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Sample records for affective pain regions

  1. Complex Regional Pain Syndrome

    MedlinePlus

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

  2. Affective brain regions are activated during the processing of pain-related words in migraine patients.

    PubMed

    Eck, Judith; Richter, Maria; Straube, Thomas; Miltner, Wolfgang H R; Weiss, Thomas

    2011-05-01

    Several brain areas that constitute the neural matrix of pain can be activated by noxious stimuli and by pain-relevant cues, such as pictures, facial expressions, and pain-related words. Although chronic pain patients are frequently exposed to pain-related words, it remains unclear whether their pain matrix is specifically activated during the processing of such stimuli in comparison to healthy subjects. To answer this question, we compared the neural activations induced by verbal pain descriptors in a sample of migraine patients with activations in healthy controls using functional magnetic resonance imaging. Participants viewed pain-related adjectives and negative, non-pain-related adjectives that were matched for valence and arousal and were instructed to either generate mental images (imagination condition) or to count the number of vowels (distraction condition). In migraine patients, pain-related adjectives as compared with negative adjectives elicited increased activations in the left orbitofrontal cortex and anterior insula during imagination and in the right secondary somatosensory cortex and posterior insula during distraction. More pronounced pain-related activation was observed in affective pain-related regions in the patient as compared with the control group during imagination. During distraction, no differential engagement of single brain structures in response to pain-related words could be observed between groups. Overall, our findings indicate that there is an involvement of brain regions associated with the affective and sensory-discriminative dimension of pain in the processing of pain-related words in migraine patients, and that the recruitment of those regions associated with pain-related affect is enhanced in patients with chronic pain experiences. Copyright © 2011 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

  3. Complex Regional Pain Syndrome

    MedlinePlus

    ... regional pain syndrome is an uncommon form of chronic pain that usually affects an arm or a ... I need? Is my condition likely temporary or chronic? What types of treatments are available? Which do ...

  4. Regional cancer pain syndromes.

    PubMed

    Chang, Victor T; Janjan, Nora; Jain, Subash; Chau, Chi

    2006-12-01

    Cancer pain often presents in a body region. This review summarizes articles from 1999-2004 relevant to cancer pain syndromes in the head and neck, chest, back, abdomen, pelvis, and limbs. Although the evidence is limited, progress is being made in further development of the evidence base to support and guide current practice.

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

    PubMed Central

    Fallon, Nicholas

    2015-01-01

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

  6. [Factors affecting postoperative pain].

    PubMed

    Soler Company, E; Faus Soler, M; Montaner Abasolo, M; Morales Olivas, F; Martínez-Pons Navarro, V

    2001-04-01

    To determine the influence on the intensity of postoperative pain of the following variables: sex, age, type of surgery, surgical approach, anesthetic technique and analgesia administered. Six hundred twenty-three hospitalized patients were enrolled from the units of general and digestive surgery, gynecology and obstetrics, ophthalmology, otorhinolaryngology, traumatology and orthopedics, and urology. Pain intensity was measured on a visual analog scale (VAS) when the patient left the post-anesthesia recovery ward (PARU) and 24 and 48 h after surgery, and on a verbal evaluation scale (VES) during the first and second days after surgery. Gynecology is the department where the most pain is reported, both when the patient leaves the PARU (>= 4 for 56.6% of patients) and during the first day on the ward (71.3% of patients suffer pain of moderate or high intensity). The correlation of pain with duration of procedure was strongest in the urology and surgery units, with common variances of 32.3% and 23.4%, respectively. More pain is felt during open procedures in the traumatology and urology units, which is not the case in gynecology and surgery. Patients receiving general anesthesia leave the PARU with pain at 3.4 +/- 1.8 cm on the VAS scale, versus 1.3 +/- 1.6 cm for patients receiving locoregional anesthesia. Patients who received only ketorolac for pain in the PARU generally experienced less intense pain (2.5 +/- 2.0 cm) than did those who received metamizol (3.3 +/- 1.5 cm), morphine (4.0 +/- 1.8 cm) or tramadol (4.5 +/- 1.8 cm). Surgical department, surgical approach, anesthetic technique and, finally, analgesic administered are the factors that determine the intensity of postoperative pain. These factors should therefore be taken into account when establishing treatment protocols to assure adequate control of postoperative pain. Neither sex nor age were determining factors for the intensity of postoperative pain.

  7. Complex regional pain syndrome

    PubMed Central

    Sebastin, Sandeep J

    2011-01-01

    Complex regional pain syndrome (CRPS) previously known as reflex sympathetic dystrophy is a chronic neurological disorder involving the limbs characterized by disabling pain, swelling, vasomotor instability, sudomotor abnormality, and impairment of motor function. CRPS is not uncommon after hand surgery and may complicate post-operative care. There is no specific diagnostic test for CRPS and the diagnosis is based on history, clinical examination, and supportive laboratory findings. Recent modifications to diagnostic criteria have enabled clinicians to diagnose this disease more consistently. This review gives a synopsis of CRPS and discusses the diagnosis, pathophysiology, and treatment options based on the limited evidence in the literature. PMID:22022040

  8. Complex regional pain syndrome

    PubMed Central

    Carr, Emily S.; De La Cerda, Ashley

    2016-01-01

    Complex regional pain syndrome (CRPS) is a neurologic disorder that often results in debilitating chronic pain, but the diagnosis may elude providers as it is one of exclusion. A history of trauma may be elucidated. We report a case of CRPS and review the clinical findings, appropriate workup, and treatment options for the patient. The patient we describe went through an extensive workup before receiving the correct diagnosis. Delay in diagnosis leads to prolonged suffering for the patient and, at times, unnecessary invasive debridement procedures. Raising awareness of this entity may help physicians make the correct diagnosis early, as well as initiate a collaborative effort between neurology, anesthesiology, and dermatology to provide the patient the most favorable outcome. PMID:27365892

  9. Acute Pain Management/Regional Anesthesia.

    PubMed

    Tedore, Tiffany; Weinberg, Roniel; Witkin, Lisa; Giambrone, Gregory P; Faggiani, Susan L; Fleischut, Peter M

    2015-12-01

    Effective and efficient acute pain management strategies have the potential to improve medical outcomes, enhance patient satisfaction, and reduce costs. Pain management records are having an increasing influence on patient choice of health care providers and will affect future financial reimbursement. Dedicated acute pain and regional anesthesia services are invaluable in improving acute pain management. In addition, nonpharmacologic and alternative therapies, as well as information technology, should be viewed as complimentary to traditional pharmacologic treatments commonly used in the management of acute pain. The use of innovative technologies to improve acute pain management may be worthwhile for health care institutions. Copyright © 2015 Elsevier Inc. All rights reserved.

  10. Complex regional pain syndrome

    MedlinePlus

    ... skin temperature, switching between warm or cold Faster growth of nails and hair Muscle spasms and joint pain Severe burning, aching pain ... easily Pain that is becoming worse Slower hair growth Stiff joints and weak muscles Stage 3 (irreversible changes can be seen) Limited ...

  11. Fear of pain in children and adolescents with neuropathic pain and complex regional pain syndrome.

    PubMed

    Simons, Laura E

    2016-02-01

    A significant proportion of children and adolescents with chronic pain endorse elevated pain-related fear. Pain-related fear is associated with high levels of disability, depressive symptoms, and school impairment. Because of faulty nerve signaling, individuals with neuropathic pain and complex regional pain syndrome may be more prone to develop pain-related fear as they avoid use of and neglect the affected body area(s), resulting in exacerbated symptoms, muscle atrophy, maintenance of pain signaling, and ongoing pain-related disability. Not surprisingly, effective treatments for elevated pain-related fears involve exposure to previously avoided activities to downregulate incorrect pain signaling. In the context of intensive interdisciplinary pain treatment of youth with neuropathic pain, decreasing pain-related fear is associated with improved physical and psychological functioning, whereas high initial pain-related fear is a risk factor for less treatment responsiveness. An innovative approach to targeting pain-related fear and evidence of a neural response to treatment involving decoupling of the amygdala with key fear circuits in youth with complex regional pain syndrome suggest breakthroughs in our ability to ameliorate these issues.

  12. Demographic and affective covariates of pain.

    PubMed

    Garron, D C; Leavitt, F

    1979-11-01

    Relationships of four demographic variables and five affective variables to eight attributes of low back pain were investigated in 251 patients by stepwise, multivariate analysis. The demographic variables are age, sex, race, and education. The affective variables are state anxiety, trait anxiety anxiety, hostility, and depression. Seven of the pain variables are from the factorially derived Low Back Pain Questionnaire. The eighth pain variable is a self-estimate of intensity. Relationships among demographic and pain variables are small and unsystematic. Hostility has a small, systematically inverse relation to pain variables, supporting theories relating low back pain to inhibition of anger. Anxiety has a small positive relationship, and depression has no relationship to pain variables. In general, the small relationships indicate that the Low Back Pain Questionnaire provides descriptions of pain that are not confounded by social characteristics or current emotional states of patients.

  13. Expanding hypnotic pain management to the affective dimension of pain.

    PubMed

    Feldman, Jeffrey B

    2009-01-01

    Experimental (Price & Barber, 1987) and neuroimaging studies (Rainville, Carrier, Hofbauer, Bushnell, & Duncan, 1999), suggest that it is the affective dimension of pain as processed in the anterior cingulate cortex (ACC) that is most associated with suffering and autonomic arousal. Conversely, pain related emotions (Rainville, Bao, & Chretien, 2005) and expectations (Koyama, McHaffie, Laurenti, & Coghill, 2005) modulate pain perception and associated pain affect. This paper presents both the scientific background and the general clinical steps involved in a practical hypnotic approach that uses emotion specific wording and the elicitation of prior positive experience to intervene at both the affective and sensory dimensions of pain. Such an approach enables patients to therapeutically use hypnosis to reduce their subjective distress even if they are not able to greatly reduce the sensation of pain. The utilization of positive state dependent learning (Rossi, 1986), following the advice of Milton Erickson to "discover their patterns of happiness" (Parsons-Fein, 2005) is emphasized.

  14. Menopause affects pain depending on pain type and characteristics.

    PubMed

    Meriggiola, Maria Cristina; Nanni, Michela; Bachiocco, Valeria; Vodo, Stellina; Aloisi, Anna M

    2012-05-01

    Women are more affected than men by many chronic pain conditions, suggesting the effect of sex-related mechanisms in their occurrence. The role of gonadal hormones has been studied but with contrasting results depending on the pain syndrome, reproductive status, and hormone considered. The aim of the present study was to evaluate the pain changes related to the menopausal transition period. In this observational study, postmenopausal women were asked to evaluate the presence of pain in their life during the premenopausal and postmenopausal periods and its modification with menopause. One hundred one women were enrolled and completed questionnaires on their sociodemographic status, pain characteristics, and evolution. The most common pain syndromes were headache (38%), osteoarticular pain (31%), and cervical/lumbar pain (21%). Pain was present before menopause in 66 women, ceased with menopause in 17, and started after menopause in 18. Data were used for cluster analysis, which allowed the division of participants into four groups. In the first, all women experienced headaches that disappeared or improved with menopause. The second group included osteoarticular pain; the pain improved in half of these women and remained stable in the other half. The third group had cervical/lumbar pain, which disappeared or improved with menopause in all. The fourth group presented different kinds of moderate pain, which worsened in all. The present study provides preliminary data suggesting that menopause can affect pain depending on the painful condition experienced by the woman. This underlines the different interactions of menopause-related events with body structures involved in pain.

  15. The complex regional pain syndrome.

    PubMed

    Oaklander, Anne Louise; Horowitz, Steven H

    2015-01-01

    Complex regional pain syndrome (CRPS) is the current consensus-derived name for a syndrome usually triggered by limb trauma. Required elements include prolonged, disproportionate distal-limb pain and microvascular dysregulation (e.g., edema or color changes) or altered sweating. CRPS-II (formerly "causalgia") describes patients with identified nerve injuries. CRPS-I (formerly "reflex sympathetic dystrophy") describes most patients who lack evidence of specific nerve injuries. Diagnosis is clinical and the pathophysiology involves combinations of small-fiber axonopathy, microvasculopathy, inflammation, and brain plasticity/sensitization. Females have much higher risk and workplace accidents are a well-recognized cause. Inflammation and dysimmunity, perhaps facilitated by injury to the blood-nerve barrier, may contribute. Most patients, particularly the young, recover gradually, but treatment can speed healing. Evidence of efficacy is strongest for rehabilitation therapies (e.g., graded-motor imagery), neuropathic pain medications, and electric stimulation of the spinal cord, injured nerve, or motor cortex. Investigational treatments include ketamine, botulinum toxin, immunoglobulins, and transcranial neuromodulation. Nonrecovering patients should be re-evaluated for neurosurgically treatable causal lesions (nerve entrapment, impingement, infections, or tumors) and treatable potentiating medical conditions, including polyneuropathy and circulatory insufficiency. Earlier impressions that CRPS represents malingering or psychosomatic illness have been replaced by evidence that CRPS is a rare complication of limb injury in biologically susceptible individuals. © 2015 Elsevier B.V. All rights reserved.

  16. Interventional modalities in the treatment of complex regional pain syndrome.

    PubMed

    Nambi-Joseph, Pushpa; Stanton-Hicks, Michael; Sferra, James J

    2004-06-01

    Complex regional pain syndrome (CRPS) applies to a variety of conditions in which symptoms such as allodynia and hyperalgesia predominate along with hyperpathia and vasomotor/sudomotor disturbances. The incidence of CRPS in the chronic pain population varies and is difficult to determine, though it appears to affect women more than men. Treatment is multidisciplinary, and recovery of function and the reduction of pain are the main goals of treatment;this article addresses some of the interventional modalities that are used.

  17. Orofacial complex regional pain syndrome: pathophysiologic mechanisms and functional MRI.

    PubMed

    Lee, Yeon-Hee; Lee, Kyung Mi; Kim, Hyug-Gi; Kang, Soo-Kyung; Auh, Q-Schick; Hong, Jyung-Pyo; Chun, Yang-Hyun

    2017-08-01

    Complex regional pain syndrome (CRPS) is one of the most challenging chronic pain conditions and is characterized by burning pain, allodynia, hyperalgesia, autonomic changes, trophic changes, edema, and functional loss involving mainly the extremities. Until recently, very few reports have been published concerning CRPS involving the orofacial area. We report on a 50-year-old female patient who presented with unbearable pain in all of her teeth and hypersensitivity of the facial skin. She also reported intractable pain in both extremities accompanied by temperature changes and orofacial pain that increased when the other pains were aggravated. In the case of CRPS with trigeminal neuropathic pain, protocols for proper diagnosis and prompt treatment have yet to be established in academia or in the clinical field. We performed functional magnetic resonance imaging for a thorough analysis of the cortical representation of the affected orofacial area immediately before and immediately after isolated light stimulus of the affected hand and foot and concluded that CRPS can be correlated with trigeminal neuropathy in the orofacial area. Furthermore, the patient was treated with carbamazepine administration and stellate ganglion block, which can result in a rapid improvement of pain in the trigeminal region. Copyright © 2017 Elsevier Inc. All rights reserved.

  18. The words of pain in complex regional pain syndrome.

    PubMed

    Casale, Roberto; Atzeni, Fabiola; Masala, Ignazio Francesco; Sarzi-Puttini, Piercarlo

    2015-02-01

    Complex regional pain syndrome (CRPS) encompasses a wide range of painful conditions, but it is characterised by continuing (spontaneous and/or evoked) limb pain that is seemingly disproportionate in time or degree to the usual course of any known trauma or other lesion. The pain is regional, with distal predominance usually but not related to a specific nerve territory or dermatome, and it is usually associated with abnormal sensory, motor, sudomotor, vasomotor and/or trophic findings. The complexity of the aetiopathogenetic factors making up the clinical picture of CRPS is mirrored by the inconsistency of almost all of the monotherapies used to treat it so far. Motor and sensory symptoms significantly interfere with the patients' daily function and quality of life, and almost all of them report substantial disability in their working and recreational activities, mood and mobility. Copyright © 2015 Elsevier Ltd. All rights reserved.

  19. 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.

  20. A preliminary investigation of affective interaction in chronic pain couples.

    PubMed

    Johansen, Ayna Beate; Cano, Annmarie

    2007-11-01

    The objective of this preliminary study was to examine the extent to which affective marital interaction related to depressive symptoms in persons with chronic pain and their spouses and to pain severity in persons with pain. Couples from the community completed self-report surveys and engaged in a videotaped conversation on a topic of mutual disagreement that was coded for three affect types (i.e., anger/contempt, sadness, humor). Humor was positively related to marital satisfaction in both partners. Spouse anger/contempt and sadness were positively related to depressive symptoms in spouses. Several significant interaction effects between couple pain status (i.e., whether one or both partners reported pain) and affect also emerged. Specifically, sadness in the participant designated as the person with pain was associated with greater depressive symptoms and pain severity when only he or she reported pain whereas sadness was related to fewer depressive symptoms and less pain severity when both partners reported pain. The relationships between spouse anger and spouse depressive symptoms and between spouse humor and pain severity in the person with pain were also moderated by couple pain status. These exploratory findings can be interpreted in light of emotion regulation and pain empathy theories. For example, partners who have not experienced pain themselves may fail to empathize with persons in pain, thus preventing effective emotion regulation. When both spouses report chronic pain, expressions of negative affect may instead promote emotion regulation because the affect is experienced with a spouse who may be more empathetic.

  1. Inflammation in cold complex regional pain syndrome.

    PubMed

    Dirckx, M; Stronks, D L; van Bodegraven-Hof, E A M; Wesseldijk, F; Groeneweg, J G; Huygen, F J P M

    2015-07-01

    In patients with complex regional pain syndrome (CRPS), the temperature of the affected side often differs from that of the contralateral side. In the acute phase, the affected side is usually warmer than the contralateral side, the so-called 'warm' CRPS. This thermal asymmetry can develop into a colder affected side, the so-called 'cold' CRPS. In contrast to cold CRPS, in warm CRPS, inflammation is generally assumed to be present. However, there are reports of cold CRPS patients, successfully treated with vasodilatation therapy, who subsequently displayed warm CRPS. It seems that inflammation could be 'hidden' behind vasomotor disturbance. This study was designed to test this hypothesis. A retrospective analysis was made of patients in our CRPS database. We defined three types of CRPS: cold CRPS, neither cold nor warm (intermediate) CRPS, and warm CRPS. Of these patients, the difference between the level of the pro-inflammatory cytokines interleukin (IL)-6 (Δ IL-6) and tumor necrosis factor (TNF)-α (Δ TNF-α) in the affected extremity and that in the contralateral extremity was determined. The bilateral difference of the level of these cytokines did not differ among patients with cold CRPS, intermediate CRPS, or those with warm CRPS. Inflammation may be involved in cold CRPS. © 2015 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

  2. Relationships between psychological factors, pain, and disability in complex regional pain syndrome and low back pain.

    PubMed

    Bean, Debbie J; Johnson, Malcolm H; Kydd, Robert R

    2014-08-01

    Cognitive and emotional factors are known to influence peoples' pain experiences in many conditions, including low back pain. However, in complex regional pain syndrome (CRPS), their role is unclear. This study aimed to assess the relationships between psychological factors, pain, and disability in CRPS, compared with low back pain. This could help to identify target variables for psychological treatment. A total of 88 CRPS patients and 88 low back pain patients completed measures of pain, disability, depression, anxiety, and fear of movement and reinjury (kinesiophobia). Mean scores between the 2 groups were compared, and correlations between psychological factors, pain, and disability were compared between the 2 groups. Predictors of pain and disability were assessed using multiple regression analyses. The 2 groups had remarkably similar scores on measures of pain, disability, depression, anxiety, and kinesiophobia. In both groups, those who were more depressed, anxious, and kinesiophobic were more disabled. For the CRPS group (but not the low back pain group), pain intensity significantly correlated with distress. Multivariate analyses showed that the unique predictors of disability for the 2 groups were pain and depression, and that depression had a stronger relationship with disability for the CRPS group. For both groups, pain intensity was predicted by kinesiophobia, and anxiety was a unique predictor in the CRPS group only. In CRPS, disability and pain severity were more strongly associated with psychological factors than they were in low back pain. Cause and effect relationships could not be established by this cross-sectional study.

  3. Treatment of complex regional pain syndrome.

    PubMed

    Resmini, Giuseppina; Ratti, Chiara; Canton, Gianluca; Murena, Luigi; Moretti, Antimo; Iolascon, Giovanni

    2015-01-01

    Complex Regional Pain Syndrome (CRPS) is a multifactorial and disabling disorder with complex etiology and pathogenesis. Goals of therapy in CRPS should be pain relief, functional restoration, and psychological stabilization, but early interventions are needed in order to achieve these objectives. Several drugs have been used to reduce pain and to improve functional status in CRPS, despite the lack of scientific evidence supporting their use in this scenario. They include anti-inflammatory drugs, analgesics, anesthetics, anticonvulsants, antidepressants, oral muscle relaxants, corticosteroids, calcitonin, bisphosphonates, calcium channel blockers and topical agents. NSAIDs showed no value in treating CRPS. Glucocorticoids are the only anti-inflammatory drugs for which there is direct clinical trial evidence in early stage of CRPS. Opioids are a reasonable second or third-line treatment option, but tolerance and long term toxicity are unresolved issues. The use of anticonvulsants and tricyclic antidepressants has not been well investigated for pain management in CRPS. During the last years, bisphosphonates have been the mostly studied pharmacologic agents in CRPS treatment and there are good evidence to support their use in this condition. Recently, the efficacy of intravenous (IV) administration of neridronate has been reported in a randomized controlled trial. Significant improvements in VAS score and other indices of pain and quality of life in patients who received four 100 mg IV doses of neridronate versus placebo were reported. These findings were confirmed in the open-extension phase of the study, when patients formerly enrolled in the placebo group received neridronate at the same dosage, and these results were maintained at 1 year follow-up. The current literature concerning sympathetic blocks and sympathectomy techniques lacks evidence of efficacy. Low evidence was recorded for a free radical scavenger, dimethylsulphoxide (DMSO) cream (50%). The same level

  4. Cerebral stimulation for the affective component of neuropathic pain.

    PubMed

    Machado, Andre G; Baker, Kenneth B; Plow, Ela; Malone, Donald A

    2013-01-01

    To review the current state of cerebral stimulation for neuropathic pain and to propose that cerebral stimulation should aim also at the affective sphere of chronic pain rather than solely focusing on the primary sensory-discriminative sphere. The past and current goals of cerebral stimulation are reviewed as well as its limitations. A novel deep brain stimulation approach is proposed to evaluate this conceptual shift from somatosensory to affective sphere of pain targeting. Thalamic and other central pain syndromes are typically intractable to current treatment methods, including cerebral neuromodulation of somatosensory pathways, leading to long-term distress and disability. Our modern understanding of chronic pain pathophysiology is based largely on the neuromatrix theory, where cognitive, affective, and sensory-discriminative spheres contribute equally to the overall pain experience. During the last decade, the safety and feasibility of chronic stimulation of neural pathways related to mood and affect has been explored with promising results. Here, we propose a novel approach to modulate the affective sphere of chronic pain by targeting similar networks in patients with treatment-refractory central pain. Our primary goal is not to produce (or measure) analgesia, but rather to modulate the affective burden of chronic pain. Cerebral neuromodulation for neuropathic pain has had limited efficacy thus far. Shifting our aim to neural networks related to the affective sphere of pain may allow us to reduce pain conditioning and pain-related disability. Our ultimate goal is to promote rehabilitation from chronic pain-social and occupational. © 2012 International Neuromodulation Society.

  5. From Pavlov to pain: How predictability affects the anticipation and processing of visceral pain in a fear conditioning paradigm.

    PubMed

    Labrenz, Franziska; Icenhour, Adriane; Schlamann, Marc; Forsting, Michael; Bingel, Ulrike; Elsenbruch, Sigrid

    2016-04-15

    Conditioned pain-related fear may contribute to hyperalgesia and central sensitization, but this has not been tested for interoceptive, visceral pain. The underlying ability to accurately predict pain is based on predictive cue properties and may alter the sensory processing and cognitive-emotional modulation of pain thus exacerbating the subjective pain experience. In this functional magnetic resonance imaging study using painful rectal distensions as unconditioned stimuli (US), we addressed changes in the neural processing of pain during the acquisition of pain-related fear and subsequently tested if conditioned stimuli (CS) contribute to hyperalgesia and increased neural responses in pain-encoding regions. N=49 healthy volunteers were assigned to one of two groups and underwent 3T fMRI during acquisition of either differential fear conditioning (predictable) or non-contingent presentation of CS and US (unpredictable). During a subsequent test phase, pain stimuli signaled randomly by the CSs were delivered. For the acquisition, results confirmed differential conditioning in the predictable but not the unpredictable group. With regard to activation in response to painful stimuli, the unpredictable compared to the predictable group revealed greater activation in pain-encoding (somatosensory cortex, insula) and pain-modulatory (prefrontal and cingulate cortices, periaqueductal grey, parahippocampus) regions. In the test phase, no evidence of hyperalgesia or central sensitization was found, but the predictable group demonstrated enhanced caudate nucleus activation in response to CS(-)-signaled pain. These findings support that during fear conditioning, the ability to predict pain affects neural processing of visceral pain and alters the associative learning processes underlying the acquisition of predictive properties of cues signaling pain, but conditioned pain-related fear does not result in visceral hyperalgesia or central sensitization. Copyright © 2016 Elsevier

  6. Cerebral stimulation for the affective component of neuropathic pain

    PubMed Central

    Machado, Andre G.; Baker, Kenneth B.; Plow, Ela; Malone, Donald A.

    2012-01-01

    Objective To review the current state of cerebral stimulation for neuropathic pain and to propose that cerebral stimulation should aim at the affective sphere of chronic pain rather than solely focusing on the primary sensory-discriminative sphere. Methods The past and current goals of cerebral stimulation are reviewed as well as its limitations. A novel deep brain stimulation approach is proposed to evaluate this conceptual shift fromsomatosensory to affective sphere of pain targeting Approach Thalamic and other central pain syndromes aretypically intractable to current treatment methods, including cerebral neuromodulation of somatosensory pathways, leading to long-term distress and disability. Our modern understanding of chronic pain pathophysiology is based largely on the neuromatrix theory, where cognitive, affective and sensory-discriminative spheres contribute equally to the overall pain experience. During the last decade, the safety and feasibility of chronic stimulation of neural pathways related to mood and affect has been explored with promising results. Here, we propose a novel approach to modulate the affective sphere of chronic pain by targeting similar networks in patients with treatment-refractory central pain. Our primary goal is not to produce (or measure) analgesia, but rather to modulate the affective burden of chronic. Discussion Cerebral neuromodulation for neuropathic pain has had limited efficacy thus far. Shifting our aim to neural networks related to the affective sphere of pain may allow us to reduce pain conditioning and pain-related disability. Our ultimate goal is to promote rehabilitation from chronic pain - social and occupational. PMID:23094938

  7. 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®

  8. Affective instability in patients with chronic pain: a diary approach.

    PubMed

    Rost, Silke; Van Ryckeghem, Dimitri M L; Koval, Peter; Sütterlin, Stefan; Vögele, Claus; Crombez, Geert

    2016-08-01

    Affective instability, conceptualized as fluctuations in mood over time, has been related to ill-health and psychopathology. In this study, we examined the role of affective instability on daily pain outcomes in 70 patients with chronic pain (Mage = 49.7 years; 46 females) using an end-of-day diary. During a baseline phase, patients completed self-reported questionnaires of pain severity, pain duration, disability, depression, and anxiety. During a subsequent diary phase, patients filled out an electronic end-of-day diary over 14 consecutive days assessing daily levels of pain severity, disability, cognitive complaints, negative affect (NA) and positive affect. Affective instability was operationalized as the mean square of successive differences in daily mood (separately for NA and positive affect), which takes into account the size of affective changes over consecutive days. Results indicated that NA instability was positively associated with daily disability, beyond the effects of daily pain severity. Furthermore, NA instability moderated the relationship between daily pain severity and daily disability and the relationship between daily pain severity and daily cognitive complaints. Positive affect instability, however, showed to be unrelated to all outcomes. Current findings extend previous results and reveal the putative role of affective instability on pain-related outcomes and may yield important clinical implications. Indeed, they suggest that targeting NA instability by improving emotion regulation skills may be a strategy to diminish disability and cognitive complaints in patients with chronic pain.

  9. The effect of pain on memory for affective words.

    PubMed

    Kuhajda, M C; Thorn, B E; Klinger, M R

    1998-01-01

    Memory is a key cognitive variable in pain management, but lacks extensive research. This study is a replication and extension of Seltzer and Yarczower's investigation of pain's influence on memory for affective words, which found fewer positive words and more negative words recalled if subjects were in acute pain (versus no pain). In the present study, two experiments were conducted: one with a recall memory test and one with a recognition memory test. One hundred sixty undergraduate subjects were randomly placed in one of four groups: two groups had the same condition (pain or no pain) for both the encoding task and memory test, and two groups had mixed conditions (pain at encoding-no pain at memory test or no pain at encoding-pain at memory test). Pain was induced by 0 degrees-2 degrees C water immersion. At encoding, subjects categorized words by judging them as either positive or negative. Results of both experiments show that pain impairs memory. In neither experiment were differences found on memory for positive and negative words. These results do not support Seltzer and Yarczower's discriminative effects of pain on word category, but they are consistent with other research using acute pain manipulations and chronic pain populations, suggesting that pain interferes with memory. It is hypothesized that pain depletes scarce attentional resources, thereby interfering with concurrent cognitive tasks such as thinking, reasoning, and remembering.

  10. A Preliminary Investigation of Affective Interaction in Chronic Pain Couples

    PubMed Central

    Johansen, Ayna Beate; Cano, Annmarie

    2007-01-01

    The objective of this preliminary study was to examine the extent to which affective marital interaction related to depressive symptoms in persons with chronic pain and their spouses and to pain severity in persons with pain. Couples from the community completed self-report surveys and engaged in a videotaped conversation on a topic of mutual disagreement that was coded for three affect types (i.e., anger/contempt, sadness, humor). Humor was positively related to marital satisfaction in both partners. Spouse anger/contempt and sadness were positively related to depressive symptoms in spouses. Several significant interaction effects between couple pain status (i.e., whether one or both partners reported pain) and affect also emerged. Specifically, sadness in the participant designated as the person with pain was associated with greater depressive symptoms and pain severity when only he or she reported pain whereas sadness was related to fewer depressive symptoms and less pain severity when both partners reported pain. The relationships between spouse anger and spouse depressive symptoms and between spouse humor and pain severity in the person with pain were also moderated by couple pain status. These exploratory findings can be interpreted in light of emotion regulation and pain empathy theories. For example, partners who have not experienced pain themselves may fail to empathize with persons in pain, thus preventing effective emotion regulation. When both spouses report chronic pain, expressions of negative affect may instead promote emotion regulation because the affect is experienced with a spouse who may be more empathetic. PMID:17521810

  11. Catastrophizing and pain sensitivity among chronic pain patients: moderating effects of sensory and affect focus.

    PubMed

    Michael, Elizabeth S; Burns, John W

    2004-06-01

    Pain catastrophizing is a particularly harmful cognitive factor among patients with chronic pain, but little is known of mechanisms linking this factor to pain and disability. The study examined whether attentional focus on sensory versus affective information about pain constitutes a pathway by which catastrophizing affects responses to painful stimuli. Participants were 82 chronic pain patients assigned randomly to sensory focus, affect focus, or control conditions. They underwent cold pressors first prior to and then following an information focus manipulation, and they completed the Pain Catastrophizing Scale (PCS). Regressions produced significant Condition x PCS interaction effects on threshold and tolerance change from first to second cold pressor, such that PCS scores were significantly and negatively related to these changes in both sensory and affect focus conditions, but not in the control condition. Only a main effect for PCS scores emerged for self-reported pain changes. Solving regression equations for hypothetical PCS values (+- 1 SD from the mean) revealed that (a) high catastrophizers decreased threshold and tolerance in the affect focus condition and showed no appreciable changes in sensory focus and (b) low catastrophziers showed increases in threshold and tolerance in sensory focus, but no appreciable changes in affect focus. Further, the degree to which patients focused on emotions during pain partly mediated effects of PCS scores on threshold and tolerance changes. Catastrophizing about pain may affect pain severity and distress of chronic pain patients through a bias toward processing the most disturbing elements of a painful stimulus.

  12. 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.

  13. Pain with pericoronitis affects quality of life.

    PubMed

    Magraw, Caitlin B L; Golden, Brent; Phillips, Ceib; Tang, Dana T; Munson, Joshua; Nelson, Blake P; White, Raymond P

    2015-01-01

    To assess the association between patients' pericoronitis pain symptoms and quality-of-life (QOL) outcomes for lifestyle and oral function. Subjects (American Society of Anesthesiologists health risk assessment level I or II) with mild symptoms of pericoronitis were enrolled in a study approved by the institutional review board and asked to complete a QOL instrument specifically for third molar problems covering lifestyle, oral function, and pain. Subjects assessed lifestyle and oral function using a 5-point Likert-type scale, ranging from "no trouble" (score, 1) to "lots of trouble" (score, 5), and worst and average pain using a 7-point Likert-type scale, ranging from "no pain" (score, 1) to "worst pain imaginable" (score, 7). Pain levels reported at enrollment were compared with QOL outcomes for lifestyle and oral function using Spearman correlation coefficients. Correlations of at least 0.6 were considered clinically quite important, and correlations of at least 0.4 were considered clinically important. Associations between these outcome measurements were considered statistically significant at a P value less than .05. Most of the 113 subjects were Caucasian (51%), women (56%), 23 years old or younger (58%), and well educated (91% with at least some college). Mean pain levels ± standard deviation were low (worst pain, 3.3 ± 1.5; average pain, 2.4 ± 1.2). All pain outcomes were significantly associated with items in the lifestyle and oral function domains (P < .01). Clinically important correlations were seen between pain outcomes and daily routine, social life, eating a regular diet, chewing food, and talking (P < .0001). Clinically important correlations existed between subjects' pericoronitis pain and lifestyle and oral function, associations not often considered by clinicians or policy makers. Copyright © 2015 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  14. Pain and emotion: effects of affective picture modulation.

    PubMed

    Meagher, M W; Arnau, R C; Rhudy, J L

    2001-01-01

    Two experiments examined the impact of viewing unpleasant, pleasant, and neutral photographic slides on cold-pain perception in healthy men and women. In each experiment, participants viewed one of three slide shows (experiment 1 = fear, disgust, or neutral; experiment 2 = erotic, nurturant, or neutral) immediately before a cold-pressor task. Skin conductance and heart rate were recorded during the slide shows, whereas visual analog scale ratings of pain intensity and unpleasantness thresholds and pain tolerance were recorded during the cold-pressor task. Viewing fear and disgust slides decreased pain intensity and unpleasantness thresholds, but only the fear slides decreased pain tolerance. In contrast, viewing erotic, but not nurturant, slides increased pain intensity and unpleasantness threshold ratings on the visual analog scale in men, whereas neither nurturant nor erotic slides altered pain tolerance. These results are consistent with a motivational priming model that predicts that unpleasant affective states should enhance pain and that pleasant affective states should attenuate it.

  15. The Factors Affecting Pain Pattern after Arthroscopic Rotator Cuff Repair

    PubMed Central

    Kim, Chang-Wan; Kim, Dong-Gyun

    2014-01-01

    Background We evaluated the factors that affect pain pattern after arthroscopic rotator cuff repair. Methods From June 2009 to October 2010, 210 patients underwent arthroscopic rotator cuff repair operations. Of them, 84 patients were enrolled as subjects of the present study. The evaluation of postoperative pain was conducted by visual analog scale (VAS) scores during postoperative outpatient interviews at 6 weeks, 3 months, 6 months, and 12 months. The factors that were thought to affect postoperative pain were evaluated by dividing into three categories: preoperative, operative, and postoperative. Results Pain after arthroscopic rotator cuff repair surgery showed a strictly decreasing pain pattern. In single analysis and multiple regression tests for factors influencing the strictly decreasing pain pattern, initial VAS and pain onset were shown to be statistically significant factors (p = 0.012, 0.012, 0.044 and 0.028, respectively). With regard to the factors influencing lower than average intensity pain pattern for each period, the stiffness of internal rotation at 3 months postoperatively was shown to be a statistically significant factor in single and multiple regression tests (p = 0.017 and p = 0.004, respectively). Conclusions High initial VAS scores and the acute onset of pain affected the strictly decreasing postoperative pain pattern. Additionally, stiffness of internal rotation at postoperative 3 months affected the higher than average intensity pain pattern for each period after arthroscopic rotator cuff repair. PMID:25436062

  16. Affective, sensory and empathic sharing of another's pain: The Empathy for Pain Scale.

    PubMed

    Giummarra, M J; Fitzgibbon, B M; Georgiou-Karistianis, N; Beukelman, M; Verdejo-Garcia, A; Blumberg, Z; Chou, M; Gibson, S J

    2015-07-01

    Through two studies, we introduce and validate the Empathy for Pain Scale (EPS), which characterizes the phenomenology of empathy for pain, including the vicarious experience of pain when seeing others in pain. In study 1, 406 individuals completed the EPS and Interpersonal Reactivity Index (IRI). In the EPS, four painful scenarios (witnessing surgery, patient recovering from surgery, assault and accidental injury) were rated for 12 emotional, empathic and sensory responses. In study 2, 59 participants completed the same questionnaires and then watched and rated videos of sporting injuries. In study 1, we identified three factors of the EPS with principal component analysis, which were validated with confirmatory factor analysis: affective distress; vicarious pain; and empathic concern. The EPS demonstrated good psychometric properties, re-test reliability (n = 105) and concurrent validity. In study 2, we validated the EPS against empathic reactions to the pain of others as displayed in video clips depicting sporting injuries and showed that the scale has unique utility to characterize empathic reactions to pain above general trait empathy measures. Both studies showed that the affective distress and empathic concern subscales of the EPS correlated with measures of cognitive and affective empathy from the IRI, whereas the vicarious pain subscale was only correlated with the personal distress IRI subscale. The EPS is a psychometrically sound new scale that characterizes empathy for pain and vicarious pain. The EPS offers valuable insight to the phenomenological profile of the affective, empathic and sensory dimensions of empathy for pain. © 2014 European Pain Federation - EFIC®

  17. The Role of Positive Affect in Pain and its Treatment

    PubMed Central

    Finan, Patrick H.; Garland, Eric L.

    2014-01-01

    This narrative review summarizes and integrates the available literature on PA and pain to: 1) Provide a brief overview of PA and summarize the key findings that have emerged in the study of PA and chronic pain; 2) Provide a theoretical foundation from which to understand how PA operates in the context of chronic pain; and 3) Highlight how the prevailing psychosocial treatments for chronic pain address PA in the therapeutic context, and offer suggestions for how future treatment development research can maximize the benefit of PA for patients with chronic pain. To that end, we review experimental studies that have assessed the association of evoked PA and pain sensitivity, as well as clinical studies that have assessed the association of naturally occurring PA and clinical pain in the context of chronic pain. The evidence suggests PA influences pain, over and above the influence of NA. We offer an “upward spiral” model of positive affect, resilience and pain self-management, which makes specific predictions that PA will buffer maladaptive cognitive and affective responses to pain, and promote active engagement in valued goals that enhance chronic pain self-management. PMID:24751543

  18. Anxiety and depression affect pain drawings in cervical degenerative disc disease

    PubMed Central

    MacDowall, Anna; Robinson, Yohan; Skeppholm, Martin; Olerud, Claes

    2017-01-01

    Introduction Pain drawings have been frequently used in the preoperative evaluation of spine patients. Until now most investigations have focused on low back pain patients, even though pain drawings are used in neck pain patients as well. The aims of this study were to investigate the pain drawing and its association to preoperative demographics, psychological impairment, and pain intensity. Methods We carried out a post hoc analysis of a randomized controlled trial, comparing cervical disc replacement to fusion for radiculopathy related to degenerative disc disease. Preoperatively the patients completed a pain drawing, the Hospital Anxiety and Depression Scale (HADS), and a visual analogue scale (VAS). The pain drawing was evaluated according to four established methods, now modified for cervical conditions. Comparisons were made between the pain drawing and age, sex, smoking, and employment status as well as HADS and VAS. Results Included were 151 patients, mean age of 47 years, female/male: 78/73. Pain drawing results were not affected by age, sex, smoking, and employment status. Patients with non-neurogenic pain drawings according to the modified method by Ransford had higher points on HADS-anxiety, HADS-depression, and HADS-total. Patients with markings in the head region had higher score on HADS-depression. Markings in the neck and lower arm region were associated with high values of VAS-neck and VAS-arm. Conclusions Pain drawings were affected by both pain intensity and anxiety/depression in cervical spine patients. Therefore, the pain drawing can be a useful tool when interpreting the patients’ pain in correlation to psychological impairment and pain location. PMID:28503982

  19. Affective modulation of pain in substance-dependent veterans.

    PubMed

    Rhudy, Jamie L; Dubbert, Patricia M; Parker, Jefferson D; Burke, Randy S; Williams, Amy E

    2006-01-01

    Prior work suggests that positive affect inhibits pain while negative affect facilitates it. The current study sought to determine whether: 1) affective modulation of pain extends to a patient population; 2) cocaine and alcohol dependence influences the pattern of modulation; and 3) affective modulation of pain is mediated by changes in arm temperature. Thirty-seven participants with and without substance dependence (14 alcohol, 13 cocaine, 10 none) attended three experimental sessions intended to induce emotions (negative, neutral, positive) by picture-viewing. Following emotion-induction, participants were asked to submerge their arm in 33 degrees F water and keep it there until they reached tolerance. During submersion, pain ratings were made on a mechanical visual analog scale (M-VAS). Latency from submersion to first movement of the M-VAS (pain threshold) and latency to arm removal (pain tolerance) were measured. Arm temperature and manipulation checks for emotion-induction (corrugator electromyogram, heart rate, skin conductance, self-report) were also recorded. Manipulation checks confirmed that targeted affective states were achieved. Pain threshold and tolerance were higher after viewing pleasant pictures than after unpleasant ones. Although arm temperature did vary based on the affect induced, analyses suggested that temperature did not influence pain outcomes. Affect modulates pain perception in patients and does not appear to be mediated by changes in arm temperature. Additionally, pain modulation was not significantly influenced by cocaine or alcohol dependence. These data are encouraging, because they suggest that nonpharmacological methods of pain modulation may be effective in substance-dependent individuals.

  20. A preliminary study on how hypohydration affects pain perception.

    PubMed

    Bear, Tracey; Philipp, Michael; Hill, Stephen; Mündel, Toby

    2016-05-01

    Chronic pain is a prevalent health issue with one in five people suffering from some form of chronic pain, with loss of productivity and medical costs of chronic pain considerable. However, the treatment of pain can be difficult, as pain perception is complex and can be affected by factors other than tissue damage. This study investigated the effect of hypohydration (mild, voluntary dehydration from ∼24 h of limiting fluid intake, mimicking someone drinking less than usual) on a person's pain perception. Seventeen healthy males (age 27 ± 5 years) visited the laboratory on three occasions, once as a familiarization and then twice again while either euhydrated (urine specific gravity: 1.008 ± 0.005) or hypohydrated (urine specific gravity: 1.024 ± 0.003, and -1.4 ± 0.9% body mass). Each visit, they performed a cold pressor test, where their feet were placed in cold water (0-3 °C) for a maximum of 4 min. Measures of hydration status, pain sensitivity, pain threshold, and catastrophization were taken. We found that hypohydration predicted increased pain sensitivity (β = 0.43), trait pain catastrophizing, and baseline pain sensitivity (β = 0.37 and 0.47, respectively). These results are consistent with previous research, and suggest that a person's hydration status may be an important factor in their perception of acute pain. © 2016 Society for Psychophysiological Research.

  1. Affect balance style, experimental pain sensitivity, and pain-related responses

    PubMed Central

    Sibille, Kimberly T.; Kindler, Lindsay L.; Glover, Toni L.; Staud, Roland; Riley, Joseph L.; Fillingim, Roger B.

    2011-01-01

    Objectives Affect is neurobiologically based, influences emotions, contributes to temperamental characteristics, and can be evaluated from both a state and trait perspective. Associations between state-related positive affect (PA), negative affect (NA), and chronic pain have been investigated. However, little is known about the relationship between trait affect patterns and pain-related experiences. Affect balance style (ABS) provides a framework to assess the combined contribution of trait PA and NA. Psychological factors and experimental pain sensitivity are indicated as predictors of chronic pain onset. The current study investigated the relationship between ABS, pain sensitivity, and pain-related measures in healthy adults. Methods Subjects (n=372) completed quantitative sensory testing, pain-related questionnaires, and the Positive and Negative Affect Scale (PANAS). ABS groups were categorized as Healthy (high PA, low NA), Low (low PA, low NA), Depressive (low PA, high NA), and Reactive (high PA, high NA). Z-scores were computed for three experimental pain measures: ischemic, pressure, and heat. Results ABS groups significantly differed on ischemic pain sensitivity and pain-related measures. Specifically, the Healthy group demonstrated lower ischemic pain sensitivity compared to the Reactive group (p=0.02); the Depressive and Reactive groups endorsed higher somatic symptoms compared to the Healthy group (p<0.02); the Low and Depressive groups reported more physical stimuli sensitivity than the Healthy group (p<0.02); and the Reactive group indicated more passive coping strategies then the Low and Healthy groups (p=0.001). Discussion Findings from the study suggest that among healthy adults, trait affect patterns are associated with ischemic experimental pain sensitivity and other pain-related measures. PMID:22367502

  2. Affect balance style, experimental pain sensitivity, and pain-related responses.

    PubMed

    Sibille, Kimberly T; Kindler, Lindsay L; Glover, Toni L; Staud, Roland; Riley, Joseph L; Fillingim, Roger B

    2012-06-01

    Affect is neurobiologically based, influences emotions, contributes to temperamental characteristics, and can be evaluated from both state and trait perspectives. Associations between state-related positive affect (PA), negative affect (NA), and chronic pain have been investigated. However, little is known about the relationship between trait affect patterns and pain-related experiences. Affect balance style (ABS) provides a framework to assess the combined contribution of trait PA and NA. Psychological factors and experimental pain sensitivity are indicated as predictors of chronic pain onset. The current study investigated the relationship between ABS, pain sensitivity, and pain-related measures in healthy adults. Participants (n=372) completed quantitative sensory testing, pain-related questionnaires, and the Positive and Negative Affect Scale. ABS groups were categorized as Healthy (high PA, low NA), Low (low PA, low NA), Depressive (low PA, high NA), and Reactive (high PA, high NA). Z-scores were computed for 3 experimental pain measures: ischemic, pressure, and heat. ABS groups significantly differed on ischemic pain sensitivity and pain-related measures. Specifically, the Healthy group demonstrated lower ischemic pain sensitivity compared with the Reactive group (P=0.02); the Depressive and Reactive groups endorsed higher somatic symptoms compared with the Healthy group (P<0.02); the Low and Depressive groups reported more physical stimuli sensitivity than the Healthy group (P<0.02); and the Reactive group indicated more passive coping strategies then the Low and Healthy groups (P=0.001). Findings from the study suggest that among healthy adults, trait affect patterns are associated with ischemic experimental pain sensitivity and other pain-related measures.

  3. Pain vulnerability and DNA methyltransferase 3a involved in the affective dimension of chronic pain.

    PubMed

    Wang, Wei; Li, Caiyue; Cai, Youqing; Pan, Zhizhong Z

    2017-01-01

    Chronic pain with comorbid emotional disorders is a prevalent neurological disease in patients under various pathological conditions, yet patients show considerable difference in their vulnerability to developing chronic pain. Understanding the neurobiological basis underlying this pain vulnerability is essential to develop targeted therapies of higher efficiency in pain treatment of precision medicine. However, this pain vulnerability has not been addressed in preclinical pain research in animals to date. In this study, we investigated individual variance in both sensory and affective/emotional dimensions of pain behaviors in response to chronic neuropathic pain condition in a mouse model of chronic pain. We found that mice displayed considerably diverse sensitivities in the chronic pain-induced anxiety- and depression-like behaviors of affective pain. Importantly, the mouse group that was more vulnerable to developing anxiety was also more vulnerable to developing depressive behavior under the chronic pain condition. In contrast, there was relatively much less variance in individual responses in the sensory dimension of pain sensitization. Molecular analysis revealed that those mice vulnerable to developing the emotional disorders showed a significant reduction in the protein level of DNA methyltransferase 3a in the emotion-processing central nucleus of the amygdala. In addition, social stress also revealed significant individual variance in anxiety behavior in mice. These findings suggest that individual pain vulnerability may be inherent mostly in the emotional/affective component of chronic pain and remain consistent in different aspects of negative emotion, in which adaptive changes in the function of DNA methyltransferase 3a for DNA methylation in central amygdala may play an important role. This may open a new avenue of basic research into the neurobiological mechanisms underlying pain vulnerability.

  4. Pain vulnerability and DNA methyltransferase 3a involved in the affective dimension of chronic pain

    PubMed Central

    Wang, Wei; Li, Caiyue; Cai, Youqing

    2017-01-01

    Chronic pain with comorbid emotional disorders is a prevalent neurological disease in patients under various pathological conditions, yet patients show considerable difference in their vulnerability to developing chronic pain. Understanding the neurobiological basis underlying this pain vulnerability is essential to develop targeted therapies of higher efficiency in pain treatment of precision medicine. However, this pain vulnerability has not been addressed in preclinical pain research in animals to date. In this study, we investigated individual variance in both sensory and affective/emotional dimensions of pain behaviors in response to chronic neuropathic pain condition in a mouse model of chronic pain. We found that mice displayed considerably diverse sensitivities in the chronic pain-induced anxiety- and depression-like behaviors of affective pain. Importantly, the mouse group that was more vulnerable to developing anxiety was also more vulnerable to developing depressive behavior under the chronic pain condition. In contrast, there was relatively much less variance in individual responses in the sensory dimension of pain sensitization. Molecular analysis revealed that those mice vulnerable to developing the emotional disorders showed a significant reduction in the protein level of DNA methyltransferase 3a in the emotion-processing central nucleus of the amygdala. In addition, social stress also revealed significant individual variance in anxiety behavior in mice. These findings suggest that individual pain vulnerability may be inherent mostly in the emotional/affective component of chronic pain and remain consistent in different aspects of negative emotion, in which adaptive changes in the function of DNA methyltransferase 3a for DNA methylation in central amygdala may play an important role. This may open a new avenue of basic research into the neurobiological mechanisms underlying pain vulnerability. PMID:28849714

  5. Associations between pain drawing and psychological characteristics of different body region pains.

    PubMed

    Hayashi, Kazuhiro; Arai, Young-Chang P; Morimoto, Atsuko; Aono, Shuichi; Yoshimoto, Takahiko; Nishihara, Makoto; Osuga, Tomoaki; Inoue, Shinsuke; Ushida, Takahiro

    2015-04-01

    Pain drawings have frequently been used for documentation of pain and a convenient diagnosis tool. Pain drawings were found to be associated with psychological states in chronic patients with low back pain. Few researchers have investigated pain drawings except in low back pain. The aim of this study was to investigate the pain, pain drawings, psychological characteristics, and pain interference in the head, neck-shoulder (NS), and low-back/lower-limb (LB-LL) regions among patients with chronic pain. We included a total of 291 patients with new chronic pain (headache, 62; NS pain, 87; LB-LL pain, 142). The pain drawings and scores of 10-cm Visual Analogue Scale (VAS), Hospital Anxiety and Depression Scale (HADS), Pain Catastrophizing Scale (PCS), Short-Form McGill Pain Questionnaire (SF-MPQ), and Pain Disability Assessment Scale (PDAS) were extracted from medical records. A subset of 60 pain drawings was scored by senior and junior evaluators to assess inter-rater agreement. We investigated the correlation between pain drawings and VAS, HADS, PCS, SF-MPQ, and PDAS in each body region group at the initial visit. Moreover, almost all patients received nonsurgical treatment as a follow-up and were investigated using VAS after treatment. The reliability of pain drawings was substantial with an interevaluator reliability in headache, NS, and LB-LL pain. Nonorganic pain drawings were associated with psychological disturbances in NS and LB-LL pain, but not headache. Poor outcomes were associated with nonorganic drawings in LB-LL pain, but not in the case of headache or NS pain. Our results suggest that the characteristics of patients with nonorganic drawings differ according to body regions. © 2014 World Institute of Pain.

  6. Vagus nerve stimulation modulates visceral pain-related affective memory.

    PubMed

    Zhang, Xu; Cao, Bing; Yan, Ni; Liu, Jin; Wang, Jun; Tung, Vivian Oi Vian; Li, Ying

    2013-01-01

    Within a biopsychosocial model of pain, pain is seen as a conscious experience modulated by mental, emotional and sensory mechanisms. Recently, using a rodent visceral pain assay that combines the colorectal distension (CRD) model with the conditioned place avoidance (CPA) paradigms, we measured a learned behavior that directly reflects the affective component of visceral pain, and showed that perigenual anterior cingulate cortex (pACC) activation is critical for memory processing involved in long-term visceral affective state and prediction of aversive stimuli by contextual cue. Electrical vagus nerve stimulation (VNS) has become an established therapy for treatment-resistant epilepsy. VNS has also been shown to enhance memory performance in rats and humans. High-intensity VNS (400 μA) immediately following conditional training significantly increases the CRD-induced CPA scores, and enhanced the pain affective memory retention. In contrast, VNS (400 μA) had no effect on CPA induced by non-nociceptive aversive stimulus (U69,593). Low-intensity VNS (40 μA) had no effect on CRD-induced CPA. Electrophysiological recording showed that VNS (400 μA) had no effect on basal and CRD-induced ACC neuronal firing. Further, VNS did not alter CRD-induced visceral pain responses suggesting high intensity VNS facilitates visceral pain aversive memory independent of sensory discriminative aspects of visceral pain processing. The findings that vagus nerve stimulation facilities visceral pain-related affective memory underscore the importance of memory in visceral pain perception, and support the theory that postprandial factors may act on vagal afferents to modulate ongoing nature of visceral pain-induced affective disorder observed in the clinic, such as irritable bowel syndrome. Copyright © 2012 Elsevier B.V. All rights reserved.

  7. Sensory and affective pain discrimination after inhalation of essential oils.

    PubMed

    Gedney, Jeffrey J; Glover, Toni L; Fillingim, Roger B

    2004-01-01

    The purpose of this investigation was to examine the effects of olfactory absorption of two commonly used therapeutic essential oils on sensory and affective responses to experimentally induced pain. A sex-balanced (13 men and 13 women) randomized crossover design was used to obtain pre- and posttreatment change scores for quantitative sensory ratings of contact heat, pressure, and ischemic pain across separate inhalation treatment conditions using essential oil of lavender, essential oil of rosemary, and distilled water (control). Subjective reports of treatment-related changes in pain intensity and pain unpleasantness were obtained for each condition using a visual analog scale. We interpret our findings with respect to the separate dimensions of sensory and affective processing of pain. Analyses revealed the absence of changes in quantitative pain sensitivity ratings between conditions. However, retrospectively, subjects' global impression of treatment outcome indicated that both pain intensity and pain unpleasantness were reduced after treatment with lavender and marginally reduced after treatment with rosemary, compared with the control condition. These findings suggest that aromatherapy may not elicit a direct analgesic effect but instead may alter affective appraisal of the experience and consequent retrospective evaluation of treatment-related pain.

  8. Determining the pain-affecting factors of university students with nonspecific low back pain.

    PubMed

    Taspinar, Ferruh; Taspinar, Betul; Cavlak, Ugur; Celik, Erdal

    2013-12-01

    [Purpose] This study was conducted on university students with nonspecific low back pain in order to determine the independent variables that affect their pain. [Methods] A total of 514 students were included in this study. Pain was evaluated using a Visual Analogue Scale (VAS). A special form was prepared in order to evaluate the following independent variables: gender, weight, height, Body Mass Index (BMI), working periods sitting straight (television, computer, seminar, etc.), working periods bending at a table (reading, writing, etc.), using lumbar support while sitting, the mean duration of pain within the last one year, type of pain, time of the pain, faculty, class, physical activity habits and smoking. The collected data were evaluated using the CHAID (Chi-squared Automatic Interaction Detection) analysis method. [Results] The working hours bending at a table, physical activity, height, weight, BMI and educational departments were found not to affect the severity of the pain. The pain severity was affected by the duration of pain complaints within the last one year, the duration of working staying upright, smoking, classes, usage of lumbar support and age variables. [Conclusions] The results of this study show that nonspecific low back pain of university students is affected by many factors such as smoking, class, age, using a computer and lumbar support.

  9. Complex regional pain syndrome following transfemoral catheterization.

    PubMed

    Saad, Andre; Knolla, Raelene; Gupta, Kamal

    2011-11-01

    Complex regional pain syndrome (CRPS) (previously reflex sympathetic dystrophy) is a chronic pain condition usually resulting as a consequence of trauma or surgery. Though described occasionally after vascular surgery, it is distinctly rare after percutaneous cardiovascular procedures. We report a case of CRPS following trans- femoral catheterization-related groin pseudoaneurysm. To our knowledge, this is the first such report following transfemoral catheterization. A 36-year-old female underwent an electrophysiological study and AV node re-entry tachycardia ablation using the left femoral vein approach. One month later she presented complaining of numbness and tingling in her left foot with swelling and mild groin discomfort. A lower extremity duplex scan showed a left common femoral artery pseudoaneurysm that was partially thrombosed and subsequently resolved spontaneously. The patient had intractable symptoms of pain, temperature changes, color changes, and trophic changes of the left foot. Conventional angiography was done to rule out occlusive arterial disease but just showed very sluggish flow. Further evaluation with transcutaneous oxymetry and 3-phase bone scan was consistent with microvascular dysfunction and poor cutaneous blood flow suggestive of cold-type CRPS. In this case report, we also review the clinical features and the vascular changes associated with CRPS and discuss the pathophysiology of the syndrome from a cardiovascular specialist's perspective. Interventionalists should be aware that CRPS is a possible, albeit rare, condition that may follow many vascular procedures that they perform on a daily basis.

  10. [Complex regional pain syndrome versus chronic regional pain syndrome (Hand-Finger Syndrome)].

    PubMed

    Wulle, C

    2010-02-01

    Dystrophy is a main factor of CRPS. A large number of patients do not develop dystrophy but, instead, they suffer from pain with limitation in movement, possible paraesthesia and/or swelling. This is then a chronic regional pain syndrome or (shoulder-arm-) hand-finger syndrome. These patients should never be confronted with the diagnosis Morbus Sudeck or algodystrophy, which are today also well known among non-professionals, to avoid pushing them into a status of constant severe invalidity. Histories, clinical examination, as well as a good personal understanding of the patient are indispensable. Knowing that pain, or the extent of pain, remains subjective until today, the clinical diagnosis depends on the absence of side differences in: a) the circumference of soft tissues of both upper extremities; b) the callosity of the palm; c) the bone-density. These three parameters allow verification of the consequences of the pain complaints (indirect pain verification). It is essential to find the cause for their suffering and to treat it as far as possible: 1) Too long and inappropriate immobilisation (patient's suffering not considered sufficiently). These patients can recover quickly when the right diagnosis is made in good time. 2) Limitation of movement due to scar, neuroma, or elongation pain: a) bizarre functional disabilities can develop; b) due to the patient's complaints, one or several operations would finally be performed, which will not lead to an improvement but rather to an aggravation of the pain; c) socially-induced purposeful pain increase, the typical statement of the patient will be: "I can't stand it any longer". Patients who are socially over-burdened, or have psycho-social problems, may experience a decline of performance or a post-traumatic stress disorder. Several patients will be introduced as illustrations for each of the relevant groups.

  11. Affect and Low Back Pain: More to Consider than the Influence of Negative Affect Alone

    PubMed Central

    Hassett, Afton L.; Goesling, Jenna; Mathur, Sunjay N.; Moser, Stephanie E.; Brummett, Chad M.; Sibille, Kimberly T.

    2016-01-01

    Objectives Affect balance style, a measure of trait positive and negative affect, 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. Methods In this cross-sectional study, patients with low back pain (N=443) completed questionnaires and were categorized as having one of four distinct affect balance styles: Healthy (high levels of positive affect [PA] and low levels of negative affect [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. Results High NA was observed in 63% (n=281), while low positive affect 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 to having a Healthy or Low style. Yet, those with a Low style were at increased risk for depression compared to a Healthy style, while patients with a Reactive style had similar levels of pain, functioning and depression as those with a Healthy affective style Conclusion 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 negative affect alone. PMID:26889620

  12. Stroke, complex regional pain syndrome and phantom limb pain: can commonalities direct future management?

    PubMed

    Acerra, Nicole E; Souvlis, Tina; Moseley, G Lorimer

    2007-03-01

    Despite being different conditions, complex regional pain syndrome type 1, phantom limb pain and stroke share some potentially important similarities. This report examines experimental and clinical findings from each patient population. It identifies common aspects of symptomatic presentation, sensory phenomena and patterns of cortical reorganization. Based on these common findings, we argue that established principles of stroke rehabilitation are also applicable to rehabilitation of complex regional pain syndrome type 1 and phantom limb pain. In addition, we contend that promising treatment approaches for complex regional pain syndrome type 1 and phantom limb pain may be helpful in stroke rehabilitation. Examples of emerging supportive evidence for these hypotheses are provided and discussed.

  13. Negative affect, pain and sex: the role of endogenous opioids.

    PubMed

    Frew, Ashley K; Drummond, Peter D

    2007-11-01

    Opioid neurotransmission modulates pain and negative affect during psychological stress. To determine whether these effects differ between men and women, the opioid receptor antagonist naltrexone or placebo was administered double-blind to 21 men and 22 women before they completed 30 min of difficult mental arithmetic. To heighten negative affect, participants received seven moderately noxious electric shocks during the math task, which were believed to be contingent upon performance. Before and after the math task, participants rated pain intensity and unpleasantness while their left hand was immersed in 2 degrees C water for up to 4 min. Anxiety, discouragement and anger were also rated before, during and after the math task. Tolerance of cold-induced pain was greater in men, whereas discouragement during the math task was greater in women. Opioid blockade did not influence ratings of negative affect, which increased in line with the intensity and unpleasantness of shock-induced pain. The intensity and unpleasantness of cold-induced pain increased after the math task only in women administered naltrexone. Within the naltrexone condition, pain ratings increased most in the most discouraged subjects. However, this relationship was absent in placebo recipients, implying that the hyperalgesic effect of psychological distress was tempered by opioid release. Greater stress-evoked discouragement in women than men may explain why cold-induced pain increased after the math task only in women administered naltrexone.

  14. Rethinking the Psychogenic Model of Complex Regional Pain Syndrome: Somatoform Disorders and Complex Regional Pain Syndrome

    PubMed Central

    Hill, Renee J.; Chopra, Pradeep; Richardi, Toni

    2012-01-01

    Abstract Explaining the etiology of Complex Regional Pain Syndrome (CRPS) from the psychogenic model is exceedingly unsophisticated, because neurocognitive deficits, neuroanatomical abnormalities, and distortions in cognitive mapping are features of CRPS pathology. More importantly, many people who have developed CRPS have no history of mental illness. The psychogenic model offers comfort to physicians and mental health practitioners (MHPs) who have difficulty understanding pain maintained by newly uncovered neuro inflammatory processes. With increased education about CRPS through a biopsychosocial perspective, both physicians and MHPs can better diagnose, treat, and manage CRPS symptomatology. PMID:24223338

  15. Rethinking the psychogenic model of complex regional pain syndrome: somatoform disorders and complex regional pain syndrome.

    PubMed

    Hill, Renee J; Chopra, Pradeep; Richardi, Toni

    2012-01-01

    Explaining the etiology of Complex Regional Pain Syndrome (CRPS) from the psychogenic model is exceedingly unsophisticated, because neurocognitive deficits, neuroanatomical abnormalities, and distortions in cognitive mapping are features of CRPS pathology. More importantly, many people who have developed CRPS have no history of mental illness. The psychogenic model offers comfort to physicians and mental health practitioners (MHPs) who have difficulty understanding pain maintained by newly uncovered neuro inflammatory processes. With increased education about CRPS through a biopsychosocial perspective, both physicians and MHPs can better diagnose, treat, and manage CRPS symptomatology.

  16. Neuroanatomy of the female abdominopelvic region: A review with application to pelvic pain syndromes.

    PubMed

    Shoja, Mohammadali M; Sharma, Amit; Mirzayan, Nadine; Groat, Chris; Watanabe, Koichi; Loukas, Marios; Tubbs, R Shane

    2013-01-01

    Pelvic pain can be a life altering disease. Multiple pathologies can affect this region resulting in neurologic issues. Therefore, a thorough understanding of the nerve supply to this region is important for the clinician who treats such patients. The current review outlines the anatomy of the nervous system of the abdominopelvic region with special attention to this anatomy in the female.

  17. Are pain-related fears mediators for reducing disability and pain in patients with complex regional pain syndrome type 1? An explorative analysis on pain exposure physical therapy.

    PubMed

    Barnhoorn, Karlijn J; Staal, J Bart; van Dongen, Robert T M; Frölke, Jan Paul M; Klomp, Frank P; van de Meent, Henk; Samwel, Han; Nijhuis-van der Sanden, Maria W G

    2014-01-01

    To investigate whether pain-related fears are mediators for reducing disability and pain in patients with Complex Regional Pain Syndrome type 1 when treating with Pain Exposure Physical Therapy. An explorative secondary analysis of a randomised controlled trial. Fifty-six patients with Complex Regional Pain Syndrome type 1. The experimental group received Pain Exposure Physical Therapy in a maximum of five treatment sessions; the control group received conventional treatment following the Dutch multidisciplinary guideline. Levels of disability, pain, and pain-related fears (fear-avoidance beliefs, pain catastrophizing, and kinesiophobia) were measured at baseline and after 3, 6, and 9 months follow-up. The experimental group had a significantly larger decrease in disability of 7.77 points (95% CI 1.09 to 14.45) and in pain of 1.83 points (95% CI 0.44 to 3.23) over nine months than the control group. The potential mediators pain-related fears decreased significantly in both groups, but there were no significant differences between groups, which indicated that there was no mediation. The reduction of pain-related fears was comparable in both groups. We found no indication that pain-related fears mediate the larger reduction of disability and pain in patients with Complex Regional Pain Syndrome type 1 treated with Pain Exposure Physical Therapy compared to conventional treatment. International Clinical Trials Registry NCT00817128.

  18. Chronic visceral pain secondary to ventral disc herniation: Development of visceral complex regional pain syndrome.

    PubMed

    Lauretti, Gabriela Rocha; de Oliveira, Raquel

    2015-01-01

    When an organ disease is ruled out as the origin of pelvic pain, the superior hypogastric plexus (SHP) injury and consequent dysfunction could be the mechanism of visceral chronic pain perpetuation. As much as a dorsal discus herniation may harm the dorsal or ventral roots, a ventral discus herniation at L4-L5 or L5-S1 may result in direct physical trauma to the SHP, maintaining chronic visceral pain mediated by sympathetic dysfunction, conceivably also afferent fibers dysfunction. We propose that similarly to nociceptive somatic dysfunction named complex regional pain syndrome, the maintained sympathetic pelvic pain secondary to straight physical damage to the SHP characterize in fact the same disease, but in nociceptive visceral tissue, named visceral complex regional pain syndrome, a concept constructed based on the International Association for the Study of Pain criteria (1994).

  19. The story of the Texas Pain Society: formation and function of a regional pain society.

    PubMed

    Raj, P Prithvi; Hill, C Stratton; Racz, Gabor; Heavner, James; Grabois, Martin; Neill, Lynn; Willis, William; Schade, C M; Rashbaum, Ralph; Calodney, Aaron; Burton, Allen W; Somerville, Judson

    2012-01-01

    The idea of forming a Texas Pain Society came to the Founders in 1987 due to disparity and deficiencies in the practice of pain management in the United States and, in particular, the State of Texas. The Founders considered very carefully the implication of forming such a society. They diligently mapped out the mission and goals of the Texas Pain Society in those early formative years. This report is the history of Texas Pain Society as the activities unfolded from 1989 to 2011. The reader may question why there is a need to tell such a story. We believe strongly that, with disparities of standards of practice in pain medicine and poor recognition of advances in pain management, this scenario is quite common in many states and countries. The practitioners of pain management in these regions certainly must have considered getting together and forming a consensus on the standards of practice in their communities. This historical report of the Texas Pain Society provides the relevant information necessary and the efforts to be made for a society's mission to achieve its goals and have an ongoing impact in its own region. We hope that we have shed some light on a process for the formation of a regional pain society such as ours.  © 2011 The Authors. Pain Practice © 2011 World Institute of Pain.

  20. Pain management and regional anesthesia for the dental patient.

    PubMed

    Woodward, Tony M

    2008-05-01

    Current standards of care in veterinary medicine dictate an adequate level of pain control for our patients. Effective pain control uses a proactive, multimode approach that starts with preoperative medications, includes the anesthetic protocol selected, and continues into the postoperative period. A basic understanding of the physiology of pain assists in selecting those agents and modalities best suited for individual patients. Analgesic drug selection and local anesthesia are both integral parts of pain control when performing surgery in the oral cavity. Local (regional) anesthesia plays an important part in the pain control of oral surgical patients. Regional anesthetic techniques are used for many common oral procedures, including extractions, periodontal flap surgery, treatment of traumatic injuries of the oral cavity, tumor removal, palatal surgery, periodontal therapy, and root canal therapy. This presentation will cover strategies for analgesia and the techniques and materials used in local/regional anesthesia in the oral cavity. Anatomic landmarks and guidelines for effective regional blocks will be covered.

  1. Neuropathic pain in the orofacial region: The role of pain history. A retrospective study.

    PubMed

    Dieb, W; Moreau, N; Chemla, I; Descroix, V; Boucher, Y

    2017-06-01

    Orofacial neuropathic pain is often difficult to treat, mostly because of still unclear underlying mechanisms. The occurrence of such neuropathic pain varies depending on different factors, of which preexisting preoperative pain seems to be of high importance. The aim of this study was thus to test the hypothesis that prior history of pain could indeed be considered a risk factor for the development of orofacial neuropathic pain in the same region. The study was performed in the dental department of the Groupe Hospitalier Pitié-Salpêtrière (GHPS) in Paris, France. We investigated the presence of prior inflammatory pain before development of orofacial neuropathic pain in 56 patients. For each patient file, the following items were collected: age, gender; medical history; diagnosis; description of the pain (at time of consultation); presence or absence of prior dental treatment; date and type of dental treatment received. 41 patients (73%) of orofacial neuropathic pain patients had a history of pain compatible with an inflammatory condition; 4% (n=2) did not report any prior pain and 23% (n=13) could not remember. Among the patients with documented history of pain prior to neuropathy, 88% (n=36) received surgical treatment; 61%, (n=25) endodontic treatment and 22%, (n=9) restorative treatment. All eventually received endodontic treatment or tooth extraction. These dental treatments are compatible with the hypothesis of prior inflammatory pain in these patients. These results support the hypothesis that prior inflammatory pain could favor the development of orofacial neuropathic pain. Prevention and treatment of inflammatory trigeminal pain may therefore play a key role in preventing future neuropathic pain development. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  2. Effects of daily pain intensity, positive affect, and individual differences in pain acceptance on work goal interference and progress.

    PubMed

    Mun, Chung Jung; Karoly, Paul; Okun, Morris A

    2015-11-01

    Multilevel modeling was used to examine the effects of morning pain intensity and morning positive and negative affect on pain's interference with afternoon work goal pursuit and with evening work goal progress in a community sample of 132 adults who completed a 21-day diary. The moderating effects of pain acceptance and pain catastrophizing on the associations between morning pain intensity and afternoon work goal interference were also tested. Results revealed that the positive relationship between morning pain intensity and pain's interference with work goal pursuit was significantly moderated by pain acceptance, but not by pain catastrophizing. Both morning pain intensity and positive affect exerted significant indirect effects on evening work goal progress through the perception of pain's interference with work goal pursuit in the afternoon. Furthermore, the mediated effect of morning pain on evening work goal progress was significant when pain acceptance was at the grand mean and 1 SD below the grand mean, but not when pain acceptance was 1 SD above the grand mean. Thus, it appears that high pain acceptance significantly attenuates pain's capacity to disrupt work goal pursuit. Moreover, morning positive affect appears to operate as a protective factor. Additional interpretations and potential explanations for some inconsistent outcomes are discussed along with limitations, clinical implications, and suggestions for future studies.

  3. 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.

  4. [Pleasure, pain and affectivity in the nervous system].

    PubMed

    Houdart, R

    1999-01-01

    Affectivity plays an essential role in human life. It gives life its quality, and is responsible for what human beings have always considered to be main endeavor happiness. Still, looking for its description or organisation, in physiology or neurology, treatises is fruitless; there only one of its components is described pain, with no mention of pleasure. We wish to show, here, first, that pain and pleasure, depend of a same function, of which they are, of sorts, both extremities, and which in nothing but the most primitive function of the nervous system, and secondly, that this function in one of the components of an "affectivity center", which has its organisation in the limbic system. This center, integrating all the informations that arrives to the nervous system, triggers to each of them neuro-vegetative and neuro-hormonal informations that are "felt" by the organism, and thus transforms the information in a subjective feeling.

  5. Prevalence of facet joint pain in chronic spinal pain of cervical, thoracic, and lumbar regions

    PubMed Central

    Manchikanti, Laxmaiah; Boswell, Mark V; Singh, Vijay; Pampati, Vidyasagar; Damron, Kim S; Beyer, Carla D

    2004-01-01

    Background Facet joints are a clinically important source of chronic cervical, thoracic, and lumbar spine pain. The purpose of this study was to systematically evaluate the prevalence of facet joint pain by spinal region in patients with chronic spine pain referred to an interventional pain management practice. Methods Five hundred consecutive patients with chronic, non-specific spine pain were evaluated. The prevalence of facet joint pain was determined using controlled comparative local anesthetic blocks (1% lidocaine or 1% lidocaine followed by 0.25% bupivacaine), in accordance with the criteria established by the International Association for the Study of Pain (IASP). The study was performed in the United States in a non-university based ambulatory interventional pain management setting. Results The prevalence of facet joint pain in patients with chronic cervical spine pain was 55% 5(95% CI, 49% – 61%), with thoracic spine pain was 42% (95% CI, 30% – 53%), and in with lumbar spine pain was 31% (95% CI, 27% – 36%). The false-positive rate with single blocks with lidocaine was 63% (95% CI, 54% – 72%) in the cervical spine, 55% (95% CI, 39% – 78%) in the thoracic spine, and 27% (95% CI, 22% – 32%) in the lumbar spine. Conclusion This study demonstrated that in an interventional pain management setting, facet joints are clinically important spinal pain generators in a significant proportion of patients with chronic spinal pain. Because these patients typically have failed conservative management, including physical therapy, chiropractic treatment and analgesics, they may benefit from specific interventions designed to manage facet joint pain. PMID:15169547

  6. Children and adolescents with complex regional pain syndrome: more psychologically distressed than other children in pain?

    PubMed

    Logan, Deirdre E; Williams, Sara E; Carullo, Veronica P; Claar, Robyn Lewis; Bruehl, Stephen; Berde, Charles B

    2013-01-01

    Historically, in both adult and pediatric populations, a lack of knowledge regarding complex regional pain syndrome (CRPS) and absence of clear diagnostic criteria have contributed to the view that this is a primarily psychiatric condition. To test the hypothesis that children with CRPS are more functionally disabled, have more pain and are more psychologically distressed than children with other pain conditions. A total of 101 children evaluated in a tertiary care pediatric pain clinic who met the International Association for the Study of Pain consensus diagnostic criteria for CRPS participated in the present retrospective study. Comparison groups included 103 children with abdominal pain, 291 with headache and 119 with back pain. Children and parents completed self-report questionnaires assessing disability, somatization, pain coping, depression, anxiety and school attendance. Children with CRPS reported higher pain intensity and more recent onset of pain at the initial tertiary pain clinic evaluation compared with children with other chronic pain conditions. They reported greater functional disability and more somatic symptoms than children with headaches or back pain. Scores on measures of depression and anxiety were within normal limits and similar to those of children in other pain diagnostic groups. As a group, clinic-referred children with CRPS may be more functionally impaired and experience more somatic symptoms compared with children with other pain conditions. However, overall psychological functioning as assessed by self-report appears to be similar to that of children with other chronic pain diagnoses. Comprehensive assessment using a biopsychosocial framework is essential to understanding and appropriately treating children with symptoms of CRPS.

  7. Children and adolescents with complex regional pain syndrome: More psychologically distressed than other children in pain?

    PubMed Central

    Logan, Deirdre E; Williams, Sara E; Carullo, Veronica P; Claar, Robyn Lewis; Bruehl, Stephen; Berde, Charles B

    2013-01-01

    BACKGROUND Historically, in both adult and pediatric populations, a lack of knowledge regarding complex regional pain syndrome (CRPS) and absence of clear diagnostic criteria have contributed to the view that this is a primarily psychiatric condition. OBJECTIVE: To test the hypothesis that children with CRPS are more functionally disabled, have more pain and are more psychologically distressed than children with other pain conditions. METHODS: A total of 101 children evaluated in a tertiary care pediatric pain clinic who met the International Association for the Study of Pain consensus diagnostic criteria for CRPS participated in the present retrospective study. Comparison groups included 103 children with abdominal pain, 291 with headache and 119 with back pain. Children and parents completed self-report questionnaires assessing disability, somatization, pain coping, depression, anxiety and school attendance. RESULTS: Children with CRPS reported higher pain intensity and more recent onset of pain at the initial tertiary pain clinic evaluation compared with children with other chronic pain conditions. They reported greater functional disability and more somatic symptoms than children with headaches or back pain. Scores on measures of depression and anxiety were within normal limits and similar to those of children in other pain diagnostic groups. CONCLUSIONS: As a group, clinic-referred children with CRPS may be more functionally impaired and experience more somatic symptoms compared with children with other pain conditions. However, overall psychological functioning as assessed by self-report appears to be similar to that of children with other chronic pain diagnoses. Comprehensive assessment using a biopsychosocial framework is essential to understanding and appropriately treating children with symptoms of CRPS. PMID:23662291

  8. Regulation of peripheral blood flow in Complex Regional Pain Syndrome: clinical implication for symptomatic relief and pain management

    PubMed Central

    Groeneweg, George; Huygen, Frank JPM; Coderre, Terence J; Zijlstra, Freek J

    2009-01-01

    Background During the chronic stage of Complex Regional Pain Syndrome (CRPS), impaired microcirculation is related to increased vasoconstriction, tissue hypoxia, and metabolic tissue acidosis in the affected limb. Several mechanisms may be responsible for the ischemia and pain in chronic cold CPRS. Discussion The diminished blood flow may be caused by either sympathetic dysfunction, hypersensitivity to circulating catecholamines, or endothelial dysfunction. The pain may be of neuropathic, inflammatory, nociceptive, or functional nature, or of mixed origin. Summary The origin of the pain should be the basis of the symptomatic therapy. Since the difference in temperature between both hands fluctuates over time in cold CRPS, when in doubt, the clinician should prioritize the patient's report of a persistent cold extremity over clinical tests that show no difference. Future research should focus on developing easily applied methods for clinical use to differentiate between central and peripheral blood flow regulation disorders in individual patients. PMID:19775468

  9. Repeated verum but not placebo acupuncture normalizes connectivity in brain regions dysregulated in chronic pain.

    PubMed

    Egorova, Natalia; Gollub, Randy L; Kong, Jian

    2015-01-01

    Acupuncture, an ancient East Asian therapy, is aimed at rectifying the imbalance within the body caused by disease. Studies evaluating the efficacy of acupuncture with neuroimaging tend to concentrate on brain regions within the pain matrix, associated with acute pain. We, however, focused on the effect of repeated acupuncture treatment specifically on brain regions known to support functions dysregulated in chronic pain disorders. Transition to chronic pain is associated with increased attention to pain, emotional rumination, nociceptive memory and avoidance learning, resulting in brain connectivity changes, specifically affecting the periaqueductal gray (PAG), medial frontal cortex (MFC) and bilateral hippocampus (Hpc). We demonstrate that the PAG-MFC and PAG-Hpc connectivity in patients with chronic pain due to knee osteoarthritis indeed correlates with clinical severity scores and further show that verum acupuncture-induced improvement in pain scores (compared to sham) is related to the modulation of PAG-MFC and PAG-Hpc connectivity in the predicted direction. This study shows that repeated verum acupuncture might act by restoring the balance in the connectivity of the key pain brain regions, altering pain-related attention and memory.

  10. Free flap transfer for complex regional pain syndrome type II

    PubMed Central

    Matsuda, Ken; Kikuchi, Mamoru; Murase, Tsuyoshi; Hosokawa, Ko; Shibata, Minoru

    2014-01-01

    Abstract A patient with complex regional pain syndrome type II was successfully treated using free anterolateral thigh flap transfer with digital nerve coaptation to the cutaneous nerve of the flap. Release of the scarred tissue and soft tissue coverage with targeted sensory nerve coaptation were useful in relieving severe pain. PMID:27252946

  11. Frequency-dependent changes in sensorimotor and pain affective systems induced by empathy for pain

    PubMed Central

    Motoyama, Yoshimasa; Ogata, Katsuya; Hoka, Sumio; Tobimatsu, Shozo

    2017-01-01

    Background Empathy for pain helps us to understand the pain of others indirectly. To better comprehend the processing of empathic pain, we report the frequency-dependent modulation of cortical oscillations induced by watching movies depicting pain using high-density electroencephalography (EEG), magnetoencephalography (MEG), and motor evoked potentials (MEP). Methods Event-related desynchronization of EEG and MEG was assessed while participants viewed videos of painful (needle) or neutral (cotton swab) situations. The amplitudes of MEPs were also compared between the needle and cotton swab conditions. Results The degree of suppression in α/β band power was significantly increased, whereas that of γ band power was significantly decreased, in the needle condition compared with the cotton swab condition. EEG revealed that significant differences in α/β band were distributed in the right frontocentral and left parietooccipital regions, whereas significant γ band differences were distributed predominantly over the right hemisphere, which were confirmed by source estimation using MEG. There was a significant positive correlation between the difference in γ power of the two conditions and the visual analog scale subjective rating of aversion, but not in the α/β band. The amplitude of MEPs decreased in the needle condition, which confirmed the inhibition of the primary motor cortex. Conclusion MEP suppression supports that modulation of cortical oscillations by viewing movies depicting pain involves sensorimotor processing. Our results suggest that α/β oscillations underlie the sensory qualities of others’ pain, whereas the γ band reflects the cognitive aspect. Therefore, α/β and γ band oscillations are differentially involved in empathic pain processing under the condition of motor cortical suppression. PMID:28615963

  12. Are both the sensory and the affective dimensions of pain encoded in the face?

    PubMed

    Kunz, Miriam; Lautenbacher, Stefan; LeBlanc, Nadine; Rainville, Pierre

    2012-02-01

    The facial expression of pain plays a crucial role in pain communication and pain diagnostics. Despite its importance, it has remained unknown which dimensions of pain (sensory and/or affective) are encoded in the face. To answer this question, we used a well-established cognitive strategy (suggestions) to differentially modulate the sensory and affective dimensions of pain and investigate the effect of this manipulation on facial responses to experimental pain. Twenty-two subjects participated in the study. Their facial expressions, pain intensity, and unpleasantness ratings as well as skin conductance responses to tonic and phasic heat pain were assessed before and after suggestions directed toward increase in affective and sensory qualities of pain, respectively, were provided. Facial expressions were analyzed with the Facial Action Coding system. As expected, suggestions designed to increase the sensory dimension produced a selective increase in pain intensity ratings, whereas suggestions designed to increase pain affect produced increased unpleasantness ratings and elevated skin conductance responses. Furthermore, suggestions for either increased pain affect or pain sensation produced selective modulations in facial response patterns, with facial movements around the eyes mostly encoding sensory aspects, whereas movements of the eyebrows and of the upper lip were closely associated with the affective pain dimension. The facial expression of pain is a multidimensional response system that differentially encodes affective and sensory pain qualities. This differential encoding might have evolved to guarantee that the specific characteristics of one's pain experience are facially communicated, thereby ensuring adequate help and support from others.

  13. Pain referral and regional deep tissue hyperalgesia in experimental human hip pain models.

    PubMed

    Izumi, Masashi; Petersen, Kristian Kjær; Arendt-Nielsen, Lars; Graven-Nielsen, Thomas

    2014-04-01

    Hip disorder patients typically present with extensive pain referral and hyperalgesia. To better understand underlying mechanisms, an experimental hip pain model was established in which pain referrals and hyperalgesia could be studied under standardized conditions. In 16 healthy subjects, pain was induced by hypertonic saline injection into the gluteus medius tendon (GMT), adductor longus tendon (ALT), or gluteus medius muscle (GMM). Isotonic saline was injected contralaterally as control. Pain intensity was assessed on a visual analogue scale (VAS), and subjects mapped the pain distribution. Before, during, and after injections, passive hip joint pain provocation tests were completed, together with quantitative sensory testing as follows: pressure pain thresholds (PPTs), cuff algometry pain thresholds (cuff PPTs), cutaneous pin-prick sensitivity, and thermal pain thresholds. Hypertonic saline injected into the GMT resulted in higher VAS scores than hypertonic injections into the ALT and GMM (P<.05). Referred pain areas spread to larger parts of the leg after GMT and GMM injections compared with more regionalized pain pattern after ALT injections (P<.05). PPTs at the injection site were decreased after hypertonic saline injections into GMT and GMM compared with baseline, ALT injections, and isotonic saline. Cuff PPTs from the thigh were decreased after hypertonic saline injections into the ALT compared with baseline, GMT injections, and isotonic saline (P<.05). More subjects had positive joint pain provocation tests after hypertonic compared with isotonic saline injections (P<.05), indicating that this provocation test also assessed hyperalgesia in extra-articular soft tissues. The experimental models may open for better understanding of pain mechanisms associated with painful hip disorders.

  14. Algodystrophy: complex regional pain syndrome and incomplete forms

    PubMed Central

    Giannotti, Stefano; Bottai, Vanna; Dell’Osso, Giacomo; Bugelli, Giulia; Celli, Fabio; Cazzella, Niki; Guido, Giulio

    2016-01-01

    Summary The algodystrophy, also known as complex regional pain syndrome (CRPS), is a painful disease characterized by erythema, edema, functional impairment, sensory and vasomotor disturbance. The diagnosis of CRPS is based solely on clinical signs and symptoms, and for exclusion compared to other forms of chronic pain. There is not a specific diagnostic procedure; careful clinical evaluation and additional test should lead to an accurate diagnosis. There are similar forms of chronic pain known as bone marrow edema syndrome, in which is absent the history of trauma or triggering events and the skin dystrophic changes and vasomotor alterations. These incomplete forms are self-limited, and surgical treatment is generally not needed. It is still controversial, if these forms represent a distinct self-limiting entity or an incomplete variant of CRPS. In painful unexplained conditions such as frozen shoulder, post-operative stiff shoulder or painful knee prosthesis, the algodystrophy, especially in its incomplete forms, could represent the cause. PMID:27252736

  15. Electroencephalographic evoked pain response is suppressed by spinal cord stimulation in complex regional pain syndrome: a case report.

    PubMed

    Hylands-White, Nicholas; Duarte, Rui V; Beeson, Paul; Mayhew, Stephen D; Raphael, Jon H

    2016-12-01

    Pain is a subjective response that limits assessment. The purpose of this case report was to explore how the objectivity of the electroencephalographic response to thermal stimuli would be affected by concurrent spinal cord stimulation. A patient had been implanted with a spinal cord stimulator for the management of complex regional pain syndrome of both hands for 8 years. Following ethical approval and written informed consent we induced thermal stimuli using the Medoc PATHWAY Pain & Sensory Evaluation System on the right hand of the patient with the spinal cord stimulator switched off and with the spinal cord stimulator switched on. The patient reported a clinically significant reduction in thermal induced pain using the numerical rating scale (71.4 % reduction) with spinal cord stimulator switched on. Analysis of electroencephalogram recordings indicated the occurrence of contact heat evoked potentials (N2-P2) with spinal cord stimulator off, but not with spinal cord stimulator on. This case report suggests that thermal pain can be reduced in complex regional pain syndrome patients with the use of spinal cord stimulation and offers objective validation of the reported outcomes with this treatment.

  16. The affective dimension of pain as a risk factor for drug and alcohol addiction.

    PubMed

    LeBlanc, Dana M; McGinn, M Adrienne; Itoga, Christy A; Edwards, Scott

    2015-12-01

    Addiction, or substance use disorder (SUD), is a devastating psychiatric disease composed of multiple elemental features. As a biobehavioral disorder, escalation of drug and/or alcohol intake is both a cause and consequence of molecular neuroadaptations in central brain reinforcement circuitry. Multiple mesolimbic areas mediate a host of negative affective and motivational symptoms that appear to be central to the addiction process. Brain stress- and reinforcement-related regions such as the central amygdala (CeA), prefrontal cortex (PFC), and nucleus accumbens (NAc) also serve as central processors of ascending nociceptive input. We hypothesize that a sensitization of brain mechanisms underlying the processing of persistent and maladaptive pain contributes to a composite negative affective state to drive the enduring, relapsing nature of addiction, particularly in the case of alcohol and opioid use disorder. At the neurochemical level, pain activates central stress-related neuropeptide signaling, including the dynorphin and corticotropin-releasing factor (CRF) systems, and by this process may facilitate negative affect and escalated drug and alcohol use over time. Importantly, the widespread prevalence of unresolved pain and associated affective dysregulation in clinical populations highlights the need for more effective analgesic medications with reduced potential for tolerance and dependence. The burgeoning epidemic of prescription opioid abuse also demands a closer investigation into the neurobiological mechanisms of how pain treatment could potentially represent a significant risk factor for addiction in vulnerable populations. Finally, the continuing convergence of sensory and affective neuroscience fields is expected to generate insight into the critical balance between pain relief and addiction liability, as well as provide more effective therapeutic strategies for chronic pain and addiction.

  17. Cannabidiol Is a Potential Therapeutic for the Affective-Motivational Dimension of Incision Pain in Rats

    PubMed Central

    Genaro, Karina; Fabris, Débora; Arantes, Ana L. F.; Zuardi, Antônio W.; Crippa, José A. S.; Prado, Wiliam A.

    2017-01-01

    Background: Pain involves different brain regions and is critically determined by emotional processing. Among other areas, the rostral anterior cingulate cortex (rACC) is implicated in the processing of affective pain. Drugs that interfere with the endocannabinoid system are alternatives for the management of clinical pain. Cannabidiol (CBD), a phytocannabinoid found in Cannabis sativa, has been utilized in preclinical and clinical studies for the treatment of pain. Herein, we evaluate the effects of CBD, injected either systemically or locally into the rACC, on mechanical allodynia in a postoperative pain model and on the negative reinforcement produced by relief of spontaneous incision pain. Additionally, we explored whether CBD underlies the reward of pain relief after systemic or rACC injection. Methods and Results: Male Wistar rats were submitted to a model of incision pain. All rats had mechanical allodynia, which was less intense after intraperitoneal CBD (3 and 10 mg/kg). Conditioned place preference (CPP) paradigm was used to assess negative reinforcement. Intraperitoneal CBD (1 and 3 mg/kg) inverted the CPP produced by peripheral nerve block even at doses that do not change mechanical allodynia. CBD (10 to 40 nmol/0.25 μL) injected into the rACC reduced mechanical allodynia in a dose-dependent manner. CBD (5 nmol/0.25 μL) did not change mechanical allodynia, but reduced peripheral nerve block-induced CPP, and the higher doses inverted the CPP. Additionally, CBD injected systemically or into the rACC at doses that did not change the incision pain evoked by mechanical stimulation significantly produced CPP by itself. Therefore, a non-rewarding dose of CBD in sham-incised rats becomes rewarding in incised rats, presumably because of pain relief or reduction of pain aversiveness. Conclusion: The study provides evidence that CBD influences different dimensions of the response of rats to a surgical incision, and the results establish the rACC as a brain area

  18. 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.

  19. Enlargement of choroid plexus in complex regional pain syndrome.

    PubMed

    Zhou, Guangyu; Hotta, Jaakko; Lehtinen, Maria K; Forss, Nina; Hari, Riitta

    2015-09-21

    The choroid plexus, located in brain ventricles, has received surprisingly little attention in clinical neuroscience. In morphometric brain analysis, we serendipitously found a 21% increase in choroid plexus volume in 12 patients suffering from complex regional pain syndrome (CRPS) compared with age- and gender-matched healthy subjects. No enlargement was observed in a group of 8 patients suffering from chronic pain of other etiologies. Our findings suggest involvement of the choroid plexus in the pathogenesis of CRPS. Since the choroid plexus can mediate interaction between peripheral and brain inflammation, our findings pinpoint the choroid plexus as an important target for future research of central pain mechanisms.

  20. Perinatal exposure to xenoestrogens affects pain in adult female rats.

    PubMed

    Ceccarelli, Ilaria; Fiorenzani, Paolo; Della Seta, Daniele; Massafra, Cosimo; Cinci, Giuliano; Bocci, Anna; Aloisi, Anna Maria

    2009-01-01

    Estrogens have a variety of effects in addition to their action on reproductive structures, including permanent effects on the Central Nervous System (CNS). Therefore environmental chemicals with estrogenic activity (xenoestrogens) can potentially affect a number of CNS functions. In the present experiment, female rats receiving ethynylestradiol (EE) or methoxychlor (MXC) via the mothers during pregnancy (pre) or lactation (post) were tested in comparison with females born from mothers treated with OIL. The Object Recognition, Plantar and Formalin tests were carried out to evaluate the effects of these compounds on integrated functions such as memory and pain. Testosterone and estradiol plasma levels were determined by RIA. The results of the Object Recognition and Plantar tests did not differ among groups. However the groups differed in the Formalin test since flexing duration was higher in the EE- and MXC-pre groups than in the EE- and MXC-post and OIL groups. Estradiol plasma levels were higher in EE-pre than in the other groups. These results confirm the possibility that estrogen-like compounds (EE and MXC) can affect complex neural processes like pain when taken during critical stages of CNS development.

  1. Pain reduction due to novel sensory-motor training in Complex Regional Pain Syndrome I - A pilot study.

    PubMed

    Schmid, Anne-Christine; Schwarz, Anja; Gustin, Sylvia M; Greenspan, Joel D; Hummel, Friedhelm C; Birbaumer, Niels

    2017-04-01

    Patients suffering from Complex Regional Pain Syndrome (CRPS) of the upper limb show a changed cortical representation of the affected hand. The lip area invades the former hand area contralateral to the affected hand. This change in cortical representation is correlated to the intensity of ongoing pain in patients with CRPS. Further studies revealed that restoration of the original representation coincides with a decrease of pain. Sensory-motor training protocols can increase and/or relocate cortical somatosensory and motor representation areas of the fingers, as shown, for example, in Braille reading individuals and professional violin players. Further, there is evidence that sensory-motor discrimination training has a beneficial effect on both the intensity of pain and the mislocalization of sensory-motor cortical areas in CRPS patients. Based on these propositions, we developed a novel sensory-motor self-training paradigm for CRPS patients to use in a home-based manner. Ten CRPS patients performed the sensory-motor training for 2weeks. The training consists of a braille-like haptic task with different training modes (bi-manual, speed and memory training). During the training, as well as 1week before and after, patients were asked to fill out pain diaries. Furthermore, measures of impairment were acquired at baseline and post training. Patients showed significant pain reduction after the 2week training period. The overall disability as well as the depression scores showed a trend to improve after the 2week training. The reduction in pain was correlated with the total amount of training performed. This is a first proof of principle study of a novel sensory-motor self-training protocol to reduce pain in CRPS patients. The more consistent the patients trained the larger the pain reduction. Sensory-motor training, which can be performed on a regular basis at home might provide a novel interventional strategy to improve symptoms of CRPS. Although a larger study needs

  2. Safety of "pain exposure" physical therapy in patients with complex regional pain syndrome type 1.

    PubMed

    van de Meent, Hendrik; Oerlemans, Margreet; Bruggeman, Almar; Klomp, Frank; van Dongen, Robert; Oostendorp, Rob; Frölke, Jan Paul

    2011-06-01

    "Pain exposure" physical therapy (PEPT) is a new treatment for patients with complex regional pain syndrome type 1 (CRPS-1) that consists of a progressive-loading exercise program and management of pain-avoidance behavior without the use of specific CRPS-1 medication or analgesics. The aim of this study was to investigate primarily whether PEPT could be applied safely in patients with CRPS-1. Twenty patients with CRPS-1 were consecutively enrolled in the study after giving informed consent. The diagnosis of CRPS-1 was defined using the Bruehl and Harden/IASP diagnostic criteria. CRPS-1 was diagnosed between 3 and 18 months after the inciting event (trauma). According to a multiple single-case design (baseline [A1], treatment [B], follow-up [A2]), multiple baseline and follow-up measurements were performed to evaluate changes in CRPS signs and symptoms and to assess functional parameters. When comparing the baseline with the follow-up phase, patients improved significantly with respect to pain on the visual analogue scale (57%), pain intensity (48%), muscle strength (52%), arm/shoulder/hand disability (36%), 10-meter walking speed (29%), pain disability index (60%), kinesiophobia (18%), and the domains of perceived health change in the SF-36 survey (269%). Three patients initially showed increased vegetative signs but improved in all other CRPS parameters and showed good functional recovery at follow-up. We conclude that PEPT is a safe and effective treatment for patients with CRPS-1. A progressive-loading exercise program and management of pain-avoidance behavior without the use of specific medication ("pain exposure" physical therapy) is safe and effective for patients with complex regional pain syndrome. Copyright © 2011 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

  3. Caregivers' attentional bias to pain: does it affect caregiver accuracy in detecting patient pain behaviors?

    PubMed

    Mohammadi, Somayyeh; Dehghani, Mohsen; Khatibi, Ali; Sanderman, Robbert; Hagedoorn, Mariët

    2015-01-01

    Attentional bias to pain among family caregivers of patients with pain may enhance the detection of pain behaviors in patients. However, both relatively high and low levels of attentional bias may increase disagreement between patients and caregivers in reporting pain behaviors. This study aims to provide further evidence for the presence of attentional bias to pain among family caregivers, to examine the association between caregivers' attentional bias to pain and detecting pain behaviors, and test whether caregivers' attentional bias to pain is curvilinearly related to patient and caregiver disagreement in reporting pain behaviors. The sample consisted of 96 caregivers, 94 patients with chronic pain, and 42 control participants. Caregivers and controls completed a dot-probe task assessing attention to painful and happy stimuli. Both patients and caregivers completed a checklist assessing patients' pain behavior. Although caregivers did not respond faster to pain congruent than pain incongruent trials, caregiver responses were slower in pain incongruent trials compared with happy incongruent trials. Caregivers showed more bias toward pain faces than happy faces, whereas control participants showed more bias toward happy faces than pain faces. Importantly, caregivers' attentional bias to pain was significantly positively associated with reporting pain behaviors in patients above and beyond pain severity. It is reassuring that attentional bias to pain was not related to disagreement between patients and caregivers in reporting pain behaviors. In other words, attentional bias does not seem to cause overestimation of pain signals.

  4. Sensitization of the Nociceptive System in Complex Regional Pain Syndrome

    PubMed Central

    Diedrichs, Carolina; Baron, Ralf; Gierthmühlen, Janne

    2016-01-01

    Background Complex regional pain syndrome type I (CRPS-I) is characterized by sensory, motor and autonomic abnormalities without electrophysiological evidence of a nerve lesion. Objective Aims were to investigate how sensory, autonomic and motor function change in the course of the disease. Methods 19 CRPS-I patients (17 with acute, 2 with chronic CRPS, mean duration of disease 5.7±8.3, range 1–33 months) were examined with questionnaires (LANSS, NPS, MPI, Quick DASH, multiple choice list of descriptors for sensory, motor, autonomic symptoms), motor and autonomic tests as well as quantitative sensory testing according to the German Research Network on Neuropathic Pain at two visits (baseline and 36±10.6, range 16–53 months later). Results CRPS-I patients had an improvement of sudomotor and vasomotor function, but still a great impairment of sensory and motor function upon follow-up. Although pain and mechanical detection improved upon follow-up, thermal and mechanical pain sensitivity increased, including the contralateral side. Increase in mechanical pain sensitivity and loss of mechanical detection were associated with presence of ongoing pain. Conclusions The results demonstrate that patients with CRPS-I show a sensitization of the nociceptive system in the course of the disease, for which ongoing pain seems to be the most important trigger. They further suggest that measured loss of function in CRPS-I is due to pain-induced hypoesthesia rather than a minimal nerve lesion. In conclusion, this article gives evidence for a pronociceptive pain modulation profile developing in the course of CRPS and thus helps to assess underlying mechanisms of CRPS that contribute to the maintenance of patients’ pain and disability. PMID:27149519

  5. Optimal control of reaching is disturbed in complex regional pain syndrome: a single-case study

    PubMed Central

    Osumi, Michihiro; Sumitani, Masahiko; Kumagaya, Shin-ichiro; Morioka, Shu

    2017-01-01

    Objective Disturbance of goal-directed motor control may cause or exacerbate pathological pain in patients with complex regional pain syndrome (CRPS). We conducted a single-case study about motor control involved in reaching with a patient with CRPS in an upper limb. Methods Using a three-dimensional measurement system, we recorded reaching movement trajectories of the intact and affected hand before and after pain alleviation by therapeutic nerve blockade. We assessed degrees of tremor in the acceleration phase (from start until maximum peak velocity) and the deceleration phase (from maximum peak velocity until goal). To quantify the smoothness of reaching movements, we analyzed the curves of the trajectories during the initial movement phase (from start and maximum peak acceleration). Results The results showed that the tremor of the affected hand was greater than that of the intact hand during the deceleration phase, both before and after pain alleviation. Reaching trajectories of the intact hand smoothly traced curves convexed toward the intact side, while those of the affected hand represented unnaturally rectilinear functions associated with the loss of smooth movements. Further, these unnatural trajectories partially recovered after pain alleviation. Conclusion Disturbance of sensorimotor integration and pain-related fear might affect goal-directed motor control in CRPS patients. PMID:28138265

  6. Optimal control of reaching is disturbed in complex regional pain syndrome: a single-case study.

    PubMed

    Osumi, Michihiro; Sumitani, Masahiko; Kumagaya, Shin-Ichiro; Morioka, Shu

    2017-01-01

    Disturbance of goal-directed motor control may cause or exacerbate pathological pain in patients with complex regional pain syndrome (CRPS). We conducted a single-case study about motor control involved in reaching with a patient with CRPS in an upper limb. Using a three-dimensional measurement system, we recorded reaching movement trajectories of the intact and affected hand before and after pain alleviation by therapeutic nerve blockade. We assessed degrees of tremor in the acceleration phase (from start until maximum peak velocity) and the deceleration phase (from maximum peak velocity until goal). To quantify the smoothness of reaching movements, we analyzed the curves of the trajectories during the initial movement phase (from start and maximum peak acceleration). The results showed that the tremor of the affected hand was greater than that of the intact hand during the deceleration phase, both before and after pain alleviation. Reaching trajectories of the intact hand smoothly traced curves convexed toward the intact side, while those of the affected hand represented unnaturally rectilinear functions associated with the loss of smooth movements. Further, these unnatural trajectories partially recovered after pain alleviation. Disturbance of sensorimotor integration and pain-related fear might affect goal-directed motor control in CRPS patients.

  7. Complex regional pain syndrome in a competitive athlete and regional osteoporosis assessed by dual-energy X-ray absorptiometry: a case report

    PubMed Central

    2014-01-01

    Introduction Dual-energy X-ray absorptiometry is rarely utilized in the clinical care of patients with complex regional pain syndrome, but may be useful for the non-invasive determination of regional bone fragility and fracture risk, as well as muscular atrophy and regional body composition. This is the first report in the literature of complex regional pain syndrome and musculoskeletal co-morbidities in an athlete, and is the first to focus on dual-energy X-ray absorptiometry for the clinical assessment of complex regional pain syndrome. Case presentation In this report, we describe the case of a 29-year-old Caucasian man with type 1 complex regional pain syndrome. His body mass index was 29.4kg/m2 at the time of presentation. Despite severe complex regional pain syndrome in the left limb and long term use of a wheelchair, the patient participated in high-performance powerlifting. Dual-energy X-ray absorptiometry revealed marked unilateral differences in bone strength and lean mass between the affected regions and the contralateral regions. Low bone mineral density for age was found in the left hip, with Z-scores ranging from −2.2 to −3.0, and the patient had previously suffered two fractures. Bone density Z-scores in the right hip and legs were normal. Conclusions Dual-energy X-ray absorptiometry is a valuable tool for the clinical investigation of musculoskeletal health in patients with complex regional pain syndrome. Regional osteoporosis in complex regional pain syndrome patients is complicated and should be investigated and monitored. Physical activity is possible for some complex regional pain syndrome patients, depending on the type of exercise and the region affected, and it may protect bone density and strength at non affected skeletal sites. PMID:24885227

  8. Complex regional pain syndrome in a competitive athlete and regional osteoporosis assessed by dual-energy X-ray absorptiometry: a case report.

    PubMed

    Hind, Karen; Johnson, Mark I

    2014-05-27

    Dual-energy X-ray absorptiometry is rarely utilized in the clinical care of patients with complex regional pain syndrome, but may be useful for the non-invasive determination of regional bone fragility and fracture risk, as well as muscular atrophy and regional body composition. This is the first report in the literature of complex regional pain syndrome and musculoskeletal co-morbidities in an athlete, and is the first to focus on dual-energy X-ray absorptiometry for the clinical assessment of complex regional pain syndrome. In this report, we describe the case of a 29-year-old Caucasian man with type 1 complex regional pain syndrome. His body mass index was 29.4kg/m2 at the time of presentation. Despite severe complex regional pain syndrome in the left limb and long term use of a wheelchair, the patient participated in high-performance powerlifting. Dual-energy X-ray absorptiometry revealed marked unilateral differences in bone strength and lean mass between the affected regions and the contralateral regions. Low bone mineral density for age was found in the left hip, with Z-scores ranging from -2.2 to -3.0, and the patient had previously suffered two fractures. Bone density Z-scores in the right hip and legs were normal. Dual-energy X-ray absorptiometry is a valuable tool for the clinical investigation of musculoskeletal health in patients with complex regional pain syndrome. Regional osteoporosis in complex regional pain syndrome patients is complicated and should be investigated and monitored. Physical activity is possible for some complex regional pain syndrome patients, depending on the type of exercise and the region affected, and it may protect bone density and strength at non affected skeletal sites.

  9. Rising prevalence of back pain in Austria: considering regional disparities.

    PubMed

    Großschädl, Franziska; Stolz, Erwin; Mayerl, Hannes; Rásky, Éva; Freidl, Wolfgang; Stronegger, Willibald J

    2016-01-01

    Back pain is the most common form of musculoskeletal conditions and leads to high health care costs. Information about geographic variations in highly prevalent diseases/disorders represents important implications for public health planning to face structural challenges. The present study aims to investigate regional trends in the prevalence of back pain and the role of obesity and social inequalities among Austrian adults. A secondary data analysis based on five nationally representative cross-sectional surveys (1973-2007) was carried out (N = 178,818). Back pain was measured as self-reported presence. Obesity (BMI ≥ 30 kg/m²) was adjusted for self-report bias. For the regional analyses, Austria was divided into Western, Central and Eastern Austria. A relative index of inequality (RII) was computed to quantify the extent of social inequality. A continuous rise in back pain prevalence was observed in the three regions and among all investigated subgroups. In 2007 the age-standardised prevalence was similar in Central (36.9 %), Western (35.2 %) and Eastern Austria (34.3 %). The absolute change in back pain prevalence was highest among obese subjects in Central Austria (women: + 29.8 %, men: + 32.5 %). RIIs were unstable during the study period and in 2007 highest in Eastern Austria. Variation and trends in back pain are not attributable to geographic variation in Austria: an assumed East-West gradient in Austria has not been confirmed. Nevertheless our study confirms that back pain dramatically increased in all Austrian regions and investigated subgroups. This worrying trend should be further monitored and public health interventions should be implemented increasingly, especially among obese women and men.

  10. [Pharmacological sympathetic block in complex regional pain syndrome].

    PubMed

    Verre, M; De Santis, F; Glyronakis, S; Grande, A M; Renzi, A; Santangelo, E; Tortorella, V; Varano, M

    2002-01-01

    The Complex Regional Pain Syndrome (CRPS) is a chronic pain state provoked by lesions of the soft tissues or of the bony tissues (type CRPS-I or reflex sympathetic dystrophy-RSD) or by lesions of the nerves (type CRPS-II or causalgia) with vegetative alterations (perspiration, vasomotory alterations) and trophic alterations (bony cutaneous atrophy, alopecia, articular contractures). The pharmacological block of the sympathetic nerves through a peripheral vein is inserted in the multidisciplinary approach that characterizes the therapy of this syndrome. A retrospective survey was carried out on a group of 185 patients affected by RDS/CRPS with block of the sympathetic nerves through a peripheral vein with guanethidine. Superior limb: Inflation of the tourniquet till disappearance of the radial wrist. Cannulation of a peripheral vein with Butterfly needle n. 23. Guanethidine 10 mg, lidocaine 20 mg, sodic heparin 500 u.i, NaCl 0.9% 20 ml. Injection in 5 minutes. Permanence of the pneumatic tourniquet inflated above systolic blood pressure for 15 minutes. Deflation slowly. Inferior limb: Inflation of the tourniquet till disappearance of the pedidium wrist. Cannulation of a peripheral vein with Butterfly needle n. 23. Guanethidine 20 mg, lidocaine 40 mg, sodic heparin 1000 u.i, NaCl 0.9% 40 ml. Injection in 5 minutes. Permanence of the pneumatic tourniquet inflated above systolic blood pressure for 15 minutes. Deflation slowly. The first stage (hyperemic) showed the highest incidence of remissions: (83, 33%). Even in the second stage (dystrophic) the answer to the therapy has been fundamentally positive: (53, 68%). In the third stage (atrophic) the results have been more modest: (8, 33%). The block of sympathetic system with guanethidine is still an important method in the therapy of the CRPS; in fact it is surely less invading than the blocks of the stellate ganglion or of the lumbar sympathetic.

  11. Chronic pain acceptance and affective well-being: a coping perspective.

    PubMed

    Kranz, Dirk; Bollinger, Annicka; Nilges, Paul

    2010-11-01

    This study examined the relationship between chronic pain acceptance and affective well-being from a coping perspective. One hundred-fifty patients from a multidisciplinary pain centre provided self-report data including measures of pain acceptance, positive and negative affect, and accommodative flexibility. The bivariate and multiple correlation patterns were consistent with the assumption that pain willingness (the attitudinal component of pain acceptance including the recognition of the uncontrollability of pain) primarily reduces negative affect, whereas activity engagement (the behavioural component of pain acceptance including the pursuit of life activities despite pain) additionally produces positive affect. The data furthermore suggested activity engagement as a mediating link between pain willingness and positive affect. Moderation analyses showed that accommodative flexibility (the general readiness to adjust personal goals to situational constraints) facilitates both pain willingness and activity engagement--especially when average pain intensity is high. In sum, the results support the view that chronic pain patients' well-being is closely tied to the maintenance of life activities which presupposes an accepting attitude towards pain. Copyright © 2010 European Federation of International Association for the Study of Pain Chapters. Published by Elsevier Ltd. All rights reserved.

  12. The effect of affect on memory of pain induced by tooth restoration.

    PubMed

    Bąbel, Przemysław

    2014-10-01

    Memories of dental pain may influence both subsequent pain experiences during dental treatment and future decisions about whether to go to a dentist. The main aims of this study were to assess memory of pain and pain-related affect induced by tooth restoration. A total of 39 women who underwent tooth restoration rated their state anxiety before dental treatment, and the intensity and unpleasantness of pain and the emotions they felt immediately after dental treatment. Either 3 months or 6 months later, the participants were asked to recall their state anxiety, the intensity and unpleasantness of pain and the emotions they had felt. Regardless of the length of recall delay, participants accurately remembered both pain intensity and unpleasantness. Although the state anxiety felt before the pain experience was found to be remembered accurately, the positive affect that accompanied pain was underestimated and the negative affect that accompanied pain was overestimated. Positive affect experienced, state anxiety experienced and recalled state anxiety accounted for 32% and 30%, respectively, of the total variance in recalled intensity and unpleasantness of pain. It is concluded that although dental pain is remembered accurately, affective variables, rather than experienced pain, have an effect on memory of pain. © 2014 FDI World Dental Federation.

  13. Bi-directional changes in affective state elicited by manipulation of medullary pain-modulatory circuitry.

    PubMed

    Hirakawa, N; Tershner, S A; Fields, H L; Manning, B H

    2000-01-01

    The rostral ventromedial medulla contains three physiologically defined classes of pain-modulating neuron that project to the spinal and trigeminal dorsal horns. OFF cells contribute to anti-nociceptive processes, ON cells contribute to pro-nociceptive processes (i.e. hyperalgesia) and neutral cells tonically modulate spinal nociceptive responsiveness. In the setting of noxious peripheral input, the different cell classes in this region permit bi-directional modulation of pain perception (analgesia vs hyperalgesia). It is unclear, however, whether changes in the activity of these neurons are relevant to the behaving animal in the absence of a painful stimulus. Here, we pharmacologically manipulated neurons in the rostral ventromedial medulla and used the place-conditioning paradigm to assess changes in the affective state of the animal. Local microinjection of the alpha(1)-adrenoceptor agonist methoxamine (50.0 microg in 0.5 microl; to activate ON cells, primarily), combined with local microinjection of the kappa-opioid receptor agonist U69,593 (0.178 microg in 0.5 microl; to inhibit OFF cells), produced an increase in spinal nociceptive reactivity (i.e. hyperalgesia on the tail flick assay) and a negative affective state (as inferred from the production of conditioned place avoidance) in the conscious, freely moving rat. Additional microinjection experiments using various concentrations of methoxamine alone or U69, 593 alone revealed that the rostral ventromedial medulla is capable of eliciting a range of affective changes resulting in conditioned place avoidance, no place-conditioning effect or conditioned place preference (reflecting production of a positive affective state). Overall, however, there was no consistent relationship between place-conditioning effects and changes in spinal nociceptive reactivity. This is the first report of bi-directional changes in affective state (i.e. reward or aversion production) associated with pharmacological manipulation of

  14. [Analysis of regional anesthetic efficacy in pediatric postop pain].

    PubMed

    Martínez-Tellería, A; Cano Serrano, M E; Martínez-Tellería, M J; Castejón Casado, J

    1997-01-01

    A randomized, double blind study was carried out in 76 paediatric surgical patients scheduled for herniography or circumcision. Patients were randomly assigned to receive ilioinguinal and iliohipogastric nerve block (group A), penile block (group B), caudal block (group C) or metamizol intravenously (group D). Postoperative pain was evaluated by Objective pain scale at the end of surgical process and at 15, 30, 60 minutes and 6 hours after surgery. Pain free time was also recorded. There was no difference between groups regarding demographic data. We find a significatively less pain scores in the children who received regional anaesthesia. In those groups the administration of any analgesic were not necessary. No side effects were recorded. We conclude that locorregional anaesthesia techniques are safe and effective for minor surgery in children, because they are easy to carry out, comfortable for the patient, and provide a good postoperative analgesia.

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

    PubMed

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

    2015-01-01

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

  16. Pain management in the special operations environment: regional anesthetics.

    PubMed

    Calkins, M D; Kuzma, P J; Larkin, T M; Green, D L

    2001-03-01

    Pain relief is an essential component of combat casualty care. For the injured soldier, analgesia is not only a matter of comfort. Alleviating pain may allow the soldier to remain quiet when noise discipline is at a premium. It may also allow that person to continue to move, thus avoiding detection and potentially permitting the mission to carry on. Regional anesthetics provide an alternative to systemic medications and thus may avoid a clouded sensorium, limit narcotic administration, and provide superior pain relief. Standard local anesthetics and newer agents with potential field applicability are discussed along with their side effect profiles. Simple nerve block techniques that can be used by Army Special Forces medics, Navy SEAL and Reconnaissance corpsmen, and Air Force pararescuemen in the far forward environment are described step by step. The advantages of these regional anesthetic methods should make their use a must for every special operations medical care provider.

  17. The American Society of Regional Anesthesia and Pain Medicine, the European Society of Regional Anaesthesia and Pain Therapy, and the Asian Australasian Federation of Pain Societies Joint Committee recommendations for education and training in ultrasound-guided interventional pain procedures.

    PubMed

    Narouze, Samer N; Provenzano, David; Peng, Philip; Eichenberger, Urs; Lee, Sang Chul; Nicholls, Barry; Moriggl, Bernhard

    2012-01-01

    The use of ultrasound in pain medicine for interventional axial, nonaxial, and musculoskeletal pain procedures is rapidly evolving and growing. Because of the lack of specialty-specific guidelines for ultrasonography in pain medicine, an international collaborative effort consisting of members of the Special Interest Group on Ultrasonography in Pain Medicine from the American Society of Regional Anesthesia and Pain Medicine, the European Society of Regional Anaesthesia and Pain Therapy, and the Asian Australasian Federation of Pain Societies developed the following recommendations for education and training in ultrasound-guided interventional pain procedures. The purpose of these recommendations is to define the required skills for performing ultrasound-guided pain procedures, the processes for appropriate education, and training and quality improvement. Training algorithms are outlined for practice- and fellowship-based pathways. The previously published American Society of Regional Anesthesia and Pain Medicine and European Society of Regional Anaesthesia and Pain Therapy education and teaching recommendations for ultrasound-guided regional anesthesia served as a foundation for the pain medicine recommendations. Although the decision to grant ultrasound privileges occurs at the institutional level, the committee recommends that the training guidelines outlined in this document serve as the foundation for educational training and the advancement of the practice of ultrasonography in pain medicine.

  18. Complex regional pain syndromes: the influence of cutaneous and deep somatic sympathetic innervation on pain.

    PubMed

    Schattschneider, Jörn; Binder, Andreas; Siebrecht, Dieter; Wasner, Gunnar; Baron, Ralf

    2006-01-01

    Complex regional pain syndromes (CRPS) can be relieved by sympathetic blockade. Different sympathetic efferent output channels innervate distinct effector organs (ie, cutaneous vasoconstrictor, muscle vasoconstrictor. and sudomotor neurons, as well as neurons innervating deep somatic tissues like bone, joints, and tendons). The aim of the present study was to elucidate in CRPS patients the sympathetically maintained pain (SMP) component that exclusively depends on cutaneous sympathetic activity compared with the SMP depending on the sympathetic innervation of deep somatic tissues. The sympathetic outflow to the painful skin was modulated selectively in awake humans. High and low cutaneous vasoconstrictor activity was produced in 12 CRPS type 1 patients by whole-body cooling and warming (thermal suit). Spontaneous pain was quantified during high and low cutaneous vasoconstrictor activity. By comparing the cutaneous SMP component with the change in pain that was achieved by modulation of the entire sympathetic outflow (sympathetic ganglion block), the SMP component originating in deep somatic structures was estimated. The relief of spontaneous pain after sympathetic blockade was more pronounced than changes in spontaneous pain that could be induced by selective sympathetic cutaneous modulation. The entire SMP component (cutaneous and deep) changes considerably over time. It is most prominent in the acute stages of CRPS. Sympathetic afferent coupling takes place in the skin and in the deep somatic tissues, but especially in the acute stages of CRPS, the pain component that is influenced by the sympathetic innervation of deep somatic structures is more important than the cutaneous activation. The entire sympathetic maintained pain component is not constant in the course of the disease but decreases over time.

  19. Cervico-thoracic or lumbar sympathectomy for neuropathic pain and complex regional pain syndrome.

    PubMed

    Straube, Sebastian; Derry, Sheena; Moore, R Andrew; Cole, Peter

    2013-09-02

    This review is an update of a review first published in Issue 2, 2003, which was substantially updated in Issue 7, 2010. The concept that many neuropathic pain syndromes (traditionally this definition would include complex regional pain syndromes (CRPS)) are "sympathetically maintained pains" has historically led to treatments that interrupt the sympathetic nervous system. Chemical sympathectomies use alcohol or phenol injections to destroy ganglia of the sympathetic chain, while surgical ablation is performed by open removal or electrocoagulation of the sympathetic chain or by minimally invasive procedures using thermal or laser interruption. To review the evidence from randomised, double blind, controlled trials on the efficacy and safety of chemical and surgical sympathectomy for neuropathic pain, including complex regional pain syndrome. Sympathectomy may be compared with placebo (sham) or other active treatment, provided both participants and outcome assessors are blind to treatment group allocation. On 2 July 2013, we searched CENTRAL, MEDLINE, EMBASE, and the Oxford Pain Relief Database. We reviewed the bibliographies of all randomised trials identified and of review articles and also searched two clinical trial databases, ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform, to identify additional published or unpublished data. We screened references in the retrieved articles and literature reviews and contacted experts in the field of neuropathic pain. Randomised, double blind, placebo or active controlled studies assessing the effects of sympathectomy for neuropathic pain and CRPS. Two review authors independently assessed trial quality and validity, and extracted data. No pooled analysis of data was possible. Only one study satisfied our inclusion criteria, comparing percutaneous radiofrequency thermal lumbar sympathectomy with lumbar sympathetic neurolysis using phenol in 20 participants with CRPS. There was no comparison of

  20. Pressure Pain Sensitivity Maps of the Neck-Shoulder Region in Breast Cancer Survivors.

    PubMed

    Caro-Morán, Elena; Fernández-Lao, Carolina; Díaz-Rodríguez, Lourdes; Cantarero-Villanueva, Irene; Madeleine, Pascal; Arroyo-Morales, Manuel

    2016-10-01

    The aim of the present study was to report pressure pain sensitivity topographical maps of the frontal and dorsal parts of the shoulder region, and locate the pressure pain sensitive areas in breast cancer survivors compared with matched healthy control subjects. Twenty-two breast cancer survivors (BCS) and 22 matched control subjects participated. A numeric pain rating scale of the neck-shoulder area and pressure pain thresholds (PPTs) was assessed bilaterally over 28 points in the frontal and dorsal neck-shoulder area. Topographical pain sensitivity maps of the upper trapezius, pectoral, and anterior deltoid areas were computed. A three-way analysis of variance was carried out to evaluate the differences in PPTs. The BCS reported spontaneous neck pain (mean ± SD 3.6 ± 2.8), pain in the affected shoulder (4.3 ± 2.7), and pain in the non-affected shoulder (0.9 ± 1.8). Additionally, the BCS exhibited bilaterally lower PPTs in all the measurement points as compared with the control subjects (P < 0.05). The PPTs were lower at the superior part of the trapezius muscle (P < 0.001), the musculotendinous insertion, the anterior part of the deltoid muscle (P < 0.001), and the tendon of the pectoral muscle (P < 0.001) as compared with the control subjects. The results suggest the sensitization processes in the BCS and give preliminary evidence to most sensitive areas in the superior part of the upper trapezius and musculotendinous insertion of the pectoral muscle. © 2016 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  1. Ultrasound-Guided Intra-articular Injection of the Radio-ulnar and Radio-humeral Joints and Ultrasound-Guided Dry Needling of the Affected Limb Muscles to Relieve Fixed Pronation Deformity and Myofascial Issues around the Shoulder, in a Case of Complex Regional Pain Syndrome Type 1.

    PubMed

    Pai, Renuka S; Vas, Lakshmi

    2017-04-23

    Complex regional pain syndrome (CRPS) occurs due to different pathophysiological mechanisms. Presently there is no description of definitive treatment that can resolve the especially recalcitrant motor issues of disability in CRPS type 1 (CRPS-1). We have herein described the successful management of motor disability with a multimodal approach in a patient with CRPS-1 that occurred as a result of a fracture sustained in the lower end of the radius. Sensory/sudomotor/vasomotor symptoms were relieved completely by medications and stellate ganglion block in 2 weeks. Ultrasound-guided dry needling secured near-complete improvement of shoulder and hand movements in 45 days. Ultrasound guided intra-articular (radio-ulnar and radio-humeral joint) injections with steroid reduced residual pain and improved forearm movements by 50% initially. The patient continued to receive regular sessions of dry needling, physiotherapy, and cognitive behavioral therapy. By the end of 1 year, the functions of the limb improved remarkably, as did the functional outcome scores. In this patient with CRPS-1, intra-articular injections with steroid reduced nociception in the affected local structures and sensitization in the nervous system; dry needling resolved the myofascial issues; sustained physiotherapy maintained the motor recovery; and behavioral therapy techniques addressed the cognitive and life stress issues. It was concluded that the presenting symptoms in this case were a consequence of interactions between humoral, nervous, and myofascial systems. © 2017 World Institute of Pain.

  2. Pain evaluation in patients affected by cutaneous squamous cell carcinoma and actinic keratosis: an observational study.

    PubMed

    Dika, Emi; Vaccari, Sabina; Fanti, Pier A; Piraccini, Bianca M; Barisani, Alessia; Baraldi, Carlotta; Patrizi, Annalisa

    2017-10-01

    Pain is a frequent symptom in cancer patients. The aim of our study was to evaluate the presence of pain in histopathologically-diagnosed hypertrophic actinic keratosis (AK) or cutaneous squamous cell carcinoma (SCC). An observational study evaluating pain presence and intensity in skin cancer was performed, including patients affected either by SCC or by hypertrophic AK. Pain intensity was assessed using the 11-point Numeric Rating Scale, ranging from 0 (absence of pain) to 10 (most intense pain). Both spontaneous pain and pressure-related pain intensity, due to local digital pressure, were evaluated. In patients with SCC, spontaneous pain was present in 57.5% of the cases, while pressure-related pain was revealed in 80.0% of the cases. In hypertrophic AK patients, spontaneous pain was detected only in 15.0% of the cases, while pressure-related pain was present in 25.0% of the cases. A statistically significant difference between the 2 groups was found in the evaluation of spontaneous and pressure-related pain values, these values being significantly higher in the SCC group. No significant correlations between the degree of inflammation, the histotype or invasiveness of SCCs, and the intensity of pain were found. The recognition of pain as a symptom, more frequently associated with SCC, might prove useful in the clinical practice. Further research is needed, in order to better understand and characterize pain associated with different skin neoplasms.

  3. Genome-Wide Expression Profiling of Complex Regional Pain Syndrome

    PubMed Central

    Jin, Eun-Heui; Zhang, Enji; Ko, Youngkwon; Sim, Woo Seog; Moon, Dong Eon; Yoon, Keon Jung; Hong, Jang Hee; Lee, Won Hyung

    2013-01-01

    Complex regional pain syndrome (CRPS) is a chronic, progressive, and devastating pain syndrome characterized by spontaneous pain, hyperalgesia, allodynia, altered skin temperature, and motor dysfunction. Although previous gene expression profiling studies have been conducted in animal pain models, there genome-wide expression profiling in the whole blood of CRPS patients has not been reported yet. Here, we successfully identified certain pain-related genes through genome-wide expression profiling in the blood from CRPS patients. We found that 80 genes were differentially expressed between 4 CRPS patients (2 CRPS I and 2 CRPS II) and 5 controls (cut-off value: 1.5-fold change and p<0.05). Most of those genes were associated with signal transduction, developmental processes, cell structure and motility, and immunity and defense. The expression levels of major histocompatibility complex class I A subtype (HLA-A29.1), matrix metalloproteinase 9 (MMP9), alanine aminopeptidase N (ANPEP), l-histidine decarboxylase (HDC), granulocyte colony-stimulating factor 3 receptor (G-CSF3R), and signal transducer and activator of transcription 3 (STAT3) genes selected from the microarray were confirmed in 24 CRPS patients and 18 controls by quantitative reverse transcription-polymerase chain reaction (qRT-PCR). We focused on the MMP9 gene that, by qRT-PCR, showed a statistically significant difference in expression in CRPS patients compared to controls with the highest relative fold change (4.0±1.23 times and p = 1.4×10−4). The up-regulation of MMP9 gene in the blood may be related to the pain progression in CRPS patients. Our findings, which offer a valuable contribution to the understanding of the differential gene expression in CRPS may help in the understanding of the pathophysiology of CRPS pain progression. PMID:24244504

  4. Low back pain prevalence in healthcare professionals and identification of factors affecting low back pain.

    PubMed

    Çınar-Medeni, Özge; Elbasan, Bulent; Duzgun, Irem

    2017-01-01

    Work-related musculoskeletal system diseases are commonly observed among nurses, physiotherapists, dentists, and dieticians. To assess working postures of nurses, physiotherapists, dentists and dieticians, to identify whether low back pain (LBP) is present, and to put forth the correlation between LBP, working posture, and other factors. Twenty seven physiotherapists, 34 nurses, 30 dentists, and 16 dieticians were included. Impairment ratings of cases with LBP were analysed with Quebec Back Pain Disability Scale (Quebec). Working postures were analysed with Owako Working Posture Analysis System. LBP was observed in 70.09% of healthcare professionals. Of the individuals suffering from LBP, 57.2% were working with a risky posture. 40.63% of individuals without LBP were using risky working postures. Trunk and head posture distribution of individuals with and without LBP was found as different from each other (p < 0.05). LBP prevalence of dentists and nurses were higher compared to other groups (p < 0.05). Quebec scores of professionals with LBP were not different among occupations (p > 0.05). Quebec scores were observed as correlated with various factors in various occupation groups. Considering that head-neck and trunk postures are changeable factors that are among the factors affecting LBP, correcting the working posture gains importance.

  5. Plasma Amino Acids Changes in Complex Regional Pain Syndrome

    PubMed Central

    Alexander, Guillermo M.; Reichenberger, Erin; Peterlin, B. Lee; Perreault, Marielle J.; Grothusen, John R.; Schwartzman, Robert J.

    2013-01-01

    Complex regional pain syndrome (CRPS) is a severe chronic pain condition that most often develops following trauma. Blood samples were collected from 220 individuals, 160 CRPS subjects, and 60 healthy pain-free controls. Plasma amino acid levels were compared and contrasted between groups. L-Aspartate, L-glutamate, and L-ornithine were significantly increased, whereas L-tryptophan and L-arginine were significantly decreased in CRPS subjects as compared to controls. In addition, the L-kynurenine to L-tryptophan ratio demonstrated a significant increase, whereas the global arginine bioavailability ratio (GABR) was significantly decreased in the CRPS subjects. The CRPS subjects demonstrated a significant correlation between overall pain and the plasma levels of L-glutamate and the L-kynurenine to L-tryptophan ratio. CRPS subjects also showed a correlation between the decrease in plasma L-tryptophan and disease duration. This study shows that CRPS subjects exhibit significant changes in plasma levels of amino acids involved in glutamate receptor activation and in amino acids associated with immune function as compared to healthy pain-free controls. A better understanding of the role plasma amino acids play in the pathophysiology of CRPS may lead to novel treatments for this crippling condition. PMID:24303215

  6. Plasma amino acids changes in complex regional pain syndrome.

    PubMed

    Alexander, Guillermo M; Reichenberger, Erin; Peterlin, B Lee; Perreault, Marielle J; Grothusen, John R; Schwartzman, Robert J

    2013-01-01

    Complex regional pain syndrome (CRPS) is a severe chronic pain condition that most often develops following trauma. Blood samples were collected from 220 individuals, 160 CRPS subjects, and 60 healthy pain-free controls. Plasma amino acid levels were compared and contrasted between groups. L-Aspartate, L-glutamate, and L-ornithine were significantly increased, whereas L-tryptophan and L-arginine were significantly decreased in CRPS subjects as compared to controls. In addition, the L-kynurenine to L-tryptophan ratio demonstrated a significant increase, whereas the global arginine bioavailability ratio (GABR) was significantly decreased in the CRPS subjects. The CRPS subjects demonstrated a significant correlation between overall pain and the plasma levels of L-glutamate and the L-kynurenine to L-tryptophan ratio. CRPS subjects also showed a correlation between the decrease in plasma L-tryptophan and disease duration. This study shows that CRPS subjects exhibit significant changes in plasma levels of amino acids involved in glutamate receptor activation and in amino acids associated with immune function as compared to healthy pain-free controls. A better understanding of the role plasma amino acids play in the pathophysiology of CRPS may lead to novel treatments for this crippling condition.

  7. The pain persists: how social exclusion affects individuals with schizophrenia.

    PubMed

    Perry, Yael; Henry, Julie D; Sethi, Nisha; Grisham, Jessica R

    2011-11-01

    OBJECTIVES. Evidence suggests that ostracism exerts an immediate and painful threat to an individual's primary needs for belonging, meaningful existence, control, and self-esteem. Individuals with schizophrenia are particularly likely to experience the effects of ostracism, being amongst the most stigmatized of all the mental illnesses. The aims of the present study were therefore to assess the immediate and delayed effects of ostracism in these individuals, and to explore associations between any observed effects and indices of negative affect and clinical symptoms. METHODS. Individuals diagnosed with schizophrenia or schizoaffective disorder, and non-clinical controls engaged in a virtual ball-toss game with two fictitious others. All participants played the game on two separate occasions, participating in both an inclusion and an ostracism condition. Measures of primary needs were obtained after each game. RESULTS. Findings suggest that the negative impact of social exclusion lasts longer in individuals with schizophrenia, compared with non-clinical controls. Further, clinical participants who reported lower primary needs after a delay were more likely to exhibit higher levels of depression, anxiety, and stress. CONCLUSIONS. Future studies should examine the use of regulatory strategies and personal responses to stigma as potential mediators in the maintenance of the negative effects of social exclusion. These lines of research may offer insight into interventions that may assist individuals to better cope with this experience.

  8. Stress influences the level of negative affectivity after forehead cold pressor pain.

    PubMed

    Logan, Henrietta L; Gedney, Jeffrey J; Sheffield, David; Xiang, Yiwen; Starrenburg, Eva

    2003-11-01

    The purpose of this study was to investigate simultaneously a stress manipulation and an experimental pain manipulation to determine how stress and pain interact to influence negative affectivity. One hundred healthy subjects completed a counterbalanced repeated measure crossover design in which stress (speech task) versus a nonstress control condition (magazine reading) was manipulated. Each session was immediately followed by a 2-minute forehead cold pressor task. Measures of affectivity (Positive Affect Negative Affect Schedule), pain ratings, cardiovascular measures (systolic blood pressure, diastolic blood pressure, heart rate), and salivary cortisol were obtained during each session. Regression analysis showed that the stress manipulation influenced the level of anger and that change in anger predicted post-pain negative affectivity independently of the contribution of maximum pain (model R(2) =.31), with 45% of the total model variance accounted for by change in anger and 17% of the total model variance accounted for by maximum pain intensity. In the nonstress condition only level of pain intensity was an independent predictor of negative affectivity (model R(2) =.16), with 69% of the total model variance accounted for by maximum pain intensity. These results show that stress significantly amplifies post-pain negative mood beyond that accounted for by the level of pain intensity alone.

  9. Cervico-thoracic or lumbar sympathectomy for neuropathic pain and complex regional pain syndrome.

    PubMed

    Straube, Sebastian; Derry, Sheena; Moore, R Andrew; McQuay, Henry J

    2010-07-07

    This review is an update on 'Sympathectomy for neuropathic pain' originally published in Issue 2, 2003. The concept that many neuropathic pain syndromes (traditionally this definition would include complex regional pain syndromes (CRPS)) are "sympathetically maintained pains" has historically led to treatments that interrupt the sympathetic nervous system. Chemical sympathectomies use alcohol or phenol injections to destroy ganglia of the sympathetic chain, while surgical ablation is performed by open removal or electrocoagulation of the sympathetic chain, or minimally invasive procedures using thermal or laser interruption. To review the evidence from randomised, double blind, controlled trials on the efficacy and safety of chemical and surgical sympathectomy for neuropathic pain. Sympathectomy could be compared with placebo (sham) or other active treatment. We searched MEDLINE, EMBASE and The Cochrane Library to May 2010. We screened references in the retrieved articles and literature reviews, and contacted experts in the field of neuropathic pain. Randomised, double blind, placebo or active controlled studies assessing the effects of sympathectomy for neuropathic pain and CRPS. Two review authors independently assessed trial quality and validity, and extracted data. No pooled analysis of data was possible. Only one study satisfied our inclusion criteria, comparing percutaneous radiofrequency thermal lumbar sympathectomy with lumbar sympathetic neurolysis using phenol in 20 participants with CRPS. There was no comparison of sympathectomy versus sham or placebo. No dichotomous pain outcomes were reported. Average baseline scores of 8-9/10 on several pain scales fell to about 4/10 initially (1 day) and remained at 3-5/10 over four months. There were no significant differences between groups, except for "unpleasant sensation", which was higher with radiofrequency ablation. One participant in the phenol group experienced postsympathectomy neuralgia, while two in the

  10. Intrathecal glycine for pain and dystonia in complex regional pain syndrome.

    PubMed

    Munts, Alexander G; van der Plas, Anton A; Voormolen, Joan H; Marinus, Johan; Teepe-Twiss, Irene M; Onkenhout, Willem; van Gerven, Joop M; van Hilten, Jacobus J

    2009-11-01

    Since glycinergic neurotransmission plays an important inhibitory role in the processing of sensory and motor information, intrathecal glycine (ITG) administration may be a potential therapy for both pain and movement disorders in patients with complex regional pain syndrome (CRPS). Aims of the current study, which is the first report on ITG in humans, were to evaluate its safety and efficacy. ITG treatment during 4 weeks was studied in CRPS patients with dystonia in the period before they received intrathecal baclofen treatment. Twenty patients were assessed and after exclusion of one patient, the remaining 19 patients were randomized in a double-blind placebo-controlled crossover study. Safety was assessed by clinical evaluation, blood examinations and electrocardiograms. Efficacy measures involved pain (numeric rating scale, McGill pain questionnaire), movement disorders (Burke-Fahn-Marsden dystonia rating scale, unified myoclonus rating scale, tremor research group rating scale), activity (Radboud skills questionnaire, walking ability questionnaire), and a clinical global impression (CGI) and patient's global impression score (PGI). Treatment-emergent adverse events were generally mild to moderate and not different from placebo treatment. During ITG treatment growth hormone levels were slightly increased. Although there was a trend to worsening on the CGI and PGI during ITG treatment, there were no significant differences between ITG and placebo treatment in any of the outcomes. ITG given over 4 weeks was ineffective for pain or dystonia in CRPS. Although no serious adverse events occurred, further studies are required to rule out potential neurotoxicity of ITG.

  11. Intrathecal ziconotide for complex regional pain syndrome: seven case reports.

    PubMed

    Kapural, Leonardo; Lokey, Kristi; Leong, Michael S; Fiekowsky, Sharon; Stanton-Hicks, Michael; Sapienza-Crawford, Anne J; Webster, Lynn R

    2009-01-01

    Ziconotide is a nonopioid analgesic currently indicated as monotherapy, but frequently used in combination with opioids, for the management of severe chronic pain in patients for whom intrathecal (IT) therapy is warranted and who are intolerant of, or whose pain is, refractory to other treatments. There is a paucity of information regarding ziconotide use in patients with complex regional pain syndrome (CRPS). Seven cases in which IT ziconotide was used in patients with CRPS were analyzed. All patients (4 male, 3 female; age range, 14 to 52 years) had experienced inadequate pain relief with multiple conventional and interventional treatments. Three patients received ziconotide monotherapy exclusively; 4 patients received ziconotide monotherapy initially, then combination IT therapy. The mean ziconotide dose was 5.2 mcg/d (range, 0.5 to 13 mcg/d) at initiation and 24.7 mcg/d (range, 0.06 to 146 mcg/d) at the last available assessment. The mean duration of ziconotide therapy was 3.1 years (range, 26 days to 8 years). At ziconotide initiation, the mean visual analog scale (VAS) score was 89.3 mm (range, 75 to 100 mm); VAS scores decreased by a mean of 47.5% (range, 5% to 100%) at last assessment. Of the 5 patients who experienced substantial improvement in pain, edema, skin abnormalities, and/or mobility with ziconotide therapy, 2 have discontinued ziconotide and are pain free. Another patient experienced marked reversal of both edema and advanced skin trophic changes. Adverse events included urinary retention, depression, anxiety, and hallucinations. Adverse events generally resolved spontaneously, with treatment, or with ziconotide discontinuation/dose reduction. Although further studies are required, ziconotide holds promise as an effective treatment for CRPS.

  12. Intravenous regional block with phentolamine in the treatment of complex regional pain syndrome.

    PubMed

    Niaki, Asadollah Saadat; Bagherzadi, Kambiz; Momenzadeh, Sirous; Shahriyari, Hooshang; Dori, Mehrdad Mokarram

    2011-01-01

    Complex regional pain syndrome (CRPS) is a variety of painful conditions following injury which appears regionally having a distal predominance of abnormal findings. This study, evaluate the use of phentolamine for sympathetic block and regional anesthesia in treatment of CRPS related pain. In this study, 68 patients with CRPS who were referred to pain clinics of Imam Hossein and Akhtar Hospitals and Gandy Center of Surgery between 2003-2008 were evaluated. Forty three of 87 patients finally undertaken intravenous regional sympatholytic block according to therapeutic protocol. 37 patients (86%) received one block, 2 of them (4.75%) received 2 repetitions of blocks and finally repeated block for three times occurred in 4 patients (9.3%). A week after block pain relief outcomes was recorded as following; excellent in 7 patients (16.3%), good in the 32 patients (74.4%) and moderate in the 4 patients (9.3%). After a month, 8 patients (18.5%) showed excellent relief and it was good and moderate in 32 (78%) and one case (2.4%), respectively. Pain relief after three months was excellent, good and moderate in the 13 patients (31.7%), 25 patients (61%) and 3 patients (7.3%), respectively. In this study level of pain relief was significant in various intervals and it showed significant difference in relief three months after block (P=0.04). CRPS due to SMP(sympathetically maintained pain) is thought to be alleviated by phentolamine. Intravenous phentolamine infusion is potentially a new significant option for the therapy of CRPS.

  13. Continuous Regional Anesthesia and Inpatient Rehabilitation for Pediatric Complex Regional Pain Syndrome.

    PubMed

    Donado, Carolina; Lobo, Kimberly; Velarde-Álvarez, María Fe; Kim, Joseph; Kenney, Anne; Logan, Deirdre; Berde, Charles B

    Evidence supports treatment of pediatric complex regional pain syndromes (CRPS) with physical and occupational therapy and cognitive-behavioral therapy. Some patients have persistent pain and/or limb dysfunction despite these treatments. We performed a retrospective study of pediatric patients with CRPS treated by continuous epidural or peripheral perineural local anesthetic infusions along with inpatient rehabilitation at Boston Children's Hospital. After approval from the institutional review board, electronic medical records were reviewed for patients treated between September 2003 and September 2014. Primary outcomes were pain and functional scores. Data were collected at the first encounter, at follow-up visits between 4 months before and after admission, and daily while inpatient. Changes over time were assessed using Wilcoxon tests with Dunn corrections. Clinical significance of benefit or harm was assessed by the method of Jacobson and Truax. Response predictors were analyzed using linear mixed models and exploratory logarithmic regression analyses. Pain, function, and disability scores improved during hospitalization and in follow-up over a 4-month period. Seventy percent of patients achieved clinically significant benefit (56% for pain reduction and 40% increased functionality, respectively). Univariate and adjusted predictors of favorable outcome included preadmission resting Numeric Pain Rating Scale score of less than 6 (odds ratio, 5.0; P = 0.0164 and subsequent attendance at the Pediatric Pain Rehabilitation Center at Boston Children's Hospital (odds ratio, 5.0; P = 0.0206). Mean pain scores greater than 3 during the regional anesthesia infusion predicted less favorable outcome. Continuous regional anesthesia may be an option to facilitate intensive rehabilitation for selected pediatric patients with CRPS. Further research should help clarify the role of regional anesthesia in a comprehensive management program.

  14. Consumption of attention versus affect elicited by cognitions in modifying acute pain.

    PubMed

    Stevens, M J; Heise, R A; Pfost, K S

    1989-02-01

    40 subjects were randomly assigned to conditions of high pleasure, low pleasure, high anger, or low anger in a 2 x 2 (intensity x affect) design. Although subjects used highly intense cognitions more than less intense ones, pleasant cognitions produced higher tolerance for pressure pain. Modification of pain may be mediated by specific affect rather than intensity or consumption of attention.

  15. Positive Affect as a Source of Resilience for Women in Chronic Pain.

    ERIC Educational Resources Information Center

    Zautra, Alex J.; Johnson, Lisa M.; Davis, Mary C.

    2005-01-01

    A sample of 124 women with osteoarthritis or fibromyalgia, or both, completed initial assessments for demographic data, health status, and personality traits and 10-12 weekly interviews regarding pain, stress, negative affect, and positive affect. Multilevel modeling analyses indicated that weekly elevations of pain and stress predicted increases…

  16. Positive Affect as a Source of Resilience for Women in Chronic Pain.

    ERIC Educational Resources Information Center

    Zautra, Alex J.; Johnson, Lisa M.; Davis, Mary C.

    2005-01-01

    A sample of 124 women with osteoarthritis or fibromyalgia, or both, completed initial assessments for demographic data, health status, and personality traits and 10-12 weekly interviews regarding pain, stress, negative affect, and positive affect. Multilevel modeling analyses indicated that weekly elevations of pain and stress predicted increases…

  17. Does vitamin C prevent the occurrence of complex regional pain syndrome in patients with extremity trauma requiring surgery?

    PubMed

    Cabrolier, Jorge; Molina, Marcelo

    2015-07-29

    The complex regional pain syndrome is a neuroinflammatory pathology that affects the central and peripheral nervous system, characterized by disproportional pain in relation to the trauma experimented by the patient. It has been proposed that vitamin C could prevent the development of this syndrome in patients with limb trauma and surgery. Searching in Epistemonikos database, which is maintained by screening 30 databases, we identified two systematic reviews that indentified four primary studies, including one randomized controlled trial. We generated a summary of findings table following the GRADE approach. We concluded it is uncertain whether vitamin C prevents complex regional pain syndrome because the certainty of the evidence is very low.

  18. 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

  19. [Clinical practice guideline 'Complex regional pain syndrome type I'].

    PubMed

    Perez, R S G M; Zollinger, P E; Dijkstra, P U; Thomassen-Hilgersom, I L; Zuurmond, W W A; Rosenbrand, C J G M; Geertzen, J H B

    2007-07-28

    The development and treatment ofthe complex regional pain syndrome type I (CRPS-I) are a subject of much discussion. Using the method for the development ofevidence-based guidelines, a multidisciplinary guideline for the diagnosis and treatment of this syndrome has been drawn up. The diagnosis of CRPS-I is based on the clinical observation of signs and symptoms. For pain treatment, the WHO analgesic ladder is advised up to step z. In case of pain ofa neuropathic nature, anticonvulsants and tricyclic antidepressants may be considered. For the treatment ofinflammatory symptoms, free-radical scavengers (dimethylsulphoxide or acetylcysteine) are advised. In order to enhance peripheral blood flow, vasodilatory medication may be considered. Percutaneous sympathetic blockades may be used for a cold extremity ifvasodilatory medication produces insufficient effect. To decrease functional limitations, standardised physiotherapy and occupational therapy are advised. To prevent the occurrence of CRPS-I after wrist fractures, the use of vitamin C is recommended. Adequate perioperative analgesia, limitation of operation time and limited use of bloodlessness are advised for the secondary prevention of CRPS-I. Use of regional anaesthetic techniques can also be considered in this connection.

  20. Evidence based guidelines for complex regional pain syndrome type 1

    PubMed Central

    2010-01-01

    Background Treatment of complex regional pain syndrome type I (CRPS-I) is subject to discussion. The purpose of this study was to develop multidisciplinary guidelines for treatment of CRPS-I. Method A multidisciplinary task force graded literature evaluating treatment effects for CRPS-I according to their strength of evidence, published between 1980 to June 2005. Treatment recommendations based on the literature findings were formulated and formally approved by all Dutch professional associations involved in CRPS-I treatment. Results For pain treatment, the WHO analgesic ladder is advised with the exception of strong opioids. For neuropathic pain, anticonvulsants and tricyclic antidepressants may be considered. For inflammatory symptoms, free-radical scavengers (dimethylsulphoxide or acetylcysteine) are advised. To promote peripheral blood flow, vasodilatory medication may be considered. Percutaneous sympathetic blockades may be used to increase blood flow in case vasodilatory medication has insufficient effect. To decrease functional limitations, standardised physiotherapy and occupational therapy are advised. To prevent the occurrence of CRPS-I after wrist fractures, vitamin C is recommended. Adequate perioperative analgesia, limitation of operating time, limited use of tourniquet, and use of regional anaesthetic techniques are recommended for secondary prevention of CRPS-I. Conclusions Based on the literature identified and the extent of evidence found for therapeutic interventions for CRPS-I, we conclude that further research is needed into each of the therapeutic modalities discussed in the guidelines. PMID:20356382

  1. Focused Cardiac Ultrasound for the Regional Anesthesiologist and Pain Specialist.

    PubMed

    Haskins, Stephen C; Tanaka, Christopher Y; Boublik, Jan; Wu, Christopher L; Sloth, Erik

    This article in our point-of-care ultrasound (PoCUS) series discusses the benefits of focused cardiac ultrasound (FoCUS) for the regional anesthesiologist and pain specialist. Focused cardiac US is an important tool for all anesthesiologists assessing patients with critical conditions such as shock and cardiac arrest. However, given that ultrasound-guided regional anesthesia is emerging as the new standard of care, there is an expanding role for ultrasound in the perioperative setting for regional anesthesiologists to help improve patient assessment and management. In addition to providing valuable insight into cardiac physiology (preload, afterload, and myocardial contractility), FoCUS can also be used either to assess patients at risk of complications related to regional anesthetic technique or to improve management of patients undergoing regional anesthesia care. Preoperatively, FoCUS can be used to assess patients for significant valvular disease, such as severe aortic stenosis or derangements in volume status before induction of neuraxial anesthesia. Intraoperatively, FoCUS can help differentiate among complications related to regional anesthesia, including high spinal or local anesthetic toxicity resulting in hemodynamic instability or cardiac arrest. Postoperatively, FoCUS can help diagnose and manage common yet life-threatening complications such as pulmonary embolism or derangements in volume status. In this article, we introduce to the regional anesthesiologist interested in learning FoCUS the basic views (subcostal 4-chamber, subcostal inferior vena cava, parasternal short axis, parasternal long axis, and apical 4-chamber), as well as the relevant sonoanatomy. We will also use the I-AIM (Indication, Acquisition, Interpretation, and Medical decision making) framework to describe the clinical circumstances where FoCUS can help identify and manage obvious pathology relevant to the regional anesthesiologist and pain specialist, specifically severe aortic

  2. Sex differences in perceived pain are affected by an anxious brain.

    PubMed

    Goffaux, Philippe; Michaud, Karine; Gaudreau, Janou; Chalaye, Philippe; Rainville, Pierre; Marchand, Serge

    2011-09-01

    Decades of research confirm that women have greater pain sensitivity than men. Women also show greater overall anxiety sensitivity than men. Given these differences, we hypothesized that sex differences in anxiety would explain sex differences in experienced pain and physiological responses to pain (at both spinal and cortical levels). By measuring subjective pain, state/trait anxiety, nociceptive flexion reflexes, and somatosensory evoked potentials (SEPs), it was possible to test the effects of anxiety on the processing of painful drives at different levels of the neuraxis while also documenting the role played by anxiety on sex differences in experienced pain. Results confirm that women are indeed more sensitive to pain than men. Importantly, this difference was accompanied by a significant sex difference in cortical activity (SEP amplitude) but not spinal nociceptive activity, suggesting that much of the sex difference in experienced pain is attributable to variations in thalamocortical processing and to ensuing changes in the appraisal of and/or emotional response to noxious insult. In support of this claim, we found that sex differences in cortical activity and subjective pain disappeared when trait anxiety was controlled for. This means that stable predispositions to respond with heightened apprehension contribute to baseline pain sensitivity differences between the sexes. These results indicate that the modulatory effect of affect on pain-related brain processes may explain why men and women experience painful shocks so differently. In our study, the mediating role of anxiety on sex differences in pain was tested and confirmed using path analysis.

  3. Cervico-thoracic or lumbar sympathectomy for neuropathic pain and complex regional pain syndrome

    PubMed Central

    Straube, Sebastian; Derry, Sheena; Moore, R Andrew; McQuay, Henry J

    2014-01-01

    Background This review is an update on ‘Sympathectomy for neuropathic pain’ originally published in Issue 2, 2003. The concept that many neuropathic pain syndromes (traditionally this definition would include complex regional pain syndromes (CRPS)) are “sympathetically maintained pains” has historically led to treatments that interrupt the sympathetic nervous system. Chemical sympathectomies use alcohol or phenol injections to destroy ganglia of the sympathetic chain, while surgical ablation is performed by open removal or electrocoagulation of the sympathetic chain, or minimally invasive procedures using thermal or laser interruption. Objectives To review the evidence from randomised, double blind, controlled trials on the efficacy and safety of chemical and surgical sympathectomy for neuropathic pain. Sympathectomy could be compared with placebo (sham) or other active treatment. Search methods We searched MEDLINE, EMBASE and The Cochrane Library to May 2010. We screened references in the retrieved articles and literature reviews, and contacted experts in the field of neuropathic pain. Selection criteria Randomised, double blind, placebo or active controlled studies assessing the effects of sympathectomy for neuropathic pain and CRPS. Data collection and analysis Two review authors independently assessed trial quality and validity, and extracted data. No pooled analysis of data was possible. Main results Only one study satisfied our inclusion criteria, comparing percutaneous radiofrequency thermal lumbar sympathectomy with lumbar sympathetic neurolysis using phenol in 20 participants with CRPS. There was no comparison of sympathectomy versus sham or placebo. No dichotomous pain outcomes were reported. Average baseline scores of 8-9/10 on several pain scales fell to about 4/10 initially (1 day) and remained at 3-5/10 over four months. There were no significant differences between groups, except for “unpleasant sensation”, which was higher with

  4. Neurogenic neuroinflammation in fibromyalgia and complex regional pain syndrome.

    PubMed

    Littlejohn, Geoffrey

    2015-11-01

    Although fibromyalgia and complex regional pain syndrome (CRPS) have distinct clinical phenotypes, they do share many other features. Pain, allodynia and dysaesthesia occur in each condition and seem to exist on a similar spectrum. Fibromyalgia and CRPS can both be triggered by specific traumatic events, although fibromyalgia is most commonly associated with psychological trauma and CRPS is most often associated with physical trauma, which is frequently deemed routine or minor by the patient. Fibromyalgia and CRPS also seem to share many pathophysiological mechanisms, among which the most important are those involving central effects. Nonetheless, peripheral effects, such as neurogenic neuroinflammation, are also important contributors to the clinical features of each of these disorders. This Review highlights the differing degrees to which neurogenic neuroinflammation might contribute to the multifactorial pathogenesis of both fibromyalgia and CRPS, and discusses the evidence suggesting that this mechanism is an important link between the two disorders, and could offer novel therapeutic targets.

  5. Pain patients' experiences of validation and invalidation from physicians before and after multimodal pain rehabilitation: Associations with pain, negative affectivity, and treatment outcome.

    PubMed

    Edlund, Sara M; Wurm, Matilda; Holländare, Fredrik; Linton, Steven J; Fruzzetti, Alan E; Tillfors, Maria

    2017-08-04

    Validating and invalidating responses play an important role in communication with pain patients, for example regarding emotion regulation and adherence to treatment. However, it is unclear how patients' perceptions of validation and invalidation relate to patient characteristics and treatment outcome. The aim of this study was to investigate the occurrence of subgroups based on pain patients' perceptions of validation and invalidation from their physicians. The stability of these perceptions and differences between subgroups regarding pain, pain interference, negative affectivity and treatment outcome were also explored. A total of 108 pain patients answered questionnaires regarding perceived validation and invalidation, pain severity, pain interference, and negative affectivity before and after pain rehabilitation treatment. Two cluster analyses using perceived validation and invalidation were performed, one on pre-scores and one on post-scores. The stability of patient perceptions from pre- to post-treatment was investigated, and clusters were compared on pain severity, pain interference, and negative affectivity. Finally, the connection between perceived validation and invalidation and treatment outcome was explored. Three clusters emerged both before and after treatment: (1) low validation and heightened invalidation, (2) moderate validation and invalidation, and (3) high validation and low invalidation. Perceptions of validation and invalidation were generally stable over time, although there were individuals whose perceptions changed. When compared to the other two clusters, the low validation/heightened invalidation cluster displayed significantly higher levels of pain interference and negative affectivity post-treatment but not pre-treatment. The whole sample significantly improved on pain interference and depression, but treatment outcome was independent of cluster. Unexpectedly, differences between clusters on pain interference and negative affectivity

  6. 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.

  7. Memory of pain and affect associated with migraine and non-migraine headaches.

    PubMed

    Bąbel, Przemysław

    2015-01-01

    The main aims of this study were to assess memory of pain and pain-related affect in headache sufferers and to compare the pain memories of individuals who suffer from migraines and those who experience non-migraine headaches. A total of 313 women participated in the study, 86 of whom had a diagnosis of migraine headache. The women rated their state anxiety about having a headache, the intensity and unpleasantness of headache pain, and their emotions while actually experiencing a headache. Either three or six months later, the participants were asked to recall their state anxiety, the intensity and unpleasantness of pain, and the emotions they had felt. Regardless of the length of recall delay or migraine diagnosis, participants accurately remembered both pain intensity and unpleasantness. Together, recalled anxiety, experienced pain and recalled positive affect were the most important predictors of memories for headache, accounting for 41% and 37% of the total variance in recalled pain intensity and unpleasantness, respectively. However, participants overestimated recalled positive and negative affect. The effect of recalled affect on memory of headache, together with the overestimation of recalled affect, suggests that although memory of headache is accurate, it is influenced by distorted memories of affect.

  8. Regional Supply of Chiropractic Care and Visits to Primary Care Physicians for Back and Neck Pain.

    PubMed

    Davis, Matthew A; Yakusheva, Olga; Gottlieb, Daniel J; Bynum, Julie P W

    2015-01-01

    Whether availability of chiropractic care affects use of primary care physician (PCP) services is unknown. We performed a cross-sectional study of 17.7 million older adults who were enrolled in Medicare from 2010 to 2011. We examined the relationship between regional supply of chiropractic care and PCP services using Spearman correlation. Generalized linear models were used to examine the association between regional supply of chiropractic care and number of annual visits to PCPs for back and/or neck pain. We found a positive association between regional supply of chiropractic care and PCP services (rs = 0.52; P <.001). An inverse association between supply of chiropractic care and the number of annual visits to PCPs for back and/or neck pain was apparent. The number of PCP visits for back and/or neck pain was 8% lower (rate ratio, 0.92; 95% confidence interval, 0.91-0.92) in the quintile with the highest supply of chiropractic care compared to the lowest quintile. We estimate chiropractic care is associated with a reduction of 0.37 million visits to PCPs nationally, at a cost of $83.5 million. Greater availability of chiropractic care in some areas may be offsetting PCP services for back and/or neck pain among older adults. © Copyright 2015 by the American Board of Family Medicine.

  9. Regional Supply of Chiropractic Care and Visits to Primary Care Physicians for Back and Neck Pain

    PubMed Central

    Davis, Matthew A.; Yakusheva, Olga; Gottlieb, Daniel J.; Bynum, Julie P.W.

    2015-01-01

    Background Whether availability of chiropractic care affects use of primary care physician (PCP) services is unknown. Methods We performed a cross-sectional study of 17.7 million older adults who were enrolled in Medicare from 2010 to 2011. We examined the relationship between regional supply of chiropractic care and PCP services using Spearman correlation. Generalized linear models were used to examine the association between regional supply of chiropractic care and number of annual visits to PCPs for back and/or neck pain. Results We found a positive association between regional supply of chiropractic care and PCP services (rs = 0.52; P <.001). An inverse association between supply of chiropractic care and the number of annual visits to PCPs for back and/or neck pain was apparent. The number of PCP visits for back and/or neck pain was 8% lower (rate ratio, 0.92; 95% confidence interval, 0.91–0.92) in the quintile with the highest supply of chiropractic care compared to the lowest quintile. We estimate chiropractic care is associated with a reduction of 0.37 million visits to PCPs nationally, at a cost of $83.5 million. Conclusions Greater availability of chiropractic care in some areas may be offsetting PCP services for back and/or neck pain among older adults. (J Am Board Fam Med 2015;28:000–000.) PMID:26152439

  10. Dynamic modulation of inflammatory pain-related affective and sensory symptoms by optical control of amygdala metabotropic glutamate receptor 4.

    PubMed

    Zussy, C; Gómez-Santacana, X; Rovira, X; De Bundel, D; Ferrazzo, S; Bosch, D; Asede, D; Malhaire, F; Acher, F; Giraldo, J; Valjent, E; Ehrlich, I; Ferraguti, F; Pin, J-P; Llebaria, A; Goudet, C

    2016-12-20

    Contrary to acute pain, chronic pain does not serve as a warning signal and must be considered as a disease per se. This pathology presents a sensory and psychological dimension at the origin of affective and cognitive disorders. Being largely refractory to current pharmacotherapies, identification of endogenous systems involved in persistent and chronic pain is crucial. The amygdala is a key brain region linking pain sensation with negative emotions. Here, we show that activation of a specific intrinsic neuromodulatory system within the amygdala associated with type 4 metabotropic glutamate receptors (mGlu4) abolishes sensory and affective symptoms of persistent pain such as hypersensitivity to pain, anxiety- and depression-related behaviors, and fear extinction impairment. Interestingly, neuroanatomical and synaptic analysis of the amygdala circuitry suggests that the effects of mGlu4 activation occur outside the central nucleus via modulation of multisensory thalamic inputs to lateral amygdala principal neurons and dorso-medial intercalated cells. Furthermore, we developed optogluram, a small diffusible photoswitchable positive allosteric modulator of mGlu4. This ligand allows the control of endogenous mGlu4 activity with light. Using this photopharmacological approach, we rapidly and reversibly inhibited behavioral symptoms associated with persistent pain through optical control of optogluram in the amygdala of freely behaving animals. Altogether, our data identify amygdala mGlu4 signaling as a mechanism that bypasses central sensitization processes to dynamically modulate persistent pain symptoms. Our findings help to define novel and more precise therapeutic interventions for chronic pain, and exemplify the potential of optopharmacology to study the dynamic activity of endogenous neuromodulatory mechanisms in vivo.Molecular Psychiatry advance online publication, 20 December 2016; doi:10.1038/mp.2016.223.

  11. Association between physical pain and alcohol treatment outcomes: The mediating role of negative affect.

    PubMed

    Witkiewitz, Katie; McCallion, Elizabeth; Vowles, Kevin E; Kirouac, Megan; Frohe, Tessa; Maisto, Stephen A; Hodgson, Ray; Heather, Nick

    2015-12-01

    Physical pain and negative affect have been described as risk factors for alcohol use following alcohol treatment. The current study was a secondary analysis of 2 clinical trials for alcohol use disorder (AUD) to examine the associations between pain, negative affect and AUD treatment outcomes. Participants included 1,383 individuals from the COMBINE Study (COMBINE Pharmacotherapies and Behavioral Interventions for Alcohol Dependence; COMBINE Study Research Group, 2003; 31% female, 23% ethnic minorities, average age = 44.4 [SD = 10.2]), a multisite combination pharmacotherapy and behavioral intervention study for AUD in the United States, and 742 individuals from the United Kingdom Alcohol Treatment Trial (UKATT Research Team, 2001; 25.9% female, 4.4% ethnic minorities, average age = 41.6 [SD = 10.1]) a multisite behavioral intervention study for AUD in the United Kingdom. The Form-90 was used to collect alcohol use data, the Short Form Health Survey and Quality of Life measures were used to assess pain, and negative affect was assessed using the Brief Symptom Inventory (COMBINE) and the General Health Questionnaire (UKATT). Pain scores were significantly associated with drinking outcomes in both datasets. Greater pain scores were associated with greater negative affect and increases in pain were associated with increases in negative affect. Negative affect significantly mediated the association between pain and drinking outcomes and this effect was moderated by social behavior network therapy (SBNT) in the UKATT study, with SBNT attenuating the association between pain and drinking. Findings suggest pain and negative affect are associated among individuals in AUD treatment and that negative affect mediated pain may be a risk factor for alcohol relapse. (c) 2015 APA, all rights reserved).

  12. Association between Physical Pain and Alcohol Treatment Outcomes: The Mediating Role of Negative Affect

    PubMed Central

    Witkiewitz, Katie; McCallion, Elizabeth; Vowles, Kevin E.; Kirouac, Megan; Frohe, Tessa; Maisto, Stephen A.; Hodgson, Ray; Heather, Nick

    2015-01-01

    Objective Physical pain and negative affect have been described as risk factors for alcohol use following alcohol treatment. The current study was a secondary analysis of two clinical trials for alcohol use disorder (AUD) to examine the associations between pain, negative affect and AUD treatment outcomes. Method Participants included 1383 individuals from the COMBINE Study (COMBINE Study Group, 2003; 31% female, 23% ethnic minorities, average age=44.4 (SD=10.2)), a multisite combination pharmacotherapy and behavioral intervention study for AUD in the United States, and 742 individuals from the United Kingdom Alcohol Treatment Trial (UKATT Research Team, 2001; 25.9% female, 4.4% ethnic minorities, average age=41.6 (SD=10.1)) a multisite behavioral intervention study for AUD in the United Kingdom. The Form-90 was used to collect alcohol use data, the Short Form Health Survey and Quality of Life measures were used to assess pain, and negative affect was assessed using the Brief Symptom Inventory (COMBINE) and the General Health Questionnaire (UKATT). Results Pain scores were significantly associated with drinking outcomes in both datasets. Greater pain scores were associated with greater negative affect and increases in pain were associated with increases in negative affect. Negative affect significantly mediated the association between pain and drinking outcomes and this effect was moderated by social behavior network therapy (SBNT) in the UKATT study, with SBNT attenuating the association between pain and drinking. Conclusion Findings suggest pain and negative affect are associated among individuals in AUD treatment and that negative affect mediated pain may be a risk factor for alcohol relapse. PMID:26098375

  13. Back pain during war: an analysis of factors affecting outcome.

    PubMed

    Cohen, Steven P; Nguyen, Conner; Kapoor, Shruti G; Anderson-Barnes, Victoria C; Foster, Leslie; Shields, Cynthia; McLean, Brian; Wichman, Todd; Plunkett, Anthony

    2009-11-09

    Back pain is the leading cause of disability in the world, but it is even more common in soldiers deployed for combat operations. Aside from battle injuries and psychiatric conditions, spine pain and other musculoskeletal conditions are associated with the lowest return-to-unit rate among service members medically evacuated out of Operations Iraqi and Enduring Freedom. Demographic, military-specific, and outcome data were prospectively collected over a 2-week period at the Deployed Warrior Medical Management Center in Germany on 1410 consecutive soldiers medically evacuated out of theaters of combat operations for a primary diagnosis pertaining to back pain between 2004 and 2007. The 2-week period represents the maximal allowable time an evacuated soldier can spend in treatment before disposition (ie, return to theater or evacuate to United States) is rendered. Electronic medical records were then reviewed to examine the effect a host of demographic and clinical variables had on the categorical outcome measure, return to unit. The overall return-to-unit rate was 13%. Factors associated with a positive outcome included female sex, deployment to Afghanistan, being an officer, and a history of back pain. Trends toward not returning to duty were found for navy and marine service members, coexisting psychiatric morbidity, and not being seen in a pain clinic. The likelihood of a service member medically evacuated out of theater with back pain returning to duty is low irrespective of any intervention(s) or characteristic(s). More research is needed to determine whether concomitant treatment of coexisting psychological factors and early treatment "in theater" can reduce attrition rates.

  14. Epidural resiniferatoxin induced prolonged regional analgesia to pain.

    PubMed

    Szabo, T; Olah, Z; Iadarola, M J; Blumberg, P M

    1999-09-04

    Adequate treatment of cancer pain remains a significant clinical problem. To reduce side effects of treatment, intrathecal and epidural routes of administration have been used where appropriate to reduce the total dose of agent administered while achieving regional control. Resiniferatoxin (RTX), an ultrapotent capsaicin analog, gives long-term desensitization of nociception via C-fiber sensory neurons. We evaluate here the analgesic effect on rats of epidurally administered RTX, using latency of response to a thermal stimulus in unrestrained animals. Results were compared with those for systemically administered RTX. Vehicle or graded doses of RTX were injected subcutaneously (s.c.) or through an indwelling lumbar (L4) epidural catheter as a single dose. Both routes of application of RTX produced profound thermal analgesia, reaching a plateau within 4-6 h and showing no restoration of pain sensitivity over 7 days. Vehicle was without effect. For the epidural route, the effect was selective as expected for the targeted spinal cord region, whereas the subcutaneous administration of RTX had a generalized analgesic effect. At doses yielding a tripling of back paw withdrawal latency, epidural treatment was 25-fold more effective than the subcutaneous route of application. Consistent with the regional selectivity of the lumbar epidural route, the front paws showed no more effect than by systemic RTX treatment. Binding experiments with [3H]RTX provided further evidence of the segmental desensitization induced by epidural RTX. We conclude that epidural administration of RTX at the lumbar spinal level produces profound, long-lasting, segmental analgesia to C-fiber mediated pain in the rat.

  15. Venipuncture Induced Complex Regional Pain Syndrome Presenting as Inflammatory Arthritis

    PubMed Central

    Arora, Pramod; Mittal, Manoj; Nair, Anugrah; Sultana, Waqia

    2016-01-01

    Venipuncture is one of the most commonly done medical procedures. We report a unique case of a 23-year-old young male who presented with features suggestive of inflammatory arthritis. The symptoms, which initially started on the right side, also involved the other side after a few weeks. Although the patient's symptoms and signs were simulating inflammatory arthritis, he had atypical features like poor response to anti-inflammatory medicines and normal laboratory parameters. His musculoskeletal ultrasonography was also not suggestive of arthritis. His history was reviewed and on direct questioning he revealed a history of venipuncture for blood sample withdrawal, done from right antecubital region for routine health check on the day prior to the onset of symptoms. Complex regional pain syndrome was suspected and triple-phase radioisotope bone scan was done which was highly suggestive of this diagnosis. The patient was managed with multidimensional approach and responded very well to the treatment. Complex regional pain syndrome is usually not thought of in the initial differential diagnosis of inflammatory arthritis. In this report we highlight the need to elicit the often overlooked history of trivial trauma like venipuncture, especially in atypical cases of arthritis. Also the role of newer diagnostic modalities in such cases is emphasized. PMID:27891152

  16. Work-Related Complex Regional Pain Syndrome: Diagnosis and Treatment.

    PubMed

    Friedman, Andrew

    2015-08-01

    Complex regional pain syndrome can be a debilitating disorder, which, in its earliest stages, can be prevented by aggressive rehabilitation based on reactivation. It is critical to follow international criteria on making the diagnosis; overdiagnosis can lead to inappropriate interventions and further disability. When present, early recognition with reactivation is the cornerstone of treatment. This article presents a phased approach to treatment that suggests movements of nonresponders quickly to more integrated levels of care. Some commonly used invasive interventions, such as sympathectomy and spinal cord stimulation, have not been proved effective; these unproven and potentially harmful therapies should be avoided.

  17. Impaired Empathic Abilities among Patients with Complex Regional Pain Syndrome (Type I)

    PubMed Central

    Sohn, Hong-Suk; Lee, Do-Hyeong; Lee, Kyung-Jun; Noh, Eun Chung; Choi, Soo-Hee; Jang, Joon Hwan; Kim, Yong Chul

    2016-01-01

    Objective The aims of this study were to evaluate differences in empathic abilities between patients with complex regional pain syndrome (CRPS) Type I and healthy control subjects (HCs) and to assess correlations between empathic abilities and multidimensional aspects of pain. Methods Empathic ability was measured in 32 patients with CRPS Type I and in 36 HCs using the Interpersonal Reactivity Index (IRI). A comprehensive assessment of pain was conducted in the patient group using the West Haven-Yale Multidimensional Pain Inventory (WHYMPI). Psychiatric symptoms were assessed using the Beck Depression and Anxiety Inventories (BDI and BAI), and quality of life was evaluated using the WHO Quality of Life (WHOQOL-BREF) questionnaire. Results Patients with CRPS showed impaired cognitive and emotional empathic abilities compared with HCs. Significantly lower levels of perspective taking and empathic concern and higher levels of personal distress on the IRI were exhibited by the patient group. Perspective taking and personal distress were associated with affective distress and poor quality of life in social contexts (BDI, BAI, and WHOQOL). However, empathic concern was positively correlated with pain severity and social support from others (WHYMPI). Conclusion A tendency toward self-oriented distress in social cognition was exhibited among patients with CRPS Type I. Impaired empathic ability was shown to have potentially negative effects on subjective emotional outcomes and social performance in the lives of patients. Interventions to improve emotional awareness and theory of mind would be beneficial for enhancing social functioning in patients with CRPS Type I. PMID:26766944

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

    PubMed

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

    2014-03-01

    Pain localized in the deep tissues occurs frequently in complex regional pain syndrome (CRPS). In addition, hyperalgesia to blunt pressure over muscles is common in CRPS, but it often appears in limb pain of other origin as well. Considering that 3-phase bone scintigraphy (TPBS) reveals periarticular enhanced bone metabolism in CRPS, joint-associated hyperalgesia to blunt pressure might be a more specific finding than hyperalgesia over muscles. In 34 patients with upper limb pain (18 CRPS, 16 non-CRPS; diagnosed in accordance to the Budapest criteria) and in 18 healthy controls, pressure-pain thresholds (PPT) were assessed bilaterally over the thenar (PPTThenar), the metacarpophalangeal (PPTMCP), and the proximal interphalangeal (PPTPIP) joints using a pressure algometer (Somedic, Sweden). Beforehand, all patients had received TPBS for diagnostic purposes independently of the study. Region-of-interest (ROI) ratios (mineralization phase) for the MCP and PIP, excluding fracture sites, were correlated with the PPT. In CRPS, all ROI ratios were significantly increased and all PPT of the affected hand were decreased compared to non-CRPS (PPTThenar: 243±150kPa vs 358±197kPa, PPTMCP: 80±67kPa vs 159±93kPa, PPTPIP: 80±56kPa vs 184±110kPa; P<.01) and controls (PPTThenar: 478±106kPa, PPTMCP: 254±50kPa, PPTPIP: 275±76kPa; P<.01). A PPTThenar below 293kPa revealed 77% sensitivity but only 63% specificity, whereas a PPTPIP below 102kPa had 82% sensitivity and 94% specificity to identify CRPS. Only in CRPS were PPTMCP and PPTPIP correlated significantly inversely with the ROI ratio (MCP: r=-0.439, PIP: r=-0.447). PPTPIP shows higher specificity for CRPS type I than PPTThenar without loss of sensitivity. Therefore, measurement of joint PPT could be a noninvasive diagnostic tool reflecting increased bone metabolism assessed by TPBS as a sign of bone pathophysiology. Copyright © 2013 International Association for the Study of Pain. Published by Elsevier B.V. All rights

  19. 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…

  20. 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…

  1. Empathy hurts: compassion for another increases both sensory and affective components of pain perception.

    PubMed

    Loggia, Marco L; Mogil, Jeffrey S; Bushnell, M Catherine

    2008-05-01

    Recent studies demonstrate that some brain structures activated by pain are also engaged when an individual observes someone else in pain, and that these empathy-related responses are modulated as a function of the affective link between the empath and the individual in pain. In this study we test the hypothesis that empathy-evoked activation in the pain network leads to heightened pain perception. After inducing in half of our subjects a state of high empathy for an actor and in the other half a state of low empathy towards him, we measured the sensitivity to heat stimuli of various intensities in healthy participants while they watched the actor being exposed to similar stimuli. Participants in the "high-empathy" group rated painful (but not non-painful) stimuli applied to themselves as more intense and unpleasant than did those in the "low-empathy" group. Positive correlations between state empathy scores and pain ratings further suggest that this perceptual phenomenon depends on the magnitude of empathic response induced in the participants. The effects were observed when subjects watched the model receiving either neutral or painful stimuli, suggesting that it is empathy itself that alters pain perception, and not necessarily the observation of pain behaviors.

  2. Vagus nerve pain referred to the craniofacial region. A case report and literature review with implications for referred cardiac pain.

    PubMed

    Myers, D E

    2008-02-23

    The pain of angina pectoris and myocardial infarction is sometimes referred to the head and neck region. The mechanism for this effect remains obscure. A case is presented here that reports that electrical stimulation of a cardiac branch of the left vagus nerve in humans can cause referred craniofacial pain. This leads to the hypothesis that the vagus nerve plays a role in mediating this pain. A review of the clinical and physiologic literature supports this hypothesis.

  3. Dry needling for management of pain in the upper quarter and craniofacial region.

    PubMed

    Kietrys, David M; Palombaro, Kerstin M; Mannheimer, Jeffrey S

    2014-01-01

    Dry needling is a therapeutic intervention that has been growing in popularity. It is primarily used with patients that have pain of myofascial origin. This review provides background about dry needling, myofascial pain, and craniofacial pain. We summarize the evidence regarding the effectiveness of dry needling. For patients with upper quarter myofascial pain, a 2013 systematic review and meta-analysis of 12 randomized controlled studies reported that dry needling is effective in reducing pain (especially immediately after treatment) in patients with upper quarter pain. There have been fewer studies of patients with craniofacial pain and myofascial pain in other regions, but most of these studies report findings to suggest the dry needling may be helpful in reducing pain and improving other pain related variables such as the pain pressure threshold. More rigorous randomized controlled trials are clearly needed to more fully elucidate the effectiveness of dry needling.

  4. Acupuncture alleviates the affective dimension of pain in a rat model of inflammatory hyperalgesia

    PubMed Central

    Zhang, Yu; Meng, Xianze; Li, Aihui; Xin, Jiajia; Berman, Brian M.; Lao, Lixing; Tan, Ming; Ren, Ke; Zhang, Rui-Xin

    2013-01-01

    Although studies demonstrate that electroacupuncture (EA) alleviates the sensory dimension of pain, they have not addressed EA’s effect on the affective dimension. 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 EA’s effects and its underpinning mechanism on the affective dimension of pain. CFA-injected rats showed place aversion, i.e. the affective dimension of pain, by spending less time in a pain-paired compartment after conditioning than before, while saline-injected rats did not. CFA rats given EA treatment at GB30 before a postconditioning test showed no aversion to the pain-paired compartment, indicating that EA inhibited the affective response. Intra-rostral anterior cingulate cortex (rACC) administration of a κ-, but not μ-opioid receptor antagonist, blocked EA action. These data demonstrate that EA activates opioid receptors in the rACC to inhibit the affective dimension of pain. PMID:21695393

  5. The Three Gorges Dam Affects Regional Precipitation

    NASA Technical Reports Server (NTRS)

    Wu, Liguang; Zhang, Qiang; Jiang, Zhihong

    2006-01-01

    Issues regarding building large-scale dams as a solution to power generation and flood control problems have been widely discussed by both natural and social scientists from various disciplines, as well as the policy-makers and public. Since the Chinese government officially approved the Three Gorges Dam (TGD) projects, this largest hydroelectric project in the world has drawn a lot of debates ranging from its social and economic to climatic impacts. The TGD has been partially in use since June 2003. The impact of the TGD is examined through analysis of the National Aeronautics and Space Administration (NASA) Tropical Rainfall Measuring Mission (TRMM) rainfall rate and Moderate Resolution Imaging Spectroradiometer (MODIS) land surface temperature and high-resolution simulation using the Pennsylvania State University-National Center for Atmospheric Research (PSU-NCAR) fifth-generation Mesoscale Model (MM5). The independent satellite data sets and numerical simulation clearly indicate that the land use change associated with the TGD construction has increased the precipitation in the region between Daba and Qinling mountains and reduced the precipitation in the vicinity of the TGD after the TGD water level abruptly rose from 66 to 135 m in June 2003. This study suggests that the climatic effect of the TGD is on the regional scale (approx.100 km) rather than on the local scale (approx.10 km) as projected in previous studies.

  6. Intrathecal baclofen for dystonia of complex regional pain syndrome.

    PubMed

    van Rijn, M A; Munts, A G; Marinus, J; Voormolen, J H C; de Boer, K S; Teepe-Twiss, I M; van Dasselaar, N T; Delhaas, E M; van Hilten, J J

    2009-05-01

    Dystonia in complex regional pain syndrome (CRPS) responds poorly to treatment. Intrathecal baclofen (ITB) may improve this type of dystonia, but information on its efficacy and safety is limited. A single-blind, placebo-run-in, dose-escalation study was carried out in 42 CRPS patients to evaluate whether dystonia responds to ITB. Thirty-six of the 38 patients, who met the responder criteria received a pump for continuous ITB administration, and were followed up for 12 months to assess long-term efficacy and safety (open-label study). Primary outcome measures were global dystonia severity (both studies) and dystonia-related functional limitations (open-label study). The dose-escalation study showed a dose-effect of baclofen on dystonia severity in 31 patients in doses up to 450 microg/day. One patient did not respond to treatment in the dose-escalation study and three patients dropped out. Thirty-six patients entered the open-label study. Intention-to-treat analysis revealed a substantial improvement in patient and assessor-rated dystonia scores, pain, disability and quality-of-life (Qol) at 12 months. The response in the dose-escalation study did not predict the response to ITB in the open-label study. Eighty-nine adverse events occurred in 26 patients and were related to baclofen (n=19), pump/catheter system defects (n=52), or could not be specified (n=18). The pump was explanted in six patients during the follow-up phase. Dystonia, pain, disability and Qol all improved on ITB and remained efficacious over a period of one year. However, ITB is associated with a high complication rate in this patient group, and methods to improve patient selection and catheter-pump integrity are warranted.

  7. Pain and dental implantology: sensory quantification and affective aspects. Part I: At the private dental office.

    PubMed

    Muller, E; Ríos Calvo, M P

    2001-01-01

    After an extensive review of the dental literature, few articles were found related to pain and implantology. Management of orofacial pain has traditionally been a difficult challenge for the dental-medical profession. Patients may be afraid of dental pain, particularly in cases of dental implantology. Therefore, a study to obtain more conclusive data was developed. Taking into account that the perception of pain and the threshold of pain vary among individuals, a 2-year clinical study was established in private practice utilizing a verbal method (double-blind). The study was used to quantify sensory and affective aspects of pain associated with dental implantology on 75 patients in a private dental office. All of the implants were placed by the same clinician. Data were recorded following a Pain Data Sheet designed for this particular study. The aim of this study was to obtain different aspects of data as follows: 1) Fear of the dentist and fear of dental implant procedures utilizing a descriptive scale of 1 to 10, with 1 indicative of no fear. 2) Dental areas and ridges: Dental pain, pain in edentulous areas, and pain in the implanted area utilizing a scale of 0 to 8, with 0 indicative of no pain. 3) Function and pain: during mastication, swallowing, speech, yawning, opening, closing, and lateral excursions and indication of cervical pain or back pain, each calibrated by the presence or absence of pain. 4) Palpation and pain of the temporomandibular joint, the temporal muscle, the area of the pterygoid muscles, masseter muscle, and sternocleidomastoid muscle, all calibrated on the indication of presence or absence of pain. 5) Others: ear pain, neuralgia, headaches, edema, and hematoma, calibrated on the basis of presence or absence. The aforementioned factors were evaluated immediately before surgery and after surgery, at 24 hours, and during a follow up for a period of 2 years at intervals of 1 week; 1, 2, 3, 4, and 6 months; and 1 and 2 years after surgery

  8. Brazil's sugarcane boom could affect regional temperatures

    NASA Astrophysics Data System (ADS)

    Schultz, Colin

    2013-04-01

    With the world seeking to cut its dependence on fossil fuels, the use of bioethanol and other biofuels is on the rise. In Brazil, the second largest producer and consumer of bioethanol, this has led to a boom in sugarcane production. Based on new laws and trade agreements, researchers expect Brazil's production of sugarcane-derived ethanol to increase tenfold over the next decade, with considerable land being converted for growing sugarcane. Much of this expansion is expected to come at a loss of some of the country's cerrado savannas. So while a major aim of the turn to biofuels is to reduce the transfer of carbon to the atmosphere and mitigate global climate change, the shifting agricultural activity could have direct consequences on Brazil's climate by changing the region's physical and biogeochemical properties.

  9. 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

  10. Intrathecal clonidine and adenosine: effects on pain and sensory processing in patients with chronic regional pain syndrome.

    PubMed

    Rauck, Richard L; North, James; Eisenach, James C

    2015-01-01

    Chronic pain may be accompanied by hyperalgesia and allodynia, and analgesic interventions may reduce these hypersensitivity phenomena. Preclinical data suggest that intrathecal clonidine and adenosine reduce hypersensitivity, but only clonidine reduces pain; therefore, we tested the effects of these interventions in patients with chronic pain. Twenty-two subjects with pain and hyperalgesia in a lower extremity from complex regional pain syndrome were recruited in a double-blind crossover study to receive intrathecal clonidine, 100 μg, or adenosine, 2 mg. Primary outcome measure was proportion with ≥30% reduction in pain 2 hours after injection, and secondary measures were pain report, areas of hypersensitivity, and temporal summation to heat stimuli. Treatments did not differ in the primary outcome measure (10 met success criterion after clonidine administration and 5 after adenosine administration), although they did differ in pain scores over time, with clonidine having a 3-fold greater effect (P = 0.014). Both drugs similarly reduced areas of hyperalgesia and allodynia by approximately 30% and also inhibited temporal summation. The percentage change in pain report did not correlate with the percentage change in areas of hyperalgesia (P = 0.09, r = 0.08) or allodynia (P = 0.24, r = 0.24) after drug treatment. Both intrathecal clonidine and adenosine acutely inhibit experimentally induced and clinical hypersensitivity in patients with chronic regional pain syndrome. Although these drugs do not differ in analgesia by the primary outcome measure, their difference in effect on pain scores over time and lack of correlation between effect on pain and hypersensitivity suggest that analgesia does not parallel antihyperalgesia with these treatments.

  11. Is poststroke complex regional pain syndrome the combination of shoulder pain and soft tissue injury of the wrist?

    PubMed Central

    Kim, Yong Wook; Kim, Yoon; Kim, Jong Moon; Hong, Ji Seong; Lim, Hyun Sun; Kim, Hyoung Seop

    2016-01-01

    Abstract Patients with poststroke complex regional pain syndrome (CRPS) show different symptoms compared to other types of CRPS, as they usually complain of shoulder and wrist pain with the elbow relatively spared. It is thus also known by the term “shoulder-hand syndrome.” The aim of this study is to present a possible pathophysiology of poststroke CRPS through ultrasonographic observation of the affected wrist before and after steroid injection at the extensor digitorum communis (EDC) tendon in patients suspected with poststroke CRPS. Prospective evaluation and observation, the STROBE guideline checklist was used. Twenty-three patients diagnosed as poststroke CRPS in accordance to clinical criteria were enrolled. They had a Three Phase Bone Scan (TPBS) done and the cross-sectional area (CSA) of EDC tendon was measured by using ultrasonography. They were then injected with steroid at the EDC tendon. The CSA of EDC tendon, visual analogue scale (VAS), and degree of swelling of the wrist were followed up 1 week after the injection. TPBS was interpreted as normal for 4 patients, suspected CRPS for 10 patients, and CRPS for 9 patients. Ultrasonographic findings of the affected wrist included swelling of the EDC tendon. After the injection of steroid to the wrist, CSA and swelling of the affected wrist compared to that before the treatment was significantly decreased (P < 0.001). The VAS score declined significantly after the injection (P < 0.001). Our results suggest that the pathophysiology of poststroke CRPS might be the combination of frozen shoulder or rotator cuff tear of shoulder and soft tissue injury of the wrist caused by the hemiplegic nature of patients with stroke. PMID:27495051

  12. 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.

  13. Integrating cognitive and affective dimensions of pain experience into health professions education

    PubMed Central

    Murinson, Beth B; Mezei, Lina; Nenortas, Elizabeth

    2011-01-01

    Pain is prevalent in clinical settings, and yet it is relatively under-represented in the education of most students in the health professions. Because pain includes both sensory-discriminative and affective features, teaching students about pain presents unique challenges and opportunities. The present article describes the evolution of a new blueprint for clinical excellence that, among other competencies, incorporates a need for the emotional development of clinical trainees. The framework has been applied to the development and implementation of two new courses in pain. The first course is designed to provide a comprehensive foundation of medical knowledge regarding pain, while integratively introducing students to the affective dimensions of pain. The second course is designed to enhance students’ appreciation for the protean effects of pain through use of the humanities to represent medical experience. It is concluded that, to be most effective, fostering the emotional development of trainees in the health professions necessitates the incorporation of affect-focused learning objectives, educational tasks and assessment methods. PMID:22184551

  14. Derangement of body representation in complex regional pain syndrome: report of a case treated with mirror and prisms.

    PubMed

    Bultitude, Janet H; Rafal, Robert D

    2010-07-01

    Perhaps the most intriguing disorders of body representation are those that are not due to primary disease of brain tissue. Strange and sometimes painful phantom limb sensations can result from loss of afference to the brain; and Complex Regional Pain Syndrome (CRPS)-the subject of the current report-can follow limb trauma without pathology of either the central or peripheral nervous system. This enigmatic and vexing condition follows relatively minor trauma, and can result in enduring misery and a useless limb. It manifests as severe pain, autonomic dysfunction, motor disability and 'neglect-like' symptoms with distorted body representation. For this special issue on body representation we describe the case of a patient suffering from CRPS, including symptoms suggesting a distorted representation of the affected limb. We report contrasting effects of mirror box therapy, as well as a new treatment-prism adaptation therapy-that provided sustained pain relief and reduced disability. The benefits were contingent upon adapting with the affected limb. Other novel observations suggest that: (1) pain may be a consequence, not the cause, of a disturbance of body representation that gives rise to the syndrome; (2) immobilisation, not pain, may precipitate this reorganisation of somatomotor circuits in susceptible individuals; and (3) limitation of voluntary movement is neither due to pain nor to weakness but, rather, to derangement of body representation which renders certain postures from the repertoire of hand movements inaccessible.

  15. Epigenetic modification of DRG neuronal gene expression subsequent to nerve injury: Etiological contribution to complex regional pain syndromes (Part I)

    PubMed Central

    Wang, Fuzhou; Stefano, George B.; Kream, Richard M.

    2014-01-01

    DRG is of importance in relaying painful stimulation to the higher pain centers and therefore could be a crucial target for early intervention aimed at suppressing primary afferent stimulation. Complex regional pain syndrome (CRPS) is a common pain condition with an unknown etiology. Recently added new information enriches our understanding of CRPS pathophysiology. Researches on genetics, biogenic amines, neurotransmitters, and mechanisms of pain modulation, central sensitization, and autonomic functions in CRPS revealed various abnormalities indicating that multiple factors and mechanisms are involved in the pathogenesis of CRPS. Epigenetics refers to mitotically and meiotically heritable changes in gene expression that do not affect the DNA sequence. As epigenetic modifications potentially play an important role in inflammatory cytokine metabolism, neurotransmitter responsiveness, and analgesic sensitivity, they are likely key factors in the development of chronic pain. In this dyad review series, we systematically examine the nerve injury-related changes in the neurological system and their contribution to CRPS. In this part, we first reviewed and summarized the role of neural sensitization in DRG neurons in performing function in the context of pain processing. Particular emphasis is placed on the cellular and molecular changes after nerve injury as well as different models of inflammatory and neuropathic pain. These were considered as the potential molecular bases that underlie nerve injury-associated pathogenesis of CRPS. PMID:24961509

  16. Resolution of Crohn's disease and complex regional pain syndrome following treatment of paratuberculosis.

    PubMed

    Kuenstner, J Todd; Chamberlin, William; Naser, Saleh A; Collins, Michael T; Dow, Coad Thomas; Aitken, John M; Weg, Stuart; Telega, Grzegorz; John, Kuruvilla; Haas, David; Eckstein, Torsten M; Kali, Maher; Welch, Christine; Petrie, Thomas

    2015-04-07

    A cohort of family members with various chronic diseases including Crohn's disease, asthma, complex regional pain syndrome, hypothyroidism, type 1 diabetes mellitus, and lymphangiomatosis and/or evidence of infection by Mycobacterium avium subsp. paratuberculosis (MAP) are described in this series of case reports. MAP was cultured from the blood of three members affected by the first five diseases and there was accompanying elevated anti-MAP IgG in two members. The patient affected by the sixth disease has a markedly elevated anti-MAP titer. The two patients affected by the first four diseases have been treated with a combination of anti-MAP antibiotics and ultraviolet blood irradiation therapy with resolution of the disease symptomatology and inability to culture MAP in post treatment blood samples. These case reports of patients with MAP infections provide supportive evidence of a pathogenic role of MAP in humans.

  17. Resolution of Crohn's disease and complex regional pain syndrome following treatment of paratuberculosis

    PubMed Central

    Kuenstner, J Todd; Chamberlin, William; Naser, Saleh A; Collins, Michael T; Dow, Coad Thomas; Aitken, John M; Weg, Stuart; Telega, Grzegorz; John, Kuruvilla; Haas, David; Eckstein, Torsten M; Kali, Maher; Welch, Christine; Petrie, Thomas

    2015-01-01

    A cohort of family members with various chronic diseases including Crohn’s disease, asthma, complex regional pain syndrome, hypothyroidism, type 1 diabetes mellitus, and lymphangiomatosis and/or evidence of infection by Mycobacterium avium subsp. paratuberculosis (MAP) are described in this series of case reports. MAP was cultured from the blood of three members affected by the first five diseases and there was accompanying elevated anti-MAP IgG in two members. The patient affected by the sixth disease has a markedly elevated anti-MAP titer. The two patients affected by the first four diseases have been treated with a combination of anti-MAP antibiotics and ultraviolet blood irradiation therapy with resolution of the disease symptomatology and inability to culture MAP in post treatment blood samples. These case reports of patients with MAP infections provide supportive evidence of a pathogenic role of MAP in humans. PMID:25852293

  18. Ambulatory electromyogram activity in the upper trapezius region: patients with muscle pain vs. pain-free control subjects.

    PubMed

    Carlson, C R; Wynn, K T; Edwards, J; Okeson, J P; Nitz, A J; Workman, D E; Cassisi, J

    1996-03-01

    This study compared the ambulatory electromyogram activity of persons reporting pain in the shoulder and cervical regions with an equal group of persons not reporting such pain. Ambulatory electromyogram data were obtained over 3-day periods. In addition, all participants completed several standard psychological questionnaires. The results were analyzed with inferential statistics to determine whether subjects reporting significant pain in the shoulder and cervical regions had greater ambulatory electromyogram activity than an equal number of subjects not reporting pain. Considerable controversy exists regarding the role of muscle activity in the etiology and maintenance of muscle pain disorders. Given the availability of ambulatory recording devices that can provide a detailed record of muscle activity over an extended period of time, the present research was conducted to determine whether persons reporting shoulder and cervical pain could be differentiated from a group of normal subjects. All subjects (N = 20) completed a battery of tests with standardized psychometric instruments and then were fitted with ambulatory electromyogram monitors to record electromyographic activity of the upper trapezius region of the dominant side; the time, duration, and amplitude of electromyogram activity greater than 2 microV was recorded. The monitors were worn during normal working hours (mean, 6.2 hours per day) over 3 consecutive days. In addition to wearing the monitors, all subjects completed hourly self-ratings of perceived muscle tension during the recording periods. As expected, subjects with muscle pain reported significantly more pain (mean, 4.9) than did the normal control subjects (mean, 0.9), t(15) = 3.29, P < 0.01. However, patients with muscle pain did not have greater average electromyogram activity (mean, 6.4 microV) over the 3-day period as compared to the normal controls (mean, 7.1 microV), t(18) = -0.25, P < 0.80. Self-monitoring of perceived muscle tension

  19. Interactions between Pain and the Motor Cortex: Insights from Research on Phantom Limb Pain and Complex Regional Pain Syndrome

    PubMed Central

    Léonard, Guillaume

    2011-01-01

    ABSTRACT Purpose: Pain is a significantly disabling problem that often interacts with other deficits during the rehabilitation process. The aim of this paper is to review evidence of interactions between pain and the motor cortex in order to attempt to answer the following questions: (1) Does acute pain interfere with motor-cortex activity? (2) Does chronic pain interfere with motor-cortex activity, and, conversely, does motor-cortex plasticity contribute to chronic pain? (3) Can the induction of motor plasticity by means of motor-cortex stimulation decrease pain? (4) Can motor training result in both motor-cortex reorganization and pain relief? Summary of Key Points: Acute experimental pain has been clearly shown to exert an inhibitory influence over the motor cortex, which can interfere with motor learning capacities. Current evidence also suggests a relationship between chronic pain and motor-cortex reorganization, but it is still unclear whether one causes the other. However, there is growing evidence that interventions aimed at normalizing motor-cortex organization can lead to pain relief. Conclusions: Interactions between pain and the motor cortex are complex, and more studies are needed to understand these interactions in our patients, as well as to develop optimal rehabilitative strategies. PMID:22654236

  20. Quality of life and functional capacity are adversely affected in osteoarthritis patients with neuropathic pain.

    PubMed

    Aşkın, Ayhan; Özkan, Ayten; Tosun, Aliye; Demirdal, Ümit Seçil; İsnaç, Fethi

    2017-03-01

    The aim of this study was to examine the neuropathic pain component of knee osteoarthritis (OA) patients and to investigate the relationship between neuropathic pain, disease stage, functional state, depression, anxiety, and quality of life. This study included 60 patients with knee OA. All demographic data and radiological results were recorded. Visual Analog Scale (VAS), Timed Up and Go Test, Chair Stand Test, Western Ontario and McMasters Universities Osteoarthritis Index (WOMAC), PainDETECT questionnaire, DN4 questionnaire, Short form-36 questionnaire, and Hospital Anxiety Depression Scale were performed for each patient. Neuropathic pain was detected in 66.7% of patients based on the PainDETECT scale and in 46.7% of patients based on DN4 scale. VAS-resting, OA grade, WOMAC scores, and SF-scores showed a significant difference in patients that detected neuropathic pain with PainDETECT (p<0.05). Based on the DN4 scale, patients with neuropathic pain had significantly higher WOMAC scores and significantly lower SF-36 scores (p<0.05). The PainDETECT questionnaire scores showed positive correlations with Timed Up-and-go Test, VAS-resting, WOMAC scores, Hospital Anxiety Depression Scale scores, and a negative correlation with all SF-36 scores (p<0.05). DN4 questionnaire scores showed a negative correlation with SF-36 scores and positive correlation with WOMAC scores (p<0.05). To conclude, it should be kept in mind that patients with knee OA who describe intense pain may have a neuropathic component involved in the clinical condition. Quality of life and functional capacity are adversely affected in patients with knee OA who have neuropathic pain. This should be taken into account while planning the treatment of these patients. Copyright © 2017. Published by Elsevier Taiwan.

  1. Different modalities of painful somatosensory stimulations affect anticipatory cortical processes: a high-resolution EEG study.

    PubMed

    Babiloni, Claudio; Brancucci, Alfredo; Capotosto, Paolo; Del Percio, Claudio; Romani, Gian Luca; Arendt-Nielsen, Lars; Rossini, Paolo Maria

    2007-03-15

    Pain sensation is characterized by multiple features that allow to differentiate pricking, burning, aching, stinging, and electrical shock. These features are sub-served by neural pathways that might give flexibility and selectivity to the cerebral anticipatory processes. In this line, the present high-resolution electroencephalography (EEG) study tested the hypothesis that the anticipatory cortical processes are stronger for painful thermal (biologically relevant) than electrical ("artificial") stimuli with similar intensity. EEG data (128 electrodes) were recorded in normal subjects during the expectancy of painful electrical or laser stimuli (visual omitted stimulus paradigm; interval between two painful stimuli: 16s), delivered over the median nerve region of the right arm (nonpainful stimuli as controls). After each stimulus, the subject reported the perceived stimulus intensity. Surface Laplacian estimation of the EEG data spatially enhanced the anticipatory stimulus-preceding negativity (SPN), which reflects motivational relevance of the stimulus. Subjects perceived no difference in the intensity of the electrical versus laser stimuli in both painful and nonpainful conditions. However, the anticipatory SPN appeared over large scalp regions before painful laser but not electrical stimulation. The same was true for the nonpainful stimulations. The present results suggest that the motivational anticipatory cortical processes are induced by nonpainful and painful biologically/ecologically relevant laser stimuli rather than by "artificial" electrical stimuli with similar intensity.

  2. Meaning-focused coping, pain, and affect: a diary study of hospitalized women with rheumatoid arthritis.

    PubMed

    Gruszczyńska, Ewa; Knoll, Nina

    2015-12-01

    The aim of the study was to investigate the relationship between affective state, pain, and coping in hospitalized women with rheumatoid arthritis, including both between- and within-person perspectives. Participants were 95 female patients between 24 and 82 years of age (M = 50.91; SD = 13.80). For three consecutive days, they rated each night their state affect (positive and negative), pain level, and coping strategies (emotion-, problem- and meaning-focused ones). Relations among variables were tested with a multilevel approach with time included as a covariate. Within-person meaning-focused coping suppressed the negative pain effect on emotional state, but only for positive affect (Sobel's z = 2.07, p = .04). Moderators of the pain-affect relationship were between-person differences in pain level (B = -.23, SE = .08, t = -2.884, p = .004) and in meaning-focused coping (B = -.63, SE = .20, t = -2.097, p = .04). Specifically, suppression was significant only for patients who reported lower than sample average pain levels and for patients who reported lower than sample average use of meaning-focused strategies. Findings indicated that meaning-focused coping can be a crucial strategy for keeping daily positive affect in the face of chronic pain and how this effect is modified by interindividual differences. Even if restricted to the specific context, it may inform an intervention for hospitalized women with rheumatoid arthritis.

  3. Neuropsychological deficits associated with Complex Regional Pain Syndrome.

    PubMed

    Libon, David J; Schwartzman, Robert J; Eppig, Joel; Wambach, Denene; Brahin, Eric; Peterlin, B Lee; Alexander, Guillermo; Kalanuria, Atul

    2010-05-01

    We sought to elucidate the existence of neuropsychological subtypes in Complex Regional Pain Syndrome (CRPS). One hundred thirty seven patients with CRPS were administered tests that assess executive control, naming/lexical retrieval, and declarative memory. A 2-step cluster analysis that does not require any a priori specification regarding the number of clusters, classified patients into three groups. Group 1 obtained scores that were in the average range on all tests (n = 48; normal CRSP group). Group 2 (n = 58; dysexecutive CRSP group) presented with mild impairment or statistically low average test performance on working memory/verbal fluency tests. Group 3 (n = 31; global CRSP group) produced scores in the statistically low average/borderline range on all tests with particularly reduced scores on naming/declarative memory tests. Between-group analyses found that the CRPS group 1 obtained higher scores than CRPS groups 2 and 3 on all tests. However, groups 2 and 3 were equally impaired on executive tests. CRPS group 3 was impaired on tests of naming/memory tests compared to the other groups. Significant neuropsychological deficits are present in 65% of patients, with many patients presenting with elements of a dysexecutive syndrome and some patients presenting with global cognitive impairment.

  4. 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

  5. A critical review of controlled clinical trials for peripheral neuropathic pain and complex regional pain syndromes.

    PubMed

    Kingery, W S

    1997-11-01

    The purpose of this review was to identify and analyze the controlled clinical trial data for peripheral neuropathic pain (PNP) and complex regional pain syndromes (CRPS). A total of 72 articles were found, which included 92 controlled drug trials using 48 different treatments. The methods of these studies were critically reviewed and the results summarized and compared. The PNP trial literature gave consistent support (two or more trials) for the analgesic effectiveness of tricyclic antidepressants, intravenous and topical lidocaine, intravenous ketamine, carbamazepine and topical aspirin. There was limited support (one trial) for the analgesic effectiveness of oral, topical and epidural clonidine and for subcutaneous ketamine. The trial data were contradictory for mexiletine, phenytoin, topical capsaicin, oral non-steroidal anti-inflammatory medication, and intravenous morphine. Analysis of the trial methods indicated that mexiletine and intravenous morphine were probably effective analgesics for PNP, while non-steroidals were probably ineffective. Codeine, magnesium chloride, propranolol, lorazepam, and intravenous phentolamine all failed to provide analgesia in single trials. There were no long-term data supporting the analgesic effectiveness of any drug and the etiology of the neuropathy did not predict treatment outcome. Review of the controlled trial literature for CRPS identified several potential problems with current clinical practices. The trial data only gave consistent support for analgesia with corticosteroids, which had long-term effectiveness. There was limited support for the analgesic effectiveness of topical dimethylsulfoxyde (DMSO), epidural clonidine and intravenous regional blocks (IVRBs) with bretylium and ketanserin. The trial data were contradictory for intranasal calcitonin and intravenous phentolamine and analysis of the trial methods indicated that both treatments were probably ineffective for most patients. There were consistent trial

  6. Glutamatergic activation of anterior cingulate cortex mediates the affective component of visceral pain memory in rats.

    PubMed

    Yan, Ni; Cao, Bing; Xu, Jiahe; Hao, Chun; Zhang, Xu; Li, Ying

    2012-01-01

    Studies of both humans and animals suggest that anterior cingulate cortex (ACC) is important for processing pain perception. We identified that perigenul ACC (pACC) sensitization and enhanced visceral pain in a visceral hypersensitive rat in previous studies. Pain contains both sensory and affective dimensions. Teasing apart the mechanisms that control the neural pathways mediating pain affect and sensation in nociceptive behavioral response is a challenge. In this study, using a rodent visceral pain assay that combines the colorectal distension (CRD)-induced visceromotor response (VMR) with the conditioning place avoidance (CPA), we measured a learned behavior that directly reflects the affective component of visceral pain. When CRD was paired with a distinct environment context, the rats spent significantly less time in this compartment on the post-conditioning test days as compared with the pre-conditioning day. Effects were lasted for 14 days. Bilateral pACC lesion significantly reduced CPA scores without reducing acute visceral pain behaviors (CRD-induced VMR). Bilateral administration of non-NMDA receptor antagonist CNQX or NMDA receptor antagonist AP5 into the pACC decreased the CPA scores. AP5 or CNQX at dose of 400 mM produced about 70% inhibition of CRD-CPA in the day 1, 4 and 7, and completely abolished the CPA in the day 14 after conditioning. We concluded that neurons in the pACC are necessary for the "aversiveness" of visceral nociceptor stimulation. pACC activation is critical for the memory processing involved in long-term negative affective state and prediction of aversive stimuli by contextual cue.

  7. [Classification of pain in the orofacial and craniofacial regions].

    PubMed

    Perez, R S G M

    2016-10-01

    Pain is a multidimensional, subjective phenomenon that can only be understood within the context of an individual operating in a specific environment. As a consequence, it is difficult from an objective standpoint to satisfy the established criteria for classification. In general, it is the case that available classification systems can only partially capture pain in all of its complexity. There are various general and specific classification systems. In 2017, the International Classification of Diseases will be complemented with classification possibilities related to chronic pain. Recently, a committee established by the Dutch Pain Society has formulated a proposal for the development of a definition and classification system for chronic pain to be applied in the Netherlands.

  8. Complex regional pain syndrome: observations on diagnosis, treatment and definition of a new subgroup.

    PubMed

    Żyluk, A; Puchalski, P

    2013-07-01

    Several definitions and sets of diagnostic criteria of complex regional pain syndrome have been proposed, but to date none has been accepted completely. This article presents a specific subtype of the disease, called 'chronic, refractory complex regional pain syndrome' which is extremely severe, disabling and resistant to treatment. It also emphasizes difficulties with diagnosing complex regional pain syndrome because of its variable clinical presentation and diagnostic criteria being insufficiently precise. The necessity to distinguish between criteria for clinical use and for scientific purposes is suggested with a proposal of practical guideline for diagnosing acute complex regional pain syndrome. A review of treatments for complex regional pain syndrome is presented, with opinion on their effectiveness: good in an early stage, less well in chronic and generally poor in the chronic, refractory subtype.

  9. The Downward Spiral of Chronic Pain, Prescription Opioid Misuse, and Addiction: Cognitive, Affective, and Neuropsychopharmacologic Pathways

    PubMed Central

    Garland, Eric L.; Froeliger, Brett; Zeidan, Fadel; Partin, Kaitlyn; Howard, Matthew O.

    2013-01-01

    Prescription opioid misuse and addiction among chronic pain patients are emerging public health concerns of considerable significance. Estimates suggest that more than 10% of chronic pain patients misuse opioid analgesics, and the number of fatalities related to nonmedical or inappropriate use of prescription opioids is climbing. Because the prevalence and adverse consequences of this threat are increasing, there is a pressing need for research that identifies the biobehavioral risk chain linking chronic pain, opioid analgesia, and addictive behaviors. To that end, the current manuscript draws upon current neuropsychopharmacologic research to provide a conceptual framework of the downward spiral leading to prescription opioid misuse and addiction among chronic pain patients receiving opioid analgesic pharmacotherapy. Addictive use of opioids is described as the outcome of a cycle initiated by chronic pain and negative affect and reinforced by opioidergic-dopamingeric interactions, leading to attentional hypervigilance for pain and drug cues, dysfunctional connectivity between self-referential and cognitive control networks in the brain, and allostatic dysregulation of stress and reward circuitry. Implications for clinical practice are discussed; multimodal, mindfulness-oriented treatment is introduced as a potentially effective approach to disrupting the downward spiral and facilitating recovery from chronic pain and opioid addiction. PMID:23988582

  10. The downward spiral of chronic pain, prescription opioid misuse, and addiction: cognitive, affective, and neuropsychopharmacologic pathways.

    PubMed

    Garland, Eric L; Froeliger, Brett; Zeidan, Fadel; Partin, Kaitlyn; Howard, Matthew O

    2013-12-01

    Prescription opioid misuse and addiction among chronic pain patients are emerging public health concerns of considerable significance. Estimates suggest that more than 10% of chronic pain patients misuse opioid analgesics, and the number of fatalities related to nonmedical or inappropriate use of prescription opioids is climbing. Because the prevalence and adverse consequences of this threat are increasing, there is a pressing need for research that identifies the biobehavioral risk chain linking chronic pain, opioid analgesia, and addictive behaviors. To that end, the current manuscript draws upon current neuropsychopharmacologic research to provide a conceptual framework of the downward spiral leading to prescription opioid misuse and addiction among chronic pain patients receiving opioid analgesic pharmacotherapy. Addictive use of opioids is described as the outcome of a cycle initiated by chronic pain and negative affect and reinforced by opioidergic-dopamingeric interactions, leading to attentional hypervigilance for pain and drug cues, dysfunctional connectivity between self-referential and cognitive control networks in the brain, and allostatic dysregulation of stress and reward circuitry. Implications for clinical practice are discussed; multimodal, mindfulness-oriented treatment is introduced as a potentially effective approach to disrupting the downward spiral and facilitating recovery from chronic pain and opioid addiction.

  11. Regional brain signal variability: a novel indicator of pain sensitivity and coping.

    PubMed

    Rogachov, Anton; Cheng, Joshua C; Erpelding, Nathalie; Hemington, Kasey S; Crawley, Adrian P; Davis, Karen D

    2016-11-01

    Variability in blood oxygen level-dependent (BOLD) functional magnetic resonance imaging (fMRI) signals reflects the moment-by-moment fluctuations in resting-state fMRI (rs-fMRI) activity within specific areas of the brain. Regional BOLD signal variability was recently proposed to serve an important functional role in the efficacy of neural systems because of its relationship to behavioural performance in aging and cognition studies. We previously showed that individuals who better cope with pain have greater fluctuations in interregional functional connectivity, but it is not known whether regional brain signal variability is a mechanism underlying pain coping. We tested the hypothesis that individual pain sensitivity and coping is reflected by regional fMRI BOLD signal variability within dynamic pain connectome-brain systems implicated in the pain experience. We acquired resting-state fMRI and assessed pain threshold, suprathreshold temporal summation of pain, and the impact of pain on cognition in 80 healthy right-handed individuals. We found that regional BOLD signal variability: (1) inversely correlated with an individual's temporal summation of pain within the ascending nociceptive pathway (primary and secondary somatosensory cortex), default mode network, and salience network; (2) was correlated with an individual's ability to cope with pain during a cognitive interference task within the periaqueductal gray, a key opiate-rich brainstem structure for descending pain modulation; and (3) provided information not captured from interregional functional connectivity. Therefore, regional BOLD variability represents a pain metric with potential implications for prediction of chronic pain resilience vs vulnerability.

  12. Successful management of complex regional pain syndrome type 1 using single injection interscalene brachial plexus block

    PubMed Central

    Fallatah, Summayah M.A.

    2014-01-01

    Complex regional pain syndrome (CRPS) type 1 of the upper limb is a painful and debilitating condition. Interscalene brachial plexus block (ISB) in conjugation with other modalities was shown to be a feasible therapy with variable success. We reported a case of CRPS type 1 as diagnosed by International Association for the Study of Pain criteria in which pharmacological approaches failed to achieve adequate pain relief and even were associated with progressive dysfunction of the upper extremity. Single injection ISB, in combination with physical therapy and botulinum toxin injection, was successful to alleviate pain with functional restoration. PMID:25422619

  13. Affective Learning in Higher Education: A Regional Perspective

    ERIC Educational Resources Information Center

    Evans, Nina; Ziaian, Tahereh; Sawyer, Janet; Gillham, David

    2013-01-01

    A pilot study was conducted in a regional university setting to promote awareness of the value of affective teaching and learning amongst staff and students. Academic staff and students from diverse disciplines at University of South Australia's (UniSA) Centre for Regional Engagement (CRE) were recruited to the study. The research investigated…

  14. Affective Learning in Higher Education: A Regional Perspective

    ERIC Educational Resources Information Center

    Evans, Nina; Ziaian, Tahereh; Sawyer, Janet; Gillham, David

    2013-01-01

    A pilot study was conducted in a regional university setting to promote awareness of the value of affective teaching and learning amongst staff and students. Academic staff and students from diverse disciplines at University of South Australia's (UniSA) Centre for Regional Engagement (CRE) were recruited to the study. The research investigated…

  15. Musically induced arousal affects pain perception in females but not in males: a psychophysiological examination.

    PubMed

    Kenntner-Mabiala, Ramona; Gorges, Susanne; Alpers, Georg W; Lehmann, Andreas C; Pauli, Paul

    2007-04-01

    The present study investigated affective and physiological responses to changes of tempo and mode in classical music and their effects on heat pain perception. Thirty-eight healthy non-musicians (17 female) listened to sequences of 24 music stimuli which were variations of 4 pieces of classical music. Tempo (46, 60, and 95 beats/min) and mode (major and minor) were manipulated digitally, all other musical elements were held constant. Participants rated valence, arousal, happiness and sadness of the musical stimuli as well as the intensity and the unpleasantness of heat pain stimuli which were applied during music listening. Heart rate, respiratory rate and end-tidal PCO(2) were recorded. Pain ratings were highest for the fastest tempo. Also, participants' arousal ratings, their respiratory rate and heart rate were accelerated by the fastest tempo. The modulation of pain perception by the tempo of music seems to be mediated by the listener's arousal.

  16. Self-efficacy and affect as mediators between pain dimensions and emotional symptoms and functional limitation in women with fibromyalgia.

    PubMed

    Peñacoba Puente, Cecilia; Velasco Furlong, Lilian; Écija Gallardo, Carmen; Cigarán Méndez, Margarita; Bedmar Cruz, Dolores; Fernández-de-Las-Peñas, César

    2015-02-01

    The aim of this study was to investigate the role of self-efficacy and affect as mediators of the relationship between pain and several fibromyalgia (FM) symptoms (functional limitation, depression, and anxiety). We evaluated 144 women with FM for self-reported pain (numerical pain scale), pressure pain sensitivity (pressure pain thresholds), functional limitation (Fibromyalgia Impact Questionnaire), self-efficacy (Chronic Pain Self-Efficacy Scale), depression-anxiety (Hospital Anxiety and Depression Scale), and positive-negative affect (Positive-Negative Affect Scale). Mediating analyses were conducted with ordinary least squares multiple regression analysis. The results demonstrated that self-reported pain and pressure pain sensitivity exhibited significant relationships with functional limitation, anxiety, depression, self-efficacy, and affect. Affect mediated the relationship between pressure pain sensitivity and anxiety, whereas self-efficacy was the mediating variable between self-reported pain and functional limitation and depression. Our results support a complex nature of pain in women presenting with FM, as cognitive and emotional variables have different mediator relationships between pain dimensions and functional and emotional outcomes in women with FM.

  17. Abnormal Brain Responses to Action Observation in Complex Regional Pain Syndrome.

    PubMed

    Hotta, Jaakko; Saari, Jukka; Koskinen, Miika; Hlushchuk, Yevhen; Forss, Nina; Hari, Riitta

    2017-03-01

    Patients with complex regional pain syndrome (CRPS) display various abnormalities in central motor function, and their pain is intensified when they perform or just observe motor actions. In this study, we examined the abnormalities of brain responses to action observation in CRPS. We analyzed 3-T functional magnetic resonance images from 13 upper limb CRPS patients (all female, ages 31-58 years) and 13 healthy, age- and sex-matched control subjects. The functional magnetic resonance imaging data were acquired while the subjects viewed brief videos of hand actions shown in the first-person perspective. A pattern-classification analysis was applied to characterize brain areas where the activation pattern differed between CRPS patients and healthy subjects. Brain areas with statistically significant group differences (q < .05, false discovery rate-corrected) included the hand representation area in the sensorimotor cortex, inferior frontal gyrus, secondary somatosensory cortex, inferior parietal lobule, orbitofrontal cortex, and thalamus. Our findings indicate that CRPS impairs action observation by affecting brain areas related to pain processing and motor control.

  18. Factors affecting pain relief in response to physical exercise interventions among healthcare workers.

    PubMed

    Jakobsen, M D; Sundstrup, E; Brandt, M; Andersen, L L

    2016-12-28

    The aim of this study is to identify factors associated with musculo-skeletal pain reduction during workplace-based or home-based physical exercise interventions among healthcare workers. Two hundred female healthcare workers (age: 42.0, BMI: 24.1, average pain intensity: 3.1 on a scale of 0-10) from three hospitals participated. Participants were randomly allocated at the cluster level (18 departments) to 10 weeks of (i) workplace physical exercise (WORK) performed in groups during working hours for 5 × 10 minutes per week and up to five group-based coaching sessions on motivation for regular physical exercise, or (ii) home-based physical exercise (HOME) performed alone during leisure-time for 5 × 10 minutes per week. Linear mixed models accounting for cluster identified factors affecting pain reduction. On average 2.2 (SD: 1.1) and 1.0 (SD: 1.2) training sessions were performed per week in WORK and HOME, respectively. The multi-adjusted analysis showed a significant effect on pain reduction of both training adherence (P=.04) and intervention group (P=.04) with participants in WORK experiencing greater reductions compared with HOME. Obesity at baseline was associated with better outcome. Leisure-time exercise, daily patient transfer, age, and chronic pain did not affect the changes in pain. In conclusion, even when adjusted for training adherence, performing physical exercise at the workplace is more effective than home-based exercise in reducing musculo-skeletal pain in healthcare workers. Noteworthy, obese individuals may especially benefit from physical exercise interventions targeting musculo-skeletal pain.

  19. The effect of regional block over pain levels during vacuum-assisted wound closure.

    PubMed

    Findikcioglu, Kemal; Sezgin, Billur; Kaya, Basar; Ozkose, Zerrin; Ayhan, Suhan

    2014-02-01

    Despite being a wound treatment method with a broad spectrum of indications, vacuum-assisted wound closure (VAWC) can be a painful treatment modality which may even result with patient unwillingness for the continuation of treatment. A prospective study was undertaken to determine the effect of regional pain blocks (RPB) for patients who wanted to abandon treatment due to pain after the first application. Patients were asked to score their pain using a visual analogue scale for two different time frames (i) during dressing changes and (ii) while daytime treatment. This evaluation was carried out for conventional wound dressings, VAWC before RPB and finally for VAWC after RPB. The pain experienced with blocks was significantly lesser than conventional and VAWC dressing changes that were applied without pain blocks. Also, the pain was significantly lesser under pain blocks for daytime treatment. For patients with refractory pain where VAWC would prove to be of most benefit, RPB can be discussed with the patient and used. This study has shown that effective pain control can be obtained through regional blocks for patients with excruciating pain undergoing VAWC treatment. © 2012 The Authors. International Wound Journal © 2012 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

  20. Evaluation of constricted affect in chronic pain: an attempt using the Toronto Alexythymia Scale.

    PubMed

    Millard, R W; Kinsler, B L

    1992-09-01

    The Toronto Alexythymia Scale (TAS) was applied as a potential measure of constricted affect among a sample of patients with chronic, non-malignant pain (n = 195). As previously demonstrated with non-clinical samples, the scale was found to possess moderate reliability with two principal internal factors. These factors seemed to reflect social introversion and a lack of proneness to fantasy. There was a moderate, negative association between them. The domain sampled by the TAS was apparently heterogeneous, with total scores showing no relationship to reported disability or pain intensity and a low relationship to reported distress. These results suggest potential limitations of the TAS and the alexythymia construct as means for evaluating constricted affect that accompanies chronic pain.

  1. Painful swelling after a noxious event and the development of complex regional pain syndrome 1: A one-year prospective study.

    PubMed

    Brunner, F; Bachmann, L M; Perez, R S G M; Marinus, J; Wertli, M M

    2017-10-01

    The timing of diagnosis of complex regional pain syndrome (CRPS) 1 remains a challenge due to the large heterogeneity of clinical presentations. We describe the distribution and differences in outcomes and clinical manifestations between time points and patient groups with and without CRPS 1 following an initiating event. Prospective cohort study with a consecutive registration of patients presenting with painful swelling of the affected extremity after an initiating event and follow-up visits after 3, 6 and 12 months. Forty-two patients were enrolled (37 females, mean age 55.1 years). At baseline, 35 participants (83%, females n = 30) fulfilled the diagnostic criteria for CRPS 1. At 3 months, 19 out of the initial 35 CRPS 1 patients (54%) did not meet the diagnostic criteria anymore. Besides our inclusion criteria of a painful swelling, early manifestations indicating a CRPS 1 primarily include an impaired quality of life (SF-35, EQ5-D), more pain (NRS, MPQ) and restricted range of motion. CRPS 1 develops within 8 weeks following a noxious event. Although many CRPS 1 patients reach partial remission within the first 3 months, signs and symptoms do not improve significantly at 1 year. In order to identify prognostic risk factors large prospective cohort studies are needed. This prospective cohort study follows patients with complaints most suspected for complex regional pain syndrome (CRPS) 1. CRPS 1 develops within 8 weeks following a noxious event. Although many CRPS 1 patients reach partial remission within the 3 months, symptoms do not improve significantly at 1 year. © 2017 European Pain Federation - EFIC®.

  2. Serum and salivary oxidative analysis in Complex Regional Pain Syndrome.

    PubMed

    Eisenberg, Elon; Shtahl, Shalom; Geller, Rimma; Reznick, Abraham Z; Sharf, Ordi; Ravbinovich, Meirav; Erenreich, Adam; Nagler, Rafael M

    2008-08-15

    Although both inflammatory and neural mechanisms have been suggested as potential contributors to Complex Regional Pain Syndrome type I (CRPS-I), the pathogenesis of the syndrome is still unclear. Clinical trials have shown that free radical scavengers can reduce signs and symptoms of CRPS-I, indirectly suggesting that free radicals and increased oxidative stress are involved in the pathogenesis of CRPS-I. This study investigated this premise by determining the levels of antioxidants in the serum and saliva of 31 patients with CRPS-I and in a control group of 21 healthy volunteers. Serum lipid peroxidation products (MDA) and all antioxidative parameters analyzed were significantly elevated in CRPS-I patients: median salivary peroxidase and superoxide dismutase (SOD) activity values, uric acid (UA) concentration and total antioxidant status (TAS) values were higher in CRPS-I patients by 150% (p=0.01), 280% (p=0.04), 60% (p=0.0001), and 200% (p=0.0003), respectively, as compared with controls. Similar although not as extensive pattern of oxidative changes were found in the serum: mean serum UA and MDA concentrations and TAS value in the CRPS-I patients were higher by 16% (p=0.04), 25% (p=0.02), and 22% (p=0.05), respectively, than in the controls. Additionally, median salivary albumin concentration and median salivary LDH activities in the patients were 2.5 times (p=0.001) and 3.1 (p=0.004) times higher than in the controls. The accumulated data show that free radicals are involved in the pathophysiology of CRPS-I, which is reflected both in serum and salivary analyses. These data could be used for both diagnostic and therapeutic purposes in CRPS-I patients.

  3. Current diagnosis and therapy of complex regional pain syndrome: refining diagnostic criteria and therapeutic options.

    PubMed

    Burton, Allen W; Bruehl, Stephen; Harden, R Norman

    2005-09-01

    Complex regional pain syndrome is a clinically challenging entity both in terms of accurate diagnosis and effective treatment. Complex regional pain syndrome is a post-traumatic painful neurologic syndrome involving the somatosensory, sympathetic and often the somatomotor systems. This complex condition consists of local neurogenic inflammation out of proportion to injury; severe pain in the skin, subcutaneous tissues and joints; and a central hyperexcitability that is often compounded with a sympathetic component. The syndrome is multifaceted manifesting both central and peripheral neurologic pathophysiology, frequently including a prominent psychosocial component. The wide array of possible patient presentations and antecedent pathologies also complicate successful treatment. To further add to the clinical challenges of complex regional pain syndrome, the epidemiology and natural history of complex regional pain syndrome are only partially known; evidence concerning complex regional pain syndrome treatment has grown slowly, due in large part to the vagaries of diagnosis; and research data--when they are available--are difficult to interpret. Thus, in spite of our evolving understanding of this neurologic disorder, in many cases complex regional pain syndrome remains difficult to diagnose and treat successfully.

  4. Sustained Pain Reduction Through Affective Self-awareness in Fibromyalgia: A Randomized Controlled Trial

    PubMed Central

    Hsu, Michael C.; Lumley, Mark A.; Stracks, John S.; Clauw, Daniel J.; Williams, David A.

    2010-01-01

    BACKGROUND AND OBJECTIVE Affect and how it is regulated plays a role in pain perception, maintenance of pain, and its resolution. This randomized, controlled trial evaluated an innovative affective self-awareness (ASA) intervention, which was designed to reduce pain and improve functioning in individuals with fibromyalgia. PARTICIPANTS AND METHODS Forty-five women with fibromyalgia were randomized to a manualized ASA intervention (n = 24) or wait-list control (n = 21). The intervention began with a one-time physician consultation, followed by 3 weekly, 2-h group sessions based upon a mind-body model of pain. Sessions focused on structured written emotional disclosure and emotional awareness exercises. Outcomes in both conditions were measured by a blinded assessor at baseline, post-intervention, and 6-month follow-up. MEASURES The primary outcome was pain severity (Brief Pain Inventory); secondary outcomes included tender-point threshold and physical function (SF-36 Physical Component Summary). Intent-to-treat analyses compared groups on outcomes using analysis of covariance and on the proportion of patients achieving ≥30% and ≥50% pain reduction at 6 months. RESULTS Adjusting for baseline scores, the intervention group had significantly lower pain severity (p < 0.001), higher self-reported physical function (p < 0.001), and higher tender-point threshold (p = 0.02) at 6 months compared to the control group. From baseline to 6 months, 45.8% of the ASA intervention group had ≥30% reduction in pain severity, compared to none of the controls (p < 0.001). CONCLUSIONS The affective self-awareness intervention improved pain, tenderness, and self-reported physical function for at least 6 months in women with fibromyalgia compared to wait-list control. This study suggests the value of interventions targeting emotional processes in fibromyalgia, although further studies should evaluate the efficacy of this intervention relative to active

  5. The effect of validating and invalidating communication on satisfaction, pain and affect in nurses suffering from low back pain during a semi-structured interview.

    PubMed

    Vangronsveld, K L; Linton, S J

    2012-02-01

    When physicians interview patients with ambiguous or nonspecific symptoms, they often try to reassure them with the purpose of explaining that no dangerous illness or disease is causing the symptoms. Unfortunately the evidence suggests that patients with benign (back) pain instead feel misunderstood, frustrated and unsatisfied with the consultation. Validation is a communication method that focuses on understanding and empathy as a platform for problem solving and it may be applicable for interviews in medical settings. The aim of this study was to examine the effects of validation on patient satisfaction, pain and affect. To this end 28 nurses with (re)current back pain were recruited and randomly assigned to be interviewed in a validating or invalidating condition. Patient satisfaction, affect, pain, disability, pain catastrophizing, and fear of movement were assessed immediately after the interview. The results show that the participants in the validated group were more satisfied with the interview than participants in the invalidating condition. Moreover, they showed a significant decrease on all measures of negative affect as well as for pain. For example, there was a significant between group difference in frustration where frustration decreased in the validation group, while it increased in the invalidation condition. A validating communication style seems to be beneficial for enhancing patient satisfaction, as well as diminishing negative affect and pain intensity ratings. Our results suggest that validation might be a viable technique to use in clinical examinations of patients suffering pain. © 2011 European Federation of International Association for the Study of Pain Chapters.

  6. Empathic control through coordinated interaction of amygdala, theory of mind and extended pain matrix brain regions.

    PubMed

    Bruneau, Emile G; Jacoby, Nir; Saxe, Rebecca

    2015-07-01

    Brain regions in the "pain matrix", can be activated by observing or reading about others in physical pain. In previous research, we found that reading stories about others' emotional suffering, by contrast, recruits a different group of brain regions mostly associated with thinking about others' minds. In the current study, we examined the neural circuits responsible for deliberately regulating empathic responses to others' pain and suffering. In Study 1, a sample of college-aged participants (n=18) read stories about physically painful and emotionally distressing events during functional magnetic resonance imaging (fMRI), while either actively empathizing with the main character or trying to remain objective. In Study 2, the same experiment was performed with professional social workers, who are chronically exposed to human suffering (n=21). Across both studies activity in the amygdala was associated with empathic regulation towards others' emotional pain, but not their physical pain. In addition, psychophysiological interaction (PPI) analysis and Granger causal modeling (GCM) showed that amygdala activity while reading about others' emotional pain was preceded by and positively coupled with activity in the theory of mind brain regions, and followed by and negatively coupled with activity in regions associated with physical pain and bodily sensations. Previous work has shown that the amygdala is critically involved in the deliberate control of self-focused distress - the current results extend the central importance of amygdala activity to the control of other-focused empathy, but only when considering others' emotional pain. Copyright © 2015 Elsevier Inc. All rights reserved.

  7. Motor dysfunction of complex regional pain syndrome is related to impaired central processing of proprioceptive information.

    PubMed

    Bank, Paulina J M; Peper, C Lieke E; Marinus, Johan; Beek, Peter J; van Hilten, Jacobus J

    2013-11-01

    Our understanding of proprioceptive deficits in complex regional pain syndrome (CRPS) and its potential contribution to impaired motor function is still limited. To gain more insight into these issues, we evaluated accuracy and precision of joint position sense over a range of flexion-extension angles of the wrist of the affected and unaffected sides in 25 chronic CRPS patients and in 50 healthy controls. The results revealed proprioceptive impairment at both the patients' affected and unaffected sides, characterized predominantly by overestimation of wrist extension angles. Precision of the position estimates was more prominently reduced at the affected side. Importantly, group differences in proprioceptive performance were observed not only for tests at identical percentages of each individual's range of wrist motion but also when controls were tested at wrist angles that corresponded to those of the patient's affected side. More severe motor impairment of the affected side was associated with poorer proprioceptive performance. Based on additional sensory tests, variations in proprioceptive performance over the range of wrist angles, and comparisons between active and passive displacements, the disturbances of proprioceptive performance most likely resulted from altered processing of afferent (and not efferent) information and its subsequent interpretation in the context of a distorted "body schema." The present results point at a significant role for impaired central processing of proprioceptive information in the motor dysfunction of CRPS and suggest that therapeutic strategies aimed at identification of proprioceptive impairments and their restoration may promote the recovery of motor function in CRPS patients. Copyright © 2013 American Pain Society. Published by Elsevier Inc. All rights reserved.

  8. Reduction of pain and EMG activity in the masseter region by trapezius trigger point injection.

    PubMed

    Carlson, C R; Okeson, J P; Falace, D A; Nitz, A J; Lindroth, J E

    1993-12-01

    In this open, uncontrolled trial, 20 patients with upper trapezius muscle trigger point pain and ipsilateral masseter muscle pain received a single trigger point injection of 2% lidocaine solution (without epinephrine) in the upper trapezius muscle. Following the trapezius injection, there was a significant (P < 0.001) reduction in pain intensity ratings for pain in the masseter region. In addition, there was a significant (P < 0.03) reduction in EMG activity in the masseter muscle. Overall, however, a significant relationship between EMG activity in the masseter and the self-report of pain was not found with the present data set. These clinical findings support the contention that sources of deep pain can produce heterotopic sensory and motor changes in distant anatomical regions.

  9. Expectation of a Decrease in Pain Affects the Prognosis of Pain in Cancer Patients: a Prospective Cohort Study of Response to Morphine.

    PubMed

    Matsuoka, Hiromichi; Yoshiuchi, Kazuhiro; Koyama, Atsuko; Makimura, Chihiro; Fujita, Yoshihiko; Tsurutani, Junji; Sakai, Kiyohiro; Sakamoto, Ryo; Nishio, Kazuto; Nakagawa, Kazuhiko

    2017-08-01

    Cancer pain is a multidimensional experience that includes physiological, sensory, affective, cognitive, behavioral, and sociocultural dimensions. Few prospective studies have examined the relationship between a patient's expectation of pain improvement and the pain prognosis. The aim of this prospective study was to investigate whether patients' expectation to pain reduction was associated with pain intensity after morphine treatment in opioid treatment-naïve patients with various types of cancer. The subjects were patients scheduled for cancer pain treatment with morphine who were taking nonsteroidal anti-inflammatory drugs daily. Morphine treatment was performed according to the standard method, including titration (NCCN Guidelines™, Adult Cancer Pain). Simple regression analysis was performed between pain intensity numerical rating scale (NRS) (day 8) as the dependent variable, expectation of pain decrease NRS (day 1), tumor types, and the following covariates as independent variables: patients' characteristics such as age, gender, PS (day 1), genotype of catechol-O-methyltransferase, total scores of Hospital Anxiety and Depression Scale (day 1), and pain intensity NRS (day 1). Multiple regression analysis was performed using forced entry methods with pain intensity NRS (day 8) as the dependent variable, and expectation of pain decrease NRS (day 1) and the covariates as independent variables that had a p value <0.05 in the simple regression models. A total of 100 patients with baseline data were included, and 97 patients (51% female) met the inclusion criteria. Patients with a high expectation of pain decrease NRS had a significantly lower pain intensity NRS (day 8) (p = 0.001). Non-pharmacological factors such as expectations for pain treatment could also be important factors to treat cancer pain, which might be associated with communication skills in physicians.

  10. The Facial Affective Scale as a Predictor for Pain Unpleasantness When Children Undergo Immunizations

    PubMed Central

    Finnström, Berit; Mörelius, Evalotte

    2014-01-01

    Needle fear is a common problem in children undergoing immunization. To ensure that the individual child's needs are met during a painful procedure it would be beneficial to be able to predict whether there is a need for extra support. The self-reporting instrument facial affective scale (FAS) could have potential for this purpose. The aim of this study was to evaluate whether the FAS can predict pain unpleasantness in girls undergoing immunization. Girls, aged 11-12 years, reported their expected pain unpleasantness on the FAS at least two weeks before and then experienced pain unpleasantness immediately before each vaccination. The experienced pain unpleasantness during the vaccination was also reported immediately after each immunization. The level of anxiety was similarly assessed during each vaccination and supplemented with stress measures in relation to the procedure in order to assess and evaluate concurrent validity. The results show that the FAS is valid to predict pain unpleasantness in 11-12-year-old girls who undergo immunizations and that it has the potential to be a feasible instrument to identify children who are in need of extra support to cope with immunization. In conclusion, the FAS measurement can facilitate caring interventions. PMID:24734174

  11. Longitudinal study on work related and individual risk factors affecting radiating neck pain

    PubMed Central

    Viikari-Juntura, E; Martikainen, R; Luukkonen, R; Mutanen, P; Takala, E; Riihimaki, H

    2001-01-01

    OBJECTIVES—To study the effects of work related and individual factors affecting radiating neck pain.
METHODS—A longitudinal study was carried out with repeated measurements. A total of 5180 Finnish forest industry workers replied to a questionnaire survey in 1992 (response rate 75%). Response rates to follow up questionnaires in 1993, 1994, and 1995 were 83%, 77%, and 90%, respectively. The outcome variable was the number of days with radiating neck pain during the preceding 12 months with three levels (<8, 8-30, >30 days). The generalised estimating equations method was used to fit a marginal model and a transition model was used in a predictive analysis.
RESULTS—Items showing associations with radiating neck pain in both analyses were sex, age, body mass index, smoking, duration of work with a hand above shoulder level, mental stress, and other musculoskeletal pains. In the transition model, radiating neck pain in a previous questionnaire was included in the model. Although it was a strong predictor, the variables already mentioned retained their significance.
CONCLUSION—Programmes targeted to reduce physical load at work, mental stress, being overweight, and smoking could potentially prevent radiating neck pain.


Keywords: neck disorder; mental stress; physical work load PMID:11303085

  12. High-Frequency Repetitive Sensory Stimulation as Intervention to Improve Sensory Loss in Patients with Complex Regional Pain Syndrome I.

    PubMed

    David, Marianne; Dinse, Hubert R; Mainka, Tina; Tegenthoff, Martin; Maier, Christoph

    2015-01-01

    Achieving perceptual gains in healthy individuals or facilitating rehabilitation in patients is generally considered to require intense training to engage neuronal plasticity mechanisms. Recent work, however, suggested that beneficial outcome similar to training can be effectively acquired by a complementary approach in which the learning occurs in response to mere exposure to repetitive sensory stimulation (rSS). For example, high-frequency repetitive sensory stimulation (HF-rSS) enhances tactile performance and induces cortical reorganization in healthy subjects and patients after stroke. Patients with complex regional pain syndrome (CRPS) show impaired tactile performance associated with shrinkage of cortical maps. We here investigated the feasibility and efficacy of HF-rSS, and low-frequency rSS (LF-rSS) to enhance tactile performance and reduce pain intensity in 20 patients with CRPS type I. Intermittent high- or low-frequency electrical stimuli were applied for 45 min/day to all fingertips of the affected hand for 5 days. Main outcome measures were spatial two-point-discrimination thresholds and mechanical detection thresholds measured on the tip of the index finger bilaterally. Secondary endpoint was current pain intensity. All measures were assessed before and on day 5 after the last stimulation session. HF-rSS applied in 16 patients improved tactile discrimination on the affected hand significantly without changes contralaterally. Current pain intensity remained unchanged on average, but decreased in four patients by ≥30%. This limited pain relief might be due to the short stimulation period of 5 days only. In contrast, after LF-rSS, tactile discrimination was impaired in all four patients, while detection thresholds and pain were not affected. Our data suggest that HF-rSS could be used as a novel approach in CRPS treatment to improve sensory loss. Longer treatment periods might be required to induce consistent pain relief.

  13. High-Frequency Repetitive Sensory Stimulation as Intervention to Improve Sensory Loss in Patients with Complex Regional Pain Syndrome I

    PubMed Central

    David, Marianne; Dinse, Hubert R.; Mainka, Tina; Tegenthoff, Martin; Maier, Christoph

    2015-01-01

    Achieving perceptual gains in healthy individuals or facilitating rehabilitation in patients is generally considered to require intense training to engage neuronal plasticity mechanisms. Recent work, however, suggested that beneficial outcome similar to training can be effectively acquired by a complementary approach in which the learning occurs in response to mere exposure to repetitive sensory stimulation (rSS). For example, high-frequency repetitive sensory stimulation (HF-rSS) enhances tactile performance and induces cortical reorganization in healthy subjects and patients after stroke. Patients with complex regional pain syndrome (CRPS) show impaired tactile performance associated with shrinkage of cortical maps. We here investigated the feasibility and efficacy of HF-rSS, and low-frequency rSS (LF-rSS) to enhance tactile performance and reduce pain intensity in 20 patients with CRPS type I. Intermittent high- or low-frequency electrical stimuli were applied for 45 min/day to all fingertips of the affected hand for 5 days. Main outcome measures were spatial two-point-discrimination thresholds and mechanical detection thresholds measured on the tip of the index finger bilaterally. Secondary endpoint was current pain intensity. All measures were assessed before and on day 5 after the last stimulation session. HF-rSS applied in 16 patients improved tactile discrimination on the affected hand significantly without changes contralaterally. Current pain intensity remained unchanged on average, but decreased in four patients by ≥30%. This limited pain relief might be due to the short stimulation period of 5 days only. In contrast, after LF-rSS, tactile discrimination was impaired in all four patients, while detection thresholds and pain were not affected. Our data suggest that HF-rSS could be used as a novel approach in CRPS treatment to improve sensory loss. Longer treatment periods might be required to induce consistent pain relief. PMID:26635719

  14. The motor system shows adaptive changes in complex regional pain syndrome.

    PubMed

    Maihöfner, Christian; Baron, Ralf; DeCol, Roberto; Binder, Andreas; Birklein, Frank; Deuschl, Günther; Handwerker, Hermann O; Schattschneider, Jörn

    2007-10-01

    The complex regional pain syndrome (CRPS) is a disabling neuropathic pain condition that may develop following injuries of the extremities. In the present study we sought to characterize motor dysfunction in CRPS patients using kinematic analysis and functional imaging investigations on the cerebral representation of finger movements. Firstly, 10 patients and 12 healthy control subjects were investigated in a kinematic analysis assessing possible changes of movement patterns during target reaching and grasping. Compared to controls, CRPS patients particularly showed a significant prolongation of the target phase in this paradigm. The pattern of motor impairment was consistent with a disturbed integration of visual and proprioceptive inputs in the posterior parietal cortex. Secondly, we used functional MRI (fMRI) and investigated cortical activations during tapping movements of the CRPS-affected hand in 12 patients compared to healthy controls (n = 12). During finger tapping of the affected extremity, CRPS patients showed a significant reorganization of central motor circuits, with an increased activation of primary motor and supplementary motor cortices (SMA). Furthermore, the ipsilateral motor cortex showed a markedly increased activation. When the individual amount of motor impairment was introduced as regressor in the fMRI analysis, we were able to demonstrate that activations of the posterior parietal cortices (i.e. areas within the intraparietal sulcus), SMA and primary motor cortex were correlated with the extent of motor dysfunction. In summary, the results of this study suggest that substantial adaptive changes within the central nervous system may contribute to motor symptoms in CRPS.

  15. State policy affecting pain management: recent improvements and the positive impact of regulatory health policies.

    PubMed

    Gilson, Aaron M; Maurer, Martha A; Joranson, David E

    2005-10-01

    Criteria-driven policy analysis resources from the University of Wisconsin Pain and Policy Studies Group (PPSG) evaluated drug control and professional practice policies that can influence use of controlled substances for pain management, and documented changes over a 3-year period. Additional research was needed to determine the extent of change, the types of messages contained in the policies, and what has contributed to changing policy content. Four research aims guided this study: (1) evaluate change between 2000 and 2003 of state policy that can affect pain relief, (2) describe content differences for statutes, regulations, guidelines, and policy statements, (3) evaluate differences between policies specific to pain management and policies governing general healthcare practice, and (4) compare content of policies specific to pain management created by healthcare regulatory boards to those created by state legislatures. Results showed that more current policies, especially policies regulating health professionals, tend to encourage pain management and avoid language that restricts professional decision-making and patient treatment. In addition, pain policies from healthcare regulatory boards were generally less restrictive than statutes or policies that govern general healthcare practice. These findings suggest that the positive policy change results primarily from state medical, pharmacy, and nursing boards adopting policies promoting pain management and the use of opioids, while containing few if any restrictions. Despite this improvement, further progress can be made when states continue to abrogate additional restrictions or clinically obsolete provisions from policies. PPSG policy evaluations provide guidance to lawmakers, healthcare regulators, and clinicians who are striving to achieve balanced policy, an attainable but redoubtable goal, to benefit patient care.

  16. Changes in sensory and pain perception thresholds after linear polarized near-infrared light radiation in the trigeminal region.

    PubMed

    Kashima, Koji; Watanabe, Naoshi; Higashinaka, Shuichi; Maeda, Sho; Shiba, Ryosuke

    2005-07-01

    Linearly polarized light in the near-infrared portion of the spectrum has recently been associated with a variety of musculoskeletal disorders including temporomandibular disorders. The purpose of this study was to determine whether short-term linearly polarized near-infrared light radiation in the trigeminal region affects sensory and pain perception thresholds in the trigeminally mediated region and in the cervically mediated region of normal subjects. Thirty-five normal female volunteers participated in this study. Each subject received an 8-minute course of irradiation in the right cheek, and sensory/nociceptive perception thresholds were compared before and immediately after the irradiation in the right cheek and the right forearm. As a result, this study demonstrated a significant elevation of the heat-induced pain threshold in both regions and a tendency for the warm sensation threshold to elevate in the cervical region. In addition, a significant increase in vibratory sensitivity was observed in the trigeminal region. In conclusion, our results provided additional evidence that the warming sensation has a negative feedback influence on heat pain intensity in humans, and provides a theoretical basis for the application of linear polarized near-infrared light radiation to the trigeminal region.

  17. [11C]-(R)-PK11195 positron emission tomography in patients with complex regional pain syndrome

    PubMed Central

    Jeon, So Yeon; Seo, Seongho; Lee, Jae Sung; Choi, Soo-Hee; Lee, Do-Hyeong; Jung, Ye-Ha; Song, Man-Kyu; Lee, Kyung-Jun; Kim, Yong Chul; Kwon, Hyun Woo; Im, Hyung-Jun; Lee, Dong Soo; Cheon, Gi Jeong; Kang, Do-Hyung

    2017-01-01

    Abstract Complex regional pain syndrome (CRPS) is characterized by severe and chronic pain, but the pathophysiology of this disease are not clearly understood. The primary aim of our case–control study was to explore neuroinflammation in patients with CRPS using positron emission tomography (PET), with an 18-kDa translocator protein specific radioligand [11C]-(R)-PK11195. [11C]-(R)-PK11195 PET scans were acquired for 11 patients with CRPS (30–55 years) and 12 control subjects (30–52 years). Parametric image of distribution volume ratio (DVR) for each participant was generated by applying a relative equilibrium-based graphical analysis. The DVR of [11C]-(R)-PK11195 in the caudate nucleus (t(21) = −3.209, P = 0.004), putamen (t(21) = −2.492, P = 0.022), nucleus accumbens (t(21) = −2.218, P = 0.040), and thalamus (t(21) = −2.395, P = 0.026) were significantly higher in CRPS patients than in healthy controls. Those of globus pallidus (t(21) = −2.045, P = 0.054) tended to be higher in CRPS patients than in healthy controls. In patients with CRPS, there was a positive correlation between the DVR of [11C]-(R)-PK11195 in the caudate nucleus and the pain score, the visual analog scale (r = 0.661, P = 0.026, R2 = 0.408) and affective subscales of McGill Pain Questionnaire (r = 0.604, P = 0.049, R2 = 0.364). We demonstrated that neuroinflammation of CRPS patients in basal ganglia. Our results suggest that microglial pathology can be an important pathophysiology of CRPS. Association between the level of caudate nucleus and pain severity indicated that neuroinflammation in this region might play a key role. These results may be essential for developing effective medical treatments. PMID:28072713

  18. ASRA Practice Advisory on Neurologic Complications in Regional Anesthesia and Pain Medicine

    PubMed Central

    Neal, Joseph M.; Bernards, Christopher M.; Hadzic, Admir; Hebl, James R.; Hogan, Quinn H.; Horlocker, Terese T.; Lee, Lorri A.; Rathmell, James P.; Sorenson, Eric J.; Suresh, Santhanam; Wedel, Denise J.

    2009-01-01

    Neurologic complications associated with regional anesthesia and pain medicine practice are extremely rare. The ASRA Practice Advisory on Neurologic Complications in Regional Anesthesia and Pain Medicine addresses the etiology, differential diagnosis, prevention, and treatment of these complications. This Advisory does not focus on hemorrhagic and infectious complications, because they have been addressed by other recent ASRA Practice Advisories. The current Practice Advisory offers recommendations to aid in the understanding and potential limitation of neurologic complications that may arise during the practice of regional anesthesia and pain medicine. PMID:18774509

  19. Affect School for chronic benign pain patients showed improved alexithymia assessments with TAS-20

    PubMed Central

    2010-01-01

    Background Alexithymia is a disturbance associated with psychosomatic disorders, pain syndromes, and a variety of psychiatric disorders. The Affect School (AS) based on Tomkins Affect Theory is a therapy focusing on innate affects and their physiological expressions, feelings, emotions and scripts. In this pilot study we tried the AS-intervention method in patients with chronic benign pain. Methods The AS-intervention, with 8 weekly group sessions and 10 individual sessions, was offered to 59 patients with chronic non-malignant pain at a pain rehabilitation clinic in Sweden 2004-2005. Pre and post intervention assessments were done with the Hospital Anxiety and Depression scale (HAD), the Toronto Alexithymia Scale-20 (TAS-20), the Visual Analogue Scale for pain assessment (VAS-pain), the European Quality of Life health barometer (EQoL) and the Stress and Crisis Inventory-93 (SCI-93). After the group sessions we used Bergdahl's Questionnaire for assessing changes in interpersonal relations, general well-being and evaluation of AS. Results The AS intervention was completed by 54 out of 59 (92%) patients. Significant reductions in total TAS-20 post-test scores (p = 0.0006) as well as TAS-20 DIF and DDF factors (Difficulties Identifying Feelings, and Difficulties Describing Feelings) were seen (p = 0.0001, and p = 0.0008) while the EOT factor (Externally Oriented Thinking) did not change. Improvements of HAD-depression scores (p = 0.04), EQoL (p = 0.02) and self-assessed changes in relations to others (p < 0.001) were also seen. After Bonferroni Correction for Multiple Analyses the TAS-20 test score reduction was still significant as well as Bergdahl's test after group sessions. The HAD, EQoL, SCI-93, and VAS-pain scores were not significantly changed. The AS-intervention was ranked high by the participants. Conclusions This pilot study involving 59 patients with chronic benign pain indicates that the alexithymia DIF and DDF, as well as depression, social relations and

  20. Relationship between daily pain and affect in women with rheumatoid arthritis: lower optimism as a vulnerability factor.

    PubMed

    Kwissa-Gajewska, Zuzanna; Gruszczyńska, Ewa

    2017-07-17

    The aim of the study was to examine the moderating effect of optimism on the relationship between daily pain-daily affect. Fifty-four female patients with rheumatoid arthritis completed self-report measures of optimism (once), daily pain and daily positive and negative affect for 7 consecutive days during hospitalization. Results of multilevel random coefficients modeling demonstrated a significant cross-level interaction for daily negative affect only. Simple slopes analysis revealed that low optimism was related to a stronger positive relationship between daily pain and daily negative affect, whereas this effect was insignificant for higher optimism. High optimism was also related to higher daily positive affect, regardless of pain level. These findings suggest that low optimism may be a vulnerability factor in the daily pain-daily affect relationship rather than high optimism acting as a protective factor.

  1. Depressive Symptoms, Anatomical Region, and Clinical Outcomes for Patients Seeking Outpatient Physical Therapy for Musculoskeletal Pain

    PubMed Central

    Coronado, Rogelio A.; Beneciuk, Jason M.; Valencia, Carolina; Werneke, Mark W.; Hart, Dennis L.

    2011-01-01

    Background Clinical guidelines advocate the routine identification of depressive symptoms for patients with pain in the lumbar or cervical spine, but not for other anatomical regions. Objective The purpose of this study was to investigate the prevalence and impact of depressive symptoms for patients with musculoskeletal pain across different anatomical regions. Design This was a prospective, associational study. Methods Demographic, clinical, depressive symptom (Symptom Checklist 90–Revised), and outcome data were collected by self-report from a convenience sample of 8,304 patients. Frequency of severe depressive symptoms was assessed by chi-square analysis for demographic and clinical variables. An analysis of variance examined the influence of depressive symptoms and anatomical region on intake pain intensity and functional status. Separate hierarchical multiple regression models by anatomical region examined the influence of depressive symptoms on clinical outcomes. Results Prevalence of severe depression was higher in women, in industrial and pain clinics, and in patients who reported chronic pain or prior surgery. Lower prevalence rates were found in patients older than 65 years and those who had upper- or lower-extremity pain. Depressive symptoms had a moderate to large effect on pain ratings (Cohen d=0.55–0.87) and a small to large effect on functional status (Cohen d=0.28–0.95). In multivariate analysis, depressive symptoms contributed additional variance to pain intensity and functional status for all anatomical locations, except for discharge values for the cervical region. Conclusions Rates of depressive symptoms varied slightly based on anatomical region of musculoskeletal pain. Depressive symptoms had a consistent detrimental influence on outcomes, except on discharge scores for the cervical anatomical region. Expanding screening recommendations for depressive symptoms to include more anatomical regions may be indicated in physical therapy

  2. Rehabilitation of a Female Dancer with Patellofemoral Pain Syndrome: Applying Concepts of Regional Interdependence in Practice

    PubMed Central

    Welsh, Caitlyn; Podschun, Laura; Kolber, Morey J.

    2010-01-01

    Due to complex movements and high physical demands, dance is often associated with a multitude of impairments including pain of the low back, pelvis, leg, knee, and foot. This case report provides an exercise progression, emphasizing enhancement of strength and neuromuscular performance using the concept of regional interdependence in a 17 year old female dancer with patellofemoral pain syndrome. PMID:21589665

  3. Limb-specific autonomic dysfunction in complex regional pain syndrome modulated by wearing prism glasses.

    PubMed

    Moseley, G Lorimer; Gallace, Alberto; Di Pietro, Flavia; Spence, Charles; Iannetti, Gian Domenico

    2013-11-01

    In unilateral upper-limb complex regional pain syndrome (CRPS), the temperature of the hands is modulated by where the arms are located relative to the body midline. We hypothesized that this effect depends on the perceived location of the hands, not on their actual location, nor on their anatomical alignment. In 2 separate cross-sectional randomized experiments, 10 (6 female) unilateral CRPS patients wore prism glasses that laterally shifted the visual field by 20°. Skin temperature was measured before and after 9-minute periods in which the position of one hand was changed. Placing the affected hand on the healthy side of the body midline increased its temperature (Δ°C=+0.47 ± 0.14°C), but not if prism glasses made the hand appear to be on the body midline (Δ°C=+0.07 ± 0.06°C). Similarly, when prism glasses made the affected hand appear to be on the healthy side of the body midline, even though it was not, the affected hand warmed up (Δ°C=+0.28 ± 0.14°C). When prism glasses made the healthy hand appear to be on the affected side of the body midline, even though it was not, the healthy hand cooled down (Δ°C=-0.30 ± 0.15°C). Friedman's analysis of variance and Wilcoxon pairs tests upheld the results (P<0.01 for all). We conclude that, in CRPS, cortical mechanisms responsible for encoding the perceived location of the limbs in space modulate the temperature of the hands. Copyright © 2013 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

  4. Diurnal and nocturnal skin temperature regulation in chronic complex regional pain syndrome.

    PubMed

    Schilder, Johanna C M; Niehof, Sjoerd P; Marinus, Johan; van Hilten, Jacobus J

    2015-03-01

    Skin temperature changes due to vasomotor disturbances are important features of complex regional pain syndrome (CRPS). Because this phenomenon has only been studied under controlled conditions, information on daily circadian variability is lacking. Also, studies in chronic CRPS patients with abnormal posturing, in which coldness of the affected extremity is more common, do not exist. We examined the response to external heating as well as circadian temperature changes over several days in the affected legs of 14 chronic CRPS patients with abnormal posturing and 17 controls. Skin temperatures were recorded hourly for 14 days using wireless sensors. Although the patients' affected extremities were significantly colder before external heating, the vasodilatory response was similar in the 2 groups. Additionally, median skin temperature differences between both legs and their variability was larger in patients than in controls during the day, but not during the night. These findings indicate that the mechanisms underlying impaired skin circulation in CRPS during daytime are reversible under certain circumstances. The large variation in skin temperature differences during the day questions the validity of using a single measurement in the diagnosis of CRPS, and our results indicate that only temperature differences >1.0 °C should be considered to reflect vasomotor disturbances. This article shows that chronic CRPS patients have a normal vasodilatory response to external heating and that skin temperature differences between the affected and unaffected lower limbs, which were highly variable during daytime, disappeared during sleep. This indicates that part of the vasomotor regulation in these patients is still functional. Copyright © 2015 American Pain Society. Published by Elsevier Inc. All rights reserved.

  5. Spatially-defined motor deficits in people with unilateral complex regional pain syndrome.

    PubMed

    Reid, Emily J; Braithwaite, Felicity A; Wallwork, Sarah B; Harvie, Daniel; Chalmers, K Jane; Spence, Charles; Gallace, Alberto; Moseley, G Lorimer

    2017-07-14

    Spatially-defined disruption of autonomic and sensory function has been identified in Complex Regional Pain Syndrome (CRPS). This study aimed to determine whether motor performance is also disrupted in a spatially-defined manner in people with CRPS. Thirteen people with CRPS type 1 of the upper limb participated in two motor experiments. In Experiment 1 participants performed a circle drawing task that primarily tested motor accuracy. In Experiment 2 participants performed a button pressing task that tested motor co-ordination. In both experiments the motor tasks were performed with either hand (affected or healthy), and on either side of the body midline - that is, on the affected side of space or healthy side of space. There was a main effect of both Limb and Side for the motor tasks. In Experiment 1, motor accuracy for the circle drawing task was poorer when participants used their affected hand than when they used their healthy one (p < .001), and when the task was performed on the affected side of their body midline than when it was performed on the healthy side (p < .001). In Experiment 2, motor co-ordination for the button pressing task was poorer when participants used their affected hand than when they used their healthy one (p < .001), and when the task was performed on the affected side of the midline (p < .001), as compared to the healthy side of the midline. Unilateral CRPS is associated with a spatially-defined disruption of motor performance. Participants perform worse when the task is performed on the affected side of the body midline, regardless of whether they use their affected or healthy hand. Copyright © 2017. Published by Elsevier Ltd.

  6. Short-Term Functional, Emotional, and Pain Outcomes of Patients with Complex Regional Pain Syndrome Treated in a Comprehensive Interdisciplinary Pain Management Program.

    PubMed

    McCormick, Zachary L; Gagnon, Christine M; Caldwell, Mary; Patel, Jaymin; Kornfeld, Sarah; Atchison, James; Stanos, Steven; Harden, R Norman; Calisoff, Randy

    2015-12-01

    Complex regional pain syndrome (CRPS) is difficult to effectively treat with unimodal approaches. To investigate whether CRPS can be effectively treated in a comprehensive interdisciplinary pain management program. Observational cohort study of 49 patients aged 18-89 who fulfilled 'Budapest Criteria' for CRPS and completed an interdisciplinary pain management program. Preprogram to postprogram changes in physical functioning, perceived disability, emotional functioning, acceptance, coping, and pain were assessed. The measures used included: Pain Disability Index, Six minute walk test, 2-minute sit-to-stand, Numerical Rating Scale, Center for Epidemiologic Studies Depression Scale, Pain Anxiety Symptoms Scale, Chronic Pain Acceptance Questionnaire, Coping Strategies Questionnaire-Revised, RIC- Multidimensional Patient Global Impression of Change (RIC-MPGIC), and Medication Quantification Scale. For worker's compensation patients, the rate of successful release to work at the end of the program was calculated. Results indicated significant improvements in physical functioning and perceived disability (P's<0.001). Patients reported increased usage of an adaptive coping strategy, distraction (P = 0.010), and decreased usage of maladaptive and passive strategies (P's < 0.001). Patients showed greater chronic pain acceptance (P's ≤ 0.010) and reductions in emotional distress (P's < 0.001). Medication usage at 1-month follow-up was significantly reduced compared to program start (P < 0.001) and discharge (P = 0.004). Patients reported "much improvement" in overall functioning, physical functioning, mood, and their ability to cope with pain and flare-ups (RIC-MPGIC). Patient report of pain was not significantly reduced at discharge (P =0.078). Fourteen (88%) of 16 total worker's compensation patients were successfully released to work at the end of the program. This study demonstrates short-term improvements in physical and emotional functioning

  7. Does body mass index and position of impacted lower third molar affect the postoperative pain intensity?

    PubMed

    Matijević, Marko; Uzarević, Zvonimir; Gvozdić, Vlatka; Leović, Dinko; Ivanisević, Zrinka; Matijević-Mikelić, Valentina; Bogut, Irella; Vcev, Aleksandar; Macan, Darko

    2012-12-01

    The main objective of this study was to determine to which extent body mass index and position of impacted lower third molar was affecting the pain intensity in the first seven postoperative days. The study was conducted following the extraction of the lower third molar in 108 patients. Depending on the type of information given to each particular patient, the patients were divided in two groups: the test group where patients were given detailed standard written and verbal instructions and the control group which received only standard written instructions about treatment after surgery. Using canonical discriminant analysis we investigated the influence of body mass index and the position of impacted lower third molar on postoperative pain intensity in two groups of patients. Results of this study showed that the body mass index or the tooth position did not have influence on intensity of postoperative pain. The body mass index and the position of impacted lower third molar do not affect the postoperative pain intensity.

  8. Craniofacial Morphology Affects Bite Force in Patients with Painful Temporomandibular Disorders.

    PubMed

    Bavia, Paula Furlan; Vilanova, Larissa Soares Reis; Garcia, Renata Cunha Matheus Rodrigues

    2016-01-01

    Craniofacial morphology affects masticatory performance in healthy dentate subjects, but little is known about its effects in patients with painful temporomandibular disorders (TMDs). Forty-eight female patients (mean age of 28±5.8 years) with painful TMDs underwent lateral cephalometric radiography. Using Ricketts' cephalometric analysis and the Vert method, subjects were assigned to three groups according to their craniofacial morphology: brachyfacial (n=22), mesofacial (n=13), and dolichofacial (n=13). Research diagnostic criteria for TMD were used to confirm the TMD diagnosis for each patient. Pain intensity was reported by each patient based on a visual analog scale (VAS). Maximum bite force (MBF) was measured with pressure sensors placed on the first molar site. Masticatory performance (MP) was assessed by chewing a silicone-based artificial material and determining the resulting particle size by the sieve method. Chewing ability (CA) was evaluated for seven food types and analyzed by a VAS questionnaire. Data were analyzed by one-way ANOVA followed by a Tukey-Kramer test (p<0.05). MBF differed in each group, with brachyfacial patients having the highest MBF values. There was no difference in MP among the groups. The groups differed only in their ability to chew one of the seven evaluated food types. In summary, craniofacial morphology affects the MBF without impairing MP or CA in patients with painful TMDs.

  9. Joint awareness after total knee arthroplasty is affected by pain and quadriceps strength.

    PubMed

    Hiyama, Y; Wada, O; Nakakita, S; Mizuno, K

    2016-06-01

    There is a growing interest in the use of patient-reported outcomes to provide a more patient-centered view on treatment. Forgetting the artificial joint can be regarded as the goal in joint arthroplasty. The goals of the study were to describe changes in joint awareness in the artificial joint after total knee arthroplasty (TKA), and to determine which factors among pain, knee range of motion (ROM), quadriceps strength, and functional ability affect joint awareness after TKA. Patients undergoing TKA demonstrate changes in joint awareness and joint awareness is associated with pain, knee ROM, quadriceps strength, and functional ability. This prospective cohort study comprised 63 individuals undergoing TKA, evaluated at 1, 6, and 12 months postoperatively. Outcomes included joint awareness assessed using the Forgotten Joint Score (FJS), pain score, knee ROM, quadriceps strength, and functional ability. Fifty-eight individuals completed all postoperative assessments. All measures except for knee extension ROM improved from 1 to 6 months. However, there were no differences in any measures from 6 to 12 months. FJS was affected most greatly by pain at 1 month and by quadriceps strength at 6 and 12 months. Patients following TKA demonstrate improvements in joint awareness and function within 6 months after surgery, but reach a plateau from 6 to 12 months. Quadriceps strength could contribute to this plateau of joint awareness. Prospective cohort study, IV. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  10. [Long term effect of spinal cord stimulation in a patient with complex regional pain syndrome and phantom pain syndrome type 1 after amputation].

    PubMed

    Enggaard, Thomas Peter; Scherer, Christian; Nikolajsen, Lone; Andersen, Claus

    2008-02-04

    The development of stump and phantom pain after limb amputation in patients with complex regional pain syndrome (CRPS) is very frequent. Stump pain is typically recurred CRPS and the possibilities for effective pharmacological pain relief are often limited. Spinal cord stimulation (SCS) has a well-documented pain relieving effect in patients with CRPS. This case story summarises the long term effect of SCS in a patient with CRPS after two amputations of the right leg. Pharmacological pain therapies as well as Guanethidine blockade were found to be ineffective.

  11. Effect of static and dynamic heat pain stimulus profiles on the temporal dynamics and interdependence of pain qualities, intensity, and affect.

    PubMed

    Hashmi, Javeria A; Davis, Karen D

    2008-10-01

    Acute and chronic pains are characterized by a particular constellation of pain qualities, such as burning, aching, stinging, or sharp feelings. However, the temporal pattern of specific pain qualities and their relationship with pain and affect is not well understood. In addition, little is known about how the temperature time course of the stimulus impacts the temporal dynamics of pain qualities and the relationship between pain qualities. Therefore we applied two types of stimuli to the feet of 16 healthy subjects, each calibrated to evoke a similar pain magnitude (50/100): static stimulus held at constant intensity and dynamic stimulus increased in intensity in small steps. Stimulus runs consisted of three 30-s stimuli (either static or dynamic) with an interstimulus interval of 60 s. Continuous on-line ratings of pain, burning, sharp, stinging, cutting, and annoyance were obtained in separate runs, and the evoked responses were characterized by within-stimulus adaptation (early: 0- to 15-s peak vs. late: 25- to 40-s peak) and by their temporal properties (time to onset, peak, and end). The temporal profile of the burning sensation was similar to the pain and annoyance evoked by the static and dynamic stimuli. However, the sharp, stinging and cutting sensations attenuated in response to the static stimuli (P<0.01) but intensified along with pain and affect in response to the dynamic stimuli (P<0.05), whereas there was no attenuation in the evoked profiles of pain (P=0.61), annoyance (P=0.27), or burning quality (P=0.27). These data demonstrate that specific pain qualities with known differences in underlying mechanisms have distinct temporal dynamics that depend on the stimulus intensity dynamics.

  12. Stressful events and information processing dispositions moderate the relationship between positive and negative affect: implications for pain patients.

    PubMed

    Potter, P T; Zautra, A J; Reich, J W

    2000-01-01

    Relationships between positive affect, negative affect, and pain were analyzed as a prospective function of stressful events in a sample of rheumatoid arthritis patients and as a cross-sectional function of an information processing disposition in persons with fibromyalgia. Positive affect and negative affect were statistically separate factors overall in both samples. In addition, negative affect and pain were related across all conditions. However, positive affect and negative affect were more negatively correlated during stressful periods and more negatively correlated for patients who processed information in a more simplistic fashion. Also, positive affect predicted pain during stressful times and did so for patients who processed information more simplistically as well. These data suggest positive affect and negative affect are unique factors whose interrelation and external correlates are not static.

  13. The Association Between Obesity and Low Back Pain and Disability Is Affected by Mood Disorders

    PubMed Central

    Chou, Louisa; Brady, Sharmayne R.E.; Urquhart, Donna M.; Teichtahl, Andrew J.; Cicuttini, Flavia M.; Pasco, Julie A.; Brennan-Olsen, Sharon L.; Wluka, Anita E.

    2016-01-01

    Abstract Low back pain (LBP) and obesity are major public health problems; however, the relationship between body composition and low back pain in men is unknown. This study aims to examine the association between body composition and LBP and disability in a population-based sample of men, as well as the factors that may affect this relationship. Nine hundred seventy-eight male participants from the Geelong Osteoporosis Study were invited to participate in a follow-up study in 2006. Participants completed questionnaires on sociodemographics and health status. Low back pain was determined using the validated Chronic Back Pain Grade Questionnaire and the presence of an emotional disorder was assessed using the Hospital Anxiety Depression Scale. Body composition was measured using dual energy x-ray absorptiometry. Of the 820 respondents (84% response rate), 124 (15%) had high-intensity low back pain and/or disability (back pain). Low back pain was associated with higher body mass index (28.7 ± 0.4 vs 27.3 ± 0.2 kg/m2, P = 0.02) and waist–hip ratio (0.97 ± 0.006 vs 0.96 ± 0.006, P = 0.04), with increased tendency toward having a higher fat mass index (8.0 vs 7.6 kg/m2, P = 0.08), but not fat-free mass index (P = 0.68). The associations between back pain and measures of obesity were stronger in those with an emotional disorder, particularly for waist–hip ratio (P = 0.05 for interaction) and fat mass index (P = 0.06 for interaction). In a population-based sample of men, high-intensity LBP and/or disability were associated with increased levels of obesity, particularly in those with an emotional disorder. This provides evidence to support a biopsychosocial interaction between emotional disorders and obesity with low back pain. PMID:27082599

  14. Temperature trends in regions affected by increasing aridity/humidity

    NASA Astrophysics Data System (ADS)

    Jones, Philip D.; Reid, Phillip A.

    A paper in 1991 claimed that regions affected by desertification experience warming trends relative to neighbouring areas. To assess this, an index of aridity/humidity based on the ratio of annual precipitation to annual potential evapotranspiration totals (P/PET) is developed. This index is used to define regions experiencing increases (and those where the increase is statistically significant) in aridity and humidity. We also consider regions always arid (average values of P/PET <0.5) and always humid (P/PET >2.0). Trends of average annual and summer surface air temperature are then calculated for regions in the various aridity/humidity categories and compared to most of the rest of the world's land areas equatorward of 60°. The results indicate that most of the differences in trends between categories are not statistically significant.

  15. Facial affect perception and mentalizing abilities in female patients with persistent somatoform pain disorder.

    PubMed

    Schönenberg, M; Mares, L; Smolka, R; Jusyte, A; Zipfel, S; Hautzinger, M

    2014-08-01

    Numerous studies have demonstrated a robust link between alexithymic traits and somatic complaints in patients suffering from psychosomatic disorders, while less is known about disease-related impairments in the processing of affective social information. Deficits in emotion recognition can lead to misinterpretations of social signals and induce distress in interpersonal interactions. This, in turn, might contribute to somatoform symptomatology in affected individuals. The aim of the present study was to investigate basal facial affect recognition as well as higher-order cognitive mind-reading skills in order to further clarify the association between alexithymia and the processing of social affective information in a homogenous sample of patients suffering from somatoform pain. We employed a series of animated morph clips that gradually displayed the onset and development of the six basic emotional expressions to investigate facial affect perception in a female sample of patients diagnosed with persistent somatoform pain disorder (PSPD) and matched healthy controls. In addition, all participants were presented with the Movie for the Assessment of Social Cognition to explore mind-reading abilities. Specifically impaired mentalizing skills and increased alexithymic traits were observed in PSPD, while emotional facial expression recognition appeared to be intact in these patients. PSPD subjects tend to overattribute inappropriate affective states to others, which could be the consequence of the inability to adequately experience and express their own emotional reactions. This cognitive bias might lead to the experience of poor psychosocial functioning and has the potential to negatively impact the course and outcome of this psychopathology. © 2014 European Pain Federation - EFIC®

  16. 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

  17. Psychologic factors in the development of complex regional pain syndrome: history, myth, and evidence.

    PubMed

    Feliu, Miriam H; Edwards, Christopher L

    2010-01-01

    The present paper examines the literature that addresses psychologic aspects involved in complex regional pain syndrome from a historic perspective to provide a rationale for the emergence of psychologic theories to explain its pathogenesis. The support of such perspective is then analyzed through the review of evidence-based studies. A review of the literature from a historic perspective was presented since its first description to the present time, including the clinical presentation and associated symptoms. An evidence-based approach was used to review the literature on complex regional pain syndrome and psychologic factors associated with the etiology or as predictors in the development of the disorder. After reviewing the literature on the history and the myths associated with complex regional pain syndrome, a hypothesis is provided based on an analysis of the Zeitgeist in the development of the psychologic theory associated with the disorder. We also concluded there is no evidence to support a linear relationship that establishes a psychologic predisposition to develop the disorder. An analysis of the Zeitgeist when complex regional pain syndrome was first described helps to understand the long-standing theories associated with a psychological theory of its etiology. This understanding should help to undermine the perpetuation of such claims which may contribute to undertreatment and misdiagnosis. To be consistent with todays Zeitgeist we must incorporate psychologic aspects, which while not causal in nature or exclusive of complex regional pain syndrome, are strongly associated with a wide spectrum of chronic pain disorders.

  18. Negative Affect and Sleep Disturbance May Be Associated With Response to Epidural Steroid Injections for Spine-Related Pain

    PubMed Central

    Karp, Jordan F.; Yu, Lan; Friedly, Janna; Amtmann, Dagmar; Pilkonis, Paul A.

    2014-01-01

    Objective To describe whether negative affect and sleep impairment are associated with the clinical effect of epidural steroid injections (ESIs) for low back pain. Design Observational study; patients were evaluated before ESI and 1 and 3 months after ESI. Setting Spine center and related treatment sites. Participants Participants (N=158) seeking treatment for low back pain with or without radiculopathy. Intervention ESI for low back pain with or without radiculopathy. Main Outcome Measures We assessed the dependent (global pain severity for back and leg pain, pain behavior, pain interference) and independent variables (depression, sleep disturbance, and covariates of back pain response) with the Patient-Reported Outcome Measurement Information System (PROMIS) and legacy measures. Outcome was assessed cross-sectionally using multiple regression and longitudinally with path analysis. Results After 1 month, sleep disturbance was the only predictor for the global ratings of improvement in back pain (R2=16.8%) and leg pain (R2=11.4%). The proportions of variance explained by sleep disturbance and negative affect for all dependent variables were greater at 3 months than 1 month. Mediation analysis was significant for negative affect for the 3-month outcomes on PROMIS pain behavior (β=.87, P<.01) and pain interference (β=.37, P<.01). There was no evidence of mediation by sleep disturbance for any outcome. Conclusions Negative affect and sleep disturbance are associated with worse outcomes after ESI. Further research is needed to determine if treatment of negative affect and sleep disturbance prior to or concurrently with ESI will improve outcomes. PMID:24060493

  19. Chest pain prevalence, causes, and disposition in the emergency department of a regional hospital in Pretoria

    PubMed Central

    2016-01-01

    Background Chest pain is a common clinical syndrome. However, there is a paucity of African studies describing the causes, prevalence, aetiology, and disposition of patients with chest pain presenting in the emergency department (ED). Aim The aim of this retrospective descriptive study was to determine the prevalence, causes, demographics, and disposition of all adult patients with the main complaint of chest pain presenting at the ED of a regional hospital in South Africa. Methods Records of all patients 18 years and older presenting with the complaint of chest pain from 1 December 2011 through 10 April 2012 were assessed. A data collection sheet capturing patient demographics and disposition from the ED was used. The diagnosis was subdivided into groups: cardiovascular, respiratory, gastrointestinal, musculoskeletal, psychiatric/psychogenic, other, and unknown. Results Of the 312 patients presenting with chest pain, 210 patient files were retrieved. The prevalence of non-traumatic chest pain was 1.66%. Respiratory disease was the most common cause (36.19%), with pneumonia the most common diagnosis (24.40%). Logistic regression showed diagnoses of acute cardiovascular disease or respiratory disease, older age, and transport by ambulance as being associated with admission. Conclusion The main cause of acute chest pain was found to be respiratory disease, followed by musculoskeletal disorders. In the African context, the aetiology of acute chest pain differs from that in first world countries. Health workers should therefore pay special attention to respiratory conditions during diagnosis and management in African patients with acute chest pain. PMID:27380782

  20. Chest pain prevalence, causes, and disposition in the emergency department of a regional hospital in Pretoria.

    PubMed

    Geyser, Mimi; Smith, Selma

    2016-06-10

    Chest pain is a common clinical syndrome. However, there is a paucity of African studies describing the causes, prevalence, aetiology, and disposition of patients with chest pain presenting in the emergency department (ED). The aim of this retrospective descriptive study was to determine the prevalence, causes, demographics, and disposition of all adult patients with the main complaint of chest pain presenting at the ED of a regional hospital in South Africa. Records of all patients 18 years and older presenting with the complaint of chest pain from 1 December 2011 through 10 April 2012 were assessed. A data collection sheet capturing patient demographics and disposition from the ED was used. The diagnosis was subdivided into groups: cardiovascular, respiratory, gastrointestinal, musculoskeletal, psychiatric/psychogenic, other, and unknown. Of the 312 patients presenting with chest pain, 210 patient files were retrieved. The prevalence of non-traumatic chest pain was 1.66%. Respiratory disease was the most common cause (36.19%), with pneumonia the most common diagnosis (24.40%). Logistic regression showed diagnoses of acute cardiovascular disease or respiratory disease, older age, and transport by ambulance as being associated with admission. The main cause of acute chest pain was found to be respiratory disease, followed by musculoskeletal disorders. In the African context, the aetiology of acute chest pain differs from that in first world countries. Health workers should therefore pay special attention to respiratory conditions during diagnosis and management in African patients with acute chest pain.

  1. I suffer more from your pain when you act like me: being imitated enhances affective responses to seeing someone else in pain.

    PubMed

    De Coster, Lize; Verschuere, Bruno; Goubert, Liesbet; Tsakiris, Manos; Brass, Marcel

    2013-09-01

    Social-psychological research has suggested that being imitated changes the way that we experience others: We like someone who imitates us more, and the interaction with this person runs more smoothly. Whether being imitated also affects basic social reactions, such as empathy for pain, is an open question. Empathy for pain refers to the observation that perceiving another person in pain results in pain-related brain activation in the observer. The aim of the present study was to combine the two lines of research, to investigate whether being imitated can influence empathy for pain. To this end, we developed an experimental approach combining an imitation task with a pain perception task. Subjective reports, as well as physiological responses, indicated that being imitated enhances affective responses to seeing someone else in pain. Furthermore, using rubber hand illusion measures, we provided evidence for the role of shared representations in the sensory and motor domains as a core underlying mechanism. In this way, our study integrated social-psychological research on being imitated with cognitive research on empathy for pain. This has broad implications, since imitation plays a crucial role in our daily social interactions, and our study provides insights into a basic cognitive mechanism that might underlie these social situations.

  2. A Study on Factors Affecting Low Back Pain and Safety and Efficacy of NSAIDs in Acute Low Back Pain in a Tertiary Care Hospital of Western Nepal

    PubMed Central

    Bhattarai, Srijana; Chhetri, Himal Paudel; Alam, Kadir; Thapa, Pabin

    2013-01-01

    Introduction: Low back pain is characterized by a range of symptoms which include pain, muscle tension or stiffness, and is localized between the shoulder blades and the folds of the buttocks, with or without spreading to the legs. Non-Steroidal Anti Inflammatory Drugs (NSAIDs) are the drugs of choice which provide an analgesic effect for acute low back pain. Aim: To study the factors affecting low back pain, efficacy and safety of different non-steroidal anti-inflammatory drugs (aceclofenac, diclofenac, naproxen and nimesulide) in low back pain. Methodology: Data collection form and numeric pain rating scale were used as study tools for studying patients’ demographies and severities of pain respectively. Patients prescribed with aceclofenac 100 mg , diclofenac 100 mg, naproxen 500 mg and nimesulide 100 mg for acute low back pain at Orthopaedics Outpatients Department of Manipal Teaching Hospital, Nepal, were enrolled in this study. The decrease in pain scores was recorded on 5th and 10th days of follow-up and pain scores were calculated. Descriptive statistics and Kruskal Wallis non parametric test were used for analysis. Results: Among 150 patients, 67.3% were females (n=101). Low back pain was more prevalent (24.7%) in age-group of 59-68 years and a positive correlation was seen. Similarly, low back pain was found to be high among people involved in agriculture, heavy weight lifters and non smokers. The decrease in average pain scores was more in the patients treated with aceclofenac (4.83 ± 0.537), followed by that in those who were treated with naproxen (4.13 ± 0.067) and diclofenac (3.84 ± 0.086). The decrease in pain scores was found to be lowest among patients who were treated with nimesulide (2.11 ± 0.148). Nimesulide presented more number of side-effects than the comparative drugs. Conclusion: Different factors affect low back pain, such as age, gender, personal habit, posture, occupation, weight lifting. Aceclofenac showed greater decrease in pain

  3. A study on factors affecting low back pain and safety and efficacy of NSAIDs in acute low back pain in a tertiary care hospital of Western Nepal.

    PubMed

    Bhattarai, Srijana; Chhetri, Himal Paudel; Alam, Kadir; Thapa, Pabin

    2013-12-01

    Low back pain is characterized by a range of symptoms which include pain, muscle tension or stiffness, and is localized between the shoulder blades and the folds of the buttocks, with or without spreading to the legs. Non-Steroidal Anti Inflammatory Drugs (NSAIDs) are the drugs of choice which provide an analgesic effect for acute low back pain. To study the factors affecting low back pain, efficacy and safety of different non-steroidal anti-inflammatory drugs (aceclofenac, diclofenac, naproxen and nimesulide) in low back pain. Data collection form and numeric pain rating scale were used as study tools for studying patients' demographies and severities of pain respectively. Patients prescribed with aceclofenac 100 mg , diclofenac 100 mg, naproxen 500 mg and nimesulide 100 mg for acute low back pain at Orthopaedics Outpatients Department of Manipal Teaching Hospital, Nepal, were enrolled in this study. The decrease in pain scores was recorded on 5th and 10th days of follow-up and pain scores were calculated. Descriptive statistics and Kruskal Wallis non parametric test were used for analysis. Among 150 patients, 67.3% were females (n=101). Low back pain was more prevalent (24.7%) in age-group of 59-68 years and a positive correlation was seen. Similarly, low back pain was found to be high among people involved in agriculture, heavy weight lifters and non smokers. The decrease in average pain scores was more in the patients treated with aceclofenac (4.83 ± 0.537), followed by that in those who were treated with naproxen (4.13 ± 0.067) and diclofenac (3.84 ± 0.086). The decrease in pain scores was found to be lowest among patients who were treated with nimesulide (2.11 ± 0.148). Nimesulide presented more number of side-effects than the comparative drugs. Different factors affect low back pain, such as age, gender, personal habit, posture, occupation, weight lifting. Aceclofenac showed greater decrease in pain scores with lesser number of side-effects.

  4. Evaluation of mirrored muscle activity in patients with Complex Regional Pain Syndrome.

    PubMed

    Bank, Paulina J M; Peper, C Lieke E; Marinus, Johan; Beek, Peter J; van Hilten, Jacobus J

    2014-10-01

    Motor dysfunction in Complex Regional Pain Syndrome (CRPS) has been associated with bilateral changes in central motor processing, suggesting abnormal coupling between the affected and unaffected limb. We evaluated the occurrence of involuntary muscle activity in a limb during voluntary movements of the contralateral limb (i.e., mirror activity) in unilaterally affected patients to examine disinhibition of contralateral motor activity in CRPS. Mirror activity was examined during unimanual rhythmic flexion-extension movements of the wrist through in-depth analysis of electromyography recordings from the passive arm in 20 CRPS patients and 40 controls. The number of mirror-epochs was comparable for both arms in both CRPS patients and controls. Mirror-epochs in the affected arm of patients were comparable to those in controls. Mirror-epochs in the unaffected arm were shorter and showed less resemblance (in terms of rhythm and timing) to activity of the homologous muscle in the moving arm compared to mirror-epochs in controls. No evidence for disinhibition of contralateral motor activity was found during unimanual movement. Although motor dysfunction in CRPS has been associated with bilateral changes in cortical motor processing, the present findings argue against disinhibition of interhemispheric projections to homologous muscles in the contralateral limb during unimanual movement. Copyright © 2014 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

  5. Does Deep Cervical Flexor Muscle Training Affect Pain Pressure Thresholds of Myofascial Trigger Points in Patients with Chronic Neck Pain? A Prospective Randomized Controlled Trial

    PubMed Central

    Billis, Evdokia; Papanikolaou, Dimitra-Tania; Koutsojannis, Constantinos

    2016-01-01

    Background. We need to understand more about how DNF performs in different contexts and whether it affects the pain threshold over myofascial trigger points (MTrPs). Purpose. The objectives were to investigate the effect of neck muscles training on disability and pain and on pain threshold over MTrPs in people with chronic neck pain. Methods. Patients with chronic neck pain were eligible for participation with a Neck Disability Index (NDI) score of over 5/50 and having at least one MTrP on either levator scapulae, upper trapezoid, or splenius capitis muscle. Patients were randomly assigned into either DNF training, superficial neck muscle exercise, or advice group. Generalized linear model (GLM) was used to detect differences in treatment groups over time. Results. Out of 67 participants, 60 (47 females, mean age: 39.45 ± 12.67) completed the study. Neck disability and neck pain were improved over time between and within groups (p < 0.05). However, no differences were found within and between the therapeutic groups (p < 0.05) in the tested muscles' PPTs and in cervicothoracic angle over a 7-week period. Conclusion. All three groups improved over time. This infers that the pain pathways involved in the neck pain relief are not those involved in pain threshold. PMID:27990302

  6. Hydration status affects mood state and pain sensation during ultra-endurance cycling.

    PubMed

    Moyen, Nicole E; Ganio, Matthew S; Wiersma, Lenny D; Kavouras, Stavros A; Gray, Michelle; McDermott, Brendon P; Adams, J D; Binns, Ashley P; Judelson, Daniel A; McKenzie, Amy L; Johnson, Evan C; Muñoz, Colleen X; Kunces, Laura J; Armstrong, Lawrence E

    2015-01-01

    Laboratory-based studies indicate mild dehydration adversely affects mood. Although ultra-endurance events often result in mild to moderate dehydration, little research has evaluated whether the relationship between hydration status and mood state also exists in these arduous events. Therefore, the purpose of this study was to evaluate how hydration status affected mood state and perceptual measures during a 161 km ultra-endurance cycling event. One hundred and nineteen cyclists (103 males, 16 females; age = 46 ± 9 years; height = 175.4 ± 17.9 cm; mass = 82.8 ± 16.3 kg) from the 2011 and 2013 Hotter'N Hell events participated. Perceived exertion, Thermal, Thirst, and Pain sensations, Brunel Profile of Mood States, and urine specific gravity (USG) were measured pre- (~1 h before), mid- (~97 km), and post-ride. Participants were classified at each time point as dehydrated (USG ≥ 1.022) or euhydrated (USG ≤ 1.018). Independent of time point, dehydrated participants (USG = 1.027 ± 0.004) had decreased Vigour and increased Fatigue, Pain, Thirst, and Thermal sensations compared to euhydrated participants (USG = 1.012 ± 0.004; all P < 0.01). USG significantly correlated with Fatigue (r = 0.36), Vigour (r = -0.27), Thirst (r = 0.15), and Pain (r = 0.22; all P < 0.05). In conclusion, dehydrated participants had greater Fatigue and Pain than euhydrated participants. These findings indicate dehydration may adversely affect mood state and perceptual ratings during ultra-endurance cycling.

  7. Examining the role of the medial thalamus in modulating the affective dimension of pain.

    PubMed

    Wilson, Hilary D; Uhelski, Megan L; Fuchs, Perry N

    2008-09-10

    The purpose of this project was to explore the role of the medial thalamus (MT), including the medial dorsal thalamus (MD) and associated midline nuclei in pain processing. Experiment 1 explored the role of electrolytic lesions to the MT in the formalin test. It was hypothesized that animals with electrolytic lesions to the MT would have attenuated paw licking behavior during the second phase of the formalin tests as compared to sham lesion controls. This hypothesis was based on evidence of projections from the MD to the ACC, and previous research demonstrating attenuation of paw licking behavior in the second phase of the formalin test in animals with ACC lesions. Experiment 2 tested the effects of electrolytic MT lesions on mechanical paw withdrawal thresholds in the L5 nerve ligation model. It was hypothesized that lesions of the MT would not alter mechanical paw withdrawal thresholds. Experiment 3 tested the effects of electrolytic MT lesions on escape/avoidance behavior in the place escape avoidance paradigm. For experiment 1, animals with MT lesions were found to have slightly elevated paw licking behavior, but only across two time points. No differences in mechanical paw withdrawal thresholds and in escape/avoidance behavior were detected as compared to the sham lesion group. These results indicate a limited role for the medial thalamic nuclei in coding for pain intensity and the affective dimension of pain. Additional research is needed to explore the role of individual medial nuclei in pain processing.

  8. Malignancy as a possible complication of complex regional pain syndrome: a case report.

    PubMed

    Kennedy, Rick; Hester, Joan; Simon, Dominic W N

    2010-01-01

    A synovial sarcoma presented in the knee of a young woman 20 years after the onset of pain which was attributed to complex regional pain syndrome (CRPS). Was this a chance occurrence, or could there be any link between the two conditions? Did the pain itself and the persistent inflammatory and immunological response to pain contribute to the development of malignancy, or could the malignancy have been present subclinically for many years and have contributed to the ongoing pain syndrome? This case report looks into the diagnosis of synovial sarcoma and CRPS and the relationship between the neurogenic inflammation seen in CRPS and that seen in malignancies. The diagnosis of CRPS is a diagnosis of exclusion. Constant vigilance of patients with this unpleasant condition is necessary.

  9. Successful Treatment of Lower Limb Complex Regional Pain Syndrome following Three Weeks of Hyperbaric Oxygen Therapy

    PubMed Central

    Katznelson, Rita; Segal, Shira C.; Clarke, Hance

    2016-01-01

    Hyperbaric oxygen therapy (HBOT) is a treatment that delivers 100% oxygen at increased atmospheric pressures. The efficacy of HBOT for treating pain has been described in various animal pain models and may have clinical efficacy in the treatment of human chronic pain syndromes. We present our experience with posttraumatic Complex Regional Pain Syndrome (CRPS) type 2 in a patient who underwent 15 sessions of HBOT. A 41-year-old male with one-year history of CRPS of left foot followed by left ankle fracture demonstrated less pain, decreased swelling, less allodynia, and improvement in skin color and range of motion of the lower limb after 3 weeks of HBOT. Patient was back to work for the first time in over a year. HBOT may be considered as a valuable therapeutic tool in the treatment of long-standing CRPS. PMID:27445607

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

    PubMed Central

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

    2015-01-01

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

  11. Unconscious affective processing and empathy: an investigation of subliminal priming on the detection of painful facial expressions.

    PubMed

    Yamada, Makiko; Decety, Jean

    2009-05-01

    Results from recent functional neuroimaging studies suggest that facial expressions of pain trigger empathic mimicry responses in the observer, in the sense of an activation in the pain matrix. However, pain itself also signals a potential threat in the environment and urges individuals to escape or avoid its source. This evolutionarily primitive aspect of pain processing, i.e., avoidance from the threat value of pain, seems to conflict with the emergence of empathic concern, i.e., a motivation to approach toward the other. The present study explored whether the affective values of targets influence the detection of pain at the unconscious level. We found that the detection of pain was facilitated by unconscious negative affective processing rather than by positive affective processing. This suggests that detection of pain is primarily influenced by its inherent threat value, and that empathy and empathic concern may not rely on a simple reflexive resonance as generally thought. The results of this study provide a deeper understanding of how fundamental the unconscious detection of pain is to the processes involved in the experience of empathy and sympathy.

  12. 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.

  13. Case study: Gluteal compartment syndrome as a cause of lumbosacral radiculoplexopathy and complex regional pain syndrome.

    PubMed

    Lederman, Andrew; Turk, David; Howard, Antonio; Reddy, Srinivas; Stern, Michelle

    2016-01-01

    We present the case of a 24 yr old male who was diagnosed with gluteal compartment syndrome and was subsequently found to have developed lumbosacral radiculoplexopathy and complex regional pain syndrome. The patient's gluteal compartment syndrome was diagnosed within 24 h of presentation to the emergency room, and he underwent emergent compartment release. While recovering postoperatively, persistent weakness was noted in the right lower limb. Results of electrodiagnostic testing were consistent with a lumbosacral radiculoplexopathy. After admission to inpatient rehabilitation, the patient complained of pain, burning sensation, and numbness in the distal right lower limb. Based on clinical findings, he was diagnosed with complex regional pain syndrome type II, or causalgia, and was referred for a lumbar sympathetic block under fluoroscopic guidance. Sympathetic block resulted in relief of the patient's symptoms. He was discharged home with good pain control on oral medications.

  14. Does direct-to-consumer advertising affect patients' choice of pain medications?

    PubMed

    Liu, Yifei; Doucette, William R

    2008-04-01

    In the United States, direct-to-consumer advertising (DTCA) has grown rapidly to promote prescription medications, including analgesics. Few studies in the literature directly examine the association between DTCA and patients' choice of pain medications. This article discusses how DTCA affects such choice from a behavioral perspective, because DTCA-prompted behaviors are important indicators of DTCA's influence. After DTCA exposure, patients may request prescriptions, seek further medication information, and ask about advertised conditions. Patients who suffer from pain may seek more communication with their health care providers because they are cautious about the information quality of DTCA, mainly because of the recall of rofecoxib (Vioxx; Merck, Whitehouse Station, NJ). However, the availability and DTCA of over-the-counter analgesics complicate their treatment choice. Patients could use DTCA as a tool to launch health communication and make an informed treatment choice with the guidance of their health care providers.

  15. Co-existing carpal tunnel syndrome in complex regional pain syndrome after hand trauma.

    PubMed

    Koh, S M; Moate, F; Grinsell, D

    2010-03-01

    This study highlights the benefits of carpal tunnel release (CTR) in four patients presenting with complex regional pain syndrome (CRPS) after hand surgery who also had carpal tunnel syndrome (CTS) diagnosed clinically and by nerve conduction studies. Three of the patients underwent pre- and postoperative volumetric, circumference, grip strength and range of motion measurements. The Disabilities of the Arm, Shoulder and Hand (DASH) functional outcome measure and pain scores were also used. There was almost complete resolution of CRPS symptoms in all four patients, with notable reductions in oedema and improvements in grip strength and range of motion. There were also improvements in DASH outcome scores and pain scores after CTR.

  16. The use of "stabilization exercises" to affect neuromuscular control in the lumbopelvic region: a narrative review.

    PubMed

    Bruno, Paul

    2014-06-01

    It is well-established that the coordination of muscular activity in the lumbopelvic region is vital to the generation of mechanical spinal stability. Several models illustrating mechanisms by which dysfunctional neuromuscular control strategies may serve as a cause and/or effect of low back pain have been described in the literature. The term "core stability" is variously used by clinicians and researchers, and this variety has led to several rehabilitative approaches suggested to affect the neuromuscular control strategies of the lumbopelvic region (e.g. "stabilization exercise", "motor control exercise"). This narrative review will highlight: 1) the ongoing debate in the clinical and research communities regarding the terms "core stability" and "stabilization exercise", 2) the importance of sub-grouping in identifying those patients most likely to benefit from such therapeutic interventions, and 3) two protocols that can assist clinicians in this process.

  17. Quantitative Ultrasound Assessment of Myofascial Pain Syndrome Affecting the Trapezius: A Reliability Study.

    PubMed

    Kumbhare, Dinesh; Shaw, Saurabh; Grosman-Rimon, Liza; Noseworthy, Michael D

    2017-07-03

    Myofascial pain syndrome is one of the most common causes of chronic pain and is highlighted by the presence of myofascial trigger points. The current practice of diagnosing myofascial pain syndrome among clinicians involves manual detection of myofascial trigger points, which can be inconsistent. However, the detection process can be strengthened with the assistance of ultrasound (US). Therefore, this study aimed to characterize the upper trapezius by using quantitative techniques in healthy asymptomatic individuals with neck pain. Study participants were recruited on the basis of the inclusion and exclusion criteria established, and US images of the trapezius, along the axial and longitudinal orientations, were obtained. Each set was obtained by 2 investigators: experienced and inexperienced personnel. Fifteen participants were recruited. The mean gray scale US echo intensity distribution obtained was 41.9. A paired t test of the global mean echo intensity value obtained for each image from the US operators did not show any significant difference (P = .77). A t test was performed, comparing the echo intensity of the group of patients with neck pain and healthy control participants, and the difference was found to be significant (P = .052). The median blob area was 2.71. The quartile range for the blob area was 1.72 for the 25th percentile to 4.90 for the 75th percentile. This study demonstrated that quantitative analysis of the echo intensity of US images can provide important information. However, further research is necessary to explore the relationships among sex, age, blob area, count, body mass index, regional anatomy, and extent of training or exercise of the particular muscle. © 2017 by the American Institute of Ultrasound in Medicine.

  18. Painful conditions in the Achilles tendon region in elite badminton players.

    PubMed

    Fahlström, Martin; Lorentzon, Ronny; Alfredson, Håkan

    2002-01-01

    The purpose of this study was to investigate the prevalence and characteristics of painful conditions in the Achilles tendon region in elite badminton players. The study group consisted of 66 players in the Swedish elite division (highest level) in badminton, 41 men (mean age, 24.4 years) and 25 women (mean age, 21.9 years). Twenty-one players (32%) reported the occurrence of a disabling painful condition in the Achilles tendon region during the previous 5 years, and 11 players (17%) had an ongoing painful condition. A majority of the painful conditions (12 of 21, or 57%) were described as involving the midportion of the Achilles tendon. The players who had a painful condition reported a significantly higher weekly training load as measured by the number of hours spent in total training, badminton training, and endurance and strength training. There were no differences in age, sex, and body mass index between the players with and without painful conditions in the Achilles tendon region.

  19. Pain exposure physical therapy (PEPT) compared to conventional treatment in complex regional pain syndrome type 1: a randomised controlled trial

    PubMed Central

    Barnhoorn, Karlijn J; van de Meent, Henk; van Dongen, Robert T M; Klomp, Frank P; Groenewoud, Hans; Samwel, Han; Nijhuis-van der Sanden, Maria W G; Frölke, Jan Paul M; Staal, J Bart

    2015-01-01

    Objective To compare the effectiveness of pain exposure physical therapy (PEPT) with conventional treatment in patients with complex regional pain syndrome type 1 (CRPS-1) in a randomised controlled trial with a blinded assessor. Setting The study was conducted at a level 1 trauma centre in the Netherlands. Participants 56 adult patients with CRPS-1 participated. Three patients were lost to follow-up. Interventions Patients received either PEPT in a maximum of five treatment sessions, or conventional treatment following the Dutch multidisciplinary guideline. Measurements Outcomes were assessed at baseline and at 3, 6 and 9 months after randomisation. The primary outcome measure was the Impairment level Sum Score—Restricted Version (ISS-RV), consisting of visual analogue scale for pain (VAS-pain), McGill Pain Questionnaire, active range of motion (AROM) and skin temperature. Secondary outcome measures included Pain Disability Index (PDI); muscle strength; Short Form 36 (SF-36); disability of arm, shoulder and hand; Lower Limb Tasks Questionnaire (LLTQ); 10 m walk test; timed up-and-go test (TUG) and EuroQol-5D. Results The intention-to-treat analysis showed a clinically relevant decrease in ISS-RV (6.7 points for PEPT and 6.2 points for conventional treatment), but the between-group difference was not significant (0.96, 95% CI −1.56 to 3.48). Participants allocated to PEPT experienced a greater improvement in AROM (between-group difference 0.51, 95% CI 0.07 to 0.94; p=0.02). The per protocol analysis showed larger and significant between-group effects on ISS-RV, VAS-pain, AROM, PDI, SF-36, LLTQ and TUG. Conclusions We cannot conclude that PEPT is superior to conventional treatment for patients with CRPS-1. Further high-quality research on the effects of PEPT is warranted given the potential effects as indicated by the per protocol analysis. Trial registration numbers NCT00817128 and NTR 2090. PMID:26628523

  20. Dysautonomia Differentially Influences the Effect of Affective Pain Perception on Quality of Life in Parkinson's Disease Patients

    PubMed Central

    Rada, D.; Seco, J.; Tijero, B.; Abecia, L. C.; Gómez-Esteban, J. C.

    2016-01-01

    Background. Our aim was to evaluate the real effect of dysautonomic symptoms on the influence of affective pain perception on quality of life in PD patients. Methods. An observational cross-sectional study was carried out using 105 Parkinson's disease (PD) patients of the Movement Disorders Unit, Hospital de Cruces (Bilbao, Spain) [men 59 (56.2%), women 46 (43.85%)]. Statistical analysis was made in order to evaluate the possible association of pain with life quality. Results. Quality of life measured by PDQ-39 (Parkinson's Disease Questionnaire for quality of life) was statistically associated with affective dimension of pain (PRIA, affective pain rating index). However, the influence of this dimension on PDQ-39 was different in the specific case of PD patients that experimented a high score (>12) in SCOPA-AUT (Scale for Outcomes in PD-Autonomic scale). Conclusions. These results confirm the effect of affective perception of pain in life quality of PD patients, indicating the critical role of autonomic symptoms in the modulation of the influence of pain on quality of life and showing the possible utility of dysautonomia as clinical prognostic indicator of quality of life in PD patients affected by pain. PMID:27239367

  1. Dysautonomia Differentially Influences the Effect of Affective Pain Perception on Quality of Life in Parkinson's Disease Patients.

    PubMed

    Rada, D; Seco, J; Echevarría, E; Tijero, B; Abecia, L C; Gómez-Esteban, J C

    2016-01-01

    Background. Our aim was to evaluate the real effect of dysautonomic symptoms on the influence of affective pain perception on quality of life in PD patients. Methods. An observational cross-sectional study was carried out using 105 Parkinson's disease (PD) patients of the Movement Disorders Unit, Hospital de Cruces (Bilbao, Spain) [men 59 (56.2%), women 46 (43.85%)]. Statistical analysis was made in order to evaluate the possible association of pain with life quality. Results. Quality of life measured by PDQ-39 (Parkinson's Disease Questionnaire for quality of life) was statistically associated with affective dimension of pain (PRIA, affective pain rating index). However, the influence of this dimension on PDQ-39 was different in the specific case of PD patients that experimented a high score (>12) in SCOPA-AUT (Scale for Outcomes in PD-Autonomic scale). Conclusions. These results confirm the effect of affective perception of pain in life quality of PD patients, indicating the critical role of autonomic symptoms in the modulation of the influence of pain on quality of life and showing the possible utility of dysautonomia as clinical prognostic indicator of quality of life in PD patients affected by pain.

  2. Objective sensory evaluation of the spread of complex regional pain syndrome.

    PubMed

    Edinger, Lara; Schwartzman, Robert J; Ahmad, Ayesha; Erwin, Kirsten; Alexander, Guillermo M

    2013-01-01

    The spread of complex regional pain syndrome (CRPS) has been well documented. Many severe refractory long-standing patients have total body pain (TBP) that evolved from a single extremity injury. The purpose of this study was to document by objective sensory threshold testing the extent of body area involvement in 20 long-standing patients with CRPS who have TBP. A comparison of sensory threshold testing parameters between 20 long-standing refractory patients with CRPS who have TBP versus 10 healthy participants. Twenty patients with CRPS who stated that they suffered from total body pain were chosen from the Drexel University College of Medicine CRPS database. They were compared to 10 healthy participants that were age and gender matched to the patients with CRPS. The sensory parameters tested were: skin temperature; static and mechanical allodynia; thermal allodynia; mechanical hyperalgesia; after sensations following all sensory tests. The sites chosen for testing in the patients with CRPS were the most painful area in each of 8 body regions that comprised the total body area. Five patients with CRPS had signs of CRPS over 100% of their body (20%). One patient had pain over 87% and another had pain over 90% of their body area. The average percentage of body involvement was 62% (range 37% - 100%). All patients with CRPS had at least one sensory parameter abnormality in all body regions. All patients with CRPS had lower pain thresholds for static allodynia in all body areas, while 50% demonstrated a lower threshold for dynamic allodynia in all body regions compared to the healthy participants. Cold allodynia had a higher median pain rating on the Likert pain scale in all body areas versus healthy participants except for the chest, abdomen, and back. Eighty-five percent of the patients with CRPS had a significantly lower pain threshold for mechanical hyperalgesia in all body areas compared to the healthy participants. After sensations occurred after all sensory

  3. Regional Anesthesia and Valproate Sodium for the Prevention of Chronic Post-Amputation Pain

    DTIC Science & Technology

    2014-10-01

    Award Number: W81XWH-12-2-0129 TITLE: Regional Anesthesia and Valproate Sodium for the Prevention of Chronic Post-Amputation Pain PRINCIPAL...From - To) 30 Sep 2013 – 29 Sep 2014 4. TITLE AND SUBTITLE Regional Anesthesia and Valproate Sodium for the Prevention of 5a. CONTRACT NUMBER...have on these genes. In summary, this research will investigate the effectiveness of valproic acid vs placebo when added to regional anesthesia in

  4. Controlling acute pain to improve the quality of postoperative pain management: an update from the European Society of Regional Anesthesia meeting held in Maastricht (September 2016).

    PubMed

    Andrés, Jose De; Pogatzki-Zahn, Esther; Huygen, Frank; Neugebauer, Edmund; Fawcett, William

    2017-08-10

    Improvement in postoperative pain management remains a global concern with a significant unmet need for patients. This was the focus of a 'Change Pain' session at the 35th European Society of Regional Anesthesia meeting (Maastricht, September 2016). Awareness of the size and nature of the problem is important to improve postoperative pain management strategies. Optimal treatment of acute pain should aim to avoid long-term sequelae such as the development of chronic pain disorders (e.g., phantom limb pain). Cases highlighting unsuccessful and successful strategies to manage individuals undergoing surgery were presented. The benefits of personalized care, encouraging patients to be more involved in decisions regarding their treatment and their preferred clinical outcomes were discussed and considered to be a step forward in acute pain management.

  5. Acid-sensing ion channels in trigeminal ganglion neurons innervating the orofacial region contribute to orofacial inflammatory pain.

    PubMed

    Fu, Hui; Fang, Peng; Zhou, Hai-Yun; Zhou, Jun; Yu, Xiao-Wei; Ni, Ming; Zheng, Jie-Yan; Jin, You; Chen, Jian-Guo; Wang, Fang; Hu, Zhuang-Li

    2016-02-01

    Orofacial pain is a common clinical symptom that is accompanied by tooth pain, migraine and gingivitis. Accumulating evidence suggests that acid-sensing ion channels (ASICs), especially ASIC3, can profoundly affect the physiological properties of nociception in peripheral sensory neurons. The aim of this study is to examine the contribution of ASICs in trigeminal ganglion (TG) neurons to orofacial inflammatory pain. A Western blot (WB), immunofluorescence assay of labelled trigeminal ganglion neurons, orofacial formalin test, cell preparation and electrophysiological experiments are performed. This study demonstrated that ASIC1, ASIC2a and ASIC3 are highly expressed in TG neurons innervating the orofacial region of rats. The amplitude of ASIC currents in these neurons increased 119.72% (for ASIC1-like current) and 230.59% (for ASIC3-like current) in the formalin-induced orofacial inflammatory pain model. In addition, WB and immunofluorescence assay demonstrated a significantly augmented expression of ASICs in orofacial TG neurons during orofacial inflammation compared with the control group. The relative protein density of ASIC1, ASIC2a and ASIC3 also increased 58.82 ± 8.92%, 45.30 ± 11.42% and 55.32 ± 14.71%, respectively, compared with the control group. Furthermore, pharmacological blockade of ASICs and genetic deletion of ASIC1 attenuated the inflammation response. These findings indicate that peripheral inflammation can induce the upregulation of ASICs in TG neurons, causing orofacial inflammatory pain. Additionally, the specific inhibitor of ASICs may have a significant analgesic effect on orofacial inflammatory pain.

  6. Does weather affect daily pain intensity levels in patients with acute low back pain? A prospective cohort study.

    PubMed

    Duong, Vicky; Maher, Chris G; Steffens, Daniel; Li, Qiang; Hancock, Mark J

    2016-05-01

    The aim of this study was to investigate the influence of various weather parameters on pain intensity levels in patients with acute low back pain (LBP). We performed a secondary analysis using data from the PACE trial that evaluated paracetamol (acetaminophen) in the treatment of acute LBP. Data on 1604 patients with LBP were included in the analysis. Weather parameters (precipitation, temperature, relative humidity, and air pressure) were obtained from the Australian Bureau of Meteorology. Pain intensity was assessed daily on a 0-10 numerical pain rating scale over a 2-week period. A generalised estimating equation analysis was used to examine the relationship between daily pain intensity levels and weather in three different time epochs (current day, previous day, and change between previous and current days). A second model was adjusted for important back pain prognostic factors. The analysis did not show any association between weather and pain intensity levels in patients with acute LBP in each of the time epochs. There was no change in strength of association after the model was adjusted for prognostic factors. Contrary to common belief, the results demonstrated that the weather parameters of precipitation, temperature, relative humidity, and air pressure did not influence the intensity of pain reported by patients during an episode of acute LBP.

  7. The role of regional anaesthesia techniques in the management of acute pain.

    PubMed

    Cowlishaw, Phillip J; Scott, David M; Barrington, Michael J

    2012-01-01

    Regional anaesthesia and analgesia techniques are used to effectively manage acute pain after a variety of surgeries. With the rapid growth of ultrasound-guided procedures, anaesthetists are re-examining regional anaesthesia and analgesia and their roles in pain management. In this evolving field previous published data may not reflect current practice. Therefore, a narrative review of recent literature was undertaken to establish the current utility and efficacy of regional anaesthesia and analgesia for the management of acute pain following surgery. Only prospective randomised controlled trials published between March 2009 and March 2011 with outcome measures of analgesia efficacy were included. Sixty-five randomised controlled trials were identified involving 4841 patients. Regional techniques for the management of knee (26%), abdominal (26%) and shoulder (14%) surgery were most frequently studied. The review provides further evidence that regional anaesthesia and analgesia can offer excellent analgesia with acceptable side-effects for the management of postsurgical pain. In addition, the results of this review support the use of ultrasound guidance when performing regional techniques and continuous catheter techniques to prolong analgesia.

  8. Intrathecal Bupivacaine Monotherapy with a Retrograde Catheter for the Management of Complex Regional Pain Syndrome of the Lower Extremity.

    PubMed

    McRoberts, W Porter; Apostol, Catalina; Haleem, Abdul

    2016-01-01

    Complex regional pain syndrome (CRPS) presents a therapeutic challenge due to its many presentations and multifaceted pathophysiology. There is no approved treatment algorithm and clinical interventions are often applied empirically. In cases of CRPS where symptoms are localized to an extremity, a targeted treatment is indicated. We describe the use of intrathecal bupivacaine monotherapy, delivered through a retrograde catheter, in the treatment of CRPS affecting the lower extremity. The patient, a 57-year-old woman with a history of failed foot surgery, was seen in our office after 2 years of ineffective treatments with local blocks and neurolytic procedures. We advanced therapy to moderately invasive procedures with an emphasis on neuromodulation. A combined central and peripheral stimulation technique that initially provided 75% pain relief, failed to provide lasting analgesia. We proceeded with an intrathecal pump implant. Based on the results of dorsal root ganglion (DRG) mapping, L5-S1 was identified as the optimal target for therapy and a retrograde catheter was placed at this level. Various intrathecal medications were tested individually. An intrathecal morphine trial was ineffective (visual analog scale [VAS] 7), while intrathecal clonidine provided excellent pain relief (VAS 0) that was limited by severe side effects. Bupivacaine provided 100% analgesia with tolerable side effects (lower extremity weakness and minor bladder incontinence) and was selected for intrathecal infusion. After 14 months, bupivacaine treatment continued to control pain exacerbations. We conclude that CRPS patients benefit from early identification of the predominant underlying symptoms and a targeted treatment with moderately invasive techniques when less invasive techniques fail. Intrathecal bupivacaine, bupivacaine monotherapy, retrograde catheter, complex regional pain syndrome (CRPS), dual stimulation, dosal root ganglion (DRG) testing.

  9. Painful conditioning stimuli of the craniofacial region evokes diffuse noxious inhibitory controls in men and women.

    PubMed

    Wang, Kelun; Svensson, Peter; Sessle, Barry J; Cairns, Brian E; Arendt-Nielsen, Lars

    2010-01-01

    different between men and women at any test site (unpaired t-test: P > .446). This study has documented that mechanical and thermal painful tonic stimuli applied to the craniofacial region can evoke diffuse noxious inhibitory control (DNIC)-like effects in the craniofacial region as well as spinally innervated areas, but without sex differences.

  10. Glacial geomorphology of the Torres del Paine region (southern Patagonia): Implications for glaciation, deglaciation and paleolake history

    NASA Astrophysics Data System (ADS)

    García, Juan-Luis; Hall, Brenda L.; Kaplan, Michael R.; Vega, Rodrigo M.; Strelin, Jorge A.

    2014-01-01

    The processes affecting paleoclimate variability and Pleistocene glacial landscape development in the southern mid-latitudes remain poorly understood, in part because of the scarcity of comprehensive, well-studied records. Glacial landforms are invaluable for reconstructing past ice-sheet, climate, and associated environmental changes along the southern Andes, but there are significant spatial and temporal gaps in existing data. In this paper, we present new geomorphic and sedimentologic analyses, including surficial maps, for the Torres del Paine region (51°S, 73°W), southern South America. Our findings provide a new framework for understanding changes in the regional glacier history and Pleistocene landscape development. Glacial extent during the local last glacial maximum (LGM) remains unknown but new chronological data supported by geomorphic evidence afford evidence for a larger ice sheet at Torres del Paine than previously assumed. Deglaciation from the local LGM was underway by 17,400 ± 200 (1σ) cal. yr. BP. As opposed to previous suggestions, we have found that most of the moraines fringing the lakes in the Torres del Paine national park were deposited during a late-glacial expansion that occurred between 14,100 and 12,500 cal. yr. BP. Late-glacial advances also have been documented recently for the Última Esperanza and Lago Argentino basins to the south and north of Torres del Paine, respectively, suggesting an overall regional ice response to a climate signal. The Tehuelche paleolake accompanied each of the ice-sheet fluctuations in Torres del Paine. New data document at least three main phases of this paleolake, which drained eastward to the Atlantic Ocean, while the Andes gaps were blocked with ice. During the late phase of glacial lake formation, when water levels reached 125-155 m a.s.l., the lake likely merged with paleolake Consuelo in the Última Esperanza area at the end of the last glaciation. Lake Tehuelche in Torres del Paine had drained

  11. Positive affect and pain: mediators of the within-day relation linking sleep quality to activity interference in fibromyalgia.

    PubMed

    Kothari, Dhwani J; Davis, Mary C; Yeung, Ellen W; Tennen, Howard A

    2015-03-01

    Fibromyalgia (FM) is a chronic pain condition often resulting in functional impairments. Nonrestorative sleep is a prominent symptom of FM that is related to disability, but the day-to-day mechanisms relating the prior night's sleep quality to next-day reports of disability have not been examined. This study examined the within-day relations among early-morning reports of sleep quality last night, late-morning reports of pain and positive and negative affect, and end-of-day reports of activity interference. Specifically, we tested whether pain, positive affect, and negative affect mediated the association between sleep quality and subsequent activity interference. Data were drawn from electronic diary reports collected from 220 patients with FM for 21 consecutive days. The direct and mediated effects at the within-person level were estimated with multilevel structural equation modeling. Results showed that pain and positive affect mediated the relation between sleep quality and activity interference. Early-morning reports of poor sleep quality last night predicted elevated levels of pain and lower levels of positive affect at late-morning, which, in turn, predicted elevated end-of-day activity interference. Of note, positive affect was a stronger mediator than pain and negative affect was not a significant mediator. In summary, the findings identify 2 parallel mechanisms, pain and positive affect, through which the prior night's sleep quality predicts disability the next day in patients with FM. Furthermore, results highlight the potential utility of boosting positive affect after a poor night's sleep as one means of preserving daily function in FM.

  12. Motor Imagery and Its Effect on Complex Regional Pain Syndrome: An Integrative Review

    PubMed Central

    de Souza, Nélio Silva; Martins, Ana Carolina Gomes; Bastos, Victor Hugo do Vale; Leite, Marco Antônio A.; Teixeira, Silmar; Velasques, Bruna; Ribeiro, Pedro; Bittencourt, Juliana; Matta, André Palma da Cunha; Filho, Pedro Moreira

    2015-01-01

    The motor imagery (MI) has been proposed as a treatment in the complex regional pain syndrome type 1 (CRPS-1), since it seems to promote a brain reorganization effect on sensory-motor areas of pain perception. The aim of this paper is to investigate, through an integrative critical review, the influence of MI on the CRPS-1, correlating their evidence to clinical practice. Research in PEDro, Medline, Bireme and Google Scholar databases was conducted. Nine randomized controlled trials (level 2), 1 non-controlled clinical study (level 3), 1 case study (level 4), 1 systematic review (level 1), 2 review articles and 1 comment (level 5) were found. We can conclude that MI has shown effect in reducing pain and functionality that remains after 6 months of treatment. However, the difference between the MI strategies for CRPS-1 is unknown as well as the intensity of mental stress influences the painful response or effect of MI or other peripheral neuropathies. PMID:26788264

  13. The first scintigraphic detection of tumor necrosis factor-alpha in patients with complex regional pain syndrome type 1.

    PubMed

    Bernateck, Michael; Karst, Matthias; Gratz, Klaus F; Meyer, Geerd J; Fischer, Michael J; Knapp, Wolfram H; Koppert, Wolfgang; Brunkhorst, Thomas

    2010-01-01

    Tumor necrosis factor (TNF)-alpha has been identified as a pathogenic factor in many immunologically based diseases and complex regional pain syndrome (CRPS). In this case series, we used radiolabeled technetium anti-TNF-alpha antibody to scintigraphically image TNF-alpha in 3 patients with type 1 CRPS. The results show that TNF-alpha was localized only in affected hands of patients with early-stage CRPS. No uptake was seen in clinically unaffected hands and late-stage CRPS. Our findings support the growing evidence for neuroimmune disturbance in patients with CRPS and may have important further implications for specific anticytokine treatment in patients with CRPS.

  14. Early Childhood Dental Caries, Mouth Pain, and Malnutrition in the Ecuadorian Amazon Region

    PubMed Central

    So, Marvin; Ellenikiotis, Yianni A.; Husby, Hannah M.; Paz, Cecilia Leonor; Seymour, Brittany; Sokal-Gutierrez, Karen

    2017-01-01

    Malnutrition and dental caries in early childhood remain persistent and intertwined global health challenges, particularly for indigenous and geographically-remote populations. To examine the prevalence and associations between early childhood dental caries, parent-reported mouth pain and malnutrition in the Amazonian region of Ecuador, we conducted a cross-sectional study of the oral health and nutrition status of 1407 children from birth through age 6 in the “Alli Kiru” program (2011–2013). We used multivariate regression analysis to examine relationships between severe caries, parent-reported mouth pain measures, and nutritional status. The prevalence of dental caries was 65.4%, with 44.7% of children having deep or severe caries, and 33.8% reporting mouth pain. The number of decayed, missing and filled teeth (dmft) increased dramatically with age. Malnutrition was prevalent, with 35.9% of children stunted, 1.1% wasted, 7.4% underweight, and 6.8% overweight. As mouth pain increased in frequency, odds for severe caries increased. For each unit increase in mouth pain frequency interfering with sleeping, children had increased odds for being underweight (Adjusted Odds Ratio (AOR): 1.27; 95% CI: 1.02–1.54) and decreased odds for being overweight (AOR: 0.76; 95% CI: 0.58–0.97). This relationship was most pronounced among 3–6 year-olds. Early childhood caries, mouth pain and malnutrition were prevalent in this sample of young children. Parent-reported mouth pain was associated with severe caries, and mouth pain interfering with sleeping was predictive of poor nutritional status. We demonstrate the utility of a parsimonious parent-reported measure of mouth pain to predict young children’s risk for severe early childhood caries and malnutrition, which has implications for community health interventions. PMID:28531148

  15. Early Childhood Dental Caries, Mouth Pain, and Malnutrition in the Ecuadorian Amazon Region.

    PubMed

    So, Marvin; Ellenikiotis, Yianni A; Husby, Hannah M; Paz, Cecilia Leonor; Seymour, Brittany; Sokal-Gutierrez, Karen

    2017-05-22

    Malnutrition and dental caries in early childhood remain persistent and intertwined global health challenges, particularly for indigenous and geographically-remote populations. To examine the prevalence and associations between early childhood dental caries, parent-reported mouth pain and malnutrition in the Amazonian region of Ecuador, we conducted a cross-sectional study of the oral health and nutrition status of 1407 children from birth through age 6 in the "Alli Kiru" program (2011-2013). We used multivariate regression analysis to examine relationships between severe caries, parent-reported mouth pain measures, and nutritional status. The prevalence of dental caries was 65.4%, with 44.7% of children having deep or severe caries, and 33.8% reporting mouth pain. The number of decayed, missing and filled teeth (dmft) increased dramatically with age. Malnutrition was prevalent, with 35.9% of children stunted, 1.1% wasted, 7.4% underweight, and 6.8% overweight. As mouth pain increased in frequency, odds for severe caries increased. For each unit increase in mouth pain frequency interfering with sleeping, children had increased odds for being underweight (Adjusted Odds Ratio (AOR): 1.27; 95% CI: 1.02-1.54) and decreased odds for being overweight (AOR: 0.76; 95% CI: 0.58-0.97). This relationship was most pronounced among 3-6 year-olds. Early childhood caries, mouth pain and malnutrition were prevalent in this sample of young children. Parent-reported mouth pain was associated with severe caries, and mouth pain interfering with sleeping was predictive of poor nutritional status. We demonstrate the utility of a parsimonious parent-reported measure of mouth pain to predict young children's risk for severe early childhood caries and malnutrition, which has implications for community health interventions.

  16. Pain.

    PubMed

    Melzack, Ronald; Katz, Joel

    2013-01-01

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

  17. Interventional spine and pain procedures in patients on antiplatelet and anticoagulant medications: guidelines from the American Society of Regional Anesthesia and Pain Medicine, the European Society of Regional Anaesthesia and Pain Therapy, the American Academy of Pain Medicine, the International Neuromodulation Society, the North American Neuromodulation Society, and the World Institute of Pain.

    PubMed

    Narouze, Samer; Benzon, Honorio T; Provenzano, David A; Buvanendran, Asokumar; De Andres, José; Deer, Timothy R; Rauck, Richard; Huntoon, Marc A

    2015-01-01

    Interventional spine and pain procedures cover a far broader spectrum than those for regional anesthesia, reflecting diverse targets and goals. When surveyed, interventional pain and spine physicians attending the American Society of Regional Anesthesia and Pain Medicine (ASRA) 11th Annual Pain Medicine Meeting exhorted that existing ASRA guidelines for regional anesthesia in patients on antiplatelet and anticoagulant medications were insufficient for their needs. Those surveyed agreed that procedure-specific and patient-specific factors necessitated separate guidelines for pain and spine procedures. In response, ASRA formed a guidelines committee. After preliminary review of published complication reports and studies, committee members stratified interventional spine and pain procedures according to potential bleeding risk as low-, intermediate-, and high-risk procedures. The ASRA guidelines were deemed largely appropriate for the low- and intermediate-risk categories, but it was agreed that the high-risk targets required an intensive look at issues specific to patient safety and optimal outcomes in pain medicine. The latest evidence was sought through extensive database search strategies and the recommendations were evidence-based when available and pharmacology-driven otherwise. We could not provide strength and grading of these recommendations as there are not enough well-designed large studies concerning interventional pain procedures to support such grading. Although the guidelines could not always be based on randomized studies or on large numbers of patients from pooled databases, it is hoped that they will provide sound recommendations and the evidentiary basis for such recommendations.

  18. Effects of Linearly Polarized Near-Infrared Irradiation Near the Stellate Ganglion Region on Pain and Heart Rate Variability in Patients with Neuropathic Pain.

    PubMed

    Liao, Chun-De; Rau, Chi-Lun; Liou, Tsan-Hon; Tsauo, Jau-Yih; Lin, Li-Fong

    2017-03-01

    Neuropathic pain associated with sympathetic overactivity can be effectively relieved by light irradiating the region near stellate ganglion (SGI), applied as an alternative to a conventional sympathetic blockade. The clinical effect of SGI on heart rate variability (HRV) and its association with pain outcomes require investigation. This study attempted to identify the effects of SGI on pain outcomes and HRV indices and to determine the association between pain and HRV outcomes. A prospective double-blind, randomized study. An outpatient pain medicine clinic. A total of 44 patients were enrolled and randomized into the experimental group ( n = 22) and control group ( n = 22). The experimental group received 12 sessions (twice weekly) of standard SGI, whereas the control group received the same protocol with sham irradiation. Pain and HRV were measured before and after each irradiation session. All outcome measures used in the first- and second-half treatment courses were analyzed. Pain and HRV outcome measures of the experimental group significantly improved after SGI when compared with the control group in both courses. Considering time and frequency domains, the changes in HRV in the second-half treatment course exceeded those in the first-half treatment course. Pain was significantly associated with postirradiated HRV indices ( P < 0.001). Twelve sessions of SGI exerted time-dependent positive effects on pain and sympathovagal imbalance. HRV outcomes, including time and frequency domains, were an independent indicator of the clinical efficiency of SGI for treating pain in patients with neuropathic pain.

  19. Forebrain medial septum region facilitates nociception in a rat formalin model of inflammatory pain.

    PubMed

    Lee, Andy Thiam-Huat; Ariffin, Mohammed Zacky; Zhou, Mingyi; Ye, Jenn Zhou; Moochhala, Shabbir M; Khanna, Sanjay

    2011-11-01

    The medial septum is anatomically and functionally linked to the hippocampus, a region implicated in nociception. However, the role of medial septum in nociception remains unclear. To investigate the role of the region in nociception in rats, muscimol, a GABA agonist, or zolpidem, a positive allosteric modulator of GABA(A) receptors, was microinjected into medial septum to attenuate the activity of neurons in the region. Electrophysiological studies in anesthetized rats indicated that muscimol evoked a stronger and longer-lasting suppression of medial septal-mediated activation of hippocampal theta field activity than zolpidem. Similarly, microinjection of muscimol (1 or 2 μg/0.5 μl) into the medial septum of awake rats suppressed both licking and flinching behaviors in the formalin test of inflammatory pain, whereas only the latter behavior was affected by zolpidem (8 or 12 μg/0.5 μl) administered into the medial septum. Interestingly, both drugs selectively attenuated nociceptive behaviors in the second phase of the formalin test that are partly driven by central plasticity. Indeed, muscimol reduced the second phase behaviors by 30% to 60%, which was comparable to the reduction seen with systemic administration of a moderate dose of the analgesic morphine. The reduction was accompanied by a decrease in formalin-induced expression of spinal c-Fos protein that serves as an index of spinal nociceptive processing. The drug effects on nociceptive behaviors were without overt sedation and were distinct from the effects observed after septal lateral microinjections. Taken together, these findings suggest that the activation of medial septum is pro-nociceptive and facilitates aspects of central neural processing underlying nociception.

  20. Affective disturbance associated with premenstrual dysphoric disorder does not disrupt emotional modulation of pain and spinal nociception.

    PubMed

    Rhudy, Jamie L; Bartley, Emily J; Palit, Shreela; Kuhn, Bethany L; Kerr, Kara L; Martin, Satin L; DelVentura, Jennifer L; Terry, Ellen L

    2014-10-01

    In healthy individuals, emotions modulate pain and spinal nociception according to a valence linear trend (ie, pain/nociception is highest during negative emotions and lowest during positive emotions). However, emerging evidence suggests that emotional modulation of pain (but not spinal nociception) is disrupted in fibromyalgia and disorders associated with chronic pain risk (eg, major depression, insomnia). The present study attempted to extend this work and to examine whether women with premenstrual dysphoric disorder (PMDD), a cyclical syndrome associated with debilitating affective symptoms during the late-luteal (premenstrual) phase of the menstrual cycle, is also associated with disrupted emotional modulation of pain. To do so, an affective picture-viewing procedure was used to study emotional modulation of pain and spinal nociception in 14 women with PMDD and 14 control women during mid-follicular, ovulatory, and late-luteal phases of the menstrual cycle (verified by salivary hormone levels and luteinizing hormone tests). At each phase, mutilation, neutral, and erotic pictures were presented to manipulate emotion. During picture viewing, suprathreshold electrocutaneous stimuli were presented to evoke pain and the nociceptive flexion reflex (NFR; a physiological measure of spinal nociception). Statistically powerful linear mixed model analyses confirmed that pictures evoked the intended emotional states in both groups across all menstrual phases. Furthermore, emotion modulated pain and NFR according to a valence linear trend in both groups and across all menstrual phases. Thus, PMDD-related affective disturbance is not associated with a failure to emotionally modulate pain, suggesting that PMDD does not share this pain phenotype with major depression, insomnia, and fibromyalgia.

  1. Inflammation-induced hyperalgesia: effects of timing, dosage, and negative affect on somatic pain sensitivity in human experimental endotoxemia.

    PubMed

    Wegner, Alexander; Elsenbruch, Sigrid; Maluck, Janina; Grigoleit, Jan-Sebastian; Engler, Harald; Jäger, Marcus; Spreitzer, Ingo; Schedlowski, Manfred; Benson, Sven

    2014-10-01

    Inflammation-induced pain amplification and hypersensitivity play a role in the pathophysiology of numerous clinical conditions. Experimental endotoxemia has recently been implemented as model to analyze immune-mediated processes in human pain. In this study, we aimed to analyze dose- and time-dependent effects of lipopolysaccharide (LPS) on clinically-relevant pain models for musculoskeletal and neuropathic pain as well as the interaction among LPS-induced changes in inflammatory markers, pain sensitivity and negative affect. In this randomized, double-blind, placebo-controlled study, healthy male subjects received an intravenous injection of either a moderate dose of LPS (0.8 ng/kg Escherichiacoli), low-dose LPS (0.4 ng/kg), or saline (placebo control group). Pressure pain thresholds (PPT), mechanical pain sensitivity (MPS), and cold pain sensitivity (CP) were assessed before and 1, 3, and 6h post injection to assess time-dependent LPS effects on pain sensitivity. Plasma cytokines (TNF-α, IL-6, IL-8, IL-10) and state anxiety were repeatedly measured before, and 1, 2, 3, 4, and 6h after injection of LPS or placebo. LPS administration induced a systemic immune activation, reflected by significant increases in cytokine levels, body temperature, and negative mood with pronounced effects to the higher LPS dose. Significant decreases of PPTs were observed only 3h after injection of the moderate dose of LPS (0.8 ng/kg). MPS and CP were not affected by LPS-induced immune activation. Correlation analyses revealed that decreased PPTs were associated with peak IL-6 increases and negative mood. Our results revealed widespread increases in musculoskeletal pain sensitivity in response to a moderate dose of LPS (0.8 ng/kg), which correlate both with changes in IL-6 and negative mood. These data extend and refine existing knowledge about immune mechanisms mediating hyperalgesia with implications for the pathophysiology of chronic pain and neuropsychiatric conditions. Copyright

  2. Regional muscle tension and pain ("fibrositis"). Effect of massage on myoglobin in plasma.

    PubMed

    Danneskiold-Samsøe, B; Christiansen, E; Lund, B; Andersen, R B

    1983-01-01

    In thirteen patients, all women, with regional muscle tension and pain ("fibrositis") plasma myoglobin concentration was measured before and after massage. A significant increase was observed in the plasma myoglobin concentration reaching a maximum three hours after the start of massage treatment (median 133 micrograms/l). A positive correlation was found between the degree of muscle tension and the increase in plasma myoglobin concentration. After repeated massage treatment a gradual decline could be demonstrated in the increase of the plasma myoglobin concentration in coincidence with the efficacy of the treatment. Opposed to this only normal levels of myoglobin were found in plasma when muscles without tenderness and pain were treated with massage. The observed increase of myoglobin in plasma after massage indicates a leak of myoglobin from the muscle fibres, which suggests that regional muscle tension and pain is associated with disorders in the muscle fibres.

  3. Physiotherapy for pain and disability in adults with complex regional pain syndrome (CRPS) types I and II.

    PubMed

    Smart, Keith M; Wand, Benedict M; O'Connell, Neil E

    2016-02-24

    Complex regional pain syndrome (CRPS) is a painful and disabling condition that usually manifests in response to trauma or surgery. When it occurs, it is associated with significant pain and disability. It is thought to arise and persist as a consequence of a maladaptive pro-inflammatory response and disturbances in sympathetically-mediated vasomotor control, together with maladaptive peripheral and central neuronal plasticity. CRPS can be classified into two types: type I (CRPS I) in which a specific nerve lesion has not been identified, and type II (CRPS II) where there is an identifiable nerve lesion. Guidelines recommend the inclusion of a variety of physiotherapy interventions as part of the multimodal treatment of people with CRPS, although their effectiveness is not known. To determine the effectiveness of physiotherapy interventions for treating the pain and disability associated with CRPS types I and II. We searched the following databases from inception up to 12 February 2015: CENTRAL (the Cochrane Library), MEDLINE, EMBASE, CINAHL, PsycINFO, LILACS, PEDro, Web of Science, DARE and Health Technology Assessments, without language restrictions, for randomised controlled trials (RCTs) of physiotherapy interventions for treating pain and disability in people CRPS. We also searched additional online sources for unpublished trials and trials in progress. We included RCTs of physiotherapy interventions (including manual therapy, therapeutic exercise, electrotherapy, physiotherapist-administered education and cortically directed sensory-motor rehabilitation strategies) employed in either a stand-alone fashion or in combination, compared with placebo, no treatment, another intervention or usual care, or of varying physiotherapy interventions compared with each other in adults with CRPS I and II. Our primary outcomes of interest were patient-centred outcomes of pain intensity and functional disability. Two review authors independently evaluated those studies

  4. Management of Postoperative Pain: A Clinical Practice Guideline From the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists' Committee on Regional Anesthesia, Executive Committee, and Administrative Council.

    PubMed

    Chou, Roger; Gordon, Debra B; de Leon-Casasola, Oscar A; Rosenberg, Jack M; Bickler, Stephen; Brennan, Tim; Carter, Todd; Cassidy, Carla L; Chittenden, Eva Hall; Degenhardt, Ernest; Griffith, Scott; Manworren, Renee; McCarberg, Bill; Montgomery, Robert; Murphy, Jamie; Perkal, Melissa F; Suresh, Santhanam; Sluka, Kathleen; Strassels, Scott; Thirlby, Richard; Viscusi, Eugene; Walco, Gary A; Warner, Lisa; Weisman, Steven J; Wu, Christopher L

    2016-02-01

    Most patients who undergo surgical procedures experience acute postoperative pain, but evidence suggests that less than half report adequate postoperative pain relief. Many preoperative, intraoperative, and postoperative interventions and management strategies are available for reducing and managing postoperative pain. The American Pain Society, with input from the American Society of Anesthesiologists, commissioned an interdisciplinary expert panel to develop a clinical practice guideline to promote evidence-based, effective, and safer postoperative pain management in children and adults. The guideline was subsequently approved by the American Society for Regional Anesthesia. As part of the guideline development process, a systematic review was commissioned on various aspects related to various interventions and management strategies for postoperative pain. After a review of the evidence, the expert panel formulated recommendations that addressed various aspects of postoperative pain management, including preoperative education, perioperative pain management planning, use of different pharmacological and nonpharmacological modalities, organizational policies, and transition to outpatient care. The recommendations are based on the underlying premise that optimal management begins in the preoperative period with an assessment of the patient and development of a plan of care tailored to the individual and the surgical procedure involved. The panel found that evidence supports the use of multimodal regimens in many situations, although the exact components of effective multimodal care will vary depending on the patient, setting, and surgical procedure. Although these guidelines are based on a systematic review of the evidence on management of postoperative pain, the panel identified numerous research gaps. Of 32 recommendations, 4 were assessed as being supported by high-quality evidence, and 11 (in the areas of patient education and perioperative planning, patient

  5. Why Social Pain Can Live on: Different Neural Mechanisms Are Associated with Reliving Social and Physical Pain

    PubMed Central

    Meyer, Meghan L.; Williams, Kipling D.; Eisenberger, Naomi I.

    2015-01-01

    Although social and physical pain recruit overlapping neural activity in regions associated with the affective component of pain, the two pains can diverge in their phenomenology. Most notably, feelings of social pain can be re-experienced or “relived,” even when the painful episode has long passed, whereas feelings of physical pain cannot be easily relived once the painful episode subsides. Here, we observed that reliving social (vs. physical) pain led to greater self-reported re-experienced pain and greater activity in affective pain regions (dorsal anterior cingulate cortex and anterior insula). Moreover, the degree of relived pain correlated positively with affective pain system activity. In contrast, reliving physical (vs. social) pain led to greater activity in the sensory-discriminative pain system (primary and secondary somatosensory cortex and posterior insula), which did not correlate with relived pain. Preferential engagement of these different pain mechanisms may reflect the use of different top-down neurocognitive pathways to elicit the pain. Social pain reliving recruited dorsomedial prefrontal cortex, often associated with mental state processing, which functionally correlated with affective pain system responses. In contrast, physical pain reliving recruited inferior frontal gyrus, known to be involved in body state processing, which functionally correlated with activation in the sensory pain system. These results update the physical-social pain overlap hypothesis: while overlapping mechanisms support live social and physical pain, distinct mechanisms guide internally-generated pain. PMID:26061877

  6. Complex regional pain syndrome (type 1): a comparison of 2 diagnostic criteria methods.

    PubMed

    Thomson McBride, Andrew Richard; Barnett, Andrew James; Livingstone, James Alexander; Atkins, Roger Michael

    2008-09-01

    Complex regional pain syndrome (CRPS) is a common problem presenting to orthopedic surgeons or pain therapists, most frequently encountered after trauma or surgery to a limb. Because of a lack of a simple objective diagnostic test, diagnosis is reliant on clinical assessment. Prospective studies have repeatedly demonstrated a higher incidence than retrospective studies, an observation that has been challenged owing to the lack of uniformity of diagnostic criteria across specialties and workers researching the condition. A series of 262 adult patients presenting to the Bristol Royal Infirmary with a closed unilateral distal radial fracture were assessed at a mean of 9.47 weeks after their injury by a single clinician (J.A.L.). Each assessment made allowed comparison of the modified International Association for the Study of Pain (Bruehl) criteria for the presence of CRPS with the criteria described by Atkins. The incidence of CRPS was similar using either criteria (Bruehl 20.61% vs. Atkins 22.52%). Using the Bruehl criteria as a gold standard, there was strong diagnostic agreement (kappa=0.79, sensitivity=0.87, specificity=0.94). Disagreements between the 2 criteria methods were found in 19 patients. The majority of these discordances were due to differences in pain and sensory abnormality assessment. These findings show that the Bruehl and Atkins criteria are basically concordant. The differences reflect only minor variations in the assessment of pain. Agreement between researchers in the orthopedic and pain therapy communities will allow improved understanding of CRPS.

  7. Prevalence of pain in the orofacial regions in patients visiting general dentists in the Northwest Practice-based REsearch Collaborative in Evidence-based DENTistry research network.

    PubMed

    Horst, Orapin V; Cunha-Cruz, Joana; Zhou, Lingmei; Manning, Walter; Mancl, Lloyd; DeRouen, Timothy A

    2015-10-01

    This study aimed to measure prevalence of pain in the orofacial regions and determine association with demographics, treatment history, and oral health conditions in dental patients visiting clinics in the Northwest Practice-based REsearch Collaborative in Evidence-based DENTistry (PRECEDENT) research network. Data were recorded in a survey with systematic random sampling of patients (n = 1,668, 18 to 93 years old, 56% female) visiting 100 general dentists in the Northwest PRECEDENT research network. Prevalence ratios (PR) of orofacial pain by each variable were estimated by generalized estimating equations for Poisson regression. The prevalence of orofacial pain during the past year was 16.1% (95% confidence interval [CI], 13.4-18.9), of which the most prevalent pain locations were dentoalveolar (9.1%; 95% CI, 7.0-11.2) and musculoligamentous tissues (6.6%; 95% CI, 4.5-8.7). Other locations included soft tissues (0.5%; 95% CI, 0.2-0.8) and nonspecific areas (0.6%; 95% CI, 0.2-1.0). The prevalence of dentoalveolar but not musculoligamentous pain decreased with age. When comparing the 18- to 29-year-old patients, dentoalveolar pain decreased significantly in 45- to 64-year-old patients (PR, 0.59; 95% CI, 0.4-0.9) and in those 65 years or older (PR, 0.5; 95% CI, 0.3-0.9). Sex significantly affected the prevalence of musculoligamentous but not dentoalveolar pain. Women (PR, 3.2; 95% CI, 2.0-5.1) were more likely to have musculoligamentous pain. The prevalence of dentoalveolar and musculoligamentous pain did not vary significantly by ethnicity. Dentoalveolar pain was reported more frequently in patients who did not receive dental maintenance (PR, 2.9; 95% CI, 2.1-4.2) and those visiting community-based public health clinics (PR, 2.2; 95% CI, 1.2-3.7). One in 6 patients visiting a general dentist had experienced orofacial pain during the past year. Dentoalveolar and musculoligamentous pains were the most prevalent types of pain. Pain in the muscles and

  8. Ethnomedicine use in the war affected region of northwest Pakistan

    PubMed Central

    2014-01-01

    Background North-West of Pakistan is bestowed with medicinal plant resources due to diverse geographical and habitat conditions. The traditional use of plants for curing various diseases forms an important part of the region’s cultural heritage. The study was carried out to document medicinal plants used in Frontier Region (FR) Bannu, an area affected by the “War on Terror”. Methods Fieldwork was carried out in four different seasons (spring, autumn, summer and winter) from March 2012 to February 2013. Data on medicinal plants was collected using structured and semi-structured questionnaires from 250 respondents. The voucher specimens were collected, processed and identified following standard methods. Results Of the 107 species of ethnomedicinal plants reported, fifty percent species are herbaceous. The majority of the reported species were wild (55%) but a substantial proportion are cultivated (29%). For most of the plant species (34%), leaves are the most commonly used part in the preparation of ethnomedicines. The most common use of species is for carminative purposes (14 species), with the next most common use being for blood purification (11 species). The main methods used in the preparation of ethnomedicinal recipes involves grinding and boiling, and nearly all the remedies are taken orally along with ingredients such as water, milk or honey for ease of ingestion. Traditional healers prepare plant remedies using one or more plants. There was a significant correlation (r2 = 0.95) between the age of local people and the number of plants known to them, which indicates that in the coming 20 years, an approximate decrease of 75% in the indigenous knowledge may be expected. Conclusion Traditional medicines are important to the livelihoods of rural communities in the region affected by the Global war on Terrorism. The medicinal recipes are indigenous; however, there is a threat to their future use on account of rapid modernization and terrorist activities

  9. Multicenter study on the asymmetry of skin temperature in complex regional pain syndrome

    PubMed Central

    Cho, Chan Woo; Nahm, Francis Sahngun; Choi, Eunjoo; Lee, Pyung-Bok; Jang, In-Ki; Lee, Chul Joong; Kim, Yong Chul; Lee, Sang Chul

    2016-01-01

    Abstract According to the International Association for the Study of Pain (IASP) and American Medical Association (AMA), the diagnostic criteria for complex regional pain syndrome (CRPS) require the presence of skin temperature asymmetry. In CRPS, it is generally accepted that the temperature of skin of affected limbs changes from warm to cold; however, in our clinical practice, we have experienced many cases with different thermographic characteristics. Therefore, we conducted a retrospective multicenter study that examined the distribution of skin temperature in patients with CRPS and skin temperature asymmetry versus symptom duration. Patients diagnosed with type 1 or 2 CRPS were recruited. After confirming CRPS according to the IASP diagnostic criteria, infrared thermographic images were evaluated for skin temperature differences (ΔT) between the affected and unaffected limbs. A total of 296 patients with CRPS were included in this study. The median duration of symptoms was 6 months and the mean ± standard deviation of ΔT was –0.72 ± 1.65°C. A skin temperature difference between bilateral limbs (|ΔT|) of 1°C or less was seen in 131 patients (44.3%); thus, these 131 patients did not meet the IASP criteria for CRPS. Further, cool skin temperature was not observed in 88 patients (29.7%), meaning that these patients did not meet the AMA criteria for CRPS. There was no correlation between the symptom duration and ΔT (Spearman's rho = –0.075, P = 0.196) and there was no significant difference in the average ΔT among the 4 symptom duration groups (0–3 months, 4–6 months, 7–12 months, >12 months, P = 0.08). In conclusion, a considerable proportion of the patients that participated in this study did not meet the thermal criteria set forth by the IASP and AMA. Further, there was no correlation between symptom duration and skin temperature difference. PMID:28033251

  10. Central processing of tactile and nociceptive stimuli in complex regional pain syndrome.

    PubMed

    Vartiainen, Nuutti V; Kirveskari, Erika; Forss, Nina

    2008-10-01

    Patients with complex regional pain syndrome (CRPS) suffer from continuous regional limb pain and from hyperesthesia to touch and pain. To better understand the pathophysiological mechanisms underlying the hyperesthesia of CRPS patients, we investigated their cortical processing of touch and acute pain. Cortical responses to tactile stimuli applied to the thumbs, index and little fingers (D1, D2, and D5) and nociceptive stimuli delivered to dorsa of the hands were recorded with a whole-scalp neuromagnetometer from eight chronic CRPS patients and from nine healthy control subjects. In the patients, primary somatosensory (SI) cortex activation to tactile stimulation of D2 was significantly stronger, and the D1-D5 distance in SI was significantly smaller for the painful hand compared to the healthy hand. The PPC activation to tactile stimulation was significantly weaker in the patients than in the control subjects. To nociceptive stimulation with equal laser energy, the secondary somatosensory (SII) cortices and posterior parietal cortex (PPC) were similarly activated in both groups. The PPC source strength correlated with the pain rating in the control subjects, but not in the patients. The enhanced SI activation in hyperesthetic CRPS patients may reflect central sensitization to touch. The decreased D1-D5 distance implies permanent changes in SI hand representations in chronic CRPS. The defective PPC activation could be associated with the neglect-like symptoms of the patients. As the SII and PPC responses were not enhanced in the CRPS patients, other brain areas are likely to contribute to the observed hyperesthesia to pain. Our results indicate changes of somatosensory processing at cortical level in CRPS.

  11. Frequency of daytime tooth clenching episodes in individuals affected by masticatory muscle pain and pain-free controls during standardized ability tasks.

    PubMed

    Cioffi, Iacopo; Landino, Donatella; Donnarumma, Valeria; Castroflorio, Tommaso; Lobbezoo, Frank; Michelotti, Ambrosina

    2017-05-01

    Tooth clenching has been suggested to be related to temporomandibular pain. However, the electromyographic characteristics of daytime clenching episodes have been minimally investigated. This study aimed to analyze the frequency, amplitude, and duration of daytime clenching episodes in patients with masticatory muscle pain and pain-free individuals. Fifteen women with masticatory muscles myalgia (MP group, mean ± SD age = 26.4 ± 7.6 years) matched for age to 18 pain-free women (CTR group, mean ± SD age = 25.3 ± 2.8 years) were submitted to three different ability tasks (filling out questionnaires for 40 min, reading for 20 min, and playing a videogame for 20 min). The electromyographic activity periods (AP) of the right masseter greater than 10 % (AP10), 20 % (AP20), and 30 % (AP30) of the maximum voluntary contraction were analyzed. The mean frequencies of AP10, AP20, and AP30 were greater in MP than in CTR individuals (all p < 0.05). The mean duration of AP10 was higher in MP group than CTR group only while filling out the questionnaires (p = 0.0033). CTR group had an increased frequency and duration of AP10 while playing the videogame than while reading a magazine. The ability tasks did not affect the muscle activity in the MP group. Individuals with masticatory muscle pain have an increased frequency of both high and low-intense daytime clenching episodes. The type of ability task affects the frequency and the duration of clenching episodes only in pain-free individuals. Clinicians should recognize that the frequency and intensity of daytime clenching are noticeably increased in individuals with masticatory muscle pain in order to better tailor treatment.

  12. Bisphosphonates inhibit pain, bone loss, and inflammation in a rat tibia fracture model of complex regional pain syndrome

    PubMed Central

    Wang, Liping; Guo, Tian-Zhi; Wei, Tzuping; Li, Wen-wu; Shi, Xiaoyou; Clark, J David; Kingery, Wade S

    2016-01-01

    BACKGROUND Bisphosphonates are used to prevent the bone loss and fractures associated with osteoporosis, bone metastases, multiple myeloma, and osteogenis deformans. Distal limb fractures cause regional bone loss with cutaneous inflammation and pain in the injured limb that can develop into complex regional pain syndrome (CRPS). Clinical trials have reported that anti-resorptive bisphosphonates can prevent fracture-induced bone loss, inhibit serum inflammatory cytokine levels, and alleviate CRPS pain. Previously we observed that the inhibition of inflammatory cytokines or adaptive immune responses attenuated the development of pain behavior in a rat fracture model of CRPS and we hypothesized that bisphosphonates could prevent pain behavior, trabecular bone loss, post-fracture cutaneous cytokine up-regulation, and adaptive immune responses in this CRPS model. METHODS Rats underwent tibia fracture and cast immobilization for 4 weeks and were chronically administered either subcutaneously perfused alendronate or oral zoledronate. Behavioral measurements included hindpaw von Frey allodynia, unweighting, warmth, and edema. Bone microarchitecture was measured by uCT and bone cellular activity was evaluated by static and dynamic histomorphometry. Spinal cord Fos immunostaining was performed and skin cytokine (TNF, IL-1, IL-6) and nerve growth factor (NGF) levels were determined by EIA. Skin and sciatic nerve immunoglobulin levels were determined by EIA. RESULTS Tibia fracture rats developed hindpaw allodynia, unweighting, warmth, and edema, increased spinal Fos expression, trabecular bone loss in the lumbar vertebra and bilateral distal femurs as measured by uCT, increased trabecular bone resorption and osteoclast surface with decreased bone formation rates, increased cutaneous inflammatory cytokine and NGF expression and elevated immunocomplex deposition in skin and nerve. Alendronate (60 μg/kg/day s.c.) or zoledronate (3 mg/kg/day p.o.) treatment for 28 days, started

  13. Bisphosphonates Inhibit Pain, Bone Loss, and Inflammation in a Rat Tibia Fracture Model of Complex Regional Pain Syndrome.

    PubMed

    Wang, Liping; Guo, Tian-Zhi; Wei, Tzuping; Li, Wen-Wu; Shi, Xiaoyou; Clark, J David; Kingery, Wade S

    2016-10-01

    Bisphosphonates are used to prevent the bone loss and fractures associated with osteoporosis, bone metastases, multiple myeloma, and osteogenesis deformans. Distal limb fractures cause regional bone loss with cutaneous inflammation and pain in the injured limb that can develop into complex regional pain syndrome (CRPS). Clinical trials have reported that antiresorptive bisphosphonates can prevent fracture-induced bone loss, inhibit serum inflammatory cytokine levels, and alleviate CRPS pain. Previously, we observed that the inhibition of inflammatory cytokines or adaptive immune responses attenuated the development of pain behavior in a rat fracture model of CRPS, and we hypothesized that bisphosphonates could prevent pain behavior, trabecular bone loss, postfracture cutaneous cytokine upregulation, and adaptive immune responses in this CRPS model. Rats underwent tibia fracture and cast immobilization for 4 weeks and were chronically administered either subcutaneously perfused alendronate or oral zoledronate. Behavioral measurements included hindpaw von Frey allodynia, unweighting, warmth, and edema. Bone microarchitecture was measured by microcomputed tomography, and bone cellular activity was evaluated by static and dynamic histomorphometry. Spinal cord Fos immunostaining was performed, and skin cytokine (tumor necrosis factor, interleukin [IL]-1, IL-6) and nerve growth factor (NGF) levels were determined by enzyme immunoassay. Skin and sciatic nerve immunoglobulin levels were determined by enzyme immunoassay. Rats with tibia fractures developed hindpaw allodynia, unweighting, warmth, and edema, increased spinal Fos expression and trabecular bone loss in the lumbar vertebra and bilateral distal femurs as measured by microcomputed tomography, increased trabecular bone resorption and osteoclast surface with decreased bone formation rates, increased cutaneous inflammatory cytokine and NGF expression, and elevated immunocomplex deposition in skin and nerve

  14. 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.

  15. The association between negative affect and prescription opioid misuse in patients with chronic pain: The mediating role of opioid craving

    PubMed Central

    Martel, MO; Dolman, AJ; Edwards, RR; Jamison, RN; Wasan, AD

    2013-01-01

    Over the past decade, considerable research has accumulated showing that chronic pain patients experiencing high levels of negative affect (i.e., anxiety, depression) are at increased risk for prescription opioid misuse. The primary objective of the present study was to examine the factors that underlie the association between negative affect (NA) and prescription opioid misuse among patients with chronic pain. In this study, 82 patients with chronic musculoskeletal pain being prescribed opioid medication completed the Current Opioid Misuse Measure (COMM), a well-validated self-report questionnaire designed to assess prescription opioid misuse. Patients were also asked to complete self-report measures of pain intensity, NA, and opioid craving. A bootstrapped multiple mediation analysis was used to examine the mediating role of patients’ pain intensity and opioid craving in the association between NA and prescription opioid misuse. Consistent with previous research, we found a significant association between NA and prescription opioid misuse. Interestingly, results revealed that opioid craving, but not pain intensity, mediated the association between NA and opioid misuse. Discussion addresses the potential psychological and neurobiological factors that might contribute to the inter-relationships between NA, opioid craving, and prescription opioid misuse in patients with pain. The clinical implications of our findings are also discussed. PMID:24295876

  16. Imaging of Posttraumatic Arthritis, Avascular Necrosis, Septic Arthritis, Complex Regional Pain Syndrome, and Cancer Mimicking Arthritis.

    PubMed

    Rupasov, Andrey; Cain, Usa; Montoya, Simone; Blickman, Johan G

    2017-09-01

    This article focuses on the imaging of 5 discrete entities with a common end result of disability: posttraumatic arthritis, a common form of secondary osteoarthritis that results from a prior insult to the joint; avascular necrosis, a disease of impaired osseous blood flow, leading to cellular death and subsequent osseous collapse; septic arthritis, an infectious process leading to destructive changes within the joint; complex regional pain syndrome, a chronic limb-confined painful condition arising after injury; and cases of cancer mimicking arthritis, in which the initial findings seem to represent arthritis, despite a more insidious cause. Copyright © 2017 Elsevier Inc. All rights reserved.

  17. Treatment of Complex Regional Pain Syndrome (CRPS) using low dose naltrexone (LDN).

    PubMed

    Chopra, Pradeep; Cooper, Mark S

    2013-06-01

    Complex Regional Pain Syndrome (CRPS) is a neuropathic pain syndrome, which involves glial activation and central sensitization in the central nervous system. Here, we describe positive outcomes of two CRPS patients, after they were treated with low-dose naltrexone (a glial attenuator), in combination with other CRPS therapies. Prominent CRPS symptoms remitted in these two patients, including dystonic spasms and fixed dystonia (respectively), following treatment with low-dose naltrexone (LDN). LDN, which is known to antagonize the Toll-like Receptor 4 pathway and attenuate activated microglia, was utilized in these patients after conventional CRPS pharmacotherapy failed to suppress their recalcitrant CRPS symptoms.

  18. Inflammatory arthritis mimicking Complex Regional Pain Syndrome (CRPS) in a child: A case report

    PubMed Central

    Egilmez, Zeliha; Turgut, Selin Turan; Icagasioglu, Afitap; Bicakci, Irem

    2016-01-01

    Joint complaints in childhood are seen frequently and differential diagnosis can be difficult. Juvenile idiopathic arthritis (JIA) is the most common rheumatological disease of childhood. It involves peripheral joint arthritis, chronic synovitis, and extra-articular manifestations. Accurate diagnosis can take a long time and sometimes multiple diagnoses are used while following the patient until a final diagnosis can be reached. Arthritis may be triggered by trauma and confused with other diseases like complex regional pain syndrome (CRPS), in which trauma plays a role in the etiology. In the present case, ankle pain in an 8-year-old girl was misdiagnosed as CRPS. PMID:28058400

  19. Inflammatory arthritis mimicking Complex Regional Pain Syndrome (CRPS) in a child: A case report.

    PubMed

    Egilmez, Zeliha; Turgut, Selin Turan; Icagasioglu, Afitap; Bicakci, Irem

    2016-01-01

    Joint complaints in childhood are seen frequently and differential diagnosis can be difficult. Juvenile idiopathic arthritis (JIA) is the most common rheumatological disease of childhood. It involves peripheral joint arthritis, chronic synovitis, and extra-articular manifestations. Accurate diagnosis can take a long time and sometimes multiple diagnoses are used while following the patient until a final diagnosis can be reached. Arthritis may be triggered by trauma and confused with other diseases like complex regional pain syndrome (CRPS), in which trauma plays a role in the etiology. In the present case, ankle pain in an 8-year-old girl was misdiagnosed as CRPS.

  20. Post-traumatic complex regional pain syndrome: clinical features and epidemiology

    PubMed Central

    Ratti, Chiara; Nordio, Andrea; Resmini, Giuseppina; Murena, Luigi

    2015-01-01

    Summary Complex Regional Pain Syndrome (CRPS) is a chronic pain condition that occurs after a tissue injury (fractures, sprain, surgery) of the upper or lower extremities. A clear pathophysiological mechanism has not been established yet and different patterns are considered to play a role in the genesis of the disease. The diagnosis is made by different diagnosis criteria and a gold standard has not been established yet. Incidence of CRPS is unclear and large prospective studies on the incidence and prevalence of CRPS are scarce. The aim of this review is to give an overview on the prevalent data regarding this chronic syndrome. PMID:27134626

  1. [Chronic back pain in the general population in Germany 2002/2003: prevalence and highly affected population groups].

    PubMed

    Neuhauser, H; Ellert, U; Ziese, T

    2005-10-01

    Back pain is one of the most common complaints in the general population and chronic back pain is a major Public Health burden. However, the prevalence of chronic back pain in Germany is not known. The aim of our study was to determine the prevalence of chronic back pain in the general adult population in Germany and to identify highly affected population groups. A nation-wide computer-assisted telephone interview (CATI) survey was conducted with 8,318 men and women aged 18 years and older residing in German households. Participants were selected using the Gabler-Häder telephone sampling method and the next-birthday method. The one-year prevalence of chronic back pain defined as daily or almost daily back pain over a period of three months was 16 % in men and 22 % in women, the lifetime prevalence 24 % in men and 30 % in women. The 12-months prevalence of any back pain was 66 % in women and 58 % in men. Back pain on the day preceding the interview was reported by 18 % of men and 27 % of women and had a median intensity on a 1 - 10 point scale of 5 in women and 4 in men. Factors independently associated with chronic back pain in the past 12 months were age, female sex, a history of arthritis, self-reported depression, lower educational level, current unemployment, overweight or obesity, no sports, smoking and living with a partner. In conclusion, chronic back pain is a highly prevalent complaint in the general population in Germany. The association not only with bone and joint diseases but also with depression, a lower level of education and with certain lifestyle behaviours emphasises that back pain should not be viewed only in the context of the spine.

  2. Interpreting Pain Symptoms and How Pain Affects Neuromuscular Control in DancersIf I'm in Pain, How Should I Train?

    PubMed

    Claus, Andrew P; Macdonald, David A

    2017-03-01

    This review draws from leading research on pain neuroscience and control of posture and movement to help inform rehabilitation approaches and when it may or may not be prudent to "dance through" pain. Control of posture and movement is frequently distorted by pain perception, and that may not be altered even when the pain is resolved. It is important to exclude serious systemic disease or major tissue injury with severe, unremitting, or persistent symptoms before focusing on movement-based rehabilitation. Both specific exercises (contraction of specific muscles and use of movement techniques) and general exercises (which promote strength, power, endurance, and flexibility) can help to manage individuals with persistent pain problems. Training control of posture and movement can improve motor skills and tissue integrity and also normalize perception of sensory stimuli from the peripheral nervous system in the brain. A framework for planning such training can be considered in terms of progression of load, complexity, and context.

  3. Transcranial magnetic stimulation studies in complex regional pain syndrome type I: A review.

    PubMed

    Nardone, R; Brigo, F; Höller, Y; Sebastianelli, L; Versace, V; Saltuari, L; Lochner, P; Trinka, E

    2017-10-03

    The sensory and motor cortical representation corresponding to the affected limb is altered in patients with complex regional pain syndrome (CRPS). Transcranial magnetic stimulation (TMS) represents a useful non-invasive approach for studying cortical physiology. If delivered repetitively, TMS can also modulate cortical excitability and induce long-lasting neuroplastic changes. In this review, we performed a systematic search of all studies using TMS to explore cortical excitability/plasticity and repetitive TMS (rTMS) for the treatment of CRPS. Literature searches were conducted using PubMed and EMBASE. We identified 8 articles matching the inclusion criteria. One hundred fourteen patients (76 females and 38 males) were included in these studies. Most of them have applied TMS in order to physiologically characterize CRPS type I. Changes in motor cortex excitability and brain mapping have been reported in CRPS-I patients. Sensory and motor hyperexcitability are in the most studies bilateral and likely involve corresponding regions within the central nervous system rather than the entire hemisphere. Conversely, sensorimotor integration and plasticity were found to be normal in CRPS-I. TMS examinations also revealed that the nature of motor dysfunction in CRPS-I patients differs from that observed in patients with functional movement disorders, limb immobilization, or idiopathic dystonia. TMS studies may thus lead to the implementation of correct rehabilitation strategies in CRPS-I patients. Two studies have begun to therapeutically use rTMS. This non-invasive brain stimulation technique could have therapeutic utility in CRPS, but further well-designed studies are needed to corroborate initial findings. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  4. Multimodal physical therapy management of a 48-year-old female with post-stroke complex regional pain syndrome.

    PubMed

    Anandkumar, Sudarshan; Manivasagam, Murugavel

    2014-01-01

    This case report describes a 48-year-old female who presented with complaints of right shoulder pain, hyperesthesias and swelling of the hand along with added symptoms of pain centralization following a cerebrovascular accident. On clinical evaluation, the patient satisfied the Budapest diagnostic criteria for Complex Regional Pain Syndrome (CRPS) type-1. Physical therapy management (1st three sessions) was initially focused on pain neurophysiology education with an aim to reduce kinesiophobia and reconceptualise her pain perception. The patient had an immediate significant improvement in her pain and functional status. Following this, pain modulation in the form of transcutaneous electrical nerve stimulation, kinesio tape application, "pain exposure" physical therapy and exercise therapy was carried out for a period of 7 weeks. The patient had complete resolution of her symptoms which was maintained at a six-month follow-up.

  5. [Comparable disorder of the body schema in patients with complex regional pain syndrome (CRPS) and phantom pain].

    PubMed

    Reinersmann, A; Haarmeyer, G S; Blankenburg, M; Frettlöh, J; Krumova, E K; Ocklenburg, S; Maier, C

    2011-09-01

    In patients with complex regional pain syndrome (CRPS) a disruption of the body schema has been shown in an altered cortical representation of the hand and in delayed reaction times (RT) in the hand laterality recognition task. However, the role of attentional processes or the effect of isolated limb laterality training has not yet been clarified. The performance of healthy subjects (n = 38), CRPS patients (n = 12) and phantom limb pain (PLP) patients (n = 12) in a test battery of attentional performance (TAP) and in a limb laterality recognition task was compared and the effect of limb laterality training in CRPS patients and healthy subjects evaluated. The RTs of both CRPS and PLP patients were significantly slower than those of healthy subjects despite normal TAP values. The CRPS and PLP patients showed bilaterally delayed RTs. Through training RTs improved significantly but the RTs of CRPS patients remained slower than those of healthy subjects. In this study an equal disruption of the body schema was found in both CRPS and PLP patients which cannot be accounted for by attentional processes. For CRPS patients this disorder cannot be fully reversed by isolated limb laterality recognition training.

  6. Psychoneuroendocrine stress response may impair neutrophil function in complex regional pain syndrome.

    PubMed

    Kaufmann, Ines; Eisner, Christoph; Richter, Peter; Huge, Volker; Beyer, Antje; Chouker, Alexander; Schelling, Gustav; Thiel, Manfred

    2007-10-01

    In order to elucidate the interaction between pain, stress and innate immunity in complex regional pain syndrome (CRPS), we assessed pain and stress levels in CRPS patients and compared ex vivo functions of neutrophils between patients with CRPS and healthy volunteers. As compared with healthy volunteers, the following major alterations in CRPS patients were found: (I) elevated stress score (PTSS-10) and stress hormone concentrations, (II) decreased expression of the CD62L and CD11b/CD18 on neutrophils, (III) impaired ability of autologous plasma to enhance the capability of neutrophils to phagocytose zymosan particles, and (IV) a negative correlation between PTSS-10 values and autologous plasma enhanced phagocytosis. In vitro incubation of neutrophils with catecholamines decreased phagocytosis of zymosan. In conclusion, CRPS patients exhibit signs of impaired innate immunity which might reflect the immunological consequence of an immunosuppressive neuroendocrine stress response.

  7. [Complex regional pain syndrome following distal fractures of the radius : Epidemiology, pathophysiological models, diagnostics and therapy].

    PubMed

    Harhaus, L; Neubrech, F; Hirche, C; Schilling, T; Kohler, H; Mayr, A; Riesmeier, A; Bickert, B; Kneser, U

    2016-09-01

    The complex regional pain syndrome (CRPS) still represents an incompletely etiologically understood complication following fractures of the distal radius. The incidence of CRPS following fractures of the distal radius varies between 1 % and 37 %. Pathophysiologically, a complex interaction of inflammatory, somatosensory, motor and autonomic changes is suspected, leading to a persistent maladaptive response and sensitization of the central and peripheral nervous systems with development of the corresponding symptoms. Decisive for the diagnostics are a detailed patient medical history and a clinical hand surgical, neurological and pain-related examination with confirmation of the Budapest criteria. Among the types of apparatus used for diagnostics, 3‑phase bone scintigraphy and temperature measurement have a certain importance. A multimodal therapy started as early as possible is the most promising approach for successful treatment. As part of a multimodal rehabilitation the main focus of therapy lies on pain relief and functional aspects.

  8. Complex Regional Pain Syndrome Type II Secondary to Endovascular Aneurysm Repair

    PubMed Central

    Chen, Hamilton; Tafazoli, Sharwin

    2015-01-01

    Complex regional pain syndrome (CRPS) is a chronic pain disorder characterized by severe pain and vasomotor and pseudomotor changes. Endovascular aneurysm repair (EVAR) of abdominal aortic aneurysms is a recent advance in vascular surgery that has allowed repair of AAA while offering reduced intensive care unit and hospital lengths of stay, reduced blood loss, fewer major complications, and more rapid recovery. Pseudoaneurysms are a rare complication of an EVAR procedure that may result in a wide range of complications. The present report examines CRPS type II as a novel consequence of pseudoaneurysm formation from brachial artery access in the EVAR procedure. To our knowledge, this is the first reported case of CRPS type II presentation as sequelae of an EVAR procedure. PMID:25650247

  9. Three cases of type-1 complex regional pain syndrome after elective total hip replacement

    PubMed Central

    Zanotti, Gerardo; Slullitel, Pablo Ariel; Comba, Fernando Martín; Buttaro, Martín Alejandro; Piccaluga, Francisco

    2017-01-01

    Complex regional pain syndrome (CRPS) constitutes an atypical cause of pain after orthopaedic procedures. To our knowledge, there is a paucity of literature reporting this syndrome after total hip arthroplasty (THR), since only two case reports have been published. We thenceforth describe the clinical outcome of three cases of type-1 CRPS developed after elective THR, two of them initially diagnosed with secondary osteoarthritis whereas the remaining one presented a sequel of a failed osteosynthesis that required conversion to THR. Remission of disease was found at an average seven months (range: 4–9). Medical treatment involved a combined therapy of pain management, bisphosphonates and intense physical therapy. One patient was additionally treated with a corticosteroid blockade of his right sympathetic lumbar ganglia. None of the patients required surgical treatment. At final follow-up, physical examinations and imaging were negative for disease. PMID:28862131

  10. Back pain-related disability and quality of life in patients affected by vertebral fractures: data from baseline characteristics of population enrolled in Denosumab In Real Practice (DIRP).

    PubMed

    Moretti, Antimo; Gimigliano, Francesca; Di Pietro, Gioconda; Gimigliano, Raffaele; Iolascon, Giovanni

    2015-10-01

    Spine fragility fractures lead to a significant acute and/or chronic pain and worsening of quality of life. Denosumab is effective in reducing the risk of new vertebral fractures, but its effectiveness on pain relief and improvement of the quality of life in patients with spine fractures are not well known. The aim of this paper is to describe the baseline demographic and clinical characteristics, back pain-related disability and quality of life of the Denosumab In Real Practice (DIRP) study population. DIRP is a multicenter prospective observational study evaluating the effectiveness of denosumab in reducing back pain-related disability and Health-Related Quality of Life (HRQoL) of women with postmenopausal osteoporosis who had already experienced at least one vertebral fragility fracture. Our evaluation protocol includes history of fractures, Spine Pain Index (SPI), HRQoL, bone mineral density (BMD) and radiological assessment of vertebral fragility fractures. Two hundred and twenty-three post-menopausal women, who received a prescription for denosumab, were enrolled. The mean SPI score was 58.6 ± 21.4 SD, and 187 (83.86%) women experienced a moderate-severe pain. The mean HRQoL health state value was 0.54 ± 0.27 SD using EQ-5D index, whereas the mean Physical and Mental Health Composite Scale scores derived from the SF-12 were 31.06 ± 7.77 SD and 39.20 ± 11.03 SD. Baseline characteristics of DIRP study cohort indicate that patients who received a prescription of denosumab in Campania region are affected by severe osteoporosis with highly prevalent vertebral fractures, disabling back pain and poor health-related quality of life. This is in contradiction with what it is expected by a front-line drug for osteoporosis.

  11. Chronic regional muscular pain in women with precise manipulation work. A study of pain characteristics, muscle function, and impact on daily activities.

    PubMed

    Henriksson, K G; Bäckman, E; Henriksson, C; de Laval, J H

    1996-01-01

    Pain characteristics, muscle function and impact on daily activities were studied in 39 women with chronic regional muscular pain (RMP). They were all blue-collar workers in work involving precise manipulations. The main location of the pain was in the neck-shoulder region. Nineteen age-matched women with fibromyalgia (FM) were studied in the same way as the RMP patients. Thirty-seven women with no pain and with the same age and weight as the RMP patients served as reference group with respect to muscle strength and endurance. A follow-up study was done with respect to pain distribution and other pain characteristics 20 months after the initial examination. The findings were of the same nature in the RMP and the FM groups. The intensity of pain, the lowering of pain threshold for pressure, and the degree of sleep disturbance were greater in the FM than in the RMP group. Isometric muscle strength and static muscular endurance were reduced in both FM and RMP compared to reference values. The reduction in strength and endurance was greater in FM than in RMP. Even if the impact on everyday activities were greater in FM than in RMP, the impact was substantial in RMP patients also, for example with regard to work capacity. There were no transitions from RMP to FM during the 20 months to follow-up. Three FM patients, however, did not meet the ACR criteria for FM at follow-up.

  12. Spontaneous behavioral responses in the orofacial region: A model of trigeminal pain in mouse

    PubMed Central

    Romero-Reyes, Marcela; Akerman, Simon; Nguyen, Elaine; Vijjeswarapu, Alice; Hom, Betty; Dong, Hong-Wei; Charles, Andrew C.

    2012-01-01

    OBJECTIVES To develop a translational mouse model for the study and measurement of non-evoked pain in the orofacial region by establishing markers of nociceptive-specific grooming behaviors in the mouse. BACKGROUND Some of the most prevalent and debilitating conditions involve pain in the trigeminal distribution. Although there are current therapies for these pain conditions, for many patients they are far from optimal. Understanding the pathophysiology of pain disorders arising from structures innervated by the trigeminal nerve is still limited and most animal behavioral models focus on the measurement of evoked pain. In patients, spontaneous (non-evoked) pain responses provide a more accurate representation of the pain experience than do responses that are evoked by an artificial stimulus. Therefore, the development of animal models that measure spontaneous nociceptive behaviors may provide a significant translational tool for a better understanding of pain neurobiology. METHODS C57BL/6 mice received either an injection of 0.9% Saline solution or complete Freund’s adjuvant (CFA) into the right masseter muscle. Animals were video recorded and then analyzed by an observer blind to the experiment group. The duration of different facial grooming patterns performed in the area of injection were measured. After 2 hrs, mice were euthanized, perfused and the brainstem was removed. Fos protein expression in the trigeminal nucleus caudalis was quantified using immunohistochemistry to investigate nociceptive-specific neuronal activation. A separate group of animals was treated with morphine sulfate, to determine the nociceptive-specific nature of their behaviors. RESULTS We characterized and quantified 3 distinct patterns of acute grooming behaviors: fore-paw rubbing, lower lip skin/cheek rubbing against enclosure floor and hind paw scratching. These behaviors occurred with a reproducible frequency and time course, and were inhibited by the analgesic morphine. CFA

  13. Spinal cord stimulation, conception, pregnancy, and labor: case study in a complex regional pain syndrome patient.

    PubMed

    Segal, R

    1999-01-01

    Introduction. Interventional modalities for pain treatment are reserved for patients failing multidisciplinary pain management, including psychological, physical, pharmacological, and anesthetic techniques. Objective. Medications for intractable pain may be unacceptable because the risk of teratogenic effects. The purpose of this study is to find out whether spinal cord stimulation may be safe during conception, pregnancy, and delivery. Materials and Methods. We report a 30-year old, female, neonatal nurse who developed left hand burning pain, swelling, coldness, and weakness following a mild brachial plexus injury in a motor vehicle accident. The patient responded well to a combination of Neurontin, Trazadone, Ultram, and Vicodin. A year later, the patient married and wanted to become pregnant but was afraid of possible teratogenic effects of the medications. Therefore, she requested an interventional modality for control of her symptoms. We recommended spinal cord stimulation (SCS) based on our excellent experience with this modality in the management of complex regional pain syndromes (CRPS). However, we did inform the patient that no data had been published regarding the safety of this modality in pregnancy and labor. Results. Cervical SCS resulted in excellent pain control and discontinuation of the medications. Thirteen months later, she delivered a healthy five pound baby girl. Mother and baby were discharged home in two days. The SCS was not turned off at any time during the labor and delivery. Conclusion. SCS was safe for implantation in our case study of a pregnant woman. This may constitute a new indication for SCS in patients otherwise successfully managed with non-interventional modalities for pain control.

  14. Factors Associated With Disability and Sick Leave in Early Complex Regional Pain Syndrome Type-1.

    PubMed

    Bean, Debbie J; Johnson, Malcolm H; Heiss-Dunlop, Wolfgang; Kydd, Robert R

    2016-02-01

    Factors influencing disability and work absence in complex regional pain syndrome type-1 (CRPS)-1 have not been thoroughly described in the literature. We sought to determine whether demographic variables, work-related factors, CRPS clinical severity ratings, pain scores, or psychological variables were associated with disability and sick leave in early CRPS-1. A total of 66 CRPS-1 patients were recruited within 12 weeks of CRPS onset. Patients completed measures of pain, depression, anxiety, stress, pain catastrophizing, and pain-related fear. A physical examination was conducted to assess signs and symptoms of CRPS and to calculate a CRPS severity score. Demographic details, clinical details, treatments, work type, and work status were recorded. In multivariate analyses, the following factors were associated with greater disability: higher pain scores, more restricted ankle or wrist extension, and higher levels of depression. Among the 49 who were either working or studying before developing CRPS, 28 had stopped work or study at the time of assessment. Multivariate analyses showed that sick leave was more likely among those whose CRPS was triggered by more severe injuries, whose work was more physically demanding, among those with higher disability scores, and there was also a significant effect of depression on sick leave, which was mediated by disability. Although the study was cross-sectional and so cannot differentiate cause from effect, results suggest that even in the early stages of CRPS, a cycle of pain, disability, depression, and work absence can emerge. Treatments aimed to prevent this cycle may help prevent adverse long-term outcomes.

  15. Predictive risk factors for chronic regional and multisite musculoskeletal pain: a 5-year prospective study in a working population.

    PubMed

    Herin, Fabrice; Vézina, Michel; Thaon, Isabelle; Soulat, Jean-Marc; Paris, Christophe

    2014-05-01

    The role of psychosocial and physical factors in the development of musculoskeletal pain (MSP) has now been clearly demonstrated. However, it is unclear whether these factors contribute to specific regional MSP or to multisite pain. The main goal of this study was to assess the impact of work-related factors according to gender on the development of regional and multisite MSP. A total of 12,591 subjects (65% men and 35% women) who were born in 1938, 1943, 1948, and 1953 and were participating in a French longitudinal prospective epidemiological survey (ESTEV) in 1990 to 1995 were eligible. Personal factors and work exposure were assessed by self-administered questionnaires. Statistical associations between chronic MSP (regional body site or multisite), personal factors, and occupational factors were analyzed using logistic regression modeling. The incidence of regional MSP and multisite pain in 1995 were, respectively, 17% and 25.6%. For women, highly repetitive movements predicted neck/shoulder pain; posture and vibrations predicted arm and low back pain; and effort with tools predicted arm pain. For men, forceful effort and vibrations predicted neck/shoulder pain; posture and forceful effort predicted lower limb and low back pain; and forceful effort and effort with tools predicted arm pain. Physical constraints (ie, forceful effort or vibrations) were associated with multisite pain in both genders. Only for women, psychological factors were risk factors predictive of upper limb pain and in 3 or 4 painful anatomical sites. These results support the hypothesis that some physical and psychological work-related factors are predictive of regional or multisite MSP but differ according to gender. Gender differences and risk factors for work-related musculoskeletal pain should be also taken into account to more effectively target preventive measures.

  16. 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

  17. Successful Treatment of Complex Regional Pain Syndrome with Pseudoaneurysm Excision and Median Nerve Neurolysis.

    PubMed

    Gillick, John L; Cooper, Jared B; Babu, Sateesh; Das, Kaushik; Murali, Raj

    2016-08-01

    Complex regional pain syndrome (CRPS), formerly referred to as reflex sympathetic dystrophy, is a pain syndrome characterized by severe pain, altered autonomic and motor function, and trophic changes. CRPS is usually associated with soft tissue injury or trauma. It has also been described as a rare complication of arterial access for angiography secondary to pseudoaneurysm formation. A 73-year-old woman underwent catheterization of the left brachial artery for angiography of the celiac artery. The following day, the patient noticed numbness and severe pain in the median nerve distribution of the left upper extremity. Over the next 6 months, the patient developed CRPS in the left hand with pain and signs of autonomic dysfunction. Further work-up revealed the formation of a left brachial artery pseudoaneurysm with impingement on the median nerve. She underwent excision of the pseudoaneurysm with decompression and neurolysis of the left median nerve. Approximately 6 weeks after surgery, the patient had noticed significant improvement in autonomic symptoms. This case involves a unique presentation of CRPS caused by brachial artery angiography and pseudoaneurysm formation. In addition, the case demonstrates the efficacy of pseudoaneurysm excision and median nerve neurolysis in the treatment of CRPS as a rare complication of arterial angiography. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. Median Nerve Stimulation in a Patient with Complex Regional Pain Syndrome Type II.

    PubMed

    Jeon, Ik-Chan; Kim, Min-Su; Kim, Seong-Ho

    2009-09-01

    A 54-year-old man experienced injury to the second finger of his left hand due to damage from a paintball gun shot 8 years prior, and the metacarpo-phalangeal joint was amputated. He gradually developed mechanical allodynia and burning pain, and there were trophic changes of the thenar muscle and he reported coldness on his left hand and forearm. A neuroma was found on the left second common digital nerve and was removed, but his symptoms continued despite various conservative treatments including a morphine infusion pump on his left arm. We therefore attempted median nerve stimulation to treat the chronic pain. The procedure was performed in two stages. The first procedure involved exposure of the median nerve on the mid-humerus level and placing of the electrode. The trial stimulation lasted for 7 days and the patient's symptoms improved. The second procedure involved implantation of a pulse generator on the left subclavian area. The mechanical allodynia and pain relief score, based on the visual analogue scale, decreased from 9 before surgery to 4 after surgery. The patient's activity improved markedly, but trophic changes and vasomotor symptom recovered only moderately. In conclusion, median nerve stimulation can improve chronic pain from complex regional pain syndrome type II.

  19. Complex regional pain syndrome (CRPS) or continuous unilateral distal experimental pain stimulation in healthy subjects does not bias visual attention towards one hemifield.

    PubMed

    Filippopulos, Filipp M; Grafenstein, Jessica; Straube, Andreas; Eggert, Thomas

    2015-11-01

    In natural life pain automatically draws attention towards the painful body part suggesting that it interacts with different attentional mechanisms such as visual attention. Complex regional pain syndrome (CRPS) patients who typically report on chronic distally located pain of one extremity may suffer from so-called neglect-like symptoms, which have also been linked to attentional mechanisms. The purpose of the study was to further evaluate how continuous pain conditions influence visual attention. Saccade latencies were recorded in two experiments using a common visual attention paradigm whereby orientating saccades to cued or uncued lateral visual targets had to be performed. In the first experiment saccade latencies of healthy subjects were measured under two conditions: one in which continuous experimental pain stimulation was applied to the index finger to imitate a continuous pain situation, and one without pain stimulation. In the second experiment saccade latencies of patients suffering from CRPS were compared to controls. The results showed that neither the continuous experimental pain stimulation during the experiment nor the chronic pain in CRPS led to an unilateral increase of saccade latencies or to a unilateral increase of the cue effect on latency. The results show that unilateral, continuously applied pain stimuli or chronic pain have no or only very limited influence on visual attention. Differently from patients with visual neglect, patients with CRPS did not show strong side asymmetries of saccade latencies or of cue effects on saccade latencies. Thus, neglect-like clinical symptoms of CRPS patients do not involve the allocation of visual attention.

  20. [Incidence of Modic degenerative changes in patients with chronic lumbar pain at Monterrey Regional ISSSTE Hospital].

    PubMed

    Villarreal-Arroyo, M; Mejia-Herrera, J C; Larios-Forte, M C

    2012-01-01

    Several papers have studied the degenerative changes of endplates, but there are no publications referring to the Mexican population. The purpose of the study is to report the incidence of Modic degenerative changes in the patients seen at the Spine Service, Monterrey Regional ISSSTE Hospital. Specific objectives are: to describe the type of Modic change and the most frequent location, to describe the degeneration patterns and to report the incidence of the various diagnoses made during 2009. Incidence study using the MRI records at the Radiology Department, Monterrey Regional ISSSTE Hospital, interpreted blindly and independently by two observers. A total of 240 lumbar spine MRIs were reviewed, for a total of 1,200 intervertebral spaces. They were divided by age groups. Group I included 16 patients, Group II 32, Group III 80, and Group IV 112. No patients in Group I had Modic changes. Four patients (12.5%) in Group II had type II Modic changes with < 25% of endplate involvement. Eight patients in Group III had Modic changes with > 25% involvement of L4-L5 (10%); 32% of Group IV patients had changes, with L5-S1 as the most affected level. Most Modic changes (85%) were located in L4-L5 and L5-S1, with the latter as the most frequently affected level. Type I represented 5%, Type II 30%, and Type III 65%. The percentage of patients with Modic changes increased with age, which confirms that degenerative changes are age related. Morphologic disc changes are expressed as the percentage of affected patients in each group. Besides the severity of degeneration, the number of affected levels also increases with age. Thirty percent of patients ages 30-39 years have one or two degenerated levels, while 50% of those over age 50 have 3 or more degenerated levels. The most frequently degenerated level was L5-S1, followed by L4-L5 and L3-L4. The most frequent degeneration pattern was lower segment degeneration (L4-L5, L5-S1). A small proportion of patients over age 50 (4%) did not

  1. Fixed Dystonia in Complex Regional Pain Syndrome: a Descriptive and Computational Modeling Approach

    PubMed Central

    2011-01-01

    Background Complex regional pain syndrome (CRPS) may occur after trauma, usually to one limb, and is characterized by pain and disturbed blood flow, temperature regulation and motor control. Approximately 25% of cases develop fixed dystonia. Involvement of dysfunctional GABAergic interneurons has been suggested, however the mechanisms that underpin fixed dystonia are still unknown. We hypothesized that dystonia could be the result of aberrant proprioceptive reflex strengths of position, velocity or force feedback. Methods We systematically characterized the pattern of dystonia in 85 CRPS-patients with dystonia according to the posture held at each joint of the affected limb. We compared the patterns with a neuromuscular computer model simulating aberrations of proprioceptive reflexes. The computer model consists of an antagonistic muscle pair with explicit contributions of the musculotendinous system and reflex pathways originating from muscle spindles and Golgi tendon organs, with time delays reflective of neural latencies. Three scenarios were simulated with the model: (i) increased reflex sensitivity (increased sensitivity of the agonistic and antagonistic reflex loops); (ii) imbalanced reflex sensitivity (increased sensitivity of the agonistic reflex loop); (iii) imbalanced reflex offset (an offset to the reflex output of the agonistic proprioceptors). Results For the arm, fixed postures were present in 123 arms of 77 patients. The dominant pattern involved flexion of the fingers (116/123), the wrists (41/123) and elbows (38/123). For the leg, fixed postures were present in 114 legs of 77 patients. The dominant pattern was plantar flexion of the toes (55/114 legs), plantar flexion and inversion of the ankle (73/114) and flexion of the knee (55/114). Only the computer simulations of imbalanced reflex sensitivity to muscle force from Golgi tendon organs caused patterns that closely resembled the observed patient characteristics. In parallel experiments using

  2. Cross-species affective functions of the medial forebrain bundle-implications for the treatment of affective pain and depression in humans.

    PubMed

    Coenen, Volker A; Schlaepfer, Thomas E; Maedler, Burkhard; Panksepp, Jaak

    2011-10-01

    Major depression (MD) might be conceptualized as pathological under-arousal of positive affective systems as parts of a network of brain regions assessing, reconciling and storing emotional stimuli versus an over-arousal of parts of the same network promoting separation-distress/GRIEF. In this context depression can be explained as an emotional pain state that is the result of a disregulation of several sub-systems that under physiological conditions are concerned with bodily or emotional homeostasis of the human organism in a social context. Physiologically, homeostasis is maintained by influences of the SEEKING system represented - amongst others - by the medial forebrain bundle (MFB). Neuroimaging studies show that the MFB has a proven access to the GRIEF/Sadness system. A functional decoupling of these systems with a dysfunctional GRIEF pathway might result in MD. Therewith GRIEF and SEEKING/PLEASURE systems play important roles as opponents in maintenance of emotional homeostasis. Chronic electrical modulation of the reward SEEKING pathways with deep brain stimulation might show anti-depressive effects in humans suffering from MD by re-initiating an emotional equilibrium (of higher or lower activity) between these opposing systems.

  3. Effect of experimental stress in 2 different pain conditions affecting the facial muscles.

    PubMed

    Woda, Alain; L'heveder, Gildas; Ouchchane, Lemlih; Bodéré, Céline

    2013-05-01

    Chronic facial muscle pain is a common feature in both fibromyalgia (FM) and myofascial (MF) pain conditions. In this controlled study, a possible difference in the mode of deregulation of the physiological response to a stressing stimulus was explored by applying an acute mental stress to FM and MF patients and to controls. The effects of the stress test were observed on pain, sympathetic variables, and both tonic and reflex electromyographic activities of masseteric and temporal muscles. The statistical analyses were performed through a generalized linear model including mixed effects. Painful reaction to the stressor was stronger (P < .001) and longer (P = .011) in FM than in MF independently of a higher pain level at baseline. The stress-induced autonomic changes only seen in FM patients did not reach significance. The electromyographic responses to the stress test were strongest for controls and weakest for FM. The stress test had no effect on reflex activity (area under the curve [AUC]) or latency, although AUC was high in FM and latencies were low in both pain groups. It is suggested that FM is characterized by a lower ability to adapt to acute stress than MF. This study showed that an acute psychosocial stress triggered several changes in 2 pain conditions including an increase in pain of larger amplitude in FM than in MF pain. Similar stress-induced changes should be explored as possible mechanisms for differentiation between dysfunctional pain conditions. Copyright © 2013 American Pain Society. Published by Elsevier Inc. All rights reserved.

  4. Decreased functional connectivity density in pain-related brain regions of female migraine patients without aura.

    PubMed

    Gao, Qing; Xu, Fei; Jiang, Cui; Chen, Zhifeng; Chen, Huafu; Liao, Huaqiang; Zhao, Ling

    2016-02-01

    Migraine is one of the most prevalent neurological disorders which is suggested to be associated with dysfunctions of the central nervous system. The purpose of the present study was to detect the altered functional connectivity architecture in the large-scale network of the whole brain in migraine without aura (MWoA). Meanwhile, the brain functional hubs which are targeted by MWoA could be identified. A new voxel-based method named functional connectivity density (FCD) mapping was applied to resting-state functional magnetic resonance imaging data of 55 female MWoA patients and 44 age-matched female healthy controls (HC). Comparing to HC, MWoA patients showed abnormal short-range FCD values in bilateral hippocampus, bilateral insula, right amygdale, right anterior cingulate cortex, bilateral putamen, bilateral caudate nucleus and the prefrontal cortex. The results suggested decreased intraregional connectivity of these pain-related brain regions in female MWoA. In addition, short-range FCD values in left prefrontal cortex, putamen and caudate nucleus were significantly negatively correlated with duration of disease in MWoA group, implying the repeated migraine attacks over time may consistently affect the resting-state functional connectivity architecture of these brain hubs. Our findings revealed the dysfunction of brain hubs in female MWoA, and suggested the left prefrontal cortex, putamen and caudate nucleus served as sensitive neuroimaging markers for reflecting the disease duration of female MWoA. This may provide us new insights into the changes in the organization of the large-scale brain network in MWoA. Copyright © 2015 Elsevier B.V. All rights reserved.

  5. Somatosensory Misrepresentation Associated with Chronic Pain: Spatiotemporal Correlates of Sensory Perception in a Patient following a Complex Regional Pain Syndrome Spread

    PubMed Central

    Büntjen, Lars; Hopf, Jens-Max; Merkel, Christian; Voges, Jürgen; Knape, Stefan; Heinze, Hans-Jochen; Schoenfeld, Mircea Ariel

    2017-01-01

    Chronic pain is suggested to be linked to reorganization processes in the sensorimotor cortex. In the current study, the somatosensory representation of the extremities was investigated in a patient with a complex regional pain syndrome (CRPS) that initially occurred in the right hand and arm and spread later into the left hand and right leg. After the spread, magnetoencephalographic recordings in conjunction with somatosensory stimulation revealed that the clinical symptoms were associated with major changes in the primary somatosensory representation. Tactile stimulation of body parts triggering CRPS-related pain elicited activity located in the left primary somatosensory region corresponding to the right hand representation, where the CRPS initially appeared. Solely the unaffected left foot was observed to have a regular S1 representation. The pain distribution pattern was matching the cortical somatosensory misrepresentation suggesting that cortical reorganization processes might contribute and possibly underlie the development and spread of the CRPS. PMID:28443062

  6. Somatosensory Misrepresentation Associated with Chronic Pain: Spatiotemporal Correlates of Sensory Perception in a Patient following a Complex Regional Pain Syndrome Spread.

    PubMed

    Büntjen, Lars; Hopf, Jens-Max; Merkel, Christian; Voges, Jürgen; Knape, Stefan; Heinze, Hans-Jochen; Schoenfeld, Mircea Ariel

    2017-01-01

    Chronic pain is suggested to be linked to reorganization processes in the sensorimotor cortex. In the current study, the somatosensory representation of the extremities was investigated in a patient with a complex regional pain syndrome (CRPS) that initially occurred in the right hand and arm and spread later into the left hand and right leg. After the spread, magnetoencephalographic recordings in conjunction with somatosensory stimulation revealed that the clinical symptoms were associated with major changes in the primary somatosensory representation. Tactile stimulation of body parts triggering CRPS-related pain elicited activity located in the left primary somatosensory region corresponding to the right hand representation, where the CRPS initially appeared. Solely the unaffected left foot was observed to have a regular S1 representation. The pain distribution pattern was matching the cortical somatosensory misrepresentation suggesting that cortical reorganization processes might contribute and possibly underlie the development and spread of the CRPS.

  7. Features and organization of Pain Centers in the Lazio Region, Italy, in 2011.

    PubMed

    Latina, R; De Marinis, M G; Baglìo, G; Cattaruzza, M S; Notaro, P; Guzzetti, V; Osborn, J; Sansoni, J; Giannarelli, D; Piredda, M; D'Angelo, D; Mastroianni, C; Casale, G; Gatti, A; Tarsitani, G; Pain Centers Group, P C G

    2014-01-01

    Evidence on pain management highlights the importance of a multidisciplinary approach in order to achieve optimal therapeutic results. Such programs can be guaranteed by the Centers for Pain Management (CPMs), in which multidisciplinary teams are able to provide advanced and specialized activities for the assessment, diagnosis and treatment of chronic benign pain. To date, information related to healthcare supply and the organizational structure of these centers in Italy is incomplete. The aim of this paper was to provide an overview of the healthcare network of the CPMs in the Lazio region. A descriptive survey was conducted in all the 37 CPMs existing in the Lazio region in 2011 of which 28 participated. CPMs were located either in Universities or in public or private hospital facilities. They included a clinic, a Day Hospital service, Day surgery and day-beds. CPMs were managed by anaesthesiologists who, in most instances, did not work in a multidisciplinary team. The number of other health professionals available, such as nurses, psychologists and physiotherapists, was limited. CPMs mainly provided drug therapy, Complementary Alternative Medicine (CAM) and complex interventional treatments. The median waiting time was 30 days. The clinics were not homogeneously distributed in the region with a higher concentration in Rome (56%), followed by other provinces of the Lazio region (26%) and the province of Rome (18%). Clearly, Rome was the city which offered the greatest range of healthcare services and the highest number of consultations with patients, which significantly differed from those of the other areas (χ²=19.6 p<0.01). In 2011, the availability of CPMs was not equally distributed throughout the territory, and there was an over-utilization of the facilities in Rome and an under-utilization in the provincial areas. Moreover, this study showed a lack of a multi-professional approach to chronic pain management.

  8. [The efficacy of hand desimpatization after sympatectomy by complex regional pain syndrome].

    PubMed

    Krupatkin, A I; Golubev, I O; Merkulov, M V; Kutepov, I A; Maksimov, A A; Kuz'michev, V A

    2011-01-01

    64 patients operated on the reason of complex regional hand pain syndrome were examined with the use of laser spectral Doppler flowmetry and thermography. 33 patients had thoracoscopic Th3 ganglion clipation; 16 patients had brachial artery and vein perivascular sympathectomy; 15 patients periarterial sympathectomy on the level of brachial artery. Desympathisation (microcirculatory hemodynamic improvement and trophotropic microcirculation regulatory changes) was mostly apparent after thoracoscopic clipation and perivascular desympatisation in comparison with isolated periarterial sympatectomy.

  9. A case of recurrent complex regional pain syndrome accompanying Raynaud's disease: a prospective coincidence?

    PubMed

    Kesikburun, Serdar; Günendi, Zafer; Aydemir, Koray; Özgül, Ahmet; Tan, Arif Kenan

    2013-01-01

    Complex regional pain syndrome (CPRS) and Raynaud's disease are disorders characterized by vasomotor disturbances associating with abnormal autonomic nervous system. We present a case of CRPS involving a history of recurrence and no initiating event. Raynaud's disease accompanying CRPS was diagnosed clinically in the patient. We propose that a sympathetic dysfunction underlies the pathophysiologies of both disorders and may be responsible for the coexistence of these two distinct entities. Recurrence and unknown etiology of CRPS might account for temporary alterations in sympathetic function.

  10. Pain description and severity of chronic orofacial pain conditions.

    PubMed

    Vickers, E R; Cousins, M J; Woodhouse, A

    1998-12-01

    A multidisciplinary pain centre study of 120 consecutive chronic orofacial pain patients assessed pain description and intensity ratings, gender differences, prevalence of concurrent conditions, and interinstrument relationships of the McGill Pain Questionnaire and visual analogue scale. Pain words chosen by patients to describe conditions were predominantly sensory words, and patients with concurrent conditions often listed words indicating a substantial affective component. Results showed pain intensity ratings of chronic orofacial pain conditions have similar or higher pain ratings when compared with other medical chronic pain conditions such as back pain, cancer pain and arthritis. There was a significantly higher female: male ratio (88:32) with gender playing an important but poorly understood causal role. The most frequent condition diagnosed was atypical facial pain (n = 40), followed by temporomandibular disorder (n = 32), atypical odontalgia (n = 29) and pathology of the orofacial region (n = 19). Temporomandibular disorder was present in 75 of the 120 subjects, as the sole pain complaint (n = 32) or as an associated secondary condition (n = 43), indicating concurrent pain conditions exist and may be related. There were significantly higher total pain scores of the McGill Pain Questionnaire in patients with multiple conditions compared with patients with a single condition. The visual analogue scale showed a significant correlation to the number of words chosen index of the McGill Pain Questionnaire for orofacial pain.

  11. Spinal cord stimulation in adolescents with complex regional pain syndrome type I (CRPS-I).

    PubMed

    Olsson, Gunnar L; Meyerson, Björn A; Linderoth, Bengt

    2008-01-01

    Complex regional pain syndrome type I (CRPS-I) is not uncommon in children, particularly in adolescent girls. Most often, the condition involves a foot and is characterized by spontaneous pain, tactile allodynia and dysautonomic signs. There is usually a history of a minor, local trauma but sometimes no reasonable cause can be identified, and there are no signs of persistent tissue injury giving rise to ongoing nociception. Common analgesics are generally of no benefit, and the standard treatment includes sociopsychological support, physiotherapy, tricyclic antidepressants and antiepileptic drugs, sympathetic blocks (SB), and cognitive-behavioural therapy. For a minority of patients who prove to be resistant to such therapies, spinal cord stimulation (SCS) may be tried. The present study comprises seven girls, 11-14 years of age, presenting with severe, incapacitating and therapy-resistant CRPS-I, who were subjected to SCS. In two of them, percutaneous electrode implantation had to be performed in general anaesthesia. Trial stimulation was performed in all, but one. In two cases, it was not possible to produce paraesthesias that entirely covered the pain area. A pain relieving effect of SCS was usually not reported until after 1-2 weeks of trial stimulation. After another 2-6 weeks, pain alleviation was complete in five of the seven patients, one to eight years after the intervention. In one case, a local infection necessitated the removal of the electrode; nevertheless a few days of trial stimulation produced substantial pain relief that still persists. In four patients, the SCS use was gradually diminished and eventually the device could be removed. The favourable outcome in all seven cases with no or minor remaining symptoms and without severe recurrences illustrates that SCS may also be an efficient treatment in paediatric cases with exceptionally therapy resistant forms of CRPS I.

  12. Metallothionein deficiency in the injured peripheral nerves of complex regional pain syndrome as revealed by proteomics.

    PubMed

    Oki, Gosuke; Wada, Takuro; Iba, Kosuke; Aiki, Hikono; Sasaki, Kouichi; Imai, Shin-ichi; Sohma, Hitoshi; Matsumoto, Kayo; Yamaguchi, Mami; Fujimiya, Mineko; Yamashita, Toshihiko; Kokai, Yasuo

    2012-03-01

    Complex regional pain syndrome (CRPS) is characterized by persistent and severe pain after trauma or surgery; however, its molecular mechanisms in the peripheral nervous system are poorly understood. Using proteomics, we investigated whether injured peripheral nerves of CRPS patients have altered protein profiles compared with control nerves. We obtained nerve samples from 3 patients with CRPS-2 who underwent resection of part of an injured peripheral nerve. Sural nerves from fresh cadavers with no history of trauma or neuropathic pain served as controls. Proteomic analysis showed that the number and functional distribution of proteins expressed in CRPS and control nerves was similar. Interestingly, metallothionein was absent in the injured nerves of CRPS-2, although it was readily detected in control nerves. Western blotting further confirmed the absence of metallothionein in CRPS-2 nerves, and immunohistochemistry corroborated the deficiency of metallothionein expression in injured nerves from 5 of 5 CRPS patients and 2 of 2 patients with painful neuromas. In contrast, all control nerves, including 5 sural nerves from fresh cadavers and 41 nerves obtained from surgically resected tumors, expressed MT. Furthermore, expression of S100 as a marker for Schwann cells, and neurofilament M as a marker of axons was comparable in both CRPS-2 and controls. Metallothioneins are zinc-binding proteins that are probably involved in protection against injury and subsequent regeneration after CNS damage. Their absence from the injured peripheral nerves of patients with CRPS-2 suggests a potential pathogenic role in generating pain in the damaged peripheral nerves. Copyright © 2011 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

  13. Peripheral and central sensitization in remote spinal cord regions contribute to central neuropathic pain after spinal cord injury

    PubMed Central

    Carlton, Susan M.; Du, Junhui; Tan, Huai Yu; Nesic, Olivera; Hargett, Gregory L.; Bopp, Anne C.; Yamani, Ammar; Lin, Qing; Willis, William D.; Hulsebosch, Claire E.

    2009-01-01

    Central neuropathic pain (CNP) developing after spinal cord injury (SCI) is described by the region affected: above-level, at-level and below-level pain occurs in dermatomes rostral, at/near, or below the SCI level, respectively. People with SCI and rodent models of SCI develop above-level pain characterized by mechanical allodynia and thermal hyperalgesia. Mechanisms underlying this pain are unknown and the goals of this study were to elucidate components contributing to the generation of above-level CNP. Following a thoracic (T10) contusion, forelimb nociceptors had enhanced spontaneous activity and were sensitized to mechanical and thermal stimulation of the forepaws 35 days post-injury. Cervical dorsal horn neurons showed enhanced responses to non-noxious and noxious mechanical stimulation as well as thermal stimulation of receptive fields. Immunostaining dorsal root ganglion (DRG) cells and cord segments with activating transcription factor 3 (ATF3, a marker for neuronal injury) ruled out neuronal damage as a cause for above-level sensitization since few C8 DRG cells expressed AFT3 and cervical cord segments had few to no ATF3-labeled cells. Finally, activated microglia and astrocytes were present in thoracic and cervical cord at 35 days post-SCI, indicating a rostral spread of glial activation from the injury site. Based on these data, we conclude that peripheral and central sensitization as well as reactive glia in the uninjured cervical cord contribute to CNP. We hypothesize that reactive glia in the cervical cord release pro-inflammatory substances which drive chronic CNP. Thus a complex cascade of events spanning many cord segments underlies above-level CNP. PMID:19853381

  14. A Day-Hospital Approach to Treatment of Pediatric Complex Regional Pain Syndrome: Initial Functional Outcomes

    PubMed Central

    Logan, Deirdre E.; Carpino, Elizabeth A.; Chiang, Gloria; Condon, Marianne; Firn, Emily; Gaughan, Veronica J.; Hogan, Melinda, P.T.; Leslie, David S.; Olson, Katie, P.T.; Sager, Susan; Sethna, Navil; Simons, Laura E.; Zurakowski, David; Berde, Charles B.

    2013-01-01

    Objectives To examine clinical outcomes of an interdisciplinary day hospital treatment program (comprised of physical, occupational, and cognitive-behavioral therapies with medical and nursing services) for pediatric complex regional pain syndrome (CRPS). Methods The study is a longitudinal case series of consecutive patients treated in a day hospital pediatric pain rehabilitation program. Participants were 56 children and adolescents ages 8–18 years (median = 14 years) with CRPS spectrum conditions who failed to progress sufficiently with a previous outpatient and/or inpatient treatments. Patients participated in daily physical therapy, occupational therapy and psychological treatment and received nursing and medical care as necessary. The model places equal emphasis on physical and cognitive-behavioral approaches to pain management. Median duration of stay was 3 weeks. Outcome measures included assessments of physical, occupational, and psychological functioning at program admission, discharge, and at post-treatment follow-up at a median of 10 months post-discharge. Scores at discharge and follow-up were compared with measures on admission by Wilcoxon tests, paired t tests, or ANOVA as appropriate, with corrections for multiple comparisons. Results Outcomes demonstrate clinically and statistically significant improvements from admission to discharge in pain intensity (p<0.001), functional disability (p<0.001), subjective report of limb function (p<0.001), timed running (p<0.001) occupational performance (p<0.001), medication use (p<0.01), use of assistive devices (p<0.001), and emotional functioning (anxiety, p<0.001; depression, p<0.01). Functional gains were maintained or further improved at follow-up. Discussion A day-hospital interdisciplinary rehabilitation approach appears effective in reducing disability and improving physical and emotional functioning and occupational performance among children and adolescents with complex regional pain syndromes that

  15. Ultrasonography-guided pulsed radiofrequency of sciatic nerve for the treatment of complex regional pain syndrome Type II

    PubMed Central

    Choi, Yi Hwa; Chang, Dong Jin; Hwang, Woon Suk; Chung, Jin Hwan

    2017-01-01

    Although the major mechanism of complex regional pain syndrome (CRPS) involves dysfunctional central or sympathetic nervous system activation, the peripheral nervous system also contributes significantly to its clinical manifestations. Pulsed radiofrequency (PRF) is a recently developed treatment option for neuropathic pain syndromes. Here, we report a case of CRPS Type II after a femur fracture and sciatic nerve injury, in which the pain was treated successfully with ultrasonography-guided selective sciatic nerve PRF application. PMID:28217060

  16. Effects of affective pictures on pain sensitivity and cortical responses induced by laser stimuli in healthy subjects and migraine patients.

    PubMed

    de Tommaso, Marina; Calabrese, Rita; Vecchio, Eleonora; De Vito Francesco, Vito; Lancioni, Giulio; Livrea, Paolo

    2009-11-01

    Visually induced analgesia has been correlated with the affective content of pleasant, neutral or unpleasant pictures. The aim of the present study was to assess the effect of affective images vision on laser evoked potentials and pain perception, in a cohort of healthy subjects and migraine patients. Twenty-two healthy subjects and 24 migraine without aura patients (recorded during the inter-critical phase) participated in the study. Eighty-four colour slides, arranged in two blocks, each consisting of 14 pleasant, 14 unpleasant and 14 neutral images, in random presentation, were chosen from the International Affective Picture System. The CO(2) laser stimuli were delivered on the dorsum of the right hand and supra-orbital zone at 7.5-watt intensity and 25-ms duration, in basal condition and during the viewing of affective pictures. Migraine patients expressed higher scores of valence and arousal for pleasant and unpleasant pictures, compared to controls. In both groups, a late positive potential in the 400-700 ms time range was clear for pleasant and unpleasant pictures, but its amplitude was significantly reduced in migraine patients. The pain rating and the N2 component were reduced in both groups during the visual task compared to basal condition. In migraineurs and controls the P2 wave was reduced during the vision of pleasant pictures, compared to basal condition. This indicates that stimulation by images with different affective content reduces subjective pain for a cognitive mechanism of attentive engagement, while a special inhibition of later LEPs is produced by a positive emotional impact. In migraine, affective images are able to modulate pain perception and LEPs, differently from other modalities of distraction, suggesting a possible emotive elaboration of painful stimuli.

  17. Ultrasound-guided pulsed radiofrequency treatment of the cervical sympathetic chain for complex regional pain syndrome

    PubMed Central

    Kim, Eung Don; Yoo, Woo Joo; Kim, Yoo Na; Park, Hue Jung

    2017-01-01

    Abstract The stellate ganglion is a common target to manage neuropathic pain in the upper extremities. However, the effect duration of a single stellate ganglion block is often temporary. To overcome the short-term effects of a single sympathetic block, pulsed radiofrequency (PRF) can be applied. The aim of the present study was to investigate the efficacy of PRF on the cervical sympathetic chain under ultrasound guidance for complex regional pain syndrome (CRPS). Twelve CRPS patients who underwent PRF on the cervical sympathetic chain were enrolled in this retrospective analysis. Under ultrasound guidance, PRF was performed for 420 seconds at 42°C on the C6- and C7-level sympathetic chain. The pain intensity decreased significantly at 1 week after the procedure. Overall, 91.7% of patients experienced at least moderate improvement. A positive correlation was observed between the extent of pain reduction at 1 week after PRF and the degree of overall benefit (r = 0.605, P = 0.037). This reduction in symptoms was maintained for a mean of 31.41 ± 26.07 days after PRF. There were no complications associated with this procedure. PRF on the cervical sympathetic chain, which can be performed easily and safely under ultrasound guidance, should be considered an option for managing CRPS of the upper extremities. PMID:28072749

  18. Women's preferences and received pain relief in childbirth - A prospective longitudinal study in a northern region of Sweden.

    PubMed

    Lindholm, Annika; Hildingsson, Ingegerd

    2015-06-01

    A range of alternatives in pain management during childbirth are available in the western countries. Women's preferences for and use of pain relief methods during labour is not fully investigated. The aim of this study was to describe what pain relief methods pregnant women preferred when asked in late pregnancy and to identify factors associated with preferred and received pain relief methods. A prospective longitudinal study in a northern region of Sweden (n = 936). Data were collected by three questionnaires. Odds ratios with a 95% confidence interval were calculated between preferred and received pain relief methods for several explanatory variables. The most preferred pain relief methods were also the most common received pain relief methods; nitrous oxide, bathing, breathing techniques, epidural analgesia and massage. The strongest factors for using different pain relief methods were primiparity and preferences. Women who used epidural analgesia, regardless of preference, were two to four times more likely to have a less positive birth experience. Women's preferences for a certain pain relief method were largely met. Greater differences were seen between background factors and preferences than the received pain relief methods. Preferences and primiparity were the most important factors for actually using pain relief. Epidural analgesia was associated with a less positive birth experience. Copyright © 2014 Elsevier B.V. All rights reserved.

  19. Distraction affects frontal alpha rhythms related to expectancy of pain: an EEG study.

    PubMed

    Del Percio, Claudio; Le Pera, Domenica; Arendt-Nielsen, Lars; Babiloni, Claudio; Brancucci, Alfredo; Chen, Andrew C N; De Armas, Liala; Miliucci, Roberto; Restuccia, Domenico; Valeriani, Massimiliano; Rossini, Paolo Maria

    2006-07-01

    Previous electroencephalographic (EEG) evidence has shown event-related desynchronization (ERD) of alpha rhythms before predictable painful stimuli, as a possible neural concomitant of attentional preparatory processes (Babiloni, C., Brancucci, A., Babiloni, F., Capotosto, P., Carducci, F., Cincotti, F., Arendt-Nielsen, L., Chen, A.C., Rossini, P.M., 2003. Anticipatory cortical responses during the expectancy of a predictable painful stimulation. A high-resolution electroencephalography study. Eur. J. Neurosci. 18 (6) 1692-700). This study tested the hypothesis that alpha ERD before predictable painful stimuli is reduced as an effect of distraction. A visual warning stimulus preceded a laser painful stimulation, which was strictly followed by visual imperative stimuli. In the Pain (control) condition, no task was required after the imperative stimuli. In the Pain + Movement condition, subjects had to perform a movement of the right index finger. In the Pain + Cognition condition, they had to mentally perform an arithmetical task. EEG data were recorded in 10 subjects from 30 electrodes. Artifact-free recordings were spatially enhanced by surface Laplacian transformation. Alpha ERD was computed at three alpha sub-bands according to subjects' individual alpha frequency peak (i.e., about 6-8 Hz, 8-10 Hz, 10-12 Hz). Compared to the control condition, the subjects reported a significantly lower stimulus intensity perception and unpleasantness in the Pain + Movement and Pain + Cognition conditions. In addition, there was a cancellation of the alpha 3 ERD (i.e., about 10-12 Hz) in Pain + Cognition condition and even a generation of a statistically significant alpha 3 ERS in Pain + Movement condition. These effects were maximum over fronto-central midline. These results suggest that distraction during the expectancy of pain is related to a reduced neural desynchronization of fronto-central midline alpha rhythms (i.e., reduced cortical activation) towards an overt hyper

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

    PubMed Central

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

    2014-01-01

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

  1. Does pain in individuals with multiple sclerosis affect employment? A systematic review and meta-analysis.

    PubMed

    Shahrbanian, Shahnaz; Auais, Mohammad; Duquette, Pierre; Andersen, Katie; Anderson, Katie; Mayo, Nancy E

    2013-01-01

    Individuals with multiple sclerosis (MS) experience some of the highest unemployment rates among all groups of chronic illnesses. Pain has been found to be a common reason for sick leave or early retirement in healthy populations or other groups with chronic illness; however, there is little awareness regarding the effect of pain on the work status of individuals with MS. To estimate the extent to which individuals with pain differ in employment status compared with those without pain among MS patients. An extensive systematic review of the scientific literature was performed within the framework of the Cochrane Collaboration to identify studies focusing on the effect of pain on employment in individuals with MS. The following databases were searched: PubMed, EMBASE, PsychInfo, Web of Science, MD Consult and Elsevier, and Science Direct. The methodological quality of studies was assessed using the McMaster Critical Review Form. Ten articles met the inclusion criteria and were included in the systematic review. Of these studies, five that exhibited clinical, methodological and statistical homogeneity were included in the meta-analysis. The between-groups (pain + versus pain -) pooled random OR of being employed was 0.7 (strong), and was significantly different from unity (95% CI 0.5 to 0.9; P=0.001). The results of the present study indicated that individuals with MS who experience pain were significantly more likely to report a decreased employment rate than individuals with MS who were pain free.

  2. Truths, errors, and lies around "reflex sympathetic dystrophy" and "complex regional pain syndrome".

    PubMed

    Ochoa, J L

    1999-10-01

    The shifting paradigm of reflex sympathetic dystrophy-sympathetically maintained pains-complex regional pain syndrome is characterized by vestigial truths and understandable errors, but also unjustifiable lies. It is true that patients with organically based neuropathic pain harbor unquestionable and physiologically demonstrable evidence of nerve fiber dysfunction leading to a predictable clinical profile with stereotyped temporal evolution. In turn, patients with psychogenic pseudoneuropathy, sustained by conversion-somatization-malingering, not only lack physiological evidence of structural nerve fiber disease but display a characteristically atypical, half-subjective, psychophysical sensory-motor profile. The objective vasomotor signs may have any variety of neurogenic, vasogenic, and psychogenic origins. Neurological differential diagnosis of "neuropathic pain" versus pseudoneuropathy is straight forward provided that stringent requirements of neurological semeiology are not bypassed. Embarrassing conceptual errors explain the assumption that there exists a clinically relevant "sympathetically maintained pain" status. Errors include historical misinterpretation of vasomotor signs in symptomatic body parts, and misconstruing symptomatic relief after "diagnostic" sympathetic blocks, due to lack of consideration of the placebo effect which explains the outcome. It is a lie that sympatholysis may specifically cure patients with unqualified "reflex sympathetic dystrophy." This was already stated by the father of sympathectomy, René Leriche, more than half a century ago. As extrapolated from observations in animals with gross experimental nerve injury, adducing hypothetical, untestable, secondary central neuron sensitization to explain psychophysical sensory-motor complaints displayed by patients with blatantly absent nerve fiber injury, is not an error, but a lie. While conceptual errors are not only forgivable, but natural to inexact medical science, lies

  3. Complex regional pain syndrome treated with intravenous immunoglobulin in a patient with common variable immune deficiency.

    PubMed

    Tachdjian, Raffi

    2013-12-01

    Common variable immunodeficiency (CVID) represents a large heterogeneous group of antibody-deficiency syndromes associated with a wide range of clinical features and a lack of defined causes in the realm of primary immunodeficiencies. Here, we present a case of CVID in a 62-year-old white male patient with a history of longstanding complex regional pain syndrome (CRPS). His medical history included multiple sinus infections per year and several pneumonias requiring antibiotics. He has had various back surgeries, including a laminectomy at the L4 level 1 year prior to his diagnosis. Thereafter, he underwent four sympathetic nerve blocks with minimal pain relief. Blood chemistries showed a normal white blood cell count with a normal differential, but increased erythrocyte sedimentation rate and C-reactive protein levels. Total Ig (Immunoglobulin)G was 611 mg/dL (normal 700-1,600), IgG1 was 425 mg/dL (341-894), IgG2 was 114 mg/dL (171-632), IgG3 was 14.4 mg/dL (18.4-106), and IgG4 was 7.4 mg/dL (2.4-121). IgA was 47 mg/dL (normal 70-400), IgM was 131 mg/dL (40-230), and IgE was 4.5 kU/L (<4.0). He only had 10 of 23 pneumococcal titers in the protective range post-vaccination. Upon treatment of the CVID with intravenous immunoglobulin, the patient's pain levels were significantly decreased and have been maintained for more than 2 years. Therefore, immunoglobulin therapy appears to have been beneficial in the treatment of the patient's symptoms of CRPS, including pain. Additional studies investigating the mechanism by which immunoglobulin therapy may reduce the inflammation and pain of CRPS are needed.

  4. Low back pain affects trunk as well as lower limb movements during walking and running.

    PubMed

    Müller, Roy; Ertelt, Thomas; Blickhan, Reinhard

    2015-04-13

    Up to now, most gait analyses on low back pain concentrate on changes in trunk coordination during walking on a treadmill. Locomotion on uneven ground as well as lower limb changes receives little attention in association with low back pain. The present study focuses on how chronic non-specific low back pain causes modifications in lower limb and trunk movements, in level and uneven walking and running. We found that trunk as well as lower limb movement was influenced by chronic non-specific low back pain. A consistent finding across all gaits and ground level changes is that patients with chronic non-specific low back pain show less pelvis and unchanged thorax rotation as compared to healthy controls. Furthermore, in chronic non-specific low back pain patients the trunk rotation decreased only during level and uneven running whereas the sagittal trunk inclination at touchdown increased only during uneven walking as compared to healthy controls. Besides significant changes in the upper body, in chronic non-specific low back pain patients the knee joint angle at touchdown was more extended during level walking but also during uneven walking and running as compared to healthy controls. We assume that trunk movements interact with lower limb movements or vice versa. Therefore, we recommend that further investigations on low back pain should consider both trunk (primarily pelvis) and lower limb (primarily knee) movements. Copyright © 2015 Elsevier Ltd. All rights reserved.

  5. Factors Affecting Health Care Utilization in OEF/OIF Veterans: The Impact of PTSD and Pain.

    PubMed

    Lang, Katie P; Veazey-Morris, Katherine; Berlin, Kristoffer S; Andrasik, Frank

    2016-01-01

    Returning Operation Enduring Freedom and Operation Iraqi Freedom veterans are at a high risk for physical and mental health symptoms including pain (90%) and post-traumatic stress disorder (PTSD) (58%). These often present concurrently and result in many health problems, functional impairments, and overall poor rehabilitation. To address postdeployment health, effective and efficient allocation of health care resources is needed. Retrospective study of 144 veterans who completed a second-level screening in the Polytrauma clinic. Veterans completed the PTSD Checklist-Civilian Version. Their pain rating and health care utilization (sum of visits during 12 months, categorized as medical or mental health) was extracted through chart review. The majority of veterans reported significant PTSD (72%) and pain (87%) symptoms; 45% received adequate mental health treatment, defined as ≥8 sessions in 12 months. PTSD and the interaction with pain predicted medical utilization; at high pain levels veterans' PTSD severity predicted utilization. PTSD alone predicted mental health utilization. The results show the increased influence of PTSD symptoms on medical health care services when pain ratings are high and suggest the need for interdisciplinary pain clinics that are able to address the overlapping symptoms of pain and common mental health conditions. Implication of results for VA planning are discussed. Reprint & Copyright © 2016 Association of Military Surgeons of the U.S.

  6. Attenuation of sensory and affective responses to heat pain: evidence for contralateral mechanisms.

    PubMed

    Gallez, Ariane; Albanese, Marie-Claire; Rainville, Pierre; Duncan, Gary H

    2005-11-01

    Attenuation of responses to repeated sensory events has been thoroughly studied in many modalities; however, attenuation of pain perception has not yet benefitted from such extensive investigation. Described here are two psychophysical studies that examined the effects of repeated exposure to thermal stimuli, assessing potential attenuation of the perception of pain and its possible spatial specificity. Twenty-two subjects were presented thermal stimuli to the volar surface of the right and left forearms. Twelve subjects in study 1 received the same stimuli and conditions on each of five daily experimental sessions, whereas 10 subjects in study 2 received thermal stimuli, which were restricted to one side for four daily sessions and then applied to the other side on the fifth session. Ratings of warmth intensity, pain intensity, and pain unpleasantness were recorded while the subjects performed a thermal sensory discrimination task. Results of study 1 demonstrate that repeated stimulation with noxious heat can lead to long-term attenuation of pain perception; results of study 2 extend these findings of attenuation to both pain intensity and unpleasantness and show that this effect is highly specific to the exposed body side for both aspects of the pain experience. We suggest that the functional plasticity underlying this attenuation effect lies in brain areas with a strong contralateral pattern of pain-related activation.

  7. Low back pain status affects pelvis-trunk coordination and variability during walking and running.

    PubMed

    Seay, Joseph F; Van Emmerik, Richard E A; Hamill, Joseph

    2011-07-01

    The purpose of this study was to compare pelvis-trunk coordination and coordination variability over a range of walking and running speeds between three groups of runners; runners with low to moderate low back pain; runners who had recovered from a single bout of acute low back pain; and runners who had never experienced any symptoms of low back pain. Pelvis and trunk kinematic data were collected as speed was systematically increased on a treadmill. Coordination between pelvis and trunk in all three planes of motion was measured using continuous relative phase, and coordination variability was defined as the standard deviation of this measure. Oswestry Disability Index indicated the low back pain group was high functioning (mean 7.9% out of 100%). During walking, frontal plane coordination was more in-phase for the low back pain group compared to controls (P=0.029), with the resolved group showing an intermediate coordination pattern (P=0.064). During running, both low back pain (P=0.021) and resolved (P=0.025) groups showed more in-phase coordination in the transverse plane than the control group. The low back pain group also showed reduced transverse plane coordination variability compared to controls (P=0.022). Coordination and coordination variability results showed a continuum of responses between our three groups. Taken together, the data lend insight into increased injury risk and performance deficits associated with even one bout of low back pain, and suggest that clinicians need to look beyond the resolution of pain when prescribing rehabilitation for low back pain. Copyright © 2010. Published by Elsevier Ltd.

  8. T Cell Mediation of Pregnancy Analgesia Affecting Chronic Pain in Mice.

    PubMed

    Rosen, Sarah F; Ham, Boram; Drouin, Shannon; Boachie, Nadia; Chabot-Dore, Anne-Julie; Austin, Jean-Sebastien; Diatchenko, Luda; Mogil, Jeffrey S

    2017-09-06

    It has been consistently reported that many female chronic pain sufferers have an attenuation of symptoms during pregnancy. Rats display increased pain tolerance during pregnancy, due to an increase in opioid receptors in the spinal cord. These past studies did not consider the role of non-neuronal cells, now appreciated to play an important role in chronic pain processing. Using an inflammatory (complete Freund's adjuvant) or neuropathic (spared nerve injury) model of persistent pain, we observe that young adult female mice in early pregnancy switch from a micgrolia-independent to a microglia-dependent pain hypersensitivity mechanism. During late pregnancy, female mice show no evidence of chronic pain whatsoever. This pregnancy-related analgesia is reversible by intrathecal administration of naloxone, suggesting an opioid-mediated mechanism; pharmacological and genetic data suggest the importance of δ-opioid receptors. We also observe that T-cell deficient (nude and Rag1 null mutant) pregnant mice do not exhibit pregnancy analgesia, which can be rescued with the adoptive transfer of CD4(+) or CD8(+) T-cells from late-pregnant wildtype mice. These results suggest that T cells are a mediator of the opioid analgesia exhibited during pregnancy.SIGNIFICANCE STATEMENTChronic pain symptoms often subside during pregnancy. This pregnancy-related analgesia has been demonstrated for acute pain in rats. Here we show that pregnancy analgesia can produce a complete cessation of chronic pain behaviors in mice. We show that the phenomenon is dependent on pregnancy hormones (estrogen and progesterone), δ-opioid receptors, and T cells of the adaptive immune system. These findings add to the recent but growing evidence of sex-specific T cell involvement in chronic pain processing. Copyright © 2017 the authors.

  9. Evaluation of Factors Affecting Acute Postoperative Pain Levels After Arthroscopic Rotator Cuff Repair.

    PubMed

    Cuff, Derek J; O'Brien, Kathleen C; Pupello, Derek R; Santoni, Brandon G

    2016-07-01

    To evaluate multiple preoperative and operative factors that may be predictive of and correlate with acute postoperative pain levels after arthroscopic rotator cuff repair. One hundred eighty-one patients underwent arthroscopic rotator cuff surgery along with subacromial decompression and met the inclusion criteria for this study. Postoperative visual analog scale (VAS) scores were obtained on postoperative days 1, 7, and 90. Multivariate linear regression analysis was used to correlate postoperative VAS scores with multiple independent factors, including preoperative subjective pain tolerance, preoperative VAS score, preoperative narcotic use, sex, smoking status, number of suture anchors used, tear size, single- or double-row repair, and patient age. Preoperative subjective pain tolerance, notably those patients rating themselves as having an extremely high pain tolerance, was the most significant predictor of high VAS pain scores on both postoperative day 1 (P = .0001) and postoperative day 7 (P < .0001). Preoperative narcotic use was also significantly predictive (P = .010) of high pain scores on postoperative day 1 and day 7 (P = .019), along with nonsmokers (P = .008) and younger patients (P = .006) being predictive on day 7. There were no patient factors that were predictive of VAS scores 3 months postoperatively (P = .567). Preoperative subjective pain tolerance, notably those patients rating themselves as having an extremely high pain tolerance, was the strongest factor predicting high acute pain levels after arthroscopic rotator cuff surgery. Preoperative narcotic use, smokers, and younger patients were also predictive of higher pain levels during the first postoperative week. Level IV, prognostic case series. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

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

    PubMed

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

    2012-10-01

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

  11. Abdominal wall Type-I complex regional pain syndrome treated effectively with peripheral nerve field stimulation: a case report

    PubMed Central

    Zhou, Linqiu; Chou, Henry; Holder, Eric

    2017-01-01

    Chronic abdominal wall pain is a well-documented complication of abdominal surgery. However, abdominal wall complex regional pain syndrome (CRPS) is a rare medical condition. We present a case of abdominal wall CRPS and its treatment with peripheral nerve field stimulation (PNfS). A 34-year-old female presented with right periumbilical pain for 2 years. She developed burning, sharp and stabbing pain with allodynia (extremely sensitive to wind and light touch) and erythema or pallor 2 weeks after an exploratory appendectomy. The extensive evaluation ruled out the underlining pathology. After she failed conservative therapies, she underwent a 7-day trial of thoracic spinal cord stimulation (SCS) and abdominal wall PNfS. Thoracic SCS failed to provide pain relief; however, PNfS provided significant relief (>90%) of burning sensation. It has now been 5 years since the PNfS was implanted and she continues to demonstrate substantial pain relief. PMID:28044002

  12. Local anaesthetics and regional anaesthesia for preventing chronic pain after surgery

    PubMed Central

    Andreae, Michael H; Andreae, Doerthe A

    2014-01-01

    Background Regional anaesthesia may reduce the rate of persistent (chronic) pain after surgery, a frequent and debilitating condition. Objectives To compare local anaesthetics and regional anaesthesia versus conventional analgesia for the prevention of persistent pain six or 12 months after surgery. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 4), PubMed (1966 to April 2012), EMBASE (1966 to May 2012) and CINAHL (1966 to May 2012) without any language restriction. We used a combination of free text search and controlled vocabulary search. The results were limited to randomized controlled clinical trials (RCTs). We conducted a handsearch in reference lists of included trials, review articles and conference abstracts. Selection criteria We included RCTs comparing local anaesthetics or regional anaesthesia versus conventional analgesia with a pain outcome at six or 12 months after surgery. Data collection and analysis Two authors independently assessed trial quality and extracted data, including information on adverse events. We contacted study authors for additional information. Results are presented as pooled odds ratios (OR) with 95% confidence intervals (CI), based on random-effects models (inverse variance method). We grouped studies according to surgical interventions. We employed the Chi2 test and calculated the I2 statistic to investigate study heterogeneity. Main results We identified 23 RCTs studying local anaesthetics or regional anaesthesia for the prevention of persistent (chronic) pain after surgery. Data from a total of 1090 patients with outcomes at six months and of 441 patients with outcomes at 12 months were presented. No study included children. We pooled data from 250 participants after thoracotomy, with outcomes at six months. Data favoured regional anaesthesia for the prevention of chronic pain at six months after thoracotomy with an OR of 0.33 (95% CI 0.20 to 0.56). We

  13. QUANTITATIVE CHANGES IN REGIONAL CEREBRAL BLOOD FLOW INDUCED BY COLD, HEAT AND ISCHEMIC PAIN: A CONTINUOUS ARTERIAL SPIN LABELING STUDY

    PubMed Central

    Frölich, Michael A.; Deshpande, Hrishikesh; Ness, Timothy; Deutsch, Georg

    2012-01-01

    Background The development of arterial spin labeling methods, has allowed measuring regional cerebral blood flow (rCBF) quantitatively and to show the pattern of cerebral activity associated with any state such as a sustained pain state or changes due to a neurotropic drug. Methods We studied the differential effects of three pain conditions in ten healthy subjects on a 3T scanner during resting baseline, heat, cold and ischemic pain using continuous arterial spin labeling. Results Cold pain showed the greatest absolute rCBF increases in left anterior cingulate cortex, left amygdala, left angular gyrus, and Brodmann Area 6, and a significant rCBF decrease in the cerebellum. Changes in rCBF were characteristic of the type of pain condition: cold and heat pain showed increases, while the ischemic condition showed a reduction in mean absolute gray matter flow compared to rest. An association of subjects’ pain tolerance and cerebral blood flow was noted. Conclusions The observation that quantitative rCBF changes are characteristic of the pain task employed and that there is a consistent rCBF change in Brodman area 6, an area responsible for the integration of a motor response to pain, should provide extremely useful information in the quest to develop an imaging biomarker of pain. Conceivably, response in BA6 may serve as an objective measure of analgesic efficacy. PMID:22913924

  14. 5% Lidocaine-medicated plaster for the treatment of chronic peripheral neuropathic pain: complex regional pain syndrome and other neuropathic conditions

    PubMed Central

    Calderón, Enrique; Calderón-Seoane, María Eloísa; García-Hernández, Rafael; Torres, Luis Miguel

    2016-01-01

    Objectives Chronic neuropathic pain and chronic complex regional pain syndrome (CRPS), in particular, are debilitating and difficult-to-treat conditions that have a strong impact on patient’s quality of life. The aim of this study was to evaluate the effectiveness of 5% lidocaine-medicated plaster as add-on therapy in patients with chronic peripheral neuropathic pain conditions, including CRPS. Patients and methods This was a single-center, prospective, observational study set in a specialized pain unit of a tertiary hospital in Spain. A total of 56 patients with long-standing peripheral neuropathic pain, ten of them with CRPS, received 5% lidocaine-medicated plaster as add-on analgesic therapy for 6 months. Results After 6 months of treatment, a ≥50% reduction in pain intensity was attained by 75% of patients, as measured by numeric rating scale (NRS) for pain. The average NRS score was reduced by 61% (4.7 points), from a baseline mean score of 7.8 to an end point mean score of 3.1. Marked improvements were also observed in the CRPS group: six out of ten patients achieved a ≥50% reduction in NRS score, and the average NRS score for patients with CRPS was reduced by 51% (4.0 points), from a baseline mean score of 7.9 to an end point mean score of 3.9. The improvements in pain intensity were partially translated into a decrease in disability index and in anxiety levels. Conclusion 5% Lidocaine-medicated plaster may be useful as add-on therapy for a number of peripheral neuropathic pain conditions, including CRPS. PMID:27785090

  15. 5% Lidocaine-medicated plaster for the treatment of chronic peripheral neuropathic pain: complex regional pain syndrome and other neuropathic conditions.

    PubMed

    Calderón, Enrique; Calderón-Seoane, María Eloísa; García-Hernández, Rafael; Torres, Luis Miguel

    2016-01-01

    Chronic neuropathic pain and chronic complex regional pain syndrome (CRPS), in particular, are debilitating and difficult-to-treat conditions that have a strong impact on patient's quality of life. The aim of this study was to evaluate the effectiveness of 5% lidocaine-medicated plaster as add-on therapy in patients with chronic peripheral neuropathic pain conditions, including CRPS. This was a single-center, prospective, observational study set in a specialized pain unit of a tertiary hospital in Spain. A total of 56 patients with long-standing peripheral neuropathic pain, ten of them with CRPS, received 5% lidocaine-medicated plaster as add-on analgesic therapy for 6 months. After 6 months of treatment, a ≥50% reduction in pain intensity was attained by 75% of patients, as measured by numeric rating scale (NRS) for pain. The average NRS score was reduced by 61% (4.7 points), from a baseline mean score of 7.8 to an end point mean score of 3.1. Marked improvements were also observed in the CRPS group: six out of ten patients achieved a ≥50% reduction in NRS score, and the average NRS score for patients with CRPS was reduced by 51% (4.0 points), from a baseline mean score of 7.9 to an end point mean score of 3.9. The improvements in pain intensity were partially translated into a decrease in disability index and in anxiety levels. 5% Lidocaine-medicated plaster may be useful as add-on therapy for a number of peripheral neuropathic pain conditions, including CRPS.

  16. Early life stress affects limited regional brain activity in depression

    PubMed Central

    Du, Lian; Wang, Jingjie; Meng, Ben; Yong, Na; Yang, Xiangying; Huang, Qingling; Zhang, Yan; Yang, Lingling; Qu, Yuan; Chen, Zhu; Li, Yongmei; Lv, Fajin; Hu, Hua

    2016-01-01

    Early life stress (ELS) can alter brain function and increases the risk of major depressive disorder (MDD) in later life. This study investigated whether ELS contributes to differences in regional brain activity between MDD patients and healthy controls (HC), as measured by amplitude of low-frequency fluctuation (ALFF)/fractional (f)ALFF. Eighteen first-episode, treatment-naïve MDD patients and HC were assessed with the Childhood Trauma Questionnaire and resting-state functional magnetic resonance imaging. We compared ALFF/fALFF between MDD patients and HC, with or without controlling for ELS, and determined whether ELS level was correlated with regional brain activity in each group. After regressing out ELS, we found that ALFF increased in bilateral amygdala and left orbital/cerebellum, while fALFF decreased in left inferior temporal and right middle frontal gyri in MDD patients relative to controls. ELS positively correlated with regional activity in the left cerebellum in MDD and in the right post-central/inferior temporal/superior frontal cingulate, inferior frontal gyrus and bilateral cerebellum in HC. Our findings indicate that there is only very limited region showing correlation between ELS and brain activity in MDD, while diverse areas in HC, suggesting ELS has few impacts on MDD patients. PMID:27138376

  17. Factors affecting regional changes in hardwood lumber production

    Treesearch

    William G. Luppold; Gilbert P. Dempsey; Gilbert P. Dempsey

    1994-01-01

    Hardwood lumber production increased by nearly 1.8 billion board feet between 1986 and 1990 and decreased sharply in 1991. However, not all areas of the country experienced the same growth in hardwood lumber production during the 1980s. While lumber production in inland regions of the eastern United States and the west increased during the 1980s, lumber output in...

  18. Early life stress affects limited regional brain activity in depression.

    PubMed

    Du, Lian; Wang, Jingjie; Meng, Ben; Yong, Na; Yang, Xiangying; Huang, Qingling; Zhang, Yan; Yang, Lingling; Qu, Yuan; Chen, Zhu; Li, Yongmei; Lv, Fajin; Hu, Hua

    2016-05-03

    Early life stress (ELS) can alter brain function and increases the risk of major depressive disorder (MDD) in later life. This study investigated whether ELS contributes to differences in regional brain activity between MDD patients and healthy controls (HC), as measured by amplitude of low-frequency fluctuation (ALFF)/fractional (f)ALFF. Eighteen first-episode, treatment-naïve MDD patients and HC were assessed with the Childhood Trauma Questionnaire and resting-state functional magnetic resonance imaging. We compared ALFF/fALFF between MDD patients and HC, with or without controlling for ELS, and determined whether ELS level was correlated with regional brain activity in each group. After regressing out ELS, we found that ALFF increased in bilateral amygdala and left orbital/cerebellum, while fALFF decreased in left inferior temporal and right middle frontal gyri in MDD patients relative to controls. ELS positively correlated with regional activity in the left cerebellum in MDD and in the right post-central/inferior temporal/superior frontal cingulate, inferior frontal gyrus and bilateral cerebellum in HC. Our findings indicate that there is only very limited region showing correlation between ELS and brain activity in MDD, while diverse areas in HC, suggesting ELS has few impacts on MDD patients.

  19. Prescription coverage in indigent patients affects the use of long-acting opiates in the management of cancer pain

    PubMed Central

    Wieder, Robert; DeLaRosa, Nila; Bryan, Margarette; Hill, Ann Marie; Amadio, William J.

    2013-01-01

    Purpose We tested the hypothesis that prescription coverage affects the prescribing of long-acting opiates to indigent inner city minority patients with cancer pain. Materials and Methods We conducted a chart review of 360 patients treated in the Oncology Practice at UMDNJ-University Hospital, who were prescribed opiate pain medications. Half the patients were Charity Care or Self Pay (CC/SP), without the benefit of prescription coverage, and half had Medicaid, with unlimited prescription coverage. We evaluated patients discharged from a hospitalization, who had three subsequent outpatient follow up visits. We compared demographics, pain intensity, the type and dose of opiates, adherence to prescribed pain regimen, unscheduled Emergency Department (ED) visits and unscheduled hospitalizations. Results There was a significantly greater use of long-acting opiates in the Medicaid group than in the CC/SP group. The Medicaid group had significantly more African American patients and a greater rate of smoking and substance use and the CC/SP group disproportionately more Hispanic and Asian patients and less smoking and substance use. Hispanic and Asian patients were less likely to have long-acting opiates prescribed to them. Pain levels and adherence were equivalent in both groups and were not affected by any of these variables except stage of disease, which was equally distributed in the two groups. Conclusion Appropriate use of long-acting opiates for equivalent levels of cancer pain are influenced only by the availability of prescription coverage. The group without prescription coverage and receiving fewer long-acting opiates had disproportionately more Hispanic and Asian patients. PMID:24106748

  20. Prescription coverage in indigent patients affects the use of long-acting opioids in the management of cancer pain.

    PubMed

    Wieder, Robert; Delarosa, Nila; Bryan, Margarette; Hill, Ann Marie; Amadio, William J

    2014-01-01

    We tested the hypothesis that prescription coverage affects the prescribing of long-acting opiates to indigent inner city minority patients with cancer pain. We conducted a chart review of 360 patients treated in the Oncology Practice at University of Medicine and Dentistry of New Jersey University Hospital, who were prescribed opiate pain medications. Half the patients were charity care or self-pay (CC/SP), without the benefit of prescription coverage, and half had Medicaid, with unlimited prescription coverage. We evaluated patients discharged from a hospitalization, who had three subsequent outpatient follow-up visits. We compared demographics, pain intensity, the type and dose of opiates, adherence to prescribed pain regimen, unscheduled emergency department visits, and unscheduled hospitalizations. There was a significantly greater use of long-acting opiates in the Medicaid group than in the CC/SP group. The Medicaid group had significantly more African American patients and a greater rate of smoking and substance use, and the CC/SP group disproportionately more Hispanic and Asian patients and less smoking and substance use. Hispanic and Asian patients were less likely to have long-acting opiates prescribed to them. Pain levels and adherence were equivalent in both groups and were not affected by any of these variables except stage of disease, which was equally distributed in the two groups. Appropriate use of long-acting opiates for equivalent levels of cancer pain was influenced only by the availability of prescription coverage. The group without prescription coverage and receiving fewer long-acting opiates had disproportionately more Hispanic and Asian patients. Wiley Periodicals, Inc.

  1. [Chronic pain : Perception, reward and neural processing].

    PubMed

    Becker, S; Diers, M

    2016-10-01

    Many chronic pain syndromes are characterized by enhanced perception of painful stimuli as well as alterations in cortical processing in sensory and motor regions. In this review article the alterations in muscle pain and neuropathic pain are described. Alterations in patients with fibromyalgia and chronic back pain are described as examples for musculoskeletal pain and also in patients with phantom limb pain after amputation and complex regional pain syndrome as examples for neuropathic pain. In addition to altered pain perception, cumulative evidence on alterations in the processing of reward and the underlying mechanisms in chronic pain has been described. A description is given of what is known on how pain and reward interact and affect each other. The relevance of such interactions for chronic pain is discussed. The implications of these findings for therapeutic approaches are delineated with respect to sensorimotor training and behavioral therapy, focusing on the effectiveness of these approaches, mechanisms and future developments. In particular, we discuss operant behavioral therapy in patients with chronic back pain and fibromyalgia as well as prosthesis training in patients with phantom limb pain and discrimination, mirror and imaginary training in patients with phantom limb pain and complex regional pain syndrome. With respect to the processing of reward, the focus of the discussion is on the role of reward and associated learning in pain therapy.

  2. Proteomic Identification of Altered Cerebral Proteins in the Complex Regional Pain Syndrome Animal Model

    PubMed Central

    Nahm, Francis Sahngun; Park, Zee-Yong; Kim, Yong Chul

    2014-01-01

    Background. Complex regional pain syndrome (CRPS) is a rare but debilitating pain disorder. Although the exact pathophysiology of CRPS is not fully understood, central and peripheral mechanisms might be involved in the development of this disorder. To reveal the central mechanism of CRPS, we conducted a proteomic analysis of rat cerebrum using the chronic postischemia pain (CPIP) model, a novel experimental model of CRPS. Materials and Methods. After generating the CPIP animal model, we performed a proteomic analysis of the rat cerebrum using a multidimensional protein identification technology, and screened the proteins differentially expressed between the CPIP and control groups. Results. A total of 155 proteins were differentially expressed between the CPIP and control groups: 125 increased and 30 decreased; expressions of proteins related to cell signaling, synaptic plasticity, regulation of cell proliferation, and cytoskeletal formation were increased in the CPIP group. However, proenkephalin A, cereblon, and neuroserpin were decreased in CPIP group. Conclusion. Altered expression of cerebral proteins in the CPIP model indicates cerebral involvement in the pathogenesis of CRPS. Further study is required to elucidate the roles of these proteins in the development and maintenance of CRPS. PMID:25313364

  3. The clinical relevance of complex regional pain syndrome type I: The Emperor's New Clothes.

    PubMed

    Borchers, Andrea T; Gershwin, M Eric

    2017-01-01

    The management of patients with chronic pain is a nearly daily challenge to rheumatologists, neurologists, orthopedic surgeons, pain specialists and indeed a issue in nearly every clinical practice. Among the myriad of causes of pain are often included a unique syndrome, generally referred to as complex regional pain syndrome type I (CRPS). Unfortunately CRPS I has become a catch all phase and there are serious questions on whether it exists at all; this has led to an extraordinary number of poorly defined diagnostic criteria. It has also led to an etiologic quagmire that includes features as diverse as autoimmunity to simple trauma. These, in turn, have led to overdiagnosis and often overzealous use of pain medications, including narcotics. In a previous paper, we raised the issue of whether CRPS type I reflected a valid diagnosis. Indeed, the diagnostic criteria for CRPS I, and therefore the diagnosis itself, is unreliable for a number of reasons: 1) the underlying pathophysiology of the signs and symptoms of CPRS I are not biologically plausible; 2) there are no consistent laboratory or imaging testing available; 3) the signs and symptoms fluctuate over time without a medical explanation; 4) the definitions of most studies are derived from statistical analysis with little consideration to required sample size, i.e. power calculations; 5) interobserver reliability in the assessment of the signs and symptoms are often only fair to moderate, and agreement on the diagnosis of "CRPS I" is poor. Even physicians who still believe in the concept of "CRPS I" admit that it is vastly overdiagnosed and has become a diagnosis of last resort, often without a complete differential diagnosis and an alternative explanation. Finally, one of the most convincing arguments that there is no clinical entity as "CRPS I" comes from the enormous heterogeneity in sign and symptom profiles and the heterogeneity of pathophysiological mechanisms postulated. This observation is underscored by

  4. NATURAL AND ATHROPOGENIC FACTORS AFFECTING GLOBAL AND REGIONAL CLIMATE

    EPA Science Inventory

    New England weather is highly variable for a number of
    reasons. Our regional climate is also quite variable. The
    winters of the past decade are milder than they were in the
    1960s and 1970s but as the ice-out and snowfall data show
    (Figs 2.5 and 2.6), the patterns of c...

  5. NATURAL AND ATHROPOGENIC FACTORS AFFECTING GLOBAL AND REGIONAL CLIMATE

    EPA Science Inventory

    New England weather is highly variable for a number of
    reasons. Our regional climate is also quite variable. The
    winters of the past decade are milder than they were in the
    1960s and 1970s but as the ice-out and snowfall data show
    (Figs 2.5 and 2.6), the patterns of c...

  6. Pain processing in four regions of human cingulate cortex localized with co-registered PET and MR imaging.

    PubMed

    Vogt, B A; Derbyshire, S; Jones, A K

    1996-07-01

    Neurosurgical and positron emission tomography (PET) human studies and animal electrophysiological studies show that part of the anterior cingulate cortex (ACC) is nociceptive. Since the contribution of the ACC to pain processing is poorly understood, this study employed PET and magnetic resonance (MR) image co-registration in grouped and individual cases to locate regions of altered relative regional cerebral blood flow (rCBF). Seven right-handed, neurologically intact males were subjects; each received neuropsychological and pain threshold testing. Subjects were scanned during infusion of H2[15O]: four randomized scans during innocuous heat stimulation to the back of the left hand and four scans during noxious but bearable heat to the same place. The averaged rCBF values during innocuous stimuli were subtracted from those during noxious stimuli and statistical parametric maps (SPMs) for the group were computed to identify regions of altered relative rCBF. Finally, single-subject PET images of elevated and reduced rCBF were co-registered with MR images and projected onto reconstructions of the medial surface of the hemisphere. The SPM analysis of the group showed one site with elevated rCBF in the midcingulate cortex and one in the perigenual cortex predominantly contralateral to the side of stimulation. There were bilateral sites of reduced rCBF in the cingulofrontal transitional cortex and in the posterior cingulate cortex (PCC). Co-registered PET and MR images for individuals showed that only one case had a single, large region of elevated rCBF, while the others had a number of smaller regions. Six cases had at least one significant elevation of rCBF in the right hemisphere that primarily involved area 24b'; five of these cases also had an elevation in area 32', while the seventh case had elevated rCBF in these areas in the left hemisphere. The rostral site of elevated rCBF in the group was at the border of areas 24/24' and areas 32/32' although most cases had

  7. Inorganic arsenic exposure affects pain behavior and inflammatory response in rat

    SciTech Connect

    Aguirre-Banuelos, Patricia; Escudero-Lourdes, Claudia; Sanchez-Pena, Luz Carmen; Del Razo, Luz Maria; Perez-Urizar, Jose

    2008-06-15

    Inorganic arsenic (iAs) contamination of drinking water is a worldwide problem associated with an increased risk for the development of various types of cancer and noncancerous damage. In vitro studies have suggested that iAs can modulate the activity of macrophages producing an over-expression of cyclooxygenase-2 (COX-2) and resulting in an increase in prostaglandin E{sub 2} (PGE{sub 2}) concentrations in endothelial cells. These effects may lead to an in vivo enhancement of inflammatory and pain responses. Our aim was to determine the effect of a single dose of arsenic or subchronic exposure to arsenic on pain behavior and tissue inflammation in rats. Rats were given a single dose of sodium arsenite (0.1, 1 and 10 mg/kg i.p.) or submitted to subchronic exposure to arsenic added to the drinking water for 4 weeks (0.1, 1, 10 and 100 ppm). Inflammatory pain was assessed by using the formalin and tail-flick tests, while inflammation was evaluated with the carrageenan model. Arsenite did not induce pain or significant inflammation by itself. In contrast, arsenite in both single dose administration and subchronic exposure increased not only the inflammatory process and the underlying hyperalgesic pain, but also induced a decrease in the pain threshold. Alterations in pain processing were dependent on the arsenic dose and the length of exposure, and the underlying mechanism involved an increased release of local PGE{sub 2}. These results suggest that inorganic arsenic exposure enhances pain perception and exacerbates the pathological state of inflammatory diseases.

  8. Sensory signs in complex regional pain syndrome and peripheral nerve injury.

    PubMed

    Gierthmühlen, Janne; Maier, Christoph; Baron, Ralf; Tölle, Thomas; Treede, Rolf-Detlef; Birbaumer, Niels; Huge, Volker; Koroschetz, Jana; Krumova, Elena K; Lauchart, Meike; Maihöfner, Christian; Richter, Helmut; Westermann, Andrea

    2012-04-01

    This study determined patterns of sensory signs in complex regional pain syndrome (CRPS) type I and II and peripheral nerve injury (PNI). Patients with upper-limb CRPS-I (n=298), CRPS-II (n=46), and PNI (n=72) were examined with quantitative sensory testing according to the protocol of the German Research Network on Neuropathic Pain. The majority of patients (66%-69%) exhibited a combination of sensory loss and gain. Patients with CRPS-I had more sensory gain (heat and pressure pain) and less sensory loss than patients with PNI (thermal and mechanical detection, hypoalgesia to heat or pinprick). CRPS-II patients shared features of CRPS-I and PNI. CRPS-I and CRPS-II had almost identical somatosensory profiles, with the exception of a stronger loss of mechanical detection in CRPS-II. In CRPS-I and -II, cold hyperalgesia/allodynia (28%-31%) and dynamic mechanical allodynia (24%-28%) were less frequent than heat or pressure hyperalgesia (36%-44%, 67%-73%), and mechanical hypoesthesia (31%-55%) was more frequent than thermal hypoesthesia (30%-44%). About 82% of PNI patients had at least one type of sensory gain. QST demonstrates more sensory loss in CRPS-I than hitherto considered, suggesting either minimal nerve injury or central inhibition. Sensory profiles suggest that CRPS-I and CRPS-II may represent one disease continuum. However, in contrast to recent suggestions, small fiber deficits were less frequent than large fiber deficits. Sensory gain is highly prevalent in PNI, indicating a better similarity of animal models to human patients than previously thought. These sensory profiles should help prioritize approaches for translation between animal and human research. Copyright © 2011 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

  9. A day-hospital approach to treatment of pediatric complex regional pain syndrome: initial functional outcomes.

    PubMed

    Logan, Deirdre E; Carpino, Elizabeth A; Chiang, Gloria; Condon, Marianne; Firn, Emily; Gaughan, Veronica J; Hogan, Melinda; Leslie, David S; Olson, Katie; Sager, Susan; Sethna, Navil; Simons, Laura E; Zurakowski, David; Berde, Charles B

    2012-01-01

    To examine clinical outcomes of an interdisciplinary day-hospital treatment program (comprised of physical, occupational, and cognitive-behavioral therapies with medical and nursing services) for pediatric complex regional pain syndrome (CRPS). The study is a longitudinal case series of consecutive patients treated in a day-hospital pediatric pain rehabilitation program. Participants were 56 children and adolescents with ages 8 to 18 years (median=14 y) with CRPS spectrum conditions who failed to progress sufficiently with a previous outpatient and/or inpatient treatments. Patients participated in daily physical therapy, occupational therapy, and psychological treatment and received nursing and medical care as necessary. The model places equal emphasis on physical and cognitive-behavioral approaches to pain management. Median duration of stay was 3 weeks. Outcome measures included assessments of physical, occupational, and psychological functioning at program admission, discharge, and at posttreatment follow-up at a median of 10 months after discharge. Scores at discharge and follow-up were compared with measures on admission by Wilcoxon tests, paired t tests, or analysis of variance as appropriate, with corrections for multiple comparisons. Outcomes demonstrate clinically and statistically significant improvements from admission to discharge in pain intensity (P<0.001), functional disability (P<0.001), subjective report of limb function (P<0.001), timed running (P<0.001), occupational performance (P<0.001), medication use (P<0.01), use of assistive devices (P<0.001), and emotional functioning (anxiety, P<0.001; depression, P<0.01). Functional gains were maintained or further improved at follow-up. A day-hospital interdisciplinary rehabilitation approach seems effective in reducing disability and improving physical and emotional functioning and occupational performance among children and adolescents with CRPSs that have failed to improve with outpatient treatment.

  10. Regional anaesthesia to improve pain outcomes in paediatric surgical patients: a qualitative systematic review of randomized controlled trials.

    PubMed

    Suresh, S; Schaldenbrand, K; Wallis, B; De Oliveira, G S

    2014-09-01

    Summary The development of analgesic interventions in paediatric surgical patients is often limited by the inherent difficulties of conducting large randomized clinical trials to test interventions in those patients. Regional anaesthesia is a valid strategy to improve postoperative pain in the adult surgical population, but the effects of regional anaesthesia on postoperative pain outcomes in paediatric patients are currently not well defined. The main objective of the current review was to systematically evaluate the use of regional anaesthesia techniques to minimize postoperative pain in paediatric patients. A systematic search was performed to identify randomized controlled trials that evaluated the effects of the regional anaesthesia techniques on postoperative pain outcomes in paediatric surgical patients' procedures. Seventy-three studies on 5125 paediatric patients were evaluated. Only few surgical procedures had more than one small randomized controlled trial favouring the use of regional anaesthesia to minimize postoperative pain (ophthalmological surgery, cleft lip repair, inguinal hernia, and urological procedures). Additional evidence is required to support the use of specific regional anaesthesia techniques to improve postoperative pain for several surgical procedures (craniectomy, adenotonsillectomy, appendectomy, cardiac surgery, umbilical hernia repair, upper and lower extremity) in paediatric patients. Currently, only a very limited number of regional anaesthesia techniques have demonstrated significant improvement on postoperative pain outcomes for a restricted number of surgical procedures. More studies are needed in order to establish regional anaesthesia as a valid strategy to improve analgesia in the paediatric surgical population. © The Author 2014. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  11. Laser-evoked potentials correlate with clinical evolution in a case of spontaneous and recurrent complex regional pain syndrome type I.

    PubMed

    Moreau, Valérie; Berquin, Anne D; Plaghki, Leon

    2007-05-01

    We describe a case of spontaneous complex regional pain syndrome developing first in the left arm and 2 years later in the right foot of a 14-year-old girl. Physical examination showed abnormalities in tactile and thermal sensitivity. Laser-evoked potentials (LEPs) after stimulation of the affected right foot were absent in the acute phase and then progressively recovered over a period of 5 months, in correlation with clinical changes. To our knowledge, no systematic analysis of LEPs in complex regional pain syndrome has been published. We suggest that the observed electrophysiologic alterations could result from a temporary dysfunction of attentional systems, which are assumed to contribute greatly to the LEPs vertex complex. Further studies are needed to test this hypothesis.

  12. Selection against tandem splice sites affecting structured protein regions.

    PubMed

    Hiller, Michael; Szafranski, Karol; Huse, Klaus; Backofen, Rolf; Platzer, Matthias

    2008-03-21

    Alternative selection of splice sites in tandem donors and acceptors is a major mode of alternative splicing. Here, we analyzed whether in-frame tandem sites leading to subtle mRNA insertions/deletions of 3, 6, or 9 nucleotides are under natural selection. We found multiple lines of evidence that the human protein coding sequences are under selection against such in-frame tandem splice events, indicating that these events are often deleterious. The strength of selection is not homogeneous within the coding sequence as protein regions that fold into a fixed 3D structure (intrinsically ordered) are under stronger selection, especially against sites with a strong minor splice site. Investigating structures of functional protein domains, we found that tandem acceptors are preferentially located at the domain surface and outside structural elements such as helices and sheets. Using three-species comparisons, we estimate that more than half of all mutations that create NAGNAG acceptors in the coding region have been eliminated by selection. We estimate that ~2,400 introns are under selection against possessing a tandem site.

  13. Regional differences in lumbar spinal posture and the influence of low back pain

    PubMed Central

    Mitchell, Tim; O'Sullivan, Peter B; Burnett, Angus F; Straker, Leon; Smith, Anne

    2008-01-01

    Background Spinal posture is commonly a focus in the assessment and clinical management of low back pain (LBP) patients. However, the link between spinal posture and LBP is not fully understood. Recent evidence suggests that considering regional, rather than total lumbar spine posture is important. The purpose of this study was to determine; if there are regional differences in habitual lumbar spine posture and movement, and if these findings are influenced by LBP. Methods One hundred and seventy female undergraduate nursing students, with and without LBP, participated in this cross-sectional study. Lower lumbar (LLx), Upper lumbar (ULx) and total lumbar (TLx) spine angles were measured using an electromagnetic tracking system in static postures and across a range of functional tasks. Results Regional differences in lumbar posture and movement were found. Mean LLx posture did not correlate with ULx posture in sitting (r = 0.036, p = 0.638), but showed a moderate inverse correlation with ULx posture in usual standing (r = -0.505, p < 0.001). Regional differences in range of motion from reference postures in sitting and standing were evident. BMI accounted for regional differences found in all sitting and some standing measures. LBP was not associated with differences in regional lumbar spine angles or range of motion, with the exception of maximal backward bending range of motion (F = 5.18, p = 0.007). Conclusion This study supports the concept of regional differences within the lumbar spine during common postures and movements. Global lumbar spine kinematics do not reflect regional lumbar spine kinematics, which has implications for interpretation of measures of spinal posture, motion and loading. BMI influenced regional lumbar posture and movement, possibly representing adaptation due to load. PMID:19014712

  14. Regional differences in lumbar spinal posture and the influence of low back pain.

    PubMed

    Mitchell, Tim; O'Sullivan, Peter B; Burnett, Angus F; Straker, Leon; Smith, Anne

    2008-11-18

    Spinal posture is commonly a focus in the assessment and clinical management of low back pain (LBP) patients. However, the link between spinal posture and LBP is not fully understood. Recent evidence suggests that considering regional, rather than total lumbar spine posture is important. The purpose of this study was to determine; if there are regional differences in habitual lumbar spine posture and movement, and if these findings are influenced by LBP. One hundred and seventy female undergraduate nursing students, with and without LBP, participated in this cross-sectional study. Lower lumbar (LLx), Upper lumbar (ULx) and total lumbar (TLx) spine angles were measured using an electromagnetic tracking system in static postures and across a range of functional tasks. Regional differences in lumbar posture and movement were found. Mean LLx posture did not correlate with ULx posture in sitting (r = 0.036, p = 0.638), but showed a moderate inverse correlation with ULx posture in usual standing (r = -0.505, p < 0.001). Regional differences in range of motion from reference postures in sitting and standing were evident. BMI accounted for regional differences found in all sitting and some standing measures. LBP was not associated with differences in regional lumbar spine angles or range of motion, with the exception of maximal backward bending range of motion (F = 5.18, p = 0.007). This study supports the concept of regional differences within the lumbar spine during common postures and movements. Global lumbar spine kinematics do not reflect regional lumbar spine kinematics, which has implications for interpretation of measures of spinal posture, motion and loading. BMI influenced regional lumbar posture and movement, possibly representing adaptation due to load.

  15. How do emission patterns in megacities affect regional air pollution?

    NASA Astrophysics Data System (ADS)

    Heil, A.; Richter, C.; Schroeder, S.; Schultz, M. G.

    2010-12-01

    Megacities around the world show distinctly different emission patterns in terms of absolute amounts and emission ratios of individual chemical compounds due to varying socio-economic developments and technological standards. The emission patterns influence the chemical reactivity of the urban pollution plume, and hence determine air quality in and around megacity areas. In this study, which is part of the European project CITYZEN (megaCITY - Zoom for the ENvironment), the effects of emission changes in four selected megacity areas on air pollution were investigated: BeNeLux (BNL), Istanbul (IST), Pearl River Delta (PRD) and Sao Paulo (SAP). The study aims at answering the question: how would air pollution in megacity X change if it had the same urban emissions per capita as megacity Y? Model simulations with the global chemistry climate model ECHAM5-MOZ were carried out for the year 2001 using a resolution of about 2 degrees in the horizontal and of 31 levels (surface to 10 hPa) in the vertical. The model was driven by meteorological input data from the ECMWF ERA Interim reanalysis. Emissions were taken from the gridded global ACCMIP emission inventory recently established for use in chemistry-climate simulations in connection to the IPCC-AR5 assessments (Lamarque et al. 2010). We carried out sensitivity simulations where emission patterns from each of the megacity areas were replaced by those from all others. This was done on the basis of the per capita emissions for each species and sector averaged over the respective region. Total per capita CO and NMVOC emissions are highest in PRD and lowest in SAP while total per capita NOx emissions are highest in BNL and lowest in SAP. There are strong differences in the relative contribution of the urban sectors to total emissions of individual compounds. As a result, each of the four megacity areas exhibits a very characteristic NMVOC speciation profile which determines the NMVOC-related photochemical ozone (O_3

  16. Complex regional pain syndrome type i. An analysis of 7 cases in children.

    PubMed

    Pedemonte Stalla, V; Medici Olaso, C; Kanopa Almada, V; Gonzalez Rabelino, G

    2015-01-01

    Complex regional pain syndrome (CRPS) is characterised by the presence of pain accompanied by sensory, autonomic and motor symptoms, usually preceded by a lesion or immobilisation. The clinical course is disproportionate to the initial injury in intensity and in duration. Its distribution is regional, predominantly in limbs. It is classified as type I and type II according to the absence or presence of nerve injury. We present the cases of seven children, 6 girls and 1 boy, aged 7 to 15 years. Three had a history of previous trauma. In 5 cases, the symptoms were located in the lower limbs. Time to diagnosis was between 4 and 90 days. Three patients had clinical features of anxiety and depression. Imaging and immunological studies were performed to rule out differential diagnoses in all the children. Interdisciplinary treatment was performed with physiotherapy, psychotherapy, and gabapentin or pregabalin. All patients had a good clinical outcome, with no relapses in the follow-up period (between 4 and 30 months). CRPS is frequently unrecognised in children, leading to family anxiety and unnecessary para-clinical costs. Paediatricians and paediatric neurologists should be aware of this syndrome in order to avoid delay in diagnosis, unnecessary studies, and multiple visits to specialists, with a view to providing effective treatment. Copyright © 2013 Sociedad Española de Neurología. Published by Elsevier España, S.L.U. All rights reserved.

  17. Insect prey characteristics affecting regional variation in chimpanzee tool use.

    PubMed

    Sanz, Crickette M; Deblauwe, Isra; Tagg, Nikki; Morgan, David B

    2014-06-01

    It is an ongoing interdisciplinary pursuit to identify the factors shaping the emergence and maintenance of tool technology. Field studies of several primate taxa have shown that tool using behaviors vary within and between populations. While similarity in tools over spatial and temporal scales may be the product of socially learned skills, it may also reflect adoption of convergent strategies that are tailored to specific prey features. Much has been claimed about regional variation in chimpanzee tool use, with little attention to the ecological circumstances that may have shaped such differences. This study examines chimpanzee tool use in termite gathering to evaluate the extent to which the behavior of insect prey may dictate chimpanzee technology. More specifically, we conducted a systematic comparison of chimpanzee tool use and termite prey between the Goualougo Triangle in the Republic of Congo and the La Belgique research site in southeast Cameroon. Apes at both of these sites are known to use tool sets to gather several species of termites. We collected insect specimens and measured the characteristics of their nests. Associated chimpanzee tool assemblages were documented at both sites and video recordings were conducted in the Goualougo Triangle. Although Macrotermitinae assemblages were identical, we found differences in the tools used to gather these termites. Based on measurements of the chimpanzee tools and termite nests at each site, we concluded that some characteristics of chimpanzee tools were directly related to termite nest structure. While there is a certain degree of uniformity within approaches to particular tool tasks across the species range, some aspects of regional variation in hominoid technology are likely adaptations to subtle environmental differences between populations or groups. Such microecological differences between sites do not negate the possibility of cultural transmission, as social learning may be required to transmit

  18. The social and political forces affecting prescribing practices for chronic pain.

    PubMed

    Fontana, Joyce S

    2008-01-01

    Very little attention has been given to chronic nonmalignant pain in the nursing literature. Although there has been increasing debate concerning prescribing practices among physicians for patients with chronic nonmalignant pain, little, if any, understanding exists about advanced practice registered nurses (APRNs) in this context. This study critically examined subjective factors that influence the prescribing practices of APRNs for patients with chronic nonmalignant pain. It was grounded in the critical tradition of Habermas as well as the emancipatory theory of Freire and used a critical methodology. Data were collected through semistructured interviews with participating APRNs. Dialectical analysis and critique were used to interpret the interviews. Critical analysis of the data revealed that prescribing decisions for patients with chronic pain were characterized by a conflict of interests in which the patients' best interests were given a low priority. This conflict, which is socially and politically created and maintained, renders these nurses unlikely to fulfill their ethical responsibility to patients. Teaching basic pain management as an ethical responsibility of practice in graduate education is a first step toward ending the conflict and ensuring that the patients' best interests are addressed.

  19. The use of “stabilization exercises” to affect neuromuscular control in the lumbopelvic region: a narrative review

    PubMed Central

    Bruno, Paul

    2014-01-01

    It is well-established that the coordination of muscular activity in the lumbopelvic region is vital to the generation of mechanical spinal stability. Several models illustrating mechanisms by which dysfunctional neuromuscular control strategies may serve as a cause and/or effect of low back pain have been described in the literature. The term “core stability” is variously used by clinicians and researchers, and this variety has led to several rehabilitative approaches suggested to affect the neuromuscular control strategies of the lumbopelvic region (e.g. “stabilization exercise”, “motor control exercise”). This narrative review will highlight: 1) the ongoing debate in the clinical and research communities regarding the terms “core stability” and “stabilization exercise”, 2) the importance of sub-grouping in identifying those patients most likely to benefit from such therapeutic interventions, and 3) two protocols that can assist clinicians in this process. PMID:24932016

  20. Complex regional pain syndrome: medical and legal ramifications of clinical variability and experience and perspective of a practicing clinician

    PubMed Central

    Lazaro, RP

    2017-01-01

    Objective The aim of this study was to demonstrate the ramifications of clinical variability of complex regional pain syndrome (CRPS) and how they can affect the various aspects of this condition, favorably or unfavorably, for both patients and participating medical and legal professionals. Methods Twelve patients diagnosed with CRPS at different times in the past 25 years were followed up, and their signs and symptoms were reviewed for variability. None had preexisting or ongoing medical disorders and prior injury to the peripheral nerves or musculoskeletal tissues. None had been involved in litigation. Physical traumas that triggered CRPS were job-related, vehicular accidents, and personal injuries. The presence of vasomotor symptoms (eg, swelling, skin discoloration, and temperature changes) and allodynia in the affected extremity was the basis for clinical diagnosis in all the patients. The need for imaging studies was precluded in some patients owing to the presence of vasomotor symptoms, which either fluctuated or were steady. Seven of the patients had type 1 CRPS, and five patients had type 2 CRPS. Results Most patients encountered delay in diagnosis and treatment and legal obstacles owing to the lack of “typical” objective signs of CRPS. The patients’ symptoms fluctuated at different times of the day. Eight patients experienced spread of vasomotor symptoms and varying degree of allodynia in the opposite extremity. One patient, who developed signs and symptoms of rheumatoid arthritis, 2 months after the injury, continued to have CRPS symptoms in the injured hand. Treatment modalities administered in all the patients were essentially ineffective. All the patients, except one, were unable to return to their original line of work, and their symptoms persisted regardless of the outcome of their legal claims. Conclusion It is likely that patients who continue to complain of pain and vasomotor symptoms followed by a physical injury have CRPS. The complex

  1. Causes, Coping, and Culture: A Comparative Survey Study on Representation of Back Pain in Three Swiss Language Regions

    PubMed Central

    Schulz, Peter J.; Hartung, Uwe; Riva, Silvia

    2013-01-01

    Introduction This study intends to contribute to a research tradition that asks how causal attributions of illnesses affect coping behavior. Causal attributions are understood as the most important element of illness representations and coping as a means to preserve quality of life. The issue is applied to a condition so far often neglected in research on illness representations–back pain–and a third concept is added to the picture: culture. Aim The aim of this study is (a) to explore the causal factors to which persons with back pain attribute the further course of their illness, (b) to find out whether the attributed causes are predictors of coping maxims, and (c) to find out whether cultural factors affect attributions and coping and moderate the relationship between the two. Methods A total of 1259 gainfully employed or self-employed persons with recent episodes of back pain were recruited in the three language regions of Switzerland. They were asked to complete a structured online interview, measuring among many other variables attributed causes, coping maxims, and affiliation to one of the Swiss micro-cultures (German-, French- or Italian-speaking). Results Attributed causes of the illness that can be influenced by a patient go along with more active coping styles. Cultural affiliation impacts on coping maxims independently, but culture moderates the relationship of attributed causes and coping maxims only in two of twenty possible cases. Implications The results show that cultural differences can be analytically incorporated in the models of illness representations. Results may help to improve healthcare providers’ communication with patients and plan public health campaigns. The approach to micro-cultural differences and the substantive relationships between alterability of causes and activity in coping may help the further development of models of illness representations. PMID:24223756

  2. Jellyfish and other cnidarian envenomations cause pain by affecting TRPV1 channels

    PubMed Central

    Cuypers, Eva; Yanagihara, Angel; Karlsson, Evert; Tytgat, Jan

    2007-01-01

    Cnidarian envenomations cause a burning-pain sensation of which the underlying mechanisms are unknown. Activation of TRPV1, a non-selective cation channel expressed in nociceptive neurons, leads to cell depolarisation and pain. Here, we show in vitro and in vivo evidence for desensitization-dependent TRPV1 activation in cnidarian envenomations. Cnidarian venom induced a nociceptive reactivity, comparable to capsaicin, in laboratory rats, which could be reduced by the selective TRPV1 antagonist, BCTC. These findings are the first to explain at least part of the symptomology of cnidarian envenomations and provide insights into the design of more effective treatments for this global public health problem. PMID:17010344

  3. An investigation of flow regimes affecting the Mexico City region

    SciTech Connect

    Bossert, J.E.

    1995-05-01

    The Mexico City region is well-known to the meteorological community for its overwhelming air pollution problem. Several factors contribute to this predicament, namely, the 20 million people and vast amount of industry within the city. The unique geographical setting of the basin encompassing Mexico City also plays an important role. This basin covers approximately 5000 km{sup 2} of the Mexican Plateau at an average elevation of 2250 m above sea level (asl) and is surrounded on three sides by mountains averaging over 3500 m asl, with peaks over 5000 m asl. Only to the north is their a significant opening in the mountainous terrain. Mexico City sprawls over 1000 km{sup 2} in the southwestern portion of the basin. In recent years, several major research programs have been undertaken to investigate the air quality problem within Mexico City. One of these, the Mexico City Air Quality Research Initiative (MARI), conducted in 1990--1993, was a cooperative study between researchers at Los Alamos National Laboratory and the Mexican Petroleum Institute. As part of this study, a field campaign was initiated in February 1991 during which numerous surface, upper air, aircraft, and LIDAR measurements were taken. Much of the work to date has focused upon defining and simulating the local meteorological conditions that are important for understanding the complex photochemistry occurring within the confines of the city. It seems reasonable to postulate, however, that flow systems originating outside of the Mexico City basin will influence conditions within the city much of the time.

  4. Oral administration of the p38α MAPK inhibitor, UR13870, inhibits affective pain behavior after spinal cord injury.

    PubMed

    Galan-Arriero, Iriana; Avila-Martin, Gerardo; Ferrer-Donato, Agueda; Gomez-Soriano, Julio; Bravo-Esteban, Elisabeth; Taylor, Julian

    2014-10-01

    The p38α mitogenous activated protein kinase (MAPK) cell signaling pathway is a key mechanism of microglia activation and has been studied as a target for neuropathic pain. The effect of UR13870, a p38α MAPK inhibitor, on microglia expression in the anterior cingulate cortex (ACC) and spinal dorsal horn was addressed after T9 contusion spinal cord injury (SCI) in the rat, in addition to behavioral testing of pain-related aversion and anxiety. Administration of intravenous UR13870 (1mg/kg i.v.) and pregabalin (30 mg/kg i.v.) reduced place escape avoidance paradigm (PEAP) but did not affect open-field anxiety behavior 42 days after SCI. PEAP behavior was also reduced in animals administered daily with oral UR13870 (10mg/kg p.o.) and preserved spinal tissue 28 days after SCI. Although UR13870 (10mg/kg p.o.) failed to reduce OX-42 and glial fibrillar acid protein immunoreactivity within the spinal dorsal horn, a reduction toward the control level was observed close to the SCI site. In the anterior cingulate cortex (ACC), a significant increase in OX-42 immunoreactivity was identified after SCI. UR13870 (10mg/kg p.o.) treatment significantly reduced OX-42, metabotropic glutamate type 5 receptor (mGluR5), and NMDA (N-methyl-d-aspartate) 2B subunit receptor (NR2B) expression in the ACC after SCI. To conclude, oral treatment with a p38α MAPK inhibitor reduces the affective behavioral component of pain after SCI in association with a reduction of microglia and specific glutamate receptors within the ACC. Nevertheless the role of neuroinflammatory processes within the vicinity of the SCI site in the development of affective neuropathic pain cannot be excluded.

  5. Regional Anesthesia and Valproate Sodium for the Prevention of Chronic Post Amputation Pain

    DTIC Science & Technology

    2016-10-01

    chronic pain, and the effect of valproic acid on DNA methylation status. Because this is a double-blinded, randomized controlled trial, we do not...Postamputation pain, Post-surgical pain, Neuralgia, Epigenetics, Valproic Acid, DNA Methylation, Neuropathic pain 16. SECURITY CLASSIFICATION OF: U 17...unique advantage over other classes of medicines used for neuropathic pain, as this drug actually modifies the epigenetic mechanisms, such as DNA

  6. Altered Spontaneous Activity in Patients with Persistent Somatoform Pain Disorder Revealed by Regional Homogeneity

    PubMed Central

    Yan, Chao; Lu, Jing; Li, Xuzhou; Tang, Chaozheng; Fan, Mingxia; Luo, Yanli

    2016-01-01

    Persistent somatoform pain disorder (PSPD) is a mental disorder un-associated with any somatic injury and can cause severe somatosensory and emotional impairments in patients. However, so far, the neuro-pathophysiological mechanism of the functional impairments in PSPD is still unclear. The present study assesses the difference in regional spontaneous activity between PSPD and healthy controls (HC) during a resting state, in order to elucidate the neural mechanisms underlying PSPD. Resting-state functional Magnetic Resonance Imaging data were obtained from 13 PSPD patients and 23 age- and gender-matched HC subjects in this study. Kendall’s coefficient of concordance was used to measure regional homogeneity (ReHo), and a two-sample t-test was subsequently performed to investigate the ReHo difference between PSPD and HC. Additionally, the correlations between the mean ReHo of each survived area and the clinical assessments were further analyzed. Compared with the HC group, patients with PSPD exhibited decreased ReHo in the bilateral primary somatosensory cortex, posterior cerebellum, and occipital lobe, while increased ReHo in the prefrontal cortex (PFC) and default mode network (including the medial PFC, right inferior parietal lobe (IPL), and left supramarginal gyrus). In addition, significant positive correlations were found between the mean ReHo of both right IPL and left supramarginal gyrus and participants’ Self-Rating Anxiety Scale (SAS) scores, and between the mean ReHo of the left middle frontal gyrus and Visual Analogue Scale (VAS) scores. Our results suggest that abnormal spontaneous brain activity in specific brain regions during a resting state may be associated with the dysfunctions in pain, memory and emotional processing commonly observed in patients with PSPD. These findings help us to understand the neural mechanisms underlying PSPD and suggest that the ReHo metric could be used as a clinical marker for PSPD. PMID:26977802

  7. Acute and Chronic Low Back Pain: Cognitive, Affective, and Behavioral Dimensions.

    ERIC Educational Resources Information Center

    Hadjistavropoulos, Heather D.; Craig, Kenneth D.

    1994-01-01

    Divided 90 chronic low back pain patients into those who demonstrated signs that were congruent or incongruent with underlying anatomical and physiological principles. Low socioeconomic status, compensation claims, use of opiate analgesics, greater disability, catastrophizing cognitions, stronger emotionality, and passive coping were more…

  8. Inability to Express Intense Affect: A Common Link Between Depression and Pain?

    ERIC Educational Resources Information Center

    Beutler, Larry E.; And Others

    1986-01-01

    Proposes that difficulty expressing anger and difficulty controlling intense emotions are predisposing factors linked to depression and chronic pain. Proceeds from an exploration of diverse models and proposals to present a unifying theory of arousal with a view toward developing research questions and paradigms. (Author/NB)

  9. Acute and Chronic Low Back Pain: Cognitive, Affective, and Behavioral Dimensions.

    ERIC Educational Resources Information Center

    Hadjistavropoulos, Heather D.; Craig, Kenneth D.

    1994-01-01

    Divided 90 chronic low back pain patients into those who demonstrated signs that were congruent or incongruent with underlying anatomical and physiological principles. Low socioeconomic status, compensation claims, use of opiate analgesics, greater disability, catastrophizing cognitions, stronger emotionality, and passive coping were more…

  10. Gender, ethnicity and smoking affect pain and function in patients with rotator cuff tears.

    PubMed

    Maher, Anthony; Leigh, Warren; Brick, Matt; Young, Simon; Millar, James; Walker, Cameron; Caughey, Michael

    2017-09-01

    This study is a collation of baseline demographic characteristics of those presenting for rotator cuff repair in New Zealand, and exploration of associations with preoperative function and pain. Data were obtained from the New Zealand Rotator Cuff Registry; a multicentre, nationwide prospective cohort of rotator cuff repairs undertaken from 1 March 2009 until 31 December 2010. A total of 1383 patients were included in the study. This required complete demographic information, preoperative Flex-SF (functional score) and pain scores. Following univariate analysis, a multivariate model was used. The average age was 58 years (69% males and 11% smokers). New Zealand Europeans made up 90% and Maori 5%. The average preoperative Flex-SF was significantly lower (poorer function) in those over 65 years, females, smokers and Maori, in the non-dominant patients, using a multivariate model. Average preoperative pain scores were significantly worse (higher scores) in females, Maori, Polynesians, smokers, using a multivariate model. This is the largest reported prospective cohort of patients presenting for rotator cuff surgery. Results can be used to understand the effect of rotator cuff tears on the different patients, for example Maori patients who are under-represented, present younger, with more pain and poorer function. © 2017 Royal Australasian College of Surgeons.

  11. A prospective, multisite, international validation of the Complex Regional Pain Syndrome Severity Score.

    PubMed

    Harden, R Norman; Maihofner, Christian; Abousaad, Elias; Vatine, Jean-Jacques; Kirsling, Amy; Perez, Roberto S G M; Kuroda, Maxine; Brunner, Florian; Stanton-Hicks, Michael; Marinus, Johan; van Hilten, Jacobus J; Mackey, Sean; Birklein, Frank; Schlereth, Tanja; Mailis-Gagnon, Angela; Graciosa, Joe; Connoly, Sara B; Dayanim, David; Massey, Michael; Frank, Hadas; Livshitz, Anatoly; Bruehl, Stephen

    2017-08-01

    Clinical diagnosis of complex regional pain syndrome (CRPS) is a dichotomous (yes/no) categorization, a format necessary for clinical decision making. Such dichotomous diagnostic categories do not convey an individual's subtle gradations in the severity of the condition over time and have poor statistical power when used as an outcome measure in research. This prospective, international, multicenter study slightly modified and further evaluated the validity of the CRPS Severity Score (CSS), a continuous index of CRPS severity. Using a prospective design, medical evaluations were conducted in 156 patients with CRPS to compare changes over time in CSS scores between patients initiating a new treatment program and patients on stable treatment regimens. New vs stable categorizations were supported by greater changes in pain and function in the former. Results indicated that CSS values in the stable CRPS treatment group exhibited much less change over time relative to the new treatment group, with intraclass correlations nearly twice as large in the former. A calculated smallest real difference value revealed that a change in the CSS of ≥4.9 scale points would indicate real differences in CRPS symptomatology (with 95% confidence). Across groups, larger changes in CRPS features on the CSS over time were associated in the expected direction with greater changes in pain intensity, fatigue, social functioning, ability to engage in physical roles, and general well-being. The overall pattern of findings further supports the validity of the CSS as a measure of CRPS severity and suggests it may prove useful in clinical monitoring and outcomes research.

  12. Endocrine disorders in women with complex regional pain syndrome type I.

    PubMed

    Buryanov, A; Kostrub, A; Kotiuk, V

    2017-02-01

    The question of hormonal dysregulation in patients with CRPS I in whole was investigated very scantily. There are only a few studies concerning catecholamines, oestrogens and endorphins independently. Other hormones were studied in patients with different other chronic pain conditions. Considering the accumulation of sufficient knowledge about the role of disadaptation processes in CRPS I pathogenesis and the role of the hypothalamic-pituitary-adrenal and hypothalamic-pituitary-ovarian systems in the process of adaptation it was logical and consistent to define the role of hormonal dysregulation of these systems in patients with CRPS I. Our objective was to determine the role of hypothalamic-pituitary-adrenal and hypothalamic-pituitary-ovarian systems in pathogenesis of complex regional pain syndrome type I (CRPS I) in women. We investigated the pituitary gonadotropic function and the function of sex glands in women with CRPS I and healthy volunteers by measuring the plasma levels of estradiol (E2 ), follicle-stimulating hormone, luteinizing hormone, prolactin, adrenocorticotropic hormone, and cortisol, and urinary excretion of 17-ketosteroids, 17-oxycocorticosteroids, epinephrine and norepinephrine. Women with CRPS I were characterized by the decreased content of oestrogens in the blood plasma and increased pituitary gonadotrophic function. The disturbed ratio of anabolic and catabolic steroids in women with CRPS I was detected due to lower adrenal cortex function. In patients with CRPS I endocrine status is characterized by hormonal imbalances of the hypothalamic-pituitary-adrenal and hypothalamic-pituitary-gonadal systems. The changes in reproductive and adaptation homeostasis characterize CRPS I as a form of the disease of disadaptation. This study determined the role of hypothalamic-pituitary-adrenal and hypothalamic-pituitary-ovarian systems in pathogenesis of CRPS I. © 2016 European Pain Federation - EFIC®.

  13. Changes in plasma cytokines and their soluble receptors in complex regional pain syndrome.

    PubMed

    Alexander, Guillermo M; Peterlin, B Lee; Perreault, Marielle J; Grothusen, John R; Schwartzman, Robert J

    2012-01-01

    Complex Regional Pain Syndrome (CRPS) is a chronic and often disabling pain disorder. There is evidence demonstrating that neurogenic inflammation and activation of the immune system play a significant role in the pathophysiology of CRPS. This study evaluated the plasma levels of cytokines, chemokines, and their soluble receptors in 148 subjects afflicted with CRPS and in 60 gender- and age-matched healthy controls. Significant changes in plasma cytokines, chemokines, and their soluble receptors were found in subjects with CRPS as compared with healthy controls. For most analytes, these changes resulted from a distinct subset of the CRPS subjects. When the plasma data from the CRPS subjects was subjected to cluster analysis, it revealed 2 clusters within the CRPS population. The category identified as most important for cluster separation by the clustering algorithm was TNFα. Cluster 1 consisted of 64% of CRPS subjects and demonstrated analyte values similar to the healthy control individuals. Cluster 2 consisted of 36% of the CRPS subjects and demonstrated significantly elevated levels of most analytes and in addition, it showed that the increased plasma analyte levels in this cluster were correlated with disease duration and severity. The identification of biomarkers that define disease subgroups can be of great value in the design of specific therapies and of great benefit to the design of clinical trials. It may also aid in advancing our understanding of the mechanisms involved in the pathophysiology of CRPS, which may lead to novel treatments for this very severe condition. Copyright © 2012 American Pain Society. Published by Elsevier Inc. All rights reserved.

  14. Involvement of Sensory Regions in Affective Experience: A Meta-Analysis

    PubMed Central

    Satpute, Ajay B.; Kang, Jian; Bickart, Kevin C.; Yardley, Helena; Wager, Tor D.; Barrett, Lisa F.

    2015-01-01

    A growing body of work suggests that sensory processes may also contribute to affective experience. In this study, we performed a meta-analysis of affective experiences driven through visual, auditory, olfactory, gustatory, and somatosensory stimulus modalities including study contrasts that compared affective stimuli to matched neutral control stimuli. We found, first, that limbic and paralimbic regions, including the amygdala, anterior insula, pre-supplementary motor area, and portions of orbitofrontal cortex were consistently engaged across two or more modalities. Second, early sensory input regions in occipital, temporal, piriform, mid-insular, and primary sensory cortex were frequently engaged during affective experiences driven by visual, auditory, olfactory, gustatory, and somatosensory inputs. A classification analysis demonstrated that the pattern of neural activity across a contrast map diagnosed the stimulus modality driving the affective experience. These findings suggest that affective experiences are constructed from activity that is distributed across limbic and paralimbic brain regions and also activity in sensory cortical regions. PMID:26696928

  15. Increased muscular and cutaneous pain sensitivity in cephalic region in patients with chronic tension-type headache.

    PubMed

    Ashina, S; Babenko, L; Jensen, R; Ashina, M; Magerl, W; Bendtsen, L

    2005-07-01

    Increased excitability of the central nervous system generated by repetitive and sustained pericranial myofascial nociception may be responsible for transformation of episodic tension-type headache into chronic form. We aimed to compare mechanical and electrical (intramuscular and cutaneous) pain thresholds in trapezius and anterior tibial regions between 20 patients with chronic tension type headache and 20 healthy controls. Pain thresholds to three types of electrical stimulation (single pulse, 2 and 100 Hz) were significantly lower in patients than in controls in trapezius muscle (P < 0.02) and in skin overlying the trapezius muscle (P < 0.05), whilst electrical pain thresholds did not differ between groups in anterior tibial muscle and skin. Quantitative sensory testing revealed increased pain sensitivity in patients as assessed by pressure-controlled manual palpation (local tenderness score, LTS; P < 0.01) and by pressure algometry (mechanical pain thresholds; P < 0.05) in test areas over the trapezius muscle, but not the anterior tibial muscle. In summary, this study demonstrates lower pain thresholds in muscle and skin of the cephalic region but not in lower limb muscle and skin in patients with chronic tension-type headache than in healthy controls. Increased sensitivity in nociceptive pathways from cephalic region may be of importance in the pathophysiology of chronic tension type headache.

  16. Psychometric Properties of the Pain Numeric Rating Scale When Applied to Multiple Body Regions among Professional Musicians

    PubMed Central

    2016-01-01

    Background Despite the broad popularity of a numeric rating scale (NRS) its psychometric properties are not well known. The objective was to determine if there is any difference in the discrimination ability of the NRS when used for measuring pain severity separately in different body regions. Methods Cross-sectional survey study of 630 professional musicians. Item Response Theory (IRT) was used to define the psychometric properties of the NRS. Results The discrimination ability of the pain NRS was dependent on the body area to which it was applied. The discrimination was low 0.5 (95% CI 0.4. to 0.7) for the hand region and perfect for the shoulder and upper part of the neck– 3.2 (95% CI 1.2 to 5.2) and 10.5 (95% CI 10.0 to 10.9), respectively. Both shoulder and neck NRSs showed a great shift towards higher levels of pain severity meaning that the ability of the NRS to discriminate low levels of pain is poor. NRS scores obtained from all other regions did not demonstrate any discrimination ability. Conclusions The pain NRS might have different psychometric properties depending on the body area to which it is applied. Overall, the modest discrimination ability of the pain NRS implies that it should be used in screening questionnaires with some reservations. PMID:27603011

  17. Psychometric Properties of the Pain Numeric Rating Scale When Applied to Multiple Body Regions among Professional Musicians.

    PubMed

    Saltychev, Mikhail; Vastamäki, Heidi; Mattie, Ryan; McCormick, Zachary; Vastamäki, Martti; Laimi, Katri

    2016-01-01

    Despite the broad popularity of a numeric rating scale (NRS) its psychometric properties are not well known. The objective was to determine if there is any difference in the discrimination ability of the NRS when used for measuring pain severity separately in different body regions. Cross-sectional survey study of 630 professional musicians. Item Response Theory (IRT) was used to define the psychometric properties of the NRS. The discrimination ability of the pain NRS was dependent on the body area to which it was applied. The discrimination was low 0.5 (95% CI 0.4. to 0.7) for the hand region and perfect for the shoulder and upper part of the neck- 3.2 (95% CI 1.2 to 5.2) and 10.5 (95% CI 10.0 to 10.9), respectively. Both shoulder and neck NRSs showed a great shift towards higher levels of pain severity meaning that the ability of the NRS to discriminate low levels of pain is poor. NRS scores obtained from all other regions did not demonstrate any discrimination ability. The pain NRS might have different psychometric properties depending on the body area to which it is applied. Overall, the modest discrimination ability of the pain NRS implies that it should be used in screening questionnaires with some reservations.

  18. Association between temporomandibular disorders and pain in other regions of the body.

    PubMed

    Bonato, L L; Quinelato, V; De Felipe Cordeiro, P C; De Sousa, E B; Tesch, R; Casado, P L

    2017-01-01

    The pain from temporomandibular disorder (TMD) is often associated with physical symptoms of other chronic pain disorders and comorbidities, such as generalised muscle and joint pain. However, this association is not widely studied. To evaluate the prevalence of comorbid pain in joints, specifically in the knees, hips, ankles, shoulders, wrists and elbows, in individuals with and without TMD. We evaluated 337 patients from a public hospital in the city of Rio de Janeiro, Brazil. The Research Diagnostic Criteria for TMD questionnaire were used for the diagnosis of TMD. To assess the presence of other joint pain, the patients were asked to answer questions considering: the presence of pain in the knee, hip, ankle, shoulder, wrist and elbow joints and time duration of pain. Individuals with TMD are 5·5 times more likely to present with other joint pain compared with those without the disorder. TMD muscle disorders were most associated with a higher number of pain at the other locations. There was a significant association between the presence of pain at the other locations, muscle (P < 0·001) and joint disorders (P = <0·001), as well as age advance, in TMD participants, showed to be a covariate factor for pain at the other locations. Individuals with TMD showed a high prevalence of pain in other joints of the body when compared with individuals without the disorder, and knee pain was the most prevalent pain complaint.

  19. Interaction of hyperalgesia and sensory loss in complex regional pain syndrome type I (CRPS I).

    PubMed

    Huge, Volker; Lauchart, Meike; Förderreuther, Stefanie; Kaufhold, Wibke; Valet, Michael; Azad, Shahnaz Christina; Beyer, Antje; Magerl, Walter

    2008-07-23

    Sensory abnormalities are a key feature of Complex Regional Pain Syndrome (CRPS). In order to characterise these changes in patients suffering from acute or chronic CRPS I, we used Quantitative Sensory Testing (QST) in comparison to an age and gender matched control group. 61 patients presenting with CRPS I of the upper extremity and 56 healthy subjects were prospectively assessed using QST. The patients' warm and cold detection thresholds (WDT; CDT), the heat and cold pain thresholds (HPT; CPT) and the occurrence of paradoxical heat sensation (PHS) were observed. In acute CRPS I, patients showed warm and cold hyperalgesia, indicated by significant changes in HPT and CPT. WDT and CDT were significantly increased as well, indicating warm and cold hypoaesthesia. In chronic CRPS, thermal hyperalgesia declined, but CDT as well as WDT further deteriorated. Solely patients with acute CRPS displayed PHS. To a minor degree, all QST changes were also present on the contralateral limb. We propose three pathomechanisms of CRPS I, which follow a distinct time course: Thermal hyperalgesia, observed in acute CRPS, indicates an ongoing aseptic peripheral inflammation. Thermal hypoaesthesia, as detected in acute and chronic CRPS, signals a degeneration of A-delta and C-fibres, which further deteriorates in chronic CRPS. PHS in acute CRPS I indicates that both inflammation and degeneration are present, whilst in chronic CRPS I, the pathomechanism of degeneration dominates, signalled by the absence of PHS. The contralateral changes observed strongly suggest the involvement of the central nervous system.

  20. Interaction of Hyperalgesia and Sensory Loss in Complex Regional Pain Syndrome Type I (CRPS I)

    PubMed Central

    Huge, Volker; Lauchart, Meike; Förderreuther, Stefanie; Kaufhold, Wibke; Valet, Michael; Azad, Shahnaz Christina; Beyer, Antje; Magerl, Walter

    2008-01-01

    Background Sensory abnormalities are a key feature of Complex Regional Pain Syndrome (CRPS). In order to characterise these changes in patients suffering from acute or chronic CRPS I, we used Quantitative Sensory Testing (QST) in comparison to an age and gender matched control group. Methods 61 patients presenting with CRPS I of the upper extremity and 56 healthy subjects were prospectively assessed using QST. The patients' warm and cold detection thresholds (WDT; CDT), the heat and cold pain thresholds (HPT; CPT) and the occurrence of paradoxical heat sensation (PHS) were observed. Results In acute CRPS I, patients showed warm and cold hyperalgesia, indicated by significant changes in HPT and CPT. WDT and CDT were significantly increased as well, indicating warm and cold hypoaesthesia. In chronic CRPS, thermal hyperalgesia declined, but CDT as well as WDT further deteriorated. Solely patients with acute CRPS displayed PHS. To a minor degree, all QST changes were also present on the contralateral limb. Conclusions We propose three pathomechanisms of CRPS I, which follow a distinct time course: Thermal hyperalgesia, observed in acute CRPS, indicates an ongoing aseptic peripheral inflammation. Thermal hypoaesthesia, as detected in acute and chronic CRPS, signals a degeneration of A-delta and C-fibres, which further deteriorates in chronic CRPS. PHS in acute CRPS I indicates that both inflammation and degeneration are present, whilst in chronic CRPS I, the pathomechanism of degeneration dominates, signalled by the absence of PHS. The contralateral changes observed strongly suggest the involvement of the central nervous system. PMID:18648647

  1. [Regional and peripheral blockades for prevention of chronic post-thoracotomy pain syndrome in oncosurgical practice].

    PubMed

    Khoronenko, V E; Malanova, A S; Baskakov, D S; Ryabov, A B; Pikin, O V

    2017-01-01

    To compare an effectiveness of thoracic epidural anesthesia/analgesia, paravertebral and intercostal blockades in prevention of chronic post-thoracotomy pain syndrome (CPTPS) in oncosurgery. There were 300 patients who underwent open surgery including lobectomy or pneumonectomy. Patients were randomized into 3 groups depending on type of anesthesia: TEA (n=100) - combined general and epidural anesthesia; PVB (n=50) - combined general and paravertebral anesthesia; ICB (n=50) - general anesthesia was supplemented by intercostal blockade after removal of the drug. CPTPS incidence was 34 and 40% in 6 months postoperatively after PVB and ICB, respectively (p>0.05). In TEA group this value was significantly lower compared with ICB group (23%, p<0.05). TEA contributes to significant reduction of CPTPS incidence, while paravertebral blockade does not affect the frequency of this complication.

  2. Evaluation of a Prototype Tool for Communicating Body Perception Disturbances in Complex Regional Pain Syndrome

    PubMed Central

    Turton, Ailie J.; Palmer, Mark; Grieve, Sharon; Moss, Timothy P.; Lewis, Jenny; McCabe, Candida S.

    2013-01-01

    Patients with Complex Regional Pain Syndrome (CRPS) experience distressing changes in body perception. However representing body perception is a challenge. A digital media tool for communicating body perception disturbances was developed. A proof of concept study evaluating the acceptability of the application for patients to communicate their body perception is reported in this methods paper. Thirteen CRPS participants admitted to a 2-week inpatient rehabilitation program used the application in a consultation with a research nurse. Audio recordings were made of the process and a structured questionnaire was administered to capture experiences of using the tool. Participants produced powerful images of disturbances in their body perception. All reported the tool acceptable for communicating their body perception. Participants described the positive impact of now seeing an image they had previously only imagined and could now convey to others. The application has provided a novel way for communicating perceptions that are otherwise difficult to convey. PMID:24009577

  3. Evaluation of a prototype tool for communicating body perception disturbances in complex regional pain syndrome.

    PubMed

    Turton, Ailie J; Palmer, Mark; Grieve, Sharon; Moss, Timothy P; Lewis, Jenny; McCabe, Candida S

    2013-01-01

    Patients with Complex Regional Pain Syndrome (CRPS) experience distressing changes in body perception. However representing body perception is a challenge. A digital media tool for communicating body perception disturbances was developed. A proof of concept study evaluating the acceptability of the application for patients to communicate their body perception is reported in this methods paper. Thirteen CRPS participants admitted to a 2-week inpatient rehabilitation program used the application in a consultation with a research nurse. Audio recordings were made of the process and a structured questionnaire was administered to capture experiences of using the tool. Participants produced powerful images of disturbances in their body perception. All reported the tool acceptable for communicating their body perception. Participants described the positive impact of now seeing an image they had previously only imagined and could now convey to others. The application has provided a novel way for communicating perceptions that are otherwise difficult to convey.

  4. Postoperative infusional continuous regional analgesia. A technique for relief of postoperative pain following major extremity surgery.

    PubMed

    Malawer, M M; Buch, R; Khurana, J S; Garvey, T; Rice, L

    1991-05-01

    A new technique using postoperative infusional continuous regional analgesia (PICRA) for postoperative pain relief was investigated in 23 surgical patients treated by amputation (12 patients) or by limb-salvage resection operations (11 patients). Bupivacaine was delivered into peripheral nerve sheaths via catheters placed therein at the time of surgery. Only patients in whom the nerves were easily accessible were treated. Catheters were placed in the axillary sheath, the lumbosacral trunk, and the femoral nerve sheaths of patients treated with shoulder girdle and pelvic procedures (resections and amputations), and within the sciatic nerve sheath of those treated with lower extremity procedures. The anesthetic agent was delivered at controllable rates. Regional analgesia was obtained in the operative site with minimal motor or sensory decrease. To assess the efficacy of this technique, the results of this study group were compared with those of a matched group of 11 patients treated with similar surgical procedures but who received epidural morphine. Eleven of the 23 patients on PICRA required no supplemental narcotic agents. The mean level of the narcotic agents required by the remaining 13 PICRA patients was approximately one third of that required by the matched group of 11 patients receiving epidural morphine. Overall, the patients on PICRA had an 80% reduction of narcotic requirements when compared to the historical controls. The technique is reliable and can be performed by the surgeon, requiring about a ten-minute increase in operating time. It has potentially wide application in orthopedics in procedures in which the major nerves are easily accessible (e.g., pelvic fractures and revision hip surgery) and for patients with intractable pain of the extremities.

  5. A study of bone densitometry in patients with complex regional pain syndrome after stroke

    PubMed Central

    Kumar, V; Kalita, J; Gujral, R; Sharma, V; Misra, U

    2001-01-01

    INTRODUCTION—This study was undertaken to evaluate the bone mineral density (BMD) in patients with complex regional pain syndrome type-I (CRPS-I) after stroke, and to correlate it with various clinical and neurophysiological parameters.
PATIENTS AND METHODS—Twenty patients with CRPS-I after stroke were included and a detailed neurological evaluation was carried out. The severity of CRPS-I was graded on the basis of shoulder hand syndrome score. All the patients underwent bone mineral densitometry of paralysed and non-paralysed forearm by dual energy x ray absorptiometry. The BMD of paralysed forearm was also compared with that of age matched healthy controls. Neurophysiological tests included sympathetic skin response in both upper and lower limbs and median somatosensory evoked potentials.
RESULTS—The mean age of patients was 57.2 (45-75) years and eight were females. Eight patients had severe weakness and 12 had moderate weakness of grade 2 on the hemiplegic side. There was significant reduction in BMD in the patients compared with controls (p<0.01). The bone density reduction correlated well with duration of illness (r = −0.673, p<0.01), shoulder hand syndrome score (r = −0.804, p<0.01), and Canadian neurological scale score (r = −0.738 p<0.01). Sympathetic skin response was not recordable bilaterally in all patients. Median somatosensory evoked potentials were not recordable in seven out of 20 patients who also had higher grade of CRPS-I.
CONCLUSION—Our results show significant reduction of BMD in patients with CRPS-I after stroke. The reduction in BMD correlates with the severity of shoulder hand syndrome score, degree of weakness, duration of hemiplegia, and the severity of stroke.


Keywords: stroke; complex regional pain syndrome type I; bone mineral density PMID:11470933

  6. Variables Affecting the Reporting of Pain Following an Acute Myocardial Infarction

    DTIC Science & Technology

    1991-05-01

    values, and determined the amount of attention that the symptoms received. For example, hallucinations were considered to be a sign of psychosis in...on to posit that successful coping often required creating the illusion that major changes have a limited impact. Denial may have played a role in...and Medicine 19. 1261- 1277. 147 Chapman, C. R. (1986). Pain, perception, and illusion . In R. A. Sternbach (Ed.), The sychology of gam (pp. 153-179

  7. Patients' perceived level of social isolation affects the prognosis of low back pain.

    PubMed

    Oliveira, V C; Ferreira, M L; Morso, L; Albert, H B; Refshauge, K M; Ferreira, P H

    2015-04-01

    Perceived social isolation is prevalent among patients with low back pain (LBP) and could be a potential prognostic factor for clinical outcomes following an episode of LBP. A secondary analysis of an original prospective cohort study, which investigated the validity of the Danish version of the STarT Back Screening Tool (STarT), investigated whether social isolation predicts the clinical outcomes of disability, anxiety, depression and pain catastrophizing in people with LBP. Patients with LBP of any duration (N = 204) from Middelfart, Denmark, were included. Social isolation was measured at baseline using the friendship scale (score ranges from 0 to 24, with lower values meaning higher perceived social isolation), and outcomes were measured at baseline and at 6-month follow-up. Regression models investigated whether social isolation at baseline predicted the outcomes at 6-month follow-up. Some level of social isolation was reported by 39.2% of the participants (n = 80) with 5.9% (n = 12) being very socially isolated. One-point difference on social isolation predicted one point on a 100-point disability scale (adjusted unstandardized coefficient: -0.91; 95% confidence interval (CI): -1.56 to -0.26). Social isolation predicted anxiety; however, a change of one point on the social isolation scale represents a difference of only 0.08 points on a 22-point scale in anxiety (95% CI: 0.01-0.15) and is unlikely to denote clinical importance. Social isolation did not predict pain catastrophizing or depression. Patients' perceived social isolation predicts disability related to LBP. Further understanding of the role of social isolation in LBP is warranted. © 2014 European Pain Federation - EFIC®

  8. Neurophysiological Traces of Interpersonal Pain: How Emotional Autobiographical Memories Affect Event-Related Potentials.

    PubMed

    Rohde, Kristina B; Caspar, Franz; Koenig, Thomas; Pascual-Leone, Antonio; Stein, Maria

    2017-08-31

    The automatic, involuntary reactivation of disturbing emotional memories, for example, of interpersonal pain, causes psychological discomfort and is central to many psychopathologies. This study aimed at elucidating the automatic brain processes underlying emotional autobiographical memories by investigating the neurophysiological dynamics within the first second after memory reactivation. Pictures of different individualized familiar faces served as cues for different specific emotional autobiographical memories, for example, for memories of interpersonal pain and grievances or for memories of appreciation in interpersonal relationships. Nineteen subjects participated in a passive face-viewing task while multichannel electroencephalogram was recorded. Analyses of event-related potentials demonstrated that emotional memories elicited an early posterior negativity and a stronger late positive potential, which tended to be particularly enhanced for painful memories. Source estimations attributed this stronger activation to networks including the posterior cingulate and ventrolateral prefrontal cortices. The findings suggest that the reactivation of emotional autobiographical memories involves privileged automatic attention at perceptual processing stages, and an enhanced recruitment of neural network activity at a postperceptual stage sensitive to emotional-motivational processing. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  9. Trunk bend and twist coordination is affected by low back pain status during running.

    PubMed

    Seay, Joseph F; Van Emmerik, Richard E A; Hamill, Joseph

    2014-01-01

    Recent literature has related differences in pelvis-trunk coordination to low back pain (LBP) status. In addition, repetitive motions involving bending and twisting have been linked to high incidence of LBP. The purpose of this study was to examine trunk sagittal motion - axial rotation ('bend and twist') coordination during locomotion in three groups of runners classified by LBP status (LBP: current low back pain; RES: resolved low back pain and CTR: control group with no history of LBP). Trunk kinematic data were collected as running speed was systematically increased on a treadmill. Within-segment coordination between trunk sagittal and transverse planes of motion (trunk lean and axial rotation, respectively) was calculated using continuous relative phase (CRP), and coordination variability was defined as the between stride cycle standard deviation of CRP (CRPvar). Bend-twist coordination was more in-phase for the LBP group than CTR (p = 0.010) regardless of running speed. No differences in CRPvar were found between the groups. The results from our coordination (CRP) analysis were sensitive to LBP status and suggest that multi-plane interactions of the trunk should be considered in the assessment of LBP. This analysis also has potential for athletically oriented tasks that involve multi-plane interactions of the trunk, particularly ones that contain asymmetric action, such as sweep rowing or a shot on goal in field hockey or ice hockey.

  10. The European Society of Regional Anaesthesia and Pain Therapy and the American Society of Regional Anesthesia and Pain Medicine Joint Committee Practice Advisory on Controversial Topics in Pediatric Regional Anesthesia.

    PubMed

    Ivani, Giorgio; Suresh, Santhanam; Ecoffey, Claude; Bosenberg, Adrian; Lonnqvist, Per-Anne; Krane, Elliot; Veyckemans, Francis; Polaner, David M; Van de Velde, Marc; Neal, Joseph M

    2015-01-01

    Some topics in the clinical management of regional anesthesia in children remain controversial. To evaluate and come to a consensus regarding some of these topics, The European Society of Regional Anaesthesia and Pain Therapy (ESRA) and the American Society of Regional Anesthesia and Pain Medicine (ASRA) developed a joint committee practice advisory on pediatric regional anesthesia (PRA). Representatives from both ASRA and ESRA comprised the joint committee practice advisory on PRA. Evidence-based recommendations were based on a systematic search of the literature. In cases where no literature was available, expert opinion was elicited. Experts selected controversial topics in PRA. The performance of PRA under general anesthesia or deep sedation is associated with acceptable safety and should be viewed as the standard of care (Evidence B2 and Evidence B3). Because of the difficulty interpreting a negative test dose, the use of test dosing should remain discretionary (Evidence B4). The use of either air-loss of resistance or saline-loss of resistance techniques is supported by expert opinion, but the literature supporting one technique over the other is sparse and controversial; when used appropriately, each technique may be safely used in children. There are no current evidence-based data that the use of RA increases the risk for acute compartment syndrome or delays its diagnosis in children. High-level evidence is not yet available for the topics evaluated, and most recommendations are based on Evidence B studies. The ESRA/ASRA recommendations intend to provide guidance for the safe practice of regional anesthesia in children.

  11. The Second ASRA Practice Advisory on Neurologic Complications Associated With Regional Anesthesia and Pain Medicine: Executive Summary 2015.

    PubMed

    Neal, Joseph M; Barrington, Michael J; Brull, Richard; Hadzic, Admir; Hebl, James R; Horlocker, Terese T; Huntoon, Marc A; Kopp, Sandra L; Rathmell, James P; Watson, James C

    2015-01-01

    Neurologic injury associated with regional anesthetic or pain medicine procedures is extremely rare. The Second American Society of Regional Anesthesia and Pain Medicine Practice Advisory on Neurologic Complications Associated With Regional Anesthesia and Pain Medicine focuses on those complications associated with mechanical, ischemic, or neurotoxic injury of the neuraxis or peripheral nervous system. As with the first advisory, this iteration does not focus on hemorrhagic or infectious complications or local anesthetic systemic toxicity, all of which are the subjects of separate practice advisories. The current advisory offers recommendations to aid in the understanding and potential limitation of rare neurologic complications that may arise during the practice of regional anesthesia and/or interventional pain medicine. The Second American Society of Regional Anesthesia and Pain Medicine Practice Advisory on Neurologic Complications Associated With Regional Anesthesia and Pain Medicine updates information that was originally presented at the Society's first open forum on this subject (2005) and published in 2008. Portions of the second advisory were presented in an open forum (2012) and are herein updated, with attention to those topics subject to evolving knowledge since the first and second advisory conferences. The second advisory briefly summarizes recommendations that have not changed substantially. New to this iteration of the advisory is information related to the risk of nerve injury inherent to common orthopedic surgical procedures. Recommendations are expanded regarding the preventive role of various monitoring technologies such as ultrasound guidance and injection pressure monitoring. New clinical recommendations focus on emerging concerns including spinal stenosis and vertebral canal pathologies, blood pressure management during neuraxial anesthesia, administering blocks in anesthetized or deeply sedated patients, patients with preexisting neurologic

  12. Chronic stress and peripheral pain: Evidence for distinct, region-specific changes in visceral and somatosensory pain regulatory pathways.

    PubMed

    Zheng, Gen; Hong, Shuangsong; Hayes, John M; Wiley, John W

    2015-11-01

    Chronic stress alters the hypothalamic-pituitary-adrenal (HPA) axis and enhances visceral and somatosensory pain perception. It is unresolved whether chronic stress has distinct effects on visceral and somatosensory pain regulatory pathways. Previous studies reported that stress-induced visceral hyperalgesia is associated with reciprocal alterations of endovanilloid and endocannabinoid pain pathways in DRG neurons innervating the pelvic viscera. In this study, we compared somatosensory and visceral hyperalgesia with respect to differential responses of peripheral pain regulatory pathways in a rat model of chronic, intermittent stress. We found that chronic stress induced reciprocal changes in the endocannabinoid 2-AG (increased) and endocannabinoid degradation enzymes COX-2 and FAAH (decreased), associated with down-regulation of CB1 and up-regulation of TRPV1 receptors in L6-S2 DRG but not L4-L5 DRG neurons. In contrast, sodium channels Nav1.7 and Nav1.8 were up-regulated in L4-L5 but not L6-S2 DRGs in stressed rats, which was reproduced in control DRGs treated with corticosterone in vitro. The reciprocal changes of CB1, TRPV1 and sodium channels were cell-specific and observed in the sub-population of nociceptive neurons. Behavioral assessment showed that visceral hyperalgesia persisted, whereas somatosensory hyperalgesia and enhanced expression of Nav1.7 and Nav1.8 sodium channels in L4-L5 DRGs normalized 3 days after completion of the stress phase. These data indicate that chronic stress induces visceral and somatosensory hyperalgesia that involves differential changes in endovanilloid and endocannabinoid pathways, and sodium channels in DRGs innervating the pelvic viscera and lower extremities. These results suggest that chronic stress-induced visceral and lower extremity somatosensory hyperalgesia can be treated selectively at different levels of the spinal cord. Copyright © 2015 Elsevier Inc. All rights reserved.

  13. Chronic Stress and Peripheral Pain: Evidence for Distinct, Region-specific Changes in Visceral and Somatosensory Pain Regulatory Pathways

    PubMed Central

    Zheng, Gen; Hong, Shuangsong; Hayes, John M; Wiley, John W

    2015-01-01

    Chronic stress alters the hypothalamic-pituitary-adrenal (HPA) axis and enhances visceral and somatosensory pain perception. It is unresolved whether chronic stress has distinct effects on visceral and somatosensory pain regulatory pathways. Previous studies reported that stress-induced visceral hyperalgesia is associated with reciprocal alterations of endovanilloid and endocannabinoid pain pathways in DRG neurons innervating the pelvic viscera. In this study, we compared somatosensory and visceral hyperalgesia with respect to differential responses of peripheral pain regulatory pathways in a rat model of chronic, intermittent stress. We found that chronic stress induced reciprocal changes in the endocannabinoid 2-AG (increased) and endocannabinoid degradation enzymes COX-2 and FAAH (decreased), associated with down-regulation of CB1 and up-regulation of TRPV1 receptors in L6-S2 DRG but not L4-L5 DRG neurons. In contrast, sodium channels Nav1.7 and Nav1.8 were up-regulated in L4-L5 but not L6-S2 DRGs in stressed rats, which was reproduced in control L4-L5 DRGs treated with corticosterone in vitro. The reciprocal changes of CB1, TRPV1 and sodium channels were cell-specific and observed in the sub-population of nociceptive neurons. Behavioral assessment showed that visceral hyperalgesia persisted, whereas somatosensory hyperalgesia and enhanced expression of Nav1.7 and Nav1.8 sodium channels in L4-L5 DRGs normalized 3 days after completion of the stress phase. These data indicate that chronic stress induces visceral and somatosensory hyperalgesia that involves differential changes in endovanilloid and endocannabinoid pathways, and sodium channels in DRGs innervating the pelvic viscera and lower extremities. These results suggest that chronic stress-induced visceral and lower extremity somatosensory hyperalgesia can be treated selectively at different levels of the spinal cord. PMID:26408049

  14. The role of genomic oxidative-reductive balance as predictor of complex regional pain syndrome development: a novel theory.

    PubMed

    Smith, Howard S

    2010-01-01

    transcription of multiple antioxidants) may render certain subjects more or less susceptible to developing complex regional pain syndrome after surgery or trauma. If this hypothesis is correct, knowing this information may translate into significant and "far-reaching" effects on clinical decision-making surrounding the management of pain in patients who may be more susceptible to develop complex regional pain syndrome. Furthermore, it could lead to the development of novel prevention or intervention strategies, in efforts to prevent, abort, or ameliorate the development of and/or effectively treat complex regional pain syndrome.

  15. Enhanced anandamide plasma levels in patients with complex regional pain syndrome following traumatic injury: a preliminary report.

    PubMed

    Kaufmann, I; Hauer, D; Huge, V; Vogeser, M; Campolongo, P; Chouker, A; Thiel, M; Schelling, G

    2009-01-01

    The complex regional pain syndrome (CRPS) is a disabling neuropathic pain condition that may develop following injuries of the extremities. The pathogenesis of this syndrome is not clear; however, it includes complex interactions between the nervous and the immune system resulting in chronic inflammation, pain and trophic changes. This interaction may be mediated by chronic stress which is thought to activate the endogenous cannabinoid (endocannabinoid) system (ECS). We conducted an open, prospective, comparative clinical study to determine plasma level of the endocannabinoid anandamide by high-performance liquid chromatography and a tandem mass spectrometry system in 10 patients with CRPS type I versus 10 age- and sex-matched healthy controls. As compared to healthy controls, CRPS patients showed significantly higher plasma concentrations of anandamide. These results indicate that the peripheral ECS is activated in CRPS. Further studies are warranted to evaluate the role of the ECS in the limitation of inflammation and pain. 2009 S. Karger AG, Basel.

  16. Quantitative Evaluation of Pain with Pain Index Extracted from Electroencephalogram

    PubMed Central

    An, Jian-Xiong; Wang, Yong; Cope, Doris K; Williams, John P

    2017-01-01

    Background: The current pain assessment methods are strongly subjective and easily affected by outside influences, and there is an urgent need to develop a reliable objective and quantitative pain-monitoring indicator. The aim of this study was to evaluate the feasibility of using Pain index (Pi) to assess pain symptoms in pain patients. Methods: Subjects were enrolled from patients seeking treatment at Pain Medicine Center of China Medical University Aviation General Hospital from October 2015 to December 2016, such as postherpetic neuralgia, spinal cord injury, femoral head necrosis, lumbar disc herniation, trigeminal neuralgia, complex regional pain syndrome, perineal pain, phantom limb pain, etc., (pain group, n = 111), as well as healthy volunteers without subjective pain (control group, n = 100). The subjective pain symptoms in pain patients were evaluated by Pi and visual analogue scale/numerical rating scales (VAS/NRS), respectively, and the relationship between them was analyzed using single factor correlation analysis and multiple factor regression analysis. Results: Pi levels in the pain group were significantly higher than those of the control group (t = 6.273, P < 0.001), the correlation analysis of Pi and VAS/NRS score in the pain group showed that the Pearson correlation coefficient was 0.797 (P < 0.001); After adjusted for types of pain, pain sites, medication, gender, and age, Pi was found to be independently correlated to VAS/NRS score (P < 0.001). Conclusions: Pi significantly correlates with VAS/NRS score, might be used to evaluate the subjective pain symptoms in patients and has good research and application value as an objective pain assessment tool. PMID:28776544

  17. Nonimmersive virtual reality mirror visual feedback therapy and its application for the treatment of complex regional pain syndrome: an open-label pilot study.

    PubMed

    Sato, Kenji; Fukumori, Satoshi; Matsusaki, Takashi; Maruo, Tomoko; Ishikawa, Shinichi; Nishie, Hiroyuki; Takata, Ken; Mizuhara, Hiroaki; Mizobuchi, Satoshi; Nakatsuka, Hideki; Matsumi, Masaki; Gofuku, Akio; Yokoyama, Masataka; Morita, Kiyoshi

    2010-04-01

    Chronic pain conditions such as phantom limb pain and complex regional pain syndrome are difficult to treat, and traditional pharmacological treatment and invasive neural block are not always effective. Plasticity in the central nervous system occurs in these conditions and may be associated with pain. Mirror visual feedback therapy aims to restore normal cortical organization and is applied in the treatment of chronic pain conditions. However, not all patients benefit from this treatment. Virtual reality technology is increasingly attracting attention for medical application, including as an analgesic modality. An advanced mirror visual feedback system with virtual reality technology may have increased analgesic efficacy and benefit a wider patient population. In this preliminary work, we developed a virtual reality mirror visual feedback system and applied it to the treatment of complex regional pain syndrome. A small open-label case series. Five patients with complex regional pain syndrome received virtual reality mirror visual feedback therapy once a week for five to eight sessions on an outpatient basis. Patients were monitored for continued medication use and pain intensity. Four of the five patients showed >50% reduction in pain intensity. Two of these patients ended their visits to our pain clinic after five sessions. Our results indicate that virtual reality mirror visual feedback therapy is a promising alternative treatment for complex regional pain syndrome. Further studies are necessary before concluding that analgesia provided from virtual reality mirror visual feedback therapy is the result of reversing maladaptive changes in pain perception.

  18. Intensity versus type of affect elicited by dissociative cognitions in moderating acute pain.

    PubMed

    Stevens, M J; Rogers, R M

    1990-12-01

    75 undergraduates were trained to use cognitions that elicited either high or low pleasure, high or low fear, or received an expectancy manipulation. Groups high in pleasure showed greater tolerance for pressure pain than other treatment groups but did not differ from expectancy; differences were not found on discomfort ratings. Results were not attributable to differential compliance with instructions, perceived effectiveness of cognitions used, or the number of cognitions used. The percentage of time during stimulation that assigned cognitions were used appeared to mediate tolerance. Expectations for improved tolerance elicited by appealing cognitions and compelling placebos may also mediate tolerance.

  19. Resilience in patients with amputation because of Complex Regional Pain Syndrome type I.

    PubMed

    Bodde, Marlies I; Schrier, Ernst; Krans, Hilde K; Geertzen, Jan H; Dijkstra, Pieter U

    2014-01-01

    Although controversial, an amputation for longstanding and therapy-resistant Complex Regional Pain Syndrome Type I (CRPS-I) may improve quality of life and pain intensity. Resilience, the way people deal with adversity in a positive way may be related to these positive outcomes. This study focused on the relationship between resilience and post-amputation outcomes, i.e. quality of life, pain and recurrence of CRPS-I and psychological distress. Twenty-six patients with an amputation related to CRPS-I filled in the Connor-Davidson Resilience Scale (CD-RISC), World Health Organisation -- Quality of life Assessment (WHOQOL-Bref) and the Symptom Checklist-90 Revised (SCL-90-R). An interview was conducted and a physical examination performed. Results were compared with reference groups from literature and a control group from the outpatient rehabilitation clinic at our medical center. Resilience correlated significantly with all domains of the WHOQOL-Bref (ρ ranged from 0.41 to 0.72) and negatively with all domains of the SCL-90-R (ρ ranged from -0.39 to -0.68). Patients with an amputation because of CRPS-I have higher scores on resilience and quality of life than the control group. Resilience was lower in patients who reported CRPS-I symptoms compared to those who did not. The results confirmed our hypothesis that patients with an amputation because of CRPS-I who have a higher resilience also have a higher quality of life and experience lower psychological distress. The prognostic value of resilience in this patient group requires further research. Implications for Rehabilitation Until characteristics of patients with positive quality of life outcome have been further unraveled, amputation for CRPS-I should only be performed in expertise centers. Resilience, the process of adapting well in the face of adversity, should be further explored in Rehabilitation Medicine research in general. Measurement of resilience should be a standard procedure when patients with CRPS

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

    PubMed

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

    2016-08-01

    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.

  1. University, Knowledge and Regional Development: Factors Affecting Knowledge Transfer in a Developing Region

    ERIC Educational Resources Information Center

    Fongwa, Neba Samuel; Marais, Lochner

    2016-01-01

    The role of knowledge in the current knowledge economy cannot be overly emphasised. Successful regions are continuously being linked to excellence in the production, accumulation, and application of knowledge. Universities have increasingly been at the centre of such knowledge production, application and transfer. Yet, there is little research and…

  2. University, Knowledge and Regional Development: Factors Affecting Knowledge Transfer in a Developing Region

    ERIC Educational Resources Information Center

    Fongwa, Neba Samuel; Marais, Lochner

    2016-01-01

    The role of knowledge in the current knowledge economy cannot be overly emphasised. Successful regions are continuously being linked to excellence in the production, accumulation, and application of knowledge. Universities have increasingly been at the centre of such knowledge production, application and transfer. Yet, there is little research and…

  3. Validation of the Malayalam Version of Leeds Assessment of Neuropathic Symptoms and Signs Pain Scale in Cancer Patients in the Regional Cancer Centre, Thiruvananthapuram, Kerala, India.

    PubMed

    Anzar, Shoukkathali; Koshy, Cherian; Abraham, Kurian Mathew

    2017-01-01

    The Self-administered Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) is a 7-item self-report scale developed to identify pain which is of predominantly neuropathic origin. The aim of this study was to develop a Malayalam version of the LANSS and to test its validity and reliability in chronic pain patients. We enrolled 101 Malayalam-speaking chronic pain patients who visited the Division of Palliative Medicine, Regional Cancer Centre, Thiruvananthapuram, Kerala, India. The translated version of S- LANSS was constructed by standard means. Fifty-one neuropathic pain and fifty nociceptive pain patients were identified by an independent pain physician and were subjected to the new pain scale by a palliative care nurse who was blinded to the diagnosis. The "gold standard diagnosis" is what the physician makes after clinical examination. Its validation, sensitivity, specificity, and positive and negative predictive values were determined. Fifty-one neuropathic pain and fifty nociceptive pain patients were subjected to the Malayalam version of S-LANSS pain scale for validity testing. The agreement by Cohen's Kappa 0.743, Chi-square test P < 0.001, sensitivity 89.58, specificity 84.91, positive predictive value 84.31, negative predictive value 90.00, accuracy by 87.13, and likelihood ratio 5.94. The Malayalam version of S-LANSS pain scale is a validated screening tool for identifying neuropathic pain in chronic pain patients in Malayalam-speaking regions.

  4. Evaluation of upper extremity rehabilitation in hemiplegic patients with and without complex regional pain syndrome type 1.

    PubMed

    Nakipoğlu, Güldal Funda; Dogan-Aslan, Meryem; Ozgirgin, Neşe

    2008-03-01

    We investigated the effects of the complex regional pain syndrome (CRPS) type 1 on upper extremity rehabilitation in hemiplegic patients. Eighty patients were enrolled and were randomly assigned to either study (40 hemiplegic patients with CRPS) or control (40 hemiplegic patients without CRPS) groups. All patients participated in a hemiplegia rehabilitation program consisting of neurodevelopmental techniques, stretching and strengthening exercises, and conventional methods. Additionally, participants in the study group received analgesic and calcitonin therapy, elevation, range of movement therapy for the affected joints, and contrast baths. Clinical findings were assessed before and after rehabilitation using the upper-limb function (ULF), hand movements (HM), and advanced hand activities (AHA) subscales of the Motor Assessment Scale (MAS) and the Ashworth scale for upper extremities. A statistically significant difference in MAS ULF was apparent at admission and upon discharge in both groups. In the control group, a significant difference was found between MAS HM and MAS AHA on admission and at discharge, no difference was found in the study group for these parameters. No difference was found for either group with regard to the Ashworth scale. No between-group differences were found regarding MAS ULF, MAS HM, and MAS AHA at admission and at discharge. Our data showed no influence of CRPS on MAS ULF, MAS HM, and MAS AHA and the Ashworth scale for upper extremities.

  5. fMRI Reveals Distinct CNS Processing during Symptomatic and Recovered Complex Regional Pain Syndrome in Children

    ERIC Educational Resources Information Center

    Lebel, A.; Becerra, L.; Wallin, D.; Moulton, E. A.; Morris, S.; Pendse, G.; Jasciewicz, J.; Stein, M.; Aiello-Lammens, M.; Grant, E.; Berde, C.; Borsook, D.

    2008-01-01

    Complex regional pain syndrome (CRPS) in paediatric patients is clinically distinct from the adult condition in which there is often complete resolution of its signs and symptoms within several months to a few years. The ability to compare the symptomatic and asymptomatic condition in the same individuals makes this population interesting for the…

  6. Complex regional pain syndrome (reflex sympathetic dystrophy) in a patient with essential mixed cryoglobulinemia and chronic hepatitis C.

    PubMed

    Bant, Ankur; Hurowitz, Bertram; Hassan, Nadeem; Du, Van Thiel; Nadir, Abdul

    2007-02-01

    Essential mixed cryoglobulinemia (EMC) is a common extra-hepatic manifestation of hepatitis C virus (HCV). Complex Regional Pain Syndrome type I (CRPS) or Reflex sympathetic dystrophy (RSD) has never been reported in association with HCV. This is the first case report of RSD in a patient with HCV related cirrhosis and EMC.

  7. fMRI Reveals Distinct CNS Processing during Symptomatic and Recovered Complex Regional Pain Syndrome in Children

    ERIC Educational Resources Information Center

    Lebel, A.; Becerra, L.; Wallin, D.; Moulton, E. A.; Morris, S.; Pendse, G.; Jasciewicz, J.; Stein, M.; Aiello-Lammens, M.; Grant, E.; Berde, C.; Borsook, D.

    2008-01-01

    Complex regional pain syndrome (CRPS) in paediatric patients is clinically distinct from the adult condition in which there is often complete resolution of its signs and symptoms within several months to a few years. The ability to compare the symptomatic and asymptomatic condition in the same individuals makes this population interesting for the…

  8. Differential activation of the μ-opioid receptor by oxycodone and morphine in pain-related brain regions in a bone cancer pain model

    PubMed Central

    Nakamura, Atsushi; Hasegawa, Minoru; Minami, Kazuhisa; Kanbara, Tomoe; Tomii, Takako; Nishiyori, Atsushi; Narita, Minoru; Suzuki, Tsutomu; Kato, Akira

    2013-01-01

    Background and Purpose Bone cancer pain is chronic and often difficult to control with opioids. However, recent studies have shown that several opioids have distinct analgesic profiles in chronic pain. Experimental Approach To clarify the mechanisms underlying these distinct analgesic profiles, functional changes in the μ-opioid receptor were examined using a mouse femur bone cancer (FBC) model. Key Results In the FBC model, the Bmax of [3H]-DAMGO binding was reduced by 15–45% in the periaqueductal grey matter (PAG), region ventral to the PAG (vPAG), mediodorsal thalamus (mTH), ventral thalamus and spinal cord. Oxycodone (10−8–10−5 M) and morphine (10−8–10−5 M) activated [35S]-GTPγS binding, but the activation was significantly attenuated in the PAG, vPAG, mTH and spinal cord in the FBC model. Interestingly, the attenuation of oxycodone-induced [35S]-GTPγS binding was quite limited (9–26%) in comparison with that of morphine (46–65%) in the PAG, vPAG and mTH, but not in the spinal cord. Furthermore, i.c.v. oxycodone at doses of 0.02–1.0 μg per mouse clearly inhibited pain-related behaviours, such as guarding, limb-use abnormalities and allodynia-like behaviour in the FBC model mice, while i.c.v. morphine (0.05–2.0 μg per mouse) had only partial or little analgesic effect on limb-use abnormalities and allodynia-like behaviour. Conclusion and Implications These results show that μ-opioid receptor functions are attenuated in several pain-related regions in bone cancer in an agonist-dependent manner, and suggest that modification of the μ-opioid receptor is responsible for the distinct analgesic effect of oxycodone and morphine. PMID:22889192

  9. Genetic variant rs3750625 in the 3'UTR of ADRA2A affects stress-dependent acute pain severity after trauma and alters a microRNA-34a regulatory site.

    PubMed

    Linnstaedt, Sarah D; Walker, Margaret G; Riker, Kyle D; Nyland, Jennifer E; Hu, JunMei; Rossi, Catherine; Swor, Robert A; Jones, Jeffrey S; Diatchenko, Luda; Bortsov, Andrey V; Peak, David A; McLean, Samuel A

    2017-02-01

    α2A adrenergic receptor (α2A-AR) activation has been shown in animal models to play an important role in regulating the balance of acute pain inhibition vs facilitation after both physical and psychological stress. To our knowledge, the influence of genetic variants in the gene encoding α2A-AR, ADRA2A, on acute pain outcomes in humans experiencing traumatic stress has not been assessed. In this study, we tested whether a genetic variant in the 3'UTR of ADRA2A, rs3750625, is associated with acute musculoskeletal pain (MSP) severity following motor vehicle collision (MVC, n = 948) and sexual assault (n = 84), and whether this influence was affected by stress severity. We evaluated rs3750625 because it is located in the seed binding region of miR-34a, a microRNA (miRNA) known to regulate pain and stress responses. In both cohorts, the minor allele at rs3750625 was associated with increased musculoskeletal pain in distressed individuals (stress*rs3750625 P = 0.043 for MVC cohort and P = 0.007 for sexual assault cohort). We further found that (1) miR-34a binds the 3'UTR of ADRA2A, (2) the amount of repression is greater when the minor (risk) allele is present, (3) miR-34a in the IMR-32 adrenergic neuroblastoma cell line affects ADRA2A expression, (4) miR-34a and ADRA2A are expressed in tissues known to play a role in pain and stress, (5) following forced swim stress exposure, rat peripheral nerve tissue expression changes are consistent with miR-34a regulation of ADRA2A. Together, these results suggest that ADRA2A rs3750625 contributes to poststress musculoskeletal pain severity by modulating miR-34a regulation.

  10. Amputation in patients with complex regional pain syndrome: a comparative study between amputees and non-amputees with intractable disease.

    PubMed

    Midbari, A; Suzan, E; Adler, T; Melamed, E; Norman, D; Vulfsons, S; Eisenberg, E

    2016-04-01

    Amputation in intractable cases of complex regional pain syndrome (CRPS) remains controversial. The likelihood of recurrent Complex Regional Pain Syndrome (CRPS), residual and phantom limb pain and persistent disability after amputation is poorly described in the literature. The aims of this study were to compare pain, function, depression and quality of life between patients with intractable CRPS who underwent amputation and those in whom amputation was considered but not performed. There were 19 patients in each group, with comparable demographic details. The amputated group included 14 men and five women with a mean age of 31 years (sd 12) at the time of CRPS diagnosis. The non-amputated group consisted of 12 men and seven women and their mean age of 36.8 years (sd 8) at CRPS diagnosis. The mean time from CRPS diagnosis to (first) amputation was 5.2 years (sd 4.3) and the mean time from amputation to data collection was 6.6 years (sd 5.8). All participants completed the following questionnaires: Short-Form (SF) 36, Short Form McGill Pain questionnaire (SF-MPQ), Pain Disability Index (PDI), the Beck Depression Inventory (BDI) and a clinical demographic questionnaire. The amputation group showed consistently better results compared to the non-amputation group in the following parameters: median pain intensity (VAS): 80 (inter-quartile range (IQR) 13 to 92) vs 91 (IQR 85 to 100); p = 0.007; median SF-MPQ score 28 (IQR 9 to 35) vs 35 (IQR 31 to 38), p = 0.025; median PDI: 42 (IQR 11 to 64) vs 58 (IQR 50 to 62), p = 0.031; median BDI: 19 (IQR 5 to 28) vs 27 (IQR 21 to 32), p = 0.061 (borderline significant) and in six of the eight SF-36 domains. Amputation should be considered as a form of treatment for patients with intractable CRPS. ©2016 The British Editorial Society of Bone & Joint Surgery.

  11. High Prevalence of Nontraumatic Shoulder Pain in a Regional Sample of Female High School Volleyball Athletes.

    PubMed

    Frisch, Kayt E; Clark, Jacob; Hanson, Chad; Fagerness, Chris; Conway, Adam; Hoogendoorn, Lindsay

    2017-06-01

    Shoulder pain is becoming increasingly problematic in young players as volleyball gains popularity. Associations between repetitive motion and pain and overuse injury have been observed in other overhand sports (most notably baseball). Studies of adult athletes suggest that there is a shoulder pain and overuse problem present in volleyball players, but minimal research has been done to establish rates and causes in juvenile participants. To establish rates of shoulder pain, regardless of whether it resulted in a loss of playing time, in female high school volleyball players. A secondary goal was to determine whether high repetition volumes correlated with an increased likelihood of experiencing pain. Descriptive epidemiology study. A self-report survey focusing on the prevalence of pain not associated with a traumatic event in female high school youth volleyball players was developed. Survey questions were formulated by certified athletic trainers, experienced volleyball coaches, and biomechanics experts. Surveys were received from 175 healthy, active high school volleyball players in Iowa, South Dakota, and Minnesota. Forty percent (70/175) of active high school volleyball players remembered experiencing shoulder pain not related to traumatic injury, but only 33% (23/70) reported taking time off to recover from the pain. Based on these self-reported data, activities associated with significantly increased risk of nontraumatic shoulder pain included number of years playing competitive volleyball (P = .01) and lifting weights out of season (P = .001). Players who reported multiple risk factors were more likely to experience nontraumatic shoulder pain. When using time off for recovery as the primary injury criterion, we found that the incidence of shoulder pain is more than twice as high as the incidence of injury reported by previous studies. Findings also indicated that the incidence of shoulder pain may be correlated with volume of previous volleyball experience.

  12. High Prevalence of Nontraumatic Shoulder Pain in a Regional Sample of Female High School Volleyball Athletes

    PubMed Central

    Frisch, Kayt E.; Clark, Jacob; Hanson, Chad; Fagerness, Chris; Conway, Adam; Hoogendoorn, Lindsay

    2017-01-01

    Background: Shoulder pain is becoming increasingly problematic in young players as volleyball gains popularity. Associations between repetitive motion and pain and overuse injury have been observed in other overhand sports (most notably baseball). Studies of adult athletes suggest that there is a shoulder pain and overuse problem present in volleyball players, but minimal research has been done to establish rates and causes in juvenile participants. Purpose: To establish rates of shoulder pain, regardless of whether it resulted in a loss of playing time, in female high school volleyball players. A secondary goal was to determine whether high repetition volumes correlated with an increased likelihood of experiencing pain. Study Design: Descriptive epidemiology study. Methods: A self-report survey focusing on the prevalence of pain not associated with a traumatic event in female high school youth volleyball players was developed. Survey questions were formulated by certified athletic trainers, experienced volleyball coaches, and biomechanics experts. Surveys were received from 175 healthy, active high school volleyball players in Iowa, South Dakota, and Minnesota. Results: Forty percent (70/175) of active high school volleyball players remembered experiencing shoulder pain not related to traumatic injury, but only 33% (23/70) reported taking time off to recover from the pain. Based on these self-reported data, activities associated with significantly increased risk of nontraumatic shoulder pain included number of years playing competitive volleyball (P = .01) and lifting weights out of season (P = .001). Players who reported multiple risk factors were more likely to experience nontraumatic shoulder pain. Conclusion: When using time off for recovery as the primary injury criterion, we found that the incidence of shoulder pain is more than twice as high as the incidence of injury reported by previous studies. Findings also indicated that the incidence of shoulder pain

  13. The effectiveness and cost evaluation of pain exposure physical therapy and conventional therapy in patients with complex regional pain syndrome type 1. Rationale and design of a randomized controlled trial

    PubMed Central

    2012-01-01

    Background Pain Exposure Physical Therapy is a new treatment option for patients with Complex Regional Pain Syndrome type 1. It has been evaluated in retrospective as well as in prospective studies and proven to be safe and possibly effective. This indicates that Pain Exposure Physical Therapy is now ready for clinical evaluation. The results of an earlier performed pilot study with an n = 1 design, in which 20 patients with Complex Regional Pain Syndrome type 1 were treated with Pain Exposure Physical Therapy, were used for the design and power calculation of the present study. After completion and evaluation of this phase III study, a multi-centre implementation study will be conducted. The aim of this study is to determine whether Pain Exposure Physical Therapy can improve functional outcomes in patients with Complex Regional Pain Syndrome type 1. Methods/design This study is designed as a single-blinded, randomized clinical trial. 62 patients will be randomized with a follow-up of 9 months to demonstrate the expected treatment effect. Complex Regional Pain Syndrome type 1 is diagnosed in accordance with the Bruehl/International Association for the Study of Pain criteria. Conventional therapy in accordance with the Dutch guideline will be compared with Pain Exposure Physical Therapy. Primary outcome measure is the Impairment level SumScore, restricted version. Discussion This is the first randomized controlled study with single blinding that has ever been planned in patients with Complex Regional Pain Syndrome type 1 and does not focus on a single aspect of the pain syndrome but compares treatment strategies based on completely different pathophysiological and cognitive theories. Trial registration Clinical trials NCT00817128; National Trial Register NTR2090 PMID:22515496

  14. The effectiveness and cost evaluation of pain exposure physical therapy and conventional therapy in patients with complex regional pain syndrome type 1. Rationale and design of a randomized controlled trial.

    PubMed

    Barnhoorn, Karlijn J; Oostendorp, Rob A B; van Dongen, Robert T M; Klomp, Frank P; Samwel, Han; van der Wilt, Gert Jan; Adang, Eddy; Groenewoud, Hans; van de Meent, Henk; Frölke, Jan Paul M

    2012-04-19

    Pain Exposure Physical Therapy is a new treatment option for patients with Complex Regional Pain Syndrome type 1. It has been evaluated in retrospective as well as in prospective studies and proven to be safe and possibly effective. This indicates that Pain Exposure Physical Therapy is now ready for clinical evaluation. The results of an earlier performed pilot study with an n = 1 design, in which 20 patients with Complex Regional Pain Syndrome type 1 were treated with Pain Exposure Physical Therapy, were used for the design and power calculation of the present study.After completion and evaluation of this phase III study, a multi-centre implementation study will be conducted.The aim of this study is to determine whether Pain Exposure Physical Therapy can improve functional outcomes in patients with Complex Regional Pain Syndrome type 1. This study is designed as a single-blinded, randomized clinical trial. 62 patients will be randomized with a follow-up of 9 months to demonstrate the expected treatment effect. Complex Regional Pain Syndrome type 1 is diagnosed in accordance with the Bruehl/International Association for the Study of Pain criteria. Conventional therapy in accordance with the Dutch guideline will be compared with Pain Exposure Physical Therapy. Primary outcome measure is the Impairment level SumScore, restricted version. This is the first randomized controlled study with single blinding that has ever been planned in patients with Complex Regional Pain Syndrome type 1 and does not focus on a single aspect of the pain syndrome but compares treatment strategies based on completely different pathophysiological and cognitive theories.

  15. Effects of Mirror Therapy in Stroke Patients With Complex Regional Pain Syndrome Type 1: A Randomized Controlled Study.

    PubMed

    Pervane Vural, Secil; Nakipoglu Yuzer, Guldal Funda; Sezgin Ozcan, Didem; Demir Ozbudak, Sibel; Ozgirgin, Nese

    2016-04-01

    To investigate the effects of mirror therapy on upper limb motor functions, spasticity, and pain intensity in patients with hemiplegia accompanied by complex regional pain syndrome type 1. Randomized controlled trial. Training and research hospital. Adult patients with first-time stroke and simultaneous complex regional pain syndrome type 1 of the upper extremity at the dystrophic stage (N=30). Both groups received a patient-specific conventional stroke rehabilitation program for 4 weeks, 5 d/wk, for 2 to 4 h/d. The mirror therapy group received an additional mirror therapy program for 30 min/d. We evaluated the scores of the Brunnstrom recovery stages of the arm and hand for motor recovery, wrist and hand subsections of the Fugl-Meyer Assessment (FMA) and motor items of the FIM-motor for functional status, Modified Ashworth Scale (MAS) for spasticity, and visual analog scale (VAS) for pain severity. After 4 weeks of rehabilitation, both groups had significant improvements in the FIM-motor and VAS scores compared with baseline scores. However, the scores improved more in the mirror therapy group than the control group (P<.001 and P=.03, respectively). Besides, the patients in the mirror therapy arm showed significant improvement in the Brunnstrom recovery stages and FMA scores (P<.05). No significant difference was found for MAS scores. In patients with stroke and simultaneous complex regional pain syndrome type 1, addition of mirror therapy to a conventional stroke rehabilitation program provides more improvement in motor functions of the upper limb and pain perception than conventional therapy without mirror therapy. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  16. The Last Glacial Maximum and Termination in the Torres del Paine Region, Southern South America

    NASA Astrophysics Data System (ADS)

    Garcia, J.; Hall, B. L.; Kaplan, M. R.; Vega, R. M.; Binnie, S.; Gómez, G.; Santana, F.

    2012-12-01

    Deciphering the timing, structure and termination of the local last glacial maximum (LGM) throughout Patagonia (42-55 S) remains one of the key unsolved paleoclimate questions in Quaternary sciences. During the last glaciation, the Patagonian ice sheet formed one ice body along the Patagonian Andes (42-55 S) in southern South America, but previous work has revealed different spatiotemporal ice dynamics along the eastern and western ice margins. The Patagonian Andes is the only landmass that exists at this latitude confronting the southern westerly wind belt, which seems to have played a key role in past glacial and climate changes. Therefore, reconstructing southern Andes glacie