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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. Auricular Acupressure Can Modulate Pain Threshold

    PubMed Central

    Santoro, Antonietta; Nori, Stefania Lucia; Lorusso, Letizia; Secondulfo, Carmine; Monda, Marcellino; Viggiano, Andrea

    2015-01-01

    The objective of our study was to investigate if auriculotherapy (AT) can modulate pain threshold. In our experiments, AT consisted of placing Vaccaria seeds over the “fingers point” of one ear. Two groups of healthy volunteers were enrolled for the study. Each subject was asked to perform an autoalgometric test developed by our group on three occasions: before, 1 hour after, AT and 24 hours after AT. Participants of the first group received a 2-minute long session of AT, while participants of the second group received a 2-minute long session of sham treatment, consisting of a puncture/massage above the skin of the neck. The autoalgometric test consisted of applying an increasing pressure with the finger-tips and finger-backs of four fingers by the subjects themselves (i.e., eight sites were evaluated) against a round-shaped needle for two times: until a minimum pain sensation (first time, minimal test) or a maximally tolerable pain sensation (second time, maximal test). Our results showed a significant higher pain threshold in the maximal test at 24 hours after AT compared to sham treatment. This result indicates for the first time that AT can increase pain tolerability, rather than affecting the minimal pain threshold. PMID:26236378

  3. 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

  4. Social laughter is correlated with an elevated pain threshold.

    PubMed

    Dunbar, R I M; Baron, Rebecca; Frangou, Anna; Pearce, Eiluned; van Leeuwen, Edwin J C; Stow, Julie; Partridge, Giselle; MacDonald, Ian; Barra, Vincent; van Vugt, Mark

    2012-03-22

    Although laughter forms an important part of human non-verbal communication, it has received rather less attention than it deserves in both the experimental and the observational literatures. Relaxed social (Duchenne) laughter is associated with feelings of wellbeing and heightened affect, a proximate explanation for which might be the release of endorphins. We tested this hypothesis in a series of six experimental studies in both the laboratory (watching videos) and naturalistic contexts (watching stage performances), using change in pain threshold as an assay for endorphin release. The results show that pain thresholds are significantly higher after laughter than in the control condition. This pain-tolerance effect is due to laughter itself and not simply due to a change in positive affect. We suggest that laughter, through an endorphin-mediated opiate effect, may play a crucial role in social bonding. PMID:21920973

  5. Dopamine Transporter Genotype Dependent Effects of Apomorphine on Cold Pain Tolerance in Healthy Volunteers

    PubMed Central

    Treister, Roi; Pud, Dorit; Ebstein, Richard P.; Eisenberg, Elon

    2013-01-01

    The aims of this study were to assess the effects of the dopamine agonist apomorphine on experimental pain models in healthy subjects and to explore the possible association between these effects and a common polymorphism within the dopamine transporter gene. Healthy volunteers (n?=?105) participated in this randomized double-blind, placebo-controlled, cross-over trial. Heat pain threshold and intensity, cold pain threshold, and the response to tonic cold pain (latency, intensity, and tolerance) were evaluated before and for up to 120 min after the administration of 1.5 mg apomorphine/placebo. A polymorphism (3?-UTR 40-bp VNTR) within the dopamine transporter gene (SLC6A3) was investigated. Apomorphine had an effect only on tolerance to cold pain, which consisted of an initial decrease and a subsequent increase in tolerance. An association was found between the enhancing effect of apomorphine on pain tolerance (120 min after its administration) and the DAT-1 polymorphism. Subjects with two copies of the 10-allele demonstrated significantly greater tolerance prolongation than the 9-allele homozygote carriers and the heterozygote carriers (p?=?0.007 and p?=?0.003 in comparison to the placebo, respectively). In conclusion, apomorphine administration produced a decrease followed by a genetically associated increase in cold pain tolerance. PMID:23704939

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

    PubMed Central

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

    2014-01-01

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

  7. Effects of mood on pain responses and pain tolerance: an experimental study in chronic back pain patients.

    PubMed

    Tang, Nicole K Y; Salkovskis, Paul M; Hodges, Amy; Wright, Kelly J; Hanna, Magdi; Hester, Joan

    2008-08-31

    Although chronic pain and depression commonly co-occur, causal relationships have yet to be established. A reciprocal relationship, with depression increasing pain and vice versa, is most frequently suggested, but experimental evidence is needed to validate such a view. The most straightforward approach would be a demonstration that increasing or decreasing depressed mood predictably modifies pain responses. The current experiment tested whether experimentally induced depressed and happy mood have differential effects on pain ratings and tolerance in 55 patients suffering from chronic back pain. Participants were randomly assigned to depressed, neutral (control) or elated mood induction conditions. They completed a physically passive baseline task prior to receiving mood induction, then a clinically relevant physically active task (holding a heavy bag) to elicit pain responses and tolerance. Measures were taken immediately after the baseline task and immediately after the mood induction to assess the changes in mood, pain ratings and tolerance before and after the experimental manipulation. Results indicate that the induction of depressed mood resulted in significantly higher pain ratings at rest and lower pain tolerance, whilst induced happy mood resulted in significantly lower pain ratings at rest and greater pain tolerance. Correlations between changes in mood on the one hand and changes in pain response and pain tolerance on the other hand were consistent with these findings. It is concluded that, in chronic back pain patients, experimentally induced negative mood increases self-reported pain and decreases tolerance for a pain-relevant task, with positive mood having the opposite effect. PMID:18325674

  8. 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.

  9. Effect of manipulated state aggression on pain tolerance.

    PubMed

    Stephens, Richard; Allsop, Claire

    2012-08-01

    Swearing produces a pain lessening (hypoalgesic) effect for many people; an emotional response may be the underlying mechanism. In this paper, the role of manipulated state aggression on pain tolerance and pain perception is assessed. In a repeated-measures design, pain outcomes were assessed in participants asked to play for 10 minutes a first-person shooter video game vs a golf video game. Sex differences were explored. After playing the first-person shooter video game, aggressive cognitions, aggressive affect, heart rate, and cold pressor latency were increased, and pain perception was decreased. These data indicate that people become more pain tolerant with raised state aggression and support our theory that raised pain tolerance from swearing occurs via an emotional response. PMID:23045874

  10. Low intensity vagal nerve stimulation lowers human thermal pain thresholds.

    PubMed

    Ness, T J; Fillingim, R B; Randich, A; Backensto, E M; Faught, E

    2000-05-01

    The effect of vagal nerve stimulation (VNS) on thermal pain sensation was studied in eight subjects who had vagal nerve stimulators surgically implanted for purposes of seizure control. Prior to their involvement in the study, all subjects had the intensity of their VNS (30 Hz, 0.5 ms, 1.0-2.75 mA) adjusted upwards until achieving their desired clinical effect of reduced seizures. Thermal pain thresholds were determined using a Medoc TSA-2001 with a thermode applied to the skin of the forearm. During VNS at settings 100% of those used clinically to control their seizures, subjects showed a statistically significant decrease in their thermal pain threshold of 1.1+/-0.4 degrees C. Acute effects of graded VNS on thermal pain thresholds were determined in seven of the subjects after cessation of chronic VNS. Two thermal threshold measurements were obtained while the subject received sham stimulation (0 mA intensity), during tactile control stimulation and during 30 s of VNS at intensities approximately 33, 66 and 100% of the settings utilized to control their seizures. Tactile control stimulation was provided by electrical stimulation of the skin of the ankle with the intensity adjusted by the patient to match the intensity of any sensations felt in the neck during VNS. Subjects were not aware of the settings employed. Their stimulator was adjusted with each trial and an ascending/descending ordering of intensity was utilized with an inter-trial interval of 2 min. Thermal pain thresholds were significantly decreased in relation to tactile control stimulation at all intensities of VNS tested with the greatest effect occurring at the 66% level. Subjects were also monitored non-invasively and hemodynamic responses to VNS were determined. No significant alterations in hemodynamic variables were observed. The findings of this human study are consistent with experiments in non-human animals which demonstrate a pro-nociceptive effect of low intensity VNS. PMID:10779664

  11. A constant affinity threshold for T cell tolerance

    PubMed Central

    Naeher, Dieter; Daniels, Mark A.; Hausmann, Barbara; Guillaume, Philippe; Luescher, Immanuel; Palmer, Ed

    2007-01-01

    T cell tolerance depends on the T cell receptor's affinity for peptide/major histocompatibility complex (MHC) ligand; this critical parameter determines whether a thymocyte will be included (positive selection) or excluded (negative selection) from the T cell repertoire. A quantitative analysis of ligand binding was performed using an experimental system permitting receptor–coreceptor interactions on live cells under physiological conditions. Using three transgenic mouse strains expressing distinct class I MHC–restricted T cell receptors, we determined the affinity that defines the threshold for negative selection. The affinity threshold for self-tolerance appears to be a constant for cytotoxic T lymphocytes. PMID:17938233

  12. Changes of cutaneous sensory thresholds induced by non-painful transcutaneous electrical nerve stimulation in normal subjects and in subjects with chronic pain.

    PubMed Central

    Zoppi, M; Francini, F; Maresca, M; Procacci, P

    1981-01-01

    Transcutaneous electrical nerve stimulation (TENS) of the nervi cutaneus surae medialis was applied to 59 healthy subjects and 30 patients suffering from chronic myofascial pain in one lower limb, with an intensity of current that induced a well tolerated tingling sensation. Each period of stimulation lasted 24 minutes. The thresholds of the tactile, tingling and painful sensations were tested at fixed intervals before, during and after stimulation. Trains of constant current square waves in the distribution area of the stimulated nerve (local thresholds) and in other areas (general thresholds) were used. In all subjects repeated changes of the current were necessary in order to maintain constant tingling during the first period of TENS (changing phase); after that few if any changes of the current were necessary (steady phase). There were changes in thresholds within the territory of the electrically stimulated nerve, and marked changes elsewhere and generally in the body. In healthy subjects local thresholds increased during both phases of TENS; general thresholds decreased during the changing phase and increased during the steady phase. After TENS, thresholds showed the same trend as during the steady phase. Trends of the sensory thresholds during and after TENS differed in different subjects according to their thresholds before TENS. Thresholds did not return to normal for more than 20 minutes after TENS. In the group of 30 patients there was a significant difference between thresholds on the two sides of the body. The difference between the two sides was reduced by TENS. Pain relief induced by TENS may be related to this fact. PMID:6975355

  13. Rowers' high: behavioural synchrony is correlated with elevated pain thresholds.

    PubMed

    Cohen, Emma E A; Ejsmond-Frey, Robin; Knight, Nicola; Dunbar, R I M

    2010-02-23

    Physical exercise is known to stimulate the release of endorphins, creating a mild sense of euphoria that has rewarding properties. Using pain tolerance (a conventional non-invasive assay for endorphin release), we show that synchronized training in a college rowing crew creates a heightened endorphin surge compared with a similar training regime carried out alone. This heightened effect from synchronized activity may explain the sense of euphoria experienced during other social activities (such as laughter, music-making and dancing) that are involved in social bonding in humans and possibly other vertebrates. PMID:19755532

  14. Insular Cortex Mediates Increased Pain Tolerance in Yoga Practitioners

    PubMed Central

    Villemure, Chantal; ?eko, Marta; Cotton, Valerie A.; Bushnell, M. Catherine

    2014-01-01

    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

  15. Intrathecal rapamycin attenuates morphine-induced analgesic tolerance and hyperalgesia in rats with neuropathic pain

    PubMed Central

    Xu, Ji-Tian; Sun, Linlin; Lutz, Brianna Marie; Bekker, Alex; Tao, Yuan-Xiang

    2015-01-01

    Repeated and long-term administration of opioids is often accompanied by the initiation of opioid-induced analgesic tolerance and hyperalgesia in chronic pain patients. Our previous studies showed that repeated intrathecal morphine injection activated the mammalian target of rapamycin complex 1 (mTORC1) in spinal dorsal horn neurons and that blocking this activation prevented the initiation of morphine-induced tolerance and hyperalgesia in healthy rats. However, whether spinal mTORC1 is required for morphine-induced tolerance and hyperalgesia under neuropathic pain conditions remains elusive. We here observed the effect of intrathecal infusion of rapamycin, a specific mTORC1 inhibitor, on morphine-induced tolerance and hyperalgesia in a neuropathic pain model in rats induced by the fifth lumbar spinal nerve ligation (SNL). Continuous intrathecal infusion of morphine for one week starting on day 8 post-SNL led to morphine tolerance demonstrated by morphine-induced reduction in maximal possible analgesic effect (MPAE) to tail heat stimuli and ipsilateral paw withdrawal threshold (PWT) to mechanical stimuli in SNL rats. Such reduction was attenuated by co-infusion of rapamycin. Co-infusion of rapamycin also blocked morphine tolerance demonstrated by attenuation of morphine-induced reduction in MPAE in sham rats and morphine-induced hyperalgesia demonstrated by the reverse of morphine-induced reduction in PWT on both sides of sham rats and on the contralateral side of SNL rats. The results suggest that mTORC1 inhibitors could serve as promising medications for use as adjuvants with opioids in clinical neuropathic pain management. PMID:26339682

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

    PubMed Central

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

    2014-01-01

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

  17. A Novel Quantitative Pain Assessment Instrument That Provides Means of Comparing Patient’s Pain Magnitude With a Measurement of Their Pain Tolerance

    PubMed Central

    Johnson, Lanny L.; Pittsley, Andrew; Becker, Ruth; Young, Allison De

    2015-01-01

    Background Traditional pain assessment instruments are subjective in nature. They are limited to subjective reporting of the presence and magnitude of pain. There is no means of validating their response or assessing their pain tolerance. The objective of this study was to determine the potential value of a novel addition to the traditional physical examination concerning a patient’s pain and more importantly their pain tolerance. Methods Extensive preliminary data were collected on 359 consecutive private practice knee patients referable the subject’s pain, including the magnitude, the most pain ever experienced, and their opinion of personal pain tolerance. The novel evaluation included physical testing of a series of small ball drops through a vertical tube from various fixed levels on the index finger and patella. The patient’s response to this impact testing provided quantitative information, from which a comparison was made to their pain opinion and also to that of other patients with similar demographics. Results Nine percent of the patients rated their pain tolerance below the midpoint on the visual analog scale. Seventy-one percent thought they were above the midpoint on the scale in regards to pain tolerance. There were discrepancies in both directions between the subject’s opinion on pain tolerance and their rating of their pain experience to the ball drop testing. Twenty-eight percent of the entire patient group rated themselves above 5 on tolerance, but experienced above the average discomfort compared to other subjects reporting on the finger impact testing. Conclusions This report introduces a novel method for collecting data concerning pain that can be subjected to quantification. The database included quantitative measures providing the opportunity to confirm, validate or refute the patient’s assertions concerning pain magnitude and tolerance. This method is best described as a patient pain profile. It has the potential to give both the patient and the physician quantified objective information rendering insight not otherwise available. PMID:26346200

  18. Performance of music elevates pain threshold and positive affect: implications for the evolutionary function of music.

    PubMed

    Dunbar, R I M; Kaskatis, Kostas; MacDonald, Ian; Barra, Vinnie

    2012-01-01

    It is well known that music arouses emotional responses. In addition, it has long been thought to play an important role in creating a sense of community, especially in small scale societies. One mechanism by which it might do this is through the endorphin system, and there is evidence to support this claim. Using pain threshold as an assay for CNS endorphin release, we ask whether it is the auditory perception of music that triggers this effect or the active performance of music. We show that singing, dancing and drumming all trigger endorphin release (indexed by an increase in post-activity pain tolerance) in contexts where merely listening to music and low energy musical activities do not. We also confirm that music performance results in elevated positive (but not negative) affect. We conclude that it is the active performance of music that generates the endorphin high, not the music itself. We discuss the implications of this in the context of community bonding mechanisms that commonly involve dance and music-making. PMID:23089077

  19. Psychophysical Investigations into the Role of Low-Threshold C Fibres in Non-Painful Affective Processing and Pain Modulation

    PubMed Central

    Shaikh, Sumaiya; Nagi, Saad S.; McGlone, Francis; Mahns, David A.

    2015-01-01

    We recently showed that C low-threshold mechanoreceptors (CLTMRs) contribute to touch-evoked pain (allodynia) during experimental muscle pain. Conversely, in absence of ongoing pain, the activation of CLTMRs has been shown to correlate with a diffuse sensation of pleasant touch. In this study, we evaluated (1) the primary afferent fibre types contributing to positive (pleasant) and negative (unpleasant) affective touch and (2) the effects of tactile stimuli on tonic muscle pain by varying affective attributes and frequency parameters. Psychophysical observations were made in 10 healthy participants. Two types of test stimuli were applied: stroking stimulus using velvet or sandpaper at speeds of 0.1, 1.0 and 10.0 cm/s; focal vibrotactile stimulus at low (20 Hz) or high (200 Hz) frequency. These stimuli were applied in the normal condition (i.e. no experimental pain) and following the induction of muscle pain by infusing hypertonic saline (5%) into the tibialis anterior muscle. These observations were repeated following the conduction block of myelinated fibres by compression of sciatic nerve. In absence of muscle pain, all participants reliably linked velvet-stroking to pleasantness and sandpaper-stroking to unpleasantness (no pain). Likewise, low-frequency vibration was linked to pleasantness and high-frequency vibration to unpleasantness. During muscle pain, the application of previously pleasant stimuli resulted in overall pain relief, whereas the application of previously unpleasant stimuli resulted in overall pain intensification. These effects were significant, reproducible and persisted following the blockade of myelinated fibres. Taken together, these findings suggest the role of low-threshold C fibres in affective and pain processing. Furthermore, these observations suggest that temporal coding need not be limited to discriminative aspects of tactile processing, but may contribute to affective attributes, which in turn predispose individual responses towards excitatory or inhibitory modulation of pain. PMID:26372601

  20. Is the Effect of Behavioral Synchrony on Cooperative Behavior Mediated by Pain Threshold?

    PubMed

    Sullivan, Philip; Gagnon, Morgan; Gammage, Kimberley; Peters, Sandra

    2015-01-01

    Synchronized behavior results in a variety of prosocial behaviors. Research has also implicated that interpersonal synchrony affects pain thresholds, inferred as indicative of endorphin levels. The current study was designed to see if these pain threshold effects mediated the effect of synchrony on interpersonal cooperation. Twenty six individuals were randomly assigned to complete a 30 minute run on a treadmill in either a synchronized or nonsynchronized condition. Pain threshold was measured both before and after exercise as an indicator of endorphin activity. A postrun social investment game measured interpersonal cooperation. Analyses showed that there was a significant direct relationship between condition and cooperation but that this effect was not mediated by pain threshold. PMID:26176818

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

    PubMed

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

    2009-03-01

    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 influence of sad mood upon heat pain processing in healthy subjects. For this purpose, we used a combination of the Velten Mood Induction procedure and a piece of music to induce sad affect. Initially we assessed heat pain threshold after successful induction of sad mood outside the MR scanner in Experiment 1. We found a highly significant reduction in heat pain threshold on the left hand and a trend for the right. In Experiment 2, we applied thermal pain stimuli on the left hand (37, 42, and 45 degrees C) in an MRI scanner. Subjects were scanned twice, one group before and after sad-mood induction and another group before and after neutral-mood induction, respectively. Our main finding was a significant group x mood-induction interaction bilaterally in the ventrolateral nucleus of the thalamus indicating a BOLD signal increase after sad-mood induction and a BOLD signal decrease in the control group. We present evidence that induced sad affect leads to reduced heat pain thresholds in healthy subjects. This is probably due to altered lateral thalamic activity, which is potentially associated with changed attentional processes. PMID:19027763

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

    PubMed Central

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

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

  3. The effects of electroacupuncture on analgesia and peripheral sensory thresholds in patients with burn scar pain.

    PubMed

    Cuignet, Olivier; Pirlot, A; Ortiz, S; Rose, T

    2015-09-01

    The aim of this study is to observe if the effects of electro-acupuncture (EA) on analgesia and peripheral sensory thresholds are transposable from the model of heat pain in volunteers to the clinical setting of burn scar pain. After severe burns, pathological burn scars (PPBS) may occur with excruciating pain that respond poorly to treatment and prevent patients from wearing their pressure garments, thereby leading to unesthetic and function-limiting scars. EA might be of greater benefit in terms of analgesia and functional recovery, should it interrupt this vicious circle by counteracting the peripheral hyperalgesia characterizing PPBS. Therefore we enrolled 32 patients (22 males/10 females) aged of 46±11 years with clinical signs of PPBS and of neuropathic pain despite treatment. The study protocol consisted in 3 weekly 30-min sessions of standardized EA with extra individual needles in accordance to Traditional Chinese Medicine, in addition of previous treatments. We assessed VAS for pain and quantitative sensory testing (QST) twice: one week before and one after protocol. QST measured electrical thresholds for non-nociceptive A-beta fibers, nociceptive A-delta and C fibers in 2 dermatomes, respectively from the PPBS and from the contralateral pain-free areas. Based on heat pain studies, EA consisted in sessions at the extremity points of the main meridian flowing through PPBS (0.300s, 5Hz, sub noxious intensity, 15min) and at the bilateral paravertebral points corresponding to the same metameric level, 15min. VAS reduction of 3 points or below 3 on a 10 points scale was considered clinically relevant. Paired t-test compared thresholds (mean [SD]) and Wilcoxon test compared VAS (median [IQR]) pre and after treatment, significant p<0.05. The reduction of VAS for pain reached statistical but not clinical relevance (6.8 [3] vs. 4.5 [3.6]). This was due to a large subgroup of 14 non-responders whose VAS did not change after treatment (6.6 [2.7] vs. 7.2 [3.8]). That subgroup exhibited significant differences in sensory thresholds when compared to the 18 responders (VAS from 7 [3] to 3 [1]). First, responders' thresholds for A-delta and C fibers in the PPBS area were significantly lower than those in the pain-free area before treatment but corrected after acupuncture (from respectively 60 [30] and 63 [10]% to 91 [11] and 106 [36]%). That might account for a nociceptive hypersensitivity in the PPBS that corrected after treatment. On the contrary, in non-responders nociceptive thresholds were similar in both the PPBS and the pain-free areas before treatment and did not change after EA. However, absolute values for thresholds in the pain-free areas where significantly lower for non-responders than for responders. The fact that non-responders had significant pain scores while presenting with lowered nociceptive thresholds even in the pain-free areas might evoke the possibility of a generalized supra-spinal hyperalgesia. The fact that acupuncture did not correct the pain nor the nociceptive thresholds in this subgroup requires further investigation. We also observed a statistically and clinically relevant reduction in VAS for pruritus for all patients - even those from the subgroup of non-responders to pain - that is worth to be mentioned and requires further studies to be confirmed. This observational study is the first that confirms the effects of acupuncture on analgesia and nociceptive thresholds in the clinical setting of burn pain only for patients presenting with a burn-localized but not a generalized hyperalgesia. PMID:26188894

  4. 76 FR 67315 - Supplemental Nutrition Assistance Program: Quality Control Error Tolerance Threshold

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-11-01

    ...DEPARTMENT OF AGRICULTURE Food and Nutrition Service 7 CFR Part 275 [FNS-2011-0060] RIN 0584-AE24 Supplemental Nutrition Assistance Program: Quality Control...Tolerance Threshold AGENCY: Food and Nutrition Service, USDA. ACTION:...

  5. 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 ...

  6. 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.

  7. Effects of topical diclofenac (DHEP plaster) on skin, subcutis and muscle pain thresholds in subjects without spontaneous pain.

    PubMed

    Affaitati, G; Vecchiet, F; Lerza, R; De Laurentis, S; Iezzi, S; Festa, F; Giamberardino, M A

    2001-01-01

    The aim of this study was to determine whether topical application of diclofenac hydroxyethylpyrrolidine (DHEP) modifies somatic pain sensitivity in subjects without spontaneous pain. Twenty male subjects (aged 19-40 years), who had not reported any pain for at least 1 month, underwent measurement of pain thresholds to bilateral electrical stimulation in the quadriceps muscle and overlying subcutis and skin. Following the double-blind study design, one diclofenac adhesive plaster (13 x 10 cm; 180 mg DHEP) was then applied over one quadriceps while a matched placebo plaster was placed contralaterally. Each subject was given two other plasters (diclofenac and placebo) and instructed to substitute those over the quadriceps after 12 h and to wear them for a further 12 h. Thirty minutes after removal of the second plasters, thresholds. were remeasured in all subjects as on the previous day. Thresholds at the first evaluation were within normal range in nine subjects (group 1) and below normal in muscle (hyperalgesia) in the remaining 11 (group 2). No significant changes were observed in skin or subcutis thresholds after diclofenac or placebo treatment in either group. In contrast, muscle thresholds significantly increased after diclofenac compared with placebo treatment (group 1: p < 0.05; group 2: p < 0.007); the increase was significantly higher in group 2 than in group 1 (p < 0.002). Topical application of diclofenac had a selective hypoalgesic effect on muscles, which was more pronounced in the case of hyperalgesia. These results suggest that the preparation is particularly effective in the treatment of algogenic conditions of deep somatic tissues. PMID:11392056

  8. [ANALGESIC EFFECT OF TROPALGIN ON THERMAL PAIN IN RATS WITH DIFFERENT PAIN THRESHOLDS].

    PubMed

    Zarubina, I V; Fedorova, O V; Shabano, P D

    2015-01-01

    Experiments on rats divided into two groups (with high and low pain sensitivity) were used to assess the effect of tropalgin, a new derivative of tropine, in thermal pain tests (tail-flick and hot plate). Tropalgin was found to possess an analgesic effect comparable to that of reference sodium metamizole. ED50 of tropalgin was 2 mg/kg for intraperitoneal administration. The duration of the analgesic effect of tropalgin in rats low pain sensitivity was longer than in animals highly sensitive to pain. It is suggested that the analgesic effect of tropalgin can be related to the adenosine liberating action of this drug. PMID:26591574

  9. Overcoming pain thresholds with multilevel models-an example using quantitative sensory testing (QST) data.

    PubMed

    Hirschfeld, Gerrit; Blankenburg, Markus R; Süß, Moritz; Zernikow, Boris

    2015-01-01

    The assessment of somatosensory function is a cornerstone of research and clinical practice in neurology. Recent initiatives have developed novel protocols for quantitative sensory testing (QST). Application of these methods led to intriguing findings, such as the presence lower pain-thresholds in healthy children compared to healthy adolescents. In this article, we (re-) introduce the basic concepts of signal detection theory (SDT) as a method to investigate such differences in somatosensory function in detail. SDT describes participants' responses according to two parameters, sensitivity and response-bias. Sensitivity refers to individuals' ability to discriminate between painful and non-painful stimulations. Response-bias refers to individuals' criterion for giving a "painful" response. We describe how multilevel models can be used to estimate these parameters and to overcome central critiques of these methods. To provide an example we apply these methods to data from the mechanical pain sensitivity test of the QST protocol. The results show that adolescents are more sensitive to mechanical pain and contradict the idea that younger children simply use more lenient criteria to report pain. Overall, we hope that the wider use of multilevel modeling to describe somatosensory functioning may advance neurology research and practice. PMID:26557435

  10. Overcoming pain thresholds with multilevel models—an example using quantitative sensory testing (QST) data

    PubMed Central

    Blankenburg, Markus R.; Süß, Moritz; Zernikow, Boris

    2015-01-01

    The assessment of somatosensory function is a cornerstone of research and clinical practice in neurology. Recent initiatives have developed novel protocols for quantitative sensory testing (QST). Application of these methods led to intriguing findings, such as the presence lower pain-thresholds in healthy children compared to healthy adolescents. In this article, we (re-) introduce the basic concepts of signal detection theory (SDT) as a method to investigate such differences in somatosensory function in detail. SDT describes participants’ responses according to two parameters, sensitivity and response-bias. Sensitivity refers to individuals’ ability to discriminate between painful and non-painful stimulations. Response-bias refers to individuals’ criterion for giving a “painful” response. We describe how multilevel models can be used to estimate these parameters and to overcome central critiques of these methods. To provide an example we apply these methods to data from the mechanical pain sensitivity test of the QST protocol. The results show that adolescents are more sensitive to mechanical pain and contradict the idea that younger children simply use more lenient criteria to report pain. Overall, we hope that the wider use of multilevel modeling to describe somatosensory functioning may advance neurology research and practice. PMID:26557435

  11. 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

  12. 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

  13. Effects of two different intensities of transcutaneous electrical nerve stimulation on pain thresholds of contralateral muscles in healthy subjects

    PubMed Central

    Tanaka, Katsuyoshi; Ikeuchi, Masahiko; Izumi, Masashi; Aso, Koji; Sugimura, Natsuki; Enoki, Hayato; Nagano, Yasunori; Ishida, Kenji; Tani, Toshikazu

    2015-01-01

    [Purpose] This study aimed to investigate the differential effects of high-intensity and low-intensity transcutaneous electrical nerve stimulation on the contralateral side on the pain threshold in healthy subjects. [Subjects and Methods] Twenty-five healthy adults, volunteers received two intensity levels (motor-level, 1.5 times the muscle motor threshold; sensory-level, sensory threshold of the common peroneal nerve), for 30?s on separate days. Pressure pain threshold was recorded on the contralateral tibialis anterior and deltoid muscle before, during, and after stimulation. [Results] Motor-level stimulation significantly increased the pressure pain threshold at both muscle sites, while effects of sensory-level stimulation on pressure pain thresholds were significant only at the deltoid site. The percent change in pressure pain thresholds at both sites was significantly higher during motor-level stimulation. [Conclusion] Motor-level stimulation, applied unilaterally to one leg, produced immediate contralateral diffuse and segmental analgesic effects. This may be of therapeutic benefit in patients for whom transcutaneous electrical nerve stimulation cannot be directly used at the painful site. PMID:26504290

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

    PubMed

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

    2013-01-01

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

  15. Real men are made, not born! Incidental exposure to energy drinks may promote men's tolerance of physical pain.

    PubMed

    Abetkoff, Darren; Karlsson, Torulf; Chiou, Wen-Bin

    2015-12-01

    The energy drink market has grown exponentially since the debut of Red Bull. Advertising of energy drinks tends to reinforce an emphasis on masculine identification. However, no previous study has addressed the symbolic effect of energy drinks on pain tolerance, that is, a particular masculine characteristic. We conducted a priming-based experiment to show that energy drink primes elevated men's pain tolerance. Induced conformity to masculinity norms mediated the priming effect of energy drinks on pain tolerance. These findings suggest that mere reminders of masculinity-related products can lead men to behave accordingly in seemingly irrelevant domains (i.e., pain tolerance). Besides distraction and placebo treatment, the connection between a symbolic masculinity prime and greater tolerance of pain may shed lights on an alternative route for pain control. PMID:26437721

  16. [Influence of simulated microgravity on the threshold of pain sensitivity in humans with single dose of ketorolac].

    PubMed

    Baranov, M V; Kovalev, A S; Perfilov, D F; Chernogorov, R V; Repenkova, L G

    2015-01-01

    The data supporting the influence of simulated microgravity effects on pain sensitivity were obtained in the series of experiments involving human. In conditions of antiorthostatic hypokinesia (ANOH) and immersion revealed no reduction in pain sensitivity in the morning, which is typical for normal conditions. Ketorolac has no effect on pain sensitivity, when determining the pain threshold (PT) by method of thermoalgometry. However, the conditions of simulated microgravity substantially alter the pharmacokinetics of ketorolac, increasing the rate of absorption of the drug and reduce its relative bioavailability and retention time in the blood plasma. This may require changes in pain therapy schemes in space flight. PMID:26571803

  17. The effects of distraction on exercise and cold pressor tolerance for chronic low back pain sufferers.

    PubMed

    Johnson, M H; Petrie, S M

    1997-01-01

    Distraction has been found to be effective for the attenuation of experimental and acute clinical pain but its efficacy for chronic pain management remains unclear. There are even some suggestions that distraction may be a counterproductive strategy for chronic pain sufferers. In this study we found that a word shadowing distraction task increased the ability of a group of 12 female and eight male chronic low back pain (CLBP) sufferers to carry out a brief (maximum 300 s) step-up exercise that temporarily increased their pain (P < 0.05). This 15% increase in exercise time was not accompanied by an increase in reported pain after the exercise. Interestingly, the same distraction task did not increase the cold pressor (CP) tolerance time for the CLBP group but produced a 26% increase in tolerance time for a pain-free control group consisting of nine females and nine males (P < 0.05). Also, performance on the distraction task during the CP was worse for the CLBP group than the controls (P < 0.05). Although these findings should be interpreted cautiously because of the parameters of the experiment, they do suggest that distraction is a potentially useful technique to assist chronic pain sufferers. PMID:9060011

  18. 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

  19. 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.

  20. Synchrony and exertion during dance independently raise pain threshold and encourage social bonding

    PubMed Central

    Tarr, Bronwyn; Launay, Jacques; Cohen, Emma; Dunbar, Robin

    2015-01-01

    Group dancing is a ubiquitous human activity that involves exertive synchronized movement to music. It is hypothesized to play a role in social bonding, potentially via the release of endorphins, which are analgesic and reward-inducing, and have been implicated in primate social bonding. We used a 2 × 2 experimental design to examine effects of exertion and synchrony on bonding. Both demonstrated significant independent positive effects on pain threshold (a proxy for endorphin activation) and in-group bonding. This suggests that dance which involves both exertive and synchronized movement may be an effective group bonding activity. PMID:26510676

  1. Synchrony and exertion during dance independently raise pain threshold and encourage social bonding.

    PubMed

    Tarr, Bronwyn; Launay, Jacques; Cohen, Emma; Dunbar, Robin

    2015-10-01

    Group dancing is a ubiquitous human activity that involves exertive synchronized movement to music. It is hypothesized to play a role in social bonding, potentially via the release of endorphins, which are analgesic and reward-inducing, and have been implicated in primate social bonding. We used a 2 × 2 experimental design to examine effects of exertion and synchrony on bonding. Both demonstrated significant independent positive effects on pain threshold (a proxy for endorphin activation) and in-group bonding. This suggests that dance which involves both exertive and synchronized movement may be an effective group bonding activity. PMID:26510676

  2. The Effect of Traditional Cupping on Pain and Mechanical Thresholds in Patients with Chronic Nonspecific Neck Pain: A Randomised Controlled Pilot Study

    PubMed Central

    Lauche, Romy; Cramer, Holger; Hohmann, Claudia; Choi, Kyung-Eun; Rampp, Thomas; Saha, Felix Joyonto; Musial, Frauke; Langhorst, Jost; Dobos, Gustav

    2012-01-01

    Introduction. Cupping has been used since antiquity in the treatment of pain conditions. In this pilot study, we investigated the effect of traditional cupping therapy on chronic nonspecific neck pain (CNP) and mechanical sensory thresholds. Methods. Fifty CNP patients were randomly assigned to treatment (TG, n = 25) or waiting list control group (WL, n = 25). TG received a single cupping treatment. Pain at rest (PR), pain related to movement (PM), quality of life (SF-36), Neck Disability Index (NDI), mechanical detection (MDT), vibration detection (MDT), and pressure pain thresholds (PPT) were measured before and three days after a single cupping treatment. Patients also kept a pain and medication diary (PaDi, MeDi) during the study. Results. Baseline characteristics were similar in the two groups. After cupping TG reported significantly less pain (PR: ?17.9?mm VAS, 95%CI ?29.2 to ?6.6; PM: ?19.7, 95%CI ?32.2 to ?7.2; PaDi: ?1.5 points on NRS, 95%CI ?2.5 to ?0.4; all P < 0.05) and higher quality of life than WL (SF-36, Physical Functioning: 7.5, 95%CI 1.4 to 13.5; Bodily Pain: 14.9, 95%CI 4.4 to 25.4; Physical Component Score: 5.0, 95%CI 1.4 to 8.5; all P < 0.05). No significant effect was found for NDI, MDT, or VDT, but TG showed significantly higher PPT at pain-areas than WL (in lg(kPa); pain-maximum: 0.088, 95%CI 0.029 to 0.148, pain-adjacent: 0.118, 95%CI 0.038 to 0.199; both P < 0.01). Conclusion. A single application of traditional cupping might be an effective treatment for improving pain, quality of life, and hyperalgesia in CNP. PMID:22203873

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

    E-print Network

    Kanungo, Aparna

    2005-11-01

    fulfillment of the requirements for the degree of MASTER OF SCIENCE Approved by: Chair of Committee, Andreas Klappenecker Committee Members, Rabi Mahapatra Suhail Zubairy Head of Department, Valerie Taylor August 2005 Major Subject: Computer Science iii... ABSTRACT Threshold Analysis with Fault-Tolerant Operations for Nonbinary Quantum Error Correcting Codes. (August 2005) Aparna Kanungo, B.E., Anna University Chair of Advisory Committee: Dr. Andreas Klappenecker Quantum error correcting codes have been...

  4. 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…

  5. Fentanyl pectin nasal spray: in breakthrough pain in opioid-tolerant adults with cancer.

    PubMed

    Lyseng-Williamson, Katherine A

    2011-06-01

    Fentanyl pectin nasal spray (PecFent®) uses a novel pectin-based delivery system that turns from an aqueous solution into a gel when applied to mucosal surfaces. Fentanyl is absorbed in a controlled manner from the pectin gel formed in the nasal cavity, and has a rapid onset of pain relief and duration of action that matches the time course of a typical episode of breakthrough pain in cancer (BTPc). Relative to administration as oral transmucosal fentanyl, fentanyl administered as fentanyl pectin nasal spray is more rapidly absorbed, reaches higher maximum plasma concentrations and has greater bioavailability. In the treatment of BTPc in two randomized, double-blind, crossover trials in opioid-tolerant adults, fentanyl pectin nasal spray (100-800??g titrated doses) was significantly more effective than placebo in reducing pain intensity and provided a significantly faster onset of pain relief than oral immediate-release morphine. During long-term treatment of BTPc episodes, fentanyl pectin nasal spray consistently provided effective pain relief in an open-label, 16-week trial. Most patients were satisfied or very satisfied with the ease of use and convenience of the nasal spray. Fentanyl pectin nasal spray 100-800??g was generally well tolerated and was not associated with nasal tolerability problems. PMID:21649451

  6. Is experimentally induced pain associated with socioeconomic status? Do poor people hurt more?

    PubMed Central

    Miljkovi?, Ana; Stip?i?, Ana; Braš, Marijana; ?or?evi?, Veljko; Brajkovi?, Lovorka; Hayward, Caroline; Pavi?, Arsen; Kol?i?, Ivana; Polašek, Ozren

    2014-01-01

    Background The association of pain and socioeconomic status is widely reported, yet much less clearly understood. The aim of this study was to investigate the association of experimentally induced pain threshold and tolerance with socioeconomic status. Material/Methods The study sample consisted of 319 adult subjects from the population of the island of Vis, Croatia, which was previously shown to have a high level of social homogeneity. A manual dolorimeter was used to measure mechanical pressure pain threshold (least stimulus intensity) and pain tolerance (maximum tolerance stimulus intensity) on both hands. Pain tolerance interval was defined as the difference between pain tolerance and threshold. Years of schooling and material status were used as socioeconomic estimates. Results Both of the socioeconomic estimates were significantly correlated with pain threshold, tolerance, and tolerance interval (P<0.001). The mixed modeling analysis, controlled for the effects of age, gender, and 4 psychological variables, indicated that education was not a significant predictor in any of the 3 models. However, lower material status was significantly associated with lower pain tolerance (P=0.038) and narrower pain tolerance interval (P=0.032), but not with pain threshold (P=0.506). The overall percentages of explained variance were lower in the tolerance interval model (20.2%) than in pain tolerance (23.1%) and threshold (33.1%), suggesting the increasing share of other confounding variables in pain tolerance and even more so in tolerance interval model. Conclusions These results suggest a significant association between experimentally induced pain tolerance and tolerance interval with material status, suggesting that poor people indeed do hurt more. PMID:25029965

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

    PubMed

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

    2011-11-01

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

  8. Nociceptive flexion reflex thresholds and pain during rest and computer game play in patients with hypertension and individuals at risk for hypertension

    PubMed Central

    Edwards, Louisa; Ring, Christopher; France, Christopher R.; al'Absi, Mustafa; McIntyre, David; Carroll, Douglas; Martin, Una

    2007-01-01

    Supraspinal pain modulation may explain hypertensive hypoalgesia. We compared nociceptive flexion reflex (NFR) thresholds and pain during rest and computer game play in hypertensives and normotensives (Experiment 1) and normotensives with and without hypertensive parents (Experiment 2). The game was selected to modulate activity in pain pathways. NFR thresholds did not differ between groups during rest or game play. Pain ratings never differed between hypertensives and normotensives, whereas individuals with hypertensive parents reported less pain during the first two NFR assessments, compared to those without. NFR thresholds and pain were reduced by game play compared to rest. The failure of game play to differentially modulate NFR thresholds or associated pain reports between groups argues against enhanced supraspinal modulation of nociception and pain in hypertensives and those at increased risk for hypertension. PMID:17686566

  9. The body fades away: investigating the effects of transparency of an embodied virtual body on pain threshold and body ownership

    PubMed Central

    Martini, Matteo; Kilteni, Konstantina; Maselli, Antonella; Sanchez-Vives, Maria V.

    2015-01-01

    The feeling of “ownership” over an external dummy/virtual body (or body part) has been proven to have both physiological and behavioural consequences. For instance, the vision of an “embodied” dummy or virtual body can modulate pain perception. However, the impact of partial or total invisibility of the body on physiology and behaviour has been hardly explored since it presents obvious difficulties in the real world. In this study we explored how body transparency affects both body ownership and pain threshold. By means of virtual reality, we presented healthy participants with a virtual co-located body with four different levels of transparency, while participants were tested for pain threshold by increasing ramps of heat stimulation. We found that the strength of the body ownership illusion decreases when the body gets more transparent. Nevertheless, in the conditions where the body was semi-transparent, higher levels of ownership over a see-through body resulted in an increased pain sensitivity. Virtual body ownership can be used for the development of pain management interventions. However, we demonstrate that providing invisibility of the body does not increase pain threshold. Therefore, body transparency is not a good strategy to decrease pain in clinical contexts, yet this remains to be tested. PMID:26415748

  10. The body fades away: investigating the effects of transparency of an embodied virtual body on pain threshold and body ownership.

    PubMed

    Martini, Matteo; Kilteni, Konstantina; Maselli, Antonella; Sanchez-Vives, Maria V

    2015-01-01

    The feeling of "ownership" over an external dummy/virtual body (or body part) has been proven to have both physiological and behavioural consequences. For instance, the vision of an "embodied" dummy or virtual body can modulate pain perception. However, the impact of partial or total invisibility of the body on physiology and behaviour has been hardly explored since it presents obvious difficulties in the real world. In this study we explored how body transparency affects both body ownership and pain threshold. By means of virtual reality, we presented healthy participants with a virtual co-located body with four different levels of transparency, while participants were tested for pain threshold by increasing ramps of heat stimulation. We found that the strength of the body ownership illusion decreases when the body gets more transparent. Nevertheless, in the conditions where the body was semi-transparent, higher levels of ownership over a see-through body resulted in an increased pain sensitivity. Virtual body ownership can be used for the development of pain management interventions. However, we demonstrate that providing invisibility of the body does not increase pain threshold. Therefore, body transparency is not a good strategy to decrease pain in clinical contexts, yet this remains to be tested. PMID:26415748

  11. 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

  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. Comparison of muscle and joint pressure-pain thresholds in patients with complex regional pain syndrome and upper limb pain of other origin.

    PubMed

    Mainka, Tina; Bischoff, Florian S; Baron, Ralf; Krumova, Elena K; Nicolas, Volkmar; Pennekamp, Werner; Treede, Rolf-Detlef; Vollert, Jan; Westermann, Andrea; Maier, Christoph

    2014-03-01

    Pain localized in the deep tissues occurs frequently in complex regional pain syndrome (CRPS). In addition, hyperalgesia to blunt pressure over muscles is common in CRPS, but it often appears in limb pain of other origin as well. Considering that 3-phase bone scintigraphy (TPBS) reveals periarticular enhanced bone metabolism in CRPS, joint-associated hyperalgesia to blunt pressure might be a more specific finding than hyperalgesia over muscles. In 34 patients with upper limb pain (18 CRPS, 16 non-CRPS; diagnosed in accordance to the Budapest criteria) and in 18 healthy controls, pressure-pain thresholds (PPT) were assessed bilaterally over the thenar (PPTThenar), the metacarpophalangeal (PPTMCP), and the proximal interphalangeal (PPTPIP) joints using a pressure algometer (Somedic, Sweden). Beforehand, all patients had received TPBS for diagnostic purposes independently of the study. Region-of-interest (ROI) ratios (mineralization phase) for the MCP and PIP, excluding fracture sites, were correlated with the PPT. In CRPS, all ROI ratios were significantly increased and all PPT of the affected hand were decreased compared to non-CRPS (PPTThenar: 243±150kPa vs 358±197kPa, PPTMCP: 80±67kPa vs 159±93kPa, PPTPIP: 80±56kPa vs 184±110kPa; P<.01) and controls (PPTThenar: 478±106kPa, PPTMCP: 254±50kPa, PPTPIP: 275±76kPa; P<.01). A PPTThenar below 293kPa revealed 77% sensitivity but only 63% specificity, whereas a PPTPIP below 102kPa had 82% sensitivity and 94% specificity to identify CRPS. Only in CRPS were PPTMCP and PPTPIP correlated significantly inversely with the ROI ratio (MCP: r=-0.439, PIP: r=-0.447). PPTPIP shows higher specificity for CRPS type I than PPTThenar without loss of sensitivity. Therefore, measurement of joint PPT could be a noninvasive diagnostic tool reflecting increased bone metabolism assessed by TPBS as a sign of bone pathophysiology. PMID:24333949

  14. The growth threshold conjecture: a theoretical framework for understanding T-cell tolerance

    PubMed Central

    Arias, Clemente F.; Herrero, Miguel A.; Cuesta, José A.; Acosta, Francisco J.; Fernández-Arias, Cristina

    2015-01-01

    Adaptive immune responses depend on the capacity of T cells to target specific antigens. As similar antigens can be expressed by pathogens and host cells, the question naturally arises of how can T cells discriminate friends from foes. In this work, we suggest that T cells tolerate cells whose proliferation rates remain below a permitted threshold. Our proposal relies on well-established facts about T-cell dynamics during acute infections: T-cell populations are elastic (they expand and contract) and they display inertia (contraction is delayed relative to antigen removal). By modelling inertia and elasticity, we show that tolerance to slow-growing populations can emerge as a population-scale feature of T cells. This result suggests a theoretical framework to understand immune tolerance that goes beyond the self versus non-self dichotomy. It also accounts for currently unexplained observations, such as the paradoxical tolerance to slow-growing pathogens or the presence of self-reactive T cells in the organism. PMID:26587263

  15. 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

  16. Evaluation of physiologic pain in relation to pain substances in healthy subjects.

    PubMed

    Ogedengbe, John Onimisi; Adelaiye, Alexander Babatunde; Mohammed, Aliyu; Ayo, Joseph Olusegun; Odili, Augustine Nonso; Adeyemi, Olusoji Matthew; Akeju, Stella; Peter, Philomina

    2015-12-01

    This study was aimed at finding a relationship between pain modulators in the blood and physiological pain in apparently healthy Nigerians. It also aimed at establishing a pilot study for finding reference values for plasma levels of substance P, serotonin and tryptophan for the first time among Nigerians. Volunteers were made up of 110 residents of Abuja, aged between 21 and 50 years. Cold pressor test was used to induce pain assessing pain intensity, threshold and tolerance. ELISA was used to assay for plasma substance P, serotonin and tryptophan. Pain parameters from cold pressor test were correlated with plasma pain modulators measured. Results from cold pressor test revealed pain intensity to be 5.79±0.25cm, pain threshold 28.77±2.32s and pain tolerance 143.62±24.39s. Blood plasma level of substance P was 116.52±20.53pg/mL, serotonin 454.18±30.16ng/mL and tryptophan 12.77±0.67?g/mL. There was negative correlation between pain threshold and plasma substance P, pain tolerance and plasma substance P and pain threshold and plasma serotonin. There was however a positive correlation between pain intensity and plasma serotonin. In conclusion, the regression formulas may aid in using cold pressor test to predict blood substance levels of the measured pain modulators in a low resource setting like Nigeria where ELISA test is very expensive. PMID:26323369

  17. Sativex: clinical efficacy and tolerability in the treatment of symptoms of multiple sclerosis and neuropathic pain.

    PubMed

    Barnes, Michael Philip

    2006-04-01

    Sativex is one of the first cannabis-based medicines to undergo conventional clinical development and to be approved as a prescription medicine. It is an oromucosal spray that allows flexible, individualised dosing. Patients self titrate their overall dose and pattern of dosing according to their response to and tolerance of the medicine. This usually results in the administration of approximately 8-12 sprays/day. Each spray delivers tetrahydrocannabinol 2.7 mg and cannabidiol 2.5 mg, giving an approximate average dose of tetrahydrocannabinol 22-32 mg/day and cannabidiol 20-30 mg/day. Development has concentrated on the treatment of symptoms of multiple sclerosis, notably spasticity and neuropathic pain, as well as the treatment of neuropathic pain of other aetiologies. Positive results in placebo-controlled trials of the use of Sativex as an add-on therapy in these indications demonstrate that Sativex is efficacious and well tolerated in the treatment of these symptoms. Sativex has been approved for use in neuropathic pain due to multiple sclerosis in Canada. If ongoing studies replicate the results already observed, further approvals for the treatment of spasticity in multiple sclerosis and for neuropathic pain are likely. PMID:16553576

  18. 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

  19. 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

  20. Transdermal Lidocaine and Ketamine for Neuropathic Pain: A Study of Effectiveness and Tolerability

    PubMed Central

    Tam, Emily; Furlan, Andrea D

    2012-01-01

    Background: Acute neuropathic pain is a common disorder. Transdermal cream could be an alternative to oral medications. Objective: To evaluate the effectiveness and tolerability of transdermal Lidocaine and Ketamine for acute neuropathic pain. Study Design: Retrospective chart review Setting: University-affiliated outpatient Physiatry clinic Methods: articipants: neuropathic pain with a prescription of a transdermal cream containing Lidocaine and Ketamine. Ef-fectiveness was evaluated by the number of patients with improvement divided by the total number of patients who re-ceived a prescription of the cream. Results: A total of 854 patient charts were reviewed. Twenty-one patients with symptoms, signs, and/or a documented di-agnosis of neuropathic pain and had been given a prescription of a transdermal preparation containing Lidocaine and Ketamine. Four groups were identified: those with a clearly stated diagnosis of neuropathic pain and prescribed a transdermal compound containing Lidocaine and Ketamine with follow-up (Group A) or without follow-up (Group B), and those with a suggested diagnosis of neuropathic pain with (Group C) or without follow-up (Group D). Effectiveness of the cream was seven out of eight (87%) for Group A and one out of three (33%) for Group C. In total, eight out of 11 patients (73%) benefited from a cream containing Lidocaine and Ketamine. Two patients experienced skin reactions that led to discontin-uation of treatment. Limitations: This is a retrospective chart review without control group. Conclusion: Transdermal cream containing Ketamine and Lidocaine was effective in 73% of patients with acute neuro-pathic pain and may be a good alternative to oral medications. PMID:22833771

  1. Transient Cervical Nerve Root Compression Modulates Pain: Load Thresholds for Allodynia and Sustained Changes in Spinal Neuropeptide Expression

    PubMed Central

    Hubbard, Raymond D.; Chen, Zhen; Winkelstein, Beth A.

    2008-01-01

    Nerve root compression produces chronic pain and altered spinal neuropeptide expression. This study utilized controlled transient loading in a rat model of painful cervical nerve root compression to investigate the dependence of mechanical allodynia on load magnitude. Injury loads (0-110mN) were applied quasistatically using a customized loading device, and load thresholds to produce maintained mechanical allodynia were defined. Bilateral spinal expression of substance P (SP) and calcitonin gene-related peptide (CGRP) was assessed 7 days following compression using immunohistochemistry to determine relationships between these neuropeptides and compression load. A three-segment change point model was implemented to model allodynia responses and their relationship to load. Load thresholds were defined at which ipsilateral and contralateral allodynia were produced and sustained. The threshold for increased allodynia was lowest for acute (day 1) ipsilateral responses (26.29mN), while thresholds for allodynia on day 7 were similar for the ipsilateral (38.16mN) and contralateral forepaw (38.26mN). CGRP, but not SP, significantly decreased with load; the thresholds for ipsilateral and contralateral CGRP decreases corresponded to 19.52mN and 24.03mN, respectively. These thresholds suggest bilateral allodynia may be mediated by spinal mechanisms, and that these mechanisms depend on the magnitude of load. PMID:17976629

  2. Catastrophizing as a mediator of sex differences in pain: differential effects for daily pain versus laboratory-induced pain.

    PubMed

    Edwards, Robert R; Haythornthwaite, Jennifer A; Sullivan, Michael J; Fillingim, Roger B

    2004-10-01

    Sex differences in the experience of pain have been widely reported, with females generally reporting more frequent clinical pain and demonstrating greater pain sensitivity. However, the mechanisms underpinning such differences, while subject to intense speculation, are not well-characterized. Catastrophizing is a cognitive and affective process that relates strongly to enhanced reports of pain and that varies as a function of sex. It is thus a prime candidate to explain sex differences; indeed, several prior studies offer evidence that controlling for catastrophizing eliminates the gap between men and women in reported pain. We recruited 198 healthy young adults (115 female) who took part in laboratory studies of pain responses, including thermal pain, cold pain, and ischemic pain, and who also completed questionnaires assessing catastrophizing, mood, and day-to-day painful symptoms (e.g. headache, backache). Women reported greater levels of catastrophizing, more recent painful symptoms, and demonstrated lower pain thresholds and tolerances for noxious heat and cold relative to men. Mediational analyses suggested that after controlling for negative mood, catastrophizing mediated the sex difference in recent daily pain but did not mediate the much larger sex differences in pain threshold and tolerance. These findings highlight the role of catastrophizing in shaping pain responses, as well as illuminating potentially important differences between experimental pain assessment and the clinical experience of pain. PMID:15363877

  3. Long-term efficacy, safety and tolerability of Remoxy for the management of chronic pain.

    PubMed

    Pergolizzi, Joseph V; Zampogna, Gianpietro; Taylor, Robert; Raffa, Robert B

    2015-03-01

    Historically, chronic pain generally went under-treated for a variety of objective and subjective reasons, including difficulty to objectively diagnose and manage over a long period of time, potential serious adverse effects of commonly available medications, and patient, healthcare and societal concerns over opioid medications. More recently, in an effort to redress the under-treatment of pain, the number of prescriptions of opioid analgesics has risen dramatically. However, paralleling the increased legitimate use has been a concomitant increase in opioid abuse, misuse and diversion. Pharmaceutical companies have responded by developing a variety of opioid formulations designed to deter abuse by making the products more difficult to tamper with. One such product is Remoxy(®), an extended-release formulation of the strong opioid oxycodone. We review the efficacy, safety and tolerability of this formulation based on the available published literature. PMID:25683255

  4. Heat pain thresholds and cerebral event-related potentials following painful CO2 laser stimulation in chronic tension-type headache.

    PubMed

    de Tommaso, Marina; Libro, Giuseppe; Guido, Marco; Sciruicchio, Vittorio; Losito, Luciana; Puca, Francomichele

    2003-07-01

    Current opinion concerning the pathophysiology of tension-type headache (TTH) and its related pericranial muscle tenderness proposes a primary role of central sensitization at the level of dorsalhorn/trigeminal nucleus as well as the supraspinal level. Investigation of these phenomena can be conducted using laser-evoked potentials (LEPs), which are objective and quantitative neurophysiological tools for the assessment of pain perception. In the present study we examined features of LEPs, as well as cutaneous heat-pain thresholds to laser stimulation, in relation to the tenderness of pericranial muscles in chronic TTH resulting from pericranial muscle disorder, during a pain-free phase. Twelve patients with TTH and 11 healthy controls were examined using the Total Tenderness Scoring (TTS) system. The stimulus was a laser pulse generated by a CO(2) laser. The dorsum of the hand and the cutaneous zones corresponding to pericranial muscles were stimulated. Subjective perception of stimulus intensity was assessed by a visual analogue scale. Two responses, the earlier named N2a and the last named P2, were considered; the absolute latency was measured at the highest peak of each response. The N2a-P2 components' peak-to-peak amplitude was detected. The heat pain threshold was similar in TTH patients and controls at the level of both the hand and pericranial skin. The TTS scores at almost all pericranial sites were higher in TTH patients than in normal controls. The amplitude of the N2a-P2 complex elicited by stimulation of the pericranial zone was greater in TTH patients than in controls; the amplitude increase was significantly associated with the TTS score. Our findings suggest that pericranial tenderness may be a primary phenomenon that precedes headache, and is mediated by a greater pain-specific hypervigilance at the cortical level. PMID:12855320

  5. 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

  6. Acupuncture-induced changes of pressure pain threshold are mediated by segmental inhibition-a randomized controlled trial.

    PubMed

    Baeumler, Petra I; Fleckenstein, Johannes; Benedikt, Franziska; Bader, Julia; Irnich, Dominik

    2015-11-01

    Our aim was to distinguish between spinal and supraspinal mechanisms in the intact nervous system by comparing homosegmental and heterosegmental effects of electroacupuncture (EA) and manual acupuncture (MA) on sensory perception in healthy volunteers by means of quantitative sensory testing. Seventy-two healthy volunteers were randomly assigned to receive either MA or EA at SP 6, SP 9, GB 39, and ST 36 at the left leg or relaxed for 30 minutes (control group [CG]). Blinded examiners assessed 13 sensory modalities (thermal and mechanical detection and pain thresholds) at the upper arms and lower legs before and after intervention by means of a standardized quantitative sensory testing battery. Change scores of all 13 sensory thresholds were compared between groups. The main outcome measure was the change score of the pressure pain threshold (PPT). There were no baseline differences between groups. Pressure pain threshold change scores at the lower left leg, in the same segment as the needling site, differed significantly (P = 0.008) between the EA (median: 103.01 kPa) and CG groups (median: 0.00 kPa) but not between the MA (median: 0.00 kPa) and CG groups. No further significant change score differences were found between one of the acupuncture groups and the CG. The PPT can be changed by EA. The PPT increase was confined to the segment of needling, which indicates that it is mainly mediated by segmental inhibition in the spinal cord. This underscores the importance of segmental needling and electrical stimulation in clinical practice. PMID:26133726

  7. The relation between the effect of a subhypnotic dose of thiopental on claw pain threshold in rats and adrenalin, noradrenalin and dopamine levels.

    PubMed

    Aksoy, Mehmet; Ahiskalioglu, Ali; Ince, Ilker; Celik, Mine; Dostbil, Aysenur; Kuyrukluyildiz, Ufuk; Altuner, Durdu; Kurt, Nezahat; Suleyman, Halis

    2015-10-23

    Thiopental sodium (TPS) needs to be applied together with adrenalin in order to establish its analgesic effect in general anesthesia. We aimed to investigate the effect of TPS on the claw pain threshold in rats and evaluated its relationship with endogenous adrenalin (ADR), noradrenalin (NDR), and dopamine (DOP) levels. Intact and adrenalectomized rats were used in the experiment. Intact animals were divided into the following groups: 15 mg/kg TPS (TS), 0.3 mg/kg ADR+15 mg/kg TPS (ATS) and 0.3 mg/kg ADR alone (ADR). Adrenalectomized animals were divided into the following groups: 15 mg/kg TPS (A-TS), 0.3 mg/kg ADR+15 mg/kg TPS (A-ATS) and 0.3 mg/kg ADR alone (A-ADR). Claw pain threshold and blood ADR, NDR, and DOP levels were measured. The TS group's claw pain threshold was found low. However, the claw pain thresholds of the ATS and ADR groups increased significantly. In the A-TS group, the pain threshold decreased compared with normal, and in the A-ATS and A-ADR groups, the pain threshold increased. TPS reduced the blood ADR levels in intact rats; however, no significant changes were observed in the NDR and DOP levels. #TPS provides hyperalgesia by reducing the production of ADR in rats. The present study shows that to achieve analgesic activity, TPS needs to be applied together with ADR. PMID:26211784

  8. The relation between the effect of a subhypnotic dose of thiopental on claw pain threshold in rats and adrenalin, noradrenalin and dopamine levels

    PubMed Central

    Aksoy, Mehmet; Ahiskalioglu, Ali; Ince, Ilker; Celik, Mine; Dostbil, Aysenur; Kuyrukluyildiz, Ufuk; Altuner, Durdu; Kurt, Nezahat; Suleyman, Halis

    2015-01-01

    Thiopental sodium (TPS) needs to be applied together with adrenalin in order to establish its analgesic effect in general anesthesia. We aimed to investigate the effect of TPS on the claw pain threshold in rats and evaluated its relationship with endogenous adrenalin (ADR), noradrenalin (NDR), and dopamine (DOP) levels. Intact and adrenalectomized rats were used in the experiment. Intact animals were divided into the following groups: 15 mg/kg TPS (TS), 0.3 mg/kg ADR+15 mg/kg TPS (ATS) and 0.3 mg/kg ADR alone (ADR). Adrenalectomized animals were divided into the following groups: 15 mg/kg TPS (A-TS), 0.3 mg/kg ADR+15 mg/kg TPS (A-ATS) and 0.3 mg/kg ADR alone (A-ADR). Claw pain threshold and blood ADR, NDR, and DOP levels were measured. The TS group’s claw pain threshold was found low. However, the claw pain thresholds of the ATS and ADR groups increased significantly. In the A-TS group, the pain threshold decreased compared with normal, and in the A-ATS and A-ADR groups, the pain threshold increased. TPS reduced the blood ADR levels in intact rats; however, no significant changes were observed in the NDR and DOP levels. #TPS provides hyperalgesia by reducing the production of ADR in rats. The present study shows that to achieve analgesic activity, TPS needs to be applied together with ADR. PMID:26211784

  9. Tolerance to non-opioid analgesics in PAG involves unresponsiveness of medullary pain-modulating neurons in male rats.

    PubMed

    Tortorici, Victor; Aponte, Yexica; Acevedo, Humberto; Nogueira, Lourdes; Vanegas, Horacio

    2009-03-01

    Opiate analgesia can be hampered by a reduction in pharmacological effectiveness (tolerance), and this crucially depends on the periaqueductal gray matter (PAG). Non-opioids like metamizol (dipyrone) or aspirin also induce PAG-dependent analgesia and tolerance, but the neuronal bases of this tolerance are unknown. Metamizol is a pyrazolon derivative and cyclooxygenase inhibitor with widespread use as an analgesic in Europe and Latin America. Metamizol was microinjected into the PAG of awake male rats, and antinociception was assessed by the tail flick (TF) and hot plate (HP) tests. Microinjection twice daily for 2.5 days caused tolerance to metamizol. The rats were then anesthetized and recordings from pain-facilitating on-cells and pain-inhibiting off-cells of the rostral ventromedial medulla (RVM) were performed. PAG microinjection of morphine or metamizol depresses on-cells, activates off-cells and thus inhibits nociception, including TF and HP. In metamizol-tolerant rats, however, PAG microinjection of metamizol failed to affect on- or off-cells, and this is interpreted as the reason for tolerance. In metamizol-tolerant rats morphine microinjection into PAG also failed to affect RVM neurons or nociception (cross-tolerance). In naïve, non-tolerant rats the antinociceptive effect of PAG-microinjected metamizol or morphine was blocked when CTOP, a mu-opioid antagonist, was previously microinjected into the same PAG site. These results emphasize a close relationship between opioid and non-opioid analgesic mechanisms in the PAG and show that, like morphine, tolerance to metamizol involves a failure of on- and off-cells to, respectively, disfacilitate and inhibit nociception. Cross-tolerance between non-opioid and opioid analgesics should be important in the clinical setting. PMID:19302154

  10. Bounding experimental quantum error rates relative to fault-tolerant thresholds

    E-print Network

    Joel J. Wallman

    2015-11-02

    Rigorously establishing that the error in an experimental quantum operation is beneath the threshold for fault-tolerant quantum computation currently requires considering the worst-case error, which can be orders of magnitude smaller than the average gate infidelities routinely reported in experiments. We show that an improved bound on the worst-case error can be obtained by also considering the recently-introduced unitarity of the noise where the upper and lower bounds differ by a factor of $\\approx 2.45$ for unital qubit channels. We prove that the contribution from the nonunital part of any noise map is at most on the order of the average gate infidelity and so is negligible relative to any coherent contribution. We also show that the ``average'' error rate when measurements are not restricted to an eigenbasis containing the state of the system exhibits the same scaling as the worst-case error, which, for coherent noise, is the square-root of the infidelity. We also obtain improved bounds for the diamond distance when the noise map is known (or approximately known).

  11. Perioperative pain management in the opioid-tolerant patient with chronic pain: an evidence-based practice project.

    PubMed

    Dykstra, Karen M

    2012-12-01

    According to the Institute of Medicine (IOM) report on pain, chronic pain affects an estimated 116 million American adults and costs the nation more than $600 billion each year in medical treatment and lost worker productivity. Many individuals with chronic pain undergo surgical procedures. Safe and effective treatment of their postoperative pain can present a significant challenge to the health care team but is essential to their optimal recovery. Administrators in a community hospital in central Pennsylvania identified a need to improve the care of their patients with chronic pain and supported a hospital-wide initiative to address various aspects of this population's hospital experience. This article presents the first phase of an evidence-based practice project that focused on improving the perioperative pain management in patients with chronic pain who receive long-acting opioids for the treatment of chronic pain before admission for surgery. PMID:23164203

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

    PubMed Central

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

    2008-01-01

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

  13. The influence of repeated pain stimulation on the emotional aspect of pain: a preliminary study in healthy volunteers

    PubMed Central

    Maeoka, Hiroshi; Hiyamizu, Makoto; Matsuo, Atsushi; Morioka, Shu

    2015-01-01

    Purpose Pain is a multidimensional experience with sensory-discriminative, cognitive-evaluative, and affective-motivational components. Emotional factors, such as unpleasantness or anxiety, are known to have influence on pain in humans. Repeated painful stimulation has been reported to reduce subjective pain intensity. Nevertheless, there is little evidence of the influence of such stimulation on the emotional factors of pain. The aim of this study was to evaluate the influence of repeated painful stimulation on the experience of unpleasantness and anxiety. Materials and methods Eight subjects (six females, two males) volunteered to participate in this study. Subjects received repeated painful stimulation for 3 consecutive days each instance lasting 6 seconds, 60 times per day, on the medial side of the forearm of the nondominant hand. We examined the following items to evaluate changes of responses to painful stimulation: pain thresholds, pain tolerance levels, pain intensities, unpleasantness, and anxiety. Furthermore, pain thresholds and pain tolerance levels were compared between different sites on the ipsilateral and contralateral forearms. Results No immediate or chronological changes in pain thresholds or pain tolerance levels were observed. Pain intensities were reduced significantly over the 3-day experimental period (P<0.05). On the other hand, there was no great change in unpleasantness during the 3-day period. Anxiety was increased significantly after the painful stimulation compared with that without the painful stimulation and before day 1 of the stimulation (P<0.05). Conclusion These results suggest that repeated painful stimulation may result in habituation to pain intensities but not habituation to emotional factors. PMID:26229502

  14. Pressure pain thresholds in different tissues in one body region. The influence of skin sensitivity in pressure algometry.

    PubMed

    Kosek, E; Ekholm, J; Hansson, P

    1999-06-01

    This study aimed at determining whether there are differences in pressure pain sensitivity in different tissues in the same body region when systematically assessed, before and after skin hypoesthesia. Pressure pain thresholds (PPTs) were assessed bilaterally in 15 healthy females at the bony part of the epicondylus lateralis humeri, at the belly of m. extensor carpi ulnaris and at m. brachioradialis where the superficial radial nerve branches pass underneath ("muscle/nerve" site). Following a double blind design, a local anaesthetic cream (EMLA) or a control cream was applied to the skin and PPTs were reassessed. The PPT was significantly (p < 0.001) lower at the "muscle/nerve" site than at the bony and "pure" muscle sites. The PPTs over the bony and "pure" muscle sites did not differ. There was no significant difference when PPTs were compared before and after application of EMLA cream. However, PPTs after control cream were lower (p < 0.001) over all examined areas than those obtained prior to cream application. Thus, EMLA cream increased PPTs compared to control sites in all examined areas (p < 0.001). Under the given circumstances, skin pressure pain sensitivity was demonstrated to influence the PPT. PMID:10380724

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

    PubMed Central

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

    2014-01-01

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

  16. Pain rating schema: three distinct subgroups of individuals emerge when rating mild, moderate, and severe pain

    PubMed Central

    Frey-Law, Laura A; Lee, Jennifer E; Wittry, Alex M; Melyon, Myles

    2014-01-01

    Background While the validity of pain assessment has been well documented, the underlying schema (ie, organized, preconceived ideas) of how individuals interpret numerical pain ratings is not well understood. This study’s objectives were to examine numerical pain intensity ratings, from (0 to 10 cm on the visual analog scale [VAS]) across multiple severities of commonly experienced acute pain conditions to determine whether the ratings differed between these pain conditions and/or between individuals. Methods A community sample (N=365, 66% female) rated their anticipated pain intensity (VAS) for threshold, mild, moderate, severe, and tolerance level, using several common pain conditions: headache, toothache, joint injury, delayed-onset muscle soreness, burns, and “general pain.” Results Cluster analysis revealed three subgroups of individuals, suggesting three types of underlying pain rating schema: 1) Low Rating subgroup (low VAS pain intensity ratings across all the pain severity categories); 2) Low/High Rating subgroup (low VAS pain intensity rating for mild, but high VAS pain intensity rating for severe pain); and 3) High Rating subgroup (high VAS pain intensity ratings across all the pain severity categories). Overall, differences between pain conditions were small: muscle soreness pain intensity was consistently rated lower than the other pain types across severities. The highest pain ratings varied between joint injury and general pain, depending on severity level. No effects of sex or current experience of pain were noted. Conclusion The results indicate that: 1) three distinct pain schemas were present in this community-based sample, indicating significant variation in how pain scales are utilized and/or interpreted between clusters of individuals; 2) pain ratings vary by condition, but these differences are minor; and 3) pain rating schemas are not significantly different between males and females or between individuals with and without current pain. PMID:24379696

  17. Pain.

    PubMed

    Melzack, Ronald; Katz, Joel

    2013-01-01

    Pain has many valuable functions. It often signals injury or disease, generates a wide range of adaptive behaviors, and promotes healing through rest. Despite these beneficial aspects of pain, there are negative features that challenge our understanding of the puzzle of pain, including persistent phantom limb pain after amputation or total spinal cord transection. Pain is a personal, subjective experience influenced by cultural learning, the meaning of the situation, attention, and other psychological variables. Pain processes do not begin with the stimulation of receptors. Rather, injury or disease produces neural signals that enter an active nervous system that (in the adult organism) is the substrate of past experience, culture, and a host of other environmental and personal factors. These brain processes actively participate in the selection, abstraction, and synthesis of information from the total sensory input. Pain is not simply the end product of a linear sensory transmission system; it is a dynamic process that involves continuous interactions among complex ascending and descending systems. The neuromatrix theory guides us away from the Cartesian concept of pain as a sensation produced by injury, inflammation, or other tissue pathology and toward the concept of pain as a multidimensional experience produced by multiple influences. These influences range from the existing synaptic architecture of the neuromatrix-which is determined by genetic and sensory factors-to influences from within the body and from other areas in the brain. Genetic influences on synaptic architecture may determine-or predispose toward-the development of chronic pain syndromes. WIREs Cogn Sci 2013, 4:1-15. doi: 10.1002/wcs.1201 For further resources related to this article, please visit the WIREs website. PMID:26304172

  18. Decreased pain sensitivity among people with schizophrenia: a meta-analysis of experimental pain induction studies.

    PubMed

    Stubbs, Brendon; Thompson, Trevor; Acaster, Sarah; Vancampfort, Davy; Gaughran, Fiona; Correll, Christoph U

    2015-11-01

    Patients with schizophrenia report reduced pain sensitivity in clinical studies, but experimental studies are required to establish pain sensitivity as a potential endophenotype. We conducted a systematic review of electronic databases from database inception until April 15, 2015, including experimental studies investigating pain among patients with schizophrenia spectrum disorder vs healthy controls. A random-effect meta-analysis yielding Hedges' g ±95% confidence intervals (CIs) as the effect size (ES) measure was conducted. Primary outcome was a pooled composite of pain threshold and pain tolerance; secondary outcomes included these parameters individually, plus sensory threshold, physiological pain response, and pain intensity or unpleasantness. Across 17 studies, patients with schizophrenia spectrum disorder (n = 387; age, 30.7 ± 6.9 years; females, 31.9%; illness duration, 7.0 ± 5.7 years) were compared with controls (n = 483; age, 29.5 ± 7.4 years; females, 31.0%). Patients had elevated pain threshold/pain tolerance vs controls (ES = 0.583; 95% CI, 0.212-0.954; P = 0.002; studies = 15). Results were similar in antipsychotic-free individuals (ES = 0.599; 95% CI, 0.291-0.907; P < 0.0001; studies = 8), with trend-level significance in antipsychotic-treated individuals (ES = 0.566; 95% CI, -0.007 to 1.125; P = 0.047; studies = 9). Likewise, patients with schizophrenia had increased pain tolerance (ES = 0.566; 95% CI, 0.235-0.897; P = 0.0001; studies = 6), sensory threshold (ES = 1.16; 95% CI, 0.505-1.727; P < 0.0001; studies = 5), and pain threshold (ES = 0.696; 95% CI, 0.407-0.986; P < 0.001; studies = 9), as well as reduced physiological response to noxious stimuli (ES = 0.456; 95% CI, 0.131-0.783; P = 0.006) and pain intensity/unpleasantness ratings (ES = 0.547; 95% CI, 0.146-0.949; P = 0.008). Findings were similarly significant in antipsychotic-free patients with schizophrenia (analysable parameters = 4) and antipsychotic-treated individuals (analysable parameters = 2). Finally, greater psychiatric symptoms moderated increased pain threshold, and younger patient age moderated increased pain tolerance. Decreased pain sensitivity seems to be an endophenotype of schizophrenia spectrum disorders. How this alteration links to other dimensions of schizophrenia and physical comorbidity-related help-seeking behaviour/morbidity/mortality requires further study. PMID:26207650

  19. 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

  20. 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.

  1. 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. PMID:26155489

  2. Pain

    MedlinePLUS

    ... to play a role in causing the pain Chronic fatigue syndrome Symptoms • long-lasting fatigue that doesn’t get ... painfoundation. org Phone number: (888) 615-7246 The Chronic Fatigue and Immune Dysfunction Syndrome Association of America PO Box 220398 Charlotte, NC ...

  3. 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

    2015-09-15

    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

  4. Influence of thyroid hormones on exercise tolerance and lactate threshold in rats.

    PubMed

    Zarzeczny, R; Pilis, W; Langfort, J; Kaciuba-U?ci?ko, H; Nazar, K

    1996-09-01

    Effects of thyroid hormone deficit, and triiodothyronine (T3) treatment on exercise performance, blood lactate (LA) concentrations and LA threshold (TLA) were studied in trained and untrained rats. Fourteen rats were thyroidectomized and then treated with propylthiouracil for 30 days (THY + PTU group). Fourteen sham operated rats served as controls. In each group there were 7 sedentary and 7 endurance-trained animals. Six weeks after thyroidectomy or sham operation the rats were subjected to a multistage running test with speed increasing from 13 m/min at 10 degrees treadmill inclination till maximum. Blood samples for LA were taken from the rats' tail after each 3-min exercise stage. During 3 days following this test rats from all groups were injected (i.p.) with 75 micrograms/100 g of triiodothyronine (T3), and 24 hrs afterwards the second exercise test was performed. In THY + PTU rats maximal running speed (RSmax) and the speed at which TLA occurred were markedly decreased in comparison with control group. The level of LA at the maximal speed (LAmax) and that corresponding to TLA were higher in THY + PTU rats than in controls. T3 injection to control animals diminished their RSmax and TLA, whereas in THY + PTU rats it increased RSmax and shifted TLA to a higher speed. Both in THY + PTU and control animals T3 elevated LAmax and the threshold LA concentration. Endurance training in control and THY + PTU animals markedly enhanced RSmax and TLA. This was accompanied by increases in LAmax and concentration of LA at TLA only in control group. After T3 injection to control trained rats RSmax and TLA were diminished, whereas in THY + PTU trained group RSmax was unchanged and TLA was elevated. Maximal blood LA increased only in THY + PTU trained rats whilst the threshold blood LA was elevated in both groups. It is concluded, that both the T3 deficiency and its excess reduce maximal exercise performance and shift TLA to lower workloads. Enduarance training or administration of T3 to hypothyroid rats markedly improve their exercise performance and elevate TLA, however, T3 treatment markedly increases maximal and submaximal LA levels. PMID:8877906

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

    PubMed

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

    2013-07-01

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

  6. Effect of Transcutaneous Electrical Nerve Stimulation on Sensation Thresholds in Patients with Painful Diabetic Neuropathy: An Observational Study

    ERIC Educational Resources Information Center

    Moharic, Metka

    2010-01-01

    Transcutaneous electrical nerve stimulation (TENS) is one of the therapies for painful neuropathy. Its analgesic mechanisms probably involve the gate control theory, the physiological block and the endogenous pain inhibitory system. The aim of the study was to determine whether TENS improves small fibre function diminished because of painful

  7. Pain Sensitisation in Women with Active Rheumatoid Arthritis: A Comparative Cross-Sectional Study

    PubMed Central

    Vladimirova, Nora; Jespersen, Anders; Bartels, Else Marie; Christensen, Anton W.; Bliddal, Henning; Danneskiold-Samsøe, Bente

    2015-01-01

    Objectives. In some rheumatoid arthritis (RA) patients, joint pain persists without signs of inflammation. This indicates that central pain sensitisation may play a role in the generation of chronic pain in a subgroup of RA. Our aim was to assess the degree of peripheral and central pain sensitisation in women with active RA compared to healthy controls (HC). Methods. 38 women with active RA (DAS28 > 2.6) and 38 female HC were included in, and completed, the study. Exclusion criteria were polyneuropathy, pregnancy, and no Danish language. Cuff Pressure Algometry measurements were carried out on the dominant lower leg. Pain threshold, pain tolerance, and pain sensitivity during tonic painful stimulation were recorded. Results. Women with active RA had significantly lower pain threshold (p < 0.01) and pain tolerance (p < 0.01) than HC. The mean temporal summation- (TS-) index in RA patients was 0.98 (SEM: 0.09) and 0.71 (SEM: 0.04) in HC (p < 0.01). Conclusion. Patients with active RA showed decreased pressure-pain threshold compared to HC. In addition, temporal summation of pressure-pain was increased, indicating central pain sensitization, at least in some patients. Defining this subgroup of patients may be of importance when considering treatment strategies. PMID:26266046

  8. Effect of a single 30?min UMTS mobile phone-like exposure on the thermal pain threshold of young healthy volunteers.

    PubMed

    Vecsei, Zsuzsanna; Csathó, Árpád; Thuróczy, György; Hernádi, István

    2013-10-01

    One of the most frequently investigated effects of radiofrequency electromagnetic fields (RF EMFs) on the behavior of complex biological systems is pain sensitivity. Despite the growing body of evidence of EMF-induced changes in pain sensation, there is no currently accepted experimental protocol for such provocation studies for the healthy human population. In the present study, therefore, we tested the effects of third generation Universal Mobile Telecommunications System (UMTS) RF EMF exposure on the thermal pain threshold (TPT) measured on the surface of the fingers of 20 young adult volunteers. The protocol was initially validated with a topical capsaicin treatment. The exposure time was 30?min and the genuine (or sham) signal was applied to the head through a patch antenna, where RF EMF specific absorption rate (SAR) values were controlled and kept constant at a level of 1.75?W/kg. Data were obtained using randomized, placebo-controlled trials in a double-blind manner. Subjective pain ratings were tested blockwise on a visual analogue rating scale (VAS). Compared to the control and sham conditions, the results provide evidence for intact TPT but a reduced desensitization effect between repeated stimulations within the individual blocks of trials, observable only on the contralateral side for the genuine UMTS exposure. Subjective pain perception (VAS) data indicated marginally decreased overall pain ratings in the genuine exposure condition only. The present results provide pioneering information about human pain sensation in relation to RF EMF exposure and thus may contribute to cover the existing gap between safety research and applied biomedical science targeting the potential biological effects of environmental RF EMFs. PMID:23787775

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

    PubMed

    Ness, T J; Follett, K A

    1998-05-22

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

  10. Neuropathic pain activates the endogenous kappa opioid system in mouse spinal cord and induces opioid receptor tolerance.

    PubMed

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

    2004-05-12

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

  11. 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

  12. Pain Intensity Recognition Rates via Biopotential Feature Patterns with Support Vector Machines

    PubMed Central

    Gruss, Sascha; Treister, Roi; Werner, Philipp; Traue, Harald C.; Crawcour, Stephen; Andrade, Adriano; Walter, Steffen

    2015-01-01

    Background The clinically used methods of pain diagnosis do not allow for objective and robust measurement, and physicians must rely on the patient’s report on the pain sensation. Verbal scales, visual analog scales (VAS) or numeric rating scales (NRS) count among the most common tools, which are restricted to patients with normal mental abilities. There also exist instruments for pain assessment in people with verbal and / or cognitive impairments and instruments for pain assessment in people who are sedated and automated ventilated. However, all these diagnostic methods either have limited reliability and validity or are very time-consuming. In contrast, biopotentials can be automatically analyzed with machine learning algorithms to provide a surrogate measure of pain intensity. Methods In this context, we created a database of biopotentials to advance an automated pain recognition system, determine its theoretical testing quality, and optimize its performance. Eighty-five participants were subjected to painful heat stimuli (baseline, pain threshold, two intermediate thresholds, and pain tolerance threshold) under controlled conditions and the signals of electromyography, skin conductance level, and electrocardiography were collected. A total of 159 features were extracted from the mathematical groupings of amplitude, frequency, stationarity, entropy, linearity, variability, and similarity. Results We achieved classification rates of 90.94% for baseline vs. pain tolerance threshold and 79.29% for baseline vs. pain threshold. The most selected pain features stemmed from the amplitude and similarity group and were derived from facial electromyography. Conclusion The machine learning measurement of pain in patients could provide valuable information for a clinical team and thus support the treatment assessment. PMID:26474183

  13. Assessment of musculoskeletal pain sensitivity and temporal summation by cuff pressure algometry: a reliability study.

    PubMed

    Graven-Nielsen, Thomas; Vaegter, Henrik Bjarke; Finocchietti, Sara; Handberg, Gitte; Arendt-Nielsen, Lars

    2015-11-01

    Chronic musculoskeletal pain is linked with sensitization, and standardized methods for assessment are needed. This study investigated (1) the test-retest reliability of computer-controlled cuff-pressure algometry (pain thresholds and temporal pain summation) on the arm and leg and (2) conditioned pain modulation (CPM) assessed by cuff algometry. The influences of age and gender were evaluated. On 2 different days, cuff pain threshold (cPPT), cuff pain tolerance (cPTT), and temporal summation of pain (TSP) by visual analog scale scores to 10 repeated cuff stimulations at cPTT intensity, as well as pressure pain threshold with handheld pressure algometry, were assessed in 136 healthy subjects. In one session, cuff pain sensitivity was also assessed before and after cold pressor-induced CPM. Good-to-excellent intraclass correlations (0.60-0.90) were demonstrated for manual and cuff algometry, and no systematic bias between sessions was found for cPPT, cPTT, and TSP on the leg and for cPTT and TSP on the arm. Cuff pressure pain threshold and cPTT were higher in men compared with women (P < 0.05). Middle-aged subjects had higher pressure pain threshold, but lower cPPT and cPTT, compared with younger subjects (P < 0.05). Temporal summation of pain was increased in women compared with men (P < 0.05). Cuff algometry was sensitive to CPM demonstrated as increased cPPT and cPTT and reduced TSP (P < 0.05). Reliability and sensitivity of computer-controlled cuff algometry for pain assessment is comparable with manual pressure algometry and constitutes a user-independent method for assessment of pain. Difference in age-related pain sensitivity between manual and cuff algometry should be further investigated. PMID:26172551

  14. 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

  15. [Difference in tolerance to anti-hyperalgesic effect and its molecular mechanisms between chronic treatment with morphine, fentanyl and oxycodone in a chronic pain-like state].

    PubMed

    Satoshi, Imai; Narita, Minoru; Ozeki, Ayumi; Nakamura, Atsushi; Hashimoto, Seiko; Narita, Michiko; Kuzumaki, Naoko; Uezono, Yasuhito; Suzuki, Tsutomu

    2008-11-01

    In the present study, we demonstrated that repeated treatment with fentanyl, but not morphine or oxycodone, causes a rapid desensitization to its ability to block the hyperalgesia associated with the attenuation of mu-opioid receptor resensitization in mice in a chronic pain-like state. In contrast, no such effect was noted in beta-endorphin knockout mice under the chronic pain-like conditions. On the assumption that beta-endorphin might be released within the spinal cord under pain-like conditions, we further examined whether beta-endorphin could be responsible for a desensitization and resensitization of fentanyl under the chronic pain. In cultured cells, unlike morphine, fentanyl and oxycodone induced a robust mu-opioid receptor internalization and, in turn, its resensitization. In the presence of beta-endorphin, the internalized mu-opioid receptor induced by fentanyl, but not oxycodone, remained within the cytosolic component even after washing out. The findings suggest that beta-endorphin could attenuate the resensitization of mu-opioid receptors. This phenomenon may explain the high degree of tolerance to fentanyl that develops with hyperalgesia caused by a chronic pain-like state. PMID:19108502

  16. Identification of Molecular Fingerprints in Human Heat Pain Thresholds by Use of an Interactive Mixture Model R Toolbox (AdaptGauss).

    PubMed

    Ultsch, Alfred; Thrun, Michael C; Hansen-Goos, Onno; Lötsch, Jörn

    2015-01-01

    Biomedical data obtained during cell experiments, laboratory animal research, or human studies often display a complex distribution. Statistical identification of subgroups in research data poses an analytical challenge. Here were introduce an interactive R-based bioinformatics tool, called "AdaptGauss". It enables a valid identification of a biologically-meaningful multimodal structure in the data by fitting a Gaussian mixture model (GMM) to the data. The interface allows a supervised selection of the number of subgroups. This enables the expectation maximization (EM) algorithm to adapt more complex GMM than usually observed with a noninteractive approach. Interactively fitting a GMM to heat pain threshold data acquired from human volunteers revealed a distribution pattern with four Gaussian modes located at temperatures of 32.3, 37.2, 41.4, and 45.4 °C. Noninteractive fitting was unable to identify a meaningful data structure. Obtained results are compatible with known activity temperatures of different TRP ion channels suggesting the mechanistic contribution of different heat sensors to the perception of thermal pain. Thus, sophisticated analysis of the modal structure of biomedical data provides a basis for the mechanistic interpretation of the observations. As it may reflect the involvement of different TRP thermosensory ion channels, the analysis provides a starting point for hypothesis-driven laboratory experiments. PMID:26516852

  17. Identification of Molecular Fingerprints in Human Heat Pain Thresholds by Use of an Interactive Mixture Model R Toolbox (AdaptGauss)

    PubMed Central

    Ultsch, Alfred; Thrun, Michael C.; Hansen-Goos, Onno; Lötsch, Jörn

    2015-01-01

    Biomedical data obtained during cell experiments, laboratory animal research, or human studies often display a complex distribution. Statistical identification of subgroups in research data poses an analytical challenge. Here were introduce an interactive R-based bioinformatics tool, called “AdaptGauss”. It enables a valid identification of a biologically-meaningful multimodal structure in the data by fitting a Gaussian mixture model (GMM) to the data. The interface allows a supervised selection of the number of subgroups. This enables the expectation maximization (EM) algorithm to adapt more complex GMM than usually observed with a noninteractive approach. Interactively fitting a GMM to heat pain threshold data acquired from human volunteers revealed a distribution pattern with four Gaussian modes located at temperatures of 32.3, 37.2, 41.4, and 45.4 °C. Noninteractive fitting was unable to identify a meaningful data structure. Obtained results are compatible with known activity temperatures of different TRP ion channels suggesting the mechanistic contribution of different heat sensors to the perception of thermal pain. Thus, sophisticated analysis of the modal structure of biomedical data provides a basis for the mechanistic interpretation of the observations. As it may reflect the involvement of different TRP thermosensory ion channels, the analysis provides a starting point for hypothesis-driven laboratory experiments. PMID:26516852

  18. Massage on experimental pain in healthy females: a randomized controlled trial.

    PubMed

    Karlson, Cynthia W; Hamilton, Nancy A; Rapoff, Michael A

    2014-03-01

    This randomized controlled study evaluated the effect of massage on affect, relaxation, and experimental pain induced by electrical stimulation. Participants were 96 healthy women (M age = 20.13 ± 5.93 years; 84.4% White) randomly assigned to a 15-minute no-treatment control, guided imagery, massage or massage plus guided imagery condition. Multilevel piecewise modeling revealed no group differences in pain intensity, threshold, or tolerance. The two massage conditions generally reported decreased pain unpleasantness, lower unpleasant affect, maintenance of pleasant affect, and increased relaxation compared to the no-treatment condition. The results suggest that massage may alter immediate affective qualities in the context of pain. PMID:23362336

  19. Evaluation of the use of thermal thresholds to investigate NSAID analgesia in a model of inflammatory pain in cats.

    PubMed

    Taylor, Polly M; Robertson, Sheilah A; Dixon, Michael J

    2007-08-01

    This study evaluated thermal threshold (TT) testing for investigation into NSAID analgesia in cats. Seven cats participated in two crossover studies. TTs were measured on thoracic skin using a device developed specifically for cats. Skin temperature was recorded, then the heater activated. At the behavioural end point heating was stopped and temperature (=TT) recorded. In part 1, TTs were measured following subcutaneous (SC) ketoprofen or saline. In part 2, the process was repeated after intradermal kaolin induced mild inflammation at the test site. TTs were measured before treatment and two hourly for 24 h. In part 1, skin temperature did not change but in part 2 it increased more after saline than ketoprofen. TT did not change significantly after any treatment. However, after ketoprofen TT fell below the 95% confidence interval (CI) in part 1 and increased above it in part 2. The method detected some NSAID effects but is unlikely to be sufficiently sensitive for study of NSAID analgesia. PMID:17658436

  20. Gender expression, sexual orientation and pain sensitivity in women

    PubMed Central

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

    2014-01-01

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

  1. Patients with chronic pain.

    PubMed

    Salama-Hanna, Joseph; Chen, Grace

    2013-11-01

    Preoperative evaluation of patients with chronic pain is important because it may lead to multidisciplinary preoperative treatment of patients' pain and a multimodal analgesia plan for effective pain control. Preoperative multidisciplinary management of chronic pain and comorbid conditions, such as depression, anxiety, deconditioning, and opioid tolerance, can improve patient satisfaction and surgical recovery. Multimodal analgesia using pharmacologic and nonpharmacologic strategies shifts the burden of analgesia away from simply increasing opioid dosing. In more complicated chronic pain patients, multidisciplinary treatment, including pain psychology, physical therapy, judicious medication management, and minimally invasive interventions by pain specialists, can improve patients' satisfaction and surgical outcome. PMID:24182727

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

    PubMed

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

    2014-11-01

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

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

    PubMed Central

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

    2005-01-01

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

  4. Development of a simple radiant heat induced experimental pain model for evaluation of analgesics in normal healthy human volunteers

    PubMed Central

    Naidu, M.U.R.; Reddy, K. Sunil Kumar; Rani, P. Usha; Rao, T. Ramesh Kumar

    2011-01-01

    Objective: Human experimental pain models help to understand the mechanism of the painful conditions and can also be adopted to test analgesic efficacy of drugs. In early phases, the clinical development of new analgesics is hindered due to the lack of reliable tests for the experimental pain models. In the present study, we have developed and validated a simple radiant heat pain model which can be used for future screening of various analgesic agents. Materials and Methods: We have standardized the thermal pain model by recording pain threshold and pain tolerance time in seconds at three different intensities and levels in 24 healthy subjects. Reproducibility of the test procedure was evaluated by recording the pain parameters by two observers on three consecutive days. Validity of model was further tested by evaluating the analgesic effect of tramadol. Results and Conclusions: Use of radiant heat pain model with high intensity and short level was found to produce low variability with coefficient of variation less than 5%. Interobserver and interperiod reproducibility was very good as shown by Bland - Altman plot; with most of the values within ± 2SD. Tramadol produced statistically significant increase in pain threshold time. The newly developed pain model produces a type of experimental pain which is responsive to analgesic effects of tramadol at clinically relevant doses. PMID:22144764

  5. A New Real-time Method for Detecting the Effect of Fentanyl Using the Preoperative Pressure Pain Threshold and Narcotrend Index

    PubMed Central

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

    2015-01-01

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

  6. The mirage of impairing drug concentration thresholds: a rationale for zero tolerance per se driving under the influence of drugs laws.

    PubMed

    Reisfield, Gary M; Goldberger, Bruce A; Gold, Mark S; DuPont, Robert L

    2012-06-01

    Motor vehicle crashes are a leading cause of morbidity and mortality in the United States. Drivers with measurable quantities of potentially impairing illicit or prescription drugs in their body fluids are multiple times more likely to be involved in motor vehicle crashes than those without such drugs in their bodies. Drug-related impairment, however, cannot be inferred solely on the basis of the presence of drugs in biological fluids. Thus, for more than a quarter century, there has been a search for drug blood concentrations that are the equivalent of the 0.08 g/dL threshold for alcohol-impaired driving in the United States. We suggest that such equivalents are a mirage, and cannot be determined due to variable drug tolerance, lack of consistent relationships between drug blood concentrations and impairment, innumerable drug combinations and multiple other factors. Thus, while the idea of determining impairing drug concentrations is attractive, it is ultimately unattainable, and withholding drugged driving legislation pending the acquisition of such data is tantamount to a plan for inaction with regard to an important and growing public health and safety problem. We propose specific legislation to address alcohol- and drug-impaired driving in the United States. PMID:22582272

  7. Efficacy and tolerability studies evaluating a sleep aid and analgesic combination of naproxen sodium and diphenhydramine in the dental impaction pain model in subjects with induced transient insomnia

    PubMed Central

    Cooper, S; Laurora, I; Wang, Y; Venkataraman, P; An, R; Roth, T

    2015-01-01

    Study Objectives The aim of this study was to evaluate the efficacy and tolerability of novel combination naproxen sodium (NS) and diphenhydramine (DPH) in subjects with postoperative dental pain along with transient insomnia induced by 5 h sleep phase advance. The present studies aimed to demonstrate the added benefit and optimal dosages of the combination product over individual ingredients alone in improving sleep and pain. Methods Each of the two studies was a two-centre, randomised, double-blind and double-dummy trial. In the first study, subjects were randomised into one of the following treatment arms: NS 440 mg/DPH 50 mg, NS 220 mg/DPH 50 mg, NS 440 mg or DPH 50 mg. In the second study, subjects received either NS 440 mg/DPH 25 mg, NS 440 mg or DPH 50 mg. The co-primary end-points in both studies were wake time after sleep onset (WASO) and sleep latency (SL) measured by actigraphy. Other secondary sleep and pain end-points were also assessed. Results The intent-to-treat population included 712 and 267 subjects from studies one and two, respectively. In the first study, only the NS 440 mg/DPH 50 mg combination showed significant improvements in both WASO vs. NS alone (?70.3 min p = 0.0002) and SL vs. DPH alone (25.50 and 41.50 min respectively, p < 0.0001). In the second study, the NS 440 mg/DPH 25 mg combination failed to show any significant improvements vs. either component alone. Conclusions Only the NS 440 mg/DPH 50 mg combination demonstrated improvement in both sleep latency vs. DPH 50 mg and sleep maintenance (WASO) vs. NS 440 mg. There were no serious or unexpected adverse events reported in either study. Clinical Trial Registration: NCT01280591 (study 1); NCT01495858 (study 2) PMID:25996289

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

    PubMed

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

    2014-05-01

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

  9. Effects of Videogame Distraction using a Virtual Reality Type Head-Mounted Display Helmet on Cold Pressor Pain in Children

    PubMed Central

    Weiss, Karen E.; Dillinger Clendaniel, Lindsay; Law, Emily F.; Ackerman, Claire Sonntag; McKenna, Kristine D.

    2009-01-01

    Objective?To test whether a head-mounted display helmet enhances the effectiveness of videogame distraction for children experiencing cold pressor pain.?Method?Forty-one children, aged 6–14 years, underwent one or two baseline cold pressor trials followed by two distraction trials in which they played the same videogame with and without the helmet in counterbalanced order. Pain threshold (elapsed time until the child reported pain) and pain tolerance (total time the child kept the hand submerged in the cold water) were measured for each cold pressor trial.?Results?Both distraction conditions resulted in improved pain tolerance relative to baseline. Older children appeared to experience additional benefits from using the helmet, whereas younger children benefited equally from both conditions. The findings suggest that virtual reality technology can enhance the effects of distraction for some children. Research is needed to identify the characteristics of children for whom this technology is best suited. PMID:18367495

  10. The effects of emotion regulation strategies on the pain experience: a structured laboratory investigation.

    PubMed

    Hampton, Amy J D; Hadjistavropoulos, Thomas; Gagnon, Michelle M; Williams, Jaime; Clark, David

    2015-05-01

    Although emotion regulation modulates the pain experience, inconsistencies have been identified regarding the impact of specific regulation strategies on pain. Our goal was to examine the effects of emotion suppression and cognitive reappraisal on automatic (ie, nonverbal) and cognitively mediated (ie, verbal) pain expressions. Nonclinical participants were randomized into either a suppression (n = 58), reappraisal (n = 51), or monitoring control (n = 42) condition. Upon arrival to the laboratory, participants completed the Emotion Regulation Questionnaire, to quantify self-reported suppression and reappraisal tendencies. Subsequently, they completed a thermal pain threshold and tolerance task. They were then provided with instructions to use, depending on their experimental condition, suppression, reappraisal, or monitoring strategies. Afterward, they were exposed to experimentally induced pain. Self-report measures of pain, anxiety, and tension were administered, and facial expressions, heart rate, and galvanic skin response were recorded. The Facial Action Coding System was used to quantify general and pain-related facial activity (ie, we defined facial actions that occurred during at least 5% of pain stimulation periods as "pain-related actions"). Reappraisal and suppression induction led to reductions in nonverbal and verbal indices of pain. Moreover, self-reported tendencies to use suppression and reappraisal (as measured by the Emotion Regulation Questionnaire) did not interact with experimental condition in the determination of participants' responses. Results suggest that consciously applying emotion regulation strategies during a painful task can moderate both cognitively mediated (e.g., verbal) and automatic (e.g., facial activity) expressions of pain. PMID:25734999

  11. Pain Sensitivity in Adolescent Males with Attention-Deficit/Hyperactivity Disorder: Testing for Associations with Conduct Disorder and Callous and Unemotional Traits

    PubMed Central

    Northover, Clare; Thapar, Anita; Langley, Kate; van Goozen, Stephanie HM

    2015-01-01

    Background Reduced processing and experience of aversive emotional cues is a common component of theories on the development and persistence of aggression and antisocial behaviour. Yet physical pain, arguably the most basic aversive cue, has attracted comparatively little attention. Methods This study measured pain sensitivity and physiological response to painful stimuli (skin conductance level, SCL) in adolescent boys with Attention-Deficit/Hyperactivity Disorder (ADHD; n = 183), who are at high risk for antisocial behaviour. We compared boys with ADHD with and without a comorbid diagnosis of Conduct Disorder (CD) on pain sensitivity, and examined patterns of association between pain measures, on the one hand, and problem severity and callous and unemotional (CU) traits, on the other. Results Boys with comorbid CD exhibited a higher pain threshold and tolerance than boys with ADHD alone, but the groups did not differ in physiology at the time the pain threshold and tolerance were reported. Regression analyses showed that ADHD problem severity positively predicted pain sensitivity, whereas levels of CU traits negatively predicted pain sensitivity. Conclusions These findings on physical pain processing extend evidence of impairments in aversive cue processing among those at risk of antisocial behaviour. The study highlights the importance of considering comorbidity and heterogeneity of disorders when developing interventions. The current findings could be used to identify subgroups within those with ADHD who might be less responsive to interventions that use corrective feedback to obtain behaviour change. PMID:26225935

  12. Implication of delta opioid receptor subtype 2 but not delta opioid receptor subtype 1 in the development of morphine analgesic tolerance in a rat model of chronic inflammatory pain.

    PubMed

    Beaudry, H; Gendron, L; Morón, J A

    2015-04-01

    Opioids are well known for their robust analgesic effects. Chronic activation of mu opioid receptors (MOPs) is, however, accompanied by various unwanted effects such as analgesic tolerance. Among other mechanisms, interactions between MOPs and delta opioid receptors (DOPs) are thought to play an important role in morphine-induced behavioral adaptations. Interestingly, certain conditions such as inflammation enhance the function of the DOP through a MOP-dependent mechanism. Here, we investigated the role of DOPs during the development of morphine tolerance in an animal model of chronic inflammatory pain. Using behavioral approaches, we first established that repeated systemic morphine treatment induced morphine analgesic tolerance in rats coping with chronic inflammatory pain. We then observed that blockade of DOPs with subcutaneous naltrindole (NTI), a selective DOP antagonist, significantly attenuated the development of morphine tolerance in a dose-dependent manner. We confirmed that this effect was DOP mediated by showing that an acute injection of NTI had no effect on morphine-induced analgesia in naive animals. Previous pharmacological characterizations revealed the existence of DOP subtype 1 and DOP subtype 2. As opposed to NTI, 7-benzylidenenaltrexone and naltriben were reported to be selective DOP subtype 1 and DOP subtype 2 antagonists, respectively. Interestingly, naltriben but not 7-benzylidenenaltrexone was able to attenuate the development of morphine analgesic tolerance in inflamed rats. Altogether, our results suggest that targeting of DOP subtype 2 with antagonists provides a valuable strategy to attenuate the analgesic tolerance that develops after repeated morphine administration in the setting of chronic inflammatory pain. PMID:25639561

  13. 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

  14. Groin pain

    MedlinePLUS

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

  15. Effects of Videogame Distraction and a Virtual Reality Type Head-Mounted Display Helmet on Cold Pressor Pain in Young Elementary School-Aged Children

    PubMed Central

    Weiss, Karen E.; Law, Emily F.; Sil, Soumitri; Herbert, Linda Jones; Horn, Susan Berrin; Wohlheiter, Karen; Ackerman, Claire Sonntag

    2010-01-01

    Objective?This study examined the effects of videogame distraction and a virtual reality (VR) type head-mounted display helmet for children undergoing cold pressor pain.?Methods?Fifty children between the ages of 6 and 10 years underwent a baseline cold pressor trial followed by two cold pressor trials in which interactive videogame distraction was delivered via a VR helmet or without a VR helmet in counterbalanced order.?Results?As expected, children demonstrated significant improvements in pain threshold and pain tolerance during both distraction conditions. However, the two distraction conditions did not differ in effectiveness.?Conclusions?Using the VR helmet did not result in improved pain tolerance over and above the effects of interactive videogame distraction without VR technology. Clinical implications and possible developmental differences in elementary school-aged children's ability to use VR technology are discussed. PMID:19786489

  16. 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

  17. Pain Sensitivity and Modulation in Primary Insomnia

    PubMed Central

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

    2013-01-01

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

  18. Flank pain

    MedlinePLUS

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

  19. Abdominal pain

    MedlinePLUS

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

  20. Childhood adversities and laboratory pain perception

    PubMed Central

    Pieritz, Karoline; Rief, Winfried; Euteneuer, Frank

    2015-01-01

    Childhood adversity has frequently been related to a wide range of psychosomatic complaints in adulthood. The present study examined the relationship between different forms of childhood adversity and laboratory measures of pain. Heat pain tolerance and perceived heat pain intensity were measured in a community-based sample of 62 women (aged 20–64 years). Participants completed the Childhood Trauma Questionnaire (CTQ), which assesses five forms of childhood adversity: physical abuse, sexual abuse, emotional abuse, physical neglect, and emotional neglect. Somatic symptoms, depressive symptoms, and pain catastrophizing were assessed as potential mediators. Bivariate analyses indicated that emotional abuse but no other forms of childhood adversity were significantly related to decreased heat pain tolerance (r=?0.27; P<0.05). Accordingly, multiple regression analyses revealed that only emotional abuse was a significant predictor of heat pain tolerance (?=?0.62; P=0.034) when entering all CTQ subscales simultaneously. Although emotional abuse was also related to somatic symptoms, depressive symptoms, and pain catastrophizing, none of these variables mediated the relationship between childhood adversity and laboratory pain (P>0.1). No significant associations were found between any forms of childhood adversity and heat pain intensity. Our findings indicate that the severity of emotional childhood abuse is associated with decreased pain tolerance, an affective component of pain, but not with heat pain intensity, which has been described as a sensory component of pain. PMID:26316757

  1. A phase 3, multicenter, randomized, double-blind, placebo-controlled, safety, tolerability, and efficacy study of Xtampza ER in patients with moderate-to-severe chronic low back pain.

    PubMed

    Katz, Nathaniel; Kopecky, Ernest A; O?Connor, Melinda; Brown, Robert H; Fleming, Alison B

    2015-12-01

    Opioid analgesics are commonly used for the treatment of chronic low back pain (CLBP); however, abuse potential is a major concern. This study used a randomized, double-blind, placebo-controlled, enriched-enrollment randomized-withdrawal study design to evaluate the safety, tolerability, and analgesic efficacy of an abuse-deterrent formulation of extended-release oxycodone, Xtampza ER, in opioid-naive and opioid-experienced adults with moderate-to-severe CLBP. Patients entered an open-label titration phase (N = 740); those who were successfully titrated on Xtampza ER (?40 to ?160 mg oxycodone hydrochloride equivalent per day) were randomized to active drug (N = 193) or placebo (N = 196) for 12 weeks. Primary efficacy results showed a statistically significant difference in average pain intensity from randomization baseline to treatment week 12 between the Xtampza ER and placebo groups (mean [±SE], -1.56 [0.267]; P < 0.0001). All sensitivity analyses results supported the primary result of the study. Secondary efficacy outcomes indicated that Xtampza ER vs placebo had more patients with improvement in patient global impression of change (26.4% vs 14.3%; P < 0.0001), longer time-to-exit from the study (58 vs 35 days; P = 0.0102), and a greater proportion of patients with ?30% (49.2% vs 33.2%; P = 0.0013) and ?50% (38.3% vs 24.5%; P = 0.0032) improvement in pain intensity. There was less rescue medication (acetaminophen) use in the Xtampza ER treatment group than in the placebo group. Xtampza ER had an adverse event profile consistent with other opioids and was well tolerated; no new safety concerns were identified. In conclusion, Xtampza ER resulted in clinically and statistically significant efficacy in patients with CLBP. PMID:26262828

  2. Adaptive Thresholds

    SciTech Connect

    2014-08-26

    ADAPT is a topological analysis code that allow to compute local threshold, in particular relevance based thresholds for features defined in scalar fields. The initial target application is vortex detection but the software is more generally applicable to all threshold based feature definitions.

  3. Nociception, Pain, Negative Moods, and Behavior Selection.

    PubMed

    Baliki, Marwan N; Apkarian, A Vania

    2015-08-01

    Recent neuroimaging studies suggest that the brain adapts with pain, as well as imparts risk for developing chronic pain. Within this context, we revisit the concepts for nociception, acute and chronic pain, and negative moods relative to behavior selection. We redefine nociception as the mechanism protecting the organism from injury, while acute pain as failure of avoidant behavior, and a mesolimbic threshold process that gates the transformation of nociceptive activity to conscious pain. Adaptations in this threshold process are envisioned to be critical for development of chronic pain. We deconstruct chronic pain into four distinct phases, each with specific mechanisms, and outline current state of knowledge regarding these mechanisms: the limbic brain imparting risk, and the mesolimbic learning processes reorganizing the neocortex into a chronic pain state. Moreover, pain and negative moods are envisioned as a continuum of aversive behavioral learning, which enhance survival by protecting against threats. PMID:26247858

  4. 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

  5. Efficacy and tolerability of a hydrocodone extended-release tablet formulated with abuse-deterrence technology for the treatment of moderate-to-severe chronic pain in patients with osteoarthritis or low back pain.

    PubMed

    Hale, Martin E; Laudadio, Charles; Yang, Ronghua; Narayana, Arvind; Malamut, Richard

    2015-01-01

    This double-blind, placebo-controlled study evaluated the efficacy and safety of hydrocodone extended release (ER) developed with abuse-deterrence technology to provide sustained pain relief and limit effects of alcohol and tablet manipulation on drug release. Eligible patients with chronic moderate-to-severe low back or osteoarthritis pain were titrated to an analgesic dose of hydrocodone ER (15-90 mg) and randomized to placebo or hydrocodone ER every 12 hours. The primary efficacy measure was change from baseline to week 12 in weekly average pain intensity (API; 0=no pain, 10=worst pain imaginable). Secondary measures included percentage of patients with >33% and >50% increases from baseline in weekly API, change from baseline in weekly worst pain intensity, supplemental opioid usage, aberrant drug-use behaviors, and adverse events. Overall, 294 patients were randomized and received ?1 dose of placebo (n=148) or hydrocodone ER (n=146). Weekly API did not differ significantly between hydrocodone ER and placebo at week 12 (P=0.134); although, in post hoc analyses, the change in weekly API was significantly lower with hydrocodone ER when excluding the lowest dose (15 mg; least squares mean, -0.20 vs 0.40; P=0.032). Significantly more patients had >33% and >50% increase in weekly API with placebo (P<0.05), and mean weekly worst pain intensity was significantly lower with hydrocodone ER at week 12 (P=0.026). Supplemental medication usage was higher with placebo (86%) than hydrocodone ER (79%). Incidence of aberrant drug-use behaviors was low, and adverse events were similar between groups. This study did not meet the primary endpoint, although results support the effectiveness of this hydrocodone ER formulation in managing chronic low back or osteoarthritis pain. Use of the hydrocodone ER 15-mg dose, a robust placebo response, and use of supplemental analgesics, particularly in the placebo group, may have limited detection of a statistically significant treatment effect, and additional research is needed to clarify these findings. PMID:26396543

  6. Efficacy and tolerability of a hydrocodone extended-release tablet formulated with abuse-deterrence technology for the treatment of moderate-to-severe chronic pain in patients with osteoarthritis or low back pain

    PubMed Central

    Hale, Martin E; Laudadio, Charles; Yang, Ronghua; Narayana, Arvind; Malamut, Richard

    2015-01-01

    This double-blind, placebo-controlled study evaluated the efficacy and safety of hydrocodone extended release (ER) developed with abuse-deterrence technology to provide sustained pain relief and limit effects of alcohol and tablet manipulation on drug release. Eligible patients with chronic moderate-to-severe low back or osteoarthritis pain were titrated to an analgesic dose of hydrocodone ER (15–90 mg) and randomized to placebo or hydrocodone ER every 12 hours. The primary efficacy measure was change from baseline to week 12 in weekly average pain intensity (API; 0=no pain, 10=worst pain imaginable). Secondary measures included percentage of patients with >33% and >50% increases from baseline in weekly API, change from baseline in weekly worst pain intensity, supplemental opioid usage, aberrant drug-use behaviors, and adverse events. Overall, 294 patients were randomized and received ?1 dose of placebo (n=148) or hydrocodone ER (n=146). Weekly API did not differ significantly between hydrocodone ER and placebo at week 12 (P=0.134); although, in post hoc analyses, the change in weekly API was significantly lower with hydrocodone ER when excluding the lowest dose (15 mg; least squares mean, ?0.20 vs 0.40; P=0.032). Significantly more patients had >33% and >50% increase in weekly API with placebo (P<0.05), and mean weekly worst pain intensity was significantly lower with hydrocodone ER at week 12 (P=0.026). Supplemental medication usage was higher with placebo (86%) than hydrocodone ER (79%). Incidence of aberrant drug-use behaviors was low, and adverse events were similar between groups. This study did not meet the primary endpoint, although results support the effectiveness of this hydrocodone ER formulation in managing chronic low back or osteoarthritis pain. Use of the hydrocodone ER 15-mg dose, a robust placebo response, and use of supplemental analgesics, particularly in the placebo group, may have limited detection of a statistically significant treatment effect, and additional research is needed to clarify these findings. PMID:26396543

  7. Increasing intensity of TENS prevents analgesic tolerance in rats

    PubMed Central

    Sato, Karina L.; Sanada, Luciana S.; Rakel, Barbara A.; Sluka, Kathleen A.

    2012-01-01

    Transcutaneous electrical nerve stimulation (TENS) reduces hyperalgesia and pain. Both low frequency (LF) and high frequency (HF) TENS, delivered at the same intensity (90% motor threshold (MT)) daily, result in analgesic tolerance with repeated use by the 5th day of treatment. Thecurrentstudytestedif 1) increasingintensityby 10% per daypreventsthedevelopmentoftolerance to repeated TENS, and 2) iflowerintensity TENS (50 % MT) produces an equivalentreduction in hyperalgesia when compared to 90% MT TENS. Sprague-Dawley rats with unilateral knee joint inflammation (3% carrageenan) were separated according to the intensity of TENS used: Sham, 50% LF, 50% HF, 90% LF, 90% HF, and increased intensity by 10% per day (LF and HF). The reduced mechanical withdrawal threshold following the induction of inflammation was reversed by application of TENS applied at 90% MT and increasing intensity for the first 4 days. On the 5th day, the groups that received 90% MT intensity showed tolerance. Nevertheless, the group that received an increased intensity on each day still showed a reversal of the mechanical withdrawal threshold with TENS. These results show that the development of tolerance can be delayed by increasing intensity of TENS. PMID:22858165

  8. Sleep and pain sensitivity in adults.

    PubMed

    Sivertsen, Børge; Lallukka, Tea; Petrie, Keith J; Steingrímsdóttir, Ólöf Anna; Stubhaug, Audun; Nielsen, Christopher Sivert

    2015-08-01

    Sleep problems and pain are major public health concerns, but the nature of the association between the 2 conditions is inadequately studied. The aim of this study was to determine whether a range of sleep measures is associated with experimental increased pain sensitivity. A cross-sectional large population-based study from 2007 to 2008, the Tromsø 6 study, provided data from 10,412 participants (age: mean [SD], 58 [13] years; 54% women). Self-reported sleep measures provided information on sleep duration, sleep onset latency (SOL), and sleep efficiency, as well as frequency and severity of insomnia. The main outcome measure was pain sensitivity tests, including assessment of cold-pressor pain tolerance. We found that all sleep parameters, except sleep duration, were significantly associated with reduced pain tolerance. Both the frequency and severity of insomnia, in addition to SOL and sleep efficiency, were associated with pain sensitivity in a dose-response manner. Adjusting for demographics and psychological distress reduced the strengths of the hazard ratios, but most associations remained significant in the fully adjusted models. There was also a synergistic interaction effect on pain tolerance when combining insomnia and chronic pain. We conclude that sleep problems significantly increase the risk for reduced pain tolerance. Because comorbid sleep problems and pain have been linked to elevated disability, the need to improve sleep among patients with chronic pain, and vice versa, should be an important agenda for future research. PMID:25915149

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

    PubMed Central

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

    2014-01-01

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

  10. Elbow pain

    MedlinePLUS

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

  11. Hip pain

    MedlinePLUS

    ... or around the hip joint. You may not feel pain from your hip directly over the hip area. ... your provider will ask questions about: Where you feel the pain When and how the pain started Things that ...

  12. Pain Relievers

    MedlinePLUS

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

  13. Brain Chemistry May Change to Cope with Pain

    MedlinePLUS

    ... nih.gov/medlineplus/news/fullstory_155317.html Brain Chemistry May Change to Cope With Pain Researchers document ... 2015 FRIDAY, Oct. 23, 2015 (HealthDay News) -- Brain chemistry may change to help people tolerate arthritis pain, ...

  14. 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

  15. Threshold Digraphs

    PubMed Central

    Cloteaux, Brian; LaMar, M. Drew; Moseman, Elizabeth; Shook, James

    2014-01-01

    A digraph whose degree sequence has a unique vertex labeled realization is called threshold. In this paper we present several characterizations of threshold digraphs and their degree sequences, and show these characterizations to be equivalent. Using this result, we obtain a new, short proof of the Fulkerson-Chen theorem on degree sequences of general digraphs.

  16. Effect of Age on Response to Experimental Pain in Normal Indian Males

    PubMed Central

    Saxena, Indu; Barath, Abhijeet Singh; Verma, Anjali; Garg, Sumit; Kumar, Manoj

    2015-01-01

    Background and Objectives Response to experimental pain depends on the nature of the pain stimulus, as well as on gender, racial, cultural and socioeconomic factors. This study investigates the effect of age on pain sensitivity and cardiovascular reactivity produced by experimental pain. We have also compared the values of body mass index (BMI) and resting blood pressure of volunteers with the normal values. Materials and Methods The study was conducted on 83 Indian males of different age groups. The volunteers were divided into 4 groups: Children, Young Adults, Middle-Aged Adults and Old Adults; and their basal parameters (BMI, resting pulse and blood pressure) were recorded. Selected volunteers were subjected to cold pressor task (CPT). Pain sensitivity (PS) (pain threshold, tolerance and pain rating on a visual analog scale) and cardiovascular reactivity (CVR) (increase in pulse and blood pressure) were recorded. Results Many volunteers had abnormal values of BMI and resting blood pressure and had to be excluded from the study. PS and CVR between different groups were compared by one-way ANOVA. Significant differences in PS were observed, with highest pain sensitivity in Children and lowest in Old Adults. No significant differences were observed in the CVR. Conclusion The high numbers of volunteers with abnormal basal parameters (BMI and resting blood pressure) show an urgent need to educate the general public about the dangers and risk factors of obesity and hypertension. Less exposure of children to painful encounters may be responsible for their high pain sensitivity while higher values of resting blood pressure and decreased sensitivity of the sensory systems with advancing age may be responsible for the hypoalgesia observed in old adults. PMID:26500901

  17. Shoulder pain

    MedlinePLUS

    Pain - shoulder ... changes around the rotator cuff can cause shoulder pain. You may have pain when lifting the arm above your head or ... The most common cause of shoulder pain occurs when rotator cuff tendons ... The tendons become inflamed or damaged. This condition ...

  18. Pelvic Pain

    MedlinePLUS

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

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

    PubMed Central

    2011-01-01

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

  20. Pain: history, culture and philosophy.

    PubMed

    Khan, Murad Ahmad; Raza, Fauzia; Khan, Iqbal Akhtar

    2015-01-01

    Pain, one of the universals of existence, has a long and venerable history, its origin initially attributed to godly punishment for disbelievers; and, with improved understanding, to physical and psycho-social factors. "Pain is emotion or sensation?" has been a debatable issue. Razes developed pleasure-pain theory, founded on the theories of Socrates, Plato, Aristotle and Epicurus. Descartes' Dualism shifted the centre of pain from the heart to the brain but negated the psychological contribution to its pathogenesis. Gate Control Theory, fascinated with the idea of "neurological gates", highlighted the important role of the brain in dealing with the messages received. The International Association of the Study of Pain, in 1979, coined a definition of pain which is currently in use and was last updated on 6th October 2014. Its validity has been challenged and a new definition has been suggested. Whereas the experience is personalized, immeasurable and unsharable, different cultural groups react differently to pain from relative tolerance to over-reaction. Gender and ethnic differences in the perception of pain are well proven and the effects of various religious beliefs adequately scored. Despite extensive research over centuries, understanding of pain mechanisms is still far from optimal. Untiring efforts to identify a paincentre in the brain have been futile. Had it been possible, millions of pain sufferers would have been relieved of their physical agony and mental anguish by the prick of needle. PMID:26203543

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

    PubMed

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

    2014-01-01

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

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

    PubMed Central

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

    2015-01-01

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

  3. Research on laser induced pain effect

    NASA Astrophysics Data System (ADS)

    Chen, P.; Wang, J. R.; Li, Y. C.; Yang, Z. F.

    2010-11-01

    To study 1.06?m laser causing pain in human skin. The skin of human dorsum hand was irradiated by a Nd: YAG laser. The energy of each pulse and whether the subjects felt a painful sensation after each stimulus were recorded. The pain threshold was defined as the laser dose at which the subjects reported a painful sensation to 50% of stimulus deliveries. The pain thresholds were determined under 3 different beam diameter and pulse duration conditions. The influence of skin temperature on the pain caused by laser stimulus was also explored. As the temperature of skin was about 30°C, the pain thresholds were 394mJ/mm2, 36.4mJ/mm2 and 8.92mJ/mm2 respectively under the stimulating condition of 1.20mm beam diameter and 85?s pulse duration, 1.20mm beam diameter and 20ns pulse duration and 2.56mm beam diameter and 20ns pulse duration. Under the first condition, when skin temperature was 25°C and radiant exposure was 383mJ/mm2, the probability of laser stimulus causing pain was 16.7%; when skin temperature was 39°C and radiant exposure was 361mJ/mm2, the probability was 56.7%. The threshold of 1.06?m laser stimulus causing pain decreases with decreasing pulse duration, increasing beam diameter and skin temperature.

  4. 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

  5. Somatosensory assessment and conditioned pain modulation in temporomandibular disorders pain patients.

    PubMed

    Kothari, Simple Futarmal; Baad-Hansen, Lene; Oono, Yuka; Svensson, Peter

    2015-12-01

    The pathophysiology and underlying pain mechanisms of temporomandibular disorders (TMD) are poorly understood. The aims were to assess somatosensory function at the temporomandibular joints (TMJs) and to examine whether conditioned pain modulation (CPM) differs between TMD pain patients (n = 34) and healthy controls (n = 34). Quantitative sensory testing was used to assess the somatosensory function. Z-scores were calculated for patients based on reference data. Conditioned pain modulation was tested by comparing pressure pain thresholds (PPTs) before, during, and after the application of painful and nonpainful cold stimuli. Pressure pain thresholds were measured at the most painful TMJ and thenar muscle (control). Data were analyzed with analyses of variance. Most (85.3%) of the patients exhibited at least 1 or more somatosensory abnormalities at the most painful TMJ with somatosensory gain with regard to PPT and punctate mechanical pain stimuli, and somatosensory loss with regard to mechanical detection and vibration detection stimuli as the most frequent abnormalities. There was a significant CPM effect (increased PPT) at both test sites during painful cold application in healthy controls and patients (P < 0.001). There was no significant difference in the relative CPM effect during painful cold application between groups (P = 0.227). In conclusion, somatosensory abnormalities were commonly detected in TMD pain patients and CPM effects were similar in TMD pain patients and healthy controls. PMID:26307861

  6. Finger pain

    MedlinePLUS

    Pain - finger ... Nearly everyone has had finger pain at some time. You may have: Tenderness Burning Stiffness Numbness Tingling Coldness Swelling Change in skin color Redness Many conditions, such ...

  7. Chronic Pain

    MedlinePLUS

    ... Complex Regional Pain Syndrome (also called Causalgia and Reflex Sympathetic Dystrophy Syndrome) information page compiled by the ... Complex Regional Pain Syndrome (also called Causalgia and Reflex Sympathetic Dystrophy Syndrome) information page compiled by the ...

  8. Ribcage pain

    MedlinePLUS

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

  9. Pain Assessment

    MedlinePLUS

    ... clarify its impact, and evaluate other medical and psychosocial problems. The assessment determines whether additional evaluation is ... pain Describe the negative effects on physical and psychosocial functioning caused by the pain Understand the medical ...

  10. Patellofemoral Pain.

    PubMed

    Dutton, Rebecca A; Khadavi, Michael J; Fredericson, Michael

    2016-02-01

    Patellofemoral pain is characterized by insidious onset anterior knee pain that is exaggerated under conditions of increased patellofemoral joint stress. A variety of risk factors may contribute to the development of patellofemoral pain. It is critical that the history and physical examination elucidate those risk factors specific to an individual in order to prescribe an appropriate and customized treatment plan. This article aims to review the epidemiology, risk factors, diagnosis, and management of patellofemoral pain. PMID:26616176

  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. Abdominal Pain

    MedlinePLUS

    ... cope. You could also try progressive relaxation or self-hypnosis . For more information about non-drug pain relief techniques, see YourChild : Pain and Your Child or Teen . What diet and medication treatments are available for the pain of functional ...

  13. Chronic Pain

    MedlinePLUS

    ... anything you do to relax or get your mind off your problems may help control pain. It's important to include relaxing activities in your daily life, even if you are already taking medicine for pain. Relaxation can actually change the body's chemicals that produce pain. You might have to ...

  14. Management of pain in older adults.

    PubMed

    Cavalieri, Thomas A

    2005-03-01

    The elderly are often untreated or undertreated for pain. Barriers to effective management include challenges to proper assessment of pain; underreporting on the part of patients; atypical manifestations of pain in the elderly; a need for increased appreciation of the pharmacokinetic and pharmacodynamic changes of aging; and misconceptions about tolerance and addiction to opioids. Physicians can effectively manage pain in the elderly by understanding different types of pain (nociceptive and neuropathic), and appropriate use of nonopioid, opioid, and adjuvant medications. Opioids have become more widely accepted for treating older adults who have persistent pain, but their use requires physicians have an understanding of prevention and management of side effects, opioid titration and withdrawal, and careful monitoring. Placebo use is unwarranted and unethical. Nonpharmacologic approaches to pain management are essential and include osteopathic manipulative treatment, cognitive behavioral therapy, exercise, and spiritual interventions. The holistic and interdisciplinary approach of osteopathic medicine offers an approach that can optimize effective pain management in older adults. PMID:18154193

  15. 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

  16. 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 ...

  17. 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

  18. Activation of P2X7 receptors in the midbrain periaqueductal gray of rats facilitates morphine tolerance.

    PubMed

    Xiao, Zhi; Li, You-Yan; Sun, Meng-Jie

    2015-08-01

    Opiates such as morphine exhibit analgesic effect in various pain models, but repeated and chronic morphine administration may develop resistance to antinociception. The purinergic signaling system is involved in the mechanisms of pain modulation and morphine tolerance. This study aimed to determine whether the P2X7 receptor in the ventrolateral midbrain periaqueductal gray (vlPAG) is involved in morphine tolerance. Development of tolerance to the antinociceptive effect of morphine was induced in normal adult male Sprague-Dawley (SD) rats through subcutaneous injection of morphine (10mg/kg). The analgesic effect of morphine (5mg/kg, i.p.) was assessed by measuring mechanical withdrawal thresholds (MWTs) in rats with an electronic von Frey anesthesiometer. The expression levels and distribution of the P2X7 receptor in the vlPAG was evaluated through Western blot analysis and immunohistochemistry. The acute effects of intra-vlPAG injection of the selective P2X7 receptor agonist Bz-ATP, the selective P2X7 receptor antagonist A-740003, or antisense oligodeoxynucleotide (AS ODN) targeting the P2X7 receptor on morphine-treated rats were also observed. Results demonstrated that repeated morphine administration decreased the mechanical pain thresholds. By contrast, the expression of the P2X7 receptor protein was up-regulated in the vlPAG in morphine tolerant rats. The percent changes in MWT were markedly but only transiently attenuated by intra-vlPAG injection of Bz-ATP (9nmol/0.3?L) but elevated by A-740003 at doses of 10 and 100nmol/0.3?L. AS ODN (15nmol/0.3?L) against the P2X7 receptor reduced the development of chronic morphine tolerance in rats. These results suggest that the development of antinociceptive tolerance to morphine is partially mediated by activating the vlPAG P2X7 receptors. The present data also suggest that the P2X7 receptors may be a therapeutic target for improving the analgesic effect of morphine in treatments of pain when morphine tolerance occurs. PMID:26054441

  19. Buprenorphine in cancer pain.

    PubMed

    Davis, Mellar P

    2005-11-01

    Buprenorphine is a broad spectrum, highly lipophilic, and long-acting partial mu opioid receptor agonist that is noncross tolerant to other opioids. Buprenorphine can be given by several routes. Metabolism is through CYP3A4 and CYP2C8 and by conjugases. Constipation and sexual dysfunction appear to be less with buprenorphine than with other opioids. The recent development of a polymer matrix patch delivery system for buprenorphine prevents "dose dumping" and facilitates pain management in those unable to take oral analgesics. Sublingual buprenorphine has been combined with naloxone to prevent illicit conversion to parenteral administration. Buprenorphine has been used extensively to control cancer pain. In certain clinical situations, buprenorphine may have particular advantages over other opioids. PMID:16010532

  20. Endogenous inhibition of somatic pain is impaired in girls with irritable bowel syndrome compared with healthy girls

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Endogenous pain inhibition is often deficient in adults with chronic pain conditions including irritable bowel syndrome (IBS). It is unclear whether deficiencies in pain inhibition are present in young children with IBS. The present study compared endogenous pain inhibition, somatic pain threshold, ...

  1. 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

  2. Pain hypersensitivity and spinal nociceptive hypersensitivity in chronic pain: prevalence and associated factors.

    PubMed

    Curatolo, Michele; Müller, Monika; Ashraf, Aroosiah; Neziri, Alban Y; Streitberger, Konrad; Andersen, Ole K; Arendt-Nielsen, Lars

    2015-11-01

    Hypersensitivity of pain pathways is considered a relevant determinant of symptoms in chronic pain patients, but data on its prevalence are very limited. To our knowledge, no data on the prevalence of spinal nociceptive hypersensitivity are available. We studied the prevalence of pain hypersensitivity and spinal nociceptive hypersensitivity in 961 consecutive patients with various chronic pain conditions. Pain threshold and nociceptive withdrawal reflex threshold to electrical stimulation were used to assess pain hypersensitivity and spinal nociceptive hypersensitivity, respectively. Using 10th percentile cutoff of previously determined reference values, the prevalence of pain hypersensitivity and spinal nociceptive hypersensitivity (95% confidence interval) was 71.2 (68.3-74.0) and 80.0 (77.0-82.6), respectively. As a secondary aim, we analyzed demographic, psychosocial, and clinical characteristics as factors potentially associated with pain hypersensitivity and spinal nociceptive hypersensitivity using logistic regression models. Both hypersensitivity parameters were unaffected by most factors analyzed. Depression, catastrophizing, pain-related sleep interference, and average pain intensity were significantly associated with hypersensitivity. However, none of them was significant for both unadjusted and adjusted analyses. Furthermore, the odds ratios were very low, indicating modest quantitative impact. To our knowledge, this is the largest prevalence study on central hypersensitivity and the first one on the prevalence of spinal nociceptive hypersensitivity in chronic pain patients. The results revealed an impressively high prevalence, supporting a high clinical relevance of this phenomenon. Electrical pain thresholds and nociceptive withdrawal reflex explore aspects of pain processing that are mostly independent of sociodemographic, psychological, and clinical pain-related characteristics. PMID:26172555

  3. [Pathophysiology of ischemic cardiac pain.].

    PubMed

    Münzel, T; Bassenge, E

    1988-09-01

    Cardiac pain is a conscious experience that can be explored only indirectly with experimental approaches. The exact machanisms eliciting cardiac pain still remain obscure. The afferent fibres running in the cardiac sympathetic nerves are regarded as the essential pathway for the transmission of cardiac pain. Atria and ventricle are abundantly supplied with sympathetic sensory innervation. In the spinal cord, impulses transmitted by the sympathetic pathway converge with impulses from somatic thoracic structures onto the same ascending spinothalamic neuron which probably explains the mechanism of referred pain (=projection of pain to another organ). Two hypotheses have been put forward to explain the peripheral mechanism for nociception. The intensity mechanism assumes that pain results from an excessive stimulation of receptive structures normally stimulated at lower levels whereas a specific sensation is considered to result from an excitation of a well defined nociceptive apparatus. Ventricular sympathetic afferent fibres whether myelinated or unmyelinated, always possess some mechanosensitivity and respond to normal chemical and mechanical stimuli, thus displaying properties of polymodal receptors. Afferent vagal fibres may contribute to the mechanisms of cardiac nociception by modulating the threshold and characteristics of pain. Experimental studies identified three main mechanisms, which may be responsible for eliciting cardiac pain during ischemic periods in humans: a) nonphysiological motion of the ischemic left ventricular wall (bulging) and an excitation of mechanical receptors by passive stretching. b) The excitation of free sensory nerve endings by chemicals such as bradykinin, PGE(2), adenosin, histamin or potassium. c) A combination of a and b: algogenic chemicals may sensitize mechanical receptors and therefore lower their threshold for nociception. PMID:18415323

  4. The imidazoline receptors and ligands in pain modulation

    PubMed Central

    Bektas, Nurcan; Nemutlu, Dilara; Arslan, Rana

    2015-01-01

    Pain is an unpleasant experience and effects daily routine negatively. Although there are various drugs, many of them are not entirely successful in relieving pain, since pain modulation is a complex process involving numerous mediators and receptors. Therefore, it is a rational approach to identify the factors involved in the complex process and develop new agents that act on these pain producing mechanisms. In this respect, the involvement of the imidazoline receptors in pain modulation has drawn attention in recent years. In this review, it is aimed to focus on the imidazoline receptors and their ligands which contribute to the pain modulation. It is demonstrated that imidazoline-2 (I2) receptors are steady new drug targets for analgesics. Even if the mechanism of I2 receptor is not well known in the modulation of pain, it is known that it plays a role in tonic and chronic pain but not in acute phasic pain. Moreover, the I2 receptor ligands increase the analgesic effects of opioids in both acute and chronic pain and prevent the development of opioid tolerance. So, they are valuable for the chronic pain treatment and also therapeutic coadjuvants in the management of chronic pain with opiate drugs due to the attenuation of opioid tolerance and addiction. Thus, the use of the ligands which bind to the imidazoline receptors is an effective strategy for relieving pain. This educational forum exhibits the role of imidazoline receptors and ligands in pain process by utilizing experimental studies. PMID:26600633

  5. 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 ...

  6. 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

  7. Accuracy threshold for postselected quantum computation

    E-print Network

    Panos Aliferis; Daniel Gottesman; John Preskill

    2007-09-17

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

  8. Heel Pain

    MedlinePLUS

    ... inflammation of the band of fibrous connective tissue (fascia) running along the bottom (plantar surface) of the ... quite painful. The condition occurs when the plantar fascia is strained over time beyond its normal extension, ...

  9. 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 ...

  10. Joint pain

    MedlinePLUS

    ... both rest and exercise are important. Warm baths, massage, and stretching exercises should be used as often ... Does keeping the joint elevated help? Do medicines, massage, or applying heat reduce the pain? What other ...

  11. Pain (PDQ)

    MedlinePLUS

    ... swelling. Decrease pain caused by muscle spasms and tension. Massage has a direct effect on body tissues ... slowly, feel yourself begin to relax; feel the tension leaving your body. Step 3. Breathe in and ...

  12. Orofacial Pain

    MedlinePLUS

    ... percent of all headaches are caused by muscle tension, which may be related to the bite. Headaches ... the touch Earaches or ringing in the ears Neck, shoulder or back pain Dizziness ?xml:namespace> Sleep ...

  13. Urination Pain

    MedlinePLUS

    ... small masses of minerals) in the urinary tract. Urinary tract infections (UTIs) are the most common cause of painful ... For Kids For Parents MORE ON THIS TOPIC Urinary Tract Infections A to Z: Dysuria Recurrent Urinary Tract Infections ...

  14. Penis pain

    MedlinePLUS

    Pain - penis ... Bites, either human or insect Cancer of the penis Erection that does not go away (priapism) Genital herpes Infected hair follicles Infected prosthesis of the penis Infection under the foreskin of uncircumcised men ( balanitis ) ...

  15. Phantom Pain 

    E-print Network

    Valentine, A.

    , and neurotransmitter release, thereby making them immensely important therapeutic targets for treating medical conditions such as pain, depression, obesity, learning, and memory.61,62 Despite their sequence homology, NTs elicit their action by binding to two...

  16. Neck Pain

    MedlinePLUS

    ... Use anti-inflammatory medicines, such as ibuprofen and aspirin, to relieve pain and discomfort, and apply heat ... Use anti-inflammatory medicines, such as ibuprofen or aspirin, and apply heat to the sore area. See ...

  17. Neonatal pain

    PubMed Central

    Walker, Suellen M

    2014-01-01

    Effective management of procedural and postoperative pain in neonates is required to minimize acute physiological and behavioral distress and may also improve acute and long-term outcomes. Painful stimuli activate nociceptive pathways, from the periphery to the cortex, in neonates and behavioral responses form the basis for validated pain assessment tools. However, there is an increasing awareness of the need to not only reduce acute behavioral responses to pain in neonates, but also to protect the developing nervous system from persistent sensitization of pain pathways and potential damaging effects of altered neural activity on central nervous system development. Analgesic requirements are influenced by age-related changes in both pharmacokinetic and pharmacodynamic response, and increasing data are available to guide safe and effective dosing with opioids and paracetamol. Regional analgesic techniques provide effective perioperative analgesia, but higher complication rates in neonates emphasize the importance of monitoring and choice of the most appropriate drug and dose. There have been significant improvements in the understanding and management of neonatal pain, but additional research evidence will further reduce the need to extrapolate data from older age groups. Translation into improved clinical care will continue to depend on an integrated approach to implementation that encompasses assessment and titration against individual response, education and training, and audit and feedback. PMID:24330444

  18. Self-Regulatory Deficits Associated with Unpracticed Mindfulness Strategies for Coping with Acute Pain

    PubMed Central

    Evans, Daniel R.; Eisenlohr-Moul, Tory A.; Button, Daniel F.; Baer, Ruth A.; Segerstrom, Suzanne C.

    2015-01-01

    Training in mindfulness is a well-supported therapeutic strategy for pain conditions, though short-term mindfulness training for acute pain is not always effective. To explore the possibility that initial attempts at mindfulness in people without previous training may drain self-regulatory resources, the current study used a student sample (N=63) to test the hypothesis that brief instruction in mindfulness would lead to reduced pain tolerance on a cold pressor task (CPT), compared to more familiar strategies for coping with acute pain. We also investigated whether high heart rate variability (HRV), a physiological indicator of self-regulatory capacity, would predict pain tolerance. Higher HRV predicted greater pain tolerance only in the control group, suggesting that applying unfamiliar mindfulness strategies while attempting to tolerate pain more rapidly sapped self-regulatory strength. PMID:25843972

  19. Pain relief can be painful

    PubMed Central

    Bindra, Ashish; Bithal, Parmod; Sokhal, Navdeep; Arora, Ankit

    2015-01-01

    Mandibular nerve block is periodically used procedure used to treat neuralgic pain in the distribution of trigeminal nerve. It is a commonly performed block in outpatient settings at our institute. We present a case of an elderly edentulous patient with trigeminal neuralgia who suffered recurrent temporomandibular joint (TMJ) dislocation following mandibular nerve block. The patient presented with complaints of severe pain, inability to close mouth, and eat food since 2 days. Anterior closed reduction of TMJ resulted in reduction of joint and immediate pain relief. However, the maneuver failed due to recurrent dislocation of the joint. A Barton dressing was applied to prevent another dislocation. This was followed by autologous blood injection into the joint. This case focuses on the preponderance of clinical evaluation and accentuates the need for additional forethought to be taken during pain procedures, particularly in the geriatric population.

  20. Tolerability of hypertonic injectables.

    PubMed

    Wang, Wei

    2015-07-25

    Injectable drug products are ideally developed as isotonic solutions. Often, hypertonic injectables may have to be marketed for a variety of reasons such as product solubilization and stabilization. A key concern during product formulation development is the local and systemic tolerability of hypertonic products upon injection. This report reviews and discusses the tolerability in terms of local discomfort, irritation, sensation of heat and pain, along with other observed side effects of hypertonicity in both in-vitro systems and in-vivo animal and human models. These side effects clearly depend on the degree of hypertonicity. The sensation of pain among different injection routes seems to follow this order: intramuscular>subcutaneous>intravenous or intravascular. It is recommended that the upper osmolality limit should be generally controlled under 600 mOsm/kg for drug products intended for intramuscular or subcutaneous injection. For drug products intended for intravenous or intravascular injection, the recommended upper limit should be generally controlled under 1,000 mOsm/kg for small-volume injections (? 100 mL) and 500 mOsm/kg for large-volume injections (>100mL). Several options are available for minimization of hypertonicity-induced pain upon product administration. PMID:26027488

  1. Witnessing hateful people in pain modulates brain activity in regions associated with physical pain and reward

    PubMed Central

    Fox, Glenn R.; Sobhani, Mona; Aziz-Zadeh, Lisa

    2013-01-01

    How does witnessing a hateful person in pain compare to witnessing a likable person in pain? The current study compared the brain bases for how we perceive likable people in pain with those of viewing hateful people in pain. While social bonds are built through sharing the plight and pain of others in the name of empathy, viewing a hateful person in pain also has many potential ramifications. In this functional Magnetic Resonance Imaging (fMRI) study, Caucasian Jewish male participants viewed videos of (1) disliked, hateful, anti-Semitic individuals, and (2) liked, non-hateful, tolerant individuals in pain. The results showed that, compared with viewing liked people, viewing hateful people in pain elicited increased responses in regions associated with observation of physical pain (the insular cortex, the anterior cingulate cortex (ACC), and the somatosensory cortex), reward processing (the striatum), and frontal regions associated with emotion regulation. Functional connectivity analyses revealed connections between seed regions in the left ACC and right insular cortex with reward regions, the amygdala, and frontal regions associated with emotion regulation. These data indicate that regions of the brain active while viewing someone in pain may be more active in response to the danger or threat posed by witnessing the pain of a hateful individual more so than the desire to empathize with a likable person's pain. PMID:24167496

  2. Analgesic effect of TAK-242 on neuropathic pain in rats

    PubMed Central

    Zhao, Yang; Xin, Yan; Gao, Jie; Teng, Ru-Yang; Chu, Hai-Chen

    2015-01-01

    Background: The current study investigated the analgesic effect of the Toll-like receptor 4 (TLR4) specific antagonist TAK-242 on neuropathic pain in rats and its underlying mechanism. Methods: A total of 132 adult Sprague-Dawley (SD) rats were randomly divided into four groups: the sham operation group, the neuropathic pain model group, the TAK-242 low-dose treatment group, and the TAK-242 high-dose treatment group. The heat pain and mechanic pain thresholds of rats were detected on preoperative day 1 and postoperative days 1, 3, 7, and 10. The expression levels of I?B?, p65, IL-1?, and TNF-? in the spinal cord dorsal horn were detected on postoperative day 7 in one group of rats. Results: Compared with rats in the sham operation group, the heat pain and mechanic pain thresholds of the rats in the neuropathic pain model group significantly decreased; their expression levels of p65, IL-1?, and TNF-? significantly increased; and their expression level of IkB? significantly decreased. Compared with the neuropathic pain group, high doses of TAK-242 significantly inhibited the expression of p65, IL-1?, and TNF-?; significantly increased the expression level of IkB?; and upregulated the heat pain and mechanic pain thresholds. Conclusion: TAK-242 might improve neuropathic pain through downregulation of the NF-?B pathway. PMID:26379924

  3. Pain management.

    PubMed

    Wild, L

    1990-12-01

    Postoperative pain management in the critically ill patient is a challenge for nurses. Knowing the basis of pain transmission and mechanisms of action of interventions can assist the critical care nurse in making clinical decisions regarding pain control for individual patients. There are a number of modalities available to treat postoperative pain including both pharmacologic and nonpharmacologic interventions. Techniques such as PCA not only can provide good analgesia, but allow the critically ill patient at least one aspect of control in the otherwise highly controlled environment of the critical care unit. Epidural or intrathecal analgesia, using either opioids or LAAs alone or in combination, provides excellent analgesic effect (with minimal side effects) and may improve patient outcomes. Nonpharmacologic techniques, unfortunately, are commonly overlooked as adjuncts to traditional analgesia routines because of the nature of the illness in the critically ill patient. Nonpharmacologic techniques of pain management have a place in the care of the critically ill when applied based on the assessment of an individual patient's needs and abilities to participate in his or her care. Ensuring optimal patient comfort can benefit critically ill patients and improve clinical outcomes. PMID:2096859

  4. Napping Reverses Increased Pain Sensitivity Due to Sleep Restriction

    PubMed Central

    Faraut, Brice; Léger, Damien; Medkour, Terkia; Dubois, Alexandre; Bayon, Virginie; Chennaoui, Mounir; Perrot, Serge

    2015-01-01

    Study Objective To investigate pain sensitivity after sleep restriction and the restorative effect of napping. Design A strictly controlled randomized crossover study with continuous polysomnography monitoring was performed. Setting Laboratory-based study. Participants 11 healthy male volunteers. Interventions Volunteers attended two three-day sessions: “sleep restriction” alone and “sleep restriction and nap”. Each session involved a baseline night of normal sleep, a night of sleep deprivation and a night of free recovery sleep. Participants were allowed to sleep only from 02:00 to 04:00 during the sleep deprivation night. During the “sleep restriction and nap” session, volunteers took two 30-minute naps, one in the morning and one in the afternoon. Measurements and Results Quantitative sensory testing was performed with heat, cold and pressure, at 10:00 and 16:00, on three areas: the supraspinatus, lower back and thigh. After sleep restriction, quantitative sensory testing revealed differential changes in pain stimuli thresholds, but not in thermal threshold detection: lower back heat pain threshold decreased, pressure pain threshold increased in the supraspinatus area and no change was observed for the thigh. Napping restored responses to heat pain stimuli in the lower back and to pressure stimuli in the supraspinatus area. Conclusions Sleep restriction induces different types of hypersensitivity to pain stimuli in different body areas, consistent with multilevel mechanisms, these changes being reversed by napping. The napping restorative effect on pain thresholds result principally from effects on pain mechanisms, since it was independent of vigilance status. PMID:25723495

  5. An experimental investigation of the effects of preferred and relaxing music listening on pain perception.

    PubMed

    Mitchell, Laura A; MacDonald, Raymond A R

    2006-01-01

    This study investigates the effects of music listening on perception and tolerance of experimentally induced cold pressor pain. Fifty-four participants (34 females, 20 males) each underwent 3 cold pressor trials while listening to (a) white noise, (b) specially designed relaxation music, and (c) their own chosen music. Tolerance time, pain intensity on visual analog scale, and the pain rating index of the McGill Pain Questionnaire and perceived control over the pain were measured in each condition. While listening to their own preferred music, male and female participants tolerated the painful stimulus significantly longer than during both the relaxation music and control conditions. However, only female participants rated the intensity of the pain as significantly lower in the preferred music condition. Both male and female participants reported feeling significantly more control when listening to their preferred music. It is suggested that personal preference is an influential factor when considering the efficacy of music listening for pain relief. PMID:17348757

  6. Fault-tolerant architecture for quantum computation using electrically controlled

    E-print Network

    Yacoby, Amir

    ARTICLES Fault-tolerant architecture for quantum computation using electrically controlled with favourable error thresholds for fault-tolerant operation, consistent with present experimental parameters physics4,5 , has been experimentally demonstrated6­9 . However, achieving fault-tolerant quantum

  7. Clavicle pain and reduction of incisional and fascial pain after posterior cervical surgery.

    PubMed

    Duetzmann, Stephan; Cole, Tyler; Senft, Christian; Seifert, Volker; Ratliff, John Kevin; Park, Jon

    2015-12-01

    OBJECT Incisional pain after posterior cervical spine surgery can be severe and very unpleasant to the patient. Ongoing incisional pain is one of the key disadvantages of posterior over anterior surgical approaches to the cervical spine. It prolongs hospital stays and delays return to work. In this study, the hypothesized that incisional pain in the immediate postoperative period is caused partially by tension on the skin as well as on the deep cervical fascia and the fascia overlying the trapezius, which are usually sewn together during closure. Reduction of this tension through retraction of the shoulders should therefore reduce pain as well as the amount of pain medication used in the early postoperative period. METHODS In this prospective randomized controlled study, 30 patients who had undergone posterior cervical spine surgery were randomized into 2 groups who either wore or did not wear a clavicle brace to retract the shoulders. Patients in the brace group began wearing the brace on postoperative day (POD) 4 and wore it continuously throughout the 30-day study period. Outcome was assessed by two measures: 1) the daily level of self reported pain according to the visual analog scale (VAS) and 2) the number of pain pills taken during the 30-day postoperative period. RESULTS Wearing a clavicle brace in the immediate postoperative period significantly reduced incisional pain and the amount of pain medication that patients took. Beginning on POD 4 and continuing until day POD 13, the mean daily VAS score for pain was significantly lower in the brace group than in the control group. Furthermore, patients who wore the clavicle brace took less pain medication from POD 4 to POD 12. At this point the difference lost significance until the end of the study period. Four patients were randomized but did not tolerate wearing the brace. CONCLUSIONS Patients who tolerated wearing the clavicle brace after posterior cervical spine surgery had reduced pain and used less pain medication. PMID:26296190

  8. Back pain during growth.

    PubMed

    Hasler, Carol C

    2013-01-01

    It is wrong to believe that back pain only burdens adults: the yearly incidence during growth ranges from 10-20%, continuously increasing from childhood to adolescence. Rapid growth-related muscular dysbalance and insufficiency, poor physical condition in an increasingly sedentary adolescent community or - vice versa - high level sports activities, account for the most prevalent functional pain syndromes. In contrast to adults the correlation of radiographic findings with pain is high: the younger the patient, the higher the probability to establish a rare morphologic cause such as benign or malignant tumours, congenital malformations and infections. In children younger than 5 years old, the likelihood is more than 50%. The following red flags should lower the threshold for a quick in-depth analysis of the problem: Age of the patient <5 years, acute trauma, functional limitation for daily activities, irradiating pain, loss of weight, duration >4 weeks, history of tumour, exposition to tuberculosis, night pain and fever. High level sport equals a biomechanical field test which reveals the biologic individual response of the growing spine to the sports-related forces. Symptomatic or asymptomatic inhibitory or stimulatory growth disturbances like Scheuermann disease, scoliosis or fatigue fractures represent the most frequent pathomorphologies. They usually occur at the disk-growth plate compound: intraspongious disk herniation, diminuition of anterior growth with vertebral wedging and apophyseal ring fractures often occur when the biomechanical impacts exceed the mechanical resistance of the cartilaginous endplates. Spondylolysis is a benign condition which rarely becomes symptomatic and responds well to conservative measures. Associated slippage of L5 on S1 is frequent but rarely progresses. The pubertal spinal growth spurt is the main risk factor for further slippage, whereas sports activity - even at a high level - is not. Therefore, the athlete should only be precluded from training if pain persists or in case of high grade slips. Perturbance of the sagittal profile with increase of lumbar lordosis, flattening of the thoracic spine and retroflexion of the pelvis with hamstrings contractures are strong signs for a grade IV olisthesis or spondyloptosis with subsequent lumbosacral kyphosis. Idiopathic scoliosis is not related to pain unless it is a marked (thoraco-) lumbar curve or if there is an underlying spinal cord pathology. Chronic back pain is an under recognised entity characterised by its duration (>3 months or recurrence within 3 months) and its social impacts such as isolation and absence from school or work. It represents an independent disease, uncoupled from any initial trigger. Multimodal therapeutic strategies are more successful than isolated, somatising orthopaedic treatment. Primary and secondary preventive active measures for the physically passive adolescents, regular sports medical check-up's for the young high level athletes, the awareness for the rare but potentially disastrous pathologies and the recognition of chronic pain syndromes are the cornerstones for successful treatment of back pain during growth. PMID:23299906

  9. Somatoform pain disorder

    MedlinePLUS

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

  10. Complex Regional Pain Syndrome

    MedlinePLUS

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

  11. Back Pain

    MedlinePLUS

    ... least 6 months. Other studies are comparing different health care approaches to the management of acute low back pain (standard care versus chiropractic, acupuncture, or massage therapy). These studies are measuring ... changes in health-related quality of life among patients suffering from ...

  12. Achilles Pain.

    ERIC Educational Resources Information Center

    Connors, G. Patrick

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

  13. Abdominal Pain

    MedlinePLUS

    ... that is sudden and sharp You also have pain in your chest, neck or shoulder You're vomiting blood or have blood in your stool Your abdomen is stiff, hard and tender to touch You can't move your bowels, especially if you're also vomiting

  14. Breast pain

    PubMed Central

    2011-01-01

    Introduction Breast pain may be cyclical (worse before a period) or non-cyclical, originating from the breast or the chest wall, and occurs at some time in 70% of women. Cyclical breast pain resolves spontaneously in 20% to 30% of women, but tends to recur in 60% of women. Non-cyclical pain responds poorly to treatment but tends to resolve spontaneously in half of women. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical question: What are the effects of treatments for breast pain? We searched: Medline, Embase, The Cochrane Library, and other important databases up to May 2010 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found 24 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review we present information relating to the effectiveness and safety of the following interventions: antibiotics, bromocriptine, combined oral contraceptive pill, danazol, diuretics, evening primrose oil, gestrinone, gonadorelin analogues, hormone replacement therapy (HRT), lisuride, low-fat diet, progestogens, pyridoxine, tamoxifen, tibolone, topical or oral non-steroidal anti-inflammatory drugs (NSAIDs), toremifene, and vitamin E. PMID:21477394

  15. [Social pain].

    PubMed

    Shimoyama, Naohito; Shimoyama, Megumi

    2011-09-01

    This chapter focuses on what social pain is and how it should be managed. In order to understand social pain in a cancer patient, it is necessary to recognize the change in the patient's daily life after the diagnosis of cancer. Because the degree of suffering and the relationships with family members and the people he or she worked with differ from patient to patient, it is important to note that the context of social pain is different in each patient. Five points shown below are essential in managing social pain. 1. Economical suffering may be alleviated by utilization of the social security system while taking into account each patient's standard of living. 2. Burdens on family members should be lessened, such as by not having them stay at the patient's bedside every day and letting them go home occasionally. 3. The normal patterns of communication, support, and conflict in the family should be identified, and the extent to which they have been disrupted by the illness should be assessed. 4. It is important to understand the ethnic, cultural, and religious background of the patient and the potential impact of their influence on the individual and the illness. 5. Practical or emotional unfinished business that the patient has needs to be identified, and efforts should be made to support fulfillment. PMID:21950034

  16. An increased response to experimental muscle pain is related to psychological status in women with chronic non-traumatic neck-shoulder pain

    PubMed Central

    2011-01-01

    Background Neck-shoulder pain conditions, e.g., chronic trapezius myalgia, have been associated with sensory disturbances such as increased sensitivity to experimentally induced pain. This study investigated pain sensitivity in terms of bilateral pressure pain thresholds over the trapezius and tibialis anterior muscles and pain responses after a unilateral hypertonic saline infusion into the right legs tibialis anterior muscle and related those parameters to intensity and area size of the clinical pain and to psychological factors (sleeping problems, depression, anxiety, catastrophizing and fear-avoidance). Methods Nineteen women with chronic non-traumatic neck-shoulder pain but without simultaneous anatomically widespread clinical pain (NSP) and 30 age-matched pain-free female control subjects (CON) participated in the study. Results NSP had lower pressure pain thresholds over the trapezius and over the tibialis anterior muscles and experienced hypertonic saline-evoked pain in the tibialis anterior muscle to be significantly more intense and locally more widespread than CON. More intense symptoms of anxiety and depression together with a higher disability level were associated with increased pain responses to experimental pain induction and a larger area size of the clinical neck-shoulder pain at its worst. Conclusion These results indicate that central mechanisms e.g., central sensitization and altered descending control, are involved in chronic neck-shoulder pain since sensory hypersensitivity was found in areas distant to the site of clinical pain. Psychological status was found to interact with the perception, intensity, duration and distribution of induced pain (hypertonic saline) together with the spreading of clinical pain. The duration and intensity of pain correlated negatively with pressure pain thresholds. PMID:21992460

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

    PubMed Central

    Allely, C. S.

    2013-01-01

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

  18. 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

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

    PubMed Central

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

    2013-01-01

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

  20. 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

  1. Evaluation of the threshold trimming method for micro inertial fluidic switch based on electrowetting technology

    NASA Astrophysics Data System (ADS)

    Liu, Tingting; Su, Wei; Yang, Tao; Han, Bin

    2014-03-01

    The switch based on electrowetting technology has the advantages of no moving part, low contact resistance, long life and adjustable acceleration threshold. The acceleration threshold of switch can be fine-tuned by adjusting the applied voltage. This paper is focused on the electrowetting properties of switch and the influence of microchannel structural parameters, applied voltage and droplet volume on acceleration threshold. In the presence of process errors of micro inertial fluidic switch and measuring errors of droplet volume, there is a deviation between test acceleration threshold and target acceleration threshold. Considering the process errors and measuring errors, worst-case analysis is used to analyze the influence of parameter tolerance on the acceleration threshold. Under worst-case condition the total acceleration threshold tolerance caused by various errors is 9.95%. The target acceleration threshold can be achieved by fine-tuning the applied voltage. The acceleration threshold trimming method of micro inertial fluidic switch is verified.

  2. Pediatric Pain, Predictive Inference, and Sensitivity Analysis.

    ERIC Educational Resources Information Center

    Weiss, Robert

    1994-01-01

    Coping style and effects of counseling intervention on pain tolerance was studied for 61 elementary school students through immersion of hands in cold water. Bayesian predictive inference tools are able to distinguish between subject characteristics and manipulable treatments. Sensitivity analysis strengthens the certainty of conclusions about…

  3. Distinct quantitative sensory testing profiles in nonspecific chronic back pain subjects with and without psychological trauma.

    PubMed

    Tesarz, Jonas; Gerhardt, Andreas; Leisner, Sabine; Janke, Susanne; Treede, Rolf-Detlef; Eich, Wolfgang

    2015-04-01

    Psychological trauma is associated with an increased risk for chronification of nonspecific chronic back pain (nsCLBP) independent of posttraumatic stress disorder (PTSD). However, the mechanisms underlying the role of psychological trauma in nsCLBP are less clear than in PTSD. Therefore, this study considered whether psychological trauma exposure (TE) is accompanied by specific alterations in pain perception. The study included 56 participants with nsCLBP and TE (nsCLBP-TE), 93 participants with nsCLBP without TE (nsCLBP-W-TE), and 31 pain-free controls. All participants underwent a thorough clinical evaluation. The standardized quantitative sensory testing protocol of the "German Research Network on Neuropathic Pain" was used to obtain comprehensive profiles on somatosensory functions in painful (back) and non-painful areas (hand). The protocol consisted of thermal and mechanical detection as well as pain thresholds, vibration thresholds, and pain sensitivity to sharp and blunt mechanical stimuli. Psychological trauma was validated by structured clinical interview. Trauma-associated symptom severity, anxiety, and depressive symptomatology were assessed by self-report questionnaires. Differences in somatosensory function were seen only for pressure pain thresholds. Compared with controls, nsCLBP-TE revealed hyperalgesia generalized in space with lower thresholds in painful and non-painful areas, whereas nsCLBP-W-TE demonstrated localized alterations with decreased thresholds only in the pain-affected area of the back (P ? 0.006). Our findings suggest an augmented central pain processing in nsCLBP-TE (alterations in painful and non-painful areas), whereas nsCLBP-W-TE show only local changes (alterations only in the painful area) suggesting regional sensitization processes. This finding might explain why TE without PTSD is associated with an increased prevalence of chronic pain. PMID:25790450

  4. Neck pain

    PubMed Central

    2008-01-01

    Introduction Non-specific neck pain has a postural or mechanical basis and affects about two thirds of people at some stage, especially in middle age. Acute neck pain resolves within days or weeks, but may become chronic in about 10% of people. Whiplash injuries follow sudden acceleration–deceleration of the neck, such as in road traffic or sporting accidents. Up to 40% of people continue to report symptoms 15 years after the accident, although this varies between countries. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of treatments for people with non-specific neck pain without severe neurological deficit? What are the effects of treatments for acute whiplash injury? What are the effects of treatments for chronic whiplash injury? What are the effects of treatments for neck pain with radiculopathy? We searched: Medline, Embase, The Cochrane Library, and other important databases up to May 2007 (BMJ Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found 91 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of the evidence for interventions. Conclusions In this systematic review we present information relating to the effectiveness and safety of the following interventions: acupuncture, biofeedback, drug treatments (analgesics, antidepressants, epidural steroid injections, muscle relaxants, non-steroidal anti-inflammatory drugs [NSAIDs]), early mobilisation, early return to normal activity, exercise, heat or cold, manipulation (alone or plus exercise), mobilisation, multimodal treatment, patient education, percutaneous radiofrequency neurotomy, physical treatments, postural techniques (yoga, pilates, Alexander technique), pulsed electromagnetic field (PEMF) treatment, soft collars and special pillows, spray and stretch, surgery, traction, and transcutaneous electrical nerve stimulation (TENS). PMID:19445809

  5. Acceptance- versus Change-Based Pain Management: The Role of Psychological Acceptance

    ERIC Educational Resources Information Center

    Blacker, Kara J.; Herbert, James D.; Forman, Evan M.; Kounios, John

    2012-01-01

    This study compared two theoretically opposed strategies for acute pain management: an acceptance-based and a change-based approach. These two strategies were compared in a within-subjects design using the cold pressor test as an acute pain induction method. Participants completed a baseline pain tolerance assessment followed by one of the two…

  6. Threshold quantum cryptography

    SciTech Connect

    Tokunaga, Yuuki; Okamoto, Tatsuaki; Imoto, Nobuyuki

    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.

  7. Pain and Hand Function.

    PubMed

    Howland, Nicholas; Lopez, Mariela; Zhang, Andrew Y

    2016-02-01

    Pain is a unique somatosensory perception that can dramatically affect our ability to function. It is also a necessary perception, without which we would do irreparable damage to ourselves. In this article, the authors assess the impact of pain on function of the hand. Pain can be categorized into acute pain, chronic pain, and neuropathic pain. Hand function and objective measurements of hand function are analyzed as well as the impact of different types of pain on each of these areas. PMID:26611383

  8. 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. PMID:26157522

  9. Pain perception in people with Down syndrome: a synthesis of clinical and experimental research

    PubMed Central

    McGuire, Brian E.; Defrin, Ruth

    2015-01-01

    People with an intellectual disability experience both acute and chronic pain with at least the same frequency as the general population. However, considerably less is known about the pain perception of people with Down syndrome. In this review paper, we evaluated the available clinical and experimental evidence. Some experimental studies of acute pain have indicated that pain threshold was higher than normal but only when using a reaction time method to measure pain sensitivity. However, when reaction time is not part of the calculation of the pain threshold, pain sensitivity in people with Down syndrome is in fact lower than normal (more sensitive to pain). Clinical studies of chronic pain have shown that people with an intellectual disability experience chronic pain and within that population, people with Down syndrome also experience chronic pain, but the precise prevalence of chronic pain in Down syndrome has yet to be established. Taken together, the literature suggests that people with Down syndrome experience pain, both acute and chronic, with at least the same frequency as the rest of the population. Furthermore, the evidence suggests that although acute pain expression appears to be delayed, once pain is registered, there appears to be a magnified pain response. We conclude by proposing an agenda for future research in this area. PMID:26283936

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

    ERIC Educational Resources Information Center

    Beacroft, Monica; Dodd, Karen

    2010-01-01

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

  11. 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

  12. Medications for back pain

    MedlinePLUS

    ... help with your back pain. Over-the-counter pain relievers Over-the-counter pain relievers can help with your back pain. Over-the- ... your health care provider. If you are taking pain relievers for more than a week, tell your doctor. ...

  13. Threshold Concepts in Biochemistry

    ERIC Educational Resources Information Center

    Loertscher, Jennifer

    2011-01-01

    Threshold concepts can be identified for any discipline and provide a framework for linking student learning to curricular design. Threshold concepts represent a transformed understanding of a discipline, without which the learner cannot progress and are therefore pivotal in learning in a discipline. Although threshold concepts have been…

  14. 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

  15. Intracerebroventricular opioids for intractable pain

    PubMed Central

    Raffa, Robert B; Pergolizzi, Joseph V

    2012-01-01

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

  16. 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

  17. Pain and pain management in dermatology.

    PubMed

    Beiteke, Ulrike; Bigge, Stefan; Reichenberger, Christina; Gralow, Ingrid

    2015-10-01

    It is estimated that 23 million Germans suffer from chronic pain. A recent survey has revealed that 30 % of chronic pain patients are dissatisfied with their pain management. Furthermore, five million Germans suffer from neuropathic pain, 20 % of whom are inadequately treated. Pain is also a symptom of many dermatologic diseases, which is mostly somatic and may be classified as mild in the majority of cases. Nevertheless, research on the quality of life (QoL) has increasingly shown a marked impairment of QoL by moderate pain such as in psoriatic arthritis. -Severe pain is associated with herpes zoster (shingles), leg ulcers, and pyoderma gangrenosum. This article addresses the basics of pain classification and, in a short excerpt, pain transduction/transmission and modulation. The use of standardized diagnostic -scales is recommended for the purpose of recording and monitoring pain intensity, which allows for the optimization of therapy and consistent interdisciplinary -communication. Any dermatology residency program includes the acquisition of knowledge and skills in pain management. This review therefore aims to present fundamental therapeutic concepts based on the expanded WHO analgesic ladder, and describes a step-wise therapeutic approach and combination therapies. The article focuses on the pain management of the above-mentioned severely painful, conservatively treated dermatoses. Besides well-established therapeutic agents and current -therapeutic standards, it discusses specific options based on guidelines (where available). Current knowledge on peri- and postoperative pain management is briefly outlined. This article addresses: ? The fundamentals of the classification and neurophysiology of pain; ? Standards for pain documentation in children and adults; ? General standards for pharmaceutical pain management; ? Current specific treatment options for postherpetic neuralgia, leg ulcers, and -pyoderma gangrenosum in conjunction with the expanded WHO analgesic -ladder. PMID:26408457

  18. Pain drawings in somatoform-functional pain

    PubMed Central

    2012-01-01

    Background Pain drawings are a diagnostic adjunct to history taking, clinical examinations, and biomedical tests in evaluating pain. We hypothesized that somatoform-functional pain, is mirrored in distinctive graphic patterns of pain drawings. Our aim was to identify the most sensitive and specific graphic criteria as a tool to help identifying somatoform-functional pain. Methods We compared 62 patients with somatoform-functional pain with a control group of 49 patients with somatic-nociceptive pain type. All patients were asked to mark their pain on a pre-printed body diagram. An investigator, blinded with regard to the patients’ diagnoses, analyzed the drawings according to a set of numeric or binary criteria. Results We identified 13 drawing criteria pointing with significance to a somatoform-functional pain disorder (all p-values???0.001). The most specific and most sensitive criteria combination for detecting somatoform-functional pain included the total number of marks, the length of the longest mark, and the presence of symmetric patterns. The area under the ROC-curve was 96.3% for this criteria combination. Conclusion Pain drawings are an easy-to-administer supplementary technique which helps to identify somatoform-functional pain in comparison to somatic-nociceptive pain. PMID:23256679

  19. Central Pain Syndrome

    MedlinePLUS

    ... Enhancing Diversity Find People About NINDS NINDS Central Pain Syndrome Information Page Table of Contents (click to ... being done? Clinical Trials Organizations What is Central Pain Syndrome? Central pain syndrome is a neurological condition ...

  20. Overview of Neck Pain

    MedlinePLUS

    ... Back) > Overview of Neck Pain Overview of Neck Pain Page Content Developing a Program That's Right for ... activity? What Kinds of Problems Might Cause Neck Pain? Treatment for any neck condition is recommended as ...

  1. Anterior knee pain

    MedlinePLUS

    Anterior knee pain is pain that occurs at the front and center of the knee. It can be caused by ... attach to the top of the kneecap) Anterior knee pain begins when the kneecap does not move properly ...

  2. 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 ...

  3. NIH Pain Consortium

    MedlinePLUS

    Skip Navigation Search: header Home About PC Symposia & Meetings NIH Pain Programs Funding Opportunities Conferences & Seminars Federal Pain Activities News & Health Info Recent News NINDS Director's Message on Pain ...

  4. What Is Chronic Pain?

    MedlinePLUS Videos and Cool Tools

    ... 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 ...

  5. Pain: Hope through Research

    MedlinePLUS

    ... pain management. Together the opioids provide effective pain relief for many people with pain. Other peptide s also ... the use of imagery as a distraction provide relief. These methods may be powerful and effective, according ...

  6. Pelvic Pain: Other FAQs

    MedlinePLUS

    ... it affect my ability to become pregnant? Can alternative therapies help? Can it affect my emotional well-being? ... pain affect my ability to become pregnant? Can alternative therapies treat my pain? Can pelvic pain affect my ...

  7. 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 ...

  8. Amantadine sulfate reduces experimental sensitization and pain in chronic back pain patients.

    PubMed

    Kleinböhl, Dieter; Görtelmeyer, Roman; Bender, Hans-Joachim; Hölzl, Rupert

    2006-03-01

    We investigated if established psychophysical measures of enhanced experimental sensitization in chronic musculoskeletal pain can be reduced by adjuvant treatment with a N-methyl-d-aspartate receptor antagonist, amantadine sulfate, and whether a reduction in sensitization might be accompanied by a concurrent improvement in clinical pain. Sensitization was evaluated by an experimental tonic heat model of short-term sensitization with concurrent subjective and behavioral psychophysical scaling. Twenty-six patients with chronic back pain were included in the randomized, double-blind, placebo-controlled study and received daily dosages of either placebo or 100 mg of amantadine sulfate during a 1-wk treatment. Participants completed quantitative sensory testing of pain thresholds and experimental sensitization before and after treatment and clinical pain ratings before, during, and after treatment. Experimental sensitization and clinical pain were reduced in patients receiving verum. Initially, experimental sensitization was enhanced in patients, with early sensitization at nonpainful intensities of contact heat and enhanced sensitization at painful intensities, as shown previously. After 1 wk of treatment, experimental sensitization was reduced with amantadine sulfate but not with placebo. We conclude that adjuvant chronic pain treatment with N-methyl-d-aspartate receptor antagonists might be beneficial for chronic pain if enhanced sensitization is involved and that the quantitative sensory test of temporal summation may be used to verify this. PMID:16492838

  9. Assessment of Pain

    PubMed Central

    Jeans, Mary-Ellen; Stratford, Joseph G.; Melzack, Ronald; Monks, Richard C.

    1979-01-01

    The assessment of pain presents a major problem in both research and clinical practice. Until recently our methods for evaluating pain were based on a sensory conceptual model of pain and an acute care approach to illness. These traditional views are often inadequate, particularly in relation to chronic pain syndromes. Clinical assessment of chronic pain must include extensive physical and psychological examination. New approaches to pain measurement and clinical assessment of the patient are discussed.

  10. Tinnitus, diminished sound-level tolerance, and elevated auditory activity in humans with clinically normal hearing sensitivity.

    PubMed

    Gu, Jianwen Wendy; Halpin, Christopher F; Nam, Eui-Cheol; Levine, Robert A; Melcher, Jennifer R

    2010-12-01

    Phantom sensations and sensory hypersensitivity are disordered perceptions that characterize a variety of intractable conditions involving the somatosensory, visual, and auditory modalities. We report physiological correlates of two perceptual abnormalities in the auditory domain: tinnitus, the phantom perception of sound, and hyperacusis, a decreased tolerance of sound based on loudness. Here, subjects with and without tinnitus, all with clinically normal hearing thresholds, underwent 1) behavioral testing to assess sound-level tolerance and 2) functional MRI to measure sound-evoked activation of central auditory centers. Despite receiving identical sound stimulation levels, subjects with diminished sound-level tolerance (i.e., hyperacusis) showed elevated activation in the auditory midbrain, thalamus, and primary auditory cortex compared with subjects with normal tolerance. Primary auditory cortex, but not subcortical centers, showed elevated activation specifically related to tinnitus. The results directly link hyperacusis and tinnitus to hyperactivity within the central auditory system. We hypothesize that the tinnitus-related elevations in cortical activation may reflect undue attention drawn to the auditory domain, an interpretation consistent with the lack of tinnitus-related effects subcortically where activation is less potently modulated by attentional state. The data strengthen, at a mechanistic level, analogies drawn previously between tinnitus/hyperacusis and other, nonauditory disordered perceptions thought to arise from neural hyperactivity such as chronic neuropathic pain and photophobia. PMID:20881196

  11. What a Pain! Kids and Growing Pains

    MedlinePLUS

    ... Games Kids' Medical Dictionary En Español What Other Kids Are Reading Girls and Puberty Boys and Puberty ... the Body Works Main Page What a Pain! Kids and Growing Pains KidsHealth > Kids > Illnesses & Injuries > Aches, ...

  12. Pain Management: Post-Amputation Pain

    MedlinePLUS

    Pain Management Post-Amputation Pain Volume 8 · Issue 2 · March/April 1998 Text size Larger text Smaller text Java ... of the most frequently asked questions. Ideas about management are one of the frequent topics of conversation ...

  13. Pain sensitivity in major depression and its relationship to central serotoninergic function as reflected by the neuroendocrine response to clomipramine.

    PubMed

    Kundermann, Bernd; Hemmeter-Spernal, Julia; Strate, Peter; Gebhardt, Stefan; Huber, Martin Tobias; Krieg, Jürgen-Christian; Lautenbacher, Stefan

    2009-12-01

    Several studies reported a decreased pain sensitivity in patients with depression, but the underlying neurobiological mechanisms of this phenomenon are unclear. While there is extensive evidence that the serotoninergic system plays a key role in pain modulation, especially in pain inhibitory mechanisms via descending pathways, as well as in the pathophysiology of depression, no study so far has examined its potential relevance in mediating the alteration of pain processing. The present study addresses the question of whether indices of serotoninergic dysfunction, as investigated by a neuroendrocine challenge paradigm, are related to pain sensitivity. Nineteen drug-free inpatients with unipolar major depression underwent a neuroendocrine challenge test by measuring cortisol and prolactin in response to intravenously administered clomipramine (12.5mg). Heat/cold pain thresholds, warmth/cold detection thresholds, measures of current pain complaints and mood were assessed the day before and three day after challenge procedure. When patients were classified in subgroups based on a median split of their cortisol response values, the low-responsive group showed significantly elevated heat pain thresholds and nearly significantly elevated cold pain thresholds compared to the high-responsive group. No such group differences were found with regard to somatosensory thresholds, measures of pain complaints and mood. Subgrouping on the basis of prolactin responsiveness did not reveal significant differences in any parameter. In summary, a decreased pain sensitivity was demonstrated in patients characterized by a reduced neuroendocrine responsiveness to clomipramine, suggesting an involvement of serotoninergic dysfunction underlying altered pain perception in depression. PMID:19467668

  14. Significant determinants of mouse pain behaviour.

    PubMed

    Minett, Michael S; Eijkelkamp, Niels; Wood, John N

    2014-01-01

    Transgenic mouse behavioural analysis has furthered our understanding of the molecular and cellular mechanisms underlying damage sensing and pain. However, it is not unusual for conflicting data on the pain phenotypes of knockout mice to be generated by reputable groups. Here we focus on some technical aspects of measuring mouse pain behaviour that are often overlooked, which may help explain discrepancies in the pain literature. We examined touch perception using von Frey hairs and mechanical pain thresholds using the Randall-Selitto test. Thermal pain thresholds were measured using the Hargreaves apparatus and a thermal place preference test. Sodium channel Nav1.7 knockout mice show a mechanical deficit in the hairy skin, but not the paw, whilst shaving the abdominal hair abolished this phenotype. Nav1.7, Nav1.8 and Nav1.9 knockout mice show deficits in noxious mechanosensation in the tail, but not the paw. TRPA1 knockout mice, however, have a loss of noxious mechanosensation in the paw but not the tail. Studies of heat and cold sensitivity also show variability depending on the intensity of the stimulus. Deleting Nav1.7, Nav1.8 or Nav1.9 in Nav1.8-positive sensory neurons attenuates responses to slow noxious heat ramps, whilst responses to fast noxious heat ramps are only reduced when Nav1.7 is lost in large diameter sensory neurons. Deleting Nav1.7 from all sensory neurons attenuates responses to noxious cooling but not extreme cold. Finally, circadian rhythms dramatically influence behavioural outcome measures such as von Frey responses, which change by 80% over the day. These observations demonstrate that fully characterising the phenotype of a transgenic mouse strain requires a range of behavioural pain models. Failure to conduct behavioural tests at different anatomical locations, stimulus intensities, and at different points in the circadian cycle may lead to a pain behavioural phenotype being misinterpreted, or missed altogether. PMID:25101983

  15. 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

  16. [Physiotherapy and physical therapy in pain management].

    PubMed

    Egan, M; Seeger, D; Schöps, P

    2015-10-01

    Patients attend physiotherapy and physical therapy (PT) due to pain problems and/or functional impairments. Although the main focus for therapists has traditionally been physical examination and treatment of tissue structures and biomechanics, over the last few decades a growing body of research has highlighted the importance of central nervous system processing and psychosocial contributors to pain perception. Treatment with PT aims to reduce disability and suffering by reducing pain and increasing tolerance to movement. In Germany, pain management conducted by physiotherapists is currently undergoing major changes. Firstly, PT education is transitioning from a vocational to a degree level and additionally new concepts for improved multidisciplinary treatment approaches are being developed. However, there still remain substantial differences between therapists working in multidisciplinary pain clinics and those following medical referral in private practices. This article provides information on how national and international impulses have contributed to the development of different concepts of passive therapies and active/functional pain rehabilitation in Germany. In the future PT will need to provide more evidence about efficiency and modes of actions for different treatment options to selectively reason the application to patients with acute, subacute and chronic pain. PMID:26373552

  17. Biological profile and bioavailability of imidazoline compounds on morphine tolerance modulation.

    PubMed

    Caprioli, Giovanni; Mammoli, Valerio; Ricciutelli, Massimo; Sagratini, Gianni; Ubaldi, Massimo; Domi, Esi; Mennuni, Laura; Sabatini, Chiara; Galimberti, Chiara; Ferrari, Flora; Milia, Chiara; Comi, Eleonora; Lanza, Marco; Giannella, Mario; Pigini, Maria; Del Bello, Fabio

    2015-12-15

    Tolerance to opioid administration represents a serious medical alert in different chronic conditions. This study compares the effects of the imidazoline compounds 1, 2, and 3 on morphine tolerance in an animal model of inflammatory pain in the rat. 1, 2, and 3 have been selected in that, although bearing a common scaffold, preferentially bind to ?2-adrenoceptors, imidazoline I2 receptors, or both systems, respectively. Such compounds have been tested in vivo by measuring the paw withdrawal threshold to mechanical pressure after complete Freund's adjuvant injection. To determine the ligand levels in rat plasma, an HPLC-mass spectrometry method has been developed. All the compounds significantly reduced the induction of morphine tolerance, showing different potency and duration of action. Indeed, the selective imidazoline I2 receptor interaction (2) restored the analgesic response by maintaining the same time-dependent profile observed after a single morphine administration. Differently, the selective ?2C-adrenoceptor activation (1) or the combination between ?2C-adrenoceptor activation and imidazoline I2 receptor engagement (3) promoted a change in the temporal profile of morphine analgesia by maintaining a mild but long lasting analgesic effect. Interestingly, the kinetics of compounds in rat plasma supported the pharmacodynamic data. Therefore, this study highlights that both peculiar biological profile and bioavailability of such ligands complement each other to modulate the reduction of morphine tolerance. Based on these observations, 1-3 can be considered useful leads in the design of new drugs able to turn off the undesired tolerance induced by opioids. PMID:26593429

  18. Tetrodotoxin suppresses thermal hyperalgesia and mechanical allodynia in a rat full thickness thermal injury pain model.

    PubMed

    Salas, Margaux M; McIntyre, Matthew K; Petz, Lawrence N; Korz, Walter; Wong, Donald; Clifford, John L

    2015-10-21

    Burn injuries have been identified as the primary cause of injury in 5% of U.S. military personnel evacuated from Operations Iraqi Freedom and Enduring Freedom. Severe burn-associated pain is typically treated with opioids such as fentanyl, morphine, and methadone. Side effects of opioids include respiratory depression, cardiac depression, decrease in motor and cognitive function, as well as the development of hyperalgesia, tolerance and dependence. These effects have led us to search for novel analgesics for the treatment of burn-associated pain in wounded combat service members. Tetrodotoxin (TTX) is a selective voltage-gated sodium channel blocker currently in clinical trials as an analgesic. A phase 3 clinical trial for cancer-related pain has been completed and phase 3 clinical trials on chemotherapy-induced neuropathic pain are planned. It has also been shown in mice to inhibit the development of chemotherapy-induced neuropathic pain. TTX was originally identified as a neurotoxin in marine animals but has now been shown to be safe in humans at therapeutic doses. The antinociceptive effects of TTX are thought to be due to inhibition of Na(+) ion influx required for initiation and conduction of nociceptive impulses. One TTX sensitive sodium channel, Nav1.7, has been shown to be essential in lowering the heat pain threshold after burn injuries. To date, the analgesic effect of TTX has not been tested in burn-associated pain. Male Sprague-Dawley rats were subjected to a full thickness thermal injury on the right hind paw. TTX (8?g/kg) was administered once a day systemically by subcutaneous injection beginning 3 days post thermal injury and continued through 7 days post thermal injury. Thermal hyperalgesia and mechanical allodynia were assessed 60 and 120min post injection on each day of TTX treatment. TTX significantly reduced thermal hyperalgesia at all days tested and had a less robust, but statistically significant suppressive effect on mechanical allodynia. These results suggest that systemic TTX may be an effective, rapidly acting analgesic for battlefield burn injuries and has the potential for replacing or reducing the need for opioid analgesics. PMID:26424077

  19. 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 (150 mg/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 (10-100 mg/kg), ibuprofen (2-50 mg/kg), aspirin (5-75 mg/kg), paracetamol (5-100 mg/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

  20. Transplantation tolerance.

    PubMed

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

    2014-12-01

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

  1. Olfactory threshold increase in trigeminal neuralgia after balloon compression.

    PubMed

    Siqueira, S R D T; Nóbrega, J C M; Teixeira, M J; Siqueira, J T T

    2006-12-01

    Idiopathic trigeminal neuralgia (ITN) is a well-known disease often treated with neurosurgical procedures, which may produce sensorial abnormalities, such as numbness, dysesthesia and taste complaints. We studied 12 patients that underwent this technique, in order to verify pain, gustative and olfactory thresholds abnormalities, with a follow-up of 120 days. We compared the patients with a matched control group of 12 patients. Our results found a significant difference in the olfactory threshold at the immediate post-operative period (p=0.048). We concluded that injured trigeminal fibers are probably associated with the increase in the olfactory threshold after the surgery, supporting the sensorial interaction theory. PMID:16446028

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

    PubMed Central

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

    2013-01-01

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

  3. 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.

  4. [Painful shoulder syndrome].

    PubMed

    Jaji?, Zrinka

    2003-01-01

    Painful shoulder syndrome was described by S.E. Duplay 1872. showing the patient with pain and stiffness of the shoulder after trauma. Codman et. al. at the beginning of 20th century expanded the syndrome on several causes of shoulder pain. Syndrome is characterized by pain and limitation of joint movements. One of the most common nontraumatic causes of shoulder pain is periarticular disorder. The potential sources of local or referred pain may be muscle, tendon, bursa or neurovascular structures. Secondary referral pain to the shoulder may be due to coronary artery disease, hepatic or splenic disease. PMID:15098371

  5. 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

  6. Error Threshold for Color Codes and Random Three-Body Ising Models

    E-print Network

    Bombin, Hector

    We study the error threshold of color codes, a class of topological quantum codes that allow a direct implementation of quantum Clifford gates suitable for entanglement distillation, teleportation, and fault-tolerant quantum ...

  7. Physicians Experience with and Expectations of the Safety and Tolerability of WHO-Step III Opioids for Chronic (Low) Back Pain: Post Hoc Analysis of Data from a German Cross-Sectional Physician Survey

    PubMed Central

    Ueberall, Michael A.; Eberhardt, Alice; Mueller-Schwefe, Gerhard H. H.

    2015-01-01

    Objective. To describe physicians' daily life experience with WHO-step III opioids in the treatment of chronic (low) back pain (CLBP). Methods. Post hoc analysis of data from a cross-sectional online survey with 4.283 Germany physicians. Results. With a reported median use in 17% of affected patients, WHO-step III opioids play a minor role in treatment of CLBP in daily practice associated with a broad spectrum of positive and negative effects. If prescribed, potent opioids were reported to show clinically relevant effects (such as ?50% pain relief) in approximately 3 of 4 patients (median 72%). Analgesic effects reported are frequently related with adverse events (AEs). Only 20% of patients were reported to remain free of any AE. Most frequently reported AE was constipation (50%), also graded highest for AE-related daily life restrictions (median 46%). Specific AE countermeasures were reported to be necessary in approximately half of patients (median 45%); nevertheless AE-related premature discontinuation rates reported were high (median 22%). Fentanyl/morphine were the most/least prevalently prescribed potent opioids mentioned (median 20 versus 8%). Conclusion. Overall, use of WHO-step III opioids for CLBP is low. AEs, especially constipation, are commonly reported and interfere significantly with analgesic effects in daily practice. Nevertheless, beneficial effects outweigh related AEs in most patients with CLBP. PMID:26568890

  8. Pausing at the Threshold

    ERIC Educational Resources Information Center

    Morgan, Patrick K.

    2015-01-01

    Since about 2003, the notion of threshold concepts--the central ideas in any field that change how learners think about other ideas--have become difficult to escape at library conferences and in general information literacy discourse. Their visibility will likely only increase because threshold concepts figure prominently in the Framework for…

  9. Bayesian Threshold Estimation

    ERIC Educational Resources Information Center

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

    2009-01-01

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

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

    ERIC Educational Resources Information Center

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

    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…

  11. 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

  12. 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. ...

  13. 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. ...

  14. 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. ...

  15. Easing pain in children.

    PubMed

    Manley, L

    1997-01-01

    The assessment and management of pain in children has been essentially ignored until recently. Thankfully, these "dark ages of pain" are ending. The trauma nurse is an integral part of the pain management team and can have a positive impact on outcome by using a combination of relatively simple strategies. These include using multiple types of assessment to measure the severity of pain; providing adequate pain relief with a combination of pharmacologic and nonpharmacologic interventions; and carefully monitoring and documenting the efficacy of all pain management approaches. PMID:9391359

  16. 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

  17. Complaining about chronic pain.

    PubMed

    Kugelmann, R

    1999-12-01

    This paper examines how a group of working class people describes and experiences chronic pain. This hermeneutical-phenomenological study concentrates on the lived body of pain from three perspectives, drawing on interviews with 14 people who were attending a pain management program. First I consider the terms in which pain is circumscribed in the narratives, stories told in the context of learning to manage pain. These terms are polarities, ways of specifying and legitimating pain in relation to "mind" and "body." Pain, in the discursive polarities that define it, is the private property of an individual, who must in some fashion prove that pain exists in an objective manner. The speaker, in this discourse, stands as the one responsible for the production of pain. In the second part, the analysis turns to what this discourse reveals about pain as a lived body phenomenon. Here the analysis centers upon the torment of having to inhabit the intolerable, upon how pain unmakes the lifeworld of the sufferer, and how, simultaneously, people make pain. The place of pain is the body, as body-in-place. The place of pain is at the boundaries of human dwelling, a kind of non-place, expressed metaphorically as "prison" or "homelessness." Finally, after these considerations of how pain is described, in part three, I turn to the act of "saying" pain, that is, to the narratives as addressed to someone else. The participants were not simply dispensing information; they were saying something to me. The narratives had the form of complaints. The form of the narratives, in the context of the pain program, was a quasi-legal call to rectify wrongs. PMID:10574237

  18. Dorsal Horn Circuits for Persistent Mechanical Pain.

    PubMed

    Peirs, Cedric; Williams, Sean-Paul G; Zhao, Xinyi; Walsh, Claire E; Gedeon, Jeremy Y; Cagle, Natalie E; Goldring, Adam C; Hioki, Hiroyuki; Liu, Zheng; Marell, Paulina S; Seal, Rebecca P

    2015-08-19

    Persistent mechanical hypersensitivity that occurs in the setting of injury or disease remains a major clinical problem largely because the underlying neural circuitry is still not known. Here we report the functional identification of key components of the elusive dorsal horn circuit for mechanical allodynia. We show that the transient expression of VGLUT3 by a discrete population of neurons in the deep dorsal horn is required for mechanical pain and that activation of the cells in the adult conveys mechanical hypersensitivity. The cells, which receive direct low threshold input, point to a novel location for circuit initiation. Subsequent analysis of c-Fos reveals the circuit extends dorsally to nociceptive lamina I projection neurons, and includes lamina II calretinin neurons, which we show also convey mechanical allodynia. Lastly, using inflammatory and neuropathic pain models, we show that multiple microcircuits in the dorsal horn encode this form of pain. PMID:26291162

  19. Case Report: Neuropathic pain in a patient with congenital insensitivity to pain

    PubMed Central

    Wheeler, Daniel W.; Lee, Michael C.H.; Harrison, E. Katherine; Menon, David K.; Woods, C. Geoffrey

    2015-01-01

    We report a unique case of a woman with Channelopathy-associated Insensitivity to Pain (CIP) Syndrome, who developed features of neuropathic pain after sustaining pelvic fractures and an epidural hematoma that impinged on the right fifth lumbar (L5) nerve root. Her pelvic injuries were sustained during painless labor, which culminated in a Cesarean section. She had been diagnosed with CIP as child, which was later confirmed when she was found to have null mutations of the SCN9A gene that encodes the voltage-gated sodium channel Nav1.7. She now complains of troubling continuous buzzing in both legs and a vice-like squeezing in the pelvis on walking. Quantitative sensory testing showed that sensory thresholds to mechanical stimulation of the dorsum of both feet had increased more than 10-fold on both sides compared with tests performed before her pregnancy. These findings fulfill the diagnostic criteria for neuropathic pain. Notably, she mostly only experiences the negative symptoms (such as numbness and tingling, but also electric shocks), and she has not reported sharp or burning sensations, although the value of verbal descriptors is somewhat limited in a person who has never felt pain before. However, her case strongly suggests that at least some of the symptoms of neuropathic pain can persist despite the absence of the Nav1.7 channel. Pain is a subjective experience and this case sheds light on the transmission of neuropathic pain in humans that cannot be learned from knockout mice.

  20. 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...

  1. New Insights Found in Pain Processing and Sleep Disturbance Among Rheumatoid Arthritis Patients

    MedlinePLUS

    ... Among Rheumatoid Arthritis Patients People with rheumatoid arthritis (RA) have lower thresholds for pain and may have deficits in a central nervous system (CNS) mechanism that helps to modulate how the ...

  2. We explore two new automated methods to quantify the impact of pain on the overall

    E-print Network

    Apkarian, A. Vania

    of the organism. Most current methods for assessing pain in animals are based on reflexive measures and require reduce the tactile threshold by about 80-90%, yet in many of the Angle Track and Thermal Track results

  3. [Perioperative analgesia for opioid tolerant patients].

    PubMed

    Lerchl-Wanie, G; Angster, R

    2010-07-01

    In this review article the special anesthesiological problems of opioid tolerance and surgical interventions will be presented. These affect patients with a long-term opioid therapy of chronic pain, addicts with long-term substitution therapy and addicts with current or previous heroin addiction ("clean"). For all patient groups a guarantee of continuous and adequate analgesia (avoidance of fear and increasing patient compliance), exploiting suitable regional anesthesia or regional analgesia procedures when possible, and prevention of a physical opioid withdrawal syndrome have utmost priority. The necessary optimization of perioperative pain therapy only succeeds when based on a thorough preoperative examination of the clinical history which subtly inquires into the drug taking habits with respect to opioids and associated medications. Systemic and/or regional analgesia procedures are possible. Regional procedures are more effective for analgesia. Systemic analgesia procedures do not basically differ from those routinely used for patients without opioid tolerance. However, higher doses of opioids are necessary as well as individual titration according to needs. Special conditions apply to patients previously addicted to opioids (clean) when they are to be operated on. Non-opioids are sufficiently effective for low level pain and opiates can be avoided. Opioid therapy with inclusion of a non-opioid is necessary following major operations or for severe postoperative pain, even as i.v. patient-controlled analgesia (i.v. PCA) if needed. For these patients a relapse to addiction can be provoked by insufficient administration of analgesics, not by pain management including opioids. PMID:20625693

  4. Pain in cancer survivors

    PubMed Central

    Ramirez, Juan D; Farquhar-Smith, Paul

    2014-01-01

    Cancer and its treatment exert a heavy psychological and physical toll. Of the myriad symptoms which result, pain is common, encountered in between 30% and 60% of cancer survivors. Pain in cancer survivors is a major and growing problem, impeding the recovery and rehabilitation of patients who have beaten cancer and negatively impacting on cancer patients’ quality of life, work prospects and mental health. Persistent pain in cancer survivors remains challenging to treat successfully. Pain can arise both due to the underlying disease and the various treatments the patient has been subjected to. Chemotherapy causes painful chemotherapy-induced peripheral neuropathy (CIPN), radiotherapy can produce late effect radiation toxicity and surgery may lead to the development of persistent post-surgical pain syndromes. This review explores a selection of the common causes of persistent pain in cancer survivors, detailing our current understanding of the pathophysiology and outlining both the clinical manifestations of individual pain states and the treatment options available. PMID:26516548

  5. Low back pain - chronic

    MedlinePLUS

    ... for low-back pain with or without sciatica. Cochrane Database Syst Rev. 2010;(5):CD003010. Henschke N, ... al. Behavioural treatment for chronic low-back pain. Cochrane Database Syst Rev. 2010;(7):CD002014. Chou R, ...

  6. Breast Pain in Women

    MedlinePLUS

    MENU Return to Web version Breast Pain in Women Overview Breast pain is a common problem in women who are having periods (menstrual ... to talk to your doctor about it. Diagnosis & Tests How can my doctor find the cause of ...

  7. Communicating about Cancer Pain

    Cancer.gov

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

  8. Chest Pain, Chronic

    MedlinePLUS

    ... Yes Your pain may be caused by POSTHERPETIC NEURALGIA, a condition that can remain after the shingles infection. See your doctor. In many cases, postherpetic neuralgia can be treated with over-the-counter pain ...

  9. Depression and Chronic Pain

    MedlinePLUS

    ... pain? For More Information on Depression Citations Reprints Depression and Chronic Pain Order a free hardcopy En ... difficult, so proper treatment is important. What is depression? Major depressive disorder, or depression, is a serious ...

  10. Pain Information Index

    MedlinePLUS

    Skip Navigation Search: header Home About PC Symposia & Meetings NIH Pain Programs Funding Opportunities Conferences & Seminars Federal Pain Activities News & Health Info You Are Here: Home Home Page Not ...

  11. 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 ...

  12. American Pain Society

    MedlinePLUS

    ... 2015. The meeting will feature invited speakers and discussions of committee business items including pain research updates from federal agencies and discussion of a federal pain research strategy. The meeting ...

  13. When Sex Is Painful

    MedlinePLUS

    ... a gynecologic problem, such as ovarian cysts or endometriosis . Pain during sex also may be caused by ... medications, or surgery. • Other causes— Pelvic inflammatory disease , endometriosis, and adhesions are all associated with pain during ...

  14. 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. ...

  15. 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 ...

  16. American Academy of Pain Medicine

    MedlinePLUS

    ... Resources Clinical Pearls AAPM... the Voice of Pain Medicine The professional organization representing over 2,200 pain ... for Anesthesia/Pain Medicine For more information... Pain Medicine Journal Members: Log in for Full Journal Access ...

  17. 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

  18. Pain Examination and Diagnosis.

    PubMed

    Curtin, Catherine

    2016-02-01

    Pain is a clinical challenge to health care providers who care for hand disorders. Pathologic pain that prevents recovery leads to dissatisfaction for both patients and providers. Despite pain being common, the root cause is often difficult to diagnose. This article reviews the examination and diagnostic tools that are helpful in identifying pathologic and neuropathic pain. This article provides tools to speed recognition of these processes to allow earlier intervention and better patient outcomes. PMID:26611385

  19. Acute vs. chronic pain.

    PubMed

    Auvenshine, R C

    2000-07-01

    The differences between acute and chronic pain are many and varied. They are so different from one another that they must be considered separate entities. The chronic pain patient does not fit the traditional acute illness model as conceptualized by patients and healthcare providers. Because of the complex nature of the pain mechanism as a protective "reflex" and the fact that the pain response gets caught up in emotional expression, pain becomes a learned behavior pattern. When the patient who presents to the dental office suffering from pain is found not to respond to conventional methods of treatment, the dentist should first consider the nature of the pain response and the fact that the patient may not meet all the requirements for the acute illness model. The manner in which the patient describes his or her pain can be a major clue as to the temporal classification of the pain, thus allowing the dentist the advantage of better decision-making. Great discernment on the part of the dental practitioner must be exercised in order to provide the optimum care for the patient. It is important for the dentist to consider the fact that there may be no underlying cause for the pain and it may be necessary to make proper referrals for management of this type of patient. At a more practical and human level, patients want to know if their pain will ever completely go away. Patients are frightened that their pain is attributable to some unrecognized pathology (catastrophic thinking). This drives them to search for the ultimate cure. Going from practitioner to practitioner worsens the confusion as the patient hopes that someone will be able to illuminate the problem. By being able to classify the pain into a recognizable and explainable syndrome, the pain practitioner is often able to offer hope to the patient. Although treatment often does not yield a completely pain-free state, understanding the basis for the pain can provide significant relief through proper management. PMID:11858059

  20. 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

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

    PubMed Central

    Fardo, Francesca; Spironelli, Chiara; Angrilli, Alessandro

    2013-01-01

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

  2. 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

  3. Acoustic analysis and mood classification of pain-relieving music.

    PubMed

    Knox, Don; Beveridge, Scott; Mitchell, Laura A; MacDonald, Raymond A R

    2011-09-01

    Listening to preferred music (that which is chosen by the participant) has been shown to be effective in mitigating the effects of pain when compared to silence and a variety of distraction techniques. The wide range of genre, tempo, and structure in music chosen by participants in studies utilizing experimentally induced pain has led to the assertion that structure does not play a significant role, rather listening to preferred music renders the music "functionally equivalent" as regards its effect upon pain perception. This study addresses this assumption and performs detailed analysis of a selection of music chosen from three pain studies. Music analysis showed significant correlation between timbral and tonal aspects of music and measurements of pain tolerance and perceived pain intensity. Mood classification was performed using a hierarchical Gaussian Mixture Model, which indicated the majority of the chosen music expressed contentment. The results suggest that in addition to personal preference, associations with music and the listening context, emotion expressed by music, as defined by its acoustical content, is important to enhancing emotional engagement with music and therefore enhances the level of pain reduction and tolerance. PMID:21895104

  4. Intensity Thresholds for Aerobic Exercise–Induced Hypoalgesia

    PubMed Central

    Naugle, Kelly M.; Naugle, Keith E.; Fillingim, Roger B.; Samuels, Brian; Riley, Joseph L.

    2014-01-01

    Despite many studies investigating exercise-induced hypoalgesia, there is limited understanding of the optimal intensity of aerobic exercise in producing hypoalgesic effects across different types of pain stimuli. Given that not all individuals are willing or capable of engaging in high intensity aerobic exercise, whether moderate intensity aerobic exercise is associated with a hypoalgesic response and whether this response generalizes to multiple pain induction techniques needs to be substantiated. Purpose This study’s purpose is to test for differences in the magnitude of pressure and heat pain modulation induced by moderate (MAE) and vigorous (VAE) intensity aerobic exercise. Methods Twelve healthy young males and 15 females completed one training session and three testing sessions consisting of 25 minutes of either 1) stationary cycling at 70% heart rate reserve (HRR), 2) stationary cycling at 50% HRR, or 3) quiet rest (control). Pain testing was conducted on both forearms prior to and immediately following each condition and included the following tests: pressure pain thresholds (PPT), suprathreshold pressure pain test, static continuous heat test, and repetitive pulse heat pain test. Repeated measures ANOVAs were conducted on each pain measure. Results VAE and MAE reduced pain ratings during static continuous heat stimuli and repetitive heat pulse stimuli, with VAE producing larger effects. VAE also increased PPTs, while neither exercise influenced suprathreshold pressure pain ratings. Conclusion These results suggest that MAE is capable of producing a hypoalgesic effect using continuous and repetitive pulse heat stimuli. However, a dose-response effect was evident as VAE produced larger effects than MAE. PMID:24002342

  5. Knee pain (image)

    MedlinePLUS

    The location of knee pain can help identify the problem. Pain on the front of the knee can be due to bursitis, arthritis, or ... synovial fluid) that forms behind the knee. Overall knee pain can be due to bursitis, arthritis, tears in ...

  6. 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…

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

    ERIC Educational Resources Information Center

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

    2004-01-01

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

  8. Pain inhibits pain; human brainstem mechanisms.

    PubMed

    Youssef, A M; Macefield, V G; Henderson, L A

    2016-01-01

    Conditioned pain modulation is a powerful analgesic mechanism, occurring when a painful stimulus is inhibited by a second painful stimulus delivered at a different body location. Reduced conditioned pain modulation capacity is associated with the development of some chronic pain conditions and the effectiveness of some analgesic medications. Human lesion studies show that the circuitry responsible for conditioned pain modulation lies within the caudal brainstem, although the precise nuclei in humans remain unknown. We employed brain imaging to determine brainstem sites responsible for conditioned pain modulation in 54 healthy individuals. In all subjects, 8 noxious heat stimuli (test stimuli) were applied to the right side of the mouth and brain activity measured using functional magnetic resonance imaging. This paradigm was then repeated. However, following the fourth noxious stimulus, a separate noxious stimulus, consisting of an intramuscular injection of hypertonic saline into the leg, was delivered (conditioning stimulus). During this test and conditioning stimulus period, 23 subjects displayed conditioned pain modulation analgesia whereas 31 subjects did not. An individual's analgesic ability was not influenced by gender, pain intensity levels of the test or conditioning stimuli or by psychological variables such as pain catastrophizing or fear of pain. Brain images were processed using SPM8 and the brainstem isolated using the SUIT toolbox. Significant increases in signal intensity were determined during each test stimulus and compared between subjects that did and did not display CPM analgesia (p<0.05, small volume correction). The expression of analgesia was associated with reduction in signal intensity increases during each test stimulus in the presence of the conditioning stimulus in three brainstem regions: the caudalis subdivision of the spinal trigeminal nucleus, i.e., the primary synapse, the region of the subnucleus reticularis dorsalis and in the dorsolateral pons in the region of the parabrachial nucleus. Furthermore, the magnitudes of these signal reductions in all three brainstem regions were significantly correlated to analgesia magnitude. Defining conditioned pain modulation circuitry provides a framework for the future investigations into the neural mechanisms responsible for the maintenance of persistent pain conditions thought to involve altered analgesic circuitry. PMID:26343321

  9. Clinical pharmacology of opioids for pain.

    PubMed

    Inturrisi, Charles E

    2002-01-01

    The pharmacological effects of the opioid analgesics are derived from their complex interactions with three opioid receptor types (mu, delta, and kappa; morphine is an agonist at the mu opioid receptor). These receptors are found in the periphery, at presynaptic and postsynaptic sites in the spinal cord dorsal horn, and in the brain stem, thalamus, and cortex, in what constitutes the ascending pain transmission system, as well as structures that comprise a descending inhibitory system that modulates pain at the level of the spinal cord. The cellular effects of opioids include a decrease in presynaptic transmitter release, hyperpolarization of postsynaptic elements, and disinhibition. The endogenous opioid peptides are part of an endogenous pain modulatory system. A number of opioids are available for clinical use, including morphine, hydromorphone, levorphanol, oxymorphone, methadone, meperidine, oxycodone, and fentanyl, and their advantages and disadvantages for the management of pain are discussed. An understanding of the pharmacokinetic properties, as well as issues related to opioid rotation, tolerance, dependence, and addiction are essential aspects of the clinical pharmacology of opioids for pain. PMID:12479250

  10. Sensory threshold measurements for electrical stimulation of the digits.

    PubMed

    Wolf, S L; Cohen, B A

    1977-03-01

    Repeated impedance measurements of electrical stimulation to the finger using the stimulator of an electromyograph were evaluated in seven normal subjects to determine whether reliable threshold values to perception of pain could be obtained. Stimuli were delivered through ring or disc electrodes separated by 3 cm and interfaced to the skin of the digit with EKG paste. Stimulation through these electrodes produced only relative values of threshold, expressed as a potentiometer dial setting. Such values proved to be meaningful only when repeated during a single session. A possible reason for the apparent unreliability of repeated measurements over time is discussed. When a constant current source was substituted, reliable and consistent threshold measurements were obtained. It is suggested that the clinician wishing to make accurate, repeatable and quantified measurements of patient thresholds to electrical stimulation of the finger employ a nonloading source, namely, a constant current or constant voltage stimulator. PMID:843204

  11. Mitochondrial threshold effects.

    PubMed Central

    Rossignol, Rodrigue; Faustin, Benjamin; Rocher, Christophe; Malgat, Monique; Mazat, Jean-Pierre; Letellier, Thierry

    2003-01-01

    The study of mitochondrial diseases has revealed dramatic variability in the phenotypic presentation of mitochondrial genetic defects. To attempt to understand this variability, different authors have studied energy metabolism in transmitochondrial cell lines carrying different proportions of various pathogenic mutations in their mitochondrial DNA. The same kinds of experiments have been performed on isolated mitochondria and on tissue biopsies taken from patients with mitochondrial diseases. The results have shown that, in most cases, phenotypic manifestation of the genetic defect occurs only when a threshold level is exceeded, and this phenomenon has been named the 'phenotypic threshold effect'. Subsequently, several authors showed that it was possible to inhibit considerably the activity of a respiratory chain complex, up to a critical value, without affecting the rate of mitochondrial respiration or ATP synthesis. This phenomenon was called the 'biochemical threshold effect'. More recently, quantitative analysis of the effects of various mutations in mitochondrial DNA on the rate of mitochondrial protein synthesis has revealed the existence of a 'translational threshold effect'. In this review these different mitochondrial threshold effects are discussed, along with their molecular bases and the roles that they play in the presentation of mitochondrial diseases. PMID:12467494

  12. 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

  13. A Novel Psychovisual Threshold on Large DCT for Image Compression

    PubMed Central

    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

  14. Role of spinal 5-HT(1A) receptors in morphine analgesia and tolerance in rats.

    PubMed

    Bardin, Laurent; Colpaert, Francis C

    2004-06-01

    We here studied the involvement of spinally located 5-HT(1A) and opioid receptors, in the paradoxical effects that their activation can produce on nociception. Intrathecal (i.t.) injection of the 5-HT(1A) receptor agonist 8-hydroxy-2-[di-n-propylamino] tetralin (8-OH-DPAT) (1-10 microg) induced analgesic effects in the formalin model of tonic pain whereas in the paw pressure test, it decreased the vocalization threshold. In this latter test, i.t. 8-OH-DPAT also markedly reduced the analgesic effect of systemic morphine (5-10 mg/kg, s.c.). At 10 microg, 8-OH-DPAT totally abolished the effect of 5 mg/kg of morphine; this inhibitory effect was antagonized by pre-treatment with 0.63 mg/kg of the 5-HT(1A) antagonist WAY-100635 (N-[2-[4-(2-methoxyphenyl)-1-piperazinyl]-ethyl]-N-(2-pyridinyl)-cyclohexanecarboxamide-trihydrochloride). In contrast, the i.t. injection of WAY-100635 (1-10 microg) dose-dependently potentiated the antinociceptive activity of a dose of morphine (2.5 mg/kg, s.c.). Furthermore, WAY-100635 (10 microg, i.t.) potentiated morphine analgesia in morphine-tolerant rats. These findings demonstrate that 5-HT(1A) receptor agonists can act in the spinal cord to produce both hyper- and hypo-algesic effects and play a major role in the opioid analgesia and tolerance. PMID:15109976

  15. Reducing pain during procedures.

    PubMed

    Liebelt, E L

    1996-10-01

    There is an increasing focus on the recognition, assessment, and management of pain in children. Children undergo many painful procedures in different clinical environments and are frequently undertreated for their pain. The pediatrician should be familiar with general concepts about the perception of pain in children. Many pain-assessment tools have been developed and restructured to provide the clinician with valid and reliable scales to assess pain in children and assess the effect of interventions. New pharmacologic agents for conscious sedation are being used with increasing frequency in the pediatric outpatient setting for reducing pain and anxiety. Also there has been increasing use of regional anesthetic techniques for procedures once requiring general anesthesia. There has been an increase in the development of topical anesthetics as well as modifying injectable local anesthetic to decrease the pain of local infiltration. Nonpharmacologic methods of pain management are being tested, developed, and used alone or as adjuncts to pharmacologic therapy for children undergoing painful procedures. It is imperative that clinicians keep themselves informed about new advances pertaining to pain treatment and incorporate them into their practices. PMID:8946121

  16. Preventing chronic postoperative pain.

    PubMed

    Reddi, D

    2016-01-01

    Chronic postoperative pain is common. Nerve injury and inflammation promote chronic pain, the risk of which is influenced by patient factors, including psychological characteristics. Interventional trials to prevent chronic postoperative pain have been underpowered with inadequate patient follow-up. Ketamine may reduce chronic postoperative pain, although the optimum treatment duration and dose for different operations have yet to be identified. The evidence for gabapentin and pregabalin is encouraging but weak; further work is needed before these drugs can be recommended for the prevention of chronic pain. Regional techniques reduce the rates of chronic pain after thoracotomy and breast cancer surgery. Nerve-sparing surgical techniques may be of benefit, although nerve injury is not necessary or sufficient for chronic pain to develop. PMID:26620149

  17. Pain in children.

    PubMed

    Eland, J M

    1990-12-01

    The assessment and management of children's pain is a topic that has received a great deal of attention since the late 1970s. Nurse researchers have played a dominant role in all areas of pediatric pain relief and likely will continue to do so. There are currently a number of pediatric pain assessment instruments developed that are used in selected practice settings, but their use should be extended to document the existence of pediatric pain and its relief. Pharmacologic interventions for pediatric pain relief have been hampered by incorrect beliefs about analgesic risks, prescribing and administrating habits, and a virtual explosion of information in the area of analgesics. Although nurses have traditionally used nonpharmacologic interventions for pain relief, these methods have not been well researched. Continued research efforts in this important area will result in improved diagnosis and management of pediatric pain. PMID:2235640

  18. The Pain of Labour

    PubMed Central

    Labor, Simona

    2008-01-01

    Labour is an emotional experience and involves both physiological and psychological mechanisms. The pain of labour is severe but despite this its memory diminishes with time. Labour pain has two components: visceral pain which occurs during the early first stage and the second stage of childbirth, and somatic pain which occurs during the late first stage and the second stage. The pain of labour in the first stage is mediated by T10 to L1 spinal segments, whereas that in the second stage is carried by T12 to L1, and S2 to S4 spinal segments. Pain relief in labour is complex and often challenging without regional analgesia. Effective management of labour pain plays a relatively minor role in a woman's satisfaction with childbirth. PMID:26526404

  19. Common medical pains

    PubMed Central

    Jacobson, Sheila

    2007-01-01

    Pain in infancy and childhood is extremely common. Sources of pain include illness, injury, and medical and dental procedures. Over the past two decades, tremendous progress has been made in the assessment, prevention and treatment of pain. It is important for the paediatric health care provider to be aware of the implications and consequences of pain in childhood. A multitude of interventions are available to reduce or alleviate pain in children of all ages, including neonates. These include behavioural and psychological methods, as well as a host of pharmacological preparations, which are safe and effective when used as indicated. Many complementary and alternative treatments appear to be promising in treating and relieving pain, although further research is required. The present article reviews the most common sources of pain in childhood and infancy, as well as current treatment strategies and options. PMID:19030348

  20. Amplitudes of Pain-Related Evoked Potentials Are Useful to Detect Small Fiber Involvement in Painful Mixed Fiber Neuropathies in Addition to Quantitative Sensory Testing – An Electrophysiological Study

    PubMed Central

    Hansen, Niels; Kahn, Ann-Kathrin; Zeller, Daniel; Katsarava, Zaza; Sommer, Claudia; Üçeyler, Nurcan

    2015-01-01

    To investigate the usefulness of pain-related evoked potentials (PREP) elicited by electrical stimulation for the identification of small fiber involvement in patients with mixed fiber neuropathy (MFN). Eleven MFN patients with clinical signs of large fiber impairment and neuropathic pain and ten healthy controls underwent clinical and electrophysiological evaluation. Small fiber function, electrical conductivity and morphology were examined by quantitative sensory testing (QST), PREP, and skin punch biopsy. MFN was diagnosed following clinical and electrophysiological examination (chronic inflammatory demyelinating neuropathy: n?=?6; vasculitic neuropathy: n?=?3; chronic axonal ­neuropathy: n?=?2). The majority of patients with MFN characterized their pain by descriptors that mainly represent C-fiber-mediated pain. In QST, patients displayed elevated cold, warm, mechanical, and vibration detection thresholds and cold pain thresholds indicative of MFN. PREP amplitudes in patients correlated with cold (p?thresholds (p?pain and the presence of par-/dysesthesias correlated negatively with PREP amplitudes (p?thresholds, burning pain, and par-/dysesthesias support employing PREP amplitudes as an additional tool in conjunction with QST for detecting small fiber impairment in patients with MFN. PMID:26696950

  1. [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

  2. Phosphorylated neuronal nitric oxide synthase in neuropathic pain in rats

    PubMed Central

    Zhou, Zhidong; Liang, Yingping; Deng, Fumou; Cheng, Yong; Sun, Jing; Guo, Lian; Xu, Guohai

    2015-01-01

    Neuropathic pain caused by nervous system damage or system dysfunction. The pathogenesis and the mechanism underlying neuropathic pain remains unclear. The only known neurobiological component involved in the neuropathic pain is nitric oxide (NO). NO is synthesized by nitric oxide synthase (nNOS) from L-arginine and oxygen. nNOS is involved in the inflammatory pain and neuropathic pain. In this study, we aimed to identify whether KN93 reduced the pain in the rats. Sixty adult male SD rat were randomly divided into 4 groups. Sham group and model group were not received treatment. Experimental group received intrathecal injection of KN93, and negative control group received DMSO injection 30 min before pain test. After last test of pain threshold, the rats were sacrificed and lumbar spinal tissues were sampled for analysis of the expression of pnNOS and pCaMK II by quantitative PCR and Western blotting. Pain threshold was increased in the rats received KN93 treatment (P<0.01), and the expression levels of pnNOS was increased (P<0.05) in experimental group and accompanied with decrease of CaMK II expression (P<0.05). By administration of KN93, the interaction of nNOS and the adaptor protein CAPON was reduced through inhibition of CaMK II by KN93. In conclusion, this study reveals that KN93 can reduce neuropathic pain via inhibiting the activity of CaMK II, and then increase the level of phosphorylated nNOS, to reduce the interaction with CAPON. PMID:26722464

  3. 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

  4. Pain in aquatic animals.

    PubMed

    Sneddon, Lynne U

    2015-04-01

    Recent developments in the study of pain in animals have demonstrated the potential for pain perception in a variety of wholly aquatic species such as molluscs, crustaceans and fish. This allows us to gain insight into how the ecological pressures and differential life history of living in a watery medium can yield novel data that inform the comparative physiology and evolution of pain. Nociception is the simple detection of potentially painful stimuli usually accompanied by a reflex withdrawal response, and nociceptors have been found in aquatic invertebrates such as the sea slug Aplysia. It would seem adaptive to have a warning system that allows animals to avoid life-threatening injury, yet debate does still continue over the capacity for non-mammalian species to experience the discomfort or suffering that is a key component of pain rather than a nociceptive reflex. Contemporary studies over the last 10?years have demonstrated that bony fish possess nociceptors that are similar to those in mammals; that they demonstrate pain-related changes in physiology and behaviour that are reduced by painkillers; that they exhibit higher brain activity when painfully stimulated; and that pain is more important than showing fear or anti-predator behaviour in bony fish. The neurophysiological basis of nociception or pain in fish is demonstrably similar to that in mammals. Pain perception in invertebrates is more controversial as they lack the vertebrate brain, yet recent research evidence confirms that there are behavioural changes in response to potentially painful events. This review will assess the field of pain perception in aquatic species, focusing on fish and selected invertebrate groups to interpret how research findings can inform our understanding of the physiology and evolution of pain. Further, if we accept these animals may be capable of experiencing the negative experience of pain, then the wider implications of human use of these animals should be considered. PMID:25833131

  5. An equine pain face

    PubMed Central

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

    2015-01-01

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

  6. 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

  7. The genetics of pain and pain inhibition.

    PubMed Central

    Mogil, J S; Sternberg, W F; Marek, P; Sadowski, B; Belknap, J K; Liebeskind, J C

    1996-01-01

    The present review summarizes the current state of knowledge about the genetics of pain-related phenomena and illustrates the scope and power of genetic approaches to the study of pain. We focus on work performed in our laboratories in Jastrzebiec, Poland; Portland, OR; and Los Angeles, which we feel demonstrates the continuing usefulness of classical genetic approaches, especially when used in combination with newly available molecular genetic techniques. PMID:8610166

  8. 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

  9. Management of sickle pain.

    PubMed

    Ballas, S K

    1997-03-01

    Sickle cell disease is characterized by recurrent episodes of acute pain. Some patients also suffer from chronic pain syndromes including avascular necrosis, leg ulcers, and intractable pain. Approaches to rational therapy of sickle pain include pharmacologic, nonpharmacologic, and preventive therapeutic interventions. Pharmacologic treatment of sickle pain entails the use of nonopioid analgesics, opioid analgesics, and adjuvants singly or in combination depending on the severity of pain. Meticulous evaluation and assessment of painful episodes should precede and accompany all approaches to management. The choice of the opioid analgesic, its route of administration, dose, and frequency of administration should be individualized on a case-by-case basis. Meperidine should be avoided whenever possible. Nonsteroidal anti-inflammatory drugs, meperidine, and morphine are contraindicated in the presence of renal failure. Administration of opioids on a fixed schedule or by patient-controlled analgesia is ideal for effective therapy. Nonpharmacologic approaches to manage sickle pain are underutilized and more studies are needed to determine their role in sickle pain. Preventive therapy of sickle pain is best achieved with hydroxyurea, which was found to decrease the frequency of crises significantly, decrease the incidence of acute chest syndrome, and decrease the need for blood transfusion. PMID:9107526

  10. Pain Management in Newborns

    PubMed Central

    Hall, Richard W.; Anand, Kanwaljeet J. S.

    2014-01-01

    Effective pain management is a desirable standard of care for preterm and term newborns and may potentially improve their clinical and neurodevelopmental outcomes. Neonatal pain should be assessed routinely using context-specific, validated and objective pain methods, despite the limitations of currently available tools. Reducing invasive procedures, and using pharmacological, behavioral or environmental measures can be used to manage neonatal pain. Non-pharmacologic approaches include kangaroo care, facilitated tucking, non-nutritive sucking, sucrose and other sweeteners, massage and acupuncture therapy. They are used for procedures causing acute, transient, or mild pain, or as adjunctive therapy for moderate or severe pain. Local and topical anesthetics can reduce the acute pain caused by skin-breaking or mucosa-injuring procedures. Opioids form the mainstay for treatment of severe pain; morphine and fentanyl are the most commonly used drugs, although other opioids are also available. Non-opioid drugs include various sedatives and anesthetic agents, mostly used as adjunctive therapy in ventilated neonates. Acetaminophen, ibuprofen and other drugs are used for neonates, although their efficacy and safety remains unproven. Approaches for implementing an effective pain management program in the Neonatal ICU are summarized, together with practical protocols for procedural, postoperative, and mechanical ventilation-associated neonatal pain and stress. PMID:25459780

  11. 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

  12. 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

  13. 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

  14. Deficits in pain perception in borderline personality disorder: results from the thermal grill illusion.

    PubMed

    Bekrater-Bodmann, Robin; Chung, Boo Young; Richter, Ingmarie; Wicking, Manon; Foell, Jens; Mancke, Falk; Schmahl, Christian; Flor, Herta

    2015-10-01

    It is well documented that borderline personality disorder (BPD) is characterized by reduced pain sensitivity, which might be related to nonsuicidal self-injury and dissociative experiences in patients with BPD. However, it remains an open question whether this insensitivity relies at least partly on altered sensory integration or on an altered evaluation of pain or a combination of both. In this study, we used the thermal grill illusion (TGI), describing a painful sensation induced by the application of alternating cold and warm nonnoxious stimuli, in patients with either current or remitted BPD as well as matched healthy controls. Two additional conditions, applying warm or cold temperatures only, served as control. We further assessed thermal perception, discrimination, and pain thresholds. We found significantly reduced heat and cold pain thresholds for the current BPD group, as well as reduced cold pain thresholds for the remitted BPD group, as compared with the HC group. Current BPD patients perceived a less-intense TGI in terms of induced pain and unpleasantness, while their general ability to perceive this kind of illusion seemed to be unaffected. Thermal grill illusion magnitude was negatively correlated with dissociation and traumatization only in the current BPD patients. These results indicate that higher-order pain perception is altered in current BPD, which seems to normalize after remission. We discuss these findings against the background of neurophysiological evidence for the TGI in general and reduced pain sensitivity in BPD and suggest a relationship to alterations in N-methyl-D-aspartate neurotransmission. PMID:26098439

  15. 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…

  16. In Lumbar Fusion Patients, How Does Establishing a Comfort Function Goal Preoperatively Impact Postoperative Pain Scores?

    PubMed

    Hennessy, Winnie; Wagner, Elizabeth; Dumas, Bonnie P; Handley, Patricia

    2015-12-01

    The purpose of this feasibility study was to determine the impact of establishing a comfort function goal preoperatively on postoperative pain scores and opiate requirements in lumbar fusion patients. A comfort function goal is defined as the pain score identified by the patient describing the level of pain tolerance to participate in healing activities such as deep breathing, ambulation and participation in activities of daily living. The design was prospective, nonrandomized, intervention group (n = 30) compared with retrospective chart review as control group (n = 30). Sample included patients scheduled for routine lumbar fusion in an urban southeastern hospital. The study intervention established a comfort function goal during a routine preoperative patient education class. No significant difference in pain score or opiate requirement was found for these data. However, a fundamental clinical question arose surrounding opiate requirements and dosing management. In our hospital, the norm for postoperative pain management is to categorize pain scores as mild (1-3), moderate (4-6), and severe (7-10) pain. Physician orders commonly use this differential to order opiate dose ranges. In this sample, the mean pain score for the intervention group at home is 5.8 and the mean comfort function goal is 4.9. Based on normative categories of pain scores, if a patient's baseline of tolerable pain is 4.9, this has potential impact on clinician responses to managing pain, as 4.9-5.8 is, for this patient, perhaps a mild range of pain, not moderate. If a patient reports a pain score of 7, and their norm is 5.8, the delta is only 1.2. Does this imply that the patient is experiencing mild or severe pain? Does the nurse deliver a dose of pain medication that is in the mild or severe dose range? PMID:26293197

  17. Case studies illustrating the management of trigeminal neuropathic pain using topical 5% lidocaine plasters

    PubMed Central

    Yilmaz, Zehra; Renton, Tara

    2013-01-01

    Chronic trigeminal pain, with its severe related functional problems, is difficult to treat. Treatment is often empirically based on medications used for other chronic pain conditions. Systemic sodium channel and calcium channel blocking agents may cause a multitude of complications that are often poorly tolerated by the patient. Aim: The aim of this case report was to assess the efficacy of topical 5% lidocaine plasters in reducing pain and reducing adjuvant medication in patients with orofacial neuropathic pain. Method: Fourteen patients with chronic orofacial pain conditions referred to the oral surgery department were instructed to wear 5% lidocaine plasters for 12 hours each day over the painful area. The conditions included post-surgical neuropathy (n = 10), multiple sclerosis-related pain (n = 1), persistent idiopathic facial pain (n = 1), Ramsay Hunt syndrome (post-herpetic neuralgia, n = 1) and trigeminal neuralgia (n = 1). Data were collected on patient demographics, pain levels and medication. Results: Pain levels improved in 12 out of 14 patients. Nine patients had a reduction in adjuvant medication, two of whom completely stopped adjuvant treatment. Conclusion: This case series demonstrates that of the use of 5% lidocaine plasters may play a useful role in the management of chronic trigeminal pain. A suggested novel approach for the management of orofacial pain, for clinicians, is presented. Summary points Management of chronic orofacial pain continues to be a major challenge to the clinician. Patients are often placed on a multitude of medications in an attempt to alleviate pain without success. Topical 5% lidocaine plasters, currently used for the management of post-herpetic neuralgia, offer the option of locally targeting trigeminal pain without the multiple side-effects of systemic medication. This case series demonstrates that lidocaine plasters decrease verbal pain scores in extraoral, trigeminal and neuropathic pain, and reduce the use of other neuromodulatory agents in some, but not all, patients. The plasters should be considered as a useful adjuvant in the management of pain in these patients. PMID:26516508

  18. Nonpharmacologic treatment of pain.

    PubMed

    Titler, M G; Rakel, B A

    2001-06-01

    Nonpharmacologic interventions for pain treatment are important complementary therapies but are not substitutes for pharmacologic management of pain. Use of nonpharmacologic pain treatments in critical care settings is helpful to decrease pain, but the challenge remains for nurses to have the knowledge, time, and skill to use these interventions in a busy daily practice with severely ill patients. Although numerous studies testing the effectiveness of nonpharmacologic interventions for pain management are available, the varying methods and interventions used in these studies make it difficult to draw conclusions. Further research on the use of these interventions for pain reduction is necessary to determine the most effective treatments and the conditions under which they should be used. PMID:11866404

  19. 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

  20. Pain and functional imaging.

    PubMed Central

    Ingvar, M

    1999-01-01

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

  1. Cannabinoids in the management of difficult to treat pain.

    PubMed

    Russo, Ethan B

    2008-02-01

    This article reviews recent research on cannabinoid analgesia via the endocannabinoid system and non-receptor mechanisms, as well as randomized clinical trials employing cannabinoids in pain treatment. Tetrahydrocannabinol (THC, Marinol((R))) and nabilone (Cesamet((R))) are currently approved in the United States and other countries, but not for pain indications. Other synthetic cannabinoids, such as ajulemic acid, are in development. Crude herbal cannabis remains illegal in most jurisdictions but is also under investigation. Sativex((R)), a cannabis derived oromucosal spray containing equal proportions of THC (partial CB(1) receptor agonist ) and cannabidiol (CBD, a non-euphoriant, anti-inflammatory analgesic with CB(1) receptor antagonist and endocannabinoid modulating effects) was approved in Canada in 2005 for treatment of central neuropathic pain in multiple sclerosis, and in 2007 for intractable cancer pain. Numerous randomized clinical trials have demonstrated safety and efficacy for Sativex in central and peripheral neuropathic pain, rheumatoid arthritis and cancer pain. An Investigational New Drug application to conduct advanced clinical trials for cancer pain was approved by the US FDA in January 2006. Cannabinoid analgesics have generally been well tolerated in clinical trials with acceptable adverse event profiles. Their adjunctive addition to the pharmacological armamentarium for treatment of pain shows great promise. PMID:18728714

  2. Cannabinoids in the management of difficult to treat pain

    PubMed Central

    Russo, Ethan B

    2008-01-01

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

  3. The effects of sex and gender role on responses to pressure pain

    PubMed Central

    Kröner-Herwig, Birgit; Gaßmann, Jennifer; Tromsdorf, Marie; Zahrend, Elfi

    2012-01-01

    Background: Several studies on experimental mechanical pain suggested a strong influence of sex demonstrating females to be more sensitive. We examined the hypothesis that not only sex but also gender role affects pain responsiveness and looked for mediators of this effect. Method: As indicators of pain the threshold the intensity and the unpleasantness of pressure stimuli were measured, as well as sensory and affective quality of pain. The gender role of 74 students was assessed by the Bem Sex Role Inventory (BSRI). Furthermore several psychological variables assumed to be potential mediators (catastrophising, fear of pain, depressive symptoms, pain coping) were obtained. Results: ANOVA revealed significant main effects of sex in all pain variables except affective quality of pain. Contrary to our hypothesis gender role had no influence on pain responses, neither was there an interaction of sex and gender. Fear of pain just missed the significance level identifying it as mediator of the sex effect on affective pain. Conclusions: In summary, our study corroborated previous findings that women are more responsive to mechanical pain stimuli with effect sizes being medium to large, whereas gender role did not predict any of the assessed pain parameters. No convincing evidence was found that the influence of sex is predominantly mediated by psychological characteristics of the individual. PMID:22400065

  4. Pain management of wound care.

    PubMed

    Senecal, S J

    1999-12-01

    Children and adults still suffer pain during wound dressing changes despite national guidelines. Assessing and managing pain are essential components of comprehensive wound care. Developmentally sensitive pain assessment tools are available to measure verbal, behavioral, and physiologic responses to pain. Holistic pain assessment includes pain intensity, location, description, relief measures, cultural background, and the patient's developmental level and anxiety. Pharmacologic and nonpharmacologic interventions should be combined to manage pain based upon patient's response and nursing assessment. Nurses with a fundamental knowledge of pain assessment and management provide their patients with pain and symptom relief during wound care. PMID:10523438

  5. Tinnitus and pain.

    PubMed

    Møller, A R

    2007-01-01

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

  6. Managing Neuropathic Pain.

    PubMed

    Jones, Robert Carter Wellford; Lawson, Erin; Backonja, Miroslav

    2016-01-01

    Neuropathic pain (NP) arises from injuries or diseases affecting the somatosensory component of the nervous system at any level of the peripheral or central nervous system. NP is diagnosed based on common neurologic signs and symptoms. NP is best treated with a combination of multiple therapeutic approaches, and treatments include conservative, complementary, medical, interventional, and surgical treatment modalities. Goals of treatment are the same as in pain management and include improvement in pain control and in coping skills as well as restoration of functional status. Most patients with NP benefit most from an individualized, multimodal approach that emphasizes both pain and function. PMID:26614725

  7. Treatment of Hidradenitis Supprurativa Associated Pain with Nonsteroidal Anti-Inflammatory Drugs, Acetaminophen, Celecoxib, Gabapentin, Pegabalin, Duloxetine, and Venlafaxine

    E-print Network

    Scheinfeld, Noah

    2013-01-01

    efficacy, and tolerability in comparison with other classes of antidepressants.possible efficacy with that of the tricyclic antidepressant,Efficacy of duloxetine in painful symptoms: an analgesic or antidepressant

  8. 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.

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

    PubMed Central

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

    2014-01-01

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

  10. Threshold Concepts in Research Education and Evidence of Threshold Crossing

    ERIC Educational Resources Information Center

    Kiley, Margaret; Wisker, Gina

    2009-01-01

    Most work on threshold concepts has hitherto related to discipline-specific undergraduate education, however, the idea of generic doctoral-level threshold concepts appeared to us to provide a strong and useful framework to support research learning and teaching at the graduate level. The early work regarding research-level threshold concepts is…

  11. Network problem threshold

    NASA Technical Reports Server (NTRS)

    Gejji, Raghvendra, R.

    1992-01-01

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

  12. 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

  13. New targets for neuropathic pain therapeutics.

    PubMed

    Kinloch, Ross A; Cox, Peter J

    2005-08-01

    Neuropathic pain (NeP) is initiated by a lesion or dysfunction in the nervous system. Unlike physiological pain it serves no useful purpose and is usually sustained and chronic. NeP encompasses a wide range of pain syndromes of diverse aetiologies which together account for > 12 million sufferers in the US. Currently, there are a number of therapies available for NeP, including gabapentin, pregabalin, anticonvulsants (tiagabine HCl), tricyclic antidepressants (amitriptyline, nortriptyline) and acetaminophen/opioid combination products (Vicodin, Tylenol #3). However, these products do not provide sufficient pain relief and a significant proportion of sufferers are refractory (60%). Therefore, there is a need for new therapies that provide more predictable efficacy in all patients with improved tolerability. Over the last decade, understanding of the basic mechanisms contributing to the generation of NeP in preclinical animal models has greatly improved. Together with the completion of the various genome sequencing projects and significant advances in microarray and target validation strategies, new therapeutic approaches are being rigourously pursued. This article reviews the rationale behind a number of these mechanism-based approaches, briefly discusses specific challenges that they face, and finally, speculates on the potential of emerging technologies as alternative therapeutic strategies to the traditional 'small-molecule' approach. PMID:16083337

  14. Association Between Depression and Acute Pain in Adults Attending a Tertiary Care Hospital in Bhubaneswar

    PubMed Central

    Barman, Diplina; Mishra, Jayanti; Mahapatra, Pranab; Manjareeka, Magna

    2015-01-01

    Background Recent burden on health care organization due to acute pain and simultaneous rise in the depression cases have been ringing alarms among the medical professionals. Aims This study was taken up with a hypothesis that acute pain and depression are inter-linked and any acute painful condition leads to some behavioural and psycho-somatic effects which needs to be detected at the earliest possible. Settings and Designs This relationship was established by designing a cross-sectional study where four most common causes of acute pain (i.e. post-labour, post-caesarean, postoperative, dental conditions) were studied in 70 subjects each and compared with 70 subjects of control group who presented to a tertiary care hospital in Bhubaneswar, without any painful condition or underlying depression. Materials and Methods Various pain scales (Visual Analogue Scale- VAS, Verbal Rating Scale – VRS, Box Scale) were used to assess the degree of pain while Montgomery-Åsberg Depression Rating Scale (MADRS) was used to assess the level of depression in these subjects. Statistical Analysis Using SPSS version 16 software, the correlation coefficient was determined between the depression levels and acute pain. Results It was seen that the geriatric populations were more depressed, while the older adults perceived more pain. The females differed from males in their pain perception; they were more depressed and proved to be more tolerant to painful conditions such as post-partum acute painful conditions. Dental pain was found to be the second most reported painful condition after postoperative acute pain. A statistically significant strong correlation was established between depression and acute pain. Conclusion Thus the psychosomatic component of pain needs to be evaluated on a priority basis by health providers. PMID:26393121

  15. Pain and symptom control in paediatric palliative care.

    PubMed

    Stevens, M M; Dalla Pozza, L; Cavalletto, B; Cooper, M G; Kilham, H A

    1994-01-01

    Important differences become evident in a comparison of cancer pain between children and adults. Management of pain in children is commonly multidisciplinary, is less dependent on invasive measures and relies more on systemic therapy. Children are not little adults: their immaturity, developing cognition and dependence all influence their experience and interpretation of pain. Much progress has been made in altering practices such as under-prescribing and underdosing that have adversely affected adequate control of pain in children. The challenge for paediatric health care providers in the mid 1990s is not only to be informed of current practices in pain and symptom control in paediatric palliative care, but also to remember to establish those practices in day to day management. Even though pain and its effects in children are now better understood, it is often still not managed optimally. Good management of pain in children depends on accurate assessment. In the past 10 years, assessment of pain in children has advanced considerably. However, assessment of pain in the preverbal child is still inadequate and in need of attention. Sedation, tolerance and involuntary movements may occur as side effects of opioids in children and may cause significant problems in management of the dying child. Psychostimulants can diminish sedation to some extent, but there is little information as yet on the value of these drugs in children. Tolerance to opioids may develop quickly, leading to poor control of pain and distress for the child. Strategies to improve management of tolerance include use of regional anaesthetic techniques such as the epidural/intrathecal route for opioid administration. Involuntary movements induced by opioids are uncommon but have the potential to cause significant distress. The mechanisms underlying these side effects of opioids need to be established. Strategies are needed for the effective treatment and prevention of these side effects. Neuropathic pain can be severe, distressing and difficult to treat. Experience of its treatment in terminally ill children is limited. Effective use of tricyclic antidepressants and systemically administered local anaesthetics is still to be determined. Regional anaesthetic techniques may be of great benefit when neuropathic pain cannot be controlled with systemic therapy. Procedural pain is more common than pain related to disease in the management of paediatric cancer. Further research is needed to identify the best approach to its management. We have found nitrous oxide to be of great benefit in management of procedural pain in children. Non-pharmacological methods of treatment of pain in children, such as transcutaneous electrical nerve stimulation or acupuncture, may also be useful and should receive continuing evaluation. There are significant and current issues in paediatric palliative care besides management of pain. There are difficulties in the provision of home nursing care for children with cancer in the terminal phase of their illness, including lack of community nursing services at night and on weekends and lack of adequate home help for parents. Attitudes of staff involved in the care of the child and family and their commitment to working as a multidisciplinary team strongly influence the quality and success of care given. Pain control and palliative medicine are evaluable by measures of quality assurance or outcome, and adoption of such evaluations should improve standards of care. Euthanasia in children is even more difficult as an ethical dilemma than in adults. Optimum symptom control with current techniques should almost always obviate its consideration. We are opposed to euthanasia. Psychosocial and cultural issues all influence the family's experience of palliative care. Further research is necessary in all of these areas.(ABSTRACT TRUNCATED) PMID:8564995

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

    NASA Astrophysics Data System (ADS)

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

    2012-12-01

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

  17. Post surgical pain treatment - adults

    MedlinePLUS

    Postoperative pain relief ... can push a button to give yourself more pain relief when you need it. This is called patient ... or given as a shot may provide enough pain relief. You may receive this medicine right away after ...

  18. Functional Abdominal Pain in Children

    MedlinePLUS

    ... pain, including recurrent abdominal pain, functional dyspepsia, and irritable bowel syndrome. Recurrent abdominal pain (RAP) was originally defined ... or constipation alternating with diarrhea) is the classic irritable bowel syndrome (IBS). Causes The trigger for functional abdominal ...

  19. Taking narcotics for back pain

    MedlinePLUS

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

  20. Chronic Pain Medicines

    MedlinePLUS

    ... to take, ask your doctor or your pharmacist. Acetaminophen Acetaminophen (one brand name: Tylenol) helps many kinds of chronic pain. Remember, many over-the-counter and prescription pain medicines have acetaminophen in them. If you're not careful, you ...

  1. Complex Regional Pain Syndrome

    MedlinePLUS

    ... works, it may be repeated. Physical therapy and psychological counseling are also helpful. However, a treatment that ... my pain? If my injury has healed, why am I still in pain? Do I need any tests? What is the best treatment option for me? ...

  2. Pseudoachondroplasia and painful sequelae.

    PubMed

    Gamble, Candace; Nguyen, Joanne; Hashmi, S Shahrukh; Hecht, Jacqueline T

    2015-11-01

    Pseudoachondroplasia (PSACH) is a well-described autosomal dominant short limb dwarfing condition caused by mutations in the cartilage oligomeric matrix protein gene (COMP). The most debilitating complication of the disorder is joint pain starting in childhood, the extent and severity of which is poorly defined. The aim of this study was to fully assess the pain and identify additional clinical complications affecting those with PSACH. An online survey was distributed to individuals with PSACH. Of the 77 surveys analyzed, 83% reported chronic pain starting as early as the newborn period. Pain was most frequently reported in weight bearing joints including the knees, hips, and back, and significantly interfered with their overall quality of life. For pain relief, patients with PSACH used a wide variety of treatments. However, patients reported only a 60% resolution of pain with their current treatments. An increase in other comorbidities was not found, specifically osteoporosis was not increased. This study documents for the first time that pain is the most common presenting symptom in PSACH and is often overlooked until short stature becomes obvious. The recognition of chronic pain as one of the earliest manifestations of PSACH is important to allow for prompt diagnosis. © 2015 Wiley Periodicals, Inc. PMID:26177939

  3. Recurrent Abdominal Pain

    ERIC Educational Resources Information Center

    Banez, Gerard A.; Gallagher, Heather M.

    2006-01-01

    The purpose of this article is to provide an empirically informed but clinically oriented overview of behavioral treatment of recurrent abdominal pain. The epidemiology and scope of recurrent abdominal pain are presented. Referral process and procedures are discussed, and standardized approaches to assessment are summarized. Treatment protocols…

  4. 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,…

  5. Persistent pain facilitates response to morphine reward by downregulation of central amygdala GABAergic function.

    PubMed

    Zhang, Zhi; Tao, Wenjuan; Hou, Yuan-Yuan; Wang, Wei; Lu, Yun-Gang; Pan, Zhizhong Z

    2014-08-01

    Opioid-based analgesics are widely used for treating chronic pain, but opioids are highly addictive when repeatedly used because of their strong rewarding effects. In recent years, abuse of prescription opioids has dramatically increased, including incidences of misuse of opioid drugs prescribed for pain control. Despite this issue in current clinical pain management, it remains unknown how pain influences the abuse liability of prescription opioids. Pain as aversive experience may affect opioid reward of positive emotion through common brain sites involved in emotion processing. In this study, on a rat model of chronic pain, we determined how persistent pain altered behavioral responses to morphine reward measured by the paradigm of unbiased conditioned place preference (CPP), focusing on GABAergic synaptic activity in neurons of the central nucleus of the amygdala (CeA), an important brain region for emotional processing of both pain and reward. We found that pain reduced the minimum number of morphine-conditioning sessions required for inducing CPP behavior. Both pain and morphine conditioning that elicited CPP inhibited GABA synaptic transmission in CeA neurons. Pharmacological activation of CeA GABAA receptors reduced the pain and inhibited CPP induced both by an effective dose of morphine and by a sub-threshold dose of morphine under pain condition. Furthermore, inhibition of CeA GABAA receptors mimicked the pain effect, rendering the sub-threshold dose of morphine effective in CPP induction. These findings suggest that pain facilitates behavioral responses to morphine reward by predisposing the inhibitory GABA function in the CeA circuitry involved in the behavior of opioid reward. PMID:24686896

  6. Postoperative pain management

    PubMed Central

    Kolettas, Alexandros; Lazaridis, George; Baka, Sofia; Mpoukovinas, Ioannis; Karavasilis, Vasilis; Kioumis, Ioannis; Pitsiou, Georgia; Papaiwannou, Antonis; Lampaki, Sofia; Karavergou, Anastasia; Pataka, Athanasia; Machairiotis, Nikolaos; Katsikogiannis, Nikolaos; Mpakas, Andreas; Tsakiridis, Kosmas; Fassiadis, Nikolaos; Zarogoulidis, Konstantinos

    2015-01-01

    Postoperative pain is a very important issue for several patients. Indifferent of the surgery type or method, pain management is very necessary. The relief from suffering leads to early mobilization, less hospital stay, reduced hospital costs, and increased patient satisfaction. An individual approach should be applied for pain control, rather than a fix dose or drugs. Additionally, medical, psychological, and physical condition, age, level of fear or anxiety, surgical procedure, personal preference, and response to agents given should be taken into account. The major goal in the management of postoperative pain is minimizing the dose of medications to lessen side effects while still providing adequate analgesia. Again a multidisciplinary team approach should be pursued planning and formulating a plan for pain relief, particularly in complicated patients, such as those who have medical comorbidities. These patients might appear increase for analgesia-related complications or side effects. PMID:25774311

  7. [Groin pain in athletes].

    PubMed

    Sanders, Rick J M; Kokshoorn, Arjan P J; Kolkman, Karel A; van der Wal, Wybren A; van Loon, Corné J M

    2014-01-01

    Groin pain in young athletes is a common problem, accounting for significant downtime in sports participation. It can be difficult to make the correct diagnosis as groin pain has a wide differential diagnosis, which encompasses acute as well as chronic causative factors. In this article this is illustrated by presenting three cases of patients who attended our hospital. In all three cases the main complaint was sports-related groin pain, and the patients presented with very similar symptoms. However, after further investigation the patients were diagnosed with three very different types of injury: sportsman's hernia; hip labral tear; and pubic osteitis. This emphasises the need for every general practitioner and medical specialist to understand that there is a wide differential diagnosis for groin pain in athletes, in order to be able to implement specific therapy targeting the actual cause of groin pain. PMID:25315329

  8. Nonpharmacologic interventions for pain management.

    PubMed

    Doody, S B; Smith, C; Webb, J

    1991-03-01

    Managing pain is a complex and inexact science. Acute and chronic pain physically and psychologically affects and disables an overwhelming number of people. Nonpharmacologic interventions for pain management have been reviewed. These methods can be used independently or in combination with other nonpharmacologic or pharmacologic methods of pain control. The goals of nonpharmacologic interventions for pain management include the reduction of pain, minimal adverse effects, and allowing patients to become active participants in their own care. Nurses are called on many times to comfort patients in pain. It is through their expertise and intervention that the goals of pain management succeed. PMID:2043331

  9. Cancer treatment: dealing with pain

    MedlinePLUS

    ... in addition to medicines or other types of pain relief. ... Guideline : no. 3. World Health Organization (WHO). WHO's pain relief ladder. World Health Organization: Programmes and projects: Cancer. ...

  10. Orthodoxy, recalcitrance and in-between: describing variation in seed storage characteristics using threshold responses to water loss

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Tolerance of desiccation is typically described by a threshold or low-water-content-limit to survival. This convention provides fairly good distinction between orthodox and recalcitrant seeds, which show thresholds of less than about 0.07 and greater than about 0.2 g H2O g dw-1, respectively. Thresh...

  11. Breast Pain: Engorgement, Nipple Pain, and Mastitis.

    PubMed

    Berens, Pamela D

    2015-12-01

    This review explores current concepts surrounding breastfeeding complications including nipple pain and trauma, breast engorgement, mastitis, and breast abscess. The review discusses possible etiologies, risk factors, incidence, differential diagnosis, and suggested treatment strategies. The evidence that supports these management options is discussed. PMID:26512442

  12. 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

  13. 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

  14. 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

  15. Brain and human pain: topographic EEG amplitude and coherence mapping.

    PubMed

    Chen, A C; Rappelsberger, P

    1994-01-01

    Nineteen young healthy volunteers (8 males and 11 females) participated in an experimental ice-cube cold pressor test to study topographic changes of EEG parameters in response to painful stimulation. EEG was recorded with 19 electrodes and quantified by amplitude and coherence analyses. Mean amplitudes and values for local (between adjacent electrodes) and interhemispheric (between electrodes on homologous sites of both hemispheres) coherences were computed for six frequency bands. For the evaluation of changes between EEG at rest (baseline) and EEG during painful stimulation (right or left hand), non-parametric paired Wilcoxon tests were performed. The obtained descriptive error probabilities were presented in probability maps. In the behavioural pain tolerance and subjective pain ratings, no difference in gender or stimulation condition was observed. Under painful stimulation the results showed: (A) most pronounced decrease of Alpha amplitude in the central areas and some increase of high Beta amplitude; (B) increase of local coherence for Alpha and Beta 2 mainly in central regions and centro-frontal leads; and (C) increase of interhemispheric coherence for Alpha and Beta 2 in the central areas. The results of this study indicate clearly that peripheral painful stimulation is reflected by EEG changes. Decrease of EEG amplitude and simultaneous increase of EEG coherence in the central regions can be cortical correlates of human pain. PMID:7696090

  16. Radiofrequency ablation of osseous metastases for the palliation of pain

    PubMed Central

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

    2007-01-01

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

  17. 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.

  18. Postoperative Pain Control

    PubMed Central

    Garimella, Veerabhadram; Cellini, Christina

    2013-01-01

    The effective relief of pain is of the utmost importance to anyone treating patients undergoing surgery. Pain relief has significant physiological benefits; hence, monitoring of pain relief is increasingly becoming an important postoperative quality measure. The goal for postoperative pain management is to reduce or eliminate pain and discomfort with a minimum of side effects. Various agents (opioid vs. nonopioid), routes (oral, intravenous, neuraxial, regional) and modes (patient controlled vs. “as needed”) for the treatment of postoperative pain exist. Although traditionally the mainstay of postoperative analgesia is opioid based, increasingly more evidence exists to support a multimodal approach with the intent to reduce opioid side effects (such as nausea and ileus) and improve pain scores. Enhanced recovery protocols to reduce length of stay in colorectal surgery are becoming more prevalent and include multimodal opioid sparing regimens as a critical component. Familiarity with the efficacy of available agents and routes of administration is important to tailor the postoperative regimen to the needs of the individual patient. PMID:24436674

  19. 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

  20. 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.

  1. The Painful Face Pain Expression Recognition Using Active Appearance Models

    E-print Network

    Chen, Tsuhan

    The Painful Face ­ Pain Expression Recognition Using Active Appearance Models Ahmed Bilal Ashraf-John Theobald ¶ b.theobald@uea.ac.uk ABSTRACT Pain is typically assessed by patient self-report. Self-reported pain, however, is difficult to interpret and may be impaired or not even possible, as in young children

  2. Low Pain vs No Pain Multi-core Haskells

    E-print Network

    Trinder, Phil

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

  3. Coloring geographical threshold graphs

    SciTech Connect

    Bradonjic, Milan; Percus, Allon; Muller, Tobias

    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.

  4. 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 ...

  5. Nonopioid medications for pain.

    PubMed

    Tauben, David

    2015-05-01

    Evidence of nonopioid analgesic effectiveness exceeds that for long-term opioids in chronic noncancer pain (CNCP), most with lower risk. Non-drug therapies such as cognitive behavioral therapy and physical activation are safer and also effective. Nonsteroidal antiinflammatory drugs are useful for inflammatory and nociceptive pain, share renal and variable gastrointestinal, bleeding and cardiovascular side effects. Antidepressants with noradrenergic activity (such as tricyclics and seroton-norepinephrine reuptake inhibitors) and neuromodulating anticonvulsant drugs (gabapentinoids and sodium-channel blockers) are proven to be effective for neuropathic and centralized pain. Ketamine and cannabinoids are other studied analgesics but have a less well-proven role in CNCP. PMID:25952062

  6. Gender Differences in Acute and Chronic Pain in the Emergency Department: Results of the 2014 Academic Emergency Medicine Consensus Conference Pain Section

    PubMed Central

    Musey, Paul I.; Linnstaedt, Sarah D.; Platts-Mills, Timothy F.; Miner, James R.; Bortsov, Andrey V.; Safdar, Basmah; Bijur, Polly; Rosenau, Alex; Tsze, Daniel S.; Chang, Andrew K.; Dorai, Suprina; Engel, Kirsten; Feldman, James A.; Fusaro, Angela M.; Lee, David C.; Rosenberg, Mark; Keefe, Francis J.; Peak, David A.; Nam, Catherine S.; Patel, Roma G.; Fillingim, Roger B.; McLean, Samuel A.

    2015-01-01

    Pain is a leading public health problem in the United States, with an annual economic burden of more than $630 billion, and is one of the most common reasons that individuals seek emergency department (ED) care. There is a paucity of data regarding sex differences in the assessment and treatment of acute and chronic pain conditions in the ED. The Academic Emergency Medicine consensus conference convened in Dallas, Texas in May of 2014 to develop a research agenda to address this issue among others related to sex differences in the ED. Prior to the conference, experts and stakeholders from emergency medicine and the pain research field reviewed the current literature and identified eight candidate priority areas. At the conference, these eight areas were reviewed and all eight were ratified using a nominal group technique to build consensus. These priority areas were: 1) gender differences in the pharmacologic and non-pharmacologic interventions for pain, including differences in opioid tolerance, side effects, or misuse; 2) gender differences in pain severity perceptions, clinically meaningful differences in acute pain, and pain treatment preferences; 3) gender differences in pain outcomes of ED patients across the lifespan; 4) gender differences in the relationship between acute pain and acute psychological responses; 5) the influence of physician-patient gender differences and characteristics on the assessment and treatment of pain; 6) gender differences in the influence of acute stress and chronic stress on acute pain responses; 7) gender differences in biologic mechanisms and molecular pathways mediating acute pain in ED populations; and 8) gender differences in biologic mechanisms and molecular pathways mediating chronic pain development after trauma, stress, or acute illness exposure. These areas represent priority areas for future scientific inquiry, and gaining understanding in these will be essential to improving our understanding of sex and gender differences in the assessment and treatment of pain conditions in emergency care settings. PMID:25422152

  7. Effects of the active release technique on pain and range of motion of patients with chronic neck pain

    PubMed Central

    Kim, Jun Ho; Lee, Han Suk; Park, Sun Wook

    2015-01-01

    [Purpose] To compare the influences of the active release technique (ART) and joint mobilization (JM) on the visual analog scale (VAS) pain score, pressure pain threshold (PPT), and neck range of motion (ROM) of patients with chronic neck pain. [Subjects] Twenty-four individuals with chronic neck pain were randomly and equally assigned to 3 groups: an ART group, a joint mobilization (JM) group, and a control group. Before and after the intervention, the degree of pain, PPT, and ROM of the neck were measured using a VAS, algometer, and goniometer, respectively. [Results] The ART group and JM group demonstrated significant changes in VAS and ROM between pre and post-intervention, while no significant change was observed in the control group. Significant differences in the PPT of all muscles were found in the ART group, while significant differences in all muscles other than the trapezius were found in the JM group. No significant difference in PPT was observed in any muscle of the control group. The posthoc test indicated no statistically significant difference between the ART and JM group, but the differences of variation in VAS, PPT, and ROM were greater in the ART group than in the JM and control groups. [Conclusion] ART for the treatment of chronic neck pain may be beneficial for neck pain and movement. PMID:26357426

  8. Exercise-induced pain intensity predicted by pre-exercise fear of pain and pain sensitivity

    PubMed Central

    Bishop, Mark D; Horn, Maggie E; George, Steven Z

    2011-01-01

    Objectives Our primary goals were to determine whether pre-existing fear of pain and pain sensitivity contributed to post-exercise pain intensity. Methods Delayed onset muscle pain was induced in the trunk extensors of 60 healthy volunteers using an exercise paradigm. Levels of fear of pain and experimental pain sensitivity were measured before exercise. Pain intensity in the low back was collected at 24 and 48 hours post-exercise. Participants were grouped based on pain intensity. Group membership was used as the dependent variable in separate regression models for 24 and 48 hours. Predictor variables included fear, pain sensitivity, torque lost during the exercise protocol, and demographic variables. Results The final models predicting whether a participant reported clinically meaningful pain intensity at 24 hours only included baseline fear of pain at each level of pain intensity tested. The final model at 48 hours included average baseline pain sensitivity and the loss of muscle performance during the exercise protocol for one level of pain intensity tested (greater than 35mm out of 100). Discussion Combined, these findings suggest that the initial reports of pain after injury maybe more strongly influenced by fear while the inflammatory process and pain sensitivity may play a larger role for later pain intensity reports. PMID:21415719

  9. 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. ...

  10. Managing Chronic Pain

    MedlinePLUS

    ... may lead to depression. With the help of occupational therapy, people with chronic pain can learn to manage ... distributed without prior written consent. Occupational therapists and occupational therapy assis- tants are trained in helping both adults ...

  11. Managing pain during labor

    MedlinePLUS

    Keep in mind that a plan is just a plan. Be flexible when you are planning for your labor and delivery. ... to have natural childbirth. Later, they change their mind and decide they want pain medicine after all. ...

  12. Mechanism of Cancer Pain

    PubMed Central

    Schmidt, Brian L.; Hamamoto, Darryl T.; Simone, Donald A.; Wilcox, George L.

    2010-01-01

    Ongoing and breakthrough pain is a primary concern for the cancer patient. Although the etiology of cancer pain remains unclear, animal models of cancer pain have allowed investigators to unravel some of the cancer-induced neuropathologic processes that occur in the region of tumor growth and in the dorsal horn of the spinal cord. Within the cancer microenvironment, cancer and immune cells produce and secrete mediators that activate and sensitize primary afferent nociceptors. Pursuant to these peripheral changes, nociceptive secondary neurons in spinal cord exhibit increased spontaneous activity and enhanced responsiveness to three modes of noxious stimulation: heat, cold, and mechanical stimuli. As our understanding of the peripheral and central mechanisms that underlie cancer pain improves, targeted analgesics for the cancer patient will likely follow. PMID:20539035

  13. Complex Regional Pain Syndrome

    MedlinePLUS

    ... NINDS Complex Regional Pain Syndrome Information Page Synonym(s): Reflex Sympathetic Dystrophy Syndrome, Causalgia Condensed from Complex Regional ... Tel: 813-907-2312 Fax: 813-830-7446 Reflex Sympathetic Dystrophy Syndrome Association (RSDSA) P.O. Box ...

  14. Chronic Pelvic Pain

    MedlinePLUS

    ... a specific diagnosis What you should know: The pelvic floor muscles act as a muscular sling that supports ... causes Chronic constipation or diarrhea can lead to pelvic floor dysfunction and pelvic pain can become very debilitating ...

  15. Pain and your emotions

    MedlinePLUS

    ... stress -- are often a result. These feelings and emotions can worsen your back pain. ... you are having a hard time controlling your emotions, talk with your ... medicines to help with your feelings of stress or sadness.

  16. Complex Regional Pain Syndrome

    MedlinePLUS

    ... pain and mild or dramatic changes in skin color, temperature, and/or swelling in the affected area. ... experience constant or intermittent changes in temperature, skin color, and swelling of the affected limb. This is ...

  17. Pain in Bali.

    PubMed

    Rajagopal, M R; Ito, Kurnia

    2015-12-01

    There is a lot of unrelieved pain in developing countries. Here is a story from Bali, Indonesia, about a woman with advanced malignancy, who is in unbelievable agony. Expensive chemotherapy is available to her. But although the necessary medications for relieving her pain are available in hospitals, they do not reach the patient, in her home, or even when she is admitted to the hospital, because of ignorance of the medical profession about pain management and because of unnecessary regulatory restrictions. The woman's pain affects the whole family, endangering the family's income and the future of her children. The intervention of palliative care during part of her life gives her some relief, only for the agony to be repeated by pointless chemotherapy and neglect of the suffering during admission to the hospital. Whatever relief could be given to her was because of the intervention of a volunteer with no schooling in medicine or palliative care. PMID:26654417

  18. Block That Pain!

    MedlinePLUS

    ... combination produces a unique effect, blocking pain-sensing neurons without impairing signals from other cells. In contrast, ... surgical procedures block activity in all types of neurons. This can cause numbness, paralysis, and other nervous ...

  19. Eldercare at Home: Pain

    MedlinePLUS

    ... bookstores. Provide pleasant activities. Being active takes the mind off the pain. Distractions such as pleasant visits with friends and grandchildren should be encouraged. Watching television, reading, and listening to music may also decrease a ...

  20. Treating Low Back Pain

    MedlinePLUS Videos and Cool Tools

    ... health news that matters to you. Related MedlinePlus Health Topics Back Injuries Back Pain About MedlinePlus Site ... Rockville Pike, Bethesda, MD 20894 U.S. Department of Health and Human Services National Institutes of Health Page ...

  1. Employees with Chronic Pain

    MedlinePLUS

    ... but seldom develop all of them. Also, the degree of limitation will vary among individuals. Be aware that not all people with chronic pain will need accommodations to perform their jobs and many others may only need a few ...

  2. Painful menstrual periods

    MedlinePLUS

    ... the uterus or other pelvic organs, such as: Endometriosis Fibroids Intrauterine device (IUD) made of copper Pelvic ... your pain. Surgery may be done to remove endometriosis, cysts, fibroids, scar tissue, or your uterus ( hysterectomy ).

  3. Patellofemoral Pain Syndrome

    MedlinePLUS

    ... basketball. If you want to keep exercising, try swimming or another low-impact activity. You may want ... after activity. This can ease the pain and speed up healing. To keep your hands free, use ...

  4. Migraines: What a Pain!

    MedlinePLUS

    ... like cola drinks) certain foods (cheese, pizza, chocolate, ice cream, fatty or fried food, lunch meats, hot dogs, ... Do Pain Relievers Work? Oooh, Your Aching Head! Ice Cream Headaches Caffeine Confusion Contact Us Print Additional resources ...

  5. PDST: Pain Decision Support Tool

    PubMed Central

    Brixey, Juliana; Gainer, Aaron

    2001-01-01

    Objective: Develop a decision support tool that guides the health care professional in the pain medication process. Background: An increased focus on the need for adequate pain management and the development of national standards was the impetus behind the development of a computerized pain management tool. Design: A rule-based program was used to develop PDST, based on the problem analysis for pain. PDST steps the nurse through the pain medication process and will suggest an appropriate type of pain medication or intervention. Conclusion: This pilot study demonstrates that a decision support program could be adapted to finding a solution to a pain management problem.

  6. Perioperative pain management.

    PubMed

    Pyati, Srinivas; Gan, Tong J

    2007-01-01

    The under-treatment of postoperative pain has been recognised to delay patient recovery and discharge from hospital. Despite recognition of the importance of effective pain control, up to 70% of patients still complain of moderate to severe pain postoperatively. The mechanistic approach to pain management, based on current understanding of the peripheral and central mechanisms involved in nociceptive transmission, provides newer options for clinicians to manage pain effectively. In this article we review the rationale for a multimodal approach with combinations of analgesics from different classes and different sites of analgesic administration. The pharmacological options of commonly used analgesics, such as opioids, NSAIDs, paracetamol, tramadol and other non-opioid analgesics, and their combinations is discussed. These analgesics have been shown to provide effective pain relief and their combinations demonstrate a reduction in opioid consumption. The basis for using non-opioid analgesic adjuvants is to reduce opioid consumption and consequently alleviate opioid-related adverse effects. We review the evidence on the opioid-sparing effect of ketamine, clonidine, gabapentin and other novel analgesics in perioperative pain management. Most available data support the addition of these adjuvants to routine analgesic techniques to reduce the need for opioids and improve quality of analgesia by their synergistic effect. Local anaesthetic infiltration, epidural and other regional techniques are also used successfully to enhance perioperative analgesia after a variety of surgical procedures. The use of continuous perineural techniques that offer prolonged analgesia with local anaesthetic infusion has been extended to the care of patients beyond hospital discharge. The use of nonpharmacological options such as acupuncture, relaxation, music therapy, hypnosis and transcutaneous nerve stimulation as adjuvants to conventional analgesia should be considered and incorporated to achieve an effective and successful perioperative pain management regimen. PMID:17338592

  7. Buprenorphine for chronic pain.

    PubMed

    Calderon, Raul; Copenhaver, David

    2013-12-01

    Questions from patients about pain conditions, analgesic pharmacotherapy and responses from authors are presented to help educate patients and make them more effective self-advocates. The use of transdermal buprenorphine for chronic pain management is discussed. A brief history of the medication is provided. The use of the medication in opioid maintenance, and withdrawal and other concerns are discussed. Possible side effects are described. PMID:24245573

  8. 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

  9. Mechanisms of Myofascial Pain

    PubMed Central

    Jafri, M. Saleet

    2014-01-01

    Myofascial pain syndrome is an important health problem. It affects a majority of the general population, impairs mobility, causes pain, and reduces the overall sense of well-being. Underlying this syndrome is the existence of painful taut bands of muscle that contain discrete, hypersensitive foci called myofascial trigger points. In spite of the significant impact on public health, a clear mechanistic understanding of the disorder does not exist. This is likely due to the complex nature of the disorder which involves the integration of cellular signaling, excitation-contraction coupling, neuromuscular inputs, local circulation, and energy metabolism. The difficulties are further exacerbated by the lack of an animal model for myofascial pain to test mechanistic hypothesis. In this review, current theories for myofascial pain are presented and their relative strengths and weaknesses are discussed. Based on new findings linking mechanoactivation of reactive oxygen species signaling to destabilized calcium signaling, we put forth a novel mechanistic hypothesis for the initiation and maintenance of myofascial trigger points. It is hoped that this lays a new foundation for understanding myofascial pain syndrome and how current therapies work, and gives key insights that will lead to the improvement of therapies for its treatment. PMID:25574501

  10. 13. Sacroiliac joint pain.

    PubMed

    Vanelderen, Pascal; Szadek, Karolina; Cohen, Steven P; De Witte, Jan; Lataster, Arno; Patijn, Jacob; Mekhail, Nagy; van Kleef, Maarten; Van Zundert, Jan

    2010-01-01

    The sacroiliac joint accounts for approximately 16% to 30% of cases of chronic mechanical low back pain. Pain originating in the sacroiliac joint is predominantly perceived in the gluteal region, although pain is often referred into the lower and upper lumbar region, groin, abdomen, and/ or lower limb(s). Because sacroiliac joint pain is difficult to distinguish from other forms of low back pain based on history, different provocative maneuvers have been advocated. Individually, they have weak predictive value, but combined batteries of tests can help ascertain a diagnosis. Radiological imaging is important to exclude "red flags" but contributes little in the diagnosis. Diagnostic blocks are the diagnostic gold standard but must be interpreted with caution, because false-positive as well as false-negative results occur frequently. Treatment of sacroiliac joint pain is best performed in the context of a multidisciplinary approach. Conservative treatments address the underlying causes (posture and gait disturbances) and consist of exercise therapy and manipulation. Intra-articular sacroiliac joint infiltrations with local anesthetic and corticosteroids hold the highest evidence rating (1 B+). If the latter fail or produce only short-term effects, cooled radiofrequency treatment of the lateral branches of S1 to S3 (S4) is recommended (2 B+) if available. When this procedure cannot be used, (pulsed) radiofrequency procedures targeted at L5 dorsal ramus and lateral branches of S1 to S3 may be considered (2 C+). PMID:20667026

  11. [Pain management in dentistry].

    PubMed

    Kandreli, M G; Vadachkoriia, N R; Gumberidze, N Sh; Mandzhavidze, N A

    2013-12-01

    The aim of the study was to determine the most effective dose of Ibuprofen - one of the non-steroidal anti-inflammatory drugs frequently used in dental practice for pain management. According to our observations, Ibuprofen markedly softens and quickly reduces procedural pain in 55 (91.67%) patients and post-procedural pain in 44 (73.33%) patients, reduces the post-procedural need for or the amount of the drug, removes the fear of anesthesia and endodontic treatment; with irreversible pulpits significantly increases the efficiency of the inferior alveolar nerve block by local anesthetics. Our clinical observation of taking ibuprofen pre-procedurally demonstrates its effectiveness not only as a means for the relief of pain episodes, but also as an excellent anti-inflammatory treatment for chronic toothache Based on our research, the appointment of non-steroidal anti-inflammatory drugs before dental interventions, in this case - Ibuprofen turned out to be the key to the success of effective pain management. We suggest that administration of analgesics in order to relieve and effectively pre-empt pain before, during or after treatment should start before surgery and furthermore, this treatment should be extended into the postoperative period. Premedication with ibuprofen significantly increased the success rates of inferior alveolar nerve block anesthesia in teeth with irreversible pulpitis. PMID:24423675

  12. Impact of early developmental fluoride exposure on the peripheral pain sensitivity in mice.

    PubMed

    Ma, Jing; Liu, Fei; Liu, Peng; Dong, Ying-Ying; Chu, Zheng; Hou, Tie-Zhou; Dang, Yong-Hui

    2015-12-01

    Consumption of high concentration of fluoride in the drinking water would cause the fluorosis and chronic pain. Similar pain syndrome appeared in the patients in fluoride therapy of osteoporotic. The aim of the current study was to examine whether exposing immature mice to fluoride would modify the peripheral pain sensitivity or even cause a pain syndrome. We gave developmental fluoride exposure to mice in different concentration (0mg/L, 50mg/L and 100mg/L) and evaluated their basal pain threshold. Von Frey hair test, hot plate test and formalin test were conducted to examine the mechanical, thermal nociceptive threshold and inflammatory pain, respectively. In addition, the expression of hippocampal brain-derived neurotrophic factor (BDNF) was also evaluated by Western blotting. Hyperalgesia in fluoride exposure mice was exhibited in the Von Frey hair test, hot plate test and formalin test. Meanwhile, the expression of BDNF was significantly higher than that of control group. The results suggest that early developmental fluoride exposure may lower the basal pain threshold and be associated with the increasing of BDNF expression in hippocampus. PMID:26431775

  13. Spinal cord stimulation for treatment of pain in a patient with post thoracotomy pain syndrome.

    PubMed

    Graybill, Jordan; Conermann, Till; Kabazie, Abraham J; Chandy, Sunil

    2011-01-01

    Post Thoracotomy Pain Syndrome (PTPS) is defined as pain that occurs or persists in the area of the thoracotomy incision for at least 2 months following the initial procedure.  The true incidence of PTPS is hard to define as literature reports a wide range of occurrence from 5% to 90%.  Thoracotomy is associated with a high risk of severe chronic postoperative pain.  Presenting symptoms include both neuropathic pain in the area of the incision, as well as myofascial pain commonly in the ipsilateral scapula and shoulder.  Pain management can be challenging in these patients.  Multiple treatments have been described including conservative treatments with oral nonsteroidal anti-inflammatory drugs (NSAIDs); topically applied, peripherally acting drugs; neuromodulating agents; physical therapy; transcutaneous electrical nerve stimulation as well as more invasive treatments including intercostal nerve blocks, trigger point steroid injections, epidural steroid injections, radiofrequency nerve ablation, cryoablation, and one case report of spinal cord stimulation.  Unfortunately, a portion of these patients will have persistent pain in spite of multiple treatment modalities, and in some cases will experience worsening of pain. This case report describes the novel utility and complete resolution of symptoms with spinal cord stimulation (SCS) in treatment of a patient with persistent PTPS. In the operating room, a percutaneous octet electrode lead was placed using sterile technique under fluoroscopic guidance and loss-of-resistance technique.  The octet electrode lead was subsequently advanced with the aid of fluoroscopy to the level of the T3 superior endplate just right of midline.  The patient's pain distribution was captured optimally with stimulation at this level.  With the assistance of a neurosurgeon, the lead was anchored, tunneled, and connected to a generator, which was implanted over the right iliac crest.  The patient tolerated the procedure well with no complications. We report the successful use of SCS as well as complete resolution of symptoms at 4 months follow-up, in a patient with persistent PTPS, which was resistant to other modalities. In conclusion, studies designed to evaluate the effectiveness of SCS for PTPS may be warranted. PMID:21927048

  14. 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

  15. Serotonin noradrenaline reuptake inhibitors: New hope for the treatment of chronic pain.

    PubMed

    Delgado, Pedro L

    2006-01-01

    Depression and painful symptoms occur frequently together. Over 75% of depressed patients report painful symptoms such as headache, stomach pain, neck and back pain as well as non-specific generalized pain. In addition, World Health Organization data have shown that primary care patients with chronic pain have a four fold greater risk of becoming depressed than pain-free patients. Increasingly, pain is considered as an integral symptom of depression and there evidence to suggest that pain and depression may arise from a common neurobiological dysfunction. Serotonergic cell bodies, in the raphe nucleus, and noradrenergic cell bodies in the locus coeruleus send projections to various parts of the brain, where they are involved in the control of mood, movement, cognitive functioning and emotions. In addition both serotonergic and noradrenergic neurons project to the spinal cord. These descending pathways serve to inhibit input from the intestines, skeletal muscles and other sensory inputs. Usually, these inhibitory effects are modest, but in times of stress, in the interest of the survival of the individual, they can completely inhibit the input from painful stimuli. A dysfunction of the serotonergic and noradrenergic neurons can thus affect both the ascending and descending pathways resulting in the psychological symptoms of depression and somatic pain symptoms such as chronic pain, fibromyalgia, non-cardiac chest pain, or irritable bowel syndrome. In view of this, it is not surprising that tricyclic antidepressants have been a standard treatment of chronic pain for many years. In contrast and in spite of their improved tolerance, selective serotonin reuptake inhibitors do not appear to be particularly effective in the treatment of pain. Recently, a number of open and controlled trials with selective serotonin and noradrenaline reuptake inhibitors such as venlafaxine, milnacipran and duloxetine, suggest that these compounds may be more effective in relieving pain than selective inhibitors of serotonin reuptake. Wherever valid comparisons have been made the newer dual action drugs appear to be as effective as the tricyclic and considerably better tolerated. Dual action antidepressants may thus soon become the new standard treatment of chronic pain whether it is associated with depression or not. In addition, these agents may also have a role in modulating neurogenesis and other neuroplastic changes in the central nervous system, thereby leading to more complete recovery in patients suffering from the symptoms of depression or chronic pain. PMID:24921678

  16. 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

  17. Learning foraging thresholds for lizards

    SciTech Connect

    Goldberg, L.A.; Hart, W.E.; Wilson, D.B.

    1996-01-12

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

  18. The emergence of adolescent onset pain hypersensitivity following neonatal nerve injury

    PubMed Central

    2012-01-01

    Background Peripheral nerve injuries can trigger neuropathic pain in adults but cause little or no pain when they are sustained in infancy or early childhood. This is confirmed in rodent models where neonatal nerve injury causes no pain behaviour. However, delayed pain can arise in man some considerable time after nerve damage and to examine this following early life nerve injury we have carried out a longer term follow up of rat pain behaviour into adolescence and adulthood. Results Spared nerve injury (SNI) or sham surgery was performed on 10 day old (P10) rat pups and mechanical nociceptive reflex thresholds were analysed 3, 7, 14, 21, 28, 38 and 44 days post surgery. While mechanical thresholds on the ipsilateral side are not significantly different from controls for the first 2–3 weeks post P10 surgery, after that time period, beginning at 21 days post surgery (P31), the SNI group developed following early life nerve injury significant hypersensitivity compared to the other groups. Ipsilateral mechanical nociceptive threshold was 2-fold below that of the contralateral and sham thresholds at 21 days post surgery (SNI-ipsilateral 28 (±5) g control groups 69 (±9) g, p < 0.001, 3-way ANOVA, n = 6 per group). Importantly, no effect was observed on thermal thresholds. This hypersensivity was accompanied by macrophage, microglial and astrocyte activation in the DRG and dorsal horn, but no significant change in dorsal horn p38 or JNK expression. Preemptive minocycline (daily 40 mg/kg, s.c) did not prevent the effect. Ketamine (20 mg/kg, s.c), on the other hand, produced a dose-dependent reversal of mechanical nociceptive thresholds ipsilateral to the nerve injury such that thresholds return to control levels at the highest doses of 20 mg/Kg. Conclusions We report a novel consequence of early life nerve injury whereby mechanical hypersensitivity only emerges later in life. This delayed adolescent onset in mechanical pain thresholds is accompanied by neuroimmune activation and NMDA dependent central sensitization of spinal nociceptive circuits. This delayed onset in mechanical pain sensitivity may provide clues to understand the long term effects of early injury such as late onset phantom pain and the emergence of complex adolescent chronic pain syndromes. PMID:22531549

  19. 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

  20. 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

  1. "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.

  2. 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

  3. Topical therapies in the management of chronic pain.

    PubMed

    Stanos, Steven P; Galluzzi, Katherine E

    2013-07-01

    Chronic pain, whether localized or generalized, is a widespread, often debilitating condition affecting > 25% of adults in the United States. Oral agents are the cornerstone of chronic pain treatment, but their use may be limited in certain patients, particularly the elderly. Topical therapies offer advantages over systemically administered medications, including the requirement of a lower total systemic daily dose for patients to achieve pain relief, site-specific drug delivery, and avoidance of first-pass metabolism, major drug interactions, infections, and systemic side effects. Several types of topical agents have been shown to be useful in the treatment of patients with chronic pain. Both capsaicin and topical diclofenac have been shown to be effective in the treatment of patients with chronic soft-tissue pain. In patients with hand and knee osteoarthritis (OA), the American College of Rheumatology generally recommends oral treatments (acetaminophen, oral nonsteroidal anti-inflammatory drugs [NSAIDs], tramadol, and intra-articular corticosteroids) and topical NSAIDs equally, favoring topical agents only for patients who have pre-existing gastrointestinal risk or are aged ? 75 years. Topical NSAIDs have been shown to provide relief superior to that of placebo and comparable to that of oral ibuprofen. Similarly, ketoprofen gel has been shown to be superior to placebo and similar to oral celecoxib in reducing pain in patients with knee OA. Different formulations of topical diclofenac (including the diclofenac hydroxyethyl pyrrolidine patch, diclofenac sodium gel, and diclofenac sodium topical solution 1.5% w/w with dimethyl sulfoxide USP) have been shown to be superior to placebo and comparable to oral diclofenac in the treatment of patients with pain due to knee OA, with a lower incidence of gastrointestinal complaints than with the oral formulation. In patients with neuropathic pain, topical forms of both capsaicin and lidocaine have been shown to be useful in the treatment of postherpetic neuralgia and diabetic peripheral neuropathic pain. Lidocaine has also demonstrated efficacy in relieving patient pain due to complex regional pain syndrome and may be useful in the treatment of patients with neuropathic pain who have cancer, although clinical trial results have not been consistent. Data suggest that topical therapies may offer a safe, well-tolerated, and effective alternative to systemic therapies in the treatment of patients with chronic, localized musculoskeletal and neuropathic pain. PMID:24547601

  4. Morphine modifies the cingulate-operculum network underlying painful rectal evoked potentials.

    PubMed

    Lelic, D; Olesen, A E; Gregersen, H; Dahan, A; Kolesnikov, Y; Drewes, A M

    2014-02-01

    The effect of opioids on brain networks underlying rectal evoked potentials (EPs) has never been investigated. This study utilized brain source connectivity to explore whether morphine induced changes in brain networks underlying painful rectal EPs would reflect changes in pain scores due to morphine. Twenty healthy volunteers were included in this placebo-controlled cross-over study. Sensory and pain thresholds to electrically induced rectal stimulation were taken before (baseline) and 70 min after placebo/morphine (30 mg) administration. The stimulation intensity required to evoke moderate pain at baseline was employed for EPs. The pain score of this stimulation intensity was recorded again 70 min after placebo/morphine administration. 62-channel EPs were recorded for both arms. Amplitudes and latencies were analysed and brain source connectivity analysis was done. Changes in any of the parameters describing EPs were correlated to changes in subjective pain ratings. Morphine increased sensory and pain thresholds by 28.8% and 27.5% (P ? 0.02). The pain score corresponding to moderate pain at baseline was attenuated in both placebo and morphine arms by 14.5% and 37.5% (P < 0.05). There was a 33.9% reduction in EP amplitudes due to placebo (P < 0.05), whereas EP amplitudes remained stable due to morphine. A dominating cingulate-operculum network to rectal pain was seen. Cingulate source shifted anteriorly in the morphine arm (P < 0.001) and this shift was positively correlated to the change in the pain score (r = 0.6, P < 0.05). These findings indicate that visceral pain relief due to morphine is associated with reorganization within cingulate cortex, which may be used as a biomarker of opioid effects. PMID:24184388

  5. 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

  6. Sweet Taste and Menthol Increase Cough Reflex Thresholds

    PubMed Central

    Wise, Paul M.; Breslin, Paul A.S.; Dalton, Pamela

    2015-01-01

    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

  7. Hepatitis C: Managing Pain

    MedlinePLUS

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  8. 15. Amygdala pain mechanisms

    PubMed Central

    Neugebauer, Volker

    2015-01-01

    A limbic brain area the amygdala plays a key role in emotional responses and affective states and disorders such as learned fear, anxiety and depression. The amygdala has also emerged as an important brain center for the emotional-affective dimension of pain and for pain modulation. Hyperactivity in the laterocapsular division of the central nucleus of the amygdala (CeLC, also termed the “nociceptive amygdala”) accounts for pain-related emotional responses and anxiety-like behavior. Abnormally enhanced output from the CeLC is the consequence of an imbalance between excitatory and inhibitory mechanisms. Impaired inhibitory control mediated by a cluster of GABAergic interneurons in the intercalated cell masses (ITC) allows the development of glutamate- and neuropeptide-driven synaptic plasticity of excitatory inputs from the brainstem (parabrachial area) and from the lateral-basolateral amygdala network (LA-BLA, site of integration of polymodal sensory information). BLA hyperactivity also generates abnormally enhanced feedforward inhibition of principal cells in the medial prefrontal cortex (mPFC), a limbic cortical area that is strongly interconnected with the amygdala. Pain-related mPFC deactivation results in cognitive deficits and failure to engage cortically driven ITC-mediated inhibitory control of amygdala processing. Impaired cortical control allows the uncontrolled persistence of amygdala pain mechanisms. PMID:25846623

  9. Ocular neuropathic pain.

    PubMed

    Rosenthal, Perry; Borsook, David

    2016-01-01

    As the biological alarm of impending or actual tissue damage, pain is essential for our survival. However, when it is initiated and/or sustained by dysfunctional elements in the nociceptive system, it is itself a disease known as neuropathic pain. While the critical nociceptive system provides a number of protective functions, it is unique in its central role of monitoring, preserving and restoring the optical tear film in the face of evaporative attrition without which our vision would be non-functional. Meeting this existential need resulted in the evolution of the highly complex, powerful and sensitive dry eye alarm system integrated in the peripheral and central trigeminal sensory network. The clinical consequences of corneal damage to these nociceptive pathways are determined by the type and location of its pathological elements and can range from the spectrum known as dry eye disease to the centalised oculofacial neuropathic pain syndrome characterised by a striking disparity between the high intensity of symptoms and paucity of external signs. These changes parallel those observed in somatic neuropathic pain. When seen through the neuroscience lens, diseases responsible for inadequately explained chronic eye pain (including those described as dry eye) can take on new meanings that may clarify long-standing enigmas and point to new approaches for developing preventive, symptomatic and disease-modifying interventions for these currently refractory disorders. PMID:25943558

  10. Probabilistic Threshold Criterion

    SciTech Connect

    Gresshoff, M; Hrousis, C A

    2010-03-09

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

  11. Threshold Concepts and Information Literacy

    ERIC Educational Resources Information Center

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

    2011-01-01

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

  12. 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…

  13. 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.…

  14. 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

  15. Abnormal brain processing of cutaneous pain in migraine patients during the attack.

    PubMed

    de Tommaso, Marina; Guido, Marco; Libro, Giuseppe; Losito, Luciana; Sciruicchio, Vittorio; Monetti, Carlo; Puca, Francomichele

    2002-11-15

    We examined cutaneous pain thresholds using CO(2) laser stimuli during migraine attacks, and defined the evoked cortical potential characteristics. Ten patients without aura were studied during attacks and for at least 72 h subsequently. Pain stimuli were generated on the dorsum of both hands and the right and left supraorbital zones, using pulses from a CO(2) laser. Absolute latencies of scalp potentials were measured at the highest peak of each response component, and the peak-to-peak amplitudes of N2a-P2 components were recorded. Cutaneous pain thresholds were significantly reduced on both the symptomatic and non-symptomatic sides during the attack, in comparison with the headache-free phase. The N2a-P2 complexes also increased in amplitude during attacks in comparison with the pain-free side. Thus, cutaneous hyperalgesia occurs during migraine attack, and is subtended by central sensitization phenomena, probably involving the cortex. PMID:12401553

  16. Pain Symptomatology and Pain Medication Use in Civilian PTSD

    PubMed Central

    Phifer, Justine; Skelton, Kelly; Weiss, Tamara; Schwartz, Ann; Wingo, Aliza; Gillespie, Charles F.; Sands, Lauren; Sayyar, Saleem; Bradley, Bekh; Jovanovic, Tanja; Ressler, Kerry

    2011-01-01

    The comorbidity of pain syndromes and trauma related syndromes has been shown to be high. However, there have been limited data, especially in civilian medical populations, on the role of trauma related disorders such as Post Traumatic Stress Disorder (PTSD) on chronic pain and pain medication use. We analyzed 647 general hospital patients in primary care and obstetrics and gynecological waiting rooms for the experience of trauma and PTSD related stress disorders. PTSD symptoms were found to be significantly positively correlated with pain ratings (r=.282, p<.001) and pain related function impairment (r=.303, p<.001). Those with a current PTSD diagnosis had significantly higher subjective pain and pain related-impairment ratings than those with no PTSD. Furthermore, those with a current diagnosis of PTSD were significantly more likely to have used opioid analgesics for pain control compared to those without a diagnosis of PTSD (?2=8.98, p=.011). When analyzing the separate PTSD symptom subclusters, (re-experiencing, avoidance and hyper-arousal), all symptom clusters were significantly related to pain and pain-related impairment ratings, but only the avoidance cluster was significantly related to prior opioid pain medication use. We conclude that PTSD and trauma-related disorders are common in impoverished medical populations and that their presence should be examined in patients with pain syndromes. Furthermore, these data suggest that PTSD and pain may share a vulnerability pathway including the endogenous opioid neurotransmission systems. PMID:21665366

  17. Cognitive behavioral therapy for back pain

    MedlinePLUS

    Cognitive behavioral therapy (CBT) can help many people deal with chronic back pain. ... Nonspecific back pain - cognitive behavioral; Backache - chronic - ... - back - chronic - cognitive behavioral; Chronic back pain - low - ...

  18. Pain pharmacology: focus on opioids

    PubMed Central

    Fornasari, Diego

    2014-01-01

    Summary The incidence of chronic pain is estimated to be 20–25% worldwide. Although major improvements in pain control have been obtained, more than 50% of the patients reports inadequate relief. It is accepted that chronic pain, if not adequately and rapidly treated, can become a disease in itself, often intractable and maybe irreversible. This is mainly due to neuroplasticity of pain pathways. In the present review I will discuss about pain depicting the rational for the principal pharmacological interventions and finally focusing on opioids, that represent a primary class of drug to treat pain. PMID:25568646

  19. Pain and immunity.

    PubMed

    Guillot, Xavier; Semerano, Luca; Decker, Patrice; Falgarone, Géraldine; Boissier, Marie-Christophe

    2012-05-01

    Chronic neuropathic and inflammatory pain is a major public health problem. Nociceptors undergo sensitization, first in peripheral tissues then in the central nervous sytem, via neuroimmune interactions linking neurons, glial cells (microglia and astrocytes), and immune cells. These interactions may either exacerbate or attenuate the pain and inflammation, which normally reach a state of equilibrium. With more powerful or longer lasting stimuli, specific profiles of microglial and, subsequently, astrocytic activation in the dorsal horn play a key role in neuronal plasticity and transition to chronic pain. Recent insights into the interactions between the nervous system and the immune system suggest a large number of potential therapeutic targets that could be influenced either by targeted inhibition or by directing the neuroimmune response toward the antiinflammatory and analgesic end of its spectrum. PMID:22119349

  20. Lumbar facet injection for the treatment of chronic piriformis myofascial pain syndrome: 52 case studies

    PubMed Central

    Huang, Jen-Ting; Chen, Han-Yu; Hong, Chang-Zern; Lin, Ming-Ta; Chou, Li-Wei; Chen, Hsin-Shui; Tsai, Chien-Tsung; Chang, Wen-Dien

    2014-01-01

    Background and aims The aim of this study was to demonstrate the effectiveness of lumbar facet joint injection for piriformis myofascial pain syndrome. Methods Fifty-two patients with chronic myofascial pain in the piriformis muscle each received a lumbar facet injection into the ipsilateral L5–S1 facet joint region, using the multiple insertion technique. Subjective pain intensity, trunk extension range, and lumbar facet signs were measured before, immediately after, and 2 weeks after injection. Thirty-six patients received follow-up for 6 months. Results Immediately after the injection, 27 patients (51.9%) had complete pain subsidence, 19 patients (36.5%) had pain reduction to a tolerable level, and only 6 patients (11.5%) had no pain relief to a tolerable level. Mean pain intensity was reduced from 7.4±0.9 to 1.6±2.1 after injection (P<0.01). This effectiveness lasted for 2 weeks in 49 patients (94.2%), and lasted for approximately 6 months in 35 (97.2%) of 36 patients. The mean range of motion increased from 13.4±6.8 degrees to 22.1±6.0 degrees immediately after injection, and further increased 2 weeks and 6 months later. Immediately after injection, 45 patients (86.5%) had no facet sign. In addition, 90.4% and 94.4% of patients had no facet sign after 2 weeks and after 6 months, respectively. Conclusions It is important to identify the possible cause of piriformis myofascial pain syndrome. If this pain is related to lumbar facet lesions, lumbar facet joint injection can immediately suppress piriformis myofascial pain symptoms. This effectiveness may last for at least 6 months in most patients. This study further supports the importance of eliminating the underlying etiological lesion for complete and effective relief of myofascial pain syndrome. PMID:25170256

  1. 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

  2. Effects of context and individual predispositions on hypervigilance to pain-cues: an ERP study

    PubMed Central

    Dittmar, Oliver; Baum, Corinna; Schneider, Raphaela; Lautenbacher, Stefan

    2015-01-01

    Background Hypervigilance to pain is the automatic prioritization of pain-related compared with other stimuli. The processing of threat information is influenced by negative contexts. Therefore, we intended to explore such context effects on hypervigilance to pain-cues, taking individual differences in self-reported vigilance to pain into consideration. Methods In all, 110 healthy subjects viewed task-irrelevant emotional facial expressions (anger, happy, neutral, and pain) overlaid in half of the trials with a fine grid. The instructed task was to indicate the presence/absence of this grid. A threatening context was established by applying electrical stimuli slightly below pain-threshold. Using scores of Pain Vigilance and Awareness Questionnaire, the sample was divided into high vs low pain vigilant subjects. Reaction times and event-related brain potentials were recorded. Results No distinct attentional processing of pain faces (based on the event-related brain potentials) was observed as a function of high levels of self-reported vigilance to pain and contextual threat induction. High pain vigilant subjects showed generally enhanced processing of emotional and neutral faces as indicated by parameters of early (early posterior negativity) and late (late positive complex) processing stages. This enhancement was abolished when electro-stimuli were presented. Conclusion Contextual threat does not enhance the attentional capture of pain-cues when they are presented concurrently with competing task demands. The study could, however, replicate a generally enhanced attentional processing of emotional cues in high pain vigilant subjects. This underpins that hypervigilance to pain is related to changes in emotional processing. PMID:26316802

  3. Back Pain Patients Seek Pain Relief First, Mobility Second

    MedlinePLUS

    ... gov/medlineplus/news/fullstory_154732.html Back Pain Patients Seek Pain Relief First, Mobility Second Nearly 80 percent of patients chose easing discomfort over greater movement, research shows ...

  4. [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

  5. Intravesical chondroitin sulphate for interstitial cystitis/painful bladder syndrome

    PubMed Central

    Hennessy, DB; Curry, D; Cartwright, C; Downey, P; Pahuja, A

    2015-01-01

    Introduction Interstitial cystitis/painful bladder syndrome (IC/PBS) is a chronic inflammatory condition of the bladder. Bladder instillation is one avenue of treatment but evidence for its effectiveness is limited. Chondroitin sulphate solution 2.0% (Urocyst) is a glycosaminoglycan (GAG) replenishment therapy instilled for patients with IC/PBS. We assessed its effectiveness for treating IC/PBS in Northern Ireland. Methods Patients with IC/PBS were assessed with the O'Leary-Sant interstitial cystitis index score and global response assessment questionnaire prior to commencing treatment. Assessment with these questionnaires was performed after 6 treatments (10 weeks) and again after 10 treatments (24 weeks). Assessment end points were pain, urgency, symptom score and problem score. Results Data was collected on 10 patients, 9 female and 1 male. 6 patients had failed RIMSO-50 dimethyl sulphoxide (DMSO) 50% treatment prior. At baseline the mean pain score was 6.6, urgency score 7.00, symptom score 13.5 and problem score 12.5. After 24 weeks the mean pain score fell to 2.0, urgency score to 1.80, symptom score to 6.89 and problem score to 5.67. At 10 weeks the global response to treatment was 100%. Nocturia was the first symptom to improve with urgency and pain following. No side effects were noted during instillation and all patients tolerated the treatments. Conclusion IC/PBS is a difficult disease to treat. It requires a multimodal approach. We found that intravesical chondroitin sulphate reduced pain, urgency and O'Leary-Sant symptom and problem scores in patients with IC/PBS. All patients tolerated the treatment and no side effects were reported. PMID:26668417

  6. Pain Management: Part 1: Managing Acute and Postoperative Dental Pain

    PubMed Central

    Becker, Daniel E.

    2010-01-01

    Abstract Safe and effective management of acute dental pain can be accomplished with nonopioid and opioid analgesics. To formulate regimens properly, it is essential to appreciate basic pharmacological principles and appropriate dosage strategies for each of the available analgesic classes. This article will review the basic pharmacology of analgesic drug classes, including their relative efficacy for dental pain, and will suggest appropriate regimens based on pain intensity. Management of chronic pain will be addressed in the second part of this series. PMID:20553137

  7. Emotional pain without sensory pain--dream on?

    PubMed

    Borsook, David; Becerra, Lino

    2009-01-29

    The article by Danziger and colleagues in this issue of Neuron evaluates empathy in a unique population--individuals with congenital insensitivity to pain. As such, it provides insights into the brain's ability to evaluate others' feeling to observed pain without having a specific sensory experience of pain itself. PMID:19186157

  8. [Empathy for pain: A novel bio-psychosocial-behavioral laboratory animal model].

    PubMed

    Chen, Jun; Li, Zhen; Lv, Yun-Fei; Li, Chun-Li; Wang, Yan; Wang, Rui-Rui; Geng, Kai-Wen; He, Ting

    2015-12-25

    Empathy, a basic prosocial behavior, is referred to as an ability to understand and share others' emotional state. Generally, empathy is also a social-behavioral basis of altruism. In contrast, impairment of empathy development may be associated with autism, narcissism, alexithymia, personality disorder, schizophrenia and depression. Thus, study of the brain mechanisms of empathy has great importance to not only scientific and clinical advances but also social harmony. However, research on empathy has long been avoided due to the fact that it has been considered as a distinct feature of human beings from animals, leading to paucity of knowledge in the field. In 2006, a Canadian group from McGill University found that a mouse in pain could be shared by its paired cagemate, but not a paired stranger, showing decreased pain threshold and increased pain responses through emotional contagion while they were socially interacting. In 2014, we further found that a rat in pain could also be shared by its paired cagemate 30 min after social interaction, showing long-term decreased pain threshold and increased pain responses, suggesting persistence of empathy for pain (empathic memory). We also mapped out that the medial prefrontal cortex, including the anterior cingulate cortex, prelimbic cortex and infralimbic cortex, is involved in empathy for pain in rats, suggesting that a neural network may be associated with development of pain empathy in the CNS. In the present brief review, we give a brief outline of the advances and challenges in study of empathy for pain in humans and animals, and try to provide a novel bio-psychosocial-behavioral model for study of pain and its emotional comorbidity using laboratory animals. PMID:26701631

  9. Sex differences in the relationships between parasympathetic activity and pain modulation.

    PubMed

    Nahman-Averbuch, Hadas; Dayan, Lior; Sprecher, Elliot; Hochberg, Uri; Brill, Silviu; Yarnitsky, David; Jacob, Giris

    2016-02-01

    Higher parasympathetic activity is related to lower pain perception in healthy subjects and pain patients. We aimed to examine whether this relationship depends on sex, in healthy subjects. Parasympathetic activity was assessed using time- and frequency-domain heart rate variability indices and deep breathing ratio. Pain perception parameters, consisting of heat pain thresholds and pain ratings of supra-thresholds stimuli, as well as pain modulation parameters of mechanical temporal summation, pain adaptation, offset analgesia and conditioned pain modulation (CPM) response were examined. Forty healthy subjects were examined (20 men). Women demonstrated higher parasympathetic activity compared to men (high frequency power of 0.55±0.2 and 0.40±0.2, respectively, p=0.02) and less pain reduction in the offset analgesia paradigm (-35.4±29.1 and -55.0±31.2, respectively, p=0.046). Separate slopes models analyses revealed sex differences such that a significant negative correlation was observed between higher rMSSD (the root mean square of successive differences) and higher pain adaptation in men (r=-0.649, p=0.003) but not in women (r=0.382, p=0.106). Similarly, a significant negative correlation was found between higher rMSSD and higher efficiency of the CPM response in men (r=-0.510, p=0.026) but not in women (r=0.406, p=0.085). Sex hormones levels, psychological factors or baseline autonomic activity can be possible explanations for these sex differences. Future autonomic interventions destined to change pain modulation should consider sex as an important intervening factor. PMID:26556539

  10. 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.

  11. 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

  12. Vertebroplasty for Spine Fracture Pain

    MedlinePLUS

    MENU Return to Web version Vertebroplasty for Spine Fracture Pain Vertebroplasty for Spine Fracture Pain More than 40 million people in the ... bones that puts them at risk for spine fractures (broken bones). Thinning of the bones can occur ...

  13. How Is Pelvic Pain Diagnosed?

    MedlinePLUS

    ... mechanisms Peer Review Review of the scientific & technical merit of grant applications Contacts for NICHD Funding Information ... her pain can help her health care provider figure out the pain type and what might be ...

  14. Cognitive hypnotherapy for pain management.

    PubMed

    Elkins, Gary; Johnson, Aimee; Fisher, William

    2012-04-01

    Pain is a serious health care problem and there is growing evidence to support the use of hypnosis and cognitive-behavioral interventions for pain management. This article reviews clinical techniques and methods of cognitive hypnotherapy for pain management. Current research with emphasis given to randomized, controlled trials is presented and the efficacy of hypnotherapy for pain management is discussed. Evidence for cognitive hypnotherapy in the treatment in chronic pain, cancer, osteoarthritis, sickle cell disease, temporomandibular disorder, fibromyalgia, non-cardiac chest pain, and disability related chronic pains are identified. Implications for clinical practice and research are discussed in light of the accumulating evidence in support of the efficacy and effectiveness of cognitive hypnotherapy for pain management. PMID:22655332

  15. Functional Abdominal Pain in Children

    MedlinePLUS

    ... functional pain. Your doctor will also follow your child to see if any changes take place which would suggest a different problem. Functional Abdominal Pain in Children NASPGHAN • PO Box 6 • Flourtown, PA 19031 • 215-233-0808 • ...

  16. Acid tolerance in amphibians

    SciTech Connect

    Pierce, B.A.

    1985-04-01

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

  17. Pain Management Following Spinal Cord Injury

    MedlinePLUS

    ... of nerve root pain that is but an effective pain management program can lessen described as a burning feeling ... an increased loss of sensory and motor function. effective pain management program depends on the type of pain you ...

  18. 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 ...

  19. Abdominal pain - children under age 12

    MedlinePLUS

    Stomach pain in children; Pain - abdomen - children; Abdominal cramps in children; Belly ache in children ... When your child complains of abdominal pain, see if they can describe it to you. Here are different kinds of pain: ...

  20. 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.

  1. Effects of Laughter on Discomfort Thresholds.

    ERIC Educational Resources Information Center

    Cogan, Rosemary; Waltz, William

    Pain is affected by a variety of motivational and affective variables, such as relaxation, social modeling, and social support. Norman Cousins has proposed that laughter is a particularly effective pain antagonist. To compare the effects of laughter on pain sensitivity with the effects of relaxation (a variable known to reduce pain sensitivty),…

  2. The Neuromodulation of Neuropathic Pain by Measuring Pain Response Rate and Pain Response Duration in Animal

    PubMed Central

    Kim, Jinhyung; Lee, Sung Eun; Shin, Jaewoo; Jung, Hyun Ho; Kim, Sung June

    2015-01-01

    Objective Neuropathic pain causes patients feel indescribable pain. Deep Brain Stimulation (DBS) is one of the treatment methods in neuropathic pain but the action mechanism is still unclear. To study the effect and mechanism of analgesic effects from DBS in neuropathic pain and to enhance the analgesic effect of DBS, we stimulated the ventral posterolateral nucleus (VPL) in rats. Methods To observe the effect from VPL stimulation, we established 3 groups : normal group (Normal group), neuropathic pain group (Pain group) and neuropathic pain+DBS group (DBS group). Rats in DBS group subjected to electrical stimulation and the target is VPL. Results We observed the behavioral changes by DBS in VPL (VPL-DBS) on neuropathic pain rats. In our study, the pain score which is by conventional test method was effectively decreased. In specific, the time of showing withdrawal response from painful stimulation which is not used measuring method in our animal model was also decreased by DBS. Conclusion The VPL is an effective target on pain modulation. Specifically we could demonstrate changes of pain response duration which is not used, and it was also significantly meaningful. We thought that this study would be helpful in understanding the relation between VPL-DBS and neuropathic pain. PMID:25674337

  3. Complex regional pain syndrome

    PubMed Central

    Palmer, Greta

    2015-01-01

    SUMMARY Complex regional pain syndrome is an uncommon chronic pain condition. It develops spontaneously or following an injury. The features are limb pain, allodynia, hypersensitivity, hyperalgesia, abnormalities of the vasomotor, sudomotor and motor systems, and trophic changes, with reduced use of the affected limb. The diagnosis is clinical and one of exclusion. The emphasis of therapy is graded rehabilitation and movement of the limb with physiotherapy and occupational therapy. Psychological therapies should be offered if a patient is making no or slow progress in the acute phase, and to all patients in the chronic phase as depression can occur. The goal of pharmacotherapy is to assist functional improvement. The early phase may be managed with simple analgesia. Antineuropathic drugs including tricyclic antidepressants and antiepileptic drugs may be added. Other treatments with some evidence of effectiveness include corticosteroids, calcitonin and bisphosphonates. Vitamin C has been used for primary prevention after wrist fracture and upper and lower limb surgery. There is no evidence that it is effective for treating established complex regional pain syndrome. PMID:26648626

  4. Pain Management Programs

    MedlinePLUS

    ... things: Qualities of a Well-Functioning Interdisciplinary Pain Team Share the same beliefs and mission The program is patient and family centered Work together for common, agreed upon goals Develop treatment plans based on ... communication between primary provider and team members ...

  5. Pain in childbirth.

    PubMed Central

    Kitzinger, S

    1978-01-01

    Sheila Kitzinger describes pain and its control throughout the various stages of childbirth. She stresses the value of antenatal preparation as well as the need for a supportive environment during the labour stages. All concerned--the porspective parents, doctors, midwives and any other personnel in a maternity unit should be educated to be able to provide such an environment. PMID:357724

  6. Scalp pain and hyperlipidaemia.

    PubMed

    Aravindan, P D; Lloyd-Mostyn, R H

    2000-09-01

    Acute pancreatitis and eruptive xanthomata are the only recognised direct complications of severe hypertriglyceridaemia, although peripheral neuropathy has been described in patients with hyperlipidaemia. We describe a patient with mixed hyperlipidaemia presenting with severe scalp pain and eruptive xanthomata. Both resolved with treatment. We suspect that high triglyceride concentration can affect the function of sensory nerve fibres. PMID:11070577

  7. American Chronic Pain Association

    MedlinePLUS

    ... 2015 *NEW* Veterans In Pain Events Events for December 2015: View All Events Su M Tu W Th ... Next Week 12/1/2015 SAVE THE DATE - December 1, 2015 #GivingTuesday 12/5/2015 American Headache Society Comprehensive ...

  8. Complex regional pain syndrome.

    PubMed

    Bruehl, Stephen

    2015-01-01

    Complex regional pain syndrome is a chronic pain condition characterized by autonomic and inflammatory features. It occurs acutely in about 7% of patients who have limb fractures, limb surgery, or other injuries. Many cases resolve within the first year, with a smaller subset progressing to the chronic form. This transition is often paralleled by a change from "warm complex regional pain syndrome," with inflammatory characteristics dominant, to "cold complex regional pain syndrome" in which autonomic features dominate. Multiple peripheral and central mechanisms seem to be involved, the relative contributions of which may differ between individuals and over time. Possible contributors include peripheral and central sensitization, autonomic changes and sympatho-afferent coupling, inflammatory and immune alterations, brain changes, and genetic and psychological factors. The syndrome is diagnosed purely on the basis of clinical signs and symptoms. Effective management of the chronic form of the syndrome is often challenging. Few high quality randomized controlled trials are available to support the efficacy of the most commonly used interventions. Reviews of available randomized trials suggest that physical and occupational therapy (including graded motor imagery and mirror therapy), bisphosphonates, calcitonin, subanesthetic intravenous ketamine, free radical scavengers, oral corticosteroids, and spinal cord stimulation may be effective treatments. Multidisciplinary clinical care, which centers around functionally focused therapies is recommended. Other interventions are used to facilitate engagement in functional therapies and to improve quality of life. PMID:26224572

  9. [Suffering, pain and care].

    PubMed

    Perrin-Niquet, Annick

    2012-01-01

    While psychic pain is linked to melancholy, to the loss of an object, psychological suffering indicates difficult affective phenomena, which are not necessarily connected to a personality structure or to a particular pathology, but which can be explained by the very nature of our humanity. PMID:23050357

  10. Differential diagnostic validation: acute and chronic pain.

    PubMed

    Simon, J M; Baumann, M A; Nolan, L

    1995-01-01

    The authors sought to validate the defining characteristics of acute pain and chronic pain and to compare the differences between them. Expert nurses (N = 125) rated the importance of 55 clinical indicators for each diagnosis (acute pain and chronic pain). Differential diagnostic validity (DDV) scores were calculated for each clinical indicator for both diagnoses. Only acute pain had a DDV score greater than .80, indicating that the characteristic "communication of pain descriptors" was a critical indicator for acute pain. A majority of defining characteristics differentiated between acute pain and chronic pain, thereby supporting the identification of acute pain and chronic pain as separate nursing diagnoses. PMID:7619605

  11. The effectiveness of virtual reality for dental pain control: a case study.

    PubMed

    Hoffman, H G; Garcia-Palacios, A; Patterson, D R; Jensen, M; Furness, T; Ammons, W F

    2001-08-01

    The present study explored whether immersive virtual reality can serve as an effective non-pharmacologic analgesic for dental pain. Two patients (aged 51 and 56 years old) with adult periodontitis, a chronic, progressive inflammatory disease that affects gums, ligaments, and bones around the teeth, were studied in the treatment room of a periodontist. Each patient received periodontal scaling and root planing (scraping off/removing plaque deposits below the gum line, hereafter referred to as scaling) under three treatment conditions: (1) virtual reality distraction, (2) movie distraction, and (3) a no-distraction control condition. Condition order was randomized and counterbalanced. For each of the three treatment conditions, five visual analog pain scores for each treatment condition served as the dependent variables. On 0-10 labeled scales, both patients provided sensory and affective pain ratings, and subjective estimates of time spent thinking about his pain during the procedure. For patient 1, mean pain ratings were in the severe range while watching a movie (7.2), or no distraction (7.2) but in the mild pain range (1.2) during the VR condition. Patient 2 reported mild to moderate pain with no distraction (mean = 4.4), mild pain while watching the movie (3.3), and essentially no pain while in VR (0.6) during his periodontal scaling. Although the small sample size limits generalizability, we contend that virtual reality is a uniquely attention-grabbing medium capable of maximizing the amount of attention drawn away from the "real world," allowing patients to tolerate painful dental procedures. These preliminary results suggest that immersive VR merits more attention as a potentially viable adjunctive nonpharmacologic analgesia for procedural dental/periodontal pain. Virtual reality may also have analgesic potential for other painful procedures or pain populations. Practical implications are discussed. PMID:11708732

  12. A preliminary report on stem cell therapy for neuropathic pain in humans

    PubMed Central

    Vickers, E Russell; Karsten, Elisabeth; Flood, John; Lilischkis, Richard

    2014-01-01

    Objective Mesenchymal stem cells (MSCs) have been shown in animal models to attenuate chronic neuropathic pain. This preliminary study investigated if: i) injections of autologous MSCs can reduce human neuropathic pain and ii) evaluate the safety of the procedure. Methods Ten subjects with symptoms of neuropathic trigeminal pain underwent liposuction. The lipoaspirate was digested with collagenase and washed with saline three times. Following centrifugation, the stromal vascular fraction was resuspended in saline, and then transferred to syringes for local injections into the pain fields. Outcome measures at 6 months assessed reduction in: i) pain intensity measured by standard numerical rating scale from 0–10 and ii) daily dosage requirements of antineuropathic pain medication. Results Subjects were all female (mean age 55.3 years ± standard deviation [SD] 14.67; range 27–80 years) with pain symptoms lasting from 4 months to 6 years and 5 months. Lipoaspirate collection ranged from 102–214 g with total cell numbers injected from 33 million to 162 million cells. Cell viability was 62%–91%. There were no systemic or local tissue side effects from the stem cell therapy (n=41 oral and facial injection sites). Clinical pain outcomes showed that at 6 months, 5/9 subjects had reduced both pain intensity scores and use of antineuropathic medication. The mean pain score pre-treatment was 7.5 (SD 1.58) and at 6 months had decreased to 4.3 (SD 3.28), P=0.018, Wilcoxon signed-rank test. Antineuropathic pain medication use showed 5/9 subjects reduced their need for medication (gabapentin, P=0.053, Student’s t-test). Conclusion This preliminary open-labeled study showed autologous administration of stem cells for neuropathic trigeminal pain significantly reduced pain intensity at 6 months and is a safe and well tolerated intervention. PMID:24855388

  13. A comparison of the effects of preferred music, arithmetic and humour on cold pressor pain.

    PubMed

    Mitchell, Laura A; MacDonald, Raymond A R; Brodie, Eric E

    2006-05-01

    Research studies of 'audioanalgesia', the ability of music to affect pain perception, have significantly increased in number during the past two decades. Listening to preferred music in particular may provide an emotionally engaging distraction capable of reducing both the sensation of pain itself and the accompanying negative affective experience. The current study uses experimentally induced cold pressor pain to compare the effects of preferred music to two types of distracting stimuli found effective within the previous studies; mental arithmetic, a cognitive distraction, and humour, which may emotionally engage us in a similar manner to music. Forty-four participants (24 females, 20 males) underwent three cold pressor trials in counterbalanced order. The Paced Auditory Serial Addition Task provided the cognitive distraction and a choice was given from three types of audiotaped stand-up comedy. Participants provided their own preferred music. A circulating and cooling water bath administered cold pressor stimulation. Tolerance time, pain intensity on visual analogue scale and the pain rating index and perceived control were measured. Preferred music listening was found to significantly increase tolerance in comparison to the cognitive task, and significantly increase perceived control in comparison to humour. Ratings of pain intensity did not significantly differ. The results suggest preferred music listening to offer effective distraction and enhancement of control as a pain intervention under controlled laboratory conditions. PMID:15878297

  14. The Paradox of Painful Art

    ERIC Educational Resources Information Center

    Smuts, Aaron

    2007-01-01

    Many of the most popular genres of narrative art are designed to elicit negative emotions: emotions that are experienced as painful or involving some degree of pain, which people generally avoid in their daily lives. Traditionally, the question of why people seek out such experiences of painful art has been presented as the paradox of tragedy, and…

  15. Cortical pathophysiology of chronic pain

    E-print Network

    Apkarian, A. Vania

    Cortical pathophysiology of chronic pain A. Vania Apkarian Department of Physiology multiple non-invasive brain imaging techniques to study the characteristics of patients with chronic pain in chronic pain are summarized, emphasizing the unique role of the prefrontal cortex in chronic, especially

  16. 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

  17. 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...

  18. 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 ...

  19. Transdermal buprenorphine in pain management--experiences from clinical practice: Five case studies.

    PubMed

    Louis, F

    2006-10-01

    Buprenorphine is a semi-synthetic opioid derived from thebaine. The transdermal formulation of buprenorphine has been available in Belgium for 3 years, during which time the Pain Clinic of the St Elisabeth of Verviers Hospital has gained experience in the use of transdermal buprenorphine for the treatment of moderate-to-severe pain. This paper presents four cases of chronic, non-malignant pain, and one case of chronic cancer pain. By starting patients on low doses and slowly titrating upwards, transdermal buprenorphine matrix patches provided effective analgesia and were well tolerated. Low doses of transdermal buprenorphine were created by cutting the smallest available matrix patch (35 mug/h) into halves or quarters. The initial dose was then gradually titrated upwards to the dose needed for optimum pain relief by the patients. No problems were encountered in switching patients from prior analgesic therapy with other opioids to transdermal buprenorphine. PMID:16981980

  20. Pharmacological options for the management of refractory cancer pain-what is the evidence?

    PubMed

    Afsharimani, B; Kindl, K; Good, P; Hardy, J

    2015-05-01

    Refractory cancer pain that does not respond to standard opioid and/or co-analgesic therapy occurs in 10-20 % of patients. Risk factors include young age, neuropathic pain type, incident pain, psychological distress, previous opioid use, high tolerance, a history of addiction and impaired cognition. The management of patients with refractory pain remains a challenge. Treatment options include opioid manipulation (parenteral delivery, rotation, combination, methadone and buprenorphine), non-opioids and co-analgesics (paracetamol, non-steroidal anti-inflammatory agents, antidepressants and anticonvulsants), NMDA receptor antagonists, cannabinoids, lignocaine and corticosteroids. The evidence of benefit for any of these agents is weak, and each additional agent increases the risk of adverse events. Evidence-based guidelines cannot, therefore, be developed at present. New approaches are recommended including targeted opioid therapy, multimodal analgesia, a goal-oriented approach to pain management and increasing use of the multidisciplinary team and support services. PMID:25749509

  1. 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

  2. A multidisciplinary approach to nonpharmacologic pain management.

    PubMed

    Golden, Barbara A

    2002-09-01

    The multidisciplinary pain management team is the optimal method for delivery of comprehensive treatment to patients in pain. The biopsychosocial model of pain considers multiple factors for assessment, diagnosis, and treatment of pain. A structured approach to nonpharmacologic pain management includes medical and psychological interventions to educate and to empower patients to manage pain. Relaxation training, biofeedback, hypnosis, imagery, and cognitive-behavioral therapy are nonpharmacologic treatment modalities recommended by multidisciplinary pain management teams for effective pain control. PMID:12356034

  3. [Design of portable pressure-pained-detector based on STM32].

    PubMed

    Chen, Xiaojuan; Huo, Xiaoliang; Zhang, Shu

    2014-09-01

    In accordance with the bulky volume and not easy to carry of pain detection equipment limitations, designs a kind of portable high-precision dolorimeter based on STM32. Using the high precision pressure sensor pressure contact as the main body to make the pressure pain signals. Through the signal preprocess of the amplifying circuit and the filter circuit, to eliminate the system noise effectively. Use the TFT-LCD to display the real-time measured pressure value, and establish a pressure pain threshold of the object. The USB interface transmits the data to PC to store, and it's beneficial to the diagnosis and treatment of subsequent. PMID:25597079

  4. Pain Treatment in Arthritis-Related Pain: Beyond NSAIDs

    PubMed Central

    van Laar, Mart; Pergolizzi, Joseph V; Mellinghoff, Hans-Ulrich; Merchante, Ignacio Morón; Nalamachu, Srinivas; O'Brien, Joanne; Perrot, Serge; Raffa, Robert B

    2012-01-01

    Managing pain from chronic conditions, such as, but not limited to, osteoarthritis and rheumatoid arthritis, requires the clinician to balance the need for effective analgesia against safety risks associated with analgesic agents. Osteoarthritis and rheumatoid arthritis pain is incompletely understood but involves both nociceptive and non-nociceptive mechanisms, including neuropathic mechanisms. Prevailing guidelines for arthritis-related pain do not differentiate between nociceptive and non-nociceptive pain, sometimes leading to recommendations that do not fully address the nature of pain. NSAIDs are effective in treating the nociceptive arthritis-related pain. However, safety concerns of NSAIDs may cause clinicians to undertreat arthritis-related pain. In this context, combination therapy may be more appropriate to manage the different pain mechanisms involved. A panel convened in November 2010 found that among the currently recommended analgesic products for arthritis-related pain, fixed-low-dose combination products hold promise for pain control because such products allow lower doses of individual agents resulting in decreased toxicity and acceptable efficacy due to synergy between the individual drugs. Better evidence and recommendations are required to improve treatment of chronic arthritis-related pain. PMID:23264838

  5. Altered pain modulation in patients with persistent postendodontic pain.

    PubMed

    Nasri-Heir, Cibele; Khan, Junad; Benoliel, Rafael; Feng, Changyong; Yarnitsky, David; Kuo, Fengshen; Hirschberg, Craig; Hartwell, Gary; Huang, Ching-Yu; Heir, Gary; Korczeniewska, Olga; Diehl, Scott R; Eliav, Eli

    2015-10-01

    Persistent pain may follow nerve injuries associated with invasive therapeutic interventions. About 3% to 7% of the patients remain with chronic pain after endodontic treatment, and these are described as suffering from painful posttraumatic trigeminal neuropathy (PTTN). Unfortunately, we are unable to identify which patients undergoing such procedures are at increased risk of developing PTTN. Recent findings suggest that impaired endogenous analgesia may be associated with the development of postsurgical chronic pain. We hypothesized that patients with PTTN display pronociceptive pain modulation, in line with other chronic pain disorders. Dynamic (conditioned pain modulation, temporal summation) and static (response to mechanical and cold stimulation) psychophysical tests were performed intraorally and in the forearm of 27 patients with PTTN and 27 sex- and age-matched controls. The dynamic sensory testing demonstrated less efficient conditioned pain modulation, suggesting reduced function of the inhibitory endogenous pain-modulatory system, in patients with PTTN, mainly in those suffering from the condition for more than a year. The static sensory testing of patients with PTTN demonstrated forearm hyperalgesia to mechanical stimulation mainly in patients suffering from the condition for less than a year and prolonged painful sensation after intraoral cold stimulus mainly in patients suffering from the condition for more than a year. These findings suggest that PTTN is associated more with the inhibitory rather than the facilitatory arm of pain modulation and that the central nervous system has a role in PTTN pathophysiology, possibly in a time-dependent fashion. PMID:26098442

  6. Parton distributions with threshold resummation

    E-print Network

    Bonvini, Marco

    We construct a set of parton distribution functions (PDFs) in which fixed-order NLO and NNLO calculations are supplemented with soft-gluon (threshold) resummation up to NLL and NNLL accuracy respectively, suitable for use ...

  7. Threshold models in radiation carcinogenesis

    SciTech Connect

    Hoel, D.G.; Li, P.

    1998-09-01

    Cancer incidence and mortality data from the atomic bomb survivors cohort has been analyzed to allow for the possibility of a threshold dose response. The same dose-response models as used in the original papers were fit to the data. The estimated cancer incidence from the fitted models over-predicted the observed cancer incidence in the lowest exposure group. This is consistent with a threshold or nonlinear dose-response at low-doses. Thresholds were added to the dose-response models and the range of possible thresholds is shown for both solid tumor cancers as well as the different leukemia types. This analysis suggests that the A-bomb cancer incidence data agree more with a threshold or nonlinear dose-response model than a purely linear model although the linear model is statistically equivalent. This observation is not found with the mortality data. For both the incidence data and the mortality data the addition of a threshold term significantly improves the fit to the linear or linear-quadratic dose response for both total leukemias and also for the leukemia subtypes of ALL, AML, and CML.

  8. Transdermal buprenorphine in chronic pain: indications and clinical experience.

    PubMed

    Kusnik, Stefan; Likar, Rudolf; Sittl, Reinhard

    2008-11-01

    Transdermal buprenorphine has been shown to be effective in managing moderate-to-severe cancer pain and severe pain that is unresponsive to nonopioid analgesics. In clinical trials, it provided better pain relief than placebo, despite a higher consumption of rescue analgesia by placebo patients. Analgesia was rated as satisfactory or better by 90% of patients in a long-term follow-up study and 94.6% considered the buprenorphine matrix patch to be user friendly. Transdermal buprenorphine is well tolerated; most adverse events are transient local reactions to the patch or systemic effects typical of treatment with opioids. Even in opioid-experienced volunteers, buprenorphine does not cause respiratory depression at doses up to 70-times higher than those used for analgesia. No problems have been encountered when switching from another opioid to transdermal buprenorphine, or in combining the buprenorphine patch with intravenous morphine or tramadol for breakthrough pain. There is a growing body of evidence that transdermal buprenorphine may be particularly useful for managing neuropathic pain. Most notably, it appears to be effective in treating hyperalgesic states and syndromes characterized by pronounced central sensitization. PMID:24410602

  9. Curcumin ameliorates reserpine-induced pain-depression dyad: behavioural, biochemical, neurochemical and molecular evidences.

    PubMed

    Arora, V; Kuhad, A; Tiwari, V; Chopra, K

    2011-11-01

    An apparent clinical relationship between pain and depression has long been recognized. Depression and pain are often diagnosed in the same patients. The emerging concept for pain-depression pathogenesis is the dysfunction of biogenic amine-mediated pain-depression control and the possible involvement of nitrodative stress-induced neurogenic inflammation. The present study was designed to investigate the effect of curcumin on reserpine-induced pain-depression dyad in rats. Administration of reserpine (1mg/kg subcutaneous daily for three consecutive days) led to a significant decrease in nociceptive threshold as evident from reduced paw withdrawal threshold in Randall Sellitto and von-Frey hair test as well as significant increase in immobility time in forced swim test. This behavioural deficit was integrated with decrease in the biogenic amine (dopamine, norepinephrine and serotonin) levels along with increased substance P concentration, nitrodative stress, inflammatory cytokines, NF-?? and caspase-3 levels in different brain regions (cortex and hippocampus) of the reserpinised rats. Curcumin (100, 200, 300mg/kg; ip) dose dependently ameliorated the behavioural deficits associated with pain and depression by restoring behavioural, biochemical, neurochemical and molecular alterations against reserpine-induced pain-depression dyad in rats. PMID:21612876

  10. Acculturation and Cancer Pain Experience

    PubMed Central

    Im, Eun-Ok; Ho, Tsung-Han; Brown, Adama; Chee, Wonshik

    2009-01-01

    Purpose: Using a feminist perspective, the relationship between acculturation and cancer pain experience was explored. Design: This was a cross-sectional, correlational Internet study among 104 Hispanic and 114 Asian cancer patients. The instruments included both unidimensional and multidimensional cancer pain measures. Findings: There were significant differences in cancer pain scores by country of birth. Yet, there was no significant association of acculturation to cancer pain scores. Discussion and Conclusions: This study indicated inconsistent findings. Implications for Practice: To provide directions for adequate cancer pain management, further studies with a larger number of diverse groups of immigrant cancer patients are needed. PMID:19376965

  11. Frost tolerance in plants

    Technology Transfer Automated Retrieval System (TEKTRAN)

    When conducting studies to characterize and determine the underlying mechanisms for freezing tolerance, it is essential to take into account that the type and form of freezing injury varies with the species and its degree of freezing tolerance. There are at least seven different patterns of freezin...

  12. Maize aluminum tolerance

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Maize is one of the most economically important food crops grown on acid soils, where aluminum (Al) toxicity greatly limits crop yields. Considerable variation for Al tolerance exists in maize, and this variation has been exploited for many years by plant breeders to enhance maize Al tolerance. Curr...

  13. T Cell Activation Thresholds are Affected by Gravitational

    NASA Technical Reports Server (NTRS)

    Adams, Charley; Gonzalez, M.; Nelman-Gonzalez, M.

    1999-01-01

    T cells stimulated in space flight by various mitogenic signals show a dramatic reduction in proliferation and expression of early activation markers. Similar results are also obtained in a ground based model of microgravity, clinorotation, which provides a vector-averaged reduction of the apparent gravity on cells without significant shear force. Here we demonstrate that T cell inhibition is due to an increase in the required threshold for activation. Dose response curves indicate that cells activated during clinorotation require higher stimulation to achieve the same level of activation, as measured by CD69 expression. Interleukin 2 receptor expression, and DNA synthesis. The amount of stimulation necessary for 50% activation is 5 fold in the clinostat relative to static. Correlation of TCR internalization with activation also exhibit a dramatic right shift in clinorotation, demonstrating unequivocally that signal transduction mechanism independent of TCR triggering account for the increased activation threshold. Previous results from space flight experiments are consistent with the dose response curves obtained for clinorotation. Activation thresholds are important aspects of T cell memory, autoimmunity and tolerance Clinorotation is a useful, noninvasive tool for the study of cellular and biochemical event regulating T cell activation threshold and the effects of gravitation forces on these systems.

  14. An evaluation of corn earworm damage and thresholds in soybean

    NASA Astrophysics Data System (ADS)

    Adams, Brian Patrick

    Interactions between corn earworm, Helicoverpa zea (Boddie), and soybean, Glycine max L. (Merrill), were investigated in the Mid-South to evaluate thresholds and damage levels. Field studies were conducted in both indeterminate and determinate modern cultivars to evaluate damage, critical injury levels, and soybean response to simulated corn earworm injury. Field studies were also conducted to evaluate the response of indeterminate cultivars to infestations of corn earworm. Field studies were also conducted to investigate the relationship between pyrethroid insecticide application and corn earworm oviposition in soybean. Results of field studies involving simulated corn earworm damage indicated the need for a dynamic threshold that becomes more conservative as soybean phenology progressed through the reproductive growth stages. This suggested that soybean was more tolerant to fruit loss during the earlier reproductive stages and was able to compensate for fruit loss better during this time than at later growth stages. Results of field studies involving infestations of corn earworm indicated that current thresholds are likely too liberal. This resulted in economic injury level tables being constructed based upon a range of crop values and control costs, however, a general action threshold was also recommended for indeterminate soybean in the Mid-South. Field study results investigating the relationship of pyrethroid application and corn earworm oviposition indicated that even in the presence of an insecticide, corn earworm prefers to oviposit in the upper portion of the canopy, as well as on the leaves as opposed to all other plant parts, consistent with all previous literature.

  15. Induction of opioid tolerance by lysine-acetylsalicylate in rats.

    PubMed

    Pernia-Andrade, Alejandro J; Tortorici, Victor; Vanegas, Horacio

    2004-09-01

    The analgesic effect of non-steroidal antiinflammatory drugs (NSAIDs) is due to their action upon the peripheral damaged tissues, the spinal cord, and brain stem structures of the 'descending pain-control system' such as the periaqueductal gray matter (PAG) and the nucleus raphe magnus (NRM). The NSAID dipyrone (metamizol) has been shown to engage opioidergic circuits at the PAG, the NRM and the spinal cord, but it is unknown whether this can be generalized to typical NSAIDs and to systemic administration. In the present study lysine-acetylsalicylate (LASA), an injectable form of the prototypical NSAID aspirin, was microinjected into the PAG (100 microg/0.5 microl) in freely moving rats to induce inhibition of tail flick and hot plate responses. This antinociception was reverted by naloxone (1 mg/kg i.p.). PAG microinjection of LASA twice daily for three days induced tolerance to LASA (i.e. a progressive loss of effectiveness) and cross-tolerance to PAG-microinjected morphine (5 microg/0.5 microl). The antinociceptive effect of systemically administered LASA (300 mg/kg i.p., equivalent to the 1000 mg analgesic dose for humans) was also abolished by naloxone. Intraperitoneal injection of LASA twice daily induced tolerance to LASA and cross-tolerance to i.p. morphine (1 or 5 mg/kg). LASA-tolerant rats showed opioid withdrawal signs when injected with naloxone. These findings support the notion that the contribution of the PAG and downstream pain-control structures to the analgesic effect of NSAIDs involves opioidergic mechanisms, and suggest that repeated therapeutic administration of NSAIDs may induce tolerance, cross-tolerance to opiates, and susceptibility to a withdrawal syndrome. PMID:15327823

  16. Reduction of blood nitric oxide levels is associated with clinical improvement of the chronic pelvic pain related to endometriosis

    PubMed Central

    Rocha, M.G.; Gomes, V.A.; Tanus-Santos, J.E.; Rosa-e-Silva, J.C.; Candido-dos-Reis, F.J.; Nogueira, A.A.; Poli-Neto, O.B.

    2015-01-01

    The objective of this prospective study was to determine the plasma levels of nitric oxide (NO) in women with chronic pelvic pain secondary to endometriosis (n=24) and abdominal myofascial pain syndrome (n=16). NO levels were measured in plasma collected before and 1 month after treatment. Pretreatment NO levels (?M) were lower in healthy volunteers (47.0±12.7) than in women with myofascial pain (64.2±5.0, P=0.01) or endometriosis (99.5±12.9, P<0.0001). After treatment, plasma NO levels were reduced only in the endometriosis group (99.5±12.9 vs 61.6±5.9, P=0.002). A correlation between reduction of pain intensity and reduction of NO level was observed in the endometriosis group [correlation = 0.67 (95%CI = 0.35 to 0.85), P<0.0001]. Reduction of NO levels was associated with an increase of pain threshold in this group [correlation = -0.53 (-0.78 to -0.14), P<0.0001]. NO levels appeared elevated in women with chronic pelvic pain diagnosed as secondary to endometriosis, and were directly associated with reduction in pain intensity and increase in pain threshold after treatment. Further studies are needed to investigate the role of NO in the pathophysiology of pain in women with endometriosis and its eventual association with central sensitization. PMID:25714893

  17. Pain modulation effect of breathing-controlled electrical stimulation (BreEStim) is not likely to be mediated by deep and fast voluntary breathing

    PubMed Central

    Hu, Huijing; Li, Shengai; Li, Sheng

    2015-01-01

    Voluntary breathing-controlled electrical stimulation (BreEStim), a novel non-invasive and non-pharmacological treatment protocol for neuropathic pain management, was reported to selectively reduce the affective component of pain possibly by increasing pain threshold. The underlying mechanisms involved in the analgesic effect of BreEStim were considered to result from combination of multiple internal pain coping mechanisms triggered during BreEStim. Findings from our recent studies have excluded possible roles of acupuncture and aversiveness and habituation of painful electrical stimulation in mediating the analgesia effect of BreEStim. To further investigate the possible role of voluntary breathing during BreEStim, the effectiveness of fast and deep voluntary breathing-only and BreEStim on experimentally induced pain was compared in healthy human subjects. Results showed no change in electrical pain threshold after Breathing-only, but a significant increase in electrical pain threshold after BreEStim. There was no statistically significant change in other thresholds after Breathing-only and BreEStim. The findings suggest that the analgesic effect of BreEStim is not likely attributed to fast and deep voluntary breathing. Possible mechanisms are discussed. PMID:26382644

  18. [Rapid release fentanyl administration forms. Comments of the Working Group on Tumor Pain of the German Pain Society].

    PubMed

    Wirz, S; Wiese, C H R; Zimmermann, M; Junker, U; Heuser-Grannemann, E; Schenk, M

    2013-02-01

    The spectrum of indications for rapid release fentanyl preparations is controversial. For this reason the Working Group on Tumor Pain will formulate comments on how to deal with these substances. Breakthrough pain should receive individualized therapy; therefore, the use of opioids of various galenic formulations seems to be advisable. New rapid release fentanyl preparations are suitable for alleviating spontaneous breakthrough pain in tumor patients due to a rapid but short-acting effect. However, a prior optimization of the analgesic basis medication is absolutely necessary. Uncontrolled prescription for non-cancer pain must be criticized due to the problem of addiction. The medical profession should be informed about the benefits of rapid release fentanyl preparations but must also be made aware of the risk of a rapid development of addiction and tolerance. A self-commitment of the pharmaceutical industry to waive advertising for the dangerous off-label use would be desirable. In the opinion of the Working Group on Tumor Pain the use of fentanyl should be openly discussed and further scientific investigations are imperative with the aim of formulating clear recommendations. PMID:23377349

  19. Intracellular signaling in primary sensory neurons and persistent pain

    PubMed Central

    Cheng, Jen-Kun; Ji, Ru-Rong

    2008-01-01

    During evolution, living organisms develop a specialized apparatus called nociceptors to sense their environment and avoid hazardous situations. Intense stimulation of high threshold C- and A?-fibers of nociceptive primary sensory neurons will elicit pain, which is acute and protective under normal conditions. A further evolution of the early pain system results in the development of nociceptor sensitization under injury or disease conditions, leading to enhanced pain states. This sensitization in the peripheral nervous system is also called peripheral sensitization, as compared to its counterpart, central sensitization. Inflammatory mediators such as proinflammatory cytokines (TNF-?, IL-1?), PGE2, bradykinin, and NGF increase the sensitivity and excitability of nociceptors by enhancing the activity of pronociceptive receptors and ion channels (e.g., TRPV1 and Nav1.8). We will review the evidence demonstrating that activation of multiple intracellular signal pathways such as MAPK pathways in primary sensory neurons results in the induction and maintenance of peripheral sensitization and produces persistent pain. Targeting the critical signaling pathways in the periphery will tackle pain at the source. PMID:18427980

  20. Combination of morphine with nortriptyline for neuropathic pain.

    PubMed

    Gilron, Ian; Tu, Dongsheng; Holden, Ronald R; Jackson, Alan C; DuMerton-Shore, Deborah

    2015-08-01

    First-line neuropathic pain drugs, including tricyclic antidepressants, are not always effective, and opioids have been recommended as second line. This trial evaluates a nortriptyline-morphine combination, compared with each monotherapy. In this randomized, double-blind crossover trial, patients with neuropathic pain were enrolled at 1 site between January 25, 2010, and May 22, 2014, and randomized in a 1:1:1 ratio using a balanced Latin square design to receive oral nortriptyline, morphine, and their combination. During each of three 6-week periods, doses were titrated toward maximal tolerated dose (MTD). The primary outcome was average daily pain at MTD, and secondary outcomes included other pain, mood and quality of life measures, and adverse effects. Sixty-two patients were screened, 52 enrolled, and 39 completed at least 2 treatment periods. Average daily pain (0-10) at baseline was 5.3 and at MTD was 2.6 for combination vs 3.1 for nortriptyline (P = 0.046) and 3.4 for morphine (P = 0.002). Brief Pain Inventory scores for average and present pain were also significantly lower for combination vs each monotherapy. Combination treatment resulted in moderate-severe constipation in 43% vs 46% with morphine (P = 0.82) and 5% with nortriptyline (P < 0.0001). Combination treatment resulted in moderate-severe dry mouth in 58% vs 49% with nortriptyline (P = 0.84) and 13% with morphine (P < 0.0001). This trial suggests superior efficacy of a nortriptyline-morphine combination over either monotherapy with constipation, dry mouth, and somnolence as the most frequent adverse effects. PMID:25749306

  1. Somatosensory nociceptive characteristics differentiate subgroups in people with chronic low back pain: a cluster analysis.

    PubMed

    Rabey, Martin; Slater, Helen; O?Sullivan, Peter; Beales, Darren; Smith, Anne

    2015-10-01

    The objectives of this study were to explore the existence of subgroups in a cohort with chronic low back pain (n = 294) based on the results of multimodal sensory testing and profile subgroups on demographic, psychological, lifestyle, and general health factors. Bedside (2-point discrimination, brush, vibration and pinprick perception, temporal summation on repeated monofilament stimulation) and laboratory (mechanical detection threshold, pressure, heat and cold pain thresholds, conditioned pain modulation) sensory testing were examined at wrist and lumbar sites. Data were entered into principal component analysis, and 5 component scores were entered into latent class analysis. Three clusters, with different sensory characteristics, were derived. Cluster 1 (31.9%) was characterised by average to high temperature and pressure pain sensitivity. Cluster 2 (52.0%) was characterised by average to high pressure pain sensitivity. Cluster 3 (16.0%) was characterised by low temperature and pressure pain sensitivity. Temporal summation occurred significantly more frequently in cluster 1. Subgroups were profiled on pain intensity, disability, depression, anxiety, stress, life events, fear avoidance, catastrophizing, perception of the low back region, comorbidities, body mass index, multiple pain sites, sleep, and activity levels. Clusters 1 and 2 had a significantly greater proportion of female participants and higher depression and sleep disturbance scores than cluster 3. The proportion of participants undertaking <300 minutes per week of moderate activity was significantly greater in cluster 1 than in clusters 2 and 3. Low back pain, therefore, does not appear to be homogeneous. Pain mechanisms relating to presentations of each subgroup were postulated. Future research may investigate prognoses and interventions tailored towards these subgroups. PMID:26020225

  2. Validation of a Modified Algometer to Measure Mechanical Nociceptive Thresholds in Awake Dogs

    PubMed Central

    Chen, Hui Cheng; Goh, Yong Meng; Abubakar, Adamu Abdul; Fakurazi, Sharida

    2015-01-01

    This study was conducted to validate the use of a modified algometer device to measure mechanical nociceptive thresholds in six dogs. Dogs were administered morphine intravenously (IV) at 1?mg/kg or saline at equivolume in a crossover design with one-week washout period. Mechanical nociceptive thresholds were determined before, after the administration of treatments at 5 minutes, and hourly for 8 hours. Thresholds were recorded at the carpal pad, metacarpal foot pad, tibia, femur, and abdomen. Heart rates, body temperature, and respiration were recorded at similar time points. Thresholds increased significantly (P < 0.05) from baseline values for up to 3 hours at tibia and abdomen, 4 hours at metacarpal pad, and 5 hours at the carpal pad and femur. Hypothermia, bradycardia, and change in respiration were observed in all dogs after morphine injection. Saline did not alter any threshold levels during the eight-hour study period, indicating no evidence of tolerance, learned avoidance, or local hyperaesthesia. The device and methods of testing were well tolerated by all the dogs. Results suggest that the modified algometer and method of application are useful to measure nociceptive mechanical thresholds in awake dogs. PMID:26075236

  3. [Pain medication during pregnancy].

    PubMed

    Pereira, Miozzari Anne Catherine; Senhaji, Selim; Rollason, Gumprecht Victoria; Jungo, Nançoz Carol; Luthy, Christophe; Piguet, Valérie

    2012-06-27

    To treat pain that does not respond to non-pharmacological approaches in a pregnant woman represents a challenge for the primary care physician. He is often the first health professional to be consulted and finds himself confronted to not only one but two patients:the motherand the fetus. His knowledge on pain treatment and the practical approach that he is used to, will have to be adapted to this new equation. He will have to weigh the benefit for the mother against the risk for the fetus, while creating a true relationship with his patient. Although only a few drugs are considered compatible with pregnancy, the data available from the literature allow nowadays to better understand the nature of the risk when exposing the fetus to a given drug and to elaborate evidence-based recommendations. PMID:22872938

  4. SPRIX (ketorolac tromethamine) nasal spray: a novel nonopioid alternative for managing moderate to moderately severe dental pain.

    PubMed

    Snyder, Mark B; Bregmen, David B

    2012-02-01

    In summary, SPRIX is a nonopioid alternative for the management of moderate to moderately severe pain. SPRIX offers dentists, physicians, and patients a new non-opioid option to control acute moderate to moderately severe pain in situations in which use of an IM or IV access is not feasible or not wanted. SPRIX is a valuable treatment option for patients with nausea or vomiting, those unable to take oral medications, and those unable to tolerate the side effects of opioids. In ambulatory acute pain settings, use of SPRIX will allow patients who need to remain alert to receive effective pain control. Currently, there are no nonopioid alternatives for the treatment of moderate to moderately severe pain other than ketorolac. In patients with more severe pain states, the combination of opioids and SPRIX provides unique advantages in maximizing analgesia while minimizing the unwanted adverse effects of both classes of drugs (referred to as multimodal or "balanced analgesia"). PMID:22428363

  5. Anterior knee pain.

    PubMed

    LLopis, Eva; Padrón, Mario

    2007-04-01

    Anterior knee pain is a common complain in all ages athletes. It may be caused by a large variety of injuries. There is a continuum of diagnoses and most of the disorders are closely related. Repeated minor trauma and overuse play an important role for the development of lesions in Hoffa's pad, extensor mechanism, lateral and medial restrain structures or cartilage surface, however usually an increase or change of activity is referred. Although the direct relation of cartilage lesions, especially chondral, and pain is a subject of debate these lesions may be responsible of early osteoarthrosis and can determine athlete's prognosis. The anatomy and biomechanics of patellofemoral joint is complex and symptoms are often unspecific. Transient patellar dislocation has MR distinct features that provide evidence of prior dislocation and rules our complication. However, anterior knee pain more often is related to overuse and repeated minor trauma. Patella and quadriceps tendon have been also implicated in anterior knee pain, as well as lateral or medial restraint structures and Hoffa's pad. US and MR are excellent tools for the diagnosis of superficial tendons, the advantage of MR is that permits to rule out other sources of intraarticular derangements. Due to the complex anatomy and biomechanic of patellofemoral joint maltracking is not fully understood; plain films and CT allow the study of malalignment, new CT and MR kinematic studies have promising results but further studies are needed. Our purpose here is to describe how imaging techniques can be helpful in precisely defining the origin of the patient's complaint and thus improve understanding and management of these injuries. PMID:17350782

  6. Differences in two-point discrimination and sensory threshold in the blind between braille and text reading: a pilot study

    PubMed Central

    Noh, Ji-Woong; Park, Byoung-Sun; Kim, Mee-Young; Lee, Lim-Kyu; Yang, Seung-Min; Lee, Won-Deok; Shin, Yong-Sub; Kang, Ji-Hye; Kim, Ju-Hyun; Lee, Jeong-Uk; Kwak, Taek-Yong; Lee, Tae-Hyun; Kim, Ju-Young; Kim, Junghwan

    2015-01-01

    [Purpose] This study investigated two-point discrimination (TPD) and the electrical sensory threshold of the blind to define the effect of using Braille on the tactile and electrical senses. [Subjects and Methods] Twenty-eight blind participants were divided equally into a text-reading and a Braille-reading group. We measured tactile sensory and electrical thresholds using the TPD method and a transcutaneous electrical nerve stimulator. [Results] The left palm TPD values were significantly different between the groups. The values of the electrical sensory threshold in the left hand, the electrical pain threshold in the left hand, and the electrical pain threshold in the right hand were significantly lower in the Braille group than in the text group. [Conclusion] These findings make it difficult to explain the difference in tactility between groups, excluding both palms. However, our data show that using Braille can enhance development of the sensory median nerve in the blind, particularly in terms of the electrical sensory and pain thresholds. PMID:26180348

  7. Differences in two-point discrimination and sensory threshold in the blind between braille and text reading: a pilot study.

    PubMed

    Noh, Ji-Woong; Park, Byoung-Sun; Kim, Mee-Young; Lee, Lim-Kyu; Yang, Seung-Min; Lee, Won-Deok; Shin, Yong-Sub; Kang, Ji-Hye; Kim, Ju-Hyun; Lee, Jeong-Uk; Kwak, Taek-Yong; Lee, Tae-Hyun; Kim, Ju-Young; Kim, Junghwan

    2015-06-01

    [Purpose] This study investigated two-point discrimination (TPD) and the electrical sensory threshold of the blind to define the effect of using Braille on the tactile and electrical senses. [Subjects and Methods] Twenty-eight blind participants were divided equally into a text-reading and a Braille-reading group. We measured tactile sensory and electrical thresholds using the TPD method and a transcutaneous electrical nerve stimulator. [Results] The left palm TPD values were significantly different between the groups. The values of the electrical sensory threshold in the left hand, the electrical pain threshold in the left hand, and the electrical pain threshold in the right hand were significantly lower in the Braille group than in the text group. [Conclusion] These findings make it difficult to explain the difference in tactility between groups, excluding both palms. However, our data show that using Braille can enhance development of the sensory median nerve in the blind, particularly in terms of the electrical sensory and pain thresholds. PMID:26180348

  8. Laboratory personnel gender and cold pressor apparatus affect subjective pain reports

    PubMed Central

    Vigil, Jacob M; Rowell, Lauren N; Alcock, Joe; Maestes, Randy

    2014-01-01

    BACKGROUND: There is no standardized method for cold pressor pain tasks across experiments. Temperature, apparatus and aspects of experimenters vary widely among studies. It is well known that experimental pain tolerance is influenced by setting as well as the sex of the experimenter. It is not known whether other contextual factors influence experimental pain reporting. OBJECTIVES: The present two-part experiment examines whether minimizing and standardizing interactions with laboratory personnel (eg, limiting interaction with participants to consenting and questions and not during the actual pain task) eliminates the influence of examiner characteristics on subjective pain reports and whether using different cold pain apparatus (cooler versus machine) influences reports. METHODS: The present experiment manipulated the gender of the experimenter (male, female and transgender) and the type of cold pressor task (CPT) apparatus (ice cooler versus refrigerated bath circulator). Participants conducted the CPT at one of two pain levels (5°C or 16°C) without an experimenter present. RESULTS: Men and women showed lower pain sensitivity when they were processed by biological male personnel than by biological female personnel before the CPT. Women who interacted with a transgendered researcher likewise reported higher pain sensitivity than women processed by biological male or female researchers. The type of CPT apparatus, despite operating at equivalent temperatures, also influenced subjective pain reports. DISCUSSION: The findings show that even minimal interactions with laboratory personnel who differ in gender, and differences in laboratory materials impact the reliable measurement of pain. CONCLUSION: More standardized protocols for measuring pain across varying research and clinical settings should be developed. PMID:24367796

  9. A journey to pain.

    PubMed

    Kogan, I

    1990-01-01

    This paper explored the restoration of the capacity to feel pain and guilt as a result of the emotional experience in analysis. This was illustrated by the first part of an analysis of a woman who lost her four-month-old baby in a car accident. Analysis revealed in this case a fragmented self unable to deal with unbearable feelings of pain and guilt which threatened to annihilate it. She connected the accident to a series of events which appeared to her to be the realization of her aggressive wishes towards primary objects throughout her life. The perception of the impairment and loss of loved objects as due to her destructiveness led to the inability to differentiate self from object, the impairment in the work of mourning, and aggression turned against the self. The analyst's survival of the destructive attack without retaliation enabled the differentiation, a better adaptation to reality and the restoration of the capacity to feel pain and guilt. PMID:2074150

  10. [Congenital insensitivity to pain].

    PubMed

    Popko, Janusz; Karpi?ski, Micha?; Guszczyn, Tomasz

    2014-02-01

    Congenital insensitivity to pain belongs to rare diseases called hereditary sensory neuropathy (HSN). The disturbance of sense and secondary harms are creating clinical picture. The aim of this report was to describe therapeutic problems with which we met with a three siblings with congenital insensitivity to pain. The authors have described three children with congenital insensitivity to pain. The disease was diagnosed at the age of 3-5. These children painlessly have broken their lower limbs. These fractures were late diagnosed what resulted in a badly healed deformation of legs. For this reason, the right knee of the oldest boy had to be stiffened. This boy had also late diagnosed the left hip luxation, and hematomas had arisen, which become filled with pus. The boy was in sepsis and a dramatic life-and-death struggle was performed. A purulent focuses were removed from abdomen and femoral head was also resected. The other two siblings had fractures and infections, but not such severe as the oldest boy. It is well known that a causal treatment of this disease in unknown. Patients must learn to avoid mechanical and thermal trauma. It is the only way to prevent complications of this disease. PMID:24720108

  11. Calcium-Permeable AMPA Receptors in the Nucleus Accumbens Regulate Depression-Like Behaviors in the Chronic Neuropathic Pain State

    PubMed Central

    Goffer, Yossef; Xu, Duo; Eberle, Sarah E.; D'amour, James; Lee, Michelle; Tukey, David; Froemke, Robert C.; Ziff, Edward B.

    2013-01-01

    Depression is a salient emotional feature of chronic pain. Depression alters the pain threshold and impairs functional recovery. To date, however, there has been limited understanding of synaptic or circuit mechanisms that regulate depression in the pain state. Here, we demonstrate that depression-like behaviors are induced in a rat model of chronic neuropathic pain. Using this model, we show that chronic pain selectively increases the level of GluA1 subunits of AMPA-type glutamate receptors at the synapses of the nucleus accumbens (NAc), a key component of the brain reward system. We find, in addition, that this increase in GluA1 levels leads to the formation of calcium-permeable AMPA receptors (CPARs). Surprisingly, pharmacologic blockade of these CPARs in the NAc increases depression-like behaviors associated with pain. Consistent with these findings, an AMPA receptor potentiator delivered into the NAc decreases pain-induced depression. These results show that transmission through CPARs in the NAc represents a novel molecular mechanism modulating the depressive symptoms of pain, and thus CPARs may be a promising therapeutic target for the treatment of pain-induced depression. More generally, these findings highlight the role of central glutamate signaling in pain states and define the brain reward system as an important region for the regulation of depressive symptoms of pain. PMID:24285907

  12. Calcium-permeable AMPA receptors in the nucleus accumbens regulate depression-like behaviors in the chronic neuropathic pain state.

    PubMed

    Goffer, Yossef; Xu, Duo; Eberle, Sarah E; D'amour, James; Lee, Michelle; Tukey, David; Froemke, Robert C; Ziff, Edward B; Wang, Jing

    2013-11-27

    Depression is a salient emotional feature of chronic pain. Depression alters the pain threshold and impairs functional recovery. To date, however, there has been limited understanding of synaptic or circuit mechanisms that regulate depression in the pain state. Here, we demonstrate that depression-like behaviors are induced in a rat model of chronic neuropathic pain. Using this model, we show that chronic pain selectively increases the level of GluA1 subunits of AMPA-type glutamate receptors at the synapses of the nucleus accumbens (NAc), a key component of the brain reward system. We find, in addition, that this increase in GluA1 levels leads to the formation of calcium-permeable AMPA receptors (CPARs). Surprisingly, pharmacologic blockade of these CPARs in the NAc increases depression-like behaviors associated with pain. Consistent with these findings, an AMPA receptor potentiator delivered into the NAc decreases pain-induced depression. These results show that transmission through CPARs in the NAc represents a novel molecular mechanism modulating the depressive symptoms of pain, and thus CPARs may be a promising therapeutic target for the treatment of pain-induced depression. More generally, these findings highlight the role of central glutamate signaling in pain states and define the brain reward system as an important region for the regulation of depressive symptoms of pain. PMID:24285907

  13. Effects of the Delta Opioid Receptor Agonist SNC80 on Pain-Related Depression of Intracranial Self-Stimulation (ICSS) in Rats

    PubMed Central

    Negus, S. Stevens; Rosenberg, Marisa B.; Altarifi, Ahmad A.; O’Connell, Robert H.; Folk, John E.; Rice, Kenner C.

    2011-01-01

    The delta opioid receptor agonist SNC80 produces both antinociceptive and antidepressant effects in rodents. This profile suggests that SNC80 may also reverse prodepressant effects of pain. Accordingly, this study compared SNC80 effects in complementary assays of pain-stimulated and pain-depressed behavior in rats. Intraperitoneal injection of dilute acid served as an acute noxious visceral stimulus in rats to stimulate abdominal stretching (a pain-stimulated behavior) or depress intracranial self-stimulation of the medial forebrain bundle (ICSS; a pain-depressed behavior). When administered once per week to minimize acute tolerance, SNC80 (1-10 mg/kg IP) decreased acid-stimulated stretching but had little effect on acid-induced depression of ICSS. More frequent SNC80 administration produced tolerance to SNC80 effects on acid-stimulated stretching, but unmasked antinociception in the assay of acid-depressed ICSS. SNC80 did not facilitate ICSS in the absence of pain, and effects of SNC80 were not duplicated by ARM390, a delta agonist congener of SNC80 that does not internalize delta receptors. These findings support continued consideration of delta agonists as candidate analgesics to treat prodepressant effects of pain and illustrate the potential for diametrically opposite effects of drug treatments on preclinical measures of pain-stimulated and pain-depressed behavior. Perspective The delta opioid agonist SNC80 blocked pain-related depression of intracranial self-stimulation in rats, suggesting that delta agonists may be useful to treat prodepressant effects of pain. Repeated SNC80 produced tolerance to SNC80 antinociception in a conventional assay of pain-stimulated behavior but unmasked SNC80 antinociception in an assay of pain-depressed behavior. PMID:22424913

  14. The Zero Acceptance of Pain (ZAP) Quality Improvement Project: evaluation of pain severity, pain interference, global quality of life, and pain-related costs.

    PubMed

    Fortner, Barry V; Okon, Theodore A; Ashley, Jeri; Kepler, Ginney; Chavez, Jana; Tauer, Kurt; Clements-Thompson, Michele; Schwartzberg, Lee; Demarco, Gail; Houts, Arthur C

    2003-04-01

    The Zero Acceptance of Pain (ZAP) Quality Improvement Project was a multi-site effort to improve the lives of outpatients with cancer pain by enhancing the clinical practice of pain assessment and management. Independent samples of patients completed self-report measures of severity of pain, pain interference, global quality of life, pain treatment satisfaction, general medical treatment satisfaction, pain attitudes, and pain-related medical costs before and after the implementation of ZAP. Results suggested that ZAP decreased the severity of recent pain, decreased interference of pain on daily functioning, and improved satisfaction with pain treatment and attitudes about addiction to opioid medication. Direct medical costs consisting of pain-related hospitalizations, emergency department visits, and physician office visits were greatly reduced. In summary, the findings of this study support the idea that clinic-based efforts to improve the practice of pain management are effective in improving the lives of cancer patients who are experiencing pain. PMID:12691685

  15. Videogame Distraction using Virtual Reality Technology for Children Experiencing Cold Pressor Pain: The Role of Cognitive Processing

    PubMed Central

    Law, Emily F.; Sil, Soumitri; Weiss, Karen E.; Herbert, Linda Jones; Wohlheiter, Karen; Horn, Susan Berrin

    2011-01-01

    Objective?This study examined whether increasing the demand for central cognitive processing involved in a distraction task, by involving the child in ongoing, effortful interaction with the distraction stimulus, would increase children's tolerance for cold pressor pain.?Methods?Seventy-nine children ages 6–15 years underwent a baseline cold pressor trial followed by two cold pressor trials in which they received interactive distraction (i.e., used voice commands to play a videogame) or passive distraction (in which they merely watched the output from the same videogame segment) in counterbalanced order. Both distraction conditions were presented via a virtual reality-type helmet.?Results?As expected, children demonstrated significant improvement in pain tolerance during distraction relative to baseline. Children showed the greatest improvement during the interactive distraction task.?Conclusion?The effects of distraction on children's cold pressor pain tolerance are significantly enhanced when the distraction task also includes greater demands for central cognitive processing. PMID:20656761

  16. Characterization and treatment of postsurgical dental implant pain employing intranasal ketorolac.

    PubMed

    Bockow, Rebecca; Korostoff, Jonathan; Pinto, Andres; Hutcheson, Matthew; Secreto, Stacey A; Bodner, Laura; Hersh, Elliot V

    2013-09-01

    The intensity and duration of pain following surgical placement of dental implants has not been well studied. Thus, the aim of this open-label study was to characterize the nature of postsurgical pain following the placement of one to three implants. The secondary goal was to explore the analgesic efficacy and tolerability of intranasal ketorolac in this patient population. Following implant surgery, postoperative pain was rated moderate or severe in 25/28 patients (89 percent), requiring prn analgesic dosing for up to 3 days in 14/25 individuals (56 percent). Intranasal ketorolac displayed an analgesic onset within 20 minutes, a duration of at least 6 hours, and was well tolerated by the cohort with brief stinging of the nasal mucosa reported by 9/25 individuals (36 percent). PMID:24564610

  17. Antimicrobial Tolerance in Biofilms

    PubMed Central

    Stewart, Philip S.

    2015-01-01

    The tolerance of microorganisms in biofilms to antimicrobial agents is examined through a meta-analysis of literature data. A numerical tolerance factor comparing the rates of killing in the planktonic and biofilm states is defined to provide a quantitative basis for the analysis. Tolerance factors for biocides and antibiotics range over three orders of magnitude. This variation is not explained by taking into account the molecular weight of the agent, the chemistry of the agent, the substratum material, or the speciation of the microorganisms. Tolerance factors do depend on the areal cell density of the biofilm at the time of treatment and on the age of the biofilm as grown in a particular experimental system. This suggests that there is something that happens during biofilm maturation, either physical or physiological, that is essential for full biofilm tolerance. Experimental measurements of antimicrobial penetration times in biofilms range over orders of magnitude, with slower penetration (>12 min) observed for reactive oxidants and cationic molecules. These agents are retarded through the interaction of reaction, sorption, and diffusion. The specific physiological status of microbial cells in a biofilm contributes to antimicrobial tolerance. A conceptual framework for categorizing physiological cell states is discussed in the context of antimicrobial susceptibility. It is likely that biofilms harbor cells in multiple states simultaneously (e.g., growing, stress-adapted, dormant, inactive) and that this physiological heterogeneity is an important factor in the tolerance of the biofilm state. PMID:26185072

  18. PAIN INTENSITY MODERATES THE RELATIONSHIP BETWEEN AGE AND PAIN INTERFERENCE IN CHRONIC OROFACIAL PAIN PATIENTS

    PubMed Central

    Boggero, Ian A.; Geiger, Paul J.; Segerstrom, Suzanne C.; Carlson, Charles R.

    2015-01-01

    Background/Study Context Chronic pain is associated with increased interference in daily functioning that becomes more pronounced as pain intensity increases. Based on previous research showing that older adults maintain well-being in the face of pain as well as or better than their younger counterparts, the current study examined the interaction of age and pain intensity on interference in a sample of chronic orofacial pain patients. Methods Data were obtained from the records of 508 chronic orofacial pain patients being seen for an initial evaluation from 2008 to 2012. Collected data included age (range: 18–78) and self-reported measures of pain intensity and pain interference. Bivariate correlations and regression models were used to assess for statistical interactions. Results Regression analyses revealed that pain intensity positively predicted pain interference (R2 = .35, B = 10.40, SE = 0.62, t(507) = 16.70, p < .001). A significant interaction supported the primary hypothesis that aging was associated with reduced interference at high levels of pain intensity (?R2 = .01, B = ?1.31, SE = 0.63, t(505) = ?2.90, p = .04). Conclusion At high levels of pain intensity, interference decreased with age, although the age by pain intensity interaction effect was small. This evidence converges with aging theories, including socioemotional selectivity theory, which posits that as people age, they become more motivated to maximize positive emotions and minimize negative ones. The results highlight the importance of studying the mechanisms older adults use to successfully cope with pain. PMID:26214102

  19. Starshade Shape Tolerances and Mechanical Deployment

    NASA Astrophysics Data System (ADS)

    Dailey, Dean; Glassman, T.; NWO Study Team

    2009-01-01

    Starshade Shape Tolerances and Mechanical Deployment Dean Dailey, Tiffany Glassman, NWO Study Team The primary purpose of the New Worlds Observer (NWO) Starshade is to suppress the light from a star to 10-10 without blocking the light from planets in the habitable zone of that star. In order to successfully deploy a properly functioning Starshade 10s of meters in diameter, we must know precisely how much the shape of the Starshade is allowed to deviate from the theoretical profile without causing its performance to fall below the established threshold. We use a simulation of the optical performance of the Starshade to establish the tolerance of the Starshade to various shape deformations. These Starshade shape tolerance terms are combined into a budget set of the maximum level of tolerable deformations. These budgets become the deployed dimensional stability requirements for structural engineering to use in accessing competing deployment concepts. The effects that we consider to determine if a deployment scheme will meet the shape tolerance requirements include: 1. Mechanical piece-part manufacturing error 2. Mechanical assembly errors 3. 1 G assembly shape verification error 4. Launch Shift 5. Deployment repeatability errors 6. Thermal distortion errors 7. On-orbit dynamics - jitter 8. CME errors (coefficient of moisture expansion) 9. Contamination errors Deployed dimensional stability performance margins can then be determined for each deployment concept over each shape distortion effect and a suitable deployment concept can be selected. Each of these effects are described along with the sensitivity analysis to their contribution to the overall performance.

  20. 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