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.

Hypnosis and pain perception: An Activation Likelihood Estimation (ALE) meta-analysis of functional neuroimaging studies.

PubMed

Del Casale, Antonio; Ferracuti, Stefano; Rapinesi, Chiara; De Rossi, Pietro; Angeletti, Gloria; Sani, Gabriele; Kotzalidis, Georgios D; Girardi, Paolo

2015-12-01

Several studies reported that hypnosis can modulate pain perception and tolerance by affecting cortical and subcortical activity in brain regions involved in these processes. We conducted an Activation Likelihood Estimation (ALE) meta-analysis on functional neuroimaging studies of pain perception under hypnosis to identify brain activation-deactivation patterns occurring during hypnotic suggestions aiming at pain reduction, including hypnotic analgesic, pleasant, or depersonalization suggestions (HASs). We searched the PubMed, Embase and PsycInfo databases; we included papers published in peer-reviewed journals dealing with functional neuroimaging and hypnosis-modulated pain perception. The ALE meta-analysis encompassed data from 75 healthy volunteers reported in 8 functional neuroimaging studies. HASs during experimentally-induced pain compared to control conditions correlated with significant activations of the right anterior cingulate cortex (Brodmann's Area [BA] 32), left superior frontal gyrus (BA 6), and right insula, and deactivation of right midline nuclei of the thalamus. HASs during experimental pain impact both cortical and subcortical brain activity. The anterior cingulate, left superior frontal, and right insular cortices activation increases could induce a thalamic deactivation (top-down inhibition), which may correlate with reductions in pain intensity. Copyright © 2016 Elsevier Ltd. All rights reserved.

[Effect of oxytocin on human pain perception].

PubMed

Pfeifer, A-C; Ditzen, B; Neubauer, E; Schiltenwolf, M

2016-10-01

Over the years the effect of the neuropeptide oxytocin and its possible utilization for pain management has been increasingly more investigated and discussed. Initial results emphasized the effects of oxytocin with respect to labor and breastfeeding. Diverse animals studies were also able to demonstrate the effectiveness of the peptide in attachment behavior and pain perception; however, it is still unclear how oxytocin affects pain perception in humans. The potential therapeutic effectiveness of oxytocin could be particularly important for primary and secondary treatment of pain patients because chronification of pain can occur more frequently in this area. For this review the databases PubMed, Medline und PsycINFO were searched using the terms oxytocin, pain, human and analgesic. The search resulted in a total of 89 original articles after excluding articles regarding labor pain, breastfeeding and animal studies. Only those studies were included which were carried out between 1994 and 2015. A total of 17 articles remained for inclusion in this review and included 13 studies on the exogenous application of oxytocin and 4 on measurement of oxytocin levels in plasma. This review article gives a summary of the current state of research on oxytocin and its direct and indirect association with human pain perception and emphasizes its relevance for the multimodal management of pain.

Complex regional pain syndrome (CRPS) impairs visuospatial perception,whereas post-herpetic neuralgia does not: possible implications for supraspinal mechanism of CRPS.

PubMed

Uematsu, Hironobu; Sumitani, Masahiko; Yozu, Arito; Otake, Yuko; Shibata, Masahiko; Mashimo, Takashi; Miyauchi, Satoru

2009-11-01

Complex regional pain syndrome (CRPS) patients show impaired visuospatial perception in the dark, as compared to normal patients with acute nociceptive pain. The purpose of this study is 2-fold: (i) to ascertain whether this distorted visuospatial perception is related to the chronicity of pain, and (ii) to analyse visuospatial perception of CRPS in comparison with another neuropathic pain condition. We evaluated visual subjective body-midline (vSM) representation in 27 patients with post-herpetic neuralgia (PHN) and 22 with CRPS under light and dark conditions. A red laser dot was projected onto a screen and moved horizontally towards the sagittal plane of the objective body-midline (OM). Each participant was asked to direct the dot to a position where it crossed their vSM. The distance between the vSM and OM was analysed to determine how and in which direction the vSM deviated. Under light condition, all vSM judgments approximately matched the OM. However, in the dark, CRPS patients, but not PHN patients, showed a shifted vSM towards the affected side. We demonstrated that chronic pain does not always impair visuospatial perception. The aetiology of PHN is limited to the peripheral nervous system, whereas the distorted visuospatial perception suggests a supraspinal aetiology of CRPS.

Ethnicity and patient's perception of risk in joint replacement surgery.

PubMed

Gandhi, Rajiv; Razak, Fahad; Davey, J Roderick; Mahomed, Nizar N

2008-08-01

Despite much evidence showing racial disparities in the use of surgical procedures, it is unknown whether ethnicity affects perception of surgical risk. We surveyed 1609 patients undergoing primary hip or knee replacement surgery. Relevant covariates including demographic data, body mass index (BMI), sex, comorbidities, education, and ethnicity were recorded. Pain and joint functional status were assessed at baseline and at 1-year followup with the Western Ontario McMaster University Osteoarthritis Index (WOMAC) pain and function scores. Risk perception was assessed with 3 survey questions. Non-European patients had greater functional disability and pain prior to surgery and demonstrated significantly greater perception of risk than European patients (p < 0.001). Independent of other covariates, non-European ethnicity was an independent predictor of a greater perception of risk (p < 0.05). Patient ethnicity is an important factor to consider in understanding a patient's perception of risk in joint replacement surgery.

Measurement of acute nonspecific low back pain perception in primary care physical therapy: reliability and validity of the brief illness perception questionnaire.

PubMed

Hallegraeff, Joannes M; van der Schans, Cees P; Krijnen, Wim P; de Greef, Mathieu H G

2013-02-01

The eight-item Brief Illness Perception Questionnaire is used as a screening instrument in physical therapy to assess mental defeat in patients with acute low back pain, besides patient perception might determine the course and risk for chronic low back pain. However, the psychometric properties of the Brief Illness Perception Questionnaire in common musculoskeletal disorders like acute low back pain have not been adequately studied. Patients' perceptions vary across different populations and affect coping styles. Thus, our aim was to determine the internal consistency, test-retest reliability and validity of the Dutch language version of the Brief Illness Perception Questionnaire in acute non-specific low back pain patients in primary care physical therapy. A non-experimental cross-sectional study with two measurements was performed. Eighty-four acute low back pain patients, in multidisciplinary health care center in Dutch primary care with a sample mean (SD) age of 42 (12) years, participated in the study. Internal consistency (Cronbach's α) and test-retest procedures (Intraclass Correlation Coefficients and limits of agreement) were evaluated at a one-week interval. The concurrent validity of the Brief Illness Perception Questionnaire was examined by using the Mental Health Component of the Short Form 36 Health Survey. The Cronbach's α for internal consistency was 0.73 (95% CI, 0.67 - 0.83); and the Intraclass Correlation Coefficient test-retest reliability was acceptable: 0.72 (95% CI, 0.53 - 0.82), however, the limits of agreement were large. The Intraclass Correlation Coefficient measuring concurrent validity 0.65 (95% CI, 0.46 - 0.80). The Dutch version of the Brief Illness Perception Questionnaire is an appropriate instrument for measuring patients' perceptions in acute low back pain patients, showing acceptable internal consistency and reliability. Concurrent validity is adequate, however, the instrument may be unsuitable for detecting changes in low back pain perception over time.

Pain and other symptoms of CRPS can be increased by ambiguous visual stimuli--an exploratory study.

PubMed

Hall, Jane; Harrison, Simon; Cohen, Helen; McCabe, Candida S; Harris, N; Blake, David R

2011-01-01

Visual disturbance, visuo-spatial difficulties, and exacerbations of pain associated with these, have been reported by some patients with Complex Regional Pain Syndrome (CRPS). We investigated the hypothesis that some visual stimuli (i.e. those which produce ambiguous perceptions) can induce pain and other somatic sensations in people with CRPS. Thirty patients with CRPS, 33 with rheumatology conditions and 45 healthy controls viewed two images: a bistable spatial image and a control image. For each image participants recorded the frequency of percept change in 1 min and reported any changes in somatosensation. 73% of patients with CRPS reported increases in pain and/or sensory disturbances including changes in perception of the affected limb, temperature and weight changes and feelings of disorientation after viewing the bistable image. Additionally, 13% of the CRPS group responded with striking worsening of their symptoms which necessitated task cessation. Subjects in the control groups did not report pain increases or somatic sensations. It is possible to worsen the pain suffered in CRPS, and to produce other somatic sensations, by means of a visual stimulus alone. This is a newly described finding. As a clinical and research tool, the experimental method provides a means to generate and exacerbate somaesthetic disturbances, including pain, without moving the affected limb and causing nociceptive interference. This may be particularly useful for brain imaging studies. Copyright © 2010 European Federation of International Association for the Study of Pain Chapters. Published by Elsevier Ltd. All rights reserved.

Short-term pre- and post-operative stress prolongs incision-induced pain hypersensitivity without changing basal pain perception.

PubMed

Cao, Jing; Wang, Po-Kai; Tiwari, Vinod; Liang, Lingli; Lutz, Brianna Marie; Shieh, Kun-Ruey; Zang, Wei-Dong; Kaufman, Andrew G; Bekker, Alex; Gao, Xiao-Qun; Tao, Yuan-Xiang

2015-12-02

Chronic stress has been reported to increase basal pain sensitivity and/or exacerbate existing persistent pain. However, most surgical patients have normal physiological and psychological health status such as normal pain perception before surgery although they do experience short-term stress during pre- and post-operative periods. Whether or not this short-term stress affects persistent postsurgical pain is unclear. In this study, we showed that pre- or post-surgical exposure to immobilization 6 h daily for three consecutive days did not change basal responses to mechanical, thermal, or cold stimuli or peak levels of incision-induced hypersensitivity to these stimuli; however, immobilization did prolong the duration of incision-induced hypersensitivity in both male and female rats. These phenomena were also observed in post-surgical exposure to forced swimming 25 min daily for 3 consecutive days. Short-term stress induced by immobilization was demonstrated by an elevation in the level of serum corticosterone, an increase in swim immobility, and a decrease in sucrose consumption. Blocking this short-term stress via intrathecal administration of a selective glucocorticoid receptor antagonist, RU38486, or bilateral adrenalectomy significantly attenuated the prolongation of incision-induced hypersensitivity to mechanical, thermal, and cold stimuli. Our results indicate that short-term stress during the pre- or post-operative period delays postoperative pain recovery although it does not affect basal pain perception. Prevention of short-term stress may facilitate patients' recovery from postoperative pain.

Subliminal perception of others' physical pain and pleasure.

PubMed

Chiesa, Patrizia Andrea; Liuzza, Marco Tullio; Acciarino, Adriano; Aglioti, Salvatore Maria

2015-08-01

Studies indicate that explicit and implicit processing of affectively charged stimuli may be reflected in specific behavioral markers and physiological signatures. This study investigated whether the pleasantness ratings of a neutral target were affected by subliminal perception of pleasant and painful facial expressions. Participants were presented images depicting face of non-famous models being slapped (painful condition), caressed (pleasant condition) or touched (neutral condition) by the right hand of another individual. In particular, we combined the continuous flash suppression technique with the affective misattribution procedure (AMP) to explore subliminal empathic processing. Measures of pupil reactivity along with empathy traits were also collected. Results showed that participants rated the neutral target as less or more likeable congruently with the painful or pleasant facial expression presented, respectively. Pupil dilation was associated both with the implicit attitudes (AMP score) and with empathic concern. Thus, the results provide behavioral and physiological evidence that state-related empathic reactivity can occur at an entirely subliminal level and that it is linked to autonomic responses and empathic traits.

Affective associative learning modifies the sensory perception of nociceptive stimuli without participant's awareness.

PubMed

Wunsch, Annabel; Philippot, Pierre; Plaghki, Léon

2003-03-01

The present experiment examined the possibility to change the sensory and/or the affective perception of thermal stimuli by an emotional associative learning procedure known to operate without participants' awareness (evaluative conditioning). In a mixed design, an aversive conditioning procedure was compared between subjects to an appetitive conditioning procedure. Both groups were also compared within-subject to a control condition (neutral conditioning). The aversive conditioning was induced by associating non-painful and painful thermal stimuli - delivered on the right forearm - with unpleasant slides. The appetitive conditioning consisted in an association between thermal stimuli - also delivered on the right forearm - and pleasant slides. The control condition consisted in an association between thermal stimuli - delivered for all participants on the left forearm - and neutral slides. The effects of the conditioning procedures on the sensory and affective dimensions were evaluated with visual analogue scale (VAS)-intensity and VAS-unpleasantness. Startle reflex was used as a physiological index of emotional valence disposition. Results confirmed that no participants were aware of the conditioning procedure. After unpleasant slides (aversive conditioning), non-painful and painful thermal stimuli were judged more intense and more unpleasant than when preceded by neutral slides (control condition) or pleasant slides (appetitive conditioning). Despite a strong correlation between the intensity and the unpleasantness scales, effects were weaker for the affective scale and, became statistically non-significant when VAS-intensity was used as covariate. This experiment shows that it is possible to modify the perception of intensity of thermal stimuli by a non-conscious learning procedure based on the transfer of the valence of the unconditioned stimuli (pleasant or unpleasant slides) towards the conditioned stimuli (non-painful and painful thermal stimuli). These results plead for a conception of pain as a conscious output of complex informational processes all of which are not accessible to participants' awareness. Mechanisms by which affective input may influence sensory experience and clinical implications of the present study are discussed.

A Systematic Review of the Impact of Educational Programs on Factors That Affect Nurses' Post-Operative Pain Management for Children.

PubMed

AlReshidi, Nahar; Long, Tony; Darvill, Angela

2018-03-01

Despite extensive research in the international arena into pain and its management, there is, as yet, little research on the topic of pain in children in Saudi Arabia and in the Gulf countries generally. A systematic review was conducted to explore the impact of education programs on factors affecting paediatric nurses' postoperative pain management practice. This was done in order to advise the creation of an educational program for nurses in Saudi Arabia. Knowledge about pain, attitudes towards pain, beliefs about children's pain, perceptions of children's reports of pain, self-efficacy with regard to pain management, and perceptions of barriers to optimal practice were all considered to be relevant factors. The review was restricted to randomized controlled trials and quasi-experimental designs, excluding studies focussed on chronic pain or populations other than solely children. Studies published in English between 2000 and 2016 were identified using CINAHL, MEDLINE, Ovid SP, The Cochrane Library, ProQuest, and Google Scholar databases. Of 499 published studies identified by the search, 14 met the inclusion criteria and were included in the review. There was evidence of educational programs exerting a postive impact on enhancing pediatric nurses' knowledge of pain and modifing their attitudes towards it, but only limited evidence was available about the impact on nurses' beliefs and perceptions of children's reports of pain, nurses' self-efficacy, or barriers to optimal practice. None of the studies was conducted in Saudi Arabia. Studies were needed to address additional aspects of preparedness for effective postperative pain management. Details of educational programs used as experimental intervention must be included in reports.

Neurophysiology and functional neuroanatomy of pain perception.

PubMed

Schnitzler, A; Ploner, M

2000-11-01

The traditional view that the cerebral cortex is not involved in pain processing has been abandoned during the past decades based on anatomic and physiologic investigations in animals, and lesion, functional neuroimaging, and neurophysiologic studies in humans. These studies have revealed an extensive central network associated with nociception that consistently includes the thalamus, the primary (SI) and secondary (SII) somatosensory cortices, the insula, and the anterior cingulate cortex (ACC). Anatomic and electrophysiologic data show that these cortical regions receive direct nociceptive thalamic input. From the results of human studies there is growing evidence that these different cortical structures contribute to different dimensions of pain experience. The SI cortex appears to be mainly involved in sensory-discriminative aspects of pain. The SII cortex seems to have an important role in recognition, learning, and memory of painful events. The insula has been proposed to be involved in autonomic reactions to noxious stimuli and in affective aspects of pain-related learning and memory. The ACC is closely related to pain unpleasantness and may subserve the integration of general affect, cognition, and response selection. The authors review the evidence on which the proposed relationship between cortical areas, pain-related neural activations, and components of pain perception is based.

An observational study of the impact of genetic testing for pain perception in the clinical management of chronic non-cancer pain.

PubMed

Sharma, Maneesh; Kantorovich, Svetlana; Lee, Chee; Anand, Natasha; Blanchard, John; Fung, Eric T; Meshkin, Brian; Brenton, Ashley; Richeimer, Steven

2017-06-01

Pain levels are a key metric in clinical care. However, the assessment of pain is limited to basic questionnaires and physician interpretation, which yield subjective data. Genetic markers of pain sensitivity, such as single nucleotide polymorphisms in the catechol-O-methyltransferase gene, have been shown to be associated with pain perception and have been used to provide objective information about a patient's pain. The goal of this study was to determine if physician treatment adjustments based on genetic tests of pain perception resulted in improved outcomes for patients. A prospective, longitudinal study was conducted with 134 chronic non-cancer pain patients genotyped for pain perception-related catechol-O-methyltransferase haplotypes. Physicians were provided with patients' results and asked to document 1) their assessment of benefit of the genetic test; 2) treatment changes made based on the genetic test; and 3) patient clinical responses to changes implemented. Based on genetic testing results, physicians adjusted treatment plans for 40% of patients. When medication changes were made based on genetic testing results, 72% of patients showed improvement in clinical status. When non-pharmacological actions were performed, 69% of physicians felt their patients' clinical status improved. Moreover, physicians believed the genetic test results were consistent with patient pain levels in 85% of cases. These results demonstrate that providing personalized medicine with genetic information related to pain perception affected physician clinical decision-making for a substantial proportion of patients in this study, and that the availability and utilization of this information was a contributing factor in clinical improvement. Copyright © 2017 Elsevier Ltd. All rights reserved.

Successful Graded Mirror Therapy in a Patient with Chronic Deafferentation Pain in Whom Traditional Mirror Therapy was Ineffective: A Case Report.

PubMed

Mibu, Akira; Nishigami, Tomohiko; Tanaka, Katsuyoshi; Osumi, Michihiro; Tanabe, Akihito

2016-04-01

A 43-year-old man had deafferentation pain in his right upper extremity secondary to brachial plexus avulsion from a traffic accident 23 years previously. On our initial examination, he had severe tingling pain with numbness in the right fingers rated 10 on the numerical rating scale. The body perception of the affected third and fourth fingers was distorted in the flexed position. Although he performed traditional mirror therapy (TMT) for 4 weeks in the same methods as seen in previous studies, he could not obtain willed motor imagery and pain-alleviation effect. Therefore, we modified the task of TMT: Graded mirror therapy (GMT). GMT consisted of five stages: (1) observation of the mirror reflection of the unaffected side without imagining any movements of the affected side; (2) observation of the mirror reflection of the third and fourth fingers changing shape gradually adjusted from a flexed position to a extended position; (3) observation of the mirror reflection of passive movement; (4) motor imagery of affected fingers with observation of the mirror reflection (similar to TMT); (5) motor imagery of affected fingers without mirror. Each task was performed for 3 to 4 weeks. As a result, pain intensity during mirror therapy gradually decreased and finally disappeared. The body perception of the affected fingers also improved, and he could imagine the movement of the fingers with or without mirror. We suggested that GMT starting from the observation task without motor imagery may effectively decrease deafferentation pain compared to TMT. © 2016 World Institute of Pain.

Extenuating Circumstances in Perceptions of Suicide: Disease Diagnosis (AIDS, Cancer), Pain Level, and Life Expectancy.

ERIC Educational Resources Information Center

Martin, Stephen K.; Range, Lillian M.

1991-01-01

Examined whether illness type, pain level, and life expectancy affected reactions of undergraduates (n=160) toward a terminal illness suicide with Acquired Immune Deficiency Syndrome (AIDS) or cancer. AIDS patients were more stigmatized than cancer patients; suicide was more tolerated if victim was suffering greater pain. (Author/ABL)

Effects of Acupuncture on Sensory Perception: A Systematic Review and Meta-Analysis

PubMed Central

Baeumler, Petra I.; Fleckenstein, Johannes; Takayama, Shin; Simang, Michael; Seki, Takashi; Irnich, Dominik

2014-01-01

Background The effect of acupuncture on sensory perception has never been systematically reviewed; although, studies on acupuncture mechanisms are frequently based on the idea that changes in sensory thresholds reflect its effect on the nervous system. Methods Pubmed, EMBASE and Scopus were screened for studies investigating the effect of acupuncture on thermal or mechanical detection or pain thresholds in humans published in English or German. A meta-analysis of high quality studies was performed. Results Out of 3007 identified articles 85 were included. Sixty five studies showed that acupuncture affects at least one sensory threshold. Most studies assessed the pressure pain threshold of which 80% reported an increase after acupuncture. Significant short- and long-term effects on the pressure pain threshold in pain patients were revealed by two meta-analyses including four and two high quality studies, respectively. In over 60% of studies, acupuncture reduced sensitivity to noxious thermal stimuli, but measuring methods might influence results. Few but consistent data indicate that acupuncture reduces pin-prick like pain but not mechanical detection. Results on thermal detection are heterogeneous. Sensory threshold changes were equally frequent reported after manual acupuncture as after electroacupuncture. Among 48 sham-controlled studies, 25 showed stronger effects on sensory thresholds through verum than through sham acupuncture, but in 9 studies significant threshold changes were also observed after sham acupuncture. Overall, there is a lack of high quality acupuncture studies applying comprehensive assessments of sensory perception. Conclusions Our findings indicate that acupuncture affects sensory perception. Results are most compelling for the pressure pain threshold, especially in pain conditions associated with tenderness. Sham acupuncture can also cause such effects. Future studies should incorporate comprehensive, standardized assessments of sensory profiles in order to fully characterize its effect on sensory perception and to explore the predictive value of sensory profiles for the effectiveness of acupuncture. PMID:25502787

Effects of acupuncture on sensory perception: a systematic review and meta-analysis.

PubMed

Baeumler, Petra I; Fleckenstein, Johannes; Takayama, Shin; Simang, Michael; Seki, Takashi; Irnich, Dominik

2014-01-01

The effect of acupuncture on sensory perception has never been systematically reviewed; although, studies on acupuncture mechanisms are frequently based on the idea that changes in sensory thresholds reflect its effect on the nervous system. Pubmed, EMBASE and Scopus were screened for studies investigating the effect of acupuncture on thermal or mechanical detection or pain thresholds in humans published in English or German. A meta-analysis of high quality studies was performed. Out of 3007 identified articles 85 were included. Sixty five studies showed that acupuncture affects at least one sensory threshold. Most studies assessed the pressure pain threshold of which 80% reported an increase after acupuncture. Significant short- and long-term effects on the pressure pain threshold in pain patients were revealed by two meta-analyses including four and two high quality studies, respectively. In over 60% of studies, acupuncture reduced sensitivity to noxious thermal stimuli, but measuring methods might influence results. Few but consistent data indicate that acupuncture reduces pin-prick like pain but not mechanical detection. Results on thermal detection are heterogeneous. Sensory threshold changes were equally frequent reported after manual acupuncture as after electroacupuncture. Among 48 sham-controlled studies, 25 showed stronger effects on sensory thresholds through verum than through sham acupuncture, but in 9 studies significant threshold changes were also observed after sham acupuncture. Overall, there is a lack of high quality acupuncture studies applying comprehensive assessments of sensory perception. Our findings indicate that acupuncture affects sensory perception. Results are most compelling for the pressure pain threshold, especially in pain conditions associated with tenderness. Sham acupuncture can also cause such effects. Future studies should incorporate comprehensive, standardized assessments of sensory profiles in order to fully characterize its effect on sensory perception and to explore the predictive value of sensory profiles for the effectiveness of acupuncture.

Perceptions and practices of Finnish dairy producers on disbudding pain in calves.

PubMed

Hokkanen, A-H; Wikman, I; Korhonen, T; Pastell, M; Valros, A; Vainio, O; Hänninen, L

2015-02-01

Disbudding causes pain-related distress and behavioral changes in calves. Local anesthesia and non-steroidal anti-inflammatory drugs are effective for treating disbudding-related pain. Dairy producers play a key role in whether or not calves to be disbudded are properly medicated. Pain and distress related to disbudding of calves often remains untreated. Thus, we conducted this study to characterize perceptions and practices of dairy producers on disbudding and disbudding-related pain management. A questionnaire was sent to 1,000 randomly selected Finnish dairy producers (response rate: 45%). Our aim was to investigate producer perceptions about disbudding-related pain, the perceived need for pain alleviation before disbudding, and how these perceptions affect the valuing and use of pain alleviation before disbudding. More than 70% of Finnish dairy farms disbud their calves. Producers who ranked disbudding-related pain and need for pain alleviation higher called a veterinarian to medicate calves before disbudding more often than producers who ranked disbudding pain and need for pain alleviation lower. Among respondents who disbudded calves on their farms, 69% stated that disbudding caused severe pain, 63% stated that pain alleviation during disbudding is important, and 45% always had a veterinarian medicate their calves before disbudding. Producers with a herd healthcare agreement with their veterinarian estimated disbudding-related pain to be higher and had a veterinarian medicate calves more often than producers without such an agreement. Producers with tiestall systems and producers who did not use disbudding valued pain alleviation prior to disbudding higher than producers with freestalls and producers who used disbudding. Copyright © 2015 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

Brain responses to vestibular pain and its anticipation in women with Genito-Pelvic Pain/Penetration Disorder.

PubMed

Pazmany, Els; Ly, Huynh Giao; Aerts, Leen; Kano, Michiko; Bergeron, Sophie; Verhaeghe, Johan; Peeters, Ronald; Tack, Jan; Dupont, Patrick; Enzlin, Paul; Van Oudenhove, Lukas

2017-01-01

In DSM-5, pain-related fear during anticipation of vaginal penetration is a diagnostic criterion of Genito-Pelvic Pain/Penetration Disorder (GPPPD). We aimed to investigate subjective and brain responses during anticipatory fear and subsequent induction of vestibular pain in women with GPPPD. Women with GPPPD (n = 18) and age-matched healthy controls (HC) (n = 15) underwent fMRI scanning during vestibular pain induction at individually titrated pain threshold after a cued anticipation period. (Pain-related) fear and anxiety traits were measured with questionnaires prior to scanning, and anticipatory fear and pain intensity were rated during scanning using visual analog scales. Women with GPPPD reported significantly higher levels of anticipatory fear and pain intensity. During anticipation and pain induction they had stronger and more extensive brain responses in regions involved in cognitive and affective aspects of pain perception, but the group difference did not reach significance for the anticipation condition. Pain-related fear and anxiety traits as well as anticipatory fear ratings were positively associated with pain ratings in GPPPD, but not in HC. Further, in HC, a negative association was found between anticipatory fear ratings and brain responses in regions involved in cognitive and affective aspects of pain perception, but not in women with GPPPD. Women with GPPPD are characterized by increased subjective and brain responses to vestibular pain and, to a lesser extent, its anticipation, with fear and anxiety associated with responses to pain, supporting the introduction of anticipatory fear as a criterion of GPPPD in DSM-5.

Perceptions of children and their parents about the pain experienced during their hospitalization and its impact on parents' quality of life.

PubMed

Matziou, Vasiliki; Vlachioti, Efrosini; Megapanou, Eustathia; Ntoumou, Agapi; Dionisakopoulou, Christina; Dimitriou, Vasia; Tsoumakas, Konstantinos; Matziou, Theodora; Perdikaris, Pantelis

2016-09-01

The aim of the study was to assess pain levels and perceptions concerning pain by both children and their parents during hospitalization, as well as the impact of that pain upon parents' quality of life. The sample of the study consisted of 92 pediatric cancer patients, 159 pediatric patients with musculoskeletal problems and one of their parents. The study was performed between November 2010 and May 2011. The Pediatric Pain Questionnaire (Parent Version) and the PedsQL-Family Impact Module were used for pain assessment and the quality of life by the parents. Young patients completed the pediatric version of the Pediatric Pain Questionnaire for the evaluation of pediatric pain. Pain was measured by using the Wong-Baker facial pain scale, included in both parent and child version of the Pediatric Pain Questionnaire. This rating scale is recommended for children 3 years and older. Young patients reported higher acute pain scores than their parents (z = -2.5, P = 0.011; 99% confidence interval: 0.008-0.013). Young patients with orthopedic disorders had higher acute and chronic pain scores in comparison to their parents' reports (z = -3.4, P = 0.001; 99% confidence interval: 0.000-0.001 and z = -2.3, P = 0.021; 99% confidence interval: 0.017-0.025, respectively). Girls reported higher pain scores than boys (z = -2.0, P = 0.047; 99% CI: 0.041-0.052). Parental reports tended to underestimated children's pain, especially acute pain. The sex of children, the age and the marital status affect the perceptions of both children and their parents about pain. The parental quality of life is affected especially when the pain is caused by life-threatening diseases such as cancer. However, it improves as the treatment of their children is completed with no complications. © The Author 2016. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Healthy and maladaptive dependency and its relationship to pain management and perceptions in physical therapy patients.

PubMed

Huprich, Steven K; Hoban, Patrick; Boys, Ashley; Rosen, Alexandra

2013-12-01

This study examined the association among healthy and maladaptive aspects of interpersonal dependency and the management of pain in physical therapy outpatients. Ninety-eight patients were administered the Relationship Profile Test, West Haven-Yale Multidimensional Pain Inventory, and Pain Catastrophizing Scale. Results indicated that Destructive Overdependence was positively associated with an increased number of office visits, pain interference in one's daily life, pain severity, affective distress, and receiving positive partner responses. Dysfunctional Detachment was associated with affective distress, pain interference in one's daily life, and rumination about pain. Healthy Dependency was only associated with receiving distracting responses from others. Believing that a spouse/partner is supportive and caring about one's pain partially mediated the relationship between overdependency and pain interfering in one's life. These results support the clinical utility of assessing interpersonal dependency for its relationship to managing one's pain and health care utilization.

Patients' perception of Parkinson's disease-associated pain following initiation of rotigotine: a multicenter non-interventional study.

PubMed

Timmermann, Lars; Oehlwein, Christian; Ransmayr, Gerhard; Fröhlich, Holger; Will, Edgar; Schroeder, Hanna; Lauterbach, Thomas; Bauer, Lars; Kassubek, Jan

2017-01-01

To evaluate Parkinson's disease (PD)-associated pain as perceived by the patients (subjective characterization), and how this may change following initiation of rotigotine transdermal patch. SP1058 was a non-interventional study conducted in routine clinical practice in Germany and Austria in patients experiencing PD-associated pain (per the physician's assessment). Data were collected at baseline (ie, before rotigotine initiation) and at a routine visit after ≥25 days (-3 days allowed) of treatment on a maintenance dose of rotigotine (end of study [EoS]). Pain perception was assessed using the 12-item Pain Description List of the validated German Pain Questionnaire (each item ranked 0 = 'not true' to 3 = 'very true'). Primary effectiveness variable: change from baseline to EoS in the sum score of the 4 'affective dimension' items of the Pain Description List. Secondary effectiveness variables: change from baseline to EoS in Unified Parkinson's Disease Rating Scale (UPDRS) II, III, and II+III scores, and Parkinson's Disease Questionnaire (PDQ-8) total score (PD-related quality-of-life). Other variables included scores of the eight 'sensory dimension' items of the Pain Description List. Of 93 enrolled patients (mean [SD] age: 71.1 [9.0] years; male: 48 [52%]), 77 (83%) completed the study, and 70 comprised the full analysis set. The mean (SD) change from baseline in the sum score of the four 'affective dimension' items was -1.3 (2.8) indicating a numerical improvement (baseline: 3.9 [3.4]). In the 'sensory dimension', pain was mostly perceived as 'pulling' at baseline (49/70 [70%]); 'largely true'/'very true'). Numerical improvements were observed in all UPDRS scores (mean [SD] change in UPDRS II+III: -5.3 [10.5]; baseline: 36.0 [15.9]), and in PDQ-8 total score (-2.0 [4.8]; baseline: 10.7 [5.9]). Adverse drug reactions were consistent with dopaminergic stimulation and transdermal administration. The perception of the 'affective dimension' of PD-associated pain numerically improved in patients treated with rotigotine. ClinicalTrials.gov identifier: NCT01606670; https://clinicaltrials.gov/ct2/show/NCT01606670?term=NCT01606670&rank=1.

Postoperative Pain and Analgesia: Is There a Genetic Basis to the Opioid Crisis?

PubMed

Elmallah, Randa K; Ramkumar, Prem N; Khlopas, Anton; Ramkumar, Rathika R; Chughtai, Morad; Sodhi, Nipun; Sultan, Assem A; Mont, Michael A

2018-06-01

Multiple factors have been implicated in determining why certain patients have increased postoperative pain, with the potential to develop chronic pain. The purpose of this study was to: 1) identify and describe genes that affect postoperative pain perception and control; 2) address modifiable risk factors that result in epigenetic altered responses to pain; and 3) characterize differences in pain sensitivity and thresholds between opioid-naïve and opioid-dependent patients. Three electronic databases were used to conduct the literature search: Pubmed, EBSCO host, and SCOPUS. A total of 372 abstracts were reviewed, of which 46 studies were deemed relevant and are included in this review. Specific gene alterations that were shown to affect postoperative pain control included single nucleotide polymorphisms in the mu, kappa, and delta opioid receptors, ion channel genes, cytotoxic T-cells, glutamate receptors and cytokine genes, among others. Alcoholism, obesity, and smoking were all linked with genetic polymorphisms that altered pain sensitivity. Opioid abuse was found to be associated with a poorer response to analgesics postoperatively, as well as a risk for prescription overdose. Although pain perception has multiple complex influences, the greatest variability seen in response to opioids among postoperative patients known to date can be traced to genetic differences in opioid metabolism. Further study is needed to determine the clinical significance of these genetic associations.

Effect of gender and hand laterality on pain processing in human neonates.

PubMed

Ozawa, Mio; Kanda, Katsuya; Hirata, Michio; Kusakawa, Isao; Suzuki, Chieko

2011-01-01

Previous studies in adults have reported that handedness and gender can affect pain perception. However, it is currently unclear when these differences emerge in human development. Therefore, we examined prefrontal responses to pain stimulation among newborns during their first acute pain experience after birth. Forty newborns at 4-6 days postnatal age were observed during clinically required blood sampling while prefrontal activation was measured with near infrared spectroscopy. Blood sampling in this study was the first experience of a procedure involving skin breaking for these infants. We divided subjects into a right-hand stimulation group (n=21) and a left-hand stimulation group (n=19), depending on whether blood was sampled from the right or the left hand. A three-way analysis of variance (ANOVA) was conducted to examine the effects of several variables on the magnitude of the oxy-Hb value in response to pain stimulus, including stimulus side (right hand or left hand), gender (male or female), recording side (right prefrontal area or left prefrontal area) and interactions between these variables. The data revealed a significant effect of stimulus side (F (1, 72)=9.892, P=0.002), showing that the right-hand stimulation induced a greater prefrontal activation than the left-hand stimulation. No significant gender difference or interactions were found. Our findings suggest that hand laterality affects pain perception even in neonates. However, gender differences in pain perception did not appear to occur during the neonatal period. Further investigations using brain-imaging techniques are required to identify laterality- or gender-related differences in pain processing in humans. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Acute psychosocial stress reduces pain modulation capabilities in healthy men.

PubMed

Geva, Nirit; Pruessner, Jens; Defrin, Ruth

2014-11-01

Anecdotes on the ability of individuals to continue to function under stressful conditions despite injuries causing excruciating pain suggest that acute stress may induce analgesia. However, studies exploring the effect of acute experimental stress on pain perception show inconsistent results, possibly due to methodological differences. Our aim was to systematically study the effect of acute stress on pain perception using static and dynamic, state-of-the-art pain measurements. Participants were 29 healthy men who underwent the measurement of heat-pain threshold, heat-pain intolerance, temporal summation of pain, and conditioned pain modulation (CPM). Testing was conducted before and during exposure to the Montreal Imaging Stress Task (MIST), inducing acute psychosocial stress. Stress levels were evaluated using perceived ratings of stress and anxiety, autonomic variables, and salivary cortisol. The MIST induced a significant stress reaction. Although pain threshold and pain intolerance were unaffected by stress, an increase in temporal summation of pain and a decrease in CPM were observed. These changes were significantly more robust among individuals with stronger reaction to stress ("high responders"), with a significant correlation between the perception of stress and the performance in the pain measurements. We conclude that acute psychosocial stress seems not to affect the sensitivity to pain, however, it significantly reduces the ability to modulate pain in a dose-response manner. Considering the diverse effects of stress in this and other studies, it appears that the type of stress and the magnitude of its appraisal determine its interactions with the pain system. Copyright © 2014 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

Interactions among sex, ethnicity, religion, and gender role expectations of pain.

PubMed

Defrin, Ruth; Eli, Ilana; Pud, Dorit

2011-06-01

Sex, gender, ethnicity, and religion are powerful factors that may affect pain experience. Recently, gender role expectations of pain (GREP) were suggested to account for some of the differences in pain perception between men and women. However, the interaction between GREP and ethnicity and religion was not examined. This interaction was studied with regard to pain sensitivity, pain endurance, and willingness to report pain. Our objective was to study the interaction among GREP, sex, and ethno-religious belonging. Participants (548 healthy men and women) of 3 different ethno-religious groups (341 Jews, 105 Muslim-Arabs, 102 Christian-Arabs) completed the GREP questionnaire; pain sensitivity, pain endurance, and willingness to report pain were analyzed. Men of all 3 ethno-religious groups perceived themselves and other men as less sensitive and less willing to report pain than typical women. Women of all 3 ethno-religious groups perceived themselves and other women as more sensitive and more willing to report pain than men. Ethno-religious differences were observed in the attitudes towards typical men and women, with Christian men and women exhibiting stronger stereotypical views regarding pain sensitivity and pain endurance. Individual's perceptions of pain regarding one's self compared with the same or opposite sex were similar regardless of ethno-religious belonging and were related to sex. However, attitudes on pain of typical men and women seemed to be influenced by ethno-religious belonging. This differential effect of ethno-religion on GREP with relation to sex suggests that these factors should be considered when pain perception is evaluated. Copyright © 2011 Elsevier HS Journals, Inc. All rights reserved.

What Influences How Patients Rate Their Hospital After Total Knee Arthroplasty?

PubMed

Chughtai, Morad; Jauregui, Julio J; Mistry, Jaydev B; Elmallah, Randa K; Diedrich, Aloise M; Bonutti, Peter M; Delanois, Ronald; Mont, Michael A

2016-04-01

There is increasing pressure from Centers for Medicare and Medicaid Services (CMS) to report quality measures for all hospitalizations. These quality measures are determined based on results from satisfaction surveys, such as Press Ganey® (PG) (Press Ganey® Performance Solutions, Wakefield, Massachusetts). Included in this particular survey element are questions regarding staff, including nurses and doctors, as well as items such as pain control. The results of these surveys will dictate the amount doctors are compensated for their services. Therefore, this study was undertaken to evaluate the effect of treating orthopaedists and nurses, as well as pain control, on PG surveys in patients who underwent total knee arthroplasty (TKA). Specifically, we aimed to ascertain the effect of these factors on how post-TKA patients perceive: 1) their orthopaedist, and 2) their overall surgical experience. We queried the Press Ganey® Database for all patients who underwent a TKA at our institution between November 2009 and January 2015. A weighted mean of question domains was utilized since each had multiple questions. In order to assess if pain management influences orthopaedist perception, a correlation analysis was performed between pain control and perception. In order to assess the influence of pain management on surgical experience, we performed a correlation analysis between pain control and overall hospital rating. A multiple regression analysis was performed using the hospital rating as the dependent variable to determine the most influential factors on surgical experience. Our analysis demonstrated a significantly positive correlation between patient perception of their pain control and their orthopaedist. There was a significant positive correlation between patient's perception of their pain control and their overall surgical experience. Multiple regression analysis using overall surgical experience as the dependent variable demonstrated a significant positive influence of perception of nurses and orthopaedists. Pain management positively influenced surgical experience; however, this was not significant. We found that perception of pain control in post-TKA patients affects perception of the treating orthopaedists, as well as their overall surgical experience. In addition, perception of orthopaedists and nurses both outweigh perception of pain control on overall surgical experience, with nurses being the most important. Orthopaedists should focus on staff education-particularly nurses-and educate them in order to optimize results on PG surveys and, ultimately, improve patient satisfaction. Further studies should correlate current standardized scoring systems and questionnaires for TKA with PG surveys in order to recognize gaps that need to be bridged to improve post-TKA patient satisfaction.

Spatially defined modulation of skin temperature and hand ownership of both hands in patients with unilateral complex regional pain syndrome.

PubMed

Moseley, G Lorimer; Gallace, Alberto; Iannetti, Gian Domenico

2012-12-01

Numerous clinical conditions, including complex regional pain syndrome, are characterized by autonomic dysfunctions (e.g. altered thermoregulation, sometimes confined to a single limb), and disrupted cortical representation of the body and the surrounding space. The presence, in patients with complex regional pain syndrome, of a disruption in spatial perception, bodily ownership and thermoregulation led us to hypothesize that impaired spatial perception might result in a spatial-dependent modulation of thermoregulation and bodily ownership over the affected limb. In five experiments involving a total of 23 patients with complex regional pain syndrome of one arm and 10 healthy control subjects, we measured skin temperature of the hand with infrared thermal imaging, before and after experimental periods of either 9 or 10 min each, during which the hand was held on one or the other side of the body midline. Tactile processing was assessed by temporal order judgements of pairs of vibrotactile stimuli, delivered one to each hand. Pain and sense of ownership over the hand were assessed by self-report scales. Across experiments, when kept on its usual side of the body midline, the affected hand was 0.5 ± 0.3°C cooler than the healthy hand (P < 0.02 for all, a common finding in cold-type complex regional pain syndrome), and tactile stimuli delivered to the healthy hand were prioritized over those delivered to the affected hand. Simply crossing both hands over the midline resulted in (i) warming of the affected hand (the affected hand became 0.4 ± 0.3°C warmer than when it was in the uncrossed position; P = 0.01); (ii) cooling of the healthy hand (by 0.3 ± 0.3°C; P = 0.02); and (iii) reversal of the prioritization of tactile processing. When only the affected hand was crossed over the midline, it became warmer (by 0.5 ± 0.3°C; P = 0.01). When only the healthy hand was crossed over the midline, it became cooler (by 0.3 ± 0.3°C; P = 0.01). The temperature change of either hand was positively related to its distance from the body midline (pooled data: r = 0.76, P < 0.001). Crossing the affected hand over the body midline had small but significant effects on both spontaneous pain (which was reduced) and the sense of ownership over the hand (which was increased) (P < 0.04 for both). We conclude that impaired spatial perception modulated temperature of the limbs, tactile processing, spontaneous pain and the sense of ownership over the hands. These results show that complex regional pain syndrome involves more complex neurological dysfunction than has previously been considered.

The causal role of the somatosensory cortex in prosocial behaviour

PubMed Central

Gallo, Selene; Paracampo, Riccardo; Müller-Pinzler, Laura; Severo, Mario Carlo; Suttrup, Judith; Avenanti, Alessio; Keysers, Christian

2018-01-01

Witnessing another person’s suffering elicits vicarious brain activity in areas that are active when we ourselves are in pain. Whether this activity influences prosocial behavior remains the subject of debate. Here participants witnessed a confederate express pain through a reaction of the swatted hand or through a facial expression, and could decide to reduce that pain by donating money. Participants donate more money on trials in which the confederate expressed more pain. Electroencephalography shows that activity of the somatosensory cortex I (SI) hand region explains variance in donation. Transcranial magnetic stimulation (TMS) shows that altering this activity interferes with the pain–donation coupling only when pain is expressed by the hand. High-definition transcranial direct current stimulation (HD-tDCS) shows that altering SI activity also interferes with pain perception. These experiments show that vicarious somatosensory activations contribute to prosocial decision-making and suggest that they do so by helping to transform observed reactions of affected body-parts into accurate perceptions of pain that are necessary for decision-making. PMID:29735015

Eina! Ouch! Eish! Professionals’ Perceptions of How Children with Cerebral Palsy Communicate About Pain in South African School Settings: Implications for the use of AAC

PubMed Central

Johnson, Ensa; Nilsson, Stefan; Adolfsson, Margareta

2015-01-01

Abstract Most children with severe cerebral palsy experience daily pain that affects their school performance. School professionals need to assess pain in these children, who may also have communication difficulties, in order to pay attention to the pain and support the children’s continued participation in school. In this study, South African school professionals’ perceptions of how they observed pain in children with cerebral palsy, how they questioned them about it and how the children communicated their pain back to them were investigated. Thirty-eight school professionals participated in five focus groups. Their statements were categorized using qualitative content analysis. From the results it became clear that professionals observed children’s pain communication through their bodily expressions, behavioral changes, and verbal and non-verbal messages. Augmentative and alternative communication (AAC) methods were rarely used. The necessity of considering pain-related vocabulary in a multilingual South African context, and of advocating for the use of AAC strategies to enable children with cerebral palsy to communicate their pain was highlighted in this study. PMID:26372118

Short-Term Sleep Disturbance-Induced Stress Does not Affect Basal Pain Perception, but Does Delay Postsurgical Pain Recovery.

PubMed

Wang, Po-Kai; Cao, Jing; Wang, Hongzhen; Liang, Lingli; Zhang, Jun; Lutz, Brianna Marie; Shieh, Kun-Ruey; Bekker, Alex; Tao, Yuan-Xiang

2015-11-01

Chronic sleep disturbance-induced stress is known to increase basal pain sensitivity. However, most surgical patients frequently report short-term sleep disturbance/deprivation during the pre- and postoperation periods and have normal pain perception presurgery. Whether this short-term sleep disturbance affects postsurgical pain is elusive. Here, we report that pre- or postexposure to rapid eye movement sleep disturbance (REMSD) for 6 hours daily for 3 consecutive days did not alter basal responses to mechanical, heat, and cold stimuli, but did delay recovery in incision-induced reductions in paw withdrawal threshold to mechanical stimulation and paw withdrawal latencies to heat and cold stimuli on the ipsilateral side of male or female rats. This short-term REMSD led to stress shown by an increase in swim immobility time, a decrease in sucrose consumption, and an increase in the level of corticosterone in serum. Blocking this stress via intrathecal RU38486 or bilateral adrenalectomy abolished REMSD-caused delay in recovery of incision-induced reductions in behavioral responses to mechanical, heat, and cold stimuli. Moreover, this short-term REMSD produced significant reductions in the levels of mu opioid receptor and kappa opioid receptor, but not Kv1.2, in the ipsilateral L4/5 spinal cord and dorsal root ganglia on day 9 after incision (but not after sham surgery). Our findings show that short-term sleep disturbance either pre- or postsurgery does not alter basal pain perception, but does exacerbate postsurgical pain hypersensitivity. The latter may be related to the reductions of mu and kappa opioid receptors in the spinal cord and dorsal root ganglia caused by REMSD plus incision. Prevention of short-term sleep disturbance may help recovery from postsurgical pain in patients. Copyright © 2015 American Pain Society. Published by Elsevier Inc. All rights reserved.

Activation of Corticostriatal Circuitry Relieves Chronic Neuropathic Pain

PubMed Central

Lee, Michelle; Manders, Toby R.; Eberle, Sarah E.; Su, Chen; D'amour, James; Yang, Runtao; Lin, Hau Yueh; Deisseroth, Karl; Froemke, Robert C.

2015-01-01

Neural circuits that determine the perception and modulation of pain remain poorly understood. The prefrontal cortex (PFC) provides top-down control of sensory and affective processes. While animal and human imaging studies have shown that the PFC is involved in pain regulation, its exact role in pain states remains incompletely understood. A key output target for the PFC is the nucleus accumbens (NAc), an important component of the reward circuitry. Interestingly, recent human imaging studies suggest that the projection from the PFC to the NAc is altered in chronic pain. The function of this corticostriatal projection in pain states, however, is not known. Here we show that optogenetic activation of the PFC produces strong antinociceptive effects in a rat model (spared nerve injury model) of persistent neuropathic pain. PFC activation also reduces the affective symptoms of pain. Furthermore, we show that this pain-relieving function of the PFC is likely mediated by projections to the NAc. Thus, our results support a novel role for corticostriatal circuitry in pain regulation. PMID:25834050

Stress Reactivity in Traditional Chinese Medicine–Based Subgroups of Patients with Irritable Bowel Syndrome

PubMed Central

Chang, Megan C.; Shapiro, David; Joshi, Aditi; Shahabi, Leila; Tan, Steven; Smith, Suzanne; Hui, Ka Kit; Tillisch, Kirsten; Mayer, Emeran A.

2014-01-01

Abstract Objectives: This study aimed to examine differences in autonomic responses to stress, pain perception, and the role of negative affect in these responses in individuals with irritable bowel syndrome (IBS) according to Traditional Chinese Medicine (TCM) classifications. Design: Fifty-nine female patients with IBS age 18–65 years diagnosed by TCM practitioners as showing primarily an excess (n=32) or an overlap (n=27) pattern (mixed excess and deficiency) were assessed for symptom differences, heart rate, and skin conductance responses to a psychosocial stressor and pain perception. Settings/Locations: University of California in Los Angeles, California. Results: Compared with the excess group, the overlap group showed significantly greater overall gastrointestinal symptom severity, abdominal pain, and negative affect. The excess group with higher levels of negative affect showed greater reactivity to stress, whereas the overlap group showed an opposite response pattern. The overlap group showed increased cold sensitivity. Conclusions: IBS patients with the overlap pattern have greater disease severity and comorbidity than those with excess alone. Those with excess showed a pattern of increased stress response with greater negative affect, whereas the overlap group with greater deficiency showed lower physiologic arousal with greater negative affect, consistent with depletion resulting from allostatic load. PMID:24256027

Separating brain processing of pain from that of stimulus intensity.

PubMed

Oertel, Bruno G; Preibisch, Christine; Martin, Till; Walter, Carmen; Gamer, Matthias; Deichmann, Ralf; Lötsch, Jörn

2012-04-01

Regions of the brain network activated by painful stimuli are also activated by nonpainful and even nonsomatosensory stimuli. We therefore analyzed where the qualitative change from nonpainful to painful perception at the pain thresholds is coded. Noxious stimuli of gaseous carbon dioxide (n = 50) were applied to the nasal mucosa of 24 healthy volunteers at various concentrations from 10% below to 10% above the individual pain threshold. Functional magnetic resonance images showed that these trigeminal stimuli activated brain regions regarded as the "pain matrix." However, most of these activations, including the posterior insula, the primary and secondary somatosensory cortex, the amygdala, and the middle cingulate cortex, were associated with quantitative changes in stimulus intensity and did not exclusively reflect the qualitative change from nonpainful to pain. After subtracting brain activations associated with quantitative changes in the stimuli, the qualitative change, reflecting pain-exclusive activations, could be localized mainly in the posterior insular cortex. This shows that cerebral processing of noxious stimuli focuses predominately on the quantitative properties of stimulus intensity in both their sensory and affective dimensions, whereas the integration of this information into the perception of pain is restricted to a small part of the pain matrix. Copyright © 2011 Wiley Periodicals, Inc.

Pain-related anxiety influences pain perception differently in men and women: a quantitative sensory test across thermal pain modalities.

PubMed

Thibodeau, Michel A; Welch, Patrick G; Katz, Joel; Asmundson, Gordon J G

2013-03-01

The sexes differ with respect to perception of experimental pain. Anxiety influences pain perception more in men than in women; however, there lacks research exploring which anxiety constructs influence pain perception differentially between men and women. Furthermore, research examining whether depression is associated with pain perception differently between the sexes remains scant. The present investigation was designed to examine how trait anxiety, pain-related anxiety constructs (ie, fear of pain, pain-related anxiety, anxiety sensitivity), and depression are associated with pain perception between the sexes. A total of 95 nonclinical participants (55% women) completed measures assessing the constructs of interest and participated in quantitative sensory testing using heat and cold stimuli administered by a Medoc Pathway Pain and Sensory Evaluation System. The findings suggest that pain-related anxiety constructs, but not trait anxiety, are associated with pain perception. Furthermore, these constructs are associated with pain intensity ratings in men and pain tolerance levels in women. This contrasts with previous research suggesting that anxiety influences pain perception mostly or uniquely in men. Depression was not systematically associated with pain perception in either sex. Systematic relationships were not identified that allow conclusions regarding how fear of pain, pain-related anxiety, and anxiety sensitivity may contribute to pain perception differentially in men and women; however, anxiety sensitivity was associated with increased pain tolerance, a novel finding needing further examination. The results provide directions for future research and clinical endeavors and support that fear and anxiety are important features associated with hyperalgesia in both men and women. Copyright © 2012 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

Prevalence of Chronic Pain, Treatments, Perception, and Interference on Life Activities: Brazilian Population-Based Survey

PubMed Central

Perissinotti, Dirce Maria Navas; de Oliveira Junior, Jose Oswaldo; da Fonseca, Paulo Renato Barreiros; Posso, Irimar de Paula

2017-01-01

Background and Objectives Chronic pain affects between 30% and 50% of the world population. Our objective was to estimate the prevalence of chronic pain in Brazil, describe and compare differences between pain types and characteristics, and identify the types of therapies adopted and the impact of pain on daily life. Methods Cross-sectional study of a population-based survey with randomized sample from a private database. The interviews were conducted by phone. 78% of the respondents aged 18 years or more agreed to be interviewed, for a total of 723 respondents distributed throughout the country. Independent variables were demographic data, pain and treatment characteristics, and impact of pain on daily life. Comparative and associative statistical analyses were conducted to select variables for nonhierarchical logistic regression. Results Chronic pain prevalence was 39% and mean age was 41 years with predominance of females (56%). We found higher prevalence of chronic pain in the Southern and Southeastern regions. Pain treatment was not specific to gender. Dissatisfaction with chronic pain management was reported by 49% of participants. Conclusion 39% of interviewed participants reported chronic pain, with prevalence of females. Gender-associated differences were found in intensity perception and interference of pain on daily life activities. PMID:29081680

Single-Spot Yellow Laser Versus Conventional Green Laser on Panretinal Photocoagulation: Patient Pain Scores and Preferences.

PubMed

González-Saldivar, Gerardo; Rojas-Juárez, Sergio; Espinosa-Soto, Itzel; Sánchez-Ramos, Jorge; Jaurieta-Hinojosa, Noel; Ramírez-Estudillo, Abel

2017-11-01

Panretinal photocoagulation (PRP) is the mainstay therapy for proliferative diabetic retinopathy. Pain during and after its application is a complication that affects patients' therapeutic adherence. This study aimed to compare pain perception and patient preference for the 577-nm yellow laser (YL-577) (LIGHTL as 577; LIGHTMED, San Clemente, CA) and the conventional 532-nm green laser (GL-532) (Purepoint Laser; Alcon, Fort Worth, TX) with PRP. A total of 92 patient eyes with proliferative diabetic retinopathy treated with PRP were randomly assigned to receive both GL-532 and YL-577 (184 eyes) - one on each eye, with the order of application randomized, as well. Afterward, verbal rapid answer and visual analogue scale (VAS) scores for pain perception and patient preference were evaluated. VAS score was 7 ± 2 for the GL-532 group compared to 5 ± 3 in the YL-577 group (P = .001). Overall, 75% of the patients preferred YL-577 therapy if they were to receive a second PRP session. The use of YL-577 as an alternative approach for PRP reduces pain perception and is preferred by patients. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:902-905.]. Copyright 2017, SLACK Incorporated.

Neural correlates of deficits in pain-related affective meaning construction in patients with chronic pain disorder.

PubMed

Noll-Hussong, Michael; Otti, Alexander; Wohlschlaeger, Afra M; Zimmer, Claus; Henningsen, Peter; Lahmann, Claas; Ronel, Joram; Subic-Wrana, Claudia; Lane, Richard D; Decety, Jean; Guendel, Harald

2013-02-01

Psychological and neural mechanisms of the affective dimension of pain are known to be disturbed in patients with chronic pain disorder. The aim of this functional magnetic resonance imaging study was to assess the neurofunctional and behavioral measures underlying the ability to construct pain-related affective meaning in a painful situation by comparing 21 clinically and psychometrically well-characterized patients with persistent non-nociceptive somatoform pain with 19 healthy controls. The functional magnetic resonance imaging task involved viewing pictures depicting human hands and feet in different painful and nonpainful situations. Participants were asked to estimate the perceived pain intensity. These data were correlated with behavioral measures of depression, alexithymia, and general cognitive and emotional empathy. In a hypothesis-driven region-of-interest analysis, the healthy control group exhibited greater activation of the left perigenual anterior cingulate cortex than patients with pain (Montreal Neurological Institute coordinates (x y z)=-8 38 0; cluster extent=54 voxels; T=4.28; p=.006 corrected for multiple comparisons at cluster level). No group differences in the activation of the anterior insular cortex were found. Scores on self-assessment instruments (Beck Depression Inventory I, Interpersonal Reactivity Index, and 20-item Toronto Alexithymia Scale) did not influence neuroimaging results. Our results suggest that patients with chronic medically unexplained pain have an altered neural pain perception process owing to decreased activation of empathetic-affective networks, which we interpret as a deficit in pain-related affective meaning construction. These findings may lead to a more specific and detailed neurobiological understanding of the clinical impression of disturbed affect in patients with chronic pain disorder.

Factors affecting the use of postincisional analgesics in dogs and cats by Canadian veterinarians in 2001

PubMed Central

Hewson, Caroline J.; Dohoo, Ian R.

2006-01-01

Abstract Factors affecting the postincisional use of analgesics for ovariohysterectomy (OVH) in dogs and cats were assessed by using data collected from 280 Canadian veterinarians, as part of a national, randomized mail survey (response rate 57.8%). Predictors of analgesic usage identified by logistic regression included the presence of at least 1 animal health technician (AHT) per 2 veterinarians (OR = 2.3, P = 0.004), and the veterinarians’ perception of the pain caused by surgery without analgesia (OR = 1.5, P < 0.001). Linear regression identified the following predictors of veterinarians’ perception of pain: the presence of more than 1 AHT per 2 veterinarians (coefficient = 0.42, P = 0.048) and the number of years since graduation (coefficient = −0.073, P < 0.001). Some of these risk factors are similar to those identified in 1994. The results suggest that continuing education may help to increase analgesic usage. Other important contributors may be client education and a valid method of pain assessment. PMID:16734371

Gender differences in pain: do emotions play a role?

PubMed

Rhudy, Jamie L; Williams, Amy E

2005-12-01

Research suggests that the influence of gender on the processing and experience of pain is a result of several mechanisms. One mediating variable is emotion, which may modulate pain through an interaction of valence (pleasant-unpleasant) and arousal (calm-excited). This review examines whether gender differences in the experience and processing of emotion contribute to differences in the modulation and perception of pain. An English-language search of MEDLINE and PsycINFO was conducted from 1887 to May 2005. Additional literature was obtained from reference lists of articles retained in the initial search. Emotion appears to influence pain through a valence-by-arousal interaction. Specifically, negatively valenced emotions with low to moderate arousal (eg, anxiety) enhance pain, whereas negatively valenced emotions with high arousal (eg, fear) reduce pain. In contrast, positively valenced emotions always reduce pain, as long as minimal arousal is achieved. Some evidence suggests that women are more sensitive than men to threat-related stimuli and thus experience more negative affect than men. This would generally lead to enhanced pain perception in women. It is also possible that women are more likely than men to experience negative affect with high arousal (intense fear) and thus pain inhibition. However, the relatively lower base rate of intense negative emotions is not likely to contribute much to gender differences in pain. Evidence also suggests that men may be more sensitive to positive events, particularly sexual/erotic stimuli, which may lead to more positive emotion-induced pain reduction in men, relative to women. This review suggests that gender differences in the experience of pain may arise from differences in the experience and processing of emotion that, in turn, differentially alter pain processing. Specifically, the system associated with negative affect may be more attuned to threatening stimuli in women, and the system associated with positive affect may be more attuned to pleasurable stimuli in men. However, there is a paucity of research directly addressing this issue; much of the research on this topic has failed to test a comprehensive model of emotion, failed to use adequate manipulation checks, or failed to use within-subject experimental designs that control for intra- and interindividual differences. Therefore, it is concluded that additional research is warranted.

Cultural influences on the assessment of children’s pain

PubMed Central

Finley, G Allen; Kristjánsdóttir, Ólöf; Forgeron, Paula A

2009-01-01

Culture is commonly regarded as a factor in pain behaviour and experience, but the meaning of the term is often unclear. There is little evidence that pain perception is modified by cultural or ethnic factors, but pain expression by children and interpretation by caregivers may be affected by the culture of the patient or the caregiver. The present paper examines some of the research regarding cultural influences on children’s pain assessment, and addresses directions for future research. A focus on cultural influences should not distract clinicians from the need to be sensitive to individual beliefs and attitudes. PMID:19262914

The painful tweet: text, sentiment, and community structure analyses of tweets pertaining to pain.

PubMed

Tighe, Patrick J; Goldsmith, Ryan C; Gravenstein, Michael; Bernard, H Russell; Fillingim, Roger B

2015-04-02

Despite the widespread popularity of social media, little is known about the extent or context of pain-related posts by users of those media. The aim was to examine the type, context, and dissemination of pain-related tweets. We used content analysis of pain-related tweets from 50 cities to unobtrusively explore the meanings and patterns of communications about pain. Content was examined by location and time of day, as well as within the context of online social networks. The most common terms published in conjunction with the term "pain" included feel (n=1504), don't (n=702), and love (n=649). The proportion of tweets with positive sentiment ranged from 13% in Manila to 56% in Los Angeles, CA, with a median of 29% across cities. Temporally, the proportion of tweets with positive sentiment ranged from 24% at 1600 to 38% at 2400, with a median of 32%. The Twitter-based social networks pertaining to pain exhibited greater sparsity and lower connectedness than did those social networks pertaining to common terms such as apple, Manchester United, and Obama. The number of word clusters in proportion to node count was greater for emotion terms such as tired (0.45), happy (0.43), and sad (0.4) when compared with objective terms such as apple (0.26), Manchester United (0.14), and Obama (0.25). Taken together, our results suggest that pain-related tweets carry special characteristics reflecting unique content and their communication among tweeters. Further work will explore how geopolitical events and seasonal changes affect tweeters' perceptions of pain and how such perceptions may affect therapies for pain.

A pilot study of the tolerability and effects of high-definition transcranial direct current stimulation (HD-tDCS) on pain perception.

PubMed

Borckardt, Jeffrey J; Bikson, Marom; Frohman, Heather; Reeves, Scott T; Datta, Abhishek; Bansal, Varun; Madan, Alok; Barth, Kelly; George, Mark S

2012-02-01

Several brain stimulation technologies are beginning to evidence promise as pain treatments. However, traditional versions of 1 specific technique, transcranial direct current stimulation (tDCS), stimulate broad regions of cortex with poor spatial precision. A new tDCS design, called high definition tDCS (HD-tDCS), allows for focal delivery of the charge to discrete regions of the cortex. We sought to preliminarily test the safety and tolerability of the HD-tDCS technique as well as to evaluate whether HD-tDCS over the motor cortex would decrease pain and sensory experience. Twenty-four healthy adult volunteers underwent quantitative sensory testing before and after 20 minutes of real (n = 13) or sham (n = 11) 2 mA HD-tDCS over the motor cortex. No adverse events occurred and no side effects were reported. Real HD-tDCS was associated with significantly decreased heat and cold sensory thresholds, decreased thermal wind-up pain, and a marginal analgesic effect for cold pain thresholds. No significant effects were observed for mechanical pain thresholds or heat pain thresholds. HD-tDCS appears well tolerated, and produced changes in underlying cortex that are associated with changes in pain perception. Future studies are warranted to investigate HD-tDCS in other applications, and to examine further its potential to affect pain perception. This article presents preliminary tolerability and efficacy data for a new focal brain stimulation technique called high definition transcranial direct current stimulation. This technique may have applications in the management of pain. Copyright © 2012. Published by Elsevier Inc.

Reward Circuitry Plasticity in Pain Perception and Modulation

PubMed Central

DosSantos, Marcos F.; Moura, Brenda de Souza; DaSilva, Alexandre F.

2017-01-01

Although pain is a widely known phenomenon and an important clinical symptom that occurs in numerous diseases, its mechanisms are still barely understood. Owing to the scarce information concerning its pathophysiology, particularly what is involved in the transition from an acute state to a chronic condition, pain treatment is frequently unsatisfactory, therefore contributing to the amplification of the chronic pain burden. In fact, pain is an extremely complex experience that demands the recruitment of an intricate set of central nervous system components. This includes cortical and subcortical areas involved in interpretation of the general characteristics of noxious stimuli. It also comprises neural circuits that process the motivational-affective dimension of pain. Hence, the reward circuitry represents a vital element for pain experience and modulation. This review article focuses on the interpretation of the extensive data available connecting the major components of the reward circuitry to pain suffering, including the nucleus accumbens, ventral tegmental area, and the medial prefrontal cortex; with especial attention dedicated to the evaluation of neuroplastic changes affecting these structures found in chronic pain syndromes, such as migraine, trigeminal neuropathic pain, chronic back pain, and fibromyalgia. PMID:29209204

Social context and perceived agency affects empathy for pain: an event-related fMRI investigation.

PubMed

Akitsuki, Yuko; Decety, Jean

2009-08-15

Studying of the impact of social context on the perception of pain in others is important for understanding the role of intentionality in interpersonal sensitivity, empathy, and implicit moral reasoning. Here we used an event-related fMRI with pain and social context (i.e., the number of individuals in the stimuli) as the two factors to investigate how different social contexts and resulting perceived agency modulate the neural response to the perception of pain in others. Twenty-six healthy participants were scanned while presented with short dynamic visual stimuli depicting painful situations accidentally caused by or intentionally caused by another individual. The main effect of perception of pain was associated with signal increase in the aMCC, insula, somatosensory cortex, SMA and PAG. Importantly, perceiving the presence of another individual led to specific hemodynamic increase in regions involved in representing social interaction and emotion regulation including the temporoparietal junction, medial prefrontal cortex, inferior frontal gyrus, and orbitofrontal cortex. Furthermore, the functional connectivity pattern between the left amygdala and other brain areas was modulated by the perceived agency. Our study demonstrates that the social context in which pain occurs modulate the brain response to other's pain. This modulation may reflect successful adaptation to potential danger present in a social interaction. Our results contribute to a better understanding of the neural mechanisms underpinning implicit moral reasoning that concern actions that can harm other people.

Cultural modulation of the neural correlates of emotional pain perception: the role of other-focusedness.

PubMed

Cheon, Bobby K; Im, Dong-Mi; Harada, Tokiko; Kim, Ji-Sook; Mathur, Vani A; Scimeca, Jason M; Parrish, Todd B; Park, Hyunwook; Chiao, Joan Y

2013-06-01

Cultures vary in the extent to which they emphasize group members to habitually attend to the needs, perspectives, and internal experiences of others compared to the self. Here we examined the influence that collectivistic and individualistic cultural environments may play on the engagement of the neurobiological processes that underlie the perception and processing of emotional pain. Using cross-cultural fMRI, Korean and Caucasian-American participants passively viewed scenes of others in situations of emotional pain and distress. Regression analyses revealed that the value of other-focusedness was associated with heightened neural response within the affective pain matrix (i.e. anterior cingulate cortex and insula) to a greater extent for Korean relative to Caucasian-American participants. These findings suggest that mindsets promoting attunement to the subjective experience of others may be especially critical for pain-related and potentially empathic processing within collectivistic relative to individualistic cultural environments. Copyright © 2013 Elsevier Ltd. All rights reserved.

The Painful Tweet: Text, Sentiment, and Community Structure Analyses of Tweets Pertaining to Pain

PubMed Central

Goldsmith, Ryan C; Gravenstein, Michael; Bernard, H Russell; Fillingim, Roger B

2015-01-01

Background Despite the widespread popularity of social media, little is known about the extent or context of pain-related posts by users of those media. Objective The aim was to examine the type, context, and dissemination of pain-related tweets. Methods We used content analysis of pain-related tweets from 50 cities to unobtrusively explore the meanings and patterns of communications about pain. Content was examined by location and time of day, as well as within the context of online social networks. Results The most common terms published in conjunction with the term “pain” included feel (n=1504), don’t (n=702), and love (n=649). The proportion of tweets with positive sentiment ranged from 13% in Manila to 56% in Los Angeles, CA, with a median of 29% across cities. Temporally, the proportion of tweets with positive sentiment ranged from 24% at 1600 to 38% at 2400, with a median of 32%. The Twitter-based social networks pertaining to pain exhibited greater sparsity and lower connectedness than did those social networks pertaining to common terms such as apple, Manchester United, and Obama. The number of word clusters in proportion to node count was greater for emotion terms such as tired (0.45), happy (0.43), and sad (0.4) when compared with objective terms such as apple (0.26), Manchester United (0.14), and Obama (0.25). Conclusions Taken together, our results suggest that pain-related tweets carry special characteristics reflecting unique content and their communication among tweeters. Further work will explore how geopolitical events and seasonal changes affect tweeters’ perceptions of pain and how such perceptions may affect therapies for pain. PMID:25843553

The Role of Positive Traits and Pain Catastrophizing in Pain Perception

PubMed Central

Hood, Anna

2013-01-01

A variety of biological, psychological, and social factors interact to influence pain. This article focuses on two distinct, but connected, psychological factors—positive personality traits and pain catastrophizing—and their link with pain perception in healthy and clinical populations. First, we review the protective link between positive personality traits, such as optimism, hope, and self-efficacy, and pain perception. Second, we provide evidence of the well-established relationship between pain catastrophizing and pain perception and other related outcomes. Third, we outline the inverse relationship between positive traits and pain catastrophizing, and offer a model that explains the inverse link between positive traits and pain perception through lower pain catastrophizing. Finally, we discuss clinical practice recommendations based on the aforementioned relationships. PMID:23512722

Viewing a needle pricking a hand that you perceive as yours enhances unpleasantness of pain.

PubMed

Höfle, Marion; Hauck, Michael; Engel, Andreas K; Senkowski, Daniel

2012-05-01

"Don't look and it won't hurt" is commonly heard advice when receiving an injection, which implies that observing needle pricks enhances pain perception. Throughout our lives, we repeatedly learn that sharp objects cause pain when penetrating our skin, but situational expectations, like information given by the clinician prior to an injection, may also influence how viewing needle pricks affects forthcoming pain. How both previous experiences and acute situational expectations related to viewing needle pricks modulate pain perception is unknown. We presented participants with video clips of a hand perceived as their own being either pricked by a needle or touched by a Q-tip, while concurrently applying painful or nonpainful electrical stimuli. Intensity and unpleasantness ratings, as well as pupil dilation responses, were monitored. Effects of situational expectations about the strength of electrical stimuli were investigated by manipulating the contingency between clips and electrical stimuli across experimental blocks. Participants were explicitly informed about the contingency. Intensity ratings of electrical stimuli were higher when a clip was associated with expectation of painful compared to nonpainful stimuli, suggesting that situational expectations about forthcoming pain bias perceived intensity. Unpleasantness ratings and pupil dilation responses were higher when participants viewed a needle prick, compared to when they viewed a Q-tip touch, suggesting that previous experiences with viewing needle pricks primarily act upon perceived unpleasantness. Thus, remote painful experiences with viewing needle pricks, together with information given prior to an injection, differentially shape the impact of viewing a needle prick on pain perception. Copyright © 2012 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

Exercise increases pressure pain tolerance but not pressure and heat pain thresholds in healthy young men.

PubMed

Vaegter, H B; Hoeger Bement, M; Madsen, A B; Fridriksson, J; Dasa, M; Graven-Nielsen, T

2017-01-01

Exercise causes an acute decrease in the pain sensitivity known as exercise-induced hypoalgesia (EIH), but the specificity to certain pain modalities remains unknown. This study aimed to compare the effect of isometric exercise on the heat and pressure pain sensitivity. On three different days, 20 healthy young men performed two submaximal isometric knee extensions (30% maximal voluntary contraction in 3 min) and a control condition (quiet rest). Before and immediately after exercise and rest, the sensitivity to heat pain and pressure pain was assessed in randomized and counterbalanced order. Cuff pressure pain threshold (cPPT) and pain tolerance (cPTT) were assessed on the ipsilateral lower leg by computer-controlled cuff algometry. Heat pain threshold (HPT) was recorded on the ipsilateral foot by a computer-controlled thermal stimulator. Cuff pressure pain tolerance was significantly increased after exercise compared with baseline and rest (p < 0.05). Compared with rest, cPPT and HPT were not significantly increased by exercise. No significant correlation between exercise-induced changes in HPT and cPPT was found. Test-retest reliability before and after the rest condition was better for cPPT and CPTT (intraclass correlation > 0.77) compared with HPT (intraclass correlation = 0.54). The results indicate that hypoalgesia after submaximal isometric exercise is primarily affecting tolerance of pressure pain compared with the pain threshold. These data contribute to the understanding of how isometric exercise influences pain perception, which is necessary to optimize the clinical utility of exercise in management of chronic pain. The effect of isometric exercise on pain tolerance may be relevant for patients in chronic musculoskeletal pain as a pain-coping strategy. WHAT DOES THIS STUDY ADD?: The results indicate that hypoalgesia after submaximal isometric exercise is primarily affecting tolerance of pressure pain compared with the heat and pressure pain threshold. These data contribute to the understanding of how isometric exercise influences pain perception, which is necessary to optimize the clinical utility of exercise in management of chronic pain. © 2016 European Pain Federation - EFIC®.

Enhanced pain perception prior to smoking cessation is associated with early relapse.

PubMed

Nakajima, Motohiro; al'Absi, Mustafa

2011-09-01

Accumulated evidence suggests that nicotine induces analgesia, and endogenous pain regulatory mechanisms may be altered by chronic smoking. The extent to which individual differences in pain perception are related to smokers' ability to abstain from smoking has not been directly examined. Seventy-one smokers who were interested in quitting completed a pre-cessation laboratory session which included the cold pressor test (CPT). Pain ratings were collected during and after CPT. Also, mood changes, cardiovascular measures, and salivary cortisol samples were evaluated prior to, during, and after CPT. Participants attended 4 weekly follow-up assessment sessions after their quit day. Cox regression analysis revealed that higher pain ratings during and after CPT predicted greater risk for smoking relapse. These results remained significant after affective and physiological responses to CPT were controlled, suggesting that pain ratings prior to smoking cessation are potentially useful in identifying smokers who are at greater risk of early smoking relapse and may reflect underlying putative risk for nicotine dependence and relapse. Copyright © 2011 Elsevier B.V. All rights reserved.

Affective touch and attachment style modulate pain: a laser-evoked potentials study

PubMed Central

Drabek, Marianne M.; Paloyelis, Yannis; Fotopoulou, Aikaterini

2016-01-01

Affective touch and cutaneous pain are two sub-modalities of interoception with contrasting affective qualities (pleasantness/unpleasantness) and social meanings (care/harm), yet their direct relationship has not been investigated. In 50 women, taking into account individual attachment styles, we assessed the role of affective touch and particularly the contribution of the C tactile (CT) system in subjective and electrophysiological responses to noxious skin stimulation, namely N1 and N2-P2 laser-evoked potentials. When pleasant, slow (versus fast) velocity touch was administered to the (non-CT-containing) palm of the hand, higher attachment anxiety predicted increased subjective pain ratings, in the same direction as changes in N2 amplitude. By contrast, when pleasant touch was administered to CT-containing skin of the arm, higher attachment anxiety predicted attenuated N1 and N2 amplitudes. Higher attachment avoidance predicted opposite results. Thus, CT-based affective touch can modulate pain in early and late processing stages (N1 and N2 components), with the direction of effects depending on attachment style. Affective touch not involving the CT system seems to affect predominately the conscious perception of pain, possibly reflecting socio-cognitive factors further up the neurocognitive hierarchy. Affective touch may thus convey information about available social resources and gate pain responses depending on individual expectations of social support. This article is part of the themed issue ‘Interoception beyond homeostasis: affect, cognition and mental health’. PMID:28080967

Pain in People With Alzheimer Disease: Potential Applications for Psychophysical and Neurophysiological Research

PubMed Central

Monroe, Todd B.; Gore, John C.; Chen, Li Min; Mion, Lorraine C.; Cowan, Ronald L.

2015-01-01

Pain management in people with dementia is a critical problem. Recently, psychophysical and neuroimaging techniques have been used to extend our understanding of pain processing in the brain as well as to identify structural and functional changes in Alzheimer disease (AD). But interpreting the complex relationship between AD pathology, brain activation, and pain reports is challenging. This review proposes a conceptual framework for designing and interpreting psychophysical and neuroimaging studies of pain processing in people with AD. Previous human studies describe the lateral (sensory) and medial (affective) pain networks. Although the majority of the literature on pain supports the lateral and medial networks, some evidence supports an additional rostral pain network, which is believed to function in the production of pain behaviors. The sensory perception of pain as assessed through verbal report and behavioral display may be altered in AD. In addition, neural circuits mediating pain perception and behavioral expression may be hyperactive or underactive, depending on the brain region involved, stage of the disease, and type of pain (acute experimental stimuli or chronic medical conditions). People with worsening AD may therefore experience pain but be unable to indicate pain through verbal or behavioral reports, leaving them at great risk of experiencing untreated pain. Psychophysical (verbal or behavioral) and neurophysiological (brain activation) approaches can potentially address gaps in our knowledge of pain processing in AD by revealing the relationship between neural processes and verbal and behavioral outcomes in the presence of acute or chronic pain. PMID:23277361

[School bathrooms: children's perceptions and prevalence of gastrointestinal and urinary disorders, a survey in 3 secondary schools near Saint-Etienne].

PubMed

Hoarau, Bénédicte; Vercherin, Paul; Bois, Christophe

2014-01-01

Irregular use of toilets can contribute to urinary and gastrointestinal disorders. The aim of this study was to assess the prevalence of gastrointestinal and urinary symptoms among a secondary school teenage population and to evaluate their perception and use of school toilets. 791 adolescents aged 12 to 16 filled in an anonymous questionnaire, which was administered in three secondary schools near Saint-Etienne, France. 22% reported abdominal pain at least once a week during the past two months and 26% experienced abdominal pain about once every month. 9% of schoolchildren suffered from urinary incontinence at least once during the two months before the study: 4% of boys and 13% of girls. Children had a negative perception of school toilets: 62% didn't feel safe and 54% of boys reported a lack of privacy. 34% of students avoided school toilets: 21% never used them to urinate and 85% never used them to defecate. 28% of children acknowledged they had experienced abdominal pain because they couldn't use school toilets and 29% said that they had experienced poor concentration as a result of their pain. Abdominal pain and urinary disorders are common among secondary schoolchildren. Stool and urine withholding behaviours are be widespread and affect students' concentration while at school.

Perception and duration of pain after office-based vocal fold injection augmentation.

PubMed

Crawley, Brianna K; Dehom, Salem; Kutzner, Emily; Murry, Thomas; Krishna, Priya; Hata, Justin

2018-04-01

In-office laryngology procedures are important in the treatment of voice and swallowing disorders. Patient tolerance determines which procedures can be performed without sedation or formal anesthesia. This study examines pain perception during and after in-office vocal fold injection augmentation. Prospective cohort study. Patients scheduled for office-based vocal fold injection augmentation were prospectively enrolled at an academic voice center. The short-form McGill Pain Questionnaire was administered before, during, and after the procedure and on postprocedure days 1, 3, and 7. Pre- and postprocedure vital signs were recorded and heart rate was continuously monitored. Telephone questionnaires were completed on postprocedure days 1 and 3. Forty-five patients consented to participate in our study (24 males, mean age 61 years). Most patients experienced mild to moderate pain with increasing heart rate during the procedure. Pain remained or increased 20 minutes after the procedure and improved but persisted for 1 day. Sensory and affective discomfort was endorsed by the majority. A minority of patients experienced bruising and changes in swallowing with diet modification for 3 days after the procedure. Sixteen percent had discomfort after 1 week. This is the first prospective study examining patient perception of pain during and after in-office injection augmentation using a validated scale and pain descriptors with extended follow-up. The results may offer guidance for patient counseling, consent, and treatment to improve tolerance and success. 4. Laryngoscope, 128:929-934, 2018. © 2018 The American Laryngological, Rhinological and Otological Society, Inc.

Effect of intrathecal baclofen on evoked pain perception: an evoked potentials and quantitative thermal testing study.

PubMed

Kumru, H; Kofler, M; Flores, M C; Portell, E; Robles, V; Leon, N; Vidal, J

2013-08-01

Somatic antinociceptive effects of baclofen have been demonstrated in animal models. We hypothesized that if enhanced thermal or pain sensitivity is produced by loss of gamma-aminobutyric acid (GABA)-ergic tone in the central nervous system, spinal administration of GABA agonists might be predicted to be effective in thermal and/or pain perception changes and pain-related evoked potentials in candidates for intrathecal baclofen (ITB) treatment. Eleven patients with severe spinal cord injury (SCI) who suffered from severe spasticity were evaluated during a 50-μg ITB bolus test. Warm and heat pain thresholds, evoked heat pain perception, and contact heat-evoked potentials (CHEPs) were determined above SCI level from the right and left sides. Nine age- and gender-matched healthy volunteers undergoing repeat testing without any placebo injection served as control group. In patients, heat pain perception threshold increased, and evoked pain perception and amplitude of CHEPs decreased significantly after ITB bolus application in comparison with baseline (p < 0.005), with no change in warm perception threshold. In controls, no significant changes were observed in repeat testing over time. Our findings indicate that ITB modulates heat pain perception threshold, evoked heat pain perception and heat pain-related evoked potentials without inducing warm perception threshold changes in SCI patients. This phenomenon should be taken into account in the clinical evaluation and management of pain in patients receiving baclofen. © 2012 European Federation of International Association for the Study of Pain Chapters.

Short-term sleep disturbance-induced stress does not affect basal pain perception, but does delay postsurgical pain recovery

PubMed Central

Wang, Po-Kai; Cao, Jing; Wang, Hongzhen; Liang, Lingli; Zhang, Jun; Lutz, Brianna Marie; Shieh, Kun-Ruey; Bekker, Alex; Tao, Yuan-Xiang

2015-01-01

Chronic sleep disturbance-induced stress is known to increase basal pain sensitivity. However, most surgical patients frequently report short-term sleep disturbance/deprivation during pre- and post-operation periods and have normal pain perception pre-surgery. Whether this short-term sleep disturbance affects postsurgical pain is elusive. We here reported that pre- or post-exposure to rapid eye movement sleep disturbance (REMSD) 6 h daily for 3 consecutive days did not alter basal responses to mechanical, heat, and cold stimuli, but did delay recovery in incision-induced reductions in paw withdrawal threshold to mechanical stimulation and paw withdrawal latencies to heat and cold stimuli on the ipsilateral side of male or female rats. This short-term REMSD led to stress evidenced by an increase in swim immobility time, a decrease in sucrose consumption, and an elevation in the level of corticosterone in serum. Blocking this stress via intrathecal RU38486 or bilateral adrenalectomy abolished REMSD-caused delay in recovery of incision-induced reductions in behavioral responses to mechanical, heat, and cold stimuli. Moreover, this short-term REMSD produced significant reductions in the levels of mu opioid receptor and kappa opioid receptor, but not Kv1.2, in the ipsilateral L4/5 spinal cord and dorsal root ganglia on day 9 post-incision (but not post-sham surgery). PMID:26342649

Bodily Sensory Inputs and Anomalous Bodily Experiences in Complex Regional Pain Syndrome: Evaluation of the Potential Effects of Sound Feedback

PubMed Central

Tajadura-Jiménez, Ana; Cohen, Helen; Bianchi-Berthouze, Nadia

2017-01-01

Neuroscientific studies have shown that human's mental body representations are not fixed but are constantly updated through sensory feedback, including sound feedback. This suggests potential new therapeutic sensory approaches for patients experiencing body-perception disturbances (BPD). BPD can occur in association with chronic pain, for example in Complex Regional Pain Syndrome (CRPS). BPD often impacts on emotional, social, and motor functioning. Here we present the results from a proof-of-principle pilot study investigating the potential value of using sound feedback for altering BPD and its related emotional state and motor behavior in those with CRPS. We build on previous findings that real-time alteration of the sounds produced by walking can alter healthy people's perception of their own body size, while also resulting in more active gait patterns and a more positive emotional state. In the present study we quantified the emotional state, BPD, pain levels and gait of twelve people with CRPS Type 1, who were exposed to real-time alteration of their walking sounds. Results confirm previous reports of the complexity of the BPD linked to CRPS, as participants could be classified into four BPD subgroups according to how they mentally visualize their body. Further, results suggest that sound feedback may affect the perceived size of the CRPS affected limb and the pain experienced, but that the effects may differ according to the type of BPD. Sound feedback affected CRPS descriptors and other bodily feelings and emotions including feelings of emotional dominance, limb detachment, position awareness, attention and negative feelings toward the limb. Gait also varied with sound feedback, affecting the foot contact time with the ground in a way consistent with experienced changes in body weight. Although, findings from this small pilot study should be interpreted with caution, they suggest potential applications for regenerating BDP and its related bodily feelings in a clinical setting for patients with chronic pain and BPD. PMID:28798671

Pain in Alzheimer's disease: A study of behavior and neural correlates

NASA Astrophysics Data System (ADS)

Beach, Paul Anthony

Alzheimer's disease (AD) is a devastating neurodegenerative disease characterized by insidious and progressive impairment of cognition, emotion, and memory. Though pain in patients with AD is a major medical concern it is under diagnosed and under treated in patients, compared to cognitively healthy elderly. Further complicating matters, subjective self-report of pain by becomes increasingly compromised with disease progression; this often leaves clinicians and caregivers no choice but to rely on discerning pain from behavior alone. Patients also report pain at a lower frequency and intensity than healthy seniors (HS). These findings, coupled with recognition that AD pathology affects many pain processing brain regions, have prompted examination of whether AD alters pain perception. While there is evidence that AD actually predisposes heightened perception of pain, several issues remain: experimental work is limited to a handful of studies, whose results have been inconsistent; few examinations of pain in AD have included patients with advanced disease; the neural mechanism underlying altered pain in AD is not clear. I addressed these gaps in the literature by examining subjective, behavioral, and autonomic pain responses in 33 HS and 38 patients with varying severities of AD. A subset of these subjects (24 HS and 20 AD) were scanned, using fMRI. I then determined how the functional connectivity of various resting-state networks (RSNs) were associated with measured pain responses. I found that AD patients rated low-level stimuli as more painful than HS. Also, patients, regardless of severity, showed greater degrees of pain behaviors than HS - both with respect to global behaviors as measured by a clinical pain scale and facial responses as measured by an experimental tool. In contrast, autonomic responses were blunted with advancing AD. Altered pain responses in AD were associated with altered function of RSNs involved in attention and internal mentation, affect, somatosensation, and interoception (p<0.05, FWE corrected). These findings provide further evidence and an improved understanding of the neural basis for heightened pain sensitivity in patients with AD. They also emphasize the necessity to improve pain assessment and treatment strategies for a vulnerable patient population set to expand greatly in the coming decades.

Space-based bias of covert visual attention in complex regional pain syndrome.

PubMed

Bultitude, Janet H; Walker, Ian; Spence, Charles

2017-09-01

See Legrain (doi:10.1093/awx188) for a scientific commentary on this article. Some patients with complex regional pain syndrome report that movements of the affected limb are slow, more effortful, and lack automaticity. These symptoms have been likened to the syndrome that sometimes follows brain injury called hemispatial neglect, in which patients exhibit attentional impairments and problems with movements affecting the contralesional side of the body and space. Psychophysical testing of patients with complex regional pain syndrome has found evidence for spatial biases when judging visual targets distanced at 2 m, but not in directions that indicate reduced attention to the affected side. In contrast, when judging visual or tactile stimuli presented on their own body surface, or pictures of hands and feet within arm's reach, patients with complex regional pain syndrome exhibited a bias away from the affected side. What is not yet known is whether patients with complex regional pain syndrome only have biased attention for bodily-specific information in the space within arm's reach, or whether they also show a bias for information that is not associated with the body, suggesting a more generalized attention deficit. Using a temporal order judgement task, we found that patients with complex regional pain syndrome processed visual stimuli more slowly on the affected side (relative to the unaffected side) when the lights were projected onto a blank surface (i.e. when no bodily information was visible), and when the lights were projected onto the dorsal surfaces of their uncrossed hands. However, with the arms crossed (such that the left and right lights projected onto the right and left hands, respectively), patients' responses were no different than controls. These results provide the first demonstration of a generalized attention bias away from the affected side of space in complex regional pain syndrome patients that is not specifically related to bodily information. They also suggest a separate and additional bias of visual attention away from the affected hand. The strength of attention bias was predicted by scores on a self-report measure of body perception distortion; but not by pain intensity, time since diagnosis, or affected body side (left or right). At an individual level, those patients whose upper limbs were most affected had a higher incidence of inattention than those whose lower limbs were most affected. However, at a group level, affected limb (upper or lower) did not predict bias magnitude; nor did three measures designed to assess possible asymmetries in the distribution of movements across space. It is concluded that inattention in near space in complex regional pain syndrome may arise in parallel with a distorted perception of the body.10.1093/brain/awx152_video1awx152media15495542665001. © The Author (2017). Published by Oxford University Press on behalf of the Guarantors of Brain.

[Childbirth pain, perinatal dissociation and perinatal distress as predictors of posttraumatic stress symptoms].

PubMed

Boudou, M; Séjourné, N; Chabrol, H

2007-11-01

This prospective, longitudinal study investigated the contributive role of childbirth pain, perinatal distress and perinatal dissociation to the development of PTSD symptoms following childbirth. One hundred and seventeen women participated at the study. The first day after delivery they completed a questionnaire to evaluate pain, the peritraumatic distress inventory (PDI) and the peritraumatic dissociative experience questionnaire (PDEQ). Six weeks after birth, they completed the impact of event scale-revised (IES-R) to measure posttraumatic stress symptoms and the Edinburgh Postnatal Depression Scale (EPDS) to assess maternal depression. A multiple regression analysis revealed that only both components of perinatal distress, life-threat perception and dysphoric emotions were significant predictors of posttraumatic stress symptoms. In another multiple regression analysis predicting dysphoric emotions, affective dimension of pain was the only significant predictor. Perinatal distress was the best predictor of posttraumatic stress symptoms. Dysphoric emotions were associated with affective dimension of pain, suggesting that women distressed by the childbirth pain would have higher risk to develop posttraumatic stress symptoms.

Effect of knee osteoarthritis on the perception of quality of life in Venezuelan patients.

PubMed

Chacón, José G; González, Nancy E; Véliz, Aleida; Losada, Benito R; Paul, Hernando; Santiago, Luís G; Antúnez, Ana; Finol, Yelitza; González, María E; Granados, Isabel; Maldonado, Irama; Maldonado, Teolinda; Marín, Francisco; Zambrano, Gisela; Rodríguez, Martín A

2004-06-15

To measure the perception of quality of life in Venezuelan patients with knee osteoarthritis and to identify those variables that may influence it. A multicenter, cross-sectional study of 126 mestizo patients with knee osteoarthritis recruited from 8 rheumatology centers in Venezuela. We used a Spanish-translated version of the Arthritis Impact Measurement Scales (AIMS), as adapted in Venezuela. One-way analysis of variance was used to compare the AIMS mean total score among subgroups of knee pain, anatomic stage, and socioeconomic status (SES); a post-hoc test was performed to identify significant intragroup differences. Pearson's correlation coefficient was used to examine correlations between age, body mass index (BMI), disease duration, knee pain, and AIMS score. Associations between radiologic stage, SES, and AIMS scores were examined using Spearman's rank correlation. Multiple regression analysis was used to estimate predictor factors of AIMS scores. A significant correlation was found between total AIMS scores and knee pain, age, and socioeconomic status, but not with BMI, disease duration, or anatomic stage. Patients with severe knee pain differed from those with mild and moderate pain, and the highest AIMS mean total score was seen in patients within the severe knee pain subset. Patients in the highest socioeconomic levels differed from those within lowest categories. Patients classified as being at the levels of relative and critical poverty showed the highest AIMS scores. Multiple regression analysis showed that knee pain was the only variable that exerted an independent effect on the quality of life in our patients. The perception of quality of life is negatively affected by increasing levels of joint pain, old age, and low socioeconomic status in Venezuelan patients with knee osteoarthritis. Our study supports the need for an early and vigorous approach to treat pain in this group of patients.

Changes of Pain Perception, Autonomic Function, and Endocrine Parameters during Treatment of Anorectic Adolescents

ERIC Educational Resources Information Center

Bar, Karl-Jurgen; Boettger, Silke; Wagner, Gerd; Wilsdorf, Christine; Gerhard, Uwe Jens; Boettger, Michael K.; Blanz, Bernhard; Sauer, Heinrich

2006-01-01

Objectives: The underlying mechanisms of reduced pain perception in anorexia nervosa (AN) are unknown. To gain more insight into the pathology, the authors investigated pain perception, autonomic function, and endocrine parameters before and during successful treatment of adolescent AN patients. Method: Heat pain perception was assessed in 15…

Impaired spatial body representation in complex regional pain syndrome type 1 (CRPS I).

PubMed

Reinersmann, Annika; Landwehrt, Julia; Krumova, Elena K; Ocklenburg, Sebastian; Güntürkün, Onur; Maier, Christoph

2012-11-01

Recently, a shift of the visual subjective body midline (vSM), a correlate of the egocentric reference frame, towards the affected side was reported in patients with complex regional pain syndrome (CRPS). However, the specificity of this finding is as yet unclear. This study compares 24 CRPS patients to 21 patients with upper limb pain of other origin (pain control) and to 24 healthy subjects using a comprehensive test battery, including assessment of the vSM in light and dark, line bisection, hand laterality recognition, neglect-like severity symptoms, and motor impairment (disability of the arm, shoulder, and hand). 1-way analysis of variance, t-tests, significance level: 0.05. In the dark, CRPS patients displayed a significantly larger leftward spatial bias when estimating their vSM, compared to pain controls and healthy subjects, and also reported lower motor function than pain controls. For right-affected CRPS patients only, the deviation of the vSM correlated significantly with the severity of distorted body perception. Results confirm previous findings of impaired visuospatial perception in CRPS patients, which might be the result of the involvement of supraspinal mechanisms in this pain syndrome. These mechanisms might accentuate the leftward bias that results from a right-hemispheric dominance in visuospatial processing and is known as pseudoneglect. Pseudoneglect reveals itself in the tendency to perceive the midpoint of horizontal lines or the subjective body midline left of the centre. It was observable in all 3 groups, but most pronounced in CRPS patients, which might be due to the cortical reorganisation processes associated with this syndrome. Copyright © 2012 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

Decreased Pain Perception by Unconscious Emotional Pictures

PubMed Central

Peláez, Irene; Martínez-Iñigo, David; Barjola, Paloma; Cardoso, Susana; Mercado, Francisco

2016-01-01

Pain perception arises from a complex interaction between a nociceptive stimulus and different emotional and cognitive factors, which appear to be mediated by both automatic and controlled systems. Previous evidence has shown that whereas conscious processing of unpleasant stimuli enhances pain perception, emotional influences on pain under unaware conditions are much less known. The aim of the present study was to investigate the modulation of pain perception by unconscious emotional pictures through an emotional masking paradigm. Two kinds of both somatosensory (painful and non-painful) and emotional stimulation (negative and neutral pictures) were employed. Fifty pain-free participants were asked to rate the perception of pain they were feeling in response to laser-induced somatosensory stimuli as faster as they can. Data from pain intensity and reaction times were measured. Statistical analyses revealed a significant effect for the interaction between pain and emotional stimulation, but surprisingly this relationship was opposite to expected. In particular, lower pain intensity scores and longer reaction times were found in response to negative images being strengthened this effect for painful stimulation. Present findings suggest a clear pain perception modulation by unconscious emotional contexts. Attentional capture mechanisms triggered by unaware negative stimulation could explain this phenomenon leading to a withdrawal of processing resources from pain. PMID:27818642

Decreased Pain Perception by Unconscious Emotional Pictures.

PubMed

Peláez, Irene; Martínez-Iñigo, David; Barjola, Paloma; Cardoso, Susana; Mercado, Francisco

2016-01-01

Pain perception arises from a complex interaction between a nociceptive stimulus and different emotional and cognitive factors, which appear to be mediated by both automatic and controlled systems. Previous evidence has shown that whereas conscious processing of unpleasant stimuli enhances pain perception, emotional influences on pain under unaware conditions are much less known. The aim of the present study was to investigate the modulation of pain perception by unconscious emotional pictures through an emotional masking paradigm. Two kinds of both somatosensory (painful and non-painful) and emotional stimulation (negative and neutral pictures) were employed. Fifty pain-free participants were asked to rate the perception of pain they were feeling in response to laser-induced somatosensory stimuli as faster as they can. Data from pain intensity and reaction times were measured. Statistical analyses revealed a significant effect for the interaction between pain and emotional stimulation, but surprisingly this relationship was opposite to expected. In particular, lower pain intensity scores and longer reaction times were found in response to negative images being strengthened this effect for painful stimulation. Present findings suggest a clear pain perception modulation by unconscious emotional contexts. Attentional capture mechanisms triggered by unaware negative stimulation could explain this phenomenon leading to a withdrawal of processing resources from pain.

Ethnic differences in thermal pain responses: a comparison of South Asian and White British healthy males.

PubMed

Watson, Paul J; Latif, R Khalid; Rowbotham, David J

2005-11-01

The expression and report of pain is influenced by social environment and culture. Previous studies have suggested ethnically determined differences in report of pain threshold, intensity and affect. The influence of ethnic differences between White British and South Asians has remained unexplored. Twenty age-matched, male volunteers in each group underwent evaluation. Cold and warm perception and cold and heat threshold were assessed using an ascending method of limits. Magnitude estimation of pain unpleasantness and pain intensity were investigated with thermal stimuli of 46, 47, 48 and 49 degrees C. Subjects also completed a pain anxiety questionnaire. Data was analysed using t-test, Mann-Whitney and repeated measures analysis of variance as appropriate. There were no differences in cold and warm perception between the two groups. There was a statistically significant difference between the two groups for heat pain threshold (P=0.006) and heat pain intensity demonstrated a significant effect for ethnicity (F=13.84, P=0.001). Although no group differences emerged for cold pain threshold and heat unpleasantness, South Asians demonstrated lower cold pain threshold and reported more unpleasantness at all temperatures but this was not statistically significant. Our study shows that ethnicity plays an important role in heat pain threshold and pain report, South Asian males demonstrated lower pain thresholds and higher pain report when compared with matched White British males. There were no differences in pain anxiety between the two groups and no correlations were identified between pain and pain anxiety Haemodynamic measures and anthropometry did not explain group differences.

Influence of anxiety and alexithymia on brain activations associated with the perception of others' pain in autism.

PubMed

Lassalle, Amandine; Zürcher, Nicole R; Porro, Carlo A; Benuzzi, Francesca; Hippolyte, Loyse; Lemonnier, Eric; Åsberg Johnels, Jakob; Hadjikhani, Nouchine

2018-05-07

The circumstances under which empathy is altered in ASD remain unclear, as previous studies did not systematically find differences in brain activation between ASD and controls in empathy-eliciting paradigms, and did not always monitor whether differences were primarily due to ASD "per se", or to conditions overlapping with ASD, such as alexithymia and anxiety. Here, we collected fMRI data from 47 participants (22 ASD) viewing pictures depicting hands and feet of unknown others in painful, disgusting, or neutral situations. We computed brain activity for painful and disgusting stimuli (vs. neutral) in whole brain and in regions of interest among the brain areas typically activated during the perception of nociceptive stimuli. Group differences in brain activation disappeared when either alexithymia or anxiety - both elevated in the ASD group - were controlled for. Regression analyses indicated that the influence of symptoms was mainly shared between autistic symptomatology, alexithymia and anxiety or driven by unique contributions from alexithymia or anxiety. Our results suggest that affective empathy may be affected in ASD, but that this association is complex. The respective contribution of alexithymia and anxiety to decreased affective empathy of people with ASD may be due to the association of those psychiatric conditions with reduced motor resonance/Theory of Mind.

The effects of music on pain perception of stroke patients during upper extremity joint exercises.

PubMed

Kim, Soo Ji; Koh, Iljoo

2005-01-01

The purpose of this study was to determine the effects of music therapy on pain perception of stroke patients during upper extremity joint exercises. Ten stroke patients (1 male and 9 females) ranging in age from 61 to 73 participated in the study. Music conditions used in the study consisted of: (a) song, (b) karaoke accompaniment (same music to condition A except singers' voices), and (c) no music. Exercise movements in this study included hand, wrist, and shoulder joints. During the 8-week period music therapy sessions, subjects repeated 3 conditions according to the randomized orders and subjects rated their perceived pain on a scale immediately after each condition. The General Linear Model (GLM) Repeated Measures ANOVA revealed that there were no significant differences in pain rating across the three music conditions. However, positive affects and verbal responses, while performing upper extremity exercises with both music and karaoke accompaniment music, were observed using video observations.

Psychosocial characteristics associated with symptom perception 1 year after gastric bypass surgery-a prospective study.

PubMed

Kvalem, Ingela Lundin; Bergh, Irmelin; Sogg, Stephanie; Mala, Tom

2017-11-01

The experience of symptoms after bariatric surgery, such as pain, dumping, and fatigue, may affect behavior, quality of life, and the need for healthcare consultations. Attention to and interpretation of symptoms are influenced by psychological and contextual factors. Prospective studies of psychological factors predicting physical symptom perception after bariatric surgery are scarce. To explore associations of preoperative negative affect and history of stressful and traumatic events with frequency and intensity of self-reported symptoms 1 year after Roux-en-Y gastric bypass (RYGB). University hospital. Questionnaire data were collected before and 1 year after RYGB from 230 patients. Negative affect and stressful events were measured preoperatively. The participants reported the number and impact of various physical symptoms postoperatively. The most common symptoms reported to have a high impact on behavior were fatigue (32.8%) and dumping (28.4%). Reporting more symptoms was associated with preoperative anxiety (r = .22, P = .001) and the number of stressful life events (r = .21, P = .002). Participants with a probable preoperative anxiety disorder reported a higher impact of fatigue, pain, dumping, and diarrhea after surgery, while those with a probable mood disorder and a history of traumatic sexual/violent events reported a higher impact of dumping. Preoperative anxiety symptoms and stressful experiences were associated with a higher perceived impact of symptoms, such as dumping, fatigue, and pain after RYGB. The evaluation of psychological characteristics associated with symptom perception may be relevant when managing symptoms that are not responsive to other treatment measures. Copyright © 2017 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

The Brief Illness Perceptions Questionnaire identifies 3 classes of people seeking rehabilitation for mechanical neck pain.

PubMed

Walton, David M; Lefebvre, Andy; Reynolds, Darcy

2015-06-01

Illness representations pertain to the ways in which an individual constructs and understands the experience of a health condition. The Brief Illness Perceptions Questionnaire (BIPQ) comprises 9 items intended to capture the key components of the Illness Representations Model. The purpose of this paper was to explore the utility of the BIPQ for evaluating and classifying uncomplicated mechanical neck pain in the rehabilitation setting. A convenience sample of 198 subjects presenting to physiotherapy for neck pain problems were used in this study. In the first step, 183 subjects completed the BIPQ and a series of related cognitive measures. Latent class analysis (LCA) was used to explore the number of identifiable classes amongst the sample based on BIPQ response patterns. A regression equation was created to facilitate classification. In the second step, an independent sample of 15 subjects were classified using the equation established in step 1, and they were followed over a 3 month period. The LCA revealed 3 classes of subjects with optimal fit statistics: mildly affected, moderately affected, and severely affected. Inter-group comparisons of the secondary cognitive measures supported these labels. Classification accuracy of a regression equation was high (94.5%). Applying the equation to the independent longitudinal sample revealed that it functioned equally well and that the classes may have prognostic value. The BIPQ may be a useful clinical tool for classification of neck pain. Copyright © 2014 Elsevier Ltd. All rights reserved.

Understanding cultural influences on back pain and back pain research.

PubMed

Henschke, Nicholas; Lorenz, Eva; Pokora, Roman; Michaleff, Zoe A; Quartey, Jonathan N A; Oliveira, Vinicius Cunha

2016-12-01

Low back pain is highly prevalent and places a considerable burden on individuals, their families and communities. This back pain burden is unequally distributed around the world and within populations. Clinicians and researchers addressing back pain should be aware of the cultural, social and political context of back pain patients and how this context can influence pain perception, disability and health care use. Culture, which influences the beliefs and behaviour of individuals within a social group, could be considered an important contributor to the unequal distribution of back pain. However, there is paucity of high-quality research exploring the influence of culture on the experience and management of back pain. Further development and testing of specific tools, assessment methods and communication strategies are needed to improve our understanding of how cultural practices, values and identifications affect those dealing with back pain. Copyright © 2017 Elsevier Ltd. All rights reserved.

Positive and Negative Affect Is Related to Experiencing Chest Pain During Exercise-Induced Myocardial Ischemia.

PubMed

Stébenne, Philippe; Bacon, Simon L; Austin, Anthony; Paine, Nicola J; Arsenault, André; Laurin, Catherine; Meloche, Bernard; Gordon, Jennifer; Dupuis, Jocelyn; Lavoie, Kim L

2017-05-01

Silent myocardial ischemia is thought to be associated with worse cardiovascular outcomes due to a lack of perception of pain cues that initiate treatment seeking. Negative affect (NA) has been associated with increased pain reporting and positive affect (PA) with decreased pain reporting, but these psychological factors have not been examined within the context of myocardial ischemia. This study evaluated the associations between PA, NA, and chest pain reporting in patients with and without ischemia during exercise testing. A total of 246 patients referred for myocardial perfusion single-photon emission computed tomography exercise stress testing completed the positive and negative affect schedule-expanded version, a measure of PA and NA. Presence of chest pain and myocardial ischemia were evaluated using standardized protocols. Logistic regression analyses revealed that for every 1-point increase in NA, there was a 13% higher chance for ischemic patients (odds ratio [OR] = 1.13; 95% confidence interval [CI] = 1.02 to 1.26) and an 11% higher chance in nonischemic patients (OR = 1.11; 95% CI = 1.03 to 1.19) to report chest pain. A significant interaction of PA and NA on chest pain reporting (β = 0.02; 95% CI = 0.002 to 0.031) was also observed; nonischemic patients with high NA and PA reported more chest pain (57%) versus patients with low NA and low PA (13%), with high NA and low PA (17%), and with high PA and low NA (7%). Patients who experience higher NA are more likely to report experiencing chest pain. In patients without ischemia, high NA and PA was also associated with a higher likelihood of reporting chest pain. Results suggest that high levels of PA as well as NA may increase the experience and/or reporting of chest pain.

Ethnic differences in pain perception and patient-controlled analgesia usage for postoperative pain.

PubMed

Tan, Ene-Choo; Lim, Yvonne; Teo, Yik-Ying; Goh, Rachelle; Law, Hai-Yang; Sia, Alex T

2008-09-01

There are reports suggesting that sensitivity to and tolerance of both clinical and experimental pain differ among ethnic groups. We examined self-rated pain score and morphine usage in 1034 women who underwent elective lower cesarian section (LSCS) for their deliveries. Data on pain scores and amount of total morphine use according to patient-controlled analgesia were collected every 4 hours. Overall, lowest pain scores were recorded 12 hours after surgery and highest at 24 hours. Morphine consumption was highest within the first 4 hours and lowest between 12 and 16 hours. There were statistically significant ethnic group differences in pain scores (P = 1.7 x 10(-7)) and morphine usage (P = 2.8 x 10(-15)) between ethnic groups, with Indians having the highest mean pain score and using the highest amount of morphine. The ethnic differences in pain score and morphine self-administration persisted after controlling for age, body mass index, and duration of operation. Our findings of highly significant ethnic group difference in self-reported pain level and the amount of analgesia self-administered may have implications on optimal management of acute postoperative pain. Inadequate management of pain after cesarian deliveries might affect the emotional well-being and physical recovery of patients and affect mother-child bonding.

Posttraumatic Stress Disorder, Orientation to Pain, and Pain Perception in Ex-Prisoners of War Who Underwent Torture.

PubMed

Tsur, Noga; Defrin, Ruth; Ginzburg, Karni

Studies suggest that torture survivors often experience long-term chronic pain and increased pain perception. However, it is unclear whether the actual experience of torture or rather the subsequent posttraumatic stress disorder (PTSD) explains these pain problems. Furthermore, although catastrophic and fearful orientations to pain have been suggested to play a significant role in the association between trauma and pain, the underlying mechanisms remain unclear. This study examined whether chronic pain and pain perception among torture survivors are associated with torture experience or PTSD and whether catastrophic and fearful orientations mediate or moderate these associations. Fifty-nine ex-prisoners of war who underwent torture and 44 matched veterans participated in this study. Pain perception was evaluated by assessing pain threshold and reactivity to experimental suprathreshold noxious stimuli. Participants completed self-administered questionnaires assessing PTSD, chronic pain, pain catastrophizing, and fear of pain. Although chronic pain was associated with PTSD (0.44 < β < 0.49, p < .002), increased pain perception was correlated with torture (0.33 < β < 0.65, p < .05). Pain catastrophizing was found to mediate the association between PTSD and chronic pain (β = 0.18 and 0.19, respectively; p < .05). Fear of pain moderated the association between torture and pain perception (β = 0.41 and 0.42, respectively; p < .017). The findings suggest that chronic pain is contingent upon the psychological toll of torture, that is, PTSD. This study also indicates that PTSD exacerbates catastrophic orientation, which in turn may amplify chronic pain. Reactivity to experimental noxious stimuli was related to previous experiences of torture, which enhances perceived pain intensity when interacting with a fearful pain orientation. These findings highlight the significance of orientation to bodily experiences after trauma.

Was it less painful for knights? Influence of appearance on pain perception.

PubMed

Weeth, A; Mühlberger, A; Shiban, Y

2017-11-01

Pain perception is a subjective experience shaped by different factors. In this study, we investigated the influence of a visually manipulated appearance of a virtual arm on pain perception. Specifically, we investigated how pain perception and vegetative skin responses were modified by inducing a virtual protection on the right arm by a virtual armour. Participants (n = 32) immersed in virtual reality embodied a virtual arm, which appeared in three different versions (uncovered, neutral or protected). During the virtual reality simulation, the participants received electrical stimulations of varying intensities. Skin conductance level (SCL) was analysed for the phase anticipation (from the moment the arm appeared until the electric stimulation) and perception of pain (after the electric stimulation). Pain ratings were acquired after the painful stimuli occurred. The sense of embodiment was positive for the unprotected and neutral condition and lower for the protected than for the neutral arm. Pain ratings were significantly decreased in the protected arm condition compared with both the unprotected arm and the neutral arm conditions. The SCL measurements showed no significant differences for the three arm types. According to the pain ratings, participants felt significantly less pain in the covered arm condition compared with the unprotected and the neutral arm condition. Subjective pain perception was decreased by a virtual protection of the arm in VR. The simplicity of the manipulation suggests possible practical uses in pain therapy by strengthening the patients' own capacities to influence their pain using simple cognitive manipulations via virtual reality. A virtual, covered arm causes differences in reported pain ratings. Physiological measurements do not confirm the findings. Visual information about body protection can have an impact on pain perception. © 2017 European Pain Federation - EFIC®.

Talking About Sex When Sex Is Painful: Dyadic Sexual Communication Is Associated With Women's Pain, and Couples' Sexual and Psychological Outcomes in Provoked Vestibulodynia.

PubMed

Rancourt, Kate M; Rosen, Natalie O; Bergeron, Sophie; Nealis, Logan J

2016-11-01

Provoked vestibulodynia (PVD) is a recurrent vulvovaginal pain condition associated with psychological and sexual consequences for affected women and their partners, including lower quality of dyadic sexual communication compared to pain-free couples. Although greater sexual communication is associated with positive sexual and relational outcomes for both pain-free couples and couples experiencing painful sex, little is known about its role in women's pain and psychological outcomes, especially in a relational context. The present study examined associations between dyadic sexual communication and pain, sexual satisfaction, sexual functioning, and depressive symptoms in a sample of 107 couples in which the woman was diagnosed with PVD via a standardized gynecological assessment. Women completed a measure of pain intensity, and both members of the couple completed measures of their dyadic sexual communication, sexual satisfaction, sexual functioning, and depressive symptoms. Analyses were guided by the actor-partner interdependence model. Women and partners' own perceptions of greater dyadic sexual communication were associated with their own greater sexual satisfaction and sexual functioning, and lower depressive symptoms. Partners' perceptions of greater dyadic sexual communication were also associated with women's lower pain and greater sexual satisfaction. Results point to the importance of dyadic coping conceptualizations for both individual and interpersonal outcomes in PVD. Dyadic sexual communication may be a key treatment target for interventions aimed at improving the pain and psychological and sexual impairments of women with PVD and their partners.

Pain Perception in Phacoemulsification with Topical Anesthesia and Evaluation of Factors Related with Pain

PubMed Central

Dadacı, Zeynep; Borazan, Mehmet; Öncel Acır, Nurşen

2016-01-01

Objectives: Evaluation of pain during and after phacoemulsification with topical anesthesia in patients with senile cataract and investigation of factors related with pain. Materials and Methods: Ninety-two adult patients scheduled for routine clear corneal phacoemulsification with topical anesthesia who had no previous cataract surgery in their fellow eyes were included in the study. Verbal pain scale and visual analog scale were used to measure pain intensity. Demographic characteristics, concomitant systemic diseases, drug consumption, need of additional anesthesia during surgery, surgical complications, duration of surgery and surgeon comfort were also evaluated for each patient. Results: Seventy-two patients (78.3%) reported pain during surgery and 68 patients (73.9%) reported pain in the period after the surgery. When the intensity of pain during the surgery was evaluated, the percentage of patients reporting mild, moderate and intense pain was 35.9%, 25.0% and 17.4%, respectively. The average verbal pain score during the surgery was 1.4±1.0 (0-3). Reported pain level was not associated with age or gender (p>0.05). Diabetic patients and patients who consumed nonsteroidal anti-inflammatory drugs in the morning before operation reported less pain during and after the surgery (p<0.05). There were no complications except posterior capsule rupture in one patient. Duration of surgery was longer in patients who reported pain during surgery (p<0.05). There was no significant difference between pain reported during surgery and surgeon comfort (p>0.05). Conclusion: Patients frequently experience pain during phacoemulsification with topical anesthesia. Although pain perception does not affect surgical success, preoperative administration of analgesics in suitable patients or giving additional anesthesia to patients reporting severe pain during surgery may increase patient comfort. PMID:28058148

Poor Illness Perceptions Are a Risk Factor for Depressive and Anxious Symptomatology in Fibromyalgia Syndrome: A Longitudinal Cohort Study.

PubMed

de Heer, Eric W; Vriezekolk, Johanna E; van der Feltz-Cornelis, Christina M

2017-01-01

Patients with widespread pain, such as in fibromyalgia, are vulnerable for depression and anxiety, which composes a relevant public health problem. Identifying risk factors for the onset of depression and anxiety is therefore warranted. Objective of this study was to determine whether severe pain, maladaptive coping, and poor illness perceptions are associated with depressive and anxious symptomatology in fibromyalgia. Consecutive patients referred to an outpatient clinic completed sets of physical and psychological questionnaires at baseline and at 18-month follow-up. A total of 452 patients with fibromyalgia syndrome (FMS) were eligible for inclusion, and subsequently, 280 patients returned the baseline questionnaire. Depressive and anxious symptomatology was measured with the Hospital Anxiety and Depression Scale. To measure pain severity, coping style, and illness perceptions, the Fibromyalgia Impact Questionnaire, Pain Coping Inventory, and the Illness Perception Questionnaire-Revised (IPQ-R) were used, respectively. Multivariable logistic regression analyses, bootstrapping and calibration, were performed to examine the association of pain severity, pain coping, and illness perception with depressive and anxiety symptoms at follow-up, adjusted for sociodemographic variables. Initial level of depressive and anxiety symptoms was selected as covariates. Mean age was 42.6 years and 95.4% were female. At 18-month follow-up, 68 (of the 195) patients were depressed and 80 (of the 197) were anxious. Only the IPQ-R subscale "emotional representations" showed a significant positive association with depressive symptoms at follow-up (OR = 1.10), next to the initial level of depressive symptoms (OR = 1.30). In case of anxiety, only the IPQ-R subscale "treatment control" showed a significant negative association with anxiety symptoms at follow-up (OR = 0.87), next to the initial level of anxiety symptoms (OR = 1.45). Our data suggest that not pain severity or maladaptive coping, but poor illness perceptions are important in elevated depressive and anxious symptomatology. Patients with fibromyalgia who think their illness negatively affects their mental well-being are at increased risk for more depressive symptoms, and those who think treatment of their illness will not be effective are at increased risk for more anxiety symptoms. Strengthening illness beliefs and reducing catastrophic thinking, therefore, seem crucial factors in the treatment of patients with FMS.

Effects of Competing Narratives on Public Perceptions of Opioid Pain Reliever Addiction during Pregnancy.

PubMed

Kennedy-Hendricks, Alene; McGinty, Emma E; Barry, Colleen L

2016-10-01

Opioid pain reliever addiction has increased among women of reproductive age over the last fifteen years. News media and public attention have focused on the implications of this trend for infants exposed to opioids prenatally, with state policy responses varying in the extent to which they are punitive or public health oriented. We fielded a six-group randomized experiment among a nationally representative sample of US adults to test the effects of narratives portraying a woman with opioid pain reliever addiction during pregnancy on beliefs about people addicted to opioid pain relievers, perceptions of treatment effectiveness, policy attitudes, and emotional responses. Portraying a high socioeconomic status (SES) woman in the narrative lowered perceptions of individual blame for addiction and reduced public support for punitive policies. Depicting the barriers to treatment faced by a low SES woman lowered support for punitive policies and increased support for expanded insurance coverage for treatment. The extent to which narratives portraying successfully treated addiction affected public attitudes depended on the SES of the woman portrayed. These findings can inform the development of communication strategies to reduce stigma toward this population, reduce support for punitive policies, and increase support for more public health-oriented approaches to addressing this problem. Copyright © 2016 by Duke University Press.

African Americans' Perceptions of Pain and Pain Management: A Systematic Review.

PubMed

Booker, Staja Q

2016-01-01

The purpose of this systematic review is to explore the perceptions of acute, persistent, and disease-specific pain and treatment options held by adult African Americans. Underassessment and undermanagement of pain in African Americans has been well documented; however, the cultural continuum of pain perceptions and their influence on pain assessment and management has not been synthesized. Electronic database searches of the Cumulative Index for Nursing and Allied Health Literature and PubMed, Web-based searches of the pain-specific journals plus a manual search of reference lists identified 41 relevant articles addressing perceptions of pain and/or pain management. Analysis of the literature revealed six themes: (a) meaning of pain, (b) description of pain, (c) coping with pain, (d) impact of pain, (e) patient-provider relationship, and (f) treatment approaches. These findings warrant further research and indicate the need for more precise evaluation of pain in African Americans, highlighting an imperative to incorporate cultural patterns into pain management practice and education. © The Author(s) 2014.

Depiction of pain in the self-drawings of children with sickle cell disease.

PubMed

Stefanatou, A; Bowler, D

1997-03-01

In an attempt to explore the perception of pain in children, 30 children with sickle cell disease were asked to make two drawings; one of themselves and one of themselves in pain. It was hypothesized that the cognitive ability and the emotional state of the child would be affected by the pain experience. Children and their parents were interviewed on the incidence of pain and on the child's control over it. The cognitive ability of the child was related to the kind of control he/she exercised over the pain. An analysis of the drawing concerning their thematic representations, colour and size is also presented. The mental age of the child dropped in the drawing of pain as compared to the non-pain drawing but it was found to be irrelevant to the kind of control the child exercised on the pain.

Disrupted Self-Perception in People With Chronic Low Back Pain. Further Evaluation of the Fremantle Back Awareness Questionnaire.

PubMed

Wand, Benedict Martin; Catley, Mark Jon; Rabey, Martin Ian; O'Sullivan, Peter Bruce; O'Connell, Neil Edward; Smith, Anne Julia

2016-09-01

Several lines of evidence suggest that body perception is altered in people with chronic back pain. Maladaptive perceptual awareness of the back might contribute to the pain experience as well as serve as a target for treatment. The Fremantle Back Awareness Questionnaire (FreBAQ) is a simple questionnaire recently developed to assess back-specific altered self-perception. The aims of this study were to present the outcomes of a comprehensive evaluation of the questionnaire's psychometric properties and explore the potential relationships between body perception, nociceptive sensitivity, distress, and beliefs about back pain and the contribution these factors might play in explaining pain and disability. Two hundred fifty-one people with chronic back pain completed the questionnaire as well as a battery of clinical tests. The Rasch model was used to explore the questionnaires' psychometric properties and correlation and multiple linear regression analyses were used to explore the relationship between altered body perception and clinical status. The FreBAQ appears unidimensional with no redundant items, has minimal ceiling and floor effects, acceptable internal consistency, was functional on the category rating scale, and was not biased by demographic or clinical variables. FreBAQ scores were correlated with sensitivity, distress, and beliefs and were uniquely associated with pain and disability. Several lines of evidence suggest that body perception might be disturbed in people with chronic low back pain, possibly contributing to the condition and offering a potential target for treatment. The FreBAQ was developed as a quick and simple way of measuring back-specific body perception in people with chronic low back pain. The questionnaire appears to be a psychometrically sound way of assessing altered self-perception. The level of altered self-perception is positively correlated with pain intensity and disability as well as showing associations with psychological distress, pain catastrophization, fear avoidance beliefs, and lumbar pressure pain threshold. In this sample, it appears that altered self-perception might be a more important determinant of clinical severity than psychological distress, pain catastrophization, fear avoidance beliefs, or lumbar pressure pain threshold. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

Overview of persistent pain in older adults.

PubMed

Molton, Ivan R; Terrill, Alexandra L

2014-01-01

With the shifting age demographics of the U.S. population, more psychologists will be asked to provide clinical services to older adults. Given the high prevalence of persistent pain in aging, in many cases this will mean providing empirically supported interventions for pain and the interference it creates. The purpose of this review is to provide a broad overview of the scope and impact of persistent pain in older people and to discuss mechanisms by which persistent geriatric pain can lead to suffering and disability. We consider the unique context of pain in older adulthood and review differences between older and younger people in terms of pain perception, the social network, beliefs about pain, pain-related coping, and adherence to pain medication. Finally, we discuss special issues affecting pain management in older adults, including dementia, polypharmacy, and barriers to accessing adequate pain care. This review also highlights a need for greater provider training in pain management to meet the needs of a changing U.S. population. PsycINFO Database Record (c) 2014 APA, all rights reserved.

Structural Brain Anomalies and Chronic Pain: A Quantitative Meta-Analysis of Gray Matter Volume

PubMed Central

Smallwood, Rachel F.; Laird, Angela R.; Ramage, Amy E.; Parkinson, Amy L.; Lewis, Jeffrey; Clauw, Daniel J.; Williams, David A.; Schmidt-Wilcke, Tobias; Farrell, Michael J.; Eickhoff, Simon B.; Robin, Donald A.

2016-01-01

The diversity of chronic pain syndromes and the methods employed to study them make integrating experimental findings challenging. This study performed coordinate-based meta-analyses using voxel-based morphometry imaging results to examine gray matter volume (GMV) differences between chronic pain patients and healthy controls. There were 12 clusters where GMV was decreased in patients compared with controls, including many regions thought to be part of the “pain matrix” of regions involved in pain perception, but also including many other regions that are not commonly regarded as pain-processing areas. The right hippocampus and parahippocampal gyrus were the only regions noted to have increased GMV in patients. Functional characterizations were implemented using the BrainMap database to determine which behavioral domains were significantly represented in these regions. The most common behavioral domains associated with these regions were cognitive, affective, and perceptual domains. Because many of these regions are not classically connected with pain and because there was such significance in functionality outside of perception, it is proposed that many of these regions are related to the constellation of comorbidities of chronic pain, such as fatigue and cognitive and emotional impairments. Further research into the mechanisms of GMV changes could provide a perspective on these findings. Perspective Quantitative meta-analyses revealed structural differences between brains of individuals with chronic pain and healthy controls. These differences may be related to comorbidities of chronic pain. PMID:23685185

Patient-related and ENT-related predictive factors based on the pain experienced during flexible nasendoscopy.

PubMed

Seccia, Veronica; Dallan, Iacopo; Massimetti, Gabriele; Segnini, Giovanni; Navari, Elena; Fortunato, Susanna; Bajraktari, Arisa; Lenzi, Riccardo; Muscatello, Luca; Sellari-Franceschini, Stefano

2014-07-01

The objective was to explore the role of specific patient-related and operator-related factors in pain perception during flexible laryngoscopy, which is one of the most common ENT procedures. Monocentric, randomized, individual prospective study. A total of 532 patients (145 men and 387 women), without any relevant ENT diseases, underwent laryngoscopy performed by otolaryngologists with various degrees of experience. Patient discomfort was reported using visual analog scores, and willingness to repeat the experience was also recorded. Statistical analysis showed that greater pain was significantly associated with female patients and female otolaryngologists, whereas the pain was less severe in the cases of experienced laryngologists and older patients. Pain plays an important role in determining the willingness to repeat the examination; in fact, patients who experienced lower levels of pain during laryngoscopy were more prone to repeat the experience. This article explores the importance of the extrinsic factors that are related to the patient and the otolaryngologist in determining the level of pain associated with laryngoscopy. Our study indicated that laryngoscopy is generally a well-tolerated procedure, causing little overall discomfort, but that a subgroup of patients may experience more pain than others, which may affect the patient's perspective toward undergoing a similar future experience. Our analysis may be helpful for clinicians in understanding pain perception during a routine procedure, enabling them to focus more on that subgroup of patients who are more prone to pain. 1b. © 2013 The American Laryngological, Rhinological and Otological Society, Inc.

Racial bias in sport medical staff's perceptions of others' pain.

PubMed

Druckman, James N; Trawalter, Sophie; Montes, Ivonne; Fredendall, Alexandria; Kanter, Noah; Rubenstein, Allison Paige

2017-11-27

Unequal treatment based on race is well documented in higher education and healthcare settings. In the present work, we examine racial bias at the intersection of these domains: racial bias in pain-related perceptions among National Collegiate Athletic Association (NCAA) Division 1 sport medical staff. Using experimental vignettes about a student-athlete who injured his/her anterior cruciate ligament (ACL), we find, like prior work, that respondents perceived Black (vs. White) targets as having higher initial pain tolerance. Moreover, this bias was mediated by perceptions of social class. We extend prior work by showing racial bias was not evident on other outcome measures, including perception of recovery process pain, likelihood of over-reporting pain, and over-use of drugs to combat pain. This suggests stricter boundary conditions on bias in pain perceptions than had been previously recognized.

Lunar cycle may have an effect on Shock Wave Lithotripsy related pain outcome.

PubMed

Tokgöz, Hüsnü; Yalçınkaya, Soner; İslamoğlu, Ekrem; Karamık, Kaan; Tokgöz, Özlem; Savaş, Murat

2017-12-01

We tried to investigate the effects of lunar phase on Shock Wave Lithotripsy (SWL) related pain. In addition, correlation of various clinical parameters with the pain perception during SWL procedure, were also investigated. A total of 378 patients who underwent first SWL sessions for renal or ureteral stones were prospectively enrolled in the study. The degree of pain perception during the procedure was evaluated with 10-point visual analog scale (VAS) and pain questionnaires. The date of SWL was allocated to dates and times of lunar phases as: newmoon, waxing crescent, first quarter, waxing gibbus, fullmoon, waning gibbus, last quarter and waning gibbus. Mean VAS scores in first quarter (2,41±1,06) were significantly lower when compared to mean VAS scores in waning crescent (3,58±1,83) and waning gibbus (3,42±1,98) ( p=0,005 and 0,041 , respectively). No statistically significant differences were observed when other lunar phases were compared between each other. Mean pain scores were not affected from gender, age, body mass index (BMI) and stone characteristics (stone laterality, burden and location). SWL procedure performed in first quarter of the lunar phase may become less painful. To the best of our knowledge, this is the first study which evaluated the effect of lunar phase on post-SWL pain outcome. Thus, additional randomized studies with larger series may be more informative.

Central Pain Processing in Early-Stage Parkinson's Disease: A Laser Pain fMRI Study

PubMed Central

Petschow, Christine; Scheef, Lukas; Paus, Sebastian; Zimmermann, Nadine; Schild, Hans H.; Klockgether, Thomas; Boecker, Henning

2016-01-01

Background & Objective Pain is a common non-motor symptom in Parkinson’s disease. As dopaminergic dysfunction is suggested to affect intrinsic nociceptive processing, this study was designed to characterize laser-induced pain processing in early-stage Parkinson’s disease patients in the dopaminergic OFF state, using a multimodal experimental approach at behavioral, autonomic, imaging levels. Methods 13 right-handed early-stage Parkinson’s disease patients without cognitive or sensory impairment were investigated OFF medication, along with 13 age-matched healthy control subjects. Measurements included warmth perception thresholds, heat pain thresholds, and central pain processing with event-related functional magnetic resonance imaging (erfMRI) during laser-induced pain stimulation at lower (E = 440 mJ) and higher (E = 640 mJ) target energies. Additionally, electrodermal activity was characterized during delivery of 60 randomized pain stimuli ranging from 440 mJ to 640 mJ, along with evaluation of subjective pain ratings on a visual analogue scale. Results No significant differences in warmth perception thresholds, heat pain thresholds, electrodermal activity and subjective pain ratings were found between Parkinson’s disease patients and controls, and erfMRI revealed a generally comparable activation pattern induced by laser-pain stimuli in brain areas belonging to the central pain matrix. However, relatively reduced deactivation was found in Parkinson’s disease patients in posterior regions of the default mode network, notably the precuneus and the posterior cingulate cortex. Conclusion Our data during pain processing extend previous findings suggesting default mode network dysfunction in Parkinson’s disease. On the other hand, they argue against a genuine pain-specific processing abnormality in early-stage Parkinson’s disease. Future studies are now required using similar multimodal experimental designs to examine pain processing in more advanced stages of Parkinson’s disease. PMID:27776130

The efficacy of relaxation training on stress, anxiety, and pain perception in hemodialysis patients.

PubMed

Heidari Gorji, M A; Davanloo, A Abbaskhani; Heidarigorji, A M

2014-11-01

Patients on dialysis experience psychological distress, which can impact pain perception. Reduction of stress and anxiety in patients provides psychological resources to cope with their physical condition. We examined the efficacy of relaxation training on stress, anxiety, and pain perception of hemodialysis (HD) patients. eighty HD patients were randomized into two groups (intervention and control). Benson relaxation training was implemented in the intervention group for 15 min twice daily during 4 weeks. Pain perception, stress, and anxiety scale were evaluated before and after intervention. There were significant differences between pain perception, stress, and anxiety levels in case group before and after intervention (P < 0.001) and there was a correlation between pain perception with stress and anxiety. Instructing Benson's relaxation technique is accompanied by reducing pain, stress, and anxiety level of HD patients. Reducing stress and anxiety can provide calmness for the patients so that pursuing medical therapy would be accompanied with more tranquility and low pain intensity. We suggest improving and preventing the patients' psychological problems as well as other chronic disorders through applying nonpharmacological interventions.

American and German students' knowledge, perceptions, and behaviors with respect to over-the-counter pain relievers.

PubMed

Hanoch, Yaniv; Katsikopoulos, Konstantinos V; Gummerum, Michaela; Brass, Eric P

2007-11-01

To better understand the knowledge base and perceptions involved in the decision to buy and use over-the-counter pain relievers (OTCPRs) by taking into account the environment in which these decisions are made. The authors expected that the differences in access and marketing would affect knowledge and decision making related to OTCPRs in the United States and Germany. A survey was given to 108 undergraduate university students in the United States and Germany (58 and 50 participants, respectively). The authors found that significantly more Americans than Germans take OTCPRs and that they also take significantly more OTCPRs. Americans exhibited less knowledge about side effects than their German counterparts. When asked when they consulted package labels, Americans reported they were more likely to do so before buying a product, whereas Germans reported consulting labels before taking OTCPRs for the first time. Package labels affected more Americans' decisions to purchase OTCPRs; Americans were also less likely to consult a doctor when feeling pain but more likely to take OTCPRs. Finally, Americans viewed OTCPRs as riskier after their status changed from prescription only to over the counter, whereas Germans believed they posed less risk. This study analyzed health-related behavior by looking at how environmental factors shape decision processes related to over-the-counter drug use. The results indicate that looking at environmental factors does help to explain differences in knowledge, perceptions, and behaviors among German and American students. (PsycINFO Database Record (c) 2007 APA, all rights reserved).

Ethnocultural and sex characteristics of patients attending a tertiary care pain clinic in Toronto, Ontario

PubMed Central

Mailis-Gagnon, Angela; Yegneswaran, Balaji; Nicholson, Keith; Lakha, SF; Papagapiou, Marios; Steiman, Amanda J; Ng, Danny; Cohodarevic, Tea; Umana, Margarita; Zurowski, Mateusz

2007-01-01

BACKGROUND: Ethnocultural factors and sex may greatly affect pain perception and expression. Emerging literature is also documenting racial and ethnic differences in pain access and care. OBJECTIVE: To define the sex and ethnocultural characteristics of patients attending a tertiary care, university-affiliated pain clinic in Toronto, Ontario. METHODS: Data were collected on 1242 consecutive, new patients seen over a three-year period at the Comprehensive Pain Program (CPP) in downtown Toronto. Data were compared with the Canada 2001 Census. RESULTS: English-speaking, Canadian-born patients constituted 58.6% of the CPP population, similar to the 2001 Canadian Census data for the Greater Toronto Area. Certain visible minority groups (Indo-Pakistani and Chinese) were significantly under-represented, while European groups were over-represented. While women outnumbered men, they presented with lower levels of physical pathology in general, particularly in certain ethnic groups. Patients from Europe (representing primarily immigrants who arrived in Canada before 1960), were older, by 10 years to 15 years, than the average CPP population, and had a much higher incidence of physical or medical disorders. CONCLUSIONS: The implications of the study and the importance of sex and ethnicity in terms of presentation to Canadian pain clinics are discussed. Future well-designed studies are needed to shed light on the role of both patients’ and physicians’ ethnicity and sex in pain perception and expression, decision-making regarding pain treatments and acceptance of pain treatments. PMID:17505571

Perception of labour pain among the Yoruba ethnic group in Nigeria.

PubMed

Kuti, O; Faponle, A F

2006-05-01

In Nigeria, it is generally assumed that labour is well tolerated and pain relief is not usually considered an important part of intra-partum care. This prospective study was carried out to assess mothers' perception of labour pain and determine any factor that may influence it. During the period of study, 281 women who delivered at Wesley Guild Hospital Ilesa, Nigeria were interviewed within 2 h of delivery to assess the severity of labour pain and desire for analgesia. Perception of labour pain was assessed using a 3-point verbal rating. The majority (68.3%) of women described labour pain as severe with only 5.3% describing it as mild. More than 86% of the women would want the pain relieved. Perception of pain was not influenced by age, parity and educational level. Management of pain in labour should form an important part of intra-partum care as is the case in developed countries.

The cerebral signature for pain perception and its modulation.

PubMed

Tracey, Irene; Mantyh, Patrick W

2007-08-02

Our understanding of the neural correlates of pain perception in humans has increased significantly since the advent of neuroimaging. Relating neural activity changes to the varied pain experiences has led to an increased awareness of how factors (e.g., cognition, emotion, context, injury) can separately influence pain perception. Tying this body of knowledge in humans to work in animal models of pain provides an opportunity to determine common features that reliably contribute to pain perception and its modulation. One key system that underpins the ability to change pain intensity is the brainstem's descending modulatory network with its pro- and antinociceptive components. We discuss not only the latest data describing the cerebral signature of pain and its modulation in humans, but also suggest that the brainstem plays a pivotal role in gating the degree of nociceptive transmission so that the resultant pain experienced is appropriate for the particular situation of the individual.

Effect of ambient temperature on human pain and temperature perception.

PubMed

Strigo, I A; Carli, F; Bushnell, M C

2000-03-01

Animal studies show reduced nociceptive responses to noxious heat stimuli and increases in endogenous beta-endorphin levels in cold environments, suggesting that human pain perception may be dependent on ambient temperature. However, studies of changes in local skin temperature on human pain perception have yielded variable results. This study examines the effect of both warm and cool ambient temperature on the perception of noxious and innocuous mechanical and thermal stimuli. Ten subjects (7 men and 3 women, aged 20-23 yr) used visual analog scales to rate the stimulus intensity, pain intensity, and unpleasantness of thermal (0-50 degrees C) and mechanical (1.2-28.9 g) stimuli applied on the volar forearm with a 1-cm2 contact thermode and von Frey filaments, respectively. Mean skin temperatures were measured throughout the experiment by infrared pyrometer. Each subject was tested in ambient temperatures of 15 degrees C (cool), 25 degrees C (neutral), and 35 degrees C (warm) on separate days, after a 30-min acclimation to the environment. Studies began in the morning after an 8-h fast. Mean skin temperature was altered by ambient temperature (cool room: 30.1 degrees C; neutral room: 33.4 degrees C; warm room: 34.5 degrees C; P < 0.0001). Ambient temperature affected both heat (44-50 degrees C) and cold (25-0 degrees C) perception (P < 0.01). Stimulus intensity ratings tended to be lower in the cool than in the neutral environment (P < 0.07) but were not different between the neutral and warm environments. Unpleasantness ratings revealed that cold stimuli were more unpleasant than hot stimuli in the cool room and that noxious heat stimuli were more unpleasant in a warm environment. Environmental temperature did not alter ratings of warm (37 and 40 degrees C) or mechanical stimuli. These results indicate that, in humans, a decrease in skin temperature following exposure to cool environments reduces thermal pain. Suppression of Adelta primary afferent cold fiber activity has been shown to increase cold pain produced by skin cooling. Our current findings may represent the reverse phenomenon, i.e., a reduction in thermal nociceptive transmission by the activation of Adelta cutaneous cold fibers.

Factors affecting acute pain perception and analgesics consumption in patients undergoing bariatric surgery.

PubMed

Aceto, Paola; Lai, Carlo; Perilli, Valter; Sacco, Teresa; Modesti, Cristina; Raffaelli, Marco; Sollazzi, Liliana

2016-09-01

Previous studies performed in non-obese patients undergoing elective surgery have revealed that psychological factors may affect postoperative analgesic requirements. The aim of this observational prospective study was to investigate the extent to which psychopathological dimensions, including anxiety, depression and alexithymia, may influence postoperative pain intensity and analgesics consumption using patient-controlled analgesia (PCA) in patients undergoing bariatric surgery. 120 patients, aged 18-60years, with an ASA physical status I-II, undergoing gastric bypass were enrolled. Anxiety and depression Hamilton scales, and Toronto Alexithymia scale, were administered to patients on the day before surgery. General anesthesia was standardized. After awakening, a PCA pump with intravenous tramadol was immediately made available for a 36-hour postoperative analgesia. Visual analog scale at rest (VASr) and after coughing (VASi), and effective PCA requests number were postoperatively recorded. Pearson's correlations, Anova analyses and multiple linear regression were used for statistical purpose. Positive correlations were found between anxiety, depression, alexithymia and all pain indicators (p<0.01). Analyses of variance showed that anxious (p<0.001), depressed (p<0.001) and alexithymic (p<0.05) patients had high pain indicators. VASr and VASi were predicted by anxiety and depression (p<0.05), but not by alexithymia; effective PCA requests number was predicted by anxiety, depression and alexithymia (p<0.001). Obese patients with high depression, anxiety and alexithymia levels rated their pain as more intense and required a larger amount of tramadol. Pain perception intensity was predicted by anxiety and depression but not by alexithymia, whereas analgesics consumption was predicted by all the investigated psychopathological dimensions. Copyright © 2016. Published by Elsevier Inc.

Effects of stress and relaxation on pain perception in subjects with pain-free occlusional disharmony compared with healthy controls.

PubMed

Ruscheweyh, R; Becker, T; Born, Y; Çolak-Ekici, R; Marziniak, M; Evers, S; Gerlach, A L; Wolowski, A

2015-04-01

The significance of occlusal disharmony for the development of painful temporomandibular disorder (TMD) is controversial. The ongoing biomechanical strain caused by occlusal disharmony might lead to sensitization processes in the nociceptive system. Understanding these processes might be an important step toward understanding the possible relationship between occlusal disharmony and TMD. In this study, we therefore investigated whether subjects with occlusal disharmony (n = 22) differ from healthy controls (n = 26) in their pain perception and pain modulation by stress and relaxation. Trigeminal and extratrigeminal experimental pain perception (pinprick, heat, and pressure pain) was assessed before and after stress (mental arithmetic) and relaxation (viewing of low-arousal pictures). There were no group differences in pain perception at baseline or during the stress task. Compared with controls, the occlusal disharmony group exhibited an inadequate reduction in pain perception during relaxation, which was significant for the extratrigeminal site (P < 0.01) and reached a trend for significance at the trigeminal site (P = 0.1). These results suggest that subjects with occlusal disharmony show signs of disturbed endogenous pain inhibition during relaxation. There is evidence for the presence of sensitization of the nociceptive system in subjects with occlusal disharmony. Possibly, deficient inhibition of extratrigeminal and trigeminal pain perception by relaxation might contribute to the development of TMD or other chronic pain disorders. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Racial bias in pain perception and response: experimental examination of automatic and deliberate processes

PubMed Central

Mathur, Vani A.; Richeson, Jennifer A.; Paice, Judith A.; Muzyka, Michael; Chiao, Joan Y.

2014-01-01

Racial disparities in pain treatment pose a significant public health and scientific problem. Prior studies demonstrate clinicians and non-clinicians are less perceptive, and suggest less treatment for, the pain of African Americans, relative to European Americans. Here we investigate the effects of explicit/implicit patient race presentation, patient race, and perceiver race on pain perception and response. African American and European American participants rated pain perception, empathy, helping motivation, and treatment suggestion in response to vignettes about patients’ pain. Vignettes were accompanied by a rapid (implicit), or static (explicit) presentation of an African or European American patient’s face. Participants perceived and responded more to European American patients in the implicit prime condition, when the effect of patient race was below the level of conscious regulation. This effect was reversed when patient race was presented explicitly. Additionally, female participants perceived and responded more to the pain of all patients, relative to male participants, and in the implicit prime condition, African American participants were more perceptive and responsive than European Americans to the pain of all patients. Taken together, these results suggest that known disparities in pain treatment may be largely due to automatic (below the level of conscious regulation), rather than deliberate (subject to conscious regulation) biases. These biases were not associated with traditional implicit measures of racial attitudes, suggesting that biases in pain perception and response may be independent of general prejudice. Perspective Results suggest racial biases in pain perception and treatment are at least partially due to automatic processes. When the relevance of patient race is made explicit, however, biases are attenuated and even reversed. We also find preliminary evidence that African Americans may be more sensitive to the pain of others than European Americans. PMID:24462976

Interdisciplinary Cognitive-Behavioral Therapy as Part of Lumbar Spinal Fusion Surgery Rehabilitation: Experience of Patients With Chronic Low Back Pain.

PubMed

Lindgreen, Pil; Rolving, Nanna; Nielsen, Claus Vinther; Lomborg, Kirsten

2016-01-01

Patients receiving lumbar spinal fusion surgery often have persisting postoperative pain negatively affecting their daily life. These patients may be helped by interdisciplinary cognitive-behavioral therapy which is recognized as an effective intervention for improving beneficial pain coping behavior, thereby facilitating the rehabilitation process of patients with chronic pain. The purpose of this study was to describe the lived experience of patients recovering from lumbar spinal fusion surgery and to explore potential similarities and disparities in pain coping behavior between receivers and nonreceivers of interdisciplinary cognitive-behavioral group therapy. We conducted semistructured interviews with 10 patients; 5 receiving cognitive-behavioral therapy in connection with their lumbar spinal fusion surgery and 5 receiving usual care. We conducted a phenomenological analysis to reach our first aim and then conducted a comparative content analysis to reach our second aim. Patients' postoperative experience was characterized by the need to adapt to the limitations imposed by back discomfort (coexisting with the back), need for recognition and support from others regarding their pain, a relatively long rehabilitation period during which they "awaited the result of surgery", and ambivalence toward analgesics. The patients in both groups had similar negative perception of analgesics and tended to abstain from them to avoid addiction. Coping behavior apparently differed among receivers and nonreceivers of interdisciplinary cognitive-behavioral group therapy. Receivers prevented or minimized pain by resting before pain onset, whereas nonreceivers awaited pain onset before resting. The postoperative experience entailed ambivalence, causing uncertainty, worry and insecurity. This ambivalence was relieved when others recognized the patient's pain and offered support. Cognitive-behavioral therapy as part of rehabilitation may have encouraged beneficial pain coping behavior by altering patients' pain perception and coping behavior, thereby reducing adverse effects of pain.

Has aerobic exercise effect on pain perception in persons with migraine and coexisting tension-type headache and neck pain? A randomized, controlled, clinical trial.

PubMed

Krøll, L S; Sjödahl Hammarlund, C; Gard, G; Jensen, R H; Bendtsen, L

2018-04-10

A large subset of persons with migraine suffers from coexisting tension-type headache and neck pain which may adversely affect the prognosis of migraine. Aerobic exercise has been shown to decrease migraine burden in these persons. Therefore, the aim of this study was to investigate whether the effect of aerobic exercise in persons with migraine and coexisting tension-type headache and neck pain can be explained by changes in pain perception. Seventy consecutively recruited persons with migraine and coexisting tension-type headache and neck pain were randomized into exercise group or control group. Aerobic exercise consisted of bike/cross-trainer/brisk walking for 45 min, three times/week for 3 months. Controls continued their usual daily activities. Pericranial tenderness, pain thresholds, supra-thresholds and temporal summation were assessed at baseline, after treatment and at follow-up (6 months from baseline). Fifty-two persons with migraine and coexisting tension-type headache and neck pain completed the study. Aerobic exercise did not induce consistent changes in nociceptive pathways measured by pericranial tenderness, pressure pain thresholds and sensitivity to electrical stimulation. The effect of aerobic exercise cannot be explained by measurable effects on the pain modulation system. Thus, the positive effect on migraine burden may rather be explained by positive alteration of avoidance behaviour. Aerobic exercise can be recommended as a safe and inexpensive migraine treatment strategy. This study adds further knowledge about the positive effect of aerobic exercise for persons with migraine and coexisting tension-type headache and neck pain. This effect cannot be measured by changes in pain modulation, but may rather be explained by positive alteration of avoidance behaviour. © 2018 European Pain Federation - EFIC®.

Seeing the Body Distorts Tactile Size Perception

ERIC Educational Resources Information Center

Longo, Matthew R.; Sadibolova, Renata

2013-01-01

Vision of the body modulates somatosensation, even when entirely non-informative about stimulation. For example, seeing the body increases tactile spatial acuity, but reduces acute pain. While previous results demonstrate that vision of the body modulates somatosensory sensitivity, it is unknown whether vision also affects metric properties of…

The Influence of Social Threat on Pain, Aggression, and Empathy in Women.

PubMed

Karos, Kai; Meulders, Ann; Goubert, Liesbet; Vlaeyen, Johan W S

2018-03-01

Only one published study has investigated the effect of a threatening social context on the perception and expression of pain, showing that social threat leads to increased pain reports but reduced nonverbal pain expression. The current study aimed to replicate and extend these findings to further explore the effects of a threatening social context. Healthy, female participants (N = 71) received 10 electrocutaneous stimuli delivered by a confederate. They were led to believe that the confederate was requested to administer 10 painful stimuli (control group) or that the confederate deliberately chose to deliver 10 painful stimuli when given the choice to deliver between 1 to 10 painful stimuli (social threat group). Self-reported pain intensity, unpleasantness, threat value of pain, and painful facial expression were assessed. Additionally, empathy and aggression toward the confederate were investigated. Social threat did not affect painful facial expression or self-reported pain intensity, but led to increased aggression toward the confederate. Moreover, perceived social threat predicted the threat value of pain and reduced empathy toward the confederate. We were not able to replicate the previously reported dissociation between pain reports and pain expression as a result of social threat. However, social threat was associated with an increased threat value of pain, increased aggression, and reduced empathy. A threatening social context affects how threatening pain is perceived and has interpersonal consequences such as increased aggression and reduced empathy, thereby creating a double burden on the individual suffering from pain. Copyright © 2017 The American Pain Society. Published by Elsevier Inc. All rights reserved.

Brain Functional Changes before, during, and after Clinical Pain.

PubMed

Hu, X; Racek, A J; Bellile, E; Nascimento, T D; Bender, M C; Toback, R L; Burnett, D; Khatib, L; McMahan, R; Kovelman, I; Ellwood, R P; DaSilva, A F

2018-05-01

This study used an emerging brain imaging technique, functional near-infrared spectroscopy (fNIRS), to investigate functional brain activation and connectivity that modulates sometimes traumatic pain experience in a clinical setting. Hemodynamic responses were recorded at bilateral somatosensory (S1) and prefrontal cortices (PFCs) from 12 patients with dentin hypersensitivity in a dental chair before, during, and after clinical pain. Clinical dental pain was triggered with 20 consecutive descending cold stimulations (32° to 0°C) to the affected teeth. We used a partial least squares path modeling framework to link patients' clinical pain experience with recorded hemodynamic responses at sequential stages and baseline resting-state functional connectivity (RSFC). Hemodynamic responses at PFC/S1 were sequentially elicited by expectation, cold detection, and pain perception at a high-level coefficient (coefficients: 0.92, 0.98, and 0.99, P < 0.05). We found that the pain ratings were positively affected only at a moderate level of coefficients by such sequence of functional activation (coefficient: 0.52, P < 0.05) and the baseline PFC-S1 RSFC (coefficient: 0.59, P < 0.05). Furthermore, when the dental pain had finally subsided, the PFC increased its functional connection with the affected S1 orofacial region contralateral to the pain stimulus and, in contrast, decreased with the ipsilateral homuncular S1 regions ( P < 0.05). Our study indicated for the first time that patients' clinical pain experience in the dental chair can be predicted concomitantly by their baseline functional connectivity between S1 and PFC, as well as their sequence of ongoing hemodynamic responses. In addition, this linked cascade of events had immediate after-effects on the patients' brain connectivity, even when clinical pain had already ceased. Our findings offer a better understating of the ongoing impact of affective and sensory experience in the brain before, during, and after clinical dental pain.

The Efficacy of a Perceptive Rehabilitation on Postural Control in Patients with Chronic Nonspecific Low Back Pain

ERIC Educational Resources Information Center

Paolucci, Teresa; Fusco, Augusto; Iosa, Marco; Grasso, Maria R.; Spadini, Ennio; Paolucci, Stefano; Saraceni, Vincenzo M.; Morone, Giovanni

2012-01-01

Patients with chronic low back pain have a worse posture, probably related to poor control of the back muscles and altered perception of the trunk midline. The aim of this study was to evaluate the efficacy of a perceptive rehabilitation in terms of stability and pain relief in patients with chronic nonspecific low back pain. Thirty patients were…

Emotional modulation of pain: is it the sensation or what we recall?

PubMed

Godinho, Fabio; Magnin, Michel; Frot, Maud; Perchet, Caroline; Garcia-Larrea, Luis

2006-11-01

Emotions modulate pain perception, although the mechanisms underlying this phenomenon remain unclear. In this study, we show that intensity reports significantly increased when painful stimuli were concomitant to images showing human pain, whereas pictures with identical emotional values but without somatic content failed to modulate pain. Early somatosensory responses (<200 ms) remained unmodified by emotions. Conversely, late responses showed a significant enhancement associated with increased pain ratings, localized to the right prefrontal, right temporo-occipital junction, and right temporal pole. In contrast to selective attention, which enhances pain ratings by increasing sensory gain, emotions triggered by seeing other people's pain did not alter processing in SI-SII (primary and second somatosensory areas), but may have biased the transfer to, and the representation of pain in short-term memory buffers (prefrontal), as well as the affective assignment to this representation (temporal pole). Memory encoding and recall, rather than sensory processing, appear to be modulated by empathy with others' physical suffering.

When sex hurts, anxiety and fear orient attention towards pain.

PubMed

Payne, Kimberley A; Binik, Yitzchak M; Amsel, Rhonda; Khalifé, Samir

2005-08-01

Hypervigilance for pain-relevant stimuli has been associated with anxiety, fear of pain and anxiety sensitivity. This attentional bias has been primarily investigated in heterogeneous pain groups or pain-free controls, but has not been examined in pain conditions where anxiety and fear are likely to play a central role. Due to the intimate and interpersonal nature of genital pain experienced during sexual intercourse, Vulvar Vestibulitis Syndrome (VVS) constitutes an ideal sample in which to investigate the role of cognitive and affective factors in pain perception and maintenance. Seventeen women suffering from VVS and an equal number of age and education matched control women completed an emotional Stroop and memory recall task in addition to a series of questionnaires assessing pain-hypervigilance, state and trait anxiety, fear of pain, and anxiety sensitivity. VVS sufferers reported hypervigilance for coital pain and also exhibited a selective attentional bias towards pain stimuli on the emotional Stroop task as compared with controls. This effect was predicted by state and trait anxiety and fear of pain. According to these data, treament strategies for VVS should target anxiety and fear in addition to sensory systems.

Are the treatment expectations of 'significant others' psychosocial obstacles to work participation for those with persistent low back pain?

PubMed

McCluskey, Serena; Brooks, Joanna; King, Nigel; Burton, Kim

2014-01-01

Treatment expectations form a fundamental component of the self-regulatory model of health behavior, which defines such cognitions as illness perceptions. Unrealistic and/or unhelpful treatment expectations have been linked to detrimental clinical and work outcomes in those with persistent low back pain. However, research of this nature has rarely focused on the influence of 'significant others' (spouse/partner/close family member). To provide an in-depth examination of the treatment expectations of the 'significant others' of individuals who have become unable to work due to persistent low back pain, highlighting how significant others may influence recovery and work participation outcomes for such individuals. A convenience sample (n=18) of work disability benefit claimants and their significant others were recruited from two settings in the North of England. A qualitative research design was employed, and semi-structured interviews based on the chronic pain version of the Illness Perceptions Questionnaire-Revised were conducted with claimants and their significant others. Interview data were analysed using template analysis. It was found that significant others expected a substantial reduction or complete removal of pain in order for treatment to be considered successful. The pursuit of diagnostic tests was important in validating such expectations, and there was continued scepticism of treatments already undertaken or offered as an alternative. Like the individuals affected, significant others believed that a correct diagnosis had not yet been received, which led to a continued delay in return to work. This study demonstrates that significant others have similar unrealistic and/or unhelpful treatment expectations to those widely reported by individuals with persistent low back pain, and could further reinforce such illness perceptions and serve as wider psychosocial obstacles to recovery and continued work participation.

Perceived quality of life in obsessive-compulsive disorder: related factors

PubMed Central

Rodriguez-Salgado, Beatriz; Dolengevich-Segal, Helen; Arrojo-Romero, Manuel; Castelli-Candia, Paola; Navio-Acosta, Mercedes; Perez-Rodriguez, Maria M; Saiz-Ruiz, Jeronimo; Baca-Garcia, Enrique

2006-01-01

Background Obsessive-compulsive disorder (OCD) affects young adults and has great impact on the social, emotional and work spheres. Methods We measured perceived quality of life (QOL) in OCD patients, in order to analyse socio-demographic and clinical factors that may be associated with QOL perception. 64 OCD outpatients were assessed with the Mini International Neuropsychiatric Interview for DSM-IV, the Yale-Brown Obsessions and Compulsions scale (Y-BOCS), Hamilton's depression scale and the SF-36 self-administered global QOL perception scale. Results We found a correlation among Hamilton's scale scores and all SF-36 subscales. The severity of the obsessive-compulsive disorder was correlated with all SF-36 subscales and with the highest scores in Hamilton's scale. The obsessions subscale was correlated to all SF-36 subscales, while the compulsions subscale was correlated only to social functioning, emotional role, mental health and vitality. Compulsions were not related to general health perception. There were significant differences between OCD patients and the Spanish general population in all SF-36 subscales except those related to physical health and pain. Gender, age, age of onset of the disorder, years of evolution and marital status of the patients did not significantly affect quality of life perception. Being employed was related to better scores in the subscale of physical role. Patients with medical comorbidity scored lower in the subscales of general health, social functioning and mental health. Patients with comorbid psychiatric disorders had worse scores in the subscales of pain, general health, social functioning and mental health. Conclusion Quality of life perception was different in OCD patients and the general population. Quality of life perception was related to severity of the disorder, physical and psychiatric comorbidity and employment status. PMID:16684346

Neurophysiology of the cortical pain network: revisiting the role of S1 in subjective pain perception via standardized low-resolution brain electromagnetic tomography (sLORETA).

PubMed

Nir, Rony-Reuven; Lev, Rina; Moont, Ruth; Granovsky, Yelena; Sprecher, Elliot; Yarnitsky, David

2008-11-01

Multiple studies have supported the usefulness of standardized low-resolution brain electromagnetic tomography (sLORETA) in localizing generators of scalp-recorded potentials. The current study implemented sLORETA on pain event-related potentials, primarily aiming at validating this technique for pain research by identifying well-known pain-related regions. Subsequently, we pointed at investigating the still-debated and ambiguous topic of pain intensity coding at these regions, focusing on their relative impact on subjective pain perception. sLORETA revealed significant activations of the bilateral primary somatosensory (SI) and anterior cingulate cortices and of the contralateral operculoinsular and dorsolateral prefrontal (DLPFC) cortices (P < .05 for each). Activity of these regions, excluding DLPFC, correlated with subjective numerical pain scores (P < .05 for each). However, a multivariate regression analysis (R = .80; P = .024) distinguished the contralateral SI as the only region whose activation magnitude significantly predicted the subjective perception of noxious stimuli (P = .020), further substantiated by a reduced regression model (R = .75, P = .008). Based on (1) correspondence of the pain-activated regions identified by sLORETA with the acknowledged imaging-based pain-network and (2) the contralateral SI proving to be the most contributing region in pain intensity coding, we found sLORETA to be an appropriate tool for relevant pain research and further substantiated the role of SI in pain perception. Because the literature of pain intensity coding offers inconsistent findings, the current article used a novel tool for revisiting this controversial issue. Results suggest that it is the activation magnitude of SI, which solely establishes the significant correlation with subjective pain ratings, in accordance with the classical clinical thinking, relating SI lesions to diminished perception of pain. Although this study cannot support a causal relation between SI activation magnitude and pain perception, such relation might be insinuated.

The Relationship between Strategies of Coping and Perception of Pain in Three Chronic Pain Groups.

ERIC Educational Resources Information Center

Anderson, Louis P.; Rehm, Lynn P.

1984-01-01

Examined the relationship between perception of pain, personality, coping, and the reaction of family members in three chronic pain groups (sickle cell anemia, arthritis, and low back pain) (N=60). Analyses suggested that the three groups were not distinguishable in coping, personality, or in their experience of pain. (LLL)

Racial bias in pain perception and response: experimental examination of automatic and deliberate processes.

PubMed

Mathur, Vani A; Richeson, Jennifer A; Paice, Judith A; Muzyka, Michael; Chiao, Joan Y

2014-05-01

Racial disparities in pain treatment pose a significant public health and scientific problem. Prior studies have demonstrated that clinicians and nonclinicians are less perceptive of, and suggest less treatment for, the pain of African Americans relative to European Americans. Here we investigate the effects of explicit/implicit patient race presentation, patient race, and perceiver race on pain perception and response. African American and European American participants rated pain perception, empathy, helping motivation, and treatment suggestion in response to vignettes about patients' pain. Vignettes were accompanied by a rapid (implicit) or static (explicit) presentation of an African or European American patient's face. Participants perceived and responded more to European American patients in the implicit prime condition, when the effect of patient race was below the level of conscious regulation. This effect was reversed when patient race was presented explicitly. Additionally, female participants perceived and responded more to the pain of all patients, relative to male participants, and in the implicit prime condition, African American participants were more perceptive and responsive than European Americans to the pain of all patients. Taken together, these results suggest that known disparities in pain treatment may be largely due to automatic (below the level of conscious regulation) rather than deliberate (subject to conscious regulation) biases. These biases were not associated with traditional implicit measures of racial attitudes, suggesting that biases in pain perception and response may be independent of general prejudice. Results suggest that racial biases in pain perception and treatment are at least partially due to automatic processes. When the relevance of patient race is made explicit, however, biases are attenuated and even reversed. We also find preliminary evidence that African Americans may be more sensitive to the pain of others than are European Americans. Copyright © 2014 American Pain Society. Published by Elsevier Inc. All rights reserved.

Anxiety and stress can predict pain perception following a cognitive stress.

PubMed

Hoeger Bement, Marie; Weyer, Andy; Keller, Manda; Harkins, April L; Hunter, Sandra K

2010-08-04

Hoeger Bement, M.K., A. Weyer, M. Keller, A. Harkins, and S.K. Hunter. Anxiety and stress can predict pain perception following a cognitive stressor. PHYSIOL BEHAV 000-000. The purpose of this study was to investigate the influence of a cognitive stressor on pain perception and determine individual characteristics that may predict the pain response. Twenty-five subjects participated in three sessions: one familiarization and two experimental. The experimental sessions involved measurement of pain perception before and after 1) mental math tasks (stressor session) and 2) quiet rest (control session). Pain threshold and ratings were assessed with a mechanical noxious stimulus. Changes in stress and anxiety were examined with self-reported and physiological measures including questionnaires, visual analogue scales, and salivary cortisol levels. During the control session, stress and anxiety decreased and pain reports remain unchanged. During the stressor session, stress and anxiety increased and pain reports were variable among subjects. Based on the pain response to mental math, subjects were divided into three groups (increase, decrease or no change in pain). The increase-pain group (n=8) had lower baseline stress and anxiety, lower baseline pain reports, and large anxiety response following the mental math. In contrast, the decrease-pain group (n=9) had higher baseline stress and anxiety levels, higher baseline pain reports, and a large increase in cortisol levels. Thus, the differential response in the changes in pain perception was related to anxiety and stress levels prior to and during the cognitive stressor, indicating that psychosocial characteristics can help determine the stress-induced pain response. Copyright 2010 Elsevier Inc. All rights reserved.

Beliefs about expectations moderate the influence of expectations on pain perception.

PubMed

Handley, Ian M; Fowler, Stephanie L; Rasinski, Heather M; Helfer, Suzanne G; Geers, Andrew L

2013-03-01

Expectations congruently influence, or bias, pain perception. Recent social psychological research reveals that individuals differ in the extent to which they believe in expectation biases and that individuals who believe in expectation biases may adjust for this bias in their perceptions and reactions. That is, idiosyncratic beliefs about expectations can moderate the influence of expectations on experience. Prior research has not examined whether idiosyncratic beliefs about expectations can alter the degree to which one's expectations influence pain perception. Using a laboratory pain stimulus, we examined the possibility that beliefs about expectation biases alter pain responses following both pain- and placebo-analgesic expectations. Participants' beliefs about expectation biases were measured. Next, participants were randomly assigned to receive either a pain expectation or a placebo-analgesia expectation prior to a cold-pressor task. After the task, participants rated their pain. Beliefs about expectation biases significantly influenced pain reports. Specifically, pain reports were more influenced by provided expectations the less participants believed in expectation biases (i.e., pain expectations resulted in more pain than analgesia expectations). Beliefs about the expectation bias are an important and under-examined predictor of pain and placebo analgesia.

Valence and Arousal Value of Visual Stimuli and Their Role in the Mitigation of Chronic Pain: What Is the Power of Pictures?

PubMed

Shaygan, Maryam; Böger, Andreas; Kröner-Herwig, Birgit

2017-02-01

The present study investigated the pain-reducing effects of various pictures in a sample of 88 patients receiving inpatient treatment for chronic pain. We investigated whether the pain-attenuating effects of the pictures were mediated by picture valence, arousal, or change in subjective social support. The study was carried out over 4 consecutive days. Patients were presented with photographs of loved ones, strangers, landscapes, or optical illusions via digital albums and were asked to rate their pain intensity and their sensory and affective experience of pain immediately before and after viewing the pictures. They also evaluated the valence of the pictures and the extent to which they were arousing. Before and after participation in the study, patients provided information on their subjective social support. The valence attributed to the pictures varied; photographs of loved ones elicited the greatest pleasure. Pictures of varying emotional content and arousal value all reduced affective and sensory perceptions of pain. Viewing photographs of loved ones reduced pain intensity more than viewing other picture types. The association between picture type and decrease in pain intensity was mediated by picture valence. These findings suggest an easy to implement supplementary intervention that could be used in multidisciplinary pain treatment. To our knowledge, this is the first demonstration that pictures mitigate pain in chronic pain patients receiving treatment in a multidisciplinary pain center. The procedure could be used routinely to treat pain, particularly severe pain. Copyright © 2016 American Pain Society. Published by Elsevier Inc. All rights reserved.

Work problems due to low back pain: what do GPs do? A questionnaire survey.

PubMed

Coole, Carol; Watson, Paul J; Drummond, Avril

2010-02-01

Low back pain can affect work ability and remains a main cause of sickness absence. In the UK the GP is usually the first contact for patients seeking health care. The UK government intends that the GP will continue to be responsible for sickness certification and work advice. This role requires a considerable level of understanding of work rehabilitation, and effective communication between GPs, patients, employers and therapists. The aim of this study was to identify GPs' current practice in managing patients whose ability to work is affected by low back pain, and their perception of the support services required. A postal questionnaire of 441 GPs in the South Nottinghamshire area of the UK was carried out. Areas covered included referral patterns, sickness certification, and communication with therapists and employers. There was a 54.6% response rate. The majority of GPs (76.8%) reported that they did not take overall responsibility for managing the work problems of patients arising from low back pain. Few 'mainly agreed' that they initiated communication with employers (2.5%) and/or therapists (10.4%) regarding their patients' work. The results of this study demonstrate that most GPs do not readily engage in vocational rehabilitation and do not initiate contact with employers or other health care practitioners regarding patients' work problems. Thus the current government expectation that GPs are able to successfully manage this role may be unrealistic; considerable training and a change in the GPs' perception of their role will be required.

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.

Catechol-O-methlytransferase inhibition alters pain and anxiety-related volitional behaviors through activation of β-adrenergic receptors in the rat

PubMed Central

Kline, R. H.; Exposto, F. G.; O’Buckley, S. C.; Westlund, K. N.; Nackley, A. G.

2015-01-01

Reduced catechol-O-methyltransferase (COMT) activity resulting from genetic variation or pharmacological depletion results in enhanced pain perception in humans and nociceptive behaviors in animals. Using phasic mechanical and thermal reflex tests (e.g. von Frey, Hargreaves), recent studies show that acute COMT-dependent pain in rats is mediated by β-adrenergic receptors (βARs). In order to more closely mimic the characteristics of human chronic pain conditions associated with prolonged reductions in COMT, the present study sought to determine volitional pain-related and anxiety-like behavioral responses following sustained as well as acute COMT inhibition using an operant 10–45°C thermal place preference task and a light/dark preference test. In addition, we sought to evaluate the effects of sustained COMT inhibition on generalized body pain by measuring tactile sensory thresholds of the abdominal region. Results demonstrated that acute and sustained administration of the COMT inhibitor OR486 increased pain behavior in response to thermal heat. Further, sustained administration of OR486 increased anxiety behavior in response to bright light, as well as abdominal mechanosensation. Finally, all pain-related behaviors were blocked by the non-selective βAR antagonist propranolol. Collectively, these findings provide the first evidence that stimulation of ARs following acute or chronic COMT inhibition drives cognitive-affective behaviors associated with heightened pain that affects multiple body sites. PMID:25659347

The translocator protein gene is associated with symptom severity and cerebral pain processing in fibromyalgia.

PubMed

Kosek, Eva; Martinsen, Sofia; Gerdle, Björn; Mannerkorpi, Kaisa; Löfgren, Monika; Bileviciute-Ljungar, Indre; Fransson, Peter; Schalling, Martin; Ingvar, Martin; Ernberg, Malin; Jensen, Karin B

2016-11-01

The translocator protein (TSPO) is upregulated during glia activation in chronic pain patients. TSPO constitutes the rate-limiting step in neurosteroid synthesis, thus modulating synaptic transmission. Related serotonergic mechanisms influence if pro- or anti-nociceptive neurosteroids are produced. This study investigated the effects of a functional genetic polymorphism regulating the binding affinity to the TSPO, thus affecting symptom severity and cerebral pain processing in fibromyalgia patients. Gene-to-gene interactions with a functional polymorphism of the serotonin transporter gene were assessed. Fibromyalgia patients (n=126) were genotyped regarding the polymorphisms of the TSPO (rs6971) and the serotonin transporter (5-HTTLPR/rs25531). Functional magnetic resonance imaging (n=24) was used to study brain activation during individually calibrated pressure pain. Compared to mixed/low TSPO affinity binders, the high TSPO affinity binders rated more severe pain (p=0.016) and fibromyalgia symptoms (p=0.02). A significant interaction was found between the TSPO and the serotonin transporter polymorphisms regarding pain severity (p<0.0001). Functional connectivity analyses revealed that the TSPO high affinity binding group had more pronounced pain-evoked functional connectivity in the right frontoparietal network, between the dorsolateral prefrontal area and the parietal cortex. In conclusion, fibromyalgia patients with the TSPO high affinity binding genotype reported a higher pain intensity and more severe fibromyalgia symptoms compared to mixed/low affinity binders, and this was modulated by interaction with the serotonin transporter gene. To our knowledge this is the first evidence of functional genetic polymorphisms affecting pain severity in FM and our findings are in line with proposed glia-related mechanisms. Furthermore, the functional magnetic resonance findings indicated an effect of translocator protein on the affective-motivational components of pain perception. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

The Impact of Educational Status on the Postoperative Perception of Pain

PubMed Central

Mimigianni, Christina; Raptis, Demetris; Sourtse, Gionous; Sgourakis, George; Karaliotas, Constantine

2015-01-01

Background Postoperative (PO) pain interferes with the recovery and mobilization of the surgical patients. The impact of the educational status has not been studied adequately up to now. Methods This prospective study involved 400 consecutive general surgery patients. Various factors known to be associated with the perception of pain including the educational status were recorded as was the preoperative and postoperative pain and the analgesia requirements for the 1st PO week. Based on the educational status, we classified the patients in 3 groups and we compared these groups for the main outcomes: i.e. PO pain and PO analgesia. Results There were 145 patients of lower education (junior school), 150 patients of high education (high school) and 101 of higher education (university). Patients of lower education were found to experience more pain than patients of higher education in all postoperative days (from the 2nd to the 6th). No difference was identified in the type and quantity of the analgesia used. The subgroup analysis showed that patients with depression and young patients (< 40 years) had the maximum effect. Conclusions The educational status may be a significant predictor of postoperative pain due to various reasons, including the poor understanding of the preoperative information, the level of anxiety and depression caused by that and the suboptimal request and use of analgesia. Younger patients (< 40), and patients with subclinical depression are mostly affected while there is no impact on patients over 60 years old. PMID:26495081

The Impact of Educational Status on the Postoperative Perception of Pain.

PubMed

Lanitis, Sophocles; Mimigianni, Christina; Raptis, Demetris; Sourtse, Gionous; Sgourakis, George; Karaliotas, Constantine

2015-10-01

Postoperative (PO) pain interferes with the recovery and mobilization of the surgical patients. The impact of the educational status has not been studied adequately up to now. This prospective study involved 400 consecutive general surgery patients. Various factors known to be associated with the perception of pain including the educational status were recorded as was the preoperative and postoperative pain and the analgesia requirements for the 1(st) PO week. Based on the educational status, we classified the patients in 3 groups and we compared these groups for the main outcomes: i.e. PO pain and PO analgesia. There were 145 patients of lower education (junior school), 150 patients of high education (high school) and 101 of higher education (university). Patients of lower education were found to experience more pain than patients of higher education in all postoperative days (from the 2(nd) to the 6(th)). No difference was identified in the type and quantity of the analgesia used. The subgroup analysis showed that patients with depression and young patients (< 40 years) had the maximum effect. The educational status may be a significant predictor of postoperative pain due to various reasons, including the poor understanding of the preoperative information, the level of anxiety and depression caused by that and the suboptimal request and use of analgesia. Younger patients (< 40), and patients with subclinical depression are mostly affected while there is no impact on patients over 60 years old.

Early diagnosis of peripheral nervous system involvement in Fabry disease and treatment of neuropathic pain: the report of an expert panel

PubMed Central

2011-01-01

Background Fabry disease is an inherited metabolic disorder characterized by progressive lysosomal accumulation of lipids in a variety of cell types, including neural cells. Small, unmyelinated nerve fibers are particularly affected and small fiber peripheral neuropathy often clinically manifests at young age. Peripheral pain can be chronic and/or occur as provoked attacks of excruciating pain. Manifestations of dysfunction of small autonomic fibers may include, among others, impaired sweating, gastrointestinal dysmotility, and abnormal pain perception. Patients with Fabry disease often remain undiagnosed until severe complications involving the kidney, heart, peripheral nerves and/or brain have arisen. Methods An international expert panel convened with the goal to provide guidance to clinicians who may encounter unrecognized patients with Fabry disease on how to diagnose these patients early using simple diagnostic tests. A further aim was to offer recommendations to control neuropathic pain. Results We describe the neuropathy in Fabry disease, focusing on peripheral small fiber dysfunction - the hallmark of early neurologic involvement in this disorder. The clinical course of peripheral pain is summarized, and the importance of medical history-taking, including family history, is highlighted. A thorough physical examination (e.g., angiokeratoma, corneal opacities) and simple non-invasive sensory perception tests could provide clues to the diagnosis of Fabry disease. Reported early clinical benefits of enzyme replacement therapy include reduction of neuropathic pain, and adequate management of residual pain to a tolerable and functional level can substantially improve the quality of life for patients. Conclusions Our recommendations can assist in diagnosing Fabry small fiber neuropathy early, and offer clinicians guidance in controlling peripheral pain. This is particularly important since management of pain in young patients with Fabry disease appears to be inadequate. PMID:21619592

Pain Perception in Buddhism Perspective.

PubMed

Waikakul, Waraporn; Waikakul, Saranatra

2016-08-01

Dhamma, which Lord Buddha has presented to people after his enlightenment, analyzes every phenomenon and objects into their ultimate elements. The explanation of sensory system is also found in a part of Dhamma named Abhidhammapitaka, the Book of the Higher Doctrine in Buddhism. To find out the relationship between explanation of pain in the present neuroscience and the explanation of pain in Abhidhamma, the study was carried out by the use of a comprehensive review. The comparisons were in terms of peripheral stimulation, signal transmission, modulation, perception, suffering, determination and decision making for the responding to pain. We found that details of the explanation on pain mechanism and perception in Abhidhamma could associate well with our present scientific knowledge. Furthermore, more refinement information about the process and its function in particular aspects of pain perception were provided in Abhidhammapitaka.

The analgesic effect of benzocaine mucoadhesive patches on orthodontic pain caused by elastomeric separators, a preliminary study.

PubMed

Eslamian, Ladan; Borzabadi-Farahani, Ali; Edini, Hosniye Zia; Badiee, Mohammad R; Lynch, Edward; Mortazavi, Alireza

2013-09-01

To study the effect of benzocaine mucoadhesive patches (20%) on orthodontic pain caused by elastomeric separators. A split-mouth design was used in 30 patients (12 female, 18 male, aged 23 ± 3.75 years). They were instructed to apply benzocaine and placebo patches randomly for right or left first permanent molars of maxillary/mandibular arches for 20 min and repeat this procedure every 6 h with a similar type patch. A 10 cm Visual Analogue Scale (VAS) was used for pain perception assessment in patients who were given benzocaine (benzocaine group) or placebo (placebo group) patches. Pain perception (VAS) was recorded immediately after separator placement and after 2, 6, 12, 18, 24, 48 and 72 h. The mean VAS (SD) for the placebo and benzocaine groups were 2.28 (1.08) and 1.63 (0.67), respectively. The pain peaked at 24 h. Significant pain perception differences were observed between groups at 2, 18, 24, 48 and 72 h. Pain perception was not different between genders or jaws investigated (p > 0.05). The Friedman test revealed significant differences in pain perception among various time intervals for benzocaine (χ (2) = 99.84, p = 0.000) and placebo (χ (2) = 102.361, p = 0.000) groups. Significant negative correlations (ρ) were found only between pain perception scores and patient's ages in the placebo group at 18 (-0.438), 24 (-0.526), 48 (-0.565) and 72 h (-0.458). The recorded mean VAS values were relatively low; however, the benzocaine 20% patches significantly reduced the post-separation orthodontic pain.

Student and Teacher Perception of Disciplinary Practices: Types, Reasons, Consequences and Alternatives

ERIC Educational Resources Information Center

Mumthas, N. S.; Munavvir, Jouhar; Abdul Gafoor, K.

2014-01-01

Inculcating self-discipline is important for systematic pursuit of learning, development of interest and potential in the child. Punishments involve employing a noxious or painful stimulus that generates a variety of problems and negative side effects to the child. Corporal punishments severely affect the human dignity of children. This study…

The Impact of Arthritis on Life Satisfaction of Older Adults.

ERIC Educational Resources Information Center

Burckhardt, Carol S.

Poor health has been implicated as a suppressor of the life satisfaction of older adults. To clarify the contribution of arthritis to this process, functional disability, negative affect, pain, current severity of the disease, self-esteem, perception of general health, and internal health locus of control, were placed within a causal model as…

Knowledge, perception and practices of healthcare professionals at tertiary level hospitals in Kingston, Jamaica, regarding neonatal pain management.

PubMed

Young, J; Barton, M; Richards-Dawson, M A; Trotman, H

2008-01-01

To determine knowledge, perception and practices of healthcare professionals at tertiary level hospitals in Kingston, Jamaica, regarding neonatal pain management. Physicians and nurses actively involved in providing neonatal care at three tertiary level hospitals were invited to participate. A 21-item self-administered questionnaire was used to obtain information on knowledge, perception and practice of neonatal pain management. Descriptive analyses were performed. A total of 147 healthcare workers participated giving a response rate of 85%. Male to female ratio was 1: 4.4. Nurses accounted for 76 (52%) of the respondents while 70 (48%) were physicians. Seventy-three (50%) individuals were unaware of the degree of pain neonates were capable of experiencing and only 38 (27%) knew that premature infants were capable of feeling pain. One hundred and four (71%) respondents were able to identify physiological markers of pain and most respondents were able to discriminate between painful and non-painful procedures. However, 100 (68%) respondents rarely prescribed analgesia for procedures previously rated as painful. Seventy-one (51%) respondents admitted to not using analgesia for alleviating procedural pain in neonates. Twenty-five (18%) individuals thought that the procedure was too short to require analgesic support while 41 (30%) stated that medication was not usually prescribed for procedural pain. Physician scores were significantly higher than those attained by nurses for knowledge (p = 0.003) and for pain perception (p = 0.001) but no significant differences were noted for practice (p = 0.18). There is an overwhelming deficiency in the knowledge, perception and practice of neonatal pain management at tertiary level institutions in Kingston, Jamaica. There is the urgent need for the education of health professionals on neonatal pain management. This will in turn facilitate change in perception and eventually, along with the institution of local policies and protocols, influence practice.

Neural Activation during Anticipation of Near Pain-Threshold Stimulation among the Pain-Fearful.

PubMed

Yang, Zhou; Jackson, Todd; Huang, Chengzhi

2016-01-01

Fear of pain (FOP) can increase risk for chronic pain and disability but little is known about corresponding neural responses in anticipation of potential pain. In this study, more (10 women, 6 men) and less (7 women, 6 men) pain-fearful groups underwent whole-brain functional magnetic resonance imaging (fMRI) during anticipation of near pain-threshold stimulation. Groups did not differ in the proportion of stimuli judged to be painful but pain-fearful participants reported significantly more state fear prior to stimulus exposure. Within the entire sample, stronger activation was found in several pain perception regions (e.g., bilateral insula, midcingulate cortex (MCC), thalamus, superior frontal gyrus) and visual areas linked to decoding stimulus valences (inferior orbital cortex) during anticipation of "painful" stimuli. Between groups and correlation analyses indicated pain-fearful participants experienced comparatively more activity in regions implicated in evaluating potential threats and processing negative emotions during anticipation (i.e., MCC, mid occipital cortex, superior temporal pole), though group differences were not apparent in most so-called "pain matrix" regions. In sum, trait- and task-based FOP is associated with enhanced responsiveness in regions involved in threat processing and negative affect during anticipation of potentially painful stimulation.

[Influence of early childhood stress exposure and traumatic life events on pain perception].

PubMed

Tesarz, J; Gerhardt, A; Eich, W

2018-06-05

Adult pain perception is influenced substantially by interactions between mind, body, and social environment during early life. Early stress exposure and traumatic life events induce powerful psychophysical stress reactions that exert multiple neurofunctional processes. This has significant implications for pain perception and pain processing. As part of this review, the complex relationships between traumatic stress experiences and associated psychobiological mechanisms of chronic pain will be discussed. Based on selected studies, psychophysiological findings are presented and possible underlying mechanisms are discussed. The article concludes with a discussion of potential implications for treatment.

Dissatisfaction with own body makes patients with eating disorders more sensitive to pain

PubMed Central

Yamamotova, Anna; Bulant, Josef; Bocek, Vaclav; Papezova, Hana

2017-01-01

Body image represents a multidimensional concept including body image evaluation and perception of body appearance. Disturbances of body image perception are considered to be one of the central aspects of anorexia nervosa and bulimia nervosa. There is growing evidence that body image distortion can be associated with changes in pain perception. The aim of our study was to examine the associations between body image perception, body dissatisfaction, and nociception in women with eating disorders and age-matched healthy control women. We measured body dissatisfaction and pain sensitivity in 61 patients with Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition diagnoses of eating disorders (31 anorexia nervosa and 30 bulimia nervosa) and in 30 healthy women. Thermal pain threshold latencies were evaluated using an analgesia meter and body image perception and body dissatisfaction were assessed using Anamorphic Micro software (digital pictures of their own body distorted into larger-body and thinner-body images). Patients with eating disorders overestimated their body size in comparison with healthy controls, but the two groups did not differ in body dissatisfaction. In anorexia and bulimia patient groups, body dissatisfaction (calculated in pixels as desired size/true image size) correlated with pain threshold latencies (r=0.55, p=0.001), while between body image perception (determined as estimation size/true image size) and pain threshold, no correlation was found. Thus, we demonstrated that in patients with eating disorders, pain perception is significantly associated with emotional contrary to sensory (visual) processing of one’s own body image. The more the patients desired to be thin, the more pain-sensitive they were. Our findings based on some shared mechanisms of body dissatisfaction and pain perception support the significance of negative emotions specific for eating disorders and contribute to better understanding of the psychosomatic characteristics of this spectrum of illnesses. PMID:28761371

A literature review exploring how healthcare professionals contribute to the assessment and control of postoperative pain in older people.

PubMed

Brown, Donna

2004-09-01

Little research has examined the care older people receive in the acute surgical setting. Although pain assessment and management are judged to be a priority in nursing, often pain, in older people, is undermanaged for a variety of reasons. Factors such as stoicism, communication and ageism can shape both the patients' and nurses' attitude towards the perception of pain which subsequently affects pain management. Through a review of the literature, this paper aims to: (i) identify how healthcare professionals contribute to the assessment and control of postoperative pain in older people and (ii) explore potential barriers to achieving more advantageous pain control in this group. It is suggested that to improve pain management there is a need to individualize pain assessment for older people and to assist clinicians with enhancing their education and decision-making abilities in this field. This may best be achieved by supporting a programme of change to develop the skills of staff and encouraging learning through reflective practice. There is however a need for further research in this area.

Bilateral Sensory Abnormalities in Patients with Unilateral Neuropathic Pain; A Quantitative Sensory Testing (QST) Study

PubMed Central

Konopka, Karl-Heinz; Harbers, Marten; Houghton, Andrea; Kortekaas, Rudie; van Vliet, Andre; Timmerman, Wia; den Boer, Johan A.; Struys, Michel M.R.F.; van Wijhe, Marten

2012-01-01

In patients who experience unilateral chronic pain, abnormal sensory perception at the non-painful side has been reported. Contralateral sensory changes in these patients have been given little attention, possibly because they are regarded as clinically irrelevant. Still, bilateral sensory changes in these patients could become clinically relevant if they challenge the correct identification of their sensory dysfunction in terms of hyperalgesia and allodynia. Therefore, we have used the standardized quantitative sensory testing (QST) protocol of the German Research Network on Neuropathic Pain (DFNS) to investigate somatosensory function at the painful side and the corresponding non-painful side in unilateral neuropathic pain patients using gender- and age-matched healthy volunteers as a reference cohort. Sensory abnormalities were observed across all QST parameters at the painful side, but also, to a lesser extent, at the contralateral, non-painful side. Similar relative distributions regarding sensory loss/gain for non-nociceptive and nociceptive stimuli were found for both sides. Once a sensory abnormality for a QST parameter at the affected side was observed, the prevalence of an abnormality for the same parameter at the non-affected side was as high as 57% (for Pressure Pain Threshold). Our results show that bilateral sensory dysfunction in patients with unilateral neuropathic pain is more rule than exception. Therefore, this phenomenon should be taken into account for appropriate diagnostic evaluation in clinical practice. This is particularly true for mechanical stimuli where the 95% Confidence Interval for the prevalence of sensory abnormalities at the non-painful side ranges between 33% and 50%. PMID:22629414

Negative Illness Perceptions are Associated with a Pro-nociceptive Modulation Profile and Augmented Pelvic Pain.

PubMed

Grinberg, Keren; Granot, Michal; Lowenstein, Lior; Abramov, Liora; Weissman-Fogel, Irit

2018-05-25

A patient's personal interpretations of a health threat or "illness perceptions" (IPs) are associated with their clinical outcomes. This study explored whether IPs are associated with pain severity and ability to modulate pain in women with chronic pelvic pain syndrome (CPPS), as well as the predictive value of IPs on Myofascial Physical Therapy (MPT) success. Illness Perceptions Questionnaire - Revised (IPQ-R), mechanical and heat pain thresholds, mechanical temporal summation (mTS), and conditioned pain modulation (CPM) were evaluated in CPPS patients (n=39) before, and 3 months after MPT. CPPS severity was obtained by the Brief Pain Inventory (BPI). Stronger perceptions of illness chronicity were correlated with less efficient CPM (r=0.488, P=0.002) and increased mechanical pain intensity (r=0.405, P=0.02). Lower perceptions of control over illness were associated with enhanced mTS (r=0.399, P=0.01). Higher BPI scores were correlated with emotional representations ("negative emotional representations") and severe consequences due to CPPS. Regression analyses revealed that negative IPs predict less efficient MPT. Cognitive representations play a unique role in CPPS expression and MPT outcomes. The interplay between negative IPs and a pro-nociceptive modulation profile, mediated by enhanced facilitatory and reduced inhibitory processes, may be involved in the manifestation of CPPS.

Acquisition of Involuntary Spinal Locomotion (Spinal Walking) in Dogs with Irreversible Thoracolumbar Spinal Cord Lesion: 81 Dogs.

PubMed

Gallucci, A; Dragone, L; Menchetti, M; Gagliardo, T; Pietra, M; Cardinali, M; Gandini, G

2017-03-01

Spinal walking (SW) is described as the acquisition of an involuntary motor function in paraplegic dogs and cats without pain perception affected by a thoracolumbar lesion. Whereas spinal locomotion is well described in cats that underwent training trials after experimental spinal cord resection, less consistent information is available for dogs. Paraplegic dogs affected by a thoracolumbar complete spinal cord lesion undergoing intensive physical rehabilitation could acquire an autonomous SW gait under field conditions. Eighty-one acute paraplegic thoracolumbar dogs without pelvic limb pain perception. Retrospective study of medical records of dogs selected for intensive rehabilitation treatment in paraplegic dogs with absence of pain perception on admission and during the whole treatment. Binary regression and multivariate logistic regression were used to analyze potential associations with the development of SW. Autonomous SW was achieved in 48 dogs (59%). Median time to achieve SW was of 75.5 days (range: 16-350 days). On univariate analysis, SW gait was associated with younger age (P = .002) and early start of physiotherapy (P = .024). Multivariate logistic regression showed that younger age (≤60 months) and lightweight (≤7.8 kg) were positively associated with development of SW (P = .012 and P < .001, respectively). BCS, full-time hospitalization, and type and site of the lesion were not significantly associated with development of SW. Dogs with irreversible thoracolumbar lesion undergoing intensive physiotherapic treatment can acquire SW. Younger age and lightweight are positively associated with the development of SW gait. Copyright © 2017 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals, Inc. on behalf of the American College of Veterinary Internal Medicine.

Altered Associations between Pain Symptoms and Brain Morphometry in the Pain Matrix of HIV-Seropositive Individuals.

PubMed

Castillo, Deborrah; Ernst, Thomas; Cunningham, Eric; Chang, Linda

2018-03-01

Pain remains highly prevalent in HIV-seropositive (HIV+) patients despite their well-suppressed viremia with combined antiretroviral therapy. Investigating brain abnormalities within the pain matrix, and in relation to pain symptoms, in HIV+ participants may provide objective biomarkers and insights regarding their pain symptoms. We used Patient-Reported Outcome Measurement Information System (PROMIS®) pain questionnaire to evaluate pain symptoms (pain intensity, pain interference and pain behavior), and structural MRI to assess brain morphometry using FreeSurfer (cortical area, cortical thickness and subcortical volumes were evaluated in 12 regions within the pain matrix). Compared to seronegative (SN) controls, HIV+ participants had smaller surface areas in prefrontal pars triangularis (right: p = 0.04, left: p = 0.007) and right anterior cingulate cortex (p = 0.03) and smaller subcortical regions (thalamus: p ≤ 0.003 bilaterally; right putamen: p = 0.01), as well as higher pain scores (pain intensity-p = 0.005; pain interference-p = 0.008; pain-behavior-p = 0.04). Furthermore, higher pain scores were associated with larger cortical areas, thinner cortices and larger subcortical volumes in HIV+ participants; but smaller cortical areas, thicker cortices and smaller subcortical volumes in SN controls (interaction-p = 0.009 to p = 0.04). These group differences in the pain-associated brain abnormalities suggest that HIV+ individuals have abnormal pain responses. Since these abnormal pain-associated brain regions belong to the affective component of the pain matrix, affective symptoms may influence pain perception in HIV+ patients and should be treated along with their physical pain symptoms. Lastly, associations of lower pain scores with better physical or mental health scores, regardless of HIV-serostatus (p < 0.001), suggest adequate pain treatment would lead to better quality of life in all participants.

Catechol-O-methyltransferase inhibition alters pain and anxiety-related volitional behaviors through activation of β-adrenergic receptors in the rat.

PubMed

Kline, R H; Exposto, F G; O'Buckley, S C; Westlund, K N; Nackley, A G

2015-04-02

Reduced catechol-O-methyltransferase (COMT) activity resulting from genetic variation or pharmacological depletion results in enhanced pain perception in humans and nociceptive behaviors in animals. Using phasic mechanical and thermal reflex tests (e.g. von Frey, Hargreaves), recent studies show that acute COMT-dependent pain in rats is mediated by β-adrenergic receptors (βARs). In order to more closely mimic the characteristics of human chronic pain conditions associated with prolonged reductions in COMT, the present study sought to determine volitional pain-related and anxiety-like behavioral responses following sustained as well as acute COMT inhibition using an operant 10-45°C thermal place preference task and a light/dark preference test. In addition, we sought to evaluate the effects of sustained COMT inhibition on generalized body pain by measuring tactile sensory thresholds of the abdominal region. Results demonstrated that acute and sustained administration of the COMT inhibitor OR486 increased pain behavior in response to thermal heat. Further, sustained administration of OR486 increased anxiety behavior in response to bright light, as well as abdominal mechanosensation. Finally, all pain-related behaviors were blocked by the non-selective βAR antagonist propranolol. Collectively, these findings provide the first evidence that stimulation of βARs following acute or chronic COMT inhibition drives cognitive-affective behaviors associated with heightened pain that affects multiple body sites. Copyright © 2015 IBRO. Published by Elsevier Ltd. All rights reserved.

[High-intensity focused ultrasound (HIFU) for tumor pain relief in inoperable pancreatic cancer : Evaluation with the pain sensation scale (SES)].

PubMed

Marinova, M; Strunk, H M; Rauch, M; Henseler, J; Clarens, T; Brüx, L; Dolscheid-Pommerich, R; Conrad, R; Cuhls, H; Radbruch, L; Schild, H H; Mücke, M

2017-02-01

High-intensity focused ultrasound (HIFU) in combination with palliative standard therapy is an innovative and effective treatment option for pain reduction in patients with inoperable pancreatic cancer. Evaluation of the effects of additive ultrasound (US)-guided HIFU treatment in inoperable pancreatic cancer on the sensory and affective pain perception using validated questionnaries. In this study 20 patients with locally advanced inoperable pancreatic cancer and tumor-related pain were treated by US-guided HIFU (6 stage III, 12 stage IV according to UICC and 2 with local recurrence after surgery). Ablation was performed using the JC HIFU system (HAIFU, Chongqing, China) with an ultrasonic device for real-time imaging. Clinical assessment included evaluation of pain severity using validated questionnaires with particular attention to the pain sensation scale (SES) with its affective and sensory component and the numeric rating scale (NRS). The average pain reduction after HIFU was 2.87 points on the NRS scale and 57.3 % compared to the mean baseline score (n = 15, 75 %) in 19 of 20 treated patients. Four patients did not report pain relief, however, the previous opioid medication could be stopped (n = 2) or the analgesic dosage could be reduced (n = 2). No pain reduction was achieved in one patient. Furthermore, after HIFU emotional as well as sensory pain aspects were significantly reduced (before vs. 1 week after HIFU, p < 0.05 for all pain scales). US-guided HIFU can be used for effective and early pain relief and reduction of emotional and sensory pain sensation in patients with locally advanced pancreatic cancer.

A randomized, controlled trial of immersive virtual reality analgesia, during physical therapy for pediatric burns.

PubMed

Schmitt, Yuko S; Hoffman, Hunter G; Blough, David K; Patterson, David R; Jensen, Mark P; Soltani, Maryam; Carrougher, Gretchen J; Nakamura, Dana; Sharar, Sam R

2011-02-01

This randomized, controlled, within-subjects (crossover design) study examined the effects of immersive virtual reality as an adjunctive analgesic technique for hospitalized pediatric burn inpatients undergoing painful physical therapy. Fifty-four subjects (6-19 years old) performed range-of-motion exercises under a therapist's direction for 1-5 days. During each session, subjects spent equivalent time in both the virtual reality and the control conditions (treatment order randomized and counterbalanced). Graphic rating scale scores assessing the sensory, affective, and cognitive components of pain were obtained for each treatment condition. Secondary outcomes assessed subjects' perception of the virtual reality experience and maximum range-of-motion. Results showed that on study day one, subjects reported significant decreases (27-44%) in pain ratings during virtual reality. They also reported improved affect ("fun") during virtual reality. The analgesia and affect improvements were maintained with repeated virtual reality use over multiple therapy sessions. Maximum range-of-motion was not different between treatment conditions, but was significantly greater after the second treatment condition (regardless of treatment order). These results suggest that immersive virtual reality is an effective nonpharmacologic, adjunctive pain reduction technique in the pediatric burn population undergoing painful rehabilitation therapy. The magnitude of the analgesic effect is clinically meaningful and is maintained with repeated use. Copyright © 2010 Elsevier Ltd and ISBI. All rights reserved.

A Randomized, Controlled Trial of Immersive Virtual Reality Analgesia during Physical Therapy for Pediatric Burn Injuries

PubMed Central

Schmitt, Yuko S.; Hoffman, Hunter G.; Blough, David K.; Patterson, David R.; Jensen, Mark P.; Soltani, Maryam; Carrougher, Gretchen J.; Nakamura, Dana; Sharar, Sam R.

2010-01-01

This randomized, controlled, within-subjects (crossover design) study examined the effects of immersive virtual reality as an adjunctive analgesic technique for hospitalized pediatric burn inpatients undergoing painful physical therapy. Fifty-four subjects (6–19 years old) performed range-of-motion exercises under a therapist’s direction for one to five days. During each session, subjects spent equivalent time in both the virtual reality and the control conditions (treatment order randomized and counterbalanced). Graphic rating scale scores assessing the sensory, affective, and cognitive components of pain were obtained for each treatment condition. Secondary outcomes assessed subjects’ perception of the virtual reality experience and maximum range-of-motion. Results showed that on study day one, subjects reported significant decreases (27–44%) in pain ratings during virtual reality. They also reported improved affect (“fun”) during virtual reality. The analgesia and affect improvements were maintained with repeated virtual reality use over multiple therapy sessions. Maximum range-of-motion was not different between treatment conditions, but was significantly greater after the second treatment condition (regardless of treatment order). These results suggest that immersive virtual reality is an effective nonpharmacologic, adjunctive pain reduction technique in the pediatric burn population undergoing painful rehabilitation therapy. The magnitude of the analgesic effect is clinically meaningful and is maintained with repeated use. PMID:20692769

The Effects of Stretching Exercises during Rehearsals on String Students' Self-Reported Perceptions of Discomfort

ERIC Educational Resources Information Center

Cooper, Shelly C.; Hamann, Donald L.; Frost, Robert

2012-01-01

Musicians have recognized that physical problems often accompany playing, yet examinations of performance-related injuries and medical problems remain relatively new. The type of instrument played can affect musicians' pain-related problems as well as physical stature. The focus of this study was to determine whether physical intervention--easily…

Pain perception and expression: the influence of gender, personal self-efficacy, and lifespan socialization.

PubMed

Miller, Carly; Newton, Sarah E

2006-12-01

There are differences between males and females regarding the perception, expression, and tolerance of pain that stems from a variety of social and psychologic influences. Personal self-efficacy and lifespan socialization are two such influences, and they provide new dimensions for nurses to better understand the pain experience. This article will present a review of the literature regarding personal self-efficacy and lifespan socialization and their effects on pain perception and expression among males and females. Finally, nursing implications related to the topic will be discussed.

The role of pain catastrophizing in experimental pain perception.

PubMed

Kristiansen, Frederik L; Olesen, Anne E; Brock, Christina; Gazerani, Parisa; Petrini, Laura; Mogil, Jeffrey S; Drewes, Asbjørn M

2014-03-01

Pain is a subjective experience influenced by multiple factors, and tremendous variety within individuals is present. To evaluate emotional state of pain, catastrophizing score can be used. This study investigated pain catastrophizing ratings in association with experimental pain perception. Experimental pain was induced using thermal heat and cold stimulation of skin, mechanical stimulation of muscle and bone, and thermal, mechanical, and electrical stimulation of the gastrointestinal tract in healthy participants (N = 41). Prior to experimental sessions, a pain catastrophizing questionnaire was filled out by each participant. Based on the median catastophizing score, participants were divided into two groups: noncatastrophizers and low-catastrophizers. No significant difference was found between low-catastrophizers and noncatastrophizers in thermal heat stimulation of skin, mechanical stimulation of muscle and bone, and rectal electrical stimulation (All P > 0.05). Low-catastrophizers were more sensitive to visceral thermal stimulation (4.7%, P = 0.02) and visceral mechanical stimulation (29.7%, P = 0.03). For participants that completed the 120 seconds ice water stimulation, noncatastrophizers reported 13.8% less pain than low-catastrophizers (P = 0.02). A positive correlation between PCS score and pain perception on cold pressor test was found (r = 0.4, P = 0.02). By extrapolating data, further analysis of the total group was performed and no differences (both P > 0.05) were observed. Even small increments in pain catastrophizing score can influence pain perception to deep and tonic stimulations. Catatrophizing may partly explain the variability found in experimental pain studies. © 2013 World Institute of Pain.

Self-perceived weather sensitivity and joint pain in older people with osteoarthritis in six European countries: results from the European Project on OSteoArthritis (EPOSA)

PubMed Central

2014-01-01

Background People with osteoarthritis (OA) frequently report that their joint pain is influenced by weather conditions. This study aimed to examine whether there are differences in perceived joint pain between older people with OA who reported to be weather-sensitive versus those who did not in six European countries with different climates and to identify characteristics of older persons with OA that are most predictive of perceived weather sensitivity. Methods Baseline data from the European Project on OSteoArthritis (EPOSA) were used. ACR classification criteria were used to determine OA. Participants with OA were asked about their perception of weather as influencing their pain. Using a two-week follow-up pain calendar, average self-reported joint pain was assessed (range: 0 (no pain)-10 (greatest pain intensity)). Linear regression analyses, logistic regression analyses and an independent t-test were used. Analyses were adjusted for several confounders. Results The majority of participants with OA (67.2%) perceived the weather as affecting their pain. Weather-sensitive participants reported more pain than non-weather-sensitive participants (M = 4.1, SD = 2.4 versus M = 3.1, SD = 2.4; p < 0.001). After adjusting for several confounding factors, the association between self-perceived weather sensitivity and joint pain remained present (B = 0.37, p = 0.03). Logistic regression analyses revealed that women and more anxious people were more likely to report weather sensitivity. Older people with OA from Southern Europe were more likely to indicate themselves as weather-sensitive persons than those from Northern Europe. Conclusions Weather (in)stability may have a greater impact on joint structures and pain perception in people from Southern Europe. The results emphasize the importance of considering weather sensitivity in daily life of older people with OA and may help to identify weather-sensitive older people with OA. PMID:24597710

Self-perceived weather sensitivity and joint pain in older people with osteoarthritis in six European countries: results from the European Project on OSteoArthritis (EPOSA).

PubMed

Timmermans, Erik J; van der Pas, Suzan; Schaap, Laura A; Sánchez-Martínez, Mercedes; Zambon, Sabina; Peter, Richard; Pedersen, Nancy L; Dennison, Elaine M; Denkinger, Michael; Castell, Maria Victoria; Siviero, Paola; Herbolsheimer, Florian; Edwards, Mark H; Otero, Angel; Deeg, Dorly J H

2014-03-05

People with osteoarthritis (OA) frequently report that their joint pain is influenced by weather conditions. This study aimed to examine whether there are differences in perceived joint pain between older people with OA who reported to be weather-sensitive versus those who did not in six European countries with different climates and to identify characteristics of older persons with OA that are most predictive of perceived weather sensitivity. Baseline data from the European Project on OSteoArthritis (EPOSA) were used. ACR classification criteria were used to determine OA. Participants with OA were asked about their perception of weather as influencing their pain. Using a two-week follow-up pain calendar, average self-reported joint pain was assessed (range: 0 (no pain)-10 (greatest pain intensity)). Linear regression analyses, logistic regression analyses and an independent t-test were used. Analyses were adjusted for several confounders. The majority of participants with OA (67.2%) perceived the weather as affecting their pain. Weather-sensitive participants reported more pain than non-weather-sensitive participants (M = 4.1, SD = 2.4 versus M = 3.1, SD = 2.4; p < 0.001). After adjusting for several confounding factors, the association between self-perceived weather sensitivity and joint pain remained present (B = 0.37, p = 0.03). Logistic regression analyses revealed that women and more anxious people were more likely to report weather sensitivity. Older people with OA from Southern Europe were more likely to indicate themselves as weather-sensitive persons than those from Northern Europe. Weather (in)stability may have a greater impact on joint structures and pain perception in people from Southern Europe. The results emphasize the importance of considering weather sensitivity in daily life of older people with OA and may help to identify weather-sensitive older people with OA.

The soothing function of touch: affective touch reduces feelings of social exclusion.

PubMed

von Mohr, Mariana; Kirsch, Louise P; Fotopoulou, Aikaterini

2017-10-18

The mammalian need for social proximity, attachment and belonging may have an adaptive and evolutionary value in terms of survival and reproductive success. Consequently, ostracism may induce strong negative feelings of social exclusion. Recent studies suggest that slow, affective touch, which is mediated by a separate, specific C tactile neurophysiological system than faster, neutral touch, modulates the perception of physical pain. However, it remains unknown whether slow, affective touch, can also reduce feelings of social exclusion, a form of social pain. Here, we employed a social exclusion paradigm, namely the Cyberball task (N = 84), to examine whether the administration of slow, affective touch may reduce the negative feelings of ostracism induced by the social exclusion manipulations of the Cyberball task. As predicted, the provision of slow-affective, as compared to fast-neutral, touch led to a specific decrease in feelings of social exclusion, beyond general mood effects. These findings point to the soothing function of slow, affective touch, particularly in the context of social separation or rejection, and suggest a specific relation between affective touch and social bonding.

The Communal Coping Model of Pain Catastrophizing in Daily Life: A Within-Couples Daily Diary Study

PubMed Central

Burns, John W.; Gerhart, James I.; Post, Kristina M.; Smith, David A.; Porter, Laura S.; Schuster, Erik; Buvanendran, Asokumar; Fras, Anne Marie; Keefe, Francis J.

2015-01-01

The Communal Coping Model (CCM) characterizes pain catastrophizing as a coping tactic whereby pain expression elicits assistance and empathic responses from others. Married couples (N = 105 couples; one spouse with chronic low back pain) completed electronic daily diary assessments 5 times/day for 14 days. On these diaries, patients reported pain catastrophizing, pain, function, and perceived spouse support, criticism and hostility. Non-patient spouses reported on their support, criticism, and hostility directed toward patients, as well as their observations of patient pain and pain behaviors. Hierarchical linear modeling tested concurrent and lagged (3 hours later) relationships. Principal findings included: a) within-person increases in pain catastrophizing were positively associated with spouse reports of patient pain behavior in concurrent and lagged analyses; b) within-person increases in pain catastrophizing were positively associated with patient perceptions of spouse support, criticism, and hostility in concurrent analyses; c) within-person increases in pain catastrophizing were negatively associated with spouse reports of criticism and hostility in lagged analyses. Spouses reported patient behaviors that were tied to elevated pain catastrophizing, and spouses changed their behavior during and following elevated pain catastrophizing episodes. Pain catastrophizing may affect the interpersonal environment of patients and spouses in ways consistent with the CCM. PMID:26320945

Multiple faces of pain: effects of chronic pain on the brain regulation of facial expression

PubMed Central

Vachon-Presseau, Etienne; Roy, Mathieu; Woo, Choong-Wan; Kunz, Miriam; Martel, Marc-Olivier; Sullivan, Michael J.; Jackson, Philip L.; Wager, Tor D.; Rainville, Pierre

2018-01-01

Pain behaviors are shaped by social demands and learning processes, and chronic pain has been previously suggested to affect their meaning. In this study, we combined functional magnetic resonance imaging with in-scanner video recording during thermal pain stimulations and use multilevel mediation analyses to study the brain mediators of pain facial expressions and the perception of pain intensity (self-reports) in healthy individuals and patients with chronic back pain (CBP). Behavioral data showed that the relation between pain expression and pain report was disrupted in CBP. In both patients with CBP and healthy controls, brain activity varying on a trial-by-trial basis with pain facial expressions was mainly located in the primary motor cortex and completely dissociated from the pattern of brain activity varying with pain intensity ratings. Stronger activity was observed in CBP specifically during pain facial expressions in several nonmotor brain regions such as the medial prefrontal cortex, the precuneus, and the medial temporal lobe. In sharp contrast, no moderating effect of chronic pain was observed on brain activity associated with pain intensity ratings. Our results demonstrate that pain facial expressions and pain intensity ratings reflect different aspects of pain processing and support psychosocial models of pain suggesting that distinctive mechanisms are involved in the regulation of pain behaviors in chronic pain. PMID:27411160

Determinants of pain perception after external cephalic version in pregnant women.

PubMed

Truijens, Sophie E M; van der Zalm, Marieke; Pop, Victor J M; Kuppens, Simone M I

2014-03-01

A considerable proportion of pregnant women with a fetus in breech position refuses external cephalic version (ECV), with fear of pain as important barrier. As a consequence, they are at high risk for caesarean section at term. The current study investigated determinants of pain perception during ECV, with special attention to maternal mental state such as depression and fear of ECV. Prospective study of 249 third-trimester pregnant women with breech position with a request for an ECV attempt. Department of Obstetrics and Gynaecology in a large teaching hospital in the Netherlands. Prior to the ECV attempts, obstetric factors were registered, participants fulfilled the Edinburgh Depression Scale (EDS) and reported fear of ECV on a 10-point visual analog scale. Perception of pain intensity was measured with a 10-point visual analog scale, immediately after ECV. Multivariate linear regression analyses showed success of ECV to be the strongest predictor of pain perception. Furthermore, scores on the depression questionnaire and degree of fear of ECV independently explained pain perception, which was not the case for obstetrical or ECV related factors. Apart from ECV outcome, psychological factors like depression and fear of ECV were independently related to pain perception of an ECV attempt. Maternal mood state should be taken into account when offering an ECV attempt to women with a fetus in breech position. Due to the painful experience and the importance of successful outcome, ECV should only be attempted in institutions with experienced practitioners and with careful attention to maternal mood and the way a woman is coping with the ECV attempt. © 2013 Published by Elsevier Ltd.

Seeing and identifying with a virtual body decreases pain perception.

PubMed

Hänsel, Alexander; Lenggenhager, Bigna; von Känel, Roland; Curatolo, Michele; Blanke, Olaf

2011-09-01

Pain and the conscious mind (or the self) are experienced in our body. Both are intimately linked to the subjective quality of conscious experience. Here, we used virtual reality technology and visuo-tactile conflicts in healthy subjects to test whether experimentally induced changes of bodily self-consciousness (self-location; self-identification) lead to changes in pain perception. We found that visuo-tactile stroking of a virtual body but not of a control object led to increased pressure pain thresholds and self-location. This increase was not modulated by the synchrony of stroking as predicted based on earlier work. This differed for self-identification where we found as predicted that synchrony of stroking increased self-identification with the virtual body (but not a control object), and positively correlated with an increase in pain thresholds. We discuss the functional mechanisms of self-identification, self-location, and the visual perception of human bodies with respect to pain perception. Copyright © 2011 European Federation of International Association for the Study of Pain Chapters. Published by Elsevier Ltd. All rights reserved.

Validated Measures of Illness Perception and Behavior in People with Knee Pain and Knee Osteoarthritis: A Scoping Review.

PubMed

Hamilton, Clayon B; Wong, Ming-Kin; Gignac, Monique A M; Davis, Aileen M; Chesworth, Bert M

2017-01-01

To identify validated measures that capture illness perception and behavior and have been used to assess people who have knee pain/osteoarthritis. A scoping review was performed. Nine electronic databases were searched for records from inception through April 19, 2015. Search terms included illness perception, illness behavior, knee, pain, osteoarthritis, and their related terms. This review included English language publications of primary data on people with knee pain/osteoarthritis who were assessed with validated measures capturing any of 4 components of illness perception and behavior: monitor body, define and interpret symptoms, take remedial action, and utilize sources of help. Seventy-one publications included relevant measures. Two reviewers independently coded and analyzed each relevant measure within the 4 components. Sixteen measures were identified that capture components of illness perception and behavior in the target population. These measures were originally developed to capture constructs that include coping strategies/skills/styles, illness belief, illness perception, self-efficacy, and pain behavior. Coding results indicated that 5, 11, 12, and 5 of these measures included the monitor body, define and interpret symptoms, take remedial action, and utilize sources of help components, respectively. Several validated measures were interpreted as capturing some components, and only 1 measure was interpreted as capturing all of the components of illness perception and behavior in the target population. A measure that comprehensively captures illness perception and behavior could be valuable for informing and evaluating therapy for patients along a continuum of symptomatic knee osteoarthritis. © 2016 World Institute of Pain.

Intrinsic Brain Connectivity in Chronic Pain: A Resting-State fMRI Study in Patients with Rheumatoid Arthritis

PubMed Central

Flodin, Pär; Martinsen, Sofia; Altawil, Reem; Waldheim, Eva; Lampa, Jon; Kosek, Eva; Fransson, Peter

2016-01-01

Background: Rheumatoid arthritis (RA) is commonly accompanied by pain that is discordant with the degree of peripheral pathology. Very little is known about the cerebral processes involved in pain processing in RA. Here we investigated resting-state brain connectivity associated with prolonged pain in RA. Methods: 24 RA subjects and 19 matched controls were compared with regard to both behavioral measures of pain perception and resting-resting state fMRI data acquired subsequently to fMRI sessions involving pain stimuli. The resting-state fMRI brain connectivity was investigated using 159 seed regions located in cardinal pain processing brain regions. Additional principal component based multivariate pattern analysis of the whole brain connectivity pattern was carried out in a data driven analysis to localize group differences in functional connectivity. Results: When RA patients were compared to controls, we observed significantly lower pain resilience for pressure on the affected finger joints (i.e., P50-joint) and an overall heightened level of perceived global pain in RA patients. Relative to controls, RA patients displayed increased brain connectivity predominately for the supplementary motor areas, mid-cingulate cortex, and the primary sensorimotor cortex. Additionally, we observed an increase in brain connectivity between the insula and prefrontal cortex as well as between anterior cingulate cortex and occipital areas for RA patients. None of the group differences in brain connectivity were significantly correlated with behavioral parameters. Conclusion: Our study provides experimental evidence of increased connectivity between frontal midline regions that are implicated in affective pain processing and bilateral sensorimotor regions in RA patients. PMID:27014038

Stress perception and social indicators for low back, shoulder and joint pains in Japan: national surveys in 1995 and 2001.

PubMed

Takeuchi, Takeaki; Nakao, Mutsuhiro; Nishikitani, Mariko; Yano, Eiji

2004-07-01

This study aims to clarify the effects of stress perception and related social indicators on three major musculoskeletal symptoms: low back, shoulder, and joint pains in a Japanese population. Twenty health-related variables (stress perception and 19 social indicators) and the three symptoms were obtained from the following Japanese national surveys: the Comprehensive Survey of Living Condition of the People on Health and Welfare, the System of Social and Demographic Statistics of Japan, and the Statistical Report on Health Administration Services. The results were compared among 46 Japanese prefectures in 1995 and 2001. By factor analysis, the 19 indicators were classified into three factors of urbanization, aging and life-regularity, and individualization. The prevalence of stress perception was significantly correlated to the 8 indicators of urbanization factor. Although simple correlation analysis revealed a significant relationship of stress perception only to shoulder pain (in both years) and low back pain (in 2001), the results of multiple regression analysis showed that stress perception and some urbanization factors were significantly associated with all the three symptoms in both years exclusive of joint pain in 1995. Taking the effects of urbanization into consideration, stress perception seems to be closely related to the complaints of musculoskeletal symptoms in Japan.

Some Words Hurt More Than Others: Semantic Activation of Pain Concepts in Memory and Subsequent Experiences of Pain.

PubMed

Swannell, Ellen R; Brown, Christopher A; Jones, Anthony K P; Brown, Richard J

2016-03-01

Theory suggests that as activation of pain concepts in memory increases, so too does subsequent pain perception. Previously, researchers have found that activating pain concepts in memory increases pain perception of subsequent painful stimuli, relative to neutral information. However, they have not attempted to quantify the nature of the association between information studied and ensuing pain perception. We subliminally presented words that had either a low or high degree of association to the word 'pain,' although this was only partially successful and some words were consciously perceived. Participants then received randomized laser heat stimuli, delivered at 1 of 3 intensity levels (low, moderate, high), and we measured the effect of this on behavioral and electrophysiological measures of pain. Participants (N = 27) rated moderate- and high-intensity laser stimuli as more painful after viewing high relative to low associates of pain; these effects remained present when we controlled for measures of mood, anxiety, and physical symptom reporting. Similar effects were observed physiologically, with higher stimulus negativity preceding after high relative to low associates and greater amplitudes for the N2 component of the laser-evoked potential after presentation of high associates in the moderate and high laser intensity conditions. These data support activation-based models of the effects of memory on pain perception. Consistent with current theories of memory and pain, we found that high, relative to low activation of pain concepts in memory increased psychological and physiological responses to laser-induced pain. The effect remained regardless of whether participants showed conscious awareness of activation. Theoretical and clinical implications are discussed. Copyright © 2016 American Pain Society. Published by Elsevier Inc. All rights reserved.

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

Polysomnographic Measurement of Sleep Duration and Bodily Pain Perception in the Sleep Heart Health Study.

PubMed

Weingarten, Jeremy A; Dubrovsky, Boris; Basner, Robert C; Redline, Susan; George, Liziamma; Lederer, David J

2016-08-01

To determine whether total sleep time (TST) and specific sleep stage duration are associated with bodily pain perception and whether sex, age, or subjective sleepiness modifies this relationship. Data from adults ages 39-90 y (n = 5,199) who took part in the Sleep Heart Health Study Exam 1 were analyzed. TST, rapid eye movement (REM) sleep time, and slow wave sleep (SWS) time were measured by unattended, in-home nocturnal polysomnography. Bodily pain perception was measured via the Short Form-36 questionnaire bodily pain component. We used logistic regression to examine associations between total and individual sleep stage durations and bodily pain perception controlling for age, sex, race, body mass index, apnea-hypopnea index, antidepressant use, and important cardiovascular conditions (smoking [pack-years], history of diabetes, and history of percutaneous coronary intervention and/or coronary artery bypass graft). In the fully adjusted model, REM sleep time and SWS time were not associated with "moderate to severe pain," whereas TST was: Each 1-h decrement in TST was associated with a 7% increased odds of "moderate to severe pain" (odds ratio 1.07, 95% confidence interval 1.002, 1.14). Due to modification of the association between SWS time and "moderate to severe pain" by sex (P for interaction = 0.01), we performed analyses stratified by sex: Each 1-h decrement in SWS time was associated with a 20% higher odds of "moderate to severe pain" among men (odds ratio 1.20, 95% confidence interval 1.03-1.42) whereas an association was not observed among women. Shorter TST among all subjects and shorter SWS time in men was associated with "moderate to severe pain." REM sleep time was not associated with bodily pain perception in this cohort. © 2016 Associated Professional Sleep Societies, LLC.

Pap Screening Goals and Perceptions of Pain among Black, Latina, and Arab Women: Steps toward Breaking down Psychological Barriers

PubMed Central

Gauss, Julie W.; Mabiso, Athur; Williams, Karen Patricia

2013-01-01

BACKGROUND Understanding women’s psychological barriers to getting Papanicolaou (Pap) screening has potential to impact cancer disparities. This study examined pain perceptions of Pap testing among Black, Latina and Arab women and goal setting to receive Pap tests. METHODS Data on 420 women, a longitudinal study, were analyzed using Chi-square tests of differences and generalized linear mixed models. RESULTS At baseline, 30.3% of Black and 35.5% of Latina women perceived Pap tests to be very painful compared to 24.2% of Arab women. Perceptions of pain influenced goal settings, such as scheduling a first ever Pap test (Odds ratio = 0.58, 95% Confidence interval: 0.14-0.94). Immediately following the intervention, women’s perception that Pap tests are very painful significantly declined (P-value<0.001) with Arab and Black women registering the greatest improvements (20.3 and 17.3 percent reduction, respectively compared to 8.4 percent for Latina). CONCLUSIONS Having the perception that the Pap test is very painful significantly reduces the likelihood of Black, Latina and Arab women setting the goal to schedule their first ever Pap test. Latina women are the least likely to improve their perception that the Pap test is very painful, though national statistics show they have the highest rates of morbidity and mortality from cervical cancer. These findings are instructive for designing tailored interventions to break down psychological barriers to Pap screening among underserved women. PMID:23288606

Perceptions about traditional and novel methods to learn about postoperative pain management: a qualitative study.

PubMed

Ingadottir, Brynja; Blondal, Katrin; Jaarsma, Tiny; Thylen, Ingela

2016-11-01

The aim of this study was to explore the perceptions of surgical patients about traditional and novel methods to learn about postoperative pain management. Patient education is an important part of postoperative care. Contemporary technology offers new ways for patients to learn about self-care, although face-to-face discussions and brochures are the most common methods of delivering education in nursing practice. A qualitative design with a vignette and semi-structured interviews used for data collection. A purposeful sample of 13 postsurgical patients, who had been discharged from hospital, was recruited during 2013-2014. The patients were given a vignette about anticipated hospital discharge after surgery with four different options for communication (face-to-face, brochure, website, serious game) to learn about postoperative pain management. They were asked to rank their preferred method of learning and thereafter to reflect on their choices. Data were analysed using an inductive content analysis approach. Patients preferred face-to-face education with a nurse, followed by brochures and websites, while games were least preferred. Two categories, each with two sub-categories, emerged from the data. These conceptualized the factors affecting patients' perceptions: (1) 'Trusting the source', sub-categorized into 'Being familiar with the method' and 'Having own prejudgments'; and (2) 'Being motivated to learn' sub-categorized into 'Managing an impaired cognition' and 'Aspiring for increased knowledge'. To implement successfully novel educational methods into postoperative care, healthcare professionals need to be aware of the factors influencing patients' perceptions about how to learn, such as trust and motivation. © 2016 John Wiley & Sons Ltd.

“Let’s Talk about OA Pain”: A Qualitative Analysis of the Perceptions of People Suffering from OA. Towards the Development of a Specific Pain OA-Related Questionnaire, the Osteoarthritis Symptom Inventory Scale (OASIS)

PubMed Central

Cedraschi, Christine; Delézay, Sylvie; Marty, Marc; Berenbaum, Francis; Bouhassira, Didier; Henrotin, Yves; Laroche, Françoise; Perrot, Serge

2013-01-01

Introduction Pain is the primary outcome measurement in osteoarthritis, and its assessment is mostly based on its intensity. The management of this difficult chronic condition could be improved by using pain descriptors to improve analyses of painful sensations. This should help to define subgroups of patients based on pain phenotype, for more adapted treatment. This study draws upon patients’ descriptions of their pain, to identify and understand their perception of osteoarthritis pain and to categorize pain dimensions. Methods This qualitative study was conducted with representative types of patients suffering from osteoarthritis. Two focus groups were conducted with a sample of 14 participants, with either recent or chronic OA, at one or multiple sites. Focus groups were semi-structured and used open-ended questions addressing personal experiences to explore the experiences of patients with OA pain and the meanings they attributed to these pains. Results Two main points emerged from content analyses: -A major difficulty in getting patients to describe their osteoarthritis pain: perception that nobody wants to hear about it; necessity to preserve one’s self and social image; notion of self-imposed stoicism; and perception of osteoarthritis as a complex, changing, illogical disease associated with aging. -Osteoarthritis pains were numerous and differed in intensity, duration, depth, type of occurrence, impact and rhythm, but also in painful sensations and associated symptoms. Based on analyses of the verbatim interviews, seven dimensions of OA pain emerged: pain sensory description, OA-related symptoms, pain variability profile, pain-triggering factors, pain and physical activity, mood and image, general physical symptoms. Summary In osteoarthritis, pain analysis should not be restricted to intensity. Our qualitative study identified pain descriptors and defined seven dimensions of osteoarthritis pain. Based on these dimensions, we aim to develop a specific questionnaire on osteoarthritis pain quality for osteoarthritis pain phenotyping: the OsteoArthritis Symptom Inventory Scale (OASIS). PMID:24244589

Neural Activation during Anticipation of Near Pain-Threshold Stimulation among the Pain-Fearful

PubMed Central

Yang, Zhou; Jackson, Todd; Huang, Chengzhi

2016-01-01

Fear of pain (FOP) can increase risk for chronic pain and disability but little is known about corresponding neural responses in anticipation of potential pain. In this study, more (10 women, 6 men) and less (7 women, 6 men) pain-fearful groups underwent whole-brain functional magnetic resonance imaging (fMRI) during anticipation of near pain-threshold stimulation. Groups did not differ in the proportion of stimuli judged to be painful but pain-fearful participants reported significantly more state fear prior to stimulus exposure. Within the entire sample, stronger activation was found in several pain perception regions (e.g., bilateral insula, midcingulate cortex (MCC), thalamus, superior frontal gyrus) and visual areas linked to decoding stimulus valences (inferior orbital cortex) during anticipation of “painful” stimuli. Between groups and correlation analyses indicated pain-fearful participants experienced comparatively more activity in regions implicated in evaluating potential threats and processing negative emotions during anticipation (i.e., MCC, mid occipital cortex, superior temporal pole), though group differences were not apparent in most so-called “pain matrix” regions. In sum, trait- and task-based FOP is associated with enhanced responsiveness in regions involved in threat processing and negative affect during anticipation of potentially painful stimulation. PMID:27489536

Intramuscular temperature modulates glutamate-evoked masseter muscle pain intensity in humans.

PubMed

Sato, Hitoshi; Castrillon, Eduardo E; Cairns, Brian E; Bendixen, Karina H; Wang, Kelun; Nakagawa, Taneaki; Wajima, Koichi; Svensson, Peter

2015-01-01

To determine whether glutamate-evoked jaw muscle pain is altered by the temperature of the solution injected. Sixteen healthy volunteers participated and received injections of hot (48°C), neutral (36°C), or cold (3°C) solutions (0.5 mL) of glutamate or isotonic saline into the masseter muscle. Pain intensity was assessed with an electronic visual analog scale (eVAS). Numeric rating scale (NRS) scores of unpleasantness and temperature perception, pain-drawing areas, and pressure pain thresholds (PPTs) were also measured. Participants filled out the McGill Pain Questionnaire (MPQ). Two-way or three-way repeated measures ANOVA were used for data analyses. Injection of hot glutamate and cold glutamate solutions significantly increased and decreased, respectively, the peak pain intensity compared with injection of neutral glutamate solution. The duration of glutamate-evoked pain was significantly longer when hot glutamate was injected than when cold glutamate was injected. No significant effect of temperature on pain intensity was observed when isotonic saline was injected. No effect of solution temperature was detected on unpleasantness, heat perception, cold perception, area of pain drawings, or PPTs. There was a significantly greater use of the "numb" term in the MPQ to describe the injection of cold solutions compared to the injection of both neutral and hot solutions. Glutamate-evoked jaw muscle pain was significantly altered by the temperature of the injection solution. Although temperature perception in the jaw muscle is poor, pain intensity is increased when the muscle tissue temperature is elevated.

Do romantic partners' responses to entry dyspareunia affect women's experience of pain? The roles of catastrophizing and self-efficacy.

PubMed

Lemieux, Ashley J; Bergeron, Sophie; Steben, Marc; Lambert, Bernard

2013-09-01

Entry dyspareunia is a sexual health concern which affects about 21% of women in the general population. Characterized by pain provoked during vaginal penetration, introital dyspareunia has been shown by controlled studies to have a negative impact on the psychological well-being, sexual function, sexual satisfaction, and quality of life of afflicted women. Many cognitive and affective variables may influence the experience of pain and associated psychosexual problems. However, the role of the partner's cognitive responses has been studied very little. The aim of the present study was to examine the associations between partners' catastrophizing and their perceptions of women's self-efficacy at managing pain on one side and women's pain intensity, sexual function, and sexual satisfaction on the other. One hundred seventy-nine heterosexual couples (mean age for women = 31, SD = 10.0; mean age for men = 33, SD = 10.6) in which the woman suffered from entry dyspareunia participated in the study. Both partners completed quantitative measures. Women completed the Pain Catastrophizing Scale and the Painful Intercourse Self-Efficacy Scale. Men completed the significant-other versions of these measures. Dependent measures were women's responses to (i) the Pain Numeric Visual Analog Scale; (ii) the Female Sexual Function Index; and (iii) the Global Measure of Sexual Satisfaction scale. Controlled for women's pain catastrophizing and self-efficacy, results indicate that higher levels of partner-perceived self-efficacy and lower levels of partner catastrophizing are associated with decreased pain intensity in women with entry dyspareunia, although only partner catastrophizing contributed unique variance. Partner-perceived self-efficacy and catastrophizing were not significantly associated with sexual function or satisfaction in women. The findings suggest that partners' cognitive responses may influence the experience of entry dyspareunia for women, pointing toward the importance of considering the partner when treating this sexual health problem. © 2013 International Society for Sexual Medicine.

[Fournier syndrome: the perception of the patient].

PubMed

Cavalini, Fernanda; Moriya, Tokico Murakawa; Pelá, Nilza Teresa Rotter

2002-06-01

The purpose of the present investigation was to identify the perception of the Fournier syndrome's patients about their disease and caregivers. Data was collected by means of interviews with a structured routine and the analysis was based on the André's analysis of prose. According to the patients, the syndrome causes intense pain, edema, fever and wounds, demanding surgical treatment, dressings and bringing physical, economical and familiar problems. The caregivers' attitudes and behaviors were described as having more negative aspects than good ones. The necessity of a better training of the caregivers in the cognitive, psychomotor and affective sense is evident.

Pain perception studies in tension-type headache.

PubMed

Bezov, David; Ashina, Sait; Jensen, Rigmor; Bendtsen, Lars

2011-02-01

Tension-type headache (TTH) is a disorder with high prevalence and significant impact on society. Understanding of pathophysiology of TTH is paramount for development of effective treatments and prevention of chronification of TTH. Our aim was to review the findings from pain perception studies of pathophysiology of TTH as well as to review the research of pathophysiology of TTH. Pain perception studies such as measurement of muscle tenderness, pain detection thresholds, pain tolerance thresholds, pain response to suprathreshold stimulation, temporal summation and diffuse noxious inhibitory control (DNIC) have played a central role in elucidating the pathophysiology of TTH. It has been demonstrated that continuous nociceptive input from peripheral myofascial structures may induce central sensitization and thereby chronification of the headache. Measurements of pain tolerance thresholds and suprathreshold stimulation have shown presence of generalized hyperalgesia in chronic tension-type headache (CTTH) patients, while DNIC function has been shown to be reduced in CTTH. One imaging study showed loss of gray matter structures involved in pain processing in CTTH patients. Future studies should aim to integrate pain perception and imaging to confirm this finding. Pharmacological studies have shown that drugs like tricyclic anti-depressant amitriptyline and nitric oxide synthase inhibitors can reverse central sensitization and the chronicity of headache. Finally, low frequency electrical stimulation has been shown to rapidly reverse central sensitization and may be a new modality in treatment of CTTH and other chronic pain disorders. © 2010 American Headache Society.

Is appreciation of written education about pain neurophysiology related to changes in illness perceptions and health status in patients with fibromyalgia?

PubMed

van Ittersum, M W; van Wilgen, C P; Groothoff, J W; van der Schans, C P

2011-11-01

To investigate the appreciation of written education about pain neurophysiology in patients with fibromyalgia (FM) and its effects on illness perceptions and perceived health status. A booklet explaining pain neurophysiology was sent to participants with FM. Appreciation was assessed with 10 questions addressing relevance (0-30) and reassurance (0-30). Illness perceptions, catastrophizing and health status were measured with the Revised Illness Perception Questionnaire (IPQ-R), the Pain Catastrophizing Scale (PCS) and the Fibromyalgia Impact Questionnaire (FIQ) at baseline (T0), after a 2-week control period (T1) and 6 weeks after the intervention (T2). Forty-one patients participated. Mean (SD) scores for relevance and reassurance were 21.6 (5.6) and 18.7 (5.7), respectively. Only illness coherence, emotional representations, pain and fatigue changed significantly between T0 and T2. Correlations between appreciation and changes in outcomes ranged between r=0.00 and r=0.34. Although a majority of subjects appreciated the written information, it did not have clinically relevant effects on illness perceptions, catastrophizing or impact of FM on daily life. Written education about pain neurophysiology is inadequate toward changing illness perceptions, catastrophizing or perceived health status of participants with FM; education should be incorporated into a broader multidisciplinary self-management program. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Pain experiences of patients with advanced cancer: A qualitative descriptive study.

PubMed

Erol, Ozgul; Unsar, Serap; Yacan, Lale; Pelin, Meryem; Kurt, Seda; Erdogan, Bülent

2018-04-01

Uncontrolled pain, especially in patients with advanced cancer, affects quality of life negatively and causes negative physical and psychological conditions. The aim of this study was to explore the pain experiences of patients with advanced cancer and how they manage with pain, and to present a view of pain management approaches of nurses from the perspectives of the patients. This was a qualitative descriptive study of sixteen hospitalized patients with advanced cancer. Data were collected using semi-structured interviews with patients. Data were analysed by Colaizzi's phenomenological method. This study found that patients with advanced cancer who had pain experienced anxiety, helplessness, hopelessness and many restrictions in daily life as well as inability to manage with pain. Most of the patients with advanced cancer were not satisfied with their nursing care with regard to pain management. The themes that emerged were pain perception and experiences, effects of pain on daily life, pain management and management strategies and the patients' perspectives about nursing approaches to pain. This study demonstrated the difficulties of patients with advanced cancer who experienced pain in their daily lives, yet lack pain management strategies. Furthermore, nurses' caring approaches to patients with advanced cancer who experienced pain was found inadequate. Oncology nurses should provide educational interventions in order to enhance knowledge and skills about pain assessment and non-pharmacologic and pharmacologic strategies used in pain management. Copyright © 2018 Elsevier Ltd. All rights reserved.

Targeting novel mechanisms of pain in sickle cell disease.

PubMed

Tran, Huy; Gupta, Mihir; Gupta, Kalpna

2017-11-30

Patients with sickle cell disease (SCD) suffer from intense pain that can start during infancy and increase in severity throughout life, leading to hospitalization and poor quality of life. A unique feature of SCD is vaso-occlusive crises (VOCs) characterized by episodic, recurrent, and unpredictable episodes of acute pain. Microvascular obstruction during a VOC leads to impaired oxygen supply to the periphery and ischemia reperfusion injury, inflammation, oxidative stress, and endothelial dysfunction, all of which may perpetuate a noxious microenvironment leading to pain. In addition to episodic acute pain, patients with SCD also report chronic pain. Current treatment of moderate to severe pain in SCD is mostly reliant upon opioids; however, long-term use of opioids is associated with multiple side effects. This review presents up-to-date developments in our understanding of the pathobiology of pain in SCD. To help focus future research efforts, major gaps in knowledge are identified regarding how sickle pathobiology evokes pain, pathways specific to chronic and acute sickle pain, perception-based targets of "top-down" mechanisms originating from the brain and neuromodulation, and how pain affects the sickle microenvironment and pathophysiology. This review also describes mechanism-based targets that may help develop novel therapeutic and/or preventive strategies to ameliorate pain in SCD. © 2017 by The American Society of Hematology.

Patient preference and willingness to pay for knee osteoarthritis treatments

PubMed Central

Posnett, John; Dixit, Sanjeev; Oppenheimer, Brooks; Kili, Sven; Mehin, Nazanin

2015-01-01

Purpose To review treatments for osteoarthritis of the knee (OAK) received by patients across five European countries, and to obtain patients’ perceptions and willingness to pay for current treatments. Patients and methods A prospective, internet-based, double-blind survey of adults with OAK was conducted in France, Germany, Italy, Spain, and the United Kingdom. The questionnaire included questions about diagnosis, treatment history, and perceptions of OAK treatments, followed by a discrete choice-based conjoint exercise to identify preferred attributes of OAK treatments, evaluating 14 sets of four unbranded products. Results Two thousand and seventy-three patients with self-reported OAK completed the survey; 17.4% of patients rated their knee pain as drastically affecting their ability to perform normal daily activities, and 39.3% of employed patients reported that they had lost work time because of OAK. The most common treatments were exercise (69.7%), physical therapy (68.2%), and nonprescription oral pain medication (73.9%). Treatments perceived as most effective were: viscosupplement injections (74.1%), narcotics (67.8%), and steroid injection (67.6%). Patient co-pay, duration of pain relief, and type of therapy exhibited the largest impact on patient preference for OAK treatments. The average patient was willing to pay €35 and €64 more in co-pay for steroid and viscosupplement injections, respectively, over the cost of oral over-the-counter painkillers (per treatment course, per knee) (each P<0.05). Conclusion OAK is a debilitating condition that affects normal daily activities. In general, treatments most commonly offered to patients are not those perceived as being the most effective. Patients are willing to pay a premium for treatments that they perceive as being more effective and result in longer-lasting pain relief, and those that can be administered with fewer visits to a physician. PMID:26089650

Hormones in pain modulation and their clinical implications for pain control: a critical review.

PubMed

Chen, Xueyin; Zhang, Jinyuan; Wang, Xiangrui

2016-07-01

Recently, more and more studies have found that pain generation, transmission and modulation are under hormonal regulation. Indeed, hormonal dysregulation is a common component of chronic pain syndromes. Studies have attempted to determine whether the relationship between the pain and its perception and hormones is a causative relationship and how these processes interrelate. This review summarizes and analyzes the current experimental data and provides an overview of the studies addressing these questions. The relationship between pain perception and endocrine effects suggests that hormones can be used as important biomarkers of chronic pain syndromes and/or be developed into therapeutic agents in the fight against pain.

[Pain medicine from intercultural and gender-related perspectives].

PubMed

Schiltenwolf, M; Pogatzki-Zahn, E M

2015-10-01

Cultural setting and sex and gender of the patient are important factors affecting the occurrence, severity, clinical course and prognosis of pain and pain-related diseases. Intercultural differences in the perception and verbal expression of symptoms and emotional function are fundamental and it is important to realize these differences in order to understand patients with a migration background. A trusting doctor-patient relationship is generally very sensitive and it is even more difficult to establish when differences in the cultural background impair mutual understanding. Regarding sex and gender there is evidence that females are more susceptible to developing chronic pain conditions, experience more severe pain and respond differently to pain therapy; however, results of recent studies indicate that females are not that different to males when comparing several modalities of experimental pain (although some differences exist). Similarly, sex and gender differences in postoperative pain seem to exist but the differences are relatively small when pain scores are compared. Other aspects, such as the response to analgesics and role of psychosocial factors should be addressed when sex and gender aspects are studied. Similarly, sex and gender differences in the prevalence of chronic pain exist but the results of some studies, e.g. those controlling for confounders, are not very clear. Research is needed to delineate the role of specific aspects affecting sex and gender differences and the underlying mechanisms (e.g. reduced inhibitory control, hormones, psychological aspects and social factors). Altogether, we need to open our minds to some intercultural and sex and gender aspects in the clinical setting. For sex and gender differences we may need a more biopsychosocial approach to understand the underlying differences and differentiate between sex and gender and sex and gender-associated aspects for acute and chronic pain.

A single subcutaneous dose of tramadol for mild to moderate musculoskeletal trauma in the emergency department

PubMed Central

Cardozo, Alejandro; Silva, Carlos; Dominguez, Luis; Botero, Beatriz; Zambrano, Paulo; Bareno, Jose

2014-01-01

BACKGROUND: Mild to moderate musculoskeletal trauma is a common cause for an emergency room visit, and frequent pain is one of the cardinal symptoms of consultation. The objective of this study is to assess the perception of a single subcutaneous dose of 50 mg tramadol for pain management in patients with mild to moderate musculoskeletal trauma, likewise to appraise the perception of pain by subcutaneous injection. METHODS: A total of 77 patients, who met inclusion criteria, received a single subcutaneous dose of tramadol. Pain control was evaluated based on the verbal numerical pain scale (0–10) at baseline, 20 and 60 minutes; similarly, pain perception was evaluated secondary to subcutaneous injection of the analgesic. RESULTS: On admission, the average pain perceived by patients was 8; twenty minutes later, 89% of the patients reported five or less, and after sixty minutes, 94% had three or less on the verbal numerical pain scale. Of the patients, 88% reported pain perception by verbal numeric scale of 3 or less by injection of the drug, and 6.5% required a second analgesic for pain control. Two events with drug administration (soft tissue infection and mild abdominal rectus injection) were reported. CONCLUSION: We conclude that a single subcutaneous dose of tramadol is a safe and effective option for the management of patients with mild to moderate pain and musculoskeletal disease in the emergency department. PMID:25548601

Combined analgesics in (headache) pain therapy: shotgun approach or precise multi-target therapeutics?

PubMed

Straube, Andreas; Aicher, Bernhard; Fiebich, Bernd L; Haag, Gunther

2011-03-31

Pain in general and headache in particular are characterized by a change in activity in brain areas involved in pain processing. The therapeutic challenge is to identify drugs with molecular targets that restore the healthy state, resulting in meaningful pain relief or even freedom from pain. Different aspects of pain perception, i.e. sensory and affective components, also explain why there is not just one single target structure for therapeutic approaches to pain. A network of brain areas ("pain matrix") are involved in pain perception and pain control. This diversification of the pain system explains why a wide range of molecularly different substances can be used in the treatment of different pain states and why in recent years more and more studies have described a superior efficacy of a precise multi-target combination therapy compared to therapy with monotherapeutics. In this article, we discuss the available literature on the effects of several fixed-dose combinations in the treatment of headaches and discuss the evidence in support of the role of combination therapy in the pharmacotherapy of pain, particularly of headaches. The scientific rationale behind multi-target combinations is the therapeutic benefit that could not be achieved by the individual constituents and that the single substances of the combinations act together additively or even multiplicatively and cooperate to achieve a completeness of the desired therapeutic effect.As an example the fixed-dose combination of acetylsalicylic acid (ASA), paracetamol (acetaminophen) and caffeine is reviewed in detail. The major advantage of using such a fixed combination is that the active ingredients act on different but distinct molecular targets and thus are able to act on more signalling cascades involved in pain than most single analgesics without adding more side effects to the therapy. Multitarget therapeutics like combined analgesics broaden the array of therapeutic options, enable the completeness of the therapeutic effect, and allow doctors (and, in self-medication with OTC medications, the patients themselves) to customize treatment to the patient's specific needs. There is substantial clinical evidence that such a multi-component therapy is more effective than mono-component therapies.

Combined analgesics in (headache) pain therapy: shotgun approach or precise multi-target therapeutics?

PubMed Central

2011-01-01

Background Pain in general and headache in particular are characterized by a change in activity in brain areas involved in pain processing. The therapeutic challenge is to identify drugs with molecular targets that restore the healthy state, resulting in meaningful pain relief or even freedom from pain. Different aspects of pain perception, i.e. sensory and affective components, also explain why there is not just one single target structure for therapeutic approaches to pain. A network of brain areas ("pain matrix") are involved in pain perception and pain control. This diversification of the pain system explains why a wide range of molecularly different substances can be used in the treatment of different pain states and why in recent years more and more studies have described a superior efficacy of a precise multi-target combination therapy compared to therapy with monotherapeutics. Discussion In this article, we discuss the available literature on the effects of several fixed-dose combinations in the treatment of headaches and discuss the evidence in support of the role of combination therapy in the pharmacotherapy of pain, particularly of headaches. The scientific rationale behind multi-target combinations is the therapeutic benefit that could not be achieved by the individual constituents and that the single substances of the combinations act together additively or even multiplicatively and cooperate to achieve a completeness of the desired therapeutic effect. As an example the fixesd-dose combination of acetylsalicylic acid (ASA), paracetamol (acetaminophen) and caffeine is reviewed in detail. The major advantage of using such a fixed combination is that the active ingredients act on different but distinct molecular targets and thus are able to act on more signalling cascades involved in pain than most single analgesics without adding more side effects to the therapy. Summary Multitarget therapeutics like combined analgesics broaden the array of therapeutic options, enable the completeness of the therapeutic effect, and allow doctors (and, in self-medication with OTC medications, the patients themselves) to customize treatment to the patient's specific needs. There is substantial clinical evidence that such a multi-component therapy is more effective than mono-component therapies. PMID:21453539

Preprocedural Anxiety and Pain Perception Following Root Surface Debridement in Chronic Periodontitis Patients.

PubMed

Naik, Vanaja Krishna; Balasundaram, Aruna; Appukuttan, Devapriya; Nainar, Deepavalli Arumuga; Milward, Michael Robert; Victor, Dhayanand John; Junaid, Mohammed

2018-01-01

The aim of this study was to evaluate and compare preprocedural dental anxiety levels and postprocedural pain perception in chronic periodontitis patients during conventional-staged root surface debridement (RSD) and single-stage RSD. Thirty-seven adult generalized chronic periodontitis patients requiring RSD were recruited in this study. Preprocedural anxiety levels were assessed using a self-reported questionnaire and postprocedural pain perceptions were assessed using 0-10 cm visual analog scale. The subject population was divided into two groups: staged RSD ( n = 18) and single-stage RSD ( n = 19). Staged RSD patients visited four times as opposed to single-stage RSD patients. Data were subjected to Pearson Chi-square test, Mann-Whitney U-test, and Spearman's rank correlation. There was no statistically significant difference in dental anxiety levels or pain perceptions in both the groups. Within Group 1, there was statistical significant difference in dental anxiety levels between visit 4 and visit 3 ( P = 0.037) and pain perception between visit 3 and visit 1 ( P = 0.005), visit 4 and visit 1 ( P = 0.002), and visit 4 and visit 2 (0.04) was statistically significant. There was a positive correlation of anxiety questionnaire (Q1-Q4) to the pain score in Group 1 which was statistically significant and in single-stage RSD. Conventional quadrant-wise RSD tends to cognitively condition the anxiety experience thus influencing pain experience.

Nurses' perceptions and experiences regarding Morphine usage in burn pain management.

PubMed

Bayuo, J; Agbenorku, P

2015-06-01

Morphine, a classical example of opioid has been described as one of the analgesics of choice for burn pain management but there have been reports of under utilization of the medication and subsequent poor pain management. Nurses have a pivotal role in successful burn pain management and should therefore possess positive perception as well as strong knowledge base of pain care. In light of this realization, this study sought to investigate the perception and experiences of nurses working in the burns unit possess towards the medication. Purposive sampling approach was used to select twenty (20) nurses. Descriptive and themed content analysis approaches were used to analyze data. Mean years in general nursing practice and practice in the burns unit were obtained as 7.4 and 3.4 years respectively. Results indicate that nurses have a clear understanding of the intensity of burn pain but perception towards morphine was mixed and some respondents were unsure about some of the pertinent facts of morphine and thus, would prefer other medications such as paracetamol, diclofenac and pethidine. Addiction to the medication and morphine causing death were major themes identified. The resultant effect of these perception and experiences imply and confirm the under usage of morphine. It is therefore recommended that nurses within the burn unit be taken through training modules on the suitability of morphine in burn pain management. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

Illness perception is significantly determined by depression and anxiety in systemic lupus erythematosus.

PubMed

Nowicka-Sauer, K; Hajduk, A; Kujawska-Danecka, H; Banaszkiewicz, D; Smoleńska, Ż; Czuszyńska, Z; Siebert, J

2018-03-01

Objectives Illness perception is a cognitive representation influencing physical and psychological functioning and adherence in patients with rheumatic disease. Studies exploring illness perception in systemic lupus erythematosus (SLE) are still scarce and none of them have investigated factors determining illness perception. We aimed to assess illness perception and to identify psychological, clinical and sociodemographic factors that might influence illness perception in SLE. Methods The study involved 80 patients with SLE (87.5% women, mean age 41.56 years). The Brief Illness Perception Questionnaire, State Trait Anxiety Inventory, Beck Depression Inventory, Pittsburgh Sleep Quality Index, Visual Analogue Scale-Pain and Fatigue Severity Scale were used. Clinical and sociodemographic data were collected via structured interview and medical files review. Results Illness perception was significantly positively correlated with anxiety, depression, sleep quality, fatigue and pain while it was not related to age, education, steroid treatment, disease duration and activity (SLEDAI) or organ damage (SLICC/ACR). Regression analysis revealed that state anxiety and depression explained 43% of illness perception variance. Cluster analysis identified three patient groups among which the middle-aged group had the most negative illness perception, the highest levels of anxiety, depression, pain and fatigue, and the poorest sleep quality. Conclusions The study has proved a significant relationship between negative illness perception and anxiety and depression. Patients reporting fatigue, poor sleep and pain might have special needs in terms of psychological intervention focused on negative illness perception and distress symptoms. Multidisciplinary care in managing SLE seems to be of great importance.

Generating physical symptoms from visual cues: An experimental study.

PubMed

Ogden, Jane; Zoukas, Serafim

2009-12-01

This experimental study explored whether the physical symptoms of cold, pain and itchiness could be generated by visual cues, whether they varied in the ease with which they could be generated and whether they were related to negative affect. Participants were randomly allocated by group to watch one of three videos relating to cold (e.g. ice, snow, wind), pain (e.g. sporting injuries, tattoos) or itchiness (e.g. head lice, scratching). They then rated their self-reported symptoms of cold, pain and itchiness as well as their negative affect (depression and anxiety). The researcher recorded their observed behaviour relating to these symptoms. The results showed that the interventions were successful and that all three symptoms could be generated by the visual cues in terms of both self-report and observed behaviour. In addition, the pain video generated higher levels of anxiety and depression than the other two videos. Further, the degree of itchiness was related to the degree of anxiety. This symptom onset process also showed variability between symptoms with self-reported cold symptoms being greater than either pain or itchy symptoms. The results show that physical symptoms can be generated by visual cues indicating that psychological factors are not only involved in symptom perception but also in symptom onset.

Propionyl-L-carnitine improves endothelial function, microcirculation and pain management in critical limb ischemia.

PubMed

De Marchi, S; Zecchetto, S; Rigoni, A; Prior, M; Fondrieschi, L; Scuro, A; Rulfo, F; Arosio, E

2012-10-01

Chronic critical limb ischemia (CLI) is a severe condition of hypo-perfusion of lower limbs, which is associated with inflammation and a pro-coagulative state. It is a disease at high risk of amputation and cardiovascular death. Propionyl-L-carnitine (PLC) is efficacious in improving pain free walking distance in peripheral arterial disease with claudication; it also exerts favorable effects on the arterial wall and on endothelial function. The purpose of this study was to evaluate the effects of PLC on microcirculation, endothelial function and pain relief in patients affected by CLI not suitable for surgical intervention. We enrolled 48 patients with CLI. Patients were randomized into two groups: the first group was treated with PLC, the second was treated with saline solution. All of them underwent the following tests: laser Doppler flowmetry at the forefoot at rest and after ischemia, trans cutaneous oxygen partial pressure and carbon dioxide partial pressure at the forefoot at rest and after ischemia, endothelium dependent dilation of the brachial artery. All tests were repeated after treatments. Pain was assessed by visual analog pain scale. Endothelium dependent dilation increased after PLC (9.5 ± 3.2 vs 4.9 ± 1.4 %; p < 0.05). Post-ischemic peak flow with laser-Doppler flow increased after PLC. TcPO2 increased, while TcPCO2 decreased after PLC; CO2 production decreased after PLC. VAS showed a significant reduction in pain perception after active treatment. In CLI patients, PLC can improve microcirculation (post ischemic hyperemia, TcPO2 and TcPCO2 production). PLC also enhances endothelium dependent dilation and reduces analgesic consumption and pain perception.

Written pain neuroscience education in fibromyalgia: a multicenter randomized controlled trial.

PubMed

van Ittersum, Miriam W; van Wilgen, C Paul; van der Schans, Cees P; Lambrecht, Luc; Groothoff, Johan W; Nijs, Jo

2014-11-01

Mounting evidence supports the use of face-to-face pain neuroscience education for the treatment of chronic pain patients. This study aimed at examining whether written education about pain neuroscience improves illness perceptions, catastrophizing, and health status in patients with fibromyalgia. A double-blind, multicenter randomized controlled clinical trial with 6-month follow-up was conducted. Patients with FM (n = 114) that consented to participate were randomly allocated to receive either written pain neuroscience education or written relaxation training. Written pain neuroscience education comprised of a booklet with pain neuroscience education plus a telephone call to clarify any difficulties; the relaxation group received a booklet with relaxation education and a telephone call. The revised illness perception questionnaire, Pain Catastrophizing Scale, and fibromyalgia impact questionnaire were used as outcome measures. Both patients and assessors were blinded. Repeated-measures analyses with last observation carried forward principle were performed. Cohen's d effect sizes (ES) were calculated for all within-group changes and between-group differences. The results reveal that written pain neuroscience education does not change the impact of FM on daily life, catastrophizing, or perceived symptoms of patients with FM. Compared with written relaxation training, written pain neuroscience education improved beliefs in a chronic timeline of FM (P = 0.03; ES = 0.50), but it does not impact upon other domains of illness perceptions. Compared with written relaxation training, written pain neuroscience education slightly improved illness perceptions of patients with FM, but it did not impart clinically meaningful effects on pain, catastrophizing, or the impact of FM on daily life. Face-to-face sessions of pain neuroscience education are required to change inappropriate cognitions and perceived health in patients with FM. © 2013 World Institute of Pain.

Different activation of opercular and posterior cingulate cortex (PCC) in patients with complex regional pain syndrome (CRPS I) compared with healthy controls during perception of electrically induced pain: a functional MRI study.

PubMed

Freund, Wolfgang; Wunderlich, Arthur P; Stuber, Gregor; Mayer, Florian; Steffen, Peter; Mentzel, Martin; Weber, Frank; Schmitz, Bernd

2010-05-01

Although the etiology of complex regional pain syndrome type 1 (CRPS 1) is still debated, many arguments favor central maladaptive changes in pain processing as an important causative factor. To look for the suspected alterations, 10 patients with CRPS affecting the left hand were explored with functional magnetic resonance imaging during graded electrical painful stimulation of both hands subsequently and compared with healthy participants. Activation of the anterior insula, posterior cingulate cortex (PCC), and caudate nucleus was seen in patients during painful stimulation. Compared with controls, CRPS patients had stronger activation of the PCC during painful stimulation of the symptomatic hand. The comparison of insular/opercular activation between controls and patients with CRPS I during painful stimulation showed stronger (posterior) opercular activation in controls than in patients. Stronger PCC activation during painful stimulation may be interpreted as a correlate of motor inhibition during painful stimuli different from controls. Also, the decreased opercular activation in CRPS patients shows less sensory-discriminative processing of painful stimuli.These results show that changed cerebral pain processing in CRPS patients is less sensory-discriminative but more motor inhibition during painful stimuli. These changes are not limited to the diseased side but show generalized alterations of cerebral pain processing in chronic pain patients.

Impact of pictorial story on pain perception, situational anxiety and behavior in children: a cognitive-behavioral schema.

PubMed

Aminabadi, N A; Vafaei, A; Erfanparast, L; Oskouei, S G; Jamali, Z

2011-01-01

The present study evaluated the effect of listening to a pictorial story about going to the dentist on pain perception, situational anxiety and behavioral feedback during dental treatment in pediatric dental patients. Eighty, 6-7-year-old children were included The childhood anxiety-related disorders using Screen for Child Anxiety Related Disorders (SCARED) Parent Version scale and intelligence quotient using Raven's Progressive Matrices were evaluated The subjects were randomly assigned to two groups, listening to a pictorial story about going to a dentist (test), or listening to a pictorial story about going to a barbershop (control). A dental treatment was performed on each subject, during which, behavior was assessed using Sound, Eye, and Motor Scale. Pain perception and situational anxiety were then assessed using Wong-Baker Fasces Pain Rating Scale and Faces version of the Modified Child Dental Anxiety Scale, respectively. There was a significant decrease in pain perception (P=0.02) and situational anxiety (P<0.001) in the test group. In addition, the test intervention significantly improved children behavioral feedback during dental treatment (P<0.001). Preparation of children with pictorial story can be effective in decreasing pain perception and situational anxiety as well as improving behavior during dental treatment.

Impaired insula functional connectivity associated with persistent pain perception in patients with complex regional pain syndrome

PubMed Central

Jang, Joon Hwan; Lee, Do-Hyeong; Lee, Kyung-Jun; Lee, Won Joon; Moon, Jee Youn; Kim, Yong Chul

2017-01-01

Given that the insula plays a contributory role in the perception of chronic pain, we examined the resting-state functional connectivity between the insular cortex and other brain regions to investigate neural underpinnings of persisting perception of background pain in patients with complex regional pain syndrome (CRPS). A total of 25 patients with CRPS and 25 matched healthy controls underwent functional magnetic resonance imaging at rest. With the anterior and posterior insular cortices as seed regions, we compared the strength of the resting-state functional connectivity between the two groups. Functional connectivity between the anterior and posterior insular cortices and the postcentral and inferior frontal gyri, cingulate cortices was reduced in patients with CRPS compared with controls. Additionally, greater reductions in functional connectivity between the anterior insula and right postcentral gyrus were associated with more severe sensory pain in patients with CRPS (short-form McGill Pain Questionnaire sensory subscores, r = -.517, P = .023). The present results imply a possible role of the insula in aberrant processing of pain information in patients with CRPS. The findings suggest that a functional derangement of the connection between one of the somatosensory cortical functions of perception and one of the insular functions of awareness can play a significant role in the persistent experience of regional pain that is not confined to a specific nerve territory. PMID:28692702

Influence of prior information on pain involves biased perceptual decision-making.

PubMed

Wiech, Katja; Vandekerckhove, Joachim; Zaman, Jonas; Tuerlinckx, Francis; Vlaeyen, Johan W S; Tracey, Irene

2014-08-04

Prior information about features of a stimulus is a strong modulator of perception. For instance, the prospect of more intense pain leads to an increased perception of pain, whereas the expectation of analgesia reduces pain, as shown in placebo analgesia and expectancy modulations during drug administration. This influence is commonly assumed to be rooted in altered sensory processing and expectancy-related modulations in the spinal cord, are often taken as evidence for this notion. Contemporary models of perception, however, suggest that prior information can also modulate perception by biasing perceptual decision-making - the inferential process underlying perception in which prior information is used to interpret sensory information. In this type of bias, the information is already present in the system before the stimulus is observed. Computational models can distinguish between changes in sensory processing and altered decision-making as they result in different response times for incorrect choices in a perceptual decision-making task (Figure S1A,B). Using a drift-diffusion model, we investigated the influence of both processes in two independent experiments. The results of both experiments strongly suggest that these changes in pain perception are predominantly based on altered perceptual decision-making. Copyright © 2014 The Authors. Published by Elsevier Inc. All rights reserved.

When in doubt, ask the audience: potential users' perceptions of Internet-delivered cognitive behavioural therapy for chronic pain.

PubMed

Schneider, Luke H; Hadjistavropoulos, Heather D

2014-01-01

Although research has demonstrated that Internet-delivered cognitive behavioural therapy (ICBT) for chronic pain helps with adjustment to pain, it remains unclear how this treatment option would initially be perceived by individuals with chronic pain. To explore initial perceptions of ICBT and to examine variables that correlate with an expressed interest in ICBT as a treatment option among individuals with chronic pain. A total of 129 individuals with chronic pain completed a survey assessing perceptions of ICBT and individual difference variables that could be correlated with expressed interest in ICBT (eg, demographic characteristics, pain, computer self-efficacy). Results showed that most participants perceived ICBT as a potentially valuable service with multiple benefits. Being female, having greater pain severity and interference, and having greater computer self-efficacy and lower computer anxiety were positively correlated with interest in receiving ICBT. Combined with previous research on treatment efficacy of ICBT for chronic pain, the results should serve to stimulate further research on integrating ICBT within existing health care services.

Pain and pain management in haemophilia

PubMed Central

Auerswald, Günter; Dolan, Gerry; Duffy, Anne; Hermans, Cedric; Jiménez-Yuste, Victor; Ljung, Rolf; Morfini, Massimo; Lambert, Thierry; Šalek, Silva Zupančić

2016-01-01

Joint pain is common in haemophilia and may be acute or chronic. Effective pain management in haemophilia is essential to reduce the burden that pain imposes on patients. However, the choice of appropriate pain-relieving measures is challenging, as there is a complex interplay of factors affecting pain perception. This can manifest as differences in patients’ experiences and response to pain, which require an individualized approach to pain management. Prophylaxis with factor replacement reduces the likelihood of bleeds and bleed-related pain, whereas on-demand therapy ensures rapid bleed resolution and pain relief. Although use of replacement or bypassing therapy is often the first intervention for pain, additional pain relief strategies may be required. There is an array of analgesic options, but consideration should be paid to the adverse effects of each class. Nevertheless, a combination of medications that act at different points in the pain pathway may be beneficial. Nonpharmacological measures may also help patients and include active coping strategies; rest, ice, compression, and elevation; complementary therapies; and physiotherapy. Joint aspiration may also reduce acute joint pain, and joint steroid injections may alleviate chronic pain. In the longer term, increasing use of prophylaxis or performing surgery may be necessary to reduce the burden of pain caused by the degenerative effects of repeated bleeds. Whichever treatment option is chosen, it is important to monitor pain and adjust patient management accordingly. Beyond specific pain management approaches, ongoing collaboration between multidisciplinary teams, which should include physiotherapists and pain specialists, may improve outcomes for patients. PMID:27439216

Transcranial Direct Current Stimulation Targeting Primary Motor Versus Dorsolateral Prefrontal Cortices: Proof-of-Concept Study Investigating Functional Connectivity of Thalamocortical Networks Specific to Sensory-Affective Information Processing.

PubMed

Sankarasubramanian, Vishwanath; Cunningham, David A; Potter-Baker, Kelsey A; Beall, Erik B; Roelle, Sarah M; Varnerin, Nicole M; Machado, Andre G; Jones, Stephen E; Lowe, Mark J; Plow, Ela B

2017-04-01

The pain matrix is comprised of an extensive network of brain structures involved in sensory and/or affective information processing. The thalamus is a key structure constituting the pain matrix. The thalamus serves as a relay center receiving information from multiple ascending pathways and relating information to and from multiple cortical areas. However, it is unknown how thalamocortical networks specific to sensory-affective information processing are functionally integrated. Here, in a proof-of-concept study in healthy humans, we aimed to understand this connectivity using transcranial direct current stimulation (tDCS) targeting primary motor (M1) or dorsolateral prefrontal cortices (DLPFC). We compared changes in functional connectivity (FC) with DLPFC tDCS to changes in FC with M1 tDCS. FC changes were also compared to further investigate its relation with individual's baseline experience of pain. We hypothesized that resting-state FC would change based on tDCS location and would represent known thalamocortical networks. Ten right-handed individuals received a single application of anodal tDCS (1 mA, 20 min) to right M1 and DLPFC in a single-blind, sham-controlled crossover study. FC changes were studied between ventroposterolateral (VPL), the sensory nucleus of thalamus, and cortical areas involved in sensory information processing and between medial dorsal (MD), the affective nucleus, and cortical areas involved in affective information processing. Individual's perception of pain at baseline was assessed using cutaneous heat pain stimuli. We found that anodal M1 tDCS and anodal DLPFC tDCS both increased FC between VPL and sensorimotor cortices, although FC effects were greater with M1 tDCS. Similarly, anodal M1 tDCS and anodal DLPFC tDCS both increased FC between MD and motor cortices, but only DLPFC tDCS modulated FC between MD and affective cortices, like DLPFC. Our findings suggest that M1 stimulation primarily modulates FC of sensory networks, whereas DLPFC stimulation modulates FC of both sensory and affective networks. Our findings when replicated in a larger group of individuals could provide useful evidence that may inform future studies on pain to differentiate between effects of M1 and DLPFC stimulation. Notably, our finding that individuals with high baseline pain thresholds experience greater FC changes with DLPFC tDCS implies the role of DLPFC in pain modulation, particularly pain tolerance.

Transcranial Direct Current Stimulation Targeting Primary Motor Versus Dorsolateral Prefrontal Cortices: Proof-of-Concept Study Investigating Functional Connectivity of Thalamocortical Networks Specific to Sensory-Affective Information Processing

PubMed Central

Sankarasubramanian, Vishwanath; Cunningham, David A.; Potter-Baker, Kelsey A.; Beall, Erik B.; Roelle, Sarah M.; Varnerin, Nicole M.; Machado, Andre G.; Jones, Stephen E.; Lowe, Mark J.

2017-01-01

Abstract The pain matrix is comprised of an extensive network of brain structures involved in sensory and/or affective information processing. The thalamus is a key structure constituting the pain matrix. The thalamus serves as a relay center receiving information from multiple ascending pathways and relating information to and from multiple cortical areas. However, it is unknown how thalamocortical networks specific to sensory-affective information processing are functionally integrated. Here, in a proof-of-concept study in healthy humans, we aimed to understand this connectivity using transcranial direct current stimulation (tDCS) targeting primary motor (M1) or dorsolateral prefrontal cortices (DLPFC). We compared changes in functional connectivity (FC) with DLPFC tDCS to changes in FC with M1 tDCS. FC changes were also compared to further investigate its relation with individual's baseline experience of pain. We hypothesized that resting-state FC would change based on tDCS location and would represent known thalamocortical networks. Ten right-handed individuals received a single application of anodal tDCS (1 mA, 20 min) to right M1 and DLPFC in a single-blind, sham-controlled crossover study. FC changes were studied between ventroposterolateral (VPL), the sensory nucleus of thalamus, and cortical areas involved in sensory information processing and between medial dorsal (MD), the affective nucleus, and cortical areas involved in affective information processing. Individual's perception of pain at baseline was assessed using cutaneous heat pain stimuli. We found that anodal M1 tDCS and anodal DLPFC tDCS both increased FC between VPL and sensorimotor cortices, although FC effects were greater with M1 tDCS. Similarly, anodal M1 tDCS and anodal DLPFC tDCS both increased FC between MD and motor cortices, but only DLPFC tDCS modulated FC between MD and affective cortices, like DLPFC. Our findings suggest that M1 stimulation primarily modulates FC of sensory networks, whereas DLPFC stimulation modulates FC of both sensory and affective networks. Our findings when replicated in a larger group of individuals could provide useful evidence that may inform future studies on pain to differentiate between effects of M1 and DLPFC stimulation. Notably, our finding that individuals with high baseline pain thresholds experience greater FC changes with DLPFC tDCS implies the role of DLPFC in pain modulation, particularly pain tolerance. PMID:28142257

Neural Correlates of Empathy with Pain Show Habituation Effects. An fMRI Study

PubMed Central

Preis, Mira A.; Kröner-Herwig, Birgit; Schmidt-Samoa, Carsten; Dechent, Peter; Barke, Antonia

2015-01-01

Background Neuroimaging studies have demonstrated that the actual experience of pain and the perception of another person in pain share common neural substrates, including the bilateral anterior insular cortex and the anterior midcingulate cortex. As many fMRI studies include the exposure of participants to repeated, similar stimuli, we examined whether empathic neural responses were affected by habituation and whether the participants' prior pain experience influenced these habituation effects. Method In 128 trials (four runs), 62 participants (31 women, 23.0 ± 4.2 years) were shown pictures of hands exposed to painful pressure (pain pictures) and unexposed (neutral pictures). After each trial, the participants rated the pain of the model. Prior to the experiment, participants were either exposed to the same pain stimulus (pain exposure group) or not (touch exposure group). In order to assess possible habituation effects, linear changes in the strength of the BOLD response to the pain pictures (relative to the neutral pictures) and in the ratings of the model’s pain were evaluated across the four runs. Results Although the ratings of the model’s pain remained constant over time, we found neural habituation in the bilateral anterior/midinsular cortex, the posterior midcingulate extending to dorsal posterior cingulate cortex, the supplementary motor area, the cerebellum, the right inferior parietal lobule, and the left superior frontal gyrus, stretching to the pregenual anterior cingulate cortex. The participant’s prior pain experience did neither affect their ratings of the model’s pain nor their maintenance of BOLD activity in areas associated with empathy. Interestingly, participants with high trait personal distress and fantasy tended to show less habituation in the anterior insula. Conclusion Neural structures showed a decrease of the BOLD signal, indicating habituation over the course of 45 minutes. This can be interpreted as a neuronal mechanism responding to the repeated exposure to pain depictions, which may be regarded as functional in a range of contexts. PMID:26317858

Effect of deafferentation from spinal anesthesia on pain sensitivity and resting-state functional brain connectivity in healthy male volunteers.

PubMed

Niesters, Marieke; Sitsen, Elske; Oudejans, Linda; Vuyk, Jaap; Aarts, Leon P H J; Rombouts, Serge A R B; de Rover, Mischa; Khalili-Mahani, Najmeh; Dahan, Albert

2014-08-01

Patients may perceive paradoxical heat sensation during spinal anesthesia. This could be due to deafferentation-related functional changes at cortical, subcortical, or spinal levels. In the current study, the effect of spinal deafferentation on sensory (pain) sensitivity was studied and linked to whole-brain functional connectivity as assessed by resting-state functional magnetic resonance imaging (RS-fMRI) imaging. Deafferentation was induced by sham or spinal anesthesia (15 mg bupivacaine injected at L3-4) in 12 male volunteers. RS-fMRI brain connectivity was determined in relation to eight predefined and seven thalamic resting-state networks (RSNs) and measured before, and 1 and 2 h after spinal/sham injection. To measure the effect of deafferentation on pain sensitivity, responses to heat pain were measured at 15-min intervals on nondeafferented skin and correlated to RS-fMRI connectivity data. Spinal anesthesia altered functional brain connectivity within brain regions involved in the sensory discriminative (i.e., pain intensity related) and affective dimensions of pain perception in relation to somatosensory and thalamic RSNs. A significant enhancement of pain sensitivity on nondeafferented skin was observed after spinal anesthesia compared to sham (area-under-the-curve [mean (SEM)]: 190.4 [33.8] versus 13.7 [7.2]; p<0.001), which significantly correlated to functional connectivity changes observed within the thalamus in relation to the thalamo-prefrontal network, and in the anterior cingulate cortex and insula in relation to the thalamo-parietal network. Enhanced pain sensitivity from spinal deafferentation correlated with functional connectivity changes within brain regions involved in affective and sensory pain processing and areas involved in descending control of pain.

The effectiveness of a multidisciplinary pain management programme managing chronic pain.

PubMed

Dysvik, Elin; Vinsnes, Anne Guttormsen; Eikeland, Ole-Johan

2004-10-01

The aim of this study was to develop and evaluate the effects of a multidisciplinary pain management programme on coping, health-related quality of life and pain intensity. Seventy-six outpatients suffering from chronic pain completed this eight-week programme with the primary aims to increase coping, as measured by the Ways of Coping Checklist, and health-related quality of life, as measured by the Short Form-36 Health Survey. Therapeutic dialogues and education, combined with physical activity, were given in order to increase understanding of and attention to non-medical factors that might affect pain perception. The programme was active, time-limited and structured on the basis of multidisciplinary pain management programmes based on a cognitive-behavioural approach. The findings suggest that this programme has the potential to improve coping skills and health-related quality of life. Additionally, pain intensity, as measured by the Visual Analogue Scale, was reduced. Age and disability were revealed as the prominent predictors of change after treatment. The differences in this sample indicated that the drop-outs tended to be older and reported more health problems, although these findings were non-significant. Clinical and research implications are discussed.

Effect of Parkinson Disease on Emotion Perception Using the Persian Affective Voices Test.

PubMed

Saffarian, Arezoo; Shavaki, Yunes Amiri; Shahidi, Gholam Ali; Jafari, Zahra

2018-05-04

Emotion perception plays a major role in proper communication with people in different social interactions. Nonverbal affect bursts can be used to evaluate vocal emotion perception. The present study was a preliminary step to establishing the psychometric properties of the Persian version of the Montreal Affective Voices (MAV) test, as well as to investigate the effect of Parkinson disease (PD) on vocal emotion perception. The short, emotional sound made by pronouncing the vowel "a" in Persian was recorded by 22 actors and actresses to develop the Persian version of the MAV, the Persian Affective Voices (PAV), for emotions of happiness, sadness, pleasure, pain, anger, disgust, fear, surprise, and neutrality. The results of the recordings of five of the actresses and five of the actors who obtained the highest score were used to generate the test. For convergent validity assessment, the correlation between the PAV and a speech prosody comprehension test was examined using a gender- and age-matched control group. To investigate the effect of the PD on emotion perception, the PAV test was performed on 28 patients with mild PD between ages 50 and 70 years. The PAV showed a high internal consistency (Cronbach's α = 0.80). A significant positive correlation was observed between the PAV and the speech prosody comprehension test. The test-retest reliability also showed the high repeatability of the PAV (intraclass correlation coefficient = 0.815, P ≤ 0.001). A significant difference was observed between the patients with PD and the controls in all subtests. The PAV test is a useful psychometric tool for examining vocal emotion perception that can be used in both behavioral and neuroimaging studies. Copyright © 2018 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Pain Perception: Computerized versus Traditional Local Anesthesia in Pediatric Patients.

PubMed

Mittal, M; Kumar, A; Srivastava, D; Sharma, P; Sharma, S

2015-01-01

Local anesthetic injection is one of the most anxiety- provoking procedure for both children and adult patients in dentistry. A computerized system for slow delivery of local anesthetic has been developed as a possible solution to reduce the pain related to the local anesthetic injection. The present study was conducted to evaluate and compare pain perception rates in pediatric patients with computerized system and traditional methods, both objectively and subjectively. It was a randomized controlled study in one hundred children aged 8-12 years in healthy physical and mental state, assessed as being cooperative, requiring extraction of maxillary primary molars. Children were divided into two groups by random sampling - Group A received buccal and palatal infiltration injection using Wand, while Group B received buccal and palatal infiltration using traditional syringe. Visual Analog scale (VAS) was used for subjective evaluation of pain perception by patient. Sound, Eye, Motor (SEM) scale was used as an objective method where sound, eye and motor reactions of patient were observed and heart rate measurement using pulse oximeter was used as the physiological parameter for objective evaluation. Patients experienced significantly less pain of injection with the computerized method during palatal infiltration, while less pain was not statistically significant during buccal infiltration. Heart rate increased during both buccal and palatal infiltration in traditional and computerized local anesthesia, but difference between traditional and computerized method was not statistically significant. It was concluded that pain perception was significantly more during traditional palatal infiltration injection as compared to computerized palatal infiltration, while there was no difference in pain perception during buccal infiltration in both the groups.

Serum dehydroepiandrosterone sulphate, psychosocial factors and musculoskeletal pain in workers.

PubMed

Marinelli, A; Prodi, A; Pesel, G; Ronchese, F; Bovenzi, M; Negro, C; Larese Filon, F

2017-12-30

The serum level of dehydroepiandrosterone sulphate (DHEA-S) has been suggested as a biological marker of stress. To assess the association between serum DHEA-S, psychosocial factors and musculoskeletal (MS) pain in university workers. The study population included voluntary workers at the scientific departments of the University of Trieste (Italy) who underwent periodical health surveillance from January 2011 to June 2012. DHEA-S level was analysed in serum. The assessment tools included the General Health Questionnaire (GHQ) and a modified Nordic musculoskeletal symptoms questionnaire. The relation between DHEA-S, individual characteristics, pain perception and psychological factors was assessed by means of multivariable linear regression analysis. There were 189 study participants. The study population was characterized by high reward and low effort. Pain perception in the neck, shoulder, upper limbs, upper back and lower back was reported by 42, 32, 19, 29 and 43% of people, respectively. In multivariable regression analysis, gender, age and pain perception in the shoulder and upper limbs were significantly related to serum DHEA-S. Effort and overcommitment were related to shoulder and neck pain but not to DHEA-S. The GHQ score was associated with pain perception in different body sites and inversely to DHEA-S but significance was lost in multivariable regression analysis. DHEA-S was associated with age, gender and perception of MS pain, while effort-reward imbalance dimensions and GHQ score failed to reach the statistical significance in multivariable regression analysis. © The Author(s) 2017. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com

Pain as the Perception of Someone: An Analysis of the Interface Between Pain Medicine and Philosophy.

PubMed

Bäckryd, Emmanuel

2018-06-23

Based largely on the so-called problem of "asymmetry in concept application", philosopher Murat Aydede has argued for a non-perceptual view of pain. Aydede is of course not denying basic neurobiological facts about neurons, action potentials, and the like, but he nonetheless makes a strong philosophical case for pain not being the perception of something extramental. In the present paper, after having stated some of the presuppositions I hold as a physician and pain researcher, and after having shortly described Aydede's critique of perceptual theories of pain, I make a constructive proposal centred around the concept of pain as the perception of some-one, not some-thing. In doing so, I propose that there often is a problematic duality at work when we think about pain, namely the mental/extramental duality. This pre-reflective mindset creates difficulties when reflecting over pain. Instead, I propose the body/world duality as being more helpful. Two neologisms, cosmoception and egoception, are presented as an alternative to the twin concepts of exteroception and interoception. It is argued that the new concepts have the advantage of not pushing our thought into a mental/extra-mental dichotomy. Hence, when in pain (which is an instance of egoception), I get epistemic access to the body that is I, to how I fare in this world. From that perspective, pain is not the perception of something, but of someone-namely, the self. In the final part of the paper, this proposal is discussed in dialogue with a paper from phenomenological thinker Jennifer Bullington.

A qualitative study exploring the effects of attending a community pain service choir on wellbeing in people who experience chronic pain

PubMed Central

Hopper, Mirella J; Curtis, Suzi; Hodge, Suzanne; Simm, Rebecca

2016-01-01

In line with growing evidence of the health benefits of singing, this study aimed to explore participants’ perceptions of the impact of a service-user-led community pain choir on their psychological wellbeing, self-efficacy and relationships with their chronic pain. The choir has links to a multidisciplinary pain management service, which is informed by the ethos of solution-focused (SF) principles, specifically in identifying and drawing upon patients’ resources. Seven choir members participated in semi-structured interviews, grounded in lines of enquiry commonly used in SF practice. Thematic analysis of the data uncovered seven themes: Physical Improvements, Emotional Impact, Personal Growth, Interpersonal Processes, Relationship with the ‘Self’, Living Well with Pain and Sharing the Music and Spreading the Word. Participants’ narratives provided support for participation in the choir in enhancing positive affect, self-worth, interpersonal relationships and overall wellbeing. The choir enabled continued progress towards accomplishing key pain management programme aims: self-management, coping and living well with pain. Findings expanded upon existing evidence relating to singing and wellbeing by highlighting the choir’s role in promoting resilience and acceptance of pain. Clinical implications are explored in relation to psychosocial dimensions of pain. PMID:27583139

Single-trial laser-evoked potentials feature extraction for prediction of pain perception.

PubMed

Huang, Gan; Xiao, Ping; Hu, Li; Hung, Yeung Sam; Zhang, Zhiguo

2013-01-01

Pain is a highly subjective experience, and the availability of an objective assessment of pain perception would be of great importance for both basic and clinical applications. The objective of the present study is to develop a novel approach to extract pain-related features from single-trial laser-evoked potentials (LEPs) for classification of pain perception. The single-trial LEP feature extraction approach combines a spatial filtering using common spatial pattern (CSP) and a multiple linear regression (MLR). The CSP method is effective in separating laser-evoked EEG response from ongoing EEG activity, while MLR is capable of automatically estimating the amplitudes and latencies of N2 and P2 from single-trial LEP waveforms. The extracted single-trial LEP features are used in a Naïve Bayes classifier to classify different levels of pain perceived by the subjects. The experimental results show that the proposed single-trial LEP feature extraction approach can effectively extract pain-related LEP features for achieving high classification accuracy.

Pain modality- and sex-specific effects of COMT genetic functional variants

PubMed Central

Belfer, Inna; Segall, Samantha K.; Lariviere, William R.; Smith, Shad B.; Dai, Feng; Slade, Gary G.; Rashid, Naim U.; Mogil, Jeffrey S.; Campbell, Claudia; Edwards, Robert; Liu, Qian; Bair, Eric; Maixner, William; Diatchenko, Luda

2013-01-01

The enzyme catechol-O-methyltransferase (COMT) metabolizes catecholamine neurotransmitters involved in a number of physiological functions including pain perception. Both human and mouse COMT genes possess functional polymorphisms contributing to inter-individual variability in pain phenotypes such as sensitivity to noxious stimuli, severity of clinical pain and response to pain treatment. In this study, we found that the effects of Comt functional variation in mice are modality-specific. Spontaneous inflammatory nociception and thermal nociception behaviors were correlated the most with the presence of the B2 SINE transposon insertion residing in the 3’UTR mRNA region. Similarly, in humans, COMT functional haplotypes were associated with thermal pain perception and with capsaicin-induced pain. Furthermore, COMT genetic variations contributed to pain behaviors in mice and pain ratings in humans in a sex-specific manner. The ancestral Comt variant, without a B2 SINE insertion, was more strongly associated with sensitivity to capsaicin in female versus male mice. In humans, the haplotype coding for low COMT activity increased capsaicin-induced pain perception in women, but not men. These findings reemphasize the fundamental contribution of COMT to pain processes, and provide a fine-grained resolution of this contribution at the genetic level that can be used to guide future studies in the area of pain genetics. PMID:23701723

Do anxiety, stress, or depression have any impact on pain perception during shock wave lithotripsy?

PubMed

Altok, Muammer; Akpinar, Abdullah; Güneş, Mustafa; Umul, Mehmet; Demirci, Kadir; Baş, Ercan

2016-01-01

The most important adverse effect during shock wave lithotripsy (SWL) is pain perception. In this study, we evaluated the effect of anxiety, stress, and depression on pain perception during SWL. From November 2013 to December 2014, 189 consecutive patients undergoing SWL for kidney stones were evaluated prospectively. Patient characteristics (age, sex, body mass index [BMI], urologic intervention history, the presence of a double-j catheter, and stone-related parameters) were also recorded. Anxiety, stress, and depression states were assessed before the first procedure using the Depression, Anxiety, and Stress Scales (DASS-42), which is a self-report scale. The degree of pain perception was evaluated with a 10-point Visual Analogue Scale (VAS) at the end of the first SWL session. There were no statistically significant differences in terms of VAS scores during SWL between patients with and without anxiety, stress, or depression (p >0.05). Furthermore, no statistically significant relationships were found between VAS scores and patient age, sex, side of the stone, presence of a double-j stent, number of stones, and SWL experience (p >0.05). According to our findings, anxiety, stress, or depression seemed to have no impact on pain perception during SWL.

The Drosophila TRPA channel, Painless, regulates sexual receptivity in virgin females

PubMed Central

Sakai, Takaomi; Kasuya, Junko; Kitamoto, Toshihiro; Aigaki, Toshiro

2009-01-01

Transient receptor potential (TRP) channels play crucial roles in sensory perception. Expression of the Drosophila painless (pain) gene, a homolog of the mammalian TRPA1/ANKTM1 gene, in the peripheral nervous system is required for avoidance behavior of noxious heat or wasabi. Here we report a novel role of the Pain TRP channel expressed in the nervous system in the sexual receptivity in Drosophila virgin females. Compared with wild-type females, pain mutant females copulated with wild-type males significantly earlier. Wild-type males showed comparable courtship latency and courtship index toward wild-type and pain mutant females. Therefore, the early copulation observed in wild-type male and pain mutant female pairs is the result of enhanced sexual receptivity in pain mutant females. Involvement of pain in enhanced female sexual receptivity was confirmed by rescue experiments in which expression of a pain transgene in a pain mutant background restored the female sexual receptivity to the wild-type level. Targeted expression of pain RNAi in putative cholinergic or GABAergic neurons phenocopied the mutant phenotype of pain females. On the other hand, target expression of pain RNAi in dopaminergic neurons did not affect female sexual receptivity. In addition, conditional suppression of neurotransmission in putative GABAergic neurons resulted in a similar enhanced sexual receptivity. Our results suggest that Pain TRP channels expressed in cholinergic and/or GABAergic neurons are involved in female sexual receptivity. PMID:19531155

The Drosophila TRPA channel, Painless, regulates sexual receptivity in virgin females.

PubMed

Sakai, T; Kasuya, J; Kitamoto, T; Aigaki, T

2009-07-01

Transient receptor potential (TRP) channels play crucial roles in sensory perception. Expression of the Drosophila painless (pain) gene, a homolog of the mammalian TRPA1/ANKTM1 gene, in the peripheral nervous system is required for avoidance behavior of noxious heat or wasabi. In this study, we report a novel role of the Pain TRP channel expressed in the nervous system in the sexual receptivity in Drosophila virgin females. Compared with wild-type females, pain mutant females copulated with wild-type males significantly earlier. Wild-type males showed comparable courtship latency and courtship index toward wild-type and pain mutant females. Therefore, the early copulation observed in wild-type male and pain mutant female pairs is the result of enhanced sexual receptivity in pain mutant females. Involvement of pain in enhanced female sexual receptivity was confirmed by rescue experiments in which expression of a pain transgene in a pain mutant background restored the female sexual receptivity to the wild-type level. Targeted expression of pain RNA interference (RNAi) in putative cholinergic or GABAergic neurons phenocopied the mutant phenotype of pain females. However, target expression of pain RNAi in dopaminergic neurons did not affect female sexual receptivity. In addition, conditional suppression of neurotransmission in putative GABAergic neurons resulted in a similar enhanced sexual receptivity. Our results suggest that Pain TRP channels expressed in cholinergic and/or GABAergic neurons are involved in female sexual receptivity.

Controllability and hippocampal activation during pain expectation in fibromyalgia syndrome.

PubMed

González-Roldán, Ana María; Bomba, Isabelle C; Diesch, Eugen; Montoya, Pedro; Flor, Herta; Kamping, Sandra

2016-12-01

To examine the role of perceived control in pain perception, fibromyalgia patients and healthy controls participated in a reaction time experiment under different conditions of pain controllability. No significant differences between groups were found in pain intensity and unpleasantness ratings. However, during the expectation of uncontrollable pain, patients compared to controls showed higher hippocampal activation. In addition, hippocampal activity during the pain expectation period predicted activation of the posterior cingulate cortex (PCC), precuneus and hippocampus during pain stimulation in fibromyalgia patients. The increased activation of the hippocampus during pain expectation and subsequent activation of the PCC/precuneus during the lack of control phase points towards an influence of pain perception through heightening of alertness and anxiety responses to pain in fibromyalgia patients. Copyright © 2016 Elsevier B.V. All rights reserved.

Service providers' perception of affective influences on decision-making about treatments for chronic pain.

PubMed

Brown, Cary A

2004-01-07

Service providers working with people who have complex health problems like chronic pain are considered at particular risk from the heavy emotional content of these interactions (frustration, guilt, hostility). For the good of service users and in the interests of healthcare workers' own health it is important for them to employ reflective practice acknowledging these issues. Service providers are inculcated to negate the affective domain of their practice despite the growing awareness that wellbeing can no longer be envisioned as a linear (cause and effect) process divorced from socio-cultural influences and attendant values and beliefs. The aim of this report is to examine to what degree service users (SU) and service providers (SP) believe their decisions about treatment importance are influenced by self-image and emotion. These results are extrapolated from a larger study based on a postal questionnaire that went to members of the Pain Society (UK Chapter of IASP) and service users belonging to chronic pain support groups in the North-West of England. The question of interest in this report asked participants to identify their level of agreement with statements about how four themes influence their decision-making about whether a treatment is important. The themes (coherence, purposiveness, self-image and affect) arise from Chapman's model of consciousness and pain. Only 20.5% of service providers rated the influence of self-image (what someone like me would think) as 3 (mostly) or 4 (completely). Service provider rating for the influence of affect (how this treatment makes me feel) were similarly low with only 19.4% of respondents selecting a rating of 3 or 4. In marked contrast, 73.3% of the service users selected self-image and 92.9% selected affect as a strong influence. Service providers felt that affect and self-image had little influence on their decision-making. However, there is growing evidence in the literature to suggest that it is not possible, nor preferable, to divorce emotion from the clinical encounter.

Effects of distraction on magnetoencephalographic responses ascending through C-fibers in humans.

PubMed

Qiu, Yunhai; Inui, Koji; Wang, Xiaohong; Nguyen, Binh Thi; Tran, Tuan Diep; Kakigi, Ryusuke

2004-03-01

Using magnetoencephalography (MEG), we evaluated the cerebral regions relating to second pain perception ascending through C-fibers and investigated the effect of distraction on each region. Thirteen normal subjects participated in this study. CO2 laser pulses were delivered to the dorsum of the left hand to selectively activate C-fibers. The MEG responses were analyzed using a multi-dipole model. (1) primary somatosensory cortex (SI), and (2) secondary somatosensory cortex (SII)--insula were the main generators for the primary component, 1M, whose mean peak latency was 744 ms. In addition to (1) and (2), (3) cingulate cortex and (4) medial temporal area (MT) were also activated for the subsequent component, 2M, whose mean peak latency was 947 ms. During a mental calculation task (Distraction), all 6 sources were significantly reduced in amplitude, but the SII-insula (P < 0.01) and cingulate cortex (P < 0.001) were more sensitive than the SI (P < 0.05) and MT (P < 0.05). We confirmed that SI in the contralateral hemisphere and SII-insula, cingulate cortex and MT in bilateral hemispheres play a major role in second pain perception, and all sites were much affected by a change of attention, indicating that these regions are related to the cognitive aspect of second pain perception. The SI, SII, cingulate and MT were activated during the C-fiber-related MEG response, and responses in these regions were significantly diminished during mental distraction.

The Use of Music in Labor: Pain Perception

DTIC Science & Technology

1991-01-01

AD-A267 985liiiiiii ii ii iii lillinl lJtlflllllIi 1\\k . Music in Labor DTIC43.t ELECTE wN AUGt 1 1993UThe Use of Music in Labor: A C1 Pain...Perception Kathy Jo Keever Patricia A. Shepherd AFIT/Georgetown University School of Nursing Running head: MUSIC IN LABOR Ap9i" "r85T16x• ~ ;u~c r~eca _W...FUNDING NUMBERS The Use of Music in Labor: Pain Perception 6. AUTHOR(S) 1st Lt Kathy Keever Capt Patricia Shepherd PERFORMING ORGANIZATION NAME(S) AND

Sex differences in the neural representation of pain unpleasantness.

PubMed

Girard-Tremblay, Lydia; Auclair, Vincent; Daigle, Kathya; Léonard, Guillaume; Whittingstall, Kevin; Goffaux, Philippe

2014-08-01

Sex differences in pain perception are still poorly understood, but they may be related to the way the brains of men and women respond to the affective dimensions of pain. Using a matched pain intensity paradigm, where pain intensity was kept constant across participants but pain unpleasantness was left free to vary among participants, we studied the relationship between pain unpleasantness and pain-evoked brain activity in healthy men and women separately. Experimental pain was provoked using transcutaneous electrical stimulation of the sural nerve while pain-related brain activity was measured using somatosensory-evoked brain potentials with source localization. Cardiac responses to pain were also measured using electrocardiac recordings. Results revealed that subjective pain unpleasantness was strongly associated with increased perigenual anterior cingulate cortex activity in women, whereas it was strongly associated with decreased ventromedial prefrontal cortex activity in men. Only ventromedial prefrontal cortex deactivations in men were additionally associated with increased autonomic cardiac arousal. These results suggest that in order to deal with pain's objectionable properties, men preferentially deactivate prefrontal suppression regions, leading to the mobilization of threat-control circuits, whereas women recruit well-known emotion-processing areas of the brain. This article presents neuroimaging findings demonstrating that subjective pain unpleasantness ratings are associated with different pain-evoked brain responses in men and women, which has potentially important implications regarding sex differences in the risk of developing chronic pain. Copyright © 2014 American Pain Society. Published by Elsevier Inc. All rights reserved.

Effects of vicarious pain on self-pain perception: investigating the role of awareness

PubMed Central

Terrighena, Esslin L; Lu, Ge; Yuen, Wai Ping; Lee, Tatia MC; Keuper, Kati

2017-01-01

The observation of pain in others may enhance or reduce self-pain, yet the boundary conditions and factors that determine the direction of such effects are poorly understood. The current study set out to show that visual stimulus awareness plays a crucial role in determining whether vicarious pain primarily activates behavioral defense systems that enhance pain sensitivity and stimulate withdrawal or appetitive systems that attenuate pain sensitivity and stimulate approach. We employed a mixed factorial design with the between-subject factors exposure time (subliminal vs optimal) and vicarious pain (pain vs no pain images), and the within-subject factor session (baseline vs trial) to investigate how visual awareness of vicarious pain images affects subsequent self-pain in the cold-pressor test. Self-pain tolerance, intensity and unpleasantness were evaluated in a sample of 77 healthy participants. Results revealed significant interactions of exposure time and vicarious pain in all three dependent measures. In the presence of visual awareness (optimal condition), vicarious pain compared to no-pain elicited overall enhanced self-pain sensitivity, indexed by reduced pain tolerance and enhanced ratings of pain intensity and unpleasantness. Conversely, in the absence of visual awareness (subliminal condition), vicarious pain evoked decreased self-pain intensity and unpleasantness while pain tolerance remained unaffected. These findings suggest that the activation of defense mechanisms by vicarious pain depends on relatively elaborate cognitive processes, while – strikingly – the appetitive system is activated in highly automatic manner independent from stimulus awareness. Such mechanisms may have evolved to facilitate empathic, protective approach responses toward suffering individuals, ensuring survival of the protective social group. PMID:28831270

Pain perception and low back pain functional disability after a 10-week core and mobility training program: A pilot study.

PubMed

Lima, Vicente Pinheiro; de Alkmim Moreira Nunes, Rodolfo; da Silva, Jurandir Baptista; Paz, Gabriel Andrade; Jesus, Marco; de Castro, Juliana Brandão Pinto; Dantas, Estélio Henrique Martin; de Souza Vale, Rodrigo Gomes

2018-03-02

The aim of this study was to evaluate the effects of a 10-week core and mobility training program on pain perception and low back disability score in professors, students and employees of a university. Twenty-four individuals of a university who previously reported pain and low back disability were randomly assigned to an experimental group (EG; n= 8) that received 2 weekly sessions of 50 minutes of core and mobility training for 10 weeks; or to a control group (CG; n= 16). Both groups received a guideline to adopt ergonomic postures during work and activities of daily living. The visual analog pain scale (VAS) and the Roland-Morris questionnaire (RMQ) were applied pre and post intervention. Significant reductions in the pain intensity perception (p= 0.014) and low back functional disability (p= 0.011) were noted in the EG pre and post measures. However, no significant difference was observed in the CG. Thus, there was a significant difference between the EG and the CG in the post-intervention measures (p= 0.001). Core and mobility training and home-ergonomic instructions were effective to reduce the pain intensity perception and low back functional disability in the EG.

Mutations in the Heme Exporter FLVCR1 Cause Sensory Neurodegeneration with Loss of Pain Perception.

PubMed

Chiabrando, Deborah; Castori, Marco; di Rocco, Maja; Ungelenk, Martin; Gießelmann, Sebastian; Di Capua, Matteo; Madeo, Annalisa; Grammatico, Paola; Bartsch, Sophie; Hübner, Christian A; Altruda, Fiorella; Silengo, Lorenzo; Tolosano, Emanuela; Kurth, Ingo

2016-12-01

Pain is necessary to alert us to actual or potential tissue damage. Specialized nerve cells in the body periphery, so called nociceptors, are fundamental to mediate pain perception and humans without pain perception are at permanent risk for injuries, burns and mutilations. Pain insensitivity can be caused by sensory neurodegeneration which is a hallmark of hereditary sensory and autonomic neuropathies (HSANs). Although mutations in several genes were previously associated with sensory neurodegeneration, the etiology of many cases remains unknown. Using next generation sequencing in patients with congenital loss of pain perception, we here identify bi-allelic mutations in the FLVCR1 (Feline Leukemia Virus subgroup C Receptor 1) gene, which encodes a broadly expressed heme exporter. Different FLVCR1 isoforms control the size of the cytosolic heme pool required to sustain metabolic activity of different cell types. Mutations in FLVCR1 have previously been linked to vision impairment and posterior column ataxia in humans, but not to HSAN. Using fibroblasts and lymphoblastoid cell lines from patients with sensory neurodegeneration, we here show that the FLVCR1-mutations reduce heme export activity, enhance oxidative stress and increase sensitivity to programmed cell death. Our data link heme metabolism to sensory neuron maintenance and suggest that intracellular heme overload causes early-onset degeneration of pain-sensing neurons in humans.

Corticomotor excitability during a noxious stimulus before and after exercise in women with fibromyalgia.

PubMed

Hoeger Bement, Marie K; Weyer, Andy D; Yoon, Tejin; Hunter, Sandra K

2014-02-01

The purposes of this study were to assess corticomotor excitability in people with fibromyalgia during a noxious stimulus before and after fatiguing exercise and examine associations with pain perception. Fifteen women with fibromyalgia completed three sessions: one familiarization and two experimental. The experimental sessions were randomized and involved measurement of pain perception and motor evoked potentials before and after (1) quiet rest and (2) isometric contraction of the elbow flexor muscles. Motor evoked potential amplitude of brachioradialis muscle was measured following transcranial magnetic stimulation delivered before, during, and after a noxious mechanical stimulus. After quiet rest, there was no change in pain perception. After the submaximal contraction, there was considerable variability in the pain response. Based on the changes in the experimental pain, subjects were divided into three groups (increase, decrease, and no change in pain). There was an interaction between pain response and the pain-induced change in motor evoked potentials. Those individuals who had an increase in motor evoked potentials during the pain test had an increase in pain after exercise. Thus, women with fibromyalgia were classified based on their pain response to exercise, and this response was associated with the change in corticomotor excitability during the application of a noxious stimulus.

No significant correlation between the intensity of static stretching and subject's perception of pain.

PubMed

Lim, Wootaek; Park, Hyunju

2017-10-01

[Purpose] The purpose of this study was to determine whether the intensity of static stretching measured quantitatively is related to subjects' perception of pain. [Subjects and Methods] Sixty-eight participants were recruited. Static stretching was performed once for 30 seconds while maintaining the knee at 0° flexion and was continued to the point where pain was recognized. The intensity of stretching exerted by the practitioner was quantitatively measured by using a handheld dynamometer (HHD). A subject's pain scaled on one's perception was measured by using the visual analog scale (VAS). [Results] No significant correlation was found between the intensity of stretching and the VAS score representing the subject's pain scaled on one's perception. In this study, the most frequent VAS score was 7, and the mean VAS score was 5.57 ± 1.77. The stretching intensity measured by using a HHD ranged from 28.4 to 133.0 N (mean, 72.04 ± 22.37 N). [Conclusion] This study showed that the intensity of stretching quantitatively measured by using HHD did not correlate with the degree of pain reported by the subjects. Therefore, subjective responses cannot guarantee a consistent application of intensity.

Tonic pain and continuous EEG: prediction of subjective pain perception by alpha-1 power during stimulation and at rest.

PubMed

Nir, Rony-Reuven; Sinai, Alon; Moont, Ruth; Harari, Eyal; Yarnitsky, David

2012-03-01

Pain neurophysiology has been chiefly characterized via event-related potentials (ERPs), which are exerted using brief, phase-locked noxious stimuli. Striving for objectively characterizing clinical pain states using more natural, prolonged stimuli, tonic pain has been recently associated with the individual peak frequency of alpha oscillations. This finding encouraged us to explore whether alpha power, reflecting the magnitude of the synchronized activity within this frequency range, will demonstrate a corresponding relationship with subjective perception of tonic pain. Five-minute-long continuous EEG was recorded in 18 healthy volunteers under: (i) resting-state; (ii) innocuous temperature; and (iii) psychophysically-anchored noxious temperature. Numerical pain scores (NPSs) collected during the application of tonic noxious stimuli were tested for correlation with alpha-1 and alpha-2 power. NPSs and alpha power remained stable throughout the recording conditions (Ps⩾0.381). In the noxious condition, alpha-1 power obtained at the bilateral temporal scalp was negatively correlated with NPSs (Ps⩽0.04). Additionally, resting-state alpha-1 power recorded at the bilateral temporal scalp was negatively correlated with NPSs reported during the noxious condition (Ps⩽0.038). Current findings suggest alpha-1 power may serve as a direct, objective and experimentally stable measure of subjective perception of tonic pain. Furthermore, resting-state alpha-1 power might reflect individuals' inherent tonic pain responsiveness. The relevance of alpha-1 power to tonic pain perception may deepen the understanding of the mechanisms underlying the processing of prolonged noxious stimulation. Copyright © 2011 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

A Qualitative Study of Hospitalists' Perceptions of Patient Satisfaction Metrics on Pain Management.

PubMed

Calcaterra, Susan L; Drabkin, Anne D; Doyle, Reina; Leslie, Sarah E; Binswanger, Ingrid A; Frank, Joseph W; Reich, Jennifer A; Koester, Stephen

2017-01-01

Hospital initiatives to promote pain management may unintentionally contribute to excessive opioid prescribing. To better understand hospitalists' perceptions of satisfaction metrics on pain management, the authors conducted 25 interviews with hospitalists. Transcribed interviews were systematically analyzed to identify emergent themes. Hospitalists felt institutional pressure to earn high satisfaction scores for pain, which they perceived influenced practices toward opioid prescribing. They felt tying compensation to satisfaction scores commoditized pain. Hospitalists believed satisfaction would improve with increased time spent at the bedside. Focusing on methods to improve patient-physician communication, while maintaining efficiency in clinical practice, may promote both patient-centered pain management and satisfaction.

Self-reported pain perception of patients after mucosal graft harvesting in the palatal area.

PubMed

Burkhardt, Rino; Hämmerle, Christoph H F; Lang, Niklaus P

2015-03-01

To evaluate the patient-reported pain perception after palatal graft harvesting during a 4 weeks healing period Ninety patients, scheduled for different periodontal and peri-implant plastic surgeries requiring palatal mucosal graft harvesting, were consecutively recruited. Mucosal thickness was measured at the donor sites with an ultrasonic device prior to the surgeries. Graft thickness, length, and width were assessed after harvesting, and the wound areas were calculated. Based on a Visual Analogue Scale (VAS), the patients were asked to report their perceived pain after the intervention and 1, 3, 7, 14, 21 and 28 days thereafter. Pain was most pronounced on the first postoperative day and decreased within the course of time. Graft thickness directly correlated with the amount of pain perceived while increased palatal mucosal thickness before and after graft harvesting decreased pain levels. The denuded wound surface area, however, did not influence the perceived pain level. The wound depth at the donor site (graft thickness) was positively correlated with the patient's perception for pain. The wound surface area, however, did not influence the perceived pain level. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Pain, dissociation and subliminal self-representations.

PubMed

Bob, Petr

2008-03-01

According to recent evidence, neurophysiological processes coupled to pain are closely related to the mechanisms of consciousness. This evidence is in accordance with findings that changes in states of consciousness during hypnosis or traumatic dissociation strongly affect conscious perception and experience of pain, and markedly influence brain functions. Past research indicates that painful experience may induce dissociated state and information about the experience may be stored or processed unconsciously. Reported findings suggest common neurophysiological mechanisms of pain and dissociation and point to a hypothesis of dissociation as a defense mechanism against psychological and physical pain that substantially influences functions of consciousness. The hypothesis is also supported by findings that information can be represented in the mind/brain without the subject's awareness. The findings of unconsciously present information suggest possible binding between conscious contents and self-functions that constitute self-representational dimensions of consciousness. The self-representation means that certain inner states of own body are interpreted as mental and somatic identity, while other bodily signals, currently not accessible to the dominant interpreter's access are dissociated and may be defined as subliminal self-representations. In conclusion, the neurophysiological aspects of consciousness and its integrative role in the therapy of painful traumatic memories are discussed.

Factors affecting the psychological functioning of Australian adults with chronic pain.

PubMed

Viggers, Lorna C; Caltabiano, Marie L

2012-12-01

The role of resilience, for adults facing ongoing adversity in the form of chronic medical conditions, has received little attention in the past. This research investigated the impact of resilience and coping strategies on the psychological functioning of 87 Australian adults with chronic pain, using a self-report questionnaire. It included the McGill Pain Questionnaire, the Connor-Davidson Resilience Scale, the Coping Strategies Questionnaire, the 36-item Short Form Health Survey, and the Depression, Anxiety and Stress Scale. Using hierarchical regression, after the effects of pain severity, catastrophizing, and ignoring the pain were controlled for, resilience was significantly associated with mental health-related quality of life (β = 0.18, P < 0.05), depression (β = -0.31, P < 0.01), and anxiety (β = -0.20, P < 0.05). In the final model for depression, resilience had a stronger association than pain severity. Resilience did not, however, influence individual's perceptions of their physical health-related quality of life. The link between resilience and mental health-related quality of life outcomes provides initial evidence for the potential application of resilience related interventions to pain management programs. © 2012 Wiley Publishing Asia Pty Ltd.

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

2012-10-22

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.

Efficacy of the "body movement and perception" method in the treatment of fibromyalgia syndrome: an open pilot study.

PubMed

Maddali Bongi, S; Di Felice, C; Del Rosso, A; Landi, G; Maresca, M; Giambalvo Dal Ben, G; Matucci-Cerinic, M

2011-01-01

Group exercises may be useful in fibromyalgia syndrome (FMS). The 'Body movement and perception' (BMP) method is based on low impact exercises, awareness of body perception and relaxation, aimed at treating small groups of patients following the Resseguier method (RM) and integrating RM with exercises derived from soft gymnastics. We assessed the effects of BMP method on FMS. 40 women with FMS (age and disease duration: 51.7±7.2 and 4.9±3.8 years) participated in an open pilot study. BMP sessions were performer twice a week (50 minutes each) for 8 weeks. Patients were assessed at enrolment (T0) and at the end of the study (T1) by a self-administered questionnaire (temporal characteristics of pain, pain interference in working and recreational activities and in night-time rest, awareness of pain, fatigue, irritability, well-being, quality of movement, ability to focus on perception and to perceive whole body, postural selfcontrol, ability to relax) and a clinical evaluation (tender points, assumption of analgesics/NSAIDs, distribution of pain, pain in sitting and standing position, pain during postural passages and gait, postural body alignment, muscular contractures). At T1, FMS patients significantly improved with respect to T0 in pain, fatigue, irritability, well-being, quality of movement, postural self-control, ability to relax mind and body, movement perception, tender point scores, assumption of analgesic/NSAIDs, body alignment and muscle contractures (p<0.05 for all the comparisons T1 versus T0). In FMS patients, rehabilitation with BMP improves pain and well being, reduces the number of tender points and muscle contractures, thus it is useful in FMS management.

[Chronic Pelvic Pain Syndrome and Personality--Association of Somatic Symptoms and Psychic Structure].

PubMed

Albrecht, Rebecca; Löwe, Bernd; A Brünahl, Christian; Riegel, Björn

2015-11-01

Despite its high prevalence, little is known about the aetiology and maintenance of Chronic Pelvic Pain Syndrome (CPPS). CPPS is is considered to be a multi-causal syndrome with discomfort and pain in the pelvis. Recent literature suggests that psychosocial factors are important for understanding CPPS. For example, CPPS has been associated with deficits in mentalization and bonding experiences. Our study aims to characterize features of personality disorders according to DSM-IV and psychic structure according to OPD-2 in CPPS patients. Furthermore, we examine the association of personality aspects with urological symptoms (NIH Questionnaire) and pain perception (MPQ Questionnaire). Personality aspects were assessed in a total of 109 patients from our CPPS outpatient clinic using standardized questionnaires. To characterize CPPS patients, we compared the sample's scores with reference groups, mostly the general population. In addition, the associations between personality aspects and both the urologic symptoms and pain perception were assessed using correlations. Missing data were replaced using multiple imputation methods. Compared to reference values, we found 'experiencing emotions' and 'creating relationships' as specific deficits in CPPS patients. Furthermore, patients' self-image (more dominant, higher depressive mood) differs from the general population. A higher pain perception was correlated with deficits in most personality aspects we measured. However, this was not the case for the severity of urological symptoms. Compared to the reference values, only a few personality aspects differed in CPPS patients but there was a correlational association between different personality traits and pain perception. Despite the extend of symptoms, pain perception is associated with difficulty (emotional ability) in dealing with emotions, self-management and relationships. These personality aspects should be taken into account when planning therapy. © Georg Thieme Verlag KG Stuttgart · New York.

Effect of pulsed electromagnetic field therapy on experimental pain: A double-blind, randomized study in healthy young adults.

PubMed

Beaulieu, Karen; Beland, Patricia; Pinard, Marilee; Handfield, Guilène; Handfield, Nicole; Goffaux, Philippe; Corriveau, Hélène; Léonard, Guillaume

2016-01-01

Previous studies suggested that pulsed electromagnetic field (PEMF) therapy can decrease pain. To date, however, it remains difficult to determine whether the analgesic effect observed in patients are attributable to a direct effect of PEMF on pain or to an indirect effect of PEMF on inflammation and healing. In the present study, we used an experimental pain paradigm to evaluate the direct effect of PEMF on pain intensity, pain unpleasantness, and temporal summation of pain. Twenty-four healthy subjects (mean age 22 ± 2 years; 9 males) participated in the experiment. Both real and sham PEMF were administered to every participant using a randomized, double-blind, cross-over design. For each visit, PEMF was applied for 10 minutes on the right forearm using a portable device. Experimental pain was evoked before (baseline) and after PEMF with a 9 cm(2) Pelletier-type thermode, applied on the right forearm (120 s stimulation; temperature individually adjusted to produce moderate baseline pain). Pain intensity and unpleasantness were evaluated using a 0-100 numerical pain rating scale. Temporal summation was evaluated by comparing pain intensity ratings obtained at the end of tonic nociceptive stimulation (120 s) with pain intensity ratings obtained after 60 s of stimulation. When compared to baseline, there was no change in pain intensity and unpleasantness following the application of real or sham PEMF. PEMF did not affect temporal summation. The present observations suggest that PEMF does not directly influence heat pain perception in healthy individuals.

Why Neck Pain Patients Are Not Referred to Manual Therapy: A Qualitative Study among Dutch Primary Care Stakeholders

PubMed Central

Dikkers, Marije F.; Westerman, Marjan J.; Rubinstein, Sidney M.; van Tulder, Maurits W.; Anema, Johannes R.

2016-01-01

Background Treatment of neck pain with manual therapy demonstrated to be more effective and cost-effective than general practitioner (GP) care or physiotherapy in a high quality RCT in the Netherlands in 2002. However, referral to manual therapy for neck pain is still relatively low. This study aims to explore the barriers and facilitators affecting the implementation of manual therapy in neck pain management in primary care. Methods An explorative study was conducted comprising semi-structured interviews with GPs (n = 13), physiotherapists (n = 10), manual therapists (n = 7) and their patients with neck pain (n = 27), and three focus groups with additional stakeholders (n = 10–12 per group). A thematic analysis approach was used. Results Different barriers and facilitators for referral were found for patients, GPs and physiotherapists on the individual level, but also in the interaction between stakeholders and their context. Individual perceptions such as knowledge and beliefs about manual therapy for neck pain either impeded or facilitated referral. Fear for complications associated with cervical manipulation was an important barrier for patients as well as GPs. For GPs and physiotherapists it was important whether they perceived it was part of their professional role to refer for manual therapy. Existing relations formed referral behavior, and the trust in a particular practitioner was a recurrent theme among GPs and physiotherapist as well as patients. The contextual factor availability of manual therapy played a role for all stakeholders. Conclusions Barriers and facilitators were found especially in individual perceptions on manual therapy for neck pain (e.g. knowledge and beliefs), the interaction between stakeholders (e.g. collaboration and trust) and the organizational context. Implementation strategies that focus on these different aspects seem to be likely to optimize referral rates and the use of manual therapy in primary care management of neck pain. PMID:27311067

"I've Actually Changed How I Live"-Patients' Long-Term Perceptions of a Cognitive Behavioral Pain Management Program.

PubMed

Egan, Aine; Lennon, Olive; Power, Camillus K; Fullen, Brona M

2017-02-01

To determine patients’ perceptions regarding cognitive behavioral pain management programs, and to determine what, if any, strategies learned on the program patients continue to use long-term to manage their pain. A qualitative, focus-group based study. An outpatient multidisciplinary pain management program in a university teaching hospital. Patients with chronic pain who had previously completed a 4-week cognitive behavioral pain management program (2001–2014). Sixteen patients attended one of four focus groups. A battery of semi-structured questions explored their perceptions of the cognitive behavioral program, and which strategies they found useful and continued to use long-term to manage their pain. Six key themes emerged: 1) universal long-term positive feedback on the utility of the program; 2) the program facilitated long-term changes in daily life; 3) participants now considered themselves as the “new me”; 4) request for more updates on emerging new treatments/pain knowledge; 5) recognizing that the key to maximizing gain from the program was to be open, to listen, and accept; and 6) participants sharing pain management knowledge with others in pain. There was universal positive feedback for the pain management program. Despite the years since they participated in one, patients continue to use key strategies to effectively manage their pain (pacing, relaxation), embedding them in their daily lives to maximize their quality of life.

Reductions in Perceived Injustice are Associated With Reductions in Disability and Depressive Symptoms After Total Knee Arthroplasty.

PubMed

Yakobov, Esther; Scott, Whitney; Stanish, William D; Tanzer, Michael; Dunbar, Michael; Richardson, Glen; Sullivan, Michael J L

2018-05-01

Perceptions of injustice have been associated with problematic recovery outcomes in individuals with a wide range of debilitating pain conditions. It has been suggested that, in patients with chronic pain, perceptions of injustice might arise in response to experiences characterized by illness-related pain severity, depressive symptoms, and disability. If symptoms severity and disability are important contributors to perceived injustice (PI), it follows that interventions that yield reductions in symptom severity and disability should also contribute to reductions in perceptions of injustice. The present study examined the relative contributions of postsurgical reductions in pain severity, depressive symptoms, and disability to the prediction of reductions in perceptions of injustice. The study sample consisted of 110 individuals (69 women and 41 men) with osteoarthritis of the knee scheduled for total knee arthroplasty (TKA). Patients completed measures of perceived injustice, depressive symptoms, pain, and disability at their presurgical evaluation, and at 1-year follow-up. The results revealed that reductions in depressive symptoms and disability, but not pain severity, were correlated with reductions in perceived injustice. Regression analyses revealed that reductions in disability and reductions in depressive symptoms contributed modest but significant unique variance to the prediction of postsurgical reductions in perceived injustice. The present findings are consistent with current conceptualizations of injustice appraisals that propose a central role for symptom severity and disability as determinants of perceptions of injustice in patients with persistent pain. The results suggest that the inclusion of psychosocial interventions that target depressive symptoms and perceived injustice might augment the impact of rehabilitation programs made available for individuals recovering from TKA.

What we know about primary dysmenorrhea today: a critical review.

PubMed

Iacovides, Stella; Avidon, Ingrid; Baker, Fiona C

2015-01-01

Primary dysmenorrhea, or painful menstruation in the absence of pelvic pathology, is a common, and often debilitating, gynecological condition that affects between 45 and 95% of menstruating women. Despite the high prevalence, dysmenorrhea is often poorly treated, and even disregarded, by health professionals, pain researchers, and the women themselves, who may accept it as a normal part of the menstrual cycle. This review reports on current knowledge, particularly with regards to the impact and consequences of recurrent menstrual pain on pain sensitivity, mood, quality of life and sleep in women with primary dysmenorrhea. Comprehensive literature searches on primary dysmenorrhea were performed using the electronic databases PubMed, Google Scholar and the Cochrane Library. Full-text manuscripts published between the years 1944 and 2015 were reviewed for relevancy and reference lists were cross-checked for additional relevant studies. In combination with the word 'dysmenorrhea' one or more of the following search terms were used to obtain articles published in peer-reviewed journals only: pain, risk factors, etiology, experimental pain, clinical pain, adenomyosis, chronic pain, women, menstrual cycle, hyperalgesia, pain threshold, pain tolerance, pain sensitivity, pain reactivity, pain perception, central sensitization, quality of life, sleep, treatment, non-steroidal anti-inflammatory drugs. Women with dysmenorrhea, compared with women without dysmenorrhea, have greater sensitivity to experimental pain both within and outside areas of referred menstrual pain. Importantly, the enhanced pain sensitivity is evident even in phases of the menstrual cycle when women are not experiencing menstrual pain, illustrating that long-term differences in pain perception extend outside of the painful menstruation phase. This enhanced pain sensitivity may increase susceptibility to other chronic pain conditions in later life; dysmenorrhea is a risk factor for fibromyalgia. Further, dysmenorrheic pain has an immediate negative impact on quality of life, for up to a few days every month. Women with primary dysmenorrhea have a significantly reduced quality of life, poorer mood and poorer sleep quality during menstruation compared with their pain-free follicular phase, and compared with the menstruation phase of pain-free control women. The prescribed first-line therapy for menstrual pain remains non-steroidal anti-inflammatory drugs, which are effective in relieving daytime and night-time pain. Further study is needed to determine whether effectively blocking dysmenorrheic pain ameliorates risk for the development of chronic pain disorders and to explore whether it is possible to prevent the development-and not just treat-severe dysmenorrheic pain in adolescent girls. In conclusion, we demonstrate the extensive multi-factorial impact of dysmenorrhea and we encourage and direct researchers to necessary future studies. © The Author 2015. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Attenuation of pCREB and Egr1 expression in the insular and anterior cingulate cortices associated with enhancement of CFA-evoked mechanical hypersensitivity after repeated forced swim stress.

PubMed

Imbe, Hiroki; Kimura, Akihisa

2017-09-01

The perception and response to pain are severely impacted by exposure to stressors. In some animal models, stress increases pain sensitivity, which is termed stress-induced hyperalgesia (SIH). The insular cortex (IC) and anterior cingulate cortex (ACC), which are typically activated by noxious stimuli, affect pain perception through the descending pain modulatory system. In the present study, we examined the expression of phospho-cAMP response element-binding protein (pCREB) and early growth response 1 (Egr1) in the IC and ACC at 3h (the acute phase of peripheral tissue inflammation) after complete Freund's adjuvant (CFA) injection in naïve rats and rats preconditioned with forced swim stress (FS) to clarify the effect of FS, a stressor, on cortical cell activities in the rats showing SIH induced by FS. The CFA injection into the hindpaw induced mechanical hypersensitivity and increased the expression of the pCREB and Egr1 in the IC and ACC at 3h after the injection. FS (day 1, 10min; days 2-3, 20min) prior to the CFA injection enhanced the CFA-induced mechanical hypersensitivity and attenuated the increase in the expression of pCREB and Egr1 in the IC and ACC. These findings suggested that FS modulates the CFA injection-induced neuroplasticity in the IC and ACC to enhance the mechanical hypersensitivity. These findings are thought to signify stressor-induced dysfunction of the descending pain modulatory system. Copyright © 2017 Elsevier Inc. All rights reserved.

Nursing ward managers' perceptions of pain prevalence at the aged-care facilities in Japan: a nationwide survey.

PubMed

Takai, Yukari; Yamamoto-Mitani, Noriko; Fukahori, Hiroki; Kobayashi, Sayuri; Chiba, Yumi

2013-09-01

This study aimed to examine nursing ward managers' perceptions of pain prevalence among older residents and the strategies of pain management at the Health Service Facilities for the Elderly Requiring Care (HSFERC) in Japan and to investigate the factors related to the prevalence. Nursing ward managers in 3,644 HSFERC were asked to participate in this study. Questionnaires were sent to them regarding pain prevalence among the older residents in their wards, their provisions for pain care, and other pain management strategies. The perceived pain prevalence factors were examined statistically. The final sample comprised 439 participants (12.0%). A total of 5,219 residents (22.3%) were recognized as suffering from pain on the investigation day. Only 8 wards (1.8%) used pain management guidelines or care manuals, and 14 (3.2%) used a standardized pain scale. The ward managers' age (p = .008) and nursing experience (p = .006) showed a significant negative association with pain prevalence estimation. Moreover, there was a significant association between the groups' pain prevalence estimation and the nursing managers' beliefs that older adults were less sensitive to pain (p = .01), that pain was common among older people (p = .007), and that the time to treat residents' pain was insufficient (p = .001). The ward managers' perceptions regarding pain prevalence varied; the perceived pain rates were possibly lower than the actual percentages. Insufficient pain management strategies at the HSFERC were also suggested. An appropriate pain management strategy for Japanese aged care and its dissemination are urgently required. Copyright © 2013 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

"When I feel the worst pain, I look like shit" - body image concerns in persistent pain.

PubMed

Sündermann, Oliver; Rydberg, Karin; Linder, Ludwig; Linton, Steven James

2018-04-17

Persistent pain is a pervasive condition that is often associated with a distorted body image. Most research into pain and body image investigated neural or physiological correlates (e.g. phantom limb pain), and much less is known about the psychological experience of body image changes in response to pain such as appearance concerns. The aim was to examine body image concerns in people with persistent pain, in particular appearance concerns and related coping behaviours and appearance-related emotions such as anger and shame. Design was cross-sectional and data was collected through in-depth semi-structured interviews with people suffering from persistent musculoskeletal pain (n=7; six females; age=19-56), and analysed with inductive thematic analysis (TA). Two main themes were identified: "Relationship to the painful body" and "Dissatisfaction with the body", each containing three subthemes, along with the side-theme "Appearance concerns affected by pain and mood". All participants reported appearance concerns, predominantly about their weight and related coping behaviours such as avoidance of mirrors, exercising or dieting and pain-induced mood changes that were associated with a negative body image. People with persistent pain report appearance concerns, often related to pain-induced negative mood changes, and reduced functioning. It remains unclear to what extent attitudes towards the body change over time in accordance with pain. A wider concept of body image is required, including the perception of reduced functioning, related appraisals (e.g. "I look weak and old") and appearance investment.

Influence of structural integration and fascial fitness on body image and the perception of back pain.

PubMed

Baur, Heidi; Gatterer, Hannes; Hotter, Barbara; Kopp, Martin

2017-06-01

[Purpose] The aim of this study was to examine the influence of Structural Integration and Fascial Fitness, a new form of physical exercise, on body image and the perception of back pain. [Subjects and Methods] In total, 33 participants with non-specific back pain were split into two groups and performed three sessions of Structural Integration or Fascial Fitness within a 3-week period. Before and after the interventions, perception of back pain and body image were evaluated using standardized questionnaires. [Results] Structural Integration significantly decreased non-specified back pain and improved both "negative body image" and "vital body dynamics". Fascial Fitness led to a significant improvement on the "negative body image" subscale. Benefits of Structural Integration did not significantly vary in magnitude from those for fascial fitness. [Conclusion] Both Structural Integration and Fascial Fitness can lead to a more positive body image after only three sessions. Moreover, the therapeutic technique of Structural Integration can reduce back pain.

Aberrant pain perception in direct and indirect non-suicidal self-injury: an empirical test of Joiner's interpersonal theory.

PubMed

St Germain, Sarah A; Hooley, Jill M

2013-08-01

Using a community sample (N=148) we examined pressure pain perception in 3 study groups--people who engaged in non-suicidal self-injury, people who engaged in indirect forms of self-injury, and non-self-injuring controls. In so doing we tested hypotheses derived from Joiner's (2005) interpersonal theory of suicide. Consistent with previous studies and with Joiner's model, people who engaged in NSSI endured pain for significantly longer than non-self-injuring controls. Importantly, pain endurance in the Indirect self-injury group was comparable to that found in the NSSI group and significantly elevated relative to controls. This pattern of results suggests that abnormal pain perception may not be specific to forms of self-injury (e.g., NSSI) that involve immediate physical pain (e.g., cutting). Our findings further suggest that the concept of acquired capability for suicide might have relevance for both direct and indirect forms of self-injurious behavior. Copyright © 2013 Elsevier Inc. All rights reserved.

Which symptoms contribute the most to patients' perception of health in multiple sclerosis?

PubMed

Green, Rivka; Cutter, Gary; Friendly, Michael; Kister, Ilya

2017-01-01

Multiple sclerosis is a polysymptomatic disease. Little is known about relative contributions of the different multiple sclerosis symptoms to self-perception of health. To investigate the relationship between symptom severity in 11 domains affected by multiple sclerosis and self-rated health. Multiple sclerosis patients in two multiple sclerosis centers assessed self-rated health with a validated instrument and symptom burden with symptoMScreen, a validated battery of Likert scales for 11 domains commonly affected by multiple sclerosis. Pearson correlations and multivariate linear regressions were used to investigate the relationship between symptoMScreen scores and self-rated health. Among 1865 multiple sclerosis outpatients (68% women, 78% with relapsing-remitting multiple sclerosis, mean age 46.38 ± 12.47 years, disease duration 13.43 ± 10.04 years), average self-rated health score was 2.30 ('moderate to good'). Symptom burden (composite symptoMScreen score) highly correlated with self-rated health ( r  = 0.68, P  < 0.0001) as did each of the symptoMScreen domain subscores. In regression analysis, pain ( t  = 7.00), ambulation ( t  = 6.91), and fatigue ( t  = 5.85) contributed the highest amount of variance in self-rated health ( P  < 0.001). Pain contributed the most to multiple sclerosis outpatients' perception of health, followed by gait dysfunction and fatigue. These findings suggest that 'invisible disability' may be more important to patients' sense of wellbeing than physical disability, and challenge the notion that physical disability should be the primary outcome measure in multiple sclerosis.

Barriers to Using Nonpharmacologic Approaches and Reducing Opioid Use in Primary Care.

PubMed

Giannitrapani, Karleen F; Ahluwalia, Sangeeta C; McCaa, Matthew; Pisciotta, Maura; Dobscha, Steven; Lorenz, Karl A

2017-10-20

Opioid prescribing for chronic pain, including the potential for over-reliance and misuse, is a public health concern. In the context of Veterans Administration (VA) primary care team-based pain management, we aimed to understand providers' perceptions of barriers to reducing opioid use and improving the use of nonpharmacologic pain management therapies (NPTs) for chronic pain. A semistructured interview elucidated provider experiences with assessing and managing pain. Emergent themes were mapped to known dimensions of VA primary care access. Informants included 60 primary care providers, registered nurses, licensed practical nurses, clerks, psychologists, and social workers at two VA Medical Centers. Nine multidisciplinary focus groups. Provider perceptions of barriers to reducing opioids and improving use of NPTs for patients with chronic pain clustered around availability and access. Barriers to NPT access included the following subthemes: geographical (patient distance from service), financial (out-of-pocket cost to patient), temporal (treatment time delays), cultural (belief that NPTs increased provider workload, perception of insufficient training on NPTs, perceptions of patient resistance to change, confrontation avoidance, and insufficient leadership support), and digital (measure used for pain assessment, older patients hesitant to use technology, providers overwhelmed by information). Decreasing reliance on opioids for chronic pain requires a commitment to local availability and provider-facing strategies that increase efficacy in prescribing NPTs. Policies and interventions for decreasing utilization of opioids and increasing use of NPTs should comprehensively consider access barriers. 2017 American Academy of Pain Medicine. This work is written by US Government employees and is in the public domain in the US.

The Impact of Patient-to-Patient Interaction in Health Facility Waiting Rooms on Their Perception of Health Professionals.

PubMed

Willis, William Kent; Ozturk, Ahmet Ozzie; Chandra, Ashish

2015-01-01

Patients have to wait in waiting rooms prior to seeing the physician. But there are few studies that demonstrate what they are actually doing in the waiting room. This exploratory study was designed to investigate the types of discussions that patients in the waiting room typically engage in with other patients and how the conversations affected their opinion on general reputation of the clinic, injections/blocks as treatment procedures, waiting time, time spent with the caregiver, overall patient satisfaction, and the pain medication usage policy. The study demonstrates that patient interaction in the waiting room has a positive effect on patient opinion of the pain clinic and the caregivers.

Pain perception and nonsuicidal self-injury: a laboratory investigation.

PubMed

Hooley, Jill M; Ho, Doreen T; Slater, Joshua; Lockshin, Amanda

2010-07-01

People who engage in self-injurious behaviors such as cutting and burning may have altered pain perception. Using a community sample, we examined group differences in pain threshold and pain endurance between participants who self-injured and control participants who were exposed to pressure pain applied to the finger. Participants who self-injured had higher pain thresholds (time to report pain) and endured pain for longer than control participants. Among participants who self-injured, those with longer histories of self-injury had higher pain thresholds. Duration of self-injury was unrelated to pain endurance. Instead, greater pain endurance was predicted by higher levels of introversion and neuroticism and by more negative beliefs about one's self-worth. A highly self-critical cognitive style was the strongest predictor of prolonged pain endurance. People who self-injure may regard suffering and pain as something that they deserve. Our findings also have implications for understanding factors that might be involved in the development and maintenance of self-injury. PsycINFO Database Record (c) 2010 APA, all rights reserved

Negative mood influences default mode network functional connectivity in patients with chronic low back pain: implications for functional neuroimaging biomarkers.

PubMed

Letzen, Janelle E; Robinson, Michael E

2017-01-01

The default mode network (DMN) has been proposed as a biomarker for several chronic pain conditions. Default mode network functional connectivity (FC) is typically examined during resting-state functional neuroimaging, in which participants are instructed to let thoughts wander. However, factors at the time of data collection (eg, negative mood) that might systematically impact pain perception and its brain activity, influencing the application of the DMN as a pain biomarker, are rarely reported. This study measured whether positive and negative moods altered DMN FC patterns in patients with chronic low back pain (CLBP), specifically focusing on negative mood because of its clinical relevance. Thirty-three participants (CLBP = 17) underwent resting-state functional magnetic resonance imaging scanning before and after sad and happy mood inductions, and rated levels of mood and pain intensity at the time of scanning. Two-way repeated-measures analysis of variances were conducted on resting-state functional connectivity data. Significant group (CLBP > healthy controls) × condition (sadness > baseline) interaction effects were identified in clusters spanning parietal operculum/postcentral gyrus, insular cortices, anterior cingulate cortex, frontal pole, and a portion of the cerebellum (PFDR < 0.05). However, only 1 significant cluster covering a portion of the cerebellum was identified examining a two-way repeated-measures analysis of variance for happiness > baseline (PFDR < 0.05). Overall, these findings suggest that DMN FC is affected by negative mood in individuals with and without CLBP. It is possible that DMN FC seen in patients with chronic pain is related to an affective dimension of pain, which is important to consider in future neuroimaging biomarker development and implementation.

Negative mood influences default mode network functional connectivity in chronic low back pain patients: Implications for functional neuroimaging biomarkers

PubMed Central

Letzen, Janelle E.; Robinson, Michael E.

2016-01-01

The default mode network (DMN) has been proposed as a biomarker for several chronic pain conditions. DMN functional connectivity (fcMRI) is typically examined during resting-state fMRI, in which participants are instructed to let thoughts wander. However, factors at the time of data collection (e.g., negative mood) that might systematically impact pain perception and its brain activity, influencing the application of the DMN as a pain biomarker, are rarely reported. The present study measured whether positive and negative moods altered DMN fcMRI patterns in chronic low back pain (CLBP) patients, specifically focusing on negative mood due to its clinical-relevance. Thirty-three participants (CLBP = 17) underwent resting-state fMRI scanning before and after sad and happy mood inductions, and rated levels of mood and pain intensity at the time of scanning. Two-way repeated measures ANOVAs were conducted on resting-state functional connectivity data. Significant group (CLBP > HC) X condition (sadness > baseline) interaction effects were identified in clusters spanning parietal operculum/postcentral gyrus, insular cortices, anterior cingulate cortex, frontal pole, and a portion of the cerebellum (pFDR < .05). However, only one significant cluster covering a portion of the cerebellum was identified examining a two-way repeated measures ANOVA for happiness > baseline (pFDR < .05). Overall, these findings suggest that DMN fcMRI is affected by negative mood in individuals with and without CLBP. It is possible that DMN fcMRI seen in chronic pain patients is related to an affective dimension of pain, which is important to consider in future neuroimaging biomarker development and implementation. PMID:27583568

Identification of Indirect Effects in a Cognitive Patient Education (COPE) Intervention for Low Back Pain.

PubMed

Mansell, Gemma; Storheim, Kjersti; Løchting, Ida; Werner, Erik L; Grotle, Margreth

2017-12-01

Many interventions for the treatment of low back pain exist, but the mechanisms through which such treatments work are not always clear. This situation is especially true for biopsychosocial interventions that incorporate several different components and methods of delivery. The study objective was to examine the indirect effects of the Cognitive Patient Education (COPE) intervention via illness perceptions, back pain myths, and pain catastrophizing on disability outcome. This study was a secondary analysis of the COPE randomized controlled trial. Mediation analysis techniques were employed to examine the indirect effects of the COPE intervention via residualized change (baseline - posttreatment) in the 3 variables hypothesized to be targeted by the COPE intervention on posttreatment disability outcome. Pain intensity at baseline, pain duration, clinician type, and a treatment-mediator interaction term were controlled for in the analysis. Preliminary analyses confirmed that changes in pain catastrophizing and illness perceptions (not back pain myths) were related to both allocation to the intervention arm and posttreatment disability score. The treatment exerted statistically significant indirect effects via changes in illness perceptions and pain catastrophizing on posttreatment disability score (illness perceptions standardized indirect effect = 0.09 [95% CI = 0.03 to 0.16]; pain catastrophizing standardized indirect effect = 0.05 [95% CI = 0.01 to 0.12]). However, the inclusion of an interaction term led to the indirect effects being significantly reduced, with the effects no longer being statistically significant. This study presents a secondary analysis of variables not identified a priori as being potentially important treatment targets; other, unmeasured factors could also be important in explaining treatment effects. The finding that small indirect effects of the COPE intervention via changes in illness perceptions and pain catastrophizing on posttreatment disability could be estimated indicates that these variables may be viable treatment targets for biopsychosocial interventions; however, this finding must be viewed in light of the adjusted analyses, which showed that the indirect effects were significantly reduced through the inclusion of a treatment-mediator interaction term. © Crown copyright 2015

Laterality of pain: modulation by placebo and participants' paranormal belief.

PubMed

Klemenz, Caroline; Regard, Marianne; Brugger, Peter; Emch, Oliver

2009-09-01

To investigate the effects of placebo and paranormal belief on the laterality of pain perception. The right hemisphere is dominantly involved in both the mediation of pain sensation and the belief in paranormal phenomena. We set out to assess a possible influence of long-term belief systems on placebo analgesia in response to unilateral nociceptive stimuli. Forty healthy participants (20 high and 20 low believers as indexed by the Magical Ideation Scale) underwent a placebo analgesia study measuring stimulus detection, pain threshold, and pain tolerance by electrostimulation on the right and left hand. Placebo treatment consisted of the application of a sham cream on the hands. Placebo had a positive influence on pain perception in the 3 variables. Enhanced pain sensitivity for the left side was only found for the disbelievers. Placebo treatment resulted in a double dissociation: in believers, it increased tolerance exclusively on the left side, in disbelievers on the right side. Our results confirm laterality effects in pain perception. However, only disbelievers conformed to the expected higher left-sided sensitivity. Placebo effects were dissociated between believers and disbelievers suggesting that short-term reactions to a placebo are modulated by a person's long-term belief system.

Patient's pain perception during mandibular molar extraction with articaine: a comparison study between infiltration and inferior alveolar nerve block.

PubMed

Bataineh, Anwar B; Alwarafi, Majid A

2016-11-01

The aim of this study was to investigate the effectiveness of a local anesthetic agent comprising of 4 % articaine with 1:100,000 adrenaline, administered through an infiltration technique prior to the extraction of mandibular permanent first molar teeth. The study adopted a split mouth approach and involved patients who needed simple extractions of permanent mandibular first molar teeth on both sides. A combination of buccal and lingual infiltrations was used on one side, while the conventional inferior alveolar nerve block (IANB) technique, with a 1.8-ml cartridge of 4 % articaine with 1:100,000 epinephrine, was administered to the other. The patients' pain perception was assessed using visual analogue scale (VAS) and verbal rating scale (VRS) after the injection, followed by extraction. As a part of the study, 104 teeth were extracted from mouths of 52 patients. The difference in pain perception was statistically insignificant (p > .05) regarding the local anesthetic injection between the two techniques. The difference in pain perception regarding the extraction between the two techniques was also statistically insignificant (p < .05). No difference in pain perception between the two techniques among the study population was noted. This indicates that the extraction of permanent mandibular first molar teeth is possible without the administration of an IANB with the use of 4 % articaine with 1:100,000 epinephrine. The buccal and lingual infiltrations are slightly less painful than the conventional IANB technique.

Digit ratio (2D:4D) and postoperative pain perception.

PubMed

Kasielska-Trojan, Anna; Stabryła, Piotr; Antoszewski, Bogusław

2017-07-01

It has not been established whether sex differences in pain perception are influenced by prenatal sex hormones. Digit ratio as an indicator of prenatal hormone exposure can be used as a simple measure of the influence of prenatal hormones on pain sensitivity or perception in adulthood. The aim of this study was to determine a correlation between the 2D:4D ratio and pain perception in the postoperative period after rhinoplasty. A prospective cohort study of 100 patients (50 women of the mean age of 30.74±8.09years and 50 men of the mean age of 30.98±10.86years) who underwent posttraumatic rhinoplasty due to the nose trauma in Plastic, Reconstructive and Aesthetic Surgery Clinic. The following measurements were taken the day before a surgery: body height, waist and hip circumference, II and IV digits' lengths and body weight. All subjects filled in a questionnaire including 0-10-point VAS scales to assess postoperative pain 1h after an operation (AO), 6h AO, 12h AO, 24h AO and 48h AO. Women with low 2D:4D reported significantly more pain 1h after an operation than women with high 2D:4D. Similar correlation was observed for low 2D:4D in women 48h AO. In men, low 2D:4D was associated with lower postoperative pain 12h AO (p=0.029). In conclusion, we showed that low 2D:4D in women was associated with high postoperative pain, and low right 2D:4D in men was associated with low postoperative pain. This may suggest that intrauterine estrogen exposure makes women more resistant to pain. Copyright © 2017 Elsevier B.V. All rights reserved.

Disturbed body perception, reduced sleep, and kinesiophobia in subjects with pregnancy-related persistent lumbopelvic pain and moderate levels of disability: An exploratory study.

PubMed

Beales, Darren; Lutz, Alison; Thompson, Judith; Wand, Benedict Martin; O'Sullivan, Peter

2016-02-01

For a small but significant group, pregnancy-related lumbopelvic pain may become persistent. While multiple factors may contribute to disability in this group, previous studies have not investigated sleep impairments, body perception or mindfulness as potential factors associated with disability post-partum. To compare women experiencing no pain post-pregnancy with those experiencing pregnancy-related persistent lumbopelvic pain (either low- or high-level disability) across multiple biopsychosocial domains. Cross-sectional. Participants completed questionnaires for thorough profiling of factors thought to be important in pregnancy-related lumbopelvic pain. Specific measures were the Urinary Distress Inventory, Medical Outcomes Study Sleep Scale, Back Beliefs Questionnaire, Tampa Scale for Kinesiophobia, Depression Anxiety Stress Scale, Coping Strategies Questionnaire, Pain Catastrophising Scale, The Fremantle Back Awareness Questionnaire and the Mindful Attention Awareness Scale. Women where categorised into three groups; pain free (n = 26), mild disability (n = 12) and moderate disability (n = 12) (based on Oswestry Disability Index scores). Non-parametric group comparisons were used to compare groups across the profiling variables. Differences were identified for kinesiophobia (p = 0.03), body perception (p = 0.02), sleep quantity (p < 0.01) and sleep adequacy (p = 0.02). Generally subjects in the moderate disability group had more negative findings for these variables. Disturbances in body-perception, sleep and elevated kinesiophobia were found in pregnancy-related lumbopelvic pain subjects with moderate disability, factors previously linked to persistent low back pain. The cross-sectional nature of this study does not allow for identification of directional pathways between factors. The results support the consideration of these factors in the assessment and management of pregnancy-related lumbopelvic pain. Copyright © 2015 Elsevier Ltd. All rights reserved.

Emotional foundations of music as a non-pharmacological pain management tool in modern medicine.

PubMed

Bernatzky, Guenther; Presch, Michaela; Anderson, Mary; Panksepp, Jaak

2011-10-01

This paper reviews the use of music as an adjuvant to the control of pain, especially in medical procedures. Surgery causes stress and anxiety that exacerbates the experience of pain. Self-report of and physiological measures on post-surgical patients indicate that music therapy or music stimulation reduces the perception of pain, both alone and when part of a multimodal pain management program, and can reduce the need for pharmaceutical interventions. However, multimodal pain therapy, including non-pharmacological interventions after surgery, is still rare in medical practice. We summarize how music can enhance medical therapies and can be used as an adjuvant with other pain-management programs to increase the effectiveness of those therapies. As summarized, we currently know that musical pieces chosen by the patient are commonly, but not always, more effective than pieces chosen by another person. Further research should focus both on finding the specific indications and contra-indications of music therapy and on the biological and neurological pathways responsible for those findings (related evidence has implicated brain opioid and oxytocin mechanisms in affective changes evoked by music). In turn, these findings will allow medical investigators and practitioners to design guidelines and reliable, standardized applications for this promising method of pain management in modern medicine. Copyright © 2011 Elsevier Ltd. All rights reserved.

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

2015-09-29

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.

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

Pain and suffering: a legal and medical lexicon for the 21st century.

PubMed

Hirshberg, Richard M

2012-09-01

Defining "suffering and pain" from both legal and medical perspectives is essential in understanding how misinterpretations, confusion and misconceptions can occur through "impressions" of events by uninvolved observers of these basic human sensations. Subjective interpretations of an individual's pain/narrative by professionals can lead to collisions in the courtroom and be a cause for clinical ambivalence in the physician's office. The phenomenon of cognitive, affective experiences with acute, chronic, and emotional pain and its association with "suffering" will be discussed. Contemporary experimental results in neuroscience and advances in clinical medical research attempting to explain how varied expressions of pain in man may have evolved, can be more carefully evaluated, and possibly visualized and measured, will be reviewed. The neurobiological impact of empathy and compassion derived from an individual's narrative and self-reporting of pain and suffering upon the psyches of physicians, juries and otherwise dispassionate observers will be discussed. The purpose of this discussion is to emphasize the importance of considering the complexities embodied in any decision-making process, legal or medical, involving the phenomenon of human perceptions and responses to pain. The data discussed are based on a comprehensive search and review of past and current pertinent literature attempting to explain and decipher man's expressions of pain and suffering in its legal, societal, clinical and scientific ramifications.

Dairy cows change locomotion score and sensitivity to pain with trimming and infectious or non-infectious lesions.

PubMed

Passos, L T; Cruz, E A da; Fischer, V; Porciuncula, G C da; Werncke, D; Dalto, A G C; Stumpf, M T; Vizzotto, E F; da Silveira, I D B

2017-04-01

Lameness can negatively affect production, but there is still controversy about the perception of pain in dairy cows. This study aimed to verify the effects of hoof affections in dairy cows on locomotion score, physiological attributes, pressure nociceptive threshold, and thermographic variables, as well as assess improvement on these variables after corrective trimming and treatment. Thirty-four lame lactating cows were gait-scored, and all cows with locomotion score ≥4 were retained for this study 1 day before trimming. Lame cows were diagnosed, pressure nociceptive threshold at sound, and affected hooves were measured, thermographic images were recorded, and physiological attributes were evaluated. Hooves with lesions were trimmed and treated and cows were re-evaluated 1 week after such procedures. The experimental design was a completely randomized design. Each cow was considered an experimental unit and traits were analyzed using paired t test, linear correlation, and linear regression. Digital and interdigital dermatitis were classified as infectious diseases while laminitis sequels, sole ulcers, and white line were classified as non-infectious diseases. After 1 week, the locomotion score was reduced on average in 1.5 points. Trimming increased the pressure nociceptive threshold for cows with non-infectious affections while tended to increase the pressure nociceptive threshold for cows with infectious affections. Physiological attributes and thermographic values did not change with trimming. Trimming and treatment have benefic effects on animal welfare as gait is improved and sensitivity to pain is reduced.

Woman and partner-perceived partner responses predict pain and sexual satisfaction in provoked vestibulodynia (PVD) couples.

PubMed

Rosen, Natalie O; Bergeron, Sophie; Leclerc, Bianca; Lambert, Bernard; Steben, Marc

2010-11-01

Provoked vestibulodynia (PVD) is a highly prevalent vulvovaginal pain condition that results in significant sexual dysfunction, psychological distress, and reduced quality of life. Although some intra-individual psychological factors have been associated with PVD, studies to date have neglected the interpersonal context of this condition. We examined whether partner responses to women's pain experience-from the perspective of both the woman and her partner-are associated with pain intensity, sexual function, and sexual satisfaction. One hundred ninety-one couples (M age for women=33.28, standard deviation [SD]=12.07, M age for men=35.79, SD=12.44) in which the woman suffered from PVD completed the spouse response scale of the Multidimensional Pain Inventory, assessing perceptions of partners' responses to the pain. Women with PVD also completed measures of pain, sexual function, sexual satisfaction, depression, and dyadic adjustment. Dependent measures were women's responses to: (i) a horizontal analog scale assessing the intensity of their pain during intercourse; (ii) the Female Sexual Function Index; and (iii) the Global Measure of Sexual Satisfaction Scale. Controlling for depression, higher solicitous partner responses were associated with higher levels of women's vulvovaginal pain intensity. This association was significant for partner-perceived responses (β=0.29, P<0.001) and for woman-perceived partner responses (β=0.16, P=0.04). After controlling for sexual function and dyadic adjustment, woman-perceived greater solicitous partner responses (β=0.16, P=0.02) predicted greater sexual satisfaction. Partner-perceived responses did not predict women's sexual satisfaction. Partner responses were not associated with women's sexual function. Findings support the integration of dyadic processes in the conceptualization and treatment of PVD by suggesting that partner responses to pain affect pain intensity and sexual satisfaction in affected women. © 2010 International Society for Sexual Medicine.

Ethnicity and OPRM variant independently predict pain perception and patient-controlled analgesia usage for post-operative pain.

PubMed

Tan, Ene-choo; Lim, Eileen C P; Teo, Yik-ying; Lim, Yvonne; Law, Hai-yang; Sia, Alex T

2009-06-23

Morphine consumption can vary widely between individuals even for identical surgical procedures. As mu-opioid receptor (OPRM1) is known to modulate pain perception and mediate the analgesic effects of opioid compounds in the central nervous system, we examined the influence of two OPRM polymorphisms on acute post-operative pain and morphine usage in women undergoing elective caesarean delivery. Data on self-reported pain scores and amount of total morphine use according to patient-controlled analgesia were collected from 994 women from the three main ethnic groups in Singapore. We found statistically significant association of the OPRM 118A>G with self-administered morphine during the first 24-hour postoperative period both in terms of total morphine (p = 1.7 x 10(-5)) and weight-adjusted morphine (p = 6.6 x 10(-5)). There was also significant association of this OPRM variant and time-averaged self-rated pain scores (p = 0.024). OPRM 118G homozygotes used more morphine and reported higher pain scores than 118A carriers. Other factors which influenced pain score and morphine usage include ethnicity, age and paying class. Our results suggest that ethnicity and OPRM 118A>G genotype are independent and significant contributors to variation in pain perception and postoperative morphine use in patients undergoing cesarean delivery.

Effects of psychological state on pain perception in the dental environment.

PubMed

Loggia, Marco L; Schweinhardt, Petra; Villemure, Chantal; Bushnell, M Catherine

2008-09-01

Psychological factors have an important influence on pain perception. Both in the clinic and in experimental settings, distraction has been shown to reduce pain. Further, negative emotions increase pain, whereas positive emotions have the opposite effect. Other more complex psychological states alter the way we feel pain. For instance, empathy for another person who is suffering increases our own pain experience, and expectation of pain relief underlies much of the placebo effect. Neuroimaging studies show a physiological basis for psychological pain modulation, with activity in pain pathways altered by attentional state, positive and negative emotions, empathy and the administration of a placebo. The same psychological factors activate intrinsic modulatory systems in the brain, including those stimulated when opiates are given for pain relief. It is important for the dentist and patients to understand the influence of psychological state on pain transmission. Such an understanding will not only help patients learn how to participate in their own pain control, but will also help the clinician create a fostering environment.

Intensity, perception, and descriptive characteristics of chronic pain in children with cerebral palsy.

PubMed

Houlihan, Christine M; Hanson, Amber; Quinlan, Nicole; Puryear, Carol; Stevenson, Richard D

2008-01-01

Children with cerebral palsy (CP) experience bodily pain, leading to functional impairment and decreased quality of life. The purpose of this study is to characterize subjective descriptors of chronic pain in children with CP. One hundred fifty-seven children were invited to participate in a quantitative pilot survey. Parents were mailed the Varni-Thompson Pediatric Pain Questionnaire, designed to assess three dimensions of pain: sensory (physical aspects), affective (emotional response), and evaluative (the combined intensity of the emotional and physical responses). Parents assessed their child's pain using non-verbal and verbal cues. Fifty-two families responded (33% return rate). Thirty-eight children ages 6-8 years with CP and Gross Motor Function Classification System (GMFCS) levels I-V were included. Ninety percent of families reported that their child was experiencing some pain at the time of the survey. At the time of assessment the children's pain was mild. Their pain, at its worst, was in the distressing range. The two largest GMFCS groups of children, levels I and IV, were compared in both severity and intensity of pain experienced. Increasing intensity of pain was reported in children in the level IV group compared to children classified as level I. Pain severity in all dimensions was reported as increasing in Level IV children compared to Level I. Children with CP experience frequent pain, which increases with worsening impairment. Descriptive qualifiers of pain help to elucidate the etiology of various types of pain which would lead to the development of more effective approaches to pain management and treatment.

Artiss Symposium 2014: Psychiatry and Pain Management

DTIC Science & Technology

2014-01-01

1983 to spur military psychiatry residents to con - duct high quality research. This award still exists today and was presented at the conclusion of...important to understand, in con - text, what it means to take care of severe trauma over great distances with the team of people that impact on the...perception and how it affects the psyche are extremely important. There is a post- con - cussive syndrome called chronic traumatic encephalopathy (CTE

Practices and perceptions of adolescent girls regarding the impact of dysmenorrhea on their routine life: a comparative study in the urban, rural, and slum areas of Chandigarh.

PubMed

Rani, Alka; Sharma, Manoj Kumar; Singh, Amarjeet

2016-02-01

To estimate the prevalence, to compare the impact of dysmenorrhea on routine life among adolescent girls, to compare the practices and perceptions regarding Dysmenorrhea and to ascertain the reason for difference if any, a cross-sectional study was conducted in urban, rural and slum areas of Chandigarh, India. 300 girls in age group of 11-18 years, who had attained menarche were included in the study. A questionnaire including the Demographic and Family profile, menstrual history, Symptoms of Dysmenorrhea, Effect of pain on daily activities, Faces scale, Practices regarding Dysmenorrhea, Beliefs about menstruation was used. Analysis was done by percentage and chi square prevalance of dysmenorrhea was 61.33%. Sickness absenteeism due to dysmenorrhea was reported in 24.45% girls. Most common symptom experienced by the girls was stomach ache which was experienced by 139 girls; others symptoms experienced during menstruation were backache (107), and general body pain (80). Only 11.63% of the girls ever visited physician due to pain during menstruation. During menstruation only 10 girls use hot water bottle, 71 skip meal. Due to poor knowledge the practices were not optimal for pain management, which affected their school attendance. Formal as well as informal channels of communication, such as mothers and peers, need to be emphasized for the delivery of such information particularly linking instructions on menstrual hygiene to an expanded programme of health education in schools.

Immediate effects of spinal manipulation on thermal pain sensitivity: an experimental study

PubMed Central

George, Steven Z; Bishop, Mark D; Bialosky, Joel E; Zeppieri, Giorgio; Robinson, Michael E

2006-01-01

Background The underlying causes of spinal manipulation hypoalgesia are largely unknown. The beneficial clinical effects were originally theorized to be due to biomechanical changes, but recent research has suggested spinal manipulation may have a direct neurophysiological effect on pain perception through dorsal horn inhibition. This study added to this literature by investigating whether spinal manipulation hypoalgesia was: a) local to anatomical areas innervated by the lumbar spine; b) correlated with psychological variables; c) greater than hypoalgesia from physical activity; and d) different for A-delta and C-fiber mediated pain perception. Methods Asymptomatic subjects (n = 60) completed baseline psychological questionnaires and underwent thermal quantitative sensory testing for A-delta and C-fiber mediated pain perception. Subjects were then randomized to ride a stationary bicycle, perform lumbar extension exercise, or receive spinal manipulation. Quantitative sensory testing was repeated 5 minutes after the intervention period. Data were analyzed with repeated measures ANOVA and post-hoc testing was performed with Bonferroni correction, as appropriate. Results Subjects in the three intervention groups did not differ on baseline characteristics. Hypoalgesia from spinal manipulation was observed in lumbar innervated areas, but not control (cervical innervated) areas. Hypoalgesic response was not strongly correlated with psychological variables. Spinal manipulation hypoalgesia for A-delta fiber mediated pain perception did not differ from stationary bicycle and lumbar extension (p > 0.05). Spinal manipulation hypoalgesia for C-fiber mediated pain perception was greater than stationary bicycle riding (p = 0.040), but not for lumbar extension (p = 0.105). Conclusion Local dorsal horn mediated inhibition of C-fiber input is a potential hypoalgesic mechanism of spinal manipulation for asymptomatic subjects, but further study is required to replicate this finding in subjects with low back pain. PMID:16911795

Intergroup relationships do not reduce racial bias in empathic neural responses to pain.

PubMed

Contreras-Huerta, Luis Sebastian; Hielscher, Emily; Sherwell, Chase S; Rens, Natalie; Cunnington, Ross

2014-11-01

Perceiving the pain of others activates similar neural structures to those involved in the direct experience of pain, including sensory and affective-motivational areas. Empathic responses can be modulated by race, such that stronger neural activation is elicited by the perception of pain in people of the same race compared with another race. In the present study, we aimed to identify when racial bias occurs in the time course of neural empathic responses to pain. We also investigated whether group affiliation could modulate the race effect. Using the minimal group paradigm, we assigned participants to one of two mixed-race teams. We examined event-related potentials from participants when viewing members of their own and the other team receiving painful or non-painful touch. We identified a significant racial bias in early ERP components at N1 over frontal electrodes, where Painful stimuli elicited a greater negative shift relative to Non-Painful stimuli in response to own race faces only. A long latency empathic response was also found at P3, where there was significant differentiation between Painful and Non-Painful stimuli regardless of Race or Group. There was no evidence that empathy-related brain activity was modulated by minimal group manipulation. These results support a model of empathy for pain that consists of early, automatic bias towards own-race empathic responses and a later top-down cognitive evaluation that does not differentiate between races and may ultimately lead to unbiased behaviour. Copyright © 2014 Elsevier Ltd. All rights reserved.

The Impact of Social Isolation on Pain Interference: A Longitudinal Study.

PubMed

Karayannis, Nicholas V; Baumann, Isabel; Sturgeon, John A; Melloh, Markus; Mackey, Sean C

2018-04-12

Evidence suggests social interactions play an important role in pain perception. The aim of this study was to determine whether social isolation (SI) in people with persistent pain determines pain interference (PI) and physical function over time. Patients seeking care at a tertiary pain management referral center were administered the Patient Reported Outcome Measurement Information System (PROMIS®) SI, PI, physical function, depression, and average pain intensity item banks at their initial consultation and subsequent visits as part of their routine clinical care. We used a post hoc simulation of an experiment using propensity score matching (n = 4,950) and carried out a cross-lagged longitudinal analysis (n = 312) of retrospective observational data. Cross-lagged longitudinal analysis showed that SI predicted PI at the next time point, above and beyond the effects of pain intensity and covariates, but not vice versa. These data support the importance of SI as a factor in pain-related appraisal and coping and demonstrate that a comprehensive assessment of the individuals' social context can provide a better understanding of the differential trajectories for a person living with pain. Our study provides evidence that the impact of pain is reduced in individuals who perceive a greater sense of inclusion from and engagement with others. This study enhances the understanding of how social factors affect pain and have implications for how the effectiveness of therapeutic interventions may be improved. Therapeutic interventions aimed at increasing social connection hold merit in reducing the impact of pain on engagement with activities.

How Does Anodal Transcranial Direct Current Stimulation of the Pain Neuromatrix Affect Brain Excitability and Pain Perception? A Randomised, Double-Blind, Sham-Control Study

PubMed Central

Vaseghi, Bita; Zoghi, Maryam; Jaberzadeh, Shapour

2015-01-01

Background Integration of information between multiple cortical regions of the pain neuromatrix is thought to underpin pain modulation. Although altered processing in the primary motor (M1) and sensory (S1) cortices is implicated in separate studies, the simultaneous changes in and the relationship between these regions are unknown yet. The primary aim was to assess the effects of anodal transcranial direct current stimulation (a-tDCS) over superficial regions of the pain neuromatrix on M1 and S1 excitability. The secondary aim was to investigate how M1 and S1 excitability changes affect sensory (STh) and pain thresholds (PTh). Methods Twelve healthy participants received 20 min a-tDCS under five different conditions including a-tDCS of M1, a-tDCS of S1, a-tDCS of DLPFC, sham a-tDCS, and no-tDCS. Excitability of dominant M1 and S1 were measured before, immediately, and 30 minutes after intervention respectively. Moreover, STh and PTh to peripheral electrical and mechanical stimulation were evaluated. All outcome measures were assessed at three time-points of measurement by a blind rater. Results A-tDCS of M1 and dorsolateral prefrontal cortex (DLPFC) significantly increased brain excitability in M1 (p < 0.05) for at least 30 min. Following application of a-tDCS over the S1, the amplitude of the N20-P25 component of SEPs increased immediately after the stimulation (p < 0.05), whilst M1 stimulation decreased it. Compared to baseline values, significant STh and PTh increase was observed after a-tDCS of all three stimulated areas. Except in M1 stimulation, there was significant PTh difference between a-tDCS and sham tDCS. Conclusion a-tDCS of M1 is the best spots to enhance brain excitability than a-tDCS of S1 and DLPFC. Surprisingly, a-tDCS of M1 and S1 has diverse effects on S1 and M1 excitability. A-tDCS of M1, S1, and DLPFC increased STh and PTh levels. Given the placebo effects of a-tDCS of M1 in pain perception, our results should be interpreted with caution, particularly with respect to the behavioural aspects of pain modulation. Trial Registration Australian New Zealand Clinical Trials, ACTRN12614000817640, http://www.anzctr.org.au/. PMID:25738603

Immediate Changes After Manual Therapy in Patients With Persistent, Nonspecific Back Pain: A Randomized Controlled Trial.

PubMed

Espí-López, Gemma Victoria; Ruescas-Nicolau, Maria-Arantzazu; Sanchez-Sanchez, M Luz; Arnal-Gómez, Anna; Balasch-Bernat, Mercè; Marques-Sule, Elena

2018-02-10

Context • Thoracic manipulation decreases pain and disability. However, when such manipulation is contraindicated, the use of other manual techniques based on the regional interdependence of the thoracic spine, upper ribs, and shoulders is an alternative approach. Objective • The study intended to investigate the immediate changes resulting from 3 manual therapy treatments on spinal mobility, flexibility, comfort, and pain perception in patients with persistent, nonspecific back pain as well as changes in their sense of physical well-being and their perception of change after treatment. Design • The study was a randomized, double-blind, controlled trial. Setting • The study took place in the Department of Physiotherapy of the Faculty of Physiotherapy at the University of Valencia (Valencia, Spain). Participants • Participants were 112 individuals from the community-56.6% female, with a mean age of 21.8 ± 0.2 y-who had persistent, nonspecific back pain. Intervention • Participants were randomly assigned to 1 of 3 groups, receiving (1) neurolymphatic therapy (NL group), (2) articulatory spinal manual therapy (AS group), or (3) articulatory costal manual therapy (AC group). Outcome Measures • Cervical mobility, lumbar flexibility, comfort, pain perception, and physical well-being were assessed at baseline and immediately postintervention. Perception of change was evaluated postintervention. Results • Between baseline and postintervention, the AC group showed a significant increase in cervical flexion (P = .010), whereas the NL and AS groups improved in lumbar flexibility, P = .047 and P = .012, respectively. For that period, significant changes were found in lumbar comfort for the AS group (P < .001) and the NL group (P < .026) and in thoracic comfort (P < .001) for the AC group. All groups improved in physical well-being and pain perception (P < .05). Changes in thoracic comfort, lumbar comfort, and physical well-being differed among the groups, with some differences being statistically significant. Conclusions • All treatments improved pain perception and increased physical well-being. The NL and AS treatments were more effective in lumbar flexibility, the AC treatment in cervical flexion and thoracic comfort, and the NL treatment in lumbar comfort.

Survey of Conventional and Complementary and Alternative Therapy in Patients With Low Back Pain.

PubMed

O'Gara, Tadhg; Kemper, Kathi J; Birkedal, John; Curl, Walton; Miller, Neal; Abadie, Bryan

2016-01-01

Both conventional and alternative medical therapies are used by patients to treat low back pain, a condition that affects approximately 33% of the U.S. Little is known about patients' perceptions of conventional versus alternative therapies. Patients recruited from an orthopedic spine clinic completed surveys containing questions about their use of many conventional and alternative therapies. Patients rated perceived helpfulness, side effects, and their recommendation for each therapy. They also completed a questionnaire that detailed demographic information, stress, and pain. Questionnaires were completed by 166 patients. Conventional medications were used by 154 (95%) patients, most commonly acetaminophen and opioid derivatives. Alternative therapies were used by 159 (96%) patients, including therapeutic exercises, salves, supplements, and stress management techniques. Generally, patients reported that alternative therapies are more effective and have fewer side effects and would more likely recommend their use. These data can be used to counsel patients and guide future research.

Differential effects of two virtual reality interventions: distraction versus pain control.

PubMed

Loreto-Quijada, Desirée; Gutiérrez-Maldonado, José; Nieto, Rubén; Gutiérrez-Martínez, Olga; Ferrer-García, Marta; Saldaña, Carmina; Fusté-Escolano, Adela; Liutsko, Liudmila

2014-06-01

There is evidence that virtual reality (VR) pain distraction is effective at improving pain-related outcomes. However, more research is needed to investigate VR environments with other pain-related goals. The main aim of this study was to compare the differential effects of two VR environments on a set of pain-related and cognitive variables during a cold pressor experiment. One of these environments aimed to distract attention away from pain (VRD), whereas the other was designed to enhance pain control (VRC). Participants were 77 psychology students, who were randomly assigned to one of the following three conditions during the cold pressor experiment: (a) VRD, (b) VRC, or (c) Non-VR (control condition). Data were collected regarding both pain-related variables (intensity, tolerance, threshold, time perception, and pain sensitivity range) and cognitive variables (self-efficacy and catastrophizing). Results showed that in comparison with the control condition, the VRC intervention significantly increased pain tolerance, the pain sensitivity range, and the degree of time underestimation. It also increased self-efficacy in tolerating pain and led to a reduction in reported helplessness. The VRD intervention significantly increased the pain threshold and pain tolerance in comparison with the control condition, but it did not affect any of the cognitive variables. Overall, the intervention designed to enhance control seems to have a greater effect on the cognitive variables assessed. Although these results need to be replicated in further studies, the findings suggest that the VRC intervention has considerable potential in terms of increasing self-efficacy and modifying the negative thoughts that commonly accompany pain problems.

Side Effect Perceptions and Their Impact on Treatment Decisions in Women.

PubMed

Waters, Erika A; Pachur, Thorsten; Colditz, Graham A

2017-04-01

Side effects prompt some patients to forego otherwise-beneficial therapies. This study explored which characteristics make side effects particularly aversive. We used a psychometric approach, originating from research on risk perception, to identify the factors (or components) underlying side effect perceptions. Women ( N = 149) aged 40 to 74 years were recruited from a patient registry to complete an online experiment. Participants were presented with hypothetical scenarios in which an effective and necessary medication conferred a small risk of a single side effect (e.g., nausea, dizziness). They rated a broad range of side effects on several characteristics (e.g., embarrassing, treatable). In addition, we collected 4 measures of aversiveness for each side effect: choosing to take the medication, willingness to pay to avoid the side effect (WTP), negative affective attitude associated with the side effect, and how each side effect ranks among others in terms of undesirability. A principal components analysis (PCA) was used to identify the components underlying side effect perceptions. Then, for each aversiveness measure separately, regression analyses were used to determine which components predicted differences in aversiveness among the side effects. The PCA revealed 4 components underlying side effect perceptions: affective challenge (e.g., frightening), social challenge (e.g., disfiguring), physical challenge (e.g., painful), and familiarity (e.g., common). Side effects perceived as affectively and physically challenging elicited the highest levels of aversiveness across all 4 measures. Understanding what side effect characteristics are most aversive may inform interventions to improve medical decisions and facilitate the translation of novel biomedical therapies into clinical practice.

Side Effect Perceptions and their Impact on Treatment Decisions in Women

PubMed Central

Waters, Erika A.; Pachur, Thorsten; Colditz, Graham A.

2016-01-01

Background Side effects prompt some patients to forego otherwise-beneficial therapies. This study explored which characteristics make side effects particularly aversive. Methods We used a psychometric approach, originating from research on risk perception, to identify the factors (or components) underlying side effect perceptions. Women (N=149) aged 40–74 were recruited from a patient registry to complete an online experiment. Participants were presented with hypothetical scenarios in which an effective and necessary medication conferred a small risk of a single side effect (e.g., nausea, dizziness). They rated a broad range of side effects on several characteristics (e.g., embarrassing, treatable). In addition, we collected four measures of aversiveness for each side effect: choosing to take the medication, willingness to pay to avoid the side effect (WTP), negative affective attitude associated with the side effect, and how each side effect ranks among others in terms of undesirability. A principle-components analysis (PCA) was used to identify the components underlying side effect perceptions. Then, for each aversiveness measure separately, regression analyses were used to determine which components predicted differences in aversiveness among the side effects. Results The PCA revealed four components underlying side effect perceptions: affective challenge (e.g., frightening), social challenge (e.g., disfiguring), physical challenge (e.g., painful), and familiarity (e.g., common). Side effects perceived as affectively and physically challenging elicited the highest levels of aversiveness across all four measures. Conclusions Understanding what side effect characteristics are most aversive may inform interventions to improve medical decisions and facilitate the translation of novel biomedical therapies into clinical practice. PMID:27216581

Perspectives, perceptions and experiences in postoperative pain management in developing countries: A focus group study conducted in Rwanda

PubMed Central

Johnson, Ana P; Mahaffey, Ryan; Egan, Rylan; Twagirumugabe, Theogene; Parlow, Joel L

2015-01-01

BACKGROUND: Access to postoperative acute pain treatment is an important component of perioperative care and is frequently managed by a multidisciplinary team of anesthesiologists, surgeons, pharmacists, technicians and nurses. In some developing countries, treatment modalities are often not performed due to scarce health care resources, knowledge deficiencies and cultural attitudes. OBJECTIVES: In advance of a comprehensive knowledge translation initiative, the present study aimed to determine the perspectives, perceptions and experiences of anesthesia residents regarding postoperative pain management strategies. METHODS: The present study was conducted using a qualitative assessment strategy in a large teaching hospital in Rwanda. During two sessions separated by seven days, a 10-participant semistructured focus group needs analysis was conducted with anesthesia residents at the Centre Hospitalier Universitaire de Kigali (Kigali, Rwanda). Field notes were analyzed using interpretative and descriptive phenomenological approaches. Participants were questioned regarding their perspectives, perceptions and experiences in pain management. RESULTS: The responses from the focus groups were related to five general areas: general patient and medical practice management; knowledge base regarding postoperative pain management; pain evaluation; institutional/system issues related to protocol implementation; and perceptions about resource allocation. Within these areas, challenges (eg, communication among stakeholders and with patients) and opportunities (eg, on-the-job training, use of protocols, routine pain assessment, participation in resource allocation decisions) were identified. CONCLUSIONS: The present study revealed the prevalent challenges residents perceive in implementing postoperative pain management strategies, and offers practical suggestions to overcoming them, primarily through training and the implementation of practice recommendations. PMID:26448971

Pain mechanisms: a commentary on concepts and issues.

PubMed

Perl, Edward R

2011-06-01

This commentary on ideas about neural mechanisms underlying pain is aimed at providing perspective for a reader who does not work in the field of mammalian somatic sensation. It is not a comprehensive review of the literature. The organization is historical to chronicle the evolution of ideas. The aim is to call attention to source of concepts and how various ideas have fared over time. One difficulty in relating concepts about pain is that the term is used to refer to human and animal reactions ranging from protective spinal reflexes to complex affective behaviors. As a result, the spectrum of "pain"-related neural organization extends to operation of multiple neuronal arrangements. Thinking about pain has shadowed progress in understanding biological mechanisms, in particular the manner of function of nervous systems. This essay concentrates on the evolution of information and concepts from the early 19th century to the present. Topics include the assumptions underlying currently active theories about pain mechanisms. At the end, brief consideration is given to present-day issues, e.g., chronic pain, central pain, and the view of pain as an emotion rather than a sensation. The conceptual progression shows that current controversies have old roots and that failed percepts often resurface after seemingly having been put to rest by argument and evidence. Copyright © 2011 Elsevier Ltd. All rights reserved.

Prevalence of chronic pain, impact on daily life, and treatment practices in India.

PubMed

Dureja, Gur Prasad; Jain, Paramanand N; Shetty, Naresh; Mandal, Shyama Prasad; Prabhoo, Ram; Joshi, Muralidhar; Goswami, Subrata; Natarajan, Karthic Babu; Iyer, Rajagopalan; Tanna, D D; Ghosh, Pahari; Saxena, Ashok; Kadhe, Ganesh; Phansalkar, Abhay A

2014-02-01

Chronic pain is of concern to health professionals, patients, society, and negatively impacts quality of life (QoL). The present epidemiologic study identified point prevalence of chronic pain in India, impact on individual's QoL, unveiling current pain treatment practices, and levels of satisfaction with treatment. This epidemiological telephonic survey consisted of two questionnaires: screening questionnaire that assessed prevalence of pain, its frequency during the past week, intensity during last episode, sites of pain, and main causes, and in-depth questionnaire that evaluated demography, frequency, duration, and intensity of pain; impact of pain on QoL; respondent's perception regarding the attitude of their family, friends, and doctors toward their pain. A total of 5004 respondents were included from eight cities across India. The overall point prevalence of chronic pain was 13%, and the mean intensity of pain on NRS scale was 6.93. Respondents with chronic moderate and chronic severe pain were 37% and 63%, respectively. Pain in knees (32%), legs (28%), and joints (22%) was most prevalent. Respondents with chronic pain were no longer able to exercise, sleep, maintain relationships with friends and family, and maintain an independent lifestyle. About 32% of patients lost ≥4 hours of work in the past 3 months. Majority (68%) of respondents were treated for pain with over the counter (OTC) drugs, and most were taking NSAIDs (95%). A significant population of India suffers from chronic pain, and their QoL is affected leading to disability. A proportion of respondents receiving pain treatment were taking nonprescription medications with a majority of respondents on NSAIDs. A very few were consulting pain management specialists. © 2013 World Institute of Pain.

Psychosocial factors partially mediate the relationship between mechanical hyperalgesia and self-reported pain.

PubMed

Mason, Kayleigh J; O'Neill, Terence W; Lunt, Mark; Jones, Anthony K P; McBeth, John

2018-01-26

Amplification of sensory signalling within the nervous system along with psychosocial factors contributes to the variation and severity of knee pain. Quantitative sensory testing (QST) is a non-invasive test battery that assesses sensory perception of thermal, pressure, mechanical and vibration stimuli used in the assessment of pain. Psychosocial factors also have an important role in explaining the occurrence of pain. The aim was to determine whether QST measures were associated with self-reported pain, and whether those associations were mediated by psychosocial factors. Participants with knee pain identified from a population-based cohort completed a tender point count and a reduced QST battery of thermal, mechanical and pressure pain thresholds, temporal summation, mechanical pain sensitivity (MPS), dynamic mechanical allodynia (DMA) and vibration detection threshold performed following the protocol by the German Research Network on Neuropathic Pain. QST assessments were performed at the most painful knee and opposite forearm (if pain-free). Participants were asked to score for their global and knee pain intensities within the past month (range 0-10), and complete questionnaire items investigating anxiety, depression, illness perceptions, pain catastrophising, and physical functioning. QST measures (independent variable) significantly correlated (Spearman's rho) with self-reported pain intensity (dependent variable) were included in structural equation models with psychosocial factors (latent mediators). Seventy-two participants were recruited with 61 participants (36 women; median age 64 years) with complete data included in subsequent analyses. Tender point count was significantly correlated with global pain intensity. DMA at the knee and MPS at the most painful knee and opposite pain-free forearm were significantly correlated with both global pain and knee pain intensities. Psychosocial factors including pain catastrophising sub-scales (rumination and helplessness) and illness perceptions (consequences and concern) were significant partial mediators of the association with global pain intensity when loaded on to a latent mediator for: tender point count [75% total effect; 95% confidence interval (CI) 22%, 100%]; MPS at the knee (49%; 12%, 86%); and DMA at the knee (63%; 5%, 100%). Latent psychosocial factors were also significant partial mediators of the association between pain intensity at the tested knee with MPS at the knee (30%; 2%, 58%), but not for DMA at the knee. Measures of mechanical hyperalgesia at the most painful knee and pain-free opposite forearm were associated with increased knee and global pain indicative of altered central processing. Psychosocial factors were significant partial mediators, highlighting the importance of the central integration of emotional processing in pain perception. Associations between mechanical hyperalgesia at the forearm and knee, psychosocial factors and increased levels of clinical global and knee pain intensity provide evidence of altered central processing as a key mechanism in knee pain, with psychological factors playing a key role in the expression of clinical pain.

The affective response to health-related information and its relationship to health anxiety: an ambulatory approach.

PubMed

Jasper, Fabian; Hiller, Wolfgang; Berking, Matthias; Rommel, Thilo; Witthöft, Michael

2015-01-01

Affective reactions to health-related information play a central role in health anxiety. Therefore, using ambulatory assessment, we analysed the time course of negative affect in a control group (CG, n = 60) which only rated their negative affect and an experimental group (EG, n = 97) which also rated the presence of somatic symptoms (e.g., back pain). By means of mixed regression models, we observed a decline of negative affect following the symptom self-ratings in the EG and a stable affect in the CG. The decline of negative affect was not moderated by the degree of health anxiety. Our findings might indicate that evaluating one's health status leads to a general reduction of negative affect in healthy individuals. The results of the study are in line with a bidirectional symptom perception model and underline the crucial role of affect regulation in the processing of health-related information.

Objective correlate of subjective pain perception by contact heat-evoked potentials.

PubMed

Granovsky, Yelena; Granot, Michal; Nir, Rony-Reuven; Yarnitsky, David

2008-01-01

The method of pain-evoked potentials has gained considerable acceptance over the last 3 decades regarding its objectivity, repeatability, and quantifiability. The present study explored whether the relationship between pain-evoked potentials and pain psychophysics obtained by contact heat stimuli is similar to those observed for the conventionally used laser stimulation. Evoked potentials (EPs) were recorded in response to contact heat stimuli at different body sites in 24 healthy volunteers. Stimuli at various temperatures were applied to the forearm (43 degrees C, 46 degrees C, 49 degrees C, and 52 degrees C) and leg (46 degrees C and 49 degrees C). The amplitudes of both components (N2 and P2) were strongly associated with the intensity of the applied stimuli and with subjective pain perception. Yet, regression analysis revealed pain perception and not stimulus intensity as the major contributing factor. A significant correlation was found between the forearm and the leg for both psychophysics and EPs amplitude. Contact heat can generate readily distinguishable evoked potentials on the scalp, consistent between upper and lower limbs. Although these potentials bear positive correlation with both stimulus intensity and pain magnitude, the latter is the main contributor to the evoked brain response.

Efficacy of manual and manipulative therapy in the perception of pain and cervical motion in patients with tension-type headache: a randomized, controlled clinical trial.

PubMed

Espí-López, Gemma V; Gómez-Conesa, Antonia

2014-03-01

The purpose of this study was to evaluate the efficacy of manipulative and manual therapy treatments with regard to pain perception and neck mobility in patients with tension-type headache. A randomized clinical trial was conducted on 84 adults diagnosed with tension-type headache. Eighty-four subjects were enrolled in this study: 68 women and 16 men. Mean age was 39.76 years, ranging from 18 to 65 years. A total of 57.1% were diagnosed with chronic tension-type headache and 42.9% with tension-type headache. Participants were divided into 3 treatment groups (manual therapy, manipulative therapy, a combination of manual and manipulative therapy) and a control group. Four treatment sessions were administered during 4 weeks, with posttreatment assessment and follow-up at 1 month. Cervical ranges of motion pain perception, and frequency and intensity of headaches were assessed. All 3 treatment groups showed significant improvements in the different dimensions of pain perception. Manual therapy and manipulative treatment improved some cervical ranges of motion. Headache frequency was reduced with manipulative treatment (P < .008). Combined treatment reported improvement after the treatment (P < .000) and at follow-up (P < .002). Pain intensity improved after the treatment and at follow-up with manipulative therapy (P < .01) and combined treatment (P < .01). Both treatments, administered both separately and combined together, showed efficacy for patients with tension-type headache with regard to pain perception. As for cervical ranges of motion, treatments produced greater effect when separately administered.

Analgesic effect of Facebook: Priming with online social networking may boost felt relatedness that buffers against physical pain.

PubMed

Ho, Liang-Chu; Wu, Wen-Hsiung; Chiou, Wen-Bin

2016-10-01

Social networking sites (SNSs) are extremely popular for providing users with a convenient platform for acquiring social connections and thereby feeling relatedness. Plenty of literature has shown that mental representations of social support can reduce the perception of physical pain. The current study tested whether thinking about SNS would interfere with users' perceptions of experimentally induced pain. Ninety-six undergraduate Facebook users were recruited to participate in a priming-based experiment. They were randomly assigned to one of the three study conditions (SNS prime, neutral prime, or no prime) via rating the aesthetics of logos. The results showed that participants exposed to SNS primes reported less pain of immersion in hot water than did both control groups (neutral- and no-prime). Felt relatedness mediated the link between SNS primes and diminished pain perceptions. This research provides the first demonstration that thinking about SNS can lower experienced physical pain among Facebook users. Online social networking may serve as an analgesic buffer against pain experience than previously thought. The SNS-enabled analgesia has far reaching implications for pain relief applications and the enhancement of well-being in human-interaction techniques. © 2016 Scandinavian Psychological Associations and John Wiley & Sons Ltd.

Sustained deep-tissue pain alters functional brain connectivity.

PubMed

Kim, Jieun; Loggia, Marco L; Edwards, Robert R; Wasan, Ajay D; Gollub, Randy L; Napadow, Vitaly

2013-08-01

Recent functional brain connectivity studies have contributed to our understanding of the neurocircuitry supporting pain perception. However, evoked-pain connectivity studies have employed cutaneous and/or brief stimuli, which induce sensations that differ appreciably from the clinical pain experience. Sustained myofascial pain evoked by pressure cuff affords an excellent opportunity to evaluate functional connectivity change to more clinically relevant sustained deep-tissue pain. Connectivity in specific networks known to be modulated by evoked pain (sensorimotor, salience, dorsal attention, frontoparietal control, and default mode networks: SMN, SLN, DAN, FCN, and DMN) was evaluated with functional-connectivity magnetic resonance imaging, both at rest and during a sustained (6-minute) pain state in healthy adults. We found that pain was stable, with no significant changes of subjects' pain ratings over the stimulation period. Sustained pain reduced connectivity between the SMN and the contralateral leg primary sensorimotor (S1/M1) representation. Such SMN-S1/M1 connectivity decreases were also accompanied by and correlated with increased SLN-S1/M1 connectivity, suggesting recruitment of activated S1/M1 from SMN to SLN. Sustained pain also increased DAN connectivity to pain processing regions such as mid-cingulate cortex, posterior insula, and putamen. Moreover, greater connectivity during pain between contralateral S1/M1 and posterior insula, thalamus, putamen, and amygdala was associated with lower cuff pressures needed to reach the targeted pain sensation. These results demonstrate that sustained pain disrupts resting S1/M1 connectivity by shifting it to a network known to process stimulus salience. Furthermore, increased connectivity between S1/M1 and both sensory and affective processing areas may be an important contribution to interindividual differences in pain sensitivity. Copyright © 2013 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

Factors of accepting pain management decision support systems by nurse anesthetists

PubMed Central

2013-01-01

Background Pain management is a critical but complex issue for the relief of acute pain, particularly for postoperative pain and severe pain in cancer patients. It also plays important roles in promoting quality of care. The introduction of pain management decision support systems (PM-DSS) is considered a potential solution for addressing the complex problems encountered in pain management. This study aims to investigate factors affecting acceptance of PM-DSS from a nurse anesthetist perspective. Methods A questionnaire survey was conducted to collect data from nurse anesthetists in a case hospital. A total of 113 questionnaires were distributed, and 101 complete copies were returned, indicating a valid response rate of 89.3%. Collected data were analyzed by structure equation modeling using the partial least square tool. Results The results show that perceived information quality (γ=.451, p<.001), computer self-efficacy (γ=.315, p<.01), and organizational structure (γ=.210, p<.05), both significantly impact nurse anesthetists’ perceived usefulness of PM-DSS. Information quality (γ=.267, p<.05) significantly impacts nurse anesthetists’ perceptions of PM-DSS ease of use. Furthermore, both perceived ease of use (β=.436, p<.001, R2=.487) and perceived usefulness (β=.443, p<.001, R2=.646) significantly affected nurse anesthetists’ PM-DSS acceptance (R2=.640). Thus, the critical role of information quality in the development of clinical decision support system is demonstrated. Conclusions The findings of this study enable hospital managers to understand the important considerations for nurse anesthetists in accepting PM-DSS, particularly for the issues related to the improvement of information quality, perceived usefulness and perceived ease of use of the system. In addition, the results also provide useful suggestions for designers and implementers of PM-DSS in improving system development. PMID:23360305

Numeric rating scale: patients' perceptions of its use in postoperative pain assessments.

PubMed

Eriksson, Kerstin; Wikström, Lotta; Årestedt, Kristofer; Fridlund, Bengt; Broström, Anders

2014-02-01

The purpose of this study was to describe how patients perceive the use of the numeric rating scale in postoperative pain assessments. There are recommendations to use a pain scale to follow patients' postoperative pain. Most patients prefer the NRS but there is a discrepancy between patients and healthcare professionals how to interpret the ratings from the pain assessments. A descriptive design with a phenomenographic approach was used. Semi structured interviews were held with 25 patients. Three description categories emerged that illustrate patients' perceptions; use of the NRS facilitated communication of pain, it put demands on healthcare professionals and care routines and it contained interpretation difficulties. The NRS has a place in pain management according to the patients but there is a need for a dialogue to give the patients the opportunity to describe their pain and set a common goal. Copyright © 2014 Elsevier Inc. All rights reserved.

Somato-Visceral Effects in the Treatment of Dysmenorrhea: Neuromuscular Manual Therapy and Standard Pharmacological Treatment.

PubMed

Barassi, Giovanni; Bellomo, Rosa Grazia; Porreca, Annamaria; Di Felice, Piera Attilia; Prosperi, Loris; Saggini, Raoul

2018-03-01

This study aims to verify whether neuromuscular therapy (NMT) or pharmacology therapy (PT) is more effective for reducing symptoms in women affected by primary dysmenorrhea and the effects associated with each treatment. A controlled, randomized, single-blind clinical trial within the framework of the chair of physical medicine and rehabilitation of the University "G. d'Annunzio" of Chieti-Pescara. The study was conducted on a sample of 60 women suffering from primary dysmenorrhea. Subjects were randomly divided in two groups (A and B). Group A was treated with NMT and group B with PT. Group B was given ibuprofen or naproxen because they are considered the best painkillers for this condition. Group A was treated with 8 neuromuscular manual lumbosacral and abdominal therapy sessions twice per week for 4 weeks. Results were analyzed at the beginning (T0) and end (T1) of the study with a menstrual distress questionnaire, brief pain inventory, and visual analogue scale. Twenty patients from Group A were selected for evaluation of their maintenance of the eventual improvement that was detected in T1 at follow-up (T2). Both therapies had significant short-term effects in reducing the perception and duration of pain. However, NMT appears to give more improvements in the duration of pain. NMT had a long-term effect on perception of pain because patients conserved the positive effects of treatment after 4 weeks. NMT also had a long-term effect on duration of pain because patients conserved benefits of treatment, but this improvement started to decrease after 4 weeks. In the treatment of primary dysmenorrhea, NMT represents a valid therapeutic alternative method to PT. NMT is free from potential adverse effects of analgesics, is noninvasive, and is easy to perform.

Fetal pain perception and pain management.

PubMed

Van de Velde, Marc; Jani, Jacques; De Buck, Frederik; Deprest, J

2006-08-01

This paper gives an overview of current science related to the concept of fetal pain. We have answered three important questions: (1) does fetal pain exist? (2) does management of fetal pain benefit the unborn child? and (3) which techniques are available to provide good fetal analgesia?

Alterations in affective behavior during the time course of alcohol hangover.

PubMed

Karadayian, Analía G; Busso, María J; Feleder, Carlos; Cutrera, Rodolfo A

2013-09-15

Alcohol hangover is a temporary state described as the unpleasant next-day effects after binge-like drinking. Hangover begins when ethanol is absent in plasma and is characterized by physical and psychological symptoms. Affective behavior is impaired during the acute phase of alcohol intoxication; however, no reports indicate if similar effects are observed during withdrawal. The aim of this work was to study the time-extension and possible fluctuations in affective behavior during a hangover episode. Male Swiss mice were injected i.p. either with saline (control group) or with ethanol (3.8g/kg BW) (hangover group). Anxiety, fear-related behavior and despair phenotype were evaluated at a basal point (ZT0) and every 2h up to 20h after blood alcohol levels were close to zero (hangover onset). Also, anhedonia signs and pain perception disabilities were studied. Mice exhibited an increase in anxiety-like behavior during 4h and 14h after hangover onset when evaluated by the elevated-plus maze and open field test respectively (p<0.05). Fear-related behavior was detected in hangover animals by the increase of freezing and decrease of line crossings and rearing frequency during 16h after hangover onset (p<0.001). Depression signs were found in hangover mice during 14h (p<0.05). Hangover mice showed a significant decrease in pain perception when tested by tail immersion test at the beginning of hangover (p<0.05). Our findings demonstrate a time-extension between 14 and 16h for hangover affective impairments. This study shows the long lasting effects of hangover over the phase of ethanol intoxication. Copyright © 2013 Elsevier B.V. All rights reserved.

[Pain in children in historical perspective].

PubMed

Pabis, Emilia; Kowalczyk, Michał; Kulik, Teresa Bernadetta

2010-01-01

Pain in children, especially in infancy, is frequently underestimated. Surprisingly, in ancient times, writers were more aware of the existence of pain in infancy and the need for its relief than in 20th century. They rated pain perception as being higher in infancy than in childhood. The study by McGraw (1941), although badly designed, convinced the vast majority of clinicians that infants do not feel pain and do not require analgesia. This theory, reinforced by the fear of using opioids in young children, dominated medical thinking for more than 30 years. Later studies on pain perception in foetuses, and careful analysis of infants' reactions to blood sampling, helped doctors to understand the necessity of adequate analgesia in young children. In this review, we present the approach to pain in children over centuries, from ancient times to the latest developments in this field.

Psychological Risk Factors in Headache

PubMed Central

Nicholson, Robert A.; Houle, Timothy T.; Rhudy, Jamie L.; Norton, Peter J.

2008-01-01

Headache is a chronic disease that occurs with varying frequency and results in varying levels of disability. To date, the majority of research and clinical focus has been on the role of biological factors in headache and headache-related disability. However, reliance on a purely biomedical model of headache does not account for all aspects of headache and associated disability. Using a biopsychosocial framework, the current manuscript expands the view of what factors influence headache by considering the role psychological (i.e., cognitive and affective) factors have in the development, course, and consequences of headache. The manuscript initially reviews evidence showing that neural circuits responsible for cognitive–affective phenomena are highly interconnected with the circuitry responsible for headache pain. The manuscript then reviews the influence cognitions (locus of control and self-efficacy) and negative affect (depression, anxiety, and anger) have on the development of headache attacks, perception of headache pain, adherence to prescribed treatment, headache treatment outcome, and headache-related disability. The manuscript concludes with a discussion of the clinical implications of considering psychological factors when treating headache. PMID:17371358

Negative expectations interfere with the analgesic effect of safety cues on pain perception by priming the cortical representation of pain in the midcingulate cortex

PubMed Central

Almarzouki, Abeer F.; Brown, Christopher A.; Brown, Richard J.; Leung, Matthew H. K.; Jones, Anthony K. P.

2017-01-01

It is well known that the efficacy of treatment effects, including those of placebos, is heavily dependent on positive expectations regarding treatment outcomes. For example, positive expectations about pain treatments are essential for pain reduction. Such positive expectations not only depend on the properties of the treatment itself, but also on the context in which the treatment is presented. However, it is not clear how the preceding threat of pain will bias positive expectancy effects. One hypothesis is that threatening contexts trigger fearful and catastrophic thinking, reducing the pain-relieving effects of positive expectancy. In this study, we investigated the disruptive influence of threatening contexts on positive expectancy effects while 41 healthy volunteers experienced laser-induced heat pain. A threatening context was induced using pain-threatening cues that preceded the induction of positive expectancies via subsequent pain-safety cues. We also utilised electroencephalography (EEG) to investigate potential neural mechanisms underlying these effects. Lastly, we used the Fear of Pain Questionnaire to address whether the disruptive effect of negative contexts on cued pain relief was related to the degree of fear of pain. As predicted, participants responded less to pain-safety cues (i.e., experienced more pain) when these were preceded by pain-threatening cues. In this threatening context, an enhancement of the N2 component of the laser-evoked potential was detected, which was more pronounced in fearful individuals. This effect was localised to the midcingulate cortex, an area thought to integrate negative affect with pain experience to enable adaptive behaviour in aversive situations. These results suggest that threatening contexts disrupt the effect of pain relief cues via an aversive priming mechanism that enhances neural responses in the early stages of sensory processing. PMID:28665973

Perceived stereotyping and seeking care for chronic vulvar pain.

PubMed

Nguyen, Ruby H N; Turner, Rachael M; Rydell, Sarah A; Maclehose, Richard F; Harlow, Bernard L

2013-10-01

We examined stereotyping of chronic pain sufferers among women aged 18-40 years and determined whether perceived stereotyping affects seeking care for women with chronic vulvar pain. Cross-sectional study using a community-based survey of vulvodynia asking if "Doctors think that people with chronic pain exaggerate their pain," and if "People believe that vulvar pain is used as an excuse to avoid having sex". Twelve thousand eight hundred thirty-four women aged 18-40 years in metropolitan Minneapolis/St. Paul, Minnesota. Women were considered to have a history of chronic vulvar pain if they reported vulvar burning lasting more than 3 months or vulvar pain on contact. Four thousand nine hundred eighty-seven (38.9%) women reported a chronic pain condition; 1,651 had chronic vulvar pain. Women experiencing chronic pain were more likely than those without to perceive stereotyping from both doctors and others; a dose-response with the number of pain conditions existed. Women with chronic vulvar pain were more likely to believe that people think vulvar pain is an excuse to avoid intercourse. Half of the women with chronic vulvar pain did not seek medical care for it; of these, 40.4% perceived stereotyping from doctors. However, it was women who actually sought care (45.1%) who were more likely to feel stigmatized by doctors (adjusted relative risk = 1.11, 95% confidence interval: 1.01-1.23). Perceived negative stereotyping among chronic pain sufferers is common, particularly negative perceptions about physicians. In fact, chronic vulvar pain sufferers who felt stigmatized were more likely to have sought care than those who did not feel stigmatized. Wiley Periodicals, Inc.

Sustained deep-tissue pain alters functional brain connectivity

PubMed Central

Kim, Jieun; Loggia, Marco L.; Edwards, Robert; Wasan, Ajay D.; Gollub, Randy L.; Napadow, Vitaly

2013-01-01

Recent functional brain connectivity studies have contributed to our understanding of the neurocircuitry supporting pain perception. However, evoked-pain connectivity studies have employed cutaneous and/or brief stimuli, which induce sensations that differ appreciably from the clinical pain experience. Sustained myofascial pain evoked by pressure cuff affords an excellent opportunity to evaluate functional connectivity change to more clinically-relevant sustained deep-tissue pain. Connectivity in specific networks known to be modulated by evoked pain (sensorimotor, salience, dorsal attention, fronto-parietal control and default mode networks; SMN, SLN, DAN, FCN and DMN) was evaluated with functional-connectivity MRI, both at rest and during a sustained (6-minute) pain state in healthy adults. We found that pain was stable with no significant changes of subjects’ pain ratings over the stimulation period. Sustained pain reduced connectivity between the SMN and the contralateral leg primary sensorimotor (S1/M1) representation. Such SMN-S1/M1 connectivity decreases were also accompanied by and correlated with increased SLN-S1/M1 connectivity, suggesting recruitment of activated S1/M1 from SMN to SLN. Sustained pain also increased DAN connectivity to pain processing regions such as mid-cingulate cortex, posterior insula and putamen. Moreover, greater connectivity during pain between contralateral S1/M1 and posterior insula, thalamus, putamen, and amygdala, was associated with lower cuff pressures needed to reach the targeted pain sensation. These results demonstrate that sustained pain disrupts resting S1/M1 connectivity by shifting it to a network known to process stimulus salience. Furthermore, increased connectivity between S1/M1 and both sensory and affective processing areas may be an important contribution to inter-individual differences in pain sensitivity. PMID:23718988

The relationship between different facets of empathy, pain perception and compassion fatigue among physicians.

PubMed

Gleichgerrcht, Ezequiel; Decety, Jean

2014-01-01

Medical practitioners such as physicians are continuously exposed to the suffering and the distress of patients. Understanding the way pain perception relates to empathetic dispositions and professional quality of life can contribute to the development of strategies aimed at protecting health professionals from burnout and compassion fatigue. In the present study we investigate the way individual dispositions relate to behavioral measures of pain sensitivity, empathy, and professional quality of life. A secure Web-based series of self-report measures and a behavioral task were administered to 1,199 board-certified physicians. Additionally, surveys were used to obtain measures of demographic and professional background; dispositional empathy (empathic concern, personal distress, and perspective taking); positive (compassion satisfaction) and negative (burnout and secondary traumatic stress) aspects of their professional life. In the behavioral task, participants were asked to watch a series of video clips of patients experiencing different levels of pain and provide ratings of pain intensity and induced personal distress. Perceived pain intensity was significantly lower among more experienced physicians but similar across specialty fields with varying demands of emotional stress. Watching videos of patients in pain, however, elicited more personal distress among physicians in highly demanding medical fields, despite comparable empathy dispositions with other fields. The pain of male patients was perceived as less intense than the pain of female patients, and this effect was more marked for female physicians. The effect of dispositional empathy on pain perception and induced personal distress was different for each sub-component, with perspective taking and empathic concern (EC) being predictive of the behavioral outcomes. Physicians who experience both compassion satisfaction and fatigue perceive more pain and suffer more personal distress from it than those who only suffer the negative aspects of professional quality of life. Professional experience seems to desensitize physicians to the pain of others without necessarily helping them down-regulate their own personal distress. Pain perception is also related with specific aspects of empathy and varies depending on context, as is the case with the gender of their patients. Minimum levels of empathy appear necessary to benefit from the positive aspects of professional quality of life in medicine.

Blended-Learning Pain Neuroscience Education for People With Chronic Spinal Pain: Randomized Controlled Multicenter Trial.

PubMed

Malfliet, Anneleen; Kregel, Jeroen; Meeus, Mira; Roussel, Nathalie; Danneels, Lieven; Cagnie, Barbara; Dolphens, Mieke; Nijs, Jo

2018-05-01

Available evidence favors the use of pain neuroscience education (PNE) in patients with chronic pain. However, PNE trials are often limited to small sample sizes and, despite the current digital era, the effects of blended-learning PNE (ie, the combination of online digital media with traditional educational methods) have not yet been investigated. The study objective was to examine whether blended-learning PNE is able to improve disability, catastrophizing, kinesiophobia, and illness perceptions. This study was a 2-center, triple-blind randomized controlled trial (participants, statistician, and outcome assessor were masked). The study took place at university hospitals in Ghent and Brussels, Belgium. Participants were 120 people with nonspecific chronic spinal pain (ie, chronic neck pain and low back pain). The intervention was 3 sessions of PNE or biomedically focused back/neck school education (addressing spinal anatomy and physiology). Measurements were self-report questionnaires (Pain Disability Index, Pain Catastrophizing Scale, Tampa Scale for Kinesiophobia, Illness Perception Questionnaire, and Pain Vigilance and Awareness Questionnaire). None of the treatment groups showed a significant change in the perceived disability (Pain Disability Index) due to pain (mean group difference posteducation: 1.84; 95% CI = -2.80 to 6.47). Significant interaction effects were seen for kinesiophobia and several subscales of the Illness Perception Questionnaire, including negative consequences, cyclical time line, and acute/chronic time line. In-depth analysis revealed that only in the PNE group were these outcomes significantly improved (9% to 17% improvement; 0.37 ≤ Cohen d ≥ 0.86). Effect sizes are small to moderate, which might raise the concern of limited clinical utility; however, changes in kinesiophobia exceed the minimal detectable difference. PNE should not be used as the sole treatment modality but should be combined with other treatment strategies. Blended-learning PNE was able to improve kinesiophobia and illness perceptions in participants with chronic spinal pain. As effect sizes remained small to medium, PNE should not be used as a sole treatment but rather should be used as a key element within a comprehensive active rehabilitation program. Future studies should compare the effects of blended-learning PNE with offline PNE and should consider cost-effectiveness.

Migraine, vertigo and migrainous vertigo: Links between vestibular and pain mechanisms.

PubMed

Balaban, Carey D

2011-01-01

This review develops the hypothesis that co-morbid balance disorders and migraine can be understood as additive effects of processing afferent vestibular and pain information in pre-parabrachial and pre-thalamic pathways, that have consequences on cortical mechanisms influencing perception, interoception and affect. There are remarkable parallel neurochemical phenotypes for inner ear and trigeminal ganglion cells and these afferent channels appear to converge in shared central pathways for vestibular and nociceptive information processing. These pathways share expression of receptors targeted by anti-migraine drugs. New evidence is also presented regarding the distribution of serotonin receptors in the planum semilunatum of the primate cristae ampullaris, which may indicate involvement of inner ear ionic homeostatic mechanisms in audiovestibular symptoms that can accompany migraine.

Association between pain, central sensitization and anxiety in postherpetic neuralgia.

PubMed

Schlereth, T; Heiland, A; Breimhorst, M; Féchir, M; Kern, U; Magerl, W; Birklein, F

2015-02-01

In postherpetic neuralgia (PHN), dorsal root ganglia neurons are damaged. According to the proposed models, PHN pain might be associated with nociceptive deafferentation, and peripheral (heat hyperalgesia) or central sensitization (allodynia). In 36 PHN patients, afferent nerve fibre function was characterized using quantitative sensory testing and histamine-induced flare analysis. Psychological factors were evaluated with the Hospital Anxiety and Depression Scale (HADS), disease-related quality of life (QoL) with SF-36 and pain with the McGill questionnaire [pain rating index (PRI)]. The patients were also divided into subgroups according to the presence or absence of brush-evoked allodynia as a sign of central sensitization. For all patients, warm, cold and mechanical detection was impaired (p < 0.001 each) and the size of the histamine flare was diminished on the affected side (p < 0.05); pain thresholds with the exception of brush-evoked allodynia (p < 0.05) were unaltered. Correlation analysis revealed allodynia, anxiety, depression, QoL and age as relevant factors associated with pain severity (PRI). Allodynia was present in 23 patients (64%). In these patients, heat pain perception was preserved; the histamine flare was larger; the pinprick pain was increased as were McGill PRI sensory subscore, actual pain rating and almost significantly pain (McGill PRI) over the last 4 weeks. PHN is associated with damage of afferent fibres. Central sensitization (i.e., allodynia) might contribute to PHN pain. There was a striking association between anxiety, depression and age, and the magnitude of PHN pain. © 2014 European Pain Federation - EFIC®

Quantitative Sensory Testing and Current Perception Threshold Testing in Patients With Chronic Pain Following Lower Extremity Fracture.

PubMed

Griffioen, Mari A; Greenspan, Joel D; Johantgen, Meg; Von Rueden, Kathryn; O'Toole, Robert V; Dorsey, Susan G; Renn, Cynthia L

2018-01-01

Chronic pain is a significant problem for patients with lower extremity injuries. While pain hypersensitivity has been identified in many chronic pain conditions, it is not known whether patients with chronic pain following lower extremity fracture report pain hypersensitivity in the injured leg. To quantify and compare peripheral somatosensory function and sensory nerve activation thresholds in persons with chronic pain following lower extremity fractures with a cohort of persons with no history of lower extremity fractures. This was a cross-sectional study where quantitative sensory testing and current perception threshold testing were conducted on the injured and noninjured legs of cases and both legs of controls. A total of 14 cases and 28 controls participated in the study. Mean time since injury at the time of testing for cases was 22.3 (standard deviation = 12.1) months. The warmth detection threshold ( p = .024) and nerve activation thresholds at 2,000 Hz ( p < .001) and 250 Hz ( p = .002), respectively, were significantly higher in cases compared to controls. This study suggests that patients with chronic pain following lower extremity fractures may experience hypoesthesia in the injured leg, which contrasts with the finding of hyperesthesia previously observed in other chronic pain conditions but is in accord with patients with nerve injuries and surgeries. This is the first study to examine peripheral sensory nerve function at the site of injury in patients with chronic pain following lower extremity fractures using quantitative sensory testing and current perception threshold testing.

Rheumatoid hand surgery: differing perceptions amongst surgeons, rheumatologists and therapists in the UK.

PubMed

Burke, F D; Miranda, S M; Owen, V M F; Bradley, M J; Sinha, S

2011-10-01

Rheumatoid arthritis is a systemic disease that requires coordinated management by rheumatologists, surgical specialists and therapists working in a multidisciplinary team. Differences of opinion within the team may adversely affect patient care. Our aim was to assess differences in perception about rheumatoid hand surgery between rheumatologists, hand surgeons and hand therapists in the UK. We used a postal questionnaire to assess commonly performed rheumatoid hand operations. For each procedure, respondents rated the most important indication for surgery and scored effectiveness at reducing pain, improving function and aesthetics, and preventing deformity. Statistically significant differences were found between all three groups with regards to expected outcome and main indications for surgery. We concluded that significant differences do exist in the perceptions of rheumatologists, surgeons and therapists. Rheumatoid hand operations require more detailed study, clarifying indications and outcome to allow consistent advice to patients from all members of the multidisciplinary team.

Changes in regional gray matter volume in women with chronic pelvic pain - a voxel based morphometry study

PubMed Central

As-Sanie, Sawsan; Harris, Richard; Napadow, Vitaly; Kim, Jieun; Neshewat, Gina; Kairys, Anson; Williams, David; Clauw, Daniel; Schmidt-Wilcke, Tobias

2012-01-01

Chronic pelvic pain (CPP) is a highly prevalent pain condition, estimated to affect 15-20% of women in the United States. Endometriosis is often associated with CPP, however other factors, such as pre-existing or concomitant changes of the central pain system, might contribute to the development of chronic pain. We applied voxel-based morphometry to determine whether women with CPP with and without endometriosis display changes in brain morphology in regions known to be involved in pain processing.Four subgroups of women participated: 17 with endometriosis and CPP, 15 with endometriosis without CPP, 6 with CPP without endometriosis, as well as 23 healthy controls. All patients with endometriosis and/or CPP were surgically-confirmed. Relative to controls, women with endometriosis-associated CPP displayed decreased gray matter volume in brain regions involved in pain perception including the left thalamus, left cingulategyrus, right putamen, and right insula. Women with CPP without endometriosis also showed decreases in gray matter volume in the left thalamus. Such decreases were not observed in patients with endometriosis that had no CPP. We conclude thatCPP is associated with changes in regional gray matter volume within the central pain system. Although endometriosis may be an important risk factor for the development of CPP, acting as a cyclic source of peripheral nociceptive input, our data support the notion that changes in the central pain system also play an important role in the development of chronic pain, regardless of the presence of endometriosis. PMID:22387096

Decreased ventral anterior cingulate cortex activity is associated with reduced social pain during emotional support.

PubMed

Onoda, Keiichi; Okamoto, Yasumasa; Nakashima, Ken'ichiro; Nittono, Hiroshi; Ura, Mitsuhiro; Yamawaki, Shigeto

2009-01-01

People feel psychological pain when they are excluded, and this pain is often attenuated when emotional support is received. It is therefore likely that a specific neural mechanism underlies the detection of social exclusion. Similarly, specific neural mechanisms may underlie the beneficial effects of emotional support. Although neuroimaging researchers have recently examined the neural basis of social pain, there is presently no agreement as to which part of the anterior cingulate cortex (ACC) is involved in the perception and modulation of social pain. We hypothesized that activity in those brain regions that are associated with social pain would be correlated with decrements in social pain induced by emotional support. To examine the effects of emotional support on social pain caused by exclusion, we conducted an fMRI study in which participants played a virtual ball-tossing game. Participants were initially included and later excluded from the game. In the latter half of the session from which participants were excluded, participants received emotionally supportive text messages. We found that emotional support led to increased activity in the left lateral/medial prefrontal cortices and some temporal regions. Those individuals who experienced greater attenuation of social pain exhibited lower ventral ACC and higher left lateral prefrontal cortex activation. These results suggest that the ventral ACC underlies social pain, and that emotional support enhances prefrontal cortex activity, which in turn may lead to a weakened affective response.

Exploring attentional biases towards facial expressions of pain in men and women.

PubMed

Keogh, E; Cheng, F; Wang, S

2018-05-14

Interpersonal factors may help explain why men and women differ in their perception and expression of pain. Whilst the focus is often on the person in pain, how observers respond to those in pain is important. This study explored whether male-female differences exist in the way observers attend to expressions of pain in others. Fifty-three adults (26 females) completed a visual dot-probe task, to measure selective attentional biases to facial expressions of pain and fear. Expression pairs (e.g. pain/neutral) were displayed by either the same male or female actor, and in two different viewing duration conditions: 150 and 1250 ms. Dot-probes appeared in either a congruent or incongruent location to the target expression. No evidence was found for sex-related attentional biases towards pain or fear. However, when examining congruency and incongruency indexes separately, differences emerged. The congruency index analysis indicated that in the 150-ms presentation condition, both men and women were slower during congruent female pain/neutral trials when compared to neutral/neutral trials, and relatively faster at responding during congruent male pain/neutral trials. There is utility in exploring the attentional processes involved in the decoding of pain-related expressions to understand the influence of sex and gender differences in pain. Although male-female differences were found, this was most clearly related to the actor. Our results point to an early attentional mechanism that orients attention away from female expressions of pain. Future consideration of sex- and gender-related contextual factors in attentional processing is warranted. Sex-related factors seem to affect how observers view the pain of others. Our results point to an early attentional mechanism that orients the attention of observers away from female expressions of pain. © 2018 European Pain Federation - EFIC®.

Opioid management and dependency among adult patients with sickle cell disease.

PubMed

Feliu, Miriam H; Wellington, Chante; Crawford, Regina D; Wood, Mary; Edwards, Lekisha; Byrd, Goldie; Edwards, Christopher L

2011-01-01

While pain is one of the most debilitating symptoms of sickle cell disease, narcotics remain an effective although controversial widely practiced intervention. Vaso-occlusive crises are the most common cause for seeking pharmacological treatment. The influence of stigmatization and pseudo addiction in emergency departments and outpatient clinics was reviewed. We analyzed patterns of narcotic utilization in a sample of 63 adult patients with sickle cell disease to determine if their psychological functioning and reports of pain differed as a function of the primary narcotics they were taking for oral pain management. Fifty-one percent of patients reported treatment of Oxycodone, 35% OxyContin, 24% methadone and 11% morphine. Patients who were treated with Oxycodone reported greater sensory reactions to pain (p = 0.001), visual analog scale (VAS) (p = 0.02), and averaged weekly pain intensity ratings than patients who did not use this medication. There were no differences in pain or affective response in patients treated with OxyContin, methadone or morphine. We suggest there are clear differences between the reports of pain in patients with sickle cell disease taking short-acting narcotics for pain management as compared to those who are not, a pattern that does not distinguish patients who are managed with long-acting preparations. We discuss the relevance of addressing narcotic management in the context of the perception of health care providers and patients with sickle cell disease.

Knowledge, Perceptions and Attitudes toward Chronic Pain and Its Management: A Cross-Sectional Survey of Frontline Pharmacists in Ontario, Canada

PubMed Central

Patel, Tejal; Chang, Feng; Mohammed, Heba Tallah; Raman-Wilms, Lalitha; Jurcic, Jane; Khan, Ayesha; Sproule, Beth

2016-01-01

The treatment of chronic pain consumes a significant share of primary care. Community and family health team pharmacists frequently see patients with chronic pain, thus have the opportunity to improve their care. To assess the knowledge, perceptions, and attitudes of Ontario pharmacists, we invited 5,324 Ontario pharmacists, to participate in an online survey we developed using Qualtrics. The 31-question survey gathered demographic information, assessed pharmacists’ knowledge of three chronic pain conditions; chronic lower back pain (CLBP, eight true/false statements); chronic headache disorder (CHD, eight true/false statements) and painful diabetic neuropathy (PDN, seven true/false statements), and their attitudes toward and perceptions of patients with these conditions, and knowledge, attitudes, and perceptions of opioids in pain management. We received 688 responses (12.9%) and 392 pharmacists completed the survey. The mean age of respondents was 48.5 years and 48.5% were male. More than 50% of respondents were in practice for more than 20 years and 58.7% worked 25–40 hours per week. The mean knowledge scores were 4.5/8, 5.5/8, and 5.3/8 for CBLP, CHD, and PDN respectively. While 95% of respondents were aware of the increasing death rates due to opioid use, only half were familiar with the Canadian guideline for safe opioid prescribing for non-cancer use. Responses were compared based on gender, time in practice and location of practice. Pharmacists with more than ten years of experience scored significantly higher than those with less experience. Fewer differences were found in comparisons of gender and location of practice. Safe and effective care of chronic pain patients, particularly with opioids, will require additional pharmacist education. PMID:27270723

Knowledge, Perceptions and Attitudes toward Chronic Pain and Its Management: A Cross-Sectional Survey of Frontline Pharmacists in Ontario, Canada.

PubMed

Patel, Tejal; Chang, Feng; Mohammed, Heba Tallah; Raman-Wilms, Lalitha; Jurcic, Jane; Khan, Ayesha; Sproule, Beth

2016-01-01

The treatment of chronic pain consumes a significant share of primary care. Community and family health team pharmacists frequently see patients with chronic pain, thus have the opportunity to improve their care. To assess the knowledge, perceptions, and attitudes of Ontario pharmacists, we invited 5,324 Ontario pharmacists, to participate in an online survey we developed using Qualtrics. The 31-question survey gathered demographic information, assessed pharmacists' knowledge of three chronic pain conditions; chronic lower back pain (CLBP, eight true/false statements); chronic headache disorder (CHD, eight true/false statements) and painful diabetic neuropathy (PDN, seven true/false statements), and their attitudes toward and perceptions of patients with these conditions, and knowledge, attitudes, and perceptions of opioids in pain management. We received 688 responses (12.9%) and 392 pharmacists completed the survey. The mean age of respondents was 48.5 years and 48.5% were male. More than 50% of respondents were in practice for more than 20 years and 58.7% worked 25-40 hours per week. The mean knowledge scores were 4.5/8, 5.5/8, and 5.3/8 for CBLP, CHD, and PDN respectively. While 95% of respondents were aware of the increasing death rates due to opioid use, only half were familiar with the Canadian guideline for safe opioid prescribing for non-cancer use. Responses were compared based on gender, time in practice and location of practice. Pharmacists with more than ten years of experience scored significantly higher than those with less experience. Fewer differences were found in comparisons of gender and location of practice. Safe and effective care of chronic pain patients, particularly with opioids, will require additional pharmacist education.

Best candidates for cognitive treatment of illness perceptions in chronic low back pain: results of a theory-driven predictor study.

PubMed

Siemonsma, Petra C; Stuvie, Ilse; Roorda, Leo D; Vollebregt, Joke A; Lankhorst, Gustaaf J; Lettinga, Ant T

2011-04-01

The aim of this study was to identify treatment-specific predictors of the effectiveness of a method of evidence-based treatment: cognitive treatment of illness perceptions. This study focuses on what treatment works for whom, whereas most prognostic studies focusing on chronic non-specific low back pain rehabilitation aim to reduce the heterogeneity of the population of patients who are suitable for rehabilitation treatment in general. Three treatment-specific predictors were studied in patients with chronic non-specific low back pain receiving cognitive treatment of illness perceptions: a rational approach to problem-solving, discussion skills and verbal skills. Hierarchical linear regression analysis was used to assess their predictive value. Short-term changes in physical activity, measured with the Patient-Specific Functioning List, were the outcome measure for cognitive treatment of illness perceptions effect. A total of 156 patients with chronic non-specific low back pain participated in the study. Rational problem-solving was found to be a significant predictor for the change in physical activity. Discussion skills and verbal skills were non-significant. Rational problem-solving explained 3.9% of the total variance. The rational problem-solving scale results are encouraging, because chronic non-specific low back pain problems are complex by nature and can be influenced by a variety of factors. A minimum score of 44 points on the rational problem-solving scale may assist clinicians in selecting the most appropriate candidates for cognitive treatment of illness perceptions.

Self perceptions as predictors for return to work 2 years after rehabilitation in orthopedic trauma inpatients.

PubMed

Iakova, Maria; Ballabeni, Pierluigi; Erhart, Peter; Seichert, Nikola; Luthi, François; Dériaz, Olivier

2012-12-01

This study aimed to identify self-perception variables which may predict return to work (RTW) in orthopedic trauma patients 2 years after rehabilitation. A prospective cohort investigated 1,207 orthopedic trauma inpatients, hospitalised in rehabilitation, clinics at admission, discharge, and 2 years after discharge. Information on potential predictors was obtained from self administered questionnaires. Multiple logistic regression models were applied. In the final model, a higher likelihood of RTW was predicted by: better general health and lower pain at admission; health and pain improvements during hospitalisation; lower impact of event (IES-R) avoidance behaviour score; higher IES-R hyperarousal score, higher SF-36 mental score and low perceived severity of the injury. RTW is not only predicted by perceived health, pain and severity of the accident at the beginning of a rehabilitation program, but also by the changes in pain and health perceptions observed during hospitalisation.

Repeated forced swim stress enhances CFA-evoked thermal hyperalgesia and affects the expressions of pCREB and c-Fos in the insular cortex.

PubMed

Imbe, H; Kimura, A; Donishi, T; Kaneoke, Y

2014-02-14

Stress affects brain activity and promotes long-term changes in multiple neural systems. Exposure to stressors causes substantial effects on the perception and response to pain. In several animal models, chronic stress produces lasting hyperalgesia. The insular (IC) and anterior cingulate cortices (ACC) are the regions exhibiting most reliable pain-related activity. And the IC and ACC play an important role in pain modulation via the descending pain modulatory system. In the present study we examined the expression of phospho-cAMP response element-binding protein (pCREB) and c-Fos in the IC and ACC after forced swim stress (FS) and complete Freund's adjuvant (CFA) injection to clarify changes in the cerebral cortices that affect the activity of the descending pain modulatory system in the rats with stress-induced hyperalgesia. FS (day 1, 10min; days 2-3, 20min) induced an increase in the expression of pCREB and c-Fos in the anterior IC (AIC). CFA injection into the hindpaw after the FS shows significantly enhanced thermal hyperalgesia and induced a decrease in the expression of c-Fos in the AIC and the posterior IC (PIC). Quantitative image analysis showed that the numbers of c-Fos-immunoreactive neurons in the left AIC and PIC were significantly lower in the FS+CFA group (L AIC, 95.9±6.8; L PIC, 181.9±23.1) than those in the naive group (L AIC, 151.1±19.3, p<0.05; L PIC, 274.2±37.3, p<0.05). These findings suggest a neuroplastic change in the IC after FS, which may be involved in the enhancement of CFA-induced thermal hyperalgesia through dysfunction of the descending pain modulatory system. Copyright © 2013 IBRO. Published by Elsevier Ltd. All rights reserved.

5-HT modulation of pain perception in humans.

PubMed

Martin, Sarah L; Power, Andrea; Boyle, Yvonne; Anderson, Ian M; Silverdale, Monty A; Jones, Anthony K P

2017-10-01

Although there is clear evidence for the serotonergic regulation of descending control of pain in animals, little direct evidence exists in humans. The majority of our knowledge comes from the use of serotonin (5-HT)-modulating antidepressants as analgesics in the clinical management of chronic pain. Here, we have used an acute tryptophan depletion (ATD) to manipulate 5-HT function and examine its effects of ATD on heat pain threshold and tolerance, attentional manipulation of nociceptive processing and mood in human volunteers. Fifteen healthy participants received both ATD and balanced amino acid (BAL) drinks on two separate sessions in a double-blind cross-over design. Pain threshold and tolerance were determined 4 h post-drink via a heat thermode. Additional attention, distraction and temperature discrimination paradigms were completed using a laser-induced heat pain stimulus. Mood was assessed prior and throughout each session. Our investigation reported that the ATD lowered plasma TRP levels by 65.05 ± 7.29% and significantly reduced pain threshold and tolerance in response to the heat thermode. There was a direct correlation between the reduction in total plasma TRP levels and reduction in thermode temperature. In contrast, ATD showed no effect on laser-induced pain nor significant impact of the distraction-induced analgesia on pain perception but did reduce performance of the painful temperature discrimination task. Importantly, all findings were independent of any effects of ATD on mood. As far as we are aware, it is the first demonstration of 5-HT effects on pain perception which are not confounded by mood changes.

Can brief measures effectively screen for pain and somatic malingering? Examination of the Modified Somatic Perception Questionnaire and Pain Disability Index.

PubMed

Crighton, Adam H; Wygant, Dustin B; Applegate, Kathryn C; Umlauf, Robert L; Granacher, Robert P

2014-09-01

Recent rise in fraudulent disability claims in the United States has resulted in psychologists being increasingly called upon to use psychological tests to determine whether disability claims based on psychological or somatic/pain complaints are legitimate. To examine two brief measures, Modified Somatic Perception Questionnaire (MSPQ) and the Pain Disability Index (PDI), and their ability to screen for malingering in relation to the Bianchini et al. criteria for malingered pain-related disability published in The Spine Journal (2005). Examined brief self-report measures between litigating and nonlitigating pain samples. We compared 144 disability litigants, predominantly presenting a history of musculoskeletal injuries with psychiatric overlay, with 167 nonlitigating pain patients who were predominantly in treatment for chronic back pain issues and other musculoskeletal conditions. Modified Somatic Perception Questionnaire, Pain Disability Index, Minnesota Multiphasic Personality Inventory-2 Restructured Form, Test of Memory Malingering, Letter Memory Test, Victoria Symptom Validity Test, Structured Interview of Reported Symptoms-second edition, Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders somatoform disorders module. We examined a sample of 144 individuals undergoing compensation-seeking evaluations in relation to 167 nonlitigating pain patients. Group differences on both the MSPQ and PDI were calculated, as well as sensitivities, specificities, and positive and negative predictive powers for both measures at selected cutoffs. The results suggest that both the MSPQ and PDI are useful to screen for pain malingering in forensic evaluations, especially the MSPQ, which performed the best in differentiating between the groups. Copyright © 2014 Elsevier Inc. All rights reserved.

Fear, Pain, Denial, and Spiritual Experiences in Dying Processes

PubMed Central

Reichmuth, O.; Bueche, D.; Traichel, B.; Mao, M. Schuett; Cerny, T.; Strasser, F.

2017-01-01

Purpose: Approaching death seems to be associated with physiological/spiritual changes. Trajectories including the physical–psychological–social–spiritual dimension have indicated a terminal drop. Existential suffering or deathbed visions describe complex phenomena. However, interrelationships between different constituent factors (e.g., fear and pain, spiritual experiences and altered consciousness) are largely unknown. We lack deeper understanding of patients’ inner processes to which care should respond. In this study, we hypothesized that fear/pain/denial would happen simultaneously and be associated with a transformation of perception from ego-based (pre-transition) to ego-distant perception/consciousness (post-transition) and that spiritual (transcendental) experiences would primarily occur in periods of calmness and post-transition. Parameters for observing transformation of perception (pre-transition, transition itself, and post-transition) were patients’ altered awareness of time/space/body and patients’ altered social connectedness. Method: Two interdisciplinary teams observed 80 dying patients with cancer in palliative units at 2 Swiss cantonal hospitals. We applied participant observation based on semistructured observation protocols, supplemented by the list of analgesic and psychotropic medication. Descriptive statistical analysis and Interpretative Phenomenological Analysis (IPA) were combined. International interdisciplinary experts supported the analysis. Results: Most patients showed at least fear and pain once. Many seemed to have spiritual experiences and to undergo a transformation of perception only partly depending on medication. Line graphs representatively illustrate associations between fear/pain/denial/spiritual experiences and a transformation of perception. No trajectory displayed uninterrupted distress. Many patients seemed to die in peace. Previous near-death or spiritual/mystical experiences may facilitate the dying process. Conclusion: Approaching death seems not only characterized by periods of distress but even more by states beyond fear/pain/denial. PMID:28823175

Changes in head and neck position have a greater effect on elbow joint position sense in people with whiplash-associated disorders.

PubMed

Knox, Joanna Joy; Beilstein, Darren Jay; Charles, Scott Darren; Aarseth, Geir Arne; Rayar, Shivanthi; Treleaven, Julia; Hodges, Paul William

2006-01-01

It has been shown that perception of elbow joint position is affected by changes in head and neck position. Further, people with whiplash-associated disorders (WAD) present with deficits in upper limb coordination and movement. This study is aimed to determine whether the effect of changes in head position on elbow joint position error (JPE) is more pronounced in people with WAD, and to determine whether this is related to the participant's pain and anxiety levels. Nine people with chronic and disabling WAD and 11 healthy people participated in this experiment. The ability to reproduce a position at the elbow joint was assessed after changes in the position of the head and neck to 30 degrees , and with the head in the midline. Pain was monitored in WAD participants. Absolute elbow JPE with the head in neutral was not different between WAD and control participants (P=0.5). Changes in the head and neck position increased absolute elbow JPE in the WAD group (P<0.05), but did not affect elbow JPE in the control group (P=0.4). There was a connection between pain during testing and the effect of changes in head position on elbow JPE (P<0.05). Elbow JPE is affected by movement of the head and neck, with smaller angles of neck rotation in people with WAD than in healthy individuals. This observation may explain deficits in upper limb coordination in people with WAD, which may be due to the presence of pain or reduced range of motion in this population.

Simple neck pain questions used in surveys, evaluated in relation to health outcomes: a cohort study

PubMed Central

2012-01-01

Background The high prevalence of pain reported in many epidemiological studies, and the degree to which this prevalence reflects severe pain is under discussion in the literature. The aim of the present study was to evaluate use of the simple neck pain questions commonly included in large epidemiological survey studies with respect to aspects of health. We investigated if and how an increase in number of days with pain is associated with reduction in health outcomes. Methods A cohort of university students (baseline age 19–25 years) were recruited in 2002 and followed annually for 4 years. The baseline response rate was 69% which resulted in 1200 respondents (627 women, 573 men). Participants were asked about present and past pain and perceptions of their general health, sleep disturbance, stress and energy levels, and general performance. The data were analyzed using a mixed model for repeated measurements and a random intercept logistic model. Results When reporting present pain, participants also reported lower prevalence of very good health, higher stress and sleep disturbance scores and lower energy score. Among those with current neck pain, additional questions characterizing the pain such as duration (categorized), additional pain sites and decreased general performance were associated with lower probability of very good health and higher amounts of sleep disturbance. Knowing about the presence or not of pain explains more of the variation in health between individuals, than within individuals. Conclusion This study of young university students has demonstrated that simple neck pain survey questions capture features of pain that affect aspects of health such as perceived general health, sleep disturbance, mood in terms of stress and energy. Simple pain questions are more useful for group descriptions than for describing or following pain in an individual. PMID:23102060

Simple neck pain questions used in surveys, evaluated in relation to health outcomes: a cohort study.

PubMed

Grimby-Ekman, Anna; Hagberg, Mats

2012-10-26

The high prevalence of pain reported in many epidemiological studies, and the degree to which this prevalence reflects severe pain is under discussion in the literature. The aim of the present study was to evaluate use of the simple neck pain questions commonly included in large epidemiological survey studies with respect to aspects of health. We investigated if and how an increase in number of days with pain is associated with reduction in health outcomes. A cohort of university students (baseline age 19-25 years) were recruited in 2002 and followed annually for 4 years. The baseline response rate was 69% which resulted in 1200 respondents (627 women, 573 men). Participants were asked about present and past pain and perceptions of their general health, sleep disturbance, stress and energy levels, and general performance. The data were analyzed using a mixed model for repeated measurements and a random intercept logistic model. When reporting present pain, participants also reported lower prevalence of very good health, higher stress and sleep disturbance scores and lower energy score. Among those with current neck pain, additional questions characterizing the pain such as duration (categorized), additional pain sites and decreased general performance were associated with lower probability of very good health and higher amounts of sleep disturbance. Knowing about the presence or not of pain explains more of the variation in health between individuals, than within individuals. This study of young university students has demonstrated that simple neck pain survey questions capture features of pain that affect aspects of health such as perceived general health, sleep disturbance, mood in terms of stress and energy. Simple pain questions are more useful for group descriptions than for describing or following pain in an individual.

Stress perception and depressive symptoms: functionality and impact on the quality of life of women with fibromyalgia.

PubMed

Homann, Diogo; Stefanello, Joice Mara Facco; Góes, Suelen Meira; Breda, Chris Andreissy; Paiva, Eduardo dos Santos; Leite, Neiva

2012-01-01

Depression is one of the most frequent psychiatric comorbidities in patients with fibromyalgia (FM), and chronic stress might be one of the triggering events of the characteristic FM symptoms. To compare depressive symptoms and stress perception between women with and without FM, in addition to investigate the relationship between those characteristics and the functionality and the impact on the quality of life of those patients. The study included 20 women with FM (FM group) and 20 healthy women (control group). The following instruments were used: Beck Depression Inventory, Perceived Stress Scale-10, Health Assessment Questionnaire, Fibromyalgia Impact Questionnaire, and Visual Analogue Scale for pain (0-10 cm). The FM group showed higher severity of the depressive symptoms (24.10 ± 11.68) and greater perception of stress (25.10 ± 4.82) as compared with those of the control group (10.20 ± 12.78, P < 0.01;and 15.45 ± 7.29, P < 0.01;respectively). A higher incidence of depressive symptoms was observed in the FM group (75%) than in the control group (25%) (χ² = 10.00, P < 0.01). In the FM group, a positive correlation was observed between the depressive symptoms and perceived stress (r = 0.54, P < 0.05), pain (r = 0.58, P < 0.01), impaired functionality (r = 0.56, P < 0.01), and impact on the quality of life (r = 0.46, P < 0.05). In this group there was also correlation between perceived stress and impaired functionality (r = 0.50;P < 0.05). Pain showed no relationship with perceived stress. The relationship between stress, depression and functionality seems to be part of a complex mechanism, which might affect the quality of life of patients with FM.

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

Effects of physical activity programmes in the workplace (PAPW) on the perception and intensity of musculoskeletal pain experienced by garment workers.

PubMed

Pereira, Cynara Cristina Domingues Alves; López, Ramón Fabian Alonso; Vilarta, Roberto

2013-01-01

The physical activity programmes in the workplace (PAPW) are applied to minimize the prevalence, incidence and intensity of pain. This study evaluated the perception of pain and quantifies its intensity among garment workers before and after performing a PAPW. We included 61 workers of a clothing company, who were classified randomly into experimental group (n = 44) 28.7 ± 8.8 years old and a control group (n = 17) 27.8 ± 7.4 years (20-43 years). The Trigger Points test questionnaire was used to assess pain perception and quantify its intensity. The PAPW was conducted in 15-minute sessions per day, consisting of stretching exercises (40%), muscular endurance (40%), self-massage relaxation and massage techniques (10%), and group dynamics (10%). The garment workers who participated in the PAPW showed a significant reduction of pain felt in the neck and wrists, and also a reduction in pain intensity in shoulders, arms, fingers and wrists that are most often strained during sewing. Our findings suggest that PAPW that target muscle groups that are more tense in sewing tasks, may be considered by companies for supporting adaptation to the work environment and improving health by reducing muscle and joint pain.

Interprofessional Team's Perception of Care Delivery After Implementation of a Pediatric Pain and Sedation Protocol.

PubMed

Staveski, Sandra L; Wu, May; Tesoro, Tiffany M; Roth, Stephen J; Cisco, Michael J

2017-06-01

Pain and agitation are common experiences of patients in pediatric cardiac intensive care units. Variability in assessments by health care providers, communication, and treatment of pain and agitation creates challenges in management of pain and sedation. To develop guidelines for assessment and treatment of pain, agitation, and delirium in the pediatric cardiac intensive unit in an academic children's hospital and to document the effects of implementation of the guidelines on the interprofessional team's perception of care delivery and team function. Before and after implementation of the guidelines, interprofessional team members were surveyed about the members' perception of analgesia, sedation, and delirium management RESULTS: Members of the interprofessional team felt more comfortable with pain and sedation management after implementation of the guidelines. Team members reported improvements in team communication on patients' comfort. Members thought that important information was less likely to be lost during transfer of care. They also noted that the team carried out comfort management plans and used pharmacological and nonpharmacological therapies better after implementation of the guidelines than they did before implementation. Guidelines for pain and sedation management were associated with perceived improvements in team function and patient care by members of the interprofessional team. ©2017 American Association of Critical-Care Nurses.

Hypnosis in Cancer Care.

PubMed

Wortzel, Joshua; Spiegel, David

2017-07-01

Cancer affects a growing proportion of the population as survival improves. The illness and its treatment brings a substantial burden of symptoms, including pain, anxiety, insomnia, and grief. Here, the uses of hypnosis in the treatment of these cancer-related problems will be reviewed. The utility of measuring hypnotizability in the clinical setting will be discussed. The current neurobiology of hypnotizability and hypnosis will be reviewed. Methods and results of using hypnosis for pain control in acute and chronic settings will be presented. Effects of hypnotic analgesia in specific brain regions associated with pain reduction, notably the dorsal anterior cingulate cortex and the somatosensory cortex, underlies its utility as a potent and side-effect free analgesic. Methods for helping those with cancer to better manage their anxiety, insomnia, and grief will be described. These involve facing disease-related stressors while dissociating the experience from somatic arousal. Given the serious complications of medications widely used to treat pain, anxiety, and insomnia, this article provides methods and an evidence base for wider use of techniques involving hypnosis in cancer care. Altering patients' perception of pain, disease-related stress, and anxiety can help change the reality of their life with cancer.

Night-shift work increases cold pain perception.

PubMed

Pieh, Christoph; Jank, Robert; Waiß, Christoph; Pfeifer, Christian; Probst, Thomas; Lahmann, Claas; Oberndorfer, Stefan

2018-05-01

Although night-shift work (NSW) is associated with a higher risk for several physical and mental disorders, the impact of NSW on pain perception is still unclear. This study investigates the impact of NSW on cold pain perception considering the impact of mood and sleepiness. Quantitative sensory testing (QST) was performed in healthy night-shift workers. Cold pain threshold as well as tonic cold pain was assessed after one habitual night (T1), after a 12-hour NSW (T2) and after one recovery night (T3). Sleep quality was measured with the Pittsburgh Sleep Quality Index (PSQI) before T1, sleepiness with the Stanford Sleepiness Scale (SSS) and mood with a German short-version of the Profile of Mood States (ASTS) at T1, T2 and T3. Depending on the distribution of the data, ANOVAs or Friedman tests as well as t- or Wilcoxon tests were performed. Nineteen healthy shift-workers (13 females; 29.7 ± 7.5 years old; 8.1 ± 6.6 years in shift work, PSQI: 4.7 ± 2.2) were included. Tonic cold pain showed a significant difference between T1 (48.2 ± 27.5 mm), T2 (61.7 ± 26.6 mm; effect size: Cohen's d=.49; percent change 28%), and T3 (52.1 ± 28.7 mm) on a 0-100 mm Visual Analog Scale (p = 0.007). Cold pain threshold changed from 11.0 ± 7.9 °C (T1) to 14.5 ± 8.8 °C (T2) (p = 0.04), however, an ANOVA comparing T1, T2, and T3 was not significant (p = 0.095). Sleepiness (SSS) and mood (ASTS) changed significantly between T1, T2 and T3 (p-values < 0.01). The change of mood but not of sleepiness correlated with the difference in tonic cold pain from T1 to T2 (R: 0.53; R 2 : 0.29; p = 0.022). NSW increases cold pain perception. The same tonic cold pain stimulus is rated 28% more painful after NSW and normalizes after a recovery night. Increases in cold pain perception due to NSW appear to be more strongly related to changes in mood as compared to changes in sleepiness. Copyright © 2018 Elsevier B.V. All rights reserved.

The association of perceived discrimination with low back pain.

PubMed

Edwards, Robert R

2008-10-01

A handful of recent studies have documented perceived discrimination as a correlate of poor physical and mental health status among ethnic and racial minority groups. To date, however, despite a proliferation of research on ethnic disparities in the severity and impact of a number of persistent pain conditions, there have been no reports on associations between perceived discrimination and pain-related symptoms. Using data from a national survey (the National Survey of Midlife Development in the United States; MIDUS), we explore the relationships between perceived discriminatory events and the report of back pain among African-American and white men and women. As expected, African-American participants reported substantially greater perceptions of discrimination than white participants. Moreover, in models that included a variety of physical and mental health variables, episodes of major lifetime discriminatory events were the strongest predictors of back pain report in African-Americans, and perceived day-to-day discrimination was the strongest predictor of back pain report specifically in African-American women. Among white participants, perceptions of discrimination were minimally related or unrelated to back pain. To our knowledge, these are the first data documenting an association between perceived discrimination and report of back pain; the fact that perceptions of discrimination were stronger predictors than physical health variables highlights the potential salience and adverse impact of perceived discrimination in ethnic and racial minority groups.

No Influence of Transcutaneous Electrical Nerve Stimulation on Exercise-Induced Pain and 5-Km Cycling Time-Trial Performance

PubMed Central

Hibbert, Andrew W.; Billaut, François; Varley, Matthew C.; Polman, Remco C. J.

2017-01-01

Introduction: Afferent information from exercising muscle contributes to the sensation of exercise-induced muscle pain. Transcutaneous electrical nerve stimulation (TENS) delivers low–voltage electrical currents to the skin, inhibiting nociceptive afferent information. The use of TENS in reducing perceptions of exercise-induced pain has not yet been fully explored. This study aimed to investigate the effect of TENS on exercise-induced muscle pain, pacing strategy, and performance during a 5-km cycling time trial (TT). Methods: On three separate occasions, in a single-blind, randomized, and cross-over design, 13 recreationally active participants underwent a 30-min TENS protocol, before performing a 5-km cycling TT. TENS was applied to the quadriceps prior to exercise under the following conditions; control (CONT), placebo with sham TENS application (PLAC), and an experimental condition with TENS application (TENS). Quadriceps fatigue was assessed with magnetic femoral nerve stimulation assessing changes in potentiated quadriceps twitch force at baseline, pre and post exercise. Subjective scores of exertion, affect and pain were taken every 1-km. Results: During TTs, application of TENS did not influence pain perceptions (P = 0.68, ηp2 = 0.03). There was no significant change in mean power (P = 0.16, ηp2 = 0.16) or TT duration (P = 0.17, ηp2 = 0.14), although effect sizes were large for these two variables. Changes in power output were not significant but showed moderate effect sizes at 500-m (ηp2 = 0.10) and 750-m (ηp2 = 0.10). Muscle recruitment as inferred by electromyography data was not significant, but showed large effect sizes at 250-m (ηp2 = 0.16), 500-m (ηp2 = 0.15), and 750-m (ηp2 = 0.14). This indicates a possible effect for TENS influencing performance up to 1-km. Discussion: These findings do not support the use of TENS to improve 5-km TT performance. PMID:28223939

Spinal Manipulative Therapy Has an Immediate Effect on Thermal Pain Sensitivity in People With Low Back Pain: A Randomized Controlled Trial

PubMed Central

Bishop, Mark D.; Robinson, Michael E.; Zeppieri, Giorgio; George, Steven Z.

2009-01-01

Background Current evidence suggests that spinal manipulative therapy (SMT) is effective in the treatment of people with low back pain (LBP); however, the corresponding mechanisms are unknown. Hypoalgesia is associated with SMT and is suggestive of specific mechanisms. Objective The primary purpose of this study was to assess the immediate effects of SMT on thermal pain perception in people with LBP. A secondary purpose was to determine whether the resulting hypoalgesia was a local effect and whether psychological influences were associated with changes in pain perception. Design This study was a randomized controlled trial. Setting A sample of convenience was recruited from community and outpatient clinics. Participants Thirty-six people (10 men, 26 women) currently experiencing LBP participated in the study. The average age of the participants was 32.39 (SD=12.63) years, and the average duration of LBP was 221.79 (SD=365.37) weeks. Intervention and Measurements Baseline demographic and psychological measurements were obtained, followed by quantitative sensory testing to assess temporal summation and Aδ fiber–mediated pain perception. Next, participants were randomly assigned to ride a stationary bicycle, perform low back extension exercises, or receive SMT. Finally, the same quantitative sensory testing protocol was reassessed to determine the immediate effects of each intervention on thermal pain sensitivity. Results Hypoalgesia to Aδ fiber–mediated pain perception was not observed. Group-dependent hypoalgesia of temporal summation specific to the lumbar innervated region was observed. Pair-wise comparisons indicated significant hypoalgesia in participants who received SMT, but not in those who rode a stationary bicycle or performed low back extension exercises. Psychological factors did not significantly correlate with changes in temporal summation in participants who received SMT. Limitations Only immediate effects of SMT were measured, so the authors are unable to comment on whether the inhibition of temporal summation is a lasting effect. Furthermore, the authors are unable to comment on the relationship between their findings and changes in clinical pain. Conclusions Inhibition of Aδ fiber–mediated pain perception was similar for all groups. However, inhibition of temporal summation was observed only in participants receiving SMT, suggesting a modulation of dorsal horn excitability that was observed primarily in the lumbar innervated area. PMID:19797305

White Cancer Patients’ Perception of Gender and Ethnic Differences in Pain Experience

PubMed Central

Im, Eun-Ok

2008-01-01

Not considering cancer patients’ own views and experience with pain, especially gender and ethnic differences in their cancer pain experience, was reported to be a major contributor to the miscommunication that frequently results in inadequate cancer pain management. The purpose of this study was to explore white cancer patients’ perception of gender and ethnic differences in pain experience through an online forum. This was a descriptive qualitative study among 29 white cancer patients based on a feminist approach. Nine topics related to cancer pain experience were used. The data were analyzed using thematic analysis: 5 themes were identified. First, the participants perceived that pain accompanies cancer throughout the diagnosis and treatment process. Second, the specific characteristics of the participants’ individual culture and its view of pain and cancer could result in different cancer pain experience even among white cancer patients. Third, the participants complained that women’s pain was not taken seriously by health care providers. Fourth, the participants reported highly individualized pain experience with emotional pain. Finally, the participants wanted to have a control of their own pain management process. Based on the findings, implications for nursing research and practice are proposed. PMID:17135816

Does health status affect perceptions of factors influencing dignity at the end of life?

PubMed

Albers, Gwenda; Pasman, H Roeline W; Deliens, Luc; de Vet, Henrica C W; Onwuteaka-Philipsen, Bregje D

2013-06-01

More people are surviving into old age, and chronic diseases tend to become more common with age. Ill health and disability can lead to concerns about loss of personal dignity. To investigate whether health status affects the perceptions of factors influencing personal dignity at the end of life, and the relationship between those perceptions and sociodemographic characteristics. A subsample (n=2282) of a large advance directives cohort study was used. Three different health status groups (good, moderate, and poor) were defined based on the Euroqol-5D and a question on whether they had an illness. For each health status group, we calculated the percentage of respondents who indicated the extent to which the items of the Patient Dignity Inventory would influence their dignity as (very) large. Logistic regression analyses were used to investigate the associations between the perceptions of factors influencing personal dignity and sociodemographics. The percentage of respondents who indicated the factors as having a (very) large influence on dignity at the end of life were not significantly different for the three health status groups, except for three physical items on symptoms, roles, and routines. Those items were significantly more influential on dignity for people with a poor health status. Gender, old age, having a partner, and having a belief or religion that is important to one's life were associated with an understanding of factors influential to dignity. Health status seems only to affect the perceptions of physical factors maintaining dignity at the end of life. This might suggest that the understanding of dignity will not substantially change as health status changes and may support starting advance care planning early. Copyright © 2013 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

Co-occurrence of posttraumatic stress symptoms, pain, and disability 12 months after traumatic injury

PubMed Central

Giummarra, Melita J.; Casey, Sara L.; Devlin, Anna; Ioannou, Liane J.; Gibson, Stephen J.; Georgiou-Karistianis, Nellie; Jennings, Paul A.; Cameron, Peter A.; Ponsford, Jennie

2017-01-01

Abstract Introduction: Chronic pain is common after traumatic injury and frequently co-occurs with posttraumatic stress disorder (PTSD) and PTSD symptoms (PTSS). Objectives: This study sought to understand the association between probable PTSD, PTSS, and pain. Methods: Four hundred thirty-three participants were recruited from the Victorian Orthopaedic Trauma Outcomes Registry and Victorian State Trauma Registry and completed outcome measures. Participants were predominantly male (n = 324, 74.8%) and aged 17-75 years at the time of their injury (M = 44.83 years, SD = 14.16). Participants completed the Posttraumatic Stress Disorder Checklist, Brief Pain Inventory, Pain Catastrophizing Scale, Pain Self-Efficacy Questionnaire, Tampa Scale of Kinesiophobia, EQ-5D-3L and Roland-Morris Disability Questionnaire 12 months after hospitalization for traumatic injury. Data were linked with injury and hospital admission data from the trauma registries. Results: Those who reported having current problems with pain were 3 times more likely to have probable PTSD than those without pain. Canonical correlation showed that pain outcomes (pain severity, interference, catastrophizing, kinesiophobia, self-efficacy, and disability) were associated with all PTSSs, but especially symptoms of cognition and affect, hyperarousal, and avoidance. Posttraumatic stress disorder symptoms, on the contrary, were predominantly associated with high catastrophizing and low self-efficacy. When controlling for demographics, pain and injury severity, depression, and self-efficacy explained the greatest proportion of the total relationship between PTSS and pain-related disability. Conclusion: Persons with both PTSS and chronic pain after injury may need tailored interventions to overcome fear-related beliefs and to increase their perception that they can engage in everyday activities, despite their pain. PMID:29392235

Functional dissociation of stimulus intensity encoding and predictive coding of pain in the insula

PubMed Central

Geuter, Stephan; Boll, Sabrina; Eippert, Falk; Büchel, Christian

2017-01-01

The computational principles by which the brain creates a painful experience from nociception are still unknown. Classic theories suggest that cortical regions either reflect stimulus intensity or additive effects of intensity and expectations, respectively. By contrast, predictive coding theories provide a unified framework explaining how perception is shaped by the integration of beliefs about the world with mismatches resulting from the comparison of these beliefs against sensory input. Using functional magnetic resonance imaging during a probabilistic heat pain paradigm, we investigated which computations underlie pain perception. Skin conductance, pupil dilation, and anterior insula responses to cued pain stimuli strictly followed the response patterns hypothesized by the predictive coding model, whereas posterior insula encoded stimulus intensity. This novel functional dissociation of pain processing within the insula together with previously observed alterations in chronic pain offer a novel interpretation of aberrant pain processing as disturbed weighting of predictions and prediction errors. DOI: http://dx.doi.org/10.7554/eLife.24770.001 PMID:28524817

Text neck and neck pain in 18-21-year-old young adults.

PubMed

Damasceno, Gerson Moreira; Ferreira, Arthur Sá; Nogueira, Leandro Alberto Calazans; Reis, Felipe José Jandre; Andrade, Igor Caio Santana; Meziat-Filho, Ney

2018-06-01

The aim of this study was to investigate whether there is an association between text neck and neck pain in young adults. Observational cross-sectional study with 150 18-21-year-old young adults from a public high school in the state of Rio de Janeiro was performed. In the self-report questionnaire, the participants answered questions on sociodemographic factors, anthropometric factors, time spent texting or playing on a mobile phone, visual impairments, and concern with the body posture. The neck posture was assessed by participants' self-perception and physiotherapists' judgment during a mobile phone texting message task. The Young Spine Questionnaire was used to evaluate the neck pain. Four multivariate logistic regression models were fitted to investigate the association between neck posture during mobile phone texting and neck pain, considering potential confounding factors. There is no association between neck posture, assessed by self-perception, and neck pain (OR = 1.66, p = 0.29), nor between neck posture, assessed by physiotherapists' judgment, and neck pain (OR = 1.23, p = 0.61). There was also no association between neck posture, assessed by self-perception, and frequency of neck pain (OR = 2.19, p = 0.09), nor between neck posture, assessed by physiotherapists' judgment, and frequency of neck pain (OR = 1.17, p = 0.68). This study did not show an association between text neck and neck pain in 18-21-year-old young adults. The findings challenge the belief that neck posture during mobile phone texting is associated to the growing prevalence of neck pain.

A snap shot of patients' recall, attitudes, and perceptions of their pain contracts from a family medicine resident outpatient clinic.

PubMed

Bahniwal, Robinder; Sell, Jarrett; Waheed, Abdul

Determine patient recall, attitudes, and perceptions of their pain contract in a family medicine resident out-patient clinic. A cross-sectional study design using a telephone survey to all eligible subjects who signed a hardcopy pain contract from August 29, 2014 to May 19, 2016 at a resident outpatient clinic. Penn State Hershey Family and Community Medicine Residency clinic. All patients who signed a hardcopy pain contract at the practice site who met specific inclusion criteria. What proportions of items are remembered from the standardized Penn State Hershey pain contract and does recall vary with time of contract signing. Patient attitudes and perceptions of their pain contract. Ninety-five percent of patients recalled agreeing to random urine drug screens (UDS) and 60 percent recalled they were not to receive prescriptions from another provider unless approved by their practice site. The recall rate for the remaining 33 items in the contract ranged from 0 percent to 20 percent. The highest recall rate was for contracts signed between 0-3 months. Patient feedback regarding the pain contract was recorded and while five were positive or neutral, 15 patients recorded negative attitudes toward the process, the physician, and/or the UDS. This study highlights limited recall and negative patient attitudes toward the pain contract. Considering the public health concerns with regard to the current opioid epidemic in the United States, additional training of providers, redesign of pain contracts and new models for informing patients about safe chronic pain management may be warranted.

Attractiveness, diagnostic ambiguity, and disability cues impact perceptions of women with pain.

PubMed

LaChapelle, Diane L; Lavoie, Susan; Higgins, Nancy C; Hadjistavropoulos, Thomas

2014-05-01

This experimental study investigated how physical attractiveness, disability cue, and diagnostic ambiguity stereotypes impact perceptions of a patient's pain/disability and personality. After viewing photographs of women pictured with or without a cane, accompanied by descriptions of the women's diagnosis (fibromyalgia or rheumatoid arthritis), 147 university students rated the women's pain/disability and personality. Analyses revealed that more attractive women received lower ratings on pain/disability and higher ratings (more positive) on personality. Moreover, those pictured with a disability cue got higher ratings on both pain/disability and personality, and those with medical evidence of pathology (less ambiguity) got higher ratings on pain/disability and lower ratings on personality. Examination of the 3 stereotypes in a single study enabled an evaluation of their interactions. An Attractiveness × Disability Cue × Diagnostic Ambiguity interaction for ratings of pain/disability revealed that the presence of both medical evidence and a disability cue were needed to override the strong "beautiful is healthy" stereotype. Significant 2-way interactions for ratings of personality indicated that the impact of the disability stereotype tends to be overshadowed by the attractiveness stereotype. The results indicate that these stereotypes have a large effect on perceptions of women with chronic pain and that attractiveness, a contextual variable unrelated to the pain experience, exerts an even stronger effect when there is less objective information available. This could have clinical ramifications for assessment and treatment of patients with chronic pain, which often occurs in the absence of "objective" medical evidence or any external cues of disability. (c) 2014 APA, all rights reserved.

Sex-dependent effects of stress on brain correlates to empathy for pain.

PubMed

Gonzalez-Liencres, Cristina; Breidenstein, Anja; Wolf, Oliver T; Brüne, Martin

2016-07-01

Empathy is a fundamental attribute required for appropriate social functioning. The extent to which we empathize with others in pain is influenced by numerous factors. Being highly social species, humans face social stress on a regular basis, which undoubtedly affects how we react to our environment. It is not yet known how social stress may modulate our neural mechanisms when we empathize with others in painful circumstances, and its effects on empathic behavior are still unclear. For this reason, we recorded the electroencephalography (EEG) of healthy men and women, half of which were previously exposed to psychosocial stress, while they observed photographs of hands in painful and neutral situations. At the behavioral level, stress induced higher unpleasantness ratings to painful stimuli, and lower ratings to neutral pictures, independent of sex. At the neurophysiological level, we found that early (N110 over fronto-central sites) event-related potentials (ERPs) were not affected by stress, while late (P3 over centro-parietal regions) components showed a sex-dependent differential effect of stress. Correlation analyses further indicated a strong association between N110 with trait markers of empathy in all participants, while P3 was associated with the change in cortisol in stressed males. Our findings suggest that sex-dependent effects of social stress on the neural responses to empathy for pain give rise to comparable behaviors in men and women in the paradigm we employed, implying that each sex may engage in distinct mechanisms to cope with stress. Moreover, stress seems to modulate late neural mechanisms of empathy but not our early perception. Copyright © 2016 Elsevier B.V. All rights reserved.

Perceptive rehabilitation and trunk posture alignment in patients with Parkinson disease: a single blind randomized controlled trial.

PubMed

Morrone, Michelangelo; Miccinilli, Sandra; Bravi, Marco; Paolucci, Teresa; Melgari, Jean M; Salomone, Gaetano; Picelli, Alessandro; Spadini, Ennio; Ranavolo, Alberto; Saraceni, Vincenzo M; DI Lazzaro, Vincenzo; Sterzi, Silvia

2016-12-01

Recent studies aimed to evaluate the potential effects of perceptive rehabilitation in Parkinson Disease reporting promising preliminary results for postural balance and pain symptoms. To date, no randomized controlled trial was carried out to compare the effects of perceptive rehabilitation and conventional treatment in patients with Parkinson Disease. To evaluate whether a perceptive rehabilitation treatment could be more effective than a conventional physical therapy program in improving postural control and gait pattern in patients with Parkinson Disease. Single blind, randomized controlled trial. Department of Physical and Rehabilitation Medicine of a University Hospital. Twenty outpatients affected by idiopathic Parkinson Disease at Hoehn and Yahr stage ≤3. Recruited patients were divided into two groups: the first one underwent individual treatment with Surfaces for Perceptive Rehabilitation (Su-Per), consisting of rigid wood surfaces supporting deformable latex cones of various dimensions, and the second one received conventional group physical therapy treatment. Each patient underwent a training program consisting of ten, 45-minute sessions, three days a week for 4 consecutive weeks. Each subject was evaluated before treatment, immediately after treatment and at one month of follow-up, by an optoelectronic stereophotogrammetric system for gait and posture analysis, and by a computerized platform for stabilometric assessment. Kyphosis angle decreased after ten sessions of perceptive rehabilitation, thus showing a substantial difference with respect to the control group. No significant differences were found as for gait parameters (cadence, gait speed and stride length) within Su-Per group and between groups. Parameters of static and dynamic evaluation on stabilometric platform failed to demonstrate any statistically relevant difference both within-groups and between-groups. Perceptive training may help patients affected by Parkinson Disease into restoring a correct midline perception and, in turn, to improve postural control. Perceptive surfaces represent an alternative to conventional rehabilitation of postural disorders in Parkinson Disease. Further studies are needed to determine if the association of perceptive treatment and active motor training would be useful in improving also gait dexterity.

Mirror therapy for phantom limb pain in an adolescent cancer survivor.

PubMed

Clerici, Carlo Alfredo; Spreafico, Filippo; Cavallotti, Gaia; Consoli, Annalisa; Veneroni, Laura; Sala, Alessio; Massimino, Maura

2012-01-01

Several pediatric tumors require mutilating procedures in order to be treated effectively. Although the pain caused by the surgery is usually of a transient nature, the perception of pain in the amputated limb may persist. This prolonged pain, which is often refractory to pain-killing medication, may severely affect the patient's quality of life. The phenomenon of phantom limb pain (or phantom limb syndrome) has been investigated using neurological, neurophysiological and psychopathological approaches. Here we discuss the advantages of an unconventional rehabilitation technique, the recently reported mirror therapy, whose positive effects might be due, according to some researchers, to neuronal plasticity mechanisms. We describe the use of mirror therapy to treat phantom limb syndrome in a 39-year-old patient whose right leg had been amputated at the age of 17 because of an osteosarcoma. The patient suffered from frequent episodes of pain, with severely negative effects on his quality of life. We obtained positive subjective feedback from the patient, who reported having benefited significantly from using the mirror. The beneficial effect was still present six months after the start of mirror therapy. The reported case highlights the value of an integrated multidisciplinary approach including neurological/physiatric assessment, clinical psychological support, physiotherapy and other, unconventional treatment modalities. This report should guide future studies towards the application of mirror therapy in order to elucidate its effects and efficacy.

Doctors and patients in pain: Conflict and collaboration in opioid prescription in primary care.

PubMed

Esquibel, Angela Y; Borkan, Jeffrey

2014-12-01

Use of chronic opioid therapy (COT) for chronic noncancer pain has dramatically increased in the United States. Patients seek compassionate care and relief while physicians struggle to manage patients' pain effectively without doing harm. This study explores the narratives of chronic noncancer pain patients receiving chronic opioid therapy and those of their physicians to better understand the effects of COT on the doctor-patient relationship. A mixed method study was conducted that included in-depth interviews and qualitative analysis of 21 paired patients with chronic pain and their physicians in the following groups: patients, physicians, and patient-physician pairs. Findings revealed that patients' narratives focus on suffering from chronic pain, with emphasis on the role of opioid therapy for pain relief, and physicians' narratives describe the challenges of treating patients with chronic pain on COT. Results elucidate the perceptions of ideal vs difficult patients and show that divergent patterns surrounding the consequences, utility, and goals of COT can negatively affect the doctor-patient relationship. The use of paired interviews through a narrative lens in this exploratory study offers a novel and informative approach for clinical practice and research. The findings have significant implications for improving doctor-patient communication and health outcomes by encouraging shared decision making and goal-directed health care encounters for physicians and patients with chronic pain on COT. This study found patterns of understanding pain, opioid pain medications, and the doctor-patient relationship for patients with chronic pain and their physicians using a narrative lens. Thematic findings in this exploratory study, which include a portrayal of collaborative vs conflictual relationships, suggest areas of future intervention and investigation. Copyright © 2014 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

Parents' perspective of their journey caring for a child with chronic neuropathic pain.

PubMed

Gaughan, Veronica; Logan, Deirdre; Sethna, Navil; Mott, Sandra

2014-03-01

When a child has chronic pain, it affects the parents. Their response and how it is factored into their lives and family function was the phenomenon of interest that drove this study. The available literature was sparse, especially when the pain etiology was neuropathic. The purpose of this study was to describe the parents' perception of the pain journey from the initial occurrence of their child's pain through the labyrinth of treatment options to successful outcome, to gain a better understanding of parental beliefs about pain, and to learn how parental attitudes and behaviors relate to children's response to treatment for chronic pain. Qualitative descriptive design was used to better understand the phenomenon from those who were the experts because they had experienced it. Parents whose child was enrolled in a pain rehabilitation program participated in open-ended interviews. The children/adolescents were 8-18 years old and diagnosed with complex regional pain syndrome or a related chronic pain condition. During data immersion, the investigators uncovered the pervasive underlying themes of suffering and disempowerment. In addition, the multiple meaning elements were grouped into three categories and supportive subcategories labeled as follows: parent distress, with subcategories schism in parenting, searching, and disabled parenting; and lack of control, with the subcategories family/community, fear, and empowerment. The voices of parents were heard in their description of the exhausting and difficult journey in search of pain relief for their child. Their comments provided insight into how they defined the child's pain and their related parental role. Copyright © 2014 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

Effect of intraoperative analgesia on children's pain perception during recovery after painful dental procedures performed under general anaesthesia.

PubMed

El Batawi, H Y

2015-02-01

To investigate the possible effect of intraoperative analgesia, namely diclofenac sodium compared to acetaminophen on post-recovery pain perception in children undergoing painful dental procedures under general anaesthesia. A double-blind randomised clinical trial. A sample of 180 consecutive cases of children undergoing full dental rehabilitation under general anaesthesia in a private hospital in Saudi Arabia during 2013 was divided into three groups (60 children each) according to the analgesic used prior to extubation. Group A, children had diclofenac sodium suppository. Group B, children received acetaminophen suppository and Group C, the control group. Using an authenticated Arabic version of the Wong and Baker faces Pain assessment Scale, patients were asked to choose the face that suits best the pain he/she is suffering. Data were collected and recorded for statistical analysis. Student's t test was used for comparison of sample means. A preliminary F test to compare sample variances was carried out to determine the appropriate t test variant to be used. A "p" value less than 0.05 was considered significant. More than 93% of children had post-operative pain in varying degrees. High statistical significance was observed between children in groups A and B compared to control group C with the later scoring high pain perception. Diclofenac showed higher potency in multiple painful procedures, while the statistical difference was not significant in children with three or less painful dental procedures. Diclophenac sodium is more potent than acetaminophen, especially for multiple pain-provoking or traumatic procedures. A timely use of NSAID analgesia just before extubation helps provide adequate coverage during recovery. Peri-operative analgesia is to be recommended as an essential treatment adjunct for child dental rehabilitation under general anaesthesia.

Pain assessment by continuous EEG: association between subjective perception of tonic pain and peak frequency of alpha oscillations during stimulation and at rest.

PubMed

Nir, Rony-Reuven; Sinai, Alon; Raz, Einat; Sprecher, Elliot; Yarnitsky, David

2010-07-16

Recordings of neurophysiological brain responses to noxious stimuli have been traditionally based on short stimuli, in the order of milliseconds, which induce distinct event-related potentials (ERPs). However, using such stimuli in the experimental setting is disadvantageous as they are too brief to faithfully simulate clinical pain. We aimed at utilizing continuous EEG to investigate the properties of peak alpha frequency (PAF) as an objective cortical measure associated with subjective perception of tonic pain. Five minute long continuous EEG was recorded in 18 healthy volunteers under: (i) resting-state; (ii) innocuous temperature; and (iii) psychophysically-anchored noxious temperature. Numerical pain scores (NPSs) collected during the application of tonic noxious stimuli were tested for correlation with peak frequencies of alpha power-curves derived from central, temporal and frontal electrodes. NPSs and PAFs remained stable throughout the recording conditions (RM-ANOVAs; Ps>0.51). In the noxious condition, PAFs obtained at the bilateral temporal scalp were correlated with NPSs (Ps<0.001). Moreover, resting-state PAFs recorded at the bilateral temporal scalp were correlated with NPSs reported during the noxious condition (Ps<0.01). These psychophysical-neurophysiological relations attest to the properties of PAF as a novel cortical objective measure of subjective perception of tonic pain. Moreover, resting-state PAFs might hold inherent pain modulation attributes, possibly enabling the prediction of individual responsiveness to prolonged pain. The relevance of PAF to the neural processing of tonic pain may indicate its potential to advance pain research as well as clinical pain characterization. Copyright (c) 2010 Elsevier B.V. All rights reserved.

[The phenomenon of pain in the history of music – observations of neurobiological mechanisms of pain and its expressions in western music].

PubMed

Gasenzer, E R; Neugebauer, E A M

2014-12-01

Purpose of this essay is to provide a historical overview how music has dealt with the emotion and sensation of pain, as well as an overview over the more recent medical research into the relationship of music and pain. Since the beginnings of western music humans have put their emotions into musical sounds. During the baroque era, composers developed musical styles that expressed human emotions and our experiences of nature. In some compositions, like in operas, we find musical representations of pain. During Romanticism artists began to intrude into the soul of their audience. New expressive harmonies and styles touch the soul and the consciousness of the listener. With the inception of atonality dissonant sounds where experienced as a physical pain.The physiology of deep brain structures (like thalamus, hypothalamus or limbic system) and the physiology of the acoustic pathway process consonant and dissonant sound and musical perceptions in ways, that are similar to the perception of pain. In the thalamus and in the limbic system music and pain meet.The relationships of music and pain is a wide open research field with such interesting questions as the role of dopamine in the perception of consonant or dissonant music, or the processing of pain during music listening. Musicology has not yet embarked on a general investigation of how musical compositions express pain and how that has developed or changed over the centuries. Music therapy, neuro-musicology and the performing arts medicine are scientific fields that offer a lot of ideas for medical and musical research projects. © Georg Thieme Verlag KG Stuttgart · New York.

The relationship between different facets of empathy, pain perception and compassion fatigue among physicians

PubMed Central

Gleichgerrcht, Ezequiel; Decety, Jean

2014-01-01

Background: Medical practitioners such as physicians are continuously exposed to the suffering and the distress of patients. Understanding the way pain perception relates to empathetic dispositions and professional quality of life can contribute to the development of strategies aimed at protecting health professionals from burnout and compassion fatigue. In the present study we investigate the way individual dispositions relate to behavioral measures of pain sensitivity, empathy, and professional quality of life. Methods: A secure Web-based series of self-report measures and a behavioral task were administered to 1,199 board-certified physicians. Additionally, surveys were used to obtain measures of demographic and professional background; dispositional empathy (empathic concern, personal distress, and perspective taking); positive (compassion satisfaction) and negative (burnout and secondary traumatic stress) aspects of their professional life. In the behavioral task, participants were asked to watch a series of video clips of patients experiencing different levels of pain and provide ratings of pain intensity and induced personal distress. Results: Perceived pain intensity was significantly lower among more experienced physicians but similar across specialty fields with varying demands of emotional stress. Watching videos of patients in pain, however, elicited more personal distress among physicians in highly demanding medical fields, despite comparable empathy dispositions with other fields. The pain of male patients was perceived as less intense than the pain of female patients, and this effect was more marked for female physicians. The effect of dispositional empathy on pain perception and induced personal distress was different for each sub-component, with perspective taking and empathic concern (EC) being predictive of the behavioral outcomes. Physicians who experience both compassion satisfaction and fatigue perceive more pain and suffer more personal distress from it than those who only suffer the negative aspects of professional quality of life. Conclusions: Professional experience seems to desensitize physicians to the pain of others without necessarily helping them down-regulate their own personal distress. Pain perception is also related with specific aspects of empathy and varies depending on context, as is the case with the gender of their patients. Minimum levels of empathy appear necessary to benefit from the positive aspects of professional quality of life in medicine. PMID:25071495

Salivary Alpha-Amylase Correlates with Subjective Heat Pain Perception.

PubMed

Wittwer, Amrei; Krummenacher, Peter; La Marca, Roberto; Ehlert, Ulrike; Folkers, Gerd

2016-06-01

Self-reports of pain are important for an adequate therapy. This is a problem with patients and infants who are restricted in providing an accurate verbal estimation of their pain. Reliable, real-time, economical, and non-invasive physiological correlates might contribute to a more comprehensive description of pain. Salivary alpha-amylase constitutes one candidate biomarker, which reflects predominantly sympathetic nervous system alterations under stressful conditions and can be measured non-invasively. The current study investigated the effects of acute heat pain on salivary alpha-amylase activity. Heat pain tolerance was measured on the non-dominant forearm. Participants completed visual analog scales on pain intensity and unpleasantness. Saliva samples were collected directly after pain induction. Twenty-seven healthy volunteers were recruited for this study. While salivary alpha-amylase levels correlated positively with intensity and unpleasantness ratings in response to acute heat pain stimuli, there was no corresponding association with pain tolerance. Salivary alpha-amylase is suggested to be an indirect physiologic correlate of subjective heat pain perception. Future studies should address the role of salivary alpha-amylase depending on the origin of pain, the concerned tissue, and other pain assessment methods. © 2016 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Pain perception and cardiovascular system response among athletes playing contact sports.

PubMed

Leźnicka, Katarzyna; Pawlak, Matthias; Białecka, Monika; Safranow, Krzysztof; Cięszczyk, Paweł

2017-01-01

The aim of this study was to determine whether the contact sports change the perception of pain as assessed by the cold pressor test (CPT), and if the test induces the same reaction of the cardiovascular system in contact athletes and non-athletes. The study involved 321 healthy men; 140 contact athletes and 181 students of the University of Szczecin (control). Pain threshold and pain tolerance were evaluated using CPT. Cardiovascular measurements were made during CPT. The contact athletes showed a much higher tolerance to pain than the control group (median time 120 vs. 94 s, respectively, p = 0.0002). The thresholds of pain in both groups did not differ significantly between the groups. Systolic blood pressure measured before and during the test in all three measurements was statistically significantly higher in athletes compared with the control group. Heart rate and diastolic blood pressure did not differ significantly between the studied groups.

Being bullied in childhood, and pain and pain perception in adulthood.

PubMed

Sansone, Randy A; Watts, Daron A; Wiederman, Michael W

2014-08-01

While a number of negative health outcomes have been associated with bullying in childhood, we are not aware of any studies examining relationships between bullying in childhood, and pain symptoms and pain perception in adulthood - the focus of the present study. Using a cross-sectional consecutive sample and a self-report survey methodology, we examined among 243 primary-care outpatients a history of being bullied in childhood (yes/no) in relationship to three pain ratings (now, past month, past year) and catastrophic thoughts and feelings about pain as assessed by the Pain Catastrophizing Scale (PCS). Being bullied in childhood was statistically significantly associated with present pain ratings (p < .001) as well as pain ratings over the past month and the past year (p < .01), and with the total score on the PCS as well as each of its sub-scales (i.e. rumination, magnification, helplessness) (p < .001). Being bullied in childhood is associated with higher reported levels of pain at various time points as well as greater levels of self-reported catastrophic thoughts and feelings about pain. Importantly, the methodology of this study does not allow for the examination of a causal relationship. © The Author(s) 2013.

[Analgesia in intensive care medicine].

PubMed

Ortlepp, J R; Luethje, F; Walz, R

2016-02-01

The administration of sedatives and analgesics on the intensive care unit (ICU) is routine daily practice. The correct discrimination between delirium, pain and anxiety or confusion is essential for the strategy and selection of medication. The correct pain therapy and sedation are essential for patient quality of life on the ICU and for the prognosis. The aim of this article is to present state of the art recommendations on the classification of pain and pain therapy on the ICU. An online search was carried out in PubMed for publications on the topics of "pain" and "ICU". Critical care patients are frequently subjected to many procedures and situations which can cause pain. The perception of pain is, among other things, influenced by the degree of orientation, anxiety and the degree of sedation. The administration of analgesics and non-pharmacological approaches are effective in reducing the stress perceived by patients. The main aim is improvement in the awareness of nursing and medical personnel for pain inducers and pain perception in ICU patients. The classification of pain must be made objectively. Therapeutic targets must be defined and in addition to the correct selection of pain medication, non-pharmacological approaches must also be consistently implemented.

Attitude and knowledge of physicians about cancer pain management: young doctors of South Korea in their early career.

PubMed

Kim, Myung-Hyun; Park, Hyeonggeun; Park, Eun Chul; Park, Keeho

2011-06-01

This study is aimed at evaluating the attitude and knowledge about the optimal use of opioids and finding out the barriers to cancer pain management especially for young doctors in South Korea. A survey through questionnaire form was conducted on 1204 physicians. Physicians were grouped by their medical specialties and personal characteristics. Specialties were grouped into internal medicine and family medicine doctors, surgeons, anesthesiologists, pediatricians, other board holders and general physicians. Personal characteristics were grouped by their past experiences and current surroundings. Though many doctors thought that they were fairly well educated for pain management strategy, a large population of physicians showed a negative attitude and inadequate knowledge status about cancer pain management. The degree of attitude and knowledge status was different as their specialties and personal experiences. The factors that affected doctors' attitude and knowledge were: (i) medical specialty, (ii) past history of using practical pain assessment tool, (iii) self-perception of knowledge status about pain management, (iv) experience of prescribing opioids, (v) experience of education for cancer pain management. Although many physicians had a passive attitude in prescribing opioid analgesics, they are willingly open to use opioids for cancer pain management in the future. The most important perceived barriers to optimal cancer pain management were the fear for risk of tolerance, drug addiction, side effects of opioid analgesics and knowledge deficit about opioid analgesics. From this study, we found that further education and practical training will be needed for adequate cancer pain management for young physicians in their early career.

Wound treatment and pain management: a stressful time.

PubMed

Matsuzaki, Kyoichi; Upton, Dominic

2013-12-01

This review and case study report considers the evidence to indicate that the progress of wound healing is negatively affected by the presence of stressors and in circumstances where patients are in pain. It considers the relationship between perceptions of pain, stress and delayed wound healing with a specific focus on guidance for clinical practice. It is appreciated that although the literature has examined these issues in the management of acute wounds, demonstrating that psychological stress can have detrimental effects on the wound-healing process, the evidence to support this link in relation to chronic wounds is limited. The review considers evidence indicating that punch biopsy wounds heal more slowly in subjects under stress on account of caring for family members with long-term illnesses and also considers briefly the relationship between cortisol secretion in response to stress and the consequent influences on cytokine levels and the wound-healing process. © 2012 The Authors. International Wound Journal © 2012 John Wiley & Sons Ltd and Medicalhelplines.com Inc.

Effectiveness of an Educational Physiotherapy and Therapeutic Exercise Program in Adult Patients With Hemophilia: A Randomized Controlled Trial.

PubMed

Cuesta-Barriuso, Rubén; Torres-Ortuño, Ana; Nieto-Munuera, Joaquín; López-Pina, José Antonio

2017-05-01

To assess the efficacy of an educational physiotherapy home exercise intervention for physical improvement, pain perception, quality of life, and illness behavior in patients with hemophilic arthropathy. Single-blind randomized controlled trial. Home. Patients with hemophilia (N=20) were randomly allocated to an educational intervention group or to a control group. The educational intervention was performed every 2 weeks over a 15-week period, and home exercises were carried out once a day, 6 days a week, over the same period. Joint status was evaluated using the Gilbert scale; pain was assessed using the visual analog scale; illness behavior was evaluated using the Illness Behavior Questionnaire; and the perception of the quality of life was evaluated using the A36 Hemophilia-QoL questionnaire. We observed significant differences in the intervention group and the control group for both quality of life and illness behavior. There was no significant improvement in joint status; however, an improvement was noted in terms of perception of pain in the ankle. A physiotherapy program based on educational sessions and home exercises can improve the perception of pain in patients with hemophilic arthropathy of the ankle. It improves some variables in the perception of the quality of life and illness behavior. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Pain Management and Use of Opioids in Pediatric Oncology in India: A Qualitative Approach.

PubMed

Angelini, Paola; Boydell, Katherine M; Breakey, Vicky; Kurkure, Purna A; Muckaden, Marian A; Bouffet, Eric; Arora, Brijesh

2017-08-01

Consumption of medical opium for pain relief in India is low, despite the country being one of the main world producers of the substance. We investigated obstacles to opioid use and physician perceptions about optimal pain management in pediatric oncology patients in India. Semistructured interviews were conducted with oncologists who work in pediatric oncology settings. A mixed sampling strategy was used, including maximum variation and confirmation and disconfirmation of cases, as well as snowball sampling. Key informants were identified. Interviews were audio recorded, transcribed verbatim, and analyzed by thematic analysis methodology. Twenty-three interviews were performed across 20 Indian institutions. The main obstacles identified were lack of financial resources, inadequate education of health care providers on pain management, insufficient human resources (particularly lack of dedicated trained oncology nurses), poor access to opioids, and cultural perceptions about pain. Children from rural areas, treated in public hospitals, and from lower socioeconomic classes appear disadvantaged. A significant equality gap exists between public institutions and private institutions, which provide state-of-the-art treatment. The study illuminates the complexity of pain management in pediatric oncology in India, where financial constraints, lack of education, and poor access to opioids play a dominant role, but lack of awareness and cultural perceptions about pain management among health care providers and parents emerged as important contributing factors. Urgent interventions are needed to optimize care in this vulnerable population.

Exercise Benefits for Chronic Low Back Pain in Overweight and Obese Individuals.

PubMed

Wasser, Joseph G; Vasilopoulos, Terrie; Zdziarski, Laura Ann; Vincent, Heather K

2017-02-01

Overweight and obese individuals with chronic low back pain (LBP) struggle with the combined physical challenges of physical activity and pain interference during daily life; perceived disability increases, pain symptoms worsen, and performance of functional tasks and quality of life (QOL) decline. Consistent participation in exercise programs positively affects several factors including musculoskeletal pain, perceptions of disability due to pain, functional ability, QOL, and body composition. It is not yet clear, however, what differential effects occur among different easily accessible exercise modalities in the overweight-obese population with chronic LBP. This narrative review synopsizes available randomized and controlled, or controlled and comparative, studies of easily accessible exercise programs on pain severity, QOL, and other outcomes, such as physical function or body composition change, in overweight-obese persons with chronic LBP. We identified 16 studies (N = 1,351) of various exercise programs (aerobic exercise [AX], resistance exercise [RX], aquatic exercise [AQU], and yoga-Pilates) that measured efficacy on LBP symptoms, and at least one other outcome such as perceived disability, QOL, physical function, and body composition. RX, AQU, and Pilates exercise programs demonstrated the greatest effects on pain reduction, perceived disability, QOL, and other health components. The highest adherence rate occurred with RX and AQU exercise programs, indicating that these types of programs may provide a greater overall impact on relevant outcomes for overweight-obese LBP patients. V. Copyright © 2017 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

Pain Assessment–Can it be Done with a Computerised System? A Systematic Review and Meta-Analysis

PubMed Central

Pombo, Nuno; Garcia, Nuno; Bousson, Kouamana; Spinsante, Susanna; Chorbev, Ivan

2016-01-01

Background: Mobile and web technologies are becoming increasingly used to support the treatment of chronic pain conditions. However, the subjectivity of pain perception makes its management and evaluation very difficult. Pain treatment requires a multi-dimensional approach (e.g., sensory, affective, cognitive) whence the evidence of technology effects across dimensions is lacking. This study aims to describe computerised monitoring systems and to suggest a methodology, based on statistical analysis, to evaluate their effects on pain assessment. Methods: We conducted a review of the English-language literature about computerised systems related to chronic pain complaints that included data collected via mobile devices or Internet, published since 2000 in three relevant bibliographical databases such as BioMed Central, PubMed Central and ScienceDirect. The extracted data include: objective and duration of the study, age and condition of the participants, and type of collected information (e.g., questionnaires, scales). Results: Sixty-two studies were included, encompassing 13,338 participants. A total of 50 (81%) studies related to mobile systems, and 12 (19%) related to web-based systems. Technology and pen-and-paper approaches presented equivalent outcomes related with pain intensity. Conclusions: The adoption of technology was revealed as accurate and feasible as pen-and-paper methods. The proposed assessment model based on data fusion combined with a qualitative assessment method was revealed to be suitable. Data integration raises several concerns and challenges to the design, development and application of monitoring systems applied to pain. PMID:27089351

Changes of spontaneous oscillatory activity to tonic heat pain.

PubMed

Peng, Weiwei; Hu, Li; Zhang, Zhiguo; Hu, Yong

2014-01-01

Transient painful stimuli could induce suppression of alpha oscillatory activities and enhancement of gamma oscillatory activities that also could be greatly modulated by attention. Here, we attempted to characterize changes in cortical activities during tonic heat pain perception and investigated the influence of directed/distracted attention on these responses. We collected 5-minute long continuous Electroencephalography (EEG) data from 38 healthy volunteers during four conditions presented in a counterbalanced order: (A) resting condition; (B) innoxious-distracted condition; (C) noxious-distracted condition; (D) noxious-attended condition. The effects of tonic heat pain stimulation and selective attention on oscillatory activities were investigated by comparing the EEG power spectra among the four experimental conditions and assessing the relationship between spectral power difference and subjective pain intensity. The change of oscillatory activities in condition D was characterized by stable and persistent decrease of alpha oscillation power over contralateral-central electrodes and widespread increase of gamma oscillation power, which were even significantly correlated with subjective pain intensity. Since EEG responses in the alpha and gamma frequency band were affected by attention in different manners, they are likely related to different aspects of the multidimensional sensory experience of pain. The observed contralateral-central alpha suppression (conditions D vs. B and D vs. C) may reflect primarily a top-down cognitive process such as attention, while the widespread gamma enhancement (conditions D vs. A) may partly reflect tonic pain processing, representing the summary effects of bottom-up stimulus-related and top-down subject-driven cognitive processes.

Changes of Spontaneous Oscillatory Activity to Tonic Heat Pain

PubMed Central

Zhang, Zhiguo; Hu, Yong

2014-01-01

Transient painful stimuli could induce suppression of alpha oscillatory activities and enhancement of gamma oscillatory activities that also could be greatly modulated by attention. Here, we attempted to characterize changes in cortical activities during tonic heat pain perception and investigated the influence of directed/distracted attention on these responses. We collected 5-minute long continuous Electroencephalography (EEG) data from 38 healthy volunteers during four conditions presented in a counterbalanced order: (A) resting condition; (B) innoxious-distracted condition; (C) noxious-distracted condition; (D) noxious-attended condition. The effects of tonic heat pain stimulation and selective attention on oscillatory activities were investigated by comparing the EEG power spectra among the four experimental conditions and assessing the relationship between spectral power difference and subjective pain intensity. The change of oscillatory activities in condition D was characterized by stable and persistent decrease of alpha oscillation power over contralateral-central electrodes and widespread increase of gamma oscillation power, which were even significantly correlated with subjective pain intensity. Since EEG responses in the alpha and gamma frequency band were affected by attention in different manners, they are likely related to different aspects of the multidimensional sensory experience of pain. The observed contralateral-central alpha suppression (conditions D vs. B and D vs. C) may reflect primarily a top-down cognitive process such as attention, while the widespread gamma enhancement (conditions D vs. A) may partly reflect tonic pain processing, representing the summary effects of bottom-up stimulus-related and top-down subject-driven cognitive processes. PMID:24603703

Effectiveness of home-based cupping massage compared to progressive muscle relaxation in patients with chronic neck pain--a randomized controlled trial.

PubMed

Lauche, Romy; Materdey, Svitlana; Cramer, Holger; Haller, Heidemarie; Stange, Rainer; Dobos, Gustav; Rampp, Thomas

2013-01-01

Chronic neck pain is a major public health problem with very few evidence-based complementary treatment options. This study aimed to test the efficacy of 12 weeks of a partner-delivered home-based cupping massage, compared to the same period of progressive muscle relaxation in patients with chronic non-specific neck pain. Patients were randomly assigned to self-directed cupping massage or progressive muscle relaxation. They were trained and asked to undertake the assigned treatment twice weekly for 12 weeks. Primary outcome measure was the current neck pain intensity (0-100 mm visual analog scale; VAS) after 12 weeks. Secondary outcome measures included pain on motion, affective pain perception, functional disability, psychological distress, wellbeing, health-related quality of life, pressure pain thresholds and adverse events. Sixty one patients (54.1±12.7 years; 73.8%female) were randomized to cupping massage (n = 30) or progressive muscle relaxation (n = 31). After treatment, both groups showed significantly less pain compared to baseline however without significant group differences. Significant effects in favor of cupping massage were only found for wellbeing and pressure pain thresholds. In conclusion, cupping massage is no more effective than progressive muscle relaxation in reducing chronic non-specific neck pain. Both therapies can be easily used at home and can reduce pain to a minimal clinically relevant extent. Cupping massage may however be better than PMR in improving well-being and decreasing pressure pain sensitivity but more studies with larger samples and longer follow-up periods are needed to confirm these results. ClinicalTrials.gov NCT01500330.

Turning on the alarm: the neural mechanisms of the transition from innocuous to painful sensation.

PubMed

Johnstone, Tom; Salomons, Tim V; Backonja, Miroslav Misha; Davidson, Richard J

2012-01-16

The experience of pain occurs when the level of a stimulus is sufficient to elicit a marked affective response, putatively to warn the organism of potential danger and motivate appropriate behavioral responses. Understanding the biological mechanisms of the transition from innocuous to painful levels of sensation is essential to understanding pain perception as well as clinical conditions characterized by abnormal relationships between stimulation and pain response. Thus, the primary objective of this study was to characterize the neural response associated with this transition and the correspondence between that response and subjective reports of pain. Towards this goal, this study examined BOLD response profiles across a range of temperatures spanning the pain threshold. 14 healthy adults underwent functional magnetic resonance imaging (fMRI) while a range of thermal stimuli (44-49°C) were applied. BOLD responses showed a sigmoidal profile along the range of temperatures in a network of brain regions including insula and mid-cingulate, as well as a number of regions associated with motor responses including ventral lateral nuclei of the thalamus, globus pallidus and premotor cortex. A sigmoid function fit to the BOLD responses in these regions explained up to 85% of the variance in individual pain ratings, and yielded an estimate of the temperature of steepest transition from non-painful to painful heat that was nearly identical to that generated by subjective ratings. These results demonstrate a precise characterization of the relationship between objective levels of stimulation, resulting neural activation, and subjective experience of pain and provide direct evidence for a neural mechanism supporting the nonlinear transition from innocuous to painful levels along the sensory continuum. Copyright © 2011 Elsevier Inc. All rights reserved.

Current practices in cancer pain management in Asia: a survey of patients and physicians across 10 countries.

PubMed

Kim, Yong-Chul; Ahn, Jin Seok; Calimag, Maria Minerva P; Chao, Ta Chung; Ho, Kok Yuen; Tho, Lye Mun; Xia, Zhong-Jun; Ward, Lois; Moon, Hanlim; Bhagat, Abhishek

2015-08-01

In order to implement more effective policies for cancer pain management, a better understanding of current practices is needed. Physicians managing cancer pain and patients experiencing cancer pain were randomly surveyed across 10 Asian countries to assess attitudes and perceptions toward cancer pain management. A total of 463 physicians (77.3% oncologists) with a median experience of 13 years were included. Medical school training on opioid use was considered inadequate by 30.5% of physicians and 55.9% indicated ≤ 10 h of continuing medical education (CME). Of the 1190 patients included, 1026 reported moderate-to-severe pain (median duration, 12 months). Discordance was observed between physician and patient outcomes on pain assessment with 88.3% of physicians reporting pain quantification, while 49.5% of patients claimed that no scale was used. Inadequate assessment of pain was recognized as a barrier to therapy optimization by 49.7% of physicians. Additional barriers identified were patients' reluctance owing to fear of addiction (67.2%) and adverse events (65.0%), patients' reluctance to report pain (52.5%), excessive regulations (48.0%) and reluctance to prescribe opioids (42.8%). Opioid use was confirmed only in 53.2% (286/538) of patients remembering their medication. Pain affected the activities of daily living for 81.3% of patients. These findings highlight the need for better training and CME opportunities for cancer pain management in Asia. Collaborative efforts between physicians, patients, policy makers, and related parties may assist in overcoming the barriers identified. Addressing the opioid stigma and enhancing awareness is vital to improving current standards of patient care. © 2015 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.

Current practices in cancer pain management in Asia: a survey of patients and physicians across 10 countries

PubMed Central

Kim, Yong-Chul; Ahn, Jin Seok; Calimag, Maria Minerva P; Chao, Ta Chung; Ho, Kok Yuen; Tho, Lye Mun; Xia, Zhong-Jun; Ward, Lois; Moon, Hanlim; Bhagat, Abhishek

2015-01-01

In order to implement more effective policies for cancer pain management, a better understanding of current practices is needed. Physicians managing cancer pain and patients experiencing cancer pain were randomly surveyed across 10 Asian countries to assess attitudes and perceptions toward cancer pain management. A total of 463 physicians (77.3% oncologists) with a median experience of 13 years were included. Medical school training on opioid use was considered inadequate by 30.5% of physicians and 55.9% indicated ≤10 h of continuing medical education (CME). Of the 1190 patients included, 1026 reported moderate-to-severe pain (median duration, 12 months). Discordance was observed between physician and patient outcomes on pain assessment with 88.3% of physicians reporting pain quantification, while 49.5% of patients claimed that no scale was used. Inadequate assessment of pain was recognized as a barrier to therapy optimization by 49.7% of physicians. Additional barriers identified were patients’ reluctance owing to fear of addiction (67.2%) and adverse events (65.0%), patients’ reluctance to report pain (52.5%), excessive regulations (48.0%) and reluctance to prescribe opioids (42.8%). Opioid use was confirmed only in 53.2% (286/538) of patients remembering their medication. Pain affected the activities of daily living for 81.3% of patients. These findings highlight the need for better training and CME opportunities for cancer pain management in Asia. Collaborative efforts between physicians, patients, policy makers, and related parties may assist in overcoming the barriers identified. Addressing the opioid stigma and enhancing awareness is vital to improving current standards of patient care. PMID:25914253

Parenting in the context of chronic pain: A controlled study of parents with chronic pain

PubMed Central

Wilson, Anna C.; Fales, Jessica L.

2014-01-01

Objectives This study aims to describe what adults with chronic pain experience in their role as parents, utilizing quantitative and qualitative methods. The first aim is to compare parents with chronic pain to parents without chronic pain on perceptions of their adolescent’s pain, parental response to pain, and catastrophizing beliefs about pain. The study also examined predictors of parental protective behaviors, and examined whether these associations differed by study group. Methods Parents with chronic pain (n=58) and parents without chronic pain (n=72) participated, and completed questionnaire measures of pain characteristics and pain interference, as well as measures of parental catastrophizing and protective pain responses. Parents with chronic pain also completed a structured interview about their experience of being a parent. Interview responses were videotaped and subsequently coded for content. Results Compared to controls, parents with chronic pain endorsed more pain in their adolescents, and were more likely to catastrophize about their adolescent’s pain and respond with protective behaviors. Parent’s own pain interference and the perception of higher pain in their adolescent was associated with increased protective parenting in the chronic pain group. Qualitative coding revealed a number of areas of common impact of chronic pain on parenting. Discussion Chronic pain impacts everyday parenting activities and emotions, and impacts pain-specific parent responses that are known to be related to increased pain and pain catastrophizing in children and adolescents. Parents with chronic pain might benefit from interventions that address potential parenting difficulties, and might improve outcomes for their children. PMID:25232862

Decreased sensitivity to thermal pain in rats bred for high anxiety-related behaviour is attenuated by citalopram or diazepam treatment.

PubMed

Jochum, Thomas; Boettger, Michael Karl; Wigger, Alexandra; Beiderbeck, Daniela; Neumann, Inga D; Landgraf, Rainer; Sauer, Heinrich; Bär, Karl-Jürgen

2007-10-01

Complex interactions between pain perception, anxiety and depressive symptoms have repeatedly been described. However, pathophysiological or biochemical mechanisms underlying the alterations of pain perception in patients suffering from anxiety or depression still remain a matter of debate. Thus, we aimed to perform an investigation on pain perception in an animal model of extremes in anxiety-related behaviour, which might provide a tool for future studies. Here, thermal pain thresholds were obtained from rats with a genetic predisposition to high anxiety-related behaviour (HAB), including signs of comorbid depression-like behaviour and from controls (low-anxiety rats (LAB); cross-bred HAB and LAB rats; Wistar rats). Furthermore, the effect of eight-week antidepressive treatment using citalopram and of short-term anxiolytic treatment with diazepam on pain-related behaviour was assessed. Simultaneously, anxiety-related behaviour was monitored. At baseline, HAB animals showed 35% higher thresholds for thermal pain than controls. These were normalized to control levels after eight weeks of continuous citalopram treatment paralleled by a reduction of anxiety-related behaviour, but also acutely after diazepam administration. Overall, thermal pain thresholds in HAB animals are shifted in a similar fashion as seen in patients suffering from major depressive disorder. Antidepressive, as well as anxiolytic treatments, attenuated these differences. As the relative importance of the factors anxiety and depression cannot be derived from this study with certainty, extending these investigations to additional animal models might represent a valuable tool for future investigations concerning the interrelations between anxiety, depression, and pain at a molecular level.

Pain-processing abnormalities in bipolar I disorder, bipolar II disorder, and schizophrenia: A novel trait marker for psychosis proneness and functional outcome?

PubMed

Minichino, Amedeo; Delle Chiaie, Roberto; Cruccu, Giorgio; Piroso, Serena; Di Stefano, Giulia; Francesconi, Marta; Bersani, Francesco Saverio; Biondi, Massimo; Truini, Andrea

2016-11-01

Overlapping neural system dysfunctions, mainly involving the secondary somatosensory cortex (S2), the anterior cingulate cortex (ACC) and the anterior insular cortex (AIC), seem to be related to both pain-perception abnormalities and psychotic symptoms in schizophrenia (SCZ) and bipolar disorder (BD). Laser-evoked potentials (LEPs) were used to investigate pain-perception and central pain-processing abnormalities in SCZ, bipolar I disorder (BD-I), and bipolar II disorder (BD-II), and to evaluate their relationship with history of psychosis, and social-cognitive and functional impairments. Twenty patients with SCZ, 17 patients with BD-I, and 21 patients with BD-II who were all under similar pharmacological treatment underwent clinical, functional, and neuro-psychological assessment. LEPs were analyzed in patients and 19 healthy subjects (HS). LEPs elicit responses reflecting the activity of the S2 (N1 wave) and the ACC/AIC cortices (N2/P2 complex). A four-group ANOVA was conducted between patients and HS to compare pain-perceptive thresholds (PThs), N1, and N2/P2-LEP components. Compared to HS: (i) patients with SCZ showed pain-processing and pain-perception abnormalities, as revealed by significantly higher PTh (P<.01), and lower N1 (P<.01) and N2/P2 (P<.01) amplitudes, (ii) patients with BD-I showed only pain-processing abnormalities, as revealed by significantly lower N1 (P<.05) and N2 (P<.01) amplitudes; and patients with BD-II did not differ for any of the LEP variables investigated. N1 and N2 amplitudes negatively correlated to history of psychosis (P<.01), social-cognition (P<.05), and real-world functioning (P<.01) measures in the whole group of patients. To the best of our knowledge, this is the first study comparing central pain processing in patients with SCZ, BD-I, and BD-II. Our results suggest that pain-processing abnormalities may represent a novel locus of interest for research investigating trait markers of the psychosis spectrum. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Fear of pain, pain catastrophizing, and acute pain perception: relative prediction and timing of assessment.

PubMed

Hirsh, Adam T; George, Steven Z; Bialosky, Joel E; Robinson, Michael E

2008-09-01

Pain-related fear and catastrophizing are important variables of consideration in an individual's pain experience. Methodological limitations of previous studies limit strong conclusions regarding these relationships. In this follow-up study, we examined the relationships between fear of pain, pain catastrophizing, and experimental pain perception. One hundred healthy volunteers completed the Fear of Pain Questionnaire (FPQ-III), Pain Catastrophizing Scale (PCS), and Coping Strategies Questionnaire-Catastrophizing scale (CSQ-CAT) before undergoing the cold pressor test (CPT). The CSQ-CAT and PCS were completed again after the CPT, with participants instructed to complete these measures based on their experience during the procedure. Measures of pain threshold, tolerance, and intensity were collected and served as dependent variables in separate regression models. Sex, pain catastrophizing, and pain-related fear were included as predictor variables. Results of regression analyses indicated that after controlling for sex, pain-related fear was a consistently stronger predictor of pain in comparison to catastrophizing. These results were consistent when separate measures (CSQ-CAT vs PCS) and time points (pretask vs "in vivo") of catastrophizing were used. These findings largely corroborate those from our previous study and are suggestive of the absolute and relative importance of pain-related fear in the experimental pain experience. Although pain-related fear has received less attention in the experimental literature than pain catastrophizing, results of the current study are consistent with clinical reports highlighting this variable as an important aspect of the experience of pain.

The Experience of Chinese Couples Undergoing In Vitro Fertilization Treatment: Perception of the Treatment Process and Partner Support.

PubMed

Ying, Li-Ying; Wu, Lai Har; Loke, Alice Yuen

2015-01-01

Couples undergoing In Vitro Fertilization (IVF) Treatment suffer as dyads from the stressful experience of the painful treatment and the fear that the IVF cycle will fail. They are likely to report that their marital relationship has become unstable due to the prolonged period of treatment. This is a qualitative study that was conducted to explore the experiences that Chinese couples have had with IVF treatment, especially their perceptions of the process and the support between couples. The interviews revealed that couples suffered from the process, experiencing physical and emotional pain, struggling with the urgency and inflexibility of bearing a child, and experiencing disturbances in their daily routines and work. The participants described how they endured the hardships as a couple and how it affected their relationship. The couples felt that sharing feelings and supporting each other contribute to psychological well-being and improves the marital relationship. They also identified some unfavorable aspects in their partner relationship. They were ambivalent about receiving social support from friends and family members. With the couples indicating that the support that they received from each other affected their experience during the treatment process, it is suggested that a supportive intervention that focuses on enhancing the partnership of the couples and dealing with their inflexibility on the issue of bearing a child might result in improvements in the psychological status and marital relationship of infertile couples undergoing IVF treatment.

The Experience of Chinese Couples Undergoing In Vitro Fertilization Treatment: Perception of the Treatment Process and Partner Support

PubMed Central

Ying, Li-Ying; Wu, Lai Har; Loke, Alice Yuen

2015-01-01

Background Couples undergoing In Vitro Fertilization (IVF) Treatment suffer as dyads from the stressful experience of the painful treatment and the fear that the IVF cycle will fail. They are likely to report that their marital relationship has become unstable due to the prolonged period of treatment. Methods This is a qualitative study that was conducted to explore the experiences that Chinese couples have had with IVF treatment, especially their perceptions of the process and the support between couples. Results The interviews revealed that couples suffered from the process, experiencing physical and emotional pain, struggling with the urgency and inflexibility of bearing a child, and experiencing disturbances in their daily routines and work. The participants described how they endured the hardships as a couple and how it affected their relationship. The couples felt that sharing feelings and supporting each other contribute to psychological well-being and improves the marital relationship. They also identified some unfavorable aspects in their partner relationship. They were ambivalent about receiving social support from friends and family members. Conclusions With the couples indicating that the support that they received from each other affected their experience during the treatment process, it is suggested that a supportive intervention that focuses on enhancing the partnership of the couples and dealing with their inflexibility on the issue of bearing a child might result in improvements in the psychological status and marital relationship of infertile couples undergoing IVF treatment. PMID:26431545

Discovery of unexpected pain in intubated and sedated patients.

PubMed

Clukey, Lory; Weyant, Ruth A; Roberts, Melanie; Henderson, Ann

2014-05-01

The perceptions of patients who are restrained and sedated while being treated with mechanical ventilation in the intensive care unit are not well understood. The effectiveness of sedation used to aid in recovery and enhance comfort during intubation is unknown. To explore the perceptions of patients who were intubated and receiving pain medication while sedated and restrained in the intensive care unit, in particular, their experience and their memories of the experience. In a phenomenological study, 14 patients who were intubated and receiving pain medication while sedated and restrained were interviewed at the bedside. A semistructured interview guide was used. Data were analyzed by using an inductive method consistent with qualitative research. Three major themes were identified from the data: lack of memory of being restrained; a perception of being intubated as horrific; nursing behaviors that were helpful and comforting. An unexpected discovery was that sedation may be interfering with pain assessment and management. Being intubated can be painful and traumatic despite administration of sedatives and analgesics. Sedation may mask uncontrolled pain for intubated patients and prevent them from communicating this condition to a nurse. Nurses may need to evaluate current interventions in order to provide maximum comfort and promote optimal positive outcomes for intensive care patients who are intubated.

Impact of reassurance on pain perception in patients with primary burning mouth syndrome.

PubMed

Brailo, V; Firić, M; Vučićević Boras, V; Andabak Rogulj, A; Krstevski, I; Alajbeg, I

2016-09-01

In spite of extensive research, no effective treatment of primary burning mouth syndrome (BMS) still exists. The aim of this study was to determine the impact of informative intervention/reassurance on pain perception and quality of life in patients with primary BMS. Informative intervention/reassurance was undertaken in 28 patients diagnosed with primary BMS. Patients received information about all aspects of BMS verbally and in an informative leaflet. Numerical scale (0-10), Pain Catastrophizing Scale and Oral Health Impact Profile-14 (OHIP-14) were used to assess pain intensity, pain perception, and quality of life before the intervention and 6 months after. No other treatment was given to the patients. Significant reduction in symptom intensity, pain catastrophizing along with positive increase in the quality of life compared with baseline, was observed on a follow-up examination 6 months after the informative intervention (P < 0.001). The results of this study confirm that objective informing/reassurance of patients with primary BMS can result in decreased catastrophizing and improvement in the quality of life. By eliminating/changing negative patterns of behavior, a reduction in symptoms comparable with pharmacological treatment can be achieved. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Sex moderates the effects of positive and negative affect on clinical pain in patients with knee osteoarthritis.

PubMed

Speed, Traci J; Richards, Jessica M; Finan, Patrick H; Smith, Michael T

2017-07-01

Sex differences in clinical pain severity and response to experimental pain are commonly reported, with women generally showing greater vulnerability. Affect, including state (a single rating) and stable (average daily ratings over two weeks) positive affect and negative affect has also been found to impact pain sensitivity and severity, and research suggests that affect may modulate pain differentially as a function of sex. The current study aimed to examine sex as a moderator of the relationships between affect and pain-related outcomes among participants with knee osteoarthritis (KOA). One hundred and seventy-nine participants (59 men) with KOA completed electronic diaries assessing clinical pain, positive affect, and negative affect. A subset of participants (n=120) underwent quantitative sensory testing, from which a single index of central sensitization to pain was derived. We used multiple regression models to test for the interactive effects of sex and affect (positive versus negative and stable versus state) on pain-related outcomes. We used mixed effects models to test for the moderating effects of sex on the relationships between state affect and pain over time. Sex differences in affect and pain were identified, with men reporting significantly higher stable positive affect and lower central sensitization to pain indexed by quantitative sensory testing, as well as marginally lower KOA-specific clinical pain compared to women. Moreover, there was an interaction between stable positive affect and sex on KOA-specific clinical pain and average daily non-specific pain ratings. Post hoc analyses revealed that men showed trends towards an inverse relationship between stable positive affect and pain outcomes, while women showed no relationship between positive affect and pain. There was also a significant interaction between sex and stable negative affect and sex on KOA-specific pain such that men showed a significantly stronger positive relationship between stable negative affect and KOA-specific pain than women. Sex did not interact with state affect on pain outcomes. Findings suggest that men may be particularly sensitive to the effects of stable positive affect and negative affect on clinical pain. Future work with larger samples is needed in order to identify potential mechanisms driving the sex-specific effects of affect on pain. The current study provides novel data that suggesting that the association of positive affect, negative affect, and pain are different in men versus women with KOA. Further understanding of the difference in affective expression between men and women may lead to the development of novel therapeutic interventions and help to identify additional modifiable factors in the prevention and management of pain. Copyright © 2017 Scandinavian Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

Effect of interferential current therapy on pain perception and disability level in subjects with chronic low back pain: a randomized controlled trial.

PubMed

Albornoz-Cabello, Manuel; Maya-Martín, Julián; Domínguez-Maldonado, Gabriel; Espejo-Antúnez, Luis; Heredia-Rizo, Alberto Marcos

2017-02-01

To assess the short-term efficacy of transregional interferential current therapy on pain perception and disability level in chronic non-specific low back pain. A randomized, single-blinded (the assessor collecting the outcome data was blinded), controlled trial. A private physiotherapy research clinic. A total of 64 individuals, 20 men and 44 women, mean (SD) age was 51 years (11.93), with low back pain of more than three months, with or without pain radiating to the lower extremities above the knee, were distributed into a control ( n = 20) or an experimental group ( n = 44). A 2:1 randomization ratio was used in favour of the latter. A transregional interferential current electrotherapy protocol was performed for participants in the experimental group, while the control group underwent a 'usual care' treatment (massage, mobilization and soft-tissue techniques). All subjects received up to 10 treatment sessions of 25 minutes over a two-week period, and completed the intervention and follow-up evaluations. Self-perceived pain was assessed with a Visual Analogue Scale. Secondary measure included the Oswestry Low Back Disability Index. Evaluations were collected at baseline and after the intervention protocol. Significant between-group differences were found for interferential current therapy on pain perception ( p = 0.032) and disability level ( p = 0.002). The observed differences in the between-group mean changes were of 11.34 mm (1.77/20.91) and 13.38 points (4.97/21.78), respectively. A two-week transregional interferential current treatment has shown significant short-term efficacy, when compared with a 'usual care' protocol, on self-perceived pain and functionality in subjects with chronic low back pain.

Disentangling interoception: insights from focal strokes affecting the perception of external and internal milieus

PubMed Central

Couto, Blas; Adolfi, Federico; Sedeño, Lucas; Salles, Alejo; Canales-Johnson, Andrés; Alvarez-Abut, Pablo; Garcia-Cordero, Indira; Pietto, Marcos; Bekinschtein, Tristan; Sigman, Mariano; Manes, Facundo; Ibanez, Agustin

2015-01-01

Interoception is the moment-to-moment sensing of the physiological condition of the body. The multimodal sources of interoception can be classified into two different streams of afferents: an internal pathway of signals arising from core structures (i.e., heart, blood vessels, and bronchi) and an external pathway of body-mapped sensations (i.e., chemosensation and pain) arising from peripersonal space. This study examines differential processing along these streams within the insular cortex (IC) and their subcortical tracts connecting frontotemporal networks. Two rare patients presenting focal lesions of the IC (insular lesion, IL) or its subcortical tracts (subcortical lesion, SL) were tested. Internally generated interoceptive streams were assessed through a heartbeat detection (HBD) task, while those externally triggered were tapped via taste, smell, and pain recognition tasks. A differential pattern was observed. The IC patient showed impaired internal signal processing while the SL patient exhibited external perception deficits. Such selective deficits remained even when comparing each patient with a group of healthy controls and a group of brain-damaged patients. These outcomes suggest the existence of distinguishable interoceptive streams. Results are discussed in relation with neuroanatomical substrates, involving a fronto-insulo-temporal network for interoceptive and cognitive contextual integration. PMID:25983697

Altered attentional control over the salience network in complex regional pain syndrome.

PubMed

Kim, Jungyoon; Kang, Ilhyang; Chung, Yong-An; Kim, Tae-Suk; Namgung, Eun; Lee, Suji; Oh, Jin Kyoung; Jeong, Hyeonseok S; Cho, Hanbyul; Kim, Myeong Ju; Kim, Tammy D; Choi, Soo Hyun; Lim, Soo Mee; Lyoo, In Kyoon; Yoon, Sujung

2018-05-10

The degree and salience of pain have been known to be constantly monitored and modulated by the brain. In the case of maladaptive neural responses as reported in centralized pain conditions such as complex regional pain syndrome (CRPS), the perception of pain is amplified and remains elevated even without sustained peripheral pain inputs. Given that the attentional state of the brain greatly influences the perception and interpretation of pain, we investigated the role of the attention network and its dynamic interactions with other pain-related networks of the brain in CRPS. We examined alterations in the intra- and inter-network functional connectivities in 21 individuals with CRPS and 49 controls. CRPS-related reduction in intra-network functional connectivity was found in the attention network. Individuals with CRPS had greater inter-network connectivities between the attention and salience networks as compared with healthy controls. Furthermore, individuals within the CRPS group with high levels of pain catastrophizing showed greater inter-network connectivities between the attention and salience networks. Taken together, the current findings suggest that these altered connectivities may be potentially associated with the maladaptive pain coping as found in CRPS patients.

Dysfunctional pain modulation in somatoform pain disorder patients.

PubMed

Klug, Stefanie; Stefanie, Klug; Anderer, Peter; Peter, Anderer; Saletu-Zyhlarz, Gerda; Gerda, Saletu-Zyhlarz; Freidl, Marion; Marion, Freidl; Saletu, Bernd; Bernd, Saletu; Prause, Wolfgang; Wolfgang, Prause; Aigner, Martin; Martin, Aigner

2011-06-01

To date, pain perception is thought to be a creative process of modulation carried out by an interplay of pro- and anti-nociceptive mechanisms. Recent research demonstrates that pain experience constitutes the result of top-down processes represented in cortical descending pain modulation. Cortical, mainly medial and frontal areas, as well as subcortical structures such as the brain stem, medulla and thalamus seem to be key players in pain modulation. An imbalance of pro- and anti-nociceptive mechanisms are assumed to cause chronic pain disorders, which are associated with spontaneous pain perception without physiologic scaffolding or exaggerated cortical activation in response to pain exposure. In contrast to recent investigations, the aim of the present study was to elucidate cortical activation of somatoform pain disorder patients during baseline condition. Scalp EEG, quantitative Fourier-spectral analyses and LORETA were employed to compare patient group (N = 15) to age- and sex-matched controls (N = 15) at rest. SI, SII, ACC, SMA, PFC, PPC, insular, amygdale and hippocampus displayed significant spectral power reductions within the beta band range (12-30 Hz). These results suggest decreased cortical baseline arousal in somatoform pain disorder patients. We finally conclude that obtained results may point to an altered baseline activity, maybe characteristic for chronic somatoform pain disorder.

Dyadic analysis of child and parent trait and state pain catastrophizing in the process of children's pain communication.

PubMed

Birnie, Kathryn A; Chambers, Christine T; Chorney, Jill; Fernandez, Conrad V; McGrath, Patrick J

2016-04-01

When explored separately, child and parent catastrophic thoughts about child pain show robust negative relations with child pain. The objective of this study was to conduct a dyadic analysis to elucidate intrapersonal and interpersonal influences of child and parent pain catastrophizing on aspects of pain communication, including observed behaviours and perceptions of child pain. A community sample of 171 dyads including children aged 8 to 12 years (89 girls) and parents (135 mothers) rated pain catastrophizing (trait and state versions) and child pain intensity and unpleasantness following a cold pressor task. Child pain tolerance was also assessed. Parent-child interactions during the cold pressor task were coded for parent attending, nonattending, and other talk, and child symptom complaints and other talk. Data were analyzed using the actor-partner interdependence model and hierarchical multiple regressions. Children reporting higher state pain catastrophizing had greater symptom complaints regardless of level of parent state pain catastrophizing. Children reporting low state pain catastrophizing had similar high levels of symptom complaints, but only when parents reported high state pain catastrophizing. Higher child and parent state and/or trait pain catastrophizing predicted their own ratings of higher child pain intensity and unpleasantness, with child state pain catastrophizing additionally predicting parent ratings. Higher pain tolerance was predicted by older child age and lower child state pain catastrophizing. These newly identified interpersonal effects highlight the relevance of the social context to children's pain expressions and parent perceptions of child pain. Both child and parent pain catastrophizing warrant consideration when managing child pain.

Association of serum total antioxidant capacity and total oxidant status with pain perception in patients with myofacial pain dysfunction.

PubMed

Etoz, Osman A; Ataoglu, Hanife; Erel, Ozcan; Celik, Hakim; Herken, Emine Nur; Bayazit, Yildirim Ahmet

2009-01-01

We aimed to find out the association of total antioxidant capacity (TAC) and total oxidant status (TOS) with generalized pressure pain thresholds (PPT) of patients with myofacial pain dysfunction (MPD). PPT scores of patients with MPD (n = 37) and healthy individuals (n = 43) were measured on the hypothenar region of the hand using a mechanical algometer. Serum samples were collected and TAC and TOS were measured by novel methods. The TAC of patients was significantly lower than that of the control subjects. The difference between the TOS measurements of patients and control subjects was not significant. The PPT scores of the patients were significantly lower than that of control subjects. There may be an association between serum antioxidant capacity and MPD. Low serum TAC might also be related with pain perception.

[MODERN VIEWS ON THE PHARMACOGENETICS OF PAIN.

PubMed

Makharin, O A; Zhenilo, V M; Patyuchenko, O Yu

2017-09-01

Quality anesthesia during surgery and in the postoperative period remains a topical problem of modern anesthesiology. The study of genetic characteristics of a patient is a goal that may be allow us to develop a personalized approach to solve this problem. The purpose of the review is a synthesis of literature data about the influence of genetic factors on pain perception and its treatment. The review included information obtained from SCOPUS, MedLine, EMBASE. The search keywords were: pain, pharmacogenetics, polymorphism, analgesics.Describe the effect ofgene polymorphisms of OPRM, 5HTRIA, 5HTR2A, COMT GCHI, SCN9A, KCNSI, CACNA2D3, CACNG2, PTGSI, PTGS2, MDRJ/ABCB] on the perception of pain, and CYP2D6, CYP2C9, CYP3A4 on the pharmacokinetics and pharmacodynamics of medi- cations used in the treatment of pain.

Adolescent peer-rejection persistently alters pain perception and CB1 receptor expression in female rats.

PubMed

Schneider, Peggy; Hannusch, Christin; Schmahl, Christian; Bohus, Martin; Spanagel, Rainer; Schneider, Miriam

2014-02-01

Peer-interactions are particularly important during adolescence and teenagers display enhanced sensitivity toward rejection by peers. Social rejection has been shown to induce alterations in pain perception in humans. However, the neurobiological consequences of adolescent social rejection have yet to be extensively characterized, and no appropriate animal model is available. Here, we propose inadequate playful interactions in adolescent rats as a novel animal model for social peer-rejection and examine potential long-term consequences into adulthood. Acute social pairing of female adolescent Wistar rats with an age-matched rat from the less playful Fischer344 strain was found to alter social play and decrease pain reactivity, indicating Fischer rats as inadequate social partners for Wistar animals. Therefore, in a second experiment, adolescent female Wistar rats were either reared with another Wistar rat (adequate social rearing; control) or with a Fischer rat (inadequate social rearing; play-deprived). Beginning on day 50, all Wistar rats were group housed with same-strain partners and tested for behavioral, neurobiological and endocrine differences in adulthood. Playful peer-interactions were decreased during adolescence in play-deprived animals, without affecting social contact behavior. Consequently, adult play-deprived rats showed decreased pain sensitivity and increased startle reactivity compared to controls, but did not differ in activity, anxiety-related behavior or social interaction. Both groups also differed in their endocrine stress-response, and expression levels of the cannabinoid CB1 receptor were increased in the thalamus, whereas FAAH levels were decreased in the amygdala. The present animal model therefore represents a novel approach to assess the long-term consequences of peer-rejection during adolescence. Copyright © 2013 Elsevier B.V. and ECNP. All rights reserved.

TRPV1 Antagonists and Chronic Pain: Beyond Thermal Perception

PubMed Central

Brandt, Michael R.; Beyer, Chad E.; Stahl, Stephen M.

2012-01-01

In the last decade, considerable evidence as accumulated to support the development of Transient Receptor Potential Vanilloid 1 (TRPV1) antagonists for the treatment of various chronic pain conditions. Whereas there is a widely accepted rationale for the development of TRPV1 antagonists for the treatment of various inflammatory pain conditions, their development for indications of chronic pain, where conditions of tactical, mechanical and spontaneous pain predominate, is less clear. Preclinical localization and expression studies provide a firm foundation for the use of molecules targeting TRPV1 for conditions of bone pain, osteoarthritis and neuropathic pain. Selective TRPV1 antagonists weakly attenuate tactile and mechanical hypersensivity and are partially effective for behavioral and electrophysiological endpoints that incorporate aspects of spontaneous pain. While initial studies with TRPV1 antagonist in normal human subjects indicate a loss of warm thermal perception, clinical studies assessing allelic variants suggests that TRPV1 may mediate other sensory modalities under certain conditions. The focus of this review is to summarize the current perspectives of TRPV1 for the treatment of conditions beyond those with a primary thermal sensitivity. PMID:24288084

Comparative Analysis of Registered Nurses' and Nursing Students' Attitudes and Use of Nonpharmacologic Methods of Pain Management.

PubMed

Stewart, Malcolm; Cox-Davenport, Rebecca A

2015-08-01

Despite the benefits that nonpharmacologic methods of pain management have to offer, nurses cite barriers that inhibit their use in practice. The purpose of this research study was to compare the perceptions of prelicensed student nurses (SNs) and registered nurses (RNs) toward nonpharmacologic methods of pain management. A sample size of 64 students and 49 RNs was recruited. Each participant completed a questionnaire about their use and perceptions nonpharmacologic pain control methods. Sixty-nine percent of RNs reported a stronger belief that nonpharmacologic methods gave relief to their patients compared with 59% of SNs (p = .028). Seventy-five percent of student nurses felt they had adequate education about nonpharmacologic pain modalities compared with 51% of RN who felt less than adequately educated (p = .016). These findings highlight the need for education about nonpharmacologic approaches to pain management. Applications of these findings may decrease barriers to the use of nonpharmacologic methods of pain management. Copyright © 2015 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

Ethnicity Interacts with the OPRM1 Gene in Experimental Pain Sensitivity

PubMed Central

Hastie, Barbara A.; Riley, Joseph L.; Kaplan, Lee; Herrera, Dyanne G.; Campbell, Claudia M.; Virtusio, Kathrina; Mogil, Jeffrey S.; Wallace, Margaret R.; Fillingim, Roger B.

2013-01-01

Robust inter-individual variation in pain sensitivity has been observed and recent evidence suggests that some of the variability may be genetically-mediated. Our previous data revealed significantly higher pressure pain thresholds among individuals possessing the minor G allele of the A118G SNP of the mu-opioid receptor gene (OPRM1) compared to those with two consensus alleles. Moreover, ethnic differences in pain sensitivity have been widely reported. Yet, little is known about the potential interactive associations of ethnicity and genotype with pain perception. This study aimed to identify ethnic differences in OPRM1 allelic associations with experimental pain responses. Two-hundred and forty-seven healthy young adults from three ethnic groups (81 African Americans; 79 non-white Hispanics; and 87 non-Hispanic whites) underwent multiple experimental pain modalities (thermal, pressure, ischemic, cold pressor). Few African Americans (7.4%) expressed the rare allele of OPRM1 compared to non-Hispanic-whites and Hispanics (28.7% vs. 27.8%, respectively). Across the entire sample, OPRM1 genotype did not significantly affect pain sensitivity. However, analysis in each ethnic group separately revealed significant genotype effects for most pain modalities among non-Hispanic-whites (ps<0.05) but not Hispanics or African Americans. The G allele was associated with decreased pain sensitivity among whites only; a trend in the opposite direction emerged in Hispanics. The reasons for this dichotomy are unclear but may involve ethnic differences in haplotypic structure or A118G may be a tag-SNP linked to other functional polymorphisms. These findings demonstrate an ethnic-dependent association of OPRM1 genotype with pain sensitivity. Additional research is warranted to uncover the mechanisms influencing these relationships. PMID:22717102

Effectiveness of Home-Based Cupping Massage Compared to Progressive Muscle Relaxation in Patients with Chronic Neck Pain—A Randomized Controlled Trial

PubMed Central

Lauche, Romy; Materdey, Svitlana; Cramer, Holger; Haller, Heidemarie; Stange, Rainer; Dobos, Gustav; Rampp, Thomas

2013-01-01

Chronic neck pain is a major public health problem with very few evidence-based complementary treatment options. This study aimed to test the efficacy of 12 weeks of a partner-delivered home-based cupping massage, compared to the same period of progressive muscle relaxation in patients with chronic non-specific neck pain. Patients were randomly assigned to self-directed cupping massage or progressive muscle relaxation. They were trained and asked to undertake the assigned treatment twice weekly for 12 weeks. Primary outcome measure was the current neck pain intensity (0–100 mm visual analog scale; VAS) after 12 weeks. Secondary outcome measures included pain on motion, affective pain perception, functional disability, psychological distress, wellbeing, health-related quality of life, pressure pain thresholds and adverse events. Sixty one patients (54.1±12.7 years; 73.8%female) were randomized to cupping massage (n = 30) or progressive muscle relaxation (n = 31). After treatment, both groups showed significantly less pain compared to baseline however without significant group differences. Significant effects in favor of cupping massage were only found for wellbeing and pressure pain thresholds. In conclusion, cupping massage is no more effective than progressive muscle relaxation in reducing chronic non-specific neck pain. Both therapies can be easily used at home and can reduce pain to a minimal clinically relevant extent. Cupping massage may however be better than PMR in improving well-being and decreasing pressure pain sensitivity but more studies with larger samples and longer follow-up periods are needed to confirm these results. Trial Registration ClinicalTrials.gov NCT01500330 PMID:23762355

Investigating the neural processing of spatial summation of pain: the role of A-delta nociceptors.

PubMed

Raz, Netta; Granovsky, Yelena; Defrin, Ruth

2015-02-01

The underlying mechanism of spatial summation (SS) of pain, an essential component in pain perception and detection, is unknown. Because of the possible differential innervations by A-delta nociceptors and pain sensitivity of hairy and glabrous skin, a comparison of the SS characteristics between the two skin types could contribute to the elucidation of its subserving system and processing. The effect of sex on SS of pain was also evaluated due to the scarcity of information on the subject. Twenty-nine healthy subjects (13 males, 16 females) received four series of heat stimuli of various intensities, in hairy and glabrous skin of the hand using large (27 mm diameter) and small (12 mm) stimulation areas, and the perceived pain intensity (PPI) was rated. A fast temperature increase rate (70°/s) was used in order to selectively activate A-delta nociceptors. The effect of skin type, stimulation intensity and sex on SS and PPI was calculated. Skin type significantly affected PPI and SS of pain; values of both variables were significantly greater in hairy compared with glabrous skin. SS of pain gradually increased concomitantly with stimulation intensity magnitude, to a point when it became saturated in both skin types. Females exhibited greater SS in glabrous skin. It would appear that AMH-II nociceptive fibers in particular subserve SS of pain. Furthermore, SS is increased under stronger stimulation intensities, probably as defense mechanism against tissue damage. Sex differences in dynamic sensory processes such as SS are revealed only under conditions where the phenomenon is subtle (as in glabrous skin).

Disparities Between Clinician and Patient Perception of Breakthrough Pain Control.

PubMed

Webber, Katherine; Davies, Andrew N; Cowie, Martin R

2016-05-01

There are disparities in the level of symptom severity as perceived by patients and health professionals. There is limited information about patients' and clinicians' global assessment of breakthrough pain control, the need to change analgesics, and change in breakthrough pain over time. To establish whether patients and clinicians independently agree on adequacy of breakthrough pain control, management strategy, and impression of change over time. One hundred patients with breakthrough cancer pain were assessed and followed up one week later by a palliative medicine specialist. The patient and clinician independently answered the same questions about the adequacy of the patient's breakthrough pain control and breakthrough pain management. The results were compared with items on the Breakthrough Pain Assessment Tool (BAT). At initial consultation, 35% of patients rated their breakthrough cancer pain as inadequately controlled compared with 72% of clinicians. Breakthrough pain analgesics were changed in 68% of cases. At one-week follow-up consultation, 62% of patients considered their breakthrough cancer pain to be better, and in 57% of cases, the clinicians also categorized the pain this way. There are significant differences in global impressions of breakthrough pain between patients and pain clinicians that become less disparate as a therapeutic relationship evolves. Therapeutic decisions were based on clinical rather than patient perceptions. Copyright © 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Altered Pain Perception and Fear-Learning Deficits in Subjects With Posttraumatic Stress Disorder.

PubMed

Jenewein, Josef; Erni, Jeannine; Moergeli, Hanspeter; Grillon, Christian; Schumacher, Sonja; Mueller-Pfeiffer, Christoph; Hassanpour, Katayun; Seiler, Annina; Wittmann, Lutz; Schnyder, Ulrich; Hasler, Gregor

2016-12-01

There is growing evidence that fear-learning abnormalities are involved in the development of posttraumatic stress disorder (PTSD) and chronic pain. More than 50% of PTSD patients suffer from chronic pain. This study aimed to examine the role of fear-learning deficits in the link between pain perception and PTSD. We included 19 subjects with PTSD and 21 age- and sex-matched healthy control subjects in a fear-conditioning experiment. The conditioned stimulus (CS) consisted of visual signs flashed upon a screen in front of each subject. The unconditioned stimulus was either a low or high temperature impulse delivered through a thermal contact thermode on the subjects' hand. A designation of 'CS-' was assigned to CS always followed by nonpainful low-temperature stimuli; a designation of 'CS+' was given to CS that were randomly followed by either a low or a more painful high temperature. Skin conductance was used as a physiological marker of fear. In healthy control subjects, CS+ induced more fear than CS-, and a low-temperature stimulus induced less subjective pain after CS- than after CS+. PTSD subjects failed to demonstrate such adaptive conditioning. Fear ratings after CS presentation were significantly higher in the PTSD group than in the control group. There were significant interaction effects between group and the type of CS on fear and pain ratings. Fear-learning deficits are a potentially promising, specific psychopathological factor in altered pain perception associated with PTSD. Deficits in safety learning may increase fear and, consequently, pain sensations. These findings may contribute to elucidating the pathogenesis behind the highly prevalent comorbidity that exists between PTSD and pain disorders, and to developing new treatments. This study provides new insights into the pathogenesis of chronic pain in patients with PTSD. The findings may help to develop new treatment strategies for this highly prevalent comorbidity in PTSD. Copyright © 2016 American Pain Society. All rights reserved.

Young people's experiences of persistent musculoskeletal pain, needs, gaps and perceptions about the role of digital technologies to support their co-care: a qualitative study

PubMed Central

Jordan, Joanne E; Chua, Jason; Schütze, Robert; Wark, John D

2016-01-01

Objective To investigate young people's experiences of persistent musculoskeletal pain, including care needs and current service gaps as well as perceptions about the role of digital technologies to support their co-care. Methods A qualitative study employing two independent data collection modes: in-depth individual semistructured interviews and focus groups. Setting Community settings throughout Australia. Participants Participants were included if they had experienced persistent musculoskeletal pain of >3-month duration with an average of ≥3 on the visual analogue scale over the preceding 3 months, including non-specific conditions (eg, low back pain) and specific conditions (eg, juvenile idiopathic arthritis and other systemic arthritides), with/without pre-existing or current diagnosed mental health conditions. 23 young people (87.0% women; mean (SD) age: 20.8 (2.4) years) from across 6 Australian jurisdictions participated. Almost two-thirds of participants with persistent musculoskeletal pain reported comorbid mental health conditions. Main outcome measures Inductive and deductive approaches to analyse and derive key themes from verbatim transcripts. Results Participants described their daily experiences of living with persistent musculoskeletal pain, their fears and the challenges imposed by the invisibility of pain, and the two-way relationship between their pain and mental well-being. A lack of relevant and accessible information and resources tailored to young people's unique needs, integrated and youth-relevant healthcare services and adequately skilled healthcare practitioners were identified as key care gaps. Participants strongly advocated for the use of digital technologies to improve access to age-appropriate resources and support for co-care. Conclusions Young people living with persistent musculoskeletal pain described the absence of age-appropriate pain services and clearly articulated their perceptions on the role of, and opportunities provided by, digital technologies to connect with and support improved pain healthcare. Innovative and digitally-enabled models of pain care are likely to be helpful for this group. PMID:27940635

Understanding patient perspectives on management of their chronic pain - online survey protocol.

PubMed

Gaikwad, Manasi; Vanlint, Simon; Moseley, G Lorimer; Mittinty, Murthy N; Stocks, Nigel

2017-01-01

It is widely recognized that both doctors and patients report discontent regarding pain management provided and received. The impact of chronic pain on an individual's life resonates beyond physical and mental suffering; equal or at times even greater impact is observed on an individual's personal relationships, ability to work, and social interactions. The degree of these effects in each individual varies, mainly because of differences in biological factors, social environment, past experiences, support, and belief systems. Therefore, it is equally possible that these individual patient characteristics could influence their treatment outcome. Research shows that meeting patient expectations is a major challenge for health care systems attempting to provide optimal treatment strategies. However, patient perspectives and expectations in chronic pain management have not been studied extensively. The aim of this study is to investigate the views, perceptions, beliefs, and expectations of individuals who experience chronic pain on a daily basis, and the strategies used by them in managing chronic pain. This paper describes the study protocol to be used in a cross sectional survey of chronic pain patients. The study population will comprise of individuals aged ≥18 years, who have experienced pain for ≥3 months with no restrictions of sex, ethnicity, or region of residence. Ethics approval for our study was obtained from Humans research ethics committees, University of Adelaide and University of South Australia. Multinomial logistic regression will be used to estimate the effect of duration and character of pain, on patient's perception of time to recovery and supplement intake. Logistic regression will also be used for estimating the effect of patient-provider relationship and pain education on patient-reported recovery and pain intensity. Knowledge about the perceptions and beliefs of patients with chronic pain could inform future policies, research, health care professional education, and development of individualized treatment strategies.

Feelings of Clinician-Patient Similarity and Trust Influence Pain: Evidence From Simulated Clinical Interactions.

PubMed

Losin, Elizabeth A Reynolds; Anderson, Steven R; Wager, Tor D

2017-07-01

Pain is influenced by many factors other than external sources of tissue damage. Among these, the clinician-patient relationship is particularly important for pain diagnosis and treatment. However, the effects of the clinician-patient relationship on pain remain underexamined. We tested the hypothesis that patients who believe they share core beliefs and values with their clinician will report less pain than patients who do not. We also measured feelings of perceived clinician-patient similarity and trust to see if these interpersonal factors influenced pain. We did so by experimentally manipulating perceptions of similarity between participants playing the role of clinicians and participants playing the role of patients in simulated clinical interactions. Participants were placed in 2 groups on the basis of their responses to a questionnaire about their personal beliefs and values, and painful thermal stimulation was used as an analog of a painful medical procedure. We found that patients reported feeling more similarity and trust toward their clinician when they were paired with clinicians from their own group. In turn, patients' positive feelings of similarity and trust toward their clinicians-but not clinicians' feelings toward patients or whether the clinician and patient were from the same group-predicted lower pain ratings. Finally, the most anxious patients exhibited the strongest relationship between their feelings about their clinicians and their pain report. These findings increase our understanding of context-driven pain modulation and suggest that interventions aimed at increasing patients' feelings of similarity to and trust in health care providers may help reduce the pain experienced during medical care. We present novel evidence that the clinician-patient relationship can affect the pain experienced during medical care. We found that "patients" in simulated clinical interactions who reported feeling more similarity and trust toward their "clinicians" reported less pain, suggesting that increasing feelings of clinician-patient similarity and trust may reduce pain disparities. Copyright © 2017 American Pain Society. Published by Elsevier Inc. All rights reserved.

The neurologist facing pain in dementia.

PubMed

Álvaro González, Luis Carlos

2015-01-01

Ageing, a common background in dementia, is usually associated with painful disorders. Nevertheless, the use of analgesics is limited due to poor communication. On the other hand, dementia lesions are placed in the nociceptive pathways. For this reason, the painful experience becomes different and distinctive for every lesional type. The lateral nociceptive pathway (lateral thalamic nuclei and primary parietal cortex), which is in charge of the primary pain perception, is preserved in dementia. Thereafter, the shear painful perception, including pain intensity and threshold, remains unmodified. Distinctly, the medial pain pathways are affected by dementia lesions. In this pathway are included: the intralaminar thalamic nuclei, the pons (locus ceruleus:LC), the mesencephalon (periaacueductal grey substance: PGS), the hypothalamus (paraventricular nuclei, mamilary tuberculum) and different areas of the parietal (primary, secondary, operculum), temporal (amigdala, hypoccampus) and frontal (anterior cingular: ACC). As a consequence, the features of pain executed by these areas will be compromised: the cognitive assessment, the mood and emotion inherent to pain, the pain memory or the autonomic responses are modified in dementia. Specifically, in Alzheimer's disease (AD) there is a reduction in the anticipatory and avoidance responses and also a flattening of the autonomic responses. These are essentially secondary to the degenerative changes in the medial temporal (pain memory) and ACC (cognitive and mood aspects) areas. In vascular dementias, there is a cortico-subcortical deafferentation secondary to the white matter lesions. The consequence is the presence of hyperpathy and hyperalgesia. In the frontotemporal dementias, there is a reduction in pain expressivity. It is linked to the lesions in the orbitofrontal and anterior temporal areas, which are responsible of the emotional aspects of pain. In Parkinson's disease, painful conditions are a common characteristic. They are attributed to an early lesion in the LC, which reduces its prominent antinociceptive activity. Finally, in the demented patients there is a lack of expectations to analgesic treatments. This means an absence of the placebo effect, which is, alongside the pharmacokinetic action, an inherent part of the analgesic response. The placebo response is related to activity in the ACC and PGS. Giving its lack, higher doses of analgesics are necessary in dementias. The assessment of pain in dementia is rather complex, which is the main reason for the scarcity of the analgesic treatment in dementias. It must be specific and systematic. For this purpose, the pain scales are a useful tool. For communicative patients, simple visual scales are helpful, meanwhile in the non-communicative patients the multidimensional scales are the most suitable. By this means, the expressive, motor, emotional, functional and social interactions are evaluated. Pain may be responsible of progression and cognitive deterioration in dementia. This evolution could be reversible, and consequently it has to be foreseen in order to implement analgesic treatment. Trying to minimize adverse events, it has to be potent but closely monitored. Copyright © 2010 Sociedad Española de Neurología. Published by Elsevier España, S.L.U. All rights reserved.

Flip-flop footwear with a moulded foot-bed for the treatment of foot pain: a randomised controlled trial.

PubMed

Chuter, Vivienne Helaine; Searle, Angela; Spink, Martin J

2016-11-11

Foot pain is a common problem affecting up to 1 in 5 adults and is known to adversely affect activities of daily living and health related quality of life. Orthopaedic footwear interventions are used as a conservative treatment for foot pain, although adherence is known to be low, in part due to the perception of poor comfort and unattractiveness of the footwear. The objective of this trial was to assess the efficacy of flip-flop style footwear (Foot Bio-Tec©) with a moulded foot-bed in reducing foot pain compared to participant's usual footwear. Two-arm parallel randomised controlled trial using computer generated random allocation schedule at an Australian university podiatry clinic. 108 volunteers with disabling foot pain were enrolled after responding to an advertisement and eligibility screening. Participants were randomly allocated to receive footwear education and moulded flip-flop footwear to wear as much as they were comfortable with for the next 12 weeks (n = 54) or footwear education and instructions to wear their normal footwear for the next 12 weeks (n = 54). Primary outcome was the pain domain of the Foot Health Status Questionnaire (FHSQ). Secondary outcomes were the foot function and general foot health domains of the FHSQ, a visual analogue scale (VAS) for foot pain and perceived comfort of the intervention footwear. Compared to the control group, the moulded flip-flop group showed a significant improvement in the primary outcome measure of the FHSQ pain domain (adjusted mean difference 8.36 points, 95 % CI 5.58 to 13.27, p < 0.01). Statistical and clinically significant differences were observed for the secondary measure of foot pain assessed by a VAS and the FSHQ domains of foot function and general foot health. None of the participants reported any pain or discomfort from the intervention footwear and six (footwear group = 4) were lost to follow up. Our results demonstrate that flip-flop footwear with a moulded foot-bed can have a significant effect on foot pain, function and foot health and might be a valuable adjunct therapy for people with foot pain. ACTRN12614000933651 . Retrospectively registered: 01/09/2014.

[Gender influence on health related quality of life among resident physicians working in an emergency department].

PubMed

Fernández-Prada, María; González-Cabrera, Joaquín; Torres G, Francisco; Iribar-Ibabe, Concepción; María Peinado, José

2014-02-01

The high emotional burden of physicians working in emergency departments may affect their quality of life perception. To evaluate health related quality of life among resident physicians performing shifts at an emergency department. Seventy one physicians aged 26,3 ± 1,7 years (47 women), working as residents in an emergency department, answered the short version of the Short-Form Health Survey Questionnaire (SF-36®). This questionnaire analyses eight domains: physical function, body pain, general health, vitality, social function, emotional role and mental health. Women had a significantly worse perception than a reference population in four dimensions of the SF-36, especially mental health and social functioning. Men had scores similar to the reference population. Among women, vitality is the best predictor of mental health and social functioning. Women working as residents in an emergency department have a worse perception of their quality of life than men performing the same job.

Sleep Quality, Affect, Pain, and Disability in Children With Chronic Pain: Is Affect a Mediator or Moderator?

PubMed

Evans, Subhadra; Djilas, Vesna; Seidman, Laura C; Zeltzer, Lonnie K; Tsao, Jennie C I

2017-09-01

Sleep problems have been identified as a potential antecedent of chronic pain and pain-related disability in pediatric populations. In adult studies, affect has been implicated in these relationships. This study sought to better understand the relationships between sleep quality, negative and positive affect, and pain and functioning in children with chronic pain. Participants included 213 children and adolescents (aged 7-17 years) presenting to a tertiary pain clinic with chronic pain. Children completed questionnaires measuring sleep quality, positive and negative affect, pain intensity, and functional disability. Results indicated that 74% of children reported disordered sleeping and that poor sleep quality was significantly associated with increased pain, disability, negative affect, and decreased positive affect. Our hypotheses were partially supported, with negative affect (but not positive affect) mediating the relationship between poor sleep and increased pain; and positive as well as negative affect mediating the relationship between poor sleep and increased functional disability. There was no evidence for affect as a moderator. This study adds to the growing literature demonstrating the effect of poor sleep quality on children's pain and functioning, highlighting the need to develop further longitudinal research to confirm the causal roles of these variables. This article examines the relationship between poor sleep quality, affect (negative as well as positive), pain, and disability in children with chronic pain. The findings have the potential to better understand the processes involved in how poor sleep may lead to increased pain and pain-related disability. Copyright © 2017 American Pain Society. All rights reserved.

Effect of pre-cooling injection site on pain perception in pediatric dentistry: “A randomized clinical trial”

PubMed Central

Ghaderi, Faezeh; Banakar, Shahin; Rostami, Shima

2013-01-01

Background: Injection of local anesthesia is one of the most important reasons for development of avoidance behavior in children. Efforts have been performed to decrease pain perception of injection. The present research evaluated the effect of cooling the injection site on pain perception before infiltration of local anesthetics. Materials and Methods: A prospective single-blind crossover clinical trial was used to investigate pain perception in 50 healthy pediatric patients who needed bilateral buccal infiltration of local anesthetics for dental treatment. They received a topical anesthetic agent (Benzocaine) on one side (control) for 1 min and topical anesthetic agent plus one minute of ice pack on the other side (trial) prior to the injection. A dentist blind to the study assessed the patients’ reaction during injection. Wilcoxon and Mann-Whitney U tests were used for statistical analysis. Statistical significance was defined at P < 0.05. Results: The means of sound, eye, and motor scales (SEM) were 4.06 ± 1.32 and 5.44 ± 1.79 for the study and control groups, respectively. The means of visual analogue scales (VAS) for the study and control groups were 42.20 ± 12.70 and 58.40 ± 16.83, respectively; with statistically significant differences between the two groups (P < 0.05). Conclusion: Cooling the injection site before infiltration of local anesthetics in the buccal mucosa for 1 min, reduced pain perceived by pediatric patients. PMID:24379869

Psychological interventions influence patients' attitudes and beliefs about their chronic pain.

PubMed

Vanhaudenhuyse, Audrey; Gillet, Aline; Malaise, Nicole; Salamun, Irène; Grosdent, Stéphanie; Maquet, Didier; Nyssen, Anne-Sophie; Faymonville, Marie-Elisabeth

2018-04-01

Patients' changing attitudes and beliefs about pain are considered as improvements in the treatment of chronic pain. Multidisciplinary approaches to pain allow modifications of coping strategies of patients, from passive to active. We investigate how two therapeutic treatments impact patients' attitudes and beliefs regarding pain, as measured with the Survey of Pain Attitudes (SOPA). We allocated 415 patients with chronic pain either to psychoeducation combined with physiotherapy, self-hypnosis combined with self-care learning, or to control groups. Pain intensity, global impression of change, and beliefs and attitudes regarding pain were assessed before and after treatment. Our main results showed a significant effect of psychoeducation/physiotherapy on control, harm, and medical cure SOPA subscales; and a significant effect of self-hypnosis/self-care on control, disability and medical cure subscales. Correlation results showed that pain perception was negatively associated with control, while positively associated with disability, and a belief that hurt signifies harm. Patients' impression of improvement was associated with greater control, lower disability, and lower belief that hurt signifies harm. The present study showed that self-hypnosis/self-care and psychoeducation/physiotherapy were associated with patients' evolution of coping strategies from passive to active, allowing them to reduce pain perception and improve their global impression of treatment effectiveness.

[Mirror therapy for inflammatory rheumatic pain: Potentials and limitations].

PubMed

Bekrater-Bodmann, R

2015-11-01

Mirror therapy reduces chronic pain and might also be suitable for the treatment of inflammatory rheumatic pain. On the basis of the relevant literature this article a) characterizes the universal alterations in body perception and body representation in chronic pain, b) describes the potential mechanisms underlying mirror therapy and c) discusses the chances of success of mirror therapy for the treatment of inflammatory rheumatic pain. Literature search on the effectiveness and mechanisms of mirror therapy and derived procedures for the potential treatment of pain in inflammatory rheumatic disorders. There is evidence that mirror therapy can alleviate chronic pain experiences by correcting the accompanying distorted body perception as well as body representation by multimodal sensory stimulation. As there is probably a similar distortion in persons with chronic pain related to inflammatory rheumatic disorders, mirror therapy might also have positive effects in this field; however, the accompanying characteristics of these disorders, such as motor impairment and motor-evoked pain, may complicate the implementation of this kind of treatment. Mirror therapy represents an intervention with few side effects and might have positive effects on the experience of chronic pain in patients with inflammatory rheumatic disorders. Further clinical research is required in order to evaluate the potential of mirror therapy and associated interventional methods for the treatment of inflammatory rheumatic pain.

Selective ablation of nociceptive neurons for elimination of hyperalgesia and neurogenic inflammation.

PubMed

Tender, Gabriel C; Walbridge, Stuart; Olah, Zoltan; Karai, Laszlo; Iadarola, Michael; Oldfield, Edward H; Lonser, Russell R

2005-03-01

Neuropathic pain is mediated by nociceptive neurons that selectively express the vanilloid receptor 1 (VR1). Resiniferatoxin (RTX) is an excitotoxic VR1 agonist that causes destruction of VR1-positive neurons. To determine whether RTX can be used to ablate VR1-positive neurons selectively and to eliminate hyperalgesia and neurogenic inflammation without affecting tactile sensation and motor function, the authors infused it unilaterally into the trigeminal ganglia in Rhesus monkeys. Either RTX (three animals) or vehicle (one animal) was directly infused (20 microl) into the right trigeminal ganglion in Rhesus monkeys. Animals were tested postoperatively at 1, 4, and 7 weeks thereafter for touch and pain perception in the trigeminal distribution (application of saline and capsaicin to the cornea). The number of eye blinks, eye wipes, and duration of squinting were recorded. Neurogenic inflammation was tested using capsaicin cream. Animals were killed 4 (one monkey) and 12 (three monkeys) weeks postinfusion. Histological and immunohistochemical analyses were performed. Throughout the duration of the study, response to high-intensity pain stimulation (capsaicin) was selectively and significantly reduced (p < 0.001, RTX-treated compared with vehicle-treated eye [mean +/- standard deviation]): blinks, 25.7 +/- 4.4 compared with 106.6 +/- 20.8; eye wipes, 1.4 +/- 0.8 compared with 19.3 +/- 2.5; and squinting, 1.4 +/- 0.6 seconds compared with 11.4 +/- 1.6 seconds. Normal response to sensation was maintained. Animals showed no neurological deficit or sign of toxicity. Neurogenic inflammation was blocked on the RTX-treated side. Immunohistochemical analysis of the RTX-treated ganglia showed selective elimination of VR1-positive neurons. Nociceptive neurons can be selectively ablated by intraganglionic RTX infusion, resulting in the elimination of high-intensity pain perception and neurogenic inflammation while maintaining normal sensation and motor function. Analysis of these findings indicated that intraganglionic RTX infusion may provide a new treatment for pain syndromes such as trigeminal neuralgia as well as others.

Effects of live music therapy sessions on quality of life indicators, medications administered and hospital length of stay for patients undergoing elective surgical procedures for brain.

PubMed

Walworth, Darcy; Rumana, Christopher S; Nguyen, Judy; Jarred, Jennifer

2008-01-01

The physiological and psychological stress that brain tumor patients undergo during the entire surgical experience can considerably affect several aspects of their hospitalization. The purpose of this study was to examine the effects of live music therapy on quality of life indicators, amount of medications administered and length of stay for persons receiving elective surgical procedures of the brain. Subjects (N = 27) were patients admitted for some type of surgical procedure of the brain. Subjects were randomly assigned to either the control group receiving no music intervention (n = 13) or the experimental group receiving pre and postoperative live music therapy sessions (n = 14). Anxiety, mood, pain, perception of hospitalization or procedure, relaxation, and stress were measured using a self-report Visual Analog Scale (VAS) for each of the variables. The documented administration of postoperative pain medications; the frequency, dosage, type, and how it was given was also compared between groups. Experimental subjects live and interactive music therapy sessions, including a pre-operative session and continuing with daily sessions until the patient was discharged home. Control subjects received routine hospital care without any music therapy intervention. Differences in experimental pretest and posttest scores were analyzed using a Wilcoxon Matched-Pairs Signed-Rank test. Results indicated statistically significant differences for 4 of the 6 quality of life measures: anxiety (p = .03), perception of hospitalization (p = .03), relaxation (p = .001), and stress (p = .001). No statistically significant differences were found for mood (p > .05) or pain (p > .05) levels. Administration amounts of nausea and pain medications were compared with a Two-Way ANOVA with One Repeated Measure resulting in no significant differences between groups and medications, F(1, 51) = 0.03; p > .05. Results indicate no significant differences between groups for length of stay (t = .97, df = 25, p > .05). This research study indicates that live music therapy using patient-preferred music can be beneficial in improving quality of life indicators such as anxiety, perception of the hospitalization or procedure, relaxation, and stress in patients undergoing surgical procedures of the brain.

The effects of physical training without equipment on pain perception and balance in the elderly: A randomized controlled trial.

PubMed

Patti, Antonino; Bianco, Antonino; Karsten, Bettina; Montalto, Maria Alessandra; Battaglia, Giuseppe; Bellafiore, Marianna; Cassata, Daniela; Scoppa, Fabio; Paoli, Antonio; Iovane, Angelo; Messina, Giuseppe; Palma, Antonio

2017-01-01

Research supports a link between exercise and falls prevention in the older population. Our aims were to evaluate pain perception and balance skills in a group of elderly subjects and to examine the consequences of a standardized equipment-free exercise program intervention on these variables. The study utilized a randomized controlled trial method. 92 subjects were recruited from a rural Sicilian village (Resuttano, Sicily, Italy). Subjects were randomly split into two groups, an experimental group (EG; n = 49) and a control group (CG; n = 43). Qualified fitness instructors delivered the standardized physical exercise program for the EG whilst the CG did not receive this exercise intervention. The Berg Balance Scale and the Oswestry Disability Index were administered in both groups before (T0) and after the intervention (T1). At T1, the EG group significantly improvement in balance (p < 0.0001) and pain perception (p < 0.0001). No significant differences were found within the CG both in BBS and ODI, respectively. Our findings suggest that a 13-weeks standardized exercise equipment-free program is effective in improving balance and perception of pain in the elderly. This type of intervention can consequently provide a low cost strategy to counteract the rate of disability in elderly.

Audiovisual distraction reduces pain perception during aural microsuction.

PubMed

Choudhury, N; Amer, I; Daniels, M; Wareing, M J

2013-01-01

Aural microsuction is a common ear, nose and throat procedure used in the outpatient setting. Some patients, however, find it difficult to tolerate owing to discomfort, pain or noise. This study evaluated the effect of audiovisual distraction on patients' pain perception and overall satisfaction. A prospective study was conducted for patients attending our aural care clinic requiring aural toileting of bilateral mastoid cavities over a three-month period. All microsuction was performed by a single clinical nurse specialist. Any patients with active infection were excluded. For each patient, during microsuction of one ear, they watched the procedure on a television screen while for the other ear they did not view the procedure. All patients received the same real time explanations during microsuction of both ears. After the procedure, each patient completed a visual analogue scale (VAS) to rate the pain they experienced for each ear, with and without access to the television screen. They also documented their preference and reasons why. A total of 37 patients were included in the study. The mean pain score for patients viewing the procedure was 2.43 compared with a mean of 3.48 for patients with no television view. This difference in patients' pain perception was statistically lower in the group who observed the procedure on the television (p=0.003), consistent with the majority of patients reporting a preference to viewing their procedure (65%). Audiovisual distraction significantly lowered patients' VAS pain scores during aural microsuction. This simple intervention can therefore reduce patients' perceived pain and help improve acceptance of this procedure.

The effect of deep and slow breathing on pain perception, autonomic activity, and mood processing--an experimental study.

PubMed

Busch, Volker; Magerl, Walter; Kern, Uwe; Haas, Joachim; Hajak, Göran; Eichhammer, Peter

2012-02-01

Deep and slow breathing (DSB) techniques, as a component of various relaxation techniques, have been reported as complementary approaches in the treatment of chronic pain syndromes, but the relevance of relaxation for alleviating pain during a breathing intervention was not evaluated so far. In order to disentangle the effects of relaxation and respiration, we investigated two different DSB techniques at the same respiration rates and depths on pain perception, autonomic activity, and mood in 16 healthy subjects. In the attentive DSB intervention, subjects were asked to breathe guided by a respiratory feedback task requiring a high degree of concentration and constant attention. In the relaxing DSB intervention, the subjects relaxed during the breathing training. The skin conductance levels, indicating sympathetic tone, were measured during the breathing maneuvers. Thermal detection and pain thresholds for cold and hot stimuli and profile of mood states were examined before and after the breathing sessions. The mean detection and pain thresholds showed a significant increase resulting from the relaxing DSB, whereas no significant changes of these thresholds were found associated with the attentive DSB. The mean skin conductance levels indicating sympathetic activity decreased significantly during the relaxing DSB intervention but not during the attentive DSB. Both breathing interventions showed similar reductions in negative feelings (tension, anger, and depression). Our results suggest that the way of breathing decisively influences autonomic and pain processing, thereby identifying DSB in concert with relaxation as the essential feature in the modulation of sympathetic arousal and pain perception. Wiley Periodicals, Inc.

Barriers to pediatric pain management: a nursing perspective.

PubMed

Czarnecki, Michelle L; Simon, Katherine; Thompson, Jamie J; Armus, Cheryl L; Hanson, Tom C; Berg, Kristin A; Petrie, Jodie L; Xiang, Qun; Malin, Shelly

2011-09-01

This study describes strategies used by the Joint Clinical Practice Council of Children's Hospital of Wisconsin to identify barriers perceived as interfering with nurses' (RNs) ability to provide optimal pain management. A survey was used to ascertain how nurses described optimal pain management and how much nurses perceived potential barriers as interfering with their ability to provide that level of care. The survey, "Barriers to Optimal Pain management" (adapted from Van Hulle Vincent & Denyes, 2004), was distributed to all RNs working in all patient care settings. Two hundred seventy-two surveys were returned. The five most significant barriers identified were insufficient physician (MD) orders, insufficient MD orders before procedures, insufficient time to premedicate patients before procedures, the perception of a low priority given to pain management by medical staff, and parents' reluctance to have patients receive pain medication. Additional barriers were identified through narrative comments. Information regarding the impact of the Acute Pain Service on patient care, RNs' ability to overcome barriers, and RNs' perception of current pain management practices is included, as are several specific interventions aimed at improving or ultimately eliminating identified barriers. Copyright © 2011 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

Effect of Change in Position and Back Massage on Pain Perception during First Stage of Labor.

PubMed

Abdul-Sattar Khudhur Ali, Suad; Mirkhan Ahmed, Hamdia

2018-06-01

Labor is one of the most painful events in a women's life. Frequent change in positions and back massage may be effective in reducing pain during the first stage of labor. The focus of this study was to identify the impact of either change in position or back massage on pain perception during first stage of labor. A quasi-experimental study. Teaching hospital, Kurdistan Region, Iraq, November 2014 to October 2015. Eighty women were interviewed as a study sample when admitted to the labor and delivery area and divided into three groups: 20 women received frequent changes in position (group A), 20 women received back massage (Group B), and 40 women constituted the control group (group C). A structured interview questionnaire to collect background data was completed by the researcher in personal interviews with the mothers. The intervention was performed at three points in each group, and pain perception was measured after each intervention using the Face Pain Scale. The mean rank of the difference in pain scores among the study groups was as follows after the first, second, and third interventions, respectively: group A-52.33, 47.00, 49.2; group B-32.8, 30.28, 30.38; group C-38.44, 42.36, 41.21. There were significant differences between groups A, B, and C after the first, second, and third interventions (p 1  = .011, p 2  = .042, p 3  = .024). Back massage may be a more effective pain management approach than change in position during the first stage of labor. Copyright © 2018 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

Meditation reduces pain-related neural activity in the anterior cingulate cortex, insula, secondary somatosensory cortex, and thalamus

PubMed Central

Nakata, Hiroki; Sakamoto, Kiwako; Kakigi, Ryusuke

2014-01-01

Recent studies have shown that meditation inhibits or relieves pain perception. To clarify the underlying mechanisms for this phenomenon, neuroimaging methods, such as functional magnetic resonance imaging, and neurophysiological methods, such as magnetoencephalography and electroencephalography, have been used. However, it has been difficult to interpret the results, because there is some paradoxical evidence. For example, some studies reported increased neural responses to pain stimulation during meditation in the anterior cingulate cortex (ACC) and insula, whereas others showed a decrease in these regions. There have been inconsistent findings to date. Moreover, in general, since the activities of the ACC and insula are correlated with pain perception, the increase in neural activities during meditation would be related to the enhancement of pain perception rather than its reduction. These contradictions might directly contribute to the ‘mystery of meditation.’ In this review, we presented previous findings for brain regions during meditation and the anatomical changes that occurred in the brain with long-term meditation training. We then discussed the findings of previous studies that examined pain-related neural activity during meditation. We also described the brain mechanisms responsible for pain relief during meditation, and possible reasons for paradoxical evidence among previous studies. By thoroughly overviewing previous findings, we hypothesized that meditation reduces pain-related neural activity in the ACC, insula, secondary somatosensory cortex, and thalamus. We suggest that the characteristics of the modulation of this activity may depend on the kind of meditation and/or number of years of experience of meditation, which were associated with paradoxical findings among previous studies that investigated pain-related neural activities during meditation. PMID:25566158

Parental involvement in neonatal pain management: an empirical and conceptual update.

PubMed

Franck, Linda S; Oulton, Kate; Bruce, Elizabeth

2012-03-01

New findings are emerging about parental perceptions and desires for involvement in infant pain management in the neonatal intensive care unit (NICU) setting, and the importance of building greater knowledge about this aspect of the patient care is beginning to be appreciated. The study had two aims: (a) to describe perceptions and feelings of parents who participated in a randomized controlled trial of an intervention to increase parent knowledge and involvement in infant pain management; and (b) to further refine the conceptual representation of the parental experience of involvement in infant pain management (or lack thereof) and the influencing factors. Thematic analysis was used to explore the content of parents' written comments and to integrate the present and previous research findings. Parents expressed strong preferences for more information about all aspects of infant pain care, improved timing of information giving, and involvement opportunities. They further desired increased sensitivity and consistency in infant care giving and increased use of specific pain-relieving interventions by NICU staff. Contextual factors such as parents' emotional state and the communication and support from NICU staff influenced parents' ability to achieve their desired level of involvement. The role of parents in infant pain management is a relatively new area of research. The discussion of conceptual models to guide research and practice is an important milestone representing new opportunity for further scientific developments with important clinical implications for the nursing care of critically ill infants and their families. New data continue to emerge about parental perceptions and desires for involvement in infant pain management. A new empirically based model may be useful to nurses in providing optimal pain management for NICU infants in partnership with parents. © 2012 Sigma Theta Tau International.

Emergency Department Patient Perceptions of Transvaginal Ultrasound for Complications of First-Trimester Pregnancy.

PubMed

Panebianco, Nova; Shofer, Frances; O'Conor, Katie; Wihbey, Tristan; Mulugeta, Lakeisha; Baston, Cameron M; Suzuki, Evan; Alghamdi, Adel; Dean, Anthony

2018-01-30

Emergency department (ED) transvaginal ultrasound (US) is underused in clinical practice. This study assessed pregnant women's perceptions of ED transvaginal US in terms of pain, embarrassment, anxiety, and willingness to receive the procedure. Secondary variables include physicians' perceptions of patients' experiences. Women undergoing US examinations for complications of first-trimester pregnancy were prospectively surveyed before any US and after ED and/or radiology transvaginal US. Patients' and physicians' assessments of pain, embarrassment, and anxiety were measured with visual analog scales (0-100). A total of 398 women were enrolled. In the pre-US survey, the median anxiety score was 14 (interquartile range, 3-51), and 96% of patients were willing to have an ED transvaginal US if necessary. Of those who had ED transvaginal US, 96% would agree to have another examination. Patients reported minimal pain/embarrassment, and there was no difference if performed in the ED versus radiology (median pain, 11.5 versus 13; P = .433; median embarrassment, 7 versus 4; P = .345). Of the 48 who had both ED and radiology transvaginal US, 85% thought the ED transvaginal US was worthwhile. Physicians accurately assessed patient's embarrassment and pain (mean differences, 3.5 and -1.9, respectively; P > .25 for both); however, they overestimated them relative to the pelvic examination (mean difference for embarrassment, 12.8; P < .0001; pain, 8.0; P = .01). Pregnant ED patients report low levels of anxiety, pain, and embarrassment, and after ED transvaginal US, 96% would agree to have the examination again. There is no difference in pain/embarrassment between ED and radiology transvaginal US. Emergency department physicians accurately assessed patients' pain and embarrassment with ED transvaginal US but overestimated them compared to the pelvic examination. © 2018 by the American Institute of Ultrasound in Medicine.

Pain Management and Use of Opioids in Pediatric Oncology in India: A Qualitative Approach

PubMed Central

Boydell, Katherine M.; Breakey, Vicky; Kurkure, Purna A.; Muckaden, Marian A.; Bouffet, Eric; Arora, Brijesh

2017-01-01

Purpose Consumption of medical opium for pain relief in India is low, despite the country being one of the main world producers of the substance. We investigated obstacles to opioid use and physician perceptions about optimal pain management in pediatric oncology patients in India. Methods Semistructured interviews were conducted with oncologists who work in pediatric oncology settings. A mixed sampling strategy was used, including maximum variation and confirmation and disconfirmation of cases, as well as snowball sampling. Key informants were identified. Interviews were audio recorded, transcribed verbatim, and analyzed by thematic analysis methodology. Results Twenty-three interviews were performed across 20 Indian institutions. The main obstacles identified were lack of financial resources, inadequate education of health care providers on pain management, insufficient human resources (particularly lack of dedicated trained oncology nurses), poor access to opioids, and cultural perceptions about pain. Children from rural areas, treated in public hospitals, and from lower socioeconomic classes appear disadvantaged. A significant equality gap exists between public institutions and private institutions, which provide state-of-the-art treatment. Conclusion The study illuminates the complexity of pain management in pediatric oncology in India, where financial constraints, lack of education, and poor access to opioids play a dominant role, but lack of awareness and cultural perceptions about pain management among health care providers and parents emerged as important contributing factors. Urgent interventions are needed to optimize care in this vulnerable population. PMID:28831441

Abnormal thalamocortical activity in patients with Complex Regional Pain Syndrome (CRPS) type I.

PubMed

Walton, K D; Dubois, M; Llinás, R R

2010-07-01

Complex Regional Pain Syndrome (CRPS) is a neuropathic disease that presents a continuing challenge in terms of pathophysiology, diagnosis, and treatment. Recent studies of neuropathic pain, in both animals and patients, have established a direct relationship between abnormal thalamic rhythmicity related to Thalamo-cortical Dysrhythmia (TCD) and the occurrence of central pain. Here, this relationship has been examined using magneto-encephalographic (MEG) imaging in CRPS Type I, characterized by the absence of nerve lesions. The study addresses spontaneous MEG activity from 13 awake, adult patients (2 men, 11 women; age 15-62), with CRPS Type I of one extremity (duration range: 3months to 10years) and from 13 control subjects. All CRPS I patients demonstrated peaks in power spectrum in the delta (<4Hz) and/or theta (4-9Hz) frequency ranges resulting in a characteristically increased spectral power in those ranges when compared to control subjects. The localization of such abnormal activity, implemented using independent component analysis (ICA) of the sensor data, showed delta and/or theta range activity localized to the somatosensory cortex corresponding to the pain localization, and to orbitofrontal-temporal cortices related to the affective pain perception. Indeed, CRPS Type I patients presented abnormal brain activity typical of TCD, which has both diagnostic value indicating a central origin for this ailment and a potential treatment interest involving pharmacological and electrical stimulation therapies. Copyright 2010 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

Patients' perceptions of sleep in a Critical Care Unit.

PubMed

Carrera-Hernández, L; Aizpitarte-Pejenaute, E; Zugazagoitia-Ciarrusta, N; Goñi-Viguria, R

Patients' sleep can be disturbed during their stay in an Intensive Care Unit. Many factors can explain this disturbance, both within the ICU environment and caused by patients' illnesses. There is evidence that patients' sleep can be improved within ICUs. The aim of this study is to describe patientś perceptions of a night's sleep and develop a care plan that promotes a night's sleep. A prospective descriptive study was performed in the ICU of a training hospital. The sleep of 125 patients was explored. Sociodemographic and clinical variables were collected from patients' medical records. The 5-item Richards-Campbell Sleep Questionnaire was utilised to assess patients' perception of a night's sleep. In addition, an ad-hoc 9-item questionnaire was developed which included factors that can affect sleep according to the literature. Patients had to grade the level of interference of those factors with their night's sleep. The sleep of patients in our Intensive Care Unit was moderately deep, with light arousals and ease in falling sleep again. The average value on the Richards-Campbell Sleep Questionnaire was 52.92mm. The factors that significantly interfered with sleep were: pain (P=0.009), worries/anxiety (P=.01), staff voices (P=0.033), alarm/medical devices sounds (P=0.047) and peripheral intravenous lines (P=.036). Our patients' perception of a night's sleep in the ICU was fair. Optimising pain management, answering questions or worries, minimizing background noise and voices have the potential to improve sleep quality. Copyright © 2018 Sociedad Española de Enfermería Intensiva y Unidades Coronarias (SEEIUC). Publicado por Elsevier España, S.L.U. All rights reserved.

Hypnotizability and Placebo Analgesia in Waking and Hypnosis as Modulators of Auditory Startle Responses in Healthy Women: An ERP Study.

PubMed

De Pascalis, Vilfredo; Scacchia, Paolo

2016-01-01

We evaluated the influence of hypnotizability, pain expectation, placebo analgesia in waking and hypnosis on tonic pain relief. We also investigated how placebo analgesia affects somatic responses (eye blink) and N100 and P200 waves of event-related potentials (ERPs) elicited by auditory startle probes. Although expectation plays an important role in placebo and hypnotic analgesia, the neural mechanisms underlying these treatments are still poorly understood. We used the cold cup test (CCT) to induce tonic pain in 53 healthy women. Placebo analgesia was initially produced by manipulation, in which the intensity of pain induced by the CCT was surreptitiously reduced after the administration of a sham analgesic cream. Participants were then tested in waking and hypnosis under three treatments: (1) resting (Baseline); (2) CCT-alone (Pain); and (3) CCT plus placebo cream for pain relief (Placebo). For each painful treatment, we assessed pain and distress ratings, eye blink responses, N100 and P200 amplitudes. We used LORETA analysis of N100 and P200 waves, as elicited by auditory startle, to identify cortical regions sensitive to pain reduction through placebo and hypnotic analgesia. Higher pain expectation was associated with higher pain reductions. In highly hypnotizable participants placebo treatment produced significant reductions of pain and distress perception in both waking and hypnosis condition. P200 wave, during placebo analgesia, was larger in the frontal left hemisphere while placebo analgesia, during hypnosis, involved the activity of the left hemisphere including the occipital region. These findings demonstrate that hypnosis and placebo analgesia are different processes of top-down regulation. Pain reduction was associated with larger EMG startle amplitudes, N100 and P200 responses, and enhanced activity within the frontal, parietal, and anterior and posterior cingulate gyres. LORETA results showed that placebo analgesia modulated pain-responsive areas known to reflect the ongoing pain experience.

Hypnotizability and Placebo Analgesia in Waking and Hypnosis as Modulators of Auditory Startle Responses in Healthy Women: An ERP Study

PubMed Central

De Pascalis, Vilfredo; Scacchia, Paolo

2016-01-01

We evaluated the influence of hypnotizability, pain expectation, placebo analgesia in waking and hypnosis on tonic pain relief. We also investigated how placebo analgesia affects somatic responses (eye blink) and N100 and P200 waves of event-related potentials (ERPs) elicited by auditory startle probes. Although expectation plays an important role in placebo and hypnotic analgesia, the neural mechanisms underlying these treatments are still poorly understood. We used the cold cup test (CCT) to induce tonic pain in 53 healthy women. Placebo analgesia was initially produced by manipulation, in which the intensity of pain induced by the CCT was surreptitiously reduced after the administration of a sham analgesic cream. Participants were then tested in waking and hypnosis under three treatments: (1) resting (Baseline); (2) CCT-alone (Pain); and (3) CCT plus placebo cream for pain relief (Placebo). For each painful treatment, we assessed pain and distress ratings, eye blink responses, N100 and P200 amplitudes. We used LORETA analysis of N100 and P200 waves, as elicited by auditory startle, to identify cortical regions sensitive to pain reduction through placebo and hypnotic analgesia. Higher pain expectation was associated with higher pain reductions. In highly hypnotizable participants placebo treatment produced significant reductions of pain and distress perception in both waking and hypnosis condition. P200 wave, during placebo analgesia, was larger in the frontal left hemisphere while placebo analgesia, during hypnosis, involved the activity of the left hemisphere including the occipital region. These findings demonstrate that hypnosis and placebo analgesia are different processes of top-down regulation. Pain reduction was associated with larger EMG startle amplitudes, N100 and P200 responses, and enhanced activity within the frontal, parietal, and anterior and posterior cingulate gyres. LORETA results showed that placebo analgesia modulated pain-responsive areas known to reflect the ongoing pain experience. PMID:27486748

Pain perception of children undergoing nasendoscopy for investigation of voice and resonance disorders.

PubMed

Hay, Imogen; Oates, Jennifer; Giannini, Alessandra; Berkowitz, Robert; Rotenberg, Brian

2009-05-01

The primary objective of this descriptive and correlational study was to determine the level of pain and discomfort perceived by children undergoing nasendoscopy for investigation of voice and resonance disorders. The secondary objective was to explore whether gender, age, previous experience of painful or distressing medical procedures, and previous experience of nasendoscopy influenced the perception of pain during nasendoscopy. Twenty-three children self-reported the degree of pain perceived during nasendoscopy using the Wong-Baker Faces Pain Rating Scale. Parents also used this scale to rate their child's perceived pain. Otolaryngologists and speech pathologists rated the intensity and frequency of observed pain-related behaviors using the Child-Adult Medical Procedure Interaction Scale-Revised and the Procedure Behavior Checklist. Children perceived the procedure, on average, to be moderately painful, as did their parents. Only two children reported perceiving no pain during the procedure. The most frequently observed pain-related behaviors were muscle tension (86.96%), physical resistance (69.57%), requiring physical restraint (60.87%), crying (43.48%), and expressions of verbal pain (39.13%). No significant correlations were found between self-reported pain or observed pain and the variables of age, gender, previous experience of nasendoscopy, and previous experience of painful or distressing medical procedures, although children aged 4-7 years reported significantly more pain than children aged 8-18 years. Most children perceive nasendoscopy to be painful to some degree. This perceived pain occurred in conjunction with several observable pain-related behaviors that have the potential to interfere with the success of the procedure.

A life shaped by pain: women and endometriosis.

PubMed

Huntington, Annette; Gilmour, Jean A

2005-10-01

The research aim was to explore women's perceptions of living with endometriosis, its effects on their lives and the strategies used to manage their disease. Symptomatic endometriosis significantly affects women's quality of life. Characteristically the condition causes severe pain and has a negative impact on the ability to work, on family relationships and self-esteem. There has been little discussion about women's experience of endometriosis in nursing literature. A qualitative research design informed by feminist research principles was chosen for this project. Eighteen women agreed to take part in the research. The individual, audio taped interviews were semi-structured and interactive. The interviews were analysed using a thematic analysis approach. The dominant feature of data from the interviews was the experience of severe and chronic pain impacting on all aspects of life. Analysis related to pain resulted in four themes: manifestations of pain, the pain trajectory, intractable pain and controlling pain. The diagnostic process typically took 5-10 years indicating that primary health care practitioners need higher levels of 'suspicion' for this condition. Case studies and problem-based scenarios focusing on endometriosis in health professional education programmes would enhance diagnostic skills and knowledge development. No formal pain management follow up after diagnosis and treatment meant women actively sought information from other sources as they made major lifestyle changes in the areas of activity and nutrition. Pain management services specifically for women with endometriosis would provide much needed support with this neglected aspect of the disease. This is a fertile area for the development of the Nurse Practitioner role which, also drawing on the considerable collective expertise of women with endometriosis, could provide significant information and support for women as they manage this highly complex condition.

Disturbance of the gut microbiota in early-life selectively affects visceral pain in adulthood without impacting cognitive or anxiety-related behaviors in male rats.

PubMed

O'Mahony, S M; Felice, V D; Nally, K; Savignac, H M; Claesson, M J; Scully, P; Woznicki, J; Hyland, N P; Shanahan, F; Quigley, E M; Marchesi, J R; O'Toole, P W; Dinan, T G; Cryan, J F

2014-09-26

Disruption of bacterial colonization during the early postnatal period is increasingly being linked to adverse health outcomes. Indeed, there is a growing appreciation that the gut microbiota plays a role in neurodevelopment. However, there is a paucity of information on the consequences of early-life manipulations of the gut microbiota on behavior. To this end we administered an antibiotic (vancomycin) from postnatal days 4-13 to male rat pups and assessed behavioral and physiological measures across all aspects of the brain-gut axis. In addition, we sought to confirm and expand the effects of early-life antibiotic treatment using a different antibiotic strategy (a cocktail of pimaricin, bacitracin, neomycin; orally) during the same time period in both female and male rat pups. Vancomycin significantly altered the microbiota, which was restored to control levels by 8 weeks of age. Notably, vancomycin-treated animals displayed visceral hypersensitivity in adulthood without any significant effect on anxiety responses as assessed in the elevated plus maze or open field tests. Moreover, cognitive performance in the Morris water maze was not affected by early-life dysbiosis. Immune and stress-related physiological responses were equally unaffected. The early-life antibiotic-induced visceral hypersensitivity was also observed in male rats given the antibiotic cocktail. Both treatments did not alter visceral pain perception in female rats. Changes in visceral pain perception in males were paralleled by distinct decreases in the transient receptor potential cation channel subfamily V member 1, the α-2A adrenergic receptor and cholecystokinin B receptor. In conclusion, a temporary disruption of the gut microbiota in early-life results in very specific and long-lasting changes in visceral sensitivity in male rats, a hallmark of stress-related functional disorders of the brain-gut axis such as irritable bowel disorder. Copyright © 2014 IBRO. Published by Elsevier Ltd. All rights reserved.

Partners' Overestimation of Patients' Pain Severity: Relationships with Partners' Interpersonal Responses.

PubMed

Junghaenel, Doerte U; Schneider, Stefan; Broderick, Joan E

2017-09-26

The present study examined whether concordance between patients' and their partners' reports of patient pain severity relates to partners' social support and behavioral responses in couples coping with chronic pain. Fifty-two couples completed questionnaires about the patient's pain severity. Both dyad members also rated the partner's social support and negative, solicitous, and distracting responses toward the patient when in pain. Bivariate correlations showed moderate correspondence between patient and partner ratings of pain severity (r = 0.55) and negative (r = 0.46), solicitous (r = 0.47), and distracting responses (r = 0.53), but lower correspondence for social support (r = 0.28). Twenty-eight couples (54%) were concordant in their perceptions of patient pain; partners overestimated pain in 14 couples (27%), and partners underestimated pain in 10 couples (19%). Couple concordance in pain perceptions was not related to patients' reports; however, it significantly predicted partners' reports: Partners who overestimated pain reported giving more social support (β = 0.383, P = 0.016), fewer negative responses (β = -0.332, P = 0.029), and more solicitous responses (β = 0.438, P = 0.016) than partners who were in agreement or who underestimated pain. Partner overestimation of pain severity is associated with partner-reported but not with patient-reported support-related responses. This finding has important clinical implications for couple interventions in chronic pain. © 2017 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Night-shift work is associated with increased pain perception.

PubMed

Matre, Dagfinn; Knardahl, Stein; Nilsen, Kristian Bernhard

2017-05-01

Objectives The aim of the present study was to determine whether shift workers exhibit increased perception of experimentally induced pain after working night shifts. Methods The study was a paired cross-over design with two sleep conditions, after at least two nights of habitual sleep and after two consecutive night shifts at work. Fifty-three nurses in rotating shift work participated. The sensitivity to electrically induced pain, heat pain, cold pain, pressure pain and pain inhibition was determined experimentally in each sleep condition. Sleepiness and vigilance were also assessed. Results Night-shift work (NSW) increased the sensitivity to electrically induced pain and heat pain (P≤0.001). Relative to habitual sleep, electrically induced pain increased by 22.3% and heat pain increased by 26.5%. The sensitivity to cold and pressure pain did not change, changes relative to habitual sleep was <5% (P>0.5). Pain inhibition was 66.9% stronger after NSW versus after habitual sleep (P<0.001). Sleepiness (measured with the Karolinska Sleepiness Scale) increased from 4.1 after habitual sleep to 6.9 after NSW (P<0.001). Vigilance decreased after NSW, measured as a 0.03-second decrease in reaction time (P<0.005). Conclusions Changes in pain sensitivity after NSW is measurable with clinically relevant effect sizes and may be an important marker for studies comparing the physiological effects of different shift work schedules. Explanations for the differential effect on different pain modalities should be a focus for future studies.

Beyond Negative Pain-Related Psychological Factors: Resilience Is Related to Lower Pain Affect in Healthy Adults.

PubMed

Hemington, Kasey S; Cheng, Joshua C; Bosma, Rachael L; Rogachov, Anton; Kim, Junseok A; Davis, Karen D

2017-09-01

Resilience, a characteristic that enhances adaptation in response to stressful events, is a positive psychological factor that can predict and modulate health outcomes. However, resilience is rarely considered in pain research. Conversely, negative psychological factors (eg, anxiety, depression) are known to be related to the affective dimension of pain. It is critical to understand all potential psychological drivers of pain affect, a prominent component of chronic pain. We tested the hypothesis that higher resilience is associated with lower pain affect, above and beyond the predictive value of negative psychological factors. Healthy adults underwent psychophysical testing to acquire ratings of heat pain intensity and unpleasantness and completed the Resilience Scale, the State-Trait Anxiety Inventory (trait form), Beck Depression Inventory, Pain Catastrophizing Scale, and the Pain Vigilance and Attention Questionnaire. Multiple regression modeling (n = 68) showed resilience to be a negatively associated with pain affect (unpleasantness). Furthermore, in individuals with higher anxiety scores, resilience was protective against higher pain affect. This highlights the importance of resilience, a positive psychological factor, in the affective dimension of pain. This study is the first to assess a positive psychological factor and experimental pain affect, and has the potential to improve prediction of and treatment strategies for clinical pain. We report that resilience, a positive psychological factor, interacts with anxiety and is associated with heat pain affect (unpleasantness) in healthy individuals. Resilience may provide predictive value of chronic pain affect and treatment outcomes, and could be a target for behavioral therapy. Copyright © 2017 American Pain Society. Published by Elsevier Inc. All rights reserved.

The perception threshold counterpart to dynamic and static mechanical allodynia assessed using von Frey filaments in peripheral neuropathic pain patients.

PubMed

Landerholm, Åsa H; Hansson, Per T

2017-12-29

Background and aim Pain due to a usually non-painful mechanical stimulus, mechanical allodynia, is an oppressive symptom in subgroups of patients with neuropathic pain. Dynamic mechanical allodynia (DMA) is evoked by a normally innocuous light moving mechanical stimulus on the skin and static mechanical allodynia (SMA) by a sustained, normally innocuous pressure against the skin. DMA is claimed to be mediated by myelinated fibres and SMA by C-fibres. Also A-delta fibres have been implicated in the static subtype. A low intensity vertically applied stimulus of 1 second (s) is expected to activate predominantly rapidly adapting A-beta mechanoreceptors thus recruiting the same peripheral substrate as a horizontally moving brush on top of the skin. In patients with SMA we assumed an activation of Cbut also A-delta fibres from a static 10 s von Frey filament stimulus. The aim was to investigate if DMA and SMA could be assessed at perception threshold level using short or longer lasting usually non-painful von Frey filament prodding of the neuropathic skin. Patients and methods Eighteen patients with painful unilateral partial peripheral traumatic nerve injury suffering from SMA (n = 9) and/or DMA (n = 18) in a limb were studied. A compression/ischemia-induced (differential) nerve block in conjunction with repeated quantitative sensory testing of A-delta and C-fibre function using cold and warm stimuli was used to assess which nerve fibre population that contributes to pain at perception threshold level using 1 s (vF1) and 10 s (vF10) von Frey filament stimulation of the skin. Results The main outcome was the finding that elevation of vF1 and vF10 occurred simultaneously and significantly prior to an increase in the perception level to cold or warmth during the continuous nerve block. Single patients demonstrated a slight decrease in cold perception levels at the time of elevation of vF1 or vF10 and a possible contribution to mechanical allodynia from A-delta-fibres can therefore not completely be ruled out although the recorded alterations were minor. None of the patients reported an elevation of the perception level to warmth at the time of elevation of vF1 or vF10 excluding contribution from C-fibres. Further, only patients with clinically established SMA (n = 9) reported continuous pain to a sustained 10 s von Frey filament stimulation (vF10). Patients with only DMA (n = 9) reported pain merely for the initial 1-3 s of the total stimulus duration of 10 s and for a few seconds after the filament was lifted from the skin. Conclusions These findings support the role of A-beta fibres as peripheral mediators of both vF1 and vF10 although different receptor organs may be involved, i.e., rapidly (RA) and slowly (SA-I) adapting mechanoreceptors. Implications Techniques to quantify the different allodynias at perception threshold level deserve further attention as possible adjuncts to suprathreshold stimuli in intervention studies aimed at modifying these stimulus-evoked phenomena.

Progressive Muscle Relaxation and Pain Perception in Abdominal Surgery Patients

DTIC Science & Technology

1989-05-01

Twenty-one females were randomly assigned to one of three treatment groups: dental splint and physiotherapy , a relaxation program, or a minimal...overall treatment effect was average weekly frequency of pain (F = 5.25, p < .05). The relaxation and dental physiotherapy groups reported lower pain...significantly less pain intensity than the control group (TENS), while the dental/ physiotherapy group reported significantly less frequency of pain than

The influence of working memory capacity on experimental heat pain.

PubMed

Nakae, Aya; Endo, Kaori; Adachi, Tomonori; Ikeda, Takashi; Hagihira, Satoshi; Mashimo, Takashi; Osaka, Mariko

2013-10-01

Pain processing and attention have a bidirectional interaction that depends upon one's relative ability to use limited-capacity resources. However, correlations between the size of limited-capacity resources and pain have not been evaluated. Working memory capacity, which is a cognitive resource, can be measured using the reading span task (RST). In this study, we hypothesized that an individual's potential working memory capacity and subjective pain intensity are related. To test this hypothesis, we evaluated 31 healthy participants' potential working memory capacity using the RST, and then applied continuous experimental heat stimulation using the listening span test (LST), which is a modified version of the RST. Subjective pain intensities were significantly lower during the challenging parts of the RST. The pain intensity under conditions where memorizing tasks were performed was compared with that under the control condition, and it showed a correlation with potential working memory capacity. These results indicate that working memory capacity reflects the ability to process information, including precise evaluations of changes in pain perception. In this work, we present data suggesting that changes in subjective pain intensity are related, depending upon individual potential working memory capacities. Individual working memory capacity may be a phenotype that reflects sensitivity to changes in pain perception. Copyright © 2013 American Pain Society. Published by Elsevier Inc. All rights reserved.

Neonatal nurses' perceptions of pain management.

PubMed

Collados-Gómez, L; Camacho-Vicente, V; González-Villalba, M; Sanz-Prades, G; Bellón-Vaquerizo, B

To describe the perceptions of nurses in neonatal units on pain management, meet the educational profile and describe the use of pain assessment tools and non-pharmacological management for treatment. Cross-sectional descriptive multicentre study, developed during the months of February to September 2015, in the neonatology services of three hospitals at the Community of Madrid, Spain. Data collection was performed through an ad hoc questionnaire on paper or electronically using Survey Monkey platform. The sample consisted of 142 professionals, with a response rate of 55%: 47.9% (68) confirmed they had received specific training in pain management; 39.5% (56) stated that pain is regularly assessed in the unit; only 43.6% reported using validated scales, the most used being the Premature Infant Pain Profile (PIPP). As for the non-pharmacological management, swaddling and non-nutritive sucking it is the most used, followed by sucrose. Intravenous cannulation was identified as the most painful procedure. Pain management is in the process of improvement, because of training and because there is little pain assessment using validated scales. The improvement in the use of non-pharmacological management for the relief of pain in minor procedures is noteworthy. Copyright © 2017 Sociedad Española de Enfermería Intensiva y Unidades Coronarias (SEEIUC). Publicado por Elsevier España, S.L.U. All rights reserved.

Remembering the dynamic changes in pain intensity and unpleasantness: a psychophysical study.

PubMed

Khoshnejad, Mina; Fortin, Marie C; Rohani, Farzan; Duncan, Gary H; Rainville, Pierre

2014-03-01

This study investigated the short-term memory of dynamic changes in acute pain using psychophysical methods. Pain intensity or unpleasantness induced by painful contact-heat stimuli of 8, 9, or 10s was rated continuously during the stimulus or after a 14-s delay using an electronic visual analog scale in 10 healthy volunteers. Because the continuous visual analog scale time courses contained large amounts of redundant information, a principal component analysis was applied to characterize the main features inherent to both the concurrent rating and retrospective evaluations. Three components explained about 90% of the total variance across all trials and subjects, with the first component reflecting the global perceptual profile, and the second and third components explaining finer perceptual aspects (eg, changes in slope at onset and offset and shifts in peak latency). We postulate that these 3 principal components may provide some information about the structure of the mental representations of what one perceives, stores, and remembers during the course of few seconds. Analysis performed on the components confirmed significant memory distortions and revealed that the discriminative information about pain dimensions in concurrent ratings was partly or completely lost in retrospective ratings. Importantly, our results highlight individual differences affecting these memory processes. These results provide further evidence of the important transformations underlying the processing of pain in explicit memory and raise fundamental questions about the conversion of dynamic nociceptive signals into a mental representation of pain in perception and memory. Copyright © 2013 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

Effect of Audioanalgesia in 6- to 12-year-old Children during Dental Treatment Procedure.

PubMed

Ramar, Kavitha; Hariharavel, V P; Sinnaduri, Gayathri; Sambath, Gayathri; Zohni, Fathima; Alagu, Palani J

2016-12-01

To evaluate the effect of audioanalgesia in 6- to 12-year-old children during dental treatment procedure. A total of 40 children were selected and divided into two groups, study group - with audioanalgesia and control group - without audioanalgesia. The value of their pain was evaluated using Venham's pain rating scale. Data were compared using one-sample t-test using Statistical Package for the Social Sciences (SPSS) (Inc.; Chicago, IL, USA), version 17.0. The difference in the control group and study group was statistically significant (p < 0.05). The method of distraction using audioanalgesia instills better positive dental attitude in children and decreases their pain perception. Playing or hearing music during dental procedure significantly alters the perception of pain in 6- to 12-year-old children.

The Effect of Positive Affect on the Memory of Pain.

PubMed

Bąbel, Przemysław

2017-06-01

The aim of the study was to assess the accuracy of the memory of experimentally induced pain and the affect that accompanies experimentally induced pain. Sixty-two healthy female volunteers participated in the study. In the first phase of the study, the participants received three pain stimuli and rated pain intensity, pain unpleasantness, state anxiety, and their positive and negative affect. About a month later, in the second phase of the study, the participants were asked to rate the pain intensity, pain unpleasantness, state anxiety, and the emotions they had felt during the first phase of the study. Both recalled pain intensity and recalled pain unpleasantness were found to be underestimated. Although the positive affect that accompanied pain was remembered accurately, recalled negative affect was overestimated and recalled state anxiety was underestimated. Experienced pain, recalled state anxiety, and recalled positive affect accounted for 44% of the total variance in predicting recalled pain intensity and 61% of the total variance in predicting recalled pain unpleasantness. Together with recent research findings on the memory of other types of pain, the present study supports the idea that pain is accompanied by positive as well as negative emotions, and that positive affect influences the memory of pain. Copyright © 2017 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

Public perception of the terms "cosmetic," "plastic," and "reconstructive" surgery.

PubMed

Hamilton, Grant S; Carrithers, Jeffrey S; Karnell, Lucy H

2004-01-01

To investigate potential differences in perception of the terms "cosmetic," "plastic," and "reconstructive" as descriptors for surgery. An anonymous questionnaire was offered to subjects over 18 years of age throughout the Unites States via the Internet and in person. The multiple-choice survey measured variables including permanence, risk, expense, recovery, reversibility, pain, technical difficulty, and surgeon training. The questionnaire also included several open-ended questions to capture qualitative perceptions. Semantic differential data were analyzed to measure statistical significance. For most variables--permanence, risk, recovery, reversibility, pain, and surgeon training--the 216 subjects had significantly lower mean responses for cosmetic surgery than those for plastic or reconstructive surgery (P < .002). Overall, the results of this study support the authors' hypothesis that there is a significant difference in perception of cosmetic surgery and plastic or reconstructive surgery. Cosmetic surgery is perceived to be more temporary and less technically difficult than plastic or reconstructive surgery. In addition, cosmetic surgery is believed to be associated with less risk, shorter recovery time, and less pain. Subjects also thought that cosmetic surgeons required significantly less training than plastic or reconstructive surgeons.

Listening to parents: The role of symptom perception in pediatric palliative home care.

PubMed

Vollenbroich, René; Borasio, Gian Domenico; Duroux, Ayda; Grasser, Monika; Brandstätter, Monika; Führer, Monika

2016-02-01

This study analyzes symptom perception by parents and healthcare professionals and the quality of symptom management in a pediatric palliative home care setting and identifies which factors contribute to a high quality of palliative and end-of-life care for children. In this retrospective, cross-sectional study, parents were surveyed at the earliest three months after their child's death. All children were cared for by a specialized home pediatric palliative care team that provides a 24/7 medical on-call service. Questionnaires assessed symptom prevalence and intensity during the child's last month of life as perceived by parents, symptom perception, and treatment by medical staff. The responses were correlated with essential palliative care outcome measures (e.g., satisfaction with the care provided, quality-of-life of affected children and parents, and peacefulness of the dying phase). Thirty-eight parent dyads participated (return rate 84%; 35% oncological disorders). According to parental report, dyspnea (61%) and pain (58%) were the dominant symptoms with an overall high symptom load (83%). Pain, agitation, and seizures could be treated more successfully than other symptoms. Successful symptom perception was achieved in most cases and predicted the quality of symptom treatment (R 2, 0.612). Concordant assessment of symptom severity between parents and healthcare professionals (HCPs) improved the satisfaction with the care provided (p = 0.037) as well as the parental quality-of-life (p = 0.041). Even in cases with unsuccessful symptom control, parents were very satisfied with the SHPPC team's care (median 10; numeric rating scale 0-10) and rated the child's death as highly peaceful (median 9). Significance of the results: The quality and the concordance of symptom perception between parents and HCPs essentially influence parental quality-of-life as well as parental satisfaction and constitute a predictive factor for the quality of symptom treatment and palliative care.

Factors affecting general practitioners' decisions about plain radiography for back pain: implications for classification of guideline barriers--a qualitative study.

PubMed

Espeland, Ansgar; Baerheim, Anders

2003-03-24

General practitioners often diverge from clinical guidelines regarding spine radiography. This study aimed to identify and describe A) factors general practitioners consider may affect their decisions about ordering plain radiography for back pain and B) barriers to guideline adherence suggested by such factors. Focus group interviews regarding factors affecting ordering decisions were carried out on a diverse sample of Norwegian general practitioners and were analysed qualitatively. Results of this study and two qualitative studies from the Netherlands and USA on use of spine radiography were interpreted for barriers to guideline adherence. These were compared with an existing barrier classification system described by Dr Cabana's group. The factors which Norwegian general practitioners considered might affect their decisions about ordering plain radiography for back pain concerned the following broader issues: clinical ordering criteria, patients' wishes for radiography and the general practitioner's response, uncertainty, professional dignity, access to radiology services, perception of whether the patient really was ill, sense of pressure from other health care providers/social security, and expectations about the consequences of ordering radiography. The three studies suggested several attitude-related and external barriers as classified in a previously reported system described by Dr Cabana in another study. Identified barriers not listed in this system were: lack of expectancy that guideline adherence will lead to desired health care process, emotional difficulty with adherence, improper access to actual/alternative health care services, and pressure from health care providers/organisations. Our findings may help implement spine radiography guidelines. They also indicate that Cabana et al.'s barrier classification system needs extending. A revised system is proposed.

Factors affecting general practitioners' decisions about plain radiography for back pain: implications for classification of guideline barriers – a qualitative study

PubMed Central

Espeland, Ansgar; Baerheim, Anders

2003-01-01

Background General practitioners often diverge from clinical guidelines regarding spine radiography. This study aimed to identify and describe A) factors general practitioners consider may affect their decisions about ordering plain radiography for back pain and B) barriers to guideline adherence suggested by such factors. Methods Focus group interviews regarding factors affecting ordering decisions were carried out on a diverse sample of Norwegian general practitioners and were analysed qualitatively. Results of this study and two qualitative studies from the Netherlands and USA on use of spine radiography were interpreted for barriers to guideline adherence. These were compared with an existing barrier classification system described by Dr Cabana's group. Results The factors which Norwegian general practitioners considered might affect their decisions about ordering plain radiography for back pain concerned the following broader issues: clinical ordering criteria, patients' wishes for radiography and the general practitioner's response, uncertainty, professional dignity, access to radiology services, perception of whether the patient really was ill, sense of pressure from other health care providers/social security, and expectations about the consequences of ordering radiography. The three studies suggested several attitude-related and external barriers as classified in a previously reported system described by Dr Cabana in another study. Identified barriers not listed in this system were: lack of expectancy that guideline adherence will lead to desired health care process, emotional difficulty with adherence, improper access to actual/alternative health care services, and pressure from health care providers/organisations. Conclusions Our findings may help implement spine radiography guidelines. They also indicate that Cabana et al.'s barrier classification system needs extending. A revised system is proposed. PMID:12659640

Objective evaluation of chemotherapy-induced peripheral neuropathy using quantitative pain measurement system (Pain Vision®), a pilot study.

PubMed

Sato, Junya; Mori, Megumi; Nihei, Satoru; Takeuchi, Satoshi; Kashiwaba, Masahiro; Kudo, Kenzo

2017-01-01

In an evaluation of chemotherapy-induced peripheral neuropathy (CIPN), objectivity may be poor because the evaluation is determined by the patient's subjective assessment. In such cases, management of neuropathy may be delayed and CIPN symptoms may become severe. In this pilot study, we attempted an objective evaluation of CIPN using a quantitative pain measurement system (Pain Vision ® ). The subjects were patients with gynecologic cancer who underwent chemotherapy using taxane and platinum drugs. The grade of the peripheral sensory nerve disorder was based on the Common Terminology Criteria for Adverse Events (CTC-AE) ver. 4.0 and was evaluated before the initiation of therapy and up to six chemotherapy cycles. A symptom scale assessed by the patients using a peripheral neuropathy questionnaire (PNQ) was also evaluated. Simultaneously during these evaluations, graded electric current was applied from the probe to a fingertip and measured both the lowest perceptible current and lowest current perceived as pain by Pain Vision ® . From these values, the pain degree was calculated from the following formula: (pain perception current value - lowest perceptible current value) ÷ lowest perceptible current value × 100. We compared the pain degrees by Pain Vision ® during CIPN development with the value obtained before chemotherapy initiation. Forty-one patients were enrolled. In the evaluation by a medical professional, 28 (64.3%) patients developed CIPN during 2.5 ± 1.1 chemotherapy cycles (mean ± standard deviation). The pain degree by Pain Vision ® at grade 1 and 2 CIPN development according to the evaluation (CTC-AE) was significantly decreased compared to that before chemotherapy initiation (126.0 ± 114.5 vs. 69.8 ± 46.8, p  = 0.001, and 126.0 ± 114.5 vs. 32.8 ± 32.6, p  = 0.004). Changes in the pain degree by Pain Vision ® were also found during scale B and C, D CIPN development in the patient evaluation (PNQ) (115.9 ± 112.4 vs. 70.6 ± 56.5, p  = 0.005, and 115.9 ± 112.4 vs. 46.3 ± 42.9, p  = 0.004). In the 13 patients in whom CIPN did not occur, no significant decrease in the pain degree by Pain Vision ® was detected ( p  = 0.764). There was no discontinuation of the measurements because of adverse events such as discomfort from the electric current. The decrease in the pain degree measured by Pain Vision ® was associated with the onset of CIPN symptoms. Particularly, detection of CIPN by Pain Vision ® was possible, though most of the CIPN that occurred was low grade or mild symptom. Pain Vision ® might become a noninvasive and convenient objective CIPN detection tool to supplement subjective CIPN evaluation. The study approval number in the institution; H25-140. Registered December 17, 2013.

Magnitude and Temporal Variability of Inter-stimulus EEG Modulate the Linear Relationship Between Laser-Evoked Potentials and Fast-Pain Perception

PubMed Central

Li, Linling; Huang, Gan; Lin, Qianqian; Liu, Jia; Zhang, Shengli; Zhang, Zhiguo

2018-01-01

The level of pain perception is correlated with the magnitude of pain-evoked brain responses, such as laser-evoked potentials (LEP), across trials. The positive LEP-pain relationship lays the foundation for pain prediction based on single-trial LEP, but cross-individual pain prediction does not have a good performance because the LEP-pain relationship exhibits substantial cross-individual difference. In this study, we aim to explain the cross-individual difference in the LEP-pain relationship using inter-stimulus EEG (isEEG) features. The isEEG features (root mean square as magnitude and mean square successive difference as temporal variability) were estimated from isEEG data (at full band and five frequency bands) recorded between painful stimuli. A linear model was fitted to investigate the relationship between pain ratings and LEP response for fast-pain trials on a trial-by-trial basis. Then the correlation between isEEG features and the parameters of LEP-pain model (slope and intercept) was evaluated. We found that the magnitude and temporal variability of isEEG could modulate the parameters of an individual's linear LEP-pain model for fast-pain trials. Based on this, we further developed a new individualized fast-pain prediction scheme, which only used training individuals with similar isEEG features as the test individual to train the fast-pain prediction model, and obtained improved accuracy in cross-individual fast-pain prediction. The findings could help elucidate the neural mechanism of cross-individual difference in pain experience and the proposed fast-pain prediction scheme could be potentially used as a practical and feasible pain prediction method in clinical practice. PMID:29904336

Nurse Perceptions of Pain in Pediatric Traumatic Brain Injury: A Pilot Study.

PubMed

McCaa, Robin

2017-01-01

Pain assessment in the pediatric population is challenging because of age, developmental stage, and patient cooperation. Cognitive impairment, impaired communication, and physical disability that may accompany traumatic brain injury (TBI) further complicate pain assessments. A pilot descriptive qualitative research study was conducted to investigate nurse perceptions of pain in pediatric patients diagnosed with TBI. Specifically, this study sought to answer the following questions: a) Is pain accurately assessed in this population? b) Is pain adequately treated in this population? and c) What obstacles exist, if any, to the assessment and treatment of pain? A convenience sample of three registered nurses employed in a pediatric neurosurgery setting participated in this study. Each nurse participated in one individual, semi-structured, face-to-face interview lasting approximately 30 minutes. Interviews were transcribed verbatim and analyzed for common themes. Common themes identified across all interviews were a) challenging assessments; b) limited, although effective, treatments; and c) communication as an area of opportunity for improvement. Implications for practice and policy include a need for more sensitive pain assessment tools to improve the objectivity and accuracy of pain assessment, clarification of care priorities and organization of care from clinical and management perspectives, and additional research in alternative pain treatments for this population. Findings from this study will guide the development of a larger, more comprehensive study, with the aim of improving practice and policy in pain management for this population.

Factors affecting finger and hand pain in workers with HAVS.

PubMed

House, R; Krajnak, K; Jiang, D

2016-06-01

Pain and its management are important aspects of hand-arm vibration syndrome (HAVS). To determine the factors associated with finger and hand pain in workers with HAVS and, specifically, to assess the impact of several neurological variables as well as the vascular component of HAVS, grip strength and age. We assessed men with HAVS at a hospital occupational medicine clinic over 2 years. Subjects scored finger and hand pain separately using the Borg Scale (0-10). The possible predictors we evaluated included the Stockholm Neurological Scale (SNS) and Stockholm Vascular Scale (SVS) stages, current perception threshold (CPT), carpal tunnel syndrome (CTS), ulnar neuropathy, grip strength and age. We carried out nerve conduction testing to confirm the presence of CTS and ulnar neuropathy and measured CPT in the fingers at 2000 Hz, 250 Hz and 5 Hz corresponding to A-beta (large myelinated), A-delta (small myelinated) and C (unmyelinated) fibres, respectively. We calculated Spearman rank correlations to examine the relation between finger and hand pain and possible predictor variables. Among the 134 subjects, the median (25th-75th percentile) pain scores were 6 (4-8) for the fingers and 5 (1-7) for the hands. We found statistically significant correlations with finger pain for the SVS stage (r = 0.239; P < 0.01) and CTS (r = 0.184; P < 0.05). The only statistically significant correlation identified for hand pain was a negative correlation with grip strength (r = -0.185; P < 0.05). Management of finger and hand pain in HAVS should focus on the correlates we have identified. © The Author 2016. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Pain Reduction and Improvement in Range of Motion After Daily Consumption of an Açai (Euterpe oleracea Mart.) Pulp–Fortified Polyphenolic-Rich Fruit and Berry Juice Blend

PubMed Central

Ager, David M.; Redman, Kimberlee A.; Mitzner, Marcie A.; Benson, Kathleen F.; Schauss, Alexander G.

2011-01-01

Abstract Dietary interventions involving antioxidants are of interest for reducing inflammation, improving joint motion, and altering pain perception. We evaluated the effect of oral consumption of a fruit and berry blend on pain and range of motion (ROM). This open-label clinical pilot study involved 14 study participants with limitations in ROM that was associated with pain and affected daily living. Participants included but were not limited to those with age-related osteoarthritis. Study participants consumed 120 mL MonaVie Active® fruit juice, predominantly containing açai pulp (Euterpe oleracea Mart.) and other fruit concentrates, daily for 12 weeks. Study participants were assessed at baseline and 2, 4, 8, and 12 weeks by structured nurse interviews, pain and activities of daily living (ADL) questionnaires, blood samples, and ROM assessment. Pain was scored by using a visual analogue scale. ROM was assessed by using dual digital inclinometry as recommended by American Medical Association guidelines. Consumption of the juice resulted in significant pain reduction, improved ROM measures, and improvement in ADLs. Serum antioxidant status, as monitored by the cell-based antioxidant protection in erythrocytes (CAP-e) assay, was improved within 2 weeks and continued to improve throughout the 12 weeks of study participation (P<.01). The inflammatory marker C-reactive protein was reduced at 12 weeks, but this change did not reach statistical significance. Lipid peroxidation decreased mildly at 12 weeks. The antioxidant status, as measured by the CAP-e bioassay, showed the best correlation with improvements in physical well-being (pain, ROM, and ADL). The significant association among increased antioxidant status, improved ROM, and pain reduction warrants further study. PMID:21470042

Perceptions of adults with overweight/obesity and chronic musculoskeletal pain: An interpretative phenomenological analysis.

PubMed

Cooper, Lesley; Ells, Louisa; Ryan, Cormac; Martin, Denis

2018-03-01

To gain insight into the lived experience of adults with overweight/obesity and chronic musculoskeletal pain. Knowledge gained will inform healthcare professionals about the complexity of the weight-pain relationship and enable more effective engagement with this population. Quantitative studies show links between weight and pain. Adults with overweight/obesity are more likely to experience comorbidity; however, qualitative research describing the complexities of the relationship is limited. A purposive sample of adults with overweight/obesity and chronic musculoskeletal pain participated in face-to-face interviews. Interviews were audio-recorded, transcribed verbatim and analysed using interpretive phenomenological analysis. Eighteen adults (16 female) aged 29-71, body mass index ≥25-46, participated in this study. Three superordinate themes emerged: "pain as a motivator and barrier to weight loss"; "fear of weight causing more damage"; and "activity is positive." Pain motivates some individuals to lose weight while simultaneously inhibiting weight loss efforts. Participants' perception that extra pressure caused by their weight further damaged joints contributed to fear and catastrophising. Fear is often exacerbated by healthcare professionals' descriptions of musculoskeletal damage, or participants' perception of healthcare professionals' attitude towards people with overweight/obesity. Conversely, individuals acknowledged the benefits of increased activity. Adults with overweight/obesity and chronic musculoskeletal pain in this study identified a bidirectional relationship between their weight and pain that challenged their weight loss efforts. Overweight/obesity contributed to fear and catastrophising, which resulted in avoidance of exercise that would have assisted their weight loss. Healthcare professionals need to understand the complex relationship between weight and pain, and their patients' understanding of that relationship. Healthcare professionals should use therapeutic communication to reduce the fear of weight causing damage, and thus promote physical activities that will contribute to weight loss. It is also important to ensure that the language used with this patient group does not stigmatise individuals, or cause or exacerbate fear of normal movement. © 2017 John Wiley & Sons Ltd.

Subliminal presentation of other faces (but not own face) primes behavioral and evoked cortical processing of empathy for pain.

PubMed

Ibáñez, Agustín; Hurtado, Esteban; Lobos, Alejandro; Escobar, Josefina; Trujillo, Natalia; Baez, Sandra; Huepe, David; Manes, Facundo; Decety, Jean

2011-06-29

Current research on empathy for pain emphasizes the overlap in the neural response between the first-hand experience of pain and its perception in others. However, recent studies suggest that the perception of the pain of others may reflect the processing of a threat or negative arousal rather than an automatic pro-social response. It can thus be suggested that pain processing of other-related, but not self-related, information could imply danger rather than empathy, due to the possible threat represented in the expressions of others (especially if associated with pain stimuli). To test this hypothesis, two experiments considering subliminal stimuli were designed. In Experiment 1, neutral and semantic pain expressions previously primed with own or other faces were presented to participants. When other-face priming was used, only the detection of semantic pain expressions was facilitated. In Experiment 2, pictures with pain and neutral scenarios previously used in ERP and fMRI research were used in a categorization task. Those pictures were primed with own or other faces following the same procedure as in Experiment 1 while ERPs were recorded. Early (N1) and late (P3) cortical responses between pain and no-pain were modulated only in the other-face priming condition. These results support the threat value of pain hypothesis and suggest the necessity for the inclusion of own- versus other-related information in future empathy for pain research. Copyright © 2011 Elsevier B.V. All rights reserved.

The influence of music and music therapy on pain-induced neuronal oscillations measured by magnetencephalography.

PubMed

Hauck, Michael; Metzner, Susanne; Rohlffs, Fiona; Lorenz, Jürgen; Engel, Andreas K

2013-04-01

Modern forms of music therapy are clinically established for various therapeutic or rehabilitative goals, especially in the treatment of chronic pain. However, little is known about the neuronal mechanisms that underlie pain modulation by music. Therefore, we attempted to characterize the effects of music therapy on pain perception by comparing the effects of 2 different therapeutic concepts, referred to as receptive and entrainment methods, on cortical activity recorded by magnetencephalography in combination with laser heat pain. Listening to preferred music within the receptive method yielded a significant reduction of pain ratings associated with a significant power reduction of delta-band activity in the cingulate gyrus, which suggests that participants displaced their focus of attention away from the pain stimulus. On the other hand, listening to self-composed "pain music" and "healing music" within the entrainment method exerted major effects on gamma-band activity in primary and secondary somatosensory cortices. Pain music, in contrast to healing music, increased pain ratings in parallel with an increase in gamma-band activity in somatosensory brain structures. In conclusion, our data suggest that the 2 music therapy approaches operationalized in this study seem to modulate pain perception through at least 2 different mechanisms, involving changes of activity in the delta and gamma bands at different stages of the pain processing system. Copyright © 2012 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

Comparison of personality traits, attitude toward orthodontic treatment, and pain perception and experience before and after orthodontic treatment.

PubMed

Abu Alhaija, Elham S; Abu Nabaa, Mona A; Al Maaitah, Emad F; Al-Omairi, Mahmoud K

2015-05-01

To compare personality traits, attitude toward orthodontic treatment, and pain perception and experience before and after orthodontic treatment. One hundred subjects (50 male and 50 female) were included in this study. The mean (SD) age was 17.5 (2.05) years at T1 and 19.15 (2.32) years at T2. The instruments for data collection were questionnaires that included assessment of patients' personality traits, attitudes toward orthodontic treatment, and pain perception/experience. Subjects completed the questionnaires at two different times: before orthodontic treatment (T1) and after fixed orthodontic treatment (T2). Subjects were treated by fixed orthodontic appliances for an average (SD) period of 18.64 (0.35) months. Paired sample t-test and chi-square test were used to detect any differences. Significant changes in personality traits were detected after orthodontic treatment irrespective of gender. Neuroticism, openness, agreeableness, and conscientiousness scores were improved (P < .001). A positive attitude toward orthodontic treatment was reported at T1 (4.31 [±1.26]) and improved at T2 (3.98 [±1.16]) irrespective of gender (P < .05). The average (SD) expected pain score (T1) was 4.73 (1.88) and the average (SD) experienced pain score (T2) was 4.63 (1.58). Significant difference in the expected and experienced pain scores was not detected (P  =  .11). Personality traits and attitude toward orthodontic treatment improved after orthodontic treatment. Reported actual pain experience during orthodontic treatment was similar to that expected before treatment.

The effects of physical training without equipment on pain perception and balance in the elderly: A randomized controlled trial

PubMed Central

Patti, Antonino; Bianco, Antonino; Karsten, Bettina; Montalto, Maria Alessandra; Battaglia, Giuseppe; Bellafiore, Marianna; Cassata, Daniela; Scoppa, Fabio; Paoli, Antonio; Iovane, Angelo; Messina, Giuseppe; Palma, Antonio

2017-01-01

BACKGROUND: Research supports a link between exercise and falls prevention in the older population. OBJECTIVES: Our aims were to evaluate pain perception and balance skills in a group of elderly subjects and to examine the consequences of a standardized equipment-free exercise program intervention on these variables. The study utilized a randomized controlled trial method. METHODS: 92 subjects were recruited from a rural Sicilian village (Resuttano, Sicily, Italy). Subjects were randomly split into two groups, an experimental group (EG; n = 49) and a control group (CG; n = 43). Qualified fitness instructors delivered the standardized physical exercise program for the EG whilst the CG did not receive this exercise intervention. The Berg Balance Scale and the Oswestry Disability Index were administered in both groups before (T0) and after the intervention (T1). RESULTS: At T1, the EG group significantly improvement in balance (p < 0.0001) and pain perception (p < 0.0001). No significant differences were found within the CG both in BBS and ODI, respectively. CONCLUSIONS: Our findings suggest that a 13-weeks standardized exercise equipment-free program is effective in improving balance and perception of pain in the elderly. This type of intervention can consequently provide a low cost strategy to counteract the rate of disability in elderly. PMID:28506013

[Self-efficacy and self management of healthy habits in fibromyalgia].

PubMed

Pérez-Velasco, María; Peñacoba-Puente, Cecilia

2015-01-01

Fibromyalgia is a disorder characterized by general chronic pain, together with other symptoms such as fatigue, sleep disorders, anxiety and depression. To analyze, in FM patients, the effects of a multi-component intervention program (nursing+cognitive-behavioural therapy, focused on improving resting habits, physical exercise, and family relationships, working simultaneously on empowerment and patient self-efficacy. A quasi-experimental design was used following-up 5 women diagnosed with fibromyalgia. An analysis was performed on their daily habits, self-efficacy for chronic pain, pain perception, functional limitation, and affect. The intervention was composed by 8 group sessions: Six of them aimed at health education and self-management of healthy habits (nursing), and two sessions dedicated to increasing self-efficacy (cognitive-behavioural therapy). Follow-up consisted of five individual sessions (nursing) so as to consolidate the newly acquired habits, maintain self-management and self-efficacy based on observing compliance. Statistically significant improvements were observed (pre-, pos-) in habit modification and in self-efficacy, as well as for positive and negative affect. Also, statistically significant differences were found pre-follow up for functional limitation. The role of nursing has to be considered within multi-component programs, in particular during follow-up, for changing habits and for self-efficacy, in response to some of the current limitations of interventions with these patients. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

Illness beliefs among patients with chronic widespread pain - associations with self-reported health status, anxiety and depressive symptoms and impact of pain.

PubMed

Järemo, P; Arman, M; Gerdle, B; Larsson, B; Gottberg, K

2017-07-05

Chronic widespread pain (CWP) is a disabling condition associated with a decrease in health. Illness beliefs are individual and are acquired during life. Constraining beliefs may prevent patients from regaining health. Understanding these patients' illness beliefs may be a way to improve the health care they are offered. The aim of this study was to describe illness beliefs among patients with CWP and associations with self-reported health, anxiety and depressive symptoms, and impact of pain. In this cross-sectional study, questionnaires were sent by mail to 330 patients including socio-demographic information, the Illness Perception Questionnaire (IPQ-R), the Short-Form General Health Survey (SF-36) and the Hospital Anxiety and Depression Scale (HADS). Data were analysed using descriptive statistics, non-parametric tests and linear regression analyses. Patients experienced and related a high number of symptoms to CWP (mean (SD) 9 (3)). The patients believed their illness to be long lasting, to affect their emotional well being, and to have negative consequences for their lives. Some 72% reported having severe or very severe pain, and impact of pain according to SF-36 was negatively correlated to several illness beliefs dimensions, anxiety- and depressive symptoms. In regression analyses, the Identity, Consequences and Personal control dimensions of IPQ-R and Anxiety- and Depressive symptoms explained 32.6-56.1% of the variance in the two component scores of SF-36. Constraining illness beliefs in patients with CWP are related to worse health status, especially in cases of high number of physical or mental symptoms, beliefs of negative consequences or the illness affecting them emotionally. Identification and understanding of these beliefs may reduce patients' suffering if they are taken into consideration in rehabilitation programs and in development of new evidence-based interventions aimed at increasing health in patients with CWP.

Rehabilitation Medicine Approaches to Pain Management.

PubMed

Cheville, Andrea L; Smith, Sean R; Basford, Jeffrey R

2018-06-01

Rehabilitation medicine offers strategies that reduce musculoskeletal pain, targeted approaches to alleviate movement-related pain, and interventions to optimize patients' function despite the persistence of pain. These approaches fall into four categories: modulating nociception, stabilizing and unloading painful structures, influencing pain perception, and alleviating soft tissue musculotendinous pain. Incorporating these interventions into individualized, comprehensive pain management programs offers the potential to empower patients and limit pain associated with mobility and required daily activities. Rehabilitative approach may be particularly helpful for patients with refractory movement-associated pain and functional vulnerability, and for those who do not wish for, or cannot, tolerate pharmacoanalgesia. Copyright © 2018 Elsevier Inc. All rights reserved.

The Effect of Live Spontaneous Harp Music on Patients in the Intensive Care Unit

PubMed Central

Chiasson, Ann Marie; Linda Baldwin, Ann; Mclaughlin, Carrol; Cook, Paula; Sethi, Gulshan

2013-01-01

This study was performed to investigate the effect of live, spontaneous harp music on individual patients in an intensive care unit (ICU), either pre- or postoperatively. The purpose was to determine whether this intervention would serve as a relaxation or healing modality, as evidenced by the effect on patient's pain, heart rate, respiratory rate, blood pressure, oxygen saturation, and heart rate variability. Each consenting patient was randomly assigned to receive either a live 10-minute concert of spontaneous music played by an expert harpist or a 10-minute rest period. Spontaneous harp music significantly decreased patient perception of pain by 27% but did not significantly affect heart rate, respiratory rate, oxygen saturation, blood pressure, or heart rate variability. Trends emerged, although being not statistically significant, that systolic blood pressure increased while heart rate variability decreased. These findings may invoke patient engagement, as opposed to relaxation, as the underlying mechanism of the decrease in the patients' pain and of the healing benefit that arises from the relationship between healer, healing modality, and patient. PMID:24371459

Paradoxical Pain Perception in Posttraumatic Stress Disorder: The Unique Role of Anxiety and Dissociation.

PubMed

Defrin, Ruth; Schreiber, Shaul; Ginzburg, Karni

2015-10-01

Posttraumatic stress disorder (PTSD) and chronic pain often co-occur and exacerbate each other. Elucidating the mechanism of this co-occurrence therefore has clinical importance. Previously, patients with PTSD with chronic pain were found to demonstrate a unique paradoxical pain profile: hyperresponsiveness together with hyposensitivity to pain. Our aim was to examine whether 2 seemingly paradoxical facets of PTSD (anxiety and dissociation) underlie this paradoxical profile. Patients with PTSD (n = 32) and healthy control individuals (n = 43) underwent psychophysical testing and completed questionnaires. Patients with PTSD had higher pain thresholds and higher pain ratings to suprathreshold stimuli than control individuals. Pain thresholds were positively associated with dissociation levels and negatively associated with anxiety sensitivity levels. Experimental pain ratings were positively associated with anxiety sensitivity and negatively related to dissociation levels. Chronic pain intensity was associated with anxiety, anxiety sensitivity, and pain catastrophizing. It appears that reduced conscious attention toward incoming stimuli, resulting from dissociation, causes delayed response in pain threshold measurement, whereas biases toward threatening stimuli and decreased inhibition, possibly caused by increased anxiety, are responsible for the intensification of experimental and chronic pain. The paradoxical facets of PTSD and their particular influences over pain perception seem to reinforce the coexistence of PTSD and chronic pain, and should be considered when treating traumatized individuals. This article provides new information regarding the underlying mechanism of the coexistence of PTSD and chronic pain. This knowledge could help to provide better management of PTSD and chronic pain among individuals in the aftermath of trauma. Copyright © 2015 American Pain Society. Published by Elsevier Inc. All rights reserved.

The effect of the type of pain on the accuracy of memory of pain and affect.

PubMed

Bąbel, P; Pieniążek, L; Zarotyński, D

2015-03-01

Memory of chronic, acute and experimental pain may be inaccurate, but the research findings are inconsistent. The main aim of the study was to compare the memory of three types of pain and their associated affect. A total of 140 women, who gave birth by vaginal delivery or Caesarean section, or underwent gynaecological surgery, participated in the study. Before childbirth or surgery, the women rated their anxiety about the pain they would experience. Between 24 and 48 h after childbirth or surgery, they rated the intensity and unpleasantness of the pain, and their positive and negative affect. Either 3 or 6 months later, the participants recalled the pain and affect they had felt. The study found that the type of pain had an effect on memory of pain and affect. Surgery led to an overestimation of all but one of the recalled variables. Participants who gave birth by Caesarean section were the most accurate at recalling pain and affect. Memories of pain and affect were most variable in participants who gave birth by vaginal delivery. The three groups of participants differed in terms of the predictors of recalled pain intensity and unpleasantness, and the proportion of variance predicted by the same independent variables. The results of the current study suggest that memory of pain and affect is influenced by the meaning and affective value of the pain experience. This may help us to understand why the previous research on the memory of pain were so diverse. © 2014 European Pain Federation - EFIC®

Young people's experiences of persistent musculoskeletal pain, needs, gaps and perceptions about the role of digital technologies to support their co-care: a qualitative study.

PubMed

Slater, Helen; Jordan, Joanne E; Chua, Jason; Schütze, Robert; Wark, John D; Briggs, Andrew M

2016-12-09

To investigate young people's experiences of persistent musculoskeletal pain, including care needs and current service gaps as well as perceptions about the role of digital technologies to support their co-care. A qualitative study employing two independent data collection modes: in-depth individual semistructured interviews and focus groups. Community settings throughout Australia. Participants were included if they had experienced persistent musculoskeletal pain of >3-month duration with an average of ≥3 on the visual analogue scale over the preceding 3 months, including non-specific conditions (eg, low back pain) and specific conditions (eg, juvenile idiopathic arthritis and other systemic arthritides), with/without pre-existing or current diagnosed mental health conditions. 23 young people (87.0% women; mean (SD) age: 20.8 (2.4) years) from across 6 Australian jurisdictions participated. Almost two-thirds of participants with persistent musculoskeletal pain reported comorbid mental health conditions. Inductive and deductive approaches to analyse and derive key themes from verbatim transcripts. Participants described their daily experiences of living with persistent musculoskeletal pain, their fears and the challenges imposed by the invisibility of pain, and the two-way relationship between their pain and mental well-being. A lack of relevant and accessible information and resources tailored to young people's unique needs, integrated and youth-relevant healthcare services and adequately skilled healthcare practitioners were identified as key care gaps. Participants strongly advocated for the use of digital technologies to improve access to age-appropriate resources and support for co-care. Young people living with persistent musculoskeletal pain described the absence of age-appropriate pain services and clearly articulated their perceptions on the role of, and opportunities provided by, digital technologies to connect with and support improved pain healthcare. Innovative and digitally-enabled models of pain care are likely to be helpful for this group. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Gender Differences Among Military Combatants: Does Social Support, Ostracism, and Pain Perception Influence Psychological Health?

PubMed

McGraw, Kate

2016-01-01

The literature on gender differences related to psychological health among in-theater service members who are deployed in a combatant role is limited. Much focuses on retrospective reports of service members who have returned from deployment. Potential key factors that contribute to gender differences in psychological health among combatants are found in literature across several topic areas, but integration of findings across disciplines is lacking. A growing body of literature on gender differences related to psychological health of postdeployment military populations suggests males and females respond differently to perceived levels of social support pre-and postdeployment. One study on service members who were deployed suggested no significant gender differences related to reported psychological health symptoms, but did appear to find significant gender differences related to reported perception of unit morale. In another related area, research explores how ostracism impacts physical and psychological health of individuals and organizations, and can result in perceptions of physical pain, although research on gender differences related to the impact of ostracism is scarce. Research has also begun to focus on sex differences in pain responses, and has identified multiple biopsychosocial, genetic, and hormonal factors that may contribute as potential underlying mechanisms. In this brief review, we focus on and begin to integrate relevant findings related to the psychological health of females in combat roles, gender differences in the impact of perception of social support on psychological health, the psychological and physical impact of ostracism on individuals and organizations, and the current literature on sex differences in pain perception. We conclude with a synthesis and discussion of research gaps identified through this review, implications for clinical practice, and potential future research directions. In conclusion, there appear to be gender differences related to the presence or absence of social support, the impact of ostracism, and the perception of pain. These differences may play a critical role in the psychological health of female combatants. More research on this topic is needed. Reprint & Copyright © 2016 Association of Military Surgeons of the U.S.

Ambient versus traditional environment in pediatric emergency department.

PubMed

Robinson, Patricia S; Green, Jeanette

2015-01-01

We sought to examine the effect of exposure to an ambient environment in a pediatric emergency department. We hypothesized that passive distraction from ambient lighting in an emergency department would lead to reduction in patient pain and anxiety and increased caregiver satisfaction with services. Passive distraction has been associated with lower anxiety and pain in patients and affects perception of wait time. A pediatric ED was designed that optimized passive distraction techniques using colorful ambient lighting. Participants were nonrandomly assigned to either an ambient ED environment or a traditional ED environment. Entry and exit questionnaires assessed caregiver expectations and experiences. Pain ratings were obtained with age-appropriate scales, and wait times were recorded. A total of 70 participants were assessed across conditions, that is, 40 in the ambient ED group and 30 in the traditional ED group. Caregivers in the traditional ED group expected a longer wait, had higher anxiety pretreatment, and felt more scared than those in the ambient ED group. Caregivers in the ambient ED group felt more included in the care of their child and rated quality of care higher than caregivers in the traditional ED group. Pain ratings and administrations of pain medication were lower in the ambient ED group. Mean scores for the ambient ED group were in the expected direction on several items measuring satisfaction with ED experiences. Results were suggestive of less stress in caregivers, less pain in patients, and higher satisfaction levels in the ambient ED group. © The Author(s) 2015.

Neuropathic pain: is quantitative sensory testing helpful?

PubMed

Krumova, Elena K; Geber, Christian; Westermann, Andrea; Maier, Christoph

2012-08-01

Neuropathic pain arises as a consequence of a lesion or disease affecting the somatosensory system and is characterised by a combination of positive and negative sensory symptoms. Quantitative sensory testing (QST) examines the sensory perception after application of different mechanical and thermal stimuli of controlled intensity and the function of both large (A-beta) and small (A-delta and C) nerve fibres, including the corresponding central pathways. QST can be used to determine detection, pain thresholds and stimulus-response curves and can thus detect both negative and positive sensory signs, the second ones not being assessed by other methods. Similarly to all other psychophysical tests QST requires standardised examination, instructions and data evaluation to receive valid and reliable results. Since normative data are available, QST can contribute also to the individual diagnosis of neuropathy, especially in the case of isolated small-fibre neuropathy, in contrast to the conventional electrophysiology which assesses only large myelinated fibres. For example, detection of early stages of subclinical neuropathy in symptomatic or asymptomatic patients with diabetes mellitus can be helpful to optimise treatment and identify diabetic foot at risk of ulceration. QST assessed the individual's sensory profile and thus can be valuable to evaluate the underlying pain mechanisms which occur in different frequencies even in the same neuropathic pain syndromes. Furthermore, assessing the exact sensory phenotype by QST might be useful in the future to identify responders to certain treatments in accordance to the underlying pain mechanisms.

Evaluation of the Environmental Bias on Accelerometer-Measured Total Daily Activity Counts and Owner Survey Responses in Dogs with Osteoarthritis.

PubMed

Katz, Erin M; Scott, Ruth M; Thomson, Christopher B; Mesa, Eileen; Evans, Richard; Conzemius, Michael G

2017-11-01

Objective  To determine if environmental variables affect the average daily activity counts (AC) of dogs with osteoarthritis (OA) and/or owners' perception of their dog's clinical signs or quality of life. Methods  The AC and Canine Brief Pain Inventory (CBPI) owner questionnaires of 62 dogs with OA were compared with daily environmental variables including the following: average temperature (°C), high temperature (°C), low temperature (°C), relative humidity (%), total precipitation (mm), average barometric pressure (hPa) and total daylight hours. Results  Daily AC significantly correlated with average temperature and total daylight hours, but average temperature and total daylight hours accounted for less than 1% of variation in AC. No other significant relationships were found between daily AC and daily high temperature, low temperature, relative humidity, total precipitation or average barometric pressure. No statistical relationship was found between daily AC and the CBPI, nor between environmental variables and the CBPI. Canine Brief Pain Inventory scores for pain severity and pain interference decreased significantly over the test period. Clinical Significance  The relationship between daily AC and average temperature and total daylight hours was significant, but unlikely to be clinically significant. Thus, environmental variables do not appear to have a clinically relevant bias on AC or owner CBPI questionnaires. The decrease over time in CBPI pain severity and pain interference values suggests owners completing the CBPI in this study were influenced by a caregiver placebo effect. Schattauer GmbH Stuttgart.

Helplessness and perceived pain intensity: relations to cortisol concentrations after electrocutaneous stimulation in healthy young men

PubMed Central

2011-01-01

Background Uncontrollable aversive events are associated with feelings of helplessness and cortisol elevation and are suitable as a model of depression. The high comorbidity of depression and pain symptoms and the importance of controllability in both conditions are clinically well-known but empirical studies are scarce. The study investigated the relationship of pain experience, helplessness, and cortisol secretion after controllable vs. uncontrollable electric skin stimulation in healthy male individuals. Methods Sixty-four male volunteers were randomly assigned to receive 30 controllable (self-administered) or uncontrollable (experimenter-administered) painful electric skin stimuli. Perceived pain intensity (PPI), subjective helplessness ratings, and salivary cortisol concentrations were assessed. PPI was assessed after stress exposure. For salivary cortisol concentrations and subjective helplessness ratings, areas under the response curve (AUC) were calculated. Results After uncontrollable vs. controllable stress exposure significantly higher PPI ratings (P = 0.023), higher subjective helplessness AUC (P < 0.0005) and higher salivary cortisol AUC (P = 0.004, t-tests) were found. Correlation analyses revealed a significant correlation between subjective helplessness AUC and PPI (r = 0.500, P < 0.0005), subjective helplessness AUC and salivary cortisol AUC (r = 0.304, P = 0.015) and between PPI and salivary cortisol AUC (r = 0.298, P = 0.017). Conclusions The results confirm the impact of uncontrollability on stress responses in humans; the relationship of PPI with subjective helplessness and salivary cortisol suggests a cognitive-affective sensitization of pain perception, particularly under uncontrollable conditions. PMID:21718526

Effects of analgesics on olfactory function and the perception of intranasal trigeminal stimuli.

PubMed

Mizera, L; Gossrau, G; Hummel, T; Haehner, A

2017-01-01

There is some evidence suggesting that analgesics have an impact on human chemosensory function, especially opioids and cannabinoids are known to interfere with olfactory function. However, largely unknown is the effect of a long-term use of analgesics on the intranasal trigeminal system so far. Here, we investigated olfactory function and the perception of intranasal trigeminal stimuli in pain patients with long-term use of analgesics compared to age-matched healthy controls. For this purpose, a psychophysical approach was chosen to measure these sensory functions in 100 chronic pain patients and 95 controls. Olfactory testing was performed using the 'Sniffin' Sticks' test kit, which involves tests for odour threshold, odour discrimination and odour identification. Further, participants were asked to rate the intensity of trigeminal stimuli by using a visual analogue scale. We observed that the chronic use of pain medication was associated with significantly reduced perception of intranasal trigeminal stimuli and olfactory function compared to age-matched controls without intake of analgesics. Results indicate that non-opioid and opioid drugs, or a combination of both did not differ in their effects on chemosensory function. Further, after eliminating the effect of a co-existing depression and the use of co-analgesics, the negative influence of analgesics on olfactory function and trigeminal perception was still evident. The observed effect might be mediated due to interaction with opioid receptors in trigeminal ganglia and nuclei or due to trigeminal/olfactory interaction. As a practical consequence, patients should be made aware of a possible impairment of their olfactory and trigeminal function under long-term analgesic treatment. WHAT DOES THIS STUDY ADD?: We observed that the chronic use of pain medication was associated with significantly reduced olfactory function and perception of intranasal trigeminal stimuli compared to age-matched controls without intake of analgesics. Non-opioid and opioid drugs did not differ in their effects on chemosensory function. © 2016 European Pain Federation - EFIC®.

Life quality of patients who underwent breast reconstruction after prophylactic mastectomy: systematic review.

PubMed

Aygin, Dilek; Cengiz, Hande

2018-05-02

Prophylactic mastectomy is used to reduce the incidence of breast cancer in women with genetic predisposition and family history of breast cancer, and the rate of application is increased nowadays. Chronic pain, body image, and sexuality may negatively affect quality of life, while patients generally have increased quality of life and satisfaction after prophylactic mastectomy. The aim of this study is the evaluation of the results of the studies about quality of life of patients who underwent breast reconstruction after prophylactic mastectomy. For the 1996-2016 literature, we searched the databases of Scopus, Science Direct, PubMed, EBSCO, Cochrane, Medline Complete, Ovid, Springer Link, Google Academic, Taylor & Francis, PsychINFO databases. For the gray literature, National Thesis Center and ULAKBIM databases were searched. Seven studies complying with the criteria were included in the review. Seven studies included in this study aimed to investigate the effect of prophylactic mastectomy on breast pain, numbness, sexuality and quality of life. When the studies were reviewed, we were found that the majority of the patients were satisfied with the results of the procedure, although the body image perception and pain/ movement/ perception and sexual problems were experienced after the breast surgery. While overall satisfaction with cosmetic results was high, most women were not satisfied with the softness of the reconstructed breasts, and had problems with breast hardness, numbness and sex. Therefore, it is very important to inform the patients about the complications that may develop after the operation, while there is not enough data about the importance of informing the patients before the operation.

Fibromyalgia--a syndrome associated with decreased nocturnal melatonin secretion.

PubMed

Wikner, J; Hirsch, U; Wetterberg, L; Röjdmark, S

1998-08-01

Most patients with fibromyalgic syndrome (FMS) complain of sleep disturbances, fatigue, and pain. These symptoms might be a consequence of changed melatonin (MT) secretion, since MT is known to have sleep promoting properties. Moreover, serum concentrations of two MT precursors (tryptophan and serotonin)--affecting both sleep and pain perception--appear to be low in patients with FMS. Therefore, the objective of this investigation was to study whether serum MT (s-MT) level is also low in these patients. Eight patients with FMS and 8 healthy sex-, BMI-, and age-matched controls were included in the study. s-MT concentrations were determined every second hour between 1800 and 0800 h. Urine was collected between 2200 and 0700 h for determination of urinary MT excretion. To evaluate total MT secretion between 1800 and 0800 h and MT secretion during the hours of darkness (between 23 and 07 h) individual MT areas under the curve (AUC) were calculated and expressed as group means. The FMS patients had a 31% lower MT secretion than healthy subjects during the hours of darkness (MT AUC 2300-0700 h (mean +/- SEM): 1.70 +/- 0.17 vs 2.48 +/- 0.38 nmol/l; P < 0.05). Also the s-MT peak value was significantly lower in the patient group: 0.28 +/- 0.03 vs 0.44 +/- 0.06 nmol/l; P < 0.05). Patients with fibromyalgic syndrome have a lower melatonin secretion during the hours of darkness than healthy subjects. This may contribute to impaired sleep at night, fatigue during the day, and changed pain perception.

Postoperative pain management experiences among school-aged children: a qualitative study.

PubMed

Sng, Qian Wen; Taylor, Beverley; Liam, Joanne Lw; Klainin-Yobas, Piyanee; Wang, Wenru; He, Hong-Gu

2013-04-01

To explore postoperative pain management experiences among school-aged children. Ineffective postoperative pain management among children has been commonly reported. School-aged children are able to evaluate how their pain is managed and what their preferred strategies are. Most studies in pain management have adopted quantitative methods and have overlooked children's pain management experiences. This is a qualitative study using face-to-face interviews. Data were collected from 15 school-aged children admitted to a tertiary hospital in Singapore by in-depth interviews conducted between November 2010 and January 2011. Data were analysed by thematic analysis. Five themes were identified: children's self-directed actions to relieve their postoperative pain (e.g. using cognitive-behavioural methods of distraction and imagery, physical method of positioning, sleeping and drinking, seeking other people's help by informing parents and crying and using pain medications); children's perceptions of actions parents take for their postoperative pain relief (assessing pain, administering pain medications, using various cognitive-behavioural, physical methods and emotional support strategies, assisting in activities and alerting health professionals); children's perception of actions nurses take for their postoperative pain relief (administering medication, using cognitive-behavioural methods, emotional support strategies and helping with activities of daily living) and suggestions for parents (using distraction and presence) and nurses (administering medications, distraction and positioning) for their postoperative pain relief improvement. This study contributed to the existing knowledge about children's postoperative pain management based on their own experiences. Children, their parents and nurses used various strategies, including pain medication and non-pharmacological methods, especially distraction, for children's postoperative pain relief. This study provides evidence for health care professionals to consider using more pain relief strategies when caring for children postoperatively and provide guidance for children to practice these strategies. © 2013 Blackwell Publishing Ltd.

Altered neural responses to heat pain in drug-naive patients with Parkinson disease.

PubMed

Forkmann, Katarina; Grashorn, Wiebke; Schmidt, Katharina; Fründt, Odette; Buhmann, Carsten; Bingel, Ulrike

2017-08-01

Pain is a frequent but still neglected nonmotor symptom of Parkinson disease (PD). However, neural mechanisms underlying pain in PD are poorly understood. Here, we explored whether the high prevalence of pain in PD might be related to dysfunctional descending pain control. Using functional magnetic resonance imaging we explored neural responses during the anticipation and processing of heat pain in 21 PD patients (Hoehn and Yahr I-III) and 23 healthy controls (HC). Parkinson disease patients were naive to dopaminergic medication to avoid confounding drug effects. Fifteen heat pain stimuli were applied to the participants' forearm. Intensity and unpleasantness ratings were provided for each stimulus. Subjective pain perception was comparable for PD patients and HC. Neural processing, however, differed between groups: PD patients showed lower activity in several descending pain modulation regions (dorsal anterior cingulate cortex [dACC], subgenual anterior cingulate cortex, and dorsolateral prefrontal cortex [DLPFC]) and lower functional connectivity between dACC and DLPFC during pain anticipation. Parkinson disease symptom severity was negatively correlated with dACC-DLPFC connectivity indicating impaired functional coupling of pain modulatory regions with disease progression. During pain perception PD patients showed higher midcingulate cortex activity compared with HC, which also scaled with PD severity. Interestingly, dACC-DLPFC connectivity during pain anticipation was negatively associated with midcingulate cortex activity during the receipt of pain in PD patients. This study indicates altered neural processing during the anticipation and receipt of experimental pain in drug-naive PD patients. It provides first evidence for a progressive decline in descending pain modulation in PD, which might be related to the high prevalence of pain in later stages of PD.

Do parents excuse the misbehavior of children with physical or emotional symptoms? An investigation of the pediatric sick role.

PubMed

Walker, L S; Garber, J; Van Slyke, D A

1995-06-01

Assessed attributions and responses to descriptions of the misbehavior of children with symptoms of physical and emotional illnesses. Subjects (160 mothers; 160 fathers) read a vignette about a child in one of four illness conditions (medically explained pain with organic etiology; medically unexplained pain, depression, well) who was described as misbehaving at home and school. Within each illness condition, the child protagonist varied by age (8 vs. 16) and gender. A between-subjects design was used in which subjects made judgments regarding causes and responsibility for the child's misbehavior, affective reactions to the child, and the consequences that should be administered to the child. Results indicated that, in comparison to subjects' perceptions of the misbehavior of children in the other conditions, subjects viewed the misbehavior of children with medically explained pain as less intentional, more excusable, and due to causes that were less internal to the child. Subjects held children with medically explained pain less responsible for their misbehavior and indicated that they would respond to them with less anger, disappointment, blame, and punishment than to children in the other conditions. Subjects did not hold children with symptoms of depression and children with unexplained pain complaints less responsible for their misbehavior, but indicated that they would respond to them with less anger, disappointment, and punishment than to well children.

Novel Signs and Their Clinical Utility in Diagnosing Complex Regional Pain Syndrome (CRPS): A Prospective Observational Cohort Study.

PubMed

Kuttikat, Anoop; Shaikh, Maliha; Oomatia, Amin; Parker, Richard; Shenker, Nicholas

2017-06-01

Delays in diagnosis occur with complex regional pain syndrome (CRPS). We define and prospectively demonstrate that novel bedside tests measuring body perception disruption can identify patients with CRPS postfracture. The objectives of our study were to define and validate 4 bedside tests, to identify the prevalence of positive tests in patients with CRPS and other chronic pain conditions, and to assess the clinical utility (sensitivity, specificity, positive predictive value, negative predictive value) for identifying CRPS within a Fracture cohort. This was a single UK teaching hospital prospective cohort study with 313 recruits from pain-free volunteers and patients with chronic pain conditions.Four novel tests were Finger Perception (FP), Hand Laterality identification (HL), Astereognosis (AS), and Body Scheme (BS) report. Five questionnaires (Brief Pain Inventory, Upper Extremity Functional Index, Lower Extremity Functional Index, Neglect-like Symptom Questionnaire, Hospital Anxiety and Depression Score) assessed the multidimensional pain experience. FP and BS were the best performing tests. Prospective monitoring of fracture patients showed that out of 7 fracture patients (total n=47) who had both finger misperception and abnormal BS report at initial testing, 3 developed persistent pain with 1 having a formal diagnosis of CRPS. Novel signs are reliable, easy to perform, and present in chronic pain patients. FP and BS have significant clinical utility in predicting persistent pain in a fracture group thereby allowing targeted early intervention.

Pain and Depressive Symptoms in Primary Care: Moderating Role of Positive and Negative Affect.

PubMed

Hirsch, Jameson K; Sirois, Fuschia M; Molnar, Danielle; Chang, Edward C

2016-07-01

Pain and its disruptive impact on daily life are common reasons that patients seek primary medical care. Pain contributes strongly to psychopathology, and pain and depressive symptoms are often comorbid in primary care patients. Not all those who experience pain develop depression, suggesting that the presence of individual-level characteristics, such as positive and negative affect, that may ameliorate or exacerbate this association. We assessed the potential moderating role of positive and negative affect on the pain-depression linkage. In a sample of 101 rural, primary care patients, we administered the Brief Pain Inventory, NEO Personality Inventory-Revised positive and negative affect subclusters, and the Center for Epidemiology Scale for Depression. In moderation models, covarying age, sex, and ethnicity, we found that positive affect, but not negative affect, was a significant moderator of the relation between pain intensity and severity and depressive symptoms. The association between pain and depressive symptoms is attenuated when greater levels of positive affects are present. Therapeutic bolstering of positive affect in primary care patients experiencing pain may reduce the risk for depressive symptoms.

An Evaluation of the Effectiveness of a Vibrating Syringe Attachment in Decreasing Intraoral Injection Pain Perception

DTIC Science & Technology

2012-06-01

mucosa penetrations to periosteum by a 27-gauge short needle attached to a dental cartridge syringe . New needles were used for each injection, and the...of the American Dental Association, 134(2), 228-234. 7. Bonjar AHS. (2011) Syringe micro vibrator (SMV) a new device being introduced in dentistry...Lautenbacher S. (2004) Pathophysiology of Pain Perception. New York , New York : Kluwer and Plenum. 16 Flanagan T, Wahl MJ, Schmitt MM, Wahl JA. (2007) Size

Evaluating the advances and use of hypodermic needles in dentistry.

PubMed

Boynes, Sean G

2014-10-01

Different injection techniques and patient management methodologies have been proposed to decrease the fear patients may have concerning dental needles. Dental providers should have an understanding of the technological advances, changes in techniques, and patient perceptions associated with the hypodermic needle. This article provides an overview of the pain perception process associated with dental injections. It reviews the two main sensory nerve fibers associated with injection pain and discusses needle properties as well as complications and adverse occurrences.

Flexible Magnets Are Not Effective in Decreasing Pain Perception and Recovery Time After Muscle Microinjury

PubMed Central

Borsa, Paul A.; Liggett, Charles L.

1998-01-01

Objective: To assess the therapeutic effects of flexible magnets on pain perception, intramuscular swelling, range of motion, and muscular strength in individuals with a muscle microinjury. Design and Setting: This experiment was a single-blind, placebo study using a repeated-measures design. Subjects performed an intense exercise protocol to induce a muscle microinjury. After pretreatment measurements were recorded, subjects were randomly assigned to an experimental (magnet), placebo (imitation magnet), or control (no magnet) group. Posttreatment measurements were repeated at 24, 48, and 72 hours. Subjects: Forty-five healthy subjects participated in the study. Measurements: Subjects were measured repeatedly for pain perception, upper arm girth, range of motion, and static force production. Four separate univariate analyses of variances were used to reveal statistically significant mean (±SD) differences between variables over time. Interaction effects were analyzed using Scheffe post hoc analysis. Results: Analysis of variance revealed no statistically significant (P > .05) mean differences between conditions for any dependent pretreatment and posttreatment measurements. No significant interaction effects were demonstrated between conditions and times. Conclusions: No significant therapeutic effects on pain control and muscular dysfunction were observed in subjects wearing flexible magnets. ImagesFig 2.Fig 3. PMID:16558503

Effect of ketamine on endogenous pain modulation in healthy volunteers.

PubMed

Niesters, Marieke; Dahan, Albert; Swartjes, Maarten; Noppers, Ingeborg; Fillingim, Roger B; Aarts, Leon; Sarton, Elise Y

2011-03-01

Inhibitory and facilitatory descending pathways, originating at higher central nervous system sites, modulate activity of dorsal horn nociceptive neurons, and thereby influence pain perception. Dysfunction of inhibitory pain pathways or a shift in the balance between pain facilitation and pain inhibition has been associated with the development of chronic pain. The N-methyl-d-aspartate receptor antagonist ketamine has a prolonged analgesic effect in chronic pain patients. This effect is due to desensitization of sensitized N-methyl-d-aspartate receptors. Additionally, ketamine may modulate or enhance endogenous inhibitory control of pain perception. Diffuse noxious inhibitory control (DNIC) and offset analgesia (OA) are 2 mechanisms involved in descending inhibition. The present study investigates the effect of a ketamine infusion on subsequent DNIC and OA responses to determine whether ketamine has an influence on descending pain control. Ten healthy subjects (4 men/6 women) received a 1-hour placebo or S(+)-ketamine (40mg per 70kg) infusion on 2 separate occasions in random order. Upon the termination of the infusion, DNIC and OA responses were obtained. After placebo treatment, significant descending inhibition of pain responses was present for DNIC and OA. In contrast, after ketamine infusion, no DNIC was observed, but rather a significant facilitatory pain response (P<0.01); the OA response remained unchanged. These findings suggest that the balance between pain inhibition and pain facilitation was shifted by ketamine towards pain facilitation. The absence of an effect of ketamine on OA indicates differences in the mechanisms and neurotransmitter influences between OA and DNIC. Diffuse noxious inhibitory control responses following a 1-hour low-dose ketamine treatment displayed facilitation of pain in response to experimental noxious thermal stimulation. Copyright © 2010 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

Abnormal pain perception in patients with Multiple System Atrophy.

PubMed

Ory-Magne, F; Pellaprat, J; Harroch, E; Galitzsky, M; Rousseau, V; Pavy-Le Traon, A; Rascol, O; Gerdelat, A; Brefel-Courbon, C

2018-03-01

Patients with Parkinson's disease or Multiple System Atrophy frequently experience painful sensations. The few studies investigating pain mechanisms in Multiple System Atrophy patients have reported contradictory results. In our study, we compared pain thresholds in Multiple System Atrophy and Parkinson's disease patients and healthy controls and evaluated the effect of l-DOPA on pain thresholds. We assessed subjective and objective pain thresholds (using a thermotest and RIII reflex), and pain tolerance in OFF and ON conditions, clinical pain, motor and psychological evaluation. Pain was reported in 78.6% of Multiple System Atrophy patients and in 37.5% of Parkinson's disease patients. In the OFF condition, subjective and objective pain thresholds were significantly lower in Multiple System Atrophy patients than in healthy controls (43.8 °C ± 1.3 vs 45.7 °C ± 0.8; p = 0.0005 and 7.4 mA ± 3.8 vs 13.7 mA ± 2.8; p = 0.002, respectively). They were also significantly reduced in Multiple System Atrophy compared to Parkinson's disease patients. No significant difference was found in pain tolerance for the 3 groups and in the effect of l-DOPA on pain thresholds in Multiple System Atrophy and Parkinson's disease patients. In the ON condition, pain tolerance tended to be reduced in Multiple System Atrophy versus Parkinson's disease patients (p = 0.05). Multiple System Atrophy patients had an increase in pain perception compared to Parkinson's disease patients and healthy controls. The l-DOPA effect was similar for pain thresholds in Multiple System Atrophy and Parkinson's disease patients, but tended to worsen pain tolerance in Multiple System Atrophy. Copyright © 2017 Elsevier Ltd. All rights reserved.

Pain Perception and Stabilometric Parameters in People With Chronic Low Back Pain After a Pilates Exercise Program

PubMed Central

Patti, Antonino; Bianco, Antonino; Paoli, Antonio; Messina, Giuseppe; Montalto, Maria Alessandra; Bellafiore, Marianna; Battaglia, Giuseppe; Iovane, Angelo; Palma, Antonio

2016-01-01

Abstract Various exercise interventions, such as Pilates exercises and traditional physical therapy methods, are employed to decrease low back pain (LBP). Nonspecific low back pain (NSLBP) is distinct from LBP, however, as the distribution of pain is restricted to the region between the costal margin and the inferior gluteal. The aim of our randomized controlled trial was to evaluate the effects of a program of Pilates exercises on pain perception and stabilometric parameters in patients with NSLBP. Thirty-eight participants were randomly allocated, using a 1:1 scheme, to either the experimental group (EG) or control group (CG). The EG completed a 14-week program of Pilates exercises, performed thrice per week under the supervision of an exercise specialist, while the CG was managed with a social program only. Measures of posturography and Oswestry Disability Index (ODI) for pain perception were obtained at baseline (T0) and after the 14 weeks of intervention (T1). Posturography measures improved for patients in the EG, with both eyes open and eyes closed (P < 0.05). There were no statistical differences in posturography in the CG. ODI decreased significantly in both groups over the 14 weeks of the study protocol: EG, T0, 13.7 ± 5.0 compared with T1, 6.5 ± 4.0 (P < 0.001); and CG, T0, 10.7 ± 7.8 compared with T1, 8.4 ± 7.8 (P < 0.01). A greater extent of reduction in pain was achieved in the EG. The Pilates exercise program yielded improvements in pain and posturography outcomes. Our study also confirms the applicability of posturography in evaluating postural instability in patients with NSLBP. Due to our relatively small study group, future studies would be necessary to confirm our findings. PMID:26765419

Discrepancy between stimulus response and tolerance of pain in Alzheimer disease

PubMed Central

Werner, Mads U.; Jensen, Troels Staehelin; Ballegaard, Martin; Andersen, Birgitte Bo; Høgh, Peter; Waldemar, Gunhild

2015-01-01

Background: Affective-motivational and sensory-discriminative aspects of pain were investigated in patients with mild to moderate Alzheimer disease (AD) and healthy elderly controls using the cold pressor test tolerance and repetitive stimuli of warmth and heat stimuli, evaluating the stimulus-response function. Methods: A case-control design was applied examining 33 patients with mild to moderate AD dementia and 32 healthy controls with the cold pressor test (4°C). Warmth detection threshold (WDT) and heat pain threshold (HPT) were assessed using 5 stimulations. A stimulus-response function was estimated using 4 incrementally increasing suprathreshold heat stimuli. Results: Cold pressor tolerance was lower in patients with AD dementia than in controls (p = 0.027). There were no significant differences between groups regarding WDT and HPT. Significant successive increases in HPT assessments indicated habituation (p < 0.0001), which was similar in the 2 groups (p = 0.85). A mixed model for repeated measures demonstrated that pain rating of suprathreshold stimuli depended on HPT (p = 0.0004) and stimulus intensity (p < 0.0001). Patients with AD dementia had significantly lower increases in pain ratings than controls during suprathreshold stimulation (p = 0.0072). Conclusion: Our results indicate that AD dementia is not associated with a propensity toward development of sensitization or a lack of habituation, suggesting preservation of sensory-discriminative aspects of pain perception. The results further suggest that the attenuated cold pressor pain tolerance may relate to impairment of coping abilities. Paradoxically, we found an attenuated stimulus-response function, compared to controls, suggesting that AD dementia interferes with pain ratings over time, most likely due to memory impairment. PMID:25788560

Differential structural and resting state connectivity between insular subdivisions and other pain-related brain regions.

PubMed

Wiech, K; Jbabdi, S; Lin, C S; Andersson, J; Tracey, I

2014-10-01

Functional neuroimaging studies suggest that the anterior, mid, and posterior division of the insula subserve different functions in the perception of pain. The anterior insula (AI) has predominantly been associated with cognitive-affective aspects of pain, while the mid and posterior divisions have been implicated in sensory-discriminative processing. We examined whether this functional segregation is paralleled by differences in (1) structural and (2) resting state connectivity and (3) in correlations with pain-relevant psychological traits. Analyses were restricted to the 3 insular subdivisions and other pain-related brain regions. Both type of analyses revealed largely overlapping results. The AI division was predominantly connected to the ventrolateral prefrontal cortex (structural and resting state connectivity) and orbitofrontal cortex (structural connectivity). In contrast, the posterior insula showed strong connections to the primary somatosensory cortex (SI; structural connectivity) and secondary somatosensory cortex (SII; structural and resting state connectivity). The mid insula displayed a hybrid connectivity pattern with strong connections with the ventrolateral prefrontal cortex, SII (structural and resting state connectivity) and SI (structural connectivity). Moreover, resting state connectivity revealed strong connectivity of all 3 subdivisions with the thalamus. On the behavioural level, AI structural connectivity was related to the individual degree of pain vigilance and awareness that showed a positive correlation with AI-amygdala connectivity and a negative correlation with AI-rostral anterior cingulate cortex connectivity. In sum, our findings show a differential structural and resting state connectivity for the anterior, mid, and posterior insula with other pain-relevant brain regions, which might at least partly explain their different functional profiles in pain processing. Copyright © 2014 The Authors. Published by Elsevier B.V. All rights reserved.

Experiences and consequences for women with hand-arm vibration injuries.

PubMed

Bylund, Sonya Hörnqwist; Ahlgren, Christina

2010-01-01

Vibrating machines are used in a variety of occupations. Exposure to hand-arm vibration can cause vascular, neurological, and muscular symptoms in the hands and arms. This qualitative study provides a deeper understanding of the consequences of vibration injuries in women. In depth interviews were conducted with eight women with vibration injuries. The women were metal and wood product assemblers and dental personnel. The transcribed interviews were analyzed in accordance with the grounded theory method. The core category in the findings was "another life". This was constructed by the categories "consequences for everyday activities", "work performance", "household duties", "leisure", and "self perception" and shows that the injury had affected most parts of the women's lives and decreased their quality of life. The importance of well-functioning hands in all activities was highlighted. Reduced hand function due to numbness, muscle weakness, and pain caused restricted abilities to perform activities at work, at home, and during leisure time. The women described impact on their self-perception, as the injury had affected them in their roles as a worker, mother, and woman. The findings indicate that a vibration injury is a multidimensional problem that can affect every aspect of an individual's life. Health care providers should be aware of these complex consequences.

Attitudes and concerns of Canadian animal health technologists toward postoperative pain management in dogs and cats.

PubMed

Dohoo, S E; Dohoo, I R

1998-08-01

Three hundred and twenty-two Canadian animal health technologists (AHTs) were surveyed to determine their attitudes toward postoperative pain management in dogs and cats following 6 surgical procedures, their concerns regarding the use of opioid analgesics, and their role within veterinary practices with respect to postoperative pain control. Two hundred and sixty-four (82%) returned the questionnaire. Pain perception was defined as the average of pain rankings for dogs and cats (on a scale of 1 to 10) following abdominal surgery, or the value for dogs or cats if the AHT worked with only 1 of the 2 species. Maximum concern about the risks associated with the postoperative use of morphine or oxymorphone was defined as the highest rating assigned to any of the 6 risks evaluated in either dogs or cats. Animal health technologists reported significantly higher pain perception scores than did veterinarians who completed a similar survey 2 years previously. Higher pain perception scores were associated with decreased satisfaction with the adequacy of analgesic therapy in their practice, higher pain control goals, and attendance at continuing education within the previous 12 months. The majority of AHTs (55%) agreed that one or more risks associated with the use of morphine or oxymorphone outweighed the benefits. The 3 issues that were perceived to pose the greatest risk were respiratory depression, bradycardia, and sedation and excitement, for dogs and cats, respectively. Most AHTs (68%) considered their knowledge related to the recognition and control of pain to be adequate, compared with 24% of veterinarians who responded to a similar previous survey. As for veterinarians, experience gained while in practice was ranked as the most important source of knowledge, while the technical program attended was ranked as least important. Over 88% of the AHTs provided nursing care during the postoperative period, monitored animals for side effects of postoperative analgesic therapy, informed veterinarians when animals were in pain, recommended analgesic therapy when they believed it was warranted, reported that animals received analgesics when they believed it was warranted, administered analgesics under the instruction of a veterinarian, and believed they were part of a team working to provide adequate postoperative pain control.

Factors influencing the postoperative use of analgesics in dogs and cats by Canadian veterinarians.

PubMed

Dohoo, S E; Dohoo, I R

1996-09-01

Four hundred and seventeen Canadian veterinarians were surveyed to determine their postoperative use of analgesics in dogs and cats following 6 categories of surgeries, and their opinion toward pain perception and perceived complications associated with the postoperative use of potent opioid analgesics. Three hundred and seventeen (76%) returned the questionnaire. An analgesic user was defined as a veterinarian who administers analgesics to at least 50% of dogs or 50% of cats following abdominal surgery, excluding ovariohysterectomy. The veterinarians responding exhibited a bimodal distribution of analgesic use, with 49.5% being defined as analgesic users. These veterinarians tended to use analgesics in 100% of animals following abdominal surgery. Veterinarians defined as analgesic nonusers rarely used postoperative analgesics following any abdominal surgery. Pain perception was defined as the average of pain rankings (on a scale of 1 to 10) following abdominal surgery, or the value for dogs or cats if the veterinarian worked with only 1 of the 2 species. Maximum concern about the risks associated with the postoperative use of potent opioid agonists was defined as the highest ranking assigned to any of the 7 risks evaluated in either dogs or cats. Logistic regression analysis identified the pain perception score and the maximum concern regarding the use of potent opioid agonists in the postoperative period as the 2 factors that distinguished analgesic users from analgesic nonusers. This model correctly classified 68% of veterinarians as analgesic users or nonusers. Linear regression analysis identified gender and the presence of an animal health technologist in the practice as the 2 factors that influenced pain perception by veterinarians. Linear regression analysis identified working with an animal health technologist, graduation within the past 10 years, and attendance at continuing education as factors that influenced maximum concern about the postoperative use of opioid agonists.

Shame aversion and maladaptive eating-related attitudes and behaviors.

PubMed

Manjrekar, Eishita; Schoenleber, Michelle; Mu, Wenting

2013-12-01

Consistent with affect regulation models of eating-related psychopathology, prior research indicates that trait-like shame and state self-conscious emotion are associated with maladaptive eating-related attitudes/behaviors. The present investigation extended past research on shame and maladaptive eating-related attitudes/behaviors by examining the role of shame aversion - the perception of shame as an especially unwanted and painful emotion - in these attitudes/behaviors over and above shame-proneness, general distress, and experiential avoidance. In 488 female undergraduates, shame aversion was positively associated with dieting, self-perceptions of body shape, awareness of food content, and food preoccupation even after taking into account other possible explanatory variables. Additionally, shame aversion moderated shame-proneness' associations with dieting, awareness of food content, and food preoccupation, such that shame-proneness was positively associated with these attitudes/behaviors only when shame aversion was high. Future directions for research and clinical implications of the present findings are discussed. © 2013.

Self-criticism interacts with the affective component of pain to predict depressive symptoms in female patients.

PubMed

Lerman, S F; Shahar, G; Rudich, Z

2012-01-01

This longitudinal study examined the role of the trait of self-criticism as a moderator of the relationship between the affective and sensory components of pain, and depression. One hundred and sixty-three chronic pain patients treated at a specialty pain clinic completed self-report questionnaires at two time points assessing affective and sensory components of pain, depression, and self-criticism. Hierarchical linear regression analysis revealed a significant 3-way interaction between self-criticism, affective pain and gender, whereby women with high affective pain and high self-criticism demonstrated elevated levels of depression. Our findings are the first to show within a broad, comprehensive model, that selfcriticism is activated by the affective, but not sensory component of pain in leading to depressive symptoms, and highlight the need to assess patients' personality as part of an effective treatment plan. © 2011 European Federation of International Association for the Study of Pain Chapters.

Efficacy of Periarticular Injection With a Long-Acting Local Analgesic in Joint Arthroplasty.

PubMed

Barrington, John W

2015-10-01

Attention to patient satisfaction is critical in today's health care environment-satisfaction surveys inform the development of hospital performance standards and can influence an institution's rankings and reimbursement. The effectiveness of postoperative pain management can affect clinical outcomes and also influence the patient's perception of the overall surgical experience. Ample clinical- trial data now exist that demonstrate the benefits of periarticular injections as part of a multimodal regimen in patients undergoing joint arthroplasty. One option that surgeons now use widely is bupivacaine liposome injectable suspension (EXPAREL®, Pacira Pharmaceuticals, Inc), a long-acting local analgesic that the orthopedic surgeon can administer intraoperatively. The US Food and Drug Administration has approved liposomal bupivacaine for injection into the surgical site to produce postsurgical analgesia. The safety and efficacy of liposomal bupivacaine has been demonstrated in clinical studies in multiple types of surgical procedure, including double-blind, randomized, controlled clinical trials that involved over 1300 patients. In a case-control study comparing clinical and economic parameters before and after the introduction of liposomal bupivacaine as a component of the multimodal perioperative pain regimen for total joint arthroplasty, liposomal bupivacaine provided improved overall pain scores, an increase in patients reporting a pain score of 0, increased patient satisfaction, decreased length of stay, and a decrease in overall costs.

[Pain in undernourished children: the mother's perception].

PubMed

Barbosa, Larissa Coelho; Martins, Mariana Cavalcante; Silva, Vanessa Aghata Guimarães da; Carvalho, Quitéria Clarice Magalhães

2005-01-01

This qualitative study aimed to identify how mothers perceive pain in their undernourished children. Semistructured interviews were realized at the Institute for the Prevention of Malnutrition and Exceptionality--IPREDE (Fortaleza-Ceará-Brazil). Participants were mothers who accompanied their undernourished children. Data analysis revealed the following categories: Coming to the Institution; Pain description and How to take care of the pain. Society needs to take actions, in respect of citizens' rights and culture, with a view to reverting this picture of pain in undernourished children.

Two Different Epidural Analgesic Combinations: Morphine vs. Fentanyl/Bupivacaine or Fentanyl/Ropivacaine and Their Post Operative Effects

DTIC Science & Technology

2001-10-01

Association for the Study of Pain defines pain as, "the sensory and emotional experiences associated with actual or potential tissue damage," (Taber, 1989...accentuating the pain response (Taber, 1989). In addition to the patients’ perception and experience of pain, the healthcare providers’ beliefs, biases...provide patients with quick recovery and pain-free postoperative experiences is a priority. The goal of this study was to compare the effectiveness

A Pilot Study of the Correlation between the Numeric Rating Scale used to Evaluate "Geop" and Questionnaires on Pain Perception.

PubMed

Koo, Bon Sung; Jung, Myung Jin; Lee, Joon Ho; Jin, Hee Cheol; Lee, Jeong Seok; Kim, Yong Ik

2015-01-01

The word "geop" is a unique Korean term commonly used to describe fright, fear and anxiety, and similar concepts. The purpose of this pilot study is to examine the correlation between the Numeric Rating Scale (NRS) score of geop and three different questionnaires on pain perception. Patients aged 20 to 70 years who visited our outpatient pain clinics were evaluated. They were requested to rate the NRS score (range: 0-100) if they felt geop. Next, they completed questionnaires on pain perception, in this case the Korean version of the Pain Sensitivity Questionnaire (PSQ), the Pain Catastrophizing Scale (PCS), and the Pain Anxiety Symptoms Scale (PASS). The correlations among each variable were evaluated by statistical analyses. There was no statistically significant correlation between the NRS score of geop and the PSQ score (r = 0.075, P = 0.5605). The NRS score of geop showed a significant correlation with the PCS total score (r = 0.346, P = 0.0063). Among the sub-scales, Rumination (r = 0.338, P = 0.0077) and Magnification (r = 0.343, P = 0.0069) were correlated with the NRS score of geop. In addition, the NRS score of geop showed a significant correlation with the PASS total score (r = 0.475, P = 0.0001). The cognitive (r = 0.473, P = 0.0002) and fear factors (r = 0.349, P = 0.0063) also showed significant correlations with the NRS score of geop. This study marks the first attempt to introduce the concept of "geop." The NRS score of geop showed a moderate positive correlation with the total PCS and PASS score. However, further investigations are required before the "geop" concept can be used practically in clinical fields.

Modulation of neural circuits underlying temporal production by facial expressions of pain.

PubMed

Ballotta, Daniela; Lui, Fausta; Porro, Carlo Adolfo; Nichelli, Paolo Frigio; Benuzzi, Francesca

2018-01-01

According to the Scalar Expectancy Theory, humans are equipped with a biological internal clock, possibly modulated by attention and arousal. Both emotions and pain are arousing and can absorb attentional resources, thus causing distortions of temporal perception. The aims of the present single-event fMRI study were to investigate: a) whether observation of facial expressions of pain interferes with time production; and b) the neural network subserving this kind of temporal distortions. Thirty healthy volunteers took part in the study. Subjects were asked to perform a temporal production task and a concurrent gender discrimination task, while viewing faces of unknown people with either pain-related or neutral expressions. Behavioural data showed temporal underestimation (i.e., longer produced intervals) during implicit pain expression processing; this was accompanied by increased activity of right middle temporal gyrus, a region known to be active during the perception of emotional and painful faces. Psycho-Physiological Interaction analyses showed that: 1) the activity of middle temporal gyrus was positively related to that of areas previously reported to play a role in timing: left primary motor cortex, middle cingulate cortex, supplementary motor area, right anterior insula, inferior frontal gyrus, bilateral cerebellum and basal ganglia; 2) the functional connectivity of supplementary motor area with several frontal regions, anterior cingulate cortex and right angular gyrus was correlated to the produced interval during painful expression processing. Our data support the hypothesis that observing emotional expressions distorts subjective time perception through the interaction of the neural network subserving processing of facial expressions with the brain network involved in timing. Within this frame, middle temporal gyrus appears to be the key region of the interplay between the two neural systems.

Women's experience of SLE-related fatigue: a focus group interview study.

PubMed

Pettersson, Susanne; Möller, Sonia; Svenungsson, Elisabet; Gunnarsson, Iva; Welin Henriksson, Elisabet

2010-10-01

The aim of this study was to describe women's experience of SLE-related fatigue, how they express the feeling of fatigue, impact on life and strategies developed to manage fatigue in daily living. Seven, semi-structured focus group discussions with 33 women were audio-taped, transcribed verbatim and analysed according to qualitative content analysis. Perceptions of SLE-related fatigue were sorted into four themes. Nature of Fatigue, involved the sensation, occurrence and character. Aspects Affected by Fatigue described emotions that arose together with fatigue as well as aspects of work, family life, social contacts and leisure activities that were affected by fatigue. Striving Towards Power and Control concluded the array of ways used to manage daily life and were categorized into the mental struggle, structure, restrict and provide. Factors Influencing the Perception of Fatigue described understanding from their surroundings and pain as strongly influencing the experience and perception of fatigue. SLE-related fatigue was portrayed as an overwhelming phenomenon with an unpredictable character, resulting in the feeling that fatigue dominates and controls most situations in life. The choice of strategies was described as a balance with implications for how fatigue limited a person's life. Health care professionals are advised to take a more active role to empower people with SLE to find their own balance as a way to achieve a feeling of being in control.

Abnormal brain processing of affective and sensory pain descriptors in chronic pain patients.

PubMed

Sitges, Carolina; García-Herrera, Manuel; Pericás, Miquel; Collado, Dolores; Truyols, Magdalena; Montoya, Pedro

2007-12-01

Previous research has suggested that chronic pain patients might be particularly vulnerable to the effects of negative mood during information processing. However, there is little evidence for abnormal brain processing of affective and sensory pain-related information in chronic pain. Behavioral and brain responses, to pain descriptors and pleasant words, were examined in chronic pain patients and healthy controls during a self-endorsement task. Eighteen patients with fibromyalgia (FM), 18 patients with chronic musculoskeletal pain due to identifiable physical injury (MSK), and 16 healthy controls were asked to decide whether word targets described their current or past experience of pain. The number of self-endorsed words, elapsed time to endorse the words, and event-related potentials (ERPs) elicited by words, were recorded. Data revealed that chronic pain patients used more affective and sensory pain descriptors, and were slower in responding to self-endorsed pain descriptors than to pleasant words. In addition, it was found that affective pain descriptors elicited significantly more enhanced positive ERP amplitudes than pleasant words in MSK pain patients; whereas sensory pain descriptors elicited greater positive ERP amplitudes than affective pain words in healthy controls. These data support the notion of abnormal information processing in chronic pain patients, which might be characterized by a lack of dissociation between sensory and affective components of pain-related information, and by an exaggerated rumination over word meaning during the encoding of self-referent information about pain.

Therapeutic Massage During Chemotherapy and/or Biotherapy Infusions: Patient Perceptions of Pain, Fatigue, Nausea, Anxiety, and Satisfaction.

PubMed

Robison, Jeanene G; Smith, Cheryl L

2016-04-01

Patients with cancer commonly experience disease or treatment side effects, including pain, fatigue, nausea, and anxiety. An expanding body of literature supports the use of therapeutic massage (TM) as an adjunct to conventional therapies to manage these side effects. This article describes patients' perceptions of pain, fatigue, nausea, and anxiety and their overall satisfaction with TM provided concurrently with chemotherapy and/or biotherapy. In an academic outpatient comprehensive cancer center, consenting patients were asked to identify massage site preference (hands and/or feet). The licensed massage therapist delivered TM for 20 minutes to patients concurrently receiving chemotherapy and/or biotherapy. Patients rated their pain, fatigue, nausea, and anxiety pre- and post-TM using a Likert-type scale. Qualitative and quantitative data related to patients' perceived value of TM were obtained postintervention. Participants (N = 58) reported a statistically significant reduction in each of the following variables.

Specific conditions of distress in the dental situation.

PubMed

Hentschel, U; Allander, L; Winholt, A S

1977-01-01

The general feeling of distress in the dental situation has been studied in 60 female dental patients and correlated to the following variables: Experimentally evaluated sensitivity to pain, self-rating and the dentist's rating of sensitivity to pain, the pain-threshold value in the teeth, the need of local anesthesia, extraversion-introversion, neuroticism, and some percept-genetic psychological measures of adaptive behavior. The subjects have also answered a questionnaire for grading their distress in regard to different aspects of the treatment-situation, which were combined into eight groups using factor analysis and then correlated to the general distress. The variables having a significant relation to distress in the dental situation were: the dentist's rating of the patient's sensitivity, the need of anesthesia, four groups of treatment-components and two of the percept-genetic measures. There was also a certain relation to the pain threshold in the teeth.

Effectiveness of low-level laser therapy on pain intensity, pressure pain threshold, and SF-MPQ indexes of women with myofascial pain.

PubMed

Magri, Laís Valencise; Carvalho, Vinícius Almeida; Rodrigues, Flávia Cássia Cabral; Bataglion, César; Leite-Panissi, Christie Ramos Andrade

2017-02-01

Women with temporomandibular disorders (TMD) frequently report pain areas in body regions. This process is associated with central sensitization phenomena, present in chronic pain. The low-level laser therapy (LLLT) has been reported as a therapeutic option for the painful TMD treatment. The aim of this study was to analyze the effect of LLLT on pain intensity (visual analogue scale, VAS), pain sensitivity in orofacial and corporal points (pressure pain threshold, PPT), and on Short Form-McGill Pain Questionnaire (SF-MPQ) indexes of women with myofascial pain (subtype of muscle TMD). Ninety-one women (18-60 years) were included in the study, among which 61 were diagnosed with myofascial pain (Research Diagnostic Criteria for Temporomandibular Disorder-Ia and Ib) and were divided into laser (n = 31) and placebo group (n = 30), and 30 were controls. The LLLT was applied at pre-established points, twice a week, eight sessions (780 nm; masseter and anterior temporal = 5 J/cm 2 , 20 mW, 10 s; TMJ area = 7.5 J/cm 2 , 30 mW, 10 s). Pain intensity, pain sensitivity, and the SF-MPQ indexes were measured at the baseline, during laser sessions, and 30 days after treatment. For intra-group comparisons, the Friedman test was performed, and for inter-group, the Mann-Whitney test. Increased pain sensitivity was found in women with myofascial pain when compared to controls (p < 0.05). There was a reduction in pain intensity for both groups after LLLT. The LLLT did not change the PPT for any group (p > 0.05). Active laser and placebo reduced the indexes of sensory, total pain, and VAS, maintaining the results after 30 days; there was a reduction in the affective pain rating index for both groups, with no maintenance after 30 days for placebo, and the present pain intensity decreased in the laser group and did not change in the placebo after LLLT. In conclusion, the LLLT active or placebo are effective in reducing the overall subjective perception of myofascial pain (VAS and SF-MPQ indexes); however, they have no effectiveness in reducing the pain sensitivity in orofacial and corporal points (PPT increase).

Interpersonal Responses and Pain Management Within the US Military.

PubMed

McGeary, Cindy A; Blount, Tabatha H; Peterson, Alan L; Gatchel, Robert J; Hale, Willie J; McGeary, Donald D

2016-06-01

Purpose Chronic pain poses a significant problem for the US military. The benefits of self-management treatments for chronic pain are well-documented, but interpersonal responses also influence physical and psychological health and may not be addressed through self-management treatments alone. The current study examines whether perceived interpersonal responses to pain, as measured by the Multidimensional Pain Inventory (MPI), change as a result of participation in an intensive pain management program. It was hypothesized that interpersonal responses to pain would be significantly correlated to psychosocial and physical pain outcomes and that interpersonal responses to pain would change significantly for completers of a functional restoration (FR) program compared to those who were randomized to treatment-as-usual in the military medical system. Methods Forty-four participants were randomly assigned to one of two treatment groups. One treatment group received FR (n = 26) and the other group received treatment-as-usual (n = 18). Significant other responses to chronic pain were measured by the MPI (Pain 23(4):345-356, 1985). Participants also completed measures of impacted quality of life, reported disability, psychological distress, fear avoidance, pain interference, and physical activity. Results Perceived higher punishing responses from a significant other were significantly related to worse physical health-related quality of life (p = .037), work-related fear avoidance (p = .008), pain interference (p = .026), affective distress (p = .039), and pain while lifting (p = .017). Perceived higher solicitous responses from significant others were significantly associated with lower mental health-related quality of life (p = .011), household activity (p = 017), general activity (p = .042), self-reported disability (p = .030), lifting capacity (p = .005), and aerobic capacity (p = .009). Conclusions While findings are preliminary and of limited scope, it appears that the perception of significant others' responses may be impacted by psychosocial and physical pain outcomes and may change after treatment. More work in this area is needed to uncover the benefits one might achieve when a significant other is included within the FR treatment framework.

Nociception at the diabetic foot, an uncharted territory

PubMed Central

Chantelau, Ernst A

2015-01-01

The diabetic foot is characterised by painless foot ulceration and/or arthropathy; it is a typical complication of painless diabetic neuropathy. Neuropathy depletes the foot skin of intraepidermal nerve fibre endings of the afferent A-delta and C-fibres, which are mostly nociceptors and excitable by noxious stimuli only. However, some of them are cold or warm receptors whose functions in diabetic neuropathy have frequently been reported. Hence, it is well established by quantitative sensory testing that thermal detection thresholds at the foot skin increase during the course of painless diabetic neuropathy. Pain perception (nociception), by contrast, has rarely been studied. Recent pilot studies of pinprick pain at plantar digital skinfolds showed that the perception threshold was always above the upper limit of measurement of 512 mN (equivalent to 51.2 g) at the diabetic foot. However, deep pressure pain perception threshold at musculus abductor hallucis was beyond 1400 kPa (equivalent to 14 kg; limit of measurement) only in every fifth case. These discrepancies of pain perception between forefoot and hindfoot, and between skin and muscle, demand further study. Measuring nociception at the feet in diabetes opens promising clinical perspectives. A critical nociception threshold may be quantified (probably corresponding to a critical number of intraepidermal nerve fibre endings), beyond which the individual risk of a diabetic foot rises appreciably. Staging of diabetic neuropathy according to nociception thresholds at the feet is highly desirable as guidance to an individualised injury prevention strategy. PMID:25897350

Emotion-Oriented Coping, Avoidance Coping, and Fear of Pain as Mediators of the Relationship between Positive Affect, Negative Affect, and Pain-Related Distress among African American and Caucasian College Women

ERIC Educational Resources Information Center

Lightsey, Owen Richard, Jr.; Wells, Anita G.; Wang, Mei-Chuan; Pietruszka, Todd; Ciftci, Ayse; Stancil, Brett

2009-01-01

The authors tested whether coping styles and fear of pain mediate the relationship between positive affect and negative affect on one hand and pain-related distress (PD) on the other. Among African American and Caucasian female college students, negative affect, fear of pain, and emotion-oriented coping together accounted for 34% of the variance…

Recurrent pain and discomfort in relation to fitness and physical activity among young school children.

PubMed

Sollerhed, Ann-Christin; Andersson, Ingemar; Ejlertsson, Göran

2013-01-01

As an increase in pain symptoms among children has been shown in the last decades, the aim of this study was to describe perceptions of recurrent pain, measured physical fitness and levels of reported physical activity (PA) in children, and to investigate if any associations between PA, fitness and recurrent pain could be identified. A school-based study comprised 206 Swedish children 8-12 years old, 114 boys, 92 girls. A questionnaire with questions about perceived pain, self-reported PA and lifestyle factors was used. Health-related fitness was assessed by 11 physical tests. A physical index was calculated from these tests as a z score. High physical index indicated high fitness and low physical index indicated low fitness. ANOVA test, chi-square test and logistic regression analysis were used to compare active and inactive children. The prevalence of one pain location (head, abdomen or back) was 26%, two 11% and three 4% (n=206). Female gender, living in single-parent families, low PA and low subjective health were associated with reported recurrent pain. Children reporting high levels of PA had high physical index and reported low prevalence of pain symptoms. The physical index and level of self-reported PA decreased gradually the more pain locations. Physically active children had higher fitness levels and reported less pain symptoms than inactive peers. Coping with pain is an integral part of PA, and active children learn to cope with unpleasant body sensations which together with high fitness may reduce the perception of pain.

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. Copyright © 2015 Elsevier Inc. All rights reserved.

Electroacupuncture alleviates affective pain in an inflammatory pain rat model

PubMed Central

Zhang, Yu; Meng, Xianze; Li, Aihui; Xin, Jiajia; Berman, Brian M.; Lao, Lixing; Tan, Ming; Ren, Ke; Zhang, Rui-Xin

2011-01-01

Pain has both sensory-discriminative and emotional-affective dimensions. Previous studies demonstrate that electroacupuncture (EA) alleviates the sensory dimension but do not address the affective. An inflammatory pain rat model, produced by a complete Freund adjuvant (CFA) injection into the hind paw, was combined with a conditioned place avoidance (CPA) test to determine whether EA inhibits spontaneous pain-induced affective response and, if so, to study the possibility that rostral anterior cingulate cortex (rACC) opioids underlie this effect. Male Sprague-Dawley rats (250–275g, Harlan) were used. The rats showed place aversion (i.e. affective pain) by spending less time in a pain-paired compartment after conditioning than during a preconditioning test. Systemic non-analgesic morphine (0.5 and 1.0 mg/ kg, i.p.) inhibited the affective reaction, suggesting that the affective dimension is underpinned by mechanisms different from those of the sensory dimension of pain. Morphine at 0.5 and at 1 mg/kg did not induce reward. Rats given EA treatment before pain-paired conditioning at GB 30 showed no aversion to the pain-paired compartment, indicating that EA inhibited the affective dimension. EA treatment did not produce reward or aversive effect. Intra-rACC administration of D-Phe-Cys-Tyr-D-Trp-Orn-Thr-Pen-Thr amide (CTOP), a selective mu opioid receptor antagonist, but not norbinaltorphimine (nor-BNI), a selective kappa opioid receptor antagonist, blocked EA inhibition of the affective dimension. These data demonstrate that EA activates opioid receptors in the rACC to inhibit pain-induced affective responses and that EA may be an effective therapy for both the sensory-discriminative and the affective dimensions of pain. PMID:22323370

An Insight Into Neurophysiology of Pulpal Pain: Facts and Hypotheses

PubMed Central

Gupta, Abhishek; N., Meena

2013-01-01

Pain and pain control are important to the dental profession because the general perception of the public is that dental treatment and pain go hand in hand. Successful dental treatment requires that the source of pain be detected. If the origin of pain is not found, inappropriate dental care and, ultimately, extraction may result. Pain experienced before, during, or after endodontic therapy is a serious concern to both patients and endodontists, and the variability of discomfort presents a challenge in terms of diagnostic methods, endodontic therapy, and endodontic knowledge. This review will help clinicians understand the basic neurophysiology of pulpal pain and other painful conditions of the dental pulp that are not well understood. PMID:24156000

An insight into neurophysiology of pulpal pain: facts and hypotheses.

PubMed

Jain, Niharika; Gupta, Abhishek; N, Meena

2013-10-01

Pain and pain control are important to the dental profession because the general perception of the public is that dental treatment and pain go hand in hand. Successful dental treatment requires that the source of pain be detected. If the origin of pain is not found, inappropriate dental care and, ultimately, extraction may result. Pain experienced before, during, or after endodontic therapy is a serious concern to both patients and endodontists, and the variability of discomfort presents a challenge in terms of diagnostic methods, endodontic therapy, and endodontic knowledge. This review will help clinicians understand the basic neurophysiology of pulpal pain and other painful conditions of the dental pulp that are not well understood.

A geriatric assessment in general practice: prevalence, location, impact and doctor-patient perceptions of pain.

PubMed

Kruschinski, Carsten; Wiese, Birgitt; Dierks, Marie-Luise; Hummers-Pradier, Eva; Schneider, Nils; Junius-Walker, Ulrike

2016-01-28

To investigate what a geriatric assessment in general practice adds towards previous findings of prevalence, location, impact and the dyadic doctor-patient perception of pain in this age group. Cross-sectional study. Consecutive patients aged 70 and over underwent a comprehensive geriatric assessment in general practice that included a basic pain assessment (severity, sites and impact). Patients with pain and their doctors then independently rated its importance. Pain was correlated with further findings from the assessment, such as overall health, physical impairments, everyday function, falls, mood, health related lifestyle, social circumstances, using bivariate and multivariate statistics. Patient-doctor agreement on the importance of pain was calculated using kappa statistics. 219 out of 297 patients (73.7 %) reported pain at any location. Pain was generally located at multiple sites. It was most often present at the knee (33.9%), the lumbar spine (33.5%) as well as the hip (13.8%) and correlated with specific impairments such as restrictions of daily living (knee) or sleep problems (spine). Patients with pain and their physicians poorly agreed on the importance of the pain problem. A basic pain assessment can identify older patients with pain in general practice. It has resulted in a high prevalence exceeding that determined by encounters in consultations. It has been shown that a geriatric assessment provides an opportunity to address pain in a way that is adapted to older patients' needs - addressing all sites, its specific impact on life, and the patients' perceived importance of pain. Since there is little doctor-patient agreement, this seems a valuable strategy to optimize concrete treatment decisions and patient centered care. This study is registered in the German Clinical Trial Register ( DRKS00000792 ).

The Effect of Pain on Task Performance: A Review of the Literature.

DTIC Science & Technology

1992-07-01

Pharmacology. 11 (2), 123-127 (1989) 8. J. D. Benson, Application of manual handling task in the control of low back pain. In Trends in Ergonomics /Human...Factors IV. Proceedings of the Annual International Industrial Ergonomics and Safety Conference. Amsterdam: Elsevier Science Publishers (1987). 9. T...development of a motor performance method for the measurement of pain. Ergonomics . 32 (3), 307-316 (1989) 67. K. Sedlak, Low-back pain perception and

Two Different Epidural Analgesic Combinations: Morphine vs. Fentanyl/Bupivacaine or Fentanyl/Ropivacaine and Their Post Operative Effects

DTIC Science & Technology

2001-10-01

sensory and emotional experiences associated with actual or potential tissue damage,” (Taber, 1989, p. 1405). Pain has both physical and psychological...accentuating the pain response (Taber, 1989). In addition to the patients’ perception and experience of pain, the healthcare providers’ beliefs, biases...with quick recovery and pain-free postoperative experiences is a priority. The goal of this study was to compare the effectiveness of two

Affect and Low Back Pain: More to Consider Than the Influence of Negative Affect Alone.

PubMed

Hassett, Afton L; Goesling, Jenna; Mathur, Sunjay N; Moser, Stephanie E; Brummett, Chad M; Sibille, Kimberly T

2016-10-01

Affect balance style, a measure of trait positive affect (PA) and negative affect (NA), is predictive of pain and functioning in fibromyalgia and healthy individuals. The purpose of this study was to evaluate the distribution of affect balance styles and the relationship between these styles and clinical factors in low back pain. In this cross-sectional study, patients with low back pain (N=443) completed questionnaires and were categorized as having 1 of 4 distinct affect balance styles: Healthy (high levels of PA and low levels of NA), Low (low PA/low NA), Reactive (high PA/high NA), and Depressive (low PA/high NA). Comparisons between groups were made in regard to pain, functioning, and psychiatric comorbidity. High NA was observed in 63% (n=281), whereas low PA was present in 81% (n=359). We found that having a Depressive style was associated with greater pain severity, increased odds for comorbid fibromyalgia, and worse functioning compared with having a Healthy or Low style. Yet, those with a Low style were at increased risk for depression compared with a Healthy style, whereas patients with a Reactive style had similar levels of pain, functioning, and depression as those with a Healthy affective style. Our study revealed that there are important differences between trait affect balance styles in regard to pain, mood, and functioning in low back pain. Findings related to Reactive and Low affective styles suggest that relationships between affect, pain, and disability in low back pain extend beyond considering NA alone.

[The Recognition of Emotions, Empathy and Moral Judgment in the National Mental Health Survey in Colombia, 2015].

PubMed

Matallana, Diana; Gómez-Restrepo, Carlos; Ramirez, Paulina; Martínez, Nathalie Tamayo; Rondon, Martin

2016-12-01

Social cognition refers to the mental processes involved in social interactions. Different aspects, such as the perception of others, self-knowledge, motivation and the cultural context, can modulate empathy responses and moral judgments regarding the actions of others. The National Mental Health Survey (ENSM for its acronym in Spanish) explored aspects of social cognition such as the perception of emotions, empathy and moral judgment in situations in which another person experiences pain. To describe the overall findings of the ENSM in relation to the emotional perception and empathic responses to situations where pain is inflicted on others in an intentional or accidental manner. A total of 3863 people aged 18-96 years old completed the social cognition module. They were asked to identify the emotions expressed in the images of several faces. A modified version of the awareness of social inference test (TASIT) was used. Additionally, the cognitive, affective, and moral elements of empathy were assessed with a modified version of the empathy for pain task (EPT), which uses a sequence of images in which someone is being hurt. Happiness was identified by 91.5% of those interviewed; neutral or emotionless faces were identified by 65%; 55% of respondents correctly identified surprise. Only 19.7%, 21.8% and 27.4% could identify negative emotions like fear, disgust and sadness, respectively. When the data were analysed by age, poverty status, and different regions of the country, the results tend to vary. As regards empathy, 73.7% correctly identified intentional actions, and accidental actions were identified by 56.6%. According to the moral judgment of some respondents, even in situations where the pain was caused by accident, there must be some kind of punishment (20.7% deserved a low punishment and 26.8% a moderate one). Noteworthy findings include the high recognition of happiness by the respondents, in contrast to the apparent difficulty in recognising sadness, and paradoxical results regarding punishment and empathy. This should be studied in greater detail, but these results can contribute to a deeper understanding of the complex Colombian social context. Copyright © 2016 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.

Randomized Trial of a Group Music and Imagery Method (GrpMI) for Women with Fibromyalgia.

PubMed

Torres, Esperanza; Pedersen, Inge N; Pérez-Fernández, José I

2018-06-07

Fibromyalgia (FM) affects about 2-4% of the world population. Patients, mostly women, experience chronic widespread pain, fatigue, stiffness, sleep disturbances, and psychological disorders, especially depression and anxiety. The aim of this study was to examine preliminary efficacy of a Group Music and Imagery (GrpMI) intervention, which included relaxation, music listening, and spontaneous imagery, to improve subjective psychological well-being, functional capacity and health, pain perception, anxiety, and depression in women with FM. Fifty-six women aged 35 to 65 years (M = 51.3) diagnosed with FM were randomly assigned to either GrpMI treatment (n = 33) or control (n = 26) condition. Experimental group participants received 12 weekly GrpMI sessions, and control group participants who did not receive any additional service completed measures at the same time points as the experimental group. Intra-group analyses showed that GrpMI participants had a significant increase in psychological well-being and significant decrease in the impact of FM on functional capacity and health, pain perception, anxiety, and depression post-treatment, with sustained benefit at three-month follow-up for all variables except psychological well-being. Control group participants showed decreases in trait anxiety and depression at post-treatment, with no significant benefit at three-month follow-up. Inter-group analyses showed that compared with control participants, GRpMI participants had significantly higher scores for psychological well-being and lower-state anxiety post-treatment; however, no differences were observed between groups at three-month follow-up. Findings offer preliminary evidence for the benefit of GrpMI to improve well-being and reduce anxiety in women with FM. Findings also suggest that GrpMI may help diminish pain intensity, state depression, and the impact of FM on functional capacity and health, but further studies are needed to establish efficacy.

Fish intelligence, sentience and ethics.

PubMed

Brown, Culum

2015-01-01

Fish are one of the most highly utilised vertebrate taxa by humans; they are harvested from wild stocks as part of global fishing industries, grown under intensive aquaculture conditions, are the most common pet and are widely used for scientific research. But fish are seldom afforded the same level of compassion or welfare as warm-blooded vertebrates. Part of the problem is the large gap between people's perception of fish intelligence and the scientific reality. This is an important issue because public perception guides government policy. The perception of an animal's intelligence often drives our decision whether or not to include them in our moral circle. From a welfare perspective, most researchers would suggest that if an animal is sentient, then it can most likely suffer and should therefore be offered some form of formal protection. There has been a debate about fish welfare for decades which centres on the question of whether they are sentient or conscious. The implications for affording the same level of protection to fish as other vertebrates are great, not least because of fishing-related industries. Here, I review the current state of knowledge of fish cognition starting with their sensory perception and moving on to cognition. The review reveals that fish perception and cognitive abilities often match or exceed other vertebrates. A review of the evidence for pain perception strongly suggests that fish experience pain in a manner similar to the rest of the vertebrates. Although scientists cannot provide a definitive answer on the level of consciousness for any non-human vertebrate, the extensive evidence of fish behavioural and cognitive sophistication and pain perception suggests that best practice would be to lend fish the same level of protection as any other vertebrate.

Feeling worse to feel better: pain-offset relief simultaneously stimulates positive affect and reduces negative affect.

PubMed

Franklin, Joseph C; Lee, Kent M; Hanna, Eleanor K; Prinstein, Mitchell J

2013-04-01

Although pain itself induces negative affect, the removal (or offset) of pain induces a powerful state of relief. Despite being implicated in a wide range of psychological and behavioral phenomena, relief remains a poorly understood emotion. In particular, some theorists associate relief with increased positive affect, whereas others associate relief with diminished negative affect. In the present study, we examined the affective nature of relief in a pain-offset paradigm with psychophysiological measures that were specific to negative valence (startle eyeblink reactivity) and positive valence (startle postauricular reactivity). Results revealed that pain offset simultaneously stimulates positive affect and diminishes negative affect for at least several seconds. Results also indicated that pain intensity differentially affects the positive and negative valence aspects of relief. These findings clarify the affective nature of relief and provide insight into why people engage in both normal and abnormal behaviors associated with relief.

Sex differences in thermal detection and thermal pain threshold and the thermal grill illusion: a psychophysical study in young volunteers.

PubMed

Averbeck, Beate; Seitz, Lena; Kolb, Florian P; Kutz, Dieter F

2017-09-01

Sex-related differences in human thermal and pain sensitivity are the subject of controversial discussion. The goal of this study in a large number of subjects was to investigate sex differences in thermal and thermal pain perception and the thermal grill illusion (TGI) as a phenomenon reflecting crosstalk between the thermoreceptive and nociceptive systems. The thermal grill illusion is a sensation of strong, but not necessarily painful, heat often preceded by transient cold upon skin contact with spatially interlaced innocuous warm and cool stimuli. The TGI was studied in a group of 78 female and 58 male undergraduate students and was evoked by placing the palm of the right hand on the thermal grill (20/40 °C interleaved stimulus). Sex-related thermal perception was investigated by a retrospective analysis of thermal detection and thermal pain threshold data that had been measured in student laboratory courses over 5 years (776 female and 476 male undergraduate students) using the method of quantitative sensory testing (QST). To analyse correlations between thermal pain sensitivity and the TGI, thermal pain threshold and the TGI were determined in a group of 20 female and 20 male undergraduate students. The TGI was more pronounced in females than males. Females were more sensitive with respect to thermal detection and thermal pain thresholds. Independent of sex, thermal detection thresholds were dependent on the baseline temperature with a specific progression of an optimum curve for cold detection threshold versus baseline temperature. The distribution of cold pain thresholds was multi-modal and sex-dependent. The more pronounced TGI in females correlated with higher cold sensitivity and cold pain sensitivity in females than in males. Our finding that thermal detection threshold not only differs between the sexes but is also dependent on the baseline temperature reveals a complex processing of "cold" and "warm" inputs in thermal perception. The results of the TGI experiment support the assumption that sex differences in cold-related thermoreception are responsible for sex differences in the TGI.

Spinal Cord Stimulation (SCS) and Functional Magnetic Resonance Imaging (fMRI): Modulation of Cortical Connectivity With Therapeutic SCS.

PubMed

Deogaonkar, Milind; Sharma, Mayur; Oluigbo, Chima; Nielson, Dylan M; Yang, Xiangyu; Vera-Portocarrero, Louis; Molnar, Gregory F; Abduljalil, Amir; Sederberg, Per B; Knopp, Michael; Rezai, Ali R

2016-02-01

The neurophysiological basis of pain relief due to spinal cord stimulation (SCS) and the related cortical processing of sensory information are not completely understood. The aim of this study was to use resting state functional magnetic resonance imaging (rs-fMRI) to detect changes in cortical networks and cortical processing related to the stimulator-induced pain relief. Ten patients with complex regional pain syndrome (CRPS) or neuropathic leg pain underwent thoracic epidural spinal cord stimulator implantation. Stimulation parameters associated with "optimal" pain reduction were evaluated prior to imaging studies. Rs-fMRI was obtained on a 3 Tesla, Philips Achieva MRI. Rs-fMRI was performed with stimulator off (300TRs) and stimulator at optimum (Opt, 300 TRs) pain relief settings. Seed-based analysis of the resting state functional connectivity was conducted using seeds in regions established as participating in pain networks or in the default mode network (DMN) in addition to the network analysis. NCUT (normalized cut) parcellation was used to generate 98 cortical and subcortical regions of interest in order to expand our analysis of changes in functional connections to the entire brain. We corrected for multiple comparisons by limiting the false discovery rate to 5%. Significant differences in resting state connectivity between SCS off and optimal state were seen between several regions related to pain perception, including the left frontal insula, right primary and secondary somatosensory cortices, as well as in regions involved in the DMN, such as the precuneus. In examining changes in connectivity across the entire brain, we found decreased connection strength between somatosensory and limbic areas and increased connection strength between somatosensory and DMN with optimal SCS resulting in pain relief. This suggests that pain relief from SCS may be reducing negative emotional processing associated with pain, allowing somatosensory areas to become more integrated into default mode activity. SCS reduces the affective component of pain resulting in optimal pain relief. Study shows a decreased connectivity between somatosensory and limbic areas associated with optimal pain relief due to SCS. © 2015 International Neuromodulation Society.

Knowledge, Attitude and Practice of Ear Care in Coastal Karnataka.

PubMed

Dosemane, Deviprasad; Ganapathi, Keerthan; Kanthila, Jayashree

2015-12-01

Ear as an organ is necessary for the perception of sound and body balance. Ear infection, diabetes mellitus, hypertension and excessive use of mobile phone for listening to music at high volume all can reduce hearing. No earlier study was available in the costal Karnataka population, regarding the practice of ear care. The study objective was to ascertain the level of knowledge of the community regarding ear care, to find out whether some of the common conditions affecting hearing are known and to find out the common practices involved in maintaining ear hygiene. This cross-sectional study was conducted on 500 subjects in two tertiary care hospitals by convenient sampling, using self-administered questionnaire. Knowledge, Attitude and Practice across the age groups, religion & education background were studied. Across different education groups, 66.7%-90% did not know that 'cold' can cause ear infection and 46.7%-75.0% did not know that diabetes and hypertension can reduce hearing. When there is ear pain or discharge, people put ear drops available at home in 48.3%-75.0% across 3 age groups; 58.5%-61.5% across 3 religions and 44.8%-67.9% across 5 education groups. No statistically significant difference was found in the practice of pouring oil into ears across religions. A total of 58.6%-100% daily clean inside the ear and 70-100% use cotton buds. General perception of the people is that ear is necessary only for hearing. Majority did not know that nasal infection can affect the ear and that DM and hypertension can cause hearing loss. When there is ear pain and discharge, most of the adults put drops that are available at home. Pouring oil into the ears and cleaning inside the ear canals is routinely practiced in costal Karnataka.

Ergonomic office design and aging: a quasi-experimental field study of employee reactions to an ergonomics intervention program.

PubMed

May, Douglas R; Reed, Kendra; Schwoerer, Catherine E; Potter, Paul

2004-04-01

A naturally occurring quasi-experimental longitudinal field study of 87 municipal employees using pretest and posttest measures investigated the effects of an office workstation ergonomics intervention program on employees' perceptions of their workstation characteristics, levels of persistent pain, eyestrain, and workstation satisfaction. The study examined whether reactions differed between younger and older employees. Results revealed that workstation improvements were associated with enhanced perceptions of the workstation's ergonomic qualities, less upper back pain, and greater workstation satisfaction. Among those experiencing an improvement, the perceptions of workstation ergonomic qualities increased more for younger than older employees, supporting the "impressionable years" framework in the psychological literature on aging. Implications for human resources managers are discussed.

The application of conditioning paradigms in the measurement of pain

PubMed Central

Li, Jun-Xu

2013-01-01

Pain is a private experience that involves both sensory and emotional components. Animal studies of pain can only be inferred by their responses, and therefore the measurement of reflexive responses dominate the pain literature for nearly a century. It has been argued that although reflexive responses are important to unveil the sensory nature of pain in organisms, pain affect is equally important but largely ignored in pain studies primarily due to the lack of validated animal models. One strategy to begin to understand pain affect is to use conditioning principles to indirectly reveal the affective condition of pain. This review critically analyzed several procedures that are thought to measure affective learning of pain. The procedures regarding the current knowledge, the applications, and their advantages and disadvantages in pain research are discussed. It is proposed that these procedures should be combined with traditional reflex-based pain measurements in future studies of pain, which could greatly benefit both the understanding of neural underpinnings of pain and preclinical assessment of novel analgesics. PMID:23500202

Perception of trigeminal mixtures.

PubMed

Filiou, Renée-Pier; Lepore, Franco; Bryant, Bruce; Lundström, Johan N; Frasnelli, Johannes

2015-01-01

The trigeminal system is a chemical sense allowing for the perception of chemosensory information in our environment. However, contrary to smell and taste, we lack a thorough understanding of the trigeminal processing of mixtures. We, therefore, investigated trigeminal perception using mixtures of 3 relatively receptor-specific agonists together with one control odor in different proportions to determine basic perceptual dimensions of trigeminal perception. We found that 4 main dimensions were linked to trigeminal perception: sensations of intensity, warmth, coldness, and pain. We subsequently investigated perception of binary mixtures of trigeminal stimuli by means of these 4 perceptual dimensions using different concentrations of a cooling stimulus (eucalyptol) mixed with a stimulus that evokes warmth perception (cinnamaldehyde). To determine if sensory interactions are mainly of central or peripheral origin, we presented stimuli in a physical "mixture" or as a "combination" presented separately to individual nostrils. Results showed that mixtures generally yielded higher ratings than combinations on the trigeminal dimensions "intensity," "warm," and "painful," whereas combinations yielded higher ratings than mixtures on the trigeminal dimension "cold." These results suggest dimension-specific interactions in the perception of trigeminal mixtures, which may be explained by particular interactions that may take place on peripheral or central levels. © The Author 2014. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Air Force Family Nurse Practitioner and Air Force Family Physician Perception of the Family Nurse Practitioner Role in Military Operations Other Than War

DTIC Science & Technology

2000-05-01

Supervised Practice- Physician Perception (Mean 1.5-2.49) Symptom/illness Mean SD Orthopedics Sprain 1.75 .5965 Chondromalacia 1.67 .8516 Laceration 2.16...Sprain 32.4 59.5 Chondromalacia 27.0 16.2 Laceration 64.9 13.5 Tendonitis 45.9 5.4 Bursitis 56.8 8.1 Back pain (injury) 40.5 29.7 Back pain (low) 35.1... Chondromalacia 1 2 3 4 5 35. Tendonitis: 1 2 3 4 5 36. Bursitis: 1