory and pain thresholds following experimentally induced warm and hot sensations. Thirty-nine subjects (Study 1) and 31 subjects (Study 2) were randomly and double-blindly assigned to

  5. Pain thresholds during standardized psychological stress in relation to perceived psychosocial work situation. Stockholm Music I Study Group.

    PubMed

    Theorell, T; Nordemar, R; Michélsen, H

    1993-04-01

    The hypothesis that perceived psychosocial work situation is associated with pain threshold was tested on a sample of 103 men and women aged 19-65 yr in Stockholm. Half of the studied sample was a random sample of men (N = 26) and women (N = 31), while the remaining subjects were medical secretaries (women, N = 28) and furniture movers (N = 31). Pain thresholds were measured by means of an algometer before, during and after a standardized colour word test. The measurements were made on six different points in the neck and shoulder region. Before psychological stress in the laboratory, perceived psychological demands were significantly associated with pain threshold--the higher the demands the higher the pain threshold. During stress those who reported low decision latitude and high degree of sleep disturbance were shown to have a low pain threshold. The findings are consistent with the hypothesis that subjects with high demand levels have an elevated pain threshold when they are not under excessive psychological stress. During psychological stress, on the other hand, those with low decision latitude are more pain sensitive than others, and this is aggravated in those who also report a high degree of sleep disturbance. PMID:8478825

  6. The effects of smartphone use on upper extremity muscle activity and pain threshold

    PubMed Central

    Lee, Minkyung; Hong, Yunkyung; Lee, Seunghoon; Won, Jinyoung; Yang, Jinjun; Park, Sookyoung; Chang, Kyu-Tae; Hong, Yonggeun

    2015-01-01

    [Purpose] The purpose of this study was to determine whether muscle activity and pressure-induced pain in the upper extremities are affected by smartphone use, and to compare the effects of phone handling with one hand and with both hands. [Subjects] The study subjects were asymptomatic women 20–22?years of age. [Methods] The subjects sat in a chair with their feet on the floor and the elbow flexed, holding a smartphone positioned on the thigh. Subsequently, the subjects typed the Korean anthem for 3?min, one-handed or with both hands. Each subject repeated the task three times, with a 5-min rest period between tasks to minimize fatigue. Electromyography (EMG) was used to record the muscle activity of the upper trapezius (UT), extensor pollicis longus (EPL), and abductor pollicis (AP) during phone operation. We also used a dolorimeter to measure the pressure-induced pain threshold in the UT. [Results] We observed higher muscle activity in the UT, AP, and EPL in one-handed smartphone use than in its two-handed use. The pressure-induced pain threshold of the UT was lower after use of the smartphone, especially after one-handed use. [Conclusion] Our results show that smartphone operation with one hand caused greater UT pain and induced increased upper extremity muscle activity. PMID:26180311

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

    E-print Network

    Adam Paetznick; Ben W. Reichardt

    2013-04-12

    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.

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

    PubMed

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

    2015-05-01

    Sands, WA, McNeal, JR, Murray, SR, and Stone, MH. Dynamic compression enhances pressure-to-pain threshold in elite athlete recovery: exploratory study. J Strength Cond Res 29(5): 1263-1272, 2015-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 after morning training. Muscular tenderness and stiffness are common symptoms of fatigue and exercise-induced muscle microtrauma and edema. Twenty-four highly trained athletes (men = 12 and women = 12) volunteered to participate in this study. The athletes were randomly assigned to experimental (n = 12) and control (n = 12) groups. Pressure-to-pain threshold measurements were conducted with a manual algometer on 3 lower extremity muscles. Experimental group athletes underwent PPDC on both legs through 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 pretest, treatment application (PPDC or control), an immediate post-test (PPT), and a delayed post-test (PPT) after the afternoon practice session. Difference score results showed that the experimental group's PPT threshold improved after PPDC treatment immediately and persisted the remainder of the day after afternoon practice. The control group showed no statistical change. We conclude that PPDC is a promising means of accelerating and enhancing recovery after the normal aggressive training that occurs in Olympic and aspiring Olympic athletes. PMID:24531439

  9. The Impact of Demand Characteristics on Brief Acceptance- and Control-Based Interventions for Pain Tolerance

    ERIC Educational Resources Information Center

    Roche, Bryan; Forsyth, John P.; Maher, Elaine

    2007-01-01

    The present analog study compared the effectiveness of an acceptance- and control-based intervention on pain tolerance using a cold pressor task, and is a partial replication and extension of the Hayes, Bissett et al. (Hayes, S. C., Bissett, R.T., Korn, Z., Zettle, R. D., Rosenfarb, I. S., Cooper, L. D., & Grundt, A. M. (1999). "The impact of…

  10. Tactile, thermal, and electrical thresholds in patients with and without phantom limb pain after traumatic lower limb amputation

    PubMed Central

    Li, Shengai; Melton, Danielle H; Li, Sheng

    2015-01-01

    Purpose To examine whether there is central sensitization in patients with phantom limb pain (PLP) after traumatic limb amputation. Methods Seventeen patients after unilateral lower limb amputation secondary to trauma were enrolled. Ten patients had chronic PLP, while the other seven patients had no PLP. Tactile-sensation threshold, cold- and warm-sensation thresholds, cold- and heat-pain thresholds, electrical-sensation threshold (EST), and electrical-pain threshold on the distal residual limb and the symmetrical site on the sound limb were measured in all tested patients. Their thresholds were compared within the PLP and non-PLP group, and between the groups. Results The novel findings included: 1) electrical-pain threshold was only decreased in the sound limb in the PLP group and there was no difference between two limbs in the non-PLP group, suggesting central sensitization in patients with PLP; and 2) EST was increased on the affected limb as compared to the sound limb within the PLP group, but there were no significant differences in EST between the PLP and non-PLP group. There were in general no significant differences in other tested thresholds within the groups and between groups. Conclusion Our results demonstrate central sensitization in the patients with PLP after traumatic limb amputation. PMID:25945065

  11. Influence of antipsychotic medication on pain perception in schizophrenia

    Microsoft Academic Search

    Thomas Jochum; Andrea Letzsch; Wolf Greiner; Gerd Wagner; Heinrich Sauer; Karl-Jürgen Bär

    2006-01-01

    A number of clinical observations indicate that pain processing might be disturbed in psychotic disorders such as schizophrenia. Only a few studies have investigated pain perception in schizophrenia. The main objective of this study was the investigation of thresholds of warmth perception (WP), thermal pain onset (TPO) and thermal pain tolerance (TPT) in acute schizophrenic patients and the influence of

  12. Latitudinal variation in thermal tolerance thresholds of early life stages of corals

    NASA Astrophysics Data System (ADS)

    Woolsey, E. S.; Keith, S. A.; Byrne, M.; Schmidt-Roach, S.; Baird, A. H.

    2015-06-01

    Organisms living in habitats characterized by a marked seasonal temperature variation often have a greater thermal tolerance than those living in more stable habitats. To determine the extent to which this hypothesis applies to reef corals, we compared thermal tolerance of the early life stages of five scleractinian species from three locations spanning 17° of latitude along the east coast of Australia. Embryos were exposed to an 8 °C temperature range around the local ambient temperature at the time of spawning. Upper thermal thresholds, defined as the temperature treatment at which the proportion of abnormal embryos or median life span was significantly different to ambient controls, varied predictably among locations. At Lizard Island, the northern-most site with the least annual variation in temperature, the proportion of abnormal embryos increased and life span decreased 2 °C above ambient in the two species tested. At two southern sites, One Tree Island and Lord Howe Island, where annual temperature variation was greater, upper temperature thresholds were generally 4 °C or greater above ambient for both variables in the four species tested. The absolute upper thermal threshold temperature also varied among locations: 30 °C at Lizard Island; 28 °C at One Tree Island; 26 °C at Lord Howe Island. These results support previous work on adult corals demonstrating predictable differences in upper thermal thresholds with latitude. With projected ocean warming, these temperature thresholds will be exceeded in northern locations in the near future, adding to a growing body of evidence indicating that climate change is likely to be more detrimental to low latitude than high latitude corals.

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

    PubMed Central

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

    2012-01-01

    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

  14. Overhead and noise threshold of fault-tolerant quantum error correction

    SciTech Connect

    Steane, Andrew M. [Centre for Quantum Computation, Department of Atomic and Laser Physics, Clarendon Laboratory, Parks Road, Oxford OX1 3PU (United Kingdom)

    2003-10-01

    Fault-tolerant quantum error correction (QEC) networks are studied by a combination of numerical and approximate analytical treatments. The probability of failure of the recovery operation is calculated for a variety of Calderbank-Shor-Steane codes, including large block codes and concatenated codes. Recent insights into the syndrome extraction process, which render the whole process more efficient and more noise tolerant, are incorporated. The average number of recoveries that can be completed without failure is thus estimated as a function of various parameters. The main parameters are the gate {gamma} and memory {epsilon} failure rates, the physical scale-up of the computer size, and the time t{sub m} required for measurements and classical processing. The achievable computation size is given as a surface in parameter space. This indicates the noise threshold as well as other information. It is found that concatenated codes based on the [[23,1,7

  15. Cortex glial cells activation, associated with lowered mechanical thresholds and motor dysfunction, persists into adulthood after neonatal pain

    PubMed Central

    Sanada, Luciana Sayuri; Sato, Karina Laurenti; Machado, Nathalia Leilane Berto; de Cássia do Carmo, Elisabete; Sluka, Kathleen A.; Fazan, Valeria Paula Sassoli

    2014-01-01

    We investigated if changes in glial activity in cortical areas that process nociceptive stimuli persisted in adult rats after neonatal injury. Neonatal pain was induced by repetitive needle prickling on the right paw, twice per day for 15 days starting at birth. Wistar rats received either neonatal pain or tactile stimulation and were tested behaviorally for mechanical withdrawal thresholds of the paws and gait alterations, after 15 (P15) or 180 (P180) days of life. Brains from rats on P15 and P180 were immunostained for glial markers (GFAP, MCP-1, OX-42) and the following cortical areas were analyzed for immunoreactivity density: prefrontal, anterior insular, anterior cingulated, somatosensory and motor cortices. Withdrawal thresholds of the stimulated paw remained decreased on P180 after neonatal pain when compared to controls. Neonatal pain animals showed increased density for both GFAP and MCP-1 staining, but not for OX-42, in all investigated cortical areas on both experimental times (P15 and P180). Painful stimuli in the neonatal period produced pain behaviors immediately after injury that persisted in adult life, and was accompanied by increase in the glial markers density in cortical areas that process and interpret pain. Thus, long-lasting changes in cortical glial activity could be, at least in part, responsible for the persistent hyperalgesia in adult rats that suffered from neonatal pain. PMID:24667146

  16. Winter cold-tolerance thresholds in field-grown Miscanthus hybrid rhizomes

    PubMed Central

    Peixoto, Murilo de Melo; Friesen, Patrick Calvin; Sage, Rowan F.

    2015-01-01

    The cold tolerance of winter-dormant rhizomes was evaluated in diploid, allotriploid, and allotetraploid hybrids of Miscanthus sinensis and Miscanthus sacchariflorus grown in a field setting. Two artificial freezing protocols were tested: one lowered the temperature continuously by 1°C h–1 to the treatment temperature and another lowered the temperature in stages of 24h each to the treatment temperature. Electrolyte leakage and rhizome sprouting assays after the cold treatment assessed plant and tissue viability. Results from the continuous-cooling trial showed that Miscanthus rhizomes from all genotypes tolerated temperatures as low as –6.5 °C; however, the slower, staged-cooling procedure enabled rhizomes from two diploid lines to survive temperatures as low as –14 °C. Allopolyploid genotypes showed no change in the lethal temperature threshold between the continuous and staged-cooling procedure, indicating that they have little ability to acclimate to subzero temperatures. The results demonstrated that rhizomes from diploid Miscanthus lines have superior cold tolerance that could be exploited to improve performance in more productive polyploid lines. With expected levels of soil insulation, low winter air temperatures should not harm rhizomes of tolerant diploid genotypes of Miscanthus in temperate to sub-boreal climates (up to 60°N); however, the observed winter cold in sub-boreal climates could harm rhizomes of existing polyploid varieties of Miscanthus and thus reduce stand performance. PMID:25788733

  17. Pressure pain thresholds in healthy subjects: influence of physical activity, history of lower back pain factors and the use of endermology as a placebo-like treatment

    Microsoft Academic Search

    Andre Farasyn; Romain Meeusen

    2003-01-01

    To investigate the influence of different factors on pressure pain threshold (PPT) with reference to the back and hip muscles, a group of 34 healthy adults were examined. The PPT of selected measuring points in the low thoracolumbar Erector spinae and Glutei maximus & medius and Tensor fasciae latae were determined with the aid of a Fischer pressure algometer. The

  18. Case report: efficacy and tolerability of ketamine in opioid-refractory cancer pain.

    PubMed

    Amin, Priya; Roeland, Eric; Atayee, Rabia

    2014-09-01

    A 36-year-old female with metastatic breast cancer involving bones, liver, lung, and pleura/chest wall with worsening back pain received weight-based intravenous (IV) ketamine and was transitioned to oral ketamine for cancer-related neuropathic pain. She had responded poorly to outpatient pain regimen of oxycodone sustained and immediate release, hydromorphone, gabapentin, and duloxetine (approximate 480 mg total oral morphine equivalents [OME]), reporting an initial pain score of 10/10. She was started on hydromorphone parenteral patient-controlled analgesia (PCA) bolus dose in addition to her outpatient regimen. Despite escalating doses of opioids and the addition of a lidocaine 5% patch, the patient's pain remained uncontrolled 6 days after admission. On hospital day 7, utilizing a hospital weight-based ketamine protocol, the patient was started on subanesthetic doses of ketamine at 0.2 mg/kg/h (288 mg/24 h) and titrated over 2 days to 0.4 mg/kg/h (576 mg/24 h). Then, a 3-day rotation from intravenous to oral ketamine was initiated, and the patient was discharged on ketamine oral solution, 75 mg every 8 hours. When the patient's dose was increased to 0.4 mg/kg/h, adequate pain relief was charted by the nurse within 120 minutes, "patient pain free and resting comfortably." Her pain continued to be well managed, with an average pain score of 5/10 with the ketamine continuous infusion and sustained with conversion to oral ketamine without any report of side effects. This was a 37% reduction in pain scores. With the patient's stabilized dose of ketamine, opioid requirements decreased by 61.4% (1017.5 mg reduction in total OME). The use of weight-based dosing of IV continuous infusion and transition to oral ketamine was effective and tolerable in the management of opioid-refractory, neuropathic cancer pain. It is hoped that this case report promotes a discussion regarding ketamine dosing in refractory neuropathic cancer pain. PMID:25102039

  19. Painful Intercourse Is Significantly Associated with Evoked Pain Perception and Cognitive Aspects of Pain in Women with Pelvic Pain

    PubMed Central

    Alappattu, Meryl J; George, Steven Z; Robinson, Michael E; Fillingim, Roger B; Moawad, Nashat; LeBrun, Emily Weber; Bishop, Mark D

    2015-01-01

    Introduction Evidence suggests that painful intercourse, pain-related psychosocial factors, and altered pain processing magnify the pain experience, but it is not clear how these factors are related to each other. Aim The aims were to (i) characterize differences between women with pelvic pain and pain-free women using a battery of pain-related psychosocial measures, clinical pain ratings, and evoked local and remote pain sensitivity; and (ii) examine the relationship between intercourse pain, clinical pain, and local and remote evoked pain sensitivity. Methods Women with pelvic pain lasting at least 3 months and pain-free women completed questionnaires and underwent pain sensitivity testing. Self-report measures included clinical pain intensity, pain catastrophizing, pain-related fear, pain anxiety, depression, sexual function, and self-efficacy. Pain sensitivity measures included threshold and tolerance and temporal summation of pain. Separate analyses of variance (anova) were used to test group differences in self-report and pain sensitivity measures. Correlations were calculated among dyspareunia, psychosocial factors, and evoked pain. Main Outcome Measures Self-reported pain and pain sensitivity measures. Results Twenty-eight pain-free women and 14 women with pelvic pain participated in this study. Women with pelvic pain reported greater pain intensity and greater psychosocial involvement compared with pain-free women. No differences existed between groups for thermal or pressure measures, but women with pelvic pain rated their pain with pain testing significantly higher than pain-free women. Intercourse pain was significantly associated with affective and sensory pain and pressure pain ratings at the puborectalis, vulvar vestibule, adductor longus tendons, and tibialis anterior muscle. Conclusions Differences in local pain ratings suggest that women with pelvic pain perceive stimuli in this region as more painful than pain-free women although the magnitude of stimuli does not differ. Alappattu MJ, George SZ, Robinson ME, Fillingim RB, Moawad N, LeBrun EW, and Bishop MD. Painful intercourse is significantly associated with evoked pain perception and cognitive aspects of pain in women with pelvic pain. Sex Med 2015;3:14–23. PMID:25844171

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

    PubMed Central

    Moloney, Tonya M.; Witney, Alice G.

    2014-01-01

    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

  1. Upper bounds on fault tolerance thresholds of noisy Clifford-based quantum computers

    NASA Astrophysics Data System (ADS)

    Plenio, M. B.; Virmani, S.

    2010-03-01

    We consider the possibility of adding noise to a quantum circuit to make it efficiently simulatable classically. In previous works, this approach has been used to derive upper bounds to fault tolerance thresholds—usually by identifying a privileged resource, such as an entangling gate or a non-Clifford operation, and then deriving the noise levels required to make it 'unprivileged'. In this work, we consider extensions of this approach where noise is added to Clifford gates too and then 'commuted' around until it concentrates on attacking the non-Clifford resource. While commuting noise around is not always straightforward, we find that easy instances can be identified in popular fault tolerance proposals, thereby enabling sharper upper bounds to be derived in these cases. For instance we find that if we take Knill's (2005 Nature 434 39) fault tolerance proposal together with the ability to prepare any possible state in the XY plane of the Bloch sphere, then not more than 3.69% error-per-gate noise is sufficient to make it classical, and 13.71% of Knill's ? noise model is sufficient. These bounds have been derived without noise being added to the decoding parts of the circuits. Introducing such noise in a toy example suggests that the present approach can be optimized further to yield tighter bounds.

  2. Effect of brief mindfulness intervention on tolerance and distress of pain induced by cold-pressor task.

    PubMed

    Liu, Xinghua; Wang, Sisi; Chang, Shaochen; Chen, Wenjun; Si, Mei

    2013-08-01

    A number of studies have demonstrated that short-term meditation intervention can lead to greater tolerance and lower pain or distress ratings of experimentally induced pain. However, few attempts have been made to examine the effects of short-term mindfulness-based intervention on the tolerance and distress of pain, when delivered in a therapist-free form. The present research explored the effect of brief mindfulness intervention using pre-recorded instruction on pain experimentally induced by the cold-pressor task. The effects of the mindfulness strategy, the distraction strategy and spontaneous strategy, all through the instructions of pre-recorded voices, were compared. The subjects were drawn from healthy college students and randomly assigned to the aforementioned three groups. Our results showed that compared with using spontaneous strategies, the mindfulness intervention significantly improved the participants' pain tolerance and reduced their immersion distress. The distraction strategy also significantly improved the participants' pain tolerance. However, it did not have a significant effect on the participants' level of distress during the immersion period. Our results suggest that brief mindfulness intervention without a therapist's personal involvement is capable of helping people cope with pain induced by the cold-pressor task. PMID:22961992

  3. Sliding pressure algometer, a development in eliciting pressure pain thresholds at the boundaries of surface markings of abnormally tender regions

    Microsoft Academic Search

    Alexander John R Macdonald

    2011-01-01

    The pressure algometer probe tip is usually held stationary and pressure is steadily increased from zero until a pressure pain threshold (PPT) is elicited. In order to explore the extent of surface markings of abnormally tender regions in more detail an improved method is proposed whereby the pressure algometer is not kept still. It is slid over the tissues at

  4. The effects of auricular transcutaneous electrical nerve stimulation (TENS) on experimental pain threshold and autonomic function in healthy subjects.

    PubMed

    Johnson, M I; Hajela, V K; Ashton, C H; Thompson, J W

    1991-09-01

    The present study examines the effects of auricular transcutaneous electrical nerve stimulation (TENS) on electrical pain threshold measured at the ipsilateral wrist and autonomic functions including skin temperature, blood pressure and pulse rate in 24 healthy subjects. TENS was administered as low frequency trains of pulses delivered at a 'strong but comfortable' intensity to 1 of 3 auricular points to be examined: (i) autonomic effects (autonomic point), (ii) pain threshold effects (wrist point), and (iii) placebo effects at an unrelated point (face point). A fourth untreated group was designated as a situation control. The main finding of the study was that auricular TENS produced no significant overall effects on experimental pain threshold or autonomic functions recorded under the present conditions. However, pain threshold was found to increase by over 50% of its pretreatment baseline in 4 subjects and by 30% in 6 subjects. This rise was not dependent upon the site of auricular TENS. The possible mechanisms of such changes are discussed. PMID:1758713

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

    Microsoft Academic Search

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

    2001-01-01

    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

  6. Salivary Cortisol and Cold Pain Sensitivity in Female Twins

    PubMed Central

    Godfrey, Kathryn M; Strachan, Eric; Dansie, Elizabeth; Crofford, Leslie J; Buchwald, Dedra; Goldberg, Jack; Poeschla, Brian; Succop, Annemarie; Noonan, Carolyn; Afari, Niloofar

    2013-01-01

    Background There is a dearth of knowledge about the link between cortisol and pain sensitivity. Purpose We examined the association of salivary cortisol with indices of cold pain sensitivity in 198 female twins and explored the role of familial confounding. Methods Three-day saliva samples were collected for cortisol levels and a cold pressor test was used to collect pain ratings and time to threshold and tolerance. Linear regression modeling with generalized estimating equations examined the overall and within-pair associations. Results Lower diurnal variation of cortisol was associated with higher pain ratings at threshold (p = 0.02) and tolerance (p < 0.01). The relationship of diurnal variation with pain ratings at threshold and tolerance was minimally influenced by familial factors (i.e., genetics and common environment). Conclusions Understanding the genetic and non-genetic mechanisms underlying the link between HPA axis dysregulation and pain sensitivity may help to prevent chronic pain development and maintenance. PMID:23955075

  7. Superconducting quantum circuits at the surface code threshold for fault tolerance

    NASA Astrophysics Data System (ADS)

    Barends, R.; Kelly, J.; Megrant, A.; Veitia, A.; Sank, D.; Jeffrey, E.; White, T. C.; Mutus, J.; Fowler, A. G.; Campbell, B.; Chen, Y.; Chen, Z.; Chiaro, B.; Dunsworth, A.; Neill, C.; O'Malley, P.; Roushan, P.; Vainsencher, A.; Wenner, J.; Korotkov, A. N.; Cleland, A. N.; Martinis, John M.

    2014-04-01

    A quantum computer can solve hard problems, such as prime factoring, database searching and quantum simulation, at the cost of needing to protect fragile quantum states from error. Quantum error correction provides this protection by distributing a logical state among many physical quantum bits (qubits) by means of quantum entanglement. Superconductivity is a useful phenomenon in this regard, because it allows the construction of large quantum circuits and is compatible with microfabrication. For superconducting qubits, the surface code approach to quantum computing is a natural choice for error correction, because it uses only nearest-neighbour coupling and rapidly cycled entangling gates. The gate fidelity requirements are modest: the per-step fidelity threshold is only about 99 per cent. Here we demonstrate a universal set of logic gates in a superconducting multi-qubit processor, achieving an average single-qubit gate fidelity of 99.92 per cent and a two-qubit gate fidelity of up to 99.4 per cent. This places Josephson quantum computing at the fault-tolerance threshold for surface code error correction. Our quantum processor is a first step towards the surface code, using five qubits arranged in a linear array with nearest-neighbour coupling. As a further demonstration, we construct a five-qubit Greenberger-Horne-Zeilinger state using the complete circuit and full set of gates. The results demonstrate that Josephson quantum computing is a high-fidelity technology, with a clear path to scaling up to large-scale, fault-tolerant quantum circuits.

  8. Decreased sensitivity to experimental pain in adjustment disorder

    Microsoft Academic Search

    Karl-Jürgen Bär; Stanislaw Brehm; Michael Karl Boettger; Gerd Wagner; Silke Boettger; Heinrich Sauer

    2006-01-01

    An altered perception of pain has been described for several psychiatric disorders. To date the influence of adjustment disorders (AD) on pain perception has not been described.Here, we investigated perception of experimentally induced pain in 15 patients suffering from AD (subtype with depressive symptoms) and controls matched for age and sex. Thresholds and tolerances were assessed for thermal and electrical

  9. An indentation apparatus for evaluating discomfort and pain thresholds in conjunction with mechanical properties of foot tissue in vivo.

    PubMed

    Xiong, Shuping; Goonetilleke, Ravindra S; Witana, Channa P; Rodrigo, W D Asanka S

    2010-01-01

    The mechanical properties of human foot tissue in vivo as well as discomfort and pain thresholds are important for various applications. In this study, an apparatus for measuring the discomfort and pain thresholds and the mechanical properties of human tissues is presented. The apparatus employs a stepper motor that controls the indentation speed, as well as a load cell and potentiometer that determine the corresponding reaction force and tissue deformation (displacement), respectively. A LabVIEW program (LabVIEW 8, National Instruments Corporation; Austin, Texas) was developed to control the indentation via a data acquisition card. The apparatus can accommodate indentor displacements up to 35 mm and can impart forces up to 150 N at a controlled indentation speed in the range of 0 to 10 mm/s. Tests showed that the displacement measurement error is <0.17 mm in the nominal range (0.5% in the full scale) and the measurement error of force is <1.6 N in the nominal range (1.1% in the full scale). Experimental results indicate that the apparatus is reliable and flexible for measuring the mechanical properties of foot tissue in vivo in conjunction with pain and discomfort thresholds. PMID:21110259

  10. Olea Europea-derived phenolic products attenuate antinociceptive morphine tolerance: an innovative strategic approach to treat cancer pain.

    PubMed

    Muscoli, C; Lauro, F; Dagostino, C; D'Agostino, C; Ilari, S; Giancotti, L A; Gliozzi, M; Costa, N; Carresi, C; Musolino, V; Casale, F; Ventrice, D; Oliverio, M; Oliverio, E; Palma, E; Nisticò, S; Nistico', S; Procopio, A; Rizzo, M; Mollace, V

    2014-01-01

    Morphine and related opioid drugs are currently the major drugs for severe pain. Their clinical utility is limited in the management of severe cancer pain due to the rapid development of tolerance. Restoring opioid efficacy is therefore of great clinical importance. A great body of evidence suggests the key role of free radicals and posttranslational modulation in the development of tolerance to the analgesic activity of morphine. Epidemiological studies have shown a relationship between the Mediterranean diet and a reduced incidence of pathologies such as coronary heart disease and cancer. A central hallmark of this diet is the high consumption of virgin olive oil as the main source of fat which contains antioxidant components in the non-saponifiable fraction, including phenolic compounds absent in seed oils. Here, we show that in a rodent model of opiate tolerance, removal of the free radicals with phenolic compounds of olive oil such as hydroxytyrosol and oleuropein reinstates the analgesic action of morphine. Chronic injection of morphine in mice led to the development of tolerance and this was associated with increased nitrotyrosin and malondialdehyde (MDA) formation together with nitration and deactivation of MnSOD in the spinal cord. Removal of free radicals by hydroxytyrosol and oleuropein blocked morphine tolerance by inhibiting nitration and MDA formation and replacing the MnSOD activity. The phenolic fraction of virgin olive oil exerts antioxidant activities in vivo and free radicals generation occurring during chronic morphine administration play a crucial role in the development of opioid tolerance. Our data suggest novel therapeutic approach in the management of chronic cancer pain, in particular for those patients who require long-term opioid treatment for pain relief without development of tolerance. PMID:24750796

  11. Tolerance thresholds for Aedes albopictus and Aedes caspius in Italian urban areas.

    PubMed

    Carrieri, Marco; Bellini, Romeo; Maccaferri, Simona; Gallo, Lorenza; Maini, Stefano; Celli, Giorgio

    2008-09-01

    With nuisance mosquito species, the goal of integrated pest management is to keep mosquito density below a tolerance level that is often set by economic, ecological, and political factors. This study compares actual human annoyance, as measured by a phone survey, with several measures of mosquito abundance, in order to determine a threshold that is both relevant and practical. The efficiency of CO2-baited traps, container index (CI), and oviposition traps for monitoring Aedes albopictus, and CO2-baited traps for monitoring Aedes caspius, was evaluated. CO2-baited traps were confirmed to be of low efficiency in Ae. albopictus collection, while correlation matrices showed a good relationship between CI and the number of eggs collected (R = 0.91), and between number of eggs and phone-survey nuisance level estimates (R = 0.88). Correlation between CI and phone-survey nuisance levels was slightly lower (R = 0.78). We found a close relationship between the nuisance level declared by residents and mosquito captures obtained with CO2-baited traps (Ae. caspius) and ovitraps (Ae. albopictus). An equation is presented to estimate annoyance according to dwelling characteristics and to the presence of children in the family. PMID:18939689

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

    Microsoft Academic Search

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

    2010-01-01

    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

  13. Preventive Effects of Forced Exercise against Alcohol-induced Physical Dependency and Reduction of Pain Perception Threshold

    PubMed Central

    Motaghinejad, Majid; Ghaleni, Majid Asadi; Motaghinejad, Ozra

    2014-01-01

    Background: Treatment of postabstinence syndrome of alcohol is one of the major strategies of alcoholism treatment. Exercise can be modulated major brain pathways such as a reward system and pain perception centers. The aim of this study was to evaluation the effects of forced exercise in the management of alcohol dependence and pain perception alteration which induced by alcoholism. Methods: 72 adult male rats were divided into 2 major groups: (1) 40 of them was divided into groups of positive control (alcohol dependent) negative control and alcohol dependent groups under treatment by forced exercise, diazepam (0.4 mg/kg) and forced exercise in combination with diazepam and alcohol withdrawal signs, and blood cortisols, were measured in this groups. (2) 32 rats were divided into control, alcohol dependent (without treatment), and alcohol-dependent groups under treatment by forced exercise or indometacin (5 mg/kg) and then pain perception was assessed by using writhing test, tail-flick and hot plate test. Results: Forced exercise, diazepam, and their combinations significantly attenuates withdrawal syndrome to 20 ± 2, 22 ± 1.3 and 16 ± 2 and blood cortisol level to 6.8 ± 1.3,7.9 ± 1.2 and 5.8 ± 1.1, respectively, in comparison with the positive control group (P < 0.05 and P < 0.001). In alcohol dependent animal under treatment by forced exercise, pain response significantly inhibited with 37%, 57% and 38% decreases in writhing test, hot plate, and tail-flick test, respectively, in comparison with alcohol dependent (without treatment) group (P < 0.05). Conclusions: This study suggested that forced exercise can be useful as adjunct therapy in alcoholism patient and also can be effective in modulation of pain threshold reduction that was induced by alcohol dependency. PMID:25400889

  14. Acupuncture at both ST25 and ST37 improves the pain threshold of chronic visceral hypersensitivity rats.

    PubMed

    Liu, Hui-Rong; Wang, Xiao-Mei; Zhou, En-Hua; Shi, Yin; Li, Na; Yuan, Ling-Song; Wu, Huan-Gan

    2009-11-01

    Previous studies demonstrated the efficacy of electro-acupuncture (EA) in relieving chronic visceral hypersensitivity (CVH) in IBS rats. However, ST25 which is a key acupoint for patients with IBS has not been reported in these experiments. Eight CVH rats were treated by EA at both ST25 and ST37 for 20 min, once daily for seven consecutive days, model rats (n = 8) and normal rats (n = 8) as controls. After the first EA treatment, the abdominal withdrawal reflex scores were investigated to evaluate the pain threshold. After seven EA treatments, the concentrations of 5-hydroxytryptamine (5-HT), 5-HT3 receptor (5-HT3R) and 5-HT4 receptor (5-HT4R) in colon tissue were assayed quantitatively by enzyme-linked immunosorbent assay. The results showed that EA improved the pain threshold of CVH rats, reduced the 5-HT concentration and increased the 5-HT4R concentration, but had no effect on the 5-HT3R concentration. Further studies are needed to optimize the choice of two-matching points for EA in the treatment of CVH rats. PMID:19387829

  15. Efficacy and tolerability of celecoxib versus hydrocodone\\/acetaminophen in the treatment of pain after ambulatory orthopedic surgery in adults

    Microsoft Academic Search

    Joseph S. Gimbel; Andrew Brugger; William Zhao; Kenneth M. Verburg; G. Steven Geis

    2001-01-01

    Background: Current outpatient management of postoperative pain includes the use of oral opioid analgesics or nonsteroidal anti-inflammatory drugs; however, both types of medications are associated with side effects that can limit their usefulness in the outpatient setting.Objective: Two studies with identical protocols assessed the single- and multiple-dose analgesic efficacy and tolerability of celecoxib, a specific cyclooxygenase-2 inhibitor, in the treatment

  16. Perceived racial discrimination, but not mistrust of medical researchers, predicts the heat pain tolerance of African Americans with symptomatic knee osteoarthritis

    PubMed Central

    Pham, Quyen T.; Glover, Toni L.; Sotolongo, Adriana; King, Christopher D.; Sibille, Kimberly T.; Herbert, Matthew S.; Cruz-Almeida, Yenisel; Sanden, Shelley H.; Staud, Roland; Redden, David T.; Bradley, Laurence A.; Fillingim, Roger B.

    2014-01-01

    Objective Studies have shown that perceived racial discrimination is a significant predictor of clinical pain severity among African Americans. It remains unknown whether perceived racial discrimination also alters the nociceptive processing of painful stimuli, which, in turn, could influence clinical pain severity. This study examined associations between perceived racial discrimination and responses to noxious thermal stimuli among African Americans and non-Hispanic whites. Mistrust of medical researchers was also assessed given its potential to affect responses to the noxious stimuli. Method One hundred and thirty (52% African American, 48% non-Hispanic white) community-dwelling older adults with symptomatic knee osteoarthritis completed two study sessions. In session one, individuals provided demographic, socioeconomic, physical and mental health information. They completed questionnaires related to perceived lifetime frequency of racial discrimination and mistrust of medical researchers. In session two, individuals underwent a series of controlled thermal stimulation procedures to assess heat pain sensitivity, particularly heat pain tolerance. Results African Americans were more sensitive to heat pain and reported greater perceived racial discrimination as well as greater mistrust of medical researchers compared to non-Hispanic whites. Greater perceived racial discrimination significantly predicted lower heat pain tolerance for African Americans but not non-Hispanic whites. Mistrust of medical researchers did not significantly predict heat pain tolerance for either racial group Conclusion These results lend support to the idea that perceived racial discrimination may influence the clinical pain severity of African Americans via the nociceptive processing of painful stimuli. PMID:24219416

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

    PubMed Central

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

    2013-01-01

    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

  18. Evaluation of thermal, pain, and vibration sensation thresholds in newly diagnosed type 1 diabetic patients

    Microsoft Academic Search

    D Ziegler; P Mayer; F A Gries

    1988-01-01

    Small and large fibre function was studied in 40 non-ketotic, newly diagnosed Type 1 diabetic patients and 48 age-matched controls, using 12 quantitative tests for assessment of cutaneous sensation. Patients were aged 10-39 years and had been treated with insulin for 4-31 days. Thermal discrimination (foot), warm and cold thermal perception (thenar eminence and foot), and heat and cold pain

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

    PubMed Central

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

    2014-01-01

    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

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

    E-print Network

    Kanungo, Aparna

    2005-11-01

    Codes ..................... 3 B.Motivation........................... 5 II QUDIT GATES ........................... 6 A.ElementaryGates....................... 6 B. Relevance to Nonbinary Quantum Stabilizer Codes . . . . 8 C. Encoding and Decoding Stabilizer Codes... WITH FAULT-TOLERANT QUAN- TUM COMPUTATION ....................... 25 A.Background .......................... 25 1. Assumptions ....................... 25 2. SyndromeCalculation.................. 27 vii CHAPTER Page 3. ErrorModel ....................... 29 B...

  1. Pain

    MedlinePLUS

    ... that may be adding to your pain l deep breathing exercises —helps you to relax l guided ... Independence Ave SW, Room 712E Washington, DC 20201 web site: www.womenshealth.gov/faq/ carpal.htm www. ...

  2. Enhanced pain modulation among triathletes: a possible explanation for their exceptional capabilities.

    PubMed

    Geva, Nirit; Defrin, Ruth

    2013-11-01

    Triathletes and ironman triathletes engage in an extremely intense sport that involves hours of considerable pain, as well as physical and psychological stress, every day. The basic pain modulation properties of these athletes has not been established and therefore it is not clear whether they present with unique features that enable them to engage in such efforts. The aim was to investigate the existence of possible alterations in pain perception and modulation of triathletes, as well as possible underlying factors. Participants were 19 triathletes and 17 non-athletes who underwent measurement of pain threshold, pain tolerance, suprathreshold perceived pain intensity, temporal summation of pain, and conditioned pain modulation (CPM). Participants also completed the fear of pain and the pain catastrophizing questionnaires, and rated the amount of perceived stress. Triathletes exhibited higher pain tolerance (P<.0001), lower pain ratings (P<.001), and lower fear of pain values (P<.05) than controls. The magnitude of CPM was significantly greater in triathletes (P<.05), and negatively correlated with fear of pain (P<.05) and with perceived mental stress during training and competition (P<.05). The results suggest that triathletes exhibit greater pain tolerance and more efficient pain modulation than controls, which may underlie their perseverance in extreme physical efforts and pain during training/competitions. This capability may be enhanced or mediated by psychological factors, enabling better coping with fear of pain and mental stress. PMID:23806655

  3. Structural Health Monitoring: Leveraging Pain in the Human Body

    NASA Astrophysics Data System (ADS)

    Nayak, Subhadarshi

    2012-07-01

    Tissue damage, or the perception thereof, is managed through pain experience. The neurobiological process of pain triggers most effective defense mechanisms for our safety. Structural health monitoring (SHM) is also a very similar function, albeit in engineering systems. SHM technology can leverage many aspects of pain mechanisms to progress in several critical areas. Discrimination between features from the undamaged and damaged structures can follow the threshold gate mechanism of the pain perception. Furthermore, the sensing mechanisms can be adaptive to changes by adjusting the threshold as does the pain perception. A distributed sensor network, often advanced by SHM, can be made fault-tolerant and robust by following the perception way of self-organization and redundancy. Data handling in real life is a huge challenge for large-scale SHM. As sensory data of pain is first cleaned, the threshold is then processed through experiential information gathering and use.

  4. Engagement of signaling pathways of protease-activated receptor 2 and ?-opioid receptor in bone cancer pain and morphine tolerance.

    PubMed

    Bao, Yanju; Gao, Yebo; Hou, Wei; Yang, Liping; Kong, Xiangying; Zheng, Honggang; Li, Conghuang; Hua, Baojin

    2015-09-01

    Pain is one of the most common and distressing symptoms suffered by patients with progression of cancer. Using a rat model of bone cancer, recent findings suggest that proteinase-activated receptor 2 (PAR2) signaling pathways contribute to neuropathic pain and blocking PAR2 amplifies antinociceptive effects of systemic morphine. The purpose of our study was to examine the underlying mechanisms responsible for the role of PAR2 in regulating bone cancer-evoked pain and the tolerance of systemic morphine. Breast sarcocarcinoma Walker 256 cells were implanted into the tibia bone cavity of rats and this evoked significant mechanical and thermal hyperalgesia. Our results showed that the protein expression of PAR2 and its downstream pathways (protein kinases namely, PKC? and PKA) and transient receptor potential vanilloid 1 (TRPV1) were amplified in the dorsal horn of the spinal cord of bone cancer rats compared to control rats. Blocking spinal PAR2 by using FSLLRY-NH2 significantly attenuated the activities of PKC?/PKA signaling pathways and TRPV1 expression as well as mechanical and thermal hyperalgesia. Also, inhibition of PKC?/PKA and TRPV1 significantly diminished the hyperalgesia observed in bone cancer rats. Additionally, blocking PAR2 enhanced the attenuations of PKC?/PKA and cyclic adenosine monophosphate induced by morphine and further extended analgesia of morphine via ?-opioid receptor (MOR). Our data revealed specific signaling pathways, leading to bone cancer pain, including the activation of PAR2, downstream PKC?/PKA, TRPV1 and resultant sensitization of MOR. Targeting one or more of these signaling molecules may present new opportunities for treatment and management of bone cancer pain often observed in clinics. PMID:25708385

  5. Evaluation of the Analgesic Activity of Standardized Aqueous Extract of Terminalia chebula in Healthy Human Participants Using Hot Air Pain Model

    PubMed Central

    Kumar, Chiranjeevi Uday; Pokuri, Venkata Kishan

    2015-01-01

    Background Pain affects millions of people worldwide, opioid analgesics have been used for chronic painful conditions. Due to their adverse effects, safer alternatives would be beneficial. Terminalia chebula, with proven analgesic action has been evaluated in the hot air pain model for its analgesic activity. Aim To evaluate analgesic activity and safety of single oral dose of Terminalia chebula using hot air pain model in healthy human participants. Setting and Design Randomized, Double blind, Placebo controlled, Cross over study. Materials and Methods After taking written informed consent to IEC approved protocol, 12 healthy human participants were randomized to receive either single oral dose of two capsules of Terminalia chebula 500 mg each or identical placebo capsules in a double blinded manner. Thermal pain was assessed using hot air analgesiometer, to deliver thermal pain stimulus. Mean Pain Threshold time and Mean Pain Tolerance time measured in seconds at baseline and 180 minutes post drug. A washout period of two weeks was given for cross-over between the two treatments. Results Terminalia chebula significantly increased mean pain threshold and tolerance time compared to baseline and placebo. Mean pain threshold time increased from 34.06±2.63 seconds to 41.00±2.99 seconds (p<0.001) and mean pain tolerance time increased from 49.67± 3.72 seconds to 57.30±3.07 seconds (p<0.001). The increase in mean percentage change for pain threshold time is 20.42% (p<0.001) and for pain tolerance time is 17.50% (p<0.001). Conclusion In the present study, Terminalia chebula significantly increased Pain Threshold time and Pain Tolerance time compared to Placebo. Study medications were well tolerated.

  6. [Double-blind comparative study of the effectiveness and tolerance of 900 mg dexibuprofen and 150 mg diclofenac sodium in patients with painful gonarthrosis].

    PubMed

    Hawel, R; Klein, G; Mitterhuber, J; Brugger, A

    1997-01-31

    In this randomized double-blind, parallel-group study the efficacy of 300 mg oral dexibuprofen three times daily and 50 mg oral diclofenac sodium three times daily was tested for equivalence in 110 patients with painful osteoarthritis of the knee. During the 15-day treatment period the functional index for knee osteoarthritis according to Lequesne was improved under dexibuprofen by a mean of 7.4 and by a mean of 7.3 under treatment with diclofenac sodium. The test for equivalence by one-sided Wilcoxon-Mann-Whitney test shows equivalent efficacy of dexibuprofen by a Mann-Whitney-statistic of 0.505 and 0.415 as its lower boundary of the 95% confidence interval. The descriptive analysis of secondary criteria such as intensity of pain, rest pain, pain at beginning, nocturnal pain, tenderness, restriction of movement, handicap, subjective estimation of disease progression, as well as global judgement of efficacy and tolerance by investigator and patient confirm equivalence of both preparations. The pooled analysis of all parameters, tolerability included, by a Mann-Whitney-statistic of 0.520 with the lower boundary of the 95% confidence interval of 0.467 shows equivalence of both drugs with a trend to superiority of dexibuprofen due to its better tolerability. 7.3% of the patients on dexibuprofen and 14.5% of the patients on diclofenac sodium dropped out because of side-effects. PMID:9123945

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

    PubMed Central

    Bialosky, Joel E.; Robinson, Michael E.

    2014-01-01

    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

  8. Pharmacological effects of 3-iodothyronamine (T1AM) in mice include facilitation of memory acquisition and retention and reduction of pain threshold

    PubMed Central

    Manni, Maria Elena; De Siena, Gaetano; Saba, Alessandro; Marchini, Maja; Landucci, Elisa; Gerace, Elisabetta; Zazzeri, Marina; Musilli, Claudia; Pellegrini-Giampietro, Domenico; Matucci, Rosanna; Zucchi, Riccardo; Raimondi, Laura

    2013-01-01

    Background and Purpose 3-Iodothyronamine (T1AM), an endogenous derivative of thyroid hormones, is regarded as a rapid modulator of behaviour and metabolism. To determine whether brain thyroid hormone levels contribute to these effects, we investigated the effect of central administration of T1AM on learning and pain threshold of mice either untreated or pretreated with clorgyline (2.5 mg·kg?1, i.p.), an inhibitor of amine oxidative metabolism. Experimental Approach T1AM (0.13, 0.4, 1.32 and 4 ?g·kg?1) or vehicle was injected i.c.v. into male mice, and after 30 min their effects on memory acquisition capacity, pain threshold and curiosity were evaluated by the following tests: passive avoidance, licking latency on the hot plate and movements on the hole-board platform. Plasma glycaemia was measured using a glucorefractometer. Brain levels of triiodothyroxine (T3), thyroxine (T4) and T1AM were measured by HPLC coupled to tandem MS. ERK1/2 activation and c-fos expression in different brain regions were evaluated by Western blot analysis. Results T1AM improved learning capacity, decreased pain threshold to hot stimuli, enhanced curiosity and raised plasma glycaemia in a dose-dependent way, without modifying T3 and T4 brain concentrations. T1AM effects on learning and pain were abolished or significantly affected by clorgyline, suggesting a role for some metabolite(s), or that T1AM interacts at the rapid desensitizing target(s). T1AM activated ERK in different brain areas at lower doses than those effective on behaviour. Conclusions And Implications T1AM is a novel memory enhancer. This feature might have important implications for the treatment of endocrine and neurodegenerative-induced memory disorders. PMID:22889145

  9. The Relationship of Allopregnanolone Immunoreactivity and HPA-Axis Measures to Experimental Pain Sensitivity

    PubMed Central

    Mechlin, Beth; Morrow, A. Leslie; Maixner, William; Girdler, Susan S.

    2007-01-01

    In animal models, allopregnanolone (ALLO) negatively modulates the hypothalamic-pituitary-adrenal (HPA) axis and has been shown to exert analgesic effects. The purpose of this study was to assess the relationship between plasma ALLO immunoreactivity (ALLO-ir), HPA-axis measures, and pain sensitivity in humans. Forty-five African Americans (21 men, 24 women) and 39 non-Hispanic Whites (20 men, 19 women) were tested for pain sensitivity to tourniquet ischemia, thermal heat, and cold pressor tests. Plasma ALLO-ir, cortisol, and ?-endorphin concentrations were taken following an extended rest period. Lower concentrations of ALLO-ir were associated with increased pain tolerance to all three pain tests and increased pain threshold to the thermal heat pain task in the non-Hispanic Whites only (rs = -.35 to -.49, ps < .05). Also, only in the non-Hispanic Whites was cortisol associated with thermal heat tolerance (r = +.39, p<.05) and threshold (r = +.50, p < .01) and cold pressor tolerance (r = +.32, p < .05), and was ?-endorphin concentrations associated with cold pressor tolerance (r = +.33, p<.05). Mediational analyses revealed that higher cortisol levels mediated the relationship between lower ALLO-ir and increased thermal heat pain threshold in the non-Hispanic Whites only. These results suggest that lower ALLO-ir concentrations are associated with decreased pain sensitivity in humans, especially in non-Hispanic Whites, and that this relationship may be mediated by HPA-axis function. PMID:17292548

  10. A simple pain model for the evaluation of analgesic effects of NSAIDs in healthy subjects

    PubMed Central

    Sycha, Thomas; Gustorff, Burkhard; Lehr, Stephan; Tanew, Adrian; Eichler1, Hans-Georg; Schmetterer, Leopold

    2003-01-01

    Aims Non-steroidal anti-inflammatory drugs (NSAIDs) are believed to counteract inflammation and inflammation-induced sensitization of nociceptors by inhibiting peripheral prostaglandin synthesis. We evaluated an experimental pain model for NSAIDs, that included an inflammatory component to mimic clinical inflammatory pain conditions. Methods The study was performed in a randomized, double-blind, placebo-controlled, two-way crossover design on 32 healthy volunteers. A small skin area of the proximal upper leg was irradiated with a UVB source using three times the individually estimated minimal erythema dose. Twenty hours after irradiation skin temperature, heat pain threshold and tolerance in sunburn spot were measured using a thermal sensory testing. These measurements were repeated 2 h after medication of either 800 mg ibuprofen as single oral dose or placebo capsules. Effects of ibuprofen on outcome parameters were assessed with analyses of covariance (ancova). Results Placebo did not affect heat pain threshold or tolerance. By contrast, ibuprofen increased heat pain threshold by 1.092 °C [confidence interval (CI) 0.498, 1.695; P = 0.0008) compared with placebo. Heat pain tolerance also increased significantly by 1.618 °C (CI 1.062, 2.175; P = 0.0001). Conclusion The pain model we evaluated was well tolerated in all subjects and the effects of ibuprofen were highly significant. This model is simple, sensitive to NSAIDs' effects and therefore has potential for future experimental pain studies. PMID:12895189

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

    E-print Network

    Paris-Sud XI, Université de

    in 10 min followed by a 1.5 mg.kg-1 .h-1 IV infusion and other patients received saline (control group was provided exclusively by patient-controlled IV morphine. Pain scores, morphine consumption, operative hip; Introduction Patients experience moderate to severe pain after total hip arthroplasty. Adequate control

  12. The association between personality, pain threshold and a single nucleotide polymorphism (rs3813034) in the 3'-untranslated region of the serotonin transporter gene (SLC6A4).

    PubMed

    Aoki, Jun; Ikeda, Kazutaka; Murayama, Ohoshi; Yoshihara, Eiji; Ogai, Yasukazu; Iwahashi, Kazuhiko

    2010-05-01

    In 181 healthy Japanese volunteers we examined the relationship between personality, sensitivity to pain and a single nucleotide polymorphism (rs3813034) in the 3' untranslated region (3' UTR) of the serotonin transporter (5-HTT) gene (SLC6A4). Pain sensitivity was assessed by using cold and pressure thresholds. Personality was assessed by the Temperament and Character Inventory (TCI). Males without the T allele (G/G) showed a significantly higher spiritual acceptance (ST3) score than those who had the T allele (T/T and T/G). Females with the T allele (T/T and T/G) showed significantly higher transpersonal identification (ST2) and self-transcendence (ST) scores than those without the T allele (G/G). As for pain sensitivity and its relationship with TCI, we found a low negative correlation between cold water stimulation, disorderliness (NS4) and novelty seeking (NS) in males, whereas in females we found a low positive correlation between cold water stimulation, self-acceptance (SD4) and pure-hearted principles (C5), as well as pressure stimulation and SD4. It is possible that the 5-HTT 3' UTR gene polymorphism affects the character dimensions of Cloniger's theory, and that there might be a low correlation between pain and a part of the personality. PMID:20303273

  13. Relationship between quantitative sensory testing and pain or disability in people with spinal pain-a systematic review and meta-analysis.

    PubMed

    Hübscher, Markus; Moloney, Niamh; Leaver, Andrew; Rebbeck, Trudy; McAuley, James H; Refshauge, Kathryn M

    2013-09-01

    Sensitization of the nervous system can present as pain hypersensitivity that may contribute to clinical pain. In spinal pain, however, the relationship between sensory hypersensitivity and clinical pain remains unclear. This systematic review examined the relationship between pain sensitivity measured via quantitative sensory testing (QST) and self-reported pain or pain-related disability in people with spinal pain. Electronic databases and reference lists were searched. Correlation coefficients for the relationship between QST and pain intensity or disability were pooled using random effects models. Subgroup analyses and mixed effects meta-regression were used to assess whether the strength of the relationship was moderated by variables related to the QST method or pain condition. One hundred and forty-five effect sizes from 40 studies were included in the meta-analysis. Pooled estimates for the correlation between pain threshold and pain intensity were -0.15 (95% confidence interval [CI]: -0.18 to -0.11) and for disability -0.16 (95% CI: -0.22 to -0.10). Subgroup analyses and meta-regression did not provide evidence that these relationships were moderated by the QST testing site (primary pain/remote), pain condition (back/neck pain), pain type (acute/chronic), or type of pain induction stimulus (eg, mechanical/thermal). Fair correlations were found for the relationship between pain intensity and thermal temporal summation (0.26, 95% CI: 0.09 to 0.42) or pain tolerance (-0.30, 95% CI: -0.45 to -0.13), but only a few studies were available. Our study indicates either that pain threshold is a poor marker of central sensitization or that sensitization does not play a major role in patients' reporting of pain and disability. Future research prospects are discussed. PMID:23711482

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

    PubMed Central

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

    2011-01-01

    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

  15. Psychological aspects of painful medical conditions in children. I. Developmental aspects and assessment.

    PubMed

    Lavigne, J V; Schulein, M J; Hahn, Y S

    1986-11-01

    The assessment and development of pain in children is reviewed in the first part of a two-part series. Assessment of pain in children has relied on self-report measures that have included visual analogue procedures using concrete stimuli for ratings. Behavioral assessment procedures are more sophisticated, but research on behavioral assessment of pediatric pain has begun to emergy only recently. There has been very little research on the developmental aspects of pain tolerance and pain threshold in children. There are preliminary indications that children's thoughts and attitudes about pain may change with age in a manner that contributes to more intense feelings of pain in adolescence than childhood. Children undergoing painful medical procedures show declining emotional outbursts with age and increasing signs of self-control and muscular rigidity. Possibilities for integrating the study of the developmental aspects of pain with social learning theory, cognitive developmental theory, and the psychology of physical symptom perception are discussed. PMID:3540810

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

    PubMed Central

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

    2015-01-01

    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. PMID:25565782

  17. Peripherally driven low-threshold inhibitory inputs to lamina I local-circuit and projection neurones: a new circuit for gating pain responses

    PubMed Central

    Luz, Liliana L; Szucs, Peter; Safronov, Boris V

    2014-01-01

    Spinal lamina I is a key element of the pain processing system which relays primary afferent input to supraspinal areas. However, little is known about how the signal is modulated by its intrinsic network including local-circuit neurones (LCNs) and much less numerous anterolateral tract projection neurones (PNs). Here, we used whole-cell patch clamp recordings in an isolated spinal cord preparation to examine properties of identified LCNs (n = 85) and PNs (n = 73) in their functionally preserved local networks. Forty LCNs showed spontaneous rhythmic firing (2–7 Hz) at zero current injection, which persisted in the presence of blockers of fast synaptic transmission. In the remaining cases, most LCNs and PNs fired tonically in response to depolarizing current injections. We identified LCNs and PNs receiving low-threshold primary afferent-driven inhibitory inputs, which in many cases were disynaptic and temporally preceded classical high-threshold excitatory inputs. This direct inhibitory link between low-threshold afferents and PNs can function as a postsynaptic gate controlling the nociceptive information flow in the spinal cord. The LCNs were found to be integrated into the superficial dorsal horn network by their receipt of monosynaptic and disynaptic inputs from other lamina I and II neurones. One-third of LCNs and two-thirds of PNs tested responded to substance P application. Thus, substance P released by a noxious afferent stimulation may excite PNs in two ways: directly, and via the activation of presynaptic LCN circuitries. In conclusion, we have described important properties of identified lamina I neurones and their roles in a new circuit for gating pain responses. PMID:24421354

  18. Pressure pain threshold and needle acupuncture in chronic tension-type headache – a double-blind placebo-controlled study

    Microsoft Academic Search

    Matthias Karst; Jens D Rollnik; Matthias Fink; Michaela Reinhard; Siegfried Piepenbrock

    2000-01-01

    In order to examine the role of muscular mechanisms in chronic tension-type headache a study with needle acupuncture was performed. Needle acupuncture could be of therapeutic value because it has shown some positive effects in myofascial pain syndromes. We performed a double-blind, placebo-controlled study with 39 patients (mean age 49.0 years, SD=14.8) fulfilling the International Headache Society criteria for chronic

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

    Microsoft Academic Search

    J Hughes; Victoria Infirmary; Middlesbrough TS; B Frank

    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

  20. Altered Pain Sensitivity in Elderly Women with Chronic Neck Pain

    PubMed Central

    Uthaikhup, Sureeporn; Prasert, Romchat; Paungmali, Aatit; Boontha, Kritsana

    2015-01-01

    Background Age-related changes occur in both the peripheral and central nervous system, yet little is known about the influence of chronic pain on pain sensitivity in older persons. The aim of this study was to investigate pain sensitivity in elders with chronic neck pain compared to healthy elders. Methods Thirty elderly women with chronic neck pain and 30 controls were recruited. Measures of pain sensitivity included pressure pain thresholds, heat/cold pain thresholds and suprathreshold heat pain responses. The pain measures were assessed over the cervical spine and at a remote site, the tibialis anterior muscle. Results Elders with chronic neck pain had lower pressure pain threshold over the articular pillar of C5-C6 and decreased cold pain thresholds over the cervical spine and tibialis anterior muscle when compared with controls (p < 0.05). There were no between group differences in heat pain thresholds and suprathreshold heat pain responses (p > 0.05). Conclusion The presence of pain hypersensitivity in elderly women with chronic neck pain appears to be dependent on types of painful stimuli. This may reflect changes in the peripheral and central nervous system with age. PMID:26039149

  1. Multiple pain complaints in amputees.

    PubMed Central

    Lindesay, J E

    1985-01-01

    A group of amputees complaining of longstanding phantom pain was compared with another comparable group of non-complainers. It was found that those with phantom pain made significantly more complaints of other painful conditions, both related and unrelated to the amputation; they were also more depressed. It is suggested that this association is due to a lowered pain tolerance in the group with phantom pain complaints, and that depression is one factor contributing to this lowered tolerance. PMID:3999080

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

    Microsoft Academic Search

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

    2008-01-01

    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

  3. Pressure pain thresholds assessed over temporalis, masseter, and frontalis muscles in healthy individuals, patients with tension-type headache, and those with migraine-a systematic review.

    PubMed

    Andersen, Sanne; Petersen, Marie Weinreich; Svendsen, Anette Sand; Gazerani, Parisa

    2015-08-01

    A systematic review was conducted to identify and summarize the available scientific literature addressing pressure pain threshold (PPT) values over the temporalis, masseter, and frontalis muscles in healthy humans, patients with tension-type headache (TTH), and those with migraine both in males and females. Six relevant medical databases for the literature search were included: PubMed, Web of Science, Cochrane, CINAHL, BioMed Central, and Embase. The search strategy was performed applying 15 keywords (eg, pressure pain threshold, temporalis muscle, tension type headache, pressure algometer) and their combinations. A total of 156 articles were identified, and 40 relevant articles were included. The main outcomes of the systematic review were extracted, and it was demonstrated that the PPT values in general were lower in patients compared with healthy subjects, and this was especially noted for temporalis in both females (migraine: 231.2 ± 38.3 kPa < TTH: 248.4 ± 39.3 kPa < healthy: 282.1 ± 70.8 kPa) and males (migraine: 225.5 ± 61.2 kPa < TTH: 264.2 ± 32.5 kPa < healthy: 314.8 ± 63.3 kPa). The masseter muscle seemed to be more sensitive than the other 2 muscles, in both females (healthy: masseter 194.1 ± 62.7 kPa < frontalis 277.5 ± 51.1 kPa < temporalis 282.1 ± 70.8 kPa) and males (healthy: masseter 248.2 ± 48.4 kPa < temporalis 314.8 ± 63.3 < frontalis 388 kPa). Females had lower PPT values than those of males in temporalis, masseter, and frontalis muscles. This work is the first to systematically review the scientific literature addressing PPT values over craniofacial muscles of healthy subjects, patients with TTH, and those with migraine to provide the PPT value ranges. Based on these findings, a set of guidelines was established to assist future studies including PPT assessments over craniofacial muscles. PMID:25955963

  4. Gender role affects experimental pain responses: a systematic review with meta-analysis.

    PubMed

    Alabas, O A; Tashani, O A; Tabasam, G; Johnson, M I

    2012-10-01

    Gender role refers to the culturally and socially constructed meanings that describe how women and men should behave in certain situations according to feminine and masculine roles learned throughout life. The aim of this meta-analysis was to evaluate the relationship between gender role and experimental pain responses in healthy human participants. We searched computerized databases for studies published between January 1950 and May 2011 that had measured gender role in healthy human adults and pain response to noxious stimuli. Studies were entered into a meta-analysis if they calculated a correlation coefficient (r) for gender role and experimental pain. Searches yielded 4465 'hits' and 13 studies were eligible for review. Sample sizes were 67-235 participants and the proportion of female participants was 45-67%. Eight types of gender role instrument were used. Meta-analysis of six studies (406 men and 539 women) found a significant positive correlation between masculine and feminine personality traits and pain threshold and tolerance, with a small effect size (r = 0.17, p = 0.01). Meta-analysis of four studies (263 men and 297 women) found a significant negative correlation between gender stereotypes specific to pain and pain threshold and tolerance, with a moderate effect size (r = -0.41, p < 0.001). In conclusion, individuals who considered themselves more masculine and less sensitive to pain than the typical man showed higher pain thresholds and tolerances. Gender stereotypes specific to pain scales showed stronger associations with sex differences in pain sensitivity response than masculine and feminine personality trait scales. PMID:22434689

  5. Defining clinical issues around tolerance, hyperalgesia, and addiction: a quantitative and qualitative outcome study of long-term opioid dosing in a chronic pain practice.

    PubMed

    Schneider, Jennifer P; Kirsh, Kenneth L

    2010-01-01

    Treatment with opioid medications has grown over the past decades, but has been surrounded by some ongoing controversy and debate to whether it is causing more harm than good for patients. To this end, the field of pain management has suffered from a lack of clarity about some basic definitions on concepts such as tolerance and hyperalgesia. Some characterize these issues as inevitable parts of opioid therapy while other schools of thought look at these issues as relatively rare occurrences. Unfortunately, most of the rhetoric around these topics has occurred with very little in the realm of real world data. To this end, the authors have reviewed the charts of 197 patients treated by a pain specialist for at least 1 year to better illustrate whether notions of tolerance and hyperalgesia are common occurrences and, more importantly, whether they occur within any type of specified timeframe. A total of 197 patient charts were reviewed. The sample had an average age of 49.39 years (range = 19-87 years; standard deviation [SD] = 12.48) and comprised 66 men (33.5 percent) and 131 women (66.5 percent). The patients were seen in the pain practice for an average of 56.52 months (range = 12-155 months; SD = 31.26). On average, the patients maintained an average daily dose of 180 mg morphine equivalents for a period of 35.1 months (range = 3-101 months; SD = 21.3). Looking at the pattern of medication usage change over time, 34.5 percent experienced dose stabilization after the initial titration, 13.2 percent had early dose stabilization within one dose change, and an additional 14.7 percent actually had dose decreases after surgeries or other interventional procedures. Only 6.6 percent of the sample had to be discharged or weaned from controlled substances over time in the clinic. Thus, it appears that tolerance and hyperalgesia are not foregone conclusions when considering placing a patient on long-term opioid therapy. PMID:21268999

  6. The plasticity of the association between mu-opioid receptor and glutamate ionotropic receptor N in opioid analgesic tolerance and neuropathic pain.

    PubMed

    Sánchez-Blázquez, Pilar; Rodríguez-Muñoz, Maria; Berrocoso, Esther; Garzón, Javier

    2013-09-15

    Multiple groups have reported the functional cross-regulation between mu-opioid (MOP) receptor and glutamate ionotropic receptor N (GluN), and the post-synaptic association of these receptors has been implicated in the transmission and modulation of nociceptive signals. Opioids, such as morphine, disrupt the MOP receptor-GluN receptor complex to stimulate the activity of GluN receptors via protein kinase C (PKC)/Src. This increased GluN receptor activity opposes MOP receptor signalling, and via neural nitric oxide synthase (nNOS) and calcium and calmodulin regulated kinase II (CaMKII) induces the phosphorylation and uncoupling of the opioid receptor, which results in the development of morphine analgesic tolerance. Both experimental in vivo activation of GluN receptors and neuropathic pain separate the MOP receptor-GluN receptor complex via protein kinase A (PKA) and reduce the analgesic capacity of morphine. The histidine triad nucleotide-binding protein 1 (HINT1) associates with the MOP receptor C-terminus and connects the activities of MOP receptor and GluN receptor. In HINT1?/? mice, morphine promotes enhanced analgesia and produces tolerance that is not related to GluN receptor activity. In these mice, the GluN receptor agonist N-methyl-D-aspartate acid (NMDA) does not antagonise the analgesic effects of morphine. Treatments that rescue morphine from analgesic tolerance, such as GluN receptor antagonism or PKC, nNOS and CaMKII inhibitors, all induce MOP receptor-GluN receptor re-association and reduce GluN receptor/CaMKII activity. In mice treated with NMDA or suffering from neuropathic pain (induced by chronic constriction injury, CCI), GluN receptor antagonists, PKA inhibitors or certain antidepressants also diminish CaMKII activity and restore the MOP receptor-GluN receptor association. Thus, the HINT1 protein stabilises the association between MOP receptor and GluN receptor, necessary for the analgesic efficacy of morphine, and this coupling is reduced following the activation of GluN receptors, similar to what is observed in neuropathic pain. PMID:23499699

  7. Pain evoked by polymodal stimulation of hand veins in humans.

    PubMed Central

    Arndt, J O; Klement, W

    1991-01-01

    1. To explore the function of the sensory innervation of veins in humans we used a psychophysical approach to study painful and non-painful sensations by applying polymodal stimuli (electrical, stretch, cold/heat and osmotic) inside vascularly isolated hand vein segments before and after blockade of either venous or cutaneous afferents. 2. All modes of stimulation elicited pain, which showed only slight adaptation during 10 min of maintained stimulation. Pain increased monotonically with stimulus intensity between threshold and the maximally tolerable pain. 3. The exponents of the power functions of the pain magnitude-stimulus strength relations for five stimulus modes ranged between 2.5 and 3.3 but did not significantly differ from one another (P = 0.3). 4. Pain evoked by all stimuli was reported to be of similar quality, i.e. sharp, aching and unpleasant; it was accompanied by non-painful sensations (skin movements on stretching, warm and cold sensation with intravenous thermal stimulation) unless the skin above the stimulated vein segment was numbed with benzocaine ointment. 5. Pain could no longer be evoked in the presence of 0.4-0.8% procaine within the stimulated vein segment. 6. These observations are consistent with the view that veins are invested with polymodal nociceptors only, which in all likelihood are connected with thinly myelinated afferents of the A delta group. 7. The vascularly isolated vein segment may open a new avenue for pain research in humans. PMID:1804973

  8. Nitrous oxide analgesia in humans: Acute and chronic tolerance

    PubMed Central

    Ramsay, Douglas S.; Leroux, Brian G.; Rothen, Marilynn; Prall, Christopher W.; Fiset, Louis O.; Woods, Stephen C.

    2006-01-01

    Electrical tooth stimulation was used to investigate whether humans develop tolerance to nitrous oxide (N2O) analgesia within a single administration as well as over repeated administrations. In a double-blind cross-over experiment, 77 subjects received a 40-minute administration of 38% N2O at one session and placebo gas at the other. The sessions were separated by 1 week and the order of gas administration was counterbalanced. Acute analgesic tolerance developed for pain threshold but not for detection threshold. There was no evidence of a hyperalgesic rebound effect following cessation of the N2O administration. In a second double-blind experiment, 64 subjects received both 30-min of placebo gas and 30-min of 35% N2O, separated by a 35-min gas wash-out period, during each of 5 sessions. Sensory thresholds were assessed prior to drug or placebo administration (baseline) and between 7-12 min and 25-30 min of gas administration. A control group of 16 subjects received only placebo gas at these 5 sessions. During a sixth session, the experimental procedures were similar to the previous sessions except that the control group received N2O for the first time and the experimental group was sub-divided to test for conditioned drug effects. For both detection and pain threshold measures, acute tolerance developed during the initial N2O exposure and chronic tolerance developed over repeated administrations. Although chronic tolerance developed, a test for Pavlovian drug conditioning found no evidence of conditioned effects on sensory thresholds. In conclusion, acute and chronic tolerance develop to N2O’s analgesic effects in humans. PMID:15733627

  9. Widespread sensitization in patients with chronic pain after revision total knee arthroplasty.

    PubMed

    Skou, Soren Thorgaard; Graven-Nielsen, Thomas; Rasmussen, Sten; Simonsen, Ole H; Laursen, Mogens B; Arendt-Nielsen, Lars

    2013-09-01

    Pain and sensitization are major issues in patients with osteoarthritis both before and after total knee arthroplasty (TKA) and revision TKA (re-TKA). The aim of this study was to assess sensitization in patients with and without chronic pain after re-TKAs. Twenty patients with chronic knee pain and 20 patients without pain after re-TKA participated. Spreading of pain was evaluated as the number of pain sites using a region-divided body chart. The pressure pain threshold (PPT) and pressure pain tolerance (PTT) were assessed by cuff algometry at the lower leg. Temporal summation of pain was assessed by recordings of the pain intensity on a visual analog scale (VAS) during repeated cuff pressure stimulations. Conditioning pain modulation (CPM) was recorded by experimental tonic arm pain by cuff pressure stimulation and assessment of PPTs on the knee, leg, and forearm using handheld pressure algometry. Participants with pain after re-TKA compared to participants without pain demonstrated: (1) significantly more pain sites (P=.004), (2) decreased cuff PPTs and PTTs at the lower leg (P<.001), (3) facilitated temporal summation (P<.001), and (4) impaired CPM (P<.001). Additionally, significant correlations between knee pain intensity and cuff PPTs, temporal summation, and CPM and between total duration of knee pain and temporal summation were found (P<.05). This study demonstrated widespread sensitization in patients with pain after re-TKA and highlighted the importance of ongoing nociceptive input for the chronification process. This has important implications for future revisions, and precautions should be taken if patients have widespread sensitization. PMID:23707268

  10. Pain management.

    PubMed

    Ripamonti, C I

    2012-09-01

    Despite published guidelines and educational programs on the assessment and treatment of cancer-related pain, in any stage of oncological disease, unrelieved pain continues to be a substantial worldwide public health concern either in patients with solid and haematological malignancies. The proper and regular self-reporting assessment of pain is the first step for an effective and individualized treatment. Opioids are the mainstay of analgesic therapy and can be associated with non-opioids drugs such as paracetamol or non-steroidal anti-inflammatory drugs and to adjuvant drugs (for neuropathic pain and symptom control). The role and the utility of weak opioids (i.e. codeine, dihydrocodeine, tramadol) are a controversy point. Morphine has been placed by World Health Organization on its Essential Drug List. In the comparative study with other strong opioids (hydromorphone, oxycodone), there is no evidence to show superiority or inferiority with morphine as the first choice opioid. Oral methadone is a useful and safe alternative to morphine. Methadone presents the potential to control pain difficult to manage with other opioids. although the oral route of opioid administration is considered the one of choice, intravenous, subcutaneous, rectal, transdermal, sublingual, intranasal, and spinal routes must be used in particular situation. Transdermal opioids such as fentanyl and buprenorphine are best reserved for patients whose opioid requirements are stable. Switching from one opioid to another can improve analgesia and tolerability. PMID:22987980

  11. 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

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

    2015-01-01

    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

  12. 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

    Hervera, Arnau; Leánez, Sergi; Pol, Olga

    2012-06-15

    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

  13. [Growing pains in children].

    PubMed

    Uziel, Yosef; Hashkes, Philip J

    2008-10-01

    Growing pains are the most common form of recurrent musculoskeletal pains in childhood and are present in 10-20% of children, mainly between the ages of 3-12 years. The diagnosis is based on typical historical clinical characteristics with a normal physical examination. The etiology is still unknown but current theories include low pain thresholds, as in fibromyalgia and local overuse pain that is supported by the finding of low bone strength in painful regions by ultrasound and hypermobility in many children with growing pains. There is also an associated familial and patient behavioral element. Treatment is conservative with patient and parental education on the benign outcome of these pains the most important element, in order to decrease anxiety. PMID:19039913

  14. Spatial Adaptive Wavelet Thresholding for Image Denoising

    Microsoft Academic Search

    S. Grace Chang; Martin Vetterli

    1997-01-01

    Wavelet thresholding with uniform threshold has shownsome success in denoising. For images, we propose that thiscan be improved by adjusting thresholds spatially, based onthe rationale that detailed regions such as edges and texturestolerate some noise but not blurring, whereas smoothregions tolerate blurring but not noise. The proposed algorithmis based on multiscale edge detection and imagesegmentation and then thresholding the coefficients

  15. Effects of graded oral doses of a new 5-hydroxytryptamine/noradrenaline uptake inhibitor (Ro 15-8081) in comparison with 60 mg codeine and placebo on experimentally induced pain and side effect profile in healthy men.

    PubMed Central

    Stacher, G; Steinringer, H; Schneider, S; Mittelbach, G; Gaupmann, G; Abatzi, T A; Stacher-Janotta, G

    1987-01-01

    1. Ro 15-8081 (Hoffmann-La Roche, Basle, Switzerland) is a novel mixed 5-HT/noradrenaline uptake inhibitor producing potent antinociceptive effects in animal pain models. 2. In healthy man, two models with electrically and thermally induced pain, respectively, have been shown to reliably discriminate between the effects of opioid as well as of antipyretic analgesics and placebo. 3. This study investigated the effects of single oral doses of 10, 25, and 50 mg Ro 15-8081 in comparison with 60 mg codeine and placebo on threshold and tolerance to electrically induced pain and on threshold to thermally induced pain. Furthermore, the effects on psychomotor function, self-rated subjective feelings, and side effect profile were studied. 4. Twenty healthy males participated each in five experiments in which they received, in random double-blind fashion, each of the treatments. Every experiment comprised two series of measurements before and twelve after drug administration, carried out at 30 min intervals. 5. Ro 15-8081 produced marked elevations of threshold and tolerance to electrically and of threshold to thermally induced pain. The effects of all doses of Ro 15-8081 were significantly superior to those of placebo. Threshold and tolerance to electrically induced pain were not affected differently by the three doses of Ro 15-8081, whereas the threshold to thermally induced pain was elevated significantly more by 50 mg than by 10 and 25 mg Ro 15-8081. 6. Codeine 60 mg had a more rapid onset of action and greater maximal effects than Ro 15-8081.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:3501728

  16. Heritability of pain catastrophizing and associations with experimental pain outcomes: a twin study.

    PubMed

    Trost, Zina; Strachan, Eric; Sullivan, Michael; Vervoort, Tine; Avery, Ally R; Afari, Niloofar

    2015-03-01

    This study used a twin paradigm to examine genetic and environmental contributions to pain catastrophizing and the observed association between pain catastrophizing and cold-pressor task (CPT) outcomes. Male and female monozygotic (n = 206) and dizygotic twins (n = 194) from the University of Washington Twin Registry completed a measure of pain catastrophizing and performed a CPT challenge. As expected, pain catastrophizing emerged as a significant predictor of several CPT outcomes, including cold-pressor Immersion Tolerance, Pain Tolerance, and Delayed Pain Rating. The heritability estimate for pain catastrophizing was found to be 37% with the remaining 63% of variance attributable to unique environmental influence. Additionally, the observed associations between pain catastrophizing and CPT outcomes were not found attributable to shared genetics or environmental exposure, which suggests a direct relationship between catastrophizing and experimental pain outcomes. This study is the first to examine the heritability of pain catastrophizing and potential processes by which pain catastrophizing is related to experimental pain response. PMID:25599234

  17. Efficacy and tolerance of repeated oral doses of tolperisone hydrochloride in the treatment of painful reflex muscle spasm: results of a prospective placebo-controlled double-blind trial.

    PubMed

    Pratzel, H G; Alken, R G; Ramm, S

    1996-10-01

    The efficacy and safety of oral tolperisone hydrochloride (Mydocalm) in the treatment of painful reflex muscle spasm was assessed in a prospective, randomized, double-blind, placebo-controlled trial. A total of 138 patients, aged between 20 and 75 years, with painful reflex muscle spasm associated with diseases of the spinal column or proximal joints were enrolled in eight rehabilitation centers. Patients were randomized to receive either 300 mg tolperisone hydrochloride or placebo for a period of 21 days. Both treatment groups recovered during the 3 weeks rehabilitation program. However, tolperisone hydrochloride proved to be significantly superior to placebo: the change score of the pressure pain threshold as the primary target parameter significantly increased during therapy with tolperisone hydrochloride (P = 0.03, valid-case-analysis) compared to the results obtained on placebo treatment. The overall assessment of efficacy by the patient also demonstrated significant differences in favor of tolperisone hydrochloride. Best results were seen in patients aged between 40 and 60 years with a history of complaints shorter than 1 year and with concomitant physical therapy. The evaluation of safety data, i.e., adverse events, biochemical and hematological laboratory parameters, demonstrated no differences between tolperisone hydrochloride and placebo. As a conclusion tolperisone hydrochloride represents an effective and safe treatment of painful reflex muscle spasm without the typical side effects of centrally active muscle relaxants. PMID:8951937

  18. Differential cross-tolerance development between single and repeated immobilization stress on the antinociceptive effect induced by ?-endorphin, 5-hydroxytryptamine, morphine, and WIN55,212-2 in the inflammatory mouse pain mode.

    PubMed

    Seo, Young-Jun; Kwon, Min-Soo; Choi, Seung-Min; Lee, Jin-Koo; Park, Soo-Hyun; Jung, Jun-Sub; Sim, Yun-Beom; Suh, Hong-Won

    2011-02-01

    We have evaluated the possible underlying mechanisms of immobilization stress-induced analgesia (SIA) by behavioral cross-tolerance studies and molecular studies. In the behavioral studies, the cross-tolerance between single or repeated immobilization SIA and the antinociceptive effects of ?-endorphin, morphine, 5-hydroxytryptamine (5-HT), or WIN55,212-2 were assessed. Both single and repeated (×7) immobilization stress significantly attenuated the ?-endorphin and 5-hydroxytryptamine-induced antinociception in the 2nd phase of formalin response, respectively. However, these cross-tolerances disappeared in prolonged repetition of the stress (×14). Neither single nor repeated (×7 and ×14) immobilization stress affected the antinociceptive effect of morphine or WIN55,212-2 at all. We also found that immobilization stress activated hypothalamic proopiomelanocortin (POMC) gene and ?-endorphin expression. Since, it has potent inhibitory activity on the noxious stimuli-induced POMC expression, immobilization stress seemed to dissipate the POMC gene expression process. Meanwhile, we did not find any changes in the opioid receptors' (mu-, delta- and kappa-receptor) and the cannabinoid receptors' (CB1 and CB2) expressions in the midbrain regions elicited by single or repeated stress. These results suggested that a single immobilization stress activates the descending pain modulatory system, which is mainly mediated through endorphinergic and serotonergic activation. Moreover, the tolerance of SIA induced by repeated stresses may be due to the prolonged activation of these systems induced by repeated immobilization. PMID:21380811

  19. 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

    Yehuda, S; Carasso, R L

    1993-01-01

    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

  20. Increased sensitivity to heat pain after sad mood induction in female patients with major depression

    Microsoft Academic Search

    Janneke Terhaar; Michael Karl Boettger; Christiane Schwier; Gerd Wagner; Anna-Karoline Israel; Karl-Jürgen Bär

    2010-01-01

    Patients suffering from major depressive disorder (MDD) have been shown to exhibit increased thresholds towards experimentally induced thermal pain applied to the skin. In contrast, the induction of sad mood can increase pain perception in healthy controls. Here, we aimed to test the hypothesis that heat pain thresholds are further increased after sad mood induction in depressed patients.Thermal pain thresholds

  1. Opioid-induced hyperalgesia in community-dwelling adults with chronic pain.

    PubMed

    Hooten, W Michael; Lamer, Tim J; Twyner, Channing

    2015-06-01

    The hyperalgesic effects of long-term opioid use in community-dwelling adults with chronic pain have not been widely reported. Therefore, the primary aim of this study was to determine the associations between opioid use and heat pain (HP) perception in a sample of community-dwelling adults with chronic pain. The study cohort involved 187 adults (85 opioid and 102 nonopioid) with chronic pain consecutively admitted to an outpatient interdisciplinary pain treatment program. Heat pain perception was assessed using a validated quantitative sensory test method of levels. An effect of opioid use was observed for nonstandardized (P = 0.004) and standardized (P = 0.005) values of HP 5-0.5 in which values of the opioid group were lower (more hyperalgesic) compared with those of the nonopioid group. HP 5-0.5 is a measure of the slope of the line connecting HP 0.5 (HP threshold) and HP 5 (intermediate measure of HP tolerance). In univariable (P = 0.019) and multiple variable (P = 0.003) linear regression analyses (adjusted for age, sex, body mass index, work status, pain diagnosis, pain severity, depression, and pain catastrophizing), opioid use was associated with lower (more hyperalgesic) nonstandardized values of HP 5-0.5. Similarly, in univariable (P = 0.004) and multiple variable (P = 0.011) linear regression analyses (adjusted for work status, pain diagnosis, pain severity, depression, and pain catastrophizing), opioid use was associated with lower standardized values of HP 5-0.5. In this sample of community-dwelling adults, these observations suggest that long-term opioid use was associated with hyperalgesia independent of other clinical factors known to influence HP perception. PMID:25815431

  2. Postamputation pain: studies on mechanisms.

    PubMed

    Nikolajsen, Lone

    2012-10-01

    Amputation is followed by both painful and non-painful phantom phenomena in a large number of amputees. Non-painful phantom sensations rarely pose any clinical problem, but 60-80% of all amputees also experience painful sensations (i.e. phantom pain) located to the missing limb. The severity of phantom pain usually decreases with time, but severe pain persists in 5-10% of patients. Pain in the residual limb (i.e. stump pain) is another consequence of amputation. Both stump and phantom pain can be very difficult to treat. Treatment guidelines used for other neuropathic pain conditions are probably the best approximation, especially for the treatment of stump pain. The aim of the present doctoral thesis was to explore some of the mechanisms underlying pain after amputation. Ten studies were carried out (I-X). My PhD thesis from 1998 dealt with pain before the amputation and showed that preamputation pain increases the risk of phantom pain after amputation (I). A perioperative epidural blockade, however, did not reduce the incidence of pain or abnormal sensory phenomena after amputation (II, III). The importance of sensitization before amputation for the subsequent development of pain is supported by study IV, in which pressure pain thresholds obtained at the limb before amputation were inversely related to stump and phantom pain after 1 week. Afferent input from the periphery is likely to contribute to postamputation pain as sodium channels were upregulated in human neuromas (VI), although neuroma removal did not always alleviate phantom pain (V). Sensitization of neurons in the spinal cord also seems to be involved in pain after amputation as phantom pain was reduced by ketamine, an NMDA-receptor antagonist. Another NMDA-receptor antagonist, memantine, and gabapentin, a drug working by binding to the ?2?-subunit of voltage-gated calcium channels, had no effect on phantom pain (VII-IX). Supraspinal factors are also important for pain after amputation as catastrophizing was associated with phantom pain (X). In conclusion, the present doctoral thesis confirmed and expanded the findings by others that several mechanisms are involved in the development and maintenance of phantom pain. A better understanding of the underlying mechanisms will hopefully lead to improved treatment of pain after amputation in the future. PMID:23158899

  3. Positive Traits Linked to Less Pain through Lower Pain Catastrophizing

    PubMed Central

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

    2011-01-01

    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

  4. Testing hyperalgesia and hypoalgesia in human pain reactivity using shock and radiant heat

    E-print Network

    Rhudy, Jamie Lynn

    1998-01-01

    the elects of an unpredictable shock and the threat of an unpredictable shock on pain thresholds using a radiant heat test (putative spinal mediation). Experiment 2 examined the effects of the same unpredictable shock and its threat on pain thresholds...

  5. 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

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

    2013-01-01

    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

  6. Chest pain

    MedlinePLUS

    ... pain that may feel like tightness, heavy pressure, squeezing, or crushing pain. The pain may spread to ... Call 911 if: You have sudden crushing, squeezing, tightening, or ... or between your shoulder blades. You have nausea, dizziness, ...

  7. Dopamine and Pain Sensitivity: Neither Sulpiride nor Acute Phenylalanine and Tyrosine Depletion Have Effects on Thermal Pain Sensations in Healthy Volunteers

    PubMed Central

    Becker, Susanne; Ceko, Marta; Louis-Foster, Mytsumi; Elfassy, Nathaniel M.; Leyton, Marco; Shir, Yoram; Schweinhardt, Petra

    2013-01-01

    Based on animal studies and some indirect clinical evidence, dopamine has been suggested to have anti-nociceptive effects. Here, we investigated directly the effects of increased and decreased availability of extracellular dopamine on pain perception in healthy volunteers. In Study 1, participants ingested, in separate sessions, a placebo and a low dose of the centrally acting D2-receptor antagonist sulpiride, intended to increase synaptic dopamine via predominant pre-synaptic blockade. No effects were seen on thermal pain thresholds, tolerance, or temporal summation. Study 2 used the acute phenylalanine and tyrosine depletion (APTD) method to transiently decrease dopamine availability. In one session participants ingested a mixture that depletes the dopamine amino acid precursors, phenylalanine and tyrosine. In the other session they ingested a nutritionally balanced control mixture. APTD led to a small mood-lowering response following aversive thermal stimulation, but had no effects on the perception of cold, warm, or pain stimuli. In both studies the experimental manipulation of dopaminergic neurotransmission was successful as indicated by manipulation checks. The results contradict proposals that dopamine has direct anti-nociceptive effects in acute experimental pain. Based on dopamine’s well-known role in reward processing, we hypothesize that also in the context of pain, dopamine acts on stimulus salience and might play a role in the initiation of avoidance behavior rather than having direct antinociceptive effects in acute experimental pain. PMID:24236199

  8. Pain and temporomandibular disorders: a pharmaco-gender dilemma.

    PubMed

    Shaefer, Jeffry R; Holland, Nicole; Whelan, Julia S; Velly, Ana Miriam

    2013-04-01

    Gender is the biggest risk factor in the development of temporomandibular disorders (TMD) and orofacial pain. Gender differences in pain thresholds, temporal summation, pain expectations, and somatic awareness exist in patients with chronic TMD or orofacial pain. There are gender differences in pharmacokenetics and pharmacodynamics of medications used to treat pain. A better understanding of the mechanisms that contribute to the increased incidence and persistence of chronic pain in females is needed. Future research will elucidate the sex effects on factors that protect against developing pain or prevent debilitating pain. Gender-based treatments for TMD and orofacial pain treatment will evolve from the translational research stimulated by this knowledge. PMID:23570804

  9. Sensory determinants of thermal pain.

    PubMed

    Defrin, Ruth; Ohry, Avi; Blumen, Nava; Urca, Gideon

    2002-03-01

    It is still unclear whether the quality of painful thermal sensation is determined only by conduction in specific, dedicated nociceptive channels (i.e. C or Adelta nociceptors) or whether it is a result of integrated activity in both nociceptive and non-nociceptive systems. To evaluate this question, we conducted quantitative and qualitative somatosensory testing in spinal cord injury subjects who suffered from partial or complete loss of thermal sensibility. Testing was performed in skin areas, below the level of the lesion, which were either lacking any thermal sensibility, lacking only one thermal sensation (either heat or cold) or having normal thermal sensations. We found that, in areas lacking any thermal sensibility, warm and cold stimuli produced a sensation of pricking pain, which had no thermal quality and was detected at significantly higher thresholds than in normal controls (48.5 +/- 1.8 and 9.7 +/- 5.1 degrees C for noxious heat- and noxious cold-induced pricking pain, respectively). Normal thermal pain sensations, consisting of normal perception of thermal quality and normal mean pain thresholds, were present both in normal skin areas (42.1 +/- 1.9 and 27.6 +/- 2.25 degrees C for heat and cold pain, respectively) and in areas in which only one thermal modality remained intact, when tested for that modality. Thus, testing for heat pain in areas in which only warm sensation was intact, or cold pain when only cold was intact produced normal qualities and thresholds of pain (42.8 +/- 3.4 and 24.4 +/- 6.2 degrees C for heat and cold pain, respectively). No spatial summation of pricking pain was observed, in contrast to the marked summation of heat pain in normal areas. In areas with only a single intact thermal modality, the quality of the perceived non-painful sensation was not determined by the thermal stimulus but by the intact modality (paradoxical sensation). Cold stimuli were perceived as warm in areas in which only warm sensation was preserved, and vice versa. A similar pattern was also seen for pain perception in areas with intact warm sensation. In these areas, both noxious heat and cold elicited a sensation of heat pain. No consistent pattern of heat-elicited pain was observed in areas in which only cold sensation was intact. These data suggest that the integrity of non-noxious thermal systems is essential for the normal perception of thermal pain, and that the subjective sensation of pain depends on the integration of information from nociceptive and non-nociceptive channels. PMID:11872608

  10. Efficacy and tolerability of lumiracoxib, a highly selective cyclo-oxygenase-2 (COX2) inhibitor, in the management of pain and osteoarthritis

    PubMed Central

    Geusens, Piet; Lems, Willem

    2008-01-01

    Lumiracoxib is a COX2 inhibitor that is highly selective, is more effective than placebo on pain in osteoarthritis (OA), with similar analgesic and anti-inflammatory effects as non-selective NSAIDs and the selective COX2 inhibitor celecoxib, has a lower incidence of upper gastrointestinal (GI) side effects in patients not taking aspirin, and a similar incidence of cardiovascular (CV) side effects compared to naproxen or ibuprofen. In the context of earlier guidelines and taking into account the GI and CV safety results of the TARGET study, lumiracoxib had secured European Medicines Agency (EMEA) approval with as indication symptomatic treatment of OA as well as short-term management of acute pain associated with primary dysmenorrhea and following orthopedic or dental surgery. In the complex clinical context of efficiency and safety of selective and non-selective COX inhibitors, its prescription and use should be based on the risk and safety profile of the patient. In addition, there is further need for long-term GI and CV safety studies and general post-marketing safety on its use in daily practice. Meanwhile, at the time of submission of this manuscript, the EMEA has withdrawn lumiracoxib throughout Europe because of the risk of serious side effects affecting the liver. PMID:18728796

  11. Tolerating Zero Tolerance?

    ERIC Educational Resources Information Center

    Moore, Brian N.

    2010-01-01

    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…

  12. Predictors of Postoperative Movement and Resting Pain following Total Knee Replacement

    PubMed Central

    Rakel, Barbara A.; Blodgett, Nicole Petsas; Zimmerman, M. Bridget; Logsden-Sackett, Nyla; Clark, Charles; Noiseux, Nicolas; Callaghan, John; Herr, Keela; Geasland, Katharine; Yang, Xiaoyan; Sluka, Kathleen A.

    2012-01-01

    This study determined preoperative predictors of movement and resting pain following total knee replacement (TKR). We hypothesized that younger patients with higher preoperative pain intensity, pain sensitivity, trait anxiety, pain catastrophizing, and depression would be more likely to experience higher postoperative movement pain than older patients with lower scores on these variables prior to surgery and that predictors would be similar for resting pain. Demographics, analgesic intake, anxiety, depression, pain catastrophizing, resting pain, movement pain (i.e., during active knee range of motion), and quantitative sensory tests, were performed pre-operatively on 215 participants scheduled for a unilateral TKR. On postoperative day 2 (POD2), analgesic intake, resting pain, and movement pain were again assessed. Significant predictors of moderate or severe movement pain were higher preoperative movement pain, von Frey pain intensity (VFPI) and heat pain threshold (HPT). People with severe movement pain preoperatively were 20 times more likely to have severe movement pain postoperatively. When the influence of preoperative movement pain was removed, depression became a predictor. Significant predictors of moderate to severe resting pain were higher preoperative resting pain, depression, and younger age. These results suggest that patients with higher preoperative pain and depression are more likely to have higher pain following TKR and younger patients may have higher resting pain. Cutaneous pain sensitivity predicted movement pain but not resting pain, suggesting that mechanisms underlying movement pain are different from resting pain. Aggressive management of preoperative pain, pain sensitivity, and depression prior to surgery may facilitate postoperative recovery. PMID:22840570

  13. [Pain in chronic arterial occlusive disease--the effect of improved macrocirculation on pseudo-radicular irritation].

    PubMed

    Falkenbach, A; Blumenthal, E; Landgraf, H; Bühring, M

    1991-01-01

    In chronic obliterating arteriopathy the maximum walking distance does not correlate well with the ankle arm index of arterial pressure measured by Doppler ultrasound. Beside reduced macrocirculation and microcirculatory maldistribution in skeletal muscle, pseudoradicular irritation was established as a relevant factor for the onset of pain during walking. The present study investigates the influence of the macrocirculation on hyperalgesia at rest in intermittent claudication. In 35 patients with chronic obliterating arteriopathy of the lower limbs (stage II according to Fontaine) the ankle/arm index of arterial pressure and the walking tolerance, as well as the pain at rest on applying pressure to the calf muscles were determined before and 3 weeks after percutaneous transluminar angioplasty (PTA). All 3 parameters improved after dilatation. Improved macrocirculation leads not only to a decreased production and improved clearance of pain-inducing metabolites in muscle tissue, but also--through a decrease of sympathetic stimulation of the muscle--to an elevation of the pain threshold. Apart from the reduction in pain-inducing metabolites, an absence of booster effects on pseudoradicular irritation and the regeneration of sensitive cutaneous afferents with resultant inhibition of reflex pain development are considered as possible factors in the achievement of pain relief following PTA. PMID:1830437

  14. Efficacy and side effects of diclofenac patch in treatment of patients with myofascial pain syndrome of the upper trapezius.

    PubMed

    Hsieh, Lin-Fen; Hong, Chang-Zern; Chern, Shiuan-Horng; Chen, Chen-Chiao

    2010-01-01

    Locally administered nonsteroidal anti-inflammatory drugs have been widely used in acute soft-tissue damage and articular musculoskeletal pain. This double-blind, placebo-controlled, randomized study was designed to evaluate the efficacy and safety of a topical diclofenac sodium patch in the relief of pain and inflammation as a result of myofascial pain syndrome (MPS) in the upper trapezius. After sample size calculations indicated that 147 patients would be needed to detect a 25% difference between drug and control, 153 patients with MPS were recruited and randomized to receive either a diclofenac sodium patch or control (menthol) patch. Visual analog scale (VAS), cervical active range of motion, pressure pain threshold of the myofascial trigger point (MTrP), patient global assessment, Neck Disability Index, and the occurrence of adverse events were assessed on Day 0 (baseline), Day 4, and Day 8. Use of the diclofenac sodium patch elicited favorable responses for the VAS, cervical active range of motion, and Neck Disability Index by the end of the treatment course (P<0.05), and was consistently superior to the control patch at all time intervals. No significant differences were observed for the pressure pain threshold of the MTrP for either patch. Tolerability assessment similarly showed the diclofenac patch to be comparatively superior. When assessed at the end of the study, 20 diclofenac patch patients, but only four control patients, considered the tolerability of treatment to be "very good." Significant differences in adverse reactions were observed between the diclofenac and control patches, with the control patch more likely to produce overall skin irritation. This study demonstrate that the diclofenac sodium patch was superior to the control patch in terms of reducing pain and improving functional outcomes, and did not result in significant adverse effects. PMID:19822404

  15. Pain Assessment

    Microsoft Academic Search

    Frank Andrasik; Carla Rime

    In adults, pain is one of the most common physical complaints. For example, a comprehensive review of available epidemiological\\u000a studies yielded a median point prevalence of chronic benign pain of 15% in adults, with individual study values ranging from\\u000a 2–40% (Verhaak, Kerssens, Dekker, Sorbi, & Bensing, 1998). Unfortunately, pain is not limited to the adult years, as estimates\\u000a of pain

  16. Face pain

    MedlinePLUS

    Face pain may be dull and throbbing or an intense, stabbing discomfort in the face or forehead. It can occur in one or ... Pain that starts in the face may be caused by a nerve problem, ... Face pain may also begin other places in the body. Abscessed ...

  17. Sex differences in experimental measures of pain sensitivity and endogenous pain inhibition

    PubMed Central

    Bulls, Hailey W; Freeman, Emily L; Anderson, Austen JB; Robbins, Meredith T; Ness, Timothy J; Goodin, Burel R

    2015-01-01

    It has been suggested that increased pain sensitivity and disruption of endogenous pain inhibitory processes may account, at least in part, for the greater prevalence and severity of chronic pain in women compared to men. However, previous studies addressing this topic have produced mixed findings. This study examined sex differences in pain sensitivity and inhibition using quantitative sensory testing (QST), while also considering the influence of other important factors such as depressive symptoms and sleep quality. Healthy men (n=24) and women (n=24) each completed a QST battery. This battery included an ischemic pain task (IPT) that used a submaximal effort tourniquet procedure as well as a conditioned pain modulation (CPM) procedure for the assessment of endogenous pain inhibition. Prior to QST, participants completed the Center for Epidemiologic Studies Depression Scale and the Pittsburgh Sleep Quality Index. Analyses revealed significant sex differences for the ischemic pain task and the conditioned pain modulation procedure, such that women tolerated the ischemic pain for a shorter amount of time and demonstrated less pain inhibition compared with men. This remained true even when accounting for sex differences in depressive symptoms and sleep quality. The results of this study suggest that women may be more pain sensitive and possess less-efficient endogenous pain inhibitory capacity compared with men. Whether interventions that decrease pain sensitivity and enhance pain inhibition in women ultimately improve their clinical pain outcomes is an area of research that deserves additional attention in the future. PMID:26170713

  18. Voluntary and forced exercises prevent the development of tolerance to analgesic effects of morphine in rats

    PubMed Central

    Shokraviyan, Monireh; Miladi-Gorji, Hossein; Vaezi, Gholam Hassan

    2014-01-01

    Objective(s): Morphine is widely used to treat chronic pain. However, its utility is hindered by the development of tolerance to its analgesic effects. Despite the renowned beneficial effects of physical exercise on cognitive functions and signs of morphine withdrawal in morphine-dependent rats, little is known about the roles of voluntary and forced exercises in tolerance to analgesic effect of morphine in rats. Materials and Methods: In this study, rats were injected with 10 mg/kg of morphine, once daily, SC over a period of 8 days of either voluntary or treadmill exercise. Following these injections, the percent of maximum possible effect (%MPE) of morphine was measured on the 1st, 4th, and 8th days by hot plate test. Results: Both voluntary and forced exercises significantly increased pain threshold compared to the sedentary group (P<0.05). Voluntary and forced exercises also significantly increased potency of morphine compared to sedentary morphine group (P<0.05). Thus, we concluded that voluntary and forced exercises blocked the development of tolerance during 8 daily simultaneously treatments. When exercising rats were returned to sedentary conditions, sensitivity to the analgesic effects of morphine increased significantly and persisted during sedentary period in the exercising rats. In other words, %MPE of the exercising morphine-group increased significantly compared to saline group (P<0.05). Conclusion: Our results showed that voluntary and forced exercises may be possible methods for treating the development of tolerance to analgesic effect of morphine in rats. PMID:24904720

  19. Synthesis and evaluation of fault-tolerant quantum computer architectures

    E-print Network

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

    2005-01-01

    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 ...

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

    PubMed Central

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

    2015-01-01

    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. PMID:25599300

  1. The genetic influences on oxycodone response characteristics in human experimental pain.

    PubMed

    Olesen, Anne E; Sato, Hiroe; Nielsen, Lecia M; Staahl, Camilla; Droney, Joanne; Gretton, Sophy; Branford, Ruth; Drewes, Asbjørn M; Arendt-Nielsen, Lars; Riley, Julia; Ross, Joy

    2015-08-01

    Human experimental pain studies are of value to study basic pain mechanisms under controlled conditions. The aim of this study was to investigate whether genetic variation across selected mu-, kappa- and delta-opioid receptor genes (OPRM1, OPRK1and OPRD1, respectively) influenced analgesic response to oxycodone in healthy volunteers. Experimental multimodal, multitissue pain data from previously published studies carried out in Caucasian volunteers were used. Data on thermal skin pain tolerance threshold (PTT) (n = 37), muscle pressure PTT (n = 31), mechanical visceral PTT (n = 43) and thermal visceral PTT (n = 41) were included. Genetic associations with pain outcomes were explored. Nineteen opioid receptor genetic polymorphisms were included in this study. Variability in oxycodone response to skin heat was associated with OPRM1 single-nucleotide polymorphisms (SNPs) rs589046 (P < 0.0001) and rs563649 (P < 0.0001). Variability in oxycodone response to visceral pressure was associated with four OPRM1 SNPs: rs589046 (P = 0.015), rs1799971 (P = 0.045), rs9479757 (P = 0.009) and rs533586 (P = 0.046). OPRM1 SNPs were not associated with oxycodone visceral heat threshold, however, one OPRD1 rs419335 reached significance (P = 0.015). Another OPRD1 SNP rs2234918 (P = 0.041) was associated with muscle pressure. There were no associations with OPRK1 SNPs and oxycodone response for any of the pain modalities. Associations were found between analgesic effects of oxycodone and OPRM1 and OPRD1 SNPs; therefore, variation in opioid receptor genes may partly explain responder characteristics to oxycodone. PMID:26042474

  2. [Pain in elderly people with dementia].

    PubMed

    Chen, Yi-Heng; Lin, Li-Chan

    2008-04-01

    Aging is associated with an increased risk of cognitive impairment, such as Alzheimer's disease, vascular dementia and frontotemporal dementia. These diseases not only impair brain tissues and the nervous system, but also affect patients' verbal and non-verbal communicative ability. It is difficult, for instance, to assess pain in the cognitively impaired elderly because pain perception draws heavily on a patient's subjective interpretation and tolerance level. To seek an effective solution for pain detection in patients with dementia is therefore essential. From a systematic literature review covering the past decade, this paper presents a synopsis of the difficulty of pain assessment in the elderly with cognitive impairment, changes in the academic concept of pain, and explores factors resulting in obstacles to pain recognition. The obstacles to pain assessment derive mainly from three general factors. Firstly, classic definitions of early stage pain are inappropriate when applied to the elderly with cognitive impairment. Secondly, pain indicators are also unclear for this population. Thirdly, pain instruments and informants are ineffective in evaluating elderly patients with varying cognitive levels. To address these obstacles, a sound, multifaceted model of pain assessment for elderly patients with different severities of cognitive impairment is presented. On the basis of the above literature review, multiple methods for detecting aspects of pain in elderly people with cognitive impairment is recommended. To test the feasibility of the multidimensional model of pain assessment, further study is needed. PMID:18393211

  3. Neuropathic Pain

    PubMed Central

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

    2009-01-01

    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

  4. BUPRENORPHINE-NALXONE THERAPY IN PAIN MANAGEMENT

    PubMed Central

    Chen, Kelly Yan; Chen, Lucy; Mao, Jianren

    2014-01-01

    Buprenorphine-naloxone (bup/nal in 4:1 ratio; Suboxone®, Reckitt Benckiser Pharmaceuticals Incorporation, Richmond, VA) is approved by the Food and Drug Administration for outpatient office-based addiction treatment. In the past few years, bup/nal has been increasingly prescribed off-label for chronic pain management. The current data suggests that bup/nal may provide pain relief in chronic pain patients with opioid dependence or addiction. However, the unique pharmacological profile of bup/nal confers it to be a weak analgesic that is unlikely to provide adequate pain relief for patients without opioid dependence or addiction. Possible mechanisms of pain relief by bup/nal therapy in opioid-dependent chronic pain patients may include reversal of opioid-induced hyperalgesia as well as improvement in opioid tolerance and addiction. Additional studies are needed to assess the implication of bup/nal therapy in clinical anesthesia and perioperative pain management. PMID:24509068

  5. Prediction of postoperative pain after percutaneous nephrolithotomy: can preoperative experimental pain assessment identify patients at risk?

    PubMed

    Pedersen, Katja Venborg; Olesen, Anne Estrup; Osther, Palle Jørn Sloth; Arendt-Nielsen, Lars; Drewes, Asbjørn Mohr

    2013-04-01

    Postoperative pain remains a significant problem and the individual variance in postoperative pain is not fully understood. In recent years, there has been focus on identifying risk factors predicting patients with high postoperative pain intensity or consumption of analgesics, which may facilitate an improvement in rehabilitation. This study evaluates the relationship between preoperative experimental pain assessment and postoperative pain and opioid consumption. Forty-four patients with uni- or bilateral kidney stone disease scheduled for percutaneous nephrolithotomy were included. The preoperative pain thresholds were measured using electrical (single and 5 repeated) and pressure pain stimulation over the flank bilaterally (stone-side = operation side and control-side = non-operation side). Postoperative pain scores were recorded on a numerical rating scale and analgesic consumption was registered. The responses to repeated electrical stimuli (temporal summation) were preoperatively increased on the stone-side compared to the control-side (P = 0.016). Preoperative electrical pain thresholds from the control-side correlated inversely with postoperative opioid consumption (single stimuli: ? = -0.43, P < 0.01; repeated stimuli: ? = -0.45, P < 0.005). This correlation was more pronounced for the 22 patients with unilateral renal calculi (single stimuli: ? = -0.54, P < 0.02; repeated stimuli: ? = -0.58, P < 0.01). There were no other correlations between the preoperative sensory tests and postoperative pain or opioid consumption. This study showed a correlation between the preoperative electrical pain thresholds on the control-side and postoperative opioid consumption after percutaneous nephrolithotomy. Preoperative measurement of the electrical pain thresholds may, therefore, be useful as a screening tool to identify patients at high risk of postoperative pain. PMID:23503880

  6. Molecular Modulation of In Vivo Tolerance

    Microsoft Academic Search

    Charles E. Inturrisi; Ann M. Gregus

    \\u000a Opioid tolerance can limit the clinical utility of opioids for pain management. It is a neuroadaptive response to the repeated\\u000a administration of an opioid. Opioid tolerance is predominantly of the pharmacological (nonassociative) and pharmacodynamic\\u000a type. Possible contributions to tolerance at the receptor level include receptor desensitization, internalization, and recycling.\\u000a Alterations of G proteins, other intracellular signaling cascades and receptor–receptor interactions

  7. Acute psychosocial stress reduces pain modulation capabilities in healthy men.

    PubMed

    Geva, Nirit; Pruessner, Jens; Defrin, Ruth

    2014-11-01

    Anecdotes on the ability of individuals to continue to function under stressful conditions despite injuries causing excruciating pain suggest that acute stress may induce analgesia. However, studies exploring the effect of acute experimental stress on pain perception show inconsistent results, possibly due to methodological differences. Our aim was to systematically study the effect of acute stress on pain perception using static and dynamic, state-of-the-art pain measurements. Participants were 29 healthy men who underwent the measurement of heat-pain threshold, heat-pain intolerance, temporal summation of pain, and conditioned pain modulation (CPM). Testing was conducted before and during exposure to the Montreal Imaging Stress Task (MIST), inducing acute psychosocial stress. Stress levels were evaluated using perceived ratings of stress and anxiety, autonomic variables, and salivary cortisol. The MIST induced a significant stress reaction. Although pain threshold and pain intolerance were unaffected by stress, an increase in temporal summation of pain and a decrease in CPM were observed. These changes were significantly more robust among individuals with stronger reaction to stress ("high responders"), with a significant correlation between the perception of stress and the performance in the pain measurements. We conclude that acute psychosocial stress seems not to affect the sensitivity to pain, however, it significantly reduces the ability to modulate pain in a dose-response manner. Considering the diverse effects of stress in this and other studies, it appears that the type of stress and the magnitude of its appraisal determine its interactions with the pain system. PMID:25250721

  8. Pain frequency moderates the relationship between pain catastrophizing and pain

    PubMed Central

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

    2014-01-01

    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

  9. ENDOGENOUS ANALGESIA, DEPENDENCE, AND LATENT PAIN SENSITIZATION

    PubMed Central

    Taylor, Bradley K; Corder, Gregory

    2015-01-01

    Endogenous activation of ?-opioid receptors (MORs) provides relief from acute pain. Recent studies have established that tissue inflammation produces latent pain sensitization (LS) that is masked by spinal MOR signaling for months, even after complete recovery from injury and re-establishment of normal pain thresholds. Disruption with MOR inverse agonists reinstates pain and precipitates cellular, somatic and aversive signs of physical withdrawal; this phenomenon requires N-methyl-D-aspartate receptor-mediated activation of calcium-sensitive adenylyl cyclase type 1 (AC1). In this review, we present a new conceptual model of the transition from acute to chronic pain, based on the delicate balance between LS and endogenous analgesia that develops after painful tissue injury. First, injury activates pain pathways. Second, the spinal cord establishes MOR constitutive activity (MORCA) as it attempts to control pain. Third, over time, the body becomes dependent on MORCA, which paradoxically sensitizes pain pathways. Stress or injury escalates opposing inhibitory and excitatory influences on nociceptive processing as a pathological consequence of increased endogenous opioid tone. Pain begets MORCA begets pain vulnerability in a vicious cycle. The final result is a silent insidious state characterized by the escalation of two opposing excitatory and inhibitory influences on pain transmission: LS mediated by AC1 (which maintains accelerator), and pain inhibition mediated by MORCA (which maintains the brake). This raises the prospect that opposing homeostatic interactions between MORCA analgesia and latent NMDAR–AC1-mediated pain sensitization create a lasting vulnerability to develop chronic pain. Thus, chronic pain syndromes may result from a failure in constitutive signaling of spinal MORs and a loss of endogenous analgesic control. An overarching long-term therapeutic goal of future research is to alleviate chronic pain by either: a) facilitating endogenous opioid analgesia, thus restricting LS within a state of remission; or b) extinguishing LS altogether. PMID:25227929

  10. Pain Genes

    Microsoft Academic Search

    Tom Foulkes; John N. Wood

    2008-01-01

    Pain, which afflicts up to 20% of the population at any time, provides both a massive therapeutic challenge and a route to understanding mechanisms in the nervous system. Specialised sensory neurons (nociceptors) signal the existence of tissue damage to the central nervous system (CNS), where pain is represented in a complex matrix involving many CNS structures. Genetic approaches to investigating

  11. Neck Pain

    PubMed Central

    Darracott, John

    1979-01-01

    Most neck pain is treated with a varying degree of confidence and success. A better understanding of what constitutes neck pain, a pertinent history and examination, critical interpretation of investigations and treatment modalities will provide family physicians, who treat the majority of these patients, with a confident disciplined approach which can reduce morbidity.

  12. Reference values of mechanical and thermal pain tests in a pain-free population

    Microsoft Academic Search

    Alban Y. Neziri; Pasquale Scaramozzino; Ole K. Andersen; Anthony H. Dickenson; Lars Arendt-Nielsen; Michele Curatolo

    2011-01-01

    Quantitative sensory tests are widely used in human research to evaluate the effect of analgesics and explore altered pain mechanisms, such as central sensitization. In order to apply these tests in clinical practice, knowledge of reference values is essential. The aim of this study was to determine the reference values of pain thresholds for mechanical and thermal stimuli, as well

  13. Risk Tolerance

    Microsoft Academic Search

    John E. Grable

    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

  14. Psychological Factors Associated with Perception of Experimental Pain in Vulvar Vestibulitis Syndrome

    Microsoft Academic Search

    Michal Granot; Yoav Lavee

    2005-01-01

    This study assessed the association between pain perception and psychological variables in women with vulvar vestibulitis syndrome (VVS) by comparing 28 VVS women with 50 healthy women. We assessed non genital systemic pain perception with quantitative sensory testing by administering experimental pain stimuli to the forearm. The VVS women demonstrated a lower pain threshold and a higher magnitude estimation of

  15. Chronic pain - resources

    MedlinePLUS

    Pain - resources; Resources - chronic pain ... The following organizations are good resources for information on chronic pain: American Chronic Pain Association - www.theacpa.org National Fibromyalgia and Chronic Pain Association - www.fmcpaware.org ...

  16. Globally controlled fault tolerant quantum computation

    E-print Network

    J. Fitzsimons; J. Twamley

    2007-07-08

    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.

  17. Efficacy and tolerance of repeated oral doses of tolperisone hydrochloride in the treatment of painful reflex muscle spasm: results of a prospective placebo-controlled double-blind trial

    Microsoft Academic Search

    H. G. Pratzel; R.-G. Alken; S. Ramm

    1996-01-01

    The efficacy and safety of oral tolperisone hydrochloride (Mydocalm®) in the treatment of painful reflex muscle spasm was assessed in a prospective, randomized, double-blind, placebo-controlled trial. A total of 138 patients, aged between 20 and 75 years, with painful reflex muscle spasm associated with diseases of the spinal column or proximal joints were enrolled in eight rehabilitation centers. Patients were

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

    PubMed Central

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

    2014-01-01

    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

  19. Neuropathic Pain

    MedlinePLUS

    ... know that it can erode quality of life. Communication Tools View All Everyday Tools During Your Visit ... pain. Online Tool Printable Tool (PDF) Show More Communication Tools Where Does It Hurt? / Nerve Man With ...

  20. Inverted Perceptual Judgment of Nociceptive Stimuli at Threshold Level following Inconsistent Cues

    PubMed Central

    Walter, Carmen; Dimova, Violeta; Bu, Julia; Parnham, Michael J.; Oertel, Bruno G.; Lötsch, Jörn

    2015-01-01

    Objective The perception of pain is susceptible to modulation by psychological and contextual factors. It has been shown that subjects judge noxious stimuli as more painful in a respective suggestive context, which disappears when the modifying context is resolved. However, a context in which subjects judge the painfulness of a nociceptive stimulus in exactly the opposite direction to that of the cues has never been shown so far. Methods Nociceptive stimuli (300 ms intranasal gaseous CO2) at the individual pain threshold level were applied after a visual cue announcing the stimulus as either “no pain”, merely a “stimulus”, or “pain”. Among the stimuli at threshold level, other CO2 stimuli that were clearly below or above pain threshold were randomly interspersed. These were announced beforehand in 12 subjects randomly with correct or incorrect cues, i.e., clearly painful or clearly non-painful stimuli were announced equally often as not painful or painful. By contrast, in a subsequent group of another 12 subjects, the stimuli were always announced correctly with respect to the evoked pain. Results The random and often incorrect announcement of stimuli clearly below or above pain threshold caused the subjects to rate the stimuli at pain-threshold level in the opposite direction of the cue, i.e., when the stimuli were announced as “pain” significantly more often than as non-painful and vice versa (p < 10-4). By contrast, in the absence of incongruence between announcement and perception of the far-from-threshold stimuli, stimuli at pain threshold were rated in the cued direction. Conclusions The present study revealed the induction of associations incongruent with a given message in the perception of pain. We created a context of unreliable cues whereby subjects perceived the stimulus opposite to that suggested by a prior cue, i.e., potentially nociceptive stimuli at pain threshold level that were announced as painful were judged as non-painful and vice versa. These findings are consistent with reported data on the effects of distrust on non-painful cognitive responses. PMID:26147732

  1. Reflex receptive fields are enlarged in patients with musculoskeletal low back and neck pain.

    PubMed

    Biurrun Manresa, José A; Neziri, Alban Y; Curatolo, Michele; Arendt-Nielsen, Lars; Andersen, Ole K

    2013-08-01

    Pain hypersensitivity has been consistently detected in chronic pain conditions, but the underlying mechanisms are difficult to investigate in humans and thus poorly understood. Patients with endometriosis pain display enlarged reflex receptive fields (RRF), providing a new perspective in the identification of possible mechanisms behind hypersensitivity states in humans. The primary hypothesis of this study was that RRF are enlarged in patients with musculoskeletal pain. Secondary study end points were subjective pain thresholds and nociceptive withdrawal reflex (NWR) thresholds after single and repeated (temporal summation) electrical stimulation. Forty chronic neck pain patients, 40 chronic low back pain patients, and 24 acute low back pain patients were tested. Electrical stimuli were applied to 10 sites on the sole of the foot to quantify the RRF, defined as the area of the foot from where a reflex was evoked. For the secondary end points, electrical stimuli were applied to the cutaneous innervation area of the sural nerve. All patient groups presented enlarged RRF areas compared to pain-free volunteers (P<.001). Moreover, they also displayed lower NWR and pain thresholds to single and repeated electrical stimulation (P<.001). These results demonstrate that musculoskeletal pain conditions are characterized by enlarged RRF, lowered NWR and pain thresholds, and facilitated temporal summation, most likely caused by widespread spinal hyperexcitability. This study contributes to a better understanding of the mechanisms underlying these pain conditions, and it supports the use of the RRF and NWR as objective biomarkers for pain hypersensitivity in clinical and experimental pain research. PMID:23707309

  2. The pain paradox: Borderline personality disorder features, self-harm history, and the experience of pain.

    PubMed

    Carpenter, Ryan W; Trull, Timothy J

    2015-04-01

    Individuals with borderline personality disorder (BPD), compared to controls, report a relative absence of acute pain. In contrast, BPD is overrepresented among chronic pain patients, suggesting they experience a relative excess of chronic pain. To date, this "pain paradox" has been only partially explored; no study has examined both acute and chronic pain in the same sample. In addition, previous research has not fully examined the effect of nonsuicidal self-injury (NSSI) on either acute or chronic pain experience in BPD. Undergraduates (N = 206), oversampled for those high in BPD features, completed a Cold Pressor Task (CPT), rating their pain every 15 s over a maximum of 4 min. Following the CPT, participants completed measures of BPD features, NSSI history, past-year pain, and perceived pain tolerance. Results did not support the expected negative association between BPD features and acute pain. Multilevel modeling revealed an interaction of BPD features and NSSI history on CPT pain ratings: Among individuals in the no-NSSI group, BPD features were associated with greater acute pain. Among individuals in the NSSI group, BPD features were not significantly associated with acute pain. Results for past-year pain indicated that BPD features were associated with greater past-year pain regardless of NSSI history. This finding, coupled with the difference in the association of BPD features and acute pain between the NSSI and no-NSSI groups provides tentative evidence that the combination of BPD features and NSSI history, among nonclinical samples, is linked to a pain paradox. (PsycINFO Database Record PMID:25705980

  3. Changes in Pain Perception in Women During and Following an Exhaustive Incremental Cycling Exercise

    PubMed Central

    Drury, Daniel G.; Greenwood, Katelyn; Stuempfle, Kristin J.; Koltyn, Kelli F.

    2005-01-01

    Exercise has been found to alter pain sensitivity with a hypoalgesic response (i.e., diminished sensitivity to pain) typically reported during and/or following high intensity exercise. Most of this research, however, has involved the testing of men. Thus, the purpose of the following investigation was to examine changes in pain perception in women during and following exercise. Seventeen healthy female subjects (age 20.47±.87; VO2 peak 36.77± 4.95) volunteered to undergo pain assessment prior to, during, and after a graded exhaustive VO2 peak cycling challenge. Heart Rate (HR) and Oxygen Uptake (VO2) were monitored along with electro-diagnostic assessments of Pain Threshold (PT) and Pain Tolerance (PTOL) at: 1) baseline (B), 2) during exercise (i.e., 120 Watts), 3) at exhaustive intensity (VO2 peak), and 4) 10 minutes into recovery (R). Data were analyzed using repeated measures ANOVA to determine differences across trials. Significant differences in PT and PTOL were found across trials (PT, p = 0.0043; PTOL p = 0.0001). Post hoc analyses revealed that PT were significantly elevated at VO2 peak in comparison to B (p = 0.007), 120 Watts (p = 0.0178) and R (p = 0.0072). PTOL were found to be significantly elevated at 120 Watts (p = 0.0247), VO2 peak (p < 0.001), and R (p = 0.0001) in comparison to B. In addition, PTOL were found to be significantly elevated at VO2 peak in comparison to 120 Watts (p = 0.0045). It is concluded that exercise-induced hypoalgesia occurs in women during and following exercise, with the hypoalgesic response being most pronounced following exhaustive exercise. Key Points Exercise-induced hypoalgesia (i.e., elevated PT and PTOL) was found to occur in women during and following exercise, with the hypoalgesic response being most pronounced during exhaustive exercise. PMID:24453524

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

    PubMed

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

    2013-03-01

    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

  5. Predicting lactate threshold using ventilatory threshold.

    PubMed

    Plato, P A; McNulty, M; Crunk, S M; Tug Ergun, A

    2008-09-01

    Lactate threshold is an important reference point when setting training intensities for endurance athletes. Ventilatory threshold has been used as a noninvasive estimate of lactate threshold, but appears to underestimate training intensity for many athletes. This study evaluated whether data obtained during a noninvasive, maximal exercise test could be used to predict lactate threshold. Maximal oxygen consumption (55+/-2 ml O(2) x kg(-1) x min(-1)) and heart rate at the ventilatory threshold (V-slope method) were determined for 19 cyclists (10 men, 9 women, 35+/-2 years). Cyclists also performed a lactate threshold test, consisting of 8 min stages at power outputs below, at, and above the ventilatory threshold. Heart rate associated with the lactate threshold was determined using the Dmax method. The correlation coefficient between heart rates at the ventilatory and lactate thresholds was 0.67, indicating 45% shared variance. The best fitting model to predict heart rate at the lactate threshold included heart rate at the ventilatory threshold, gender, body weight, and an interaction between gender and body weight. Using this model, R(2) was 0.70. Thus, heart rate at the ventilatory threshold may be adjusted to more accurately predict a heart rate that corresponds to the lactate threshold for recreational cyclists. PMID:18214811

  6. Chloride thresholds in marine concrete

    SciTech Connect

    Thomas, M. [Univ. of Toronto, Ontario (Canada). Dept. of Civil Engineering] [Univ. of Toronto, Ontario (Canada). Dept. of Civil Engineering

    1996-04-01

    This paper reports results from an ongoing study of the performance of fly ash concrete in marine exposure. Reinforced concrete specimens exposed to tidal conditions were retrieved at ages ranging from 1 to 4 years. Steel reinforcement mass losses are compared with chloride contents at the location of the bar for concrete specimens of various strength grades and with a range of fly ash levels. The maximum level of chloride that could be tolerated without significant mass loss due to corrosion was found to vary with fly ash content. This threshold chloride level decreased with increasing fly ash content; values obtained were 0.70%, 0.65%, 0.50% and 0.20% acid-soluble chloride (by mass of cementitious material) for concrete with 0%, 15%, 30% and 50% ash, respectively. Despite the lower threshold values, fly ash concrete was found to provide better protection to the steel under these conditions, due to its increased resistance to chloride ion penetration.

  7. A flow-map model for analyzing pseudothresholds in fault-tolerant quantum computing

    E-print Network

    K. M. Svore; A. W. Cross; I. L. Chuang; A. V. Aho

    2006-01-12

    An arbitrarily reliable quantum computer can be efficiently constructed from noisy components using a recursive simulation procedure, provided that those components fail with probability less than the fault-tolerance threshold. Recent estimates of the threshold are near some experimentally achieved gate fidelities. However, the landscape of threshold estimates includes pseudothresholds, threshold estimates based on a subset of components and a low level of recursion. In this paper, we observe that pseudothresholds are a generic phenomenon in fault-tolerant computation. We define pseudothresholds and present classical and quantum fault-tolerant circuits exhibiting pseudothresholds that differ by a factor of 4 from fault-tolerance thresholds for typical relationships between component failure rates. We develop tools for visualizing how reliability is influenced by recursive simulation in order to determine the asymptotic threshold. Finally, we conjecture that refinements of these methods may establish upper bounds on the fault-tolerance threshold for particular codes and noise models.

  8. Pain Management Programs

    MedlinePLUS

    ... Pain Management Programs Pain Management Programs Assessment Communication Education Program Outcomes Conclusion Resource Guide to Chronic Pain Medications & Treatments The Art of Pain Management What We Have Learned Going ...

  9. Heel Pain

    MedlinePLUS

    ... pain is generally the result of faulty biomechanics (walking gait abnormalities) that place too much stress on the heel bone and the soft tissues that attach to it. The stress may also result from injury, or a bruise incurred while walking, running, or jumping on hard surfaces; wearing poorly ...

  10. Chest Pain

    MedlinePLUS

    Having a pain in your chest can be scary. It does not always mean that you are having a heart attack. There can be many other causes, ... embolism Costochondritis - an inflammation of joints in your chest Some of these problems can be serious. Get ...

  11. Vagal nerve stimulation: adjustments to reduce painful side effects.

    PubMed

    Liporace, J; Hucko, D; Morrow, R; Barolat, G; Nei, M; Schnur, J; Sperling, M

    2001-09-11

    Vagal nerve stimulation is an approved adjunctive treatment for medically intractable epilepsy. Although it is generally well tolerated, some patients experience pain, coughing, or hoarseness during stimulation. Lowering the pulse width in these patients alleviates pain and reduces voice alteration without loss of efficacy. This allows more optimal programming of stimulation intensities. PMID:11552021

  12. Bogus visual feedback alters onset of movement-evoked pain in people with neck pain.

    PubMed

    Harvie, Daniel S; Broecker, Markus; Smith, Ross T; Meulders, Ann; Madden, Victoria J; Moseley, G Lorimer

    2015-04-01

    Pain is a protective perceptual response shaped by contextual, psychological, and sensory inputs that suggest danger to the body. Sensory cues suggesting that a body part is moving toward a painful position may credibly signal the threat and thereby modulate pain. In this experiment, we used virtual reality to investigate whether manipulating visual proprioceptive cues could alter movement-evoked pain in 24 people with neck pain. We hypothesized that pain would occur at a lesser degree of head rotation when visual feedback overstated true rotation and at a greater degree of rotation when visual feedback understated true rotation. Our hypothesis was clearly supported: When vision overstated the amount of rotation, pain occurred at 7% less rotation than under conditions of accurate visual feedback, and when vision understated rotation, pain occurred at 6% greater rotation than under conditions of accurate visual feedback. We concluded that visual-proprioceptive information modulated the threshold for movement-evoked pain, which suggests that stimuli that become associated with pain can themselves trigger pain. PMID:25691362

  13. Clinical Issues in Pain Management Clinical Issues in Pain Management

    E-print Network

    Meagher, Mary

    Pain Clinical Issues in Pain Management #12;Clinical Issues in Pain Management: Acute Pain #12;Clinical Issues in Pain Management: Chronic Pain Chronic Pain Typically begins with an acute in Pain Management: Chronic Pain Chronic benign pain Persists more than 6 months Varies in severity

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

    PubMed Central

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

    2013-01-01

    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

  15. Skeletal muscle contractility, self-reported pain and tissue sensitivity in females with neck/shoulder pain and upper Trapezius myofascial trigger points– a randomized intervention study

    PubMed Central

    2012-01-01

    Background In relation to Myofascial Triggerpoints (MFTrPs) of the upper Trapezius, this study explored muscle contractility characteristics, the occurrence of post-intervention muscle soreness and the effect of dry needling on muscle contractile characteristics and clinical outcomes. Methods Seventy-seven female office workers (25-46yrs) with and without neck/shoulder pain were observed with respect to self-reported pain (NRS-101), pressure-pain threshold (PPT), maximum voluntary contraction (Fmax) and rate of force development (RFD) at baseline (pre-intervention), immediately post-intervention and 48 hours post-intervention. Symptomatic and asymptomatic participant groups were each randomized into two treatment sub-groups (superficial (SDN) and deep dry needling (DDN)) after baseline testing. At 48 hours post-intervention participants were asked whether delayed onset muscle soreness (DOMS) and/or post-needling soreness had developed. Results Muscle contractile characteristics did not differ between groups at baseline. Forty-six individuals developed muscle soreness (39 from mechanical testing and seven from needling). No inter-group differences were observed post-intervention for Fmax or RFD for the four sub-groups. Over the observation period, symptomatic participants reported less pain from both SDN (p= 0.003) and DDN (p=0.011). However, PPT levels were reduced for all participants (p=0.029). Those reporting DOMS experienced significant decreases in PPT, irrespective of symptom state or intervention (p=0.001). Conclusions In selected female neck/shoulder pain sufferers, maximum voluntary contraction and rapid force generation of the upper Trapezius was not influenced by clinically relevant self-reported pain or the presence of diagnostically relevant MFTrPs. Dry needling, deep or superficial, did not affect measured functional outcomes over the 48-hour observation period. DOMS affected participants uniformly irrespective of pain, MFTrP status or intervention type and therefore is like to act as a modifier. Trial registration Clinical Trials.gov- NCT01710735 Significance and Innovations The present investigation is one of the first to examine the hypothesis of gross muscle contractile inhibition due to the presence of diagnostically relevant MFTrPs. Individuals suffering from clinically relevant levels of self-reported pain are able to tolerate maximum voluntary contraction testing, but delayed onset muscle soreness (DOMS) is a likely side-effect irrespective of symptom status. As a consequence, its confounding effect during subsequent testing must be taken into account. PMID:23176709

  16. Pain management in the opioid-dependent patient

    Microsoft Academic Search

    Jon Streltzer

    2001-01-01

    The opioid-dependent patient presents great challenges for pain management. These challenges are not limited to potential\\u000a addictive behaviors. In contrast to the profound pain relieving effects of acute opioid intake, chronic opioid intake can\\u000a promote a counterintuitive state of enhanced pain sensitivity. Multiple biologic mechanisms inducing opioid tolerance and\\u000a hyperalgesia have recently been elucidated. The potential hyperalgesic state accompanying opioid

  17. Coping when pain is a potential threat: the efficacy of acceptance versus cognitive distraction.

    PubMed

    Jackson, T; Yang, Z; Li, X; Chen, H; Huang, X; Meng, J

    2012-03-01

    This experiment investigated the impact of brief training in acceptance versus distraction-based pain management on experimental pain tolerance in conditions of lower and higher potential threats. One hundred fifty-one pain-free Chinese adults (93 women, 58 men) randomly assigned to acceptance, distraction or pain education control conditions engaged in a cold pressor test (CPT) after reading validated orienting information designed to prime either the safety of the CPT (lower threat) or symptoms and damaging effects of exposure to extreme cold (higher threat). A 2 (threat level)?×?3 (training strategy) analysis of covariance, controlling for pre-intervention pain tolerance and education, indicated the acceptance group was more pain tolerant than other training groups. This main effect was qualified by an interaction with threat level: in the lower threat condition, acceptance group participants were more pain tolerant than peers in the distraction or pain education groups while no training group differences were found in the higher threat condition. Supplementary analyses identified catastrophizing as a partial mediator of training group differences in pain tolerance. In summary, findings suggested acceptance-based coping is superior to distraction as a means of managing experimental pain, particularly when pain sensations are viewed as comparatively low in potential threat. PMID:22337145

  18. Analysis of deep tissue hypersensitivity to pressure pain in professional pianists with insidious mechanical neck pain

    PubMed Central

    2011-01-01

    Background The aim of this study was to investigate whether pressure pain hyperalgesia is a feature of professional pianists suffering from neck pain as their main playing-related musculoskeletal disorder. Methods Twenty-three active expert pianists, 6 males and 17 females (age: 36 ± 12 years) with insidious neck pain and 23 pianists, 9 males and 14 females (age: 38 ± 10 years) without neck pain the previous year were recruited. A numerical pain rate scale, Neck Disability Index, hand size and pressure pain thresholds (PPT) were assessed bilaterally over the C5-C6 zygapophyseal joint, deltoid muscle, the second metacarpal and the tibialis anterior muscle in a blinded design. Results The results showed that PPT levels were significantly decreased bilaterally over the second metacarpal and tibialis anterior muscles (P < 0.05), but not over C5-C6 zygapophyseal joint and deltoid muscle (P > 0.10), in pianists with neck pain as compared to healthy pianists. Pianists with neck pain had a smaller (P < 0.05) hand size (mean: 181.8 ± 11.8) as compared to pianists without neck pain (mean: 188. 6 ± 13.1). PPT over the tibialis anterior muscles was negatively correlated with the intensity of neck pain. Conclusions Our findings revealed pressure pain hypersensitivity over distant non-symptomatic distant points but not over the symptomatic areas in pianists suffering from neck pain. In addition, pianists with neck pain also had smaller hand size than those without neck pain. Future studies are needed to further determine the relevance of these findings in the clinical course of neck pain as playing-related musculoskeletal disorder in professional pianists. PMID:22111912

  19. Presurgical assessment of temporal summation of pain predicts the development of chronic postoperative pain 12 months after total knee replacement.

    PubMed

    Petersen, Kristian Kjær; Arendt-Nielsen, Lars; Simonsen, Ole; Wilder-Smith, Oliver; Laursen, Mogens Berg

    2015-01-01

    Patients with knee osteoarthritis demonstrate decreased pressure pain thresholds (PPTs), facilitated temporal summation (TS) of pain, and decreased conditioned pain modulation (CPM) compared with healthy controls. This study aimed to correlate preoperative PPTs, TS, and CPM with the development of chronic postoperative pain after total knee replacement (TKR) surgery. Knee pain intensity (visual analog scale [VAS]: 0-10), PPTs, TS, and CPM were collected before, 2 months, and 12 months after TKR. Patients were divided into a low-pain (VAS < 3) and a high-pain (VAS ? 3) group based on their VAS 12 months after TKR. The high-pain group (N = 17) had higher pain intensities compared with the low-pain group (N = 61) before surgery (P = 0.009) and 12 months after surgery (P < 0.001). The PPTs of the low-pain groups were normalized for all measurement sites comparing presurgery with 12 months postsurgery (P < 0.05, contralateral arm: P = 0.059), which was not the case for the high-pain group. The low-pain group showed a functional inhibitory CPM preoperatively and 12 months postoperatively (P < 0.05), which was not found in the high-pain group. The high-pain group had higher facilitated TS preoperatively and 12 months postoperatively compared with the low-pain group (P < 0.05). Preoperative TS level correlated to 12-month postoperative VAS (R = 0.240, P = 0.037). Patients who developed moderate-to-severe pain had pronociceptive changes compared with patients who developed mild pain postsurgery. Preoperative TS level correlated with the postoperative pain intensity and may be a preoperative mechanistic predictor for the development of chronic postoperative pain in patients with osteoarthritis after TKR. PMID:25599301

  20. Neurobiology of Pain in Children: An Overview

    PubMed Central

    Loizzo, Alberto; Loizzo, Stefano; Capasso, Anna

    2009-01-01

    The evaluation of pain in the newborn and the infant is difficult because pain is mainly a subjective phenomenon. Until a few years ago, several myths persisted. First, the myth that children, especially infants, do not feel pain the way adults do, therefore there is no untoward consequences for them. Second, lack of assessment and reassessment for the presence of pain. Third, misunderstanding of how to conceptualise and quantify a subjective experience. Fourth, lack of knowledge of pain treatment. Fifth, the notion that addressing pain in children takes too much time and effort, in ultimate analysis resulting in wasting time. Sixth, fears of hidden -and not easy to diagnose or prevent- adverse effects of analgesic medications, including respiratory depression and addiction. Finally, from a conceptual point of view, high thresholds of pain in neonates and infants were considered to be present by natural character, and useful in protecting infant from pain during birth and transit through the narrow vaginal channel. The present review is focused on the description of different theories on the pain pathogenesis in children. PMID:19543535

  1. Pain analgesia among adolescent self-injurers.

    PubMed

    Glenn, Jeffrey J; Michel, Bethany D; Franklin, Joseph C; Hooley, Jill M; Nock, Matthew K

    2014-12-30

    Although non-suicidal self-injury (NSSI) involves self-inflicted physical harm, many self-injurers report feeling little or no pain during the act. Here we test: (1) whether the pain analgesia effects observed among adult self-injurers are also present among adolescents, and (2) three potential explanatory models proposing that habituation, dissociation, and/or self-criticism help explain the association between NSSI and pain analgesia among adolescents. Participants were 79 adolescents (12-19 years) recruited from the community who took part in a laboratory-based pain study. Results revealed that adolescent self-injurers have a higher pain threshold and greater pain endurance than non-injurers. Statistical mediation models revealed that the habituation and dissociation models were not supported; however, a self-critical style does mediate the association between NSSI and pain analgesia. The present findings extend earlier work by highlighting that a self-critical style may help to explain why self-injurers exhibit pain analgesia. Specifically, the tendency to experience self-critical thoughts in response to stressful events may represent a third variable that increases the likelihood of both NSSI and pain analgesia. Prospective experimental studies are needed to replicate and tease apart the direction of these associations, and may provide valuable leads in the development of effective treatments for this dangerous behavior problem. PMID:25172611

  2. Thermal and tactile perception thresholds in acute herpes zoster.

    PubMed

    Haanpää; Laippala; Nurmikko

    1999-12-01

    This study was conducted to determine somatosensory perception thresholds in 97 immunocompetent patients with herpes zoster (HZ), and to evaluate their associations with the development of post-herpetic neuralgia (PHN). Warm, cold and heat pain thresholds were tested by Thermotest (SOMEDIC) and tactile thresholds by Semmes-Weinstein monofilaments. To establish reference values, 103 healthy subjects underwent somatosensory testing, from which values were calculated for both genders for four age groups (<60, 60-69, 70-79 and >/=80years) in five dermatomal levels (VI, C3, T3, T10 and S1). Patients with HZ underwent quantitative somatosensory testing within the affected dermatome, its mirror image dermatome and an adjacent dermatome bilaterally. The follow-up visits with somatosensory testing took place at 2 weeks, 6 weeks, 3 months and 6 months. When evaluated as means of the results, warm and cold thresholds were significantly elevated in the affected dermatome from the initial visit until 3 and 6 months, respectively. By contrast, heat pain thresholds were lowered at the initial visit but normalized by 2 weeks, and tactile thresholds remained unchanged. These threshold changes were associated neither with further development of PHN nor each other. It is concluded that measurement of somatosensory perception thresholds in early stages of HZ shows evidence of impaired neural function but is not helpful in predicting which patient will go on to develop PHN. Copyright 1999 European Federation of Chapters of the International Association for the Study of Pain. PMID:10700365

  3. Transient receptor potential channels: targeting pain at the source

    Microsoft Academic Search

    Ardem Patapoutian; Simon Tate; Clifford J. Woolf

    2009-01-01

    Pain results from the complex processing of neural signals at different levels of the central nervous system, with each signal potentially offering multiple opportunities for pharmacological intervention. A logical strategy for developing novel analgesics is to target the beginning of the pain pathway, and aim potential treatments directly at the nociceptors — the high-threshold primary sensory neurons that detect noxious

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

    PubMed

    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

    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

  5. Risk Factor Assessment for Problematic Use of Opioids for Chronic Pain

    Microsoft Academic Search

    Robert N. Jamison; Robert R. Edwards

    2012-01-01

    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

  6. Quercetin, a bioflavonoid, attenuates thermal hyperalgesia in a mouse model of diabetic neuropathic pain

    Microsoft Academic Search

    Muragundla Anjaneyulu; Kanwaljit Chopra

    2003-01-01

    Diabetic neuropathic pain, an important microvascular complication in diabetes mellitus, has been recognised as one of the most difficult types of pain to treat. Lack of understanding of etiology involved, inadequate relief, development of tolerance and potential toxicity of classical antinociceptives warrant the investigation of newer agents to relieve pain. The aim of the present study was to explore the

  7. Referred pain.

    PubMed

    Markman, Stanley

    2014-01-01

    Comprehending orofacial referred pain requires an understanding of the neuroanatomy of the trigeminal nerve and associated cranial nerves. It also requires knowledge of the concept of neuronal convergence as well as the recognition that the caudalis is laminated and is therefore responsible for sensory receptive fields-that one interneuron may receive multiple sensory inputs and that structures within a lamina have sensory neurons which project into the caudalis and may share the same interneuron. PMID:25141487

  8. Reliability and validity of quantitative sensory testing in persons with spinal cord injury and neuropathic pain.

    PubMed

    Felix, Elizabeth R; Widerström-Noga, Eva G

    2009-01-01

    Quantitative sensory testing (QST) has been used to assess neurological function in various chronic pain patient populations. In the present study, we investigated the ability of QST to reliably characterize somatosensory dysfunction in subjects with spinal cord injury (SCI) and neuropathic pain by measuring mechanical, vibration, and thermal detection and pain thresholds. Test-retest reliability was determined based on data collected from 10 subjects with SCI and neuropathic pain who underwent QST on two occasions approximately 3 weeks apart. The intraclass correlation coefficients for mechanical, vibration, warm, and cool detection thresholds were in the "substantial" range, while thresholds for cold pain and hot pain demonstrated "fair" stability in this sample of patients. To determine the validity of QST in persons with SCI-related neuropathic pain, we evaluated the relationship between somatosensory thresholds and severity of neuropathic pain symptoms with multiple linear regression analysis. Thermal pain threshold was the only QST variable significantly related to the severity of neuropathic pain symptoms. The present study provides preliminary evidence that QST is a reliable and valid adjunct measurement strategy for quantifying the neurological dysfunction associated with neuropathic pain in persons with SCI. PMID:19533521

  9. Successful Pain Management for the Recovering Addicted Patient

    PubMed Central

    Prater, Christopher D.; Zylstra, Robert G.; Miller, Karl E.

    2002-01-01

    Successful pain management in the recovering addict provides primary care physicians with unique challenges. Pain control can be achieved in these individuals if physicians follow basic guidelines such as those put forward by the Joint Commission on Accreditation of Healthcare Organizations in their standards for pain management as well as by the World Health Organization in their stepladder approach to pain treatment. Legal concerns with using pain medications in addicted patients can be dealt with by clear documentation of indication for the medication, dose, dosing interval, and amount provided. Terms physicians need to be familiar with include physical dependence, tolerance, substance abuse, and active versus recovering addiction. Treatment is unique for 3 different types of pain: acute, chronic, and end of life. Acute pain is treated in a similar fashion for all patients regardless of addiction history. However, follow-up is important to prevent relapse. The goal of chronic pain treatment in addicted patients is the same as individuals without addictive disorders—to maximize functional level while providing pain relief. However, to minimize abuse potential, it is important to have 1 physician provide all pain medication prescriptions as well as reduce the opioid dose to a minimum effective dose, be aware of tolerance potential, wean periodically to reassess pain control, and use nonpsychotropic pain medications when possible. Patients who are at the end of their life need to receive aggressive management of pain regardless of addiction history. This management includes developing a therapeutic relationship with patients and their families so that pain medications can be used without abuse concerns. By following these strategies, physicians can successfully provide adequate pain control for individuals with histories of addiction. PMID:15014719

  10. Facilitated temporal processing of pain and defective supraspinal control of pain in cluster headache.

    PubMed

    Perrotta, Armando; Serrao, Mariano; Ambrosini, Anna; Bolla, Monica; Coppola, Gianluca; Sandrini, Giorgio; Pierelli, Francesco

    2013-08-01

    In cluster headache (CH), pathogenesis has been emphasized the role of the posterior hypothalamus. It is part of a supraspinal network involved in the descending control of pain, including the diffuse noxious inhibitory control (DNIC), which in turn modulates the pain processing. We hypothesized that CH during the active phase facilitated temporal pain processing supported by abnormal functioning of the DNIC. We studied the functional activity of the DNIC by evaluating the effect of the cold pressor test (CPT) on the temporal summation threshold (TST) of the nociceptive withdrawal reflex. Ten subjects with episodic CH (2 women, 8 men) and 10 healthy subjects were recruited. Each subject underwent neurophysiological evaluation (nociceptive withdrawal reflex TST and related painful sensation) at baseline, then before (control session), during (pain session), and 5 min after (aftereffect) the CPT (immersing hand in a 4°C water bath for 4-5 min). Patients had been studied during both the active and remission phases. During the active phase, CH revealed a significant facilitation in temporal processing of pain stimuli (reduction of TST), which reverted during the remission phase. The CPT activating the DNIC did not produce any significant inhibitory effect of pain responses in CH during the active phase, whereas it induced a clear inhibition during the remission phase. We hypothesized that in CH, a dysfunction of the supraspinal control of pain related to the clinical activity of the disease, possibly supported by an abnormal hypothalamic function, leads to a facilitation in pain processing and a predisposition to pain attacks. PMID:23707306

  11. Application of Pain Quantitative Analysis Device for Assessment of Postoperative Pain after Arthroscopic Rotator Cuff Repair

    PubMed Central

    Mifune, Yutaka; Inui, Atsuyuki; Nagura, Issei; Sakata, Ryosuke; Muto, Tomoyuki; Harada, Yoshifumi; Takase, Fumiaki; Kurosaka, Masahiro; Kokubu, Takeshi

    2015-01-01

    Purpose : The PainVision™ system was recently developed for quantitative pain assessment. Here, we used this system to evaluate the effect of plexus brachialis block on postoperative pain after arthroscopic rotator cuff repair. Methods : Fifty-five patients who underwent arthroscopic rotator cuff repair were included in this study. First 26 cases received no plexus brachialis block (control group), and the next 29 cases received the plexus brachialis block before surgery (block group). Patients completed the visual analog scale at 4, 8, 16, and 24 hours after surgery, and the intensity of postoperative pain was assessed with PainVision™ at 16 hours. The postoperative use of non-steroidal anti-inflammatory agents was also recorded. Results : The pain intensity at 16 hours after surgery assessed by PainVision™ was significantly lower in the block group than in the control group (block, 252.0 ± 47.8, control, 489.0 ± 89.1, P < 0.05). However, there were no differences in the VAS values at 16 hours between the 2 groups (block, 4.3 ± 0.6, control, 5.7 ± 0.4, P = N.S.). The pain intensity and VAS at 16 hours after surgery were highly correlated (r = 0.59, P = 0.006 in the block group and r = 0.62, P = 0.003 in the control group). The effect size of the assessment by PainVision™ was bigger than that of VAS (r=0.31 in VAS and 0.51 in Pain vision). Conclusion : The PainVision™ system could be useful to evaluate postoperative pain because it enables the quantification and comparison of pain intensity independent of individual pain thresholds.

  12. Race effects on temporal summation to heat pain in youth.

    PubMed

    Morris, Matthew C; Walker, Lynn; Bruehl, Stephen; Hellman, Natalie; Sherman, Amanda L; Rao, Uma

    2015-05-01

    Racial differences in pain responsiveness have been demonstrated in adults. However, it is unclear whether racial differences are also present in youth and whether they extend to experimental pain indices assessing temporal summation of second pain (TSSP). Temporal summation of second pain provides an index of pain sensitivity and may be especially relevant in determining risk for chronic pain. This study assessed pain tolerance and TSSP to evoked thermal pain in 78 healthy youth (age range, 10-17), 51% of whom were African American and 49% were non-Hispanic white. Multilevel models revealed within-individual increases in pain ratings during the temporal summation task in non-Hispanic white youth that were consistent with TSSP. Pain ratings did not change significantly during the temporal summation task in African-American youth. Baseline evoked pain ratings were significantly higher in African-American compared with non-Hispanic white youth. These findings suggest that enhanced responsiveness to evoked thermal pain in African Americans is present in adolescence but is unlikely to be related to elevated TSSP. These results may have implications for understanding racial differences in chronic pain experience in adulthood. PMID:25734994

  13. Intravenous patient-controlled analgesia and management of pain in post-surgical elderly with cancer

    Microsoft Academic Search

    Sebastiano Mercadante

    2010-01-01

    Postoperative pain is often underestimated in elderly patients, based on considerations of the limited function of kidney and liver with advancing age or presumed high threshold of pain sensation. Achieving adequate pain management for the older patient is complicated by comorbid diseases, increased risk of adverse drug reactions, and physician factors such as inadequate training and reluctance to prescribe opioid

  14. Central sensitization and LTP: do pain and memory share similar mechanisms?

    Microsoft Academic Search

    Ru-Rong Ji; Tatsuro Kohno; Kimberly A. Moore; Clifford J. Woolf

    2003-01-01

    Synaptic plasticity is fundamental to many neurobiological functions, including memory and pain. Central sensitization refers to the increased synaptic efficacy established in somatosensory neurons in the dorsal horn of the spinal cord following intense peripheral noxious stimuli, tissue injury or nerve damage. This heightened synaptic transmission leads to a reduction in pain threshold, an amplification of pain responses and a

  15. Cellular mechanisms of opioid tolerance and the clinical approach to the opioid tolerant patient in the post-operative period

    Microsoft Academic Search

    Oscar A. de Leon-Casasola

    2002-01-01

    The high prevalence of opioid use for recreational purposes in the USA and the European Union, as well as the use of opioids for the treatment of chronic non-malignant pain, has resulted in an increase in the number of patients with opioid tolerance who undergo surgery and require post-operative pain management. The approach to post-operative pain control in these patients

  16. Postoperative pain control.

    PubMed

    Lovich-Sapola, Jessica; Smith, Charles E; Brandt, Christopher P

    2015-04-01

    Prevention and control of postoperative pain are essential. Inadequate treatment of postoperative pain continues to be a major problem after many surgeries and leads to worse outcomes, including chronic postsurgical pain. Optimal management of postoperative pain requires an understanding of the pathophysiology of pain, methods available to reduce pain, invasiveness of the procedure, and patient factors associated with increased pain, such as anxiety, depression, catastrophizing, and neuroticism. Use of a procedure-specific, multimodal perioperative pain management provides a rational basis for enhanced postoperative pain control, optimization of analgesia, decrease in adverse effects, and improved patient satisfaction. PMID:25814108

  17. Pain perception and hypnosis: findings from recent functional neuroimaging studies.

    PubMed

    Del Casale, Antonio; Ferracuti, Stefano; Rapinesi, Chiara; Serata, Daniele; Caltagirone, Saverio Simone; Savoja, Valeria; Piacentino, Daria; Callovini, Gemma; Manfredi, Giovanni; Sani, Gabriele; Kotzalidis, Georgios D; Girardi, Paolo

    2015-01-01

    Hypnosis modulates pain perception and tolerance by affecting cortical and subcortical activity in brain regions involved in these processes. By reviewing functional neuroimaging studies focusing on pain perception under hypnosis, the authors aimed to identify brain activation-deactivation patterns occurring in hypnosis-modulated pain conditions. Different changes in brain functionality occurred throughout all components of the pain network and other brain areas. The anterior cingulate cortex appears to be central in modulating pain circuitry activity under hypnosis. Most studies also showed that the neural functions of the prefrontal, insular, and somatosensory cortices are consistently modified during hypnosis-modulated pain conditions. Functional neuroimaging studies support the clinical use of hypnosis in the management of pain conditions. PMID:25719519

  18. Inherited Pain

    PubMed Central

    Eberhardt, Mirjam; Nakajima, Julika; Klinger, Alexandra B.; Neacsu, Cristian; Hühne, Kathrin; O'Reilly, Andrias O.; Kist, Andreas M.; Lampe, Anne K.; Fischer, Kerstin; Gibson, Jane; Nau, Carla; Winterpacht, Andreas; Lampert, Angelika

    2014-01-01

    Inherited erythromelalgia (IEM) causes debilitating episodic neuropathic pain characterized by burning in the extremities. Inherited “paroxysmal extreme pain disorder” (PEPD) differs in its clinical picture and affects proximal body areas like the rectal, ocular, or jaw regions. Both pain syndromes have been linked to mutations in the voltage-gated sodium channel Nav1.7. Electrophysiological characterization shows that IEM-causing mutations generally enhance activation, whereas mutations leading to PEPD alter fast inactivation. Previously, an A1632E mutation of a patient with overlapping symptoms of IEM and PEPD was reported (Estacion, M., Dib-Hajj, S. D., Benke, P. J., Te Morsche, R. H., Eastman, E. M., Macala, L. J., Drenth, J. P., and Waxman, S. G. (2008) NaV1.7 Gain-of-function mutations as a continuum. A1632E displays physiological changes associated with erythromelalgia and paroxysmal extreme pain disorder mutations and produces symptoms of both disorders. J. Neurosci. 28, 11079–11088), displaying a shift of both activation and fast inactivation. Here, we characterize a new mutation of Nav1.7, A1632T, found in a patient suffering from IEM. Although transfection of A1632T in sensory neurons resulted in hyperexcitability and spontaneous firing of dorsal root ganglia (DRG) neurons, whole-cell patch clamp of transfected HEK cells revealed that Nav1.7 activation was unaltered by the A1632T mutation but that steady-state fast inactivation was shifted to more depolarized potentials. This is a characteristic normally attributed to PEPD-causing mutations. In contrast to the IEM/PEPD crossover mutation A1632E, A1632T failed to slow current decay (i.e. open-state inactivation) and did not increase resurgent currents, which have been suggested to contribute to high-frequency firing in physiological and pathological conditions. Reduced fast inactivation without increased resurgent currents induces symptoms of IEM, not PEPD, in the new Nav1.7 mutation, A1632T. Therefore, persistent and resurgent currents are likely to determine whether a mutation in Nav1.7 leads to IEM or PEPD. PMID:24311784

  19. Phantom Pain 

    E-print Network

    Valentine, A.

    as he tried to get me out from under the truck. I remember the anguish on his face when he saw that nothing was 195 "Phantom Pain" working. The wind and rain were lashing both of our faces and the water was getting higher and higher. The cell... phones wouldn't work and the wreck had totaled the truck's radio. Something was burning ... I'm not sure what... It made a surreal light around the place but all I remember was wondering how it could keep burning in ali that rain and wind and water...

  20. Descending pain modulation and chronification of pain

    PubMed Central

    Ossipov, Michael H.; Morimura, Kozo; Porreca, Frank

    2015-01-01

    Purpose of review Chronic pain is an important public health problem that negatively impacts quality of life of affected individuals and exacts an enormous socio-economic cost. Currently available therapeutics provide inadequate management of pain in many patients. Acute pain states generally resolve in most patients. However, for reasons that are poorly understood, in some individuals, acute pain can transform to a chronic state. Our understanding of the risk factors that underlie the development of chronic pain is limited. Recent studies have suggested an important contribution of dysfunction in descending pain modulatory circuits to pain ‘chronification’. Human studies provide insights into possible endogenous and exogenous factors that may promote the conversion of pain into a chronic condition. Recent findings Descending pain modulatory systems have been studied and characterized in animal models. Human brain imaging techniques, deep brain stimulation and the mechanisms of action of drugs that are effective in the treatment of pain confirm the clinical relevance of top-down pain modulatory circuits. Growing evidence supports the concept that chronic pain is associated with a dysregulation in descending pain modulation. Disruption of the balance of descending modulatory circuits to favour facilitation may promote and maintain chronic pain. Recent findings suggest that diminished descending inhibition is likely to be an important element in determining whether pain may become chronic. This view is consistent with the clinical success of drugs that enhance spinal noradrenergic activity, such as serotonin/norepinephrine reuptake inhibitors (SNRIs), in the treatment of chronic pain states. Consistent with this concept, a robust descending inhibitory system may be normally engaged to protect against the development of chronic pain. Imaging studies show that higher cortical and subcortical centres that govern emotional, motivational and cognitive processes communicate directly with descending pain modulatory circuits providing a mechanistic basis to explain how exogenous factors can influence the expression of chronic pain in a susceptible individual. Summary Preclinical studies coupled with clinical pharmacologic and neuroimaging investigations have advanced our understanding of brain circuits that modulate pain. Descending pain facilitatory and inhibitory circuits arising ultimately in the brainstem provide mechanisms that can be engaged to promote or protect against pain ‘chronification’. These systems interact with higher centres, thus providing a means through which exogenous factors can influence the risk of pain chronification. A greater understanding of the role of descending pain modulation can lead to novel therapeutic directions aimed at normalizing aberrant processes that can lead to chronic pain. PMID:24752199

  1. 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 ...

  2. Gabapentin in Pain Management

    Microsoft Academic Search

    Jianren Mao; Lucy L. Chen

    2000-01-01

    role of gabapentin in pain treatment will be discussed with an attempt to identify pain symptoms that are likely to be responsive to gabapentin; 2) animal stud- ies of gabapentin on neuropathic pain and other pain behaviors will be evaluated; and 3) possible mecha- nisms of gabapentin actions will be considered in re- lation to mechanisms of neuropathic pain in

  3. Threshold quantum cryptography

    SciTech Connect

    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

    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.

  4. The effect of repeated intramuscular alfentanil injections on experimental pain and abuse liability indices in healthy males

    PubMed Central

    Tompkins, D. Andrew; Smith, Michael T.; Bigelow, George E.; Moaddel, Ruin; Venkata, S.L. Vatem; Strain, Eric C.

    2013-01-01

    Objective Opioid-induced hyperalgesia (OIH), increased sensitivity to noxious stimuli following repeated opioid exposures, has been demonstrated in pre-clinical studies. However, there is no accepted, prospective model of OIH following repeated opioid exposures currently available in humans. This study assessed a potential prospective OIH model. Methods Double-blind intramuscular (IM) injections of a short-acting opioid, (alfentanil 15 mcg/kg; N=8) were compared to active placebo (diphenhydramine 25 mg; N=3) on cold and pressure pain testing and standard abuse liability measures in eight 10-hour sessions (1 injection/session) over 4–5 weeks in healthy pain-free males. Decreases from session baseline pain threshold (PThr) and tolerance (PTol) were calculated to represent hyperalgesia, and were assessed both within and across sessions. Results Mean decreases in cold PTol were seen in the alfentanil group at 180 minutes (?3.8 seconds, +/?26.5) and 480 minutes (?1.63 seconds, +/?31.5) after drug administration. There was a trend for differences between conditions on cold PThr hyperalgesia but not for pressure PThr. Alfentanil participants had greater mean ratings on LIKING and HIGH visual analog scales at peak effects (30 minutes), but these scores did not change across sessions. Discussion Repeated alfentanil exposures over 4–5 weeks resulted in within session decreases in cold pain tolerance from baseline but these differences were not substantially different from diphenhydramine controls. The results did not support the phenomenon of OIH in this model, although definitive conclusions regarding the existence of OIH in humans likely requires a larger sample size or an alternative model. PMID:23446076

  5. Pharmacotherapy for breakthrough cancer pain.

    PubMed

    Mercadante, Sebastiano

    2012-01-22

    Breakthrough pain (BTP) is a transient exacerbation of pain that occurs either spontaneously, or in relation to a specific predictable or unpredictable trigger, despite relatively stable and adequately controlled background pain. The principal pharmacological treatment of BTP is represented by the administration of opioids as needed. Oral opioids have traditionally been the only available drugs for BTP. However, the onset and duration of action of oral opioids such as morphine or oxycodone may not be suitable for treating many episodes of BTP that are of short onset and duration. Transmucosal administration of lipophilic substances has gained a growing popularity in recent years due to the rapid effect, clinically observable 10-15 minutes after drug administration, and the non-invasive form. Different technologies have been developed to provide fast pain relief with potent opioid drugs such fentanyl, delivered by non-invasive routes (rapid onset opioids, ROOs). All the studies performed with ROOs have recommended that these drugs should be administered to opioid-tolerant patients receiving doses of oral morphine equivalents of at least 60?mg. These preparations, including oral transmucosal fentanyl citrate, fentanyl buccal tablet, sublingual fentanyl, intranasal fentanyl spray, fentanyl-pectin nasal spray and fentanyl buccal soluble film have shown better efficacy than placebo or oral opioids. Long-term studies have confirmed their efficacy and safety. PMID:22233484

  6. Pain from bluebottle jellyfish stings.

    PubMed

    Li, Li; McGee, Richard G; Webster, Angela C

    2015-07-01

    An 11-year-old girl presented to the emergency department with severe pain after a jellyfish sting at a New South Wales beach. Bluebottle (Physalia) jellyfish was deemed the most likely cause considering her geographical location. The Australian Resuscitation Council Guideline (2010) suggests immersing in water as hot as can be tolerated for 20?min for treating pain from jellyfish stings. This guideline was written based on past case reports, books and randomised controlled trials (RCTs). We performed a search to assess the most current evidence for relief of pain from Bluebottle jellyfish stings, which yielded two systematic reviews and seven RCTs. Both systematic reviews had similar conclusions, with one of the RCTs used in both reviews showing the most relevance to our presenting patient in terms of demographics, location and jellyfish type. This journal club article is an appraisal of this RCT by Loten et?al. and the validity of its conclusion that hot water immersion is most effective for the relief of pain from Bluebottle stings. PMID:26135148

  7. Quantitative sensory testing in trigeminal traumatic neuropathic pain and persistent idiopathic facial pain.

    PubMed

    Siqueira, Silvia R D T de; Siviero, Mariana; Alvarez, Fábio K; Teixeira, Manoel J; Siqueira, José T T de

    2013-03-01

    The objective of this article was to investigate, with a systematic protocol of quantitative sensory testing, patients with persistent idiopathic facial pain (PIFP) and others with trigeminal traumatic neuropathic pain (TTN) compared to controls. Thirty patients with PIFP, 19 with TTN, and 30 controls were evaluated on subjective numbness and dysesthesia and with a systematic protocol of quantitative sensory testing for thermal evaluation (cold and warm), mechanical detection (touch and pinpricks for mechanical pain), superficial pain thresholds, and corneal reflex. We found that PIFP and TTN had numbness and dysesthesia higher than controls (p<0.001 and p=0.003), and that in both of them mechanical pain by pinpricks detection was abnormal intra and extra orally at the mandibular branch (p<0.001). Cold, warm, and tactile detections and pain thresholds were similar among the groups. Corneal reflex was abnormal in TTN (p=0.005). This study supports neuropathic mechanisms involving pain processing in PIFP and that the criterion on absence of sensorial variations in PIFP should be revised. PMID:23563718

  8. Pain management in Jordan: nursing students' knowledge and attitude.

    PubMed

    Al Khalaileh, Murad; Al Qadire, Mohammad

    Pain management requires knowledgeable and trained nurses. Because nursing students are the nurses of the future, it is important to ensure that students receive adequate education about pain management in nursing schools. The purpose of this study is to evaluate nursing students' knowledge and attitudes regarding pain management. A cross-sectional survey was used. The sample comprised 144 students from three nursing colleges in Jordan. Sixty-one percent were female and the average age was 21.6 years (SD 1.7). The students' Knowledge and Attitudes Survey Regarding Pain was used. The rate of correct answers ranged from 11.1% to 64%. Students showed a low level of knowledge regarding pain management-the average score was just 16 (SD 5.11) out of 40. Students were weak in their knowledge of pain medications pharmacology (actions and side effects). Less than half of students (47.9%) recognised that pain may be present, even when vital signs are normal and facial expressions relaxed. Finally, students showed negative attitudes towards pain management, believing that patients should tolerate pain as much as they can before receiving opioids; almost half (48%) of students agreed that patients' pain could be managed with placebo rather than medication. In conclusion, Jordanian nursing students showed lower levels of pain knowledge compared with other nursing students around the world. This study underlines the need to include pain-management courses throughout undergraduate nursing curricula in Jordan. PMID:24280924

  9. What Is Chronic Pain?

    MedlinePLUS Videos and Cool Tools

    ... Pain Management Programs Videos Resources Glossary FAQs Surveys September is Pain Awareness Month Partners for Understanding Pain ... range of individual contributors. Last Updated: 6/26/2015 We comply with the HONcode standard for trustworthy ...

  10. Pain medications - narcotics

    MedlinePLUS

    Narcotics (also called opioid pain relievers) are used only for pain that is severe and is not ... these drugs can be effective at reducing pain. Narcotics work by binding to receptors in the brain, ...

  11. American Chronic Pain Association

    MedlinePLUS

    ... to Chronic Pain Medications & Treatments The Art of Pain Management What We Have Learned Going to the ER Communication Tools Pain Management Programs Videos Resources Glossary FAQs Surveys September is ...

  12. Palliative care - managing pain

    MedlinePLUS

    End of life - pain management; Hospice - pain management ... or if you have side effects from your pain treatments. ... Bookbinder M, McHugh ME. Symptom management in palliative care and ... Medicine . 1st ed. Philadelphia, PA: Elsevier Saunders; 2008:chap ...

  13. Chronic Pelvic Pain

    MedlinePLUS

    ... in relieving pelvic pain, especially dysmenorrhea . • Physical therapy—Acupuncture, acupressure, and nerve stimulation therapies may be useful in treating pain caused by dysmenorrhea. Physical therapy that eases trigger points may give relief of muscular pain. Some types ...

  14. 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 ...

  15. Analgesic efficacy and tolerability of transdermal buprenorphine in patients with inadequately controlled chronic pain related to cancer and other disorders: A multicenter, randomized, double-blind, placebo-controlled trial

    Microsoft Academic Search

    Reinhard Sittl; Norbert Griessinger; Rudolf Likar

    2003-01-01

    Background: Buprenorphine is a potent opioid analgesic that is available in sublingual and parenteral formulations. A new formulation, buprenorphine transdermal delivery system (TDS), has been developed.Objective: The aim of this study was to compare the analgesic efficacy and tolerability of the 3 available dosages of buprenorphine TDS (35.0, 52.5, and 70.0 ?g\\/h) with placebo.Methods: This was a randomized, double-blind, placebo-controlled,

  16. Pain and Alzheimer's disease.

    PubMed

    Pickering, G; Eschalier, A; Dubray, C

    2000-01-01

    Literature on pain management in Alzheimer's disease is slowly emerging and this review deals with different aspects of pain in this growing population. Clinical pain, experimental pain and assessment of pain in cognitively impaired patients are presented. Treatment of pain is also discussed. This review calls for more studies and clinical trials with a view to improve the comfort and quality of life of patients suffering from Alzheimer's disease. PMID:10965178

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

    Microsoft Academic Search

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

    2009-01-01

    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

  18. Fault-Tolerant Exact State Transmission

    E-print Network

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

    2012-05-02

    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.

  19. Trigeminal Neuralgia: Unilateral Episodic Facial Pain.

    PubMed

    Zakrzewska, Joanna M

    2015-06-01

    Trigeminal neuralgia is a rare cause of episodic unilateral facial pain and often in the initial presentation dental causes need to be eliminated, as it frequently presents in the lower trigeminal divisions. The pain description is characteristic of electric shock-like pain that is light-touch provoked, paroxysmal, and occurring daily; the condition can go into remission for weeks or months, however. The first-line drug is either carbamazepine or oxcarbazepine and has to be started in low doses. Over 70% of patients will initially obtain immediate relief. If efficacy or tolerability becomes a problem, then referral to a secondary care specialist should be made. Magnetic resonance imaging (MRI) scans can determine if there is a symptomatic cause and whether surgery is indicated. Surgical options provide longest pain relief periods. Patients need to be given information about all treatment options so they can make a decision about treatment. This report is adapted from paineurope 2014; Issue 4, © Haymarket Medical Publications Ltd., and is presented with permission. paineurope is provided as a service to pain management by Mundipharma International, Ltd., and is distributed free of charge to health care professionals in Europe. Archival issues can be viewed via the Web site: www.paineurope.com , at which health professionals can find links to the original articles and request copies of the quarterly publication and access additional pain education and pain management resources. PMID:26095494

  20. Fentanyl sublingual spray for breakthrough pain in cancer patients.

    PubMed

    Zeppetella, Giovambattista

    2013-06-01

    Breakthrough pain is a transient exacerbation of pain that occurs either spontaneously, or in relation to a specific predictable or unpredictable trigger, despite relatively stable and adequately controlled background pain. Typically, breakthrough pain has a fast onset and short duration, and a significant impact on patients' quality of life. Normal-release oral opioids are the traditional pharmacological approach for patients who are receiving an around the clock opioid regimen; however, their onset and duration of action may not be suitable for treating many breakthrough pains. Efforts to provide nonparenteral opioid formulations that could provide more rapid, and more effective, relief of breakthrough pain have led to the development of transmucosal opioid formulations including fentanyl sublingual spray (FSLS). This is a formulation of fentanyl available in doses of 100, 200, 400, 600, and 800 ?g strengths approved for the management of breakthrough pain in adult cancer patients already receiving and who are tolerant to opioid therapy for their underlying persistent cancer pain. Published pharmacokinetic, efficacy, tolerability, and safety data suggest that FSLS has a valuable role to play in the symptomatic pharmacological management of breakthrough pain. The effective dose of FSLS is determined by titration according to the needs of the individual patient. PMID:25135032

  1. Anxiety sensitivity, body vigilance and fear of pain.

    PubMed

    Esteve, M Rosa; Camacho, Laura

    2008-06-01

    The aim of the present study was to investigate the role of anxiety sensitivity (AS) as a factor relevant to pain and pain persistence. Two studies were conducted to examine the relationship between AS, body vigilance and the experience of pain in non-clinical samples. Study 1 investigated the relationship between AS and body vigilance that was operationalized by the detection latency for innocuous electrical stimuli; trait anxiety and neuroticism were also included as covariates. Results indicated that the high AS group (N=69) presented shorter detection latency than the low AS group (N=70); neuroticism and trait anxiety did not have significant effects on detection latency. Using another sample, Study 2 investigated the relationship between AS, body vigilance, pain tolerance, catastrophizing, and self-reported distress and pain during a cold pressor task. Neuroticism, trait anxiety and fear of pain were included as covariates. Results showed significant differences between high- (N=66) and low- (N=69) AS groups in body vigilance, catastrophizing and tolerance. The covariates neuroticism, trait anxiety and fear of pain did not have any significant effects. No significant differences were found in pain and distress ratings. Results from both studies support the importance of AS in body vigilance and the experience of pain. The theoretical, preventive and clinical implications of these findings are discussed. PMID:18396262

  2. Quantitative testing of pain perception in subjects with PTSD--implications for the mechanism of the coexistence between PTSD and chronic pain.

    PubMed

    Defrin, Ruth; Ginzburg, Karni; Solomon, Zahava; Polad, Efrat; Bloch, Miki; Govezensky, Mirella; Schreiber, Shaul

    2008-08-31

    Post-traumatic stress disorder (PTSD) often co-occurs with chronic pain. Neither the underlying mechanism of this comorbidity nor the nature of pain perception among subjects with PTSD is well defined. This study is the first systematic and quantitative evaluation of pain perception and chronic pain in subjects with PTSD. The study group consisted of 32 outpatients with combat- and terror-related PTSD, 29 outpatients with anxiety disorder and 20 healthy controls. Quantitative somatosensory testing included the measurement of warm, cold, light touch and heat-pain thresholds and responses to acute suprathreshold heat and mechanical stimuli. Chronic pain was characterized, and levels of PTSD and anxiety symptomatology were assessed by self-report questionnaires. Subjects with PTSD exhibited higher rates of chronic pain, more intense chronic pain and more painful body regions compared with the other two groups. PTSD severity correlated with chronic pain severity. Thresholds of subjects with PTSD were significantly higher than those of subjects with anxiety and healthy controls, but they perceived suprathreshold stimuli as being much more intense than the other two groups. These results suggest that subjects with PTSD exhibit an intense and widespread chronic pain and a unique sensory profile of hyposensitivity to pain accompanied by hyper-reactivity to suprathreshold noxious stimuli. These features may be attributed to the manner with which PTSD subjects emotionally interpret and respond to painful stimuli. Alternatively, but not mutually exclusive, the findings may reflect altered sensory processing among these subjects. PMID:18585862

  3. Exercise prescription using the heart of claudication pain onset in patients with intermittent claudication

    PubMed Central

    Cucato, Gabriel Grizzo; da Rocha Chehuen, Marcel; Costa, Luis Augusto Riani; Ritti-Dias, Raphael Mendes; Wolosker, Nelson; Saxton, John Michael; de Moraes Forjaz, Cláudia Lúcia

    2013-01-01

    OBJECTIVE: To assess the acute metabolic and cardiovascular responses to walking exercise at an intensity corresponding to the heart rate of claudication pain onset and to investigate the effects of a 12-week walking training program at this intensity on walking capacity. METHODS: Twenty-nine patients with intermittent claudication were randomly allocated to the walking training (n?=?17) or control (CO, n?=?12) group. The walking training group performed an acute exercise session comprising 15×2-min bouts of walking at the heart rate of claudication pain onset, with 2-min interpolated rest intervals. The claudication symptoms and cardiovascular and metabolic responses were evaluated. Walking training was then performed at the same intensity twice each week for 12 weeks, while the control group engaged in twice weekly stretching classes. The claudication onset distance and total walking distance were evaluated before and after the interventions. Brazilian Registry Clinical Trials: RBR-7M3D8W. RESULTS: During the acute exercise session, the heart rate was maintained within tight limits. The exercise intensity was above the anaerobic threshold and >80% of the heart rate peak and VO2peak. After the exercise training period, the walking exercise group (n?=?13) showed increased claudication onset distance (309±153 vs. 413±201m) and total walking distance (784±182 vs. 1,100±236m) compared to the control group (n?=?12) (p<0.05). CONCLUSION: Walking exercise prescribed at the heart rate of claudication pain onset enables patients with intermittent claudication to exercise with tolerable levels of pain and improves walking performance. PMID:23917662

  4. Levetiracetam synergises with common analgesics in producing antinociception in a mouse model of painful diabetic neuropathy.

    PubMed

    Micov, Ana; Tomi?, Maja; Pecikoza, Uroš; Ugreši?, Nenad; Stepanovi?-Petrovi?, Radica

    2015-07-01

    Painful diabetic neuropathy is difficult to treat. Single analgesics often have insufficient efficacy and poor tolerability. Combination therapy may therefore be of particular benefit, because it might provide optimal analgesia with fewer adverse effects. This study aimed to examine the type of interaction between levetiracetam, a novel anticonvulsant with analgesic properties, and commonly used analgesics (ibuprofen, aspirin and paracetamol) in a mouse model of painful diabetic neuropathy. Diabetes was induced in C57BL/6 mice with a single high dose of streptozotocin, applied intraperitoneally (150mg/kg). Thermal (tail-flick test) and mechanical (electronic von Frey test) nociceptive thresholds were measured before and three weeks after diabetes induction. The antinociceptive effects of orally administered levetiracetam, analgesics, and their combinations were examined in diabetic mice that developed thermal/mechanical hypersensitivity. In combination experiments, the drugs were co-administered in fixed-dose fractions of single drug ED50 and the type of interaction was determined by isobolographic analysis. Levetiracetam (10-100mg/kg), ibuprofen (2-50mg/kg), aspirin (5-75mg/kg), paracetamol (5-100mg/kg), and levetiracetam-analgesic combinations produced significant, dose-dependent antinociceptive effects in diabetic mice in both tests. In the tail-flick test, isobolographic analysis revealed 15-, and 19-fold reduction of doses of both drugs in the combination of levetiracetam with aspirin/ibuprofen, and paracetamol, respectively. In the von Frey test, approximately 7- and 9-fold reduction of doses of both drugs was detected in levetiracetam-ibuprofen and levetiracetam-aspirin/levetiracetam-paracetamol combinations, respectively. These results show synergism between levetiracetam and ibuprofen/aspirin/paracetamol in a model of painful diabetic neuropathy and might provide a useful approach to the treatment of patients suffering from painful diabetic neuropathy. PMID:25958352

  5. Pain in chemotherapy-induced neuropathy--more than neuropathic?

    PubMed

    Geber, Christian; Breimhorst, Markus; Burbach, Berenike; Egenolf, Christina; Baier, Bernhard; Fechir, Marcel; Koerber, Juergen; Treede, Rolf-Detlef; Vogt, Thomas; Birklein, Frank

    2013-12-01

    Chemotherapy-induced neuropathy (CIN) is an adverse effect of chemotherapy. Pain in CIN might comprise neuropathic and nonneuropathic (ie, musculoskeletal) pain components, which might be characterized by pain patterns, electrophysiology, and somatosensory profiling. Included were 146 patients (100 female, 46 male; aged 56 ± 0.8 years) with CIN arising from different chemotherapy regimens. Patients were characterized clinically through nerve conduction studies (NCS) and quantitative sensory testing (QST). Questionnaires for pain (McGill) and anxiety/depression (Hospital Anxiety and Depression Scale) were supplied. Patients were followed-up after 17 days. Large- (61%) and mixed- (35%) fibre neuropathies were more frequent than small-fibre neuropathy (1.4%). The 5 major chemotherapeutic regimens impacted differently on large- but not on small-fibre function and did not predict painfulness. Chronic pain associated with CIN was reported in 41.7%. Painless and painful CIN did not differ in QST profiles or electrophysiological findings, but different somatosensory patterns were found in CIN subgroups (pain at rest [RestP], n = 25; movement-associated pain [MovP], n = 15; both pain characteristics [MovP+RestP], n = 21; or no pain [NonP], n = 85): small-fibre function (cold-detection threshold, CDT: z score: -1.46 ± 0.21, P < 0.01) was most impaired in RestP; mechanical hyperalgesia was exclusively found in MovP (z score: +0.81 ± 0.30, P < 0.05). "Anxiety" discriminated between painful and painless CIN; "CDT" and "anxiety" discriminated between patients with ongoing (RestP) and movement-associated pain (MovP) or pain components (MovP+RestP). The detrimental effect of chemotherapy on large fibres failed to differentiate painful from painless CIN. Patients stratified for musculoskeletal or neuropathic pain, however, differed in psychological and somatosensory parameters. This stratification might allow for the application of a more specific therapy. PMID:23999056

  6. Fault-tolerance in the Borealis distributed stream processing system

    Microsoft Academic Search

    Magdalena Balazinska; Hari Balakrishnan; Samuel Madden; Michael Stonebraker

    2005-01-01

    We present a replication-based approach to fault-tolerant distributed stream processing in the face of node failures, network failures, and network partitions. Our approach aims to reduce the degree of inconsistency in the system while guaranteeing that available inputs capable of being processed are processed within a specified time threshold. This threshold allows a user to trade availability for consistency: a

  7. Fault-tolerant quantum computation versus Gaussian noise

    E-print Network

    Hui Khoon Ng; John Preskill

    2008-10-27

    We study the robustness of a fault-tolerant quantum computer subject to Gaussian non-Markovian quantum noise, and we show that scalable quantum computation is possible if the noise power spectrum satisfies an appropriate "threshold condition." Our condition is less sensitive to very-high-frequency noise than previously derived threshold conditions for non-Markovian noise.

  8. Scaling and Renormalization in Fault-Tolerant Quantum Computers

    E-print Network

    Raginsky, Maxim

    to derive a trade-off between the complexity overhead of the fault-tolerant circuit and the threshold error of reliable large-scale quantum computation rests upon a number of results known collectively of the possibility of arbitrarily reliable sub-threshold quantum computation for a wide variety of noise models

  9. Imipramine decreases oesophageal pain perception in human male volunteers

    PubMed Central

    Peghini, P; Katz, P; Castell, D

    1998-01-01

    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

  10. Intrathecal morphine pump for neuropathic cancer pain: a case report.

    PubMed

    Gogia, Vikas; Chaudhary, Prakash; Ahmed, Arif; Khurana, Deepa; Mishra, Seema; Bhatnagar, Sushma

    2012-08-01

    The WHO ladder has been the most widely used approach for management of Cancer Pain. However, oral medications alone may be inadequate, particularly in difficult to treat cancer pain syndromes. Neuropathic pain is one of these refractory syndromes. The role of opioids has always been controversial in pain of neuropathic origin. We report a case of a 61 year old female patient with endometrial carcinoma suffering from severe neuropathic pain in her left lower limb. The pain was refractory to highest tolerable doses of oral morphine and neuromodulator drugs, viz. gabapentin and pregabalin. We managed the patient successfully with intrathecal morphine pump reducing the total morphine dose and improving patient comfort and satisfaction. Intrathecal delivery of Morphine ensured better efficacy with fewer side effects. PMID:21868426

  11. Authenticating Multicast Streams in Lossy Channels Using Threshold Techniques

    Microsoft Academic Search

    Mohamed Al-ibrahim; Josef Pieprzyk

    2001-01-01

    We first classify the state-of-the-art stream authentication problem in the multicast environment and group them into Signing\\u000a and MAC approaches. A new approach for authenticating digital streams using Threshold Techniques is introduced. The new approach\\u000a main advantages are in tolerating packet loss, up to a threshold number, and having a minimum space overhead. It is most suitable\\u000a for multicast applications

  12. The Brain in Pain

    PubMed Central

    AHMAD, Asma Hayati; ABDUL AZIZ, Che Badariah

    2014-01-01

    Pain, while salient, is highly subjective. A sensation perceived as painful by one person may be perceived as uncomfortable, not painful or even pleasant to others. Within the same person, pain may also be modulated according to its threat value and the context in which it is presented. Imaging techniques, such as functional magnetic resonance imaging and positron emission tomography, have identified a distributed network in the brain, the pain-relevant brain regions, that encode the sensory-discriminative aspect of pain, as well as its cognitive and affective/emotional factors. Current knowledge also implicates the prefrontal cortex as the modulatory area for pain, with its subdivisions forming the cortico-cortical pathway, an alternative pain modulatory pathway distinct from the descending modulatory pathway of pain. These findings from neuroimaging in human subjects have paved the way for the molecular mechanisms of pain modulation to be explored in animal studies. PMID:25941463

  13. Method for quantitative estimation of thermal thresholds in patients

    Microsoft Academic Search

    H Fruhstorfer; U Lindblom; W C Schmidt

    1976-01-01

    A quantitative method for the examination of thermal sensibility was applied in 26 normal subjects and in patients with various neurological disorders. The stimulation technique resembled Békésy audiometry: the patient reversed the direction of the temperature change of a thermode whenever warm, cold, or thermal pain thresholds were reached. The resulting temperature curve enables a quantitative description of the subject's

  14. Painful and non-painful neuropathy in HIV-infected patients: an analysis of somatosensory nerve function.

    PubMed

    Martin, Claes; Solders, Göran; Sönnerborg, Anders; Hansson, Per

    2003-01-01

    Fifteen to 50% of AIDS-patients suffer from distal predominantly sensory neuropathy (DSP), which is commonly associated with painful symptoms. In the present study, we have focused on the function of fine calibre nerve channels, in 36 consecutive HIV-1-infected patients with painful (PPN) (n=20; 54%) and non-painful (PN) (n=16) sensory neuropathy, assessed by clinical, quantitative thermal testing (QTT) (31/36), and peripheral nerve conduction examination (32/36). Control QTT data were obtained from 49 healthy subjects with a corresponding age- and sex distribution. Demographics, antiviral treatment, immunological status, and nerve conduction examination did not differ between patients with and without painful symptoms. Hypoaesthesia to warmth, cold, and heat pain was observed in both neuropathy groups when compared to healthy controls. However, the perception threshold to warmth was more often impaired (p<0.01) and the level of impairment was more pronounced (p<0.001) in patients with painful neuropathy. Furthermore, increased pain sensitivity to cold was found only in patients with painful symptoms (p<0.05). An abnormal outcome of any QTT parameter was found in all patients with pain, but only among 62% of patients without pain, p<0.01, and the cumulative frequency of abnormalities in any of the four thermal percepts (warmth, cold, heat pain, and cold pain) was higher in patients with painful symptoms, p<0.0001. This study demonstrates a more pronounced impairment of C-fibre-mediated innocuous warm perception in patients with painful neuropathy, which in the setting of impaired or absent heat pain perception suggests a more generalised loss of function in somatosensory C-fibre channels. PMID:12527314

  15. Ibuprofen liquigel for oral surgery pain

    Microsoft Academic Search

    Elliot V. Hersh; Lawrence M. Levin; Stephen A. Cooper; Geraldine Doyle; Joel Waksman; David Wedell; Douglas Hong; Stacey A. Secreto

    2000-01-01

    Background: Ibuprofen liquigel is a solubilized potassium ibuprofen 200-mg gelatin capsule formulation that was approved for over-the-counter use in 1995.Objective: This study compared the analgesic efficacy and tolerability of ibuprofen liquigel 200 mg, ibuprofen liquigel 400 mg, acetaminophen caplets 1000 mg, and placebo in patients experiencing moderate or severe pain after surgical removal of impacted third molars.Methods: This randomized, double-blind,

  16. The multitarget opioid ligand LP1's effects in persistent pain and in primary cell neuronal cultures.

    PubMed

    Parenti, Carmela; Turnaturi, Rita; Aricò, Giuseppina; Gramowski-Voss, Alexandra; Schroeder, Olaf H-U; Marrazzo, Agostino; Prezzavento, Orazio; Ronsisvalle, Simone; Scoto, Giovanna M; Ronsisvalle, Giuseppe; Pasquinucci, Lorella

    2013-08-01

    Persistent pain states, such as those caused by nerve injury or inflammation, are associated with altered sensations, allodynia and hyperalgesia, that are resistant to traditional analgesics. A contribution to development and maintenance in altered pain perception comes from nociceptive processing and descending modulation from supraspinal sites. A multitarget ligand seems to be useful for pain relief with a decreased risk of adverse events and a considerable analgesic efficacy. The multitarget MOR agonist-DOR antagonist LP1, (3-[(2R,6R,11R)-8-hydroxy-6,11-dimethyl-1,4,5,6-tetrahydro-2,6-methano-3-benazocin-3(2H)-yl]-N-phenylpropanamide, is a central acting antinociceptive agent with low potential to induce tolerance. LP1 was tested in models of neuropathic pain - induced by chronic constriction injury (CCI) of the left sciatic nerve - and inflammatory pain - produced by intraplantar injection of carrageenan. In CCI rats, subcutaneous (s.c.) LP1 (3 mg/kg) showed a significant antiallodynic effect, measured with von Frey filaments, and antihyperalgesic effect, evoked in response to a radiant heat stimulus with plantar test. Analogously, LP1 significantly reduced allodynic and hyperalgesic thresholds in a model of inflammatory pain induced by carrageenan. To evaluate the contribution of opioid receptor subtypes in LP1 antinociceptive effects, the multitarget LP1 profile was assessed using selective opioid antagonists. Moreover, functional electrophysiological in vitro assays, using primary cortical and spinal cord networks, allowed to define the "pharmacological fingerprint" of LP1. The EC?? values in this functional screening seem to confirm LP1 as a potent opioid ligand (EC?? = 0.35 fM and EC?? = 44 pM in spinal cord and frontal cortex, respectively). Using a NeuroProof data-base of well characterised reference compounds, a similarity profile of LP1 to opioid and non-opioid drugs involved in pain modulation was detected. Our studies seem to support that multitarget ligand approach should be useful for persistent pain conditions in which mechanical allodynia and thermal hyperalgesia are significant components of the nociceptive response. PMID:23541722

  17. Mechanical Data for Use in Damage Tolerance Analyses

    NASA Technical Reports Server (NTRS)

    Forth, Scott C.; James, Mark A.; Newman, John A.; Everett, Richard A., Jr.; Johnston, William M., Jr.

    2004-01-01

    This report describes the results of a research program to determine the damage tolerance properties of metallic propeller materials. Three alloys were selected for investigation: 2025-T6 Aluminum, D6AC Steel and 4340 Steel. Mechanical response, fatigue (S-N) and fatigue crack growth rate data are presented for all of the alloys. The main conclusions that can be drawn from this study are as follows. The damage tolerant design of a propeller system will require a complete understanding of the fatigue crack growth threshold. There exists no experimental procedure to reliably develop the fatigue crack growth threshold data that is needed for damage tolerant design methods. Significant research will be required to fully understand the fatigue crack growth threshold. The development of alternative precracking methods, evaluating the effect of specimen configuration and attempting to identify micromechanical issues are simply the first steps to understanding the mechanics of the threshold.

  18. Pain and the ethics of pain management.

    PubMed

    Edwards, R B

    1984-01-01

    In this article I clarify the concepts of 'pain', 'suffering', 'pains of body', 'pains of soul'. I explore the relevance of an ethic to the clinical setting which gives patients a strong prima facie right to freedom from unnecessary and unwanted pain and which places upon medical professionals two concomitant moral obligations to patients. First, there is the duty not to inflict pain and suffering beyond what is necessary for effective diagnosis, treatment and research. Next, there is the duty to do all that can be done to relieve all the pain and suffering which can be alleviated. I develop in some detail that individuality of pain sensitivity must be taken into account in fulfilling these obligations. I explore the issue of the relevance of informed consent and the right to refuse treatment to the matter of pain relief. And I raise the question of what conditions, if any, should override the right to refuse treatment where pain relief is of paramount concern. PMID:6710192

  19. Tolerance chart optimization

    Microsoft Academic Search

    S. A. IRANI; R. O. MITTAL; E. A. LEHTIHET

    1989-01-01

    A tolerance chart is a graphical representation of a process plan and a manual procedure for controlling tolerance stackup when the machining of a component involves interdependent tolerance chains. This heuristic, experience-based method of allocating tolerances to individual cuts of a process plan can be embodied in a computer-based module. This paper introduces a graph theoretic representation for the tolerance

  20. Chiropractic care for back pain

    MedlinePLUS

    ... Society Low Back Pain Guideline Panel. Interventional therapies, surgery, and interdisciplinary rehabilitation for low back pain: an evidence-based clinical practice guideline from the American Pain Society. ...

  1. Managing your chronic back pain

    MedlinePLUS

    ... Society Low Back Pain Guideline Panel. Interventional therapies, surgery, and interdisciplinary rehabilitation for low back pain: an evidence-based clinical practice guideline from the American Pain Society. ...

  2. Epidural injections for back pain

    MedlinePLUS

    ... Society Low Back Pain Guideline Panel. Interventional therapies, surgery, and interdisciplinary rehabilitation for low back pain: an evidence-based clinical practice guideline from the American Pain Society. ...

  3. Efficacy of the sustained-release hydromorphone in neuropathic pain management: pooled analysis of three open-label studies.

    PubMed

    Moulin, Dwight E; Richarz, Ute; Wallace, Mark; Jacobs, Adam; Thipphawong, John

    2010-09-01

    This pooled analysis was designed to determine whether the analgesic response to treatment with OROS hydromorphone, as measured by the "pain on average" scale of the Brief Pain Inventory (BPI), was different in patients with neuropathic pain compared to those with nociceptive pain, after adjusting for differences in baseline characteristics. Three open-label studies on patients with neuropathic and nociceptive malignant and nonmalignant chronic pain were analyzed. A mixed model for repeated measures linear regression analysis was used to compare the effect of OROS hydromorphone on patients with neuropathic and nociceptive pain, adjusting for potentially confounding factors. Data from patients with pure neuropathic pain and mixed pain were also compared. Safety and tolerability was assessed by recording the number of adverse events. The primary outcome was "pain on average" (BPI item 5) over time. Secondary outcomes were the effect of OROS hydromorphone on other BPI items including "pain relief" and "interference with sleep." Patients with neuropathic pain showed a similar response to treatment with OROS hydromorphone to those patients with nociceptive pain. There was no statistically significant difference between the pain groups (difference between groups -0.552 at visit 7; P = .060 for overall difference between groups). For some outcome variables, treatment was more effective for patients with neuropathic pain. The treatment was generally well tolerated. This pooled analysis shows that treatment with OROS hydromorphone had similar efficacy for neuropathic and nociceptive pain. PMID:20718640

  4. Blood testing in chronic pain management.

    PubMed

    Deer, Timothy R; Gunn, Joshua

    2015-01-01

    Blood testing is quickly becoming a useful laboratory tool for opioid prescribers who wish to document and assess patient tolerance, more objectively monitor patient safety, and evaluate patient compliance using information that is not available with traditional urine drug testing (UDT). Blood testing does not need to be performed as frequently as UDT but provides extremely valuable information which can be used to more accurately evaluate patient compliance and assist with interpreting blood toxicology results commonly used in impairment or overdose cases. This narrative review presents the current evidence supporting the use of blood testing within the chronic pain management setting. In addition, this review aims to introduce and discuss the role of routine blood testing within the chronic pain management setting. Blood testing for the purpose of documenting opioid tolerance is a relatively novel tool for pain physicians and as such this review is not intended to be a comprehensive or exhaustive review of the scientific or medical literature. Prescribers must also be aware that this type of laboratory testing need only be administered to chronic pain patients receiving daily opioid therapy. Patients taking infrequent, low dose, or as needed medications are not anticipated to benefit from this type of test. Based on the complexity of both achieving acceptable outcomes with opioid treatment and the legal and societal issues at hand, we feel that the addition of blood concentration levels will become the standard of care in the near future. PMID:25794214

  5. Pediatric pain management.

    PubMed

    Lederhaas, G

    1997-01-01

    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

  6. Threshold-Controlled Global Cascading in Wireless Sensor Networks

    E-print Network

    Varela, Carlos

    networks and for limits on achievable capacity and delay in mobile wireless networks). Second, sensor nodes topology changes in sensor networks even without mobility (see for example [8] for scalable and fault-tolerantThreshold-Controlled Global Cascading in Wireless Sensor Networks Qiming Lu and G. Korniss

  7. Pain Management for Children during Bone Marrow and Stem Cell Transplantation

    PubMed Central

    Vasquenza, Kelly; Ruble, Kathy; Chen, Allen; Billett, Carol; Kozlowski, Lori; Atwater, Sara; Kost-Byerly, Sabine

    2014-01-01

    Pain management for children during bone marrow and stem cell transplantation is a significant clinical challenge for the health care team. Pain management strategies vary by institution. This paper reports on the use of a pediatric pain management service and patient-and caregiver-controlled analgesia for children undergoing transplant. This 2-year retrospective chart review examined the pain management practices and outcomes of children undergoing bone marrow and stem cell transplants in a large urban teaching hospital during 2008 and 2009. We concluded that patient- and caregiver-controlled analgesia is a well-tolerated modality for pain control during hospitalization for transplantation at this institution. PMID:25267531

  8. Pain Management for Children during Bone Marrow and Stem Cell Transplantation.

    PubMed

    Vasquenza, Kelly; Ruble, Kathy; Chen, Allen; Billett, Carol; Kozlowski, Lori; Atwater, Sara; Kost-Byerly, Sabine

    2015-06-01

    Pain management for children during bone marrow and stem cell transplantation is a significant clinical challenge for the health care team. Pain management strategies vary by institution. This paper reports on the use of a pediatric pain management service and patient- and caregiver-controlled analgesia for children undergoing transplant. This 2-year retrospective chart review examined the pain management practices and outcomes of children undergoing bone marrow and stem cell transplants in a large urban teaching hospital during 2008 and 2009. We concluded that patient- and caregiver-controlled analgesia is a well-tolerated modality for pain control during hospitalization for transplantation at this institution. PMID:25267531

  9. Pain modulation efficiency delays seeking medical help in patients with acute myocardial infarction.

    PubMed

    Granot, Michal; Dagul, Pnina; Darawsha, Wisam; Aronson, Doron

    2015-01-01

    Rapid reperfusion is crucial to reduce mortality in patients with ST elevation myocardial infarction. Prehospital patient delay, defined as time from symptoms onset to the decision to seek medical attention, accounts for a large proportion of cases with delayed reperfusion. However, whether pain modulation processes are involved in this phenomenon is not known. We hypothesized that prehospital patient delay may be affected by a reduction of perceived pain perception and pain modulation pattern. Pain threshold, magnitude estimation of suprathreshold stimulation, mechanical temporal summation and conditioned pain modulation (CPM), and recalls of pain magnitude at the onset of chest pain were obtained in 67 patients with first ST elevation myocardial infarction. The study's primary outcome was prehospital patient delay. The median patient delay was 24 (interquartile range, 0.5-72) hours. Of all psychophysical pain measures including pain threshold, magnitude estimation of suprathreshold stimulation, mechanical temporal summation, as well as CPM, only warm sensation threshold was independently associated with lower clinical chest pain intensity (P = 0.01). Multivariable regression analysis (R = 0.449; P < 0.0001) revealed an inverse independent association between chest pain intensity (P < 0.001) and patient delay, whereas efficient CPM was positively associated with prolonged patient delay (P = 0.034). The electrocardiography-derived myocardial ischemic area was not associated with chest pain intensity or patient delay, indicating that the affected ischemic tissue is not a dominant component that determines pain response. In conclusion, beyond the perceived chest pain intensity, the activation pattern of descending inhibition pathways during coronary occlusion affects pain interpretation and behavior during acute coronary occlusion. PMID:25599315

  10. Patient Education on Pain

    MedlinePLUS Videos and Cool Tools

    ... People with Pain Press Room Position Statements Patient Education on Pain AAPM Past President, Perry G. Fine, ... Member Center Patient Center Research Advocacy Practice Management Education Annual Meeting Contact Us Privacy Policy Sitemap Close ...

  11. The dynamic pain connectome.

    PubMed

    Kucyi, Aaron; Davis, Karen D

    2015-02-01

    Traditionally, studies of how pain and attention modulate one another involved explicit cognitive-state manipulations. However, emerging evidence suggests that spontaneous brain-wide network communication is intrinsically dynamic on multiple timescales, and attentional states are in constant fluctuation. Here, in light of studies on neural mechanisms of spontaneous attentional fluctuations and pain variability, we introduce the concept of a dynamic 'pain connectome' in the brain. We describe how recent progress in our understanding of individual differences in intrinsic attention to pain and neural network dynamics in chronic pain can facilitate development of personalized pain therapies. Furthermore, we emphasize that the dynamics of pain-attention interactions must be accounted for in the contemporary search for a 'neural signature' of the pain connectome. PMID:25541287

  12. Sickle Cell Pain

    MedlinePLUS

    ... manage pain. Distraction – engaging activities (such as hobbies, video games and movies) that change the patient's focus can help relieve stress and pain. Psychotherapy – speaking with a mental health professional about the stress and frustration of sickle ...

  13. Eldercare at Home: Pain

    MedlinePLUS

    ... or "heaviness" or “misery.” Look for behavior or body language that looks like a response to pain. An ... to communicate about pain in words. Behaviors or body language to look for include facial expressions such as ...

  14. The perils of thresholding

    NASA Astrophysics Data System (ADS)

    Font-Clos, Francesc; Pruessner, Gunnar; Moloney, Nicholas R.; Deluca, Anna

    2015-04-01

    The thresholding of time series of activity or intensity is frequently used to define and differentiate events. This is either implicit, for example due to resolution limits, or explicit, in order to filter certain small scale physics from the supposed true asymptotic events. Thresholding the birth–death process, however, introduces a scaling region into the event size distribution, which is characterized by an exponent that is unrelated to the actual asymptote and is rather an artefact of thresholding. As a result, numerical fits of simulation data produce a range of exponents, with the true asymptote visible only in the tail of the distribution. This tail is increasingly difficult to sample as the threshold is increased. In the present case, the exponents and the spurious nature of the scaling region can be determined analytically, thus demonstrating the way in which thresholding conceals the true asymptote. The analysis also suggests a procedure for detecting the influence of the threshold by means of a data collapse involving the threshold-imposed scale.

  15. Pain Characteristics of Painful Ophthalmoplegia (The Tolosa-Hunt Syndrome)

    Microsoft Academic Search

    Jan Hannerz

    1985-01-01

    Pain characteristics of the Tolosa-Hunt syndrome were abstracted from the observations of five patients with repeated incidents of painful ophthalmoplegia. The pain was experienced either as pressure behind the ophthalmoplegic eye or as boring pain in one orbital region, fluctuating in intensity, sometimes worsening to knife stab-like pain in the eye. The unilateral pain did not shift side during a

  16. Integrating the Concept of Pain Interference into Pain Management

    Microsoft Academic Search

    Marian Wilson

    Undertreatment of pain is a significant problem. Nursing pain assessments have been identified as an area for improvement. This concept analysis sought to examine the use of pain interference as a measurement to assist pain management practices. Existing literature including the term pain interference was reviewed for the years 2000-2010. Pain interference is a common outcome measurement in clinical research.

  17. Managing Chemotherapy Side Effects: Pain

    MedlinePLUS

    ... anD human services national institutes of health Managing Chemotherapy Side Effects Pain “I was worried about getting ... need help to pay for pain medicine. Managing Chemotherapy Side Effects: Pain Keep track of the pain. ...

  18. 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 ...

  19. JAMA Patient Page: Chest Pain

    MedlinePLUS

    ... of the American Medical Association JAMA PATIENT PAGE Chest Pain C hest pain can have many causes. ... about cardiac causes of chest pain. CAUSES OF CHEST PAIN FOR MORE INFORMATION • National Heart, Lung, and ...

  20. Pain Phenotype in Patients With Knee Osteoarthritis: Classification and Measurement Properties of painDETECT and Self-Report Leeds Assessment of Neuropathic Symptoms and Signs Scale in a Cross-Sectional Study

    PubMed Central

    Moreton, Bryan J; Tew, Victoria; das Nair, Roshan; Wheeler, Maggie; Walsh, David A; Lincoln, Nadina B

    2015-01-01

    Objective Multiple mechanisms are involved in pain associated with osteoarthritis (OA). The painDETECT and Self-Report Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) questionnaires screen for neuropathic pain and may also identify individuals with musculoskeletal pain who exhibit abnormal central pain processing. The aim of this cross-sectional study was to evaluate painDETECT and S-LANSS for classification agreement and fit to the Rasch model, and to explore their relationship to pain severity and pain mechanisms in OA. Methods A total of 192 patients with knee OA completed questionnaires covering different aspects of pain. Another group of 77 patients with knee OA completed questionnaires and underwent quantitative sensory testing for pressure–pain thresholds (PPTs). Agreement between painDETECT and S-LANSS was evaluated using kappa coefficients and receiver operator characteristic (ROC) curves. Rasch analysis of both questionnaires was conducted. Relationships between screening questionnaires and measures of pain severity or PPTs were calculated using correlations. Results PainDETECT and S-LANSS shared a stronger correlation with each other than with measures of pain severity. ROC curves identified optimal cutoff scores for painDETECT and S-LANSS to maximize agreement, but the kappa coefficient was low (? = 0.33–0.46). Rasch analysis supported the measurement properties of painDETECT but not those of S-LANSS. Higher painDETECT scores were associated with widespread reductions in PPTs. Conclusion The data suggest that painDETECT assesses pain quality associated with augmented central pain processing in patients with OA. Although developed as a screening questionnaire, painDETECT may also function as a measure of characteristics that indicate augmented central pain processing. Agreement between painDETECT and S-LANSS for pain classification was low, and it is currently unknown which tool may best predict treatment outcome. PMID:25155472

  1. Cancer pain and anxiety

    Microsoft Academic Search

    Paul D. Thielking

    2003-01-01

    Anxiety and pain can be understood with a multidimensional framework that accounts for somatic, emotional, cognitive, and\\u000a behavioral aspects of these conditions. Patients who have cancer or treatment-related pain are more likely to be anxious than\\u000a cancer patients without pain. Patients with cancer pain and anxiety cause difficult diagnostic dilemmas because some degree\\u000a of anxiety is a normal response to

  2. Posttonsillectomy pain in children.

    PubMed

    Sutters, Kimberly A; Isaacson, Glenn

    2014-02-01

    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

  3. Technology for chronic pain.

    PubMed

    Zhang, Suyi; Seymour, Ben

    2014-09-22

    Technology developed for chronic pain management has been fast evolving and offers new stand-alone prospects for the diagnosis and treatment of pain, rather than simply addressing the limitations of pharmacology-based approaches. There are two central challenges to be tackled: developing objective measures that capture the subjectivity of pain experience, and providing technology-based interventions that offer new approaches for pain management. Here we highlight recent developments that hold promise in addressing both of these challenges. PMID:25247372

  4. Chronic Pain Explained

    Microsoft Academic Search

    KENNETH J. SUFKA

    2000-01-01

    Pains that persist long after damaged tissue hasrecovered remain a perplexing phenomenon. Theseso-called chronic pains serve no useful function foran organism and, given its disabling effects, mighteven be considered maladaptive. However, a remarkablesimilarity exists between the neural bases thatunderlie the hallmark symptoms of chronic pain andthose that subserve learning and memory. Bothphenomena, wind-up in the pain literature andlong-term potentiation (LTP)

  5. American Pain Society

    MedlinePLUS

    ... on Complex Regional Pain Syndrome (CRPS), August 31-September 1, 2015. The conference aims to provide a summary of ... presents Integrative Pain Care for the 21st Century, September 25-27, in Orlando, FL. Read More » Posted June 16, 2015 Pain Interprofessional Curriculum Design (PICD) Workshop PICD invites ...

  6. Sleep and chronic pain

    Microsoft Academic Search

    Jeanetta C Rains; Donald B Penzien

    2003-01-01

    Objective: The ?-EEG sleep anomaly has been associated with chronic benign pain syndromes. Although controversial, the anomaly is believed by some to be an important biologic correlate of certain otherwise poorly explained painful conditions (e.g., fibromyalgia and chronic fatigue syndrome). To shed further light on this phenomenon, this study compared the sleep and psychological characteristics of chronic pain patients who

  7. Central pain control

    Microsoft Academic Search

    Bernard Calvino; Rose Marie Grilo

    2006-01-01

    We describe the anatomic and physiological components involved in pain physiology, with the goal of providing readers with the background information needed to understand central pain control mechanisms. These include spinal segmental controls, supraspinal excitatory and inhibitory controls, and diffuse noxious inhibitory controls (DNICs). Pain is a subjective sensation produced by an emotionally unpleasant experience considered to originate in adaptive

  8. Pediatric Procedural Pain

    ERIC Educational Resources Information Center

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

    2006-01-01

    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…

  9. The association between cyclooxygenase gene polymorphisms and acute post-surgical pain in humans

    Microsoft Academic Search

    P. D. Mittal-Parikh; H. Kim; J. Brahim; J. Rowan; R. A. Dionne

    2005-01-01

    Background: Variability relating to pain sensitivity, perception and tolerance has been documented; however, the exact role of genetics in the interpretation and expression of pain is currently unknown. Given the prominent role of cyclooxygenase (COX) in the inflammatory responses to tissue injury, we examined the influence of common genetic polymorphisms of COX-1 and COX-2 genes on the modulation of responses

  10. Differential Strategies in Coping with Pain as a Function of Level of Experiential Avoidance

    ERIC Educational Resources Information Center

    Zettle, Robert D.; Hocker, Tanya R.; Mick, Katherine A.; Scofield, Brett E.; Petersen, Connie L.; Song, Hyunsung; Sudarijanto, Ratna P.

    2005-01-01

    Participants displaying high versus low levels of experiential avoidance as assessed by the Acceptance and Action Questionnaire (Hayes, Strosahl, et al., 2004) were compared in their reactions to and efforts to cope with pain induced by the cold pressor task. As expected, high avoidant participants were less tolerant of pain and more likely to…

  11. Evidence of increased non-verbal behavioral signs of pain in adults with neurodevelopmental disorders and chronic self-injury

    Microsoft Academic Search

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

    2009-01-01

    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 Non-Communicating Children's Pain Checklist (NCCPC) were compared between matched

  12. Resilient Quantum Computation: Error Models and Thresholds

    E-print Network

    Emanuel Knill; Raymond Laflamme; Wojciech H. Zurek

    1997-02-26

    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.

  13. Psychophysical study of stinging pain evoked by brief freezing of superficial skin and ensuing short-lasting changes in sensations of cool and cold pain.

    PubMed

    Beise, R D; Carstens, E; Kohllöffel, L U

    1998-02-01

    Psychophysical methods were used to investigate pain in human subjects elicited by controlled freezing of the skin using a novel vortex thermode. When cooling stimuli delivered with a small thermode (7 mm diameter) exceeded the normal cold pain threshold into the sub-zero temperature range (-5 to -11 degrees C), all subjects reported an intense, sharp stinging pain sensation which occurred suddenly and was readily differentiated from normal cold pain. The onset of this stinging 'freezing' pain was closely correlated with a sudden increase in skin temperature beneath the thermode of 4.77+/-0.86 degrees C (+/-SD) associated with the phase transition of supercooled water to ice. The mean intensity of freezing pain was rated as 1.7 times as intense as cold pain at threshold. Subjects' mean reaction-time latency to signal stinging pain following the onset of phase transition on the volar forearm was 687+/-220 ms, which was slower than that for mechanically evoked impact pain. Freezing pain is suggested to be mediated by A-delta fibers, based on estimates of conduction velocity and on the observation that the freezing pain took on a burning quality of slower onset during an A-fiber pressure block of nerve fibers. We also investigated changes in skin sensation following the freezing stimulus, and found that freezing led to (a) an immediate, significant decrease in the cold pain threshold (to higher temperatures), which recovered to baseline in < 16 min, (b) a concomitant change in the quality of cold pain from dull to burning, (c) a significant, parallel increase in the threshold for the perception of cooling (to lower temperatures) which frequently manifested as a complete loss of cold sensation, and (d) a mild heat pain hyperalgesia which was still present 24 h later. The changes in thermal sensitivity were not accompanied by consistent changes in mechanical sensitivity. These results indicate that a characteristic sharp, stinging pain is reliably evoked abruptly at the phase transition of supercooled skin water to ice The ensuing brief decrease in cold pain threshold with burning quality, coupled with decreased sensitivity to cold, are speculated to reflect a central disinhibition of C-fiber nociceptor input due to reduced cold fiber activity. These effects may be relevant to frostbite, and distinguish themselves from the more pronounced thermal and mechanical hyperalgesia seen following intense freeze lesion of the skin. PMID:9520242

  14. S(+)-ibuprofen (dexibuprofen)--Excellent tolerance has not to be combined with poor clinical efficacy.

    PubMed

    Zohmann, A; Hawel, R; Klein, G; Kullich, W; Lötsch, G

    1998-01-01

    S(+)-ibuprofen (dexibuprofen) is an NSAID offering a lot of advantages in the treatment of rheumatism and pain. A randomized double-blind, parallel group study in 110 patients showed equivalence in efficacy of 900 mg dexibuprofen (Seractil 300 mg, Gebro Fieberbrunn, Austria) vs. 150 mg diclofenac sodium. Regarding tolerance there was a trend to superiority of dexibuprofen. Therefore dexibuprofen can be characterized as an effective and very tolerable drug against inflammation and pain. PMID:17638129

  15. Targeting TRPV1 as an Alternative Approach to Narcotic Analgesics to Treat Chronic Pain Conditions

    Microsoft Academic Search

    Louis S. Premkumar

    2010-01-01

    In spite of intense research efforts and after the dedicated Decade of Pain Control and Research, there are not many alternatives\\u000a to opioid-based narcotic analgesics in the therapeutic armamentarium to treat chronic pain conditions. Chronic opioid treatment\\u000a is associated with sedation, tolerance, dependence, hyperalgesia, respiratory depression, and constipation. Since the affective\\u000a component is an integral part of pain perception, perhaps

  16. Star Formation Thresholds

    NASA Astrophysics Data System (ADS)

    Schaye, Joop

    2008-05-01

    To make predictions for the existence of “dark galaxies”, it is necessary to understand what determines whether a gas cloud will form stars. Star formation thresholds are generally explained in terms of the Toomre criterion for gravitational instability. I contrast this theory with the thermo-gravitational instability hypothesis of Schaye (2004), in which star formation is triggered by the formation of a cold gas phase and which predicts a nearly constant surface density threshold. I argue that although the Toomre analysis is useful for the global stability of disc galaxies, it relies on assumptions that break down in the outer regions, where star formation thresholds are observed. The thermo-gravitational instability hypothesis can account for a number of observed phenomena, some of which were thought to be unrelated to star formation thresholds.

  17. Threshold voltage extraction circuit 

    E-print Network

    Hoon, Siew Kuok

    2000-01-01

    A novel optimally self-biasing MOSFET threshold-voltage (V[]) extractor circuit is presented. It implements the most popular industrial extraction algorithm of biasing a saturated MOSFET to the linear portion of its [] versus [] characteristic...

  18. Threshold voltage extraction circuit

    E-print Network

    Hoon, Siew Kuok

    2000-01-01

    A novel optimally self-biasing MOSFET threshold-voltage (V[]) extractor circuit is presented. It implements the most popular industrial extraction algorithm of biasing a saturated MOSFET to the linear portion of its [] versus [] characteristic...

  19. Controversies in cancer pain. Medical perspectives.

    PubMed

    Foley, K M

    1989-06-01

    The treatment of pain in the patient with cancer has focused attention on a series of controversial issues involving medical, social, and moral factors. The medical factors include a lack of knowledge on the part of health care professionals regarding the rational use of opioid drugs. This is coupled with real limitations in the general understanding of the mechanisms of pain and its treatment using pharmacologic, anesthetic, and neurosurgical approaches. Several pharmacologic controversies, including the choice of drug, route and method of administration, and tolerance development and risk of substance abuse, have emerged with the use of opioids on a chronic basis in the cancer population. The social and moral implications involve the issue of who will pay for high technology pain management approaches for patients either at home or in hospice care and the ethical considerations in managing pain with opioid drugs. Carefully designed studies to assess these factors, coupled with broad educational programs, will improve the care of cancer patients in pain and expand our understanding of these important issues. PMID:2566369

  20. Pain perception in female adolescents with borderline personality disorder.

    PubMed

    Ludäscher, Petra; von Kalckreuth, Clemens; Parzer, Peter; Kaess, Michael; Resch, Franz; Bohus, Martin; Schmahl, Christian; Brunner, Romuald

    2015-03-01

    Borderline personality disorder (BPD) is a severe and often debilitating psychiatric disorder that begins during adolescence. Core features of BPD are affective dysregulation, dysfunctional self-concepts, and difficulties in social interactive domains. A widely accepted marker for severe emotion dysregulation in adult BPD is decreased pain sensitivity. Until now it is unclear whether this characteristic feature of BPD is already present during adolescence. Thus, this study aims to investigate pain sensitivity in adolescent patients meeting DSM-IV criteria for BPD. 20 female adolescent patients with BPD (mean age 16.4 years) and 20 healthy age-matched control participants were investigated. Detection and pain thresholds for thermal stimuli were assessed on both hands. Furthermore, self-rating instruments were used to assess overall psychopathology, dissociation, and depression. We found significantly higher pain thresholds in patients with BPD than in healthy controls. Patients with BPD had higher intensities of depression, overall psychopathology, and dissociative symptoms, but there was no correlation between pain sensitivity and any of these measures of psychopathology. These findings are in line with previous findings in adult BPD patients concerning lower pain sensitivity as compared to healthy controls. This provides support for the idea that disturbed pain processing is not only a consequence of chronic BPD but is already present in early stages of BPD. PMID:25053123

  1. Psychologic Influence on Experimental Pain Sensitivity and Clinical Pain Intensity for Patients with Shoulder Pain

    Microsoft Academic Search

    Steven Z. George; Adam T. Hirsh

    2009-01-01

    Pain-related fear and pain catastrophizing are 2 central psychologic factors in fear-avoidance models. Our previous studies in healthy subjects indicated that pain-related fear, but not pain catastrophizing, was associated with cold pressor pain outcomes. The current study extends previous work by investigating pain-related fear and pain catastrophizing in a group of subjects with shoulder pain, and included concurrent measures of

  2. Myofascial low back pain.

    PubMed

    Ramsook, Ryan R; Malanga, Gerard A

    2012-10-01

    Low back pain is a common condition that is encountered by both primary care physicians as well as various specialists, which include: orthopedic surgeons, physical medicine and rehabilitation specialists, neurologists, rheumatologists, and pain management specialists. Associated muscular pain is very common and often a reactive response from nociception from other structures. Myofascial pain may arise, which is characterized by the presence of myofascial trigger points (MTrPs) that are located in fascia, tendons, and/or muscle. This article reviews the current evidence regarding the pathophysiology, assessment, and recommended treatment options for myofascial low back pain. PMID:22945480

  3. Enhanced temporal pain processing in multiple system atrophy.

    PubMed

    Perrotta, Armando; Bolla, Monica; Serrao, Mariano; Paparatti, Marco; Tassorelli, Cristina; Pierelli, Francesco; Sandrini, Giorgio

    2013-10-25

    Pain processing has been poorly studied in multiple system atrophy (MSA), notwithstanding these subjects complaint pain very frequently. We hypothesized that, as observed in other basal ganglia neurodegenerative disorders involving the striatonigral projections, also in MSA with predominant parkinsonian signs could be detected an abnormal pain processing. We used the temporal summation threshold (TST) of the nociceptive withdrawal reflex (NWR) and the related pain sensation to evaluate the temporal pain processing at spinal level in eleven MSA subjects and compared them with fifteen Parkinson's disease (PD) subjects, in both during "on" and "off" treatment with l-Dopa, and fifteen healthy subjects. MSA showed a significant reduction in NWR TST as well as facilitation in other pain responses when compared to healthy subjects; no differences were detected between "on" and "off" condition; no differences were detected between MSA and PD subjects in term of neurophysiological and pharmacological responses. We demonstrated a facilitated temporal processing of pain in MSA subjects paralleling findings from PD. We hypothesize that the abnormal pain processing detected in both MSA and PD, could represent a consequence of the striatonigral neurodegeneration which in turn make these subjects more prone to develop pain conditions. PMID:24076144

  4. Pain in pressure ulcers.

    PubMed

    Reddy, Madhuri; Keast, David; Fowler, Evonne; Sibbald, R Gary

    2003-04-01

    Integrating pain management into a treatment paradigm for pressure ulcers can lead to improved outcomes. An approach to wound bed preparation that addresses the cause and patient-centered concerns--as well as local wound care factors of moisture balance, debridement, and bacterial balance--can be integrated with the Krasner model of chronic wound pain. The risk factors for pressure ulcers are well known, but pain may be an important contributor to immobility and the development of pressure ulcers. Pain is also an important signal of wound-related infections. Strategies must be developed to control the cyclic acute pain of dressing changes and the noncyclic acute pain of wound debridement. Spinal cord injured and elderly, cognitively impaired patients with pressure ulcers present special challenges in pain management. PMID:12856291

  5. Relation of the factor to menstrual pain and musculoskeletal pain.

    PubMed

    Lee, Jang-Won; Park, Hye-Sang

    2015-04-01

    The purpose of the present study is to investigate the relationship between the regions of menstrual pain and of myofascial pain syndrome, which is the main cause of musculoskeletal pain, as well as to examine the changes and relationships among the menstrual pain-related factors, which are pain level, pain area, activity, appetite, mood, and sleeping pattern. The subjects were 13 sufferers of musculoskeletal pain and 17 non-sufferers. Pain diary and pain chart systems were used for the measurement of menstrual pain-related factors and musculoskeletal pain. Data were analyzed using repeated ANOVA. The results show that there are significant differences between the two groups in pain level, activity, and mood during menstruation periods (P< 0.05). The area of musculoskeletal pain and menstrual pain were found to be the same. PMID:25960984

  6. Relation of the factor to menstrual pain and musculoskeletal pain

    PubMed Central

    Lee, Jang-Won; Park, Hye-Sang

    2015-01-01

    The purpose of the present study is to investigate the relationship between the regions of menstrual pain and of myofascial pain syndrome, which is the main cause of musculoskeletal pain, as well as to examine the changes and relationships among the menstrual pain-related factors, which are pain level, pain area, activity, appetite, mood, and sleeping pattern. The subjects were 13 sufferers of musculoskeletal pain and 17 non-sufferers. Pain diary and pain chart systems were used for the measurement of menstrual pain-related factors and musculoskeletal pain. Data were analyzed using repeated ANOVA. The results show that there are significant differences between the two groups in pain level, activity, and mood during menstruation periods (P< 0.05). The area of musculoskeletal pain and menstrual pain were found to be the same. PMID:25960984

  7. [Painful neuropathies and small fiber involvement].

    PubMed

    Lefaucheur, J-P

    2014-12-01

    It is customary to consider that a purely sensory and painful neuropathy accompanied by normal electroneuromyographic examination may be or must be a small fiber neuropathy. This leads to perform specific tests, such as measuring the intra-epidermal nerve fiber density on skin biopsy or neurophysiological tests, such as evoked potentials to noxious stimuli (laser) or quantification of thermal sensory thresholds. However, these tests are only sensitive to the loss of small fibers (A-delta and C), which does not reflect the mechanisms responsible for peripheral neuropathic pain. Selective loss of small sensory fibers inherently generates a sensory deficit that does not necessarily present a painful character. Also, assigning the cause of a painful neuropathy to a small fiber neuropathy has no pathophysiological sense, although there are indirect links between these two conditions. In fact, it is not possible to explain univocally peripheral neuropathic pain, which reflects complex and diverse mechanisms, involving different types of nerve fibers. In this context, the clinical and laboratory approach must be improved to better understand the underlying mechanisms. It is imperative to interpret the data provided by laboratory tests and to correlate these data to the clinical signs and symptoms presented by the patients. Thus, one must go beyond many a priori and misinterpretations that unfortunately exist in this area at present and are not based on any solid pathophysiological basis. PMID:25459125

  8. Fentanyl buccal tablets for the treatment of breakthrough pain.

    PubMed

    Mercadante, Sebastiano

    2011-11-01

    SUMMARY Fentanyl buccal tablets (FBT) have been designed to treat breakthrough pain (BTP) in patients who are already receiving, and who are tolerant to, opioid therapy for their underlying persistent pain. FBT are a formulation that uses an effervescent drug delivery system to enhance penetration across the buccal mucosa. OraVescent technology provides an effervescent reaction that liberates carbon dioxide in the buccal cavity. This reaction causes an initial decrease in pH, which facilitates solubilization, thus driving fentanyl into solution. Subsequently, carbon dioxide increases the local pH, which facilitates permeation of unionised fentanyl across the buccal mucosa. In clinical studies of opioid-tolerant patients with cancer and noncancer-related BTP, FBT have provided consistent and clinically relevant improvements in pain intensity and pain relief relative to placebo and oral opioids like oxycodone. The safety and tolerability profile is generally typical of that observed with other opioids. The pharmacokinetic properties of FBT allow for a meaningful clinical efficacy, with an onset of action that closely matches the onset of BTP. FBT, as with any other transmucosal preparations of fentanyl, should not be used in patients who are not opioid-tolerant. PMID:24645764

  9. Painfully reassuring? The effects of validation on emotions and adherence in a pain test.

    PubMed

    Linton, S J; Boersma, K; Vangronsveld, K; Fruzzetti, A

    2012-04-01

    Communicating reassurance to patients with musculoskeletal pain complaints, but no red flags, presents a dilemma of dampening worry while refraining from reinforcing undue pain behaviors. Previous research shows that reassurance does not decrease negative affect and may be perceived as not taking the symptoms seriously. Validation offers an alternative where the patient's experiences and feelings are acknowledged and has demonstrated, for other problems, a decrease in arousal which may set the stage for behavioral change. The purpose of this study was to investigate experimentally whether validation, as compared to invalidation, impacts on emotions and adherence during repeated pain tests. To this end, 50 participants were randomized to either a validation or invalidation condition. Each participant was told they would undergo four pain trials involving holding a bucket at arm's length to tolerance. During the inter-trial interval, the experimenter provided validating or invalidating responses according to the randomization. As a proxy measure of adherence subjects were asked to engage in an additional pain test. Results indicated that validation relative to invalidation resulted in significantly more positive affect and significantly less worry. Both groups had reductions in negative affect over the trials, but there were no difference between the groups on negative affect or pain. However, adherence was more than twice as high in the validation group as compared to invalidation. These results show that a relatively simple validation procedure had significant and positive effects on emotion and increased adherence. Further research should extend these findings and explore their clinical application. PMID:22396087

  10. Plant salt tolerance

    Microsoft Academic Search

    Jian-Kang Zhu

    2001-01-01

    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

  11. Pain in older adults.

    PubMed

    Miller, Lois L; Talerico, Karen Amann

    2002-01-01

    This chapter reviews 80 published research reports of pain and pain problems in older adults by nurse researchers and researchers from other disciplines. Reports were identified through searches of MEDLINE and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) using the search terms pain, older adult, aged and pain, and dementia. Reports were included if published between 1985 to 2001, if conducted on samples age 60 or older, if conducted by nurses or relevant to nursing research, and if published in English. Descriptive, qualitative, correlational, longitudinal, and intervention studies were included. Key findings include the following: pain is widely prevalent in older adult populations; few studies have included minority groups; under-identification and undertreatment of pain in older adults is a consistent interpretation of research findings; pain intensity rating scales are as valid and reliable in older populations as in younger populations; current observational methods of assessing pain in cognitively impaired older adults must be used with caution; nursing intervention studies demonstrate the beneficial effects of education and interventions aimed at improved pain assessment. The main recommendations are: careful attention should be given to the conceptualization and definition of pain; examination of pain should include physiological, motivational, cognitive, and affective factors; studies evaluating undertreatment of pain should include measures of pain self-report; standardized pain measures should be used; studies of persons over the age of 85 and studies of ethnic minorities are needed; more attention should be given to nursing intervention studies and should include both pharmacological and nonpharmacological, psychosocial interventions. PMID:12092519

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

    PubMed Central

    Eidson, Lori N.; Murphy, Anne Z.

    2014-01-01

    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

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

    PubMed

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

    2015-02-01

    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

  14. Pain management in the elderly.

    PubMed

    Malec, Monica; Shega, Joseph W

    2015-03-01

    Persistent pain in older adults is common, and associated with substantial morbidity. Optimal management starts with assessment, including pain presence, intensity, characteristics, and interference; painful conditions; pain behaviors; pain-related morbidity; pain treatments; and coping style. Treatment incorporates analgesics demonstrated to decrease pain and improve a patient's sense of well-being. The World Health Organization's 3-step pain ladder is widely accepted and adopted for selecting analgesics among patients with non-cancer pain. Shared decision making is essential to balance the benefits and burdens of analgesics. This article reviews pain assessment/management for older adults, focusing on commonly used analgesics. PMID:25700587

  15. Decoding the perception of pain from fMRI using multivariate pattern analysis

    PubMed Central

    Brodersen, Kay H.; Wiech, Katja; Lomakina, Ekaterina I.; Lin, Chia-shu; Buhmann, Joachim M.; Bingel, Ulrike; Ploner, Markus; Stephan, Klaas Enno; Tracey, Irene

    2012-01-01

    Pain is known to comprise sensory, cognitive, and affective aspects. Despite numerous previous fMRI studies, however, it remains open which spatial distribution of activity is sufficient to encode whether a stimulus is perceived as painful or not. In this study, we analyzed fMRI data from a perceptual decision-making task in which participants were exposed to near-threshold laser pulses. Using multivariate analyses on different spatial scales, we investigated the predictive capacity of fMRI data for decoding whether a stimulus had been perceived as painful. Our analysis yielded a rank order of brain regions: during pain anticipation, activity in the periaqueductal gray (PAG) and orbitofrontal cortex (OFC) afforded the most accurate trial-by-trial discrimination between painful and non-painful experiences; whereas during the actual stimulation, primary and secondary somatosensory cortex, anterior insula, dorsolateral and ventrolateral prefrontal cortex, and OFC were most discriminative. The most accurate prediction of pain perception from the stimulation period, however, was enabled by the combined activity in pain regions commonly referred to as the ‘pain matrix’. Our results demonstrate that the neural representation of (near-threshold) pain is spatially distributed and can be best described at an intermediate spatial scale. In addition to its utility in establishing structure-function mappings, our approach affords trial-by-trial predictions and thus represents a step towards the goal of establishing an objective neuronal marker of pain perception. PMID:22922369

  16. Chronic pain management: pharmacotherapy for chronic pain.

    PubMed

    Chang, Ku-Lang; Fillingim, Roger; Hurley, Robert W; Schmidt, Siegfried

    2015-05-01

    Clinicians should combine nonpharmacologic therapies and pharmacotherapy for management of chronic pain. Safety and effectiveness determine the choice of therapy. Typically, nonopioid analgesics are first-line treatment, including acetaminophen, nonsteroidal anti-inflammatory drugs, and topical drugs. A trial of an opioid, in combination with other modalities, should be considered if pain persists. Because of the potential for serious adverse effects, opioids should be prescribed only if the clinician is familiar with their use and associated risks. If pain is not controlled, consider pharmacogenetic effects or the addition of adjuvant therapy. In states with prescription drug monitoring programs, clinicians must access these programs regularly when prescribing a controlled substance. Consider performing pill counts and random urine drug screening for monitoring drug use. Adjuvant drugs to be considered include antidepressants, buspirone, anticonvulsants, muscle relaxants, onabotulinumtoxinA, clonidine, and corticosteroids, depending on type of pain and individual characteristics. PMID:25970870

  17. [Latest pain management for painful bony metastases].

    PubMed

    Ikenaga, Masayuki

    2006-04-01

    Pain management for painful bony metastases is the most important problem for symptom relief of terminally-ill cancer patients. Pathological fractures often decrease the activity of daily life (ADL) of patients, and cause deterioration of the quality of life (QOL) and prognosis. Basically pharmacological therapies of the World Health Organization (WHO) method are essential for symptom relief from cancer pain. This article provides the latest pain managements (palliative irradiation, bisphosphonate, orthopedic surgery, percutaneous vertebroplasty and radiopharmaceutical therapy) of bony metastases, and mentions the indications and the problems of these interventions. In consideration to prognosis, the QOL and patient's needs, medical staffs have to perform multidisciplinary approach for providing suitable palliative care. PMID:16582515

  18. Relationship between cold pressor pain-sensitivity and sleep quality in opioid-dependent males on methadone treatment

    PubMed Central

    Lee, Chee Siong; Tan, Soo Choon; Mohamad, Nasir; Lee, Yeong Yeh; Ismail, Rusli

    2015-01-01

    Aim. Poor sleep quality due to pain has been reported among opioid-dependent male patients on methadone maintenance therapy (MMT) but objective pain data are lacking. This study aimed to investigate the rate of pain-sensitivity using cold pressor test (CPT) and the relationship between pain-sensitivity and sleep quality in this population. Methods. A total of 168 male participants were included into the study. Objective pain-tolerance was evaluated at 0 h and at 24 h after the first CPT. Malay version of the Pittsburgh Sleep Quality Index (PSQI) and the subjective opiate withdrawal scale (SOWS) questionnaires were administered to evaluate the quality of sleep and withdrawal symptoms, respectively. Results. The mean age of study participants was 37.22 (SD 6.20) years old. Mean daily methadone dose was 76.64 (SD 37.63) mg/day, mean global PSQI score was 5.47 (SD 2.74) and mean averaged SOWS score was 5.43 (SD 6.91). The averaged pain-tolerance time ranged from 7 to 300 s with a mean time of 32.16 (SE 2.72) s, slightly below the cut-off score of 37.53 s. More specifically, 78.6% (n = 132) of participants were identified as pain-sensitive (averaged pain-tolerance time ?37.53 s), and 36 (21.4%) participants were pain-tolerant (averaged pain-tolerance time >37.53 s). The pain-sensitive group reported poorer sleep quality with mean (SD) PSQI of 5.78 (2.80) compared with the pain-tolerant group with mean (SD) PSQI of 4.31 (2.18) (p = 0.005). With analysis of covariance, pain-sensitive group was found to have higher global PSQI scores (adjusted mean 5.76, 95% CI 5.29; 6.22) than pain-tolerant participants (adjusted mean 4.42, 95% CI 3.52; 5.32) (p = 0.010). Conclusions. Majority of opioid-dependent male patients on methadone treatment are pain-sensitive with CPT. Poor sleep quality is associated with cold pressor pain-sensitivity. Pain and sleep complaints in this male population should not be overlooked. PMID:25870765

  19. A novel psychovisual threshold on large DCT for image compression.

    PubMed

    Abu, Nur Azman; Ernawan, Ferda

    2015-01-01

    A psychovisual experiment prescribes the quantization values in image compression. The quantization process is used as a threshold of the human visual system tolerance to reduce the amount of encoded transform coefficients. It is very challenging to generate an optimal quantization value based on the contribution of the transform coefficient at each frequency order. The psychovisual threshold represents the sensitivity of the human visual perception at each frequency order to the image reconstruction. An ideal contribution of the transform at each frequency order will be the primitive of the psychovisual threshold in image compression. This research study proposes a psychovisual threshold on the large discrete cosine transform (DCT) image block which will be used to automatically generate the much needed quantization tables. The proposed psychovisual threshold will be used to prescribe the quantization values at each frequency order. The psychovisual threshold on the large image block provides significant improvement in the quality of output images. The experimental results on large quantization tables from psychovisual threshold produce largely free artifacts in the visual output image. Besides, the experimental results show that the concept of psychovisual threshold produces better quality image at the higher compression rate than JPEG image compression. PMID:25874257

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

    PubMed

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

    2012-02-01

    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

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

    PubMed

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

    2015-03-01

    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

  2. Pain in cancer survivors.

    PubMed

    Glare, Paul A; Davies, Pamela S; Finlay, Esmé; Gulati, Amitabh; Lemanne, Dawn; Moryl, Natalie; Oeffinger, Kevin C; Paice, Judith A; Stubblefield, Michael D; Syrjala, Karen L

    2014-06-01

    Pain is a common problem in cancer survivors, especially in the first few years after treatment. In the longer term, approximately 5% to 10% of survivors have chronic severe pain that interferes with functioning. The prevalence is much higher in certain subpopulations, such as breast cancer survivors. All cancer treatment modalities have the potential to cause pain. Currently, the approach to managing pain in cancer survivors is similar to that for chronic cancer-related pain, pharmacotherapy being the principal treatment modality. Although it may be appropriate to continue strong opioids in survivors with moderate to severe pain, most pain problems in cancer survivors will not require them. Moreover, because more than 40% of cancer survivors now live longer than 10 years, there is growing concern about the long-term adverse effects of opioids and the risks of misuse, abuse, and overdose in the nonpatient population. As with chronic nonmalignant pain, multimodal interventions that incorporate nonpharmacologic therapies should be part of the treatment strategy for pain in cancer survivors, prescribed with the aim of restoring functionality, not just providing comfort. For patients with complex pain issues, multidisciplinary programs should be used, if available. New or worsening pain in a cancer survivor must be evaluated to determine whether the cause is recurrent disease or a second malignancy. This article focuses on patients with a history of cancer who are beyond the acute diagnosis and treatment phase and on common treatment-related pain etiologies. The benefits and harms of the various pharmacologic and nonpharmacologic options for pain management in this setting are reviewed. PMID:24799477

  3. Pain in Cancer Survivors

    PubMed Central

    Glare, Paul A.; Davies, Pamela S.; Finlay, Esmé; Gulati, Amitabh; Lemanne, Dawn; Moryl, Natalie; Oeffinger, Kevin C.; Paice, Judith A.; Stubblefield, Michael D.; Syrjala, Karen L.

    2014-01-01

    Pain is a common problem in cancer survivors, especially in the first few years after treatment. In the longer term, approximately 5% to 10% of survivors have chronic severe pain that interferes with functioning. The prevalence is much higher in certain subpopulations, such as breast cancer survivors. All cancer treatment modalities have the potential to cause pain. Currently, the approach to managing pain in cancer survivors is similar to that for chronic cancer-related pain, pharmacotherapy being the principal treatment modality. Although it may be appropriate to continue strong opioids in survivors with moderate to severe pain, most pain problems in cancer survivors will not require them. Moreover, because more than 40% of cancer survivors now live longer than 10 years, there is growing concern about the long-term adverse effects of opioids and the risks of misuse, abuse, and overdose in the nonpatient population. As with chronic nonmalignant pain, multimodal interventions that incorporate nonpharmacologic therapies should be part of the treatment strategy for pain in cancer survivors, prescribed with the aim of restoring functionality, not just providing comfort. For patients with complex pain issues, multidisciplinary programs should be used, if available. New or worsening pain in a cancer survivor must be evaluated to determine whether the cause is recurrent disease or a second malignancy. This article focuses on patients with a history of cancer who are beyond the acute diagnosis and treatment phase and on common treatment-related pain etiologies. The benefits and harms of the various pharmacologic and nonpharmacologic options for pain management in this setting are reviewed. PMID:24799477

  4. Neurological diseases and pain

    PubMed Central

    2012-01-01

    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

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

    ERIC Educational Resources Information Center

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

    2008-01-01

    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…

  6. Disengagement from pain: the role of catastrophic thinking about pain.

    PubMed

    Van Damme, Stefaan; Crombez, Geert; Eccleston, Christopher

    2004-01-01

    This paper reports an experimental investigation of attentional engagement to and disengagement from pain. Thirty-seven pain-free volunteers performed a cueing task in which they were instructed to respond to visual target stimuli, i.e. the words 'pain' and 'tone'. Targets were preceded by pain stimuli or tone stimuli as cues. Participants were characterized as high or low pain catastrophizers, using self-reports. We found that the effect of cueing upon target detection was differential for high and low pain catastrophizers. Analyses revealed a similar amount of attentional engagement to pain in both groups. However, we also found that participants high in pain catastrophizing had difficulty disengaging from pain, whereas participants low in pain catastrophizing showed no retarded disengagement from pain. Our results provide further evidence that catastrophic thinking enhances the attentional demand of pain, particularly resulting in difficulty disengaging from pain. The clinical implications of these findings are discussed. PMID:14715391

  7. Central administration of selective melanocortin 4 receptor antagonist HS014 prevents morphine tolerance and withdrawal hyperalgesia

    Microsoft Academic Search

    Annasaheb S. Kalange; Dadasaheb M. Kokare; Praful S. Singru; Manoj A. Upadhya; Chandrabhan T. Chopde; Nishikant K. Subhedar

    2007-01-01

    Major problem involved in treatment of chronic pain with morphine is the development of tolerance and dependence. Previous studies have demonstrated the participation of melanocortin (MC) system in the development of tolerance to antinociceptive effect of morphine. However, the impact of supraspinal MC4 receptors (MC4 R) modulation on this phenomenon and morphine withdrawal hyperalgesia remained unexplored. We investigated the role

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

    PubMed Central

    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

    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

  9. Pain perception and assessment.

    PubMed

    Chapman, C R

    2005-01-01

    Our inability to measure pain effectively is a major barrier to progress in pain research and advancement in clinical interventions for pain. Historically, the mind-body dichotomy has constrained our thinking about pain and its quantification. One line of work has pursued pain as the sensory end product of nociception: pain is the realization of signals of tissue injury arriving at the cortex. At the other extreme, some clinicians contend that pain is ''what the patient says it is''. In other words, it is a purely mental and entirely subjective phenomenon. Research on functional brain imaging, psychophysiological research and recent neurophysiological research on animal models provide confluent evidence that both of these positions are misleading oversimplifications. Pain is the emergent product of massive, parallel, distributed processing in the brain that engages structures involved in emotion and cognition as well as in sensation. To advance pain measurement, our research team has examined Sokolov's defense response in human subjects experiencing repeated, brief painful electrical shocks delivered to a fingertip through a tiny electrode. Sokolov proposed that threatening events elicit a hypothalamically-orchestrated pattern of arousal that prepares the organism to cope with threat. Measures of sympathetic nervous system arousal and brain evoked potentials in our subjects reveal a stable pattern of this sort when we subject the data to structural equation modeling. When subjects undergo equally intense shocks delivered through a large electrode, they experience a strong vibration-like, unpleasant sensation that causes discomfort but not nociception. The non-painful shock elicits broad levels of arousal equal to those obtained with painful shocks in subjects, but structural equation modeling demonstrates that such arousal does not conform to the defense response pattern. Moreover, multivariate measures of sympathetic arousal and evoked potentials can discriminate painful from non-painful stimuli more accurately than can subjective pain reports. These observations suggest that pain may have a unique psychophysiological signature. More importantly, perhaps, this approach suggests that the combination of psychophysiological research and multivariate statistics provides an avenue for advancing pain research outside of the mind-body dichotomy. PMID:16012413

  10. Chronic spinal infusion of loperamide alleviates postsurgical pain in rats.

    PubMed

    Kumar, Rakesh; Reeta, K H; Ray, Subrata Basu

    2014-04-01

    Plantar incision in rat generates spontaneous pain behaviour. The opioid drug, morphine used to treat postsurgical pain produces tolerance after long-term administration. Loperamide, a potent mu-opioid agonist, has documented analgesic action in various pain conditions. However, loperamide analgesia and associated tolerance following continuous spinal administration in postsurgical pain has not been reported. Chronic spinal infusion of drugs was achieved using intrathecal catheters connected to osmotic minipump. Coinciding with the onset of spinal infusion of loperamide or morphine, rats were subjected to plantar incision. Pain-related behaviour was assessed by Hargreaves apparatus (thermal hyperalgesia) and von Frey filaments (mechanical allodynia). Morphine and loperamide (0.5, 1 and 2 microL/h) induced analgesia was observed until 7th day post-plantar incision in Sprague-Dawley rats. Morphine and loperamide produced dose-dependent analgesia. Loperamide, in the highest dose, produced analgesia till 7th day. However, the highest dose of morphine produced inhibition of thermal hyperalgesia till 5th day and mechanical allodynia only till 3rd day post-plantar incision. Morphine and loperamide produced analgesia in postsurgical pain, which may be mediated through different mechanisms. Longer duration of analgesia with loperamide could probably be due sustained blockade of calcium channels. PMID:24772934

  11. Loin pain hematuria syndrome: Pain relief with intrathecal morphine

    Microsoft Academic Search

    Joshua P. Prager; Antonio DeSalles; Alan Wilkinson; Marilyn Jacobs; Marie Csete

    1995-01-01

    Loin pain hematuria syndrome (LPHS) is characterized by hematuria and incapacitating loin pain. The pain experienced with LPHS is, in general, extremely difficult to treat. Many surgical and pharmacologic therapies have been directed at LPHS pain without success. This report documents successful pain control in a patient with LPHS using long-term intrathecal morphine delivered via an implantable pump. Intrathecal narcotic

  12. Increased colonic pain sensitivity in irritable bowel syndrome is the result of an increased tendency to report pain rather than increased neurosensory sensitivity

    PubMed Central

    Dorn, Spencer D; Palsson, Olafur S; Thiwan, Syed I M; Kanazawa, Motoyori; Clark, W Crawford; van Tilburg, Miranda A L; Drossman, Douglas A; Scarlett, Yolanda; Levy, Rona L; Ringel, Yehuda; Crowell, Michael D; Olden, Kevin W; Whitehead, William E

    2007-01-01

    Objective The aim was to determine whether lower visceral pain thresholds in irritable bowel syndrome (IBS) primarily reflect physiological or psychological factors. Methods Firstly, 121 IBS patients and 28 controls underwent balloon distensions in the descending colon using the ascending methods of limits (AML) to assess pain and urge thresholds. Secondly, sensory decision theory analysis was used to separate physiological from psychological components of perception: neurosensory sensitivity (p(A)) was measured by the ability to discriminate between 30?mm?Hg vs 34?mm?Hg distensions; psychological influences were measured by the report criterion—that is, the overall tendency to report pain, indexed by the median intensity rating for all distensions, independent of intensity. Psychological symptoms were assessed using the Brief Symptom Inventory (BSI). Results IBS patients had lower AML pain thresholds (median: 28?mm?Hg vs 40?mm Hg; p<0.001), but similar neurosensory sensitivity (median p(A): 0.5 vs 0.5; p?=?0.69; 42.6% vs 42.9% were able to discriminate between the stimuli better than chance) and a greater tendency to report pain (median report criterion: 4.0 (“mild” pain) vs 5.2 (“weak” pain); p?=?0.003). AML pain thresholds were not correlated with neurosensory sensitivity (r?=??0.13; p?=?0.14), but were strongly correlated with report criterion (r?=?0.67; p<0.0001). Report criterion was inversely correlated with BSI somatisation (r?=??0.26; p?=?0.001) and BSI global score (r?=??0.18; p?=?0.035). Similar results were seen for the non?painful sensation of urgency. Conclusion Increased colonic sensitivity in IBS is strongly influenced by a psychological tendency to report pain and urge rather than increased neurosensory sensitivity. PMID:17483191

  13. Near threshold fatigue testing

    SciTech Connect

    Freeman, D.C.; Strum, M.J.

    1993-01-01

    Measurement of the near-threshold fatigue crack growth rate (FCGR) behavior provides a basis for the design and evaluation of components subjected to high cycle fatigue. Typically, the near-threshold fatigue regime describes crack growth rates below approximately 10{sup {minus}5} mm/cycle (4{times}10{sup {minus}7} inch/cycle). One such evaluation was recently performed by the authors for the binary alloy U-6Nb. The procedures developed for this evaluation are described in detail here to provide a general test method for near-threshold FCGR testing. In particular, we describe techniques for high-resolution measurements of crack length performed in-situ through a direct current, potential drop (DCPD) apparatus, and a method which eliminates crack closure effects through the use of loading cycles with constant maximum stress intensity.

  14. Near threshold fatigue testing

    SciTech Connect

    Freeman, D.C.; Strum, M.J.

    1993-01-01

    Measurement of the near-threshold fatigue crack growth rate (FCGR) behavior provides a basis for the design and evaluation of components subjected to high cycle fatigue. Typically, the near-threshold fatigue regime describes crack growth rates below approximately 10[sup [minus]5] mm/cycle (4[times]10[sup [minus]7] inch/cycle). One such evaluation was recently performed by the authors for the binary alloy U-6Nb. The procedures developed for this evaluation are described in detail here to provide a general test method for near-threshold FCGR testing. In particular, we describe techniques for high-resolution measurements of crack length performed in-situ through a direct current, potential drop (DCPD) apparatus, and a method which eliminates crack closure effects through the use of loading cycles with constant maximum stress intensity.

  15. Amphibian pain and analgesia.

    PubMed

    Machin, K L

    1999-03-01

    Analgesics are often not provided to amphibians because the presence and severity of pain may not be recognized in these animals. In addition, there is little information on the mechanism of action of analgesic agents in amphibians. However, amphibians possess appropriate neurologic components for transmitting pain from peripheral receptors to the central nervous system and antinociceptive mechanisms to modulate pain. They are capable of displaying behavioral and physiologic modification of pain systems in response to analgesic pharmacologic agents. Therefore, pain perception in amphibians is likely analogous to that in mammals and invasive, potentially painful procedures should be accompanied by appropriate analgesia and anesthesia. Although specific doses have not been established in clinical trials, basic research into the mechanisms and regulation of endogenous opioid systems demonstrates the potential clinical benefit for the use of opioids in these animals. Other analgesics such as alpha2-agonists, ketamine, and tricaine methanesulfonate have also demonstrated analgesic potential. PMID:10367638

  16. Pain management in newborns.

    PubMed

    Hall, Richard W; Anand, Kanwaljeet J S

    2014-12-01

    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

  17. Neonatal pain management

    PubMed Central

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

    2014-01-01

    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. PMID:25538531

  18. Sensitisation of spinal cord pain processing in medication overuse headache involves supraspinal pain control.

    PubMed

    Perrotta, A; Serrao, M; Sandrini, G; Burstein, R; Sances, G; Rossi, P; Bartolo, M; Pierelli, F; Nappi, G

    2010-03-01

    Medication overuse could interfere with the activity of critical brain regions involved in the supraspinal control of pain signals at the trigeminal and spinal level, leading to a sensitisation phenomenon responsible for chronic pain. We hypothesised that medication-overuse headache (MOH) patients might display abnormal processing of pain stimuli at the spinal level and defective functioning of the diffuse noxious inhibitory controls. We tested 31 MOH patients before (bWT) and after (aWT) standard inpatient withdrawal treatment, 28 episodic migraine (EM) patients and 23 healthy control subjects. We measured the threshold, the area and the temporal summation threshold (TST) of the nociceptive withdrawal reflex before, during and after activation of the diffuse noxious inhibitory controls by means of the cold pressor test. A significantly lower TST was found in both the MOH (bWT and aWT) and the EM patients compared with the controls, and in the MOH patients bWT compared with both the MOH patients aWT and the EM patients. In the MOH bWT patients the cold pressor test induced a TST increase significantly lower than that found in the MOH aWT, EM and control groups. Abnormal spinal cord pain processing and a decrease of the antinociceptive activity of the supraspinal structures in MOH patients can be hypothesised. These abnormalities could, in part, be related to the medication overuse, given that the withdrawal treatment was related to an improvement in the neurophysiological findings. PMID:19614707

  19. Fault tolerance with noisy and slow measurements and preparation.

    PubMed

    Paz-Silva, Gerardo A; Brennen, Gavin K; Twamley, Jason

    2010-09-01

    It is not so well known that measurement-free quantum error correction protocols can be designed to achieve fault-tolerant quantum computing. Despite their potential advantages in terms of the relaxation of accuracy, speed, and addressing requirements, they have usually been overlooked since they are expected to yield a very bad threshold. We show that this is not the case. We design fault-tolerant circuits for the 9-qubit Bacon-Shor code and find an error threshold for unitary gates and preparation of p((p,g)thresh)=3.76×10(-5) (30% of the best known result for the same code using measurement) while admitting up to 1/3 error rates for measurements and allocating no constraints on measurement speed. We further show that demanding gate error rates sufficiently below the threshold pushes the preparation threshold up to p((p)thresh)=1/3. PMID:20867497

  20. Fault Tolerance with Noisy and Slow Measurements and Preparation

    NASA Astrophysics Data System (ADS)

    Paz-Silva, Gerardo A.; Brennen, Gavin K.; Twamley, Jason

    2010-09-01

    It is not so well known that measurement-free quantum error correction protocols can be designed to achieve fault-tolerant quantum computing. Despite their potential advantages in terms of the relaxation of accuracy, speed, and addressing requirements, they have usually been overlooked since they are expected to yield a very bad threshold. We show that this is not the case. We design fault-tolerant circuits for the 9-qubit Bacon-Shor code and find an error threshold for unitary gates and preparation of p(p,g)thresh=3.76×10-5 (30% of the best known result for the same code using measurement) while admitting up to 1/3 error rates for measurements and allocating no constraints on measurement speed. We further show that demanding gate error rates sufficiently below the threshold pushes the preparation threshold up to p(p)thresh=1/3.

  1. Association of cardiorespiratory fitness with pressure pain sensitivity and clinical pain in women with fibromyalgia.

    PubMed

    Soriano-Maldonado, Alberto; Ortega, Francisco B; Munguía-Izquierdo, Diego

    2015-05-01

    The aim of the present study was to assess the association of cardiorespiratory fitness (CRF) with pressure pain sensitivity and clinical pain in women with fibromyalgia (FM). Thirty-one women with FM were included in the study. Pressure pain sensitivity was assessed with an electronic pressure dolorimeter. The average pressure pain threshold (PPT) from the 18 FM-related tender points and the tender points count (TPC) were recorded. Clinical pain was assessed on a 10-cm visual analog scale (VAS; from the FM impact questionnaire). The patients performed an incremental treadmill test, which consisted in six increasing workloads. Gas exchange was continuously monitored, and peak oxygen uptake (as measure of CRF) was recorded. Pairwise correlation and multiple linear regression were used to examine the association of CRF with PPT and VAS, and binary logistic regression assessed the odds of having <18 positive tender points as a function of CRF. The correlations of CRF with the average PPT and VAS were 0.355, (P < 0.001) and 0.058 (P > 0.05), respectively. Regression analyses revealed that CRF was associated with the PPT (B = 0.093; 95 % CI 0.064-0.122; P < 0.001; R (2) = 0.306) and TPC (OR 1.51; 95 % CI 1.30-1.75; P < 0.001) but not with VAS (B = 0.068; 95 % CI -0.061-0.197; P > 0.05). The findings of this study suggest that CRF is associated with pressure pain sensitivity but not with clinical pain in women with FM. Further longitudinal and intervention studies are needed to determine whether CRF could be involved in some mechanisms of pain processing. PMID:25549601

  2. Treatment of painful polyneuropathies

    Microsoft Academic Search

    Bruce Nicholson

    2005-01-01

    The treatment of painful polpyneuropathies has begun to improve over the past several years. This is based on an evolving\\u000a understanding of the pathogenesis related to the development of diabetic neuropathy and other diseases that may lead to peripheral\\u000a nerve injury. Consensus on evaluation strategies for patients presenting with pain has furthered our ability to define neuropathic\\u000a pain and accompanying

  3. Pain management and yoga.

    PubMed

    Nespor, K

    1991-01-01

    The use of yoga and yoga related techniques in pain management is reviewed and discussed. Self-awareness, relaxation, approaches which use respiration, increased self-understanding and self-acceptance, changed context of pain, increased control, life style improvements, group and social support proved beneficial. The use of yoga in pain management has its transpersonal and philosophical dimensions. Independence and self-confidence of suffering people may be protected in this way. PMID:1723397

  4. Methylprednisolone prevents the development of autotomy and neuropathic edema in rats, but has no effect on nociceptive thresholds

    Microsoft Academic Search

    Wade S. Kingery; Juan M. Castellote; Mervyn Maze

    1999-01-01

    Corticosteroids are probably an effective treatment for some types of neuropathic pain and complex regional pain syndromes. This study examined the effects of systemic methylprednisolone (MP) on acute nociception and on pain behavior and hyperalgesia in normal and neuropathic rats. There was no dose-response to intraperitoneal MP (up to 12 mg\\/kg) for nociceptive thresholds to heat (Peltier) or mechanical (analgesy-meter

  5. Painful Boney Metastases

    PubMed Central

    Smith, Howard S.

    2013-01-01

    Boney metastasis may lead to terrible suffering from debilitating pain. The most likely malignancies that spread to bone are prostate, breast, and lung. Painful osseous metastases are typically associated with multiple episodes of breakthrough pain which may occur with activities of daily living, weight bearing, lifting, coughing, and sneezing. Almost half of these breakthrough pain episodes are rapid in onset and short in duration and 44% of episodes are unpredictable. Treatment strategies include: analgesic approaches with "triple opioid therapy", bisphosphonates, chemotherapeutic agents, hormonal therapy, interventional and surgical approaches, steroids, radiation (external beam radiation, radiopharmaceuticals), ablative techniques (radiofrequency ablation, cryoablation), and intrathecal analgesics. PMID:23861996

  6. Pain: You Can Get Help

    MedlinePLUS

    ... where you hurt and exactly how it feels. Acute Pain and Chronic Pain There are two kinds of pain. Acute ... rheumatoid arthritis (RA) and sciatica. In some cases, chronic pain follows after acute pain from an injury or other health issue ...

  7. + neurobiotin mean spike threshold

    E-print Network

    Wilson, Rachel

    -80 -60 -40 Vm(mV) KCH3SO3 + neurobiotin n=5 KCH3S03 n=16 Kaspartate n=5 Kaspartate + biocytin, and the reversal potential EGABA was determined, along with the spike threshold for that cell. With a KCH3SO3-based the KCH3SO3+neurobiotin internal (supplemental Fig. 2). #12;Supplemental Figure 2. PN odor tuning

  8. Designing Acoustic Thresholds

    Microsoft Academic Search

    Pedro Rebelo; Maarten van Walstijn

    This paper introduces the notion of acoustic thresholds as a metaphor for the design of sound objects. We present an approach to sound design which is based on the idea of intervention rather than creation, actively transforming sound by manipulating the acoustic entity itself. By addressing the acoustic specificity of sound objects, as in physical modelling, and by introducing technological

  9. Undervoltage Breakdown Threshold Criteria

    Microsoft Academic Search

    James Cooley; Edgar Choueiri

    2006-01-01

    Undervoltage breakdown, the process by which a pulse of electrons induces a discharge gap to break down when it is near but has not achieved its self-breakdown conditions, is discussed. Specifically, threshold criteria that determine the number of electrons required to induce breakdown both to glow and arc discharges are presented. Numerical and theoretical predictions of these criteria are compared

  10. Elaborating on Threshold Concepts

    ERIC Educational Resources Information Center

    Rountree, Janet; Robins, Anthony; Rountree, Nathan

    2013-01-01

    We propose an expanded definition of Threshold Concepts (TCs) that requires the successful acquisition and internalisation not only of knowledge, but also its practical elaboration in the domains of applied strategies and mental models. This richer definition allows us to clarify the relationship between TCs and Fundamental Ideas, and to account…

  11. TelePain: A Community of Practice for Pain Management

    PubMed Central

    Meins, Alexa R.; Doorenbos, Ardith Z.; Eaton, Linda; Gordon, Debra; Theodore, Brian; Tauben, David

    2015-01-01

    Introduction Comprehensive pain management services are primarily located in urban areas, limiting specialist consultation opportunities for community healthcare providers. A community of practice (CoP) for pain management could create opportunities for consultation by establishing professional relationships between community healthcare providers and pain management specialists. A CoP is a group of people with a common concern, set of problems, or a passion for something they do. Members of a CoP for pain management increase their knowledge of evidence-based pain management strategies in a way that is meaningful and relevant. In this article, we provide evidence that TelePain, an interdisciplinary, case-based pain management teleconference consultation program through the University of Washington, qualifies as a CoP and present preliminary evidence of TelePain's effectiveness as a CoP for pain management. Methods Specific behaviors and conversations gathered through participant observation during TelePain sessions were analyzed based on the 14 indicators Wegner developed to evaluate the presence of a CoP. To demonstrate preliminary effectiveness of TelePain as a CoP for pain management, descriptive statistics were used to summarize TelePain evaluation forms. Results TelePain is an example of a successful CoP for pain management as demonstrated by the presence of Wegner's 14 indicators. Additionally, evaluation forms showed that TelePain enhanced community healthcare providers' knowledge of pain management strategies and that continued participation in TelePain lead to community healthcare providers' increased confidence in their ability to provide pain management. Conclusion TelePain, a CoP for pain management, facilitates multidisciplinary collaboration and allows members to develop interdisciplinary care plans for complex pain patients through case study discussions. Evidence-based pain management strategies gained through CoP membership could be disseminated to other healthcare providers in members' clinics, which has the potential of improving the care of chronic pain patients. PMID:25964869

  12. Tapentadol extended-release for treatment of chronic pain: a review

    PubMed Central

    Vadivelu, Nalini; Timchenko, Alexander; Huang, Yili; Sinatra, Raymond

    2011-01-01

    Tapentadol is a centrally acting analgesic with a dual mechanism of action of mu receptor agonism and norepinephrine reuptake inhibition. Tapentadol immediate-release is approved by the US Food and Drug Administration for the management of moderate-to-severe acute pain. It was developed to decrease the intolerability issue associated with opioids. Tapentadol extended-release has a 12-hour duration of effect, and has recently been evaluated for pain in patients with chronic osteoarthritis, low back pain, and pain associated with diabetic peripheral neuropathy. Tapentadol extended-release was found to provide safe and highly effective analgesia for the treatment of chronic pain conditions, including moderate-to-severe chronic osteoarthritis pain and low back pain. Initial trials demonstrating efficacy in neuropathic pain suggest that tapentadol has comparable analgesic effectiveness and better gastrointestinal tolerability than opioid comparators, and demonstrates effectiveness in settings of inflammatory, somatic, and neuropathic pain. Gastrointestinal intolerance and central nervous system effects were the major adverse events noted. Tapentadol will need to be rigorously tested in chronic neuropathic pain, cancer-related pain, and cancer-related neuropathic pain. PMID:21887118

  13. INTERVENTIONAL PAIN FOR MORE INFORMATION

    E-print Network

    Haykin, Simon

    experience in interventional pain management. The diagnostic and therapeutic approach to the patient. TARGET AUDIENCE Physicians from across Canada with experience in Pain Management and Physicians with experience in Pain Management pertaining to Anesthesia, Physical Medicine, Psychiatry, and Palliative Care

  14. Lactose tolerance tests

    MedlinePLUS

    Hydrogen breath test for lactose tolerance ... Two common methods include: Lactose tolerance blood test Hydrogen breath test The hydrogen breath test is the preferred method. It measures the amount of hydrogen in the air you breathe out. ...

  15. Lactose Tolerance Tests

    MedlinePLUS

    ... page: Was this page helpful? Also known as: Hydrogen Breath Test; Lactose Breath Test; Disaccharide Absorption Test; Oral Lactose Tolerance Formal name: Hydrogen Breath Test; Lactose Tolerance Test Related tests: Stool ...

  16. Chemical Interventions for Pain.

    ERIC Educational Resources Information Center

    Aronoff, Gerald M.; And Others

    1986-01-01

    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,…

  17. Chronic pain in adults.

    PubMed

    Ostler, Anneli

    2015-06-10

    Reading the CPD article helped improve my understanding of the importance of identifying chronic pain. Chronic pain may occur on its own or as a feature of other chronic conditions, and it may be nociceptive or neuropathic, or a combination of the two. PMID:26058654

  18. Painful and painless channelopathies.

    PubMed

    Bennett, David L H; Woods, C Geoffrey

    2014-06-01

    The discovery of genetic variants that substantially alter an individual's perception of pain has led to a step-change in our understanding of molecular events underlying the detection and transmission of noxious stimuli by the peripheral nervous system. For example, the voltage-gated sodium ion channel Nav1.7 is expressed selectively in sensory and autonomic neurons; inactivating mutations in SCN9A, which encodes Nav1.7, result in congenital insensitivity to pain, whereas gain-of-function mutations in this gene produce distinct pain syndromes such as inherited erythromelalgia, paroxysmal extreme pain disorder, and small-fibre neuropathy. Heterozygous mutations in TRPA1, which encodes the transient receptor potential cation channel, can cause familial episodic pain syndromes, and variants of genes coding for the voltage-gated sodium channels Nav1.8 (SCN10A) and Nav1.9 (SCN11A) lead to small-fibre neuropathy and congenital insensitivity to pain, respectively. Furthermore, other genetic polymorphisms have been identified that contribute to risk or severity of more complex pain phenotypes. Novel models of sensory disorders are in development-eg, using human sensory neurons differentiated from human induced pluripotent stem cells. Understanding rare heritable pain disorders not only improves diagnosis and treatment of patients but may also reveal new targets for analgesic drug development. PMID:24813307

  19. Hypnosis and Clinical Pain

    Microsoft Academic Search

    David R. Patterson; Mark P. Jensen

    2003-01-01

    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

  20. PAIN SCALES (ATTACHMENT A)

    E-print Network

    Oliver, Douglas L.

    back and forth, tense Arched, rigid or jerking CRY No cry (awake or asleep) Moans or whimpers; occasional complaint Crying steadily, screams or sobs, frequent complaints CONSOLABILITY Content, relaxed for Scoring Post-operative Pain in Young Children (1997) Pediatric Nursing. 23(3): 293-297. #12;PAIN SCALES

  1. Opioids in pain management

    Microsoft Academic Search

    Henry McQuay

    1999-01-01

    Dose titration and differences between clinical and laboratory pharmacology The clinical use of opioids shows a difference between their clinical pharmacology and their laboratory pharmacology. What happens when opioids are given to someone in pain is different from what happens when they are given to someone not in pain. The respiratory depression that results from the acute use of opioids

  2. Pain: Hope through Research

    MedlinePLUS

    ... without affecting other nervous system functions. As we learn more about the specific roles of GABA receptors, drug development may be accelerated. ... reverse and makes pain persist beyond its protective role. ... imaging technology, to locate pain precisely, and to assess the ...

  3. The pain of altruism.

    PubMed

    Finlay, Barbara L; Syal, Supriya

    2014-12-01

    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

  4. Analgesic Effect of Intrathecal Ginsenosides in a Murine Bone Cancer Pain

    PubMed Central

    Kim, Woong Mo; Lee, Hyung Gon; Choi, Jeong Il; Kim, Yeo Ok; Song, Ji A

    2010-01-01

    Background Bone cancer pain has a disruptive effect on the cancer patient's quality of life. Although ginsenosides have been used as traditional medicine in Eastern Medicine, the effect on bone cancer pain has not been thoroughly studied. The aim of this study was to determine whether ginsenosides may alter the bone cancer pain at the spinal level. Methods NCTC 2472 tumor cells (2.5 × 105) were injected into the femur of adult male C3H/HeJ mice to evoke bone tumor and bone cancer pain. To develop bone tumor, radiologic pictures were obtained. To assess pain, the withdrawal threshold was measured by applying a von Frey filament to the tumor cells inoculation site. The effect of intrathecal ginsenosides was investigated. Effect of ginsenosides (150, 500, 1,000 µg) was examined at 15, 30, 60, 90, 120 min after intrathecal delivery. Results The intrafemoral injection of NCTC 2472 tumor cells induced a radiological bone tumor. The withdrawal threshold with tumor development was significantly decreased compared to the sham animals. Intrathecal ginsenosides effectively increased the withdrawal threshold in the bone cancer site. Conclusions NCTC 2472 tumor cells injection into the mice femur caused bone tumor and bone cancer pain. Intrathecal ginsenosides attenuated the bone cancer-related pain behavior. Therefore, spinal ginsenosides may be an alternative analgesic for treating bone cancer pain. PMID:21217885

  5. Threshold properties of a microcavity laser with submicroampere threshold current

    SciTech Connect

    Choquette, K.D.; Hou, H.Q.; Lear, K.L.; Chow, W.W.; Mar, A.; Geib, K.M.; Hammons, B.E.

    1996-02-01

    We report the threshold characteristics of small oxide-confined vertical-cavity surface emitting lasers. Abrupt threshold transitions 105 times the spontaneous emission background are obtained at injection currents as low as 470 nanoampere.

  6. Cancer and Referred Facial Pain.

    PubMed

    Romero-Reyes, Marcela; Teruel, Antonia; Ye, Yi

    2015-08-01

    Orofacial pain may be a symptom of diverse types of cancers as a result of local or distant tumor effects. The pain can be presented with the same characteristics as any other orofacial pain disorder, and this should be recognized by the clinician. Orofacial pain also can arise as a consequence of cancer therapy. In the present article, we review the mechanisms of cancer-associated facial pain, its clinical presentation, and cancer therapy associated with orofacial pain. PMID:26088459

  7. An archaeology of pain

    NASA Astrophysics Data System (ADS)

    Gruber, Dennis Michael

    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.

  8. Musculoskeletal chest wall pain

    PubMed Central

    Fam, Adel G.; Smythe, Hugh A.

    1985-01-01

    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

  9. Tapentadol extended release: in adults with chronic pain.

    PubMed

    Hoy, Sheridan M

    2012-02-12

    The extended release (ER; as ascribed in the US) or prolonged release (PR; as ascribed in Europe) formulation (hereafter referred to as ER) of the oral analgesic tapentadol is believed to exert its analgesic effects via ?-opioid receptor agonistic and norepinephrine reuptake inhibitory activity. Direct conversion between tapentadol immediate release and tapentadol ER is permissible utilizing approximately equivalent total daily doses. For the most part, shorter-term (15 weeks) therapy with tapentadol ER 100-250?mg twice daily provided more effective pain relief and significantly improved functional and health status outcomes compared with placebo in four well designed studies in adult patients with moderate to severe chronic pain associated with knee osteoarthritis, the lower back or diabetic neuropathy. Moreover, longer-term (?24 months) therapy with tapentadol ER provided sustained analgesic effects in two multinational tolerability studies in patients with moderate to severe chronic pain associated with knee or hip osteoarthritis or the lower back. The development of tolerance was not observed in clinical studies of tapentadol ER, with the mean total daily dose and the analgesic (mean pain intensity) scores remaining relatively stable over ?24 months' therapy. Oral tapentadol ER therapy for up to 24 months was generally well tolerated, with the nature of treatment-emergent adverse events generally similar across the clinical studies. PMID:22316353

  10. Dieting and pain sensitivity: a validation of clinical findings.

    PubMed

    Lautenbacher, S; Barth, K; Friess, E; Strian, F; Pirke, K M; Krieg, J C

    1991-09-01

    To validate findings of a reduced pain sensitivity in anorexia and bulimia nervosa, the effects of dieting on somatosensation (especially pain sensitivity) were investigated in healthy young women. One group of subjects (n = 11) received a calorically reduced balanced diet for 21 days, while the other group (n = 14) continued to eat normally. The fasting state induced in the dieting subjects was comparable to that of eating disorder patients, since the dieters showed a reduction of the body mass index, a decrease in triiodothyronine and an increase in beta-hydroxybutyric acid plasma levels. However, neither the thresholds of pain, warmth, cold and vibration sensitivity nor the peripheral skin temperature changed systematically under the diet. Therefore, the reduced pain sensitivity in eating disorder patients is apparently not a mere effect of fasting, but a true pathological feature. PMID:1801020

  11. Zero Tolerance in Schools.

    ERIC Educational Resources Information Center

    Henault, Cherry

    2001-01-01

    Questions the effectiveness of the widespread use of zero-tolerance policies enacted by school boards to punish students who violate weapon and drug rules. Suggests that enforcement of zero-tolerance policies has not been equitable. Reviews proposal for alternative to zero tolerance. (PKP)

  12. Plant salt tolerance

    Microsoft Academic Search

    Viswanathan Chinnusamy; Jian-Kang Zhu

    Soil salinity adversely affects crop productivity and quality. The success of breeding programs aimed at salinity tolerant crop varieties is limited by the lack of a clear understanding of the molecular basis of salt tolerance. Recent advances in genetic analysis of Arabidopsis mutants defective in salt tolerance, and molecular cloning of these loci, have showed some insight into salt stress

  13. Nicotine withdrawal and stress-induced changes in pain sensitivity: a cross-sectional investigation between abstinent smokers and nonsmokers.

    PubMed

    Nakajima, Motohiro; Al'Absi, Mustafa

    2014-10-01

    Chronic smoking has been linked with alterations in endogenous pain regulation. These alterations may be pronounced when individuals quit smoking because nicotine withdrawal produces a variety of psychological and physiological symptoms. Smokers interested in quitting (n?=?98) and nonsmokers (n?=?37) completed a laboratory session including cold pressor test (CPT) and heat thermal pain. Smokers set a quit date and completed the session after 48?h of abstinence. Participants completed the pain assessments once after rest and once after stress. Cardiovascular and nicotine withdrawal measures were collected. Smokers showed blunted cardiovascular responses to stress relative to nonsmokers. Only nonsmokers had greater pain tolerance to CPT after stress than after rest. Lower systolic blood pressure was related to lower pain tolerance. These findings suggest that smoking withdrawal is associated with blunted stress response and increased pain sensitivity. PMID:24934193

  14. A pilot study investigating the effects of fast left prefrontal rTMS on chronic neuropathic pain

    PubMed Central

    Borckardt, Jeffrey J.; Smith, Arthur R.; Reeves, Scott T.; Madan, Alok; Shelley, Neal; Branham, Richard; Nahas, Ziad; George, Mark S.

    2010-01-01

    Objective Stimulating the human cortex using transcranial magnetic stimulation (TMS) temporarily reduces clinical and experimental pain, however, it is unclear which cortical targets are the most effective. The motor cortex has been a popular target for managing neuropathic pain, while the prefrontal cortex has been investigated for an array of nociceptive pain conditions. It is unclear whether the motor cortex is the only effective cortical target for managing neuropathic pain, and no published studies to date have investigated the effects of prefrontal stimulation on neuropathic pain. Design This preliminary pilot trial employed a sham-controlled, within-subject, cross-over design to evaluate clinical pain as well as laboratory pain thresholds among four patients with chronic neuropathic pain. Each participant underwent three real and three sham 20-minute sessions of 10Hz left prefrontal rTMS. Daily pain diaries were collected for 3-weeks before and after each treatment phase along with a battery of self-report pain and mood questionnaires. Results Time-series analysis at the individual patient level indicated that real TMS was associated with significant improvements in average daily pain in 3 of the 4 participants. These effects were independent of changes in mood in 2 of the participants. At the group level, a decrease of 19% in daily pain on average, pain at its worst, and pain at its least was observed while controlling for changes in mood, activity-level and sleep. The effects of real TMS were significantly greater than sham. Real TMS was associated with increases in thermal and mechanical pain thresholds whereas sham was not. No statistically significant effects were observed across the questionnaire data. Conclusions The prefrontal cortex may be an important TMS cortical target for managing certain types of pain, including certain neuropathic pain syndromes. PMID:19594842

  15. Wavelet Shrinkage: Unification of Basic Thresholding Functions and Thresholds

    E-print Network

    Paris-Sud XI, Université de

    in a huge number of wavelet based methods for image denoising. In addition, there exist many ways to improveWavelet Shrinkage: Unification of Basic Thresholding Functions and Thresholds Abdourrahmane M. Atto and thresholds used in non- parametric estimation of signals by shrinkage in the wavelet domain. The Soft

  16. Nitrogen threshold experiment

    NASA Technical Reports Server (NTRS)

    Treat, C. L.

    1984-01-01

    In order to obtain data on Earth geologic processes associated with wind erosion, Mar's and Venus' atmospheres were simulated. Experiments were designed to observe the effects of pressure, gravity, and density on sand movement. An experiment designed to test the operator variance was a comparative test between nitrogen and carbon dioxide. Pressure and therefore density was increased until threshold was noted. Threshold was determined at precisely the same densities of the two gases. If viscosity were a contributing factor in grain saltation the effect would be noted at low pressures. The experiment showed no such variance between carbon dioxide and nitrogen runs for low pressure (density). The largest difference in viscosity between carbon dioxide and nitrogen occurs at low pressures (densities).

  17. Pain Catastrophising Affects Cortical Responses to Viewing Pain in Others

    PubMed Central

    Fallon, Nicholas

    2015-01-01

    Pain catastrophising is an exaggerated cognitive attitude implemented during pain or when thinking about pain. Catastrophising was previously associated with increased pain severity, emotional distress and disability in chronic pain patients, and is also a contributing factor in the development of neuropathic pain. To investigate the neural basis of how pain catastrophising affects pain observed in others, we acquired EEG data in groups of participants with high (High-Cat) or low (Low-Cat) pain catastrophising scores during viewing of pain scenes and graphically matched pictures not depicting imminent pain. The High-Cat group attributed greater pain to both pain and non-pain pictures. Source dipole analysis of event-related potentials during picture viewing revealed activations in the left (PHGL) and right (PHGR) paraphippocampal gyri, rostral anterior (rACC) and posterior cingulate (PCC) cortices. The late source activity (600–1100 ms) in PHGL and PCC was augmented in High-Cat, relative to Low-Cat, participants. Conversely, greater source activity was observed in the Low-Cat group during the mid-latency window (280–450 ms) in the rACC and PCC. Low-Cat subjects demonstrated a significantly stronger correlation between source activity in PCC and pain and arousal ratings in the long latency window, relative to high pain catastrophisers. Results suggest augmented activation of limbic cortex and higher order pain processing cortical regions during the late processing period in high pain catastrophisers viewing both types of pictures. This pattern of cortical activations is consistent with the distorted and magnified cognitive appraisal of pain threats in high pain catastrophisers. In contrast, high pain catastrophising individuals exhibit a diminished response during the mid-latency period when attentional and top-down resources are ascribed to observed pain. PMID:26186545

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

    PubMed Central

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

    2014-01-01

    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

  19. Low Dose Vaporized Cannabis Significantly Improves Neuropathic Pain

    PubMed Central

    Wilsey, Barth; Marcotte, Thomas D.; Deutsch, Reena; Gouaux, Ben; Sakai, Staci; Donaghe, Haylee

    2013-01-01

    We conducted a double-blind, placebo-controlled, crossover study evaluating the analgesic efficacy of vaporized cannabis in subjects, the majority of whom were experiencing neuropathic pain despite traditional treatment. Thirty-nine patients with central and peripheral neuropathic pain underwent a standardized procedure for inhaling either medium dose (3.53%), low dose (1.29%), or placebo cannabis with the primary outcome being VAS pain intensity. Psychoactive side-effects, and neuropsychological performance were also evaluated. Mixed effects regression models demonstrated an analgesic response to vaporized cannabis. There was no significant difference between the two active dose groups’ results (p>0.7). The number needed to treat (NNT) to achieve 30% pain reduction was 3.2 for placebo vs. low dose, 2.9 for placebo vs. medium dose, and 25 for medium vs. low dose. As these NNT are comparable to those of traditional neuropathic pain medications, cannabis has analgesic efficacy with the low dose being, for all intents and purposes, as effective a pain reliever as the medium dose. Psychoactive effects were minimal and well-tolerated, and neuropsychological effects were of limited duration and readily reversible within 1–2 hours. Vaporized cannabis, even at low doses, may present an effective option for patients with treatment-resistant neuropathic pain. PMID:23237736

  20. "Infectious" Transplantation Tolerance

    NASA Astrophysics Data System (ADS)

    Qin, Shixin; Cobbold, Stephen P.; Pope, Heather; Elliott, James; Kioussis, Dimitris; Davies, Joanna; Waldmann, Herman

    1993-02-01

    The maintenance of transplantation tolerance induced in adult mice after short-term treatment with nonlytic monoclonal antibodies to CD4 and CD8 was investigated. CD4^+ T cells from tolerant mice disabled naive lymphocytes so that they too could not reject the graft. The naive lymphocytes that had been so disabled also became tolerant and, in turn, developed the capacity to specifically disable other naive lymphocytes. This process of "infectious" tolerance explains why no further immunosuppression was needed to maintain long-term transplantation tolerance.

  1. Tramadol for the treatment of joint pain associated with osteoarthritis: a randomized, double-blind, placebo-controlled trial

    Microsoft Academic Search

    Roy M. Fleischmann; Jacques R. Caldwell; Sanford H. Roth; John R. P. Tesser; William Olson; Marc Kamin

    2001-01-01

    Background: Results from short-term, non—placebo-controlled clinical trials suggest that tramadol is effective as adjunctive therapy for the treatment of joint pain associated with osteoarthritis (OA).Objective: We assessed the efficacy and tolerability of tramadol monotherapy versus placebo in the treatment of joint pain associated with OA.Methods: Patients with symptomatic OA of the knee and at least moderate pain at the end

  2. Neuropathic pain in cancer.

    PubMed

    Goyal, Alka; Bhatnagar, Sushma

    2014-01-01

    Unrelieved neuropathic pain continues to be a substantial health problem in a cancer patient arises either due to disease itself or its treatment. Review of literature showed that neuropathic pain has high prevalence rate, greater severity and analgesic requirement with worse quality of life. Underreporting by patient and under treatment by physician is an important causative factor of indefinite persistence of neuropathic pain. Careful history taking, elaborated physical examination, patient's self report and diagnostic tools with high sensitivity and specificity are needed for accurate assessment of neuropathic pain. Neuropathic cancer pain is difficult to treat and also shows poor response to opioids so in this situation alternate a treatment strategy that also includes psycosocial and spiritual counseling with yoga and meditation exercises under the palliative care framework should be practiced. To find out the burden and estimation of resource generation of this widely recognized problem, accurate establishment of incidence, prevalence, severity, and effectiveness of treatment is quite mandatory. Complex phenomenon of neuropathic pain abolishes establishment of early diagnosis and accurate etiology of this symptom, emphasizes the need of sensitive and reliable clinical grading scale, international classification system and validated diagnostic tools that correspond with clinical assessment. Multiple studies towards this direction has been culminated and some are still going on, though the data and literature is very scant and require further research for the complete evaluation of neuropathic pain. PMID:25841479

  3. Pain and natural disaster.

    PubMed

    Guetti, Cristiana; Angeletti, Chiara; Paladini, Antonella; Varrassi, Giustino; Marinangeli, Franco

    2013-09-01

    The treatment for pain in emergency medicine is a matter of increasing interest. Available data indicate that in both normal conditions and during major-emergencies, the majority of healthcare providers are culturally and professionally unprepared to adequately treat acute pain conditions. In case of natural disasters, opioid drugs are often unavailable. Moreover, no guidelines or validated protocols provide adequate indications for the treatment for pain in case of massive emergencies. Training of the medical and nursing staff, in both formal and continuing, or on-the-job education is needed to adequately face a devastating emergency. Unfortunately, there is an inadequate level of training among healthcare professionals, even in highly seismic areas, and the source of aid is frequently limited, especially in the immediate aftermath of a disaster to those already present at the scene. Pain inadequately treated may modify the characteristics of the pain itself. Pain is no longer considered just a symptom, but itself becomes an autonomous pathology heavily influencing the social life and psycho-social aspects of a person. In the disastrous situation following an earthquake, an inadequate treatment of pain was the major violation of the psycho-physical integrity of individuals and a severe violation of their rights, as human beings and patients. PMID:23241164

  4. Low back pain.

    PubMed Central

    Ehrlich, George E.

    2003-01-01

    Low back pain is a leading cause of disability. It occurs in similar proportions in all cultures, interferes with quality of life and work performance, and is the most common reason for medical consultations. Few cases of back pain are due to specific causes; most cases are non-specific. Acute back pain is the most common presentation and is usually self-limiting, lasting less than three months regardless of treatment. Chronic back pain is a more difficult problem, which often has strong psychological overlay: work dissatisfaction, boredom, and a generous compensation system contribute to it. Among the diagnoses offered for chronic pain is fibromyalgia, an urban condition (the diagnosis is not made in rural settings) that does not differ materially from other instances of widespread chronic pain. Although disc protrusions detected on X-ray are often blamed, they rarely are responsible for the pain, and surgery is seldom successful at alleviating it. No single treatment is superior to others; patients prefer manipulative therapy, but studies have not demonstrated that it has any superiority over others. A WHO Advisory Panel has defined common outcome measures to be used to judge the efficacy of treatments for studies. PMID:14710509

  5. The effect of experimentally-induced subacromial pain on proprioception.

    PubMed

    Sole, Gisela; Osborne, Hamish; Wassinger, Craig

    2015-02-01

    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

  6. Image Denoising Using Wavelet Thresholding

    Microsoft Academic Search

    Lakhwinder Kaur; Savita Gupta; R. C. Chauhan

    2002-01-01

    This paper proposes an adaptive threshold estimation method for image denoising in the wavelet domain based on the generalized Guassian distribution (GGD) modeling of subband coefficients. The proposed method called NormalShrink is computationally more efficient and adaptive because the parameters required for estimating the threshold depend on subband data. The threshold is computed by ?? 2\\/? y where ? and

  7. Making Diagnostic Thresholds Less Arbitrary 

    E-print Network

    Unger, Alexis Ariana

    2012-07-16

    MAKING DIAGNOSTIC THRESHOLDS LESS ARBITRARY A Thesis by ALEXIS ARIANA UNGER Submitted to the Office of Graduate Studies of Texas A&M University in partial fulfillment of the requirements for the degree of MASTER OF SCIENCE... May 2011 Major Subject: Psychology Making Diagnostic Thresholds Less Arbitrary Copyright 2011 Alexis Ariana Unger MAKING DIAGNOSTIC THRESHOLDS LESS ARBITRARY A Thesis by ALEXIS ARIANA...

  8. The Bootstrap in Threshold Regression

    Microsoft Academic Search

    Ping Yu

    2009-01-01

    This paper shows that the nonparametric bootstrap is inconsistent, and the parametric bootstrap is consistent for inference of the threshold point in discontinuous threshold regression. An interesting phenomenon is that the asymptotic nonparametric bootstrap distribution of the threshold point is discrete and depends on the sampling path of the original data. Furthermore, the remedies to the nonparametric bootstrap failure in

  9. Pain intensity, pain interference and characteristics of spinal cord injury

    PubMed Central

    Ullrich, PM; Jensen, MP; Loeser, JD; Cardenas, DD

    2009-01-01

    Study Design Postal survey. Objectives To examine if the intensity of pain in persons with spinal cord injury (SCI) varied as a function of pain site, and to identify the patient and SCI characteristics associated with pain location, pain intensity and pain interference in a sample of persons with SCI. Setting Community sample, United States. Methods A postal survey including measures of pain intensity, pain interference, other pain, demographic and medical characteristics was completed by 238 adults with SCI. Results Average pain intensity was moderate and pain was common across the body. Demographic and medical variables, including SCI level, were generally not associated with pain prevalence, intensity and interference. However, persons with higher level injuries were more likely to report upper extremity pain than persons with paraplegic injuries. The lower body was the location of the highest pain ratings. Conclusion Persons with SCI tend to experience high pain intensity over multiple body locations. Lower body pain was as common as upper extremity pain, but tended to be more intense. PMID:18283293

  10. Examining the Pain Stages of Change Questionnaire in Chronic Pain

    Microsoft Academic Search

    Renee M. Williams; Eleni G. Hapidou; Chia-Yu A. Lin; Hira Abbasi

    2007-01-01

    Purpose: This study examined the relationships of a readiness to adopt a self-management approach to chronic pain, measured by the Pain Stages of Change Questionnaire (PSOCQ), with other pain-related scales in patients attending a chronic pain management program and determined if these measures changed from admission to discharge. The PSOCQ consists of four stages: Pre- contemplation, Contemplation, Action and Maintenance.

  11. Over-the-counter pain relievers

    MedlinePLUS

    ... Analgesics; Acetaminophen; NSAID; Nonsteroidal anti-inflammatory drug; Pain medicine - over-the-counter; Pain medicine - OTC ... Pain medicines are also called analgesics. Each kind of pain medicine has benefits and risks. Some types of pain ...

  12. Nonspecific Arm Pain

    PubMed Central

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

    2013-01-01

    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

  13. Long-term motor cortex stimulation for phantom limb pain.

    PubMed

    Pereira, Erlick A C; Moore, Tom; Moir, Liz; Aziz, Tipu Z

    2015-04-01

    We present the long-term course of motor cortex stimulation to relieve a case of severe burning phantom arm pain after brachial plexus injury and amputation. During 16-year follow-up the device continued to provide efficacious analgesia. However, several adjustments of stimulation parameters were required, as were multiple pulse generator changes, antibiotics for infection and one electrode revision due to lead migration. Steady increases in stimulation parameters over time were required. One of the longest follow-ups of motor cortex stimulation is described; the case illustrates challenges and pitfalls in neuromodulation for chronic pain, demonstrating strategies for maintaining analgesia and overcoming tolerance. PMID:25340991

  14. The respiratory cycle modulates brain potentials, sympathetic activity, and subjective pain sensation induced by noxious stimulation.

    PubMed

    Iwabe, Tatsuya; Ozaki, Isamu; Hashizume, Akira

    2014-07-01

    To test the hypothesis that a respiratory cycle influences pain processing, we conducted an experimental pain study in 10 healthy volunteers. Intraepidermal electrical stimulation (IES) with a concentric bipolar needle electrode was applied to the hand dorsum at pain perceptual threshold or four times the perceptual threshold to produce first pain during expiration or inspiration either of which was determined by the abrupt change in an exhaled CO2 level. IES-evoked potentials (IESEPs), sympathetic skin response (SSR), digital plethysmogram (DPG), and subjective pain intensity rating scale were simultaneously recorded. With either stimulus intensity, IES during expiration produced weaker pain feeling compared to IES during inspiration. The mean amplitude of N200/P400 in IESEPs and that of SSR were smaller when IES was applied during expiration. The magnitude of DPG wave gradually decreased after IES, but a decrease in the magnitude of DPG wave was less evident when IES was delivered during expiration. Regardless of stimulus timing or stimulus intensity, pain perception was always concomitant with appearance of IESEPs and SSR, and changes in DPG. Our findings suggest that pain processing fluctuates during normal breathing and that pain is gated within the central nervous system during expiration. PMID:24667456

  15. Hemiplegic shoulder pain: evidence of a neuropathic origin.

    PubMed

    Zeilig, Gabi; Rivel, Michal; Weingarden, Harold; Gaidoukov, Evgeni; Defrin, Ruth

    2013-02-01

    Hemiplegic shoulder pain (HSP) is common after stroke. Whereas most studies have concentrated on the possible musculoskeletal factors underlying HSP, neuropathic aspects have hardly been studied. Our aim was to explore the possible neuropathic components in HSP, and if identified, whether they are specific to the shoulder or characteristic of the entire affected side. Participants included 30 poststroke patients, 16 with and 14 without HSP, and 15 healthy controls. The thresholds of warmth, cold, heat-pain, touch, and graphesthesia were measured in the intact and affected shoulder and in the affected lower leg. They were also assessed for the presence of allodynia and hyperpathia, and computed tomography/magnetic resonance imaging scans of the brain were reviewed. In addition, chronic pain was characterized. Participants with HSP exhibited higher rates of parietal lobe damage (P<0.05) compared to those without HSP. Both poststroke groups exhibited higher sensory thresholds than healthy controls. Those with HSP had higher heat-pain thresholds in both the affected shoulder (P<0.001) and leg (P<0.01), exhibited higher rates of hyperpathia in both these regions (each P<0.001), and more often reported chronic pain throughout the affected side (P<0.001) than those without HSP. The more prominent sensory alterations in the shoulder region suggest that neuropathic factors play a role in HSP. The clinical evidence of damage to the spinothalamic-thalamocortical system in the affected shoulder and leg, the presence of chronic pain throughout the affected side, and the more frequent involvement of the parietal cortex all suggest that the neuropathic component is of central origin. PMID:23218522

  16. Pain Assessment for Older Adults

    Microsoft Academic Search

    Ellen Flaherty

    WHY: Studies on pain in older adults (persons 65 years of age and older) have demonstrated that 25%-50% of community dwelling older people have persistent pain. Additionally, 45-80% of nursing home residents report pain that is often left untreated. Pain is strongly associated with depression and can result in decreased socialization, impaired ambulation and increased healthcare utilization and costs. Older

  17. Chronic Pain in College Students

    PubMed Central

    Thomas, Michael; Roy, Ranjan; Cook, Andrew; Marykuca, Steve

    1992-01-01

    A survey of university students confirms earlier studies that found chronic pain fairly common among young adults. Students with chronic pain were similar demographically and psychologically to students with pain of less than 3 months' duration, but were much more likely to use analgesics and alcohol and to report that pain interfered with school work. Treatment implications are discussed. PMID:21221345

  18. Chronic pain in elderly people

    Microsoft Academic Search

    Lucy Gagliese; Ronald Melzack

    1997-01-01

    Chronic pain in elderly people has only recently begun to receive serious empirical consideration. There is compelling evidence that a significant majority of the elderly experience pain which may interfere with normal functioning. Nonetheless, a significant proportion of these individuals do not receive adequate pain management. Three significant factors which may contribute to this are (1) lack of proper pain

  19. Fault-tolerant measurement-based quantum computing with continuous-variable cluster states.

    PubMed

    Menicucci, Nicolas C

    2014-03-28

    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. PMID:24724639

  20. Complex Regional Pain Syndrome

    MedlinePLUS

    ... injury. Your doctor may also call this condition reflex sympathetic dystrophy or causalgia. The cause of the ... specifically at dealing with chronic pain. Other Organizations Reflex Sympathetic Dystrophy Syndrome Association of America Questions to ...

  1. Complex regional pain syndrome

    MedlinePLUS

    ... plays an important role in the pain. Another theory is that CRPS is caused by a triggering ... early as possible. Starting an exercise program and learning to keep joints and muscles moving may prevent ...

  2. Anterior knee pain

    MedlinePLUS

    ... as running, jumping or twisting, skiing, or playing soccer) You have flat feet Anterior knee pain is ... to the kneecap Runners, jumpers, skiers, bicyclists, and soccer players who exercise often Teenagers and healthy young ...

  3. Fatigue Crack Growth Threshold Testing of Metallic Rotorcraft Materials

    NASA Technical Reports Server (NTRS)

    Newman, John A.; James, Mark A.; Johnson, William M.; Le, Dy D.

    2008-01-01

    Results are presented for a program to determine the near-threshold fatigue crack growth behavior appropriate for metallic rotorcraft alloys. Four alloys, all commonly used in the manufacture of rotorcraft, were selected for study: Aluminum alloy 7050, 4340 steel, AZ91E Magnesium, and Titanium alloy Ti-6Al-4V (beta-STOA). The Federal Aviation Administration (FAA) sponsored this research to advance efforts to incorporate damage tolerance design and analysis as requirements for rotorcraft certification. Rotorcraft components are subjected to high cycle fatigue and are typically subjected to higher stresses and more stress cycles per flight hour than fixed-wing aircraft components. Fatigue lives of rotorcraft components are generally spent initiating small fatigue cracks that propagate slowly under near-threshold cracktip loading conditions. For these components, the fatigue life is very sensitive to the near-threshold characteristics of the material.

  4. Unstable Particles near Threshold

    E-print Network

    Dongjin Chway; Tae Hyun Jung; Hyung Do Kim

    2015-02-12

    We explore physics of unstable particles when mother particle mass is around the sum of its daughter particle masses. In this case, the conventional wave function renormalization factor is ill-defined. We propose a simple resolution of the threshold singularity problem which still allows the use of narrow width approximation by defining branching ratio in terms of spectral density. The resonance peak and shape is different for different decay channels and no single decay width can be assigned to the unstable particles. Non-exponential decay happens in all time scales.

  5. Sodium channelopathies and pain

    Microsoft Academic Search

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

    2010-01-01

    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

  6. Low Back Pain

    PubMed Central

    Reuler, James B.

    1985-01-01

    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

  7. Isoflurane improves the tolerance to pacing-induced myocardial ischemia.

    PubMed

    Tarnow, J; Markschies-Hornung, A; Schulte-Sasse, U

    1986-02-01

    Fourteen patients with normal, global, left ventricular function scheduled for elective myocardial revascularization were studied at rest and during atrial pacing before and during isoflurane anesthesia (0.5% end-tidal) plus 50% nitrous oxide. Rapid atrial pacing was performed in a stepwise fashion until the onset of angina pectoris in the awake patients. The same step increase in pacing rate was applied in the anesthetized patients. Compared with prepacing baseline values, isoflurane significantly decreased systemic blood pressure, coronary perfusion pressure, the rate-pressure product, and cardiac index. No patient had ST-segment depression while awake or during isoflurane anesthesia before pacing was started. Prepacing left and right ventricular filling pressures and wave forms were normal, both while awake and during isoflurane anesthesia. The mean pacing rate at which first signs of myocardial ischemia appeared (V5 ST-segment depression greater than or equal to 0.1 mV, increase in pulmonary capillary wedge pressure (PCWP) to greater than or equal to 15 mmHg, and prominent PCWP v-waves greater than or equal to 20 mmHg) was significantly higher during isoflurane anesthesia than in the awake patients (128 +/- 4 vs. 115 +/- 5 beats/min). With the exception of one patient, the individual pacing rates inducing first signs of ischemia in the awake patients were below the anginal threshold. None of the patients had a reduced ischemic threshold during anesthesia. Eleven anesthetized patients tolerated a higher pacing rate until initial signs of ischemia appeared. In four of these patients, the pacing rate required to induce first signs of ischemia was above the heart rate at which chest pain had been induced while they were awake. At a peak atrial pacing rate of 129 +/- 5 beats/min, which had induced angina pectoris in the awake patients, the increase in PCWP was significantly smaller during pacing with isoflurane than during control pacing. Prominent PCWP v-waves (greater than or equal to 20 mmHg) appeared in 12 of the 14 patients during initial pacing to angina and in eight patients paced during isoflurane anesthesia. In six of these eight patients, the abnormal v-waves were less prominent than those observed during control pacing. Ischemic ST-segment changes developed in 13 of 14 patients during initial pacing and in nine patients during pacing with isoflurane. Mean V5 ST-segment depression during the two pacing periods was significantly different, averaging 0.19 and 0.11 mV, respectively.(ABSTRACT TRUNCATED AT 400 WORDS) PMID:3946802

  8. Myofascial Head Pain.

    PubMed

    Fernández-de-Las-Peñas, César

    2015-07-01

    Muscle nociception is mainly characterized by local tenderness and referred pain. The neurophysiological basis of muscle pain supports a role of sensitization mechanisms. From a clinical viewpoint, muscle pain is represented by the presence of myofascial trigger points (TrPs). Evidence suggests that TrPs are able to start a peripheral nociceptive mechanism and hence contributing to changes in the central nervous system. Several studies demonstrated that the referred pain elicited by TrPs reproduces the headache pattern in patients with tension-type headache (TTH), migraine, cervicogenic headache and, in some individuals, with cluster headache. In fact, sensitization of nociceptive pain pathways in the central nervous system due to prolonged nociceptive stimuli from TrPs seems to be responsible for the conversion of episodic to chronic TTH. In other headaches, TrPs may be able to stimulate the trigeminal nucleus caudalis and hence triggering a migraine or cluster headache attack. Proper treatment directed towards TrP inactivation has documented positive effects in individuals with these headaches; however, longitudinal studies are needed to further determine the role of TrPs in head pain. PMID:26049772

  9. Investigation of bioequivalence and tolerability of intramuscular ceftriaxone injections by using 1% lidocaine, buffered lidocaine, and sterile water diluents.

    PubMed Central

    Hayward, C J; Nafziger, A N; Kohlhepp, S J; Bertino, J S

    1996-01-01

    The pharmacokinetics and tolerability of 1-g doses of ceftriaxone diluted in sterile water, 1% lidocaine, or buffered lidocaine were investigated. No difference in bioequivalence was noted between the three treatments. No difference in peak creatine kinase values was seen. By use of a quantitative pain scale, injection of ceftriaxone with the water diluent was significantly more painful than that with either of the other two diluents. No difference in injection pain was noted for lidocaine or buffered lidocaine. PMID:8834905

  10. Elucidation of pathophysiology and treatment of neuropathic pain.

    PubMed

    Vranken, Jan H

    2012-12-01

    Neuropathic pain, pain arising as a direct consequence of a lesion or disease affecting the somatosensory system, is relatively common, occurring in about 1% of the population. Studies in animal models describe a number of peripheral and central pathophysiological processes after nerve injury that would be the basis of underlying neuropathic pain mechanism. Additionally, neuro-imaging (positron emission tomography and functional magnetic resonance imaging) provides insights in brain mechanisms corresponding with mechanistic processes including allodynia, hyperalgesia, altered sensation, and spontaneous pain. A change in function, chemistry, and structures of neurons (neural plasticity) underlie the production of the altered sensitivity characteristics of neuropathic pain. Peripheral processes in neuropathic pain involve production of mediators (cytokines, protons, nerve growth factor), alterations in calcium channels, sodium channels, hyperpolarisation-activated nucleotide-gated ion channels, and potassium channels, phenotypic switches and sprouting of nerves endings, and involvement of the sympathetic nervous system. Stimulation of the N-Methyl-D-Aspartate receptor, activation of microglia, oligodendrocytes, and astrocytes, increased production of nerve growth factor and brain-derived neurotrophic factor together with loss of spinal inhibitory control are responsible for central neuron hyperexcitability and maintenance of neuropathic pain. Recent advances, including functional imaging techniques, in identification of peripheral and central sensitization mechanisms related to nervous system injury have increased potential for affecting pain research from both diagnostic as well as therapeutic view. Key brain regions involved in generating pharmacologically induced analgesia may be identified. Despite the progress in pain research, neuropathic pain is challenge to manage. Although numerous treatment options are available for relieving neuropathic pain, there is no consensus on the most appropriate treatment. However, recommendations can be proposed for first-line, second-line, and third-line pharmacological treatments based on the level of evidence for the different treatment strategies. Available therapies shown to be effective in managing neuropathic pain include opioids and tramadol, anticonvulsants, antidepressants, topical treatments (lidocaine patch, capsaicin), and ketamine. Tricyclic antidepressants are often the first drugs selected to alleviate neuropathic pain (first-line pharmacological treatment). Although they are very effective in reducing pain in several neuropathic pain disorders, treatment may be compromised (and outweighed) by their side effects. In patients with a history of cardiovascular disorders, glaucoma, and urine retention, pregabalin and gabapentine are emerging as first-line treatment for neuropathic pain. In addition these anti-epileptic drugs have a favourable safety profile with minimal concerns regarding drug interactions and showing no interference with hepatic enzymes. Alternatively, opioids (oxycodone and methadone) and tramadol may alleviate nociceptive and neuropathic pain. Despite the numerous treatment options available for relieving neuropathic pain, no more than half of patients experience clinically meaningful pain relief, which is almost always partial but not complete relief. In addition, patients frequently experience burdensome adverse effects and as a consequence are often unable to tolerate the treatment. In the remaining patients, combination therapies using two or more analgesics with different mechanisms of action may also offer adequate pain relief. Although combination treatment is clinical practice and may result in greater pain relief, trials regarding different combinations of analgesics (which combination to use, occurrence of additive or supra-additive effects, sequential or concurrent treatment, adverse-event profiles of these analgesics, alone and in combination) are scarce. If medical treatments have failed, invasive therapies such as intrathecal drug administr

  11. Factors contributing to pain chronicity

    Microsoft Academic Search

    Charlie K. Wang; Jennifer Myunghae Hah; Ian Carroll

    2009-01-01

    The chronicity of pain is the feature of pain that is least understood and most directly linked with our inability to effectively\\u000a manage pain. Acute pain is relatively responsive to our current pharmacologic and interventional armamentarium. However, as\\u000a pain persists, our ability to treat effectively diminishes and the patient’s frustration and resource utilization increases.\\u000a This article explores our current understanding

  12. Testing the relation between dispositional optimism and conditioned pain modulation: Does ethnicity matter?

    PubMed Central

    Goodin, Burel R.; Kronfli, Tarek; King, Christopher D.; Glover, Toni L.; Sibille, Kimberly; Fillingim, Roger B.

    2013-01-01

    Greater dispositional optimism has been related to less severe pain; however, whether optimism is associated with endogenous pain modulation has not yet been examined. The beneficial effects of dispositional optimism often vary according to cultural dynamics. Thus, assessing optimism-pain relationships across different ethnic groups is warranted. This study sought to examine the association between optimism and conditioned pain modulation (CPM), and test whether this association differs according to ethnicity. Optimism and CPM were assessed in a sample of healthy, ethnically diverse young adults. CPM was determined by comparing pressure pain thresholds obtained before and during exposure to a cold pressor task. All participants completed a validated measure of dispositional optimism. Greater reported optimism was significantly associated with enhanced CPM, and the strength of this association did not vary according to individuals’ ethnic background. These findings suggest that an optimistic disposition may potentiate endogenous pain inhibition. PMID:22367226

  13. Coloring geographical threshold graphs

    SciTech Connect

    Bradonjic, Milan [Los Alamos National Laboratory; Percus, Allon [Los Alamos National Laboratory; Muller, Tobias [EINDHOVEN UNIV. OF TECH

    2008-01-01

    We propose a coloring algorithm for sparse random graphs generated by the geographical threshold graph (GTG) model, a generalization of random geometric graphs (RGG). In a GTG, nodes are distributed in a Euclidean space, and edges are assigned according to a threshold function involving the distance between nodes as well as randomly chosen node weights. The motivation for analyzing this model is that many real networks (e.g., wireless networks, the Internet, etc.) need to be studied by using a 'richer' stochastic model (which in this case includes both a distance between nodes and weights on the nodes). Here, we analyze the GTG coloring algorithm together with the graph's clique number, showing formally that in spite of the differences in structure between GTG and RGG, the asymptotic behavior of the chromatic number is identical: {chi}1n 1n n / 1n n (1 + {omicron}(1)). Finally, we consider the leading corrections to this expression, again using the coloring algorithm and clique number to provide bounds on the chromatic number. We show that the gap between the lower and upper bound is within C 1n n / (1n 1n n){sup 2}, and specify the constant C.

  14. Treatment of localized neuropathic pain of different etiologies with the 5% lidocaine medicated plaster – a case series

    PubMed Central

    Likar, Rudolf; Demschar, Susanne; Kager, Ingo; Neuwersch, Stefan; Pipam, Wolfgang; Sittl, Reinhard

    2015-01-01

    Objective To assess the efficacy and safety of the topical 5% lidocaine medicated plaster in the treatment of localized neuropathic pain. Study design This was a case series at an Austrian pain clinic, using retrospective analysis. Patients and methods Data of 27 patients treated for localized neuropathic pain with the 5% lidocaine medicated plaster were retrospectively analyzed. Assessment included changes in overall pain intensity, in intensity of different pain qualities, and of hyperalgesia and allodynia, and changes in sleep quality. Results Patients (17 female, ten male; mean age 53.4±11.4 years) presented mainly with dorsalgia (16 patients) or postoperative/posttraumatic pain (seven patients); one patient suffered from both. The mean overall pain intensity prior to treatment with lidocaine medicated plaster was 8.4±1.2 on the 11-point Likert scale. In the majority of cases, the lidocaine plaster was applied concomitantly with preexisting pain medication (81.5% of the patients). During the 6-month observation period, overall mean pain intensity was reduced by almost 5 points (4.98) to 3.5±2.6. Substantial reductions were also observed for neuralgiform pain (5 points from 7.9±2.6 at baseline) and burning pain (3 points from 5.2±4.1). Sleep quality improved from 4.6±2.6 at baseline to 5.5±1.8. Stratification by pain diagnosis showed marked improvements in overall pain intensity for patients with dorsalgia or postoperative/posttraumatic pain. The lidocaine plaster was well tolerated. Conclusion Overall, topical treatment with the 5% lidocaine medicated plaster was associated with effective pain relief and was well tolerated. PMID:25565882

  15. 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.

  16. Pain as social glue: shared pain increases cooperation.

    PubMed

    Bastian, Brock; Jetten, Jolanda; Ferris, Laura J

    2014-11-01

    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

  17. Measurement properties of painDETECT by average pain severity

    PubMed Central

    Cappelleri, Joseph C; Bienen, E Jay; Koduru, Vijaya; Sadosky, Alesia

    2014-01-01

    Background Since the burden of neuropathic pain (NeP) increases with pain severity, it is important to characterize and quantify pain severity when identifying NeP patients. This study evaluated whether painDETECT, a screening questionnaire to identify patients with NeP, can distinguish pain severity. Materials and methods Subjects (n=614, 55.4% male, 71.8% white, mean age 55.5 years) with confirmed NeP were identified during office visits to US community-based physicians. The Brief Pain Inventory – Short Form stratified subjects by mild (score 0–3, n=110), moderate (score 4–6, n=297), and severe (score 7–10, n=207) average pain. Scores on the nine-item painDETECT (seven pain-symptom items, one pain-course item, one pain-irradiation item) range from ?1 to 38 (worst NeP); the seven-item painDETECT scores (only pain symptoms) range from 0 to 35. The ability of painDETECT to discriminate average pain-severity levels, based on the average pain item from the Brief Pain Inventory – Short Form (0–10 scale), was evaluated using analysis of variance or covariance models to obtain unadjusted and adjusted (age, sex, race, ethnicity, time since NeP diagnosis, number of comorbidities) mean painDETECT scores. Cumulative distribution functions on painDETECT scores by average pain severity were compared (Kolmogorov–Smirnov test). Cronbach’s alpha assessed internal consistency reliability. Results Unadjusted mean scores were 15.2 for mild, 19.8 for moderate, and 24.0 for severe pain for the nine items, and 14.3, 18.6, and 22.7, respectively, for the seven items. Adjusted nine-item mean scores for mild, moderate, and severe pain were 17.3, 21.3, and 25.3, respectively; adjusted seven-item mean scores were 16.4, 20.1, and 24.0, respectively. All pair-wise comparisons of scores between pain-severity groups showed sizable and statistically significant differences (P<0.0001). Cumulative distribution functions showed distinct separation between severity (P<0.0001). Cronbach’s alphas were 0.76 and 0.80 for the nine- and seven-item scales, respectively. Conclusion This study provides strong psychometric evidence on the validity and reliability of painDETECT for distinguishing average pain severity in patients with NeP. PMID:25395867

  18. Fentanyl buccal tablet for the treatment of cancer-related breakthrough pain.

    PubMed

    Mercadante, Sebastiano

    2015-01-01

    Fentanyl buccal tablet (FBT) (FENTORA) is indicated for the management of breakthrough pain (BTP) in patients with cancer pain and who are tolerant to ?60 mg of oral morphine equivalents, at least with the current availability of the minimal strength of 100 ?g. FBT uses the OraVescent technology to further increase the rate and extent of absorption of fentanyl. Short-term, randomized, controlled, clinical studies of FBT in patients with cancer pain have shown the efficacy of FBT in the management of breakthrough cancer pain. The efficacy was also confirmed in long-term studies on the safety and tolerability of FBT. It has been recommended that administration should be tailored to the patient's individual requirement, through dose titration starting from the lowest dose to find the effective dose. However, recent studies have demonstrated that predictable doses calculated from the basal opioid regimen are safe and more effective than doses achieved after dose titration. PMID:25359295

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

    NASA Astrophysics Data System (ADS)

    Zhou, Bingchang; McDonnell, Mark D.

    2015-02-01

    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.

  20. Gene Therapy for the Treatment of Chronic Peripheral Nervous System Pain

    PubMed Central

    Goins, William F.; Cohen, Justus B.; Glorioso, Joseph C.

    2012-01-01

    Chronic pain is a major health concern affecting 80 million Americans at some time in their lives with significant associated morbidity and effects on individual quality of life. Chronic pain can result from a variety of inflammatory and nerve damaging events that include cancer, infectious diseases, autoimmune-related syndromes and surgery. Current pharmacotherapies have not provided an effective long-term solution as they are limited by drug tolerance and potential abuse. These concerns have led to the development and testing of gene therapy approaches to treat chronic pain. The potential efficacy of gene therapy for pain has been reported in numerous pre-clinical studies that demonstrate pain control at the level of the spinal cord. This promise has been recently supported by a Phase-I human trial in which a replication-defective herpes simplex virus (HSV) vector was used to deliver the human pre-proenkephalin (hPPE) gene, encoding the natural opioid peptides met- and leu-enkephalin (ENK), to cancer patients with intractable pain resulting from bone metastases (Fink et al., 2011). The study showed that the therapy was well tolerated and that patients receiving the higher doses of therapeutic vector experienced a substantial reduction in their overall pain scores for up to a month post vector injection. These exciting early clinical results await further patient testing to demonstrate treatment efficacy and will likely pave the way for other gene therapies to treat chronic pain. PMID:22668775

  1. Emotional modulation of pain and spinal nociception in fibromyalgia

    PubMed Central

    Rhudy, Jamie L.; DelVentura, Jennifer L.; Terry, Ellen L.; Bartley, Emily J.; Olech, Ewa; Palit, Shreela; Kerr, Kara L.

    2013-01-01

    Fibromyalgia (FM) is characterized by widespread pain, as well as affective disturbance (e.g., depression). Given that emotional processes are known to modulate pain, a disruption of emotion and emotional modulation of pain and nociception may contribute to FM. The present study used a well-validated affective picture-viewing paradigm to study emotional processing and emotional modulation of pain and spinal nociception. Participants were 18 individuals with FM, 18 individuals with rheumatoid arthritis (RA), and 19 healthy pain-free controls (HC). Mutilation, neutral, and erotic pictures were presented in four blocks; two blocks assessed only physiological-emotional reactions (i.e., pleasure/arousal ratings, corrugator EMG, startle modulation, skin conductance) in the absence of pain and two blocks assessed emotional reactivity and emotional modulation of pain and the nociceptive flexion reflex (NFR, a physiological measure of spinal nociception) evoked by suprathreshold electric stimulations over the sural nerve. In general, mutilation pictures elicited displeasure, corrugator activity, subjective arousal, and sympathetic activation, whereas erotic pictures elicited pleasure, subjective arousal, and sympathetic activation. However, FM was associated with deficits in appetitive activation (e.g., reduced pleasure/arousal to erotica). Moreover, emotional modulation of pain was observed in HC and RA, but not FM, even though all three groups evidenced modulation of NFR. Additionally, NFR thresholds were not lower in the FM group, indicating a lack of spinal sensitization. Together, these results suggest that FM is associated with a disruption of supraspinal processes associated with positive affect and emotional modulation of pain, but not brain-to-spinal cord circuitry that modulates spinal nociceptive processes. PMID:23622762

  2. Gender differences in the effect of urge?to?cough and dyspnea on perception of pain in healthy adults

    PubMed Central

    Gui, Peijun; Ebihara, Takae; Sato, Ryuhei; Ito, Kumiko; Kohzuki, Masahiro; Ebihara, Satoru

    2014-01-01

    Abstract Previous studies have reported that respiratory sensations, such as urge?to?cough and dyspnea, have an inhibitory effect on pain. Considering the existence of gender differences in both urge?to?cough and pain, it is conceivable that a gender difference also exists in the analgesia induced by urge?to?cough. In this study, we evaluated gender differences in the pain perception response to urge?to?cough, as well as to dyspnea. Twenty?seven male and 26 female healthy nonsmokers were originally enrolled. Citric acid challenge was used to induce the urge?to?cough sensation, and dyspnea was elicited by inspiratory loaded breathing. Before and during inductions of these two respiratory sensations, perception of pain was assessed by the thermal pain threshold, and differences between men and women were compared. The thermal pain threshold in women (43.83 ± 0.17°C) was significantly lower than that in men (44.75 ± 0.28°C; P < 0.05) during the baseline period. Accompanying increases in both citric acid concentration and inspiratory resistive load, thermal pain threshold values significantly increased in both men and women. The average thermal pain threshold changes for comparable increases in the urge?to?cough Borg score were parallel between men and women. Furthermore, the mean value of the thermal pain threshold plotted against the dyspnea Borg score also showed no significant gender difference. These results demonstrate that although gender differences exist in respiratory sensations, that is, urge?to?cough and dyspnea, the inhibitory effects of these respiratory sensations on the perception of pain are not significantly different between the sexes. PMID:25168875

  3. Sulfur tolerant anode materials

    SciTech Connect

    Not Available

    1987-02-01

    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.

  4. Pruritus associated with onabotulinumtoxina treatment of neuromuscular pain.

    PubMed

    Ho, Derek; Jagdeo, Jared

    2015-02-01

    OnabotulinumtoxinA is one of the most widely used agents for cosmetic and medical treatment. Studies have shown that onabotulinumtoxinA is safe and effective with minimal adverse events, and is often well tolerated by patients. We present a patient who developed neuropathic pruritus five days after treatment with onabotulinumtoxinA for neuromuscular pain. This case highlights the treatment of pruritus associated with onabotulinumtoxinA and the therapeutic method to resolve the patient's pruritus. PMID:25689816

  5. The cancer pain experience of Israeli adults 65 years and older: the influence of pain interference, symptom severity, and knowledge and attitudes on pain and pain control

    Microsoft Academic Search

    Marlene Z. Cohen; Catherine F. Musgrave; Deborah B. McGuire; Neville E. Strumpf; Mark F. Munsell; Tito R. Mendoza; Maya Gips

    2005-01-01

    Goals: Little is known about Israeli elders' cancer pain ex- perience. The purpose of this study was to explore the cancer pain expe- rience, including pain intensity, pain management index, pain interference, symptom severity, and knowledge and attitudes toward pain and pain control. Patients and methods: Descriptive cross-sectional methods were used to obtain data with four instruments. The patients were

  6. [Intrathecal morphine treatment in advanced cancer pain patients].

    PubMed

    Hattori, Seiji; Sano, Hiromi; Tanaka, Kiyotaka; Yokota, Miyuki

    2009-11-01

    For more than 20 years morphine for spinal analgesia in patients with refractory cancer pain has been one of the cornerstones for the management of chronic, medically intractable pain. In general, most types of cancer pain are treatable following the guideline of Cancer Pain Relief well established by the WHO. However, some patient are unable to tolerate pain only following the guideline and often suffer with side-effects from high doses of opioid and from prescribed multiple adjuvant drugs. Due to the proximity to the receptor sites, the therapeutic efficacy of intrathecal opioid application lasts longer and also reduces systemic side effects. Intrathecal drug application is cost effective and can significantly improve the quality of life in selected patients with limited life expectancy. However, an intensive training of physicians, careful patient selection, awareness of specific complications, and arrangement of social back-up medical system are essential to commence intrathecal morphine application using implantable access port. This article introduces the basic idea of intrathecal morphine therapy with implantable access port (not pumps) as cost effective, alternative therapy for cancer patient suffering from intractable pain. PMID:19928505

  7. Pregabalin in Neuropathic Pain: Evidences and Possible Mechanisms

    PubMed Central

    Verma, Vivek; Singh, Nirmal; Singh Jaggi, Amteshwar

    2014-01-01

    Pregabalin is an antagonist of voltage gated Ca2+ channels and specifically binds to alpha-2-delta subunit to produce antiepileptic and analgesic actions. It successfully alleviates the symptoms of various types of neuropathic pain and presents itself as a first line therapeutic agent with remarkable safety and efficacy. Preclinical studies in various animal models of neuropathic pain have shown its effectiveness in treating the symptoms like allodynia and hyperalgesia. Clinical studies in different age groups and in different types of neuropathic pain (peripheral diabetic neuropathy, fibromyalgia, post-herpetic neuralgia, cancer chemotherapy-induced neuropathic pain) have projected it as the most effective agent either as monotherapy or in combined regimens in terms of cost effectiveness, tolerability and overall improvement in neuropathic pain states. Preclinical studies employing pregabalin in different neuropathic pain models have explored various molecular targets and the signaling systems including Ca2+ channel-mediated neurotransmitter release, activation of excitatory amino acid transporters (EAATs), potassium channels and inhibition of pathways involving inflammatory mediators. The present review summarizes the important aspects of pregabalin as analgesic in preclinical and clinical studies as well as focuses on the possible mechanisms. PMID:24533015

  8. Identifying specific profiles in patients with different degrees of painful knee osteoarthritis based on serological biochemical and mechanistic pain biomarkers: a diagnostic approach based on cluster analysis.

    PubMed

    Egsgaard, Line Lindhardt; Eskehave, Thomas Navndrup; Bay-Jensen, Anne C; Hoeck, Hans Christian; Arendt-Nielsen, Lars

    2015-01-01

    Biochemical and pain biomarkers can be applied to patients with painful osteoarthritis profiles and may provide more details compared with conventional clinical tools. The aim of this study was to identify an optimal combination of biochemical and pain biomarkers for classification of patients with different degrees of knee pain and joint damage. Such profiling may provide new diagnostic and therapeutic options. A total of 216 patients with different degrees of knee pain (maximal pain during the last 24 hours rated on a visual analog scale [VAS]) (VAS 0-100) and 64 controls (VAS 0-9) were recruited. Patients were separated into 3 groups: VAS 10 to 39 (N = 81), VAS 40 to 69 (N = 70), and VAS 70 to 100 (N = 65). Pressure pain thresholds, temporal summation to pressure stimuli, and conditioning pain modulation were measured from the peripatellar and extrasegmental sites. Biochemical markers indicative for autoinflammation and immunity (VICM, CRP, and CRPM), synovial inflammation (CIIIM), cartilage loss (CIIM), and bone degradation (CIM) were analyzed. WOMAC, Lequesne, and pain catastrophizing scores were collected. Principal component analysis was applied to select the optimal variable subset, and cluster analysis was applied to this subset to create distinctly different knee pain profiles. Four distinct knee pain profiles were identified: profile A (N = 27), profile B (N = 59), profile C (N = 85), and profile D (N = 41). Each knee pain profile had a unique combination of biochemical markers, pain biomarkers, physical impairments, and psychological factors that may provide the basis for mechanism-based diagnosis, individualized treatment, and selection of patients for clinical trials evaluating analgesic compounds. These results introduce a new profiling for knee OA and should be regarded as preliminary. PMID:25599306

  9. Treatment of Intractable Pain with Topical Large-Dose Capsaicin: Preliminary Report

    Microsoft Academic Search

    Wendye R. Robbins; Peter S. Staats; Jon Levine

    1998-01-01

    Complex regional pain syndromes (CRPS) and neuro- pathic pain are often poorly controlled by conventional pharmacologic interventions. We administered g-methyl- N-vanillyl-6-noneamide (capsaicin) at doses of 5%-10% to individuals with such disorders in this trial. Previous lim- itations to trials with larger-dose, topical concentrations of caps&in included intense burning sensations experi- enced after application. To enable patients to tolerate the high

  10. Oxycodone for Cancer-Related Pain Meta-analysis of Randomized Controlled Trials

    Microsoft Academic Search

    Colette M. Reid; Richard M. Martin; Jonathan A. C. Sterne; Andrew N. Davies; Geoffrey W. Hanks; Susmita Mallik; John A. Spertus; Kimberly J. Reid; Harlan M. Krumholz; John S. Rumsfeld; William S. Weintraub; Purva Agarwal; Mugdha Santra; Savita Bidyasar; Judith H. Lichtman; Nanette K. Wenger; Viola Vaccarino; James R. Madison; Christian Spies; Irwin J. Schatz; Kamal Masaki; Randi Chen; Katsuhiko Yano; J. David Curb

    2006-01-01

    o evaluate the efficacy and tolerability of oxycodone in cancer-related pain, we con- ducted a systematic review of randomized controlled trials. Four studies, comparing oral oxycodone with either oral morphine (n=3) or oral hydromorphone (n=1), were suit- able for meta-analysis. Standardized mean differences in pain scores comparing oxy- codone with control groups were pooled using random-effects models. Overall, there was

  11. Are Phytochelatins Involved in Differential Metal Tolerance or Do They Merely Reflect Metal-Imposed Strain?

    PubMed Central

    Schat, Henk; Kalff, Mechteld M. A.

    1992-01-01

    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

  12. Oscillatory Threshold Logic

    PubMed Central

    Borresen, Jon; Lynch, Stephen

    2012-01-01

    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

  13. Cold-evoked pain varies with skin type and cooling rate: a psychophysical study in humans.

    PubMed

    Harrison, J L; Davis, K D

    1999-11-01

    The psychophysical responses to noxious cold stimulation of the skin in normal human subjects are not well understood. Continuous pain ratings with the visual analogue scale is an important method to assess these responses. In this study, we addressed several important issues about the parameters with which stimuli are delivered: the type of skin stimulated, the rate with which the stimulus temperature decreases, and the dimension of the pain rated by subjects. Cold stimuli were delivered to the thenar eminence (glabrous skin) and the dorso-lateral hand (hairy skin) via a 4 cm(2) Peltier-type stimulator. Cold and pain thresholds were determined by the method of limits (MOL). A computerized visual analogue scale (VAS) was used to obtain continuous ratings of pain intensity and affect. The McGill Pain Questionnaire (MPQ) was used to assess the quality of cold-evoked pain. Supra-threshold stimuli (34 degrees C base) were delivered at 0.5, 1 or 2 degrees C/s to 2 degrees C, held for 20s and returned to baseline at 9 degrees C/s. These studies revealed: (1) Cold thresholds, measured with MOL, were lower (i.e. occurred at higher absolute temperatures) for the hairy skin of the dorso-lateral hand compared to the glabrous skin of the thenar eminence. (2) A similar pattern was evident for cold induced pain thresholds with MOL at 1.5 degrees C/s and with intensity and affect VAS scales at 0.5 and 1 degrees C/s. (3) Exponents for supra-threshold ratings fit to power functions were larger for the glabrous skin site than the hairy skin site regardless of cooling rate or dimension of pain measured. (4) All pain indices were higher for slower cooling rates. (5) No significant differences were found in the pain indices for pain ratings of intensity and affect. (6) A substantial proportion of subjects chose words representing paradoxical heat with the MPQ. (7) Painful paradoxical heat sensations occurred most often during cooling, while innocuous warm sensations mainly occurred during the rewarming phase. PMID:10534583

  14. Lipid kinases as therapeutic targets for chronic pain.

    PubMed

    Loo, Lipin; Wright, Brittany D; Zylka, Mark J

    2015-04-01

    Existing analgesics are not efficacious in treating all patients with chronic pain and have harmful side effects when used long term. A deeper understanding of pain signaling and sensitization could lead to the development of more efficacious analgesics. Nociceptor sensitization occurs under conditions of inflammation and nerve injury where diverse chemicals are released and signal through receptors to reduce the activation threshold of ion channels, leading to an overall increase in neuronal excitability. Drugs that inhibit specific receptors have so far been unsuccessful in alleviating pain, possibly because they do not simultaneously target the diverse receptors that contribute to nociceptor sensitization. Hence, the focus has shifted toward targeting downstream convergence points of nociceptive signaling. Lipid mediators, including phosphatidylinositol 4,5-bisphosphate (PIP2), are attractive targets, as these molecules are required for signaling downstream of G-protein-coupled receptors and receptor tyrosine kinases. Furthermore, PIP2 regulates the activity of various ion channels. Thus, PIP2 sits at a critical convergence point for multiple receptors, ion channels, and signaling pathways that promote and maintain chronic pain. Decreasing the amount of PIP2 in neurons was recently shown to attenuate pronociceptive signaling and could provide a novel approach for treating pain. Here, we review the lipid kinases that are known to regulate pain signaling and sensitization and speculate on which additional lipid kinases might regulate signaling in nociceptive neurons. PMID:25789432

  15. Descending Facilitation Maintains Long-term Spontaneous Neuropathic Pain

    PubMed Central

    Wang, Ruizhong; King, Tamara; De Felice, Milena; Guo, Wenhong; Ossipov, Michael H.; Porreca, Frank

    2014-01-01

    Neuropathic pain is frequently characterized by spontaneous pain (i.e. pain at rest) and in some cases, cold and touch-induced allodynia. Mechanisms underlying the chronicity of neuropathic pain are not well understood. Rats received spinal nerve ligation (SNL) and were monitored for tactile and thermal thresholds. While heat hypersensitivity returned to baseline levels within approximately 35-40 days tactile hypersensitivity was still present at 580 days after SNL. Tactile hypersensitivity at post-SNL day 60 (D60) was reversed by microinjection of (a) lidocaine or (b) a CCK2 receptor antagonist into the rostral ventromedial medulla (RVM) or (c) dorsolateral funiculus (DLF) lesion. RVM lidocaine at D60 or spinal ondansetron, a 5HT3 antagonist, at post-SNL day 42 produced conditioned place preference (CPP) selectively in SNL treated rats, suggesting long-lasting spontaneous pain. Touch-induced FOS was increased in the spinal dorsal horn of SNL rats at D60 and prevented by prior DLF lesion suggesting that long-lasting tactile hypersensitivity depends upon spinal sensitization, which is mediated in part, by descending facilitation, in spite of resolution of heat hypersensitivity. Perspective These data suggest that spontaneous pain is present for an extended period of time and, consistent with likely actions of clinically effective drugs, is maintained by descending facilitation. PMID:23602267

  16. Restless legs syndrome and pain disorders: what's in common?

    PubMed

    Goulart, Leonardo Ierardi; Delgado Rodrigues, Raimundo Nonato; Prieto Peres, Mario Fernando

    2014-11-01

    Between 10 % and 30 % of the population report chronic pain. More than half of these also have sleep complaints. From considering these data, it can be inferred there is a significant overlapping between these conditions. Restless Legs Syndrome/Willis-Ekbom Disease (RLS/WED) is characterized by complaints of an "urge to move" frequently associated with dysesthesias. From that perspective, these sensations can also have painful characteristics. By the same token, the presence of comorbid diseases as predicted by a higher prevalence RLS/WED, have many of them with pain as an important complaint. Pain is a multidimensional response involving several levels of expression ranging from somatosensory to emotional. The potential shared mechanisms between RLS/WED and pain may involve sleep deprivation/fragmentation effect, inducing an increase in markers of inflammation and reduction in pain thresholds. These are modulated by several different settings of neurotransmitters with a huge participation of monoaminergic dysfunctional circuits. A thorough comprehension of these mechanisms is of utmost importance for the correct approach and treatment choices. PMID:25249423

  17. CLASSICAL CONDITIONING AND PAIN: CONDITIONED ANALGESIA AND HYPERALGESIA

    PubMed Central

    Miguez, Gonzalo; Laborda, Mario A.; Miller, Ralph R.

    2013-01-01

    This article reviews situations in which stimuli produce an increase or a decrease in nociceptive responses through basic associative processes and provides an associative account of such changes. Specifically, the literature suggests that cues associated with stress can produce conditioned analgesia or conditioned hyperalgesia, depending on the properties of the conditioned stimulus (e.g., contextual cues and audiovisual cues vs. gustatory and olfactory cues, respectively) and the proprieties of the unconditioned stimulus (e.g., appetitive, aversive, or analgesic, respectively). When such cues are associated with reducers of exogenous pain (e.g., opiates), they typically increase sensitivity to pain. Overall, the evidence concerning conditioned stress-induced analgesia, conditioned hyperalagesia, conditioned tolerance to morphine, and conditioned reduction of morphine analgesia suggests that selective associations between stimuli underlie changes in pain sensitivity. PMID:24269884

  18. [Nursing aspects in pain treatment].

    PubMed

    Sundqvist, A

    1994-01-01

    Pain, the concept of pain and how pain is connected with culture are discussed in this article. The experience of pain in individual. It can not be questioned. The primary task of nursing is to help and support a patient to cope with pain in spite of the fact whether there is a cause for pain or not. Besides pharmacotherapy there are other possibilities to help a patient, e.g. by taking care of the surroundings, offering interesting subjects to think about, using imagination, relaxation, cognitive behavioral therapy, massage, therapeutic touch and thermat and cryotherapy. PMID:8054647

  19. Role of intracellular calcium in acute thermal pain perception

    Microsoft Academic Search

    Nicoletta Galeotti; Alessandro Bartolini; Carla Ghelardini

    2004-01-01

    The role of intracellular calcium in acute thermal nociception was investigated in the mouse hot-plate test. Intracerebroventricular (i.c.v.) administration of TMB-8, a blocker of Ca++ release from intracellular stores, produced hypernociception. By contrast, i.c.v. pretreatment with thapsigargin, a depletor of Ca++ intracellular stores, produced an increase of the mouse pain threshold. Furthermore, non-analgesic doses of thapsigargin prevented the hypernociception produced

  20. Improving crop salt tolerance

    Microsoft Academic Search

    T. J. Flowers

    2004-01-01

    Salinity is an ever-present threat to crop yields, especially in countries where irrigation is an essential aid to agriculture. Although the tolerance of saline conditions by plants is variable, crop species are generally intolerant of one-third of the concentration of salts found in seawater. Attempts to improve the salt tolerance of crops through conventional breeding programmes have met with very

  1. Practical Byzantine Fault Tolerance

    Microsoft Academic Search

    Miguel Castro; Barbara Liskov

    1999-01-01

    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

  2. SFT: scalable fault tolerance

    Microsoft Academic Search

    Fabrizio Petrini; Jarek Nieplocha; Vinod Tipparaju

    2006-01-01

    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

  3. Emotional modulation of pain and spinal nociception in persons with major depressive disorder (MDD)

    PubMed Central

    Terry, Ellen L.; DelVentura, Jennifer L.; Bartley, Emily J.; Vincent, Ashley; Rhudy, Jamie L.

    2013-01-01

    Major depressive disorder (MDD) is associated with risk for chronic pain, but the mechanisms contributing to the MDD and pain relationship are unclear. To examine whether disrupted emotional modulation of pain might contribute, this study assessed emotional processing and emotional modulation of pain in healthy controls and unmedicated persons with MDD (14 MDD, 14 controls). Emotionally-charged pictures (erotica, neutral, mutilation) were presented in four blocks. Two blocks assessed physiological-emotional reactions (pleasure/arousal ratings, corrugator EMG, startle modulation, skin conductance) in the absence of pain and two blocks assessed emotional modulation of pain and the nociceptive flexion reflex (NFR, a physiological measure of spinal nociception) evoked by suprathreshold electric stimulations. Results indicated pictures generally evoked the intended emotional responses; erotic pictures elicited pleasure, subjective arousal, and smaller startle magnitudes, whereas mutilation pictures elicited displeasure, corrugator EMG activation, and subjective/physiological arousal. However, emotional processing was partially disrupted in MDD as evidenced by a blunted pleasure response to erotica and a failure to modulate startle according to a valence linear trend. Furthermore, emotional modulation of pain was observed in controls, but not MDD, even though there were no group differences in NFR threshold or emotional modulation of NFR. Together, these results suggest supraspinal processes associated with emotion processing and emotional modulation of pain may be disrupted in MDD, but brain-to-spinal cord processes that modulate spinal nociception are intact. Thus, emotional modulation of pain deficits may be a phenotypic marker for future pain risk in MDD. PMID:23954763

  4. Emotional modulation of pain and spinal nociception in persons with major depressive disorder (MDD).

    PubMed

    Terry, Ellen L; DelVentura, Jennifer L; Bartley, Emily J; Vincent, Ashley L; Rhudy, Jamie L

    2013-12-01

    Major depressive disorder (MDD) is associated with risk for chronic pain, but the mechanisms contributing to the MDD and pain relationship are unclear. To examine whether disrupted emotional modulation of pain might contribute, this study assessed emotional processing and emotional modulation of pain in healthy controls and unmedicated persons with MDD (14 MDD, 14 controls). Emotionally charged pictures (erotica, neutral, mutilation) were presented in 4 blocks. Two blocks assessed physiological-emotional reactions (pleasure/arousal ratings, corrugator electromyography (EMG), startle modulation, skin conductance) in the absence of pain and 2 blocks assessed emotional modulation of pain and the nociceptive flexion reflex (NFR, a physiological measure of spinal nociception) evoked by suprathreshold electric stimulations. Results indicated pictures generally evoked the intended emotional responses; erotic pictures elicited pleasure, subjective arousal, and smaller startle magnitudes, whereas mutilation pictures elicited displeasure, corrugator EMG activation, and subjective/physiological arousal. However, emotional processing was partially disrupted in MDD, as evidenced by a blunted pleasure response to erotica and a failure to modulate startle according to a valence linear trend. Furthermore, emotional modulation of pain was observed in controls but not MDD, even though there were no group differences in NFR threshold or emotional modulation of NFR. Together, these results suggest supraspinal processes associated with emotion processing and emotional modulation of pain may be disrupted in MDD, but brain to spinal cord processes that modulate spinal nociception are intact. Thus, emotional modulation of pain deficits may be a phenotypic marker for future pain risk in MDD. PMID:23954763

  5. Pressure and Activity-Related Allodynia in Delayed-Onset Muscle Pain

    PubMed Central

    Dannecker, Erin A.; Sluka, Kathleen A.

    2010-01-01

    Objectives Muscle pain from different activities was tested with the muscle pain expected to vary in ways that may clarify mechanisms of activity-induced exacerbation of myofascial pain. Methods Participants (N = 20; 45% women; 23 years old (SD = 2.09)) consented to participate in a six session protocol. Bilateral muscle pain ratings and pressure pain thresholds (PPTs) were collected before and for 4 days after lengthening (i.e., eccentric) muscle contractions were completed with the non-dominant elbow flexors to induce delayed-onset muscle pain. The muscle pain ratings were collected with the arms in several conditions (e.g., resting, moving, contracting in a static position) and PPTs were collected with the arms. Results In the ipsilateral arm, muscle pain ratings at rest and during activity significantly increased while PPTs significantly decreased after the eccentrics (? 2s = .17 – .54). The greatest increases in pain occurred during arm extension without applied load, in which there was more stretching but less force than isometrics. In the contralateral arm, neither muscle pain nor PPTs changed from baseline. Discussion These results resemble previous electrophysiology studies showing differential sensitization across stimuli and support that increased depth of information about aggravating activities from clinical patients is needed. PMID:20842023

  6. Low back pain.

    PubMed Central

    Frank, A

    1993-01-01

    The studies reviewed here show that the duration and severity of individual episodes of back pain can be lessened, reducing recurrences and their cost in terms of suffering and lost work. Frank examines differential diagnosis; acute, chronic, and intractable pain; and service implications. Modern management emphasises self care, and bed rest should usually not be longer than 48 hours. A return to physical fitness and other activities, including employment, is actively encouraged. Medication has a role in facilitating these objectives. Two points are especially emphasised: strategies to manage low back pain must be long term and preventive; and the responsibility to keep fit, maintain an exercise programme, and remain relaxed so as to avoid physically stressing the spine is that of the individual, not of the professionals. Images FIG 2 PMID:8347190

  7. [Pain and Christianity. A symbol for overcoming pain?].

    PubMed

    Markschies, C

    2007-08-01

    Pain and Christianity appear to belong together: Christ's pain stands at the centre of God's healing; his pain leads to the salvation of mankind. We can learn from Jesus' example how to bear suffering and pain. In early Christian times, the belief that Jesus Christ suffered pain on the cross was usually not accepted. In line with the "apathy axiom", freedom from emotion was something to strive for at that time. Only after the acceptance of Christianity as the state religion of the Roman Empire in 380 AD did the pain of Christ again stand in the centre of the Christian doctrine of salvation. The memory of the fact that Jesus himself had to undergo the worst pain can still help people to overcome their pain and comfort them. PMID:17674055

  8. Sweet taste and menthol increase cough reflex thresholds.

    PubMed

    Wise, Paul M; Breslin, Paul A S; Dalton, Pamela

    2012-06-01

    Cough is a vital protective reflex that is triggered by both mechanical and chemical stimuli. The current experiments explored how chemosensory stimuli modulate this important reflex. Cough thresholds were measured using a single-inhalation capsaicin challenge. Experiment 1 examined the impact of sweet taste: Cough thresholds were measured after rinsing the mouth with a sucrose solution (sweet) or with water (control). Experiment 2 examined the impact of menthol: Cough thresholds were measured after inhaling headspace above a menthol solution (menthol vapor) or headspace above the mineral oil solvent (control). Experiment 3 examined the impact of rinsing the mouth with a (bitter) sucrose octaacetate solution. Rinsing with sucrose and inhaling menthol vapor significantly increased measured cough thresholds. Rinsing with sucrose octaacete caused a non-significant decrease in cough thresholds, an important demonstration of specificity. Decreases in cough reflex sensitivity from sucrose or menthol could help explain why cough syrups without pharmacologically active ingredients are often almost as effective as formulations with an added drug. Further, the results support the idea that adding menthol to cigarettes might make tobacco smoke more tolerable for beginning smokers, at least in part, by reducing the sensitivity of an important airway defense mechanism. PMID:22465565

  9. Accepting pain management or seeking pain cure: an exploration of patients' attitudes to chronic pain.

    PubMed

    Clarke, Kathryn A; Iphofen, Ron

    2007-06-01

    This article explores the differing attitudes of patients toward chronic pain. Because pain is a subjective experience, individuals react to living with chronic pain in varying ways. Some patients successfully manage their chronic pain, whereas others continue to seek a pain cure. A convenience sample (n = 8) was generated from a district general hospital's nurse-led pain clinic. The sample was subdivided by an expert panel rating procedure into two groups: those accepting pain management and those seeking a pain cure. The study used a multimethod approach comprising extended, highly focused interviews coupled with patients' diaries and drawing on a phenomenologic theoretical framework. Initial hermeneutic data analysis provided emerging themes: "rules for living," "pain = life," and "acceptance" for the pain management group, and "pillar to post," "self-fulfilling prophecy," and "mood" for those seeking a cure. Thematic content common to both groups were "family" and "coping strategies." These themes illustrate some differences and similarities between those who manage pain compared with those who seek a pain cure. Phenomenologically based research findings can rarely be generalized, but they enlighten and highlight the need for further research to generate detailed understanding of why some patients with chronic pain can accept pain management and others relentlessly seek a cure that is frequently not possible. PMID:17544130

  10. Intrathecal administration of doxepin attenuated development of formalin-induced pain in rats

    Microsoft Academic Search

    J. Wordliczek; M. Banach; D. Labuz; B. Przewlocka

    2005-01-01

    Summary. The aim of the present research was to assess the influence of a tricyclic antidepressant doxepin administered intrathecally (i.t.) on the pain behavior in the formalin test (100?µl of 12% formalin was injected into the dorsal part of the hind paw under halotane anesthesia) in male Wistar rats. The influence of doxepin (62.5?µg i.t.) on the pain threshold and

  11. Middle and long latency somatosensory evoked potentials after painful laser stimulation in patients with fibromyalgia syndrome

    Microsoft Academic Search

    J. Lorenz; K. Grasedyck; B. Bromm

    1996-01-01

    Ten femalespatients with fibromyalgia syndrome (FS) were investigated with laser evoked potentials (LEPs) after hand stimulations and compared with 10 female pain-free and age-matched control patients. FS patients exhibited significantly lower heat pain thresholds than controls (P < 0.05) and had higher amplitudes of LEP components N170 (P < 0.01) and P390 (P < 0.05) in response to intensities of

  12. Teaching Tolerance Magazine

    NSDL National Science Digital Library

    The Teaching Tolerance magazine, which is put out by the Southern Poverty Law Center to accompany its free Teaching Tolerance educational program, is available online via the website dedicated to the Teaching Tolerance program. The magazine is loaded with wonderful information and creative ways to teach tolerance. Visitors can view the magazine's archives and read the articles online for free. If the thoughtful content and depth with which the Southern Poverty Law Center supports their Teaching Tolerance program isn't enough to convince visitors that it's a superb program, check out this quote from their "About Us" section: "Scientific surveys demonstrate that our programs help students learn respect for differences and bolster teacher practice."

  13. Tolerance Induction in Liver

    PubMed Central

    Karimi, M. H.; Geramizadeh, B.; Malek-Hosseini, S. A.

    2015-01-01

    Liver is an exclusive anatomical and immunological organ that displays a considerable tolerance effect. Liver allograft acceptance is shown to occur spontaneously within different species. Although in human transplant patients tolerance is rarely seen, the severity level and cellular mechanisms of transplant rejection vary. Non-paranchymal liver cells, including Kupffer cells, liver sinusoidal endothelial cells, hepatic stellate cells, and resident dendritic cells may participate in liver tolerogenicity. The mentioned cells secret anti-inflammatory cytokines such as TGF-? and IL-10 and express negative co-stimulatory molecules like PD-L1 to mediate immunosuppression. Other mechanisms such as microchimerism, soluble major histocompatibility complex and regulatory T cells may take part in tolerance induction. Understanding the mechanisms involved in liver transplant rejection/tolerance helps us to improve therapeutic options to induce hepatic tolerance.

  14. Chronic noncancer pain

    PubMed Central

    Mailis-Gagnon, Angela; Lakha, S. Fatima; Ou, Ting; Louffat, Ada; Yegneswaran, Balaji; Umana, Margarita; Cohodarevic, Tea; Nicholson, Keith; Deshpande, Amol

    2011-01-01

    Abstract Objective To describe the characteristics of patients with chronic noncancer pain (CNCP) prescribed opioids by community physicians and referred to a tertiary pain clinic. Design Cross-sectional, descriptive study. Setting A tertiary care, hospital-based pain clinic in Toronto, Ont. Participants A total of 455 consecutive patients newly referred to the pain clinic by community physicians. Main outcome measures Data on demographic characteristics, pain ratings, and medication intake were obtained using standardized collection forms and retrospective chart review. Patients were classified by diagnosis: group 1 patients had biomedical disorders only, group 2 patients had biomedical disorders and psychological factors, and group 3 patients had psychological factors only. Patients were also categorized based on opioid use: no opioid use (NOU); low opioid use (LOU), with a daily morphine-equivalent dosage (MED) of 200 mg or less; or high opioid use (HOU), with a daily MED of more than 200 mg. Results In the general study population, 63% of patients were taking opioids, with 1 in 5 exceeding an MED of 200 mg daily. In group 1, 59% of patients used opioids and 10% had HOU; 66% of patients in groups 2 and 3 were taking opioids, with 21% and 26% classified as having HOU. The mean (SD) daily MED for groups 2 and 3 HOU patients combined was significantly higher than that of group 1 HOU patients: 575.7 (472.9) mg/d versus 284.9 (74.6) mg/d, respectively. Men were twice as likely as women to have HOU; Canadian-born patients were 3 times as likely as foreign-born patients to have HOU. Psychoactive drugs were coprescribed in 61% of LOU patients and 76% of HOU patients. Greater opioid use was associated with group 2 and 3 diagnoses, male sex, Canadian-born origin, and high pain scores. Conclusion Our results indicate that male, Canadian-born CNCP patients presenting with psychological morbidity or comorbidity and reporting higher pain severity ratings were more likely to receive opioids. Additionally, many CNCP patients referred to our tertiary care pain clinic were receiving opioids in excess of a 200-mg/d MED. More studies are needed to determine which factors lead to high-dose opioid prescribing in a subset of this CNCP population. PMID:21402957

  15. [Greater trochanteric pain syndrome].

    PubMed

    Nissen, M J; Genevay, S

    2015-03-11

    Trochanteric bursitis, also known as "greater trochanter pain syndrome", is a frequent and often under-diagnosed cause of pain in the lateral hip region. The diagnosis is essentially based on the clinical examination; however various forms of imaging may be useful to confirm the diagnosis and particularly to ex- clude other aetiologies. The different therapeutic options include non-steroidal anti-inflammatories, physiotherapy, local injections of cortisone and local anaesthetic, and extra-corporeal shock wave therapy. Surgical intervention is only indicated in rare cases. PMID:25946869

  16. Discogenic pain in acute nonspecific low-back pain

    Microsoft Academic Search

    Hironori Hyodo; Tetsuro Sato; Hirotoshi Sasaki; Yasuhisa Tanaka

    2005-01-01

    Acute nonspecific low-back pain is characterized by the sudden onset and severe unendurable low-back pain without radicular pain or neurological deficit in the lower extremities. The study was carried out using 55 patients who visited our hospital for acute nonspecific low-back pain, who exhibited degeneration on T2-weighted MR images, and underwent intradiscal injection of local anesthetics,steroid and contrast medium. Intervertebral

  17. Low Back Pain: Where Does the Pain Come From?

    Microsoft Academic Search

    Helena Brisby

    \\u000a The pain mechanisms in patients with low back pain are unclear. Different theories exist about the mechanisms behind the experienced\\u000a pain, and different originating tissues are suggested to be of importance. The mechanisms in acute low back pain with recovery\\u000a within a few days are believed to be totally different compared to those in more long-standing (usually referred to as

  18. New advances in musculoskeletal pain

    PubMed Central

    Bove, Susan E.; Flatters, Sarah J.L.; Inglis, Julia J.; Mantyh, Patrick W.

    2015-01-01

    Non-malignant musculoskeletal pain is the most common clinical symptom that causes patients to seek medical attention and is a major cause of disability in the world. Musculoskeletal pain can arise from a variety of common conditions including osteoarthritis, rheumatoid arthritis, osteoporosis, surgery, low back pain and bone fracture. A major problem in designing new therapies to treat musculoskeletal pain is that the underlying mechanisms driving musculoskeletal pain are not well understood. This lack of knowledge is largely due to the scarcity of animal models that closely mirror the human condition which would allow the development of a mechanistic understanding and novel therapies to treat this pain. To begin to develop a mechanism-based understanding of the factors involved in generating musculoskeletal pain, in this review we present recent advances in preclinical models of osteoarthritis, post-surgical pain and bone fracture pain. The models discussed appear to offer an attractive platform for understanding the factors that drive this pain and the preclinical screening of novel therapies to treat musculoskeletal pain. Developing both an understanding of the mechanisms that drive persistent musculoskeletal pain and novel mechanism-based therapies to treat these unique pain states would address a major unmet clinical need and have significant clinical, economic and societal benefits. PMID:19166876

  19. Urine drug testing in chronic pain.

    PubMed

    Christo, Paul J; Manchikanti, Laxmaiah; Ruan, Xiulu; Bottros, Michael; Hansen, Hans; Solanki, Daneshvari R; Jordan, Arthur E; Colson, James

    2011-01-01

    Therapeutic use, overuse, abuse, and diversion of controlled substances in managing chronic non-cancer pain continue to be an issue for physicians and patients. The challenge is to eliminate or significantly curtail abuse of controlled prescription drugs while still assuring the proper treatment of those patients. Some physicians are apprehensive regarding the use of chronic opioid therapy in chronic non-cancer pain due to a perceived lack of proven evidence, the misuse of opioids, tolerance, dependence, and hyperalgesia. However, others have criticized the underuse of opioids, resulting in the undertreatment of pain. It has been the convention that federal, state, and local governments; professional associations; as well as pharmaceutical companies, physicians, accrediting bodies, medical licensure boards, and the public all share responsibility for preventing abuse of controlled prescription drugs. To overcome the critical challenge of eliminating or significantly curtailing abuse of controlled prescription drugs and at the same time assuring the appropriate treatment for those patients who can be helped by these medications, it is crucial to practice adherence or compliance monitoring of opioid therapy. Compliance monitoring has been shown to be crucial in delivering proper opioid therapy and preserving this therapy for the future. Urine drug testing (UDT) is considered one of the mainstays of adherence monitoring in conjunction with prescription monitoring programs and other screening tools, however, UDT is associated with multiple limitations secondary to potential pitfalls related to drug metabolism, reliability of the tests, and the knowledge of the pain physician. UDT is a widely available and familiar method for monitoring opioid use in chronic pain patients. UDT can provide tools for tracking patient compliance and expose possible drug misuse and abuse. UDT is one of the major tools of adherence monitoring in the assessment of the patient's predisposition to, and patterns of, drug misuse/abuse--a vital first step towards establishing and maintaining the safe and effective use of opioid analgesics in the treatment of chronic pain. This comprehensive review provides the role of UDT in monitoring chronic opioid therapy along with reliability and accuracy, appropriate use, overuse, misuse, and abuse. PMID:21412368

  20. Expressing pain: The communication and interpretation of facial pain signals

    Microsoft Academic Search

    Kenneth M. Prkachin; Kenneth D. Craig

    1995-01-01

    This article reviews recent theory and research on the origins, nature, and meaning of facial expressions of pain. A general model of pain expression, distinguishing experiential, encoding, and decoding processes involved in pain episodes, is proposed. Variables which are known to or may affect these processes are reviewed. Relationships between elements of the model and clinical phenomena of interest to

  1. Pain perception in major depression depends on pain modality

    Microsoft Academic Search

    Karl-Jürgen Bär; Stanislaw Brehm; Michael Karl Boettger; Silke Boettger; Gerd Wagner; Heinrich Sauer

    2005-01-01

    One frequently described feature of depression is an increased vulnerability to pain complaints, and chronic pain is frequently accompanied by symptoms of depression. In contrast to this, a decreased sensitivity to experimental pain has been described in major depression. The physiological basis of this phenomenon is yet elusive. We investigated 30 patients suffering from a major depressive disorder and matched

  2. Pain perception model of human skin using multiple pain sensors

    Microsoft Academic Search

    Aydin Tarik Zengin; Nobutomo Matsunaga; Hiroshi Okajima; Shigeyasu Kawaji

    2010-01-01

    In the coexistence circumstance with human and robot, sensory and emotional feelings of human should be considered in case of interaction. A typical unpleasant feeling influenced by this interaction is pain. In order to keep this interaction safe between human and robot, the pain sensing will be an important ability for the robot. In this paper, we provide a pain

  3. Pain Response and Pain Control in Burn Patients

    PubMed Central

    Castana, O.; Anagiotos, G.; Rempelos, G.; Adalopoulou, A.; Kokkinakis, C.; Giannakidou, M.; Diplas, D.B.; Alexakis, D.

    2009-01-01

    Summary Burn injury is totally correlated to pain, which depends on burn depth and extent, cause, age and the patient's general condition, and on the local therapy of the burn wound. In hospitalized patients adjectival and numerical scales have been used to measure pain. The management of pain is challenging to the therapist and extremely important for the patient. PMID:21991161

  4. The new JCAHO pain standards: Implications for pain management nurses

    Microsoft Academic Search

    Patricia H Berry; June L Dahl

    2000-01-01

    The newly approved Joint Commission on Accreditation of Healthcare Organizations (JCAHO) pain management standards present an important opportunity for widespread and sustainable improvement in pain assessment and management. Unrelieved pain is a major, yet avoidable, public health problem. Despite 20 years of work by educators, clinicians, and professional organizations and the publication of clinical practice guidelines, there have been, at

  5. Greek Brief Pain Inventory: Validation and Utility in Cancer Pain

    Microsoft Academic Search

    Kyriaki Mystakidou; Tito Mendoza; Eleni Tsilika; Sofia Befon; Efi Parpa; George Bellos; Lambros Vlahos; Charles Cleeland

    2001-01-01

    Objective: The Brief Pain Inventory (BPI) is a pain assessment tool. It has been translated into and validated in several languages. The purpose of this study was the translation into and validation of the BPI in Greek. Moreover, we wanted to detect cultural and social differences, if any, of pain interference in patients’ lives. Methods: The translation and validation of

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

    PubMed

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

    2009-01-01

    Previously, it was shown that school-aged (9-14 yr) 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 the psychosocial context of pain responses in these children, who had been hospitalized >or=7 days after birth including >or=3 days of treatment in a neonatal intensive care unit (NICU), are reported. Nineteen preterm (or=37 weeks gestational age) with NICU experience, recruited retrospectively and selected based on strict exclusion criteria, and 20 fullterm control children participated. Preterm NICU children endorsed more pain catastrophizing as compared to controls. Mothers of preterm children, who had been more severely ill and had been hospitalized longer than fullterm NICU children, were more likely to engage in solicitous pain-related behavior. Maternal influence was also assessed by comparing heat pain thresholds and perceptual sensitization to tonic painful heat obtained in the presence versus absence (i.e. standard testing conditions) of the mother. In all three groups, maternal presence was associated with increased heat pain thresholds. Control children habituated significantly more to tonic heat when their mother was present. The NICU children showed overall significantly less habituation than the controls; there was no modulating effect of maternal presence. Especially in highly vulnerable children such as preterms, neonatal pain exposure and prolonged hospitalization may, aside from neuronal plasticity, promote maladaptive pain-related cognitions and foster parental behavior that reinforces the child's pain response. PMID:18439861

  7. Chiropractic management of shoulder pain and dysfunction of myofascial origin using ischemic compression techniques

    PubMed Central

    Hains, Guy

    2002-01-01

    Shoulder pain and dysfunction is a chief complaint commonly presenting to a chiropractor's office. The purpose of this article is to review the most common etiologies of shoulder pain, focusing on those conditions of a myofascial origin. In addition to a review of the literature, the author draws upon his own clinical experience to describe a method to diagnose and manage, patients with shoulder pain of myofascial origin using ischemic compression techniques. This hands-on therapeutic approach conveys several benefits including: positive therapeutic outcomes; a favorable safety profile and; it is minimally strenuous on the doctor and well tolerated by the patient. ImagesFigure 7

  8. Skin Matters: A Review of Topical Treatments for Chronic Pain. Part Two: Treatments and Applications.

    PubMed

    Peppin, John F; Albrecht, Phillip J; Argoff, Charles; Gustorff, Burkhard; Pappagallo, Marco; Rice, Frank L; Wallace, Mark S

    2015-06-01

    In Part One of this two-part series, we discussed skin physiology and anatomy as well as generalities concerning topical analgesics. This modality of therapy has lesser side effects and drug-drug interactions, and patients tolerate this form of therapy better than many oral options. Unfortunately, this modality is not used as often as it could be in chronic pain states, such as that from neuropathic pain. Part Two discusses specific therapies, local anesthetics, and other drugs, as well as how a clinician might use specific aspects of a patient's neuropathic pain presentation to help guide them in the selection of a topical agent. PMID:25630651

  9. Iterative Thresholding Algorithms Massimo Fornasier

    E-print Network

    for denoising signals and images. When the signal is represented in terms of a suitable basis (for instance a wavelet basis) small coefficients are set to zero and larger coefficients above some threshold] established a varia- tional formulation for denoising by 1 penalization, which results in simple soft-thresholding

  10. Threshold Hypothesis: Fact or Artifact?

    ERIC Educational Resources Information Center

    Karwowski, Maciej; Gralewski, Jacek

    2013-01-01

    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…

  11. The Nature of Psychological Thresholds

    ERIC Educational Resources Information Center

    Rouder, Jeffrey N.; Morey, Richard D.

    2009-01-01

    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.…

  12. JAMA Patient Page: Knee Pain

    MedlinePLUS

    ... PAGE Knee Pain K nees are complex, weight-bearing joints (junctions between 2 bones) that provide your ... and pain. WHEN TO SEEK MEDICAL ADVICE • Difficulty bearing weight on the knee • Swelling of the knee • ...

  13. Acute pain medicine in anesthesiology

    PubMed Central

    Munro, Anastacia P.; Tighe, Patrick J.

    2013-01-01

    The American Academy of Pain Medicine and the American Society for Regional Anesthesia have recently focused on the evolving practice of acute pain medicine. There is increasing recognition that the scope and practice of acute pain therapies must extend beyond the subacute pain phase to include pre-pain and pre-intervention risk stratification, resident and fellow education in regional anesthesia and multimodal analgesia, as well as a deeper understanding of the pathophysiologic mechanisms that are integral to the variability observed among individual responses to nociception. Acute pain medicine is also being established as a vital component of successful systems-level acute pain management programs, inpatient cost containment, and patient satisfaction scores. In this review, we discuss the evolution and practice of acute pain medicine and we aim to facilitate further discussion on the evolution and advancement of this field as a subspecialty of anesthesiology. PMID:24381730

  14. Association of serum total antioxidant capacity and total oxidant status with pain perception in patients with myofacial pain dysfunction.

    PubMed

    Etoz, Osman A; Ataoglu, Hanife; Erel, Ozcan; Celik, Hakim; Herken, Emine Nur; Bayazit, Yildirim Ahmet

    2009-01-01

    We aimed to find out the association of total antioxidant capacity (TAC) and total oxidant status (TOS) with generalized pressure pain thresholds (PPT) of patients with myofacial pain dysfunction (MPD). PPT scores of patients with MPD (n = 37) and healthy individuals (n = 43) were measured on the hypothenar region of the hand using a mechanical algometer. Serum samples were collected and TAC and TOS were measured by novel methods. The TAC of patients was significantly lower than that of the control subjects. The difference between the TOS measurements of patients and control subjects was not significant. The PPT scores of the patients were significantly lower than that of control subjects. There may be an association between serum antioxidant capacity and MPD. Low serum TAC might also be related with pain perception. PMID:19922356

  15. Spinal cord plasticity in peripheral inflammatory pain 

    E-print Network

    Dickie, Allen Charles

    2014-06-28

    Inflammatory pain is a debilitating condition that can occur following tissue injury or inflammation and results in touch evoked pain (allodynia), exaggerated pain (hyperalgesia) and spontaneous pain, yet the neural ...

  16. Pain Management Following Spinal Cord Injury

    MedlinePLUS

    ... Center Spinal Cord Injury InfoSheet 10 Level - Consumer Pain Management following Spinal Cord Injury coming from somewhere other ... pain is described as burning, cramping and constant. PAIN MANAGEMENT Pain management usually includes treatment with medications, modified ...

  17. Gabapentin for chronic neuropathic pain and fibromyalgia in adults

    PubMed Central

    Moore, R Andrew; Wiffen, Philip J; Derry, Sheena; McQuay, Henry J

    2014-01-01

    Background This review updates parts of two earlier Cochrane reviews investigating effects of gabapentin in chronic neuropathic pain (pain due to nerve damage). Antiepileptic drugs are used to manage pain, predominantly for chronic neuropathic pain, especially when the pain is lancinating or burning. Objectives To evaluate the analgesic effectiveness and adverse effects of gabapentin for chronic neuropathic pain management. Search methods We identified randomised trials of gabapentin in acute, chronic or cancer pain from MEDLINE, EMBASE, and CENTRAL. We obtained clinical trial reports and synopses of published and unpublished studies from Internet sources. The date of the most recent search was January 2011. Selection criteria Randomised, double-blind studies reporting the analgesic and adverse effects of gabapentin in neuropathic pain with assessment of pain intensity and/or pain relief, using validated scales. Participants were adults aged 18 and over. Data collection and analysis Two review authors independently extracted data. We calculated numbers needed to treat to benefit (NNTs), concentrating on IMM-PACT (Initiative on Methods, Measurement and Pain Assessment in Clinical Trials) definitions of at least moderate and substantial benefit, and to harm (NNH) for adverse effects and withdrawal. Meta-analysis was undertaken using a fixed-effect model. Main results Twenty-nine studies (3571 participants), studied gabapentin at daily doses of 1200 mg or more in 12 chronic pain conditions; 78% of participants were in studies of postherpetic neuralgia, painful diabetic neuropathy or mixed neuropathic pain. Using the IMMPACT definition of at least moderate benefit, gabapentin was superior to placebo in 14 studies with 2831 participants, 43% improving with gabapentin and 26% with placebo; the NNT was 5.8 (4.8 to 7.2). Using the IMMPACT definition of substantial benefit, gabapentin was superior to placebo in 13 studies with 2627 participants, 31% improving with gabapentin and 17% with placebo; the NNT was 6.8 (5.6 to 8.7). These estimates of efficacy are more conservative than those reported in a previous review. Data from few studies and participants were available for other painful conditions. Adverse events occurred significantly more often with gabapentin. Persons taking gabapentin can expect to have at least one adverse event (66%), withdraw because of an adverse event (12%), suffer dizziness (21%), somnolence (16%), peripheral oedema (8%), and gait disturbance (9%). Serious adverse events (4%) were no more common than with placebo. There were insufficient data for comparisons with other active treatments. Authors’ conclusions Gabapentin provides pain relief of a high level in about a third of people who take if for painful neuropathic pain. Adverse events are frequent, but mostly tolerable. More conservative estimates of efficacy resulted from using better definitions of efficacy outcome at higher, clinically important, levels, combined with a considerable increase in the numbers of studies and participants available for analysis. PMID:21412914

  18. Pharmacologic treatment of neuropathic pain

    Microsoft Academic Search

    Mark S. Wallace

    2001-01-01

    Neuropathic pain, or pain after nervous system injury, can be very refractory to pharmacologic interventions. Through a better\\u000a understanding of the pathophysiology of neuropathic pain, it has been suggested that nonopioid agents, such as antidepressants\\u000a and anticonvulsants, may be more efficacious in the treatment of neuropathic pain than common analgesics, such as opioids\\u000a or nonsteroidal anti-inflammatory drugs. However, this has

  19. Knowledge Translation and Pain Management

    Microsoft Academic Search

    Shannon Scott-Findlay; Carole A. Estabrooks

    Over the last few decades, there has been substantial growth in pediatric pain research, yet children continue to endure pain\\u000a despite this well-established body of evidence. Assessing, treating, and managing pain in children is complex because of the\\u000a developmental issues involved in assessing and understanding the child’s pain, the nature and the structure of health care\\u000a professionals’ work, the immense

  20. Substance Abuse in Cancer Pain

    Microsoft Academic Search

    Tatiana D. Starr; Lauren J. Rogak; Steven D. Passik

    2010-01-01

    In the oncology community, opioids recently have become the cornerstone of cancer pain management. This has led to a rapid\\u000a increase in opioid prescribing in an effort to address the growing public health problem of chronic pain. A new paradigm in\\u000a noncancer pain management has emerged, that of risk assessment and stratification in opioid therapy. Techniques foreign to\\u000a cancer pain

  1. Interventional Strategies for Pain Management

    Microsoft Academic Search

    Kulbir S. Walia; Frederick W. Luthardt; Maneesh C. Sharma; Peter S. Staats

    \\u000a The International Association for the Study of Pain (IASP) defines pain as “an unpleasant sensory and emotional experience\\u000a associated with actual or potential tissue damage, or described in terms of such damage.” While pain is traditionally thought\\u000a of as a part of the body’s defense system, triggering a reflex reaction to retract or withdraw from a painful stimulus, in\\u000a certain

  2. Orofacial pain: diagnosis and treatment.

    PubMed

    Manusov, E G; Johnson, R

    1992-02-01

    Orofacial pain can have an inflammatory, neurologic or musculoskeletal cause. Inflammatory diseases include dental abscess, sinusitis, temporal arteritis, sialolithiasis and infections of the parotid gland. Common neurologic diseases that cause facial pain are trigeminal neuralgia, glossopharyngeal neuralgia, paratrigeminal neuralgia and cluster headaches. Musculoskeletal causes include temporomandibular joint syndrome and myofascial pain dysfunction syndrome. A clear understanding of pertinent anatomy and an organized approach to diagnosis will facilitate the evaluation of patients with orofacial pain. PMID:1739060

  3. Immune Tolerance and Transplantation

    PubMed Central

    Alpdogan, Onder; van den Brink, Marcel RM

    2012-01-01

    Successful allogeneic hematopoietic stem cell transplantation (HSCT) and solid organ transplantation require development of a degree of immune tolerance against allogeneic antigens. T lymphocytes play a critical role in allograft rejection, graft failure, and graft versus host disease (GVHD). T cell tolerance occurs by two different mechanisms; i) depletion of self-reactive T cells during their maturation in the thymus (central tolerance) ii) suppression/elimination of self-reactive mature T cells in the periphery (peripheral tolerance). Induction of transplant tolerance improves transplantation outcomes. Adoptive immunotherapy with immune suppressor cells including regulatory T cells, NK-T cells, veto cells and facilitating cells are promising therapies for modulation of immune tolerance. Achieving mixed chimerism with the combination of thymic irradiation and T cell depleting antibodies, costimulatory molecule blockade with/without inhibitory signal activation and elimination of alloreactive T cells with varying methods including pre or post-transplant cyclophosphamide administration appear to be effective methods to induce transplant tolerance. PMID:23206840

  4. Opioids in chronic pain

    Microsoft Academic Search

    Ryszard Przew?ocki; Barbara Przew?ocka

    2001-01-01

    The advance in our understanding of the biogenesis of various endogenous opioid peptides, their anatomical distribution, and the characteristics of the multiple receptors with which they interact open a new avenue for understanding the role of opioid peptide systems in chronic pain. The main groups of opioid peptides: enkephalins, dynorphins and ?-endorphin derive from proenkephalin, prodynorphin and proopiomelanocortin, respectively. Recently,

  5. Bioterrorism, stress, and pain

    Microsoft Academic Search

    Peter B. Polatin; Mark Young; Maile Mayer; Robert Gatchel

    2005-01-01

    This article reviews the accumulating scientific evidence demonstrating the negative impact caused by a cataclysmic event, such as bioterrorism, on the mental health of a community. Moreover, the potential mental health problems created by the continuing threat of possible future events are discussed. This close link among disaster events, stress, pain, and psychopathology is presented from a biopsychosocial perspective. Although

  6. What's wrong with pain?

    E-print Network

    Shriver, Adam Joseph

    2006-10-30

    The experience of pain is something that most people are extremely familiar with. However, once we begin to examine the subject from an ethical point of view, and particularly when we examine so-called marginal cases such as nonhuman animals, we...

  7. Painful diabetic neuropathy.

    PubMed

    Peltier, Amanda; Goutman, Stephen A; Callaghan, Brian C

    2014-01-01

    Diabetes is a worldwide epidemic, and associated neuropathy is its most costly and disabling complication. Given the rising prevalence of painful diabetic neuropathy, it is increasingly important that we understand the best ways to diagnose and treat this condition. Diagnostic tests in this field are evolving rapidly. These include the use of skin biopsies to measure small unmyelinated fibers, as well as even newer techniques that can measure both small unmyelinated fibers and large myelinated fibers in the same biopsy. The main treatments for painful diabetic neuropathy remain management of the underlying diabetes and drugs for the relief of pain. However, emerging evidence points to major differences between type 1 and type 2 diabetes, including the ability of glycemic control to prevent neuropathy. Enhanced glucose control is much more effective at preventing neuropathy in patients with type 1 diabetes than in those with type 2 disease [corrected]. This dichotomy emphasizes the need to study the pathophysiologic differences between the two types of diabetes, because different treatments may be needed for each condition. The impact of the metabolic syndrome on neuropathy in patients with type 2 diabetes may account for the difference between the two types of diabetes and requires further study. Finally, neuropathic pain is under-recognized and undertreated despite an ever evolving list of effective drugs. Evidence exists to support several drugs, but the optimal sequence and combination of these drugs are still to be determined. PMID:24803311

  8. Cancer pain in the opioid-addicted patient: can we treat it right?

    PubMed

    Modesto-Lowe, Vania; Girard, Lisa; Chaplin, Margaret

    2012-01-01

    Although cancer elicits an array of physical and emotional symptoms, pain is often identified as the most distressing. Cancer pain may result from the primary tumor, metastasis, surgery, radiation, chemotherapy, or medical comorbidities. Although treatment with opioid analgesics is accepted as appropriate therapy for cancer-related pain, under treatment may persist among certain patients. Opioid-addicted individuals represent a challenging and heterogeneous population to treat. Addiction is linked to psychopathology and antisocial behaviors (eg, lying) which often complicate evaluation. Chronic exposure to opioids may lead to physiologic dependence and its correlates, tolerance and hyperalgesia. Given the variability and subjectivity of the cancer pain experience, there are no objective measures which capture the adequacy of pain control. Thus, when faced with complaints of uncontrolled pain, clinicians must consider a differential diagnosis of tolerance, disease progression, addiction, pseudoaddiction, chemical coping, or even criminal behavior. This article explores the cognitive, behavioral, and physiological correlates of opioid addiction that may impact cancer pain management. It also discusses risk reduction strategies for opioid misuse and research directions that may lead to improved clinical outcomes in these patients. PMID:22798177

  9. Neuroprotectin/Protectin D1 protects neuropathic pain in mice after nerve trauma

    PubMed Central

    Xu, Zhen-Zhong; Liu, Xing-Jun; Berta, Temugin; Park, Chul-Kyu; Lü, Ning; Serhan, Charles N.; Ji, Ru-Rong

    2013-01-01

    Prevalence of neuropathic pain is high after major surgeries. However, effective treatment for preventing neuropathic pain is lacking. Here we report that peri-surgical treatment of Neuroprotectin D1/protectin D1 (NPD1/PD1), derived from docosahexaenoic acid, prevents nerve injury-induced mechanical allodynia and ongoing pain in mice. Intrathecal post-treatment of NPD1/PD1 also effectively reduces established neuropathic pain and produces no apparent signs of analgesic tolerance. Mechanistically, NPD1/PD1 treatment blocks nerve injury-induced long-term potentiation, glial reaction, inflammatory responses, and reverses synaptic plasticity in the spinal cord. Thus, NPD1/PD1 and related mimetics might serve as a new class of analgesics for preventing and treating neuropathic pain. PMID:23686636

  10. Dyspareunia: Painful Sex for Women

    MedlinePLUS

    MENU Return to Web version Dyspareunia Overview What is dyspareunia? Dyspareunia (say: "dis-par-oon-ya") is painful sexual intercourse for women. The pain can be in the genital area or deep inside the pelvis. The pain is often described as sharp, burning or similar to menstrual cramps. It can have ...

  11. Spiritual Coping with Chronic Pain 

    E-print Network

    Henderson, Kevin

    2008-06-26

    and Pain interference (PI) (p?.05). Despite SP correlating well with R/S coping, neither the positive nor negative R/S coping subscales accounted for any of the variance in pain outcomes. Three of the CSQ coping subscales correlated with pain outcomes...

  12. Scrotal pain: Evaluation and management

    PubMed Central

    Gordhan, Chirag G

    2015-01-01

    Scrotal pain is a common complaint in a urological practice. Its diagnosis can prove challenging in both acute and chronic forms and requires a thorough and complete history and physical examination. This article discusses the evaluation and management of several entities of scrotal pain, including testicular torsion, epididymitis, postvasectomy pain, varicocele, and chronic orchialgia. PMID:25598931

  13. Scrotal pain: evaluation and management.

    PubMed

    Gordhan, Chirag G; Sadeghi-Nejad, Hossein

    2015-01-01

    Scrotal pain is a common complaint in a urological practice. Its diagnosis can prove challenging in both acute and chronic forms and requires a thorough and complete history and physical examination. This article discusses the evaluation and management of several entities of scrotal pain, including testicular torsion, epididymitis, postvasectomy pain, varicocele, and chronic orchialgia. PMID:25598931

  14. Educational programs and cancer pain

    Microsoft Academic Search

    Adriana Janzantte Ducci

    Cognitive aspects are involved in cancer pain experience and management. Establishing and testing cognitive interventions, like educational programs, can improve pain control. The purpose of this investigation was to analyze studies about educational programs for cancer pain patients and their caregivers, and describe nurses' role in these programs. A literature review was made from MedLine data base, accessed through PubMed,

  15. Pain, Transportation Issues and Whiplash

    Microsoft Academic Search

    Michele Sterling

    The development of pain following a motor vehicle crash (MVC) is a common occurrence. The most frequently reported and investigated pain condition following such trauma is neck pain or whiplash associated disorders (WAD), which are usually associated with rear-end collision. However, WAD can also be caused by any event that results in the hyperextension and flexion of the cervical spine

  16. Ethical dilemmas in pain management

    Microsoft Academic Search

    Betty R. Ferrell; Diane Novy; Mark D. Sullivan; John Banja; Michel Y. Dubois; Melvin C. Gitlin; Daniel Hamaty; Allen Lebovits; Arthur G. Lipman; Philipp M. Lippe; Jeffrey Livovich

    2001-01-01

    The purpose of this study was to survey the membership of the American Pain Society and the American Academy of Pain Medicine to determine their beliefs about ethical dilemmas in pain management practice. Respondents rated ethical dilemmas for their importance as well as their own competence in dealing with these ethical issues. The survey also included an open-ended question that

  17. Intravenous high-dose methadone administered by patient controlled analgesia and continuous infusion for the treatment of cancer pain refractory to high-dose morphine

    Microsoft Academic Search

    Dermot R Fitzgibbon; L. Brian Ready

    1997-01-01

    The management of severe tumor-related pain in the patient with cancer may be problematic. Systemically administered opioids remain the cornerstone of treatment for moderate to severe cancer pain, while parenteral routes should be considered for patients who require rapid onset of analgesia, and for highly tolerant patients whose dose requirements cannot be conveniently administered. The use of intravenous methadone by

  18. The threshold for air leak: stapled versus sutured human bronchi, an experimental study

    Microsoft Academic Search

    A El-Gamel; G. M. K Tsang; D. C. T Watson

    1999-01-01

    Background: Little is known about the integrity of staple-closure of the bronchus and its tolerance to normal mechanical stresses (cough, sneezing, etc.) in the immediate early post-operative period. There are few studies which tested the mechanical strength of stapled bronchial closure compared with manually closed bronchi using the threshold for fluid leak across the bronchial suture line which differs from

  19. LIBERTY TOLERANT COTTON: WEED CONTROL AND CROP TOLERANCE Brent Burns

    E-print Network

    Mukhtar, Saqib

    LIBERTY TOLERANT COTTON: WEED CONTROL AND CROP TOLERANCE Brent Burns Texas Tech University Lubbock Acres planted with herbicide-tolerant cotton varieties have steadily increased since their introduction in 1995. Recently, the bar gene was introduced into Coker 312 cotton plants for tolerance to Liberty

  20. Sex-related psychological predictors of baseline pain perception and analgesic responses to pentazocine.

    PubMed

    Fillingim, Roger B; Hastie, Barbara A; Ness, Timothy J; Glover, Toni L; Campbell, Claudia M; Staud, Roland

    2005-04-01

    Sex differences in pain perception and analgesic responses have garnered increasing attention in recent years. We examined the association of psychological factors to baseline pain perception and pentazocine analgesia among 49 healthy women and 39 men. Subjects completed psychological questionnaires measuring positive and negative affect as well as catastrophizing. Subsequently, responses to experimental pain were assessed before and after double-blind administration of intravenous pentazocine (0.5mg/kg). In correlational analyses, positive affect predicted lower pain sensitivity among men but not women. Negative affect predicted lower baseline pain tolerances among both sexes but predicted poorer analgesia only among men. Catastrophizing was associated with greater pain sensitivity and less analgesia more consistently in men than women. Regression models revealed that positive affect predicted lower overall pain sensitivity and catastrophizing predicted poorer overall analgesic responses among men, while no significant predictors of overall pain or analgesia emerged for women. Moreover, positive affect and catastrophizing were negatively and positively correlated, respectively, with side effects from the medication, but only among men. These findings indicate sex-dependent associations of psychological factors with baseline pain perception, analgesic responses, and medication side effects. PMID:15740828

  1. Delamination, durability and damage tolerance of laminated composite materials

    NASA Technical Reports Server (NTRS)

    O'Brien, T. K.

    1991-01-01

    Research exploring the role of delamination on the durability and damage tolerance of advanced composite materials is reviewed. Recent studies on the characterization of composite delamination are summarized. Recent analytical solutions for interlaminar stresses and strain energy release rates associated with common sources of delamination are also reviewed. The role of delamination in low velocity impact, residual compression strength, and in fatigue is highlighted. Delamination is shown to be the common damage mode observed in all of these problems. A Damage Threshold/Fail-safety concept for addressing composite damage tolerance is discussed.

  2. Delay of Morphine Tolerance by Palmitoylethanolamide

    PubMed Central

    Di Cesare Mannelli, Lorenzo; Corti, Francesca; Micheli, Laura; Zanardelli, Matteo; Ghelardini, Carla

    2015-01-01

    In spite of the potency and efficacy of morphine, its clinical application for chronic persistent pain is limited by the development of tolerance to the antinociceptive effect. The cellular and molecular mechanisms underlying morphine tolerance are complex and still unclear. Recently, the activation of glial cells and the release of glia-derived proinflammatory mediators have been suggested to play a role in the phenomenon. N-Palmitoylethanolamine (PEA) is an endogenous compound with antinociceptive effects able to reduce the glial activation. On this basis, 30?mg?kg?1 PEA was subcutaneously daily administered in morphine treated rats (10?mg?kg?1 intraperitoneally, daily). PEA treatment significantly attenuated the development of tolerance doubling the number of days of morphine antinociceptive efficacy in comparison to the vehicle + morphine group. PEA prevented both microglia and astrocyte cell number increase induced by morphine in the dorsal horn; on the contrary, the morphine-dependent increase of spinal TNF-? levels was not modified by PEA. Nevertheless, the immunohistochemical analysis revealed significantly higher TNF-? immunoreactivity in astrocytes of PEA-protected rats suggesting a PEA-mediated decrease of cytokine release from astrocyte. PEA intervenes in the nervous alterations that lead to the lack of morphine antinociceptive effects; a possible application of this endogenous compound in opioid-based therapies is suggested. PMID:25874232

  3. Tapentadol in the management of chronic low back pain: a novel approach to a complex condition?

    PubMed

    Pergolizzi, Joseph; Alon, Eli; Baron, Ralf; Bonezzi, Cesare; Dobrogowski, Jan; Gálvez, Rafael; Jensen, Troels; Kress, Hans-Georg; Marcus, Marco Ae; Morlion, Bart; Perrot, Serge; Treede, Rolf-Detlef

    2011-01-01

    Chronic pain affects approximately 1 in 5 people in Europe, and around half of sufferers receive inadequate pain management. The most common location is the lower back. Pharmacological treatment of this condition is challenging because of the range of causative mechanisms and the difficulty of balancing analgesic efficacy and tolerability. An international panel of clinical pain specialists met in September, 2009, to discuss the treatment of chronic low back pain, and to review preclinical and clinical data relating to the new analgesic, tapentadol. A lack of consensus exists on the best treatment for low back pain. The range of regularly prescribed pharmacological agents extends from nonopioids (paracetamol, NSAIDs, and COX-2 inhibitors) to opioids, antidepressants and anticonvulsants. Pain relief may be compromised, however, by an undetected neuropathic component or intolerable side effects. Treatment is potentially life-long and effective analgesics are urgently needed, with demonstrable long-term safety. Combining separate agents with different mechanisms of action could overcome the limitations of present pharmacological therapy, but clinical evidence for this approach is currently lacking. Tapentadol combines ?-opioid agonism with noradrenaline reuptake inhibition in a single molecule. There is strong evidence of synergistic antinociception between these two mechanisms of action. In preclinical and clinical testing, tapentadol has shown efficacy against both nociceptive and neuropathic pain. Preclinical data indicate that tapentadol's ?-opioid agonism makes a greater contribution to analgesia in acute pain, while noradrenaline reuptake inhibition makes a greater contribution in chronic neuropathic pain models. Tapentadol also produces fewer adverse events than oxycodone at equianalgesic doses, and thus may have a '?-sparing effect'. Current evidence indicates that tapentadol's efficacy/tolerability ratio may be better than those of classical opioids. However, further research is needed to establish its role in pain management. PMID:21887117

  4. Harmonic Analysis of Polynomial Threshold Functions

    Microsoft Academic Search

    Jehoshua Bruck

    1990-01-01

    The analysis of linear threshold Boolean functions has recently attracted the attention of those interested in circuit complexity as well as of those interested in neural networks. Here a generalization of linear threshold functions is defined, namely, polynomial threshold functions, and its relation to the class of linear threshold functions is investigated. A Boolean function is polynomial threshold if it

  5. Estimating nerve excitation thresholds to cutaneous electrical stimulation by finite element modeling combined with a stochastic branching nerve fiber model

    Microsoft Academic Search

    Carsten Dahl Mørch; Kristian Hennings; Ole Kæseler Andersen

    2011-01-01

    Electrical stimulation of cutaneous tissue through surface electrodes is an often used method for evoking experimental pain.\\u000a However, at painful intensities both non-nociceptive A?-fibers and nociceptive A?- and C-fibers may be activated by the electrical\\u000a stimulation. This study proposes a finite element (FE) model of the extracellular potential and stochastic branching fiber\\u000a model of the afferent fiber excitation thresholds. The

  6. A particle tracking method to predict sand erosion threshold velocities in elbows and tees

    SciTech Connect

    McLaury, B.S.; Shirazi, S.A.; Shadley, J.R.; Rybicki, E.F. [Univ. of Tulsa, OK (United States). Dept. of Mechanical Engineering

    1994-12-31

    A review of various empirical models developed for predicting a threshold velocity in the oil and gas industry is presented. The threshold velocity discussed is defined as an operating velocity below which a tolerable amount of erosion occurs. A new procedure for prediction a threshold velocity and particle size has been developed to limit erosion rates and penetration rates to tolerable values. A unique feature of the method is that it is based on a mechanistic model. The method uses a simplified particle tracking procedure to account for fluid and sand properties. The procedure also accounts for pipe geometry and size through a new concept of equivalent stagnation length. The mechanistic model is described for use with elbow and tee geometries. Results of threshold velocity and threshold particle size obtained from the model are presented for the specific case of no tolerable erosion. A series of erosion tests with two different particle sizes have been conducted in an elbow, and the resulting erosion rates are presented and compared with model predictions. comparisons of predicted penetration rates for these cases with data show that the model is a viable technique.

  7. Bayesian estimation of dose thresholds

    NASA Technical Reports Server (NTRS)

    Groer, P. G.; Carnes, B. A.

    2003-01-01

    An example is described of Bayesian estimation of radiation absorbed dose thresholds (subsequently simply referred to as dose thresholds) using a specific parametric model applied to a data set on mice exposed to 60Co gamma rays and fission neutrons. A Weibull based relative risk model with a dose threshold parameter was used to analyse, as an example, lung cancer mortality and determine the posterior density for the threshold dose after single exposures to 60Co gamma rays or fission neutrons from the JANUS reactor at Argonne National Laboratory. The data consisted of survival, censoring times and cause of death information for male B6CF1 unexposed and exposed mice. The 60Co gamma whole-body doses for the two exposed groups were 0.86 and 1.37 Gy. The neutron whole-body doses were 0.19 and 0.38 Gy. Marginal posterior densities for the dose thresholds for neutron and gamma radiation were calculated with numerical integration and found to have quite different shapes. The density of the threshold for 60Co is unimodal with a mode at about 0.50 Gy. The threshold density for fission neutrons declines monotonically from a maximum value at zero with increasing doses. The posterior densities for all other parameters were similar for the two radiation types.

  8. Fentanyl-Induced Hyperalgesia in Acute Pain Management.

    PubMed

    Lyons, Pamela J; Rivosecchi, Ryan M; Nery, Jose P; Kane-Gill, Sandra L

    2015-06-01

    There are safety concerns with the use of fentanyl, including respiratory depression, nausea, constipation, and possibly opioid-induced hyperalgesia (OIH). The purpose of this review is to evaluate the occurrence and significance of opioid-induced hyperalgesia (OIH) after acute fentanyl exposure. A literature search was conducted from October 1995 through January 2015 using MEDLINE, Embase, and Scopus with the terms hyperalgesia, fentanyl, pronociceptive, acute tolerance, and acute. Published articles evaluating the adverse effects of fentanyl during acute pain management (?96 hours) in humans were included. Opioid-induced hyperalgesia is a phenomenon defined by increasing pain after opioid exposure with the worsening of pain occurring when opioid doses are increased. Hyperalgesia has been described following remifentanil and morphine use, but the question remains about the associated risk with acute fentanyl exposure. Six randomized, controlled trials evaluating the effect of fentanyl on pain in the acute setting have been conducted. Two trials oppose whereas four trials support the occurrence of fentanyl-induced hyperalgesia. The data on OIH after acute fentanyl exposure are limited and conflicting. Hyperalgesia should be considered in patients with uncontrolled pain despite escalating fentanyl doses, since the possibility of fentanyl-induced OIH exists in the acute setting. Well-designed trials are needed to determine the clinical significance of this phenomenon. PMID:26095487

  9. Reversal of pathological pain through specific spinal GABAA receptor subtypes.

    PubMed

    Knabl, Julia; Witschi, Robert; Hösl, Katharina; Reinold, Heiko; Zeilhofer, Ulrike B; Ahmadi, Seifollah; Brockhaus, Johannes; Sergejeva, Marina; Hess, Andreas; Brune, Kay; Fritschy, Jean-Marc; Rudolph, Uwe; Möhler, Hanns; Zeilhofer, Hanns Ulrich

    2008-01-17

    Inflammatory diseases and neuropathic insults are frequently accompanied by severe and debilitating pain, which can become chronic and often unresponsive to conventional analgesic treatment. A loss of synaptic inhibition in the spinal dorsal horn is considered to contribute significantly to this pain pathology. Facilitation of spinal gamma-aminobutyric acid (GABA)ergic neurotransmission through modulation of GABA(A) receptors should be able to compensate for this loss. With the use of GABA(A)-receptor point-mutated knock-in mice in which specific GABA(A) receptor subtypes have been selectively rendered insensitive to benzodiazepine-site ligands, we show here that pronounced analgesia can be achieved by specifically targeting spinal GABA(A) receptors containing the alpha2 and/or alpha3 subunits. We show that their selective activation by the non-sedative ('alpha1-sparing') benzodiazepine-site ligand L-838,417 (ref. 13) is highly effective against inflammatory and neuropathic pain yet devoid of unwanted sedation, motor impairment and tolerance development. L-838,417 not only diminished the nociceptive input to the brain but also reduced the activity of brain areas related to the associative-emotional components of pain, as shown by functional magnetic resonance imaging in rats. These results provide a rational basis for the development of subtype-selective GABAergic drugs for the treatment of chronic pain, which is often refractory to classical analgesics. PMID:18202657

  10. Reliability and Reproducibility of Novel Methodology for Assessment of Pressure Pain Sensitivity in Pelvis

    PubMed Central

    Zolnoun, Denniz; Bair, Eric; Essicks, Greg; Gracely, Richard; Goyal, Vinita; Maixner, William

    2012-01-01

    Vestibulodynia, the most common type of chronic vulvovaginal pain, impairs the psychological, physical health of nearly 10% of women at some point in their lifetime. The aim of this investigation was to establish reliable standardized methodologies for assessment of pain sensitivity in vulvar mucosa and pelvic musculature. We enrolled 34 women with vestibulodynia and 21 pain-free controls. The participants underwent a nuanced exam that consisted of palpation of precisely located vulvar mucosal and pelvic muscle sites. These measurements remained highly stable when participants were reexamined after two weeks, with high within-examiner correlation. Vestibulodynia patients reported greater sensitivity than pain-free controls at the majority of examination sites, particularly at mucosal sites on the lower vestibule. The pain threshold measures at the lower mucosal sites were also associated with the participants’ self-reported pain levels during intercourse. These mucosal pain threshold measurements were used to discriminate between vestibulodynia cases and controls with high sensitivity and specificity. This data supports the feasibility of contemporaneous assessment of vulvar mucosa and underlying musculature in the pelvic region, offering the hope of a more precise case definition for vestibulodynia and related disorders. PMID:22958875

  11. Regulation of µ-Opioid Receptors: Desensitization, Phosphorylation, Internalization, and Tolerance

    PubMed Central

    Williams, John T.; Ingram, Susan L.; Henderson, Graeme; Chavkin, Charles; von Zastrow, Mark; Schulz, Stefan; Koch, Thomas; Evans, Christopher J.

    2013-01-01

    Morphine and related µ-opioid receptor (MOR) agonists remain among the most effective drugs known for acute relief of severe pain. A major problem in treating painful conditions is that tolerance limits the long-term utility of opioid agonists. Considerable effort has been expended on developing an understanding of the molecular and cellular processes that underlie acute MOR signaling, short-term receptor regulation, and the progression of events that lead to tolerance for different MOR agonists. Although great progress has been made in the past decade, many points of contention and controversy cloud the realization of this progress. This review attempts to clarify some confusion by clearly defining terms, such as desensitization and tolerance, and addressing optimal pharmacological analyses for discerning relative importance of these cellular mechanisms. Cellular and molecular mechanisms regulating MOR function by phosphorylation relative to receptor desensitization and endocytosis are comprehensively reviewed, with an emphasis on agonist-biased regulation and areas where knowledge is lacking or controversial. The implications of these mechanisms for understanding the substantial contribution of MOR signaling to opioid tolerance are then considered in detail. While some functional MOR regulatory mechanisms contributing to tolerance are clearly understood, there are large gaps in understanding the molecular processes responsible for loss of MOR function after chronic exposure to opioids. Further elucidation of the cellular mechanisms that are regulated by opioids will be necessary for the successful development of MOR-based approaches to new pain therapeutics that limit the development of tolerance. PMID:23321159

  12. The Fibonacci scheme for fault-tolerant quantum computation

    E-print Network

    Panos Aliferis; John Preskill

    2008-12-17

    We rigorously analyze Knill's Fibonacci scheme for fault-tolerant quantum computation, which is based on the recursive preparation of Bell states protected by a concatenated error-detecting code. We prove lower bounds on the threshold fault rate of .67\\times 10^{-3} for adversarial local stochastic noise, and 1.25\\times 10^{-3} for independent depolarizing noise. In contrast to other schemes with comparable proved accuracy thresholds, the Fibonacci scheme has a significantly reduced overhead cost because it uses postselection far more sparingly.

  13. [Neurosurgical treatment of chronic pain].

    PubMed

    Fontaine, Denys

    2013-06-01

    Neurosurgical treatment of pain is based on 3 concepts: 1) lesional techniques interrupt the transmission of nociceptive neural input by lesionning the nociceptive pathways (cordotomy, radicotomy...), they are indicated to treat morphine-resistant cancer pain; 2) neuromodulation techniques try to decrease pain by reinforcing inhibitory mechanisms, using chronic electrical stimulation of the nervous system (peripheral nerve stimulation, spinal cord stimulation, motor cortex stimulation...) to treat chronic neuropathic pain; 3) intrathecal infusion of analgesics (morphine, ziconotide), using implantable pumps, allows to increase their efficacy and to reduce their side effects. These techniques can improve, sometimes dramatically, patients with severe and chronic pain, refractory to all other treatments. PMID:23923757

  14. [Pain perception of the fetus].

    PubMed

    Jakobovits, Akos

    2010-11-01

    Author presents a comprehensive overview of the currently available information about fetal pain perception. In this context the article discusses the concept of pain sensation, its evolution during intrauterine life and its physical and biochemical signs. Only the last mentioned phenomena allow deduction with regard to the severity of pain related stress reaction, in the absence of objective yardstick for measuring the intensity of pain felt by the fetus. The discussion also involves pain associated with birthing process and extends to its possible alleviation. PMID:20980223

  15. The consequences of chronic pain.

    PubMed

    Greenberg, Eric N

    2012-01-01

    Questions from patients about 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 untreated/undertreated chronic pain and the physical, emotional, and social consequences that can profoundly affect a patient's quality of life. Chronic pain is no longer considered a symptom; it is a disease entity itself. Anxiety and depression often coexist with chronic pain. Chronic pain is the enemy of happiness. Further, chronic pain can activate the sympathetic nervous system, leading to the fight-or-flight response. PMID:22448948

  16. Flooding tolerance in halophytes.

    PubMed

    Colmer, Timothy D; Flowers, Timothy J

    2008-01-01

    Flooding is a common environmental variable with salinity. Submerged organs can suffer from O(2) deprivation and the resulting energy deficits can compromise ion transport processes essential for salinity tolerance. Tolerance of soil waterlogging in halophytes, as in glycophytes, is often associated with the production of adventitious roots containing aerenchyma, and the resultant internal O(2) supply. For some species, shallow rooting in aerobic upper soil layers appears to be the key to survival on frequently flooded soils, although little is known of the anoxia tolerance in halophytes. Halophytic species that inhabit waterlogged substrates are able to regulate their shoot ion concentrations in spite of the hypoxic (or anoxic) medium in which they are rooted, this being in stark contrast with most other plants which suffer when salinity and waterlogging occur in combination. Very few studies have addressed the consequences of submergence of the shoots by saline water; these have, however, demonstrated tolerance of temporary submergence in some halophytes. PMID:18482227

  17. Composites Damage Tolerance Workshop

    NASA Technical Reports Server (NTRS)

    Gregg, Wayne

    2006-01-01

    The Composite Damage Tolerance Workshop included participants from NASA, academia, and private industry. The objectives of the workshop were to begin dialogue in order to establish a working group within the Agency, create awareness of damage tolerance requirements for Constellation, and discuss potential composite hardware for the Crew Launch Vehicle (CLV) Upper Stage (US) and Crew Module. It was proposed that a composites damage tolerance working group be created that acts within the framework of the existing NASA Fracture Control Methodology Panel. The working group charter would be to identify damage tolerance gaps and obstacles for implementation of composite structures into manned space flight systems and to develop strategies and recommendations to overcome these obstacles.

  18. A radiation tolerant photodetector

    SciTech Connect

    Passenheim, B.C.; Ginaven, R.O.

    1987-12-01

    This paper describes the development and test of a radiation tolerant photodetector. This was accomplished by building a single stage photo multiplier tube with a physically small, dielectrically isolated, silicon photodiode array at the anode. In this device the optically generated photocurrent is multiplied by a much larger factor than is the photo-Compton current. Using matched ''sighted'' and ''optically blind'' diodes to differentiate the optical signal from the ''common-mode'' ionizing radiation photocurrent also contributes to radiation tolerance.

  19. Biocular image misalignment tolerance

    Microsoft Academic Search

    Melvyn E. Kalich; Clarence E. Rash; Corina van de Pol; Terri L. Rowe; Lisa M. Lont; R. David Peterson

    2003-01-01

    Biocular helmet-mounted display (HMD) design flexibility and cost are directly related to image misalignment tolerance standards. Currently recommended tolerance levels are based on highly variable data from a number of studies. This paper presents progress of an ongoing study to evaluate optometric measures sensitive to misalignment in partial-overlap biocular optical systems like that proposed for the Comanche RAH-66 helicopter helmet

  20. Decreased low back pain intensity and differential gene expression following Calmare®: results from a double-blinded randomized sham-controlled study.

    PubMed

    Starkweather, Angela R; Coyne, Patrick; Lyon, Debra E; Elswick, R K; An, Kyungeh; Sturgill, Jamie

    2015-02-01

    In this double-blinded, randomized controlled trial we evaluated the effects of Calmare®, a non-invasive neurocutaneous electrical pain intervention, on lower back pain intensity as measured by the "worst" pain score and on pain interference using the Brief Pain Inventory-Short Form, on measures of pain sensitivity assessed by quantitative sensory testing, and on mRNA expression of pain sensitivity genes. Thirty participants were randomized to receive up to 10 sessions of Calmare® treatment (n?=?15) or a sham treatment (n?=?15) using the same device at a non-therapeutic threshold. At 3 weeks after conclusion of treatment, compared with the sham group, the Calmare® group reported a significant decrease in the "worst" pain and interference scores. There were also significant differences in pain sensitivity and differential mRNA expression of 17 pain genes, suggesting that Calmare® can be effective in reducing pain intensity and interference in individuals with persistent low back pain by altering the mechanisms of enhanced pain sensitivity. Further study of long-term pain outcomes, particularly functional status, analgesic use and health care utilization, is warranted. PMID:25572279