Sample records for jette ton pain

  1. STS-81 pilot Jett on aft flight deck during approach to Mir

    NASA Image and Video Library

    1997-02-26

    STS081-368-011 (12-22 Jan. 1997) --- Astronaut Brent W. Jett, Jr., STS-81 pilot, appears restful and unfazed as Russia's Mir Space Station appears in the window over his shoulder on the Space Shuttle Atlantis' aft flight deck. Following docking of Mir and Atlantis, Jett and his crew mates went on to spend several days sharing experiments and supply-transfer with the Mir-22 crewmembers.

  2. Astronauts Brent Jett and Koichi Wakata work with Protein Crystal Growth experiment

    NASA Image and Video Library

    1996-01-20

    STS072-310-007 (11-20 Jan. 1996) --- Astronauts Brent W. Jett Jr. (left) and Koichi Wakata work with the Protein Crystal Growth (PCG) experiment at the Single Locker Thermal Enclosure System (STES) on the Space Shuttle Endeavour’s mid-deck. Jett, making his first flight in space, served as the crew’s pilot, while Wakata served as a mission specialist. Wakata, also a first time Shuttle crew member, represents Japan’s National Space Development Agency (NASDA).

  3. Jett, Tanner and Garneau during re-entry preparations for STS-97

    NASA Image and Video Library

    2000-12-11

    STS097-310-032 (11 December 2000) --- Astronauts (left to right) Marc Garneau, Joseph R. Tanner, both mission specialists, and Brent W. Jett, mission commander, are photographed on the flight deck of the Space Shuttle Endeavour as they prepare for re-entry. Garneau represents the Canadian Space Agency (CSA).

  4. Pilot Bloomfield and Commander Jett talk with Dan Goldin

    NASA Technical Reports Server (NTRS)

    2000-01-01

    Shortly after the landing of Endeavour, NASA Administrator Daniel Goldin (center) talks with STS-97 Pilot Michael Bloomfield (left) and Commander Brent Jett (right) underneath the orbiter. Landing occurred at 6:04 p.m. EST. On the 4.4-million-mile mission, Endeavour carried the P6 Integrated Truss Structure with solar arrays to power the International Space Station. The arrays and other equipment were installed during three EVAs that totaled 19 hours, 20 minutes. Endeavour was docked with the Space Station for 6 days, 23 hours, 13 minutes. This is the 16th nighttime landing for a Space Shuttle and the 53rd at Kennedy Space Center.

  5. Going Outside the TonB Box: Identification of Novel FepA-TonB Interactions In Vivo.

    PubMed

    Gresock, Michael G; Postle, Kathleen

    2017-05-15

    In Gram-negative bacteria, the cytoplasmic membrane protein TonB transmits energy derived from proton motive force to energize transport of important nutrients through TonB-dependent transporters in the outer membrane. Each transporter consists of a beta barrel domain and a lumen-occluding cork domain containing an essential sequence called the TonB box. To date, the only identified site of transporter-TonB interaction is between the TonB box and residues ∼158 to 162 of TonB. While the mechanism of ligand transport is a mystery, a current model based on site-directed spin labeling and molecular dynamics simulations is that, following ligand binding, the otherwise-sequestered TonB box extends into the periplasm for recognition by TonB, which mediates transport by pulling or twisting the cork. In this study, we tested that hypothesis with the outer membrane transporter FepA using in vivo photo-cross-linking to explore interactions of its TonB box and determine whether additional FepA-TonB interaction sites exist. We found numerous specific sites of FepA interaction with TonB on the periplasmic face of the FepA cork in addition to the TonB box. Two residues, T32 and A33, might constitute a ligand-sensitive conformational switch. The facts that some interactions were enhanced in the absence of ligand and that other interactions did not require the TonB box argued against the current model and suggested that the transport process is more complex than originally conceived, with subtleties that might provide a mechanism for discrimination among ligand-loaded transporters. These results constitute the first study on the dynamics of TonB-gated transporter interaction with TonB in vivo IMPORTANCE The TonB system of Gram-negative bacteria has a noncanonical active transport mechanism involving signal transduction and proteins integral to both membranes. To achieve transport, the cytoplasmic membrane protein TonB physically contacts outer membrane transporters such as Fep

  6. Death of the TonB Shuttle Hypothesis.

    PubMed

    Gresock, Michael G; Savenkova, Marina I; Larsen, Ray A; Ollis, Anne A; Postle, Kathleen

    2011-01-01

    A complex of ExbB, ExbD, and TonB couples cytoplasmic membrane (CM) proton motive force (pmf) to the active transport of large, scarce, or important nutrients across the outer membrane (OM). TonB interacts with OM transporters to enable ligand transport. Several mechanical models and a shuttle model explain how TonB might work. In the mechanical models, TonB remains attached to the CM during energy transduction, while in the shuttle model the TonB N terminus leaves the CM to deliver conformationally stored potential energy to OM transporters. Previous studies suggested that TonB did not shuttle based on the activity of a GFP-TonB fusion that was anchored in the CM by the GFP moiety. When we recreated the GFP-TonB fusion to extend those studies, in our hands it was proteolytically unstable, giving rise to potentially shuttleable degradation products. Recently, we discovered that a fusion of the Vibrio cholerae ToxR cytoplasmic domain to the N terminus of TonB was proteolytically stable. ToxR-TonB was able to be completely converted into a proteinase K-resistant conformation in response to loss of pmf in spheroplasts and exhibited an ability to form a pmf-dependent formaldehyde crosslink to ExbD, both indicators of its location in the CM. Most importantly, ToxR-TonB had the same relative specific activity as wild-type TonB. Taken together, these results provide conclusive evidence that TonB does not shuttle during energy transduction. We had previously concluded that TonB shuttles based on the use of an Oregon Green(®) 488 maleimide probe to assess periplasmic accessibility of N-terminal TonB. Here we show that the probe was permeant to the CM, thus permitting the labeling of the TonB N-terminus. These former results are reinterpreted in the context that TonB does not shuttle, and suggest the existence of a signal transduction pathway from OM to cytoplasm.

  7. Death of the TonB Shuttle Hypothesis

    PubMed Central

    Gresock, Michael G.; Savenkova, Marina I.; Larsen, Ray A.; Ollis, Anne A.; Postle, Kathleen

    2011-01-01

    A complex of ExbB, ExbD, and TonB couples cytoplasmic membrane (CM) proton motive force (pmf) to the active transport of large, scarce, or important nutrients across the outer membrane (OM). TonB interacts with OM transporters to enable ligand transport. Several mechanical models and a shuttle model explain how TonB might work. In the mechanical models, TonB remains attached to the CM during energy transduction, while in the shuttle model the TonB N terminus leaves the CM to deliver conformationally stored potential energy to OM transporters. Previous studies suggested that TonB did not shuttle based on the activity of a GFP–TonB fusion that was anchored in the CM by the GFP moiety. When we recreated the GFP–TonB fusion to extend those studies, in our hands it was proteolytically unstable, giving rise to potentially shuttleable degradation products. Recently, we discovered that a fusion of the Vibrio cholerae ToxR cytoplasmic domain to the N terminus of TonB was proteolytically stable. ToxR–TonB was able to be completely converted into a proteinase K-resistant conformation in response to loss of pmf in spheroplasts and exhibited an ability to form a pmf-dependent formaldehyde crosslink to ExbD, both indicators of its location in the CM. Most importantly, ToxR–TonB had the same relative specific activity as wild-type TonB. Taken together, these results provide conclusive evidence that TonB does not shuttle during energy transduction. We had previously concluded that TonB shuttles based on the use of an Oregon Green® 488 maleimide probe to assess periplasmic accessibility of N-terminal TonB. Here we show that the probe was permeant to the CM, thus permitting the labeling of the TonB N-terminus. These former results are reinterpreted in the context that TonB does not shuttle, and suggest the existence of a signal transduction pathway from OM to cytoplasm. PMID:22016747

  8. Improvements in BTS estimation of ton-miles

    DOT National Transportation Integrated Search

    2004-08-01

    Ton-miles (one ton of freight shipped one mile) is the primary physical measure of freight transportation output. This paper describes improved measurements of ton-miles for air, truck, rail, water, and pipeline modes. Each modal measure contains a d...

  9. TDRSS Onboard Navigation System (TONS) flight qualification experiment

    NASA Technical Reports Server (NTRS)

    Gramling, C. J.; Hart, R. C.; Folta, D. C.; Long, A. C.

    1994-01-01

    The National Aeronautics and Space Administration (NASA) Goddard Space Flight Center (GSFC) is currently developing an operational Tracking and Data Relay Satellite (TDRS) System (TDRSS) Onboard Navigation System (TONS) to provide realtime, autonomous, high-accuracy navigation products to users of TDRSS. A TONS experiment was implemented on the Explorer Platform/Extreme Ultraviolet Explorer (EP/EUVE) spacecraft, launched June 7, 1992, to flight qualify the TONS operational system using TDRSS forward-link communications services. This paper provides a detailed evaluation of the flight hardware, an ultrastable oscillator (USO) and Doppler extractor (DE) card in one of the TDRSS user transponders and the ground-based prototype flight software performance, based on the 1 year of TONS experiment operation. The TONS experiment results are used to project the expected performance of the TONS 1 operational system. TONS 1 processes Doppler data derived from scheduled forward-link S-band services using a sequential estimation algorithm enhanced by a sophisticated process noise model to provide onboard orbit and frequency determination and time maintenance. TONS 1 will be the prime navigation system on the Earth Observing System (EOS)-AM1 spacecraft, currently scheduled for launch in 1998. Inflight evaluation of the USO and DE short-term and long-term stability indicates that the performance is excellent. Analysis of the TONS prototype flight software performance indicates that realtime onboard position accuracies of better than 25 meters root-mean-square are achievable with one tracking contact every one to two orbits for the EP/EUVE 525-kilometer altitude, 28.5 degree inclination orbit. The success of the TONS experiment demonstrates the flight readiness of TONS to support the EOS-AM1 mission.

  10. Summary and Comparison of the 2016 Billion-Ton Report with the 2011 U.S. Billion-Ton Update

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    None

    2016-06-01

    In terms of the magnitude of the resource potential, the results of the 2016 Billion-Ton Report (BT16) are consistent with the original 2005 Billion-Ton Study (BTS) and the 2011 report, U.S. Billion-Ton Update: Biomass Supply for a Bioenergy and Bioproducts Industry (BT2. An effort was made to reevaluate the potential forestland, agricultural, and waste resources at the roadside, then extend the analysis by adding transportation costs to a biorefinery under specified logistics assumptions to major resource fractions.

  11. TonB-dependent ligand trapping in the BtuB transporter.

    PubMed

    Mills, Allan; Le, Hai-Tuong; Duong, Franck

    2016-12-01

    TonB-dependent transporters are β-barrel outer membrane proteins occluded by a plug domain. Upon ligand binding, these transporters extend a periplasmic motif termed the TonB box. The TonB box permits the recruitment of the inner membrane protein complex TonB-ExbB-ExbD, which drives import of ligands in the cell periplasm. It is unknown precisely how the plug domain is moved aside during transport nor have the intermediate states between TonB recruitment and plug domain movement been characterized biochemically. Here we employ nanodiscs, native gel electrophoresis, and scintillation proximity assays to determine the binding kinetics of vitamin B 12 to BtuB. The results show that ligand-bound BtuB recruits a monomer of TonB (TonB ∆1-31 ), which in turn increases retention of vitamin B 12 within the transporter. The TonB box and the extracellular residue valine 90 that forms part of the vitamin B 12 binding site are essential for this event. These results identify a novel step in the TonB-dependent transport process. They show that TonB binding to BtuB trap the ligand, possibly until the ExbB-ExbD complex is activated or recruited to ensure subsequent transport. Copyright © 2016 Elsevier B.V. All rights reserved.

  12. The updated billion-ton resource assessment

    Treesearch

    Anthony Turhollow; Robert Perlack; Laurence Eaton; Matthew Langholtz; Craig Brandt; Mark Downing; Lynn Wright; Kenneth Skog; Chad Hellwinckel; Bryce Stokes; Patricia Lebow

    2014-01-01

    This paper summarizes the results of an update to a resource assessment, published in 2005, commonly referred to as the Billion-Ton Study (BTS). The updated results are consistent with the 2005 BTS in terms of overall magnitude. The 2005 BTS projected between 860 and 1240 Tg of biomass available in the 2050 timeframe, while the Billion-Ton Update (BT2), for a price of...

  13. TNF-α promotes nuclear enrichment of the transcription factor TonEBP/NFAT5 to selectively control inflammatory but not osmoregulatory responses in nucleus pulposus cells.

    PubMed

    Johnson, Zariel I; Doolittle, Alexandra C; Snuggs, Joseph W; Shapiro, Irving M; Le Maitre, Christine L; Risbud, Makarand V

    2017-10-20

    Intervertebral disc degeneration (IDD) causes chronic back pain and is linked to production of proinflammatory molecules by nucleus pulposus (NP) and other disc cells. Activation of tonicity-responsive enhancer-binding protein (TonEBP)/NFAT5 by non-osmotic stimuli, including proinflammatory molecules, occurs in cells involved in immune response. However, whether inflammatory stimuli activate TonEBP in NP cells and whether TonEBP controls inflammation during IDD is unknown. We show that TNF-α, but not IL-1β or LPS, promoted nuclear enrichment of TonEBP protein. However, TNF-α-mediated activation of TonEBP did not cause induction of osmoregulatory genes. RNA sequencing showed that 8.5% of TNF-α transcriptional responses were TonEBP-dependent and identified genes regulated by both TNF-α and TonEBP. These genes were over-enriched in pathways and diseases related to inflammatory response and inhibition of matrix metalloproteases. Based on RNA-sequencing results, we further investigated regulation of novel TonEBP targets CXCL1 , CXCL2 , and CXCL3 TonEBP acted synergistically with TNF-α and LPS to induce CXCL1 -proximal promoter activity. Interestingly, this regulation required a highly conserved NF-κB-binding site but not a predicted TonE, suggesting cross-talk between these two members of the Rel family. Finally, analysis of human NP tissue showed that TonEBP expression correlated with canonical osmoregulatory targets TauT/SLC6A6 , SMIT/SLC5A3 , and AR/AKR1B1 , supporting in vitro findings that the inflammatory milieu during IDD does not interfere with TonEBP osmoregulation. In summary, whereas TonEBP participates in the proinflammatory response to TNF-α, therapeutic strategies targeting this transcription factor for treatment of disc disease must spare osmoprotective, prosurvival, and matrix homeostatic activities. © 2017 by The American Society for Biochemistry and Molecular Biology, Inc.

  14. Examination of the suitability of an implementation of the Jette localized heterogeneities fluence term L(1)(x,y,z) in an electron beam treatment planning algorithm

    NASA Astrophysics Data System (ADS)

    Rodebaugh, Raymond Francis, Jr.

    2000-11-01

    In this project we applied modifications of the Fermi- Eyges multiple scattering theory to attempt to achieve the goals of a fast, accurate electron dose calculation algorithm. The dose was first calculated for an ``average configuration'' based on the patient's anatomy using a modification of the Hogstrom algorithm. It was split into a measured central axis depth dose component based on the material between the source and the dose calculation point, and an off-axis component based on the physics of multiple coulomb scattering for the average configuration. The former provided the general depth dose characteristics along the beam fan lines, while the latter provided the effects of collimation. The Gaussian localized heterogeneities theory of Jette provided the lateral redistribution of the electron fluence by heterogeneities. Here we terminated Jette's infinite series of fluence redistribution terms after the second term. Experimental comparison data were collected for 1 cm thick x 1 cm diameter air and aluminum pillboxes using the Varian 2100C linear accelerator at Rush-Presbyterian- St. Luke's Medical Center. For an air pillbox, the algorithm results were in reasonable agreement with measured data at both 9 and 20 MeV. For the Aluminum pill box, there were significant discrepancies between the results of this algorithm and experiment. This was particularly apparent for the 9 MeV beam. Of course a one cm thick Aluminum heterogeneity is unlikely to be encountered in a clinical situation; the thickness, linear stopping power, and linear scattering power of Aluminum are all well above what would normally be encountered. We found that the algorithm is highly sensitive to the choice of the average configuration. This is an indication that the series of fluence redistribution terms does not converge fast enough to terminate after the second term. It also makes it difficult to apply the algorithm to cases where there are no a priori means of choosing the best average

  15. Characterization of Two Ton NaI Scintillator

    NASA Astrophysics Data System (ADS)

    Maier, Alleta; Coherent Collaboration

    2017-09-01

    The COHERENT collaboration is dedicated to measuring Coherent Elastic Neutrino-Nucleus Scattering (CE νNS), an interaction predicted by the standard model that ultimately serves as a background floor for dark matter detection. In the pursuit of observing the N2 scaling predicted, COHERENT is deploying two tons of NaI[Tl] detector to observe CE νNS recoils of sodium nuclei. Before the two tons of this NaI[Tl] scintillator are deployed, however, all crystals and PMTs must be characterized to understand the individual properties vital to precision in the measurement of CE νNS. This detector is also expected to allow COHERENT to observe charged current and CE νNS interactions with 127I. A standard operating procedure is developed to characterize each detector based on seven properties relevant to precision in the measurement of CE νNS: energy scale, energy resolution, low-energy light yield non-linearity, decay time energy dependence, position variance, time variance, and background levels. Crystals will be tested and characterized for these properties in the context of a ton-scale NaI[Tl] detector. Preliminary development of the SOP has allowed for greater understanding of optimization methods needed for characterization for the ton scale detector. TUNL, NSF, Duke University.

  16. Functional Features of TonB Energy Transduction Systems of Acinetobacter baumannii

    PubMed Central

    Zimbler, Daniel L.; Arivett, Brock A.; Beckett, Amber C.; Menke, Sharon M.

    2013-01-01

    Acinetobacter baumannii is an opportunistic pathogen that causes severe nosocomial infections. Strain ATCC 19606T utilizes the siderophore acinetobactin to acquire iron under iron-limiting conditions encountered in the host. Accordingly, the genome of this strain has three tonB genes encoding proteins for energy transduction functions needed for the active transport of nutrients, including iron, through the outer membrane. Phylogenetic analysis indicates that these tonB genes, which are present in the genomes of all sequenced A. baumannii strains, were acquired from different sources. Two of these genes occur as components of tonB-exbB-exbD operons and one as a monocistronic copy; all are actively transcribed in ATCC 19606T. The abilities of components of these TonB systems to complement the growth defect of Escherichia coli W3110 mutants KP1344 (tonB) and RA1051 (exbBD) under iron-chelated conditions further support the roles of these TonB systems in iron acquisition. Mutagenesis analysis of ATCC 19606T tonB1 (subscripted numbers represent different copies of genes or proteins) and tonB2 supports this hypothesis: their inactivation results in growth defects in iron-chelated media, without affecting acinetobactin biosynthesis or the production of the acinetobactin outer membrane receptor protein BauA. In vivo assays using Galleria mellonella show that each TonB protein is involved in, but not essential for, bacterial virulence in this infection model. Furthermore, we observed that TonB2 plays a role in the ability of bacteria to bind to fibronectin and to adhere to A549 cells by uncharacterized mechanisms. Taken together, these results indicate that A. baumannii ATCC 19606T produces three independent TonB proteins, which appear to provide the energy-transducing functions needed for iron acquisition and cellular processes that play a role in the virulence of this pathogen. PMID:23817614

  17. First Results from the DUNE 35-ton Prototype using Cosmics

    NASA Astrophysics Data System (ADS)

    Insler, Jonathan; DUNE Collaboration

    2016-03-01

    The 35-ton prototype for the Deep Underground Neutrino Experiment (DUNE) Far Detector is a single-phase liquid argon time projection chamber (LAr-TPC) integrated detector that will take cosmics data for a two month run beginning in February 2016. The 35-ton prototype will characterize DUNE's Far Detector technology performance and provide a sample of real data for DUNE reconstruction algorithms. The 35-ton prototype has two drift volumes of lengths 2.23 m and 0.23 m on either side of its anode plane assembly (APA) and makes use of wire planes with wrapped wires and a photon detection system (PDS) utilizing photon detection panels read out by silicon photomultipliers (SiPMs). Data from the 35-ton LAr detector are expected to provide rich information on scintillation light and charged particle tracks. We present a preliminary analysis of cosmics data taken with the 35-ton detector with a focus on stopping muons.

  18. View of the 200ton derrick from east showing the boom ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    View of the 200-ton derrick from east showing the boom on it's rest and both the 200 -ton hoist and the 40-ton hoist ant their respective block and tackle. - Marshall Space Flight Center, Saturn V Dynamic Test Facility, East Test Area, Huntsville, Madison County, AL

  19. TDRSS Onboard Navigation System (TONS) experiment for the Explorer Platform (EP)

    NASA Astrophysics Data System (ADS)

    Gramling, C. J.; Hornstein, R. S.; Long, A. C.; Samii, M. V.; Elrod, B. D.

    A TDRSS Onboard Navigation System (TONS) is currently being developed by NASA to provide a high-accuracy autonomous spacecraft navigation capability for users of TDRSS and its successor, the Advanced TDRSS. A TONS experiment will be performed in conjunction with the Explorer Platform (EP)/EUV Explorer mission to flight-qualify TONS Block I. This paper presents an overview of TDRSS on-board navigation goals and plans and the technical objectives of the TONS experiment. The operations concept of the experiment is described, including the characteristics of the ultrastable oscillator, the Doppler extractor, the signal-acquisition process, the TONS ground-support system, and the navigation flight software. A description of the on-board navigation algorithms and the rationale for their selection is also presented.

  20. 7 CFR 989.20 - Ton.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 7 Agriculture 8 2012-01-01 2012-01-01 false Ton. 989.20 Section 989.20 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Marketing Agreements and Orders; Fruits, Vegetables, Nuts), DEPARTMENT OF AGRICULTURE RAISINS PRODUCED FROM GRAPES GROWN IN...

  1. 7 CFR 989.20 - Ton.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 7 Agriculture 8 2014-01-01 2014-01-01 false Ton. 989.20 Section 989.20 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (MARKETING AGREEMENTS AND ORDERS; FRUITS, VEGETABLES, NUTS), DEPARTMENT OF AGRICULTURE RAISINS PRODUCED FROM GRAPES GROWN IN...

  2. 7 CFR 989.20 - Ton.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 7 Agriculture 8 2013-01-01 2013-01-01 false Ton. 989.20 Section 989.20 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (MARKETING AGREEMENTS AND ORDERS; FRUITS, VEGETABLES, NUTS), DEPARTMENT OF AGRICULTURE RAISINS PRODUCED FROM GRAPES GROWN IN...

  3. 7 CFR 989.20 - Ton.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 8 2010-01-01 2010-01-01 false Ton. 989.20 Section 989.20 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Marketing Agreements and Orders; Fruits, Vegetables, Nuts), DEPARTMENT OF AGRICULTURE RAISINS PRODUCED FROM GRAPES GROWN IN...

  4. 7 CFR 993.17 - Ton.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 8 2010-01-01 2010-01-01 false Ton. 993.17 Section 993.17 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Marketing Agreements and Orders; Fruits, Vegetables, Nuts), DEPARTMENT OF AGRICULTURE DRIED PRUNES PRODUCED IN CALIFORNIA Order...

  5. 7 CFR 993.17 - Ton.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 7 Agriculture 8 2012-01-01 2012-01-01 false Ton. 993.17 Section 993.17 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Marketing Agreements and Orders; Fruits, Vegetables, Nuts), DEPARTMENT OF AGRICULTURE DRIED PRUNES PRODUCED IN CALIFORNIA Order...

  6. 7 CFR 993.17 - Ton.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 7 Agriculture 8 2013-01-01 2013-01-01 false Ton. 993.17 Section 993.17 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (MARKETING AGREEMENTS AND ORDERS; FRUITS, VEGETABLES, NUTS), DEPARTMENT OF AGRICULTURE DRIED PRUNES PRODUCED IN CALIFORNIA Order...

  7. 7 CFR 993.17 - Ton.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 7 Agriculture 8 2014-01-01 2014-01-01 false Ton. 993.17 Section 993.17 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (MARKETING AGREEMENTS AND ORDERS; FRUITS, VEGETABLES, NUTS), DEPARTMENT OF AGRICULTURE DRIED PRUNES PRODUCED IN CALIFORNIA Order...

  8. 7 CFR 993.17 - Ton.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 7 Agriculture 8 2011-01-01 2011-01-01 false Ton. 993.17 Section 993.17 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Marketing Agreements and Orders; Fruits, Vegetables, Nuts), DEPARTMENT OF AGRICULTURE DRIED PRUNES PRODUCED IN CALIFORNIA Order...

  9. Energy-dependent motion of TonB in the Gram-negative bacterial inner membrane

    PubMed Central

    Jordan, Lorne D.; Zhou, Yongyao; Smallwood, Chuck R.; Lill, Yoriko; Ritchie, Ken; Yip, Wai Tak; Newton, Salete M.; Klebba, Phillip E.

    2013-01-01

    Gram-negative bacteria acquire iron with TonB-dependent uptake systems. The TonB–ExbBD inner membrane complex is hypothesized to transfer energy to outer membrane (OM) iron transporters. Fluorescence microscopic characterization of green fluorescent protein (GFP)-TonB hybrid proteins revealed an unexpected, restricted localization of TonB in the cell envelope. Fluorescence polarization measurements demonstrated motion of TonB in living cells, which likely was rotation. By determining the anisotropy of GFP-TonB in the absence and presence of inhibitors, we saw the dependence of its motion on electrochemical force and on the actions of ExbBD. We observed higher anisotropy for GFP-TonB in energy-depleted cells and lower values in bacteria lacking ExbBD. However, the metabolic inhibitors did not change the anisotropy of GFP-TonB in ΔexbBD cells. These findings demonstrate that TonB undergoes energized motion in the bacterial cell envelope and that ExbBD couples this activity to the electrochemical gradient. The results portray TonB as an energized entity in a regular array underlying the OM bilayer, which promotes metal uptake through OM transporters by a rotational mechanism. PMID:23798405

  10. Role of TonB1 in pyoverdine-mediated signaling in Pseudomonas aeruginosa.

    PubMed

    Shirley, Matt; Lamont, Iain L

    2009-09-01

    Pyoverdines are siderophores secreted by Pseudomonas aeruginosa. Uptake of ferripyoverdine in P. aeruginosa PAO1 occurs via the FpvA receptor protein and requires the energy-transducing protein TonB1. Interaction of (ferri)pyoverdine with FpvA activates pyoverdine gene expression in a signaling process involving the cytoplasmic-membrane-spanning anti-sigma factor FpvR and the sigma factor PvdS. Here, we show that mutation of a region of FpvA that interacts with TonB1 (the TonB box) prevents this signaling process, as well as inhibiting bacterial growth in the presence of the iron-chelating compound ethylenediamine-di(o-hydroxy-phenylacetic acid). Signaling via wild-type FpvA was also eliminated in strains lacking TonB1 but was unaffected in strains lacking either (or both) of two other TonB proteins in P. aeruginosa, TonB2 and TonB3. An absence of pyoverdine-mediated signaling corresponded with proteolysis of PvdS. These data show that interactions between FpvA and TonB1 are required for (ferri)pyoverdine signal transduction, as well as for ferripyoverdine transport, consistent with a mechanistic link between the signaling and transport functions of FpvA.

  11. Molecular characterization of the TonB2 protein from the fish pathogen Vibrio anguillarum

    PubMed Central

    LÓPEZ, Claudia S.; PEACOCK, R. Sean; CROSA, Jorge H.; VOGEL, Hans J.

    2011-01-01

    In the fish pathogen Vibrio anguillarum the TonB2 protein is essential for the uptake of the indigenous siderophore anguibactin. Here we describe deletion mutants and alanine replacements affecting the final six amino acids of TonB2. Deletions of more than two amino acids of the TonB2 C-terminus abolished ferric-anguibactin transport, whereas replacement of the last three residues resulted in a protein with wild-type transport properties. We have solved the high-resolution solution structure of the TonB2 C-terminal domain by NMR spectroscopy. The core of this domain (residues 121–206) has an αββαβ structure, whereas residues 76–120 are flexible and extended. This overall folding topology is similar to the Escherichia coli TonB C-terminal domain, albeit with two differences: the β4 strand found at the C-terminus of TonB is absent in TonB2, and loop 3 is extended by 9 Å (0.9 nm) in TonB2. By examining several mutants, we determined that a complete loop 3 is not essential for TonB2 activity. Our results indicate that the β4 strand of E. coli TonB is not required for activity of the TonB system across Gram-negative bacterial species. We have also determined, through NMR chemical-shift-perturbation experiments, that the E. coli TonB binds in vitro to the TonB box from the TonB2-dependent outer membrane transporter FatA; moreover, it can substitute in vivo for TonB2 during ferric-anguibactin transport in V. anguillarum. Unexpectedly, TonB2 did not bind in vitro to the FatA TonB-box region, suggesting that additional factors may be required to promote this interaction. Overall our results indicate that TonB2 is a representative of a different class of TonB proteins. PMID:18973471

  12. Randolph Plant passes 60-million-ton milestone

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Sprouls, M.W.; Adam, B.O.

    1983-09-01

    Peabody Coal Co.'s Randolph coal preparation plant has processed 60 million tons of coal during 10 years of operation. The plant, which is in Illinois, receives coal from 3 mines and 2 more will eventually send their output for cleaning. Coal from one mine travels 2 miles overland to a 30,000 ton conical bunker constructed of Reinforced Earth. Clean coal is supplied for electricity generation. The plant uses water-only processes, with a jig and three stages of hydrocyclones. A flowsheet of the scalper circuit is given.

  13. Role of TonB1 in Pyoverdine-Mediated Signaling in Pseudomonas aeruginosa▿

    PubMed Central

    Shirley, Matt; Lamont, Iain L.

    2009-01-01

    Pyoverdines are siderophores secreted by Pseudomonas aeruginosa. Uptake of ferripyoverdine in P. aeruginosa PAO1 occurs via the FpvA receptor protein and requires the energy-transducing protein TonB1. Interaction of (ferri)pyoverdine with FpvA activates pyoverdine gene expression in a signaling process involving the cytoplasmic-membrane-spanning anti-sigma factor FpvR and the sigma factor PvdS. Here, we show that mutation of a region of FpvA that interacts with TonB1 (the TonB box) prevents this signaling process, as well as inhibiting bacterial growth in the presence of the iron-chelating compound ethylenediamine-di(o-hydroxy-phenylacetic acid). Signaling via wild-type FpvA was also eliminated in strains lacking TonB1 but was unaffected in strains lacking either (or both) of two other TonB proteins in P. aeruginosa, TonB2 and TonB3. An absence of pyoverdine-mediated signaling corresponded with proteolysis of PvdS. These data show that interactions between FpvA and TonB1 are required for (ferri)pyoverdine signal transduction, as well as for ferripyoverdine transport, consistent with a mechanistic link between the signaling and transport functions of FpvA. PMID:19592589

  14. View southwest of 350ton crane, showing one of four castings ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    View southwest of 350-ton crane, showing one of four castings which support a stationary, tapered steel girder structure called a "tower". This tower is located within an outer rotating framework designated as the "pintle" of the 350-ton crane. The whole crane pivots around bearing at the top of this tapered support tower. - Naval Base Philadelphia-Philadelphia Naval Shipyard, 350-Ton Hammerhead Crane, League Island, Philadelphia, Philadelphia County, PA

  15. TonB-Dependent Transporters Expressed by Neisseria gonorrhoeae

    PubMed Central

    Cornelissen, Cynthia Nau; Hollander, Aimee

    2011-01-01

    Neisseria gonorrhoeae causes the common sexually transmitted infection, gonorrhea. This microorganism is an obligate human pathogen, existing nowhere in nature except in association with humans. For growth and proliferation, N. gonorrhoeae requires iron and must acquire this nutrient from within its host. The gonococcus is well-adapted for growth in diverse niches within the human body because it expresses efficient transport systems enabling use of a diverse array of iron sources. Iron transport systems facilitating the use of transferrin, lactoferrin, and hemoglobin have two components: one TonB-dependent transporter and one lipoprotein. A single component TonB-dependent transporter also allows N. gonorrhoeae to avail itself of iron bound to heterologous siderophores produced by bacteria within the same ecological niche. Other TonB-dependent transporters are encoded by the gonococcus but have not been ascribed specific functions. The best characterized iron transport system expressed by N. gonorrhoeae enables the use of human transferrin as a sole iron source. This review summarizes the molecular mechanisms involved in gonococcal iron acquisition from human transferrin and also reviews what is currently known about the other TonB-dependent transport systems. No vaccine is available to prevent gonococcal infections and our options for treating this disease are compromised by the emergence of antibiotic resistance. Because iron transport systems are critical for the survival of the gonococcus in vivo, the surface-exposed components of these systems are attractive candidates for vaccine development or therapeutic intervention. PMID:21747812

  16. Fluorescence High-Throughput Screening for Inhibitors of TonB Action.

    PubMed

    Nairn, Brittany L; Eliasson, Olivia S; Hyder, Dallas R; Long, Noah J; Majumdar, Aritri; Chakravorty, Somnath; McDonald, Peter; Roy, Anuradha; Newton, Salete M; Klebba, Phillip E

    2017-05-15

    Gram-negative bacteria acquire ferric siderophores through TonB-dependent outer membrane transporters (TBDT). By fluorescence spectroscopic hgh-throughput screening (FLHTS), we identified inhibitors of TonB-dependent ferric enterobactin (FeEnt) uptake through Escherichia coli FepA (EcoFepA). Among 165 inhibitors found in a primary screen of 17,441 compounds, we evaluated 20 in secondary tests: TonB-dependent ferric siderophore uptake and colicin killing and proton motive force-dependent lactose transport. Six of 20 primary hits inhibited TonB-dependent activity in all tests. Comparison of their effects on [ 59 Fe]Ent and [ 14 C]lactose accumulation suggested several as proton ionophores, but two chemicals, ebselen and ST0082990, are likely not proton ionophores and may inhibit TonB-ExbBD. The facility of FLHTS against E. coli led us to adapt it to Acinetobacter baumannii We identified its FepA ortholog (AbaFepA), deleted and cloned its structural gene, genetically engineered 8 Cys substitutions in its surface loops, labeled them with fluorescein, and made fluorescence spectroscopic observations of FeEnt uptake in A. baumannii Several Cys substitutions in AbaFepA (S279C, T562C, and S665C) were readily fluoresceinated and then suitable as sensors of FeEnt transport. As in E. coli , the test monitored TonB-dependent FeEnt uptake by AbaFepA. In microtiter format with A. baumannii , FLHTS produced Z' factors 0.6 to 0.8. These data validated the FLHTS strategy against even distantly related Gram-negative bacterial pathogens. Overall, it discovered agents that block TonB-dependent transport and showed the potential to find compounds that act against Gram-negative CRE (carbapenem-resistant Enterobacteriaceae) /ESKAPE ( Enterococcus faecium , Staphylococcus aureus , Klebsiella pneumoniae , Acinetobacter baumannii , Pseudomonas aeruginosa , and Enterobacter species) pathogens. Our results suggest that hundreds of such chemicals may exist in larger compound libraries

  17. KSC-06pd2079

    NASA Image and Video Library

    2006-09-08

    KENNEDY SPACE CENTER, FLA. - In the Operations and Checkout Building at NASA Kennedy Space Center, STS-115 Commander Brent Jett dons his launch and re-entry suit before heading to the launch pad. Jett is making his fourth shuttle flight on this mission to the International Space Station aboard Space Shuttle Atlantis. On its second attempt for launch, Atlantis is scheduled to lift off at 11:41 a.m. EDT today from Launch Pad 39B. During the STS-115 mission, Atlantis' astronauts will deliver and install the 17.5-ton, bus-sized P3/P4 integrated truss segment on the station. The girder-like truss includes a set of giant solar arrays, batteries and associated electronics and will provide one-fourth of the total power-generation capability for the completed station. This mission is the 116th space shuttle flight, the 27th flight for orbiter Atlantis, and the 19th U.S. flight to the ISS. STS-115 is scheduled to last 11 days with a planned landing at KSC. Photo credit: NASA/Kim Shiflett

  18. Insight from TonB Hybrid Proteins into the Mechanism of Iron Transport through the Outer Membrane▿

    PubMed Central

    Kaserer, Wallace A.; Jiang, Xiaoxu; Xiao, Qiaobin; Scott, Daniel C.; Bauler, Matthew; Copeland, Daniel; Newton, Salete M. C.; Klebba, Phillip E.

    2008-01-01

    We created hybrid proteins to study the functions of TonB. We first fused the portion of Escherichia coli tonB that encodes the C-terminal 69 amino acids (amino acids 170 to 239) of TonB downstream from E. coli malE (MalE-TonB69C). Production of MalE-TonB69C in tonB+ bacteria inhibited siderophore transport. After overexpression and purification of the fusion protein on an amylose column, we proteolytically released the TonB C terminus and characterized it. Fluorescence spectra positioned its sole tryptophan (W213) in a weakly polar site in the protein interior, shielded from quenchers. Affinity chromatography showed the binding of the TonB C-domain to other proteins: immobilized TonB-dependent (FepA and colicin B) and TonB-independent (FepAΔ3-17, OmpA, and lysozyme) proteins adsorbed MalE-TonB69C, revealing a general affinity of the C terminus for other proteins. Additional constructions fused full-length TonB upstream or downstream of green fluorescent protein (GFP). TonB-GFP constructs had partial functionality but no fluorescence; GFP-TonB fusion proteins were functional and fluorescent. The activity of the latter constructs, which localized GFP in the cytoplasm and TonB in the cell envelope, indicate that the TonB N terminus remains in the inner membrane during its biological function. Finally, sequence analyses revealed homology in the TonB C terminus to E. coli YcfS, a proline-rich protein that contains the lysin (LysM) peptidoglycan-binding motif. LysM structural mimicry occurs in two positions of the dimeric TonB C-domain, and experiments confirmed that it physically binds to the murein sacculus. Together, these findings infer that the TonB N terminus remains associated with the inner membrane, while the downstream region bridges the cell envelope from the affinity of the C terminus for peptidoglycan. This architecture suggests a membrane surveillance model of action, in which TonB finds occupied receptor proteins by surveying the underside of

  19. INTERIOR VIEW OF MAGNESIUM TREATMENT AREA, LOOKING WEST, WITH 10TON ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    INTERIOR VIEW OF MAGNESIUM TREATMENT AREA, LOOKING WEST, WITH 10-TON LADLE POURING MOLTEN IRON INTO 20-TON LADLE - United States Pipe & Foundry Company Plant, Melting & Treatment Areas, 2023 St. Louis Avenue at I-20/59, Bessemer, Jefferson County, AL

  20. INTERIOR VIEW OF MAGNESIUM TREATMENT AREA, LOOKING NORTH, WITH 10TON ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    INTERIOR VIEW OF MAGNESIUM TREATMENT AREA, LOOKING NORTH, WITH 10-TON LADLE POURING MOLTEN IRON INTO 20-TON LADLE. - United States Pipe & Foundry Company Plant, Melting & Treatment Areas, 2023 St. Louis Avenue at I-20/59, Bessemer, Jefferson County, AL

  1. INTERIOR VIEW OF MAGNESIUM TREATMENT AREA, LOOKING WEST, WITH 10TON ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    INTERIOR VIEW OF MAGNESIUM TREATMENT AREA, LOOKING WEST, WITH 10-TON LADLE POURING MOLTEN IRON INTO 20-TON LADLE. - United States Pipe & Foundry Company Plant, Melting & Treatment Areas, 2023 St. Louis Avenue at I-20/59, Bessemer, Jefferson County, AL

  2. Regional Feedstock Partnership Summary Report: Enabling the Billion-Ton Vision

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Owens, Vance N.; Karlen, Douglas L.; Lacey, Jeffrey A.

    2016-07-12

    The U.S. Department of Energy (DOE) and the Sun Grant Initiative established the Regional Feedstock Partnership (referred to as the Partnership) to address information gaps associated with enabling the vision of a sustainable, reliable, billion-ton U.S. bioenergy industry by the year 2030 (i.e., the Billion-Ton Vision). Over the past 7 years (2008–2014), the Partnership has been successful at advancing the biomass feedstock production industry in the United States, with notable accomplishments. The Billion-Ton Study identifies the technical potential to expand domestic biomass production to offset up to 30% of U.S. petroleum consumption, while continuing to meet demands for food, feed,more » fiber, and export. This study verifies for the biofuels and chemical industries that a real and substantial resource base could justify the significant investment needed to develop robust conversion technologies and commercial-scale facilities. DOE and the Sun Grant Initiative established the Partnership to demonstrate and validate the underlying assumptions underpinning the Billion-Ton Vision to supply a sustainable and reliable source of lignocellulosic feedstock to a large-scale bioenergy industry. This report discusses the accomplishments of the Partnership, with references to accompanying scientific publications. These accomplishments include advances in sustainable feedstock production, feedstock yield, yield stability and stand persistence, energy crop commercialization readiness, information transfer, assessment of the economic impacts of achieving the Billion-Ton Vision, and the impact of feedstock species and environment conditions on feedstock quality characteristics.« less

  3. ETR, TRA642. ON GROUND FLOOR. THE 60TON ETR REACTOR VESSEL ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    ETR, TRA-642. ON GROUND FLOOR. THE 60-TON ETR REACTOR VESSEL IS DROPPED INTO PLACE OVER PIT. KAISER USED TWO MULTI-BLOCK DRUM PULLEYS WITH A COMBINED CAPACITY OF 100 TONS AND A 100-TON DRUM HOIST. THE VESSEL WAS 35 1/2 FEET LONG. INL NEGATIVE NO. 56-4149. R.G. Larsen, Photographer, 12/18/1956 - Idaho National Engineering Laboratory, Test Reactor Area, Materials & Engineering Test Reactors, Scoville, Butte County, ID

  4. In vivo evidence of TonB shuttling between the cytoplasmic and outer membrane in Escherichia coli.

    PubMed

    Larsen, Ray A; Letain, Tracy E; Postle, Kathleen

    2003-07-01

    Gram-negative bacteria are able to convert potential energy inherent in the proton gradient of the cytoplasmic membrane into active nutrient transport across the outer membrane. The transduction of energy is mediated by TonB protein. Previous studies suggest a model in which TonB makes sequential and cyclic contact with proteins in each membrane, a process called shuttling. A key feature of shuttling is that the amino-terminal signal anchor must quit its association with the cytoplasmic membrane, and TonB becomes associated solely with the outer membrane. However, the initial studies did not exclude the possibility that TonB was artifactually pulled from the cytoplasmic membrane by the fractionation process. To resolve this ambiguity, we devised a method to test whether the extreme TonB amino-terminus, located in the cytoplasm, ever became accessible to the cys-specific, cytoplasmic membrane-impermeant molecule, Oregon Green(R) 488 maleimide (OGM) in vivo. A full-length TonB and a truncated TonB were modified to carry a sole cysteine at position 3. Both full-length TonB and truncated TonB (consisting of the amino-terminal two-thirds) achieved identical conformations in the cytoplasmic membrane, as determined by their abilities to cross-link to the cytoplasmic membrane protein ExbB and their abilities to respond conformationally to the presence or absence of proton motive force. Full-length TonB could be amino-terminally labelled in vivo, suggesting that it was periplasmically exposed. In contrast, truncated TonB, which did not associate with the outer membrane, was not specifically labelled in vivo. The truncated TonB also acted as a control for leakage of OGM across the cytoplasmic membrane. Further, the extent of labelling for full-length TonB correlated roughly with the proportion of TonB found at the outer membrane. These findings suggest that TonB does indeed disengage from the cytoplasmic membrane during energy transduction and shuttle to the outer membrane.

  5. Commercial fertilizers: Total US fertilizer consumption 44.9 million tons in 1989

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Hargett, N.L.; Berry, J.T.; McKinney, S.L.

    1989-12-31

    US fertilizer consumption for the 1988--1989 year was 44.9 million tons of material-an increase of less than one percent from the previous year. The average plant nutrient content of all fertilizers decreased slightly as total plant nutrient consumption declined from 19.61 million to 19.59 million tons of N, P{sub 2}O{sub 5}, and K{sub 2}O. Total nitrogen consumption increased one percent to 10.63 million tons, while P{sub 2}O{sub 5} use decreased by less than one percent to 4.12 million tons. Potash consumption declined from 4.97 million tons to 4.83 million tons K{sub 2}O-a 2.8 percent decrease. Consumption patterns varied widely frommore » state to state as weather conditions adversely affected fertilizer application even with significant increases in total planted crop acreage. Illinois, Indiana, Iowa, Minnesota, and Ohio reported a decline in total plant nutrient application while several of the southeastern states registered an increase in consumption. Nutrient levels in mixed fertilizers remained unchanged as slight gains in the nitrogen and P{sub 2}O{sub 5} content were offset by a decline in K{sub 2}O. Consumption of ammonium polyphosphate solution (10-34-0) and monoammonium phosphates increased 9.2 percent and 12.8 percent respectively, while diammonium phosphate (18-46-0) use was 2.4 percent below last year. A general increase in the use of nitrogen materials was reported with the exception of nitrogen solutions which declined 2.1 percent from 1987--1988. Urea consumption rose almost 2 percent. ammonium nitrate was up 8.1 percent, and ammonium sulfate recorded a 9.5 percent gain in consumption. Anhydrous ammonia use was only 35,000 tons above last year. This document contains a state by state listing of individual fertilizer consumption rates, numerical data only.« less

  6. Commercial fertilizers: Total US fertilizer consumption 44. 9 million tons in 1989

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Hargett, N.L.; Berry, J.T.; McKinney, S.L.

    1989-01-01

    US fertilizer consumption for the 1988--1989 year was 44.9 million tons of material-an increase of less than one percent from the previous year. The average plant nutrient content of all fertilizers decreased slightly as total plant nutrient consumption declined from 19.61 million to 19.59 million tons of N, P[sub 2]O[sub 5], and K[sub 2]O. Total nitrogen consumption increased one percent to 10.63 million tons, while P[sub 2]O[sub 5] use decreased by less than one percent to 4.12 million tons. Potash consumption declined from 4.97 million tons to 4.83 million tons K[sub 2]O-a 2.8 percent decrease. Consumption patterns varied widely frommore » state to state as weather conditions adversely affected fertilizer application even with significant increases in total planted crop acreage. Illinois, Indiana, Iowa, Minnesota, and Ohio reported a decline in total plant nutrient application while several of the southeastern states registered an increase in consumption. Nutrient levels in mixed fertilizers remained unchanged as slight gains in the nitrogen and P[sub 2]O[sub 5] content were offset by a decline in K[sub 2]O. Consumption of ammonium polyphosphate solution (10-34-0) and monoammonium phosphates increased 9.2 percent and 12.8 percent respectively, while diammonium phosphate (18-46-0) use was 2.4 percent below last year. A general increase in the use of nitrogen materials was reported with the exception of nitrogen solutions which declined 2.1 percent from 1987--1988. Urea consumption rose almost 2 percent. ammonium nitrate was up 8.1 percent, and ammonium sulfate recorded a 9.5 percent gain in consumption. Anhydrous ammonia use was only 35,000 tons above last year. This document contains a state by state listing of individual fertilizer consumption rates, numerical data only.« less

  7. 2016 Billion-Ton Report: Advancing Domestic Resources for a Thriving Bioeconomy

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Langholtz, M. H.; Stokes, B. J.; Eaton, L. M.

    This product builds on previous efforts, namely the 2005 Billion-Ton Study (BTS) and the 2011 U.S. Billion-Ton Update (BT2).With each report, greater perspective is gained on the potential of biomass resources to contribute to a national energy strategy. Similarly, each successive report introduces new questions regarding commercialization challenges. BTS quantified the broad biophysical potential of biomass nationally, and BT2 elucidated the potential economic availability of these resources. These reports clearly established the potential availability of up to one billion tons of biomass resources nationally. However, many questions remain, including but not limited to crop yields, climate change impacts, logistical operations,more » and systems integration across production, harvest, and conversion. The present report aims to address many of these questions through empirically modeled energy crop yields, scenario analysis of resources delivered to biorefineries, and the addition of new feedstocks. Volume 2 of the 2016 Billion-Ton Report is expected to be released by the end of 2016. It seeks to evaluate environmental sustainability indicators of select scenarios from volume 1 and potential climate change impacts on future supplies.« less

  8. Preliminary navigation accuracy analysis for the TDRSS Onboard Navigation System (TONS) experiment on EP/EUVE

    NASA Technical Reports Server (NTRS)

    Gramling, C. J.; Long, A. C.; Lee, T.; Ottenstein, N. A.; Samii, M. V.

    1991-01-01

    A Tracking and Data Relay Satellite System (TDRSS) Onboard Navigation System (TONS) is currently being developed by NASA to provide a high accuracy autonomous navigation capability for users of TDRSS and its successor, the Advanced TDRSS (ATDRSS). The fully autonomous user onboard navigation system will support orbit determination, time determination, and frequency determination, based on observation of a continuously available, unscheduled navigation beacon signal. A TONS experiment will be performed in conjunction with the Explorer Platform (EP) Extreme Ultraviolet Explorer (EUVE) mission to flight quality TONS Block 1. An overview is presented of TONS and a preliminary analysis of the navigation accuracy anticipated for the TONS experiment. Descriptions of the TONS experiment and the associated navigation objectives, as well as a description of the onboard navigation algorithms, are provided. The accuracy of the selected algorithms is evaluated based on the processing of realistic simulated TDRSS one way forward link Doppler measurements. The analysis process is discussed and the associated navigation accuracy results are presented.

  9. The effect of water deprivation on the tonicity responsive enhancer binding protein (TonEBP) and TonEBP-regulated genes in the kidney of the Spinifex hopping mouse, Notomys alexis.

    PubMed

    Bartolo, Ray C; Donald, John A

    2008-03-01

    In desert rodents, the production of concentrated urine is essential for survival in xeric environments in order to conserve water. Reabsorption of water in the kidney is dependent on large osmotic gradients in the renal medulla. This causes the renal cells to be bathed in a hypertonic extracellular fluid that can compromise cellular function. In response to hypertonicity, kidney cells accumulate compatible, non-ionic osmolytes that lower the ionic strength within the cells to isotonic levels by replacing intracellular ionic electrolytes. The tonicity-responsive enhancer binding protein (TonEBP) is a transcription factor that regulates the expression of genes that encode proteins that catalyse the accumulation of compatible osmolytes. We investigated the expression of TonEBP mRNA and protein and compatible osmolyte genes in the Spinifex hopping mouse, Notomys alexis, an Australian desert rodent that produces a highly concentrated urine. TonEBP mRNA expression was unchanged after 3 days of water deprivation but was significantly increased after 7 and 14 days of water deprivation. Immunohistochemistry showed that during water deprivation TonEBP had translocated from the cytoplasm into the nucleus of cells in the renal medulla and papilla. In addition, 3, 7 and 14 days of water deprivation caused a significant increase in aldose reductase (AR), myo-inositol (SMIT), betaine/GABA (BGT-1) and taurine (TauT) transporter mRNA expression, which is indicative of an increase in TonEBP activity. In desert rodents, TonEBP regulation of gene transcription is probably an important mechanism to protect renal cells in the face of the large corticomedullary gradient that is required to concentrate urine and conserve water.

  10. Preliminary Operational Results of the TDRSS Onboard Navigation System (TONS) for the Terra Mission

    NASA Technical Reports Server (NTRS)

    Gramling, Cheryl; Lorah, John; Santoro, Ernest; Work, Kevin; Chambers, Robert; Bauer, Frank H. (Technical Monitor)

    2000-01-01

    The Earth Observing System Terra spacecraft was launched on December 18, 1999, to provide data for the characterization of the terrestrial and oceanic surfaces, clouds, radiation, aerosols, and radiative balance. The Tracking and Data Relay Satellite System (TDRSS) Onboard Navigation System (ONS) (TONS) flying on Terra provides the spacecraft with an operational real-time navigation solution. TONS is a passive system that makes judicious use of Terra's communication and computer subsystems. An objective of the ONS developed by NASA's Goddard Space Flight Center (GSFC) Guidance, Navigation and Control Center is to provide autonomous navigation with minimal power, weight, and volume impact on the user spacecraft. TONS relies on extracting tracking measurements onboard from a TDRSS forward-link communication signal and processing these measurements in an onboard extended Kalman filter to estimate Terra's current state. Terra is the first NASA low Earth orbiting mission to fly autonomous navigation which produces accurate results. The science orbital accuracy requirements for Terra are 150 meters (m) (3sigma) per axis with a goal of 5m (1 sigma) RSS which TONS is expected to meet. The TONS solutions are telemetered in real-time to the mission scientists along with their science data for immediate processing. Once set in the operational mode, TONS eliminates the need for ground orbit determination and allows for a smooth flow from the spacecraft telemetry to planning products for the mission team. This paper will present the preliminary results of the operational TONS solution available from Terra.

  11. 46 CFR 15.901 - Inspected vessels of less than 100 gross tons.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 46 Shipping 1 2010-10-01 2010-10-01 false Inspected vessels of less than 100 gross tons. 15.901 Section 15.901 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY MERCHANT MARINE OFFICERS AND SEAMEN MANNING REQUIREMENTS Equivalents § 15.901 Inspected vessels of less than 100 gross tons. (a) An individual...

  12. 46 CFR 15.901 - Inspected vessels of less than 100 gross tons.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 46 Shipping 1 2013-10-01 2013-10-01 false Inspected vessels of less than 100 gross tons. 15.901 Section 15.901 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY MERCHANT MARINE OFFICERS AND SEAMEN MANNING REQUIREMENTS Equivalents § 15.901 Inspected vessels of less than 100 gross tons. (a) An individual...

  13. An assessment of the potential products and economic and environmental impacts resulting from a billion ton bioeconomy

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Rogers, Jonathan N.; Stokes, Bryce; Dunn, Jennifer

    This study is the summation of several analyses to assess the size and benefits of a Billion Ton Bioeconomy, a vision to enable a sustainable market for producing and converting a billion tons of US biomass to bio-based energy, fuels, and products by 2030. Two alternative biomass availability scenarios in 2030, defined as the (i) Business-as-usual (598 million dry tons) and (ii) Billion Ton (1042 million dry tons), establish a range of possible outcomes for the future bioeconomy. The biomass utilized in the current (2014) (365 million dry tons) economy is estimated to displace approximately 2.4% of fossil energy consumptionmore » and avoid 116 million tons of CO 2-equivalent (CO 2e) emissions, whereas the Billion Ton bioeconomy of 2030 could displace 9.5% of fossil energy consumption and avoid as much as 446 million tons of CO 2 equivalent emissions annually. Developing the integrated systems, supply chains, and infrastructure to efficiently grow, harvest, transport, and convert large quantities of biomass in a sustainable way could support the transition to a low-carbon economy. Bio-based activities in the current (2014) economy are estimated to have directly generated more than 48 billion in revenue and 285 000 jobs. Our estimates show that developing biomass resources and addressing current limitations to achieve a Billion Ton bioeconomy could expand direct bioeconomy revenue by a factor of 5 to contribute nearly 259 billion and 1.1 million jobs to the US economy by 2030.« less

  14. An assessment of the potential products and economic and environmental impacts resulting from a billion ton bioeconomy

    DOE PAGES

    Rogers, Jonathan N.; Stokes, Bryce; Dunn, Jennifer; ...

    2016-11-21

    This study is the summation of several analyses to assess the size and benefits of a Billion Ton Bioeconomy, a vision to enable a sustainable market for producing and converting a billion tons of US biomass to bio-based energy, fuels, and products by 2030. Two alternative biomass availability scenarios in 2030, defined as the (i) Business-as-usual (598 million dry tons) and (ii) Billion Ton (1042 million dry tons), establish a range of possible outcomes for the future bioeconomy. The biomass utilized in the current (2014) (365 million dry tons) economy is estimated to displace approximately 2.4% of fossil energy consumptionmore » and avoid 116 million tons of CO 2-equivalent (CO 2e) emissions, whereas the Billion Ton bioeconomy of 2030 could displace 9.5% of fossil energy consumption and avoid as much as 446 million tons of CO 2 equivalent emissions annually. Developing the integrated systems, supply chains, and infrastructure to efficiently grow, harvest, transport, and convert large quantities of biomass in a sustainable way could support the transition to a low-carbon economy. Bio-based activities in the current (2014) economy are estimated to have directly generated more than 48 billion in revenue and 285 000 jobs. Our estimates show that developing biomass resources and addressing current limitations to achieve a Billion Ton bioeconomy could expand direct bioeconomy revenue by a factor of 5 to contribute nearly 259 billion and 1.1 million jobs to the US economy by 2030.« less

  15. 50. VIEW OF CRUSHER ADDITION FROM EAST. SHOWS 100TON STEEL ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    50. VIEW OF CRUSHER ADDITION FROM EAST. SHOWS 100-TON STEEL UNOXIDIZED ORE BIN, STEPHENS-ADAMSON 15 TON/HR INCLINED BUCKET ELEVATOR, AND DUST COLLECTION BIN IN UPPER RIGHT QUADRANT. THE ROD MILL CIRCUIT STOOD IN FRONT OF THE BUCKET ELEVATOR AND BEHIND THE BAKER COOLER (LEFT CENTER). MILL SOLUTION TANKS WERE IN FRONT OF THE CRUSHED OXIDIZED ORE BIN (CENTER), AND THE MILL FLOOR WAS THE NEXT LEVEL DOWN (RIGHT). - Bald Mountain Gold Mill, Nevada Gulch at head of False Bottom Creek, Lead, Lawrence County, SD

  16. 22 CFR 91.4 - Alcoholic liquors on vessels of not over 500 tons.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 22 Foreign Relations 1 2012-04-01 2012-04-01 false Alcoholic liquors on vessels of not over 500 tons. 91.4 Section 91.4 Foreign Relations DEPARTMENT OF STATE LEGAL AND RELATED SERVICES IMPORT CONTROLS § 91.4 Alcoholic liquors on vessels of not over 500 tons. (a) Upon request of interested shippers...

  17. Confined Mobility of TonB and FepA in Escherichia coli Membranes.

    PubMed

    Lill, Yoriko; Jordan, Lorne D; Smallwood, Chuck R; Newton, Salete M; Lill, Markus A; Klebba, Phillip E; Ritchie, Ken

    2016-01-01

    The important process of nutrient uptake in Escherichia coli, in many cases, involves transit of the nutrient through a class of beta-barrel proteins in the outer membrane known as TonB-dependent transporters (TBDTs) and requires interaction with the inner membrane protein TonB. Here we have imaged the mobility of the ferric enterobactin transporter FepA and TonB by tracking them in the membranes of live E. coli with single-molecule resolution at time-scales ranging from milliseconds to seconds. We employed simple simulations to model/analyze the lateral diffusion in the membranes of E.coli, to take into account both the highly curved geometry of the cell and artifactual effects expected due to finite exposure time imaging. We find that both molecules perform confined lateral diffusion in their respective membranes in the absence of ligand with FepA confined to a region [Formula: see text] μm in radius in the outer membrane and TonB confined to a region [Formula: see text] μm in radius in the inner membrane. The diffusion coefficient of these molecules on millisecond time-scales was estimated to be [Formula: see text] μm2/s and [Formula: see text] μm2/s for FepA and TonB, respectively, implying that each molecule is free to diffuse within its domain. Disruption of the inner membrane potential, deletion of ExbB/D from the inner membrane, presence of ligand or antibody to FepA and disruption of the MreB cytoskeleton was all found to further restrict the mobility of both molecules. Results are analyzed in terms of changes in confinement size and interactions between the two proteins.

  18. Twitching motility and biofilm formation are associated with tonB1 in Xylella fastidiosa.

    PubMed

    Cursino, Luciana; Li, Yaxin; Zaini, Paulo A; De La Fuente, Leonardo; Hoch, Harvey C; Burr, Thomas J

    2009-10-01

    A mutation in the Xylella fastidiosa tonB1 gene resulted in loss of twitching motility and in significantly less biofilm formation as compared with a wild type. The altered motility and biofilm phenotypes were restored by complementation with a functional copy of the gene. The mutation affected virulence as measured by Pierce's disease symptoms on grapevines. The role of TonB1 in twitching and biofilm formation appears to be independent of the characteristic iron-uptake function of this protein. This is the first report demonstrating a functional role for a tonB homolog in X. fastidiosa.

  19. Response Surface Model (RSM)-based Benefit Per Ton Estimates

    EPA Pesticide Factsheets

    The tables below are updated versions of the tables appearing in The influence of location, source, and emission type in estimates of the human health benefits of reducing a ton of air pollution (Fann, Fulcher and Hubbell 2009).

  20. 19 CFR 4.100 - Licensing of vessels of less than 30 net tons.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 19 Customs Duties 1 2010-04-01 2010-04-01 false Licensing of vessels of less than 30 net tons. 4... less than 30 net tons. (a) The application for a license to import merchandise in a vessel of less than... shall keep the license on board the vessel at all times and exhibit it upon demand of any duly...

  1. Confined Mobility of TonB and FepA in Escherichia coli Membranes

    PubMed Central

    Lill, Yoriko; Jordan, Lorne D.; Smallwood, Chuck R.; Newton, Salete M.; Lill, Markus A.; Klebba, Phillip E.; Ritchie, Ken

    2016-01-01

    The important process of nutrient uptake in Escherichia coli, in many cases, involves transit of the nutrient through a class of beta-barrel proteins in the outer membrane known as TonB-dependent transporters (TBDTs) and requires interaction with the inner membrane protein TonB. Here we have imaged the mobility of the ferric enterobactin transporter FepA and TonB by tracking them in the membranes of live E. coli with single-molecule resolution at time-scales ranging from milliseconds to seconds. We employed simple simulations to model/analyze the lateral diffusion in the membranes of E.coli, to take into account both the highly curved geometry of the cell and artifactual effects expected due to finite exposure time imaging. We find that both molecules perform confined lateral diffusion in their respective membranes in the absence of ligand with FepA confined to a region 0.180−0.007+0.006 μm in radius in the outer membrane and TonB confined to a region 0.266−0.009+0.007 μm in radius in the inner membrane. The diffusion coefficient of these molecules on millisecond time-scales was estimated to be 21−5+9 μm2/s and 5.4−0.8+1.5 μm2/s for FepA and TonB, respectively, implying that each molecule is free to diffuse within its domain. Disruption of the inner membrane potential, deletion of ExbB/D from the inner membrane, presence of ligand or antibody to FepA and disruption of the MreB cytoskeleton was all found to further restrict the mobility of both molecules. Results are analyzed in terms of changes in confinement size and interactions between the two proteins. PMID:27935943

  2. A method to press powder at 6000 ton using small amount of explosive

    NASA Astrophysics Data System (ADS)

    Hilmi, Ahmad Humaizi; Azmi, Nor Azmaliana; Ismail, Ariffin

    2017-12-01

    Large die hydraulic press forces are one of the key instruments in making jumbo planes. The machine can produce aircraft components such as wing spars, landing gear supports and armor plates. Superpower nations such as USA, Russia, Germany, Japan, Korea and China have large die hydraulic press which can press 50,000 tons. In Malaysia, heavy-duty press is available from companies such as Proton that builds chassis for cars. However, that heavy-duty press is not able to produce better bulkhead for engines, fuselage, and wings of an aircraft. This paper presents the design of an apparatus that uses 50 grams of commercial grade explosives to produce 6000 tons of compaction. This is a first step towards producing larger scale apparatus that can produce 50,000-ton press. The design was done using AUTODYN blast simulation software. According to the results, the maximum load the apparatus can withstand was 6000 tons which was contributed by 50 grams of commercial explosive(Emulex). Explosive size larger than 50 grams will lead to catastrophic failure. Fabrication of the apparatus was completed. However, testing of the apparatus is not presented in this article.

  3. A 2000 ton crawler/transporter for operation in Prudhoe Bay, Alaska

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Trask, W.H.; Trask, J.L.; Crane, T.

    1986-01-01

    Recently designed and fabricated in Kennewick, Washington, a pair of 2000 ton capacity crawler/transporters has been used in moving refinery modules to permanent installations on Alaska's North Slope. Vehicle design features include four corner chain-driven, track driving sprockets (tumblers), resilient track roller suspensions, elevating load platform (hereinafter ''bolsters''), dynamic braking, diesel/torque converter power, automatic lubrication and electro-pneumatic controls. Four independent power units provide 1400 horse-power per crawler and over two million pounds of drawbar pull at converter stall. Weighing 300 tons, the pin-connected crawler dissembles for highway transport into loads of under 95,000 pounds.

  4. Analysis of navigation performance for the Earth Observing System (EOS) using the TDRSS Onboard Navigation System (TONS)

    NASA Technical Reports Server (NTRS)

    Elrod, B.; Kapoor, A.; Folta, David C.; Liu, K.

    1991-01-01

    Use of the Tracking and Data Relay Satellite System (TDRSS) Onboard Navigation System (TONS) was proposed as an alternative to the Global Positioning System (GPS) for supporting the Earth Observing System (EOS) mission. The results are presented of EOS navigation performance evaluation with respect to TONS based orbit, time, and frequency determination (OD/TD/FD). Two TONS modes are considered: one uses scheduled TDRSS forward link service to derive one way Doppler tracking data for OD/FD support (TONS-I); the other uses an unscheduled navigation beacon service (proposed for Advanced TDRSS) to obtain pseudorange and Doppler data for OD/TD/FD support (TONS-II). Key objectives of the analysis were to evaluate nominal performance and potential sensitivities, such as suboptimal tracking geometry, tracking contact scheduling, and modeling parameter selection. OD/TD/FD performance predictions are presented based on covariance and simulation analyses. EOS navigation scenarios and the contributions of principal error sources impacting performance are also described. The results indicate that a TONS mode can be configured to meet current and proposed EOS position accuracy requirements of 100 and 50 m, respectively.

  5. 20. VIEW OF WATSON STILHMAN DISMOUNTING WHEEL PRESS. 600 tons. ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    20. VIEW OF WATSON STILHMAN DISMOUNTING WHEEL PRESS. 600 tons. Gary Stich, operator. - Juniata Shops, Erecting Shop & Machine Shop, East of Fourth Avenue, between Fourth & Fifth Streets, Altoona, Blair County, PA

  6. View of 175 ton hoisthouse from northeast. Hoist operator's cab ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    View of 175 ton hoist-house from northeast. Hoist operator's cab is in foreground center. - Marshall Space Flight Center, Saturn V Dynamic Test Facility, East Test Area, Huntsville, Madison County, AL

  7. Interior view of 175 ton hoist house looking at the ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Interior view of 175 ton hoist house looking at the exterior casing for the wire rope spools. - Marshall Space Flight Center, Saturn V Dynamic Test Facility, East Test Area, Huntsville, Madison County, AL

  8. 21. 175 TON CAPACITY TEEMING LADLES ON THE NEAR WESTERN ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    21. 175 TON CAPACITY TEEMING LADLES ON THE NEAR WESTERN TEEMING AISLE OF THE BOP SHOP LOOKING SOUTHEAST. - U.S. Steel Duquesne Works, Basic Oxygen Steelmaking Plant, Along Monongahela River, Duquesne, Allegheny County, PA

  9. 23. 175 TON CAPACITY CHARGING LADLE ON THE CHARGING AISLE ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    23. 175 TON CAPACITY CHARGING LADLE ON THE CHARGING AISLE OF THE BOP SHOP LOOKING SOUTH. HISTORIAN FOR SCALE. - U.S. Steel Duquesne Works, Basic Oxygen Steelmaking Plant, Along Monongahela River, Duquesne, Allegheny County, PA

  10. 32. SHAW BOX 5 TON CRANE, SANTA ANA RIVER NO. ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    32. SHAW BOX 5 TON CRANE, SANTA ANA RIVER NO. 3, JAN. 24, 1977. SCE drawing no. 455678-0. - Santa Ana River Hydroelectric System, SAR-3 Powerhouse, San Bernardino National Forest, Redlands, San Bernardino County, CA

  11. 16. LOOKING SOUTHEAST AT THE LINDE 1000 TONS PER DAY ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    16. LOOKING SOUTHEAST AT THE LINDE 1000 TONS PER DAY HIGH PURITY OXYGEN MAKING PLANT SHOWING THE TWIN OXYGEN FRACTIONATING TOWERS. - U.S. Steel Duquesne Works, Fuel & Utilities Plant, Along Monongahela River, Duquesne, Allegheny County, PA

  12. 10. LOOKING NORTHEAST AT THE LINDE 400 TONS PER DAY ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    10. LOOKING NORTHEAST AT THE LINDE 400 TONS PER DAY LOW PURITY OXYGEN MAKING PLANT IN THE LOW PURITY BULK OXYGEN BUILDING. - U.S. Steel Duquesne Works, Fuel & Utilities Plant, Along Monongahela River, Duquesne, Allegheny County, PA

  13. 12. LOOKING WEST AT THE LINDE 400 TONS PER DAY ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    12. LOOKING WEST AT THE LINDE 400 TONS PER DAY LOW PURITY OXYGEN MAKING PLANT IN THE LOW PURITY BULK OXYGEN BUILDING. - U.S. Steel Duquesne Works, Fuel & Utilities Plant, Along Monongahela River, Duquesne, Allegheny County, PA

  14. 13. LOOKING WEST AT THE LINDE 400 TONS PER DAY ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    13. LOOKING WEST AT THE LINDE 400 TONS PER DAY LOW PURITY OXYGEN MAKING PLANT IN THE LOW PURITY BULK OXYGEN BUILDING. - U.S. Steel Duquesne Works, Fuel & Utilities Plant, Along Monongahela River, Duquesne, Allegheny County, PA

  15. 20. 175 TON CAPACITY TEEMING LADLES ON THE NEAR WESTERN ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    20. 175 TON CAPACITY TEEMING LADLES ON THE NEAR WESTERN TEEMING AISLE OF THE BOP SHOP LOOKING SOUTHEAST. HISTORIAN FOR SCALE. - U.S. Steel Duquesne Works, Basic Oxygen Steelmaking Plant, Along Monongahela River, Duquesne, Allegheny County, PA

  16. 17. NORTHWEST VIEW OF LINDE 1000 TONS PER DAY HIGH ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    17. NORTHWEST VIEW OF LINDE 1000 TONS PER DAY HIGH PURITY OXYGEN MAKING PLANT SHOWING FRACTIONATING TOWER, NITROGEN REGENERATORS, AND REVERSING HEAT EXCHANGERS. - U.S. Steel Duquesne Works, Fuel & Utilities Plant, Along Monongahela River, Duquesne, Allegheny County, PA

  17. 11. VIEW OF THE LINDE 400 TONS PER DAY LOW ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    11. VIEW OF THE LINDE 400 TONS PER DAY LOW PURITY OXYGEN MAKING PLANT IN THE LOW PURITY BULK OXYGEN BUILDING LOOKING NORTH. - U.S. Steel Duquesne Works, Fuel & Utilities Plant, Along Monongahela River, Duquesne, Allegheny County, PA

  18. ICARUS 600 ton: A status report

    NASA Astrophysics Data System (ADS)

    Vignoli, C.; Arneodo, F.; Badertscher, A.; Barbieri, E.; Benetti, P.; di Tigliole, A. Borio; Brunetti, R.; Bueno, A.; Calligarich, E.; Campanelli, M.; Carli, F.; Carpanese, C.; Cavalli, D.; Cavanna, F.; Cennini, P.; Centro, S.; Cesana, A.; Chen, C.; Chen, Y.; Cinquini, C.; Cline, D.; De Mitri, I.; Dolfini, R.; Favaretto, D.; Ferrari, A.; Berzolari, A. Gigli; Goudsmit, P.; He, K.; Huang, X.; Li, Z.; Lu, F.; Ma, J.; Mannocchi, G.; Mauri, F.; Mazza, D.; Mazzone, L.; Montanari, C.; Nurzia, G. P.; Otwinowski, S.; Palamara, O.; Pascoli, D.; Pepato, A.; Periale, L.; Petrera, S.; Piano-Mortari, G.; Piazzoli, A.; Picchi, P.; Pietropaolo, F.; Rancati, T.; Rappoldi, A.; Raselli, G. L.; Rebuzzi, D.; Revol, J. P.; Rico, J.; Rossella, M.; Rossi, C.; Rubbia, A.; Rubbia, C.; Sala, P.; Scannicchio, D.; Sergiampietri, F.; Suzuki, S.; Terrani, M.; Ventura, S.; Verdecchia, M.; Wang, H.; Woo, J.; Xu, G.; Xu, Z.; Zhang, C.; Zhang, Q.; Zheng, S.

    2000-05-01

    The goal of the ICARUS Project is the installation of a multi-kiloton LAr TPC in the underground Gran Sasso Laboratory. The programme foresees the realization of the detector in a modular way. The first step is the construction of a 600 ton module which is now at an advanced phase. It will be mounted and tested in Pavia in one year and then it will be moved to Gran Sasso for the final operation. The major cryogenic and purification systems and the mechanical components of the detector have been constructed and tested in a 10 m 3 prototype. The results of these tests are here summarized.

  19. Boiler Shop (Bldg. 152) 150ton Morgan bridge crane, looking west ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Boiler Shop (Bldg. 152) 150-ton Morgan bridge crane, looking west - Atchison, Topeka, Santa Fe Railroad, Albuquerque Shops, Boiler Shop, 908 Second Street, Southwest, Albuquerque, Bernalillo County, NM

  20. Boiler Shop (Bldg. 152) 150ton Morgan bridge crane, looking east ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Boiler Shop (Bldg. 152) 150-ton Morgan bridge crane, looking east - Atchison, Topeka, Santa Fe Railroad, Albuquerque Shops, Boiler Shop, 908 Second Street, Southwest, Albuquerque, Bernalillo County, NM

  1. 49. OUTLET WORKS: THREE TON CRANE, ELECTRICAL SYSTEM NO 4. ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    49. OUTLET WORKS: THREE TON CRANE, ELECTRICAL SYSTEM NO 4. Sheet H-4, December 12, 1939. File no. SA 342/60. - Prado Dam, Outlet Works, Santa Ana River near junction of State Highways 71 & 91, Corona, Riverside County, CA

  2. 119. NORTH PLANT GB WAREHOUSE (BUILDING 1607), WITH DISCHARGED TON ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    119. NORTH PLANT GB WAREHOUSE (BUILDING 1607), WITH DISCHARGED TON CONTAINERS IN FOREGROUND. VIEW TO SOUTHEAST. - Rocky Mountain Arsenal, Bounded by Ninety-sixth Avenue & Fifty-sixth Avenue, Buckley Road, Quebec Street & Colorado Highway 2, Commerce City, Adams County, CO

  3. 21. INTERIOR DETAIL OF TON CONTAINER DEMILITARIZATION EQUIPMENT IN BUILDING ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    21. INTERIOR DETAIL OF TON CONTAINER DEMILITARIZATION EQUIPMENT IN BUILDING 1606. VIEW TO SOUTHWEST. - Rocky Mountain Arsenal, Cluster Bomb Assembly-Filling-Storage Building, 3500 feet South of Ninth Avenue; 2870 feet East of D Street, Commerce City, Adams County, CO

  4. 8. VIEW OF GANTRY ROOM, POWERHOUSE, SHOWING 25TON WHITING MOVABLE ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    8. VIEW OF GANTRY ROOM, POWERHOUSE, SHOWING 25-TON WHITING MOVABLE CRANE AND BRIDGE - Nine Mile Hydroelectric Development, Powerhouse, State Highway 291 along Spokane River, Nine Mile Falls, Spokane County, WA

  5. 46 CFR 130.240 - Anchors and chains for OSVs of 100 or more gross tons.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 46 Shipping 4 2013-10-01 2013-10-01 false Anchors and chains for OSVs of 100 or more gross tons... SUPPLY VESSELS VESSEL CONTROL, AND MISCELLANEOUS EQUIPMENT AND SYSTEMS Miscellaneous Equipment and Systems § 130.240 Anchors and chains for OSVs of 100 or more gross tons. (a) Each OSV of 100 or more gross...

  6. 46 CFR 130.240 - Anchors and chains for OSVs of 100 or more gross tons.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 46 Shipping 4 2012-10-01 2012-10-01 false Anchors and chains for OSVs of 100 or more gross tons... SUPPLY VESSELS VESSEL CONTROL, AND MISCELLANEOUS EQUIPMENT AND SYSTEMS Miscellaneous Equipment and Systems § 130.240 Anchors and chains for OSVs of 100 or more gross tons. (a) Each OSV of 100 or more gross...

  7. 46 CFR 130.240 - Anchors and chains for OSVs of 100 or more gross tons.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 46 Shipping 4 2014-10-01 2014-10-01 false Anchors and chains for OSVs of 100 or more gross tons... SUPPLY VESSELS VESSEL CONTROL, AND MISCELLANEOUS EQUIPMENT AND SYSTEMS Miscellaneous Equipment and Systems § 130.240 Anchors and chains for OSVs of 100 or more gross tons. (a) Each OSV of 100 or more gross...

  8. 46 CFR 130.240 - Anchors and chains for OSVs of 100 or more gross tons.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 46 Shipping 4 2010-10-01 2010-10-01 false Anchors and chains for OSVs of 100 or more gross tons... SUPPLY VESSELS VESSEL CONTROL, AND MISCELLANEOUS EQUIPMENT AND SYSTEMS Miscellaneous Equipment and Systems § 130.240 Anchors and chains for OSVs of 100 or more gross tons. (a) Each OSV of 100 or more gross...

  9. 46 CFR 130.240 - Anchors and chains for OSVs of 100 or more gross tons.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 46 Shipping 4 2011-10-01 2011-10-01 false Anchors and chains for OSVs of 100 or more gross tons... SUPPLY VESSELS VESSEL CONTROL, AND MISCELLANEOUS EQUIPMENT AND SYSTEMS Miscellaneous Equipment and Systems § 130.240 Anchors and chains for OSVs of 100 or more gross tons. (a) Each OSV of 100 or more gross...

  10. Detail of hoist carriage on Shaw 250ton bridge crane in ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Detail of hoist carriage on Shaw 250-ton bridge crane in Machine Shop (Bldg. 163) - Atchison, Topeka, Santa Fe Railroad, Albuquerque Shops, Machine Shop, 908 Second Street, Southwest, Albuquerque, Bernalillo County, NM

  11. Tungsten carbide: Crystals by the ton

    NASA Astrophysics Data System (ADS)

    Smith, E. N.

    1988-06-01

    A comparison is made of the conventional process of making tungsten carbide by carburizing tungsten powder and the Macro Process wherein the tungsten carbide is formed directly from the ore concentrate by an exothermic reaction of ingredients causing a simultaneous reduction and carburization. Tons of tungsten monocarbide crystals are formed in a very rapid reaction. The process is unique in that it is self regulating and produces a tungsten carbide compound with the correct stoichiometry. The high purity with respect to oxygen and nitrogen is achieved because the reactions occur beneath the molten metal. The morphology and hardness of these crystals has been studied by various investigators and reported in the listed references.

  12. View of 200ton derrick interior support beneath it's bull wheel ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    View of 200-ton derrick interior support beneath it's bull wheel and mast centerline from from southeast. - Marshall Space Flight Center, Saturn V Dynamic Test Facility, East Test Area, Huntsville, Madison County, AL

  13. 5. VIEW OF 20TON STEAMPOWERED FORGE HAMMER Manufactured by Chambersburg ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    5. VIEW OF 20-TON STEAM-POWERED FORGE HAMMER Manufactured by Chambersburg Engineering Company, Chambersburg, Pennsylvania - Juniata Shops, Blacksmith Shop No. 1, East of Fourth Avenue at Second Street, Altoona, Blair County, PA

  14. 15. VIEW OF THE ORIGINAL 10TON OVERHEAD NILES TRAVELING CRANE. ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    15. VIEW OF THE ORIGINAL 10-TON OVERHEAD NILES TRAVELING CRANE. - Washington Water Power Company Post Falls Power Plant, Middle Channel Powerhouse & Dam, West of intersection of Spokane & Fourth Streets, Post Falls, Kootenai County, ID

  15. Hexameric and pentameric complexes of the ExbBD energizer in the Ton system.

    PubMed

    Maki-Yonekura, Saori; Matsuoka, Rei; Yamashita, Yoshiki; Shimizu, Hirofumi; Tanaka, Maiko; Iwabuki, Fumie; Yonekura, Koji

    2018-04-17

    Gram-negative bacteria import essential nutrients such as iron and vitamin B 12 through outer membrane receptors. This process utilizes proton motive force harvested by the Ton system made up of three inner membrane proteins, ExbB, ExbD and TonB. ExbB and ExbD form the proton channel that energizes uptake through TonB. Recently, crystal structures suggest that the ExbB pentamer is the scaffold. Here, we present structures of hexameric complexes of ExbB and ExbD revealed by X-ray crystallography and single particle cryo-EM. Image analysis shows that hexameric and pentameric complexes coexist, with the proportion of hexamer increasing with pH. Channel current measurement and 2D crystallography support the existence and transition of the two oligomeric states in membranes. The hexameric complex consists of six ExbB subunits and three ExbD transmembrane helices enclosed within the central channel. We propose models for activation/inactivation associated with hexamer and pentamer formation and utilization of proton motive force. © 2018, Maki-Yonekura et al.

  16. THE DETERMINATION OF URANIUM BURNUP IN MWD/TON

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Rider, B.F.; Russell, J.L. Jr.; Harris, D.W.

    The mass-spectrometric and radiochemical methods for the determination of burn-up in nuclear fuel are compared for reliability in the range of 5000 to 15,000 Mwd/ton. Neither appears to be clearly superior to the other. Each appears to have an uncertainty of approximately 6 to 8%. It is concluded that both methods of analysis should be employed where reliability is of great concern. Agreement between both methods is the best possible indication of reliable results. (auth)

  17. 46 CFR 171.135 - Weather deck drainage on a vessel of 100 gross tons or more.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 46 Shipping 7 2010-10-01 2010-10-01 false Weather deck drainage on a vessel of 100 gross tons or...) SUBDIVISION AND STABILITY SPECIAL RULES PERTAINING TO VESSELS CARRYING PASSENGERS Drainage of Weather Decks § 171.135 Weather deck drainage on a vessel of 100 gross tons or more. The weather deck must have...

  18. 46 CFR 171.135 - Weather deck drainage on a vessel of 100 gross tons or more.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 46 Shipping 7 2013-10-01 2013-10-01 false Weather deck drainage on a vessel of 100 gross tons or...) SUBDIVISION AND STABILITY SPECIAL RULES PERTAINING TO VESSELS CARRYING PASSENGERS Drainage of Weather Decks § 171.135 Weather deck drainage on a vessel of 100 gross tons or more. The weather deck must have...

  19. 46 CFR 171.135 - Weather deck drainage on a vessel of 100 gross tons or more.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 46 Shipping 7 2014-10-01 2014-10-01 false Weather deck drainage on a vessel of 100 gross tons or...) SUBDIVISION AND STABILITY SPECIAL RULES PERTAINING TO VESSELS CARRYING PASSENGERS Drainage of Weather Decks § 171.135 Weather deck drainage on a vessel of 100 gross tons or more. The weather deck must have...

  20. 46 CFR 171.135 - Weather deck drainage on a vessel of 100 gross tons or more.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 46 Shipping 7 2011-10-01 2011-10-01 false Weather deck drainage on a vessel of 100 gross tons or...) SUBDIVISION AND STABILITY SPECIAL RULES PERTAINING TO VESSELS CARRYING PASSENGERS Drainage of Weather Decks § 171.135 Weather deck drainage on a vessel of 100 gross tons or more. The weather deck must have...

  1. 46 CFR 171.135 - Weather deck drainage on a vessel of 100 gross tons or more.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 46 Shipping 7 2012-10-01 2012-10-01 false Weather deck drainage on a vessel of 100 gross tons or...) SUBDIVISION AND STABILITY SPECIAL RULES PERTAINING TO VESSELS CARRYING PASSENGERS Drainage of Weather Decks § 171.135 Weather deck drainage on a vessel of 100 gross tons or more. The weather deck must have...

  2. Combustion characteristics and NO formation for biomass blends in a 35-ton-per-hour travelling grate utility boiler.

    PubMed

    Li, Zhengqi; Zhao, Wei; Li, Ruiyang; Wang, Zhenwang; Li, Yuan; Zhao, Guangbo

    2009-04-01

    Measurements were taken for a 35-ton-per-hour biomass-fired travelling grate boiler. Local mean concentrations of O(2), CO, SO(2) and NO gas species and gas temperatures were determined in the region above the grate. For a 28-ton-per-hour load, the mass ratios of biomass fly ash and boiler slag were 42% and 58%, the boiler efficiency was 81.56%, and the concentrations of NO(x) and SO(2) at 6% O(2) were 257 and 84 mg/m(3). For an 18-ton-per-hour load, the fuel burning zone was nearer to the inlet than it was for the 28-ton-per-hour load, and the contents of CO and NO in the fuel burning zone above the grate were lower.

  3. 15. GENERAL EASTERN VIEW OF LINDE 1000 TONS PER DAY ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    15. GENERAL EASTERN VIEW OF LINDE 1000 TONS PER DAY HIGH PURITY OXYGEN MAKING PLANT SHOWING TWIN OXYGEN FRACTIONATING TOWER (ON RIGHT), VERMICULITE STORAGE TOWERS (ON LEFT FOREGROUND), AND AN ARGON FRACTIONATING TOWER (BEHIND VERMICULITE STORAGE TOWER). - U.S. Steel Duquesne Works, Fuel & Utilities Plant, Along Monongahela River, Duquesne, Allegheny County, PA

  4. Constructing experimental devices for half-ton synthesis of gadolinium-loaded liquid scintillator and its performance.

    PubMed

    Park, Young Seo; Jang, Yeong Min; Joo, Kyung Kwang

    2018-04-01

    This paper describes in brief features of various experimental devices constructed for half-ton synthesis of gadolinium(Gd)-loaded liquid scintillator (GdLS) and also includes the performances and detailed chemical and physical results of a 0.5% high-concentration GdLS. Various feasibility studies on useful apparatus used for loading Gd into solvents have been carried out. The transmittance, Gd concentration, density, light yield, and moisture content were measured for quality control. We show that with the help of adequate automated experimental devices and tools, it is possible to perform ton scale synthesis of GdLS at moderate laboratory scale without difficulty. The synthesized GdLS was satisfactory to meet chemical, optical, and physical properties and various safety requirements. These synthesizing devices can be expanded into massive scale next-generation neutrino experiments of several hundred tons.

  5. Constructing experimental devices for half-ton synthesis of gadolinium-loaded liquid scintillator and its performance

    NASA Astrophysics Data System (ADS)

    Park, Young Seo; Jang, Yeong Min; Joo, Kyung Kwang

    2018-04-01

    This paper describes in brief features of various experimental devices constructed for half-ton synthesis of gadolinium(Gd)-loaded liquid scintillator (GdLS) and also includes the performances and detailed chemical and physical results of a 0.5% high-concentration GdLS. Various feasibility studies on useful apparatus used for loading Gd into solvents have been carried out. The transmittance, Gd concentration, density, light yield, and moisture content were measured for quality control. We show that with the help of adequate automated experimental devices and tools, it is possible to perform ton scale synthesis of GdLS at moderate laboratory scale without difficulty. The synthesized GdLS was satisfactory to meet chemical, optical, and physical properties and various safety requirements. These synthesizing devices can be expanded into massive scale next-generation neutrino experiments of several hundred tons.

  6. 10. SOUTH BAY SHOWING 300TON R.D. WOOD CO. HYDRAULIC CRIMPING ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    10. SOUTH BAY SHOWING 300-TON R.D. WOOD CO. HYDRAULIC CRIMPING PRESS. VIEW EAST ALSO SHOWING NORTHWEST CORNER OF OFFICE/MACHINE SHOP - Oldman Boiler Works, Fabricating Shop, 32 Illinois Street, Buffalo, Erie County, NY

  7. Optical flare observed in the flaring gamma-ray blazar Ton 599

    NASA Astrophysics Data System (ADS)

    Pursimo, Tapio; Sagues, Ana; Telting, John; Ojha, Roopesh

    2017-11-01

    We report optical photometry of the flat spectrum radio quasar Ton 599, obtained with the 2.56m Nordic Optical Telescope in La Palma, to look for any enhanced optical activity associated with a recent flare in the daily averaged gamma-ray flux (ATel#10931, ATel#10937).

  8. INTERIOR VIEW WITH SCRAP HAULER DUMPING SCRAP (C. 100,000 TONS) ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    INTERIOR VIEW WITH SCRAP HAULER DUMPING SCRAP (C. 100,000 TONS) INTO Q-BOP FURNACE. SCRAP HAULER IS GREGORY JACKS AND FURNACEMAN, VINCENT MOREL. - U.S. Steel, Fairfield Works, Q-Bop Furnace, North of Valley Road & West of Ensley, Pleasant Grove Road, Fairfield, Jefferson County, AL

  9. 2016 Billion-ton report: Advancing domestic resources for a thriving bioeconomy, Volume 1: Economic availability of feedstock

    Treesearch

    M.H. Langholtz; B.J. Stokes; L.M. Eaton

    2016-01-01

    This product builds on previous efforts, namely the 2005 Billion-Ton Study (BTS) and the 2011 U.S. Billion-Ton Update (BT2).With each report, greater perspective is gained on the potential of biomass resources to contribute to a national energy strategy. Similarly, each successive report introduces new questions regarding commercialization challenges. BTS quantified...

  10. 46 CFR 11.433 - Service requirements for master of Great Lakes and inland steam or motor vessels of any gross tons.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... inland steam or motor vessels of any gross tons. 11.433 Section 11.433 Shipping COAST GUARD, DEPARTMENT... steam or motor vessels of any gross tons. The minimum service required to qualify an applicant for an endorsement as master of Great Lakes and inland steam or motor vessels of any gross tons is: (a) One year of...

  11. U.S. Billion-Ton Update: Biomass Supply for a Bioenergy and Bioproducts Industry

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Downing, Mark; Eaton, Laurence M; Graham, Robin Lambert

    2011-08-01

    The report, Biomass as Feedstock for a Bioenergy and Bioproducts Industry: The Technical Feasibility of a Billion-Ton Annual Supply (generally referred to as the Billion-Ton Study or 2005 BTS), was an estimate of 'potential' biomass based on numerous assumptions about current and future inventory, production capacity, availability, and technology. The analysis was made to determine if conterminous U.S. agriculture and forestry resources had the capability to produce at least one billion dry tons of sustainable biomass annually to displace 30% or more of the nation's present petroleum consumption. An effort was made to use conservative estimates to assure confidence inmore » having sufficient supply to reach the goal. The potential biomass was projected to be reasonably available around mid-century when large-scale biorefineries are likely to exist. The study emphasized primary sources of forest- and agriculture-derived biomass, such as logging residues, fuel treatment thinnings, crop residues, and perennially grown grasses and trees. These primary sources have the greatest potential to supply large, reliable, and sustainable quantities of biomass. While the primary sources were emphasized, estimates of secondary residue and tertiary waste resources of biomass were also provided. The original Billion-Ton Resource Assessment, published in 2005, was divided into two parts-forest-derived resources and agriculture-derived resources. The forest resources included residues produced during the harvesting of merchantable timber, forest residues, and small-diameter trees that could become available through initiatives to reduce fire hazards and improve forest health; forest residues from land conversion; fuelwood extracted from forests; residues generated at primary forest product processing mills; and urban wood wastes, municipal solid wastes (MSW), and construction and demolition (C&D) debris. For these forest resources, only residues, wastes, and small-diameter trees

  12. 46 CFR 25.25-17 - Survival craft requirements for uninspected passenger vessels of at least 100 gross tons.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 46 Shipping 1 2010-10-01 2010-10-01 false Survival craft requirements for uninspected passenger... Survival craft requirements for uninspected passenger vessels of at least 100 gross tons. (a) Each uninspected passenger vessel of at least 100 gross tons must have adequate survival craft with enough capacity...

  13. The structure of TON1937 from archaeon Thermococcus onnurineus NA1 reveals a eukaryotic HEAT-like architecture.

    PubMed

    Jeong, Jae-Hee; Kim, Yi-Seul; Rojviriya, Catleya; Cha, Hyung Jin; Ha, Sung-Chul; Kim, Yeon-Gil

    2013-10-01

    The members of the ARM/HEAT repeat-containing protein superfamily in eukaryotes have been known to mediate protein-protein interactions by using their concave surface. However, little is known about the ARM/HEAT repeat proteins in prokaryotes. Here we report the crystal structure of TON1937, a hypothetical protein from the hyperthermophilic archaeon Thermococcus onnurineus NA1. The structure reveals a crescent-shaped molecule composed of a double layer of α-helices with seven anti-parallel α-helical repeats. A structure-based sequence alignment of the α-helical repeats identified a conserved pattern of hydrophobic or aliphatic residues reminiscent of the consensus sequence of eukaryotic HEAT repeats. The individual repeats of TON1937 also share high structural similarity with the canonical eukaryotic HEAT repeats. In addition, the concave surface of TON1937 is proposed to be its potential binding interface based on this structural comparison and its surface properties. These observations lead us to speculate that the archaeal HEAT-like repeats of TON1937 have evolved to engage in protein-protein interactions in the same manner as eukaryotic HEAT repeats. Copyright © 2013 Elsevier B.V. All rights reserved.

  14. 15. 3,000TON DAVYUNITED PRESS AND STEAM INTENSIFIER IN THE BLACKSMITH ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    15. 3,000-TON DAVY-UNITED PRESS AND STEAM INTENSIFIER IN THE BLACKSMITH SHOP. (THIS MACHINE WAS NOT EXTANT AT THE TIME OF THE INVENTORY.) Jet Lowe, Photographer, 1989. - U.S. Steel Homestead Works, Auxiliary Buildings & Shops, Along Monongahela River, Homestead, Allegheny County, PA

  15. AmeriFlux US-Ton Tonzi Ranch

    DOE Data Explorer

    Baldocchi, Dennis [University of California, Berkeley

    2016-01-01

    This is the AmeriFlux version of the carbon flux data for the site US-Ton Tonzi Ranch. Site Description - Located in the lower foothills of the Sierra Nevada Mountains, the Tonzi Ranch site is classified as an oak savanna woodland on privately owned land. Managed by local rancher, Russell Tonzi, brush has been periodically removed for cattle grazing. The overstory is dominated by blue oak trees (40% of total vegetation) with intermittent grey pine trees (3 trees/ha). Understory species include a variety of grasses and herbs, including purple false brome, smooth cat's ear, and rose clover. These two distinctive layers operate in and out from one another. Growing season of the understory is confined to the wet season only, typically from October to early May. In contrast, the deciduous blue oak trees are dormant during the rainy winter months and reach maximum LAI in April. The blue oak ecosystem rings the Great Central Valley of California, inhabiting the lower reaches of the Sierra Nevada foothills.

  16. 46 CFR 15.901 - Inspected vessels of less than 100 gross tons.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... MANNING REQUIREMENTS Equivalents § 15.901 Inspected vessels of less than 100 gross tons. (a) An individual..., of non-self-propelled vessels other than sail vessels, within any restrictions on the individual's... vessels is authorized to serve as master or mate, respectively, of other non-self-propelled vessels...

  17. 46 CFR 15.901 - Inspected vessels of less than 100 gross tons.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... MANNING REQUIREMENTS Equivalents § 15.901 Inspected vessels of less than 100 gross tons. (a) An individual..., of non-self-propelled vessels other than sail vessels, within any restrictions on the individual's... vessels is authorized to serve as master or mate, respectively, of other non-self-propelled vessels...

  18. Methodology for Estimating ton-Miles of Goods Movements for U.S. Freight Mulitimodal Network System

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Oliveira Neto, Francisco Moraes; Chin, Shih-Miao; Hwang, Ho-Ling

    2013-01-01

    Ton-miles is a commonly used measure of freight transportation output. Estimation of ton-miles in the U.S. transportation system requires freight flow data at disaggregated level (either by link flow, path flows or origin-destination flows between small geographic areas). However, the sheer magnitude of the freight data system as well as industrial confidentiality concerns in Census survey, limit the freight data which is made available to the public. Through the years, the Center for Transportation Analysis (CTA) of the Oak Ridge National Laboratory (ORNL) has been working in the development of comprehensive national and regional freight databases and network flow models.more » One of the main products of this effort is the Freight Analysis Framework (FAF), a public database released by the ORNL. FAF provides to the general public a multidimensional matrix of freight flows (weight and dollar value) on the U.S. transportation system between states, major metropolitan areas, and remainder of states. Recently, the CTA research team has developed a methodology to estimate ton-miles by mode of transportation between the 2007 FAF regions. This paper describes the data disaggregation methodology. The method relies on the estimation of disaggregation factors that are related to measures of production, attractiveness and average shipments distances by mode service. Production and attractiveness of counties are captured by the total employment payroll. Likely mileages for shipments between counties are calculated by using a geographic database, i.e. the CTA multimodal network system. Results of validation experiments demonstrate the validity of the method. Moreover, 2007 FAF ton-miles estimates are consistent with the major freight data programs for rail and water movements.« less

  19. Fluoresceination of FepA during colicin B killing: effects of temperature, toxin and TonB.

    PubMed

    Smallwood, Chuck R; Marco, Amparo Gala; Xiao, Qiaobin; Trinh, Vy; Newton, Salete M C; Klebba, Phillip E

    2009-06-01

    We studied the reactivity of 35 genetically engineered Cys sulphydryl groups at different locations in Escherichia coli FepA. Modification of surface loop residues by fluorescein maleimide (FM) was strongly temperature-dependent in vivo, whereas reactivity at other sites was much less affected. Control reactions with bovine serum albumin showed that the temperature dependence of loop residue reactivity was unusually high, indicating that conformational changes in multiple loops (L2, L3, L4, L5, L7, L8, L10) transform the receptor to a more accessible form at 37 degrees C. At 0 degrees C colicin B binding impaired or blocked labelling at 8 of 10 surface loop sites, presumably by steric hindrance. Overall, colicin B adsorption decreased the reactivity of more than half of the 35 sites, in both the N- and C- domains of FepA. However, colicin B penetration into the cell at 37 degrees C did not augment the chemical modification of any residues in FepA. The FM modification patterns were similarly unaffected by the tonB locus. FepA was expressed at lower levels in a tonB host strain, but when we accounted for this decrease its FM labelling was comparable whether TonB was present or absent. Thus we did not detect TonB-dependent structural changes in FepA, either alone or when it interacted with colicin B at 37 degrees C. The only changes in chemical modification were reductions from steric hindrance when the bacteriocin bound to the receptor protein. The absence of increases in the reactivity of N-domain residues argues against the idea that the colicin B polypeptide traverses the FepA channel.

  20. AGILE detection of gamma-ray emission from the FSRQ Ton 0599

    NASA Astrophysics Data System (ADS)

    Bulgarelli, A.; Parmiggiani, N.; Lucarelli, F.; Verrecchia, F.; Pittori, C.; Tavani, M.; Vercellone, S.; Colafrancesco, S.; Cardillo, M.; Piano, G.; Ursi, A.; Fioretti, V.; Pilia, M.; Donnarumma, I.; Gianotti, F.; Trifoglio, M.; Giuliani, A.; Mereghetti, S.; Caraveo, P.; Perotti, F.; Chen, A.; Argan, A.; Costa, E.; Del Monte, E.; Evangelista, Y.; Feroci, M.; Lazzarotto, F.; Lapshov, I.; Pacciani, L.; Soffitta, P.; Sabatini, S.; Vittorini, V.; Pucella, G.; Rapisarda, M.; Di Cocco, G.; Fuschino, F.; Galli, M.; Labanti, C.; Marisaldi, M.; Pellizzoni, A.; Trois, A.; Barbiellini, G.; Vallazza, E.; Longo, F.; Morselli, A.; Picozza, P.; Prest, M.; Lipari, P.; Zanello, D.; Cattaneo, P. W.; Rappoldi, A.; Ferrari, A.; Paoletti, F.; Antonelli, A.; Giommi, P.; Salotti, L.; Valentini, G.; D'Amico, F.

    2017-12-01

    AGILE is detecting increasing gamma-ray emission above 100 MeV from a source positionally consistent with the FSRQ Ton 0599. Integrating from 2017-12-16 05:45 to 2017-12-18 05:45 UT, a preliminary maximum likelihood analysis yields a detection above 5 sigma and a flux F(E > 100 MeV)=(2.0 +/- 0.6) x 10^-6 ph cm^-2 s^-1.

  1. Fluoresceination of FepA during Colicin B Killing: Effects of Temperature, Toxin and TonB

    PubMed Central

    Smallwood, Chuck R.; Marco, Amparo Gala; Xiao, Qiaobin; Trinh, Vy; Newton, Salete M. C.; Klebba, Phillip E.

    2009-01-01

    We studied the reactivity of 35 genetically engineered Cys sulfhydryl groups at different locations in Escherichia coli FepA. Modification of surface loop residues by fluorescein maleimide (FM) was strongly temperature-dependent in vivo, whereas reactivity at other sites was much less affected. Control reactions with bovine serum albumin showed that the temperature dependence of loop residue reactivity was unusually high, indicating that conformational changes in multiple loops (L2, L3, L4, L5, L7, L8, L10) transform the receptor to a more accessible form at 37 °C. At 0 °C colicin B binding impaired or blocked labeling at 8 of 10 surface loop sites, presumably by steric hindrance. Overall, colicin B adsorption decreased the reactivity of more than half of the 35 sites, in both the N - and C- domains of FepA. However, colicin B penetration into the cell at 37 °C did not augment the chemical modification of any residues in FepA. The FM modification patterns were similarly unaffected by the tonB locus. FepA was expressed at lower levels in a tonB host strain, but when we accounted for this decrease its FM-labeling was comparable whether TonB was present or absent. Thus we did not detect TonB-dependent structural changes in FepA, either alone or when it interacted with colicin B at 37 °C. The only changes in chemical modification were reductions from steric hindrance when the bacteriocin bound to the receptor protein. The absence of increases in the reactivity of N-domain residues argues against the idea (Devanathan and Postle, Mol. Microbiol. 65: 441–453, 2007) that the colicin B polypeptide traverses the FepA channel. PMID:19432807

  2. Fe(0) Nanomotors in Ton Quantities (10(20) Units) for Environmental Remediation.

    PubMed

    Teo, Wei Zhe; Zboril, Radek; Medrik, Ivo; Pumera, Martin

    2016-03-24

    Despite demonstrating potential for environmental remediation and biomedical applications, the practical environmental applications of autonomous self-propelled micro-/nanorobots have been limited by the inability to fabricate these devices in large (kilograms/tons) quantities. In view of the demand for large-scale environmental remediation by micro-/nanomotors, which are easily synthesized and powered by nontoxic fuel, we have developed bubble-propelled Fe(0) Janus nanomotors by a facile thermally induced solid-state procedure and investigated their potential as decontamination agents of pollutants. These Fe(0) Janus nanomotors, stabilized by an ultrathin iron oxide shell, were fuelled by their decomposition in citric acid, leading to the asymmetric bubble propulsion. The degradation of azo-dyes was dramatically increased in the presence of moving self-propelled Fe(0) nanomotors, which acted as reducing agents. Such enhanced pollutant decomposition triggered by biocompatible Fe(0) (nanoscale zero-valent iron motors), which can be handled in the air and fabricated in ton quantities for low cost, will revolutionize the way that environmental remediation is carried out. © 2016 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  3. 15 CFR 714.2 - Annual reporting requirements for exports and imports in excess of 30 metric tons of Schedule 3...

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... SECURITY, DEPARTMENT OF COMMERCE CHEMICAL WEAPONS CONVENTION REGULATIONS ACTIVITIES INVOLVING SCHEDULE 3 CHEMICALS § 714.2 Annual reporting requirements for exports and imports in excess of 30 metric tons of... exports and imports in excess of 30 metric tons of Schedule 3 chemicals. 714.2 Section 714.2 Commerce and...

  4. 15 CFR 714.2 - Annual reporting requirements for exports and imports in excess of 30 metric tons of Schedule 3...

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... SECURITY, DEPARTMENT OF COMMERCE CHEMICAL WEAPONS CONVENTION REGULATIONS ACTIVITIES INVOLVING SCHEDULE 3 CHEMICALS § 714.2 Annual reporting requirements for exports and imports in excess of 30 metric tons of... exports and imports in excess of 30 metric tons of Schedule 3 chemicals. 714.2 Section 714.2 Commerce and...

  5. The proline-rich domain of TonB possesses an extended polyproline II-like conformation of sufficient length to span the periplasm of Gram-negative bacteria

    PubMed Central

    Köhler, Silvia Domingo; Weber, Annemarie; Howard, S Peter; Welte, Wolfram; Drescher, Malte

    2010-01-01

    TonB from Escherichia coli and its homologues are critical for the uptake of siderophores through the outer membrane of Gram-negative bacteria using chemiosmotic energy. When different models for the mechanism of TonB mediated energy transfer from the inner to the outer membrane are discussed, one of the key questions is whether TonB spans the periplasm. In this article, we use long range distance measurements by spin-label pulsed EPR (Double Electron–Electron Resonance, DEER) and CD spectroscopy to show that the proline-rich segment of TonB exists in a PPII-like conformation. The result implies that the proline-rich segment of TonB possesses a length of more than 15 nm, sufficient to span the periplasm of Gram-negative bacteria. PMID:20095050

  6. STS-97 Crew Activity Report/Flight Day 11 Highlights

    NASA Technical Reports Server (NTRS)

    2000-01-01

    On this eleventh day of the STS-97 mission, Commander Brent W. Jett, Pilot Michael J. Bloomfield, and Mission Specialists Joseph R. Tanner, Carlos I. Noriega, and Marc Garneau remain docked with the International Space Station (ISS) on board the Endeavour Orbiter. Jett and Bloomfield are seen performing a check of the shuttle flight controls in preparation for tomorrow's landing. Jett, Noriega, and Tanner answer questions about the mission and the goals fulfilled. Footage shows the Earth at night as the camera on Endeavour sweeps the Mediterranean coastline, outlined by city lights, showing Spanish/French border, the French Riviera, the Alps, Italy, Switzerland, and the German/Austrian border.

  7. COX-2 expression mediated by calcium-TonEBP signaling axis under hyperosmotic conditions serves osmoprotective function in nucleus pulposus cells.

    PubMed

    Choi, Hyowon; Chaiyamongkol, Weera; Doolittle, Alexandra C; Johnson, Zariel I; Gogate, Shilpa S; Schoepflin, Zachary R; Shapiro, Irving M; Risbud, Makarand V

    2018-06-08

    The nucleus pulposus (NP) of intervertebral discs experiences dynamic changes in tissue osmolarity because of diurnal loading of the spine. TonEBP/NFAT5 is a transcription factor that is critical in osmoregulation as well as survival of NP cells in the hyperosmotic milieu. The goal of this study was to investigate whether cyclooxygenase-2 (COX-2) expression is osmoresponsive and dependent on TonEBP, and whether it serves an osmoprotective role. NP cells up-regulated COX-2 expression in hyperosmotic media. The induction of COX-2 depended on elevation of intracellular calcium levels and p38 MAPK pathway, but independent of calcineurin signaling as well as MEK/ERK and JNK pathways. Under hyperosmotic conditions, both COX-2 mRNA stability and its proximal promoter activity were increased. The proximal COX-2 promoter (-1840/+123 bp) contained predicted binding sites for TonEBP, AP-1, NF-κB, and C/EBP-β. While COX-2 promoter activity was positively regulated by both AP-1 and NF-κB, AP-1 had no effect and NF-κB negatively regulated COX-2 protein levels under hyperosmotic conditions. On the other hand, TonEBP was necessary for both COX-2 promoter activity and protein up-regulation in response to hyperosmotic stimuli. Ex vivo disc organ culture studies using hypomorphic TonEBP +/- mice confirmed that TonEBP is required for hyperosmotic induction of COX-2. Importantly, the inhibition of COX-2 activity under hyperosmotic conditions resulted in decreased cell viability, suggesting that COX-2 plays a cytoprotective and homeostatic role in NP cells for their adaptation to dynamically loaded hyperosmotic niches. © 2018 by The American Society for Biochemistry and Molecular Biology, Inc.

  8. HOT CELL BUILDING, TRA632, INTERIOR. WRIGHT 3TON HOIST ON EAST ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    HOT CELL BUILDING, TRA-632, INTERIOR. WRIGHT 3-TON HOIST ON EAST SIDE OF CELL 2. SIGN AT LEFT OF VIEW SAYS, "...DO NOT BRING FISSILE MATERIAL INTO AREA WITHOUT APPROVAL." CAMERA FACES NORTHWEST. INL NEGATIVE NO. HD46-29-2. Mike Crane, Photographer, 2/2005 - Idaho National Engineering Laboratory, Test Reactor Area, Materials & Engineering Test Reactors, Scoville, Butte County, ID

  9. Neutrino physics with multi-ton scale liquid xenon detectors

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Baudis, L.; Ferella, A.; Kish, A.

    2014-01-01

    We study the sensitivity of large-scale xenon detectors to low-energy solar neutrinos, to coherent neutrino-nucleus scattering and to neutrinoless double beta decay. As a concrete example, we consider the xenon part of the proposed DARWIN (Dark Matter WIMP Search with Noble Liquids) experiment. We perform detailed Monte Carlo simulations of the expected backgrounds, considering realistic energy resolutions and thresholds in the detector. In a low-energy window of 2–30 keV, where the sensitivity to solar pp and {sup 7}Be-neutrinos is highest, an integrated pp-neutrino rate of 5900 events can be reached in a fiducial mass of 14 tons of natural xenon,more » after 5 years of data. The pp-neutrino flux could thus be measured with a statistical uncertainty around 1%, reaching the precision of solar model predictions. These low-energy solar neutrinos will be the limiting background to the dark matter search channel for WIMP-nucleon cross sections below ∼ 2 × 10{sup −48} cm{sup 2} and WIMP masses around 50 GeV⋅c{sup −2}, for an assumed 99.5% rejection of electronic recoils due to elastic neutrino-electron scatters. Nuclear recoils from coherent scattering of solar neutrinos will limit the sensitivity to WIMP masses below ∼ 6 GeV⋅c{sup −2} to cross sections above ∼ 4 × 10{sup −45}cm{sup 2}. DARWIN could reach a competitive half-life sensitivity of 5.6 × 10{sup 26} y to the neutrinoless double beta decay of {sup 136}Xe after 5 years of data, using 6 tons of natural xenon in the central detector region.« less

  10. Drought analysis in the Tons River Basin, India during 1969-2008

    NASA Astrophysics Data System (ADS)

    Meshram, Sarita Gajbhiye; Gautam, Randhir; Kahya, Ercan

    2018-05-01

    The primary focus of this study is the analysis of droughts in the Tons River Basin during the period 1969-2008. Precipitation data observed at four gauging stations are used to identify drought over the study area. The event of drought is derived from the standardized precipitation index (SPI) on a 3-month scale. Our results indicated that severe drought occurred in the Allahabad, Rewa, and Satna stations in the years 1973 and 1979. The droughts in this region had occurred mainly due to erratic behavior in monsoons, especially due to long breaks between monsoons. During the drought years, the deficiency of the annual rainfall in the analysis of annual rainfall departure had varied from -26% in 1976 to -60% in 1973 at Allahabad station in the basin. The maximum deficiency of annual and seasonal rainfall recorded in the basin is 60%. The maximum seasonal rainfall departure observed in the basin is in the order of -60% at Allahabad station in 1973, while maximum annual rainfall departure had been recorded as -60% during 1979 at the Satna station. Extreme dry events ( z score <-2) were detected during July, August, and September. Moreover, severe dry events were observed in August, September, and October. The drought conditions in the Tons River Basin are dominantly driven by total rainfall throughout the period between June and November.

  11. 40 CFR 60.1560 - Can an affected municipal waste combustion unit reduce its capacity to less than 35 tons per day...

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... combustion unit reduce its capacity to less than 35 tons per day rather than comply with my State plan? 60... Small Municipal Waste Combustion Units Constructed on or Before August 30, 1999 Applicability of State Plans § 60.1560 Can an affected municipal waste combustion unit reduce its capacity to less than 35 tons...

  12. 40 CFR 60.1560 - Can an affected municipal waste combustion unit reduce its capacity to less than 35 tons per day...

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... combustion unit reduce its capacity to less than 35 tons per day rather than comply with my State plan? 60... Small Municipal Waste Combustion Units Constructed on or Before August 30, 1999 Applicability of State Plans § 60.1560 Can an affected municipal waste combustion unit reduce its capacity to less than 35 tons...

  13. 40 CFR 60.1560 - Can an affected municipal waste combustion unit reduce its capacity to less than 35 tons per day...

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... combustion unit reduce its capacity to less than 35 tons per day rather than comply with my State plan? 60... Small Municipal Waste Combustion Units Constructed on or Before August 30, 1999 Applicability of State Plans § 60.1560 Can an affected municipal waste combustion unit reduce its capacity to less than 35 tons...

  14. 40 CFR 60.1560 - Can an affected municipal waste combustion unit reduce its capacity to less than 35 tons per day...

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... combustion unit reduce its capacity to less than 35 tons per day rather than comply with my State plan? 60... Small Municipal Waste Combustion Units Constructed on or Before August 30, 1999 Applicability of State Plans § 60.1560 Can an affected municipal waste combustion unit reduce its capacity to less than 35 tons...

  15. 40 CFR 60.1560 - Can an affected municipal waste combustion unit reduce its capacity to less than 35 tons per day...

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... combustion unit reduce its capacity to less than 35 tons per day rather than comply with my State plan? 60... Small Municipal Waste Combustion Units Constructed on or Before August 30, 1999 Applicability of State Plans § 60.1560 Can an affected municipal waste combustion unit reduce its capacity to less than 35 tons...

  16. Space Shuttle Projects

    NASA Image and Video Library

    1999-11-30

    These five STS-97 crew members posed for a traditional portrait during training. On the front row, left to right, are astronauts Michael J. Bloomfield, pilot; Marc Garneau, mission specialist representing the Canadian Space Agency (CSA); and Brent W. Jett, Jr., commander. In the rear, wearing training versions of the extravehicular mobility unit (EMU) space suits, (left to right) are astronauts Carlos I. Noriega, and Joseph R. Tarner, both mission specialists. The primary objective of the STS-97 mission was the delivery, assembly, and activation of the U.S. electrical power system onboard the International Space Station (ISS). The electrical power system, which is built into a 73-meter (240-foot) long solar array structure consists of solar arrays, radiators, batteries, and electronics. The entire 15.4-metric ton (17-ton) package is called the P6 Integrated Truss Segment and is the heaviest and largest element yet delivered to the station aboard a space shuttle. The electrical system will eventually provide the power necessary for the first ISS crews to live and work in the U.S. segment. The STS-97 crew of five launched aboard the Space Shuttle Orbiter Endeavor on November 30, 2000 for an 11 day mission.

  17. 46 CFR 11.404 - Service requirements for master of ocean or near coastal steam or motor vessels of any gross tons.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... steam or motor vessels of any gross tons. 11.404 Section 11.404 Shipping COAST GUARD, DEPARTMENT OF... Requirements for Deck Officers § 11.404 Service requirements for master of ocean or near coastal steam or motor... master of ocean or near coastal steam or motor vessels of any gross tons is: (a) One year of service as...

  18. 46 CFR 11.437 - Service requirements for mate of Great Lakes and inland steam or motor vessels of any gross tons.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... steam or motor vessels of any gross tons. 11.437 Section 11.437 Shipping COAST GUARD, DEPARTMENT OF... Requirements for Deck Officers § 11.437 Service requirements for mate of Great Lakes and inland steam or motor... mate of Great Lakes and inland steam or motor vessels of any gross tons is: (1) Three years of service...

  19. Novel nickel transport mechanism across the bacterial outer membrane energized by the TonB/ExbB/ExbD machinery.

    PubMed

    Schauer, Kristine; Gouget, Barbara; Carrière, Marie; Labigne, Agnès; de Reuse, Hilde

    2007-02-01

    Nickel is a cofactor for various microbial enzymes, yet as a trace element, its scavenging is challenging. In the case of the pathogen Helicobacter pylori, nickel is essential for the survival in the human stomach, because it is the cofactor of the important virulence factor urease. While nickel transport across the cytoplasmic membrane is accomplished by the nickel permease NixA, the mechanism by which nickel traverses the outer membrane (OM) of this Gram-negative bacterium is unknown. Import of iron-siderophores and cobalamin through the bacterial OM is carried out by specific receptors energized by the TonB/ExbB/ExbD machinery. In this study, we show for the first time that H. pylori utilizes TonB/ExbB/ExbD for nickel uptake in addition to iron acquisition. We have identified the nickel-regulated protein FrpB4, homologous to TonB-dependent proteins, as an OM receptor involved in nickel uptake. We demonstrate that ExbB/ExbD/TonB and FrpB4 deficient bacteria are unable to efficiently scavenge nickel at low pH. This condition mimics those encountered by H. pylori during stomach colonization, under which nickel supply and full urease activity are essential to combat acidity. We anticipate that this nickel scavenging system is not restricted to H. pylori, but will be represented more largely among Gram-negative bacteria.

  20. Mediator of DNA damage checkpoint 1 (MDC1) contributes to high NaCl-induced activation of the osmoprotective transcription factor TonEBP/OREBP.

    PubMed

    Kunin, Margarita; Dmitrieva, Natalia I; Gallazzini, Morgan; Shen, Rong-Fong; Wang, Guanghui; Burg, Maurice B; Ferraris, Joan D

    2010-08-11

    Hypertonicity, such as induced by high NaCl, increases the activity of the transcription factor TonEBP/OREBP whose target genes increase osmoprotective organic osmolytes and heat shock proteins. We used mass spectrometry to analyze proteins that coimmunoprecipitate with TonEBP/OREBP in order to identify ones that might contribute to its high NaCl-induced activation. We identified 20 unique peptides from Mediator of DNA Damage Checkpoint 1 (MDC1) with high probability. The identification was confirmed by Western analysis. We used small interfering RNA knockdown of MDC1 to characterize its osmotic function. Knocking down MDC1 reduces high NaCl-induced increases in TonEBP/OREBP transcriptional and transactivating activity, but has no significant effect on its nuclear localization. We confirm six previously known phosphorylation sites in MDC1, but do not find evidence that high NaCl increases phosphorylation of MDC1. It is suggestive that MDC1 acts as a DNA damage response protein since hypertonicity reversibly increases DNA breaks, and other DNA damage response proteins, like ATM, also associate with TonEBP/OREBP and contribute to its activation by hypertonicity. MDC1 associates with TonEBP/OREBP and contributes to high NaCl-induced increase of that factor's transcriptional activity.

  1. 50 CFR Table 1b to Part 660... - 2009, Harvest Guidelines for Minor Rockfish by Depth Sub-groups (weights in metric tons)

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 50 Wildlife and Fisheries 9 2010-10-01 2010-10-01 false 2009, Harvest Guidelines for Minor Rockfish by Depth Sub-groups (weights in metric tons) 1b Table 1b to Part 660, Subpart G Wildlife and... 660, Subpart G—2009, Harvest Guidelines for Minor Rockfish by Depth Sub-groups (weights in metric tons...

  2. Efficient conditioned pain modulation despite pain persistence in painful diabetic neuropathy.

    PubMed

    Granovsky, Yelena; Nahman-Averbuch, Hadas; Khamaisi, Mogher; Granot, Michal

    2017-05-01

    Alleviation of pain, by either medical or surgical therapy, is accompanied by transition from less efficient, or pro-nociceptive, to efficient conditioned pain modulation (CPM). Spontaneous decrease or resolution of pain with disease progression is reported for some patients with painful diabetic neuropathy (PDN). To explore whether CPM changes similarly in parallel to spontaneous resolution of pain in PDN patients. In this cross-sectional study, thirty-three patients with PDN underwent psychophysical assessment of pain modulation on the forearm, remote from the clinical pain. Pain duration was not correlated with neuropathic pain intensity, yet, it correlated with CPM efficiency; patients with longer pain duration had same pain level, but more efficient CPM than those with short-pain duration (ρ = -0.417; P = 0.025, Spearman correlation). Patients with pain more than 2 years (median split) expressed efficient CPM that was not different from that of healthy controls. These patients also had lower temporal summation of pain than the short-pain duration patients group ( P < 0.05). The 2 patient groups did not differ in clinical pain characteristics or use of analgesics. Pro-nociception, expressed by less efficient CPM and high temporal summation that usually accompanies clinical painful conditions, seems to "normalize" with chronicity of the pain syndrome. This is despite continuing pain, suggesting that pro-nociceptivity in pain syndromes is multifactorial. Because the pain modulation profile affects success of therapy, this suggests that different drugs might express different efficacy pending on duration of the pain in patients with PDN.

  3. Efficient conditioned pain modulation despite pain persistence in painful diabetic neuropathy

    PubMed Central

    Granovsky, Yelena; Nahman-Averbuch, Hadas; Khamaisi, Mogher; Granot, Michal

    2017-01-01

    Abstract Introduction: Alleviation of pain, by either medical or surgical therapy, is accompanied by transition from less efficient, or pro-nociceptive, to efficient conditioned pain modulation (CPM). Spontaneous decrease or resolution of pain with disease progression is reported for some patients with painful diabetic neuropathy (PDN). Objectives: To explore whether CPM changes similarly in parallel to spontaneous resolution of pain in PDN patients. Methods: In this cross-sectional study, thirty-three patients with PDN underwent psychophysical assessment of pain modulation on the forearm, remote from the clinical pain. Results: Pain duration was not correlated with neuropathic pain intensity, yet, it correlated with CPM efficiency; patients with longer pain duration had same pain level, but more efficient CPM than those with short-pain duration (ρ = −0.417; P = 0.025, Spearman correlation). Patients with pain more than 2 years (median split) expressed efficient CPM that was not different from that of healthy controls. These patients also had lower temporal summation of pain than the short-pain duration patients group (P < 0.05). The 2 patient groups did not differ in clinical pain characteristics or use of analgesics. Conclusion: Pro-nociception, expressed by less efficient CPM and high temporal summation that usually accompanies clinical painful conditions, seems to “normalize” with chronicity of the pain syndrome. This is despite continuing pain, suggesting that pro-nociceptivity in pain syndromes is multifactorial. Because the pain modulation profile affects success of therapy, this suggests that different drugs might express different efficacy pending on duration of the pain in patients with PDN. PMID:29392208

  4. 33 CFR 158.220 - Ports and terminals loading more than 1,000 metric tons of oil other than crude oil or bunker oil.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... processing in the amount of 10 metric tons (11 short tons); (b) Bilge water containing oily mixtures in the... average, whichever quantity is greater; (c) Ballast water containing oily mixtures in the amount of 30% of... FACILITIES FOR OIL, NOXIOUS LIQUID SUBSTANCES, AND GARBAGE Criteria for Reception Facilities: Oily Mixtures...

  5. 33 CFR 158.220 - Ports and terminals loading more than 1,000 metric tons of oil other than crude oil or bunker oil.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... processing in the amount of 10 metric tons (11 short tons); (b) Bilge water containing oily mixtures in the... average, whichever quantity is greater; (c) Ballast water containing oily mixtures in the amount of 30% of... FACILITIES FOR OIL, NOXIOUS LIQUID SUBSTANCES, AND GARBAGE Criteria for Reception Facilities: Oily Mixtures...

  6. 33 CFR 158.220 - Ports and terminals loading more than 1,000 metric tons of oil other than crude oil or bunker oil.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... processing in the amount of 10 metric tons (11 short tons); (b) Bilge water containing oily mixtures in the... average, whichever quantity is greater; (c) Ballast water containing oily mixtures in the amount of 30% of... FACILITIES FOR OIL, NOXIOUS LIQUID SUBSTANCES, AND GARBAGE Criteria for Reception Facilities: Oily Mixtures...

  7. 33 CFR 158.220 - Ports and terminals loading more than 1,000 metric tons of oil other than crude oil or bunker oil.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... processing in the amount of 10 metric tons (11 short tons); (b) Bilge water containing oily mixtures in the... average, whichever quantity is greater; (c) Ballast water containing oily mixtures in the amount of 30% of... FACILITIES FOR OIL, NOXIOUS LIQUID SUBSTANCES, AND GARBAGE Criteria for Reception Facilities: Oily Mixtures...

  8. 33 CFR 158.220 - Ports and terminals loading more than 1,000 metric tons of oil other than crude oil or bunker oil.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... processing in the amount of 10 metric tons (11 short tons); (b) Bilge water containing oily mixtures in the... average, whichever quantity is greater; (c) Ballast water containing oily mixtures in the amount of 30% of... FACILITIES FOR OIL, NOXIOUS LIQUID SUBSTANCES, AND GARBAGE Criteria for Reception Facilities: Oily Mixtures...

  9. 46 CFR 129.315 - Power sources for OSVs of 100 or more gross tons.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... VESSELS ELECTRICAL INSTALLATIONS Power Sources and Distribution Systems § 129.315 Power sources for OSVs... 46 Shipping 4 2013-10-01 2013-10-01 false Power sources for OSVs of 100 or more gross tons. 129....10 of this chapter. (b) If a generator provides electrical power for any system identified as a vital...

  10. 46 CFR 129.315 - Power sources for OSVs of 100 or more gross tons.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... VESSELS ELECTRICAL INSTALLATIONS Power Sources and Distribution Systems § 129.315 Power sources for OSVs... 46 Shipping 4 2011-10-01 2011-10-01 false Power sources for OSVs of 100 or more gross tons. 129....10 of this chapter. (b) If a generator provides electrical power for any system identified as a vital...

  11. 46 CFR 129.315 - Power sources for OSVs of 100 or more gross tons.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... VESSELS ELECTRICAL INSTALLATIONS Power Sources and Distribution Systems § 129.315 Power sources for OSVs... 46 Shipping 4 2012-10-01 2012-10-01 false Power sources for OSVs of 100 or more gross tons. 129....10 of this chapter. (b) If a generator provides electrical power for any system identified as a vital...

  12. GigaTON: an extensive publicly searchable database providing a new reference transcriptome in the pacific oyster Crassostrea gigas.

    PubMed

    Riviere, Guillaume; Klopp, Christophe; Ibouniyamine, Nabihoudine; Huvet, Arnaud; Boudry, Pierre; Favrel, Pascal

    2015-12-02

    The Pacific oyster, Crassostrea gigas, is one of the most important aquaculture shellfish resources worldwide. Important efforts have been undertaken towards a better knowledge of its genome and transcriptome, which makes now C. gigas becoming a model organism among lophotrochozoans, the under-described sister clade of ecdysozoans within protostomes. These massive sequencing efforts offer the opportunity to assemble gene expression data and make such resource accessible and exploitable for the scientific community. Therefore, we undertook this assembly into an up-to-date publicly available transcriptome database: the GigaTON (Gigas TranscriptOme pipeliNe) database. We assembled 2204 million sequences obtained from 114 publicly available RNA-seq libraries that were realized using all embryo-larval development stages, adult organs, different environmental stressors including heavy metals, temperature, salinity and exposure to air, which were mostly performed as part of the Crassostrea gigas genome project. This data was analyzed in silico and resulted into 56621 newly assembled contigs that were deposited into a publicly available database, the GigaTON database. This database also provides powerful and user-friendly request tools to browse and retrieve information about annotation, expression level, UTRs, splice and polymorphism, and gene ontology associated to all the contigs into each, and between all libraries. The GigaTON database provides a convenient, potent and versatile interface to browse, retrieve, confront and compare massive transcriptomic information in an extensive range of conditions, tissues and developmental stages in Crassostrea gigas. To our knowledge, the GigaTON database constitutes the most extensive transcriptomic database to date in marine invertebrates, thereby a new reference transcriptome in the oyster, a highly valuable resource to physiologists and evolutionary biologists.

  13. Depression, Pain, and Pain Behavior.

    ERIC Educational Resources Information Center

    Keefe, Francis J.; And Others

    1986-01-01

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

  14. Pain and pain management in haemophilia

    PubMed Central

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

    2016-01-01

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

  15. Analysis of chemical weapons decontamination waste from old ton containers from Johnston Atoll using multiple analytical methods

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Creasy, W.R.; Brickhouse, M.D.; Morrisse, K.M.

    1999-07-01

    Decontamination waste from chemical weapons (CW) agents has been stored in ton containers on Johnston Atoll since 1971. The waste was recently sampled and analyzed to determine its chemical composition in preparation for future cleanups. Due to the range of products and analytical requirements, multiple chromatographic and spectroscopic methods were necessary, including gas chromatography/mass spectrometry (GC/MS), gas chromatography/atomic emission detection (GC/AED), liquid chromatography/mass spectrometry (LC/MS), capillary electrophoresis (CE), and nuclear magnetic resonance spectroscopy (NMR). The samples were screened for residual agents. No residual sarin (GB) or VX was found to detection limits of 20 ng/mL, but 3% of the samplesmore » contained residual sulfur mustard (HD) at < 140 ng/mL. Decontamination products of agents were identified. The majority (74%) of the ton containers were documented correctly, in that the observed decontamination products were in agreement with the labeled agent type, but for a number of the containers, the contents were not in agreement with the labels. In addition, arsenic compounds that are decontamination products of the agent lewisite (L) were observed in a few ton containers, suggesting that lewisite was originally present but not documented. This study was a prototype to demonstrate the level of effort required to characterize old bulk CW-related waste.« less

  16. Pain and pain behavior in burning mouth syndrome: a pain diary study.

    PubMed

    Forssell, Heli; Teerijoki-Oksa, Tuija; Kotiranta, Ulla; Kantola, Rosita; Bäck, Marjaliina; Vuorjoki-Ranta, Tiina-Riitta; Siponen, Maria; Leino, Ari; Puukka, Pauli; Estlander, Ann-Mari

    2012-01-01

    To characterize pain related to primary burning mouth syndrome (BMS) in terms of intensity, interference, and distress caused by the pain, as well as factors influencing the pain across a period of 2 weeks, and to study the use of coping and management strategies on a daily basis. Fifty-two female patients with primary BMS completed a 2-week pain diary. Pain intensity, interference, distress, and mood on a 0 to 10 numeric rating scale (NRS), as well as pain amplifying and alleviating factors, were recorded three times a day. The use of treatments (medication or other means) and coping strategies were recorded at the end of each day. Coefficient of variation, repeated measures analysis of variance, and correlative methods were used to assess the between- and within-subject variation, pain patterns, and associations between various pain scores. The overall mean pain intensity score of the 14 diary days was 3.1 (SD: 1.7); there was considerable variation in pain intensity between patients. Most patients experienced intermittent pain. On average, pain intensity increased from the morning to the evening. Intercorrelations between pain intensity, interference, distress, and mood were high, varying between rs = .75 and rs = .93 (P < .001). Pungent or hot food or beverages, stress, and tiredness were the most frequently mentioned pain-amplifying factors. The corresponding pain-alleviating factors were eating, sucking pastilles, drinking cold beverages, and relaxation. Thirty (58%) patients used pain medication and 35% reported using other means to alleviate their BMS pain. There was large variation in the use of coping strategies -between subjects. There were considerable differences in pain, in factors influencing the pain, and in pain behavior across BMS patients. This indicates that patient information and education as well as treatment of BMS pain should be individualized.

  17. Abdominal Pain (Stomach Pain), Short-Term

    MedlinePlus

    ... Long-term Abdominal Pain (Stomach Pain), Short-term Ankle Problems Breast Problems in Men Breast Problems in Women Chest Pain in Infants and Children Chest Pain, Acute Chest Pain, Chronic Cold and Flu Cough Diarrhea ...

  18. Pain and pain management in dermatology.

    PubMed

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

    2015-10-01

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

  19. Dark matter sensitivity of multi-ton liquid xenon detectors

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Schumann, Marc; Bütikofer, Lukas; Baudis, Laura

    2015-10-01

    We study the sensitivity of multi ton-scale time projection chambers using a liquid xenon target, e.g., the proposed DARWIN instrument, to spin-independent and spin-dependent WIMP-nucleon scattering interactions. Taking into account realistic backgrounds from the detector itself as well as from neutrinos, we examine the impact of exposure, energy threshold, background rejection efficiency and energy resolution on the dark matter sensitivity. With an exposure of 200 t × y and assuming detector parameters which have been already demonstrated experimentally, spin-independent cross sections as low as 2.5 × 10{sup −49} cm{sup 2} can be probed for WIMP masses around 40 GeV/c{sup 2}. Additional improvementsmore » in terms of background rejection and exposure will further increase the sensitivity, while the ultimate WIMP science reach will be limited by neutrinos scattering coherently off the xenon nuclei.« less

  20. Reconstruction and Analysis for the DUNE 35-ton Liquid Argon Prototype

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Wallbank, Michael James

    Neutrino physics is approaching the precision era, with current and future experiments aiming to perform highly accurate measurements of the parameters which govern the phenomenon of neutrino oscillations. The ultimate ambition with these results is to search for evidence of CP-violation in the lepton sector, currently hinted at in the world-leading analyses from present experiments, which may explain the dominance of matter over antimatter in the Universe. The Deep Underground Neutrino Experiment (DUNE) is a future long-baseline experiment based at Fermi National Accelerator Laboratory (FNAL), with a far detector at the Sanford Underground Research Facility (SURF) and a baseline ofmore » 1300 km. In order to make the required precision measurements, the far detector will consist of 40 kton liquid argon and an embedded time projection chamber. This promising technology is still in development and, since each detector module is around a factor 15 larger than any previous experiment employing this design, prototyping the detector and design choices is critical to the success of the experiment. The 35-ton experiment was constructed for this purpose and will be described in detail in this thesis. The outcomes of the 35-ton prototype are already influencing DUNE and, following the successes and lessons learned from the experiment, confidence can be taken forward to the next stage of the DUNE programme. The main oscillation signal at DUNE will be electron neutrino appearance from the muon neutrino beam. High-precision studies of these νe interactions requires advanced processing and event reconstruction techniques, particularly in the handling of showering particles such as electrons and photons. Novel methods developed for the purposes of shower reconstruction in liquid argon are presented with an aim to successfully develop a selection to use in a νe charged-current analysis, and a first-generation selection using the new techniques is presented.« less

  1. The role of helplessness, fear of pain, and passive pain-coping in chronic pain patients.

    PubMed

    Samwel, Han J A; Evers, Andrea W M; Crul, Ben J P; Kraaimaat, Floris W

    2006-01-01

    The goal of this study was to examine the relative contribution of helplessness, fear of pain, and passive pain-coping to pain level, disability, and depression in chronic pain patients attending an interdisciplinary pain center. One hundred sixty-nine chronic pain patients who had entered treatment at an interdisciplinary pain center completed various questionnaires and a pain diary. Helplessness, fear of pain, and passive pain-coping strategies were all related to the pain level, disability, and depression. When comparing the contribution of the predictors in multiple regression analyses, helplessness was the only significant predictor for pain level. Helplessness and the passive behavioral pain-coping strategies of resting significantly predicted disability. The passive cognitive pain-coping strategy of worrying significantly predicted depression. These findings indicate a role for helplessness and passive pain-coping in chronic pain patients and suggest that both may be relevant in the treatment of pain level, disability, and/or depression.

  2. Exploring effect of pain education on chronic pain patients' expectation of recovery and pain intensity.

    PubMed

    Mittinty, Manasi M; Vanlint, Simon; Stocks, Nigel; Mittinty, Murthy N; Moseley, G Lorimer

    2018-04-25

    Chronic pain affects an estimated 1 in 10 adults globally regardless of age, gender, ethnicity, income or geography. Chronic pain, a multifactorial problem requires multiple interventions. One intervention which demonstrates promising results to patient reported outcomes is pain education. However, patient perspective on pain education and its impact remains fairly unknown. A cross-sectional study involving individuals with chronic pain examined their perspectives on pain education; did it change their understanding about their pain and self-management and did it have any impact on their perceived pain intensity and recovery. The study complied with CHERRIES guidelines and the protocol was locked prior to data collection. Primary outcomes were pain intensity and participants' expectation of recovery. Univariate and multiple logistic regressions were used to analyze the data. Five hundred and seventy three people participated; full data sets were available for 465. Participants who observed changes in their pain cognition and self-management following pain education reported lower pain intensity and greater expectation of recovery than participants who did not observe changes to cognition and management. The results suggest that individuals who observed changes to pain cognition and self-management on receiving pain education reported lower pain intensity and higher expectations of recovery than their counterparts who did not perceive any changes to pain cognition and self-management. Pain intensity and expectations about recovery are primary considerations for people in pain. What influences these factors is not fully understood, but education about pain is potentially important. The results suggest that individuals who observed changes to pain cognition and self-management on receiving pain education reported lower pain intensity and higher expectations of recovery than their counterparts who did not perceive any changes to pain cognition and self-management. The

  3. Conditioned pain modulation in patients with nonspecific chronic back pain with chronic local pain, chronic widespread pain, and fibromyalgia.

    PubMed

    Gerhardt, Andreas; Eich, Wolfgang; Treede, Rolf-Detlef; Tesarz, Jonas

    2017-03-01

    Findings considering conditioned pain modulation (CPM) in chronic back pain (CBP) are contradictory. This might be because many patients with CBP report pain in further areas of the body, and altered CPM might influence spatial extent of pain rather than CBP per se. Therefore, we compared CPM in patients with CBP with different pain extent. Patients with fibromyalgia syndrome (FMS), for whom CPM impairment is reported most consistently, were measured for comparison. Based on clinical evaluation and pain drawings, patients were categorized into chronic local back pain (CLP; n = 53), chronic widespread back pain (CWP; n = 32), and FMS (n = 92). Conditioned pain modulation was measured by the difference in pressure pain threshold (test stimuli) at the lower back before and after tonic heat pain (conditioning stimulus). We also measured psychosocial variables. Pressure pain threshold was significantly increased in CLP patients after tonic heat pain (P < 0.001) indicating induction of CPM. Conditioned pain modulation in CLP was significantly higher than that in CWP and FMS (P < 0.001), but CPM in CWP and FMS did not differ. Interestingly, a higher number of painful areas (0-10) were associated with lower CPM (r = 0.346, P = 0.001) in CBP but not in FMS (r = -0.013, P = 0.903). Anxiety and depression were more pronounced in FMS than in CLP or CWP (P values <0.01). Our findings suggest that CPM dysfunction is associated with CWP and not with FMS as suggested previously. FMS seems to differ from CWP without FMS by higher psychosocial burden. Moreover, patients with CBP should be stratified into CLP and CWP, and centrally acting treatments targeting endogenous pain inhibition seem to be more indicated the higher the pain extent.

  4. Dancing in pain: pain appraisal and coping in dancers.

    PubMed

    Anderson, Ruth; Hanrahan, Stephanie J

    2008-01-01

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

  5. 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.

  6. Chronic pain and pain processing in Parkinson's disease.

    PubMed

    Blanchet, Pierre J; Brefel-Courbon, Christine

    2017-10-12

    Pain is experienced by the vast majority of patients living with Parkinson's disease. It is most often of nociceptive origin, but may also be ascribed to neuropathic (radicular or central) or miscellaneous sources. The recently validated King's Parkinson's Disease Pain Scale is based on 7 domains including musculoskeletal pain, chronic body pain (central or visceral), fluctuation-related pain, nocturnal pain, oro-facial pain, pain with discolouration/oedema/swelling, and radicular pain. The basal ganglia integrate incoming nociceptive information and contribute to coordinated motor responses in pain avoidance and nocifensive behaviors. In Parkinson's disease, nigral and extra-nigral pathology, involving cortical areas, brainstem nuclei, and spinal cord, may contribute to abnormal central nociceptive processing in patients experiencing pain or not. The dopamine deficit lowers multimodal pain thresholds that are amenable to correction following levodopa dosing. Functional brain imaging with positron emission tomography following administration of H 2 15 O revealed abnormalities in the sensory discriminative processing of pain (insula/SII), as well as in the affective motivational processing of pain (anterior cingulate cortex, prefrontal cortex). Pain management is dependent on efforts invested in diagnostic accuracy to distinguish nociceptive from neuropathic pain. Treatment requires an integrated approach including strategies to lessen levodopa-related response fluctuations, in addition to other pharmacological and non-pharmacological options such as deep brain stimulation and rehabilitation. Copyright © 2017. Published by Elsevier Inc.

  7. Pain-related worry in patients with chronic orofacial pain.

    PubMed

    Davis, C Ervin; Stockstill, John W; Stanley, William D; Wu, Qiang

    2014-07-01

    Pain-related worry is distinct from, but related to, pain catastrophizing (PC) and anxiety. Worry and its relationship with other variables have been studied in people with chronic pain but not in people with chronic orofacial pain. The authors explored the prevalence of trait, general and pain-related worry and the association of worry with higher pain levels and other variables. The authors assessed people who had a diagnosis of chronic orofacial pain by using nonpain-related trait worry, state anxiety, trait anxiety, PC and pain measures. The participants' answers to an open-ended question about what they were most worried about led to the identification of worry domains, including worry about pain. The authors found that worrying about pain was related significantly to worst and least pain levels, pain interference and pain duration, as well as moderated trait worry in predicting pain interference. Although trait worry was not correlated directly with pain, when moderated by PC, it made substantial contributions in predicting pain interference. Participants with chronic orofacial pain reported experiencing substantial levels of trait worry, anxiety, PC and worry about pain that related to pain ratings directly and indirectly. Clinicians should assess pain-related worry in patients with chronic orofacial pain to understand the effects of worry on pain and functioning. Clinicians could treat these patients more effectively by helping them reduce their levels of pain-related worry and focusing on improved coping.

  8. Pain Adaptability in Individuals With Chronic Musculoskeletal Pain Is Not Associated With Conditioned Pain Modulation.

    PubMed

    Wan, Dawn Wong Lit; Arendt-Nielsen, Lars; Wang, Kelun; Xue, Charlie Changli; Wang, Yanyi; Zheng, Zhen

    2018-03-27

    Healthy humans can be divided into the pain adaptive (PA) and the pain nonadaptive (PNA) groups; PA showed a greater decrease in pain rating to a cold pressor test (CPT) than PNA. This study examined if the dichotomy of pain adaptability existed in individuals with chronic musculoskeletal pain. CPTs at 2°C and 7°C were used to assess the status of pain adaptability in participants with either chronic nonspecific low back pain or knee osteoarthritis. The participants' potency of conditioned pain modulation (CPM) and local inhibition were measured. The strengths of pain adaptability at both CPTs were highly correlated. PA and PNA did not differ in their demographic characteristics, pain thresholds from thermal and pressure stimuli, or potency of local inhibition or CPM. PA reached their maximum pain faster than PNA (t 41 = -2.76, P < .01), and had a gradual reduction of pain unpleasantness over 7 days whereas PNA did not (F 6,246  = 3.01, P = .01). The dichotomy of pain adaptability exists in musculoskeletal pain patients. Consistent with the healthy human study, the strength of pain adaptability and potency of CPM are not related. Pain adaptability could be another form of endogenous pain inhibition of which clinical implication is yet to be understood. The dichotomy of pain adaptability was identified in healthy humans. The current study confirms that this dichotomy also exists in individuals with chronic musculoskeletal pain, and could be reliably assessed with CPTs at 2°C and 7°C. Similar to the healthy human study, pain adaptability is not associated with CPM, and may reflect the temporal aspect of pain inhibition. Copyright © 2018 The American Pain Society. Published by Elsevier Inc. All rights reserved.

  9. [Low back pain vs. leg dominant pain].

    PubMed

    Kovac, Ida

    2011-01-01

    There are two patterns of back pain: 1) back-dominant pain and 2) leg pain dominant, greater than back pain. The causes of back pain are very different and numerous, but mostly are due to vertebral, mechanical etiology, and rarely because of non vertebral, visceral etiology. Leg pain greater than back pain is mostly disease of spinal nerve root, generally presented by radicular pain in a dermatomal distribution. Mechanical compression of spinal roots, caused by disc herniation or by spinal stenosis, results in radicular symptoms. Rarely, in about 1% of patients, there are some other reasons except vertebral mechanical cause, like infection, tumor or fracture. There are several causes of pseudoradicular pain like periferal neuropathy, myifascial syndromes, vascular diseases, osteoarthritis. Spondylarthropathies should be taken in cosideration as well. A complete history and physical examination is important to determine further diagnostic evaluation and to provide eficient therapy.

  10. Spirituality and Religion in Pain and Pain Management

    PubMed Central

    Dedeli, Ozden; Kaptan, Gulten

    2013-01-01

    Pain relief is a management problem for many patients, their families, and the medical professionals caring for them. Although everyone experiences pain to some degree, responses to it vary from one person to another. Recognizing and specifying someone else’s pain is clinically a well know challenge. Research on the biology and neurobiology of pain has given us a relationship between spirituality and pain. There is growing recognition that persistent pain is a complex and multidimensional experience stemming from the interrelations among biological, psychological, social, and spiritual factors. Patients with pain use a number of cognitive and behavioral strategies to cope with their pain, including religious/spiritual factors, such as prayers, and seeking spiritual support to manage their pain. This article provides an overview of the complex phenomenon of pain, with a focus on spiritual and religious issues in pain management. PMID:26973914

  11. Maintenance of Pain in Children With Functional Abdominal Pain.

    PubMed

    Czyzewski, Danita I; Self, Mariella M; Williams, Amy E; Weidler, Erica M; Blatz, Allison M; Shulman, Robert J

    2016-03-01

    A significant proportion of children with functional abdominal pain develop chronic pain. Identifying clinical characteristics predicting pain persistence is important in targeting interventions. We examined whether child anxiety and/or pain-stooling relations were related to maintenance of abdominal pain frequency and compared the predictive value of 3 methods for assessing pain-stooling relations (ie, diary, parent report, child report). Seventy-six children (7-10 years old at baseline) who presented for medical treatment of functional abdominal pain were followed up 18 to 24 months later. Baseline anxiety and abdominal pain-stooling relations based on pain and stooling diaries and child- and parent questionnaires were examined in relationship to the persistence of abdominal pain frequency. Children's baseline anxiety was not related to persistence of pain frequency. Children who, however, displayed irritable bowel syndrome (IBS) symptoms at baseline maintained pain frequency at follow-up, whereas in children in whom there was no relationship between pain and stooling, pain frequency decreased. Pain and stool diaries and parent report of pain-stooling relations were predictive of pain persistence but child-report questionnaires were not. The presence of IBS symptoms in school-age children with functional abdominal pain appears to predict persistence of abdominal pain over time, whereas anxiety does not. Prospective pain and stooling diaries and parent report of IBS symptoms were predictors of pain maintenance, but child report of symptoms was not.

  12. painACTION-back pain: a self-management website for people with chronic back pain.

    PubMed

    Chiauzzi, Emil; Pujol, Lynette A; Wood, Mollie; Bond, Kathleen; Black, Ryan; Yiu, Elizabeth; Zacharoff, Kevin

    2010-07-01

    To determine whether an interactive self-management Website for people with chronic back pain would significantly improve emotional management, coping, self-efficacy to manage pain, pain levels, and physical functioning compared with standard text-based materials. The study utilized a pretest-posttest randomized controlled design comparing Website (painACTION-Back Pain) and control (text-based material) conditions at baseline and at 1-, 3, and 6-month follow-ups. Two hundred and nine people with chronic back pain were recruited through dissemination of study information online and at a pain treatment clinic. The 6-month follow-up rates for the Website and control groups were 73% and 84%, respectively. Measures were based on the recommendations of the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials and included measures of pain intensity, physical functioning, emotional functioning, coping, self-efficacy, fear-avoidance, perceived improvement with treatment, self-efficacy, and catastrophizing. Compared with controls, painACTION-Back Pain participants reported significantly: 1) lower stress; 2) increased coping self-statements; and 3) greater use of social support. Comparisons between groups suggested clinically significant differences in current pain intensity, depression, anxiety, stress, and global ratings of improvement. Among participants recruited online, those using the Website reported significantly: 1) lower "worst" pain; 2) lower "average" pain; and 3) increased coping self-statements, compared with controls. Participants recruited through the pain clinic evidenced no such differences. An online self-management program for people with chronic back pain can lead to improvements in stress, coping, and social support, and produce clinically significant differences in pain, depression, anxiety, and global rates of improvement.

  13. Analysis of Slab-column Shearwall Structure of 6000 Tons Cold Storage

    NASA Astrophysics Data System (ADS)

    He, Dongqing; Song, Pengwei; Jie, Pengyu

    2018-05-01

    Combining with the functional requirements, the site conditions and the 6000 tons load characteristics of cold storage, so determine its structure system for the slab-column-shear wall structure. The paper recommends the design of foundation, the settings of column cap, the arrangement of shear wall, the punching shear of floor slab and the analysis and calculation results of main structure. By addition shear wall in slab-column structure to increase the overall stiffness of structure and improve the seismic performance of structure. Take the detached form between the main structure and the external wall insulation, while set anchorage beam between in the main floor and the ring beam along the axis of the column grid to enhance the overall stability of the external wall insulation.

  14. Pain and the ethics of pain management.

    PubMed

    Edwards, R B

    1984-01-01

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

  15. Improvement of burn pain management through routine pain monitoring and pain management protocol.

    PubMed

    Yang, Hyeong Tae; Hur, Giyeun; Kwak, In-Suk; Yim, Haejun; Cho, Yong Suk; Kim, Dohern; Hur, Jun; Kim, Jong Hyun; Lee, Boung Chul; Seo, Cheong Hoon; Chun, Wook

    2013-06-01

    Pain management is an important aspect of burn management. We developed a routine pain monitoring system and pain management protocol for burn patients. The purpose of this study is to evaluate the effectiveness of our new pain management system. From May 2011 to November 2011, the prospective study was performed with 107 burn patients. We performed control group (n=58) data analysis and then developed the pain management protocol and monitoring system. Next, we applied our protocol to patients and performed protocol group (n=49) data analysis, and compared this to control group data. Data analysis was performed using the Numeric Rating Scale (NRS) of background pain and procedural pain, Clinician-Administered PTSD Scale (CAPS), Hamilton Depression Rating Scale (HDRS), State-Trait Anxiety Inventory Scale (STAIS), and Holmes and Rahe Stress Scale (HRSS). The NRS of background pain for the protocol group was significantly decreased compared to the control group (2.8±2.0 versus 3.9±1.9), and the NRS of procedural pain of the protocol group was significantly decreased compared to the control group (4.8±2.8 versus 3.7±2.5). CAPS and HDRS were decreased in the protocol group, but did not have statistical significance. STAIS and HRSS were decreased in the protocol group, but only the STAIS had statistical significance. Our new pain management system was effective in burn pain management. However, adequate pain management can only be accomplished by a continuous and thorough effort. Therefore, pain control protocol and pain monitoring systems need to be under constant revision and improvement using creative ideas and approaches. Copyright © 2012 Elsevier Ltd and ISBI. All rights reserved.

  16. Maintenance of Pain in Children with Functional Abdominal Pain

    PubMed Central

    Czyzewski, Danita I.; Self, Mariella M.; Williams, Amy E.; Weidler, Erica M.; Blatz, Allison M.; Shulman, Robert J.

    2015-01-01

    Objectives A significant proportion of children with functional abdominal pain develop chronic pain. Identifying clinical characteristics predicting pain persistence is important in targeting interventions. We examined whether child anxiety and/or pain-stooling relations were related to maintenance of abdominal pain frequency and compared the predictive value of three methods for assessing pain-stooling relations (i.e., diary, parent report, child report). Methods Seventy-six children (7–10-years-old at baseline) who presented for medical treatment of functional abdominal pain were followed up 18–24 months later. Baseline anxiety and abdominal pain-stooling relations based on pain and stooling diaries and child- and parent-questionnaires were examined in relationship to the persistence of abdominal pain frequency. Results Children’s baseline anxiety was not related to persistence of pain frequency. However, children who displayed irritable bowel syndrome (IBS) symptoms at baseline maintained pain frequency at follow-up, whereas in children in whom there was no relationship between pain and stooling, pain frequency decreased. Pain and stool diaries and parent report of pain-stooling relations were predictive of pain persistence but child-report questionnaires were not. Conclusions The presence of IBS symptoms in school age children with functional abdominal pain appears to predict persistence of abdominal pain over time, while anxiety does not. Prospective pain and stooling diaries and parent report of IBS symptoms were predictors of pain maintenance, but child report of symptoms was not. PMID:26301615

  17. Pain Catastrophizing and Pain-Related Fear in Osteoarthritis Patients: Relationships to Pain and Disability

    PubMed Central

    Somers, Tamara J.; Keefe, Francis J.; Pells, Jennifer J.; Dixon, Kim E.; Waters, Sandra J.; Riordan, Paul A.; Blumenthal, James A.; McKee, Daphne C.; LaCaille, Lara; Tucker, Jessica M.; Schmitt, Daniel; Caldwell, David S.; Kraus, Virginia B.; Sims, Ershela L.; Shelby, Rebecca A.; Rice, John R.

    2009-01-01

    This study examined the degree to which pain catastrophizing and pain-related fear explain pain, psychological disability, physical disability, and walking speed in patients with osteoarthritis (OA) of the knee. Participants in this study were 106 individuals diagnosed as having OA of at least one knee, who reported knee pain persisting six months or longer. Results suggest that pain catastrophizing explained a significant proportion (all P's ≤ 0.05) of variance in measures of pain (partial r2 [pr2] = 0.10), psychological disability (pr2 = 0.20), physical disability (pr2 = 0.11), and gait velocity at normal (pr2 = 0.04), fast (pr2 = 0.04), and intermediate speeds (pr2 = 0.04). Pain-related fear explained a significant proportion of the variance in measures of psychological disability (pr2 = 0.07) and walking at a fast speed (pr2 = 0.05). Pain cognitions, particularly pain catastrophizing, appear to be important variables in understanding pain, disability, and walking at normal, fast, and intermediate speeds in knee OA patients. Clinicians interested in understanding variations in pain and disability in this population may benefit by expanding the focus of their inquiries beyond traditional medical and demographic variables to include an assessment of pain catastrophizing and pain-related fear. PMID:19041218

  18. Investigation of central pain processing in shoulder pain: converging results from two musculoskeletal pain models

    PubMed Central

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

    2011-01-01

    Recent reports suggest deficits in conditioned pain modulation (CPM) and enhanced suprathreshold heat pain response (SHPR) potentially play a role in the development of chronic pain. The purpose of this study was to investigate whether central pain processing was altered in 2 musculoskeletal shoulder pain models. The goals of this study were to determine whether central pain processing: 1) differs between healthy subjects and patients with clinical shoulder pain, 2) changes with induction of exercise induced muscle pain (EIMP), and 3) changes 3 months after shoulder surgery. Fifty eight patients with clinical shoulder pain and 56 age and sex matched healthy subjects were included in these analyses. The healthy cohort was examined before inducing EIMP, and 48 and 96 hours later. The clinical cohort was examined before shoulder surgery and 3 months later. CPM did not differ between the cohorts, however; SHPR was elevated for patients with shoulder pain compared to healthy controls. Induction of acute shoulder pain with EIMP resulted in increased shoulder pain intensity but did not change CPM or SHPR. Three months following shoulder surgery clinical pain intensity decreased but CPM was unchanged from pre-operative assessment. In contrast SHPR was decreased and showed values comparable with healthy controls at 3 months. Therefore, the present study suggests that: 1) clinical shoulder pain is associated with measurable changes in central pain processing, 2) exercise-induced shoulder pain did not affect measures of central pain processing, and 3) elevated SHPR was normalized with shoulder surgery. Collectively our findings support neuroplastic changes in pain modulation were associated with decreases in clinical pain intensity only, and could be detected more readily with thermal stimuli. PMID:22208804

  19. Fear of pain, pain catastrophizing, and acute pain perception: relative prediction and timing of assessment.

    PubMed

    Hirsh, Adam T; George, Steven Z; Bialosky, Joel E; Robinson, Michael E

    2008-09-01

    Pain-related fear and catastrophizing are important variables of consideration in an individual's pain experience. Methodological limitations of previous studies limit strong conclusions regarding these relationships. In this follow-up study, we examined the relationships between fear of pain, pain catastrophizing, and experimental pain perception. One hundred healthy volunteers completed the Fear of Pain Questionnaire (FPQ-III), Pain Catastrophizing Scale (PCS), and Coping Strategies Questionnaire-Catastrophizing scale (CSQ-CAT) before undergoing the cold pressor test (CPT). The CSQ-CAT and PCS were completed again after the CPT, with participants instructed to complete these measures based on their experience during the procedure. Measures of pain threshold, tolerance, and intensity were collected and served as dependent variables in separate regression models. Sex, pain catastrophizing, and pain-related fear were included as predictor variables. Results of regression analyses indicated that after controlling for sex, pain-related fear was a consistently stronger predictor of pain in comparison to catastrophizing. These results were consistent when separate measures (CSQ-CAT vs PCS) and time points (pretask vs "in vivo") of catastrophizing were used. These findings largely corroborate those from our previous study and are suggestive of the absolute and relative importance of pain-related fear in the experimental pain experience. Although pain-related fear has received less attention in the experimental literature than pain catastrophizing, results of the current study are consistent with clinical reports highlighting this variable as an important aspect of the experience of pain.

  20. Pain assessment: the cornerstone to optimal pain management

    PubMed Central

    2000-01-01

    Pain assessment is critical to optimal pain management interventions. While pain is a highly subjective experience, its management necessitates objective standards of care. The WILDA approach to pain assessment—focusing on words to describe pain, intensity, location, duration, and aggravating or alleviating factors—offers a concise template for assessment in patients with acute and chronic pain. PMID:16389388

  1. Altering gender role expectations: effects on pain tolerance, pain threshold, and pain ratings.

    PubMed

    Robinson, Michael E; Gagnon, Christine M; Riley, Joseph L; Price, Donald D

    2003-06-01

    The literature demonstrating sex differences in pain is sizable. Most explanations for these differences have focused on biologic mechanisms, and only a few studies have examined social learning. The purpose of this study was to examine the contribution of gender-role stereotypes to sex differences in pain. This study used experimental manipulation of gender-role expectations for men and women. One hundred twenty students participated in the cold pressor task. Before the pain task, participants were given 1 of 3 instructional sets: no expectation, 30-second performance expectation, or a 90-second performance expectation. Pain ratings, threshold, and tolerance were recorded. Significant sex differences in the "no expectation" condition for pain tolerance (t = 2.32, df = 38, P <.05) and post-cold pressor pain ratings (t = 2.6, df = 37, P <.05) were found. Women had briefer tolerance times and higher post-cold pressor ratings than men. When given gender-specific tolerance expectations, men and women did not differ in their pain tolerance, pain threshold, or pain ratings. This is the first empirical study to show that manipulation of expectations alters sex differences in laboratory pain.

  2. Measured performance of a 3 ton LiBr absorption water chiller and its effect on cooling system operation

    NASA Technical Reports Server (NTRS)

    Namkoong, D.

    1976-01-01

    A three ton lithium bromide absorption water chiller was tested for a number of conditions involving hot water input, chilled water, and the cooling water. The primary influences on chiller capacity were the hot water inlet temperature and the cooling water inlet temperature. One combination of these two parameters extended the output to as much as 125% of design capacity, but no combination could lower the capacity to below 60% of design. A cooling system was conceptually designed so that it could provide several modes of operation. Such flexibility is needed for any solar cooling system to be able to accommodate the varying solar energy collection and the varying building demand. It was concluded that a three-ton absorption water chiller with the kind of performance that was measured can be incorporated into a cooling system such as that proposed, to provide efficient cooling over the specified ranges of operating conditions.

  3. Measured performance of a 3-ton LiBr absorption water chiller and its effect on cooling system operation

    NASA Technical Reports Server (NTRS)

    Namkoong, D.

    1976-01-01

    A 3-ton lithium bromide absorption water chiller was tested for a number of conditions involving hot-water input, chilled water, and the cooling water. The primary influences on chiller capacity were the hot water inlet temperature and the cooling water inlet temperature. One combination of these two parameters extended the output to as much as 125% of design capacity, but no combination could lower the capacity to below 60% of design. A cooling system was conceptually designed so that it could provide several modes of operation. Such flexibility is needed for any solar cooling system to be able to accommodate the varying solar energy collection and the varying building demand. It is concluded that a 3-ton absorption water chiller with the kind of performance that was measured can be incorporated into a cooling system such as that proposed, to provide efficient cooling over the specified ranges of operating conditions.

  4. Persistent post-surgical pain and experimental pain sensitivity in the Tromsø study: comorbid pain matters.

    PubMed

    Johansen, Aslak; Schirmer, Henrik; Stubhaug, Audun; Nielsen, Christopher S

    2014-02-01

    In a large survey incorporating medical examination (N=12,981), information on chronic pain and surgery was collected, and sensitivity to different pain modalities was tested. Tolerance to the cold pressor test was analysed with survival statistics for 10,486 individuals, perceived cold pressor pain intensity was calculated for 10,367 individuals, heat pain threshold was assessed for 4,054 individuals, and pressure pain sensitivity for 4,689 individuals. Persistent post-surgical pain, defined by self-report, was associated with lower cold pressor tolerance (sex-adjusted hazard ratio=1.34, 95% confidence interval=1.08-1.66), but not when adjusting for other chronic pain. Other experimental pain modalities did not differentiate between individuals with or without post-surgical pain. Of the individuals with chronic pain (N=3352), 6.2% indicated surgery as a cause, although only 0.5% indicated surgery as the only cause. The associations found between persistent post-surgical pain and cold pressor tolerance is largely explained by the co-existence of chronic pain from other causes. We conclude that most cases of persistent post-surgical pain are coexistent with other chronic pain, and that, in an unselected post-surgical population, persistent post-surgical pain is not significantly associated with pain sensitivity when controlling for comorbid pain from other causes. A low prevalence of self-reported persistent pain from surgery attenuates statistically significant associations. We hypothesize that general chronic pain is associated with central changes in pain processing as expressed by reduced tolerance for the cold pressor test. Copyright © 2013 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

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

    PubMed

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

    2012-08-01

    Healthy children are often required to repeatedly undergo painful medical procedures (eg, immunizations). Although memory is often implicated in children's reactions to future pain, there is a dearth of research directly examining the relationship between the 2. The current study investigated the influence of children's memories for a novel pain stimulus on their subsequent pain experience. One hundred ten healthy children (60 boys) between the ages of 8 and 12 years completed a laboratory pain task and provided pain ratings. Two weeks later, children provided pain ratings based on their memories as well as their expectancies about future pain. One month following the initial laboratory visit, children again completed the pain task and provided pain ratings. Results showed that children's memory of pain intensity was a better predictor of subsequent pain reporting than their actual initial reporting of pain intensity, and mediated the relationship between initial and subsequent pain reporting. Children who had negatively estimated pain memories developed expectations of greater pain prior to a subsequent pain experience and showed greater increases in pain ratings over time than children who had accurate or positively estimated pain memories. These findings highlight the influence of pain memories on healthy children's expectations of future pain and subsequent pain experiences and extend predictive models of subsequent pain reporting. Copyright © 2012 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

  6. Pain Control After Surgery: Pain Medicines

    MedlinePlus

    ... Emotional Well-Being Mental Health Sex and Birth Control Sex and Sexuality Birth Control Family Health Infants and Toddlers Kids and Teens ... Improving Your Health Home Prevention and Wellness Pain Control After Surgery: Pain Medicines Pain Control After Surgery: ...

  7. [Chest pain units or chest pain algorithm?].

    PubMed

    Christ, M; Dormann, H; Enk, R; Popp, S; Singler, K; Müller, C; Mang, H

    2014-10-01

    A large number of patients present to the emergency department (ED) for evaluation of acute chest pain. About 10-15% are caused by acute myocardial infarction (MI), and over 50% of cases are due to noncardiac reasons. Further improvement for chest pain evaluation appears necessary. What are current options to improve chest pain evaluation in Germany? A selective literature search was performed using the following terms: "chest pain", "emergency department", "acute coronary syndrome" and "chest pain evaluation". A working group of the German Society of Cardiology published recommendations for infrastructure, equipment and organisation of chest pain units in Germany, which should be separated from the ED of hospitals and be under the leadership of a cardiologist. A symptom-based decision for acute care would be preferable if all differential diagnoses of diseases could be managed by one medical specialty: However, all four main symptoms of patients with acute MI (chest pain, acute dyspnea, abdominal pain, dizziness) are also caused by diseases of different specialties. Evaluation and treatment of acute chest pain by representatives of one specialty would lead to over- or undertreatment of affected patients. Therefore we suggest a multidisciplinary evaluation of patients with acute chest pain including representatives of emergency and critical care physicians, cardiologists, internists, geriatricians, family physicians, premedics and emergency nurses. Definition of key indicators of performance and institutionalized feedback will help to further improve quality of care.

  8. Abdominal Pain

    MedlinePlus

    ... and Recurrent or Functional Abdominal Pain (RAP or FAP) What is abdominal pain? Abdominal pain , or stomachache, ... recurrent abdominal pain (RAP) or functional abdominal pain (FAP)? If your health care provider has ruled out ...

  9. Anxiety sensitivity, fear of pain and pain-related disability in children and adolescents with chronic pain

    PubMed Central

    Martin, Andrea L; McGrath, Patricia A; Brown, Stephen C; Katz, Joel

    2007-01-01

    BACKGROUND: Converging lines of evidence suggest that anxiety sensitivity and fear of pain may be important vulnerability factors in the development of avoidance behaviours and disability in adults with chronic pain. However, these factors have not been evaluated in children with chronic pain. OBJECTIVES: To examine the relationships among anxiety sensitivity, fear of pain and pain-related disability in children and adolescents with chronic pain. METHODS: An interview and five questionnaires (Childhood Anxiety Sensitivity Index, Pain Anxiety Symptoms Scale, Functional Disability Inventory, Multidimensional Anxiety Scale for Children, and Reynolds Child or Adolescent Depression Scale) were administered to 21 children and adolescents eight to 17 years of age (mean ± SD 14.24±2.21 years) who continued to experience pain an average of three years after discharge from a specialized pain clinic for children. RESULTS: Anxiety sensitivity accounted for 38.6% of the variance in fear of pain (F[1,20]=11.30; P=0.003) and fear of pain accounted for 39.9% of the variance in pain-related disability (F[1,20]=11.95; P=0.003), but anxiety sensitivity was not significantly related to pain disability (R2=0.09; P>0.05). CONCLUSIONS: These findings indicate that children with high levels of anxiety sensitivity had a higher fear of pain, which, in turn, was linked to increased pain disability. The results of this study suggest that anxiety sensitivity and fear of pain may play important and distinct roles in the processes that maintain chronic pain and pain-related disability in children. PMID:18080045

  10. Pain chronification: what should a non-pain medicine specialist know?

    PubMed

    Morlion, Bart; Coluzzi, Flaminia; Aldington, Dominic; Kocot-Kepska, Magdalena; Pergolizzi, Joseph; Mangas, Ana Cristina; Ahlbeck, Karsten; Kalso, Eija

    2018-04-12

    Pain is one of the most common reasons for an individual to consult their primary care physician, with most chronic pain being treated in the primary care setting. However, many primary care physicians/non-pain medicine specialists lack enough awareness, education and skills to manage pain patients appropriately, and there is currently no clear, common consensus/formal definition of "pain chronification". This article, based on an international Change Pain Chronic Advisory Board meeting which was held in Wiesbaden, Germany, in October 2016, provides primary care physicians/non-pain medicine specialists with a narrative overview of pain chronification, including underlying physiological and psychosocial processes, predictive factors for pain chronification, a brief summary of preventive strategies, and the role of primary care physicians and non-pain medicine specialists in the holistic management of pain chronification. Based on currently available evidence, we propose the following consensus-based definition of pain chronification which provides a common framework to raise awareness among non-pain medicine specialists: "Pain chronification describes the process of transient pain progressing into persistent pain; pain processing changes as a result of an imbalance between pain amplification and pain inhibition; genetic, environmental and biopsychosocial factors determine the risk, the degree, and time-course of chronification." Early intervention plays an important role in preventing pain chronification and, as key influencers in the management of patients with acute pain, it is critical that primary care physicians are equipped with the necessary awareness, education and skills to manage pain patients appropriately.

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

    PubMed

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

    2014-11-01

    Even though painful experiences are employed within social rituals across the world, little is known about the social effects of pain. We examined the possibility that painful experiences can promote cooperation within social groups. In Experiments 1 and 2, we induced pain by asking some participants to insert their hands in ice water and to perform leg squats. In Experiment 3, we induced pain by asking some participants to eat a hot chili pepper. Participants performed these tasks in small groups. We found evidence for a causal link: Sharing painful experiences with other people, compared with a no-pain control treatment, promoted trusting interpersonal relationships by increasing perceived bonding among strangers (Experiment 1) and increased cooperation in an economic game (Experiments 2 and 3). Our findings shed light on the social effects of pain, demonstrating that shared pain may be an important trigger for group formation. © The Author(s) 2014.

  12. Pain-related guilt in low back pain.

    PubMed

    Serbic, Danijela; Pincus, Tamar

    2014-12-01

    Identifying mechanisms that mediate recovery is imperative to improve outcomes in low back pain (LBP). Qualitative studies suggest that guilt may be such a mechanism, but research on this concept is scarce, and reliable instruments to measure pain-related guilt are not available. We addressed this gap by developing and testing a Pain-related Guilt Scale (PGS) for people with LBP. Two samples of participants with LBP completed the scale and provided data on rates of depression, anxiety, pain intensity, and disability. Three factors were identified using exploratory factor analysis (n=137): "Social guilt," (4 items) relating to letting down family and friends; "Managing condition/pain guilt," (5 items) relating to failing to overcome and control pain; and "Verification of pain guilt," (3 items) relating to the absence of objective evidence and diagnosis. This factor structure was confirmed using confirmatory factor analysis (n=288), demonstrating an adequate to good fit with the data (AGFI=0.913, RMSEA=0.061). The PGS subscales positively correlated with depression, anxiety, pain intensity, and disability. After controlling for depression and anxiety the majority of relationships between the PGS subscales and disability and pain intensity remained significant, suggesting that guilt shared unique variance with disability and pain intensity independent of depression and anxiety. High levels of guilt were reported by over 40% of participants. The findings suggest that pain-related guilt is common and is associated with clinical outcomes. Prospective research is needed to examine the role of guilt as a predictor, moderator, and mediator of patients' outcomes.

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

    PubMed Central

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

    2015-01-01

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

  14. Pain Intensity Moderates the Relationship Between Age and Pain Interference in Chronic Orofacial Pain Patients.

    PubMed

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

    2015-01-01

    BACKGROUND/STUDY CONTEXT: Chronic pain is associated with increased interference in daily functioning that becomes more pronounced as pain intensity increases. Based on previous research showing that older adults maintain well-being in the face of pain as well as or better than their younger counterparts, the current study examined the interaction of age and pain intensity on interference in a sample of chronic orofacial pain patients. Data were obtained from the records of 508 chronic orofacial pain patients being seen for an initial evaluation from 2008 to 2012. Collected data included age (range: 18-78) and self-reported measures of pain intensity and pain interference. Bivariate correlations and regression models were used to assess for statistical interactions. Regression analyses revealed that pain intensity positively predicted pain interference (R(2) = .35, B = 10.40, SE = 0.62, t(507) = 16.70, p < .001). A significant interaction supported the primary hypothesis that aging was associated with reduced interference at high levels of pain intensity (ΔR(2) = .01, B = -1.31, SE = 0.63, t(505) = -2.90, p = .04). At high levels of pain intensity, interference decreased with age, although the age by pain intensity interaction effect was small. This evidence converges with aging theories, including socioemotional selectivity theory, which posits that as people age, they become more motivated to maximize positive emotions and minimize negative ones. The results highlight the importance of studying the mechanisms older adults use to successfully cope with pain.

  15. When pain meets … pain-related choice behavior and pain perception in different goal conflict situations.

    PubMed

    Schrooten, Martien G S; Wiech, Katja; Vlaeyen, Johan W S

    2014-11-01

    Individuals in pain often face the choice between avoiding pain and pursuing other equally valued goals. However, little is known about pain-related choice behavior and pain perception in goal conflict situations. Seventy-eight healthy volunteers performed a computerized task requiring repeated choices between incompatible options, differing in their effect on probability to receive painful stimulation and money. Depending on group assignment, participants chose between increased pain probability versus decreased money probability (avoidance-avoidance conflict situation); decreased pain probability versus increased money probability (approach-approach conflict situation); or decrease versus increase in both probabilities (double approach/avoidance conflict situation). During the choice task, participants rated painfulness, unpleasantness, threat, and fearfulness associated with the painful stimulation and how they felt. Longer choice latency and more choice switching were associated with higher retrospective ratings of conflict and of decision difficulty, and more equal importance placed on pain avoidance and earning money. Groups did not differ in choice behavior, pain stimulus ratings, or affect. Across groups, longer choice latencies were nonsignificantly associated with higher pain, unpleasantness, threat, and fearfulness. In the avoidance-avoidance group, more choice switching was associated with higher pain-related threat and fearfulness, and with more negative affect. These results of this study suggest that associations between choice behaviors, pain perception, and affect depend on conflict situation. We present a first experimental demonstration of the relationship between pain-related choice behaviors, pain, and affect in different goal conflict situations. This experimental approach allows us to examine these relationships in a controlled fashion. Better understanding of pain-related goal conflicts and their resolution may lead to more effective pain

  16. Fetal pain perception and pain management.

    PubMed

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

    2006-08-01

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

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

    PubMed Central

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

    2015-01-01

    Background/Study Context Chronic pain is associated with increased interference in daily functioning that becomes more pronounced as pain intensity increases. Based on previous research showing that older adults maintain well-being in the face of pain as well as or better than their younger counterparts, the current study examined the interaction of age and pain intensity on interference in a sample of chronic orofacial pain patients. Methods Data were obtained from the records of 508 chronic orofacial pain patients being seen for an initial evaluation from 2008 to 2012. Collected data included age (range: 18–78) and self-reported measures of pain intensity and pain interference. Bivariate correlations and regression models were used to assess for statistical interactions. Results Regression analyses revealed that pain intensity positively predicted pain interference (R2 = .35, B = 10.40, SE = 0.62, t(507) = 16.70, p < .001). A significant interaction supported the primary hypothesis that aging was associated with reduced interference at high levels of pain intensity (ΔR2 = .01, B = −1.31, SE = 0.63, t(505) = −2.90, p = .04). Conclusion At high levels of pain intensity, interference decreased with age, although the age by pain intensity interaction effect was small. This evidence converges with aging theories, including socioemotional selectivity theory, which posits that as people age, they become more motivated to maximize positive emotions and minimize negative ones. The results highlight the importance of studying the mechanisms older adults use to successfully cope with pain. PMID:26214102

  18. 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.

  19. 2016 Billion-Ton Report: Environmental Sustainability Effects of Select Scenarios from Volume 1 (Volume 2)

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Efroymson, R. A.; Langholtz, M. H.; Johnson, K. E.

    On behalf of all the authors and contributors, it is a great privilege to present the 2016 Billion-Ton Report (BT16), volume 2: Environmental Sustainability Effects of Select Scenarios from volume 1. This report represents the culmination of several years of collaborative effort among national laboratories, government agencies, academic institutions, and industry. BT16 was developed to support the U.S. Department of Energy’s efforts towards national goals of energy security and associated quality of life.

  20. Abnormal Pain Modulation in Patients with Spatially Distributed Chronic Pain: Fibromyalgia

    PubMed Central

    Staud, Roland

    2009-01-01

    Many chronic pain syndromes including fibromyalgia, irritable bowel syndrome, chronic fatigue syndrome, migraine headache, chronic back pain, and complex regional pain syndrome are associated with hypersensitivity to painful stimuli and with reduced endogenous pain inhibition. These findings suggest that modulation of pain-related information may be related to the onset and/or maintenance of chronic pain. Although pain sensitivity and pain inhibition are normally distributed in the general population, they are not useful as reliable predictors of future pain. The combination of heightened pain sensitivity and reduced pain-inhibition, however, appears to predispose individuals to greater risk for increased acute clinical pain (e.g., postoperative pain). It is unknown at this time whether such pain processing abnormalities may also place individuals at increased risk for chronic pain. Psychophysical methods, including heat sensory and pressure pain testing have become increasingly available and can be used for the evaluation of pain sensitivity and pain inhibition. However, long-term prospective studies in the general population are lacking which could yield insight into the role of heightened pain sensitivity and pain disinhibition for the development of chronic pain disorders like fibromyalgia. PMID:19647141

  1. 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

  2. Multidisciplinary pain facility treatment outcome for pain-associated fatigue.

    PubMed

    Fishbain, David A; Lewis, John; Cole, Brandly; Cutler, Brian; Smets, Eve; Rosomoff, Hubert; Rosomoff, Rennee Steele

    2005-01-01

    Fatigue is frequently found in chronic pain patients (CPPs) and may be etiologically related to the presence of pain. Fishbain et al. have recently demonstrated that chronic low back pain (LBP) and chronic neck pain patients are more fatigued than controls. The purpose of this study was to determine whether chronic LBP- and chronic neck pain-associated fatigue responded to multidisciplinary multimodal treatment not specifically targeted to the treatment of fatigue. A total of 85 chronic LBP and 33 chronic neck pain patients completed the Multidimensional Fatigue Inventory (MFI), Neuropathic Pain Scale (NPS), and Beck Depression Inventory on admission. In addition, an information tool was completed on each CPP by the senior author. This tool listed demographic information, primary and secondary pain diagnoses, Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) psychiatric diagnoses assigned, pain location, pain precipitating event, type of injury, years in pain, number of surgeries, type of surgery, type of pain pattern, opioids consumed per day in morphine equivalents, worker compensation status, and whether, according to the clinical examination, the CPP had a neuropathic pain component. At completion of the multidisciplinary multimodal treatment, each CPP again completed the MFI. Student's t-test was utilized to test for statistical changes on the MFI five scales from pre- to post-treatment. Pearson and point-biserial correlations were utilized to determine which variables significantly correlated with MFI change scores. Variables found significant at less than or equal to 0.01 were utilized in a stepwise aggression analysis to find variables predictive of change in MFI scores. Multidisciplinary pain facility. Chronic LBP and chronic neck pain patients. Multidisciplinary multimodal treatment significantly improved CPP fatigue as measured by the MFI. The available variables utilized to predict fatigue best explained only a small percentage

  3. Gender role expectations of pain: relationship to experimental pain perception

    PubMed Central

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

    2008-01-01

    The primary purpose of this study was to investigate the influence of an individual’s Gender Role Expectations of Pain (GREP) on experimental pain report. One hundred and forty-eight subjects (87 females and 61 males) subjects underwent thermal testing and were asked to report pain threshold, pain tolerance, VAS ratings of pain intensity and unpleasantness, and a computerized visual analogue scales (VAS) rating of pain intensity during the procedure. Subjects completed the GREP questionnaire to assess sex-related stereotypic attributions of pain sensitivity, pain endurance, and willingness to report pain. Consistent with previous research, significant sex differences emerged for measures of pain threshold, pain tolerance, and pain unpleasantness. After statistically controlling for age, GREP scores were significant predictors of threshold, tolerance, and pain unpleasantness, accounting for an additional 7, 11, and 21% of the variance, respectively. Sex remained a significant predictor of pain tolerance in hierarchical regression analyses after controlling for GREP scores. Results provide support for two competing but not mutually exclusive hypotheses related to the sex differences in experimental pain. Both psychosocial factors and first-order, biological sex differences remain as viable explanations for differences in experimental pain report between the sexes. It appears that GREP do play a part in determining an individual’s pain report and may be contributing to the sex differences in the laboratory setting. PMID:11973007

  4. Dysfunctional pain modulation in somatoform pain disorder patients.

    PubMed

    Klug, Stefanie; Stefanie, Klug; Anderer, Peter; Peter, Anderer; Saletu-Zyhlarz, Gerda; Gerda, Saletu-Zyhlarz; Freidl, Marion; Marion, Freidl; Saletu, Bernd; Bernd, Saletu; Prause, Wolfgang; Wolfgang, Prause; Aigner, Martin; Martin, Aigner

    2011-06-01

    To date, pain perception is thought to be a creative process of modulation carried out by an interplay of pro- and anti-nociceptive mechanisms. Recent research demonstrates that pain experience constitutes the result of top-down processes represented in cortical descending pain modulation. Cortical, mainly medial and frontal areas, as well as subcortical structures such as the brain stem, medulla and thalamus seem to be key players in pain modulation. An imbalance of pro- and anti-nociceptive mechanisms are assumed to cause chronic pain disorders, which are associated with spontaneous pain perception without physiologic scaffolding or exaggerated cortical activation in response to pain exposure. In contrast to recent investigations, the aim of the present study was to elucidate cortical activation of somatoform pain disorder patients during baseline condition. Scalp EEG, quantitative Fourier-spectral analyses and LORETA were employed to compare patient group (N = 15) to age- and sex-matched controls (N = 15) at rest. SI, SII, ACC, SMA, PFC, PPC, insular, amygdale and hippocampus displayed significant spectral power reductions within the beta band range (12-30 Hz). These results suggest decreased cortical baseline arousal in somatoform pain disorder patients. We finally conclude that obtained results may point to an altered baseline activity, maybe characteristic for chronic somatoform pain disorder.

  5. [Visceral pain--a neglected phenomenon in pain therapy and research?].

    PubMed

    Häuser, W; Lempa, M; Jänig, W

    2002-12-01

    The topic "visceral pain"is hardly covered in basic research and pain therapy. After low back pain, headache and musculosceletal pain is abdominal pain the 4th frequent chronic pain syndrome in the general population with considerable direct and indirect disease related costs.An interdisciplinary multimodal treatment of chronic abdominal pain syndromes is rarely practiced in clinical care.

  6. Reward and motivation in pain and pain relief

    PubMed Central

    Navratilova, Edita; Porreca, Frank

    2015-01-01

    Pain is fundamentally unpleasant, a feature that protects the organism by promoting motivation and learning. Relief of aversive states, including pain, is rewarding. The aversiveness of pain, as well as the reward from relief of pain, is encoded by brain reward/motivational mesocorticolimbic circuitry. In this Review, we describe current knowledge of the impact of acute and chronic pain on reward/motivation circuits gained from preclinical models and from human neuroimaging. We highlight emerging clinical evidence suggesting that anatomical and functional changes in these circuits contribute to the transition from acute to chronic pain. We propose that assessing activity in these conserved circuits can offer new outcome measures for preclinical evaluation of analgesic efficacy to improve translation and speed drug discovery. We further suggest that targeting reward/motivation circuits may provide a path for normalizing the consequences of chronic pain to the brain, surpassing symptomatic management to promote recovery from chronic pain. PMID:25254980

  7. Pain and pain tolerance in professional ballet dancers.

    PubMed Central

    Tajet-Foxell, B; Rose, F D

    1995-01-01

    Pain experience in sport had been the subject of increasing research in recent years. While sports professionals have generally been found to have higher pain thresholds than control subjects the reasons for this are not entirely clear. The present study seeks to investigate one possible explanatory factor, the importance of the popular image of the physical activity and of the self-image of its participants, by examining pain experience in professional ballet dancers. Like sports professionals, dancers were found to have higher pain and pain tolerance thresholds than age matched controls in the Cold Pressor Test. However, they also reported a more acute experience of the sensory aspects of the pain. Explanations of this apparent paradox are discussed both in terms of the neuroticism scores of the two groups and in terms of the dancers' greater experience of pain and its relationship with physical activity. The results illustrated the importance of using multidimensional measures of pain in this type of investigation. PMID:7788215

  8. Motor-Evoked Pain Increases Force Variability in Chronic Jaw Pain.

    PubMed

    Wang, Wei-En; Roy, Arnab; Misra, Gaurav; Archer, Derek B; Ribeiro-Dasilva, Margarete C; Fillingim, Roger B; Coombes, Stephen A

    2018-06-01

    Musculoskeletal pain changes how people move. Although experimental pain is associated with increases in the variability of motor output, it is not clear whether motor-evoked pain in clinical conditions is also associated with increases in variability. In the current study, we measured jaw force production during a visually guided force paradigm in which individuals with chronic jaw pain and control subjects produced force at 2% of their maximum voluntary contraction (low target force level) and at 15% of their maximum voluntary contraction (high target force level). State measures of pain were collected before and after each trial. Trait measures of pain intensity and pain interference, self-report measures of jaw function, and measures of depression, anxiety, and fatigue were also collected. We showed that the chronic jaw pain group exhibited greater force variability compared with controls irrespective of the force level, whereas the accuracy of force production did not differ between groups. Furthermore, predictors of force variability shifted from trait measures of pain intensity and pain interference at the low force level to state measures of pain intensity at the high force level. Our observations show that motor-evoked jaw pain is associated with increases in force variability that are predicted by a combination of trait measures and state measures of pain intensity and pain interference. Chronic jaw pain is characterized by increases in variability during force production, which can be predicted by pain intensity and pain interference. This report could help clinicians better understand the long-term consequences of chronic jaw pain on the motor system. Copyright © 2018 The American Pain Society. Published by Elsevier Inc. All rights reserved.

  9. Ethnic differences in pain and pain management

    PubMed Central

    Campbell, Claudia M; Edwards, Robert R

    2012-01-01

    SUMMARY Considerable evidence demonstrates substantial ethnic disparities in the prevalence, treatment, progression and outcomes of pain-related conditions. Elucidating the mechanisms underlying these group differences is of crucial importance in reducing and eliminating disparities in the pain experience. Over recent years, accumulating evidence has identified a variety of processes, from neurophysiological factors to structural elements of the healthcare system, that may contribute to shaping individual differences in pain. For example, the experience of pain differentially activates stress-related physiological responses across various ethnic groups, members of different ethnic groups appear to use differing coping strategies in managing pain complaints, providers’ treatment decisions vary as a function of patient ethnicity and pharmacies in predominantly minority neighborhoods are far less likely to stock potent analgesics. These diverse factors, and others may all play a role in facilitating elevated levels of pain-related suffering among individuals from ethnic minority backgrounds. Here, we present a brief, nonexhaustive review of the recent literature and potential physiological and sociocultural mechanisms underlying these ethnic group disparities in pain outcomes. PMID:23687518

  10. Moving beyond pain scores: Multidimensional pain assessment is essential for adequate pain management after surgery

    PubMed Central

    Vissers, Kris C. P.; van der Sande, Rob; Bronkhorst, Ewald; Lerou, Jos G. C.; Steegers, Monique A. H.

    2017-01-01

    Background Clinical experience teaches us that patients are willing to accept postoperative pain, despite high pain intensity scores. Nevertheless, relationships between pain scores and other methods of pain assessment, e.g. acceptability of pain or its interference with physical functioning, are not fully established. Our aims were to examine these relationships. Methods A cross-sectional study was conducted on patients who underwent major surgery between January 2008 and August 2013. Using logistic regression, we quantified the relationships between movement-evoked pain scores on the numerical rating scale (NRS-MEP) and three dichotomous dependent variables: patient’s opinion on acceptability of pain (PO: acceptable or unacceptable pain); nurses’ observation of patient’s performance of necessary activities to expedite recovery (NO: good or bad performance); a compound measure judging the presence of the clinically desirable situation of acceptable pain associated with good patients’ performance (PONO: present or not). Using Receiver Operating Characteristics (ROC) analysis, NRS cut-off points were determined such that they best discriminate between patients having one versus the other outcome for PO, NO and PONO. Results 15,394 assessments were obtained in 9,082 patients in the first three postoperative days. Nine percent of the patients had unacceptable pain while having an NRS-MEP of 0–4. An estimated 47% (95%CI = 45%-49%) of patients with an NRS-MEP of 7 described their pain as acceptable on day one. Moreover, 33% (31%-35%) performed all required physical activities, and 22% (21%-24%) combined acceptable pain with appropriate movement. NRS cut-off points for PO, NO and PONO were five, four and four, respectively, but had insufficient discriminatory power. Conclusions Our results suggest pain management should be guided by the many dimensions of the patient’s pain experience, not solely by NRS cut-off points. Future research should evaluate the

  11. Period Pain

    MedlinePlus

    ... cycle. Many women have painful periods, also called dysmenorrhea. The pain is most often menstrual cramps, which ... as lower back pain, nausea, diarrhea, and headaches. Period pain is not the same as premenstrual syndrome (PMS). ...

  12. 46 CFR 11.435 - Service requirements for master of inland steam or motor vessels of any gross tons.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 46 Shipping 1 2012-10-01 2012-10-01 false Service requirements for master of inland steam or motor... Deck Officers § 11.435 Service requirements for master of inland steam or motor vessels of any gross tons. The minimum service required to qualify an applicant for an endorsement as master of inland...

  13. 46 CFR 11.435 - Service requirements for master of inland steam or motor vessels of any gross tons.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 46 Shipping 1 2013-10-01 2013-10-01 false Service requirements for master of inland steam or motor... Deck Officers § 11.435 Service requirements for master of inland steam or motor vessels of any gross tons. The minimum service required to qualify an applicant for an endorsement as master of inland...

  14. 46 CFR 11.435 - Service requirements for master of inland steam or motor vessels of any gross tons.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 46 Shipping 1 2011-10-01 2011-10-01 false Service requirements for master of inland steam or motor... Deck Officers § 11.435 Service requirements for master of inland steam or motor vessels of any gross tons. The minimum service required to qualify an applicant for an endorsement as master of inland...

  15. Managing painful chronic wounds: the Wound Pain Management Model.

    PubMed

    Price, Patricia; Fogh, Karsten; Glynn, Chris; Krasner, Diane L; Osterbrink, Jürgen; Sibbald, R Gary

    2007-04-01

    Chronic wound pain is not well understood and the literature is limited. Six of 10 patients venous leg ulcer experience pain with their ulcer, and similar trends are observed for other chronic wounds. Chronic wound pain can lead to depression and the feeling of constant tiredness. Pain related to the wound should be handled as one of the main priorities in chronic wound management together with addressing the cause. Management of pain in chronic wounds depends on proper assessment, reporting and documenting patient experiences of pain. Assessment should be based on six critical dimensions of the pain experience: location, duration, intensity, quality, onset and impact on activities of daily living. Holistic management must be based on a safe and effective mix of psychosocial approaches together with local and systemic pain management. It is no longer acceptable to ignore or inadequately document persistent wound pain and not to develop a treatment and monitoring strategy to improve the lives of persons with chronic wounds. Unless wound pain is optimally managed, patient suffering and costs to health care systems will increase.

  16. Improving paediatric pain management: introducing the 'Pain Passport'.

    PubMed

    Newstead, Beth A; Armitage, Sarah; Appelboam, Andrew

    2013-01-01

    The 'Pain Passport' is a novel method of improving the management of pain in children. It consists of a leaflet carried by the patient which records serial pain scores. It attempts to empower patients and prompt medical and nursing staff to evaluate the child's pain. Preliminary audit data in support of this concept are encouraging.

  17. Sexual pain.

    PubMed

    Boardman, Lori A; Stockdale, Colleen K

    2009-12-01

    Sexual pain is an underrecognized and poorly treated constellation of disorders that significantly impact affected women and their partners. Recognized as a form of chronic pain, sexual pain disorders are heterogeneous and include dyspareunia (superficial and deep), vaginismus, vulvodynia, vestibulitis, and noncoital sexual pain disorder. Women too often tolerate pain in the belief that this will meet their partners' needs. This article provides a review of the terminology and definition of the condition, theories on the pathophysiology, diagnostic considerations, and recommendations on the management of female sexual pain.

  18. Lumbar Disc Screening Using Back Pain Questionnaires: Oswestry Low Back Pain Score, Aberdeen Low Back Pain Scale, and Acute Low Back Pain Screening Questionnaire

    PubMed Central

    Kim, Do Yeon; Oh, Chang Hyun; Park, Hyung Chun; Park, Chong Oon

    2012-01-01

    Objective To evaluate the usefulness of back pain questionnaires for lumbar disc screening among Korean young males. Methods We carried out a survey for lumbar disc screening through back pain questionnaires among the volunteers with or without back pain. Three types of back pain questionnaire (Oswestry Low Back Pain Score, Aberdeen Low Back Pain Scale, and Acute Low Back Pain Screeing Questionnaire) were randomly assigned to the examinees. The authors reviewed lumbar imaging studies (simple lumbar radiographs, lumbar computed tomography, and magnetic resolutional images), and the severity of lumbar disc herniation was categorized according to the guidelines issued by the Korean military directorate. We calculated the relationship between the back pain questionnaire scores and the severity of lumbar disc herniation. Results The scores of back pain questionnaires increased according to the severity of lumbar disc herniation. But, the range of scores was very vague, so it is less predictable to detect lumbar disc herniation using only back pain questionnaires. The sensitivity between the back pain questionnaires and the presence of lumbar disc herniation was low (16-64%). Conclusion Screening of lumbar disc herniation using only back pain questionnaires has limited value. PMID:25983807

  19. Flank pain

    MedlinePlus

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

  20. Painful neurotrophins and their role in visceral pain.

    PubMed

    López-Pérez, Ana E; Nurgali, Kulmira; Abalo, Raquel

    2018-04-01

    Beyond their well-known role in embryonic development of the central and peripheral nervous system, neurotrophins, particularly nerve growth factor and brain-derived neurotrophic factor, exert an essential role in pain production and sensitization. This has mainly been studied within the framework of somatic pain, and even antibodies (tanezumab and fasinumab) have recently been developed for their use in chronic somatic painful conditions, such as osteoarthritis or low back pain. However, data suggest that neurotrophins also exert an important role in the occurrence of visceral pain and visceral sensitization. Visceral pain is a distressing symptom that prompts many consultations and is typically encountered in both 'organic' (generally inflammatory) and 'functional' (displaying no obvious structural changes in routine clinical evaluations) disorders of the gut, such as inflammatory bowel disease and irritable bowel syndrome, respectively. The present review provides a summary of neurotrophins as a molecular family and their role in pain in general and addresses recent investigations of the involvement of nerve growth factor and brain-derived neurotrophic factor in visceral pain, particularly that associated with inflammatory bowel disease and irritable bowel syndrome.

  1. Pain hypervigilance is associated with greater clinical pain severity and enhanced experimental pain sensitivity among adults with symptomatic knee osteoarthritis

    PubMed Central

    Herbert, Matthew S.; Goodin, Burel R.; Pero, Samuel T.; Schmidt, Jessica K.; Sotolongo, Adriana; Bulls, Hailey W.; Glover, Toni L.; King, Christopher D.; Sibille, Kimberly T.; Cruz-Almeida, Yenisel; Staud, Roland; Fessler, Barri J.; Bradley, Laurence A.; Fillingim, Roger B.

    2014-01-01

    Background Pain hypervigilance is an important aspect of the fear-avoidance model of pain that may help explain individual differences in pain sensitivity among persons with knee osteoarthritis (OA). Purpose The purpose of this study was to examine the contribution of pain hypervigilance to clinical pain severity and experimental pain sensitivity in persons with symptomatic knee OA. Methods We analyzed cross-sectional data from 168 adults with symptomatic knee OA. Quantitative sensory testing was used to measure sensitivity to heat pain, pressure pain, and cold pain, as well as temporal summation of heat pain, a marker of central sensitization. Results Pain hypervigilance was associated with greater clinical pain severity, as well as greater pressure pain. Pain hypervigilance was also a significant predictor of temporal summation of heat pain. Conclusions Pain hypervigilance may be an important contributor to pain reports and experimental pain sensitivity among persons with knee OA. PMID:24352850

  2. Pain Catastrophizing and Its Relationship with Health Outcomes: Does Pain Intensity Matter?

    PubMed Central

    García-Palacios, Azucena; Botella, Cristina; Ribera-Canudas, Maria Victoria

    2017-01-01

    Pain catastrophizing is known to contribute to physical and mental functioning, even when controlling for the effect of pain intensity. However, research has yet to explore whether the strength of the relationship between pain catastrophizing and pain-related outcomes varies across pain intensity levels (i.e., moderation). If this was the case, it would have important implications for existing models of pain and current interventions. The present investigation explored whether pain intensity moderates the relationship between pain catastrophizing and pain-related outcomes. Participants were 254 patients (62% women) with heterogeneous chronic pain. Patients completed a measure of pain intensity, pain interference, pain catastrophizing, and physical and mental health. Pain intensity moderated the relationship between pain catastrophizing and pain interference and between pain catastrophizing and physical health status. Specifically, the strength of the correlation between pain catastrophizing and these outcomes decreased considerably as pain intensity increased. In contrast, pain intensity did not moderate the relationship between pain catastrophizing and mental health. Study findings provide a new insight into the role of pain intensity (i.e., moderator) in the relationship between pain catastrophizing and various pain-related outcomes, which might help develop existent models of pain. Clinical implications are discussed in the context of personalized therapy. PMID:28348506

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

    PubMed Central

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

    2011-01-01

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

  4. The Fear of Pain Questionnaire (FOPQ): assessment of pain-related fear among children and adolescents with chronic pain.

    PubMed

    Simons, Laura E; Sieberg, Christine B; Carpino, Elizabeth; Logan, Deirdre; Berde, Charles

    2011-06-01

    An important construct in understanding pain-related disability is pain-related fear. Heightened pain-related fear may result in behavioral avoidance leading to disuse, disability, and depression; whereas confrontation of avoided activities may result in a reduction of fear over time and reengagement with activities of daily living. Although there are several measures to assess pain-related fear among adults with chronic pain, none exist for children and adolescents. The aim of the current study was to develop a new tool to assess avoidance and fear of pain with pediatric chronic pain patients: the Fear of Pain Questionnaire, child report (FOPQ-C), and Fear of Pain Questionnaire, parent proxy report (FOPQ-P). After initial pilot testing, the FOPQ-C and FOPQ-P were administered to 299 youth with chronic pain and their parents at an initial multidisciplinary pain treatment evaluation. The FOPQ demonstrated very strong internal consistency of .92 for the child and parent versions. One-month stability estimates were acceptable and suggested responsivity to change. For construct validity, the FOPQ correlated with generalized anxiety, pain catastrophizing, and somatization. Evidence of criterion-related validity was found with significant associations for the FOPQ with pain, healthcare utilization, and functional disability. These results support the FOPQ as a psychometrically sound measure. Pain-related fear plays an important role in relation to emotional distress and pain-related disability among children and adolescents with chronic pain. Identification of patients with high levels of fear avoidance of pain with the FOPQ will inform how to proceed with psychological and physical therapy interventions for chronic pain. Copyright © 2011 American Pain Society. Published by Elsevier Inc. All rights reserved.

  5. Pain Quality Descriptors in Community-Dwelling Older Adults with Nonmalignant Pain

    PubMed Central

    Thakral, Manu; Shi, Ling; Foust, Janice B.; Patel, Kushang V.; Shmerling, Robert H.; Bean, Jonathan F.; Leveille, Suzanne G.

    2016-01-01

    This study aimed to characterize the prevalence of various pain qualities in older adults with chronic non-malignant pain and determine the association of pain quality to other pain characteristics namely: severity, interference distribution, and pain-associated conditions. In the population-based MOBILIZE Boston Study, 560 participants aged≥70 years reported chronic pain in the baseline assessment, which included a home interview and clinic exam. Pain quality was assessed using a modified version of the McGill Pain Questionnaire (MPQ) consisting of 20 descriptors, from which 3 categories were derived: cognitive/affective, sensory and neuropathic. Presence of ≥2 pain-associated conditions was significantly associated with 18 of the 20 pain quality descriptors. Sensory descriptors were endorsed by nearly all older adults with chronic pain (93%), followed by cognitive/affective (83.4%) and neuropathic descriptors (68.6%). Neuropathic descriptors were associated with the greatest number of pain-associated conditions including osteoarthritis of the hand and knee. More than half of participants (59%) endorsed descriptors in all 3 categories and had more severe pain and interference, and multi-site or widespread pain than those endorsing 1 or 2 categories. Strong associations were observed between pain quality and measures of pain severity, interference, and distribution (p<.0001). Findings from this study indicate that older adults have multiple pain-associated conditions which likely reflect multiple physiological mechanisms for pain. Linking pain qualities with other associated pain characteristics serves to develop a multidimensional approach to geriatric pain assessment. Future research is needed to investigate the physiological mechanisms responsible for the variability in pain qualities endorsed by older adults. PMID:27842050

  6. Pain quality descriptors in community-dwelling older adults with nonmalignant pain.

    PubMed

    Thakral, Manu; Shi, Ling; Foust, Janice B; Patel, Kushang V; Shmerling, Robert H; Bean, Jonathan F; Leveille, Suzanne G

    2016-12-01

    This study aimed to characterize the prevalence of various pain qualities in older adults with chronic nonmalignant pain and determine the association of pain quality to other pain characteristics namely: severity, interference, distribution, and pain-associated conditions. In the population-based MOBILIZE Boston Study, 560 participants aged ≥70 years reported chronic pain in the baseline assessment, which included a home interview and clinic exam. Pain quality was assessed using a modified version of the McGill Pain Questionnaire (MPQ) consisting of 20 descriptors from which 3 categories were derived: cognitive/affective, sensory, and neuropathic. Presence of ≥2 pain-associated conditions was significantly associated with 18 of the 20 pain quality descriptors. Sensory descriptors were endorsed by nearly all older adults with chronic pain (93%), followed by cognitive/affective (83.4%) and neuropathic descriptors (68.6%). Neuropathic descriptors were associated with the greatest number of pain-associated conditions including osteoarthritis of the hand and knee. More than half of participants (59%) endorsed descriptors in all 3 categories and had more severe pain and interference, and multisite or widespread pain than those endorsing 1 or 2 categories. Strong associations were observed between pain quality and measures of pain severity, interference, and distribution (P < 0.0001). Findings from this study indicate that older adults have multiple pain-associated conditions that likely reflect multiple physiological mechanisms for pain. Linking pain qualities with other associated pain characteristics serve to develop a multidimensional approach to geriatric pain assessment. Future research is needed to investigate the physiological mechanisms responsible for the variability in pain qualities endorsed by older adults.

  7. Cancer Pain Management Education Rectifies Patients' Misconceptions of Cancer Pain, Reduces Pain, and Improves Quality of Life.

    PubMed

    Koh, Su-Jin; Keam, Bhumsuk; Hyun, Min Kyung; Ju Seo, Jeong; Uk Park, Keon; Oh, Sung Yong; Ahn, Jinseok; Lee, Ja Youn; Kim, JinShil

    2018-03-26

    More than half of the patients have reported improper management of breakthrough cancer pain. Empirical evidence is lacking concerning the effectiveness of cancer pain education on breakthrough pain control. This study aimed to examine the effects of individual pain education on pain control, use of short-acting analgesics for breakthrough pain, quality of life outcomes, and rectification of patients' misconceptions regarding cancer pain. A quasi-experimental design was used. In total, 176 (102 inpatients and 74 outpatients) and 163 (93 inpatients and 70 outpatients) cancer patients completed questionnaires on pain intensity, quality of life, use of short-acting medication for breakthrough pain, and misconceptions about cancer pain and opioid use before and immediately and/or seven days after individual pain education. The mean age of the participants was 60.9 years (±11.2), and 56.3% were male. The most common cancers were lung cancer (17.0%), colon cancer (15.9%), and breast cancer (12.5%). The subjects' reasons for attrition were conditional deterioration, death, or voluntary withdrawal (N = 13, 7.4%). Following the education, there was a significant reduction in overall pain intensity over 24 hours (P < 0.001). The outpatients showed more use of short-acting analgesics for breakthrough pain. Sleep quality change was most significantly associated with intervention; other quality of life aspects (e.g., general feelings and life enjoyment) also improved. Pain education also significantly reduced misconceptions regarding cancer pain management. The present educational intervention was effective in encouraging short-acting analgesic use for breakthrough pain, improving quality of life outcomes, and rectifying patients' misconceptions about analgesic use.

  8. Neck Pain

    MedlinePlus

    Neck pain Overview Neck pain is a common complaint. Neck muscles can be strained from poor posture — whether it's leaning over your computer or ... workbench. Osteoarthritis also is a common cause of neck pain. Rarely, neck pain can be a symptom of ...

  9. Shoulder pain

    MedlinePlus

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

  10. Pathogenesis of Pain.

    PubMed

    Dinakar, Pradeep; Stillman, Alexandra Marion

    2016-08-01

    The pathogenesis of pain sensation includes mechanisms that result in acute or chronic pain. Pain itself is described as an unpleasant sensory and emotional experience beginning with a peripheral stimulus that undergoes a physiological process ultimately resulting in the sensation of pain. Biologists recognize pain to be a common sign of potential tissue damage. Hence, pain sensation is protective in function. However, pathologic states of pain exist secondary to disruption of the nociceptive process both peripherally and centrally or secondary to psychological conditions. It is essential to identify these aberrant states of pain and distinguish them from situations of potential tissue damage. Chronic pain is defined as pain that exceeds 3 or 6 months duration. This article is an overview of the essential neuroanatomy and neurophysiology of normal pain nociception, its clinical implications, and the development of persistent and pathological pain conditions following improperly or poorly treated pain. Copyright © 2016. Published by Elsevier Inc.

  11. NIH Pain Consortium

    MedlinePlus

    ... Did You Know? Infographics on Pain Topics Resource Library Health Care Systems Research Collaboratory Pain Registries IOM Report: Relieving Pain ... Did You Know? Infographics on Pain Topics Resource Library Health Care Systems Research Collaboratory Pain Registries IOM Report: Relieving Pain ...

  12. Maintenance of pain in children with functional abdominal pain

    USDA-ARS?s Scientific Manuscript database

    A significant proportion of children with functional abdominal pain develop chronic pain. Identifying clinical characteristics predicting pain persistence is important in targeting interventions. We examined whether child anxiety and/or pain-stooling relations were related to maintenance of abdomina...

  13. The contribution of previous episodes of pain, pain intensity, physical impairment, and pain-related fear to disability in patients with chronic mechanical neck pain.

    PubMed

    Saavedra-Hernández, Manuel; Castro-Sánchez, Adelaida M; Cuesta-Vargas, Antonio I; Cleland, Joshua A; Fernández-de-las-Peñas, César; Arroyo-Morales, Manuel

    2012-12-01

    The influence of physical and psychosocial variables on self-rated disability in patients with chronic mechanical neck pain has not been fully determined. This study examined the relationship of pain, physical impairment, and pain-related fear to disability in individuals with chronic mechanical neck pain. A cross-sectional study was conducted. Ninety-seven (n = 97) subjects (28 men, 69 women; mean age, 39.3 yrs) with chronic mechanical neck pain were prospectively recruited. Demographic information, duration of pain symptoms, pain intensity, pain-related fear, and cervical range of motion were collected on all subjects. Self-reported disability was measured with the Neck Disability Index. Correlation and regression analyses were performed to determine the association among the variables and to determine the proportions of explained variance in disability. Significant positive correlations existed between disability and previous history of neck pain (r = 0.45; P < 0.001), disability and pain intensity (r = 0.32, P = 0.01), and disability and kinesiophobia (r = 0.23, P = 0.02). In addition, a significant negative correlation existed between disability and cervical extension range of motion (r = -0.18, P = 0.04). Stepwise regression analyses revealed that previous neck pain episodes, intensity of neck pain, kinesiophobia, and cervical extension range of motion were significant predictors of disability (r = 0.400; r adjusted = 0.372; F = 14.64; P < 0.001). This study found that previous episodes of neck pain, pain intensity, pain-related fear, and cervical extension range of motion explained 37.2% of the variability of self-report disability. Future longitudinal studies will help to determine the clinical implications of these findings.

  14. Memory for pain: the relationship of pain catastrophizing to the recall of daily rheumatoid arthritis pain.

    PubMed

    Lefebvre, John C; Keefe, Francis J

    2002-01-01

    The assumption that individuals are capable of accurately recalling past painful experiences has been a fundamental tenet of a number of cognitive-behavioral theories of pain, including the gate control theory. However, there has been very little research on the topic in the past, and the results have often been contradictory. A general conclusion that can be drawn is that memory for pain is variable, and there is need to identify what factors contribute to this variability in memory for pain. The current study examined the relation of catastrophizing to the recall of persistent pain associated with rheumatoid arthritis. Participants in this study were 45 individuals with persistent pain due to rheumatoid arthritis. Each participant was asked to complete a daily pain diary for a period of 30 days. Participants were subsequently asked to recall the pain they experienced over the entire period of time rather than provide a single, average rating. The results of a series of hierarchical regression analyses indicated that level of catastrophizing was related to the recall of both pain intensity and pain variability. This relation was statistically significant even after controlling for actual pain and variability and other background variables. Participants who scored higher on catastrophizing demonstrated better accuracy in the recall of general pain intensity and pattern over a 30-day diary period. The results of the study are discussed in terms of future studies as well as their potential clinical importance.

  15. Treatment Seeking and Self-Constructed Explanations of Pain and Pain Management Strategies Among Adolescents with Temporomandibular Disorder Pain.

    PubMed

    Nilsson, Ing-Marie; Willman, Ania

    2016-01-01

    To explore adolescents' explanations of their temporomandibular disorder (TMD) pain, their pain management strategies for TMD pain, and their treatment-seeking behavior. One-on-one interviews were conducted with 21 adolescents aged 15 to 19 years who had TMD pain and followed a semistructured interview guide. Subjects were strategically selected from patients referred to an orofacial pain clinic. All participants had been examined and received a pain diagnosis based on the Research Diagnostic Criteria for TMD. The interviews focused on the adolescents' experiences of TMD pain, their strategies for handling pain, and how they seek care. The interviews were recorded, transcribed verbatim, and analyzed using qualitative manifest content analysis. Qualitative manifest content analysis revealed two categories: (1) self-constructed explanations, with three subcategories (situation-based explanatory model, physical/biologic model, and psychological explanatory model); and (2) pain management strategies, with four subcategories (social support, treatment, relaxation/rest, and psychological strategies). Adolescents used physical activities and psychological and pharmacologic treatment to manage pain. Reasons for seeking treatment were to be cured, to obtain an explanation for their pain, and because their symptoms bother others. Adolescents living with TMD pain develop self-constructed explanations and pain management strategies. With access to these descriptions, dentists can be better prepared to have a dialogue with their adolescent patients about their own explanations of pain, the nature of pain, and in which situations the pain appears. Dentists can also explore adolescent patients' pain management strategies and perhaps also suggest new treatment strategies at an earlier stage.

  16. Growing Pains

    PubMed Central

    Lehman, Patrick J.; Carl, Rebecca L.

    2017-01-01

    Context: The term growing pains describes a common, benign syndrome of recurrent discomfort that occurs in young children. First described in the 1800s, the etiology of this condition remains unclear. The peak incidence does not correspond to a time of rapid growth. Children typically report bilateral pain in the lower extremities that occurs late in the day or at night. Evidence Acquisition: The PubMed database was searched using the keywords growing pains, benign nocturnal limb pains of childhood, recurrent limb pain of childhood, and limb pain in childhood. Articles were also found by reviewing references from the initial PubMed search. Only English-language articles published from 1900 through 2016 were included in the review. Study Design: Clinical review. Level of Evidence: Level 3. Results: When a patient’s history is classic for growing pains and physical examination is normal, laboratory and radiographic evaluation are not needed to make the diagnosis. Findings typical for growing pains include bilateral lower extremity pain usually experienced in the early evening or at night. The pain is not caused by activity and will not cause a limp. Conclusion: Additional workup is warranted for children with an atypical history, systemic symptoms, or for those individuals with physical examination abnormalities such as allodynia, focal tenderness, joint swelling, or decreased joint range of motion. Management of growing pains generally consists of symptomatic care with massage and over-the-counter analgesics, as well as reassurance to children and parents about the benign, self-limited nature of this condition. This review article summarizes data on the epidemiology, etiology, and management of growing pains and provides a framework for distinguishing this entity from other causes of extremity pain. PMID:28177851

  17. Enhanced Brain Responses to Pain-Related Words in Chronic Back Pain Patients and Their Modulation by Current Pain.

    PubMed

    Ritter, Alexander; Franz, Marcel; Puta, Christian; Dietrich, Caroline; Miltner, Wolfgang H R; Weiss, Thomas

    2016-08-10

    Previous functional magnetic resonance imaging (fMRI) studies in healthy controls (HC) and pain-free migraine patients found activations to pain-related words in brain regions known to be activated while subjects experience pain. The aim of the present study was to identify neural activations induced by pain-related words in a sample of chronic back pain (CBP) patients experiencing current chronic pain compared to HC. In particular, we were interested in how current pain influences brain activations induced by pain-related adjectives. Subjects viewed pain-related, negative, positive, and neutral words; subjects were asked to generate mental images related to these words during fMRI scanning. Brain activation was compared between CBP patients and HC in response to the different word categories and examined in relation to current pain in CBP patients. Pain-related words vs. neutral words activated a network of brain regions including cingulate cortex and insula in subjects and patients. There was stronger activation in medial and dorsolateral prefrontal cortex (DLPFC) and anterior midcingulate cortex in CPB patients than in HC. The magnitude of activation for pain-related vs. negative words showed a negative linear relationship to CBP patients' current pain. Our findings confirm earlier observations showing that pain-related words activate brain networks similar to noxious stimulation. Importantly, CBP patients show even stronger activation of these structures while merely processing pain-related words. Current pain directly influences on this activation.

  18. 50 CFR Table 1b to Part 660... - 2013, Allocations by Species or Species Group (Weights in Metric Tons)

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 50 Wildlife and Fisheries 13 2014-10-01 2014-10-01 false 2013, Allocations by Species or Species Group (Weights in Metric Tons) 1b Table 1b to Part 660, Subpart C Wildlife and Fisheries FISHERY CONSERVATION AND MANAGEMENT, NATIONAL OCEANIC AND ATMOSPHERIC ADMINISTRATION, DEPARTMENT OF COMMERCE (CONTINUED...

  19. No pain, no gain: pain behaviour in the armed forces.

    PubMed

    Harper, Phil

    Pain is a unique phenomenon that is difficult to express and is influenced by many different factors, including cultural expectations. A dichotomy exists within the British Armed Forces between pain being seen as necessary--the "no pain, no gain" view--and the opposite image of stoical service personnel who suppress their emotions--the "roughie-toughie" image. This dichotomy was explored through an ethnographic study of pain behaviour experienced during a training course. Pain behaviour was found to be consistent with cultural expectations and this supported the "no pain, no gain" perspective. Physical and psychological pain were expressed differently, reinforcing the western, scientific mind-body dichotomy. In addition, personnel frequently tried to suppress their pain and this supported the "roughie-toughie" philosophy. Thus, pain expression varies according to the context in which it occurs. Nurses need to be aware of this to ensure they interpret and manage their patients' pain appropriately.

  20. Acute pain management in patients with persistent pain.

    PubMed

    Quinlan, Jane; Carter, Kim

    2012-06-01

    Over the past 20 years, prescriptions of opioids for chronic pain have increased dramatically. This review addresses the difficulties in managing acute pain in this growing group of patients and discusses evidence relating to opioid tolerance and hyperalgesia and new avenues of research in specific painful conditions. There is accumulating evidence surrounding the dangers of high-dose opioids and the risk of overdose and death. Employing nonopioid analgesics and disease-modifying drugs to cover an acute exacerbation of pain will thus limit escalating opioid doses. In specific diseases, the role of oxidative stress and the disruption of calcium homeostasis may provide treatment targets in acute pancreatitis; the identification of psychological stressors may decrease the frequency of acute exacerbations of abdominal pain; modifying the adhesion of sickle cells to inflamed endothelium may reduce vaso-occlusive crises; while vertebroplasty and calcitonin appear to improve pain and functioning after osteoporotic vertebral fractures. Much of the evidence regarding the acute pain management of chronic pain patients is extrapolated from studies of opioid-naïve patients undergoing surgery. More focused research is needed to ascertain whether this model is an appropriate one to follow for such a complex group of patients.

  1. 46 CFR 171.124 - Watertight integrity above the margin line in a vessel less than 100 gross tons.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 100 gross tons. (a) Each hatch exposed to the weather must be watertight; except that, the following hatches may be weathertight: (1) Each hatch on a watertight trunk that extends at least 12 inches (30.5 centimeters) above the weather deck. (2) Each hatch in a cabin top. (3) Each hatch on a vessel that operates...

  2. 46 CFR 171.124 - Watertight integrity above the margin line in a vessel less than 100 gross tons.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 100 gross tons. (a) Each hatch exposed to the weather must be watertight; except that, the following hatches may be weathertight: (1) Each hatch on a watertight trunk that extends at least 12 inches (30.5 centimeters) above the weather deck. (2) Each hatch in a cabin top. (3) Each hatch on a vessel that operates...

  3. 46 CFR 171.124 - Watertight integrity above the margin line in a vessel less than 100 gross tons.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 100 gross tons. (a) Each hatch exposed to the weather must be watertight; except that, the following hatches may be weathertight: (1) Each hatch on a watertight trunk that extends at least 12 inches (30.5 centimeters) above the weather deck. (2) Each hatch in a cabin top. (3) Each hatch on a vessel that operates...

  4. 46 CFR 171.124 - Watertight integrity above the margin line in a vessel less than 100 gross tons.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 100 gross tons. (a) Each hatch exposed to the weather must be watertight; except that, the following hatches may be weathertight: (1) Each hatch on a watertight trunk that extends at least 12 inches (30.5 centimeters) above the weather deck. (2) Each hatch in a cabin top. (3) Each hatch on a vessel that operates...

  5. 46 CFR 171.124 - Watertight integrity above the margin line in a vessel less than 100 gross tons.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 100 gross tons. (a) Each hatch exposed to the weather must be watertight; except that, the following hatches may be weathertight: (1) Each hatch on a watertight trunk that extends at least 12 inches (30.5 centimeters) above the weather deck. (2) Each hatch in a cabin top. (3) Each hatch on a vessel that operates...

  6. 46 CFR 11.435 - Service requirements for master of inland steam or motor vessels of any gross tons.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 46 Shipping 1 2010-10-01 2010-10-01 false Service requirements for master of inland steam or motor... Deck Officers § 11.435 Service requirements for master of inland steam or motor vessels of any gross... (excluding the Great Lakes) steam or motor vessels of any gross tons is: (a) One year of service as first...

  7. Anterior herniation of lumbar disc induces persistent visceral pain: discogenic visceral pain: discogenic visceral pain.

    PubMed

    Tang, Yuan-Zhang; Shannon, Moore-Langston; Lai, Guang-Hui; Li, Xuan-Ying; Li, Na; Ni, Jia-Xiang

    2013-01-01

    Visceral pain is a common cause for seeking medical attention. Afferent fibers innervating viscera project to the central nervous system via sympathetic nerves. The lumbar sympathetic nerve trunk lies in front of the lumbar spine. Thus, it is possible for patients to suffer visceral pain originating from sympathetic nerve irritation induced by anterior herniation of the lumbar disc. This study aimed to evaluate lumbar discogenic visceral pain and its treatment. Twelve consecutive patients with a median age of 56.4 years were enrolled for investigation between June 2012 and December 2012. These patients suffered from long-term abdominal pain unresponsive to current treatment options. Apart from obvious anterior herniation of the lumbar discs and high signal intensity anterior to the herniated disc on magnetic resonance imaging, no significant pathology was noted on gastroscopy, vascular ultrasound, or abdominal computed tomography (CT). To prove that their visceral pain originated from the anteriorly protruding disc, we evaluated whether pain was relieved by sympathetic block at the level of the anteriorly protruding disc. If the block was effective, CT-guided continuous lumbar sympathetic nerve block was finally performed. All patients were positive for pain relief by sympathetic block. Furthermore, the average Visual Analog Scale of visceral pain significantly improved after treatment in all patients (P < 0.05). Up to 11/12 patients had satisfactory pain relief at 1 week after discharge, 8/12 at 4 weeks, 7/12 at 8 weeks, 6/12 at 12 weeks, and 5/12 at 24 weeks. It is important to consider the possibility of discogenic visceral pain secondary to anterior herniation of the lumbar disc when forming a differential diagnosis for seemingly idiopathic abdominal pain. Continuous lumbar sympathetic nerve block is an effective and safe therapy for patients with discogenic visceral pain.

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

    PubMed

    Booker, Staja Q

    2016-01-01

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

  9. Food-Derived Natural Compounds for Pain Relief in Neuropathic Pain.

    PubMed

    Lim, Eun Yeong; Kim, Yun Tai

    2016-01-01

    Neuropathic pain, defined as pain caused by a lesion or disease of the somatosensory nervous system, is characterized by dysesthesia, hyperalgesia, and allodynia. The number of patients with this type of pain has increased rapidly in recent years. Yet, available neuropathic pain medicines have undesired side effects, such as tolerance and physical dependence, and do not fully alleviate the pain. The mechanisms of neuropathic pain are still not fully understood. Injury causes inflammation and immune responses and changed expression and activity of receptors and ion channels in peripheral nerve terminals. Additionally, neuroinflammation is a known factor in the development and maintenance of neuropathic pain. During neuropathic pain development, the C-C motif chemokine receptor 2 (CCR2) acts as an important signaling mediator. Traditional plant treatments have been used throughout the world for treating diseases. We and others have identified food-derived compounds that alleviate neuropathic pain. Here, we review the natural compounds for neuropathic pain relief, their mechanisms of action, and the potential benefits of natural compounds with antagonistic effects on GPCRs, especially those containing CCR2, for neuropathic pain treatment.

  10. Does vigilance to pain make individuals experts in facial recognition of pain?

    PubMed

    Baum, Corinna; Kappesser, Judith; Schneider, Raphaela; Lautenbacher, Stefan

    2013-01-01

    It is well known that individual factors are important in the facial recognition of pain. However, it is unclear whether vigilance to pain as a pain-related attentional mechanism is among these relevant factors. Vigilance to pain may have two different effects on the recognition of facial pain expressions: pain-vigilant individuals may detect pain faces better but overinclude other facial displays, misinterpreting them as expressing pain; or they may be true experts in discriminating between pain and other facial expressions. The present study aimed to test these two hypotheses. Furthermore, pain vigilance was assumed to be a distinct predictor, the impact of which on recognition cannot be completely replaced by related concepts such as pain catastrophizing and fear of pain. Photographs of neutral, happy, angry and pain facial expressions were presented to 40 healthy participants, who were asked to classify them into the appropriate emotion categories and provide a confidence rating for each classification. Additionally, potential predictors of the discrimination performance for pain and anger faces - pain vigilance, pain-related catastrophizing, fear of pain--were assessed using self-report questionnaires. Pain-vigilant participants classified pain faces more accurately and did not misclassify anger as pain faces more frequently. However, vigilance to pain was not related to the confidence of recognition ratings. Pain catastrophizing and fear of pain did not account for the recognition performance. Moderate pain vigilance, as assessed in the present study, appears to be associated with appropriate detection of pain-related cues and not necessarily with the overinclusion of other negative cues.

  11. The role of pain catastrophizing in experimental pain perception.

    PubMed

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

    2014-03-01

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

  12. 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.

  13. Neuropathic pain.

    PubMed

    Colloca, Luana; Ludman, Taylor; Bouhassira, Didier; Baron, Ralf; Dickenson, Anthony H; Yarnitsky, David; Freeman, Roy; Truini, Andrea; Attal, Nadine; Finnerup, Nanna B; Eccleston, Christopher; Kalso, Eija; Bennett, David L; Dworkin, Robert H; Raja, Srinivasa N

    2017-02-16

    Neuropathic pain is caused by a lesion or disease of the somatosensory system, including peripheral fibres (Aβ, Aδ and C fibres) and central neurons, and affects 7-10% of the general population. Multiple causes of neuropathic pain have been described and its incidence is likely to increase owing to the ageing global population, increased incidence of diabetes mellitus and improved survival from cancer after chemotherapy. Indeed, imbalances between excitatory and inhibitory somatosensory signalling, alterations in ion channels and variability in the way that pain messages are modulated in the central nervous system all have been implicated in neuropathic pain. The burden of chronic neuropathic pain seems to be related to the complexity of neuropathic symptoms, poor outcomes and difficult treatment decisions. Importantly, quality of life is impaired in patients with neuropathic pain owing to increased drug prescriptions and visits to health care providers, as well as the morbidity from the pain itself and the inciting disease. Despite challenges, progress in the understanding of the pathophysiology of neuropathic pain is spurring the development of new diagnostic procedures and personalized interventions, which emphasize the need for a multidisciplinary approach to the management of neuropathic pain.

  14. Neuropathic pain

    PubMed Central

    Colloca, Luana; Ludman, Taylor; Bouhassira, Didier; Baron, Ralf; Dickenson, Anthony H.; Yarnitsky, David; Freeman, Roy; Truini, Andrea; Attal, Nadine; Finnerup, Nanna B.; Eccleston, Christopher; Kalso, Eija; Bennett, David L.; Dworkin, Robert H.; Raja, Srinivasa N.

    2017-01-01

    Neuropathic pain is caused by a lesion or disease of the somatosensory system, including peripheral fibres (Aβ, Aδ and C fibres) and central neurons, and affects 7–10% of the general population. Multiple causes of neuropathic pain have been described and its incidence is likely to increase owing to the ageing global population, increased incidence of diabetes mellitus and improved survival from cancer after chemotherapy. Indeed, imbalances between excitatory and inhibitory somatosensory signalling, alterations in ion channels and variability in the way that pain messages are modulated in the central nervous system all have been implicated in neuropathic pain. The burden of chronic neuropathic pain seems to be related to the complexity of neuropathic symptoms, poor outcomes and difficult treatment decisions. Importantly, quality of life is impaired in patients with neuropathic pain owing to increased drug prescriptions and visits to health care providers, as well as the morbidity from the pain itself and the inciting disease. Despite challenges, progress in the understanding of the pathophysiology of neuropathic pain is spurring the development of new diagnostic procedures and personalized interventions, which emphasize the need for a multidisciplinary approach to the management of neuropathic pain. PMID:28205574

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

    PubMed

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

    2013-03-01

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

  16. Does vigilance to pain make individuals experts in facial recognition of pain?

    PubMed Central

    Baum, Corinna; Kappesser, Judith; Schneider, Raphaela; Lautenbacher, Stefan

    2013-01-01

    BACKGROUND: It is well known that individual factors are important in the facial recognition of pain. However, it is unclear whether vigilance to pain as a pain-related attentional mechanism is among these relevant factors. OBJECTIVES: Vigilance to pain may have two different effects on the recognition of facial pain expressions: pain-vigilant individuals may detect pain faces better but overinclude other facial displays, misinterpreting them as expressing pain; or they may be true experts in discriminating between pain and other facial expressions. The present study aimed to test these two hypotheses. Furthermore, pain vigilance was assumed to be a distinct predictor, the impact of which on recognition cannot be completely replaced by related concepts such as pain catastrophizing and fear of pain. METHODS: Photographs of neutral, happy, angry and pain facial expressions were presented to 40 healthy participants, who were asked to classify them into the appropriate emotion categories and provide a confidence rating for each classification. Additionally, potential predictors of the discrimination performance for pain and anger faces – pain vigilance, pain-related catastrophizing, fear of pain – were assessed using self-report questionnaires. RESULTS: Pain-vigilant participants classified pain faces more accurately and did not misclassify anger as pain faces more frequently. However, vigilance to pain was not related to the confidence of recognition ratings. Pain catastrophizing and fear of pain did not account for the recognition performance. CONCLUSIONS: Moderate pain vigilance, as assessed in the present study, appears to be associated with appropriate detection of pain-related cues and not necessarily with the overinclusion of other negative cues. PMID:23717826

  17. Adaptability to pain is associated with potency of local pain inhibition, but not conditioned pain modulation: a healthy human study.

    PubMed

    Zheng, Zhen; Wang, Kelun; Yao, Dongyuan; Xue, Charlie C L; Arendt-Nielsen, Lars

    2014-05-01

    This study investigated the relationship between pain sensitivity, adaptability, and potency of endogenous pain inhibition, including conditioned pain modulation (CPM) and local pain inhibition. Forty-one healthy volunteers (20 male, 21 female) received conditioning stimulation (CS) over 2 sessions in a random order: tonic heat pain (46 °C) on the right leg for 7 minutes and cold pressor pain (1 °C to 4 °C) on the left hand for 5 minutes. Participants rated the intensity of pain continuously using a 0 to 10 electronic visual analogue scale. The primary outcome measures were pressure pain thresholds (PPT) measured at the heterotopic and homotopic location to the CS sites before, during, and 20 minutes after CS. Two groups of participants, pain adaptive and pain nonadaptive, were identified based on their response to pain in the cold pressor test. Pain-adaptive participants showed a pain reduction between peak pain and pain at end of the test by at least 2 of 10 (n=16); whereas the pain-nonadaptive participants reported unchanged peak pain during 5-minute CS (n=25). Heterotopic PPTs during the CS did not differ between the 2 groups. However, increased homotopic PPTs measured 20 minutes after CS correlated with the amount of pain reduction during CS. These results suggest that individual sensitivity and adaptability to pain does not correlate with the potency of CPM. Adaptability to pain is associated with longer-lasting local pain inhibition. Copyright © 2014 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

  18. Differential pain modulation in patients with peripheral neuropathic pain and fibromyalgia.

    PubMed

    Gormsen, Lise; Bach, Flemming W; Rosenberg, Raben; Jensen, Troels S

    2017-12-29

    Background The definition of neuropathic pain has recently been changed by the International Association for the Study of Pain. This means that conditions such as fibromyalgia cannot, as sometimes discussed, be included in the neuropathic pain conditions. However, fibromyalgia and peripheral neuropathic pain share common clinical features such as spontaneous pain and hypersensitivity to external stimuli. Therefore, it is of interest to directly compare the conditions. Material and methods In this study we directly compared the pain modulation in neuropathic pain versus fibromyalgia by recording responses to a cold pressor test in 30 patients with peripheral neuropathic pain, 28 patients with fibromyalgia, and 26 pain-free age-and gender-matched healthy controls. Patients were asked to rate their spontaneous pain on a visual analog scale (VAS (0-100 mm) immediately before and immediately after the cold pressor test. Furthermore the duration (s) of extremity immersion in cold water was used as a measure of the pain tolerance threshold, and the perceived pain intensity at pain tolerance on the VAS was recorded on the extremity in the water after the cold pressor test. In addition, thermal (thermo tester) and mechanical stimuli (pressure algometer) were used to determine sensory detection, pain detection, and pain tolerance thresholds in different body parts. All sensory tests were done by the same examiner, in the same room, and with each subject in a supine position. The sequence of examinations was the following: (1) reaction time, (2) pressure thresholds, (3) thermal thresholds, and (4) cold pressor test. Reaction time was measured to ensure that psychomotoric inhibitions did not influence pain thresholds. Results Pain modulation induced by a cold pressor test reduced spontaneous pain by 40% on average in neuropathic pain patients, but increased spontaneous pain by 2.6% in fibromyalgia patients. This difference between fibromyalgia and neuropathic pain patients was

  19. Chronic pain - resources

    MedlinePlus

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

  20. Pain facilitation and pain inhibition during conditioned pain modulation in fibromyalgia and in healthy controls.

    PubMed

    Potvin, Stéphane; Marchand, Serge

    2016-08-01

    Although fibromyalgia (FM) is associated with a deficit in inhibitory conditioned pain modulation (CPM), the discriminative power of CPM procedures is unknown. Moreover, the high intersubject heterogeneity in CPM responses in FM raises the possibility that a sizeable subgroup of these patients may experience pain facilitation during CPM, but the phenomenon has not been explicitly studied. To address these issues, 96 patients with FM and 71 healthy controls were recruited. Thermal stimuli were used to measure pain thresholds. Pain inhibition was elicited using a tonic thermal test (Peltier thermode) administered before and after activation of CPM mechanisms using a cold pressor test. Thermal pain thresholds were lower in patients with FM than in healthy controls. Pain ratings during the cold pressor test were higher in patients with FM, relative to controls. The CPM inhibitory efficacy was lower in patients with FM than in controls. The CPM procedure had good specificity (78.9%) but low sensitivity (45.7%), whereas a composite pain index had good sensitivity (75.0%) and specificity (78.9%). Finally, the rate of patients with FM who reported pain facilitation during the CPM procedure was found to be significantly increased compared with that of controls (41.7% vs 21.2%). The good discriminative power of the composite pain index highlights the need for further validation studies using mechanistically relevant psychophysical procedures in FM. The low sensitivity of the CPM procedure, combined with the large proportion of patients with FM experiencing pain facilitation during CPM, strongly suggests that endogenous pain inhibition mechanisms are deeply impaired in patients with FM, but only in a subgroup of them.

  1. Headache and co-morbid pains associated with TMD pain in adolescents.

    PubMed

    Nilsson, I-M; List, T; Drangsholt, M

    2013-09-01

    This case-control study evaluated the association of headache and other co-morbid pain with temporomandibular disorder (TMD) pain in adolescents and explored the temporal co-variance of headache and TMD pain. In a population-based sample of 12- to 19-year-olds, 350 patients with self-reported TMD pain and 350 healthy age- and sex-matched individuals were mailed questionnaires. Descriptive statistics, 95% CI, and OR analyses--logistic regression models with TMD pain as the outcome variable and adjusted for age and gender--were used for the analysis of individuals' responses. Headache, whether defined as once a week or more (OR = 6.6) or as moderate or severe (categorical), was significantly related to TMD pain. Severe headache (vs. mild) showed stronger associations with TMD (OR = 10.1) than between moderate and mild headache (OR = 5.5). Neck (OR = 4.0) and back (OR = 2.6) pain was also significantly related to TMD pain. When participants were grouped according to headache onset and TMD pain, the highest association between headache and TMD pain was found in the subgroup "Headache onset before TMD pain" (OR 9.4). In conclusion, headache appears to be independently and highly associated with TMD pain in adolescents. Neck pain and somatic complaints were also significantly associated with TMD pain. Headache seems to precede TMD pain in many adolescents with pain.

  2. Biobehavioral pain profile in individuals with chronic spine pain.

    PubMed

    Matteliano, Deborah; Scherer, Yvonne Krall; Chang, Yu-Ping

    2014-03-01

    Pain in the spine is the most frequently described pain problem in primary care, afflicting at least 54 million Americans. When spinal pain becomes chronic, the prognosis for recovery is poor, often leading to disability and reduced quality of life. Clinical treatment is inadequate, often focusing on physical pathology alone. To improve treatment outcomes for chronic pain as recommended by current guidelines, the Biobehavioral Pain Profile (BPP), which includes six pain response subscales, was developed to guide cognitive behavioral therapy (CBT). The purpose of this study was to describe the BPP in 100 individuals with chronic spine pain and examine the associations between the BPP and important clinical outcomes, including chronic pain, disability, and quality of life. Participants reported a high level of pain, a low quality of life, and a high level of disability despite receiving treatment with opioids. Scores on BPP subscales including evaluating loss of control, past and current experience, physiologic responsivity, and thoughts of disease progression were elevated, indicating a need for CBT. Five of the six BPP subscales had a significant association with quality of life, chronic pain, and disability with the thought of disease progression being a strong factor for most of the clinical outcome variables. By identifying BPP, clinicians can provide appropriate treatments to improve individuals' quality of life and prevent further disability. Further study using the BPP to guide CBT is needed. Copyright © 2014 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

  3. Pain measurement and brain activity: will neuroimages replace pain ratings?

    PubMed

    Robinson, Michael E; Staud, Roland; Price, Donald D

    2013-04-01

    Arguments made for the advantages of replacing pain ratings with brain-imaging data include assumptions that pain ratings are less reliable and objective and that brain image data would greatly benefit the measurement of treatment efficacy. None of these assumptions are supported by available evidence. Self-report of pain is predictable and does not necessarily reflect unreliability or error. Because pain is defined as an experience, magnitudes of its dimensions can be estimated by well-established methods, including those used to validate brain imaging of pain. Brain imaging helps to study pain mechanisms and might be used as proxy measures of pain in persons unable to provide verbal reports. Yet eliminating pain ratings or replacing them with neuroimaging data is misguided because brain images only help explain pain if they are used in conjunction with self-report. There is no objective readout mechanism of pain (pain thermometer) that is unaffected by psychological factors. Benefits from including neuroimaging data might include increased understanding of underlying neural mechanisms of treatment efficacy, discovery of new treatment vectors, and support of conclusions derived from self-report. However, neither brain imaging nor self-report data are privileged over the other. The assumption that treatment efficacy is hampered by self-report has not been shown; there is a plethora of treatment studies showing that self-report is sensitive to treatment. Dismissal of patients' self-reports (pain ratings) by brain-imaging data is potentially harmful. The aim of replacing self-report with brain-imaging data is misguided and has no scientific or philosophical foundation. Although brain imaging may offer considerable insight into the neural mechanisms of pain, including relevant causes and correlations, brain images cannot and should not replace self-report. Only the latter assesses the experience of pain, which is not identical to neural activity. Brain imaging may

  4. A common pronociceptive pain modulation profile typifying subgroups of chronic pelvic pain syndromes is interrelated with enhanced clinical pain.

    PubMed

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

    2017-06-01

    Provoked vestibulodynia (PVD) and painful bladder syndrome (PBS), subgroups of chronic pelvic pain syndromes (CPPS), are considered to share common biophysiological peripheral mechanisms. In addition, indications of a pronociceptive pain profile coexisting with psychological vulnerability suggest common dysfunctional pain processing and pain modulation in these 2 subgroups of CPPS. We therefore aimed at comparing the pain profile and psychological traits of patients with PVD and PBS to see whether the pain profile contributes to intersubject variability of clinical pain symptoms. Patients with PVD (n = 18) and PBS (n = 21) were compared with healthy controls (n = 20) in their responses to (1) pain psychophysical tests applied to both referred (suprapubis) and remote (hand) body areas and (2) pain-related psychological factors (pain catastrophizing, depression, anxiety, and somatization). We found a similar pronociceptive pain profile in the 2 subgroups of CPPS-enhanced facilitation (ie, hyperalgesia in the referred body area [P < 0.001]) and inefficient inhibition (ie, reduced conditioned pain modulation [P < 0.001] that were associated with both enhanced pain ratings evoked during trigger point examination [P < 0.037]) and higher Brief Pain Inventory ratings (P = 0.002). The latter was also correlated with pain catastrophizing (r = 0.504, P = 0.001) and depression symptoms (r = 0.361, P = 0.024). The findings suggest common mechanisms underlying a dysfunctional nociceptive system in both PVD and PBS. The intersubject variability in the level of dysfunction and its association with disease severity recommends a personalized pain treatment that may alleviate daily pain and dysfunction in patients with CPPS.

  5. Food-Derived Natural Compounds for Pain Relief in Neuropathic Pain

    PubMed Central

    Lim, Eun Yeong

    2016-01-01

    Neuropathic pain, defined as pain caused by a lesion or disease of the somatosensory nervous system, is characterized by dysesthesia, hyperalgesia, and allodynia. The number of patients with this type of pain has increased rapidly in recent years. Yet, available neuropathic pain medicines have undesired side effects, such as tolerance and physical dependence, and do not fully alleviate the pain. The mechanisms of neuropathic pain are still not fully understood. Injury causes inflammation and immune responses and changed expression and activity of receptors and ion channels in peripheral nerve terminals. Additionally, neuroinflammation is a known factor in the development and maintenance of neuropathic pain. During neuropathic pain development, the C-C motif chemokine receptor 2 (CCR2) acts as an important signaling mediator. Traditional plant treatments have been used throughout the world for treating diseases. We and others have identified food-derived compounds that alleviate neuropathic pain. Here, we review the natural compounds for neuropathic pain relief, their mechanisms of action, and the potential benefits of natural compounds with antagonistic effects on GPCRs, especially those containing CCR2, for neuropathic pain treatment. PMID:27891521

  6. Dopamine Precursor Depletion Influences Pain Affect Rather than Pain Sensation

    PubMed Central

    Schulz, Enrico; Baumkötter, Jochen; Ploner, Markus

    2014-01-01

    Pain is a multidimensional experience, which includes sensory, cognitive, and affective aspects. Converging lines of evidence indicate that dopaminergic neurotransmission plays an important role in human pain perception. However, the precise effects of dopamine on different aspects of pain perception remain to be elucidated. To address this question, we experimentally decreased dopaminergic neurotransmission in 22 healthy human subjects using Acute Phenylalanine and Tyrosine Depletion (APTD). During APTD and a control condition we applied brief painful laser stimuli to the hand, assessed different aspects of pain perception, and recorded electroencephalographic responses. APTD-induced decreases of cerebral dopaminergic activity did not influence sensory aspects of pain perception. In contrast, APTD yielded increases of pain unpleasantness. The increases of unpleasantness ratings positively correlated with effectiveness of APTD. Our finding of an influence of dopaminergic neurotransmission on affective but not sensory aspects of phasic pain suggests that analgesic effects of dopamine might be mediated by indirect effects on pain affect rather than by direct effects on ascending nociceptive signals. These findings contribute to our understanding of the complex relationship between dopamine and pain perception, which may play a role in various clinical pain states. PMID:24760082

  7. Temperament, Beliefs About Pain Control, and Pain Intensity in Endometriosis Patients.

    PubMed

    Bylinka, Joanna; Oniszczenko, Włodzimierz

    2016-12-01

    This correlational study investigated the relationships between temperament, beliefs about pain control, and pain intensity ratings in a group of 103 women diagnosed with endometriosis. Temperament traits were assessed using the Formal Characteristics of Behaviour-Temperament Inventory. Beliefs about pain control were measured using the Polish version of the Beliefs about Pain Control Questionnaire. The Numerical Rating Scale (NRS-11) was used to measure pain intensity. There was a high negative correlation between the temperament trait of endurance and pain intensity ratings. Moderate negative correlations with pain intensity were found for internal beliefs about pain control. Hierarchical multiple regression analysis indicated that the endurance trait and internal beliefs about pain control accounted for 33 % of the variance in pain intensity ratings in women with endometriosis.

  8. The Spectral Energy Distribution of the Seyfert Galaxy Ton S180

    NASA Technical Reports Server (NTRS)

    Turner, T. J.; Romano, P.; Kraemer, S. B.; George, I. M.; Yaqoob, T.; Crenshaw, D. M.; Storm, J.; Alloin, D.; Lazzaro, D.; DaSilva, L.; hide

    2001-01-01

    We present spectral results from a multi-satellite, broad-band campaign on the Narrow-line Seyfert 1 galaxy Ton S180 performed at the end of 1999. We discuss the spectral-energy distribution of the source, combining simultaneous Chandra, ASCA and EUVE data with contemporaneous FUSE, HST, and ground-based optical and infrared data. The resulting SED shows that most of the, energy is emitted in the 10 - 100 eV regime, which must be dominated by the primary energy source. No spectral turnover is evident in the UV regime. This, the strong soft X-ray emission, and the overall shape of the SED indicate that emission from the accretion disk peaks between 15 and 100 eV. High resolution FUSE spectra showing UV absorption due to OVI and the lack of detectable X-ray absorption in the Candra spectrum demonstrate the presence of a low column density of highly ionized gas along our line of sight.

  9. Impaired conditioned pain modulation in youth with functional abdominal pain

    PubMed Central

    Morris, Matthew C.; Walker, Lynn S.; Bruehl, Stephen; Stone, Amanda L.; Mielock, Alyssa S.; Rao, Uma

    2016-01-01

    Functional abdominal pain (FAP) is associated with enhanced pain responsiveness. Although impaired conditioned pain modulation (CPM) characterizes adults with a variety of chronic pain conditions, relatively little is known about CPM in youth with FAP. The present study assessed CPM to evoked thermal pain in 140 youth (ages 10 to 17), 63 of whom had FAP and 77 of whom were healthy controls. Multilevel models demonstrated weaker CPM effects in FAP than healthy youth, as evident in slower within-person decreases in pain ratings during the conditioning phase. Weaker CPM effects were associated with greater somatic symptom severity and functional disability. Pain responses in FAP youth were heterogeneous, with 43% of youth showing an unexpected increase in pain ratings during the conditioning phase, suggesting sensitization rather than CPM-related pain inhibition. These findings highlight directions for future research on the emergence and maintenance of FAP in youth. PMID:27389918

  10. Impaired conditioned pain modulation in youth with functional abdominal pain.

    PubMed

    Morris, Matthew C; Walker, Lynn S; Bruehl, Stephen; Stone, Amanda L; Mielock, Alyssa S; Rao, Uma

    2016-10-01

    Functional abdominal pain (FAP) is associated with enhanced pain responsiveness. Although impaired conditioned pain modulation (CPM) characterizes adults with a variety of chronic pain conditions, relatively little is known about CPM in youth with FAP. This study assessed CPM to evoked thermal pain in 140 youth (ages 10-17), 63 of whom had FAP and 77 of whom were healthy controls. Multilevel models demonstrated weaker CPM effects in youth with FAP than in healthy youth, as evident in slower within-person decreases in pain ratings during the conditioning phase. Weaker CPM effects were associated with greater somatic symptom severity and functional disability. Pain responses in youth with FAP were heterogeneous, with 43% of youth showing an unexpected increase in pain ratings during the conditioning phase, suggesting sensitization rather than CPM-related pain inhibition. These findings highlight directions for future research on the emergence and maintenance of FAP in youth.

  11. Blowing away the pain: a technique for pediatric pain management.

    PubMed

    Jacobs, Adrian; Price, Harper N; Popenhagen, Mark P

    2014-01-01

    Painful medical procedures in childhood may have long-term negative effects on development and future tolerance of pain. We describe a distraction technique for pediatric pain management that involves "blowing away the pain." This technique may be used for acute pediatric procedures as well as for patients with chronic pain. © 2014 Wiley Periodicals, Inc.

  12. Keeping pain in mind: a motivational account of attention to pain.

    PubMed

    Van Damme, Stefaan; Legrain, Valéry; Vogt, Julia; Crombez, Geert

    2010-02-01

    Attention is a key concept in many theories of pain perception. A clinically popular idea is that pain is more intense in persons who are hypervigilant for or bias their attention to pain information. So far, evidence for such bias in pain patients as compared to healthy persons is inconclusive. Furthermore, studies investigating the effects of distracting attention away from pain have shown contradictory results. In this review, we present a motivational perspective on attentional processing of pain that accounts for these inconclusive research findings. We argue that pain always has to be considered within a context of goal pursuit. From this perspective, two largely unexplored theoretical assumptions are introduced. First, when pain occurs during the pursuit of a certain goal, it may unintentionally capture attention although it is not relevant for the goal. Whether such unintentional attentional capture happens is not only dependent upon the characteristics of the pain but also on the characteristics of the focal goal. Second, attention to pain and pain-related information might be driven by a focal goal related to pain. Attentional processing of pain information will be particularly enhanced when the focal goal is related to pain management (e.g., attempting to gain control). Future research should systematically investigate the role of motivation and goal pursuit in the attentional processing of pain-related information. This motivational perspective offers a powerful framework to explain inter- and intra-individual differences in the deployment of attention to pain-related information.

  13. Competing effects of pain and fear of pain on postural control in low back pain?

    PubMed

    Mazaheri, Masood; Heidari, Elham; Mostamand, Javid; Negahban, Hossein; van Dieen, Jaap H

    2014-12-01

    A cross-sectional, observational study. To determine whether pain and fear of pain have competing effects on postural sway in patients with low back pain (LBP). Competing effects of pain and pain-related fear on postural control can be proposed as the likely explanation for inconsistent results regarding postural sway in the LBP literature. We hypothesized that although pain might increase postural sway, fear of pain might reduce sway through an increased cognitive effort or increased cocontraction to restrict body movement. The cognitive strategy would be less effective under dual-task conditions and the cocontraction strategy was expected to be less effective when standing on a narrow base of support surface. Postural sway was measured in combined conditions of base of support (full and narrow) and cognitive loading (single and dual tasks) in 3 experimental groups with current LBP, recent LBP, and no LBP. Sway amplitude, path length, mean power frequency, and sample entropy were extracted from center-of-pressure data. The current-LBP group and recent-LBP group reported significantly different levels of pain, but similar levels of pain catastrophizing and kinesiophobia. The current-LBP group tended to display larger sway amplitudes in the anteroposterior direction compared with the other 2 groups. Mean power frequency values in mediolateral direction were lower in patients with the current LBP compared with recent LBP. Smaller sample entropy was found in the current-LBP group than the other groups in most experimental conditions, particularly when standing on a narrow base of support. Alterations of postural sway are mostly mediated by pain but not pain-related fear. LBP tends to increase sway amplitude, which seems to be counteracted by increased effort invested in postural control leading to decreased frequency and increased regularity of sway particularly under increased task demands. Cross-sectional study.

  14. Evoked potentials after painful cutaneous electrical stimulation depict pain relief during a conditioned pain modulation.

    PubMed

    Höffken, Oliver; Özgül, Özüm S; Enax-Krumova, Elena K; Tegenthoff, Martin; Maier, Christoph

    2017-08-29

    Conditioned pain modulation (CPM) evaluates the pain modulating effect of a noxious conditioning stimulus (CS) on another noxious test stimulus (TS), mostly based solely on subjective pain ratings. We used painful cutaneous electrical stimulation (PCES) to induce TS in a novel CPM-model. Additionally, to evaluate a more objective parameter, we recorded the corresponding changes of cortical evoked potentials (PCES-EP). We examined the CPM-effect in 17 healthy subjects in a randomized controlled cross-over design during immersion of the non-dominant hand into 10 °C or 24 °C cold water (CS). Using three custom-built concentric surface electrodes, electrical stimuli were applied on the dominant hand, inducing pain of 40-60 on NRS 0-100 (TS). At baseline, during and after CS we assessed the electrically induced pain intensity and electrically evoked potentials recorded over the central electrode (Cz). Only in the 10 °C-condition, both pain (52.6 ± 4.4 (baseline) vs. 30.3 ± 12.5 (during CS)) and amplitudes of PCES-EP (42.1 ± 13.4 μV (baseline) vs. 28.7 ± 10.5 μV (during CS)) attenuated during CS and recovered there after (all p < 0.001). In the 10 °C-condition changes of subjective pain ratings during electrical stimulation and amplitudes of PCES-EP correlated significantly with each other (r = 0.5) and with CS pain intensity (r = 0.5). PCES-EPs are a quantitative measure of pain relief, as changes in the electrophysiological response are paralleled by a consistent decrease in subjective pain ratings. This novel CPM paradigm is a feasible method, which could help to evaluate the function of the endogenous pain modulation processes. German Clinical Trials Register DRKS-ID: DRKS00012779 , retrospectively registered on 24 July 2017.

  15. Are measures of pain sensitivity associated with pain and disability at 12-month follow up in chronic neck pain?

    PubMed

    Moloney, Niamh; Beales, Darren; Azoory, Roxanne; Hübscher, Markus; Waller, Robert; Gibbons, Rebekah; Rebbeck, Trudy

    2018-06-14

    Pain sensitivity and psychosocial issues are prognostic of poor outcome in acute neck disorders. However, knowledge of associations between pain sensitivity and ongoing pain and disability in chronic neck pain are lacking. We aimed to investigate associations of pain sensitivity with pain and disability at the 12-month follow-up in people with chronic neck pain. The predictor variables were: clinical and quantitative sensory testing (cold, pressure); neural tissue sensitivity; neuropathic symptoms; comorbidities; sleep; psychological distress; pain catastrophizing; pain intensity (for the model explaining disability at 12 months only); and disability (for the model explaining pain at 12 months only). Data were analysed using uni- and multivariate regression models to assess associations with pain and disability at the 12-month follow-up (n = 64 at baseline, n = 51 at follow-up). Univariable associations between all predictor variables and pain and disability were evident (r > 0.3; p < 0.05), except for cold and pressure pain thresholds and cold sensitivity. For disability at the 12-month follow-up, 24.0% of the variance was explained by psychological distress and comorbidities. For pain at 12 months, 39.8% of the variance was explained primarily by baseline disability. Neither clinical nor quantitative measures of pain sensitivity were meaningfully associated with long-term patient-reported outcomes in people with chronic neck pain, limiting their clinical application in evaluating prognosis. Copyright © 2018 John Wiley & Sons, Ltd.

  16. Conditioned Pain Modulation and Situational Pain Catastrophizing as Preoperative Predictors of Pain following Chest Wall Surgery: A Prospective Observational Cohort Study

    PubMed Central

    Grosen, Kasper; Vase, Lene; Pilegaard, Hans K.; Pfeiffer-Jensen, Mogens; Drewes, Asbjørn M.

    2014-01-01

    Background Variability in patients' postoperative pain experience and response to treatment challenges effective pain management. Variability in pain reflects individual differences in inhibitory pain modulation and psychological sensitivity, which in turn may be clinically relevant for the disposition to acquire pain. The aim of this study was to investigate the effects of conditioned pain modulation and situational pain catastrophizing on postoperative pain and pain persistency. Methods Preoperatively, 42 healthy males undergoing funnel chest surgery completed the Spielberger's State-Trait Anxiety Inventory and Beck's Depression Inventory before undergoing a sequential conditioned pain modulation paradigm. Subsequently, the Pain Catastrophizing Scale was introduced and patients were instructed to reference the conditioning pain while answering. Ratings of movement-evoked pain and consumption of morphine equivalents were obtained during postoperative days 2–5. Pain was reevaluated at six months postoperatively. Results Patients reporting persistent pain at six months follow-up (n = 15) were not significantly different from pain-free patients (n = 16) concerning preoperative conditioned pain modulation response (Z = 1.0, P = 0.3) or level of catastrophizing (Z = 0.4, P = 1.0). In the acute postoperative phase, situational pain catastrophizing predicted movement-evoked pain, independently of anxiety and depression (β = 1.0, P = 0.007) whereas conditioned pain modulation predicted morphine consumption (β = −0.005, P = 0.001). Conclusions Preoperative conditioned pain modulation and situational pain catastrophizing were not associated with the development of persistent postoperative pain following funnel chest repair. Secondary outcome analyses indicated that conditioned pain modulation predicted morphine consumption and situational pain catastrophizing predicted movement-evoked pain intensity in the acute postoperative

  17. Parents who catastrophize about their child's pain prioritize attempts to control pain.

    PubMed

    Caes, Line; Vervoort, Tine; Eccleston, Christopher; Goubert, Liesbet

    2012-08-01

    How parents respond to their child in pain is critically important to how both parent and child attempt to cope with pain. We examined the influence of parental catastrophic thinking about child pain on their prioritization for pain control. Using a vignette methodology, parents reported, in response to different pain scenarios, on their imagined motivation for 2 competing goals: to control their child's pain (ie, pain control) or to encourage their child's participation in daily activities (ie, activity engagement). The effects of parent gender, pain intensity, and duration on parental goal priority were also explored. Findings indicated that higher levels of parental catastrophic thoughts were associated with the parents prioritizing child pain control over activity engagement. This effect was significantly moderated by pain duration. Specifically, pain control was more of a priority for those high in catastrophic thinking when the pain was more acute. In contrast, parental catastrophic thoughts had no effect on the pain control strategy favored by parents in situations with longer-lasting pain. Furthermore, independently of parental catastrophic thoughts, heightened priority for pain control was observed in highly intense and chronic pain situations. Moreover, in highly intense pain, priority for pain control was stronger for mothers compared with fathers. Theoretical and clinical implications and directions for future research are discussed. Copyright © 2012 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

  18. [The pain-emotion: Advocating pain as an emotion].

    PubMed

    Fonseca Das Neves, J; Sule, N; Serra, E

    2017-12-01

    Pain is a common experience, both physical and emotional. However we often feel powerless with our patients suffering pain. This paper aims to give a new heuristic and psychological understanding of pain. According to new theories, recent researches as well as different points of view, we form an analogy between pain and emotion. Throughout historical considerations pain has always been perceived through theories and beliefs, changing its definition. This is also the case for emotion. Could they be two ways of expressing a single phenomenon? First, we must clarify the definition of emotion. In past, emotion was considered as a multiple-conditioned notion. To be considered as an emotion the pain had to fill numerous features, which differ according to the scientific opinions. The emotion may be considered as a physical expression or perceived only as the consequences of a real emotion, i.e., the subjective feeling. We propose as a way of thinking that emotion brings together these two concepts. We support a flexible vision of emotion. To investigate the field of the emotion different mental steps may be thought of: we should conceive of the emotion as a stimulus, as an emotional evaluation and as a tendency to action, which becomes an emotional response. These steps are colored by subjective feelings. It can be summarized in three levels: the situation decoding (1), the response organization (2) and the effectiveness of the response (3). Second pain can be considered as a complex notion involving personal and subjective feelings. We can use multidimensional patterns and consider emotion with its multiple features: the generating mechanisms, the pain perception, the pain behavior and the environment. Each stage can be divided in different ways. Hence pain treatment could be approached as an emotional treatment. Indeed, we can make a link between generating mechanisms and emotion situation decoding, between pain perception and emotion situation decoding and response

  19. 46 CFR 11.402 - Tonnage requirements for ocean or near coastal endorsements for vessels of over 1600 gross tons.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 46 Shipping 1 2011-10-01 2011-10-01 false Tonnage requirements for ocean or near coastal... Requirements for Deck Officers § 11.402 Tonnage requirements for ocean or near coastal endorsements for vessels of over 1600 gross tons. (a) To qualify for an ocean or near coastal endorsement for vessels of any...

  20. 46 CFR 11.402 - Tonnage requirements for ocean or near coastal endorsements for vessels of over 1600 gross tons.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 46 Shipping 1 2012-10-01 2012-10-01 false Tonnage requirements for ocean or near coastal... Requirements for Deck Officers § 11.402 Tonnage requirements for ocean or near coastal endorsements for vessels of over 1600 gross tons. (a) To qualify for an ocean or near coastal endorsement for vessels of any...

  1. 46 CFR 11.402 - Tonnage requirements for ocean or near coastal endorsements for vessels of over 1600 gross tons.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 46 Shipping 1 2010-10-01 2010-10-01 false Tonnage requirements for ocean or near coastal... Requirements for Deck Officers § 11.402 Tonnage requirements for ocean or near coastal endorsements for vessels of over 1600 gross tons. (a) To qualify for an ocean or near coastal endorsement for vessels of any...

  2. 46 CFR 11.402 - Tonnage requirements for ocean or near coastal endorsements for vessels of over 1600 gross tons.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 46 Shipping 1 2013-10-01 2013-10-01 false Tonnage requirements for ocean or near coastal... Requirements for Deck Officers § 11.402 Tonnage requirements for ocean or near coastal endorsements for vessels of over 1600 gross tons. (a) To qualify for an ocean or near coastal endorsement for vessels of any...

  3. Prediction of pain in orthodontic patients based on preoperative pain assessment

    PubMed Central

    Zheng, Baoyu; Ren, Manman; Lin, Feiou; Yao, Linjie

    2016-01-01

    Aim To investigate whether pretreatment assessment of experimental pain can predict the level of pain after archwire placement. Methods One hundred and twenty-one general university students seeking orthodontic treatment were enrolled in this study. A cold pressor test was performed to estimate the pain tolerance of subjects before treatment. Self-reported pain intensity was calculated using a 10 cm visual analog scale during the 7 days after treatment. The relationship between pain tolerance and orthodontic pain was analyzed using Spearman’s correlation analysis. Results The maximum mean level of pain intensity occurred at 24 hours after bonding (53.31±16.13) and fell to normal levels at day 7. Spearman’s correlation analysis found a moderate positive association between preoperative pain tolerance and self-reported pain after archwire placement (P<0.01). There was no significant difference in pain intensity between male and female patients at any time point (P>0.05). Conclusion A simple and noninvasive preoperative sensory test (the cold pressor test) was useful in predicting the risk of developing unbearable pain in patients after archwire placement. Self-reported pain after archwire placement decreased as individual pain tolerance increased. PMID:27042019

  4. 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 Central

    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.

    2015-01-01

    Objective 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. Design An explorative secondary analysis of a randomised controlled trial. Participants Fifty-six patients with Complex Regional Pain Syndrome type 1. Interventions 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. Outcome measures 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. Results 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. Conclusion 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. Trial registration International Clinical Trials Registry NCT00817128 PMID:25919011

  5. Pain modulatory phenotypes differentiate subgroups with different clinical and experimental pain sensitivity.

    PubMed

    Vaegter, Henrik B; Graven-Nielsen, Thomas

    2016-07-01

    Pain biomarkers are warranted for individualized pain management. Based on different pain modulatory phenotypes, the objectives of this study were to explore the existence of subgroups within patients with nonmalignant chronic pain and to investigate differences in clinical pain and pain hypersensitivity between subgroups. Cuff algometry was performed on lower legs in 400 patients with chronic pain to assess pressure pain threshold, pressure pain tolerance, temporal summation of pain (TSP: increase in pain scores to 10 repeated stimulations), and conditioned pain modulation (CPM: increase in cuff pressure pain threshold during cuff pain conditioning on the contralateral leg). Heat detection and heat pain thresholds at clinical painful and nonpainful body areas were assessed. Based on TSP and CPM, 4 distinct groups were formed: group 1 (n = 85) had impaired CPM and facilitated TSP; group 2 (n = 148) had impaired CPM and normal TSP; group 3 (n = 45) had normal CPM and facilitated TSP; and group 4 (n = 122) had normal CPM and normal TSP. Group 1 showed more pain regions than the other 3 groups (P < 0.001), indicating that impaired CPM and facilitated TSP play an important role in widespread pain. Groups 1 and 2 compared with group 4 had lower heat pain threshold at nonpainful areas and lower cuff pressure pain tolerance (P < 0.02), indicating that CPM plays a role for widespread hyperalgesia. Moreover, group 1 demonstrated higher clinical pain scores than group 4 (P < 0.05). Although not different between subgroups, patients were profiled on demographics, disability, pain catastrophizing, and fear of movement. Future research should investigate interventions tailored towards these subgroups.

  6. First Dutch Consensus of Pain Quality Indicators for Pain Treatment Facilities.

    PubMed

    de Meij, Nelleke; van Grotel, Marloes; Patijn, Jacob; van der Weijden, Trudy; van Kleef, Maarten

    2016-01-01

    There is a general consensus about the need to define and improve the quality of pain treatment facilities. Although guidelines and recommendations to improve the quality of pain practice management have been launched, provision of appropriate pain treatment is inconsistent and the quality of facilities varies widely. The aim of the study was to develop an expert-agreed list of quality indicators applicable to pain treatment facilities. The list was also intended to be used as the basis for a set of criteria for registered status of pain treatment facilities. The University Pain Center Maastricht at the Department of Anesthesiology and Pain Management of the Maastricht University Medical Center conducted a 3-round Delphi study in collaboration with the Board of the Pain Section of the Dutch Society of Anesthesiologists (NVA). Twenty-five quality indicators were selected as relevant to 2 types of pain treatment facilities, pain clinics and pain centers. The final expert-agreed list consisted of 22 quality indicators covering 7 quality domains: supervision, availability of care, staffing level and patient load, quality policy, multidisciplinarity, regionalization, and research and education. This set of quality indicators may facilitate organizational evaluation and improve insight into service quality from the perspectives of patients, pain specialists, and other healthcare professionals. Recommendations for improvements to the current set of quality indicators are made. In 2014 the process of registering pain treatment facilities in the Netherlands started; facilities can register as a pain clinic or pain center. © 2015 World Institute of Pain.

  7. Patterns of pain and interference in patients with painful bone metastases: a brief pain inventory validation study.

    PubMed

    Wu, Jackson S Y; Beaton, Dorcas; Smith, Peter M; Hagen, Neil A

    2010-02-01

    Bone metastases are prevalent, painful, and carry a poorer prognosis for pain control compared with other cancer pain syndromes. Standard tools to measure pain have not been validated in this patient population, and particular subgroups with more challenging symptoms have yet to be identified and studied. The objectives of this study were 1) to validate the psychometric properties of the Brief Pain Inventory (BPI) and its Pain and Interference subscales in patients with clinically significant metastatic bone pain requiring palliative radiotherapy and 2) to examine differences in BPI subscales among predefined subgroups of bone metastases patients. A total of 258 patients evaluated and treated through a rapid access radiation therapy clinic between July 2002, and November 2006, were included in the analysis. High internal consistency of the BPI subscales of Pain, Activity interference, and Affect interference was demonstrated by Cronbach's alpha between 0.81 and 0.89. Removing sleep interference improved model fit in confirmatory factor analysis. The BPI revealed an alarming pattern in patients with lower body metastases, who reported substantial interference of activity even though pain levels were mild or moderate. Such patients may require prompt clinical attention to better meet their needs. Finally, the allocation of interference from sleep within the BPI framework, in our population of pain patients, requires further study. Copyright 2010 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

  8. Investigation of Central Pain Processing in Post-Operative Shoulder Pain and Disability

    PubMed Central

    Valencia, Carolina; Fillingim, Roger B.; Bishop, Mark; Wu, Samuel S.; Wright, Thomas W.; Moser, Michael; Farmer, Kevin; George, Steven Z.

    2014-01-01

    Measures of central pain processing like conditioned pain modulation (CPM), and suprathreshold heat pain response (SHPR) have been described to assess different components of central pain modulatory mechanisms. Central pain processing potentially play a role in the development of postsurgical pain, however, the role of CPM and SHPR in explaining postoperative clinical pain and disability is still unclear. Seventy eight patients with clinical shoulder pain were included in this study. Patients were examined before shoulder surgery, at 3 months, and 6 months after surgery. The primary outcome measures were pain intensity and upper extremity disability. Analyses revealed that the change score (baseline – 3 months) of 5th pain rating of SHPR accounted for a significant amount of variance in 6 month postsurgical clinical pain intensity and disability after age, sex, preoperative pain intensity, and relevant psychological factors were considered. The present study suggests that baseline measures of central pain processing were not predictive of 6 month postoperative pain outcome. Instead, the 3 month change in SHPR might be a relevant factor in the transition to elevated 6-month postoperative pain and disability outcomes. In patients with shoulder pain, the 3 month change in a measure of central pain processing might be a relevant factor in the transition to elevated 6-month postoperative pain and disability scores. PMID:24042347

  9. Analysis of the Effects of Sea Disposal on a One-Ton Container

    NASA Technical Reports Server (NTRS)

    Jackson, Wde C.; Jackson, Karen E.; Fasanella, Edwin L.; Kelley, John

    2007-01-01

    Excess and obsolete stocks of chemical warfare material (CWM) were sea disposed by the United States between 1919 and 1970. One-ton containers were used for bulk storage of CWM and were the largest containers sea disposed. Disposal depths ranged from 300 to 17,000 feet. Based on a Type D container assembly drawing, three independent analyses (one corrosion and two structural) were performed on the containers to address the corrosion resistance from prolonged exposure to sea water and the structural response during the descent. Corrosion predictions were made using information about corrosion rates and the disposal environment. The structural analyses employed two different finite element codes and were used to predict the buckling and material response of the container during sea disposal. The results of these investigations are summarized below. Detailed reports on each study are contained in the appendices.

  10. Characterizing the Pain Narratives of Parents of Youth with Chronic Pain

    PubMed Central

    Noel, Melanie; Beals-Erickson, Sarah E.; Law, Emily F.; Alberts, Nicole; Palermo, Tonya M.

    2015-01-01

    Objectives Questionnaire-based research has shown that parents exert a powerful influence on and are profoundly influenced by living with a child with chronic pain. Examination of parents' pain narratives through an observational lens offers an alternative approach to understanding the complexity of pediatric chronic pain; however, the narratives of parents of youth with chronic pain have been largely overlooked. The present study aimed to characterize the vulnerability- and resilience-based aspects of the pain narratives of parents of youth with chronic pain. Methods Pain narratives of 46 parents were recorded during the baseline session as part of two clinical trials evaluating a behavioral intervention for parents of youth with chronic pain. The narratives were coded for aspects of pain-related vulnerability and resilience. Results Using exploratory cluster analysis, two styles of parents’ pain narratives were identified. Distress narratives were characterized by more negative affect and an exclusively unresolved orientation towards the child’s diagnosis of chronic pain whereas resilience narratives were characterized by positive affect and a predominantly resolved orientation towards the child’s diagnosis. Preliminary support for the validity of these clusters was provided through our finding of differences between clusters in parental pain catastrophizing about child pain (helplessness). Discussion Findings highlight the multidimensional nature of parents’ experience of their child’s pain problem. Clinical implications in terms of assessment and treatment are discussed. PMID:26736026

  11. Characterizing the Pain Narratives of Parents of Youth With Chronic Pain.

    PubMed

    Noel, Melanie; Beals-Erickson, Sarah E; Law, Emily F; Alberts, Nicole M; Palermo, Tonya M

    2016-10-01

    Questionnaire-based research has shown that parents exert a powerful influence on and are profoundly influenced by living with a child with chronic pain. Examination of parents' pain narratives through an observational lens offers an alternative approach to understanding the complexity of pediatric chronic pain; however, the narratives of parents of youth with chronic pain have been largely overlooked. The present study aimed to characterize the vulnerability-based and resilience-based aspects of the pain narratives of parents of youth with chronic pain. Pain narratives of 46 parents were recorded during the baseline session as part of 2 clinical trials evaluating a behavioral intervention for parents of youth with chronic pain. The narratives were coded for aspects of pain-related vulnerability and resilience. Using exploratory cluster analysis, 2 styles of parents' pain narratives were identified. Distress narratives were characterized by more negative affect and an exclusively unresolved orientation toward the child's diagnosis of chronic pain, whereas resilience narratives were characterized by positive affect and a predominantly resolved orientation toward the child's diagnosis. Preliminary support for the validity of these clusters was provided through our finding of differences between clusters in parental pain catastrophizing about child pain (helplessness). Findings highlight the multidimensional nature of parents' experience of their child's pain problem. Clinical implications in terms of assessment and treatment are discussed.

  12. Making Sense of Low Back Pain and Pain-Related Fear.

    PubMed

    Bunzli, Samantha; Smith, Anne; Schütze, Robert; Lin, Ivan; O'Sullivan, Peter

    2017-09-01

    Synopsis Pain-related fear is implicated in the transition from acute to chronic low back pain and the persistence of disabling low back pain, making it a key target for physical therapy intervention. The current understanding of pain-related fear is that it is a psychopathological problem, whereby people who catastrophize about the meaning of pain become trapped in a vicious cycle of avoidance behavior, pain, and disability, as recognized in the fear-avoidance model. However, there is evidence that pain-related fear can also be seen as a common-sense response to deal with low back pain, for example, when one is told that one's back is vulnerable, degenerating, or damaged. In this instance, avoidance is a common-sense response to protect a "damaged" back. While the fear-avoidance model proposes that when someone first develops low back pain, the confrontation of normal activity in the absence of catastrophizing leads to recovery, the pathway to recovery for individuals trapped in the fear-avoidance cycle is less clear. Understanding pain-related fear from a common-sense perspective enables physical therapists to offer individuals with low back pain and high fear a pathway to recovery by altering how they make sense of their pain. Drawing on a body of published work exploring the lived experience of pain-related fear in people with low back pain, this clinical commentary illustrates how Leventhal's common-sense model may assist physical therapists to understand the broader sense-making processes involved in the fear-avoidance cycle, and how they can be altered to facilitate fear reduction by applying strategies established in the behavioral medicine literature. J Orthop Sports Phys Ther 2017;47(9):628-636. Epub 13 Jul 2017. doi:10.2519/jospt.2017.7434.

  13. Pronociceptive pain modulation in patients with painful chemotherapy-induced polyneuropathy.

    PubMed

    Nahman-Averbuch, Hadas; Yarnitsky, David; Granovsky, Yelena; Sprecher, Elliot; Steiner, Mariana; Tzuk-Shina, Tzahala; Pud, Dorit

    2011-08-01

    Several chemotherapy agents induce polyneuropathy that is painful for some patients, but not for others. We assumed that these differences might be attributable to varying patterns of pain modulation. The aim of the present study was to evaluate pain modulation in such patients. Twenty-seven patients with chemotherapy-induced polyneuropathy were tested for detection thresholds (cold, warm, and mechanical) in both the forearm and foot, as well as for heat pain threshold, mechanical temporal summation (TS), and conditioned pain modulation (CPM; also known as the diffuse noxious inhibitory control-like effect), which were tested in the upper limbs. Positive correlations were found between clinical pain levels and both TS (r=0.52, P=0.005) and CPM (r=0.40, P=0.050) for all patients. In addition, higher TS was associated with less efficient CPM (r=0.56, P=0.004). The group of patients with painful polyneuropathy (n=12) showed a significantly higher warm detection threshold in the foot (P=0.03), higher TS (P<0.01), and less efficient CPM (P=0.03) in comparison to the group with nonpainful polyneuropathy. The painfulness of polyneuropathy is associated with a "pronociceptive" modulation pattern, which may be primary to the development of pain. The higher warm sensory thresholds in the painful polyneuropathy group suggest that the severity of polyneuropathy may be another factor in determining its painfulness. Copyright © 2011 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

  14. Chronic abdominal wall pain misdiagnosed as functional abdominal pain.

    PubMed

    van Assen, Tijmen; de Jager-Kievit, Jenneke W A J; Scheltinga, Marc R; Roumen, Rudi M H

    2013-01-01

    The abdominal wall is often neglected as a cause of chronic abdominal pain. The aim of this study was to identify chronic abdominal wall pain syndromes, such as anterior cutaneous nerve entrapment syndrome (ACNES), in a patient population diagnosed with functional abdominal pain, including irritable bowel syndrome, using a validated 18-item questionnaire as an identification tool. In this cross-sectional analysis, 4 Dutch primary care practices employing physicians who were unaware of the existence of ACNES were selected. A total of 535 patients ≥18 years old who were registered with a functional abdominal pain diagnosis were approached when they were symptomatic to complete the questionnaire (maximum 18 points). Responders who scored at least the 10-point cutoff value (sensitivity, 0.94; specificity, 0.92) underwent a diagnostic evaluation to establish their final diagnosis. The main outcome was the presence and prevalence of ACNES in a group of symptomatic patients diagnosed with functional abdominal pain. Of 535 patients, 304 (57%) responded; 167 subjects (31%) recently reporting symptoms completed the questionnaire. Of 23 patients who scored above the 10-point cutoff value, 18 were available for a diagnostic evaluation. In half of these subjects (n = 9) functional abdominal pain (including IBS) was confirmed. However, the other 9 patients were suffering from abdominal wall pain syndrome, 6 of whom were diagnosed with ACNES (3.6% prevalence rate of symptomatic subjects; 95% confidence interval, 1.7-7.6), whereas the remaining 3 harbored a painful lipoma, an abdominal herniation, and a painful scar. A clinically relevant portion of patients previously diagnosed with functional abdominal pain syndrome in a primary care environment suffers from an abdominal wall pain syndrome such as ACNES.

  15. The Role of Positive Traits and Pain Catastrophizing in Pain Perception

    PubMed Central

    Hood, Anna

    2013-01-01

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

  16. Chronic Widespread Back Pain is Distinct From Chronic Local Back Pain: Evidence From Quantitative Sensory Testing, Pain Drawings, and Psychometrics.

    PubMed

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

    2016-07-01

    Whether chronic localized pain (CLP) and chronic widespread pain (CWP) have different mechanisms or to what extent they overlap in their pathophysiology is controversial. The study compared quantitative sensory testing profiles of nonspecific chronic back pain patients with CLP (n=48) and CWP (n=29) with and fibromyalgia syndrome (FMS) patients (n=90) and pain-free controls (n = 40). The quantitative sensory testing protocol of the "German-Research-Network-on-Neuropathic-Pain" was used to measure evoked pain on the painful area in the lower back and the pain-free hand (thermal and mechanical detection and pain thresholds, vibration threshold, pain sensitivity to sharp and blunt mechanical stimuli). Ongoing pain and psychometrics were captured with pain drawings and questionnaires. CLP patients did not differ from pain-free controls, except for lower pressure pain threshold (PPT) on the back. CWP and FMS patients showed lower heat pain threshold and higher wind-up ratio on the back and lower heat pain threshold and cold pain threshold on the hand. FMS showed lower PPT on back and hand, and higher comorbidity of anxiety and depression and more functional impairment than all other groups. Even after long duration CLP presents with a local hypersensitivity for PPT, suggesting a somatotopically specific sensitization of nociceptive processing. However, CWP patients show widespread ongoing pain and hyperalgesia for different stimuli that is generalized in space, suggesting the involvement of descending control systems, as also suggested for FMS patients. Because mechanisms in nonspecific chronic back pain with CLP and CWP differ, these patients should be distinguished in future research and allocated to different treatments.

  17. Individual Differences in Pain: Understanding the Mosaic that Makes Pain Personal

    PubMed Central

    Fillingim, Roger B.

    2016-01-01

    The experience of pain is characterized by tremendous inter-individual variability. Multiple biological and psychosocial variables contribute to these individual differences in pain, including demographic variables, genetic factors, and psychosocial processes. For example, sex, age and ethnic group differences in the prevalence of chronic pain conditions have been widely reported. Moreover, these demographic factors have been associated with responses to experimentally-induced pain. Similarly, both genetic and psychosocial factors contribute to clinical and experimental pain responses. Importantly, these different biopsychosocial influences interact with each other in complex ways to sculpt the experience of pain. Some genetic associations with pain have been found to vary across sex and ethnic group. Moreover, genetic factors also interact with psychosocial factors, including stress and pain catastrophizing, to influence pain. The individual and combined influences of these biological and psychosocial variables results in a unique mosaic of factors that contributes pain in each individual. Understanding these mosaics is critically important in order to provide optimal pain treatment, and future research to further elucidate the nature of these biopsychosocial interactions is needed in order to provide more informed and personalized pain care. PMID:27902569

  18. Chronobiology of chronic pain: focus on diurnal rhythmicity of neuropathic pain.

    PubMed

    Gilron, Ian; Ghasemlou, Nader

    2014-12-01

    Although circadian rhythmicity has long been recognized in various nociceptive pain conditions such as arthritis, diurnal pain patterns in neuropathic conditions have only recently been described. The purpose of this article is to review emerging evidence and discuss future research to further understand this phenomenon. Secondary analyses of neuropathic pain clinical trials demonstrate that pain intensity fluctuations exhibit a distinct diurnal pattern that contrasts that of nociceptive pain conditions. Ongoing preclinical investigations support the phenomenon of circadian pain fluctuations and provide the opportunity to better describe pain chronobiology and to elucidate underlying mechanisms of circadian pain rhythmicity. The observation of clinically relevant diurnal pain variability in neuropathic conditions has important implications for future research and treatment of pain. This is an immature research field, and further investigation is needed to better characterize these patterns in more detail, investigate contributory mechanisms, and to develop therapeutic strategies that exploit this phenomenon.

  19. Psychological Factors Associated With Painful Versus Non-Painful HIV-Associated Sensory Neuropathy.

    PubMed

    Pillay, Prinisha; Wadley, Antonia L; Cherry, Catherine L; Karstaedt, Alan S; Kamerman, Peter R

    2018-05-01

    HIV-associated sensory neuropathy (HIV-SN) is a common, and frequently painful complication of HIV, but factors that determine the presence of pain are unresolved. We investigated: (i) if psychological factors associated with painful (n = 125) versus non-painful HIV-SN (n = 72), and (ii) if pain and psychological factors affected quality of life (QoL). We assessed anxiety and depression using the Hopkins Symptoms Checklist-25. Pain catastrophizing and QoL were assessed using the Pain Catastrophizing Scale and Euroqol-5D, respectively. Presence of neuropathy was detected using the Brief Neuropathy Screening Tool, and pain was characterised using the Wisconsin Brief Pain Questionnaire. Overall, there was a high burden of pain, depression and anxiety in the cohort. None of the psychological variables associated with having painful HIV-SN. Greater depressive symptoms and presence of pain were independently associated with lower QoL. In those participants with painful HIV-SN, greater depressive symptom scores were associated with increased pain intensity. In conclusion, in a cohort with high background levels of psychological dysfunction, psychological factors do not predict the presence of pain, but both depression and presence of pain are associated with poor quality of life.

  20. Atypical electrophysiological activity during pain observation in amputees who experience synaesthetic pain.

    PubMed

    Fitzgibbon, Bernadette M; Enticott, Peter G; Giummarra, Melita J; Thomson, Richard H; Georgiou-Karistianis, Nellie; Bradshaw, John L

    2012-03-01

    There are increasing reports of people experiencing pain when observing pain in another. This describes the phenomenon of synaesthetic pain which, until recently, had been primarily reported in amputees with phantom pain. In the current study, we used electroencephalography (EEG) to investigate how amputees who experience synaesthetic pain process pain observed in another. Participants were grouped according to amputees who experience phantom and synaesthetic pain (n=8), amputees who experience phantom pain but not synaesthetic pain (n=10) and healthy controls (n=10). Participants underwent EEG as they observed still images of hands and feet in potentially painful and non-painful situations. We found that pain synaesthetes showed some reduced event-related potential (ERP) components at certain electrode sites, and reduced theta- and alpha band power amplitude at a central electrode. The finding of reduced ERP amplitude and theta band power may reflect inhibition of the processing of observed pain (e.g. avoidance/guarding as a protective strategy), and reduced alpha band power may indicate a disinhibition in control processes that may result in synaesthetic pain. These results provide the first documentation of atypical neurophysiological activity in amputees who experience synaesthetic pain when processing pain in another. © The Author (2011). Published by Oxford University Press.

  1. Fear of pain in children and adolescents with neuropathic pain and CRPS

    PubMed Central

    Simons, Laura E.

    2015-01-01

    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. Due to faulty nerve signaling, individuals with neuropathic pain and CRPS 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 down-regulate 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, while high initial pain-related fear is a risk factor for less treatment responsiveness. An innovative approach to targeting pain-related fear as well as evidence of a neural response to treatment involving decoupling of the amygdala with key fear circuits in youth with CRPS suggest breakthroughs in our ability to ameliorate these issues. PMID:26785161

  2. Pain in children--are we accomplishing the optimal pain treatment?

    PubMed

    Lundeberg, Stefan

    2015-01-01

    Morphine, paracetamol and local anesthetics have for a long time been the foremost used analgesics in the pediatric patient by tradition but not always enough effective and associated with side effects. The purpose with this article is to propose alternative approaches in pain management, not always supported up by substantial scientific work but from a combination of science and clinical experience in the field. The scientific literature has been reviewed in parts regarding different aspects of pain assessment and analgesics used for treatment of diverse pain conditions with focus on procedural and acute pain. Clinical experience has been added to form the suggested improvements in accomplishing an improved pain management in pediatric patients. The aim with pain management in children should be a tailored analgesic medication with an individual acceptable pain level and optimal degree of mobilization with as little side effects as possible. Simple techniques of pain control are as effective as and complex techniques in pediatrics but the technique used is not of the highest importance in achieving a good pain management. Increased interest and improved education of the doctors prescribing analgesics is important in accomplishing a better pain management. The optimal treatment with analgesics is depending on the analysis of pain origin and analgesics used should be adjusted thereafter. A multimodal treatment regime is advocated for optimal analgesic effect. © 2014 John Wiley & Sons Ltd.

  3. Understanding cultural influences on back pain and back pain research.

    PubMed

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

    2016-12-01

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

  4. Eye pain

    MedlinePlus

    Ophthalmalgia; Pain - eye ... Pain in the eye can be an important symptom of a health problem. Make sure you tell your health care provider if you have eye pain that does not go away. Tired eyes or ...

  5. Breast pain

    MedlinePlus

    Pain - breast; Mastalgia; Mastodynia; Breast tenderness ... There are many possible causes for breast pain. For example, changes in the level of of hormones during menstruation or pregnancy often cause breast pain. Some swelling and tenderness just before ...

  6. Profiling the Location and Extent of Musicians' Pain Using Digital Pain Drawings.

    PubMed

    Cruder, Cinzia; Falla, Deborah; Mangili, Francesca; Azzimonti, Laura; Araújo, Liliana S; Williamon, Aaron; Barbero, Marco

    2018-01-01

    According to existing literature, musicians are at risk of experiencing a range of painful musculoskeletal conditions. Recently, a novel digital technology was developed to investigate pain location and pain extent. The aim of this study was to describe pain location and pain extent in musicians using a digital method for pain drawing (PD) analysis. Additionally, the association between PD variables and clinical features were explored in musicians with pain. One hundred and fifty-eight musicians (90 women and 68 men; aged 22.4 ± 3.6 years) were recruited from Swiss and U.K. conservatories. Participants were asked to complete a survey including both background musical information and clinical features, the QuickDASH (QD) questionnaire, and the digital PDs. Of the 158 participants, 126 musicians (79.7%) reported having pain, with higher prevalence in the areas of the neck and shoulders, the lower back, and the right arm. The mean percentage of pain extent was 3.1% ± 6.5%. The mean QD score was higher for musicians with pain than for those without pain. Additionally, the results indicated a positive correlation between the QD score and pain extent, and there were significant correlations between age and pain intensity, as well as between pain extent and pain intensity. The high prevalence of pain among musicians has been confirmed using a digital technique for PD acquisition and analysis. In addition, positive correlations between pain extent and upper limb disability have been demonstrated. Our findings highlight the need for effective prevention and treatment strategies for musicians. © 2017 The Authors. Pain Practice published by Wiley Periodicals, Inc. on behalf of World Institute of Pain.

  7. Elbow pain

    MedlinePlus

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

  8. Modeling subjective well-being in individuals with chronic pain and a physical disability: the role of pain control and pain catastrophizing.

    PubMed

    Furrer, Angela; Michel, Gisela; Terrill, Alexandra L; Jensen, Mark P; Müller, Rachel

    2017-10-23

    To investigate the associations between subjective well-being and pain intensity, pain interference, and depression in individuals with physical disabilities. We hypothesized that (1) pain control and (2) pain catastrophizing mediate the effects of subjective well-being on pain intensity, pain interference, and depression. Analyses of cross-sectional data from 96 individuals diagnosed with spinal cord injury, multiple sclerosis, neuromuscular disease, or post-polio syndrome, with average pain intensity of ≥4 (0-10) on at least half the days in the past month. Two models tested study hypotheses using structural equation. Both models showed acceptable model fit. Pain catastrophizing significantly mediated the effect of subjective well-being on pain intensity and pain interference, but not on depression. Pain control did not significantly mediate the effect of subjective well-being on pain intensity, pain interference, or depression. Path coefficients showed significant direct effects of subjective well-being on pain control (β = 0.39), pain catastrophizing (β = -0.61), pain interference (β = -0.48; -0.42), and depression (β = -0.75; -0.78). This study supports the potential of enhancing subjective well-being and lowering pain catastrophizing for reducing pain intensity, pain interference, and depressive symptoms in individuals with chronic pain and a physical disability. The findings indicate that true experiments to test for causal associations are warranted. Implications for rehabilitation The majority of individuals with physical disabilities report having persistent moderate-to-severe pain that may negatively limit daily activities and quality of life. The present cross-sectional study indicates that individuals who reported greater subjective well-being showed significantly lower pain intensity via the mediating effect of lower pain catastrophizing. Since sample size and respective power are low, these findings should be taken as first

  9. [Painful ejaculation].

    PubMed

    Delavierre, D; Sibert, L; Rigaud, J; Labat, J-J

    2014-06-01

    To clarify definition, epidemiology, diagnosis, evaluation, etiologies and treatment of painful ejaculation (PE). Review of the literature performed by searching the Medline database using keywords ejaculation, orgasm, pain, pelvic pain, sexual behavior. PE is a pelviperineal pain caused by ejaculation or orgasm. Its prevalence rate is between 1 and 4% amongst the general population. Mainly located in the penis, pain usually lasts less than 5 minutes. Assessment is clinical and there is no level of evidence about the strategy of complementary investigations. Benign prostatic hyperplasia, chronic pelvic pain syndrome, radical prostatectomy, prostate brachytherapy and some antidepressant medications are the best estimated etiologies found in the literature. A link between urogenital infections and PE is likely but not clearly established. Alpha-blockers had good therapeutic results in few low level of evidence studies. The assessment of PE is not clearly defined. Some etiologies are known but PE may be a functionnal pain. Only high level of evidence studies would validate the use of the alpha-blockers as an efficient therapeutic option. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  10. [Musculoskeletal pain].

    PubMed

    Casser, H-R; Schaible, H-G

    2015-10-01

    Among the clinically relevant pain conditions, pain in the musculoskeletal system is most frequent. This article reports extensive epidemiological data on musculoskeletal system pain in Germany and worldwide. Since back pain is most frequent, the diagnostics and therapeutic algorithms of acute, recurring, and chronic lower back pain in Germany will be particularly addressed. The importance of the physiologic-organic, the cognitive-emotional, the behavioral, and the social level to diagnostics and treatment will be discussed. We will also focus on osteoarthritic pain and address its epidemiology, clinical importance, and significance for the health care system. This article will list some reasons why the musculoskeletal system in particular is frequently the site of chronic pain. The authors believe that these reasons are to be sought in the complex structures of the musculoskeletal system; in the particular sensitivity of the deep somatic nociceptive system for long-term sensitization processes, as well as the ensuing nervous system reactions; and in the interactions between the nervous and immune systems. The article will give some insights into the research carried out on this topic in Germany.

  11. Pain and pharmacologic pain management in long-stay nursing home residents.

    PubMed

    Hunnicutt, Jacob N; Ulbricht, Christine M; Tjia, Jennifer; Lapane, Kate L

    2017-06-01

    Previous studies estimate that >40% of long-stay nursing home (NH) residents experience persistent pain, with 20% of residents in pain receiving no analgesics. Strengthened NH surveyor guidance and improved pain measures on the Minimum Data Set 3.0 were introduced in March 2009 and October 2010, respectively. This study aimed to provide estimates after the important initiatives of (1) prevalence and correlates of persistent pain; and (2) prevalence and correlates of untreated or undertreated persistent pain. We identified 1,387,405 long-stay residents in U.S. NHs between 2011 and 2012 with 2 Minimum Data Set assessments 90 days apart. Pain was categorized as persistent (pain on both assessments), intermittent (pain on either assessment), or none. Pharmacologic pain management was classified as untreated pain (no scheduled or as needed medications received) or potentially undertreated (no scheduled received). Modified Poisson models adjusting for resident clustering within NHs provided adjusted prevalence ratios (APRs) estimates and 95% confidence intervals (CIs). The prevalence of persistent and intermittent pain was 19.5% and 19.2%, respectively, but varied substantially by age, sex, race and ethnicity, cognitive impairment, and cancer. Of residents in persistent pain, 6.4% and 32.0% were untreated and undertreated, respectively. Racial and ethnic minorities (non-Hispanic blacks vs whites, APR = 1.19, 95% CI: 1.13-1.25) and severely cognitively impaired residents (severe vs no/mild APR = 1.51, 95% CI: 1.44-1.57) had an increased prevalence of untreated and undertreated pain. One in 5 NH residents has persistent pain. Although this estimate is greatly improved, many residents may be undertreated. The disturbing disparities in untreated and undertreated pain need to be addressed.

  12. Spontaneous Chronic Pain After Experimental Thoracotomy Revealed by Conditioned Place Preference: Morphine Differentiates Tactile Evoked Pain From Spontaneous Pain.

    PubMed

    Hung, Ching-Hsia; Wang, Jeffrey Chi-Fei; Strichartz, Gary R

    2015-09-01

    Chronic pain after surgery limits social activity, interferes with work, and causes emotional suffering. A major component of such pain is reported as resting or spontaneous pain with no apparent external stimulus. Although experimental animal models can simulate the stimulus-evoked chronic pain that occurs after surgery, there have been no studies of spontaneous chronic pain in such models. Here the conditioned place preference (CPP) paradigm was used to reveal resting pain after experimental thoracotomy. Male Sprague Dawley rats received a thoracotomy with 1-hour rib retraction, resulting in evoked tactile hypersensitivity, previously shown to last for at least 9 weeks. Intraperitoneal injections of morphine (2.5 mg/kg) or gabapentin (40 mg/kg) gave equivalent 2- to 3-hour-long relief of tactile hypersensitivity when tested 12 to 14 days postoperatively. In separate experiments, single trial CPP was conducted 1 week before thoracotomy and then 12 days (gabapentin) or 14 days (morphine) after surgery, followed the next day by 1 conditioning session with morphine or gabapentin, both versus saline. The gabapentin-conditioned but not the morphine-conditioned rats showed a significant preference for the analgesia-paired chamber, despite the equivalent effect of the 2 agents in relieving tactile allodynia. These results show that experimental thoracotomy in rats causes spontaneous pain and that some analgesics, such as morphine, that reduce evoked pain do not also relieve resting pain, suggesting that pathophysiological mechanisms differ between these 2 aspects of long-term postoperative pain. Perspective: Spontaneous pain, a hallmark of chronic postoperative pain, is demonstrated here in a rat model of experimental postthoracotomy pain, further validating the use of this model for the development of analgesics to treat such symptoms. Although stimulus-evoked pain was sensitive to systemic morphine, spontaneous pain was not, suggesting different mechanistic

  13. STS-97 and Expedition One Crews Pose for Onboard Photo

    NASA Technical Reports Server (NTRS)

    2000-01-01

    In this image, the five STS-97 crew members pose with the 3 members of the Expedition One crew onboard the International Space Station (ISS) for the first ever traditional onboard portrait taken in the Zvezda Service Module. On the front row, left to right, are astronauts Brent W. Jett, Jr., STS-97 commander; William M. Shepherd, Expedition One mission commander; and Joseph R. Tarner, STS-97 mission specialist. On the second row, from the left are Cosmonaut Sergei K. Krikalev, Expedition One flight engineer; astronaut Carlos I. Noriega, STS-97 mission specialist; cosmonaut Yuri P. Gidzenko, Expedition One Soyuz commander; and Michael J. Bloomfield, STS-97 pilot. Behind them is astronaut Marc Garneau, STS-97 mission specialist representing the Canadian Space Agency (CSA). The primary objective of the STS-97 mission was the delivery, assembly, and activation of the U.S. electrical power system onboard the International Space Station (ISS). The electrical power system, which is built into a 73-meter (240-foot) long solar array structure consists of solar arrays, radiators, batteries, and electronics. The entire 15.4-metric ton (17-ton) package is called the P6 Integrated Truss Segment, and is the heaviest and largest element yet delivered to the station aboard a space shuttle. The electrical system will eventually provide the power necessary for the first ISS crews to live and work in the U.S. segment. The STS-97 crew of five launched aboard the Space Shuttle Orbiter Endeavor on November 30, 2000 for an 11 day mission.

  14. International Space Station (ISS)

    NASA Image and Video Library

    2000-12-07

    In this image, the five STS-97 crew members pose with the 3 members of the Expedition One crew onboard the International Space Station (ISS) for the first ever traditional onboard portrait taken in the Zvezda Service Module. On the front row, left to right, are astronauts Brent W. Jett, Jr., STS-97 commander; William M. Shepherd, Expedition One mission commander; and Joseph R. Tarner, STS-97 mission specialist. On the second row, from the left are Cosmonaut Sergei K. Krikalev, Expedition One flight engineer; astronaut Carlos I. Noriega, STS-97 mission specialist; cosmonaut Yuri P. Gidzenko, Expedition One Soyuz commander; and Michael J. Bloomfield, STS-97 pilot. Behind them is astronaut Marc Garneau, STS-97 mission specialist representing the Canadian Space Agency (CSA). The primary objective of the STS-97 mission was the delivery, assembly, and activation of the U.S. electrical power system onboard the International Space Station (ISS). The electrical power system, which is built into a 73-meter (240-foot) long solar array structure consists of solar arrays, radiators, batteries, and electronics. The entire 15.4-metric ton (17-ton) package is called the P6 Integrated Truss Segment, and is the heaviest and largest element yet delivered to the station aboard a space shuttle. The electrical system will eventually provide the power necessary for the first ISS crews to live and work in the U.S. segment. The STS-97 crew of five launched aboard the Space Shuttle Orbiter Endeavor on November 30, 2000 for an 11 day mission.

  15. Doubling Your Payoff: Winning Pain Relief Engages Endogenous Pain Inhibition1,2,3

    PubMed Central

    Kwan, Saskia; Schweinhardt, Petra

    2015-01-01

    Abstract When in pain, pain relief is much sought after, particularly for individuals with chronic pain. In analogy to augmentation of the hedonic experience (“liking”) of a reward by the motivation to obtain a reward (“wanting”), the seeking of pain relief in a motivated state might increase the experience of pain relief when obtained. We tested this hypothesis in a psychophysical experiment in healthy human subjects, by assessing potential pain-inhibitory effects of pain relief “won” in a wheel of fortune game compared with pain relief without winning, exploiting the fact that the mere chance of winning induces a motivated state. The results show pain-inhibitory effects of pain relief obtained by winning in behaviorally assessed pain perception and ratings of pain intensity. Further, the higher participants scored on the personality trait novelty seeking, the more pain inhibition was induced. These results provide evidence that pain relief, when obtained in a motivated state, engages endogenous pain-inhibitory systems beyond the pain reduction that underlies the relief in the first place. Consequently, such pain relief might be used to improve behavioral pain therapy, inducing a positive, perhaps self-amplifying feedback loop of reduced pain and improved functionality. PMID:26464995

  16. Bilateral experimental neck pain reorganize axioscapular muscle coordination and pain sensitivity.

    PubMed

    Christensen, S W; Hirata, R P; Graven-Nielsen, T

    2017-04-01

    Neck pain is a large clinical problem where reorganized trunk and axioscapular muscle activities have been hypothesised contributing to pain persistence and pain hypersensitivity. This study investigated the effects of bilateral experimental neck pain on trunk and axioscapular muscle function and pain sensitivity. In 25 healthy volunteers, bilateral experimental neck pain was induced in the splenius capitis muscles by hypertonic saline injections. Isotonic saline was used as control. In sitting, subjects performed slow, fast and slow-resisted unilateral arm movements before, during and after injections. Electromyography (EMG) was recorded from eight shoulder and trunk muscles bilaterally. Pressure pain thresholds (PPTs) were assessed bilaterally at the neck, head and arm. Data were normalized to the before-measures. Compared with control and post measurements, experimental neck pain caused (1) decreased EMG activity of the ipsilateral upper trapezius muscles during all but slow-resisted down movements (p < 0.001), and (2) increased EMG activity in the ipsilateral erector spinae muscle during slow and fast movements (p < 0.02), and in the contralateral erector spinae muscle during all but fast up and slow-resisted down movements (p < 0.007). The PPTs in the painful condition increased at the head and arm compared with post measurements and the control condition (p < 0.001). In the post-pain condition, the neck PPT was decreased compared with the control condition (p < 0.001). Acute bilateral neck pain reorganized axioscapular and trunk muscle activity together with local hyperalgesia and widespread hypoalgesia indicating that acute neck pain immediately affects trunk and axioscapular function which may affect both assessment and treatment. Bilateral clinical neck pain alters axioscapular muscle coordination but only effects of unilateral experimental neck pain has been investigated. Bilateral experimental neck pain causes task-dependent reorganized

  17. [Pain therapy in pediatric oncology: pain experience, drugs and pharmacokinetics].

    PubMed

    Mertens, Rolf

    2011-11-01

    Paediatric cancer patients often experience fear and pain from the disease but also in connection with the necessary diagnostic and therapeutic procedures. The treatment of pain is a priority for all patients, especially for critically ill children because of their vulnerability and limited understanding. The experience of pain is always subjective and depends on the age, the pain experience and the environment.In contrast to adults, it is often difficult to detect character of pain, pain intensity and pain localization in very young patients. Diagnostic and therapeutic procedures are performed in analgosedation for a given drug scheme by a pediatrician experienced in intensive care.In addition, a local anesthetic for an access system/lumbar punctures in the form of EMLA® patch is to be carried out. A rapid and effective treatment of pain and appropriate analgesia can prevent patients from being traumatized.For severe pain, malignancy- or chemotherapy-induced (eg. mucositis WHO grade 3 and 4) initial use of strong opiates is recommended instead of climbing the WHO ladder. For strong opiates, there is no maximum dose, as long as a dose increase leads to clinically observable increase in analgesia, without severe side effects. Patient-controlled analgesia with morphine as continuous subcutaneous or intravenous infusions and the possibility of a bolus injection is suited for children aged 6 years. A measurement of O2-saturation is essential during this infusion. Prophylactic approaches also must be used consistently in regard to the acute side effect of opiate treatment. Good experience, we have also made a non-drug therapy, e.g. personnel/physical affection, cuddling, massage, etc.The choice of analgesia depends on the nature and cause of pain. In neuropathic pain or phantom pain coanalgetics should be used to effectively treat pain in young patients. Different analgesic treatment approaches of the appropriate indications and adverse effects are presented. A

  18. How well do clinical pain assessment tools reflect pain in infants?

    PubMed

    Slater, Rebeccah; Cantarella, Anne; Franck, Linda; Meek, Judith; Fitzgerald, Maria

    2008-06-24

    Pain in infancy is poorly understood, and medical staff often have difficulty assessing whether an infant is in pain. Current pain assessment tools rely on behavioural and physiological measures, such as change in facial expression, which may not accurately reflect pain experience. Our ability to measure cortical pain responses in young infants gives us the first opportunity to evaluate pain assessment tools with respect to the sensory input and establish whether the resultant pain scores reflect cortical pain processing. Cortical haemodynamic activity was measured in infants, aged 25-43 wk postmenstrual, using near-infrared spectroscopy following a clinically required heel lance and compared to the magnitude of the premature infant pain profile (PIPP) score in the same infant to the same stimulus (n = 12, 33 test occasions). Overall, there was good correlation between the PIPP score and the level of cortical activity (regression coefficient = 0.72, 95% confidence interval [CI] limits 0.32-1.11, p = 0.001; correlation coefficient = 0.57). Of the different PIPP components, facial expression correlated best with cortical activity (regression coefficient = 1.26, 95% CI limits 0.84-1.67, p < 0.0001; correlation coefficient = 0.74) (n = 12, 33 test occasions). Cortical pain responses were still recorded in some infants who did not display a change in facial expression. While painful stimulation generally evokes parallel cortical and behavioural responses in infants, pain may be processed at the cortical level without producing detectable behavioural changes. As a result, an infant with a low pain score based on behavioural assessment tools alone may not be pain free.

  19. Dental (Odontogenic) Pain

    PubMed Central

    Renton, Tara

    2011-01-01

    This article provides a simple overview of acute trigeminal pain for the non dentist. This article does not cover oral mucosal diseases (vesiculobullous disorders) that may cause acute pain. Dental pain is the most common in this group and it can present in several different ways. Of particular interest for is that dental pain can mimic both trigeminal neuralgia and other chronic trigeminal pain disorders. It is crucial to exclude these disorders whilst managing patients with chronic trigeminal pain. PMID:26527224

  20. Educational achievement and chronic pain disability: mediating role of pain-related cognitions.

    PubMed

    Roth, Randy S; Geisser, Michael E

    2002-01-01

    This study examined the relation between level of educational achievement (LOE) and the clinical morbidity associated with chronic pain. a multidisciplinary pain rehabilitation program located within a university hospital. Two hundred ninety-nine consecutive patients with chronic spinal pain, average age 39.6 years (SD = 10.7) and with an average duration of pain of 41.9 months (SD = 51.6). Age, duration of pain, sex, and compensation and litigation status were controlled for in the statistical analysis because each was found to be significantly associated with LOE. Pain intensity was assessed by the McGill Pain Questionnaire. Affective distress was assessed by the Global Severity Index from the Brief Symptom Inventory. Severity of depressive symptoms was derived from scores from the Center for Epidemiological Studies-Depression Scale. Pain beliefs and pain coping strategies were assessed by the Survey of Pain Attitudes and the Coping Strategies Questionnaire, respectively. Finally, self-report of pain-related disability was assessed by the Pain Disability Index. After controlling for relevant covariates, LOE was unrelated to pain intensity, severity of depressive symptoms, or affective distress, but was inversely related to self-reported disability. Persons with lower LOEs possessed a greater belief that pain is a "signal of harm," unrelated to emotional experience, disabling and uncontrollable. They also endorsed more passive and maladaptive coping strategies, including a tendency to catastrophize about their pain. Path analysis indicated that, after controlling for the influence of both the belief that pain is a "signal of harm" and catastrophizing on the association between LOE and disability, this relation loses statistical significance. These results suggest that pain-related cognitions mediate the relation between LOE and pain disability and that persons with lower LOEs are more likely to develop maladaptive pain beliefs and coping strategies.

  1. Fear of pain in the context of intensive pain rehabilitation among children and adolescents with neuropathic pain: associations with treatment response.

    PubMed

    Simons, Laura E; Kaczynski, Karen J; Conroy, Caitlin; Logan, Deirdre E

    2012-12-01

    Recent research has implicated pain-related fear in relation to functional outcomes in children with chronic pain. The current study examined fear of pain, disability, and depression within the context of an intensive pain rehabilitation program. One hundred forty-five children and adolescents who participated in an intensive interdisciplinary pediatric pain rehabilitation day program were assessed in this study. Patients completed measures of pain intensity, pain-related fears, functional disability, and depressive symptoms at admission, discharge, and on average, 2 months postdischarge. After controlling for pain intensity, pain-related fear was significantly related to disability and depressive symptoms at all time points. As predicted, a decline in pain-related fear was significantly associated with a decrease in disability and depressive symptoms. Interestingly, high levels of pain-related fears at admission predicted less reduction in functional disability and depression at discharge, suggesting that high levels of pain-related fear may be a risk factor in relation to treatment outcomes. Overall, results indicate that the relationship between fear of pain and changes in disability and depressive symptoms are closely linked, with fear of pain playing an important role in treatment. This paper presents results underscoring the importance of pain-related fear in relation to treatment response for children and adolescents with chronic pain. These findings support the need to develop and implement interventions that target reductions in pain-related fear. Copyright © 2012 American Pain Society. Published by Elsevier Inc. All rights reserved.

  2. Pain, emotion, headache.

    PubMed

    Bussone, Gennaro; Grazzi, Licia; Panerai, Alberto E

    2012-10-01

    Pain has been considered as part of a defensive strategy whose specific role is to signal an immediate active danger to the organism. This definition fits well for acute pain. It does not work well, however, for chronic pain that is maintained even in absence of an ongoing, active threat. Currently, acute and chronic pain are considered to be separate conditions. What follows is a review of the different theories about pain and its history. Different hypotheses regarding pain mechanisms are illustrated. New data emerging from scientific research on chronic pain (migraine in particular) involving innovative imaging techniques are reported and discussed. © 2012 American Headache Society.

  3. Exploring the associations shared by mood, pain-related attention and pain outcomes related to sleep disturbance in a chronic pain sample.

    PubMed

    Harrison, Lee; Wilson, Sue; Heron, Jon; Stannard, Catherine; Munafò, Marcus R

    2016-05-01

    Sleep disturbance in chronic pain is common, occurring in two-thirds of patients. There is a complex relationship between chronic pain and sleep; pain can disrupt sleep and poor sleep can exaggerate pain intensity. This may have an impact on both depressive symptoms and attention to pain. This study aims to evaluate the relationship between chronic pain and sleep, and the role of mood and attention. Chronic pain patients, recruited from a secondary care outpatient clinic, completed self-report measures of pain, sleep, depressive symptoms and attention to pain. Hierarchical regression and structural equation modelling were used to explore the relationships between these measures. Participants (n = 221) were aged between 20 and 84 (mean = 52) years. The majority of participants were found to be 'poor sleepers' (86%) with increased pain severity, depressive symptoms and attention to pain. Both analytical approaches indicated that sleep disturbance is indirectly associated with increased pain severity Instead the relationship shared by sleep disturbance and pain severity was further associated with depressive symptoms and attention to pain. Our results indicate that sleep disturbance may contribute to clinical pain severity indirectly though changes in mood and attention. Prospective studies exploring lagged associations between these constructs could have critical information relevant to the treatment of chronic pain.

  4. Do pain-associated contexts increase pain sensitivity? An investigation using virtual reality.

    PubMed

    Harvie, Daniel S; Sterling, Michele; Smith, Ashley D

    2018-04-30

    Pain is not a linear result of nociception, but is dependent on multisensory inputs, psychological factors, and prior experience. Since nociceptive models appear insufficient to explain chronic pain, understanding non-nociceptive contributors is imperative. Several recent models propose that cues associatively linked to painful events might acquire the capacity to augment, or even cause, pain. This experiment aimed to determine whether contexts associated with pain, could modulate mechanical pain thresholds and pain intensity. Forty-eight healthy participants underwent a contextual conditioning procedure, where three neutral virtual reality contexts were paired with either unpredictable noxious stimulation, unpredictable vibrotactile stimulation, or no stimulation. Following the conditioning procedure, mechanical pain thresholds and pain evoked by a test stimulus were examined in each context. In the test phase, the effect of expectancy was equalised across conditions by informing participants when thresholds and painful stimuli would be presented. Contrary to our hypothesis, scenes that were associated with noxious stimulation did not increase mechanical sensitivity (p=0.08), or increase pain intensity (p=0.46). However, an interaction with sex highlighted the possibility that pain-associated contexts may alter pain sensitivity in females but not males (p=0.03). Overall, our data does not support the idea that pain-associated contexts can alter pain sensitivity in healthy asymptomatic individuals. That an effect was shown in females highlights the possibility that some subgroups may be susceptible to such an effect, although the magnitude of the effect may lack real-world significance. If pain-associated cues prove to have a relevant pain augmenting effect, in some subgroups, procedures aimed at extinguishing pain-related associations may have therapeutic potential.

  5. Brain Areas Involved in Anticipation of Clinically Relevant Pain in Low Back Pain Populations With High Levels of Pain Behavior.

    PubMed

    Lloyd, Donna M; Helbig, Torben; Findlay, Gordon; Roberts, Neil; Nurmikko, Turo

    2016-05-01

    The purpose of this study was to identify neural correlates of pain anticipation in people with nonspecific low back pain (NSLBP) that correlated with pain-related distress and disability, thus providing evidence for mechanisms underlying pain behavior in this population. Thirty NSLBP sufferers, with either high levels of pain behavior or low levels on the basis of Waddell signs, were scanned with functional magnetic resonance imaging while a straight-leg raise (of the side deemed to cause moderate pain in the lower back) was performed. On each trial colored stimuli were presented and used to indicate when the leg definitely would be raised (green; 100% certainty), might be raised (yellow; 50% certainty), or would definitely not be raised (red; 100% certainty). In response to expected versus unexpected pain the group difference in activation between patients with high levels of pain behavior and low levels of pain behavior covaried as a function of anxiety scores in the right insula and pregenual anterior cingulate cortex and as a function of catastrophizing in prefrontal and parietal cortex and hippocampus. The results suggest NSLBP populations with the highest levels of pain-related distress are more likely to attend to and infer threat from innocuous cues, which may contribute to the maintenance of pain behavior associated with some chronic pain states. This article shows a likely neural network for exacerbating pain anticipation in NSLBP contributing to high levels of pain behavior in some people. This information could potentially help clinicians and patients to understand how anticipation of pain may contribute to patient pain and disability. Copyright © 2016 American Pain Society. Published by Elsevier Inc. All rights reserved.

  6. Operant conditioning of enhanced pain sensitivity by heat-pain titration.

    PubMed

    Becker, Susanne; Kleinböhl, Dieter; Klossika, Iris; Hölzl, Rupert

    2008-11-15

    Operant conditioning mechanisms have been demonstrated to be important in the development of chronic pain. Most experimental studies have investigated the operant modulation of verbal pain reports with extrinsic reinforcement, such as verbal reinforcement. Whether this reflects actual changes in the subjective experience of the nociceptive stimulus remained unclear. This study replicates and extends our previous demonstration that enhanced pain sensitivity to prolonged heat-pain stimulation could be learned in healthy participants through intrinsic reinforcement (contingent changes in nociceptive input) independent of verbal pain reports. In addition, we examine whether different magnitudes of reinforcement differentially enhance pain sensitivity using an operant heat-pain titration paradigm. It is based on the previously developed non-verbal behavioral discrimination task for the assessment of sensitization, which uses discriminative down- or up-regulation of stimulus temperatures in response to changes in subjective intensity. In operant heat-pain titration, this discriminative behavior and not verbal pain report was contingently reinforced or punished by acute decreases or increases in heat-pain intensity. The magnitude of reinforcement was varied between three groups: low (N1=13), medium (N2=11) and high reinforcement (N3=12). Continuous reinforcement was applied to acquire and train the operant behavior, followed by partial reinforcement to analyze the underlying learning mechanisms. Results demonstrated that sensitization to prolonged heat-pain stimulation was enhanced by operant learning within 1h. The extent of sensitization was directly dependent on the received magnitude of reinforcement. Thus, operant learning mechanisms based on intrinsic reinforcement may provide an explanation for the gradual development of sustained hypersensitivity during pain that is becoming chronic.

  7. Characterization of Arsenic Contamination on Rust from Ton Containers

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Gary S. Groenewold; Recep Avci; Robert V. Fox

    The speciation and spatial distribution of arsenic on rusted steel surfaces affects both measurement and removal approaches. The chemistry of arsenic residing in the rust of ton containers that held the chemical warfare agents bis(2-chloroethyl)sulfide (sulfur mustard) and 2-chlorovinyldichloroarsine (Lewisite) is of particular interest, because while the agents have been decontaminated, residual arsenic could pose a health or environmental risk. The chemistry and distribution of arsenic in rust samples was probed using imaging secondary ion mass spectrometry (SIMS), X-ray photoelectron spectroscopy (XPS), Auger electron spectroscopy, and scanning electron microscopy/energy dispersive X-ray spectroscopy (SEM/EDX). Arsenic in the +3 and or +5more » oxidation state is homogeneously distributed at the very top-most layer of the rust samples, and is intimately associated with iron. Sputter depth profiling followed by SIMS and XPS shows As at a depth of several nm, in some cases in a reduced form. The SEM/EDX experiments show that As is present at a depth of several microns, but is inhomogeneously distributed; most locations contained oxidized As at concentrations of a few percent, however several locations showed very high As in a metallic form. These results indicate that the rust material must be removed if the steel containers are to be cleared of arsenic.« less

  8. Child pain catastrophizing mediates the relation between parent responses to pain and disability in youth with functional abdominal pain.

    PubMed

    Cunningham, Natoshia R; Lynch-Jordan, Anne; Barnett, Kimberly; Peugh, James; Sil, Soumitri; Goldschneider, Kenneth; Kashikar-Zuck, Susmita

    2014-12-01

    Functional abdominal pain (FAP) in youth is associated with substantial impairment in functioning, and prior research has shown that overprotective parent responses can heighten impairment. Little is known about how a range of parental behaviors (overprotection, minimizing, and/or encouragement) in response to their child's pain interact with child coping characteristics (eg, catastrophizing) to influence functioning in youth with FAP. In this study, it was hypothesized that the relation between parenting factors and child disability would be mediated by children's levels of maladaptive coping (ie, pain catastrophizing). Seventy-five patients with FAP presenting to a pediatric pain clinic and their caregivers participated in the study. Youth completed measures of pain intensity (Numeric Rating Scale), pain catastrophizing (Pain Catastrophizing Scale), and disability (Functional Disability Inventory). Caregivers completed measures of parent pain catastrophizing (Pain Catastrophizing Scale), and parent responses to child pain behaviors (Adult Responses to Child Symptoms: Protection, Minimizing, and Encouragement/Monitoring subscales). Increased functional disability was significantly related to higher child pain intensity, increased child and parent pain catastrophizing, and higher levels of encouragement/monitoring and protection. Parent minimization was not related to disability. Child pain catastrophizing fully mediated the relation between parent encouragement/monitoring and disability and partially mediated the relation between parent protectiveness and disability. The impact of parenting behaviors in response to FAP on child disability is determined, in part, by the child's coping style. Findings highlight a more nuanced understanding of the parent-child interaction in determining pain-related disability levels, which should be taken into consideration in assessing and treating youth with FAP.

  9. Can images of pain enhance patient–clinician rapport in pain consultations?

    PubMed Central

    Ashton-James, Claire E; Dekker, Peter H; Addai-Davis, Judy; Chadwick, Tom; Zakrzewska, Joanna M; Padfield, Deborah; Williams, Amanda C de C

    2017-01-01

    A variety of treatment outcomes in chronic pain are influenced by patient–clinician rapport. Patients often report finding it difficult to explain their pain, and this potential obstacle to mutual understanding may impede patient–clinician rapport. Previous research has argued that the communication of both patients and clinicians is facilitated by the use of pain-related images in pain assessments. This study investigated whether introducing pain-related images into pain assessments would strengthen various components of patient–clinician rapport, including relative levels of affiliation and dominance, and interpersonal coordination between patient and clinician behaviour. Videos of 35 pain assessments in which pain images were present or absent were used to code behavioural displays of patient and clinician rapport at fixed intervals across the course of the assessment. Mixed modelling was used to examine patterns of patient and clinician affiliation and dominance with consultation type (Image vs Control) as a moderator. When pain images were present, clinicians showed more affiliation behaviour over the course of the consultation and there was greater correspondence between the affiliation behaviour of patient and clinician. However, relative levels of patient and clinician dominance were unaffected by the presence of pain images in consultations. Additional analyses revealed that clinicians responded directly to patients’ use of pain images with displays of affiliation. Based on the results of this study, we recommend further investigation into the utility and feasibility of incorporating pain images into pain assessments to enhance patient–clinician communication. PMID:28785410

  10. Pain

    MedlinePlus

    ... NCCIH Researchers Describe Specialized Neurons That Play a Unique Role in Mechanical Pain ( August 16, 2017 ) ... Funding for Pain Initiatives Current Funding Opportunities Research on the Impact of Creative Arts in Military ...

  11. Adult Cancer Pain

    PubMed Central

    Swarm, Robert A.; Abernethy, Amy Pickar; Anghelescu, Doralina L.; Benedetti, Costantino; Buga, Sorin; Cleeland, Charles; deLeon-Casasola, Oscar A.; Eilers, June G.; Ferrell, Betty; Green, Mark; Janjan, Nora A.; Kamdar, Mihir M.; Levy, Michael H.; Lynch, Maureen; McDowell, Rachel M.; Moryl, Natalie; Nesbit, Suzanne A.; Paice, Judith A.; Rabow, Michael W.; Syrjala, Karen L.; Urba, Susan G.; Weinstein, Sharon M.; Dwyer, Mary; Kumar, Rashmi

    2018-01-01

    Pain is a common symptom associated with cancer and its treatment. Pain management is an important aspect of oncologic care, and unrelieved pain significantly comprises overall quality of life. These NCCN Guidelines list the principles of management and acknowledge the range of complex decisions faced in the management oncologic pain. In addition to pain assessment techniques, these guidelines provide principles of use, dosing, management of adverse effects, and safe handling procedures of pharmacologic therapies and discuss a multidisciplinary approach for the management of cancer pain. PMID:23946177

  12. Pain in thalassaemia: the effects of age on pain frequency and severity.

    PubMed

    Haines, Dru; Martin, Marie; Carson, Susan; Oliveros, Olivia; Green, Sage; Coates, Thomas; Eile, Jennifer; Schilling, Leann; Dinu, Bogan; Mendoza, Tito; Gerstenberger, Eric; Trachtenberg, Felicia; Vichinsky, Elliott

    2013-03-01

    Pain is not a symptom generally associated with thalassaemia. However, providers have noted increasing patient reports of pain, creating an impetus for this prospective, observational assessment of pain in thalassaemia patients. The primary study goals were to assess pain prevalence, severity, location, and potential risk factors. This was a multicentre, prospective study of thalassaemia patients receiving care at 12 Thalassaemia Clinical Research Network sites. Pain was assessed using the Brief Pain Inventory. Two hundred and fifty-two thalassaemia patients ranging in age from 12 to 71 years (mean 28.8) were enrolled. Sixty-four per cent reported experiencing pain during the last 4 weeks, 22% of whom reported pain on a daily basis. Ordinal regression analysis of pain ratings demonstrated significant (P < 0.001) correlation of increased age with increased pain, irrespective of diagnosis, transfusion status, gender, bone density, chelator type or iron overload. Eighty-one per cent reported having pain for 1 year or longer and 31% reported pain for five or more years. Pain is a major cause of morbidity and an unrecognized problem for patients with thalassaemia. Age is the strongest predictor of frequency and severity. Little else is known about the aetiology and predictors of this pain syndrome. © 2012 Blackwell Publishing Ltd.

  13. [Mechanism of pain sensation].

    PubMed

    Gyulaházi, Judit

    2009-11-15

    Pain, as subjective content of consciousness, is an essential attention-calling sign that helps to survive. Pain relieve is obligatory for every physician, thus, its individual appearance can make the analgesia difficult to carry out. The improving neuroimaging techniques allow understanding the development of pain sensation. Through the 24 articles on the PubMed found with keywords 'pain' and 'neuroimaging', we review here the parts of the pain neuron matrix, their tasks and the assumed mechanism of the acute pain sensation. The mechanism of the individual pain sensation is illustrated by the view of the modular function of the medial part of the pain matrix. Experimental results of empathic pain suggest that pain sensation may occur without real damage of the tissues, as well. The pain network plays main role in chronic pain.

  14. The ACTTION-American Pain Society Pain Taxonomy (AAPT): an evidence-based and multidimensional approach to classifying chronic pain conditions.

    PubMed

    Fillingim, Roger B; Bruehl, Stephen; Dworkin, Robert H; Dworkin, Samuel F; Loeser, John D; Turk, Dennis C; Widerstrom-Noga, Eva; Arnold, Lesley; Bennett, Robert; Edwards, Robert R; Freeman, Roy; Gewandter, Jennifer; Hertz, Sharon; Hochberg, Marc; Krane, Elliot; Mantyh, Patrick W; Markman, John; Neogi, Tuhina; Ohrbach, Richard; Paice, Judith A; Porreca, Frank; Rappaport, Bob A; Smith, Shannon M; Smith, Thomas J; Sullivan, Mark D; Verne, G Nicholas; Wasan, Ajay D; Wesselmann, Ursula

    2014-03-01

    Current approaches to classification of chronic pain conditions suffer from the absence of a systematically implemented and evidence-based taxonomy. Moreover, existing diagnostic approaches typically fail to incorporate available knowledge regarding the biopsychosocial mechanisms contributing to pain conditions. To address these gaps, the Analgesic, Anesthetic, and Addiction Clinical Trial Translations Innovations Opportunities and Networks (ACTTION) public-private partnership with the U.S. Food and Drug Administration and the American Pain Society (APS) have joined together to develop an evidence-based chronic pain classification system called the ACTTION-APS Pain Taxonomy. This paper describes the outcome of an ACTTION-APS consensus meeting, at which experts agreed on a structure for this new taxonomy of chronic pain conditions. Several major issues around which discussion revolved are presented and summarized, and the structure of the taxonomy is presented. ACTTION-APS Pain Taxonomy will include the following dimensions: 1) core diagnostic criteria; 2) common features; 3) common medical comorbidities; 4) neurobiological, psychosocial, and functional consequences; and 5) putative neurobiological and psychosocial mechanisms, risk factors, and protective factors. In coming months, expert working groups will apply this taxonomy to clusters of chronic pain conditions, thereby developing a set of diagnostic criteria that have been consistently and systematically implemented across nearly all common chronic pain conditions. It is anticipated that the availability of this evidence-based and mechanistic approach to pain classification will be of substantial benefit to chronic pain research and treatment. The ACTTION-APS Pain Taxonomy is an evidence-based chronic pain classification system designed to classify chronic pain along the following dimensions: 1) core diagnostic criteria; 2) common features; 3) common medical comorbidities; 4) neurobiological, psychosocial

  15. Analyzing musculoskeletal neck pain, measured as present pain and periods of pain, with three different regression models: a cohort study

    PubMed Central

    Grimby-Ekman, Anna; Andersson, Eva M; Hagberg, Mats

    2009-01-01

    Background In the literature there are discussions on the choice of outcome and the need for more longitudinal studies of musculoskeletal disorders. The general aim of this longitudinal study was to analyze musculoskeletal neck pain, in a group of young adults. Specific aims were to determine whether psychosocial factors, computer use, high work/study demands, and lifestyle are long-term or short-term factors for musculoskeletal neck pain, and whether these factors are important for developing or ongoing musculoskeletal neck pain. Methods Three regression models were used to analyze the different outcomes. Pain at present was analyzed with a marginal logistic model, for number of years with pain a Poisson regression model was used and for developing and ongoing pain a logistic model was used. Presented results are odds ratios and proportion ratios (logistic models) and rate ratios (Poisson model). The material consisted of web-based questionnaires answered by 1204 Swedish university students from a prospective cohort recruited in 2002. Results Perceived stress was a risk factor for pain at present (PR = 1.6), for developing pain (PR = 1.7) and for number of years with pain (RR = 1.3). High work/study demands was associated with pain at present (PR = 1.6); and with number of years with pain when the demands negatively affect home life (RR = 1.3). Computer use pattern (number of times/week with a computer session ≥ 4 h, without break) was a risk factor for developing pain (PR = 1.7), but also associated with pain at present (PR = 1.4) and number of years with pain (RR = 1.2). Among life style factors smoking (PR = 1.8) was found to be associated to pain at present. The difference between men and women in prevalence of musculoskeletal pain was confirmed in this study. It was smallest for the outcome ongoing pain (PR = 1.4) compared to pain at present (PR = 2.4) and developing pain (PR = 2.5). Conclusion By using different regression models different aspects of neck

  16. Analyzing musculoskeletal neck pain, measured as present pain and periods of pain, with three different regression models: a cohort study.

    PubMed

    Grimby-Ekman, Anna; Andersson, Eva M; Hagberg, Mats

    2009-06-19

    In the literature there are discussions on the choice of outcome and the need for more longitudinal studies of musculoskeletal disorders. The general aim of this longitudinal study was to analyze musculoskeletal neck pain, in a group of young adults. Specific aims were to determine whether psychosocial factors, computer use, high work/study demands, and lifestyle are long-term or short-term factors for musculoskeletal neck pain, and whether these factors are important for developing or ongoing musculoskeletal neck pain. Three regression models were used to analyze the different outcomes. Pain at present was analyzed with a marginal logistic model, for number of years with pain a Poisson regression model was used and for developing and ongoing pain a logistic model was used. Presented results are odds ratios and proportion ratios (logistic models) and rate ratios (Poisson model). The material consisted of web-based questionnaires answered by 1204 Swedish university students from a prospective cohort recruited in 2002. Perceived stress was a risk factor for pain at present (PR = 1.6), for developing pain (PR = 1.7) and for number of years with pain (RR = 1.3). High work/study demands was associated with pain at present (PR = 1.6); and with number of years with pain when the demands negatively affect home life (RR = 1.3). Computer use pattern (number of times/week with a computer session > or = 4 h, without break) was a risk factor for developing pain (PR = 1.7), but also associated with pain at present (PR = 1.4) and number of years with pain (RR = 1.2). Among life style factors smoking (PR = 1.8) was found to be associated to pain at present. The difference between men and women in prevalence of musculoskeletal pain was confirmed in this study. It was smallest for the outcome ongoing pain (PR = 1.4) compared to pain at present (PR = 2.4) and developing pain (PR = 2.5). By using different regression models different aspects of neck pain pattern could be addressed and

  17. A closer look: Alternative pain management practices by heart failure patients with chronic pain.

    PubMed

    McDonald, Deborah Dillon; Soutar, Christina; Chan, Maria Agudelo; Afriyie, Angela

    2015-01-01

    To describe alternative non-pharmaceutical non-nutraceutical pain self-management strategies used by people with heart failure (HF) in order to reduce chronic non-cardiac pain. Little is known about alternative pain self-treatments used by HF patients with chronic pain. A cross-sectional descriptive design was used with 25 hospitalized HF patients who had chronic pain and used at least one alternative pain treatment. Pain intensity, pain interference with function, and current pain treatments were measured with the Brief Pain Inventory. Alternative treatments included walking, stretching, use of heat and cold. Five patients used evidence-based pain treatments for their chronic pain conditions. Patients reported moderate pain intensity and pain interference with activity. Patients with HF and chronic pain use few alternative pain treatments. Screening for chronic pain and referral to Integrative Medicine and/or Palliative care for a pain management consult might reduce the added burden of pain in people with HF. Copyright © 2015 Elsevier Inc. All rights reserved.

  18. Low back pain - chronic

    MedlinePlus

    Nonspecific back pain; Backache - chronic; Lumbar pain - chronic; Pain - back - chronic; Chronic back pain - low ... Low back pain is common. Almost everyone has back pain at some time in their life. Often, the exact cause of ...

  19. Happiness, Pain Intensity, Pain Interference, and Distress in Individuals with Physical Disabilities.

    PubMed

    Müller, Rachel; Terrill, Alexandra L; Jensen, Mark P; Molton, Ivan R; Ravesloot, Craig; Ipsen, Catherine

    2015-12-01

    The aim of this study was to examine how the construct of happiness is related to pain intensity, pain interference, and distress in individuals with physical disabilities. This study involves cross-sectional analyses of 471 individuals with a variety of health conditions reporting at least mild pain. The first hypothesis that happiness mediates the relationship between pain intensity and two outcomes, pain interference and distress, was not supported. The second hypothesis was supported by a good fitting model (χ2(10) = 12.83, P = 0.23, root-mean-square error of approximation = 0.025) and indicated that pain intensity significantly mediated the effect of happiness on pain interference (indirect effect: β = -0.13, P < 0.001) and on distress (indirect effect: β = 0.10, P = 0.01). Happiness showed a significant direct effect on pain intensity (β = -0.20, P < 0.001). A third model exploring the happiness components meaning, pleasure, and engagement fitted well (χ2(4) = 9.65, P = 0.05, root-mean-square error of approximation = 0.055). Pain intensity acted as a significant mediator but only mediated the effect of meaning on pain interference (indirect effect: β = -0.07, P = 0.05) and on distress (indirect effect via pain interference: β = -0.04, P = 0.05). Only meaning (β = -0.10, P = 0.05), but neither pleasure nor engagement, had a significant direct effect on pain intensity. Participants who reported greater happiness reported lower pain interference and distress through happiness' effects on pain intensity. Experiencing meaning and purpose in life seems to be most closely (and negatively) associated with pain intensity, pain interference, and distress. Findings from this study can lay the groundwork for intervention studies to better understand how to more effectively decrease pain intensity, pain interference, and distress.

  20. Pain cognition versus pain intensity in patients with endometriosis: toward personalized treatment.

    PubMed

    van Aken, Mieke A W; Oosterman, Joukje M; van Rijn, C M; Ferdek, Magdalena A; Ruigt, Gé S F; Peeters, B W M M; Braat, Didi D M; Nap, Annemiek W

    2017-10-01

    To explore how pain intensity and pain cognition are related to health-related quality of life (HRQoL) in women with endometriosis. Cross-sectional questionnaire-based survey. Multidisciplinary referral center. Women with laparoscopically and/or magnetic resonance imaging-proven endometriosis (n = 50) and healthy control women (n = 42). For HRQoL, two questionnaires: the generic Short Form Health Survey (SF-36) and the Endometriosis Health Profile 30 (EHP-30). For pain cognition, three questionnaires: the Pain Catastrophizing Scale (PCS), the Pain Vigilance and Awareness Questionnaire (PVAQ), and the Pain Anxiety Symptoms Scale (PASS). For pain intensity, the verbal Numeric Rating Scale (NRS). Association between pain intensity and pain cognition with HRQoL in women with endometriosis, and the differences in HRQoL and pain cognition between women with endometriosis and healthy controls. Health-related quality of life was statistically significantly impaired in women with endometriosis as compared with healthy control women. The variables of pain intensity and pain cognition were independent factors influencing the HRQoL of women with endometriosis. Patients with endometriosis had statistically significantly more negative pain cognition as compared with controls. They reported more pain anxiety and catastrophizing, and they were hypervigilant toward pain. Pain cognition is independently associated with the HRQoL in endometriosis patients. Clinicians should be aware of this phenomenon and may consider treating pain symptoms in a multidimensional, individualized way in which the psychological aspects are taken into account. In international guidelines on management of women with endometriosis more attention should be paid to the psychological aspects of care. Copyright © 2017 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  1. Child pain catastrophizing mediates the relationship between parent responses to pain and disability in youth with functional abdominal pain

    PubMed Central

    Cunningham, Natoshia Raishevich; Lynch-Jordan, Anne; Barnett, Kimberly; Peugh, James; Sil, Soumitri; Goldschneider, Kenneth; Kashikar-Zuck, Susmita

    2014-01-01

    Objectives Functional abdominal pain (FAP) in youth is associated with substantial impairment in functioning and prior research has shown that overprotective parent responses can heighten impairment. Little is known about how a range of parental behaviors in response to their child’s pain (overprotection, minimizing and/or encouragement) interact with child coping characteristics (e.g., catastrophizing) to influence functioning in youth with FAP. In this study, it was hypothesized that the relationship between parenting factors and child disability would be mediated by children’s level of maladaptive coping (i.e., pain catastrophizing). Methods Seventy-five patients with FAP presenting to a pediatric pain clinic and their caregivers participated. Youth completed measures of pain intensity (Numeric Rating Scale), pain catastrophizing (Pain Catastrophizing Scale), and disability (Functional Disability Inventory). Caregivers completed measures of parent pain catastrophizing (Pain Catastrophizing Scale), and parent responses to child pain behaviors (Adult Responses to Child Symptoms: protection, minimizing, and encouragement/monitoring subscales). Results Increased functional disability was significantly related to higher child pain intensity, increased child and parent pain catastrophizing, and higher levels of encouragement/monitoring and protection. Parent minimization was not related to disability. Child pain catastrophizing fully mediated the relationship between parent encouragement/monitoring and disability and partially mediated the relationship between parent protectiveness and disability. Conclusions The impact of parenting behaviors in response to FAP on child disability is determined in part by the child’s coping style. Findings highlight a more nuanced understanding of the parent-child interaction in determining pain-related disability levels, which should be taken into consideration in assessing and treating youth with FAP. PMID:25121521

  2. Reconsidering the International Association for the Study of Pain definition of pain.

    PubMed

    Cohen, Milton; Quintner, John; van Rysewyk, Simon

    2018-03-01

    The definition of pain promulgated by the International Association for the Study of Pain (IASP) is widely accepted as a pragmatic characterisation of that human experience. Although the Notes that accompany it characterise pain as "always subjective," the IASP definition itself fails to sufficiently integrate phenomenological aspects of pain. This essay reviews the historical development of the IASP definition, and the commentaries and suggested modifications to it over almost 40 years. Common factors of pain experience identified in phenomenological studies are described, together with theoretical insights from philosophy and biology. A fuller understanding of the pain experience and of the clinical care of those experiencing pain is achievable through greater attention to the phenomenology of pain, the social "intersubjective space" in which pain occurs, and the limitations of language. Based on these results, a revised definition of pain is offered: Pain is a mutually recognizable somatic experience that reflects a person's apprehension of threat to their bodily or existential integrity.

  3. Epidemiology of chronic pain in the office of a pain specialist neurologist.

    PubMed

    Ferreira, Karen dos Santos; Speciali, José Geraldo

    2015-07-01

    The objective of the present report was to describe the working experience of a pain specialist neurologist after concluding a medical residency program on neurology, area of concentration pain. A retrospective study was conducted for one year in the office of a pain specialist neurologist. Patients older than 18 years with chronic pain according to the criteria of the International Association for the Study of Pain, were included. Demographic data, chronic pain data and the treatments instituted were investigated. A total of 241 medical records were reviewed, mean patient age was 52.4 years and 79 (66.9%) were women, and the mean score on a numeric pain scale was 8.69. The diagnoses were headaches (74.6%), neuropathic pain (17%) and ostheomuscular pain (8.2%). We did not detect cancer pain. Patients received medication and procedures of anesthetic blockade. This data can guide new medical residency programs on Neurology, area of concentration pain, to plan activities and studies.

  4. Children's pain perspectives.

    PubMed

    Esteve, R; Marquina-Aponte, V

    2012-05-01

    Previous studies on children's pain perspectives remain limited to English-speaking populations. An exploratory cross-sectional descriptive design was used to investigate the developmental progression of children's pain perspectives, including their pain experience, its definition and attributes, causality and coping. The Children's Pain Perspectives Inventory was applied to 180 healthy Spanish children. A coding system was developed following the content analysis method. Three age groups were compared: 4-6 years, corresponding to the Piagetian pre-operational stage of cognitive development; 7-11 years, corresponding to stage of concrete operations; and 12-14 years, corresponding to the period of early formal operations. In children between 4 and 6, the predominant narratives related to physical injuries, the notion of causality and the definition of pain. In children between 7 and 11, the predominant narratives were those in which pain was described as a sensation in one part of the body. The view of pain as having an emotional basis significantly increased with age and was more frequent in adolescents. In contrast, children between 4-6 and 7-11 indicated that pain occurs spontaneously. The denial of any positive aspects of pain significantly decreased with age; some children between 7 and 11 referred to the 'possibility of relief', while the view that pain is a 'learning experience' was significantly more frequent among adolescents aged between 12 and 14 years. The use of cognitive strategies to control pain significantly increased with age. Between 12 and 14 years of age, adolescents communicate pain by non-verbal behaviour and reported that they do not express demands for relief. There was a progression from concrete to more complex notions of pain as age increased. These results may be of use to health professionals and parents to understand how children at various developmental stages express and cope with pain and to develop tools that effectively assess and

  5. Patellofemoral Pain.

    PubMed

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

    2016-02-01

    Patellofemoral pain is characterized by insidious onset anterior knee pain that is exaggerated under conditions of increased patellofemoral joint stress. A variety of risk factors may contribute to the development of patellofemoral pain. It is critical that the history and physical examination elucidate those risk factors specific to an individual in order to prescribe an appropriate and customized treatment plan. This article aims to review the epidemiology, risk factors, diagnosis, and management of patellofemoral pain. Copyright © 2016 Elsevier Inc. All rights reserved.

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

    PubMed Central

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

    2017-01-01

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

  7. Adjustment to chronic pain in back pain patients classified according to the motivational stages of chronic pain management.

    PubMed

    Zenker, Stefanie; Petraschka, Michael; Schenk, Michael; Reisshauer, Anett; Newie, Tanja; Hermanns, Kai; Wernecke, Klaus-Dieter; Spies, Claudia

    2006-06-01

    According to Prochaska's transtheoretical model, the Freiburg Questionnaire stages of chronic pain management (FQ-STAPM) were used to classify chronic back patients into 4 distinct motivational stages. The FQ-STAMP was completed by 163 chronic back pain patients. Pain chronicity was measured by the Mainz Pain Staging System; pain intensity was measured by the numeric rating scale. Healthcare system expenses were considered as number of consulted physicians, number of stays in hospital, and number of rehabilitation programs. As psychometric tests, the lower pain disability index (PDI), the Hospital Anxiety and Depression Scale (HADS), and a quality of life score (SF36) were used. Patients were in the following motivational stages: precontemplation in 30%, preparation in 19%, action in 30%, maintenance in 21%. The intensity of pain in the precontemplation stage patients was significantly higher compared to patients in the maintenance stage. A lower pain chronicity was related to a significantly higher motivation. Moreover, there was a significant increase in healthcare system expenses by the lesser motivated patients. Patients in the maintenance stage used significantly less opioids than patients in the precontemplation stage. The higher motivated patients had a significantly lower PDI, a significantly lower HADS, and a significantly higher quality of life compared to less motivated patients. The study indicates that the FQ-STAPM might be a useful tool to classify chronic back pain patients and to work out a strategy together with the patient relevant to the outcome of pain management among chronic back pain patients.

  8. Children in pain: recurrent back pain, abdominal pain, and headache in children and adolescents in a four-year-period.

    PubMed

    van Gessel, Hester; Gassmann, Jennifer; Kröner-Herwig, Birgit

    2011-06-01

    To analyze the development of recurrent pain in 3 body locations in children and adolescents (baseline age, 9 to 14 years) in a 4-year period. In a large population-based longitudinal epidemiological study data was collected through annual postal questionnaires (longitudinal, n = 2025). Descriptive statistics and generalized estimating equations were used. Girls were more likely to report recurrent pain, demonstrated a steeper development during the 4-year period, and reported multiple pain more often than boys. Younger children reported less recurrent pain, but displayed a steeper trend of increasing prevalence rates as they grew older. Older children illustrated a more stable development of recurrent pain and reported multiple pain more often. Disability experienced because of recurrent pain was related strongest to pain intensity. Stable patterns of pain were related to higher intensity and disability reports. The children experienced headache as the most disabling of the 3 pains. The results show that boys and girls report recurrent pain in different patterns in the years. To identify risk factors, analysis should be performed separately for boys and girls. Furthermore, it is recommended to include children before the age of 9 years in a prevention study. Copyright © 2011 Mosby, Inc. All rights reserved.

  9. Forward head posture is associated with pressure pain threshold and neck pain duration in university students with subclinical neck pain.

    PubMed

    Pacheco, Joana; Raimundo, João; Santos, Filipe; Ferreira, Mário; Lopes, Tiago; Ramos, Luis; Silva, Anabela G

    2018-06-08

    The aims of this study are to investigate the association between: (i) forward head posture (FHP) and pressure pain thresholds (PPTs); (ii) FHP and maladaptive cognitive processes; and (iii) FHP and neck pain characteristics in university students with subclinical neck pain. A total of 140 university students, 90 asymptomatic and 50 with subclinical neck pain, entered the study. Demographic data, anthropometric data, FHP, and PPTs were collected for both groups. In addition, pain characteristics, pain catastrophizing, and fear of movement were assessed for participants with neck pain. FHP was characterized by the angle between C7, the tragus of the ear, and the horizontal line. Correlation analysis and multivariate regression analysis were conducted. Participants with subclinical neck pain showed significantly lower PPTs than participants without neck pain (p < .05), but similar FHP (p > .05). No significant association was found between FHP and PPTs in the asymptomatic group. In the group of participants with subclinical neck pain, PPTs at the right trapezius and neck pain duration explained 19% of the variance of FHP (R 2  = 0.23; adjusted R 2  = 0.19; p < .05). This study suggests that FHP is not associated with PPTs in asymptomatic university students. In university students with subclinical neck pain, increased FHP was associated with right trapezius hypoalgesia and with neck pain of shorter duration. These findings are in contrast with current assumptions on the association between neck pain and FHP.

  10. Measuring pain in patients undergoing hemodialysis: a review of pain assessment tools

    PubMed Central

    Upadhyay, Chandani; Cameron, Karen; Murphy, Laura; Battistella, Marisa

    2014-01-01

    Background Patients undergoing hemodialysis frequently report pain with multifactorial causes, not limited to that experienced directly from hemodialysis treatment. Their pain may be nociceptive, neuropathic, somatic or visceral in nature. Despite this, pain in this population remains under-recognized and under-treated. Although several tools have been used to measure pain in patients undergoing hemodialysis as reported in the literature, none of them have been validated specifically in this population. The objective for this review was to compare and contrast these pain assessment tools and discuss their clinical utility in this patient population. Methods To identify pain assessment tools studied in patients undergoing hemodialysis, a literature search was performed in PubMed and Medline. An expert panel of dialysis and pain clinicians reviewed each tool. Each pain assessment tool was assessed on how it is administered and scored, its psychometric properties such as reliability, validity and responsiveness to change, and its clinical utility in a hemodialysis population. Brief Pain Inventory, McGill Pain Questionnaire, Pain Management Index, Edmonton Symptom Assessment System, Visual Analogue Scale and Faces Pain Scale were evaluated and compared. Results This assessment will help clinicians practicing in nephrology to determine which of these pain assessment tools is best suited for use in their individual clinical practice. PMID:25852910

  11. [Patient careers in the orthopedic pain treatment. Sociological studies on pain behavior].

    PubMed

    Göckenjan, G; Dreßke, S; Pfankuch, O

    2013-09-01

    Based on case histories the following study raises the question why some pain patients remain permanently on the path of specialist pain treatment after initial treatment whereas other patients with similar pain reports do not. In this study 134 qualitative interviews were conducted in order to research patient career paths. The study population included patients with back pain recruited from different orthopedic care settings and included persons with back pain from a general population not involved in specialized pain treatment. Patient career paths within medical care settings are effective in socializing and transforming the subjects. In the course of medical treatment patients learn their rights and obligations and subsequently acquire habits of typical pain behavior both in medical and domestic arrangements. Patients learn to formulate and preserve their interests and learn to align the different expectations which results in increasing identification with the career path. Conceptions of pain and pain behavior are formed in the course of patient careers while this is not necessarily a conscious or reflected process. As an unintended consequence it evolves into pain acting within the patient that integrates patients into distinct care milieus and holds them tight in the respective pain care. In these cases pain patients and their doctors fall so to say into a pain trap.

  12. From acute to chronic postsurgical pain: the significance of the acute pain response.

    PubMed

    Blichfeldt-Eckhardt, Morten Rune

    2018-03-01

    The thesis comprises an overview and four papers, all published or submitted for publication in international peer-reviewed scientific journals.
 
Chronic pain after surgery is a common and debilitating complication after many types of surgery. The cause and pathology behind is still mainly uncovered, though several risk factors have been proposed. One of the strongest risk factors for persistent postsurgical pain is the intensity of the acute pain response though the mechanisms involved remain unsettled. The acute pain response consists of several different types of pain (i.e. somatic pain, visceral pain, referred pain, neuropathic pain). It's uncovered whether some components of the acute pain response are closer correlated to chronic pain than others and whether treatment of acute pain can change the risk of developing chronic pain.
 The aim of the thesis was to investigate which components of the acute pain response, was correlated to chronic postsurgical pain in patients for cholecystectomy and lobectomy.
 Furthermore, to study the type and time course of ipsilateral shoulder pain after lobectomy and whether an ultrasound-guided supraclavicular phrenic nerve block was effective in preventing acute and chronic shoulder pain after major thoracic surgery.
 Paper I is based on a prospective, observational, multicenter, cohort study, in which 100 patients for cholecystectomy was examined preoperatively, 1 week postoperatively and 3, 6, and 12 months postoperatively for pain, psychological factors and signs of hypersensitivity.
 Paper II and III are based on a prospective, observational, cohort study, in which 60 patients for lobectomy ware examined preoperatively, 4 days postoperatively and 12 months postoperatively for pain, psychological factors and signs of hypersensitivity. 
Paper IV is based on a prospective, randomized, double-blind and placebo-controlled trial, where 76 patients were randomized to receive ultrasound guided supraclavicular

  13. Pain in general practice. Pain as a cause of patient-doctor contact.

    PubMed

    Frølund, F; Frølund, C

    1986-05-01

    In 1983 26 general practitioners in a Danish provincial town made a week's survey of pain as the main cause of patient-doctor contact during the day time. The population served was 45 000-50 000 persons of all ages. Coexistent pain which was not the cause of actual contact was not recorded. Out of 2 886 contacts of all causes 641 were due to pain (22% or 222/1 000 contacts). Percentages for acute and chronic pain were 61 and 39 respectively. The commonest causes of pain were musculo-skeletal (50%), visceral including cardio-vascular (20%), infectious (15%), and headaches (8%). The overall female: male ratio was 1.5: 1, but with considerable variation within the different pain categories. The ratios for acute and chronic pain were 1.4: 1 and 1.8: 1 respectively. About one hundred contacts were recorded as "problem cases" whose predominant complaints were low back pain, headaches, and visceral pain. Pain--especially chronic pain with a non-malignant cause--is a major problem in general practice. Essentially, pain is a primary health care problem and research in this field should be encouraged.

  14. Pain. Part 2a: Trigeminal Anatomy Related to Pain.

    PubMed

    Renton, Tara; Egbuniwe, Obi

    2015-04-01

    In order to understand the underlying principles of orofacial pain it is important to understand the corresponding anatomy and mechanisms. Paper 1 of this series explains the central nervous and peripheral nervous systems relating to pain. The trigeminal nerve is the 'great protector' of the most important region of our body. It is the largest sensory nerve of the body and over half of the sensory cortex is responsive to any stimulation within this system. This nerve is the main sensory system of the branchial arches and underpins the protection of the brain, sight, smell, airway, hearing and taste, underpinning our very existence. The brain reaction to pain within the trigeminal system has a significant and larger reaction to the threat of, and actual, pain compared with other sensory nerves. We are physiologically wired to run when threatened with pain in the trigeminal region and it is a 'miracle' that patients volunteer to sit in a dental chair and undergo dental treatment. Clinical Relevance: This paper aims to provide the dental and medical teams with a review of the trigeminal anatomy of pain and the principles of pain assessment.

  15. Relationship of musculoskeletal pain and well-being at work - Does pain matter?

    PubMed

    Malmberg-Ceder, Kirsi; Haanpää, Maija; Korhonen, Päivi E; Kautiainen, Hannu; Soinila, Seppo

    2017-04-01

    Musculoskeletal pain is a common symptom and many people even with chronic pain continue to work. The aim of our study is to analyze how musculoskeletal pain affects work well-being by comparing work engagement in employees with or without pain, and how pain-related risk of disability is associated with work engagement. In a separate analysis, we also studied, how psychosocial factors are related to work engagement. This is a cross-sectional study of Finnish female employees of the city of Pori, Finland (PORi To Aid Against Threats (PORTAAT) study). Data was collected by trained study nurses and self-administrated questionnaires. Work well-being was measured by work engagement using Utrecht Work Engagement Scale (UWES-9) questionnaire and the burden of pain was measured by using the short version of Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ). Study population was divided into four groups: those without pain and the groups with low (I), medium (II) or high (III) ÖMPSQ score, reflecting increasing risk of long term disability due to musculoskeletal pain. The study nurse assessed psychosocial risk factors using defined core questions. We evaluated 702 female employees, 601 (86%) had suffered from musculoskeletal pain over the past 12 months, whereas 101 (14%) reported no pain at all. Pain was chronic (duration at least 3 months) in 465/601 (77%) subjects. Subjects with musculoskeletal pain were older, had higher BMI and were on sick leave more often than subjects without pain. Of the psychosocial risk factors, depression, type D personality, anxiety and hostility were significantly more common among subjects with musculoskeletal pain. Hypertension and the use of non-steroidal anti-inflammatory drugs were significantly more frequent in the musculoskeletal pain group. Quality of sleep and working capability were significantly better among persons without pain. Average weekly working hours were slightly higher among those with musculoskeletal pain. In

  16. Physical, lifestyle, psychological, and social determinants of pain intensity, pain disability, and the number of pain locations in depressed older adults.

    PubMed

    Hanssen, Denise J C; Naarding, Paul; Collard, Rose M; Comijs, Hannie C; Oude Voshaar, Richard C

    2014-10-01

    Late-life depression and pain more often co-occur than can be explained by chance. Determinants of pain in late-life depression are unknown, even though knowledge on possible determinants of pain in depression is important for clinical practice. Therefore, the objectives of the present study were 1) to describe pain characteristics of depressed older adults and a nondepressed comparison group, and 2) to explore physical, lifestyle, psychological, and social determinants of acute and chronic pain intensity, disability, and multisite pain in depressed older adults. Data from the Netherlands Study of Depression in Older Persons cohort, consisting of 378 depressed persons, diagnosed according to Diagnostic and Statistical Manual of Mental Disorders, 4th edition criteria, and 132 nondepressed persons aged 60 years and older, were used in a cross-sectional design. Pain characteristics were measured by the Chronic Graded Pain Scale. Multiple linear regression analyses were performed to explore the contribution of physical, lifestyle, psychological, and social determinants to outcomes pain intensity, disability, and the number of pain locations. Depressed older adults more often reported chronic pain and experienced their pain as more intense and disabling compared to nondepressed older adults. Adjusted for demographic, physical, and lifestyle characteristics, multinomial logistic regression analyses showed increased odds ratios (OR) for depression in acute pain (OR 3.010; P=0.005) and chronic pain (OR 4.544, P<0.001). In addition, linear regression analyses showed that acute and chronic pain intensity, disability, and multisite pain were associated with several biopsychosocial determinants, of which anxiety was most pronounced. Further research could focus on the temporal relationship between anxiety, late-life depression, and pain. Copyright © 2014 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

  17. Bedside Testing for Chronic Pelvic Pain: Discriminating Visceral from Somatic Pain

    PubMed Central

    Jarrell, John; Giamberardino, Maria Adele; Robert, Magali; Nasr-Esfahani, Maryam

    2011-01-01

    Objectives. This study was done to evaluate three bedside tests in discriminating visceral pain from somatic pain among women with chronic pelvic pain. Study Design. The study was an exploratory cross-sectional evaluation of 81 women with chronic pelvic pain of 6 or more months' duration. Tests included abdominal cutaneous allodynia (aCA), perineal cutaneous allodynia (pCA), abdominal and perineal myofascial trigger points (aMFTP) and (pMFTP), and reduced pain thresholds (RPTs). Results. Eighty-one women were recruited, and all women provided informed consent. There were 62 women with apparent visceral pain and 19 with apparent somatic sources of pain. The positive predictive values for pelvic visceral disease were aCA-93%, pCA-91%, aMFTP-93%, pMFTP-81%, and RPT-79%. The likelihood ratio (+) and 95% C.I. for the detection of visceral sources of pain were aCA-4.19 (1.46, 12.0), pCA-2.91 (1.19, 7.11), aMTRP-4.19 (1.46, 12.0), pMFTP-1.35 (0.86, 2.13), and RPT-1.14 (0.85, 1.52), respectively. Conclusions. Tests of cutaneous allodynia, myofascial trigger points, and reduced pain thresholds are easily applied and well tolerated. The tests for cutaneous allodynia appear to have the greatest likelihood of identifying a visceral source of pain compared to somatic sources of pain. PMID:22135736

  18. Reconsidering the International Association for the Study of Pain definition of pain

    PubMed Central

    Cohen, Milton; Quintner, John; van Rysewyk, Simon

    2018-01-01

    Abstract Introduction: The definition of pain promulgated by the International Association for the Study of Pain (IASP) is widely accepted as a pragmatic characterisation of that human experience. Although the Notes that accompany it characterise pain as “always subjective,” the IASP definition itself fails to sufficiently integrate phenomenological aspects of pain. Methods: This essay reviews the historical development of the IASP definition, and the commentaries and suggested modifications to it over almost 40 years. Common factors of pain experience identified in phenomenological studies are described, together with theoretical insights from philosophy and biology. Results: A fuller understanding of the pain experience and of the clinical care of those experiencing pain is achievable through greater attention to the phenomenology of pain, the social “intersubjective space” in which pain occurs, and the limitations of language. Conclusion: Based on these results, a revised definition of pain is offered: Pain is a mutually recognizable somatic experience that reflects a person's apprehension of threat to their bodily or existential integrity. PMID:29756084

  19. Mechanistic experimental pain assessment in computer users with and without chronic musculoskeletal pain.

    PubMed

    Ge, Hong-You; Vangsgaard, Steffen; Omland, Øyvind; Madeleine, Pascal; Arendt-Nielsen, Lars

    2014-12-06

    Musculoskeletal pain from the upper extremity and shoulder region is commonly reported by computer users. However, the functional status of central pain mechanisms, i.e., central sensitization and conditioned pain modulation (CPM), has not been investigated in this population. The aim was to evaluate sensitization and CPM in computer users with and without chronic musculoskeletal pain. Pressure pain threshold (PPT) mapping in the neck-shoulder (15 points) and the elbow (12 points) was assessed together with PPT measurement at mid-point in the tibialis anterior (TA) muscle among 47 computer users with chronic pain in the upper extremity and/or neck-shoulder pain (pain group) and 17 pain-free computer users (control group). Induced pain intensities and profiles over time were recorded using a 0-10 cm electronic visual analogue scale (VAS) in response to different levels of pressure stimuli on the forearm with a new technique of dynamic pressure algometry. The efficiency of CPM was assessed using cuff-induced pain as conditioning pain stimulus and PPT at TA as test stimulus. The demographics, job seniority and number of working hours/week using a computer were similar between groups. The PPTs measured at all 15 points in the neck-shoulder region were not significantly different between groups. There were no significant differences between groups neither in PPTs nor pain intensity induced by dynamic pressure algometry. No significant difference in PPT was observed in TA between groups. During CPM, a significant increase in PPT at TA was observed in both groups (P < 0.05) without significant differences between groups. For the chronic pain group, higher clinical pain intensity, lower PPT values from the neck-shoulder and higher pain intensity evoked by the roller were all correlated with less efficient descending pain modulation (P < 0.05). This suggests that the excitability of the central pain system is normal in a large group of computer users with low pain intensity

  20. Pain Behavior in Rheumatoid Arthritis Patients: Identification of Pain Behavior Subgroups

    PubMed Central

    Waters, Sandra J.; Riordan, Paul A.; Keefe, Francis J.; Lefebvre, John C.

    2008-01-01

    This study used Ward’s minimum variance hierarchical cluster analysis to identify homogeneous subgroups of rheumatoid arthritis patients suffering from chronic pain who exhibited similar pain behavior patterns during a videotaped behavior sample. Ninety-two rheumatoid arthritis patients were divided into two samples. Six motor pain behaviors were examined: guarding, bracing, active rubbing, rigidity, grimacing, and sighing. The cluster analysis procedure identified four similar subgroups in Sample 1 and Sample 2. The first subgroup exhibited low levels of all pain behaviors. The second subgroup exhibited a high level of guarding and low levels of other pain behaviors. The third subgroup exhibited high levels of guarding and rigidity and low levels of other pain behaviors. The fourth subgroup exhibited high levels of guarding and active rubbing and low levels of other pain behaviors. Sample 1 contained a fifth subgroup that exhibited a high level of active rubbing and low levels of other pain measures. The results of this study suggest that there are homogeneous subgroups within rheumatoid arthritis patient populations who differ in the motor pain behaviors they exhibit. PMID:18358682

  1. The relationship between mindfulness, pain intensity, pain catastrophizing, depression, and quality of life among cancer survivors living with chronic neuropathic pain.

    PubMed

    Poulin, Patricia A; Romanow, Heather C; Rahbari, Noriyeh; Small, Rebecca; Smyth, Catherine E; Hatchard, Taylor; Solomon, Brahm K; Song, Xinni; Harris, Cheryl A; Kowal, John; Nathan, Howard J; Wilson, Keith G

    2016-10-01

    This study aims to examine if mindfulness is associated with pain catastrophizing, depression, disability, and health-related quality of life (HRQOL) in cancer survivors with chronic neuropathic pain (CNP). We conducted a cross-sectional survey with cancer survivors experiencing CNP. Participants (n = 76) were men (24 %) and women (76 %) with an average age of 56.5 years (SD = 9.4). Participants were at least 1 year post-treatment, with no evidence of cancer, and with symptoms of neuropathic pain for more than three months. Participants completed the Five Facets Mindfulness Questionnaire (FFMQ), along with measures of pain intensity, pain catastrophizing, pain interference, depression, and HRQOL. Mindfulness was negatively correlated with pain intensity, pain catastrophizing, pain interference, and depression, and it was positively correlated with mental health-related HRQOL. Regression analyses demonstrated that mindfulness was a negative predictor of pain intensity and depression and a positive predictor of mental HRQOL after controlling for pain catastrophizing, age, and gender. The two mindfulness facets that were most consistently associated with better outcomes were non-judging and acting with awareness. Mindfulness significantly moderated the relationships between pain intensity and pain catastrophizing and between pain intensity and pain interference. It appears that mindfulness mitigates the impact of pain experiences in cancer survivors experiencing CNP post-treatment. This study suggests that mindfulness is associated with better adjustment to CNP. This provides the foundation to explore whether mindfulness-based interventions improve quality of life among cancer survivors living with CNP.

  2. Ketamine for pain

    PubMed Central

    Jonkman, Kelly; Dahan, Albert; van de Donk, Tine; Aarts, Leon; Niesters, Marieke; van Velzen, Monique

    2017-01-01

    The efficacy of the N-methyl-D-aspartate receptor antagonist ketamine as an analgesic agent is still under debate, especially for indications such as chronic pain. To understand the efficacy of ketamine for relief of pain, we performed a literature search for relevant narrative and systematic reviews and meta-analyses. We retrieved 189 unique articles, of which 29 were deemed appropriate for use in this review. Ketamine treatment is most effective for relief of postoperative pain, causing reduced opioid consumption. In contrast, for most other indications (that is, acute pain in the emergency department, prevention of persistent postoperative pain, cancer pain, and chronic non-cancer pain), the efficacy of ketamine is limited. Ketamine’s lack of analgesic effect was associated with an increase in side effects, including schizotypical effects. PMID:28979762

  3. Abnormal brain processing of affective and sensory pain descriptors in chronic pain patients.

    PubMed

    Sitges, Carolina; García-Herrera, Manuel; Pericás, Miquel; Collado, Dolores; Truyols, Magdalena; Montoya, Pedro

    2007-12-01

    Previous research has suggested that chronic pain patients might be particularly vulnerable to the effects of negative mood during information processing. However, there is little evidence for abnormal brain processing of affective and sensory pain-related information in chronic pain. Behavioral and brain responses, to pain descriptors and pleasant words, were examined in chronic pain patients and healthy controls during a self-endorsement task. Eighteen patients with fibromyalgia (FM), 18 patients with chronic musculoskeletal pain due to identifiable physical injury (MSK), and 16 healthy controls were asked to decide whether word targets described their current or past experience of pain. The number of self-endorsed words, elapsed time to endorse the words, and event-related potentials (ERPs) elicited by words, were recorded. Data revealed that chronic pain patients used more affective and sensory pain descriptors, and were slower in responding to self-endorsed pain descriptors than to pleasant words. In addition, it was found that affective pain descriptors elicited significantly more enhanced positive ERP amplitudes than pleasant words in MSK pain patients; whereas sensory pain descriptors elicited greater positive ERP amplitudes than affective pain words in healthy controls. These data support the notion of abnormal information processing in chronic pain patients, which might be characterized by a lack of dissociation between sensory and affective components of pain-related information, and by an exaggerated rumination over word meaning during the encoding of self-referent information about pain.

  4. [From Descartes to fMRI. Pain theories and pain concepts].

    PubMed

    Handwerker, H O

    2007-08-01

    In the seventeenth century the philosopher Rene Descartes was the forerunner by establishing a scientific hypothesis on the origin of pain. Much later, in the nineteenth century, pain hypotheses emerged which explained the pain sensation either on the basis of intense stimulation of any kind of nerve fibers (intensity hypothesis) or on the basis of specific nociceptors (specificity hypothesis). The "gate control theory" established by Melzack and Wall (1964) offered an explanation of modulations of pain sensation by the interaction between nociceptive and non-nociceptive nerve fibers and by descending control in the central nervous system. Though this hypothesis is outdated in its original form, it had - in a more common formulation - a great influence on our understanding of pain. For building a bridge to our present knowledge, the molecular structure of the nociceptor membrane is of particular importance. On this basis also new pain therapies have been developed. On the other hand, the methods of functional imaging allow the identification of brain regions related to pain processing at a macroscopic level. This new technology opened up new ways of understanding chronic pain processes and new possibilities for the control of therapeutic effects.

  5. Conditioned pain modulation: a predictor for development and treatment of neuropathic pain.

    PubMed

    Granovsky, Yelena

    2013-09-01

    Psychophysical evaluation of endogenous pain inhibition via conditioned pain modulation (CPM) represents a new generation of laboratory tests for pain assessment. In this review we discuss recent findings on CPM in neuropathic pain and refer to psychophysical, neurophysiological, and methodological aspects of its clinical implications. Typically, chronic neuropathic pain patients express less efficient CPM, to the extent that incidence of acquiring neuropathic pain (e.g. post-surgery) and its intensity can be predicted by a pre-surgery CPM assessment. Moreover, pre-treatment CPM evaluation may assist in the correct choice of serotonin-noradrenalin reuptake inhibitor analgesic agents for individual patients. Evaluation of pain modulation capabilities can serve as a step forward in individualizing pain medicine.

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

    PubMed Central

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

    2010-01-01

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

  7. Association between neck and shoulder pain, back pain, low back pain and body composition parameters among the Japanese general population.

    PubMed

    Iizuka, Yoichi; Iizuka, Haku; Mieda, Tokue; Tajika, Tsuyoshi; Yamamoto, Atsushi; Ohsawa, Takashi; Sasaki, Tsuyoshi; Takagishi, Kenji

    2015-11-04

    Neck and shoulder pain, back pain and low back pain are common symptoms in Japanese subjects, and it is important to elucidate the pathology and associated factors of these pains due to their frequency and impact on the quality of life (QOL) and activities of daily living (ADL). The purpose of the present study was to investigate whether body composition is associated with these pains. We collected the data of 273 Japanese subjects regarding the presence and the visual analogue scale (VAS) of neck and shoulder pain, back pain, low back pain and body composition parameters calculated using bioelectrical impedance analysis (BIA) technology. Furthermore, we investigated the association between these pains and the body composition using statistical methods. According to a multivariate analysis adjusted for age and gender, lower total body water ratio was significantly associated with the presence of neck and shoulder pain at present (P < 0.05); additionally, total body muscle mass (standardized β = -0.26, 95 % CI, -0.17 - -0.008, P < 0.05), total body water (standardized β = -0.27, 95 % CI, -0.23 - -0.04, P < 0.01), appendicular muscle mass (standardized β = -0.29, 95 % CI, -0.36 - -0.04, P < 0.05), and the appendicular muscle mass index (AMI) (standardized β = -0.24, 95 % CI, -1.18 - -0.20, P <0.01) were negatively correlated with the VAS of neck and shoulder pain, whereas no body composition parameters were significantly associated with back pain, low back pain at present and any type of chronic pain. The present study demonstrated that some body composition parameters regarding body water and body muscle were associated or correlated with the presence or intensity of neck and shoulder pain.

  8. Conditioned pain modulation predicts duloxetine efficacy in painful diabetic neuropathy.

    PubMed

    Yarnitsky, David; Granot, Michal; Nahman-Averbuch, Hadas; Khamaisi, Mogher; Granovsky, Yelena

    2012-06-01

    This study aims to individualize the selection of drugs for neuropathic pain by examining the potential coupling of a given drug's mechanism of action with the patient's pain modulation pattern. The latter is assessed by the conditioned pain modulation (CPM) and temporal summation (TS) protocols. We hypothesized that patients with a malfunctioning pain modulation pattern, such as less efficient CPM, would benefit more from drugs augmenting descending inhibitory pain control than would patients with a normal modulation pattern of efficient CPM. Thirty patients with painful diabetic neuropathy received 1 week of placebo, 1 week of 30 mg/d duloxetine, and 4 weeks of 60 mg/d duloxetine. Pain modulation was assessed psychophysically, both before and at the end of treatment. Patient assessment of drug efficacy, assessed weekly, was the study's primary outcome. Baseline CPM was found to be correlated with duloxetine efficacy (r=0.628, P<.001, efficient CPM is marked negative), such that less efficient CPM predicted efficacious use of duloxetine. Regression analysis (R(2)=0.673; P=.012) showed that drug efficacy was predicted only by CPM (P=.001) and not by pretreatment pain levels, neuropathy severity, depression level, or patient assessment of improvement by placebo. Furthermore, beyond its predictive value, the treatment-induced improvement in CPM was correlated with drug efficacy (r=-0.411, P=.033). However, this improvement occurred only in patients with less efficient CPM (16.8±16.0 to -1.1±15.5, P<.050). No predictive role was found for TS. In conclusion, the coupling of CPM and duloxetine efficacy highlights the importance of pain pathophysiology in the clinical decision-making process. This evaluative approach promotes personalized pain therapy. Copyright © 2012 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

  9. Corporatization of pain medicine: implications for widening pain care disparities.

    PubMed

    Meghani, Salimah H

    2011-04-01

    The current health care system in the United States is structured in a way that ensures that more opportunity and resources flow to the wealthy and socially advantaged. The values intrinsic to the current profit-oriented culture are directly antithetical to the idea of equitable access. A large body of literature points to disparities in pain treatment and pain outcomes among vulnerable groups. These disparities range from the presence of disproportionately higher numbers and magnitude of risk factors for developing disabling pain, lack of access to primary care providers, analgesics and interventions, lack of referral to pain specialists, longer wait times to receive care, receipt of poor quality of pain care, and lack of geographical access to pharmacies that carry opioids. This article examines the manner in which the profit-oriented culture in medicine has directly and indirectly structured access to pain care, thereby widening pain treatment disparities among vulnerable groups. Specifically, the author argues that the corporatization of pain medicine amplifies disparities in pain outcomes in two ways: 1) directly through driving up the cost of pain care, rendering it inaccessible to the financially vulnerable; and 2) indirectly through an interface with corporate loss-aversion/risk management culture that draws upon irrelevant social characteristics, thus worsening disparities for certain populations. Thus, while financial vulnerability is the core reason for lack of access, it does not fully explain the implications of corporate microculture regarding access. The effect of corporatization on pain medicine must be conceptualized in terms of overt access to facilities, providers, pharmaceuticals, specialty services, and interventions, but also in terms of the indirect or covert effect of corporate culture in shaping clinical interactions and outcomes. Wiley Periodicals, Inc.

  10. Relationship between behavioral indices of pain during labor pain with pain intensity and duration of delivery

    PubMed Central

    Asl, Bibi Marziyeh Hashemi; Golmakani, Nahid; Najafi, Alireza

    2018-01-01

    Background Certain behaviors can be adopted by women to cope with labor pain according to their individual characteristics, which are currently called behavioral indicators during labor pain, and include facial expressions, verbal expressions, tone of voice, body movements, degree of relaxation, and respiratory system functioning during delivery. Moreover, severity of pain and duration of labor can vary due to several factors including individual characteristics. Objective The purpose of the present study was to determine the relationship between behavioral indicators during labor pain, severity of pain, and delivery duration. Methods In this cross-sectional study, 120 low risk pregnant women who referred to Omolbanin (AS) Hospital in the city of Mashhad (Iran) for delivery in 2014, were selected via convenience sampling method, which was then followed by completion of demographic information forms. From cervical dilatation of 3–5 centimeters until delivery, the Labor Pain Coping Behavior Observation Form (comprised of 6 sub-groups of facial expressions, verbal expressions, tone of voice, body movements, degree of relaxation, and respiratory function and severity and duration of pain) was completed during uterine contractions and every half an hour. Using the Inventory of Labor Information; vital signs, frequency of contractions, and duration of the first and second stages of labor were measured. Furthermore, the content validity of the questionnaire was determined and its reliability was confirmed by Cronbach’s alpha method. Then, the data were analyzed using the SPSS version 16, through Pearson Product-Moment Correlation and Spearman’s Rank-Order Correlation, Kruskal-Wallis test, and ANOVA. Results According to the results, 16.2% of the individuals had undesirable behavioral indicators during labor pain, 50% of them were endowed with acceptable behaviors, and 33.8% of these women had desirable behaviors. The findings also revealed that the duration of the

  11. Heritability of Pain Catastrophizing and Associations with Experimental Pain Outcomes: A Twin Study

    PubMed Central

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

    2014-01-01

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

  12. The interactions between pain, pain-related fear of movement and productivity.

    PubMed

    Sell, L; Lund, H L; Holtermann, A; Søgaard, K

    2014-07-01

    Employees with physically heavy work have an increased risk of musculoskeletal disorders leading to reduced work ability. To investigate if a high level of musculoskeletal pain or pain-related fear of movement was associated with low productivity among employees with physically heavy work and differing work ability levels. The study was conducted at a Danish production site and employees with physically heavy work in the production line were included in the study. Work ability was assessed with the Work Ability Index (WAI), pain-related fear of movement with the Tampa Scale for Kinesiophobia and productivity and musculoskeletal pain by self-reported measures. Sickness absence records for construction of WAI were obtained from the workplace. There was a 77% response rate with 350 employees included in the final analysis. Among employees with only moderate work ability, there was neither an association between pain and productivity nor between pain-related fear of movement and productivity. For employees with good work ability, higher levels of pain and higher levels of pain-related fear of movement both raised the odds of low productivity significantly. Despite the fact that musculoskeletal pain increases the risk of reduced work ability significantly, musculoskeletal pain and pain-related fear of movement were associated with low productivity only among employees with good work ability. © The Author 2014. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  13. Dutch version of the Fear of Pain Questionnaire for adolescents with chronic pain.

    PubMed

    Dekker, Carolien; Bastiaenen, Caroline H G; de Vries, Janneke E; Simons, Laura E; Goossens, Mariëlle E J B; Verbunt, Jeanine A M C F

    2018-06-01

    Fear of pain is important in the development and maintenance of chronic pain. The Fear of Pain Questionnaire-Child version has been developed to assess pain related fear in children and adolescents. Translating the original questionnaire into Dutch, and investigating internal consistency and construct validity to enable use in the Dutch pain rehabilitation setting for treatment and research. Cross-sectional validation study: After forward and back translation of the FOPQ-C, adolescents (11-22 years old) with chronic musculoskeletal pain completed an assessment containing the Dutch Fear of Pain Questionnaire, and questionnaires about demographics, pain catastrophizing, functional disability, and pain intensity. Internal consistency and construct validity were evaluated through exploratory factor analysis (principal axis factoring with oblique rotation) and hypotheses testing using pain catastrophizing, functional disability, and pain intensity as comparative constructs. Eighty-six adolescents completed the assessment. Exploratory factor analysis resulted in a two-factor structure, explaining 43% of the variance. Internal consistency was strong (Cronbach's α = 0.92 total scale, α = 0.88 factor 1, and α = .86 factor 2). Five out of 6 hypotheses were confirmed. The Dutch version demonstrated good internal consistency and good construct validity in a population of adolescents with chronic musculoskeletal pain. Implications for rehabilitation The Fear of Pain Questionnaire-Child version was developed to measure fear of pain and avoidance in children and adolescents with chronic pain. Identification of fear of pain and activities that are being avoided are important during screening and assessment of the adolescent for chronic pain rehabilitation treatment. The presence of fear of pain and/or avoidance behavior is important information to shape and target multidisciplinary rehabilitation treatment.

  14. Pain of methadone-maintained heroin addicts: lonelier individuals feel more intense pain.

    PubMed

    Li, Fu; Xu, Yan-Min; Zhu, Jun-Hong; Lu, Jin; Zhong, Bao-Liang

    2017-10-03

    Managing pain in patients with heroin addiction is challenging, because most pain medications are addictive. A promising way to relieve pain of heroin addicts is to identify and address modifiable psychosocial factors associated with pain. This study examined the association between loneliness and pain intensity in Chinese heroin addicts receiving methadone maintenance treatment (MMT). A consecutive sample of 603 heroin addicts were recruited from three MMT clinics in Wuhan, China. Loneliness was assessed with a single question, and socio-demographic and clinical data were collected with a standardized questionnaire. Pain intensity was assessed with the five-point Verbal Rating Scale. Multiple ordinary logistic regression was used to control for potential confounders that may bias the loneliness-pain relationship. There was a significant and positive correlation between pain intensity and loneliness scores among methadone-maintained heroin addicts ( r = 0.453, P < 0.001). After controlling for potential socio-demographic and clinical confounders, an increase in the level of loneliness was significantly associated with an increase in pain intensity (OR = 1.22, P = 0.042). Loneliness is significantly associated with pain of methadone-maintained heroin addicts. Psychosocial interventions aimed at reducing loneliness might prevent or reduce pain of patients receiving MMT.

  15. Cerebral interactions of pain and reward and their relevance for chronic pain.

    PubMed

    Becker, Susanne; Gandhi, Wiebke; Schweinhardt, Petra

    2012-06-29

    Pain and reward are opponent, interacting processes. Such interactions are enabled by neuroanatomical and neurochemical overlaps of brain systems that process pain and reward. Cerebral processing of hedonic ('liking') and motivational ('wanting') aspects of reward can be separated: the orbitofrontal cortex and opioids play an important role for the hedonic experience, and the ventral striatum and dopamine predominantly process motivation for reward. Supported by neuroimaging studies, we present here the hypothesis that the orbitofrontal cortex and opioids are responsible for pain modulation by hedonic experience, while the ventral striatum and dopamine mediate motivational effects on pain. A rewarding stimulus that appears to be particularly important in the context of pain is pain relief. Further, reward, including pain relief, leads to operant learning, which can affect pain sensitivity. Indirect evidence points at brain mechanisms that might underlie pain relief as a reward and related operant learning but studies are scarce. Investigating the cerebral systems underlying pain-reward interactions as well as related operant learning holds the potential of better understanding mechanisms that contribute to the development and maintenance of chronic pain, as detailed in the last section of this review. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  16. Prevalence of Pain Diagnoses and Burden of Pain Among Active Duty Soldiers, FY2012.

    PubMed

    Reif, Sharon; Adams, Rachel Sayko; Ritter, Grant A; Williams, Thomas V; Larson, Mary Jo

    2018-03-14

    Soldiers are at risk for acute and chronic pain due to the mental and physical challenges of military duties and ongoing training for force readiness. With the burden of pain on any individual attributable across pain sources, a broad perspective that goes beyond prior characterizations of pain is important. We aim to further the understanding of pain's effects among non-deployed active duty soldiers and the Military Health System (MHS), by describing prevalence of 10 painful conditions, reported pain levels, duration of pain and impact of pain on military duty limitations. Data are from the MHS Data Repository including outpatient MHS direct care encounters, claims for outpatient purchased care from civilian providers, and vital records, for all soldiers continuously enrolled in TRICARE and not deployed in FY 2012. Ten pain-related diagnostic categories were conceptually derived for this analysis and identified using ICD-9-CM diagnostic codes. We report the FY 2012 prevalence at the soldier-level (N = 297,120) for each pain category as a primary diagnosis, as well as in any diagnostic position, and at the soldier-level for reported pain level, duration, and military duty limitations. Institutional Review Board approval was obtained prior to analyses. Overall, 63% of soldiers had at least one pain diagnosis and 59% had a primary pain diagnosis during FY 2012. Back and neck pain (22%), non-traumatic joint disorders (28%), and other musculoskeletal pain (30%) were the most frequent categories for primary diagnosis. Nearly two-thirds of soldiers had a primary pain diagnosis in more than one category, and 23% in four or more categories. Moderate or severe pain levels were reported at least once during the year by 55% of soldiers who had a primary pain diagnosis. In the subsample of soldiers with primary pain in the first quarter, duration and chronicity of pain diagnoses varied by pain category: the back and neck pain category was the most common for both persistent

  17. Pain Volatility and Prescription Opioid Addiction Treatment Outcomes in Patients with Chronic Pain

    PubMed Central

    Worley, Matthew J.; Heinzerling, Keith G.; Shoptaw, Steven; Ling, Walter

    2015-01-01

    The combination of prescription opioid dependence and chronic pain is increasingly prevalent and hazardous to public health. Variability in pain may explain poor prescription opioid addiction treatment outcomes in persons with chronic pain. This study examined pain trajectories and pain volatility in patients with chronic pain receiving treatment for prescription opioid addiction. We conducted secondary analyses of adults with chronic pain (N = 149) who received buprenorphine-naloxone (BUP-NLX) and counseling for 12 weeks in an outpatient, multi-site clinical trial. Good treatment outcome was defined as urine-verified abstinence from opioids at treatment endpoint (Week 12) and during at least two of the previous three weeks. Pain severity significantly declined over time during treatment (b = − 0.36, p < .001). Patients with greater pain volatility were less likely to have a good treatment outcome (OR = 0.55, p < .05), controlling for baseline pain severity and rate of change in pain over time. A one standard deviation increase in pain volatility was associated with a 44% reduction in the probability of endpoint abstinence. The significant reduction in subjective pain during treatment provides observational support for the analgesic effects of BUP-NLX in patients with chronic pain and opioid dependence. Patients with greater volatility in subjective pain during treatment have increased risk for returning to opioid use by the conclusion of an intensive treatment with BUP-NLX and counseling. Future research should examine underlying mechanisms of pain volatility and identify related therapeutic targets to optimize interventions for prescription opioid addiction and co-occurring chronic pain. PMID:26302337

  18. Pain volatility and prescription opioid addiction treatment outcomes in patients with chronic pain.

    PubMed

    Worley, Matthew J; Heinzerling, Keith G; Shoptaw, Steven; Ling, Walter

    2015-12-01

    The combination of prescription opioid dependence and chronic pain is increasingly prevalent and hazardous to public health. Variability in pain may explain poor prescription opioid addiction treatment outcomes in persons with chronic pain. This study examined pain trajectories and pain volatility in patients with chronic pain receiving treatment for prescription opioid addiction. We conducted secondary analyses of adults with chronic pain (n = 149) who received buprenorphine/naloxone (BUP/NLX) and counseling for 12 weeks in an outpatient, multisite clinical trial. Good treatment outcome was defined as urine-verified abstinence from opioids at treatment endpoint (Week 12) and during at least 2 of the previous 3 weeks. Pain severity significantly declined over time during treatment (b = -0.36, p < .001). Patients with greater pain volatility were less likely to have a good treatment outcome (odds ratio = 0.55, p < .05), controlling for baseline pain severity and rate of change in pain over time. A 1 standard deviation increase in pain volatility was associated with a 44% reduction in the probability of endpoint abstinence. The significant reduction in subjective pain during treatment provides observational support for the analgesic effects of BUP/NLX in patients with chronic pain and opioid dependence. Patients with greater volatility in subjective pain during treatment have increased risk of returning to opioid use by the conclusion of an intensive treatment with BUP/NLX and counseling. Future research should examine underlying mechanisms of pain volatility and identify related therapeutic targets to optimize interventions for prescription opioid addiction and co-occurring chronic pain. (PsycINFO Database Record (c) 2015 APA, all rights reserved).

  19. Living life with my child’s pain: The Parent Pain Acceptance Questionnaire (PPAQ)

    PubMed Central

    Smith, Allison M.; Sieberg, Christine B.; Odell, Shannon; Randall, Edin; Simons, Laura E.

    2014-01-01

    Objective Parents’ emotional, cognitive, and behavioral responses are highly influential upon children’s pain and functional outcomes. One important response to pediatric pain is acceptance: the degree to which an individual participates in routine daily activities in the presence of pain and is willing to let pain be a part of their life without efforts to control or avoid it. However, no tool currently exists to assess parents’ own acceptance of their child’s pain. The aim of this study was to validate the Parent Pain Acceptance Questionnaire (PPAQ). Method The PPAQ was administered to 310 parents of youth with chronic pain in an outpatient pediatric headache program and a day hospital pain rehabilitation program. An exploratory factor analysis revealed two factors for the PPAQ: an 11-item Activity Engagement scale and a 4-item Acceptance of Pain-Related Thoughts & Feelings scale. Results The PPAQ total score and subscales demonstrated strong internal consistency. Greater parent pain acceptance was positively associated with child pain acceptance, and was negatively correlated with parent protective behaviors, parent minimizing behaviors, parent and child pain catastrophizing, and child fear of pain. Parent protective behaviors and child pain acceptance both served as mediators of the relationship between parent pain acceptance and child functional disability. Conclusions The PPAQ is a valid measure of parent pain acceptance and may provide valuable insights into parent responses to child pain and the ways in which parent acceptance influences child outcomes. Clinical implications and suggestions for future research are discussed. PMID:25119514

  20. Persistent arm pain is distinct from persistent breast pain following breast cancer surgery.

    PubMed

    Langford, Dale J; Paul, Steven M; West, Claudia; Abrams, Gary; Elboim, Charles; Levine, Jon D; Hamolsky, Deborah; Luce, Judith A; Kober, Kord M; Neuhaus, John M; Cooper, Bruce A; Aouizerat, Bradley E; Miaskowski, Christine

    2014-12-01

    Persistent pain following breast cancer surgery is well documented. However, it is not well characterized in terms of the anatomic site affected (ie, breast, arm). In 2 separate growth mixture modeling analyses, we identified subgroups of women (N = 398) with distinct breast pain and arm pain trajectories. The fact that these latent classes differed by anatomic site, types of tissue affected, and neural innervation patterns suggests the need for separate evaluations of these distinct persistent pain conditions. The purposes of this companion study were to identify demographic and clinical characteristics that differed between the 2 arm pain classes and determine if differences existed over time in sensitivity in the upper inner arm and axillary lymph node dissection sites, pain qualities, pain interference, and hand and arm function, as well as to compare findings with persistent breast pain. Higher occurrence rates for depression and lymphedema were found in the moderate arm pain class. Regardless of pain group membership, sensory loss was observed in the upper inner arm and axillary lymph node dissection site. Arm pain was described similarly to neuropathic pain and interfered with daily functioning. Persistent arm pain was associated with sustained impairments in shoulder mobility. For persistent breast and arm pain, changes in sensation following breast cancer surgery were notable. Persistent arm pain was associated with sustained interference with daily functioning and upper body mobility impairments. Long-term management of persistent pain following breast cancer surgery is warranted to improve the quality of survivorship for these women. Copyright © 2014 American Pain Society. Published by Elsevier Inc. All rights reserved.

  1. Common medical pains

    PubMed Central

    Jacobson, Sheila

    2007-01-01

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

  2. 15 CFR 714.2 - Annual reporting requirements for exports and imports in excess of 30 metric tons of Schedule 3...

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... plant site is declared for production of a Schedule 3 chemical (and has completed questions 3-3.1 and 3.... (ii) If your plant site is declared for production of a Schedule 3 chemical and you exported or... exports and imports in excess of 30 metric tons of Schedule 3 chemicals. 714.2 Section 714.2 Commerce and...

  3. 15 CFR 714.2 - Annual reporting requirements for exports and imports in excess of 30 metric tons of Schedule 3...

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... plant site is declared for production of a Schedule 3 chemical (and has completed questions 3-3.1 and 3.... (ii) If your plant site is declared for production of a Schedule 3 chemical and you exported or... exports and imports in excess of 30 metric tons of Schedule 3 chemicals. 714.2 Section 714.2 Commerce and...

  4. 15 CFR 714.2 - Annual reporting requirements for exports and imports in excess of 30 metric tons of Schedule 3...

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... plant site is declared for production of a Schedule 3 chemical (and has completed questions 3-3.1 and 3.... (ii) If your plant site is declared for production of a Schedule 3 chemical and you exported or... exports and imports in excess of 30 metric tons of Schedule 3 chemicals. 714.2 Section 714.2 Commerce and...

  5. What a Pain! Kids and Growing Pains

    MedlinePlus

    ... First Aid & Safety Doctors & Hospitals Videos Recipes for Kids Kids site Sitio para niños How the Body ... for Educators Search English Español What a Pain! Kids and Growing Pains KidsHealth / For Kids / What a ...

  6. [Pain and emotional dysregulation: Cellular memory due to pain].

    PubMed

    Narita, Minoru; Watanabe, Moe; Hamada, Yusuke; Tamura, Hideki; Ikegami, Daigo; Kuzumaki, Naoko; Igarashi, Katsuhide

    2015-08-01

    Genetic factors are involved in determinants for the risk of psychiatric disorders, and neurological and neurodegenerative diseases. Chronic pain stimuli and intense pain have effects at a cellular and/or gene expression level, and will eventually induce "cellular memory due to pain", which means that tissue damage, even if only transient, can elicit epigenetically abnormal transcription/translation and post-translational modification in related cells depending on the degree or kind of injury or associated conditions. Such cell memory/transformation due to pain can cause an abnormality in a fundamental intracellular response, such as a change in the three-dimensional structure of DNA, transcription, or translation. On the other hand, pain is a multidimensional experience with sensory-discriminative and motivational-affective components. Recent human brain imaging studies have examined differences in activity in the nucleus accumbens between controls and patients with chronic pain, and have revealed that the nucleus accumbens plays a role in predicting the value of a noxious stimulus and its offset, and in the consequent changes in the motivational state. In this review, we provide a very brief overview of a comprehensive understanding of chronic pain associated with emotional dysregulation due to transcriptional regulation, epigenetic modification and miRNA regulation.

  7. Being bullied in childhood, and pain and pain perception in adulthood.

    PubMed

    Sansone, Randy A; Watts, Daron A; Wiederman, Michael W

    2014-08-01

    While a number of negative health outcomes have been associated with bullying in childhood, we are not aware of any studies examining relationships between bullying in childhood, and pain symptoms and pain perception in adulthood - the focus of the present study. Using a cross-sectional consecutive sample and a self-report survey methodology, we examined among 243 primary-care outpatients a history of being bullied in childhood (yes/no) in relationship to three pain ratings (now, past month, past year) and catastrophic thoughts and feelings about pain as assessed by the Pain Catastrophizing Scale (PCS). Being bullied in childhood was statistically significantly associated with present pain ratings (p < .001) as well as pain ratings over the past month and the past year (p < .01), and with the total score on the PCS as well as each of its sub-scales (i.e. rumination, magnification, helplessness) (p < .001). Being bullied in childhood is associated with higher reported levels of pain at various time points as well as greater levels of self-reported catastrophic thoughts and feelings about pain. Importantly, the methodology of this study does not allow for the examination of a causal relationship. © The Author(s) 2013.

  8. Determining pain scale preference in a veteran population experiencing chronic pain.

    PubMed

    Douglas, Mary E; Randleman, Mary L; DeLane, Alice M; Palmer, Glen A

    2014-09-01

    The purpose of this study was to determine veteran pain scale preference of four common pain scales: the Faces Scale, the Visual Analog Scale, the Numeric Rating Scale, and the Mankoski Pain Scale. The study also examined the reliability and validity of the Mankoski Pain Scale with the other three scales. A sample of veterans (N = 200) with chronic pain receiving treatment in a residential rehabilitation treatment program (RRTP) and a surgical and specialty care (SSC) outpatient clinic at a Department of Veterans Affairs (VA) medical center participated in the study. There was a significant difference between scales in regard to preference, χ2(3) = 64.59, p < .001. A large percentage of the sample preferred the Mankoski Pain Scale (46%). Test-retest of the reliability was comparable for all the scales. Validity of the Mankoski scale was excellent, as it correlated very well with the Numeric (r = .84, p < .001), Analog (r = .83, p < .001), and Faces (r = .78, p < .001) scales. The findings indicate that the Mankoski Pain Scale is a valid and reliable tool for pain with veterans, and it was the preferred scale by veterans for use when describing pain. Published by Elsevier Inc.

  9. Alpha-1 adrenoceptor hyperresponsiveness in three neuropathic pain states: complex regional pain syndrome 1, diabetic peripheral neuropathic pain and central pain states following spinal cord injury.

    PubMed

    Teasell, Robert W; Arnold, J Malcolm O

    2004-01-01

    The pathophysiology of the pain associated with complex regional pain syndrome, spinal cord injury and diabetic peripheral neuropathy is not known. The pain of complex regional pain syndrome has often been attributed to abnormal sympathetic nervous system activity based on the presence of vasomotor instability and a frequently reported positive response, albeit a temporary response, to sympathetic blockade. In contrast, the pain below the level of spinal cord injury and diabetic peripheral neuropathy are generally seen as deafferentation phenomena. Each of these pain states has been associated with abnormal sympathetic nervous system function and increased peripheral alpha-1 adrenoceptor activity. This increased responsiveness may be a consequence of alpha-1 adrenoceptor postsynaptic hypersensitivity, or alpha-2 adrenoceptor presynaptic dysfunction with diminished noradrenaline reuptake, increased concentrations of noradrenaline in the synaptic cleft and increased stimulation of otherwise normal alpha-1 adrenoceptors. Plausible mechanisms based on animal research by which alpha-1 adrenoceptor hyperresponsiveness can lead to chronic neuropathic-like pain have been reported. This raises the intriguing possibility that sympathetic nervous system dysfunction may be an important factor in the generation of pain in many neuropathic pain states. Although results to date have been mixed, there may be a greater role for new drugs which target peripheral alpha-2 adrenoceptors (agonists) or alpha-1 adrenoceptors (antagonists).

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

    PubMed

    Weeth, A; Mühlberger, A; Shiban, Y

    2017-11-01

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

  11. Innovations in interventional pain management of chronic spinal pain.

    PubMed

    Manchikanti, Laxmaiah; Boswell, Mark V; Hirsch, Joshua A

    2016-09-01

    Interventional pain management dates back to 1901, with significant innovations, which include the definition, literature synthesis, pathophysiology, and technical interventions. Interventional pain management and interventional techniques include neural blockade, neural ablative procedures, spinal cord and peripheral nerve stimulation, intrathecal drug delivery systems, minimally invasive lumbar decompression (MILD®), percutaneous endoscopic spinal decompression, and regenerative medicine. In addition, advances are also related to the evidence synthesis of comparative effectiveness research. Expert commentary: Multiple innovations in interventional pain management and potential innovations may reduce costs and improve care and outcomes with proper evidence synthesis and application of principles of evidence-based medicine. Innovations in interventional pain management in managing chronic spinal pain depend on extensive research and appropriate evidence synthesis. Innovations should be developed in conjunction with health care policy based on principles of evidence-based medicine.

  12. Cancer pain physiology

    PubMed Central

    Falk, Sarah; Bannister, Kirsty

    2014-01-01

    Mechanisms of inflammatory and neuropathic pains have been elucidated and translated to patient care by the use of animal models of these pain states. Cancer pain has lagged behind since early animal models of cancer-induced bone pain were based on the systemic injection of carcinoma cells. This precluded systematic investigation of specific neuronal and pharmacological alterations that occur in cancer-induced bone pain. In 1999, Schwei et al. described a murine model of cancer-induced bone pain that paralleled the clinical condition in terms of pain development and bone destruction, confined to the mouse femur. This model prompted related approaches, and we can now state that cancer pain may include elements of inflammatory and neuropathic pains but also unique changes in sensory processing. Cancer-induced bone pain results in progressive bone destruction, elevated osteoclast activity and distinctive nocifensive behaviours (indicating the triad of ongoing, spontaneous and movement-induced hyperalgesia). In addition, cancer cells induce an inflammatory infiltrate and release growth factors, cytokines, interleukins, chemokines, prostanoids and endothelins, resulting in a reduction of pH to below 5 and direct deformation of primary afferents within bone. These peripheral changes, in turn, drive hypersensitivity of spinal cord sensory neurons, many of which project to the parts of the brain involved in the emotional response to pain. Within the spinal cord, a unique neuronal function reorganization within segments of the dorsal horn of the spinal cord receiving nociceptive input from the bone are discussed. Changes in certain neurotransmitters implicated in brain modulation of spinal function are also altered with implications for the affective components of cancer pain. Treatments are described in terms of mechanistic insights and in the case of opioids, which modulate pain transmission at spinal and supraspinal sites, their use can be compromised by opioid

  13. Stability of conditioned pain modulation in two musculoskeletal pain models: investigating the influence of shoulder pain intensity and gender

    PubMed Central

    2013-01-01

    Background Several chronic pain populations have demonstrated decreased conditioned pain modulation (CPM). However there is still a need to investigate the stability of CPM paradigms before the measure can be recommended for implementation. The purpose of the present study was to assess whether shoulder pain intensity and gender influence CPM stability within and between sessions. Methods This study examined two different musculoskeletal pain models, clinical shoulder pain and an experimental model of shoulder pain induced with eccentric exercise in healthy participants. Patients in the clinical cohort (N = 134) were tested before surgery and reassessed 3 months post-surgery. The healthy cohort (N = 190) was examined before inducing pain at the shoulder, and 48 and 96 hours later. Results Our results provide evidence that 1) stability of inhibition is not related to changes in pain intensity, and 2) there are sex differences for CPM stability within and between days. Conclusions Fluctuation of pain intensity did not significantly influence CPM stability. Overall, the more stable situations for CPM were females from the clinical cohort and males from the healthy cohort. PMID:23758907

  14. Electroacupuncture alleviates affective pain in an inflammatory pain rat model

    PubMed Central

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

    2011-01-01

    Pain has both sensory-discriminative and emotional-affective dimensions. Previous studies demonstrate that electroacupuncture (EA) alleviates the sensory dimension but do not address the affective. An inflammatory pain rat model, produced by a complete Freund adjuvant (CFA) injection into the hind paw, was combined with a conditioned place avoidance (CPA) test to determine whether EA inhibits spontaneous pain-induced affective response and, if so, to study the possibility that rostral anterior cingulate cortex (rACC) opioids underlie this effect. Male Sprague-Dawley rats (250–275g, Harlan) were used. The rats showed place aversion (i.e. affective pain) by spending less time in a pain-paired compartment after conditioning than during a preconditioning test. Systemic non-analgesic morphine (0.5 and 1.0 mg/ kg, i.p.) inhibited the affective reaction, suggesting that the affective dimension is underpinned by mechanisms different from those of the sensory dimension of pain. Morphine at 0.5 and at 1 mg/kg did not induce reward. Rats given EA treatment before pain-paired conditioning at GB 30 showed no aversion to the pain-paired compartment, indicating that EA inhibited the affective dimension. EA treatment did not produce reward or aversive effect. Intra-rACC administration of D-Phe-Cys-Tyr-D-Trp-Orn-Thr-Pen-Thr amide (CTOP), a selective mu opioid receptor antagonist, but not norbinaltorphimine (nor-BNI), a selective kappa opioid receptor antagonist, blocked EA inhibition of the affective dimension. These data demonstrate that EA activates opioid receptors in the rACC to inhibit pain-induced affective responses and that EA may be an effective therapy for both the sensory-discriminative and the affective dimensions of pain. PMID:22323370

  15. Psychological predictors of pain severity, pain interference, depression, and anxiety in rheumatoid arthritis patients with chronic pain.

    PubMed

    Ryan, Seamus; McGuire, Brian

    2016-05-01

    Rheumatoid arthritis is a chronic and progressive autoimmune disorder with symptoms sometimes including chronic pain and depression. The current study aimed to explore some of the psychological variables which predict both pain-related outcomes (pain severity and pain interference) and psychological outcomes (depression and anxiety) amongst patients with rheumatoid arthritis experiencing chronic pain. In particular, this study aimed to establish whether either self-concealment, or the satisfaction of basic psychological needs (autonomy, relatedness, and competence), could explain a significant portion of the variance in pain outcomes and psychological outcomes amongst this patient group. Online questionnaires were completed by 317 rheumatoid arthritis patients with chronic pain, providing data across a number of predictor and outcome variables. Hierarchical multiple linear regressions indicated that the predictive models for each of the four outcome variables were significant, and had good levels of fit with the data. In terms of individual predictor variables, higher relatedness significantly predicted lower depression, and higher autonomy significantly predicted lower anxiety. The model generated by this study may identify factors to be targeted by future interventions with the goal of reducing depression and anxiety amongst patients with rheumatoid arthritis experiencing chronic pain. The findings of this study have shown that the autonomy and the relatedness of patients with rheumatoid arthritis play important roles in promoting psychological well-being. Targeted interventions could help to enhance the lives of patients despite the presence of chronic pain. What is already known about the subject? Amongst a sample of chronic pain patients who primarily had a diagnosis of fibromyalgia, it was found that higher levels of self-concealment were associated with higher self-reported pain levels and reduced well-being (as measured by anxiety/depression), and these

  16. Effectiveness of low-level laser therapy on pain intensity, pressure pain threshold, and SF-MPQ indexes of women with myofascial pain.

    PubMed

    Magri, Laís Valencise; Carvalho, Vinícius Almeida; Rodrigues, Flávia Cássia Cabral; Bataglion, César; Leite-Panissi, Christie Ramos Andrade

    2017-02-01

    Women with temporomandibular disorders (TMD) frequently report pain areas in body regions. This process is associated with central sensitization phenomena, present in chronic pain. The low-level laser therapy (LLLT) has been reported as a therapeutic option for the painful TMD treatment. The aim of this study was to analyze the effect of LLLT on pain intensity (visual analogue scale, VAS), pain sensitivity in orofacial and corporal points (pressure pain threshold, PPT), and on Short Form-McGill Pain Questionnaire (SF-MPQ) indexes of women with myofascial pain (subtype of muscle TMD). Ninety-one women (18-60 years) were included in the study, among which 61 were diagnosed with myofascial pain (Research Diagnostic Criteria for Temporomandibular Disorder-Ia and Ib) and were divided into laser (n = 31) and placebo group (n = 30), and 30 were controls. The LLLT was applied at pre-established points, twice a week, eight sessions (780 nm; masseter and anterior temporal = 5 J/cm 2 , 20 mW, 10 s; TMJ area = 7.5 J/cm 2 , 30 mW, 10 s). Pain intensity, pain sensitivity, and the SF-MPQ indexes were measured at the baseline, during laser sessions, and 30 days after treatment. For intra-group comparisons, the Friedman test was performed, and for inter-group, the Mann-Whitney test. Increased pain sensitivity was found in women with myofascial pain when compared to controls (p < 0.05). There was a reduction in pain intensity for both groups after LLLT. The LLLT did not change the PPT for any group (p > 0.05). Active laser and placebo reduced the indexes of sensory, total pain, and VAS, maintaining the results after 30 days; there was a reduction in the affective pain rating index for both groups, with no maintenance after 30 days for placebo, and the present pain intensity decreased in the laser group and did not change in the placebo after LLLT. In conclusion, the LLLT active or placebo are effective in reducing the overall subjective perception

  17. The colour of pain: can patients use colour to describe osteoarthritis pain?

    PubMed

    Wylde, Vikki; Wells, Victoria; Dixon, Samantha; Gooberman-Hill, Rachael

    2014-03-01

    The aim of the present study was to explore patients' views on the acceptability and feasibility of using colour to describe osteoarthritis (OA) pain, and whether colour could be used to communicate pain to healthcare professionals. Six group interviews were conducted with 17 patients with knee OA. Discussion topics included first impressions about using colour to describe pain, whether participants could associate their pain with colour, how colours related to changes to intensity and different pain qualities, and whether they could envisage using colour to describe pain to healthcare professionals. The group interviews indicated that, although the idea of using colour was generally acceptable, it did not suit all participants as a way of describing their pain. The majority of participants chose red to describe high-intensity pain; the reasons given were because red symbolized inflammation, fire, anger and the stop signal in a traffic light system. Colours used to describe the absence of pain were chosen because of their association with positive emotional feelings, such as purity, calmness and happiness. A range of colours was chosen to represent changes in pain intensity. Aching pain was consistently identified as being associated with colours such as grey or black, whereas sharp pain was described using a wider selection of colours. The majority of participants thought that they would be able to use colour to describe their pain to healthcare professionals, although issues around the interpretability and standardization of colour were raised. For some patients, using colour to describe their pain experience may be a useful tool to improve doctor-patient communication. Copyright © 2013 John Wiley & Sons, Ltd.

  18. Slow Temporal Summation of Pain for Assessment of Central Pain Sensitivity and Clinical Pain of Fibromyalgia Patients

    PubMed Central

    Staud, Roland; Weyl, Elizabeth E.; Riley, Joseph L.; Fillingim, Roger B.

    2014-01-01

    Background In healthy individuals slow temporal summation of pain or wind-up (WU) can be evoked by repetitive heat-pulses at frequencies of ≥.33 Hz. Previous WU studies have used various stimulus frequencies and intensities to characterize central sensitization of human subjects including fibromyalgia (FM) patients. However, many trials demonstrated considerable WU-variability including zero WU or even wind-down (WD) at stimulus intensities sufficient for activating C-nociceptors. Additionally, few WU-protocols have controlled for contributions of individual pain sensitivity to WU-magnitude, which is critical for WU-comparisons. We hypothesized that integration of 3 different WU-trains into a single WU-response function (WU-RF) would not only control for individuals’ pain sensitivity but also better characterize their central pain responding including WU and WD. Methods 33 normal controls (NC) and 38 FM patients participated in a study of heat-WU. We systematically varied stimulus intensities of.4 Hz heat-pulse trains applied to the hands. Pain summation was calculated as difference scores of 1st and 5th heat-pulse ratings. WU-difference (WU-Δ) scores related to 3 heat-pulse trains (44°C, 46°C, 48°C) were integrated into WU-response functions whose slopes were used to assess group differences in central pain sensitivity. WU-aftersensations (WU-AS) at 15 s and 30 s were used to predict clinical FM pain intensity. Results WU-Δ scores linearly accelerated with increasing stimulus intensity (p<.001) in both groups of subjects (FM>NC) from WD to WU. Slope of WU-RF, which is representative of central pain sensitivity, was significantly steeper in FM patients than NC (p<.003). WU-AS predicted clinical FM pain intensity (Pearson’s r = .4; p<.04). Conclusions Compared to single WU series, WU-RFs integrate individuals’ pain sensitivity as well as WU and WD. Slope of WU-RFs was significantly different between FM patients and NC. Therefore WU-RF may be useful

  19. Quantitative assessment of chronic postsurgical pain using the McGill Pain Questionnaire.

    PubMed

    Bruce, Julie; Poobalan, Amudha S; Smith, W Cairns S; Chambers, W Alastair

    2004-01-01

    The McGill Pain Questionnaire (MPQ) provides a quantitative profile of 3 major psychologic dimensions of pain: sensory-discriminative, motivational-affective, and cognitive-evaluative. Although the MPQ is frequently used as a pain measurement tool, no studies to date have compared the characteristics of chronic post-surgical pain after different surgical procedures using a quantitative scoring method. Three separate questionnaire surveys were administered to patients who had undergone surgery at different time points between 1990 and 2000. Surgical procedures selected were mastectomy (n = 511 patients), inguinal hernia repair (n = 351 patients), and cardiac surgery via a central chest wound with or without saphenous vein harvesting (n = 1348 patients). A standard questionnaire format with the MPQ was used for each survey. The IASP definition of chronic pain, continuously or intermittently for longer than 3 months, was used with other criteria for pain location. The type of chronic pain was compared between the surgical populations using 3 different analytical methods: the Pain Rating Intensity score using scale values, (PRI-S); the Pain Rating Intensity using weighted rank values multiplied by scale value (PRI-R); and number of words chosen (NWC). The prevalence of chronic pain after mastectomy, inguinal herniorrhaphy, and median sternotomy with or without saphenectomy was 43%, 30%, and 39% respectively. Chronic pain most frequently reported was sensory-discriminative in quality with similar proportions across different surgical sites. Average PRI-S values after mastectomy, hernia repair, sternotomy (without postoperative anginal symptoms), and saphenectomy were 14.06, 13.00, 12.03, and 8.06 respectively. Analysis was conducted on cardiac patients who reported anginal symptoms with chronic post-surgical pain (PRI-S value 14.28). Patients with moderate and severe pain were more likely to choose more than 10 pain descriptors, regardless of the operative site (P < 0

  20. Shared Genetics of Temporomandibular Disorder Pain and Neck Pain: Results of a Twin Study.

    PubMed

    Visscher, Corine M; Schouten, Maarten J; Ligthart, Lannie; van Houtem, Caroline Mhh; de Jongh, Ad; Boomsma, Dorret I

    2018-03-06

    (1) To examine the heritability of TMD pain and of neck pain; and (2) to estimate the potential overlap in genetic and environmental factors influencing TMD pain and neck pain. Data from 2,238 adult female twins who completed a survey on TMD pain and neck pain were analyzed. The total variance of TMD pain and neck pain was decomposed into variance attributable to additive genetic effects and nonshared environmental effects. Bivariate structural equation modeling was applied to estimate trait-specific and genetic effects shared between traits. The prevalence of TMD pain and neck pain was 8.6% and 46.8%, respectively, while 6.7% of the twins reported both TMD pain and neck pain. The phenotypic correlation between TMD pain and neck pain, based on a liability threshold model, was 0.43 (95% confidence interval [CI] 0.34 to 0.51). The heritability for TMD was 0.35 (0.17 to 0.51), and for neck pain was 0.33 (0.23 to 0.43). The genetic correlation between TMD pain and neck pain was 0.64 (0.35 to 1.00), and the environmental correlation was 0.32 (0.14 to 0.48). This study shows that variation in TMD pain and neck pain can in part be attributed to genes. The comorbidity between them is partly explained by genes that influence both traits and partly by the same environmental factors.

  1. Qualitative Evaluation of Pediatric Pain Behavior, Quality, and Intensity Item Candidates and the PROMIS Pain Domain Framework in Children With Chronic Pain.

    PubMed

    Jacobson, C Jeffrey; Kashikar-Zuck, Susmita; Farrell, Jennifer; Barnett, Kimberly; Goldschneider, Ken; Dampier, Carlton; Cunningham, Natoshia; Crosby, Lori; DeWitt, Esi Morgan

    2015-12-01

    As initial steps in a broader effort to develop and test pediatric pain behavior and pain quality item banks for the Patient-Reported Outcomes Measurement Information System (PROMIS), we used qualitative interview and item review methods to 1) evaluate the overall conceptual scope and content validity of the PROMIS pain domain framework among children with chronic/recurrent pain conditions, and 2) develop item candidates for further psychometric testing. To elicit the experiential and conceptual scope of pain outcomes across a variety of pediatric recurrent/chronic pain conditions, we conducted 32 semi-structured individual and 2 focus-group interviews with children and adolescents (8-17 years), and 32 individual and 2 focus-group interviews with parents of children with pain. Interviews with pain experts (10) explored the operational limits of pain measurement in children. For item bank development, we identified existing items from measures in the literature, grouped them by concept, removed redundancies, and modified the remaining items to match PROMIS formatting. New items were written as needed and cognitive debriefing was completed with the children and their parents, resulting in 98 pain behavior (47 self, 51 proxy), 54 quality, and 4 intensity items for further testing. Qualitative content analyses suggest that reportable pain outcomes that matter to children with pain are captured within and consistent with the pain domain framework in PROMIS. PROMIS pediatric pain behavior, quality, and intensity items were developed based on a theoretical framework of pain that was evaluated by multiple stakeholders in the measurement of pediatric pain, including researchers, clinicians, and children with pain and their parents, and the appropriateness of the framework was verified. Copyright © 2015 American Pain Society. Published by Elsevier Inc. All rights reserved.

  2. PERSISTENT ARM PAIN IS DISTINCT FROM PERSISTENT BREAST PAIN FOLLOWING BREAST CANCER SURGERY

    PubMed Central

    Langford, Dale J.; Paul, Steven M.; West, Claudia; Abrams, Gary; Elboim, Charles; Levine, Jon D.; Hamolsky, Deborah; Luce, Judith A.; Kober, Kord M.; Neuhaus, John M.; Cooper, Bruce A.; Aouizerat, Bradley E.; Miaskowski, Christine

    2014-01-01

    Persistent pain following breast cancer surgery is well-documented. However, it is not well characterized in terms of the anatomic site effected (i.e., breast, arm). In two separate growth mixture modeling analyses, we identified subgroups of women (n=398) with distinct breast pain and arm pain trajectories. Based on the fact that these latent classes differed by anatomic site, types if tissue affected, and neural innervation patterns suggests the need for separate evaluations of these distinct persistent pain conditions. Purposes of this companion study were to identify demographic and clinical characteristics that differed between the two arm pain classes and determine if differences existed over time in sensitivity in the upper inner arm and axillary lymph node dissection (ALND) sites, pain qualities, pain interference, and hand and arm function; as well as to compare findings with persistent breast pain. Higher occurrence rates for depression and lymphedema were found in the Moderate Arm pain class. Regardless of pain group membership, sensory loss was observed in the upper inner arm and ALND site. Arm pain was described similarly to neuropathic pain and interfered with daily functioning. Persistent arm pain was associated with sustained impairments in shoulder mobility. Perspective: For persistent breast and arm pain, changes in sensation following breast cancer surgery were notable. Persistent arm pain was associated with sustained interference with daily functioning and upper body mobility impairments. Long-term management of persistent pain following breast cancer surgery is warranted to improve the quality of survivorship for these women. PMID:25439319

  3. Differences in Pain Location, Intensity and Quality by Pain Pattern in Outpatients with Cancer

    PubMed Central

    Ngamkham, Srisuda; Holden, Janean E.; Wilkie, Diana J.

    2013-01-01

    Pain pattern represents how the individual’s pain changes temporally with activities or other factors. Understanding pain pattern is important for appropriate timing of pain interventions, but researchers have studied less the temporal aspects of cancer pain than pain location, intensity, and quality parameters. The study purpose was to explore differences in pain location, intensity, and quality by pattern groups in outpatients with cancer. We conducted a comparative, secondary data analysis of data collected from 1994 to 2007. 762 outpatients with cancer had completed the 0-to-10 Pain Intensity Number Scale and the McGill Pain Questionnaire to measure pain location, quality and pattern. From all possible combinations of the three types of pain patterns, we created seven pain pattern groups. The distribution of pain pattern was: pattern-1 (27%); pattern-2 (24%); pattern-3 (8%); pattern-4 (12%); pattern-5 (3%); pattern-6 (18%); and pattern-7 (8%). A statistically significant higher proportion of patients with continuous pain patterns (pattern 1, 4, 5, and 7) reported pain location in two or more sites. Patients with pattern 1, 4, and 7 reported statistically significant, higher worst pain mean scores than patients with pattern 2, 3, and 6 (not continuous descriptors). Patients with pattern7 reported statistically significant, higher mean scores (pain rating index-sensory and total number of words selected) than patients with pattern1, 2, 3, 4, and 6. Using pain pattern groups may help clinicians to understand temporal changes in cancer pain and to provide more effective pain management by recognizing the high risk if the pain is continuous. PMID:21512345

  4. Prediction of Quality of life by Self-Efficacy, Pain Intensity and Pain Duration in Patient with Pain Disorders

    PubMed Central

    Yazdi-Ravandi, Saeid; Taslimi, Zahra; Jamshidian, Narges; Saberi, Hayede; Shams, Jamal; Haghparast, Abbas

    2013-01-01

    The quality of life (QOL) has been defined as “a person's sense of well-being that stems from satisfaction or dissatisfaction with the areas of life that are important to him/her”. It is generally accepted that pain intensity and duration have a negative impact on the QOL. One specific type of control is “self-efficacy”, or the belief that one has the ability to successfully engage in specific actions. The ability to adapt to pain may play an important role in maintaining the QOL. In this study, we investigated the role of self-efficacy, pain intensity, and pain duration in various domains of quality of life such as physical, psychological, social and environmental domains. In this study, 290 adult patients (146 men, 144 women) completed coping self-efficacy and the WHOQOL-BREF Questionnaire. Moreover, we illustrated numerical rating scale for pain intensity. The results were analyzed using SPSS version of 19.0 and means, descriptive correlation, and regression were calculated. Our data revealed that self-efficacy but not the pain duration could significantly anticipate the QOL and its four related domains (P<0.001). In addition, it is noticeable that the effect of self-efficacy on the prediction of QOL is much more obvious in the psychological domain. However, the pain intensity could predict all of the QOL domains (P<0.001) except social and environmental ones. In conclusion, to predict the quality of life (QOL) in person suffering from chronic pain, self-efficacy and pain intensity are more important factors than the pain duration and demographic variables. PMID:25337337

  5. A Child's Concept of Pain: An International Survey of Pediatric Pain Experts.

    PubMed

    Pate, Joshua W; Hush, Julia M; Hancock, Mark J; Moseley, G Lorimer; Butler, David S; Simons, Laura E; Pacey, Verity

    2018-01-15

    A child's 'concept of pain' refers to how they understand what pain actually is, what function pain serves, and what biological processes are thought to underpin it. We aimed to determine pediatric pain experts' opinions of: (1) the importance and usefulness of assessing a child's concept of pain in clinical and/or research settings; (2) the usefulness of the content of items within currently published adult-targeted resources for assessing a child's concept of pain; and (3) important domains of a child's concept of pain to assess. Forty-nine pediatric pain experts (response rate = 75.4%) completed an online survey. Descriptive statistics and frequency of responses were analyzed. Experts from all included disciplines reported that assessing a child's concept of pain is important and useful both clinically and in a research setting (>80% reported very or extremely useful for each item). Experts considered that the content of 13 items from currently published adult-targeted resources was useful, but the wording was too complex for children aged 8-12 years. Experts considered that all seven of the proposed domains of a child's concept of pain was important to assess. The findings can be used to inform the development of an assessment tool for a child's concept of pain.

  6. Pain, pain intensity and pain disability in high school students are differently associated with physical activity, screening hours and sleep.

    PubMed

    Silva, Anabela G; Sa-Couto, Pedro; Queirós, Alexandra; Neto, Maritza; Rocha, Nelson P

    2017-05-16

    Studies exploring the association between physical activity, screen time and sleep and pain usually focus on a limited number of painful body sites. Nevertheless, pain at different body sites is likely to be of different nature. Therefore, this study aims to explore and compare the association between time spent in self-reported physical activity, in screen based activities and sleeping and i) pain presence in the last 7-days for 9 different body sites; ii) pain intensity at 9 different body sites and iii) global disability. Nine hundred sixty nine students completed a questionnaire on pain, time spent in moderate and vigorous physical activity, screen based time watching TV/DVD, playing, using mobile phones and computers and sleeping hours. Univariate and multivariate associations between pain presence, pain intensity and disability and physical activity, screen based time and sleeping hours were investigated. Pain presence: sleeping remained in the multivariable model for the neck, mid back, wrists, knees and ankles/feet (OR 1.17 to 2.11); moderate physical activity remained in the multivariate model for the neck, shoulders, wrists, hips and ankles/feet (OR 1.06 to 1.08); vigorous physical activity remained in the multivariate model for mid back, knees and ankles/feet (OR 1.05 to 1.09) and screen time remained in the multivariate model for the low back (OR = 2.34. Pain intensity: screen time and moderate physical activity remained in the multivariable model for pain intensity at the neck, mid back, low back, shoulder, knees and ankles/feet (Rp 2 0.02 to 0.04) and at the wrists (Rp 2  = 0.04), respectively. Disability showed no association with sleeping, screen time or physical activity. This study suggests both similarities and differences in the patterns of association between time spent in physical activity, sleeping and in screen based activities and pain presence at 8 different body sites. In addition, they also suggest that the factors associated

  7. A typology of pain coping strategies in pediatric patients with chronic abdominal pain.

    PubMed

    Walker, Lynn S; Baber, Kari Freeman; Garber, Judy; Smith, Craig A

    2008-07-15

    This study aimed to identify clinically meaningful profiles of pain coping strategies used by youth with chronic abdominal pain (CAP). Participants (n=699) were pediatric patients (ages 8-18 years) and their parents. Patients completed the Pain Response Inventory (PRI) and measures of somatic and depressive symptoms, disability, pain severity and pain efficacy, and perceived competence. Parents rated their children's pain severity and coping efficacy. Hierarchical cluster analysis based on the 13 PRI subscales identified pain coping profiles in Sample 1 (n=311) that replicated in Sample 2 (n=388). Evidence was found of external validity and distinctiveness of the profiles. The findings support a typology of pain coping that reflects the quality of patients' pain mastery efforts and interpersonal relationships associated with pain coping. Results are discussed in relation to developmental processes, attachment styles, and treatment implications.

  8. Medial elbow pain

    PubMed Central

    Barco, Raul; Antuña, Samuel A.

    2017-01-01

    Medial elbow pain is uncommon when compared with lateral elbow pain. Medial epicondylitis is an uncommon diagnosis and can be confused with other sources of pain. Overhead throwers and workers lifting heavy objects are at increased risk of medial elbow pain. Differential diagnosis includes ulnar nerve disorders, cervical radiculopathy, injured ulnar collateral ligament, altered distal triceps anatomy or joint disorders. Children with medial elbow pain have to be assessed for ‘Little League elbow’ and fractures of the medial epicondyle following a traumatic event. This paper is primarily focused on the differential diagnosis of medial elbow pain with basic recommendations on treatment strategies. Cite this article: EFORT Open Rev 2017;2:362-371. DOI: 10.1302/2058-5241.2.160006 PMID:28932488

  9. The influence of pain-related expectations on intensity perception of non-painful somatosensory stimuli.

    PubMed

    Zaman, Jonas; Wiech, Katja; Claes, Nathalie; Van Oudenhove, Lukas; Van Diest, Ilse; Vlaeyen, Johan W S

    2018-04-03

    The extent to which pain-related expectations, known to affect pain perception, also affect perception of non-painful sensations remains unclear, as well as the potential role of unpredictability in this context. In a proprioceptive fear conditioning paradigm, various arm extension movements were associated with predictable and unpredictable electrocutaneous pain or its absence. During a subsequent test phase non-painful electrocutaneous stimuli with a high or low intensity were presented during movement execution. We used hierarchical drift diffusion modeling to examine the influence of expecting pain on the perceptual decision-making process underlying intensity perception of non-painful sensations. In the first experiment (n=36), the pain stimulus was never presented during the test phase after conditioning. In the second experiment (n=39), partial reinforcement was adopted to prevent extinction of pain expectations. In both experiments, movements that were associated with (un)predictable pain led to higher pain-expectancy, self-reported fear, unpleasantness and arousal, as compared to movements that were never paired with pain (effect sizes ηp ranging from .119 - .557; all p-values < .05). Only in the second experiment - when the threat of the pain US remained present - we found that the expectation of pain affected decision-making. Compared to the no pain condition, an a priori decision-making bias towards the high intensity decision threshold was found with the strongest bias during unpredictable pain (effect sizes ηp ranging from .469 - .504; all p-values < .001). Thus, the expectation of pain not only affects inferential processes for subsequent painful but also for non-painful bodily stimuli, with unpredictability moderating these effects, and only when the threat of pain remains present due to partial reinforcement.

  10. Pain Anxiety and Its Association With Pain Congruence Trajectories During the Cold Pressor Task.

    PubMed

    Clark, Shannon M; Cano, Annmarie; Goubert, Liesbet; Vlaeyen, Johan W S; Wurm, Lee H; Corley, Angelia M

    2017-04-01

    Incongruence of pain severity ratings among people experiencing pain and their observers has been linked to psychological distress. Previous studies have measured pain rating congruence through static self-report, involving a single rating of pain; however, this method does not capture changes in ratings over time. The present study examined the extent to which partners were congruent on multiple ratings of a participants' pain severity during the cold pressor task. Furthermore, 2 components of pain anxiety-pain catastrophizing and perceived threat-were examined as predictors of pain congruence. Undergraduate couples in a romantic relationship (N = 127 dyads) participated in this study. Both partners completed measures of pain catastrophizing and perceived threat before randomization to their cold pressor participant or observer roles. Participants and observers rated the participant's pain in writing several times over the course of the task. On average, observers rated participants' pain as less severe than participants' rated their own pain. In addition, congruence between partners increased over time because of observers' ratings becoming more similar to participant's ratings. Finally, pain catastrophizing and perceived threat independently and jointly influenced the degree to which partners similarly rated the participant's pain. This article presents a novel application of the cold pressor task to show that pain rating congruence among romantic partners changes over time. These findings indicate that pain congruence is not static and is subject to pain anxiety in both partners. Copyright © 2016 American Pain Society. Published by Elsevier Inc. All rights reserved.

  11. Prevalence and characteristics of breakthrough pain in opioid-treated patients with chronic noncancer pain.

    PubMed

    Portenoy, Russell K; Bennett, Daniel S; Rauck, Richard; Simon, Steven; Taylor, Donald; Brennan, Michael; Shoemaker, Steven

    2006-08-01

    Breakthrough pain is well-characterized in cancer patients but not in patients with chronic noncancer pain. We recruited 228 patients with diverse types of chronic noncancer pain from 9 pain programs and administered a telephone questionnaire with a breakthrough pain assessment algorithm originally designed for cancer patients. All patients had controlled baseline pain, and 168 (74%) experienced severe to excruciating breakthrough pain. Among those with breakthrough pain, the most common syndrome was low back pain (52%), and the underlying pathophysiology was variably characterized as somatic (38%), neuropathic (18%), visceral (4%), or mixed (40%). A total of 189 different types of breakthrough pain were reported. The median number of episodes per day was 2 (range, <1 to 12). Median time to maximum intensity was 10 minutes (range, 0 to 180 minutes). Median duration of the breakthrough pain was 60 minutes (range, 1 to 720 minutes). Patients identified a precipitant for 69% of pains, and 92% of these were activity-related. Onset could never be predicted for 45% of pains and only sometimes predicted for 31% of pains. Breakthrough pain is highly prevalent and varied in this population. Further studies are warranted to clarify whether the clinical impact and therapeutic challenges posed by this phenomenon are comparable to the cancer population. This article presents results from a survey that demonstrates that breakthrough pain is highly prevalent and varied in opioid-treated patients with chronic noncancer pain. These findings will assist clinicians in assessing and managing this type of pain.

  12. Loin pain hematuria syndrome.

    PubMed

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

    2014-09-01

    Loin pain hematuria syndrome is a rare disease with a prevalence of ∼0.012%. The most prominent clinical features include periods of severe intermittent or persistent unilateral or bilateral loin pain accompanied by either microscopic or gross hematuria. Patients with loin pain hematuria syndrome initially present with hematuria, flank pain, or most often both hematuria and flank pain. Kidney biopsies from patients with loin pain hematuria typically reveal only minor pathologic abnormalities. Further, loin pain hematuria syndrome is not associated with loss of kidney function or urinary tract infections. Loin pain hematuria syndrome-associated hematuria and pain are postulated to be linked to vascular disease of the kidney, coagulopathy, renal vasospasm with microinfarction, hypersensitivity, complement activation on arterioles, venocalyceal fistula, abnormal ureteral peristalsis, and intratubular deposition of calcium or uric acid microcrystals. Many patients with loin pain hematuria syndrome also meet criteria for a somatoform disorder, and analgesic medications, including narcotics, commonly are used to treat loin pain hematuria syndrome-associated pain. Interventional treatments include renal denervation, kidney autotransplantation, and nephrectomy; however, these methods should be used only as a last resort when less invasive measures have been tried unsuccessfully. In this review article, we discuss and critique current clinical practices related to loin pain hematuria syndrome pathophysiology, diagnosis, treatment, and prognosis. Copyright © 2014 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

  13. Cancer pain and current theory for pain control.

    PubMed

    Kahan, Brian

    2014-05-01

    This article discusses current trends in managing cancer pain, with specific regard to opioid transmission, descending pathway inhabitation, and ways to facilitate the endogenous antinociceptive chemicals in the human body. Various techniques for opioid and nonopioid control of potential pain situations of patients with cancer are discussed. The benefits of using pharmacogenetics to assess the appropriate medications are addressed. Finally, specific treatment of abdominal cancer pain using radiofrequency lesioning is discussed. Copyright © 2014 Elsevier Inc. All rights reserved.

  14. KSC00pp1753

    NASA Image and Video Library

    2000-11-27

    At the Shuttle Landing Facility, Center Director Roy Bridges (left) greets STS-97 Commander Brent Jett on his arrival at KSC for the mission launch. At right is Mission Specialist Carlos Noriega. Jett and Noriega traveled from Johnson Space Center, Houston, Texas, in the T-38 jet aircraft behind them. Mission STS-97is the sixth construction flight to the International Space Station. Its payload includes the P6 Integrated Truss Structure and a photovoltaic (PV) module, with giant solar arrays that will provide power to the Station. The mission includes two spacewalks to complete the solar array connections. STS-97 is scheduled to launch Nov. 30 at about 10:06 p.m. EST

  15. KSC-00pp1753

    NASA Image and Video Library

    2000-11-27

    At the Shuttle Landing Facility, Center Director Roy Bridges (left) greets STS-97 Commander Brent Jett on his arrival at KSC for the mission launch. At right is Mission Specialist Carlos Noriega. Jett and Noriega traveled from Johnson Space Center, Houston, Texas, in the T-38 jet aircraft behind them. Mission STS-97is the sixth construction flight to the International Space Station. Its payload includes the P6 Integrated Truss Structure and a photovoltaic (PV) module, with giant solar arrays that will provide power to the Station. The mission includes two spacewalks to complete the solar array connections. STS-97 is scheduled to launch Nov. 30 at about 10:06 p.m. EST

  16. Contextual influences on pain communication in couples with and without a partner with chronic pain.

    PubMed

    Gagnon, Michelle M; Hadjistavropoulos, Thomas; MacNab, Ying C

    2017-10-01

    This is an experimental study of pain communication in couples. Despite evidence that chronic pain in one partner impacts both members of the dyad, dyadic influences on pain communication have not been sufficiently examined and are typically studied based on retrospective reports. Our goal was to directly study contextual influences (ie, presence of chronic pain, gender, relationship quality, and pain catastrophizing) on self-reported and nonverbal (ie, facial expressions) pain responses. Couples with (n = 66) and without (n = 65) an individual with chronic pain (ICP) completed relationship and pain catastrophizing questionnaires. Subsequently, one partner underwent a pain task (pain target, PT), while the other partner observed (pain observer, PO). In couples with an ICP, the ICP was assigned to be the PT. Pain intensity and PO perceived pain intensity ratings were recorded at multiple intervals. Facial expressions were video recorded throughout the pain task. Pain-related facial expression was quantified using the Facial Action Coding System. The most consistent predictor of either partner's pain-related facial expression was the pain-related facial expression of the other partner. Pain targets provided higher pain ratings than POs and female PTs reported and showed more pain, regardless of chronic pain status. Gender and the interaction between gender and relationship satisfaction were predictors of pain-related facial expression among PTs, but not POs. None of the examined variables predicted self-reported pain. Results suggest that contextual variables influence pain communication in couples, with distinct influences for PTs and POs. Moreover, self-report and nonverbal responses are not displayed in a parallel manner.

  17. Parenting in the context of chronic pain: A controlled study of parents with chronic pain

    PubMed Central

    Wilson, Anna C.; Fales, Jessica L.

    2014-01-01

    Objectives This study aims to describe what adults with chronic pain experience in their role as parents, utilizing quantitative and qualitative methods. The first aim is to compare parents with chronic pain to parents without chronic pain on perceptions of their adolescent’s pain, parental response to pain, and catastrophizing beliefs about pain. The study also examined predictors of parental protective behaviors, and examined whether these associations differed by study group. Methods Parents with chronic pain (n=58) and parents without chronic pain (n=72) participated, and completed questionnaire measures of pain characteristics and pain interference, as well as measures of parental catastrophizing and protective pain responses. Parents with chronic pain also completed a structured interview about their experience of being a parent. Interview responses were videotaped and subsequently coded for content. Results Compared to controls, parents with chronic pain endorsed more pain in their adolescents, and were more likely to catastrophize about their adolescent’s pain and respond with protective behaviors. Parent’s own pain interference and the perception of higher pain in their adolescent was associated with increased protective parenting in the chronic pain group. Qualitative coding revealed a number of areas of common impact of chronic pain on parenting. Discussion Chronic pain impacts everyday parenting activities and emotions, and impacts pain-specific parent responses that are known to be related to increased pain and pain catastrophizing in children and adolescents. Parents with chronic pain might benefit from interventions that address potential parenting difficulties, and might improve outcomes for their children. PMID:25232862

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

    PubMed

    Yang, Zhou; Jackson, Todd; Huang, Chengzhi

    2016-01-01

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

  19. Patients with Concomitant Chronic Neck Pain and Myofascial Pain in Masticatory Muscles Have More Widespread Pain and Distal Hyperalgesia than Patients with Only Chronic Neck Pain.

    PubMed

    Muñoz-García, Daniel; López-de-Uralde-Villanueva, Ibai; Beltrán-Alacreu, Héctor; La Touche, Roy; Fernández-Carnero, Josué

    2017-03-01

    Insufficient evidence exists to compare widespread pain (WP), pain sensibility, and psychological factors that occur in patients presenting with chronic neck pain (CNP) or a combination of temporomandibular disorder (TMD) and other complaints. The present study compared the pain sensibility and psychological factors of subjects with CNP with those with TMD + CNP. Cross-sectional study. Local community. A nonprobabilistic convenience sample of 86 persons with CNP or TMD was recruited into three groups: CNP, TMD with myofascial pain in masticatory muscles with cocomitant CNP (TMD + CNP), and asymptomatic control groups consisted of 27, 29, and 30 participants, respectively. Participants underwent a clinical examination to evaluate WP with computerized assessment based on the pain drawing, pressure pain thresholds (PPT), and psychological factors, which were evaluated using the pain catastrophizing scale (PCS) and the state-trait anxiety inventory (STAI). Statistically significant differences were observed between participants with CNP and TMD + CNP for WP (t = -2.80, P  < 0.01, d = -1.06). Post hoc analyses only revealed significant differences between TMD + CNP participants and asymptomatic controls for PPT at extratrigeminal areas. Pearson correlation analyses showed a moderate positive association between symptomatic groups within the WP and STAI ( P  < 0.05) and a moderate negative association between PCS and PPT ( P  < 0.05) at the right tibialis muscle. TMD + CNP participants had more areas of pain and also showed widespread pain hyperalgesia. Both groups of participants had psychological factors positively associated with STAI and WP; further, PCS and the PPT at the extratrigeminal region were negatively associated with each other in both groups, except for the left tibialis in the TMD + CNP group. © 2016 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

  20. Documentation of pain care processes does not accurately reflect pain management delivered in primary care.

    PubMed

    Krebs, Erin E; Bair, Matthew J; Carey, Timothy S; Weinberger, Morris

    2010-03-01

    Researchers and quality improvement advocates sometimes use review of chart-documented pain care processes to assess the quality of pain management. Studies have found that primary care providers frequently fail to document pain assessment and management. To assess documentation of pain care processes in an academic primary care clinic and evaluate the validity of this documentation as a measure of pain care delivered. Prospective observational study. 237 adult patients at a university-affiliated internal medicine clinic who reported any pain in the last week. Immediately after a visit, we asked patients to report the pain treatment they received. Patients completed the Brief Pain Inventory (BPI) to assess pain severity at baseline and 1 month later. We extracted documentation of pain care processes from the medical record and used kappa statistics to assess agreement between documentation and patient report of pain treatment. Using multivariable linear regression, we modeled whether documented or patient-reported pain care predicted change in pain at 1 month. Participants' mean age was 53.7 years, 66% were female, and 74% had chronic pain. Physicians documented pain assessment for 83% of visits. Patients reported receiving pain treatment more often (67%) than was documented by physicians (54%). Agreement between documentation and patient report was moderate for receiving a new pain medication (k = 0.50) and slight for receiving pain management advice (k = 0.13). In multivariable models, documentation of new pain treatment was not associated with change in pain (p = 0.134). In contrast, patient-reported receipt of new pain treatment predicted pain improvement (p = 0.005). Chart documentation underestimated pain care delivered, compared with patient report. Documented pain care processes had no relationship with pain outcomes at 1 month, but patient report of receiving care predicted clinically significant improvement. Chart review measures may not accurately

  1. The ACTTION–APS–AAPM Pain Taxonomy (AAAPT) Multidimensional Approach to Classifying Acute Pain Conditions

    PubMed Central

    Kent, Michael L.; Tighe, Patrick J.; Belfer, Inna; Brennan, Timothy J.; Bruehl, Stephen; Brummett, Chad M.; Buckenmaier, Chester C.; Buvanendran, Asokumar; Cohen, Robert I.; Desjardins, Paul; Edwards, David; Fillingim, Roger; Gewandter, Jennifer; Gordon, Debra B.; Hurley, Robert W.; Kehlet, Henrik; Loeser, John D.; Mackey, Sean; McLean, Samuel A.; Polomano, Rosemary; Rahman, Siamak; Raja, Srinivasa; Rowbotham, Michael; Suresh, Santhanam; Schachtel, Bernard; Schreiber, Kristin; Schumacher, Mark; Stacey, Brett; Stanos, Steven; Todd, Knox; Turk, Dennis C.; Weisman, Steven J.; Wu, Christopher; Carr, Daniel B.; Dworkin, Robert H.; Terman, Gregory

    2017-01-01

    Objective. With the increasing societal awareness of the prevalence and impact of acute pain, there is a need to develop an acute pain classification system that both reflects contemporary mechanistic insights and helps guide future research and treatment. Existing classifications of acute pain conditions are limiting, with a predominant focus on the sensory experience (e.g., pain intensity) and pharmacologic consumption. Consequently, there is a need to more broadly characterize and classify the multidimensional experience of acute pain. Setting. Consensus report following expert panel involving the Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks (ACTTION), American Pain Society (APS), and American Academy of Pain Medicine (AAPM). Methods. As a complement to a taxonomy recently developed for chronic pain, the ACTTION public-private partnership with the US Food and Drug Administration, the APS, and the AAPM convened a consensus meeting of experts to develop an acute pain taxonomy using prevailing evidence. Key issues pertaining to the distinct nature of acute pain are presented followed by the agreed-upon taxonomy. The ACTTION-APS-AAPM Acute Pain Taxonomy will include the following dimensions: 1) core criteria, 2) common features, 3) modulating factors, 4) impact/functional consequences, and 5) putative pathophysiologic pain mechanisms. Future efforts will consist of working groups utilizing this taxonomy to develop diagnostic criteria for a comprehensive set of acute pain conditions. Perspective. The ACTTION-APS-AAPM Acute Pain Taxonomy (AAAPT) is a multidimensional acute pain classification system designed to classify acute pain along the following dimensions: 1) core criteria, 2) common features, 3) modulating factors, 4) impact/functional consequences, and 5) putative pathophysiologic pain mechanisms. Conclusions. Significant numbers of patients still suffer from significant acute pain

  2. The ACTTION-APS-AAPM Pain Taxonomy (AAAPT) Multidimensional Approach to Classifying Acute Pain Conditions.

    PubMed

    Kent, Michael L; Tighe, Patrick J; Belfer, Inna; Brennan, Timothy J; Bruehl, Stephen; Brummett, Chad M; Buckenmaier, Chester C; Buvanendran, Asokumar; Cohen, Robert I; Desjardins, Paul; Edwards, David; Fillingim, Roger; Gewandter, Jennifer; Gordon, Debra B; Hurley, Robert W; Kehlet, Henrik; Loeser, John D; Mackey, Sean; McLean, Samuel A; Polomano, Rosemary; Rahman, Siamak; Raja, Srinivasa; Rowbotham, Michael; Suresh, Santhanam; Schachtel, Bernard; Schreiber, Kristin; Schumacher, Mark; Stacey, Brett; Stanos, Steven; Todd, Knox; Turk, Dennis C; Weisman, Steven J; Wu, Christopher; Carr, Daniel B; Dworkin, Robert H; Terman, Gregory

    2017-05-01

    With the increasing societal awareness of the prevalence and impact of acute pain, there is a need to develop an acute pain classification system that both reflects contemporary mechanistic insights and helps guide future research and treatment. Existing classifications of acute pain conditions are limiting, with a predominant focus on the sensory experience (eg, pain intensity) and pharmacologic consumption. Consequently, there is a need to more broadly characterize and classify the multidimensional experience of acute pain. Consensus report following expert panel involving the Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks (ACTTION), American Pain Society (APS), and American Academy of Pain Medicine (AAPM). As a complement to a taxonomy recently developed for chronic pain, the ACTTION public-private partnership with the US Food and Drug Administration, the APS, and the AAPM convened a consensus meeting of experts to develop an acute pain taxonomy using prevailing evidence. Key issues pertaining to the distinct nature of acute pain are presented followed by the agreed-upon taxonomy. The ACTTION-APS-AAPM Acute Pain Taxonomy will include the following dimensions: 1) core criteria, 2) common features, 3) modulating factors, 4) impact/functional consequences, and 5) putative pathophysiologic pain mechanisms. Future efforts will consist of working groups utilizing this taxonomy to develop diagnostic criteria for a comprehensive set of acute pain conditions. The ACTTION-APS-AAPM Acute Pain Taxonomy (AAAPT) is a multidimensional acute pain classification system designed to classify acute pain along the following dimensions: 1) core criteria, 2) common features, 3) modulating factors, 4) impact/functional consequences, and 5) putative pathophysiologic pain mechanisms. Significant numbers of patients still suffer from significant acute pain, despite the advent of modern multimodal analgesic strategies

  3. Chronic pelvic pain.

    PubMed

    Stein, Sharon L

    2013-12-01

    Chronic pelvic pain is pain lasting longer than 6 months and is estimated to occur in 15% of women. Causes of pelvic pain include disorders of gynecologic, urologic, gastroenterologic, and musculoskeletal systems. The multidisciplinary nature of chronic pelvic pain may complicate diagnosis and treatment. Treatments vary by cause but may include medicinal, neuroablative, and surgical treatments. Copyright © 2013 Elsevier Inc. All rights reserved.

  4. Pain trajectory and exercise-induced pain flares during 8 weeks of neuromuscular exercise in individuals with knee and hip pain.

    PubMed

    Sandal, L F; Roos, E M; Bøgesvang, S J; Thorlund, J B

    2016-04-01

    Patients considering or engaged in exercise as treatment may expect or experience transient increases in joint pain, causing fear of exercise and influencing compliance. This study investigated the pain trajectory during an 8-week neuromuscular exercise (NEMEX) program together with acute exercise-induced pain flares in persons with knee or hip pain. Individuals above 35 years self-reporting persistent knee or hip pain for the past 3 months were offered 8 weeks of supervised NEMEX, performed in groups twice weekly. The program consisted of 11 exercises focusing on joint stability and neuromuscular control. Participants self-reported joint pain on a 0-10 numerical rating scale (NRS) at baseline and 8-weeks follow-up. NRS pain ratings were also collected before and immediately after every attended exercise session. Joint pain was reduced from baseline (NRS 3.6; 95% CI 3.2-4.1) to 8-weeks follow-up (2.6; 95% CI 2.1-3.1), (P < 0.01). Pain decreased 0.04 NRS (95% CI 0.02-0.05, P < 0.01) on average per exercise session and pre- to post-exercise pain decreased 0.04 NRS (95% CI 0.03-0.05, P < 0.01) on average per session, approaching no acute exercise-induced pain in the last weeks. This study found a clear decrease in size of acute exercise-induced pain flares with increasing number of exercise sessions. In parallel, pain ratings decreased over the 8 weeks exercise period. Our findings provide helpful information for clinicians, which can be used to educate and balance patient expectation when starting supervised neuromuscular exercise. Copyright © 2015 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

  5. Triggering Descending Pain Inhibition by Observing Ourselves or a Loved-One in Pain.

    PubMed

    Gougeon, Véronique; Gaumond, Isabelle; Goffaux, Philippe; Potvin, Stéphane; Marchand, Serge

    2016-03-01

    Recent studies demonstrate that empathy-evoked brain responses include the activation of brainstem structures responsible for triggering descending pain inhibition. Unfortunately, direct evidence linking empathy for pain and descending inhibitory controls (conditioned pain modulation) is lacking. This study, therefore, aimed to determine if the observation of ourselves or a loved-one in pain could activate descending pain inhibition without exposure to a noxious stimulation; which is otherwise required. Descending pain inhibition was triggered by immersing the right arm of participants (15 heterosexual couples; mean age±SE: 28.89±2.14) in a bath of cold water. The effects of empathy on descending pain inhibition were observed by immersing the right arm of participants in a bath of lukewarm water while having them watch a video of either themselves or their spouse during a previous nociceptive immersion. Immersion of the arm in a bath of lukewarm water without empathic (video) observation was also included as a control condition. A strong inhibitory response activated by the mere observation of the video of themselves or their spouse in pain without a nociceptive conditioning stimulus. Associative statistics also showed that strong pain catastrophizing responses while watching the video resulted in stronger pain inhibition. Moreover, high levels of empathy were associated with stronger pain inhibition, but only for women. This study showed that observing someone in pain triggers descending pain inhibition. Results also demonstrate how empathy and gender are affecting pain modulation mechanisms.

  6. Living in fear of your child's pain: the Parent Fear of Pain Questionnaire.

    PubMed

    Simons, Laura E; Smith, Allison; Kaczynski, Karen; Basch, Molly

    2015-04-01

    Fear and avoidance have been consistently associated with poor pain-related outcomes in children. In the context of the pediatric pain experience, parent distress and behaviors can be highly influential. This study validated the Parent Fear of Pain Questionnaire (PFOPQ) to assess a parent's fears and avoidance behaviors associated with their child's pain. Using the PFOPQ in conjunction with measures of parent and child pain-related variables, we tested the interpersonal fear-avoidance model (IFAM). The sample comprised 321 parents and their child with chronic or new-onset pain who presented to a multidisciplinary outpatient pain clinic. An exploratory factor analysis yielded a 4-factor structure for the PFOPQ consisting of Fear of Pain, Fear of Movement, Fear of School, and Avoidance. As hypothesized, Fear of Pain was most closely related to parent pain catastrophizing and child fear of pain, whereas Avoidance was most closely related to parent protective behaviors and child avoidance of activities. In testing the IFAM, parent behavior contributed directly and indirectly to child avoidance, whereas parent fear and catastrophizing contributed indirectly to child avoidance through parent behavior and child fear and catastrophizing, in turn, influencing child functional disability levels. This study provides the first measure of parent pain-related fears and avoidance behaviors and evaluates the theorized IFAM. These results underscore the important influence of parents on child pain-related outcomes and put forth a psychometrically sound measure to assess parent fear and avoidance in the context of their child's pain.

  7. Numerical simulation of a 100-ton ANFO detonation

    NASA Astrophysics Data System (ADS)

    Weber, P. W.; Millage, K. K.; Crepeau, J. E.; Happ, H. J.; Gitterman, Y.; Needham, C. E.

    2015-03-01

    This work describes the results from a US government-owned hydrocode (SHAMRC, Second-Order Hydrodynamic Automatic Mesh Refinement Code) that simulated an explosive detonation experiment with 100,000 kg of Ammonium Nitrate-Fuel Oil (ANFO) and 2,080 kg of Composition B (CompB). The explosive surface charge was nearly hemispherical and detonated in desert terrain. Two-dimensional axisymmetric (2D) and three-dimensional (3D) simulations were conducted, with the 3D model providing a more accurate representation of the experimental setup geometry. Both 2D and 3D simulations yielded overpressure and impulse waveforms that agreed qualitatively with experiment, including the capture of the secondary shock observed in the experiment. The 2D simulation predicted the primary shock arrival time correctly but secondary shock arrival time was early. The 2D-predicted impulse waveforms agreed very well with the experiment, especially at later calculation times, and prediction of the early part of the impulse waveform (associated with the initial peak) was better quantitatively for 2D compared to 3D. The 3D simulation also predicted the primary shock arrival time correctly, and secondary shock arrival times in 3D were closer to the experiment than in the 2D results. The 3D-predicted impulse waveform had better quantitative agreement than 2D for the later part of the impulse waveform. The results of this numerical study show that SHAMRC may be used reliably to predict phenomena associated with the 100-ton detonation. The ultimate fidelity of the simulations was limited by both computer time and memory. The results obtained provide good accuracy and indicate that the code is well suited to predicting the outcomes of explosive detonations.

  8. Chronic pain experience and pain management in persons with spinal cord injury in Nepal.

    PubMed

    Thapa, Sagun; Kitrungrote, Luppana; Damkliang, Jintana

    2018-04-25

    Chronic pain is the frequent and significantly challenging complications in persons with spinal cord injury (SCI). Socio-cultural background may lead people perceive and manage pain differently. The study aims to describe the chronic pain experience and pain management of SCI persons in Nepal. A descriptive cross sectional study was conducted among purposively selected sample of 120 SCI persons with chronic pain living in the eight districts of Bagmati Zone of Nepal. The data were collected using the International Spinal Cord Injury Pain Basic Data Set Version 2 (ISCIPBDS-2) and Open-ended Pain Management Questionnaire. The data were analyzed using descriptive statistics and content analysis method. The back (n=84), lower legs/feet (n=63) and buttocks/hips (n=51) was found as the common pain locations. In common, the onset of pain was found within the first 6 month of the injury. Overall pain intensity and pain interference were found to be at the moderate level. The SCI persons used pain medications and non-pharmacological pain management. Ibuprofen was the commonly used pain medication and commonly used non-pharmacological pain management methods included physical support (e.g. massage, exercise), relaxation (e.g. distraction, substance abuse), coping (e.g. acceptance, praying), and traditional herbs. SCI persons had chronic pain experience which interfered with their daily living. They used pain medications and non-pharmacological pain management methods based on their beliefs, knowledge, and community resources in Nepal. This study provides some evidence to help the team of rehabilitation professional to plan and help SCI persons with chronic pain. Based on these findings, chronic pain management intervention for SCI persons should be developed and supported continuously from hospital to home based community context of Nepal.

  9. The Key Role of Pain Catastrophizing in the Disability of Patients with Acute Back Pain.

    PubMed

    Ramírez-Maestre, C; Esteve, R; Ruiz-Párraga, G; Gómez-Pérez, L; López-Martínez, A E

    2017-04-01

    This study investigated the role of anxiety sensitivity, resilience, pain catastrophizing, depression, pain fear-avoidance beliefs, and pain intensity in patients with acute back pain-related disability. Two hundred and thirty-two patients with acute back pain completed questionnaires on anxiety sensitivity, resilience, pain catastrophizing, fear-avoidance beliefs, depression, pain intensity, and disability. A structural equation modelling analysis revealed that anxiety sensitivity was associated with pain catastrophizing, and resilience was associated with lower levels of depression. Pain catastrophizing was positively associated with fear-avoidance beliefs and pain intensity. Depression was associated with fear-avoidance beliefs, but was not associated with pain intensity. Finally, catastrophizing, fear-avoidance beliefs, and pain intensity were positively and significantly associated with acute back pain-related disability. Although fear-avoidance beliefs and pain intensity were associated with disability, the results showed that pain catastrophizing was a central variable in the pain experience and had significant direct associations with disability when pain was acute. Anxiety sensitivity appeared to be an important antecedent of catastrophizing, whereas the influence of resilience on the acute back pain experience was limited to its relationship with depression.

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

    PubMed Central

    Becker, Daniel E.

    2010-01-01

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

  11. 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. Copyright © 2014 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

  12. Words that describe chronic musculoskeletal pain: implications for assessing pain quality across cultures.

    PubMed

    Sharma, Saurab; Pathak, Anupa; Jensen, Mark P

    2016-01-01

    People from different cultures who speak different languages may experience pain differently. This possible variability has important implications for evaluating the validity of pain quality measures that are directly translated into different languages without cultural adaptations. The aim of this study was to evaluate the impact of language and culture on the validity of pain quality measures by comparing the words that individuals with chronic pain from Nepal use to describe their pain with those used by patients from the USA. A total of 101 individuals with chronic musculoskeletal pain in Nepal were asked to describe their pain. The rates of the different pain descriptor domains and phrases used by the Nepali sample were then compared to the published rates of descriptors used by patients from the USA. The content validity of commonly used measures for assessing pain quality was then evaluated. While there was some similarity between patients from Nepal and the USA in how they describe pain, there were also important differences, especially in how pain quality was described. For example, many patients from Nepal used metaphors to describe their pain. Also, the patients from Nepal often used a category of pain descriptor - which describes a physical state - not used by patients from the USA. Only the original McGill Pain Questionnaire was found to have content validity for assessing pain quality in patients from Nepal, although other existing pain quality measures could be adapted to be content valid by adding one or two additional descriptors, depending on the measure in question. The findings indicate that direct translations of measures that are developed using samples of patients from one country or culture are not necessarily content valid for use in other countries or cultures; some adaptations may be required in order for such measures to be most useful in new language and culture.

  13. Central poststroke pain: somatosensory abnormalities and the presence of associated myofascial pain syndrome

    PubMed Central

    2012-01-01

    Background Central post-stroke pain (CPSP) is a neuropathic pain syndrome associated with somatosensory abnormalities due to central nervous system lesion following a cerebrovascular insult. Post-stroke pain (PSP) refers to a broader range of clinical conditions leading to pain after stroke, but not restricted to CPSP, including other types of pain such as myofascial pain syndrome (MPS), painful shoulder, lumbar and dorsal pain, complex regional pain syndrome, and spasticity-related pain. Despite its recognition as part of the general PSP diagnostic possibilities, the prevalence of MPS has never been characterized in patients with CPSP patients. We performed a cross-sectional standardized clinical and radiological evaluation of patients with definite CPSP in order to assess the presence of other non-neuropathic pain syndromes, and in particular, the role of myofascial pain syndrome in these patients. Methods CPSP patients underwent a standardized sensory and motor neurological evaluation, and were classified according to stroke mechanism, neurological deficits, presence and profile of MPS. The Visual Analogic Scale (VAS), McGill Pain Questionnaire (MPQ), and Beck Depression Scale (BDS) were filled out by all participants. Results Forty CPSP patients were included. Thirty-six (90.0%) had one single ischemic stroke. Pain presented during the first three months after stroke in 75.0%. Median pain intensity was 10 (5 to 10). There was no difference in pain intensity among the different lesion site groups. Neuropathic pain was continuous-ongoing in 34 (85.0%) patients and intermittent in the remainder. Burning was the most common descriptor (70%). Main aggravating factors were contact to cold (62.5%). Thermo-sensory abnormalities were universal. MPS was diagnosed in 27 (67.5%) patients and was more common in the supratentorial extra-thalamic group (P <0.001). No significant differences were observed among the different stroke location groups and pain questionnaires and

  14. [Validation of the Spanish version of Parent's Postoperative Pain Management pain scale].

    PubMed

    Ullan, A M; Perelló, M; Jerez, C; Gómez, E; Planas, M J; Serrallonga, N

    2016-02-01

    Assessment of postoperative pain is a fundamental aspect of post-surgical care. When surgery is performed as an outpatient, the parents are mainly responsible for the assessment of pain, but they may not always correctly evaluate their children's pain. This makes it necessary to have tools that help them to assess postoperative pain reliably. The Parent's Postoperative Pain Measurement (PPPM) is a behavioral measurement tool of post-operative pain developed to help parents to assess their children's post-operative pain. The purpose of this work was to translate this scale into Spanish, and validate the psychometric properties of the Spanish version of the scale. Participants were 111 children aged 2 to 12 years, who had undergone surgery, and one of their parents. After the operation, the children's level of pain was assessed, and the parents completed the PPPM scale in Spanish. The PPPM items in Spanish showed good internal consistency (Cronbach alpha between 0.784 and 0.900) and the scale scores were closely related to the global pain assessment (Spearman's rho correlation between 0.626 and 0.431). The score on the scale decreased between the day of the operation and the next day, and discriminated well between children undergoing surgery qualified as low/moderate pain and high pain. We conclude that the Spanish version of the PPPM scale evaluated in this study, has good psychometric properties to assess postoperative pain by parents at home. Copyright © 2015 Asociación Española de Pediatría. Published by Elsevier España, S.L.U. All rights reserved.

  15. [Occupational low back pain in nursing workers: massage versus pain].

    PubMed

    Borges, Talita Pavarini; Kurebayashi, Leonice Fumiko Sato; Silva, Maria Júlia Paes da

    2014-08-01

    To assess the efficacy of massage for decreasing occupational low back pain in workers of a Nursing team in an Emergency Room. A randomized controlled trial, using a socio-demographic/morbidity questionnaire and a Pain Numeric Scale. Forty-five subjects were randomly allocated for intervention (G1 - Massage by acupressure), placebo group (G2 - application of Garlium Arseneid Laser 904 nm turned off) and control (G3 - no intervention). The main triggering factor, as well as the worsening of pain, was the patient manipulation, both with a prevalence of 34.9%. The main treatment for low back pain before this research was the use of medication, with a prevalence of 44.2%. In accordance with a variance analysis, only G1 presented a significant statistical difference, with a better result after 12 sessions. Massage presented an enormous effect (d = 4.59), corresponding to 86% of reduction in the pain level. Massage was effective to decrease occupational low back pain of those Nursing workers.

  16. Medical conditions and body pain in patients presenting orofacial pain.

    PubMed

    Franco, Ana Lúcia; Runho, Gabriel Henrique Farto; Siqueira, José Tadeu Tesseroli de; Camparis, Cinara Maria

    2012-05-01

    To verify the frequency of self-reported medical conditions and pain areas in orofacial pain patients, comparing them with patients from the routine dental care. Data were collected from archives of the Orofacial Pain Clinic (Group A, n=319) and of the routine dental care clinics (Group B, n=84) at Faculdade de Odontologia de Araraquara, São Paulo, in Brazil. All individuals answered a standardized clinical questionnaire and completed a body map indicating their pain areas. The Mann-Whitney's test demonstrated that Group A presented a higher mean number of medical reports than Group B (p=0.004). In both groups, Pearson's correlation test showed that the highest frequencies of medical conditions were positively correlated to highest frequencies of painful areas (0.478, p=0.001 and 0.246, p=0.000, respectively). Group A tended to report more medical conditions and there was a positive correlation between the number of medical conditions and the one of pain areas for both groups.

  17. Personalized pain medicine: the clinical value of psychophysical assessment of pain modulation profile.

    PubMed

    Granovsky, Yelena; Yarnitsky, David

    2013-01-01

    Experimental pain stimuli can be used to simulate patients' pain experience. We review recent developments in psychophysical pain testing, focusing on the application of the dynamic tests-conditioned pain modulation (CPM) and temporal summation (TS). Typically, patients with clinical pain of various types express either less efficient CPM or enhanced TS, or both. These tests can be used in prediction of incidence of acquiring pain and of its intensity, as well as in assisting the correct choice of analgesic agents for individual patients. This can help to shorten the commonly occurring long and frustrating process of adjusting analgesic agents to the individual patients. We propose that evaluating pain modulation can serve as a step forward in individualizing pain medicine.

  18. Qualitative Evaluation of Pediatric Pain-Behavior, -Quality and -Intensity Item Candidates and the PROMIS Pain Domain Framework in Children with Chronic Pain

    PubMed Central

    Jacobson, C. Jeffrey; Kashikar-Zuck, Susmita; Farrell, Jennifer; Barnett, Kimberly; Goldschneider, Ken; Dampier, Carlton; Cunningham, Natoshia; Crosby, Lori; DeWitt, Esi Morgan

    2015-01-01

    As initial steps in a broader effort to develop and test pediatric Pain Behavior and Pain Quality item banks for the Patient Reported Outcomes Measurement Information System (PROMIS®), we employed qualitative interview and item review methods to 1) evaluate the overall conceptual scope and content validity of the PROMIS pain domain framework among children with chronic /recurrent pain conditions, and 2) develop item candidates for further psychometric testing. To elicit the experiential and conceptual scope of pain outcomes across a variety of pediatric recurrent/chronic pain conditions, we conducted semi-structured individual (32) and focus-group interviews (2) with children and adolescents (8–17 years), and parents of children with pain (individual (32) and focus group (2)). Interviews with pain experts (10) explored the operational limits of pain measurement in children. For item bank development, we identified existing items from measures in the literature, grouped them by concept, removed redundancies, and modified remaining items to match PROMIS formatting. New items were written as needed and cognitive debriefing was completed with children and their parents, resulting in 98 Pain Behavior (47 self, 51 proxy), 54 Quality and 4 Intensity items for further testing. Qualitative content analyses suggest that reportable pain outcomes that matter to children with pain are captured within and consistent with the pain domain framework in PROMIS. PMID:26335990

  19. Neurophysiology of pain and hypnosis for chronic pain.

    PubMed

    Dillworth, Tiara; Mendoza, M Elena; Jensen, Mark P

    2012-03-01

    In the past decade there has been a dramatic increase in (1) understanding the neurophysiological components of the pain experiences, (2) randomized clinical trials testing the efficacy of hypnotic treatments on chronic pain, and (3) laboratory research examining the effects of hypnosis on the neurophysiological processes implicated in pain. Work done in these areas has not only demonstrated the efficacy of hypnosis for treating chronic pain but is beginning to shed light on neurophysiological processes that may play a role in its effectiveness. This paper reviews a selection of published studies from these areas of research, focusing on recent findings that have the most potential to inform both clinical work and research in this area. The paper concludes with research and clinical recommendations for maximizing treatment efficacy based on the research findings that are available.

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

    PubMed Central

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

    2008-01-01

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

  1. Side Effects: Pain

    Cancer.gov

    Controlling pain is an important part of your cancer treatment plan. Learn how to track levels of pain. Find out how pain, a side effect of cancer treatment, is treated using acupuncture, biofeedback, and physical therapy.

  2. 46 CFR 11.414 - Service requirements for mate of ocean steam or motor vessels of not more than 1600 gross tons.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... in the deck department of ocean or near coastal steam or motor, sail, or auxiliary sail vessels...) Three years total service in the deck department on ocean or near coastal steam or motor, sail, or auxiliary sail vessels of over 200 gross tons. Six months of the required service must have been as able...

  3. 46 CFR 11.414 - Service requirements for mate of ocean steam or motor vessels of not more than 1600 gross tons.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... in the deck department of ocean or near coastal steam or motor, sail, or auxiliary sail vessels...) Three years total service in the deck department on ocean or near coastal steam or motor, sail, or auxiliary sail vessels of over 200 gross tons. Six months of the required service must have been as able...

  4. Living in Fear of Your Child's Pain: The Parent Fear of Pain Questionnaire

    PubMed Central

    Simons, Laura E.; Smith, Allison; Kaczynski, Karen; Basch, Molly

    2015-01-01

    Fear and avoidance have been consistently associated with poor pain-related outcomes in children. In the context of the pediatric pain experience, parent distress and behaviors can be highly influential. The current study validated the Parent Fear of Pain Questionnaire (PFOPQ) to assess a parent's fears and avoidance behaviors associated with their child's pain. Using the PFOPQ in conjunction with measures of parent and child pain-related variables, we tested the Interpersonal Fear Avoidance Model (IFAM). The sample comprised of 321 parents and their child with chronic or new-onset pain who presented to a multidisciplinary outpatient pain clinic. An exploratory factor analysis yielded a 4-factor structure for the PFOPQ consisting of Fear of Pain, Fear of Movement, Fear of School, and Avoidance. As hypothesized, Fear of Pain was most closely related to parent pain catastrophizing and child fear of pain, while Avoidance was most closely related to parent protective behaviors and child avoidance of activities. In testing the IFAM, parent behavior contributed directly and indirectly to child avoidance while parent fear and catastrophizing contributed indirectly to child avoidance through parent behavior and child fear and catastrophizing, in turn, influencing child functional disability levels. The current study provides the first measure of parent pain-related fears and avoidance behaviors and evaluates the theorized IFAM. These results underscore the important influence of parents on child pain-related outcomes and puts forth a psychometrically sound measure to assess parent fear and avoidance in the context of their child's pain. PMID:25630026

  5. American Pain Society

    MedlinePlus

    ... 2014 News Releases Press Room - Pain Education in Physical Therapy Schools Press Room - Misuse of Therapeutic Opioids Press ... of Chronic or Severe Pain in U.S. Adults Physical Therapy for Carpal Tunnel Syndrome Pain Often As Effective ...

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

    PubMed Central

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

    2018-01-01

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

  7. The Canadian STOP-PAIN project: the burden of chronic pain-does sex really matter?

    PubMed

    Racine, Mélanie; Dion, Dominique; Dupuis, Gilles; Guerriere, Denise N; Zagorski, Brandon; Choinière, Manon; Banner, Robert; Barton, Pamela M; Boulanger, Aline; Clark, Alexander J; Gordon, Allan; Guertin, Marie-Claude; Intrater, Howard M; Lefort, Sandra M; Lynch, Mary E; Moulin, Dwight E; Ong-Lam, May; Peng, Philip; Rashiq, Saifee; Shir, Yoram; Taenzer, Paul; Ware, Mark

    2014-05-01

    The Canadian STOP-PAIN Project assessed the human and economic burden of chronic pain (CP) in individuals on waitlists of Canadian multidisciplinary pain treatment facilities. This article focuses on sex differences. Objectives were to (1) determine the pain characteristics and related biopsychosocial factors that best differentiated women and men with CP; and (2) examine whether public and private costs associated with CP differed according to sex. Sample consisted of 441 women and 287 men who were evaluated using self-administered questionnaires and a structured interview protocol. A subsample (233 women and 137 men) recorded all pain-related expenditures in a comprehensive diary over 3 months. Results revealed that the burden of illness associated with CP was comparable in both sexes for average and worst pain intensity, pain impact on daily living, quality of life, and psychological well-being. The same was true for pain-related costs. The results of a hierarchical logistic regression analysis, in which sex was treated as the dependent variable, showed that factors that differentiated men and women were: work status, certain circumstances surrounding pain onset, present pain intensity, intake of particular types of pain medication, use of certain pain management strategies, pain beliefs, and utilization of particular health care resources. This study suggests that women and men who are referred to multidisciplinary pain treatment facilities do not differ significantly in terms of their pain-related experience. However, the aspects that differ may warrant further clinical attention when assessing and managing pain.

  8. Surgical Decompression of Painful Diabetic Peripheral Neuropathy: The Role of Pain Distribution

    PubMed Central

    Liao, Chenlong; Zhang, Wenchuan; Yang, Min; Ma, Qiufeng; Li, Guowei; Zhong, Wenxiang

    2014-01-01

    Objective To investigate the effect of surgical decompression on painful diabetic peripheral neuropathy (DPN) patients and discuss the role which pain distribution and characterization play in the management of painful DPN as well as the underlying mechanism involved. Methods A total of 306 patients with painful diabetic lower-extremity neuropathy were treated with Dellon surgical nerve decompression in our department. Clinical evaluation including Visual analogue scale (VAS), Brief Pain Inventory Short Form for diabetic peripheral neuropathy (BPI-DPN) questionnaire, two-point discrimination (2-PD), nerve conduction velocity (NCV) and high-resolution ultrasonography (cross-sectional area, CSA) were performed in all cases preoperatively, and at 6 month intervals for 2 years post-decompression. The patients who underwent surgery were retrospectively assigned into two subgroups (focal and diffuse pain) according to the distribution of the diabetic neuropathic pain. The control group included 92 painful DPN patients without surgery. Results The levels of VAS, scores in BPI-DPN, 2-PD, NCV results and CSA were all improved in surgical group when compared to the control group (P<0.05). More improvement of VAS, scores in BPI-DPN and CSA was observed in focal pain group than that in diffuse group (P<0.05). Conclusions Efficacy of decompression of multiple lower-extremity peripheral nerves in patients with painful diabetic neuropathy was confirmed in this study. While both focal and diffuse group could benefit from surgical decompression, pain relief and morphological restoration could be better achieved in focal group. PMID:25290338

  9. Athletes' leg pains.

    PubMed Central

    Orava, S.; Puranen, J.

    1979-01-01

    The frequency and nature of exertion pains of the leg in athletes were studied in 2,750 cases of overuse injuries treated at the Sports Clinic of the Deaconess Institute of Oulu, Finland, during the years 1972-1977. 465 cases of exertion pain (18%) were located in the shin. The medial tibial syndrome was the most common overuse injury among these athletes, comprising 9.5% of all exertion injuries and 60% of the leg exertion pains. Together with stress fracture of the tibia, the second most common exertion pain of the leg, it accounted for 75% of the total leg pains. There are certain difficulties in differentiating between the medial tibial syndrome and stress fracture of the tibia. They both occur at the same site with similar symptoms. Radiological examination and isotope scanning are needed. The medial tibial syndrome is an overuse injury at the medial tibial border caused by running exercises. The pain is elicited by exertional ischaemia. The pathogenesis is explained by increased pressure in the fascial compartment of the deep flexor muscles due to prolonged exercise. Similar chronic ischaemic pains from exercise are also found in other fascial compartments of the leg, especially in the anterior compartment. The only treatment needed for stress fractures is rest from training. Fascial compartment pains also usually subside. If chronic fascial syndromes prevent training, fasciotomy is recommended as a reliable method to restore the athlete to normal training without pains. PMID:486888

  10. When Sex Is Painful

    MedlinePlus

    ... AQ FREQUENTLY ASKED QUESTIONS GYNECOLOGIC PROBLEMS FAQ020 When Sex Is Painful • How common is painful sex? • What causes pain during sex? • Where is pain during sex felt? • When should ...

  11. Managing pain during labor

    MedlinePlus

    ... good to prepare yourself for natural childbirth. Natural Childbirth The pain felt during childbirth is different for ... use pain medicine during childbirth. Pain Medicines for Childbirth A systemic analgesic is a pain medicine that ...

  12. Back pain and sports

    MedlinePlus

    ... Running - back pain; Weightlifting - back pain; Lumbar pain - sports; Sciatica - sports; Low back pain - sports ... MD, Thompson SR, eds. DeLee and Drez's Orthopaedic Sports Medicine: Principles and Practice . 4th ed. Philadelphia, PA: ...

  13. The ACTTION-APS-AAPM Pain Taxonomy (AAAPT) Multidimensional Approach to Classifying Acute Pain Conditions.

    PubMed

    Kent, Michael L; Tighe, Patrick J; Belfer, Inna; Brennan, Timothy J; Bruehl, Stephen; Brummett, Chad M; Buckenmaier, Chester C; Buvanendran, Asokumar; Cohen, Robert I; Desjardins, Paul; Edwards, David; Fillingim, Roger; Gewandter, Jennifer; Gordon, Debra B; Hurley, Robert W; Kehlet, Henrik; Loeser, John D; Mackey, Sean; McLean, Samuel A; Polomano, Rosemary; Rahman, Siamak; Raja, Srinivasa; Rowbotham, Michael; Suresh, Santhanam; Schachtel, Bernard; Schreiber, Kristin; Schumacher, Mark; Stacey, Brett; Stanos, Steven; Todd, Knox; Turk, Dennis C; Weisman, Steven J; Wu, Christopher; Carr, Daniel B; Dworkin, Robert H; Terman, Gregory

    2017-05-01

    With the increasing societal awareness of the prevalence and impact of acute pain, there is a need to develop an acute pain classification system that both reflects contemporary mechanistic insights and helps guide future research and treatment. Existing classifications of acute pain conditions are limiting, with a predominant focus on the sensory experience (e.g., pain intensity) and pharmacologic consumption. Consequently, there is a need to more broadly characterize and classify the multidimensional experience of acute pain. Consensus report following expert panel involving the Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks (ACTTION), American Pain Society (APS), and American Academy of Pain Medicine (AAPM). As a complement to a taxonomy recently developed for chronic pain, the ACTTION public-private partnership with the US Food and Drug Administration, the APS, and the AAPM convened a consensus meeting of experts to develop an acute pain taxonomy using prevailing evidence. Key issues pertaining to the distinct nature of acute pain are presented followed by the agreed-upon taxonomy. The ACTTION-APS-AAPM Acute Pain Taxonomy will include the following dimensions: 1) core criteria, 2) common features, 3) modulating factors, 4) impact/functional consequences, and 5) putative pathophysiologic pain mechanisms. Future efforts will consist of working groups utilizing this taxonomy to develop diagnostic criteria for a comprehensive set of acute pain conditions. The ACTTION-APS-AAPM Acute Pain Taxonomy (AAAPT) is a multidimensional acute pain classification system designed to classify acute pain along the following dimensions: 1) core criteria, 2) common features, 3) modulating factors, 4) impact/functional consequences, and 5) putative pathophysiologic pain mechanisms. Significant numbers of patients still suffer from significant acute pain, despite the advent of modern multimodal analgesic strategies

  14. [Pain therapy].

    PubMed

    Donnadieu, S; Djian, M C

    1998-12-12

    NEW OPIOID ANALGESICS: Progress in pain reliet has recently been achieved with the introduction of new opioid analgesics such as tramadol and the pediatric preparation of codeine phosphate as well as powerful long-release opioids which can be administered per os, or percutaneously for transdermal fentanyl. CO-ANALGESICS: Other drugs, mainly antidepressants and anti-convulsants, can be usefully combined with analgesics. New serotonin uptake inhibitors and anticonvulsants (gabapentin and lamotrigin) have the advantage of better tolerance. None of these drugs has marketing approval in France for their pain relieving effects. The same is true for clonidine and neostigmine which, after spinal infusion, potentialize opioids and for ketamine which can relieve neuropathy pain by dissociative anesthesia. NEW ANTI-MIGRAINE DRUGS: New drugs have been developed for specific types of pain such as migraine. The new "triptans" are tolerated better than sumatriptan and is reimbursed by the national social security. REFRACTORY NEUROPATHY PAIN: Indications for electrical stimulation techniques conducted in a neurosurgery unit have been identified. Stimulators may be implanted in spinal or supra-spinal localizations. REGULATORY ASPECTS: New legislation has reorganized health care for pain relief in France. The new texts take into consideration personnel training, the health care network and progress in therapeutics.

  15. Neonatal pain

    PubMed Central

    Walker, Suellen M

    2014-01-01

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

  16. Measuring pain phenomena after spinal cord injury: Development and psychometric properties of the SCI-QOL Pain Interference and Pain Behavior assessment tools.

    PubMed

    Cohen, Matthew L; Kisala, Pamela A; Dyson-Hudson, Trevor A; Tulsky, David S

    2018-05-01

    To develop modern patient-reported outcome measures that assess pain interference and pain behavior after spinal cord injury (SCI). Grounded-theory based qualitative item development; large-scale item calibration field-testing; confirmatory factor analyses; graded response model item response theory analyses; statistical linking techniques to transform scores to the Patient Reported Outcome Measurement Information System (PROMIS) metric. Five SCI Model Systems centers and one Department of Veterans Affairs medical center in the United States. Adults with traumatic SCI. N/A. Spinal Cord Injury - Quality of Life (SCI-QOL) Pain Interference item bank, SCI-QOL Pain Interference short form, and SCI-QOL Pain Behavior scale. Seven hundred fifty-seven individuals with traumatic SCI completed 58 items addressing various aspects of pain. Items were then separated by whether they assessed pain interference or pain behavior, and poorly functioning items were removed. Confirmatory factor analyses confirmed that each set of items was unidimensional, and item response theory analyses were used to estimate slopes and thresholds for the items. Ultimately, 7 items (4 from PROMIS) comprised the Pain Behavior scale and 25 items (18 from PROMIS) comprised the Pain Interference item bank. Ten of these 25 items were selected to form the Pain Interference short form. The SCI-QOL Pain Interference item bank and the SCI-QOL Pain Behavior scale demonstrated robust psychometric properties. The Pain Interference item bank is available as a computer adaptive test or short form for research and clinical applications, and scores are transformed to the PROMIS metric.

  17. Chronic pain: One year prevalence and associated characteristics (the HUNT pain study).

    PubMed

    Landmark, Tormod; Romundstad, Pål; Dale, Ola; Borchgrevink, Petter C; Vatten, Lars; Kaasa, Stein

    2017-12-29

    Background The reported prevalence of chronic pain ranges from 11% to 64%, and although consistently high, the calculated economic burden estimates also vary widely between studies. There is no standard way of classifying chronic pain. We have repeated measurements of pain in a longitudinal population study to improve validity ofthe case ascertainment. In this paper, associations between chronic pain and demographic characteristics, self reported health and functioning, work Incapacity and health care use were investigated in a sample from the general Norwegian population. Methods A random sample of 6419 participants from a population study (the HUNT 3 Study) was invited to report pain every three months during a 12 month period. Chronic pain was defined as moderate pain or more (on the SF-8 verbal rating scale) in at least three out of five consecutive measurements. Self reported health and functioning was measured by seven of the eight subscales on the SF-8 health survey (bodily pain was excluded). Health care utilisation during the past 12 months was measured by self report, and included seeing a general practitioner, seeing a medical specialist and seeing other therapists. The survey data was combined with information on income, education, disability pension awards and unemployment by Statistics Norway, which provided data from the National Education database (NUDB) and the Norwegian Labour and Welfare Administration (NAV). Results The total prevalence of chronic pain was 36% (95% CI34-38) among women and 25% (95% CI 22-26) among men. The prevalence increased with age, was higher among people with high BMI, and in people with low income and low educational level. Smoking was also associated with a higher prevalence of chronic pain. Subjects in the chronic pain group had a self-reported health and functioning in the range of 1-2.5 standard deviations below that of those without chronic pain. Among the chronic pain group 52% (95% CI 49-55), of participants

  18. Chronic musculoskeletal pain: ultrasound guided pain control.

    PubMed

    Chiou, Hong-Jen; Chou, Yi-Hong; Wang, Hsin-Kai; Lai, Yi-Chen

    2014-09-01

    The review demonstrates the unique advantages of ultrasonography in pain control. Several imaging modalities can be used to guide pain control, such as computed tomography, magnetic resonance imaging, and radiography. Ultrasonography has unique advantages over these other modalities in terms of its non-ionizing radiation, real-time imaging, portability, and cost-effectiveness. Ultrasonography with color Doppler and elastography can provide safer guidance to avoid blood vessels and the nerve trunk when using steroid or xylocaine infusions to encase the nerve trunk. This review focuses on the control of chronic pain in the upper limbs, lower limbs, and trunk. Copyright © 2014. Published by Elsevier B.V.

  19. Personalized Pain Medicine: The Clinical Value of Psychophysical Assessment of Pain Modulation Profile

    PubMed Central

    Granovsky, Yelena; Yarnitsky, David

    2013-01-01

    Experimental pain stimuli can be used to simulate patients’ pain experience. We review recent developments in psychophysical pain testing, focusing on the application of the dynamic tests—conditioned pain modulation (CPM) and temporal summation (TS). Typically, patients with clinical pain of various types express either less efficient CPM or enhanced TS, or both. These tests can be used in prediction of incidence of acquiring pain and of its intensity, as well as in assisting the correct choice of analgesic agents for individual patients. This can help to shorten the commonly occurring long and frustrating process of adjusting analgesic agents to the individual patients. We propose that evaluating pain modulation can serve as a step forward in individualizing pain medicine. PMID:24228167

  20. Pain management of hemiplegic shoulder pain post stroke in patients from Nanjing, China

    PubMed Central

    Zhu, Yi; Su, Bin; Li, Ning; Jin, Hongzhu

    2013-01-01

    We selected 106 hemiplegic patients with shoulder pain hospitalized after stroke from three hospitals in Nanjing, China between February 2007 and January 2012. All patients had complete clinical data sets and accounted for 45.5% of the inpatients because of stroke. Results showed that the number of patients with hemiplegic shoulder pain post stroke increased yearly, attacking mainly males 50–69 years of age. Of 106 patients, there were 60 cases (56.6%) of adhesive capsulitis, 19 (17.9%) of shoulder subluxation, 14 (13.2%) of complex regional pain syndrome, and 13 (12.6%) of central pain. The main symptoms were shoulder pain (100%), limit of shoulder mobility (98.1%), and adhesion of the scapula (56.6%). MRI of the shoulder showed tendon and ligament lesions (57.1%) and rotator cuff tear (38.1%). 53.8% of central pain was related to the thalamus, in addition to the basal ganglia, brain stem, and cerebellopontine angle. Shoulder pain, upper limb motor function, and function independence were significantly improved after comprehensive rehabilitation. In particular, electroacupuncture based on basic physical therapy exhibited efficacy on shoulder tion and complex regional pain syndrome. Multiple linear regression results showed a negative relationship of efficacy of pain management with the attack period of shoulder pain, involvement of the posterior limb of the internal capsule, and duration between onset and rehabilitation treatment, but a positive correlation with pain-related education, pain regression period, and pain diagnosis. PMID:25206549

  1. Canadian Orofacial Pain Team workshop report on the global year against orofacial pain.

    PubMed

    Lavigne, Gilles J; Sessle, Barry J

    2015-01-01

    The year 2013-2014 has been designated the Global Year Against Orofacial Pain by the International Association for the Study of Pain. Accordingly, a multidisciplinary Canadian and international group of clinical, research and knowledge-transfer experts attended a workshop in Montreal, Quebec. The workshop had two aims: to identify new pathways for innovative diagnosis and management of chronic orofacial pain states; and to identify opportunities for further collaborative orofacial pain research and education in Canada. Three topics related to chronic orofacial pain were explored: biomarkers and pain signatures for chronic orofacial pain; misuse of analgesic and opioid pain medications for managing chronic orofacial pain; and complementary alternative medicine, topical agents and the role of stress in chronic orofacial pain. It was determined that further research is needed to: identify biomarkers of chronic orofacial post-traumatic neuropathic pain, with a focus on psychosocial, physiological and chemical-genetic factors; validate the short- and long-term safety (i.e., no harm to health, and avoidance of misuse and addiction) of opioid use for two distinct conditions (acute and chronic orofacial pain, respectively); and promote the use of topical medications as an alternative treatment in dentistry, and further document the benefits and safety of complementary and alternative medicine, including stress management, in dentistry. It was proposed that burning mouth syndrome, a painful condition that is not uncommon and affects mainly postmenopausal women, should receive particular attention.

  2. Canadian Orofacial Pain Team workshop report on the Global Year Against Orofacial Pain

    PubMed Central

    Lavigne, Gilles J; Sessle, Barry J

    2015-01-01

    The year 2013–2014 has been designated the Global Year Against Orofacial Pain by the International Association for the Study of Pain. Accordingly, a multidisciplinary Canadian and international group of clinical, research and knowledge-transfer experts attended a workshop in Montreal, Quebec. The workshop had two aims: to identify new pathways for innovative diagnosis and management of chronic orofacial pain states; and to identify opportunities for further collaborative orofacial pain research and education in Canada. Three topics related to chronic orofacial pain were explored: biomarkers and pain signatures for chronic orofacial pain; misuse of analgesic and opioid pain medications for managing chronic orofacial pain; and complementary alternative medicine, topical agents and the role of stress in chronic orofacial pain. It was determined that further research is needed to: identify biomarkers of chronic orofacial post-traumatic neuropathic pain, with a focus on psychosocial, physiological and chemical-genetic factors; validate the short-and long-term safety (ie, no harm to health, and avoidance of misuse and addiction) of opioid use for two distinct conditions (acute and chronic orofacial pain, respectively); and promote the use of topical medications as an alternative treatment in dentistry, and further document the benefits and safety of complementary and alternative medicine, including stress management, in dentistry. It was proposed that burning mouth syndrome, a painful condition that is not uncommon and affects mainly postmenopausal women, should receive particular attention. PMID:25522352

  3. Involvement of the TonB System in Tolerance to Solvents and Drugs in Pseudomonas putida DOT-T1E

    PubMed Central

    Godoy, Patricia; Ramos-González, María Isabel; Ramos, Juan L.

    2001-01-01

    Pseudomonas putida DOT-T1E is able to grow with glucose as the carbon source in liquid medium with 1% (vol/vol) toluene or 17 g of (123 mM) p-hydroxybenzoate (4HBA) per liter. After random mini-Tn5′phoA-Km mutagenesis, we isolated the mutant DOT-T1E-PhoA5, which was more sensitive than the wild type to 4HBA (growth was prevented at 6 g/liter) and toluene (the mutant did not withstand sudden toluene shock). Susceptibility to toluene and 4HBA resulted from the reduced efflux of these compounds from the cell, as revealed by accumulation assays with 14C-labeled substrates. The mutant was also more susceptible to a number of antibiotics, and its growth in iron-deficient minimal medium was inhibited in the presence of ethylenediamine-di(o-hydroxyphenylacetic acid (EDDHA). Cloning the mutation in the PhoA5 strain and sequencing the region adjacent showed that the mini-Tn5 transposor interrupted the exbD gene, which forms part of the exbBD tonB operon. Complementation by the exbBD and tonB genes cloned in pJB3-Tc restored the wild-type characteristics to the PhoA5 strain. PMID:11514511

  4. Involvement of the TonB system in tolerance to solvents and drugs in Pseudomonas putida DOT-T1E.

    PubMed

    Godoy, P; Ramos-González, M I; Ramos, J L

    2001-09-01

    Pseudomonas putida DOT-T1E is able to grow with glucose as the carbon source in liquid medium with 1% (vol/vol) toluene or 17 g of (123 mM) p-hydroxybenzoate (4HBA) per liter. After random mini-Tn5'phoA-Km mutagenesis, we isolated the mutant DOT-T1E-PhoA5, which was more sensitive than the wild type to 4HBA (growth was prevented at 6 g/liter) and toluene (the mutant did not withstand sudden toluene shock). Susceptibility to toluene and 4HBA resulted from the reduced efflux of these compounds from the cell, as revealed by accumulation assays with (14)C-labeled substrates. The mutant was also more susceptible to a number of antibiotics, and its growth in iron-deficient minimal medium was inhibited in the presence of ethylenediamine-di(o-hydroxyphenylacetic acid (EDDHA). Cloning the mutation in the PhoA5 strain and sequencing the region adjacent showed that the mini-Tn5 transposor interrupted the exbD gene, which forms part of the exbBD tonB operon. Complementation by the exbBD and tonB genes cloned in pJB3-Tc restored the wild-type characteristics to the PhoA5 strain.

  5. Shape shifting pain: chronification of back pain shifts brain representation from nociceptive to emotional circuits

    PubMed Central

    Hashmi, Javeria A.; Baliki, Marwan N.; Huang, Lejian; Baria, Alex T.; Torbey, Souraya; Hermann, Kristina M.; Schnitzer, Thomas J.; Apkarian, A. Vania

    2013-01-01

    Chronic pain conditions are associated with abnormalities in brain structure and function. Moreover, some studies indicate that brain activity related to the subjective perception of chronic pain may be distinct from activity for acute pain. However, the latter are based on observations from cross-sectional studies. How brain activity reorganizes with transition from acute to chronic pain has remained unexplored. Here we study this transition by examining brain activity for rating fluctuations of back pain magnitude. First we compared back pain-related brain activity between subjects who have had the condition for ∼2 months with no prior history of back pain for 1 year (early, acute/subacute back pain group, n = 94), to subjects who have lived with back pain for >10 years (chronic back pain group, n = 59). In a subset of subacute back pain patients, we followed brain activity for back pain longitudinally over a 1-year period, and compared brain activity between those who recover (recovered acute/sub-acute back pain group, n = 19) and those in which the back pain persists (persistent acute/sub-acute back pain group, n = 20; based on a 20% decrease in intensity of back pain in 1 year). We report results in relation to meta-analytic probabilistic maps related to the terms pain, emotion, and reward (each map is based on >200 brain imaging studies, derived from neurosynth.org). We observed that brain activity for back pain in the early, acute/subacute back pain group is limited to regions involved in acute pain, whereas in the chronic back pain group, activity is confined to emotion-related circuitry. Reward circuitry was equally represented in both groups. In the recovered acute/subacute back pain group, brain activity diminished in time, whereas in the persistent acute/subacute back pain group, activity diminished in acute pain regions, increased in emotion-related circuitry, and remained unchanged in reward circuitry. The results demonstrate that brain

  6. Shape shifting pain: chronification of back pain shifts brain representation from nociceptive to emotional circuits.

    PubMed

    Hashmi, Javeria A; Baliki, Marwan N; Huang, Lejian; Baria, Alex T; Torbey, Souraya; Hermann, Kristina M; Schnitzer, Thomas J; Apkarian, A Vania

    2013-09-01

    Chronic pain conditions are associated with abnormalities in brain structure and function. Moreover, some studies indicate that brain activity related to the subjective perception of chronic pain may be distinct from activity for acute pain. However, the latter are based on observations from cross-sectional studies. How brain activity reorganizes with transition from acute to chronic pain has remained unexplored. Here we study this transition by examining brain activity for rating fluctuations of back pain magnitude. First we compared back pain-related brain activity between subjects who have had the condition for ∼2 months with no prior history of back pain for 1 year (early, acute/subacute back pain group, n = 94), to subjects who have lived with back pain for >10 years (chronic back pain group, n = 59). In a subset of subacute back pain patients, we followed brain activity for back pain longitudinally over a 1-year period, and compared brain activity between those who recover (recovered acute/sub-acute back pain group, n = 19) and those in which the back pain persists (persistent acute/sub-acute back pain group, n = 20; based on a 20% decrease in intensity of back pain in 1 year). We report results in relation to meta-analytic probabilistic maps related to the terms pain, emotion, and reward (each map is based on >200 brain imaging studies, derived from neurosynth.org). We observed that brain activity for back pain in the early, acute/subacute back pain group is limited to regions involved in acute pain, whereas in the chronic back pain group, activity is confined to emotion-related circuitry. Reward circuitry was equally represented in both groups. In the recovered acute/subacute back pain group, brain activity diminished in time, whereas in the persistent acute/subacute back pain group, activity diminished in acute pain regions, increased in emotion-related circuitry, and remained unchanged in reward circuitry. The results demonstrate that brain

  7. Neurological diseases and pain

    PubMed Central

    2012-01-01

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

  8. Back pain was less explained than leg pain: a cross-sectional study using magnetic resonance imaging in low back pain patients with and without radiculopathy.

    PubMed

    Jensen, Ole Kudsk; Nielsen, Claus Vinther; Sørensen, Joan Solgaard; Stengaard-Pedersen, Kristian

    2015-12-03

    Cross-sectional studies have shown associations between lumbar degenerative manifestations on magnetic resonance imaging (MRI) and low back pain (LBP). Disc herniations and other degenerative manifestations, however, frequently occur in asymptomatic individuals. The purpose of this cross-sectional study was to analyze for associations between pain intensity and degenerative manifestations and other pain variables in patients for whom prognostic factors have been published previously. Included were 141 consecutive patients with and without radiculopathy, all sick-listed 1-4 months due to low back pain and subsequently examined by MRI of the lumbar spine. Using different methods of grouping the degenerative manifestations, linear regression analyses were performed with the intensity of back + leg pain, back pain and leg pain as dependent variables covering actual pain and pain the preceding 2 weeks. The clinical classification into +/- radiculopathy was established before and independently of the standardised description of MRI findings. Radiculopathy was present in 43 % of the patients. Pain was best explained using rank-ordered degenerative manifestations on MRI. Back pain and leg pain were differently associated, and back pain was less explained than leg pain in the multivariate analyses (15 % vs. 31 % of the variation). Back pain intensity was higher in patients with type 1 Modic changes and in some patients with nerve root touch, but was not associated with disc herniations. Leg pain intensity was well explained by disc herniations causing MRI nerve root compromise and radiculopathy. In patients with radiculopathy, nerve root touch caused as much leg pain as nerve root displacement or compression. High intensity zones and osteophytes were not associated with back pain, but only associated with leg pain in patients with radiculopathy. Tender points explained some of the back pain, and widespread pain explained leg pain in some of the patients without

  9. Language and the pain experience.

    PubMed

    Wilson, Dianne; Williams, Marie; Butler, David

    2009-03-01

    People in persistent pain have been reported to pay increased attention to specific words or descriptors of pain. The amount of attention paid to pain or cues for pain (such as pain descriptors), has been shown to be a major factor in the modulation of persistent pain. This relationship suggests the possibility that language may have a role both in understanding and managing the persistent pain experience. The aim of this paper is to describe current models of neuromatrices for pain and language, consider the role of attention in persistent pain states and highlight discrepancies, in previous studies based on the McGill Pain Questionnaire (MPQ), of the role of attention on pain descriptors. The existence of a pain neuromatrix originally proposed by Melzack (1990) has been supported by emerging technologies. Similar technologies have recently allowed identification of multiple areas of involvement for the processing of auditory input and the construction of language. As with the construction of pain, this neuromatrix for speech and language may intersect with neural systems for broader cognitive functions such as attention, memory and emotion. A systematic search was undertaken to identify experimental or review studies, which specifically investigated the role of attention on pain descriptors (as cues for pain) in persistent pain patients. A total of 99 articles were retrieved from six databases, with 66 articles meeting the inclusion criteria. After duplicated articles were eliminated, the remaining 41 articles were reviewed in order to support a link between persistent pain, pain descriptors and attention. This review revealed a diverse range of specific pain descriptors, the majority of which were derived from the MPQ. Increased attention to pain descriptors was consistently reported to be associated with emotional state as well as being a significant factor in maintaining persistent pain. However, attempts to investigate the attentional bias of specific pain

  10. From acute musculoskeletal pain to chronic widespread pain and fibromyalgia: application of pain neurophysiology in manual therapy practice.

    PubMed

    Nijs, Jo; Van Houdenhove, Boudewijn

    2009-02-01

    During the past decade, scientific research has provided new insight into the development from an acute, localised musculoskeletal disorder towards chronic widespread pain/fibromyalgia (FM). Chronic widespread pain/FM is characterised by sensitisation of central pain pathways. An in-depth review of basic and clinical research was performed to design a theoretical framework for manual therapy in these patients. It is explained that manual therapy might be able to influence the process of chronicity in three different ways. (I) In order to prevent chronicity in (sub)acute musculoskeletal disorders, it seems crucial to limit the time course of afferent stimulation of peripheral nociceptors. (II) In the case of chronic widespread pain and established sensitisation of central pain pathways, relatively minor injuries/trauma at any locations are likely to sustain the process of central sensitisation and should be treated appropriately with manual therapy accounting for the decreased sensory threshold. Inappropriate pain beliefs should be addressed and exercise interventions should account for the process of central sensitisation. (III) However, manual therapists ignoring the processes involved in the development and maintenance of chronic widespread pain/FM may cause more harm then benefit to the patient by triggering or sustaining central sensitisation.

  11. Low-back pain during labor.

    PubMed

    Melzack, R; Schaffelberg, D

    1987-04-01

    Earlier studies have shown that labor pain is highly variable in intensity and spatial location. Most women feel pain predominantly in the abdominal area whereas others complain about severe back pain. In addition to the pains associated with contractions, many women report continuous low-back pain. This study used the McGill Pain Questionnaire to examine each type of pain. Women during labor also tracked their perceived pain levels at the same time that contractions were registered on cardiotachographic records. The results show that continuous low-back pain is severe and is reported by about 33% of women during labor. It is described as being qualitatively different from the pains associated with uterine contractions. The pain of contractions felt in the back is often reported as "riding on" the continuous low-back pain so that both together may reach "horrible" or "excruciating" intensities. Continuous low-back pain is probably caused by the distention and pressure on adjacent visceral and neural structures in the peritoneum, in contrast to the rhythmic pains that are clearly related to contractions of the uterus. It is possible that each of these major kinds of pain may be controlled by different anesthesiologic and psychologic procedures.

  12. 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.

  13. An equine pain face

    PubMed Central

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

    2015-01-01

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

  14. 46 CFR 11.433 - Service requirements for master of Great Lakes and inland steam or motor vessels of any gross tons.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 46 Shipping 1 2011-10-01 2011-10-01 false Service requirements for master of Great Lakes and... Professional Requirements for Deck Officers § 11.433 Service requirements for master of Great Lakes and inland... endorsement as master of Great Lakes and inland steam or motor vessels of any gross tons is: (a) One year of...

  15. 46 CFR 11.424 - Service requirements for master of ocean steam or motor vessels of not more than 200 gross tons.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 46 Shipping 1 2012-10-01 2012-10-01 false Service requirements for master of ocean steam or motor... Requirements for Deck Officers § 11.424 Service requirements for master of ocean steam or motor vessels of not... endorsement as master of ocean steam or motor vessels of not more than 200 gross tons is: (1) Three years...

  16. 46 CFR 11.404 - Service requirements for master of ocean or near coastal steam or motor vessels of any gross tons.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 46 Shipping 1 2012-10-01 2012-10-01 false Service requirements for master of ocean or near coastal... Requirements for Deck Officers § 11.404 Service requirements for master of ocean or near coastal steam or motor... master of ocean or near coastal steam or motor vessels of any gross tons is: (a) One year of service as...

  17. 46 CFR 11.433 - Service requirements for master of Great Lakes and inland steam or motor vessels of any gross tons.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 46 Shipping 1 2012-10-01 2012-10-01 false Service requirements for master of Great Lakes and... Professional Requirements for Deck Officers § 11.433 Service requirements for master of Great Lakes and inland... endorsement as master of Great Lakes and inland steam or motor vessels of any gross tons is: (a) One year of...

  18. 46 CFR 11.457 - Service requirements for master of inland steam or motor vessels of not more than 100 gross tons.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 46 Shipping 1 2013-10-01 2013-10-01 false Service requirements for master of inland steam or motor... Requirements for Deck Officers § 11.457 Service requirements for master of inland steam or motor vessels of not more than 100 gross tons. (a) An applicant for an endorsement as master of inland steam or motor...

  19. 46 CFR 11.404 - Service requirements for master of ocean or near coastal steam or motor vessels of any gross tons.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 46 Shipping 1 2013-10-01 2013-10-01 false Service requirements for master of ocean or near coastal... Requirements for Deck Officers § 11.404 Service requirements for master of ocean or near coastal steam or motor... master of ocean or near coastal steam or motor vessels of any gross tons is: (a) One year of service as...

  20. 46 CFR 11.424 - Service requirements for master of ocean steam or motor vessels of not more than 200 gross tons.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 46 Shipping 1 2013-10-01 2013-10-01 false Service requirements for master of ocean steam or motor... Requirements for Deck Officers § 11.424 Service requirements for master of ocean steam or motor vessels of not... endorsement as master of ocean steam or motor vessels of not more than 200 gross tons is: (1) Three years...

  1. 46 CFR 11.404 - Service requirements for master of ocean or near coastal steam or motor vessels of any gross tons.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 46 Shipping 1 2011-10-01 2011-10-01 false Service requirements for master of ocean or near coastal... Requirements for Deck Officers § 11.404 Service requirements for master of ocean or near coastal steam or motor... master of ocean or near coastal steam or motor vessels of any gross tons is: (a) One year of service as...

  2. 46 CFR 11.457 - Service requirements for master of inland steam or motor vessels of not more than 100 gross tons.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 46 Shipping 1 2012-10-01 2012-10-01 false Service requirements for master of inland steam or motor... Requirements for Deck Officers § 11.457 Service requirements for master of inland steam or motor vessels of not more than 100 gross tons. (a) An applicant for an endorsement as master of inland steam or motor...

  3. 46 CFR 11.433 - Service requirements for master of Great Lakes and inland steam or motor vessels of any gross tons.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 46 Shipping 1 2013-10-01 2013-10-01 false Service requirements for master of Great Lakes and... Professional Requirements for Deck Officers § 11.433 Service requirements for master of Great Lakes and inland... endorsement as master of Great Lakes and inland steam or motor vessels of any gross tons is: (a) One year of...

  4. 46 CFR 11.420 - Service requirements for mate of ocean steam or motor vessels of not more than 500 gross tons.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 46 Shipping 1 2010-10-01 2010-10-01 false Service requirements for mate of ocean steam or motor... Requirements for Deck Officers § 11.420 Service requirements for mate of ocean steam or motor vessels of not... mate of ocean steam and motor vessels of not more than 500 gross tons is two years total service in the...

  5. Multidimensional Diagnostic Criteria for Chronic Pain: Introduction to the ACTTION-American Pain Society Pain Taxonomy (AAPT).

    PubMed

    Dworkin, Robert H; Bruehl, Stephen; Fillingim, Roger B; Loeser, John D; Terman, Gregory W; Turk, Dennis C

    2016-09-01

    A variety of approaches have been used to develop diagnostic criteria for chronic pain. The published evidence of the reliability and validity of existing diagnostic criteria is limited, and these criteria have typically not been used in clinical practice. The availability of a widely accepted, consistently applied, and evidence-based taxonomy of diagnostic criteria would improve the quality of clinical research on chronic pain and would be of great value in clinical practice. To address the need for evidence-based diagnostic criteria for the major chronic pain conditions, the Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks (ACTTION) public-private partnership with the US Food and Drug Administration and the American Pain Society (APS) have collaborated on the development of the ACTTION-APS Pain Taxonomy (AAPT). AAPT provides a multidimensional framework that is applied systematically in the development of diagnostic criteria. This article (1) describes the background and rationale for AAPT; (2) presents the AAPT taxonomy and the specific conditions for which diagnostic criteria have been developed (to be published separately); (3) briefly reviews the 5 dimensions that constitute the AAPT multidimensional framework and describes the 7 accompanying articles that discuss these dimensions and other important issues involving AAPT; and (4) provides an overview of next steps, specifically, the general processes by which the initial set of diagnostic criteria (for which the evidence base has been drawn from the literature, systematic reviews, and secondary analyses of existing databases) will undergo additional assessments of reliability and validity. To address the need for evidence-based diagnostic criteria for the major chronic pain conditions, the AAPT provides a multidimensional framework that is applied systematically in the development of diagnostic criteria. The long-term objective of AAPT is to advance

  6. Opioids for neuropathic pain.

    PubMed

    Katz, Nathaniel; Benoit, Christine

    2005-06-01

    Whether opioids are effective for neuropathic pain has been a matter of controversy for decades. Within limits, it is clear that opioids in general are effective for neuropathic pain. Furthermore, there is no evidence that opioids are any less effective for neuropathic pain than for non-neuropathic pain, no evidence that opioids are less effective for neuropathic pain than are other medications, and no evidence that one opioid is any more effective than another for neuropathic pain. It remains uncertain whether opioids are effective for central pain, although they may have a role. Although some patients appear to enjoy long-term benefits, most studies have been short-term. Opioids have an important role in the treatment of neuropathic pain; however, skillful opioid use balances the benefits with management of side effects and prevention and treatment of abuse and addiction.

  7. Measuring pain impact versus pain severity using a numeric rating scale.

    PubMed

    Fraenkel, Liana; Falzer, Paul; Fried, Terri; Kohler, Minna; Peters, Ellen; Kerns, Robert; Leventhal, Howard

    2012-05-01

    Routine assessments of pain using an intensity numeric rating scale (NRS) have improved documentation, but have not improved clinical outcomes. This may be, in part, due to the failure of the NRS to adequately predict patients' preferences for additional treatment. To examine whether patients' illness perceptions have a stronger association with patient treatment preferences than the pain intensity NRS. Single face-to-face interview. Outpatients with chronic, noncancer, musculoskeletal pain. Experience of pain was measured using 18 illness perception items. Factor analysis of these items found that five factors accounted for 67.1% of the variance; 38% of the variance was accounted for by a single factor labeled "pain impact." Generalized linear models were used to examine how NRS scores and physical function compare with pain impact in predicting preferences for highly effective/high-risk treatment. Two hundred forty-nine subjects agreed to participate. Neither NRS nor functioning predicted patient preference (NRS: χ2 = 1.92, df = 1, p = 0.16, physical functioning: χ2 = 2.48, df = 1, p = 0.11). In contrast, pain impact was significantly associated with the preference for a riskier/more effective treatment after adjusting for age, comorbidity, efficacy of current medications and numeracy (χ2 = 4.40, df = 1, p = 0.04). Tools that measure the impact of pain may be a more valuable screening instrument than the NRS. Further research is now needed to determine if measuring the impact of pain in clinical practice is more effective at triggering appropriate management than more restricted measures of pain such as the NRS.

  8. 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 ...

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

    PubMed Central

    Yang, Zhou; Jackson, Todd; Huang, Chengzhi

    2016-01-01

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

  10. Unimpaired endogenous pain inhibition in the early phase of complex regional pain syndrome.

    PubMed

    Kumowski, N; Hegelmaier, T; Kolbenschlag, J; Maier, C; Mainka, T; Vollert, J; Enax-Krumova, E

    2017-05-01

    The complex regional pain syndrome (CRPS) is characterized by distal generalisation of pain beyond the initial trauma. This might be the result of impaired endogenous pain inhibition. We compared Conditioned Pain Modulation (CPM) between patients with CRPS (n = 24; pain: 4.5 ± 2.2, NRS 0-10; disease duration <1 year), neuralgia (n = 17; pain: 5.5 ± 1.1) and healthy subjects (n = 23) and its correlation with loss and gain of function as assessed by Quantitative Sensory Testing (QST). CPM was assessed with heat as test stimulus (TS) and cold water as conditioning stimulus (CS). The early CPM-effect was calculated as difference between heat pain during and before conditioning, the late CPM-effect, 5 minutes after and before conditioning, respectively. Heat pain decreased comparably after CS in all groups, resulting in a significant CPM-effect (healthy: -12.5 ± 12.4, NRS 0-100; CRPS: -14.7 ± 15.7; neuralgia: -7.9 ± 9.8; p < 0.001). When compared to healthy subjects, heat pain declined significantly steeper in CRPS patients (healthy: -2.0 ± 5.5, NRS 0-100/10 s; CRPS: -6.3 ± 8.1; p < 0.05). Only CRPS patients demonstrated a late CPM effect (-6.0 ± 9.0, p < 0.005). Neither spontaneous pain nor any QST parameter correlated with CPM, with the exception of a decreased cold pain threshold, which correlated with an enhanced CPM in CRPS patients only (r = -0.456, p < 0.05). An impairment of endogenous pain inhibition does not explain the extent of pain in the early stage of CRPS or in neuralgia. The unexpectedly high CPM in CRPS patients might result from activation of the intact descending pathways in response to central sensitization, as cold hyperalgesia correlated with the CPM-effect. Conditioned pain modulation (CPM) is not impaired in the early phase of complex regional pain syndrome (CRPS) and neuralgia. Only in CRPS higher CPM was associated with lower cold pain thresholds. © 2017 European Pain Federation - EFIC®.

  11. Chronic Abdominal Wall Pain.

    PubMed

    Koop, Herbert; Koprdova, Simona; Schürmann, Christine

    2016-01-29

    Chronic abdominal wall pain is a poorly recognized clinical problem despite being an important element in the differential diagnosis of abdominal pain. This review is based on pertinent articles that were retrieved by a selective search in PubMed and EMBASE employing the terms "abdominal wall pain" and "cutaneous nerve entrapment syndrome," as well as on the authors' clinical experience. In 2% to 3% of patients with chronic abdominal pain, the pain arises from the abdominal wall; in patients with previously diagnosed chronic abdominal pain who have no demonstrable pathological abnormality, this likelihood can rise as high as 30% . There have only been a small number of clinical trials of treatment for this condition. The diagnosis is made on clinical grounds, with the aid of Carnett's test. The characteristic clinical feature is strictly localized pain in the anterior abdominal wall, which is often mischaracterized as a "functional" complaint. In one study, injection of local anesthesia combined with steroids into the painful area was found to relieve pain for 4 weeks in 95% of patients. The injection of lidocaine alone brought about improvement in 83-91% of patients. Long-term pain relief ensued after a single lidocaine injection in 20-30% of patients, after repeated injections in 40-50% , and after combined lidocaine and steroid injections in up to 80% . Pain that persists despite these treatments can be treated with surgery (neurectomy). Chronic abdominal wall pain is easily diagnosed on physical examination and can often be rapidly treated. Any physician treating patients with abdominal pain should be aware of this condition. Further comparative treatment trials will be needed before a validated treatment algorithm can be established.

  12. Resolution of pain after childbirth.

    PubMed

    Eisenach, James C; Pan, Peter; Smiley, Richard M; Lavand'homme, Patricia; Landau, Ruth; Houle, Timothy T

    2013-01-01

    Chronic pain after surgery occurs in 10-40% of individuals, including 5-20% of women after cesarean delivery in previous reports. Pain and depression 2 months after childbirth are independently associated with more severe acute post-delivery pain. Here we examine other predictors of pain at 2 months and determine the incidence of pain at 6 and 12 months after childbirth. Following Institutional Review Board approval, 1228 women were interviewed within 36 h of delivery. Of these, 937 (76%) were successfully contacted by telephone at 2 months, and, if they had pain, at 6 and 12 months after delivery. The primary outcome measure was presence of pain which began at the time of delivery. We also generated a model of severity of acute post-delivery pain and 2 month pain and depression. Pain which began at the time of delivery was remarkably rare 6 and 12 months later (1.8% and 0.3% [upper 95% confidence limit, 1.2%], respectively). Past history of pain and degree of tissue damage at delivery accounted for 7.0% and 16.7%, respectively, of one aspect in the variability in acute post-delivery pain. Neither of these factors was associated with incidence of pain 2 months later. Using a definition of new onset pain from delivery, we show a remarkably low incidence of pain 1 yr after childbirth, including those with surgical delivery. Additionally, degree of tissue trauma and history of chronic pain, risk factors for pain 2 months after other surgery, were unimportant to pain 2 months after cesarean or vaginal delivery.

  13. Neuropathic pain in leprosy: symptom profile characterization and comparison with neuropathic pain of other etiologies

    PubMed Central

    Raicher, Irina; Stump, Patrick Raymond Nicolas Andre Ghislain; Harnik, Simone Bega; de Oliveira, Rodrigo Alves; Baccarelli, Rosemari; Marciano, Lucia H.S.C.; Ura, Somei; Virmond, Marcos C.L.; Teixeira, Manoel Jacobsen; de Andrade, Daniel Ciampi

    2018-01-01

    Abstract Introduction: Previous studies reported a high prevalence of neuropathic pain in leprosy, being especially present in “pharmacologically cured” patients. The presence of neuropathic pain in leprosy poses a supplementary burden in patient's quality of life, daily activities, and mood. Objectives: The aim of this study was to assess whether neuropathic pain in leprosy has similar symptom profile as neuropathic pain of other etiologies and to retrospectively assess the efficacy of neuropathic pain medications regularly prescribed to leprosy. Methods: Leprosy and nonleprosy patients had their neuropathic pain characterized by the neuropathic pain symptom inventory (NPSI, ranges from 0 to 100, with 100 being the maximal neuropathic pain intensity) in a first visit. In a second visit, leprosy patients who had significant pain and received pharmacological treatment in the first evaluation were reassessed (NPSI) and had their pain profile and treatment response further characterized, including information on drugs prescribed for neuropathic pain and their respective pain relief. Results: The pain characteristics based on NPSI did not significantly differ between leprosy and nonleprosy neuropathic pain patients in visit 1 after correction for multiple analyses, and cluster analyses confirmed these findings (ie, no discrimination between leprosy and nonleprosy groups; Pearson χ2 = 0.072, P = 0.788). The assessment of pain relief response and the drugs taken by each patient, linear regression analysis showed that amitriptyline, when effective, had the highest percentage of analgesic relief. Conclusions: Neuropathic pain in leprosy is as heterogeneous as neuropathic pain of other etiologies, further supporting the concept that neuropathic pain is a transetiological entity. Neuropathic pain in leprosy may respond to drugs usually used to control pain of neuropathic profile in general, and amitriptiline may constitute a potential candidate drug for future formal

  14. Neuropathic pain in leprosy: symptom profile characterization and comparison with neuropathic pain of other etiologies.

    PubMed

    Raicher, Irina; Stump, Patrick Raymond Nicolas Andre Ghislain; Harnik, Simone Bega; de Oliveira, Rodrigo Alves; Baccarelli, Rosemari; Marciano, Lucia H S C; Ura, Somei; Virmond, Marcos C L; Teixeira, Manoel Jacobsen; de Andrade, Daniel Ciampi

    2018-03-01

    Previous studies reported a high prevalence of neuropathic pain in leprosy, being especially present in "pharmacologically cured" patients. The presence of neuropathic pain in leprosy poses a supplementary burden in patient's quality of life, daily activities, and mood. The aim of this study was to assess whether neuropathic pain in leprosy has similar symptom profile as neuropathic pain of other etiologies and to retrospectively assess the efficacy of neuropathic pain medications regularly prescribed to leprosy. Leprosy and nonleprosy patients had their neuropathic pain characterized by the neuropathic pain symptom inventory (NPSI, ranges from 0 to 100, with 100 being the maximal neuropathic pain intensity) in a first visit. In a second visit, leprosy patients who had significant pain and received pharmacological treatment in the first evaluation were reassessed (NPSI) and had their pain profile and treatment response further characterized, including information on drugs prescribed for neuropathic pain and their respective pain relief. The pain characteristics based on NPSI did not significantly differ between leprosy and nonleprosy neuropathic pain patients in visit 1 after correction for multiple analyses, and cluster analyses confirmed these findings (ie, no discrimination between leprosy and nonleprosy groups; Pearson χ2 = 0.072, P = 0.788). The assessment of pain relief response and the drugs taken by each patient, linear regression analysis showed that amitriptyline, when effective, had the highest percentage of analgesic relief. Neuropathic pain in leprosy is as heterogeneous as neuropathic pain of other etiologies, further supporting the concept that neuropathic pain is a transetiological entity. Neuropathic pain in leprosy may respond to drugs usually used to control pain of neuropathic profile in general, and amitriptiline may constitute a potential candidate drug for future formal clinical trials aimed at controlling neuropathic pain in leprosy.

  15. MULTIPLE NONSPECIFIC SITES OF JOINT PAIN OUTSIDE THE KNEES DEVELOP IN PERSONS WITH KNEE PAIN

    PubMed Central

    Felson, David T.; Niu, Jingbo; Quinn, Emily K; Neogi, Tuhina; Lewis, Cara; Lewis, Cora E.; Law, Laura Frey; McCulloch, Chuck; Nevitt, Michael; LaValley, Michael

    2017-01-01

    Objective Many persons with knee pain have joint pain outside the knee but despite the impact and high frequency of this pain, its distribution and causes have not been studied. Those studying gait abnormalities have suggested that knee pain causes pain in adjacent joints but pain adaptation strategies are highly individualized. Methods We studied persons age 50-79 years with or at high risk of knee osteoarthritis drawn from two community-based cohorts, the Multicenter Osteoarthritis Study and the Osteoarthritis Initiative and followed for 5-7 years. We excluded those with knee pain at baseline and compared those who developed and did not develop knee pain at the first follow-up examination (the index visit). We examined pain on most days at joint regions outside the knee in examinations after the index visit. Logistic regression analyses examined the risk of joint specific pain adjusted for age, sex, BMI, depression with sensitivity analyses excluding those with widespread pain. Results In the combined cohorts, there were 693 persons with index visit knee pain vs. 2793 without it. 79.6% of those with bilateral and 63.8% of those with unilateral knee pain had pain during follow-up in a joint region outside the knee vs. 49.9% of those without knee pain. An increased risk of pain was present in most extremity joint sites without a predilection for specific sites. Results were unchanged when those with widespread pain were excluded. Conclusions Persons with chronic knee pain are at increased risk of pain in multiple joints in no specific pattern. PMID:27589036

  16. Nutraceuticals and osteoarthritis pain.

    PubMed

    Wang, Angela; Leong, Daniel J; Cardoso, Luis; Sun, Hui B

    2018-02-24

    Arthritis is a chronic disease of joints. It is highly prevalent, particularly in the elderly, and is commonly associated with pain that interferes with quality of life. Because of its chronic nature, pharmacological approaches to pain relief and joint repair must be safe for long term use, a quality many current therapies lack. Nutraceuticals refer to compounds or materials that can function as nutrition and exert a potential therapeutic effect, including the relief of pain, such as pain related to arthritis, of which osteoarthritis (OA) is the most common form. Of interest, nutraceuticals have recently been shown to have potential in relieving OA pain in human clinical trials. Emerging evidence indicates nutraceuticals may represent promising alternatives for the relief of OA pain. In this paper, we will overview OA pain and the use of nutraceuticals in OA pain management, focusing on those that have been evaluated by clinical trials. Furthermore, we discuss the biologic and pharmacologic actions underlying the nutraceutical effects on pain relief based on the potential active ingredients identified from traditional nutraceuticals in OA pain management and their potential for drug development. The review concludes by sharing our viewpoints that future studies should prioritize elucidating the mechanisms of action of nutraceuticals in OA and developing nutraceuticals that not only relieve OA pain, but also mitigate OA pathology. Copyright © 2018 Elsevier Inc. All rights reserved.

  17. Comparative Associations of Working Memory and Pain Catastrophizing With Chronic Low Back Pain Intensity.

    PubMed

    Simon, Corey B; Lentz, Trevor A; Bishop, Mark D; Riley, Joseph L; Fillingim, Roger B; George, Steven Z

    2016-07-01

    Because of its high global burden, determining biopsychosocial influences of chronic low back pain (CLBP) is a research priority. Psychological factors such as pain catastrophizing are well established. However, cognitive factors such as working memory warrant further investigation to be clinically useful. The purpose of this study was to determine how working memory and pain catastrophizing are associated with CLBP measures of daily pain intensity and movement-evoked pain intensity. This study was a cross-sectional analysis of individuals with ≥3 months of CLBP (n=60) compared with pain-free controls (n=30). Participants completed measures of working memory, pain catastrophizing, and daily pain intensity. Movement-evoked pain intensity was assessed using the Back Performance Scale. Outcome measures were compared between individuals with CLBP and those who were pain-free using nonparametric testing. Associations were determined using multivariate regression analyses. Participants with CLBP (mean age=47.7 years, 68% female) had lower working memory performance (P=.008) and higher pain catastrophizing (P<.001) compared with pain-free controls (mean age=47.6 years, 63% female). For individuals with CLBP, only working memory remained associated with daily pain intensity (R(2)=.07, standardized beta=-.308, P=.041) and movement-evoked pain intensity (R(2)=.14, standardized beta=-.502, P=.001) after accounting for age, sex, education, and interactions between pain catastrophizing and working memory. The cross-sectional design prevented prospective analysis. Findings also are not indicative of overall working memory (eg, spatial) or cognitive performance. Working memory demonstrated the strongest association with daily pain and movement-evoked pain intensity compared with (and after accounting for) established CLBP factors. Future research will elucidate the prognostic value of working memory on prevention and recovery of CLBP. © 2016 American Physical Therapy

  18. Comparative Associations of Working Memory and Pain Catastrophizing With Chronic Low Back Pain Intensity

    PubMed Central

    Lentz, Trevor A.; Bishop, Mark D.; Riley, Joseph L.; Fillingim, Roger B.; George, Steven Z.

    2016-01-01

    Background Because of its high global burden, determining biopsychosocial influences of chronic low back pain (CLBP) is a research priority. Psychological factors such as pain catastrophizing are well established. However, cognitive factors such as working memory warrant further investigation to be clinically useful. Objective The purpose of this study was to determine how working memory and pain catastrophizing are associated with CLBP measures of daily pain intensity and movement-evoked pain intensity. Design This study was a cross-sectional analysis of individuals with ≥3 months of CLBP (n=60) compared with pain-free controls (n=30). Method Participants completed measures of working memory, pain catastrophizing, and daily pain intensity. Movement-evoked pain intensity was assessed using the Back Performance Scale. Outcome measures were compared between individuals with CLBP and those who were pain-free using nonparametric testing. Associations were determined using multivariate regression analyses. Results Participants with CLBP (mean age=47.7 years, 68% female) had lower working memory performance (P=.008) and higher pain catastrophizing (P<.001) compared with pain-free controls (mean age=47.6 years, 63% female). For individuals with CLBP, only working memory remained associated with daily pain intensity (R2=.07, standardized beta=−.308, P=.041) and movement-evoked pain intensity (R2=.14, standardized beta=−.502, P=.001) after accounting for age, sex, education, and interactions between pain catastrophizing and working memory. Limitations The cross-sectional design prevented prospective analysis. Findings also are not indicative of overall working memory (eg, spatial) or cognitive performance. Conclusion Working memory demonstrated the strongest association with daily pain and movement-evoked pain intensity compared with (and after accounting for) established CLBP factors. Future research will elucidate the prognostic value of working memory on prevention

  19. Construct validity of an instrument to measure neuropathic pain in women with bladder pain syndrome.

    PubMed

    Arya, Lily A; Harvie, Heidi S; Andy, Uduak U; Cory, Lori; Propert, Kathleen J; Whitmore, Kristene

    2013-06-01

    To determine the construct validity of an instrument to measure neuropathic pain in women with bladder pain syndrome (BPS). Our hypothesis is that neuropathic, bladder, and bowel pain represent different constructs in women with BPS. Secondary planned analysis of a prospective cross-sectional study of 150 women with BPS. The relationship between neuropathic pain, urinary, and bowel symptoms was assessed. The correlation of the total neuropathic pain score with total urinary and bowel symptom scores was low to moderate (r = 0.28-0.49). The correlation of specific neuropathic pain items with bladder and bowel pain was also low to moderate (r = 0.12-0.36). Women with neuropathic pain had significantly higher scores for urinary urgency, bladder pain, abdominal pain, diarrhea, and constipation than women with non-neuropathic pain (all P < 0.0001). Somatosensory neuropathic pain and "visceral" bladder and bowel pain represent separate but related constructs in women with BPS. Copyright © 2012 Wiley Periodicals, Inc.

  20. American pain society recommendations for improving the quality of acute and cancer pain management: American Pain Society Quality of Care Task Force.

    PubMed

    Gordon, Debra B; Dahl, June L; Miaskowski, Christine; McCarberg, Bill; Todd, Knox H; Paice, Judith A; Lipman, Arthur G; Bookbinder, Marilyn; Sanders, Steve H; Turk, Dennis C; Carr, Daniel B

    2005-07-25

    The American Pain Society (APS) set out to revise and expand its 1995 Quality Improvement Guidelines for the Treatment of Acute Pain and Cancer Pain and to facilitate improvements in the quality of pain management in all care settings. Eleven multidisciplinary members of the APS with expertise in quality improvement or measurement participated in the update. Five experts from organizations that focus on health care quality reviewed the final recommendations. MEDLINE and Cumulative Index to Nursing and Allied Health Literature databases were searched (1994-2004) to identify articles on pain quality measurement and quality improvement published after the development of the 1995 guidelines. The APS task force revised and expanded recommendations on the basis of the systematic review of published studies. The more than 3000 members of the APS were invited to provide input, and the 5 experts provided additional comments. The task force synthesized reviewers' comments into the final set of recommendations. The recommendations specify that all care settings formulate structured, multilevel systems approaches (sensitive to the type of pain, population served, and setting of care) that ensure prompt recognition and treatment of pain, involvement of patients and families in the pain management plan, improved treatment patterns, regular reassessment and adjustment of the pain management plan as needed, and measurement of processes and outcomes of pain management. Efforts to improve the quality of pain management must move beyond assessment and communication of pain to implementation and evaluation of improvements in pain treatment that are timely, safe, evidence based, and multimodal.

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