Psychic Distance, Innovation, and Firm Performance

NARCIS (Netherlands)

Azar, Goudarz; Drogendijk, Rian

2014-01-01

Previous research suggests that internationalization improves a firm's ability to innovate, but the effect of internationalizing into specific target markets or destinations on the innovation ability of firms has not been fully investigated. This study examined whether the psychic distance between

Psychic Warfare: Exploring the Mind Frontier

Science.gov (United States)

1988-05-01

month later Anderson was bacrk reinforcing psychic skepticism. This time he began, "The brass hats are, indeed, dabbling in the dark arts." Other...Emotion Radiator Ray; (10) Antisubmarine Systems; (11) Teleporters (Prototype); (12) Force Generators: (13) Orthoframe Generators; (14) Quark /Antiquark

Rational Thinking and Belief in Psychic Abilities: It Depends on Level of Involvement

OpenAIRE

Stone, Anna

2016-01-01

Previous research has shown that lay believers in psychic abilities are more\\ud prone to intuitive thinking, less inclined to rational thinking, and have an external locus of\\ud control, compared to non-believers. Psychic practitioners, however, may have different\\ud characteristics. Psychic practitioners (N=31; mean age = 42.7 years, s.d.=13.1), lay believers\\ud (N=33; mean age = 33.0 years, s.d.=10.3), and non-believers (N=31; mean age = 34.4 years,\\ud s.d.=15.4) completed questionnaires me...

Exploring "psychic transparency" during pregnancy: a mixed-methods approach.

Science.gov (United States)

Oriol, Cécile; Tordjman, Sylvie; Dayan, Jacques; Poulain, Patrice; Rosenblum, Ouriel; Falissard, Bruno; Dindoyal, Asha; Naudet, Florian

2016-08-12

Psychic transparency is described as a psychic crisis occurring during pregnancy. The objective was to test if it was clinically detectable. Seven primiparous and seven nulliparous subjects were recorded during 5 min of spontaneous speech about their dreams. 25 raters from five groups (psychoanalysts, psychiatrists, general practitioners, pregnant women and medical students) listened to the audiotapes. They were asked to rate the probability of the women being pregnant or not. Their ability to discriminate the primiparous women was tested. The probability of being identified correctly or not was calculated for each woman. A qualitative analysis of the speech samples was performed. No group of rater was able to correctly classify pregnant and non-pregnant women. However, the raters' choices were not completely random. The wish to be pregnant or to have a baby could be linked to a primiparous classification whereas job priorities could be linked to a nulliparous classification. It was not possible to detect Psychic transparency in this study. The wish for a child might be easier to identify. In addition, the raters' choices seemed to be connected to social representations of motherhood.

The Great Work of the New Millennium

Science.gov (United States)

Berry, Thomas

2013-01-01

Thomas Berry explores the meaning of work from the standpoint of human civilization responding to the call of the universe, replacing use and exploitation of nature with the wonder, rapport, and intimacy so important to the psychic balance of the developing human and natural harmony of life on Earth. The Great Work is defined as the work of…

Psychic energy and synchronicity.

Science.gov (United States)

Zabriskie, Beverley

2014-04-01

Given Jung's interest in physics' formulations of psychic energy and the concept of time, overlaps and convergences in the themes addressed in analytical psychology and in quantum physics are to be expected. These are informed by the active intersections between the matter of mind and mindfulness re matter. In 1911, Jung initiated dinners with Einstein. Jung's definition of libido in the pivotal 1912 Fordham Lectures reveals the influence of these conversations. Twenty years later, a significant period in physics, Wolfgang Pauli contacted Jung. Their collaboration led to the theory of synchronicity. © 2014, The Society of Analytical Psychology.

The Psychic Distance Concept: A Review of 25 Years of Research (1990–2015

Directory of Open Access Journals (Sweden)

Mariola Ciszewska-Mlinaric

2016-03-01

Full Text Available Purpose: There have been numerous studies analyzing the role of psychic (and cultural distance in the internationalization process focused on relationships between distance and market selection, entry mode, or subsidiary performance. Still, cumulative findings of this body of research are mixed and inconclusive. Thus, this review aims for a rigorous presentation of past research on psychic distance, with particular focus on the aspects of international business operations affected by psychic distance in the light of empirical studies.Methodology: This review encompasses 55 papers, both empirical and conceptual, published between 1990–2015 in top IB, international marketing, and management journals. In general, the papers under review were published in 27 journals, with the vast majority of them being published in 2005 or later. The vast majority of reviewed papers are of empirical character (47 papers, while eight are conceptual.Findings: Since 2005, the number of articles published in top academic journals that featured the term “psychic distance” in the title has quadrupled. Common research topics include not only the core domain of internationalization process and performance, but also focus on understanding the concept of psychic distance, analyzing its antecedents and coping modes. Other studies have addressed the performance implications of psychic distance in conjunction with variables like strategy adaptation to foreign markets.Research limitations/implications: While the present review is limited in the number of papers taken into account, it does provide an initial overview of the structure of the field. However, the comparability of findings of different studies is limited by factors such as firm samples or presence of multicultural nations. In terms of directions for further research, promising topics include the relationship between perceived and ‘real’ distances or the effectiveness of different coping modes

[From reflex arc to psychic apparatus: neurology and psychoanalysis around 1900].

Science.gov (United States)

Porath, Erik

2009-03-01

As a disciple of Ernst Wilhelm von Brücke and Theodor Meynert, Sigmund Freud was familiar with 19th century physiology and neurology. He started his career with laboratory work and began later on, when being a young medic to develop an explicit psychological method for curating hysterics. These cases of hysteria ask riddles to the established medical discourse and practice. Freud's long time unpublished Entwurf einer Psychologie (1895) makes the attempt of a "psychology for the neurologist". He tried to give a sufficient theory of the psychic apparatus on the basis of natural science. At the same time he (together with Josef Breuer) published his Studies on Hysteria, which--in addition to his earlier essay on Aphasia (1891)--argued, that there is no clear cut relation between body and soul. Despite the dubious, non-reductive character of the soma-psyche-relation, Freud gave reason to search for a complex field of interrelations between the physiological and psychological knowledge, beyond the divide of natural sciences and humanities. Not until his groundbreaking Traumdeutung (1900) Freud gave up the claim of reintegrating psychological knowledge into the neuroscientific field for now. But up to his latest work he always adheres to the principal project of unifying the natural and the psychical being of the subject. In the gap between the two spheres, for long occupied by the discursive figure of the 'psycho-physical parallelism', Freud situated the Unconscious. In the passage to a psychoanalytical theory of psychic events Freud took up the model of the reflex arc well known from neurology. The transmission into psychoanalysis complexifies the unilinearity of reflexes, so that the psychic apparatus can be analysed as a cybernetic mechanism 'avant la lettre'. It is interesting enough that inhibition as well as consciousness play a key role in the regulation of the psychic apparatus. In this context Freud stresses the importance of speech and language within the

Sibling differentiation, identity development, and the lateral dimension of psychic life.

Science.gov (United States)

Vivona, Jeanine M

2007-01-01

The lateral dimension of psychic life, lived through relationships with siblings and their substitutes, is structured around a distinct psychic challenge: to find one's unique place in a world of similar others. Like the challenge that structures the vertical parent-child dimension, the lateral challenge is fraught with conflict and ambivalence; its resolution imbues psychic structure. That resolution may be accomplished through a process of differentiation, an active and unconscious process of identity development by which a child amplifies differences with siblings and minimizes similarities. Differentiation from siblings serves to mitigate interpersonal rivalry with them and to ease internal conflict associated with the lateral dimension. Three clinical examples are offered to illustrate the operation of sibling differentiation and its costs, particularly in terms of constricted identity and attenuated relationships with siblings and peers. Differentiation as a process of becoming what the other is not has been eclipsed by identification in psychoanalytic theories of identity development. Yet differentiation is a common strategy for resolving the primary rivalries and conflicts of the lateral dimension, and has unique developmental and clinical implications.

‘Spiritalismus vincit Mundum’ Dutch spiritualism and the beginning of psychical research

Directory of Open Access Journals (Sweden)

Ingrid Kloosterman

2014-11-01

Full Text Available The science of psychical research and parapsychology stemmed, among other things, from wonder about the phenomena of spiritualism: manifestations of the deceased through mediums in séances. In the Netherlands, academic psychical research emerged in 1919, when the Studievereeniging voor Psychical Research (SPR was founded. In this paper, it is argued that a revival of the popularity of spiritualism during the war contributed to the emergence of the Dutch SPR shortly after the First World War had ended. Mass bereavement does not suffice as an explanation for the growth of the spiritualistic movement in the neutral Netherlands in the war years. It is demonstrated that in the writings of spiritualists about the First World War persistent fin-de-siècle themes can be distinguished. Before and during the First World War Dutch spiritualism was dominated by ‘ideologically’ inclined spiritualists and their more ‘critical-scientific’ counterparts were a minority. This had hindered the development of Dutch psychical research. After the war spiritualists shared their hopeful and optimistic perspective of the human soul with scholars leaning towards psychoanalytical and psychomonist ideas. This eventually led to a joint foundation of the Dutch SPR. This alignment between ideological and critical-scientific spiritualists would not last; opinions on how to handle the research subjects (i.e. mediums remained too distinct.

The concept of psychical trauma: a bridge in interdisciplinary space.

Science.gov (United States)

Tutté, Juan Carlos

2004-08-01

The concept of trauma currently occupies a central position in interdisciplinary dialogue. Using the concept of psychical trauma as a bridge, the author attempts an interdisciplinary dialogue with psychiatry, biology and neuroscience. Beginning with the concept of psychical trauma in Freud, the author reviews the evolution of Freud's thinking, and links it with the ideas of Ferenczi and post-Freudian psychoanalytical authors. From a different framework, he considers the present state of research on post-traumatic stress disorder in current psychiatric nosography and attempts an interdisciplinary approximation to the concept of psychical trauma. Interesting ideas like the traumatic situation, trauma spectrum and psychopathological spectrum emerge, which enable a better understanding of the concept of psychical trauma through its relatedness, as a bridge connecting a broad psychopathological range extending from normality to psychosis. The ensuing possible relative loss of nosographical rigour is more than compensated by the resulting increased understanding and enlarged therapeutic possibilities. In the second part of the paper, the author attempts a dialogue with neuroscience, taking into account new advances in current research on emotion and memory, and making them compatible with the psychoanalytical concept of trauma. In this sense, the paper underlines the importance of emotion and crucially of memory, regarded as a fundamental axis of the subject explored in this paper. Here a substantial distinction which is pertinent for analytical work appears: declarative memories versus non-declarative or procedural memories. In a concluding discussion the author argues that, taking into account the implications of these current notions regarding a number of theoretical and technical aspects, psychoanalysis currently holds a privileged position, both in its potential for prevention and regarding the treatment of patients, in so far as, through interdisciplinary dialogue

The Psychic Life of Resistance

DEFF Research Database (Denmark)

Barinaga, Ester

2013-01-01

to power. This article is a first step to remedy that oversight. Inspired by Butler’s reading of Foucault’s notion of power at work in subjection and resistance, the article uses Goffman to substantiate such an account. Based on a 20-month ethnographic study of a traditional immigrant suburb north...... of Stockholm, Sweden, which is being redeveloped into a high-tech region, it offers empirical insight into the psychic life of resistance. Further, a particular resistance strategy is identified: symbolic dislocations through adherence to a boundary other than the one subjecting the self in the first place....

Paranormal psychic believers and skeptics: a large-scale test of the cognitive differences hypothesis.

Science.gov (United States)

Gray, Stephen J; Gallo, David A

2016-02-01

Belief in paranormal psychic phenomena is widespread in the United States, with over a third of the population believing in extrasensory perception (ESP). Why do some people believe, while others are skeptical? According to the cognitive differences hypothesis, individual differences in the way people process information about the world can contribute to the creation of psychic beliefs, such as differences in memory accuracy (e.g., selectively remembering a fortune teller's correct predictions) or analytical thinking (e.g., relying on intuition rather than scrutinizing evidence). While this hypothesis is prevalent in the literature, few have attempted to empirically test it. Here, we provided the most comprehensive test of the cognitive differences hypothesis to date. In 3 studies, we used online screening to recruit groups of strong believers and strong skeptics, matched on key demographics (age, sex, and years of education). These groups were then tested in laboratory and online settings using multiple cognitive tasks and other measures. Our cognitive testing showed that there were no consistent group differences on tasks of episodic memory distortion, autobiographical memory distortion, or working memory capacity, but skeptics consistently outperformed believers on several tasks tapping analytical or logical thinking as well as vocabulary. These findings demonstrate cognitive similarities and differences between these groups and suggest that differences in analytical thinking and conceptual knowledge might contribute to the development of psychic beliefs. We also found that psychic belief was associated with greater life satisfaction, demonstrating benefits associated with psychic beliefs and highlighting the role of both cognitive and noncognitive factors in understanding these individual differences.

Psychic wear and social vulnerability of Zapotlenses women: A descriptive study

Directory of Open Access Journals (Sweden)

Claudia Saldaña-Orozco

2017-12-01

Full Text Available Introduction: Numerous studies have documented the impact of psychosocial risks, and particularly the psychic wear on workers’ health. However, women in a situation of social vulnerability have not been the subject of exploration. Objective: To characterize the psychic wear in a sample of vulnerable women. Materials and methods: An exploratory, descriptive and correlational study was conducted. The dimension number 4 from the Battery for the study of the working conditions of psychosocial character was applied (CTCPS-MAC, which evaluates psychological wear and 3 particular factors (cognitive-emotional response; behavioral response and physiological response at 99 Vulnerable women of Zapotlán el Grande. Results: A 75.8 % of the participants presented optimal conditions with ratings between good and very good, 24.2% between normal and harmful, which indicates that they require immediate assistance. The most affected factor was number 1 (cognitive-emotional response, 52,5% presented negative symptomatology. There were no significant associations between the sociodemographic variables studied and the psychic wear. Conclusions: The results allow to open doors for deeper investigations with the population studied in order to guarantee mental health and quality of life for women with social vulnerability in Zapotlán el Grande.

Special features of pathophysiological mechanisms of psychical disadaptation under influence of the Chernobyl NPP disaster

International Nuclear Information System (INIS)

Sinitskij, V.N.; Kovtun, T.V.; Kharchenko, N.K.; Stognij, N.A.; Duplenko, P.Yu.; Opanasenko, E.V.

1994-01-01

A complex clinical-laboratory examination of 110 patients with various phenomena of psychical disadaptation has been carried out.In the first group (5% of examined patients) the signs of psychical-organical syndrome characteristics for dismnestical dementia has been stated. In the second group (75% of examined patients) the neurological (vascular, vegetative, convulsive) disorders, developed due to systemic lesion of subcortical mezodiencephalular and limbic formation of the brain, have been revealed. For the third group of patients the neurotical and neurosis-like disorders have been typical. The most characteristic changes of electroencephalogram, higher neural activity, psychic-test data, indexes of vegetative-vascular tonus, exchange of biogenic amines (catecholamines and serotonin), the content of key metabolites in the blood, glomeruli filtration of kidneys have been investigated for the patients of each group

[Establishment of rat model of psychical erectile dysfunction].

Science.gov (United States)

Wang, Qiu-lin; Wang, Shu-ren; Duan, Jin

2006-01-01

To set up a method of establishing the animal model of psychical erectile dysfunction with emotional stress. All thirty-six male rats with normal sexual function were divided into three groups, i. e. normal group, model group and demasculinized group randomly according to their weights. The rats in the model group were suspended upside down in midair over the water and irritated repeatedly. Two weeks later, the sexual abilities of all rats, i. e. the times of mounting and intromitting the estrus female rats, the latent period of mounting, intromission and ejaculation, were recorded, and the number of rats that had sexual activities was also counted. And the hemorheology indices of the rats were measured. Compared with the normal rats, the latency of mounting [(152.5 +/- 24.6) s vs (42.4 +/- 9.6) s] and intromission [(437.0 +/- 67.7) s vs (130.8 +/- 39.1) s] of the model rats were longer (P 0.05). The hemorheology indices, e. g. blood viscosity, hematocrit (Hct) and red cell aggregation (RCA), of the model rats was significant higher than that of the normal and demasculinized rats (P erectile dysfunction can be made ideally with psychical stress.

[Is the brain the creator of psychic phenomena or is a paradigm shift inevitable?].

Science.gov (United States)

Bonilla, Ernesto

2014-06-01

Every day new scientific information is appearing that cannot be explained using the classical Newtonian model and is calling for the emergence of a new paradigm that would include the explanation of such phenomena as telepathy, clairvoyance, presentiment, precognition, out of the body experiences, psychic healing, after-death communication, near-death experiences and reincarnation. The materialist paradigm which considers the brain as the sole cause of consciousness and psychic phenomena has been challenged by a new paradigm that seems to demonstrate that there is not a cause-effect relationship between brain activity and psychic phenomena but only a correlation between them, since these phenomena can be experienced without the body and appear to have an extra-cerebral origin (cosmic field, cosmic consciousness?). Of course, the brain is intensely involved in the manifestation of consciousness in our daily life but this is not equivalent to affirm that brain creates consciousness. Recent findings force us to consider a non-physical, spiritual and transpersonal aspect of reality.

Border-line neuro psychic disturbances in children and teenagers living on the territory contaminated with radionuclides

International Nuclear Information System (INIS)

Bazyl'chik, S. V.

1993-01-01

Spread of the border-line neuro psychic disturbances in children and teenagers aged 10-16 living in the districts contaminated with radionuclides was studied. A marked increase of psychic disturbances, particularly in girls, attributed to the growth of neurotic and neurosis-like disorders as compared with the control group was revealed. Asthenic type disorders prevailed in derangement structure. 7 refs., 1 tab

[Psychic factors in case histories of patients with alopecia areata--preliminary report].

Science.gov (United States)

Wygledowska-Kania, M; Bogdanowski, T

1996-01-01

We tested the significance of psychic factors in the etiopathogenesis of alopecia areata. We analysed the patient on the basis of a detailed examination based on the case history, including important events in his/her life, personality traits, serious events and the loss of emotional attachment. General important events happened to 80% of the patients, personality traits able to cause the disease were present in 73%, serious events in 62% and the loss of emotional attachment was also found in 62% of the patients. We tested 60 patients (31 women and 29 men). The evidence obtained from the detailed examination based on case histories indicated significantly frequent occurrence of the psychic factors preceding the occurrence of alopecia areata.

Subjective and objective symptoms of psychical load in nuclear power plant operators in connection with shift operation

International Nuclear Information System (INIS)

Kozeny, J.; Prochazkova, Z.

1992-01-01

A group of 56 operators (mean age=34.6 years, S.D. 3.4 year, range=30-40 years; university graduates of technical direction) in a nuclear power plant was followed during the morning, afternoon and night shift from the standpoint of subjective symptoms (an evaluation scale assessed at the beginning, in the middle and at the end of the shift) and objective symptoms (critical flicker frequency determined at the same time) of the psychical load. No significant differences were found by multivariation analysis between subjective perception of the work load and its objective reflection. The night shift, where the load lies particularly in the monotony of stimuli, appears to exert a higher psychical load aimed at maintaining mental activity when compared with the afternoon and morning shift. In contrast to subjective assessment of the psychical condition where the data fluctuated during the whole shift, the psychical activity reflected in the objective data, decreased until the middle of the shift when stabilization occurred. (author) 1 tab., 8 refs

[Aspects of aetiology of neuro-psychic disorders in male liquidators of Chernobyl nuclear power accident consequences].

Science.gov (United States)

Skavysh, V A

2009-01-01

The author considered aetiology of neuro-psychic disorders in liquidators of Chernobyl nuclear power accident consequences, demonstrated scientific value of studying the liquidators cohort, as they were protected from internal radiation factors and reside on radiation "pure" territories. External radiation doses in those liquidators vary from 16 cGy to 18.7 +/- 10.8 cGy, according to the author. Catamnesis enabled to doubt radiation aetiology of psychic organic syndrome revealed in 1991-1994 by clinical and instrumental studies among 53.6% of 213 male examinees. According to the author, prolonged over 1-2 months external radiation of low dose could not cause health deterioration in adult males. Diagnosed psychic organic syndrome and vascular encephalopathy in some cases could have alcohol aetiology. This conclusion is not extrapolated to the whole liquidators cohort.

[Advances in the research of effects of music therapy on pain and anxiety in burn patients].

Science.gov (United States)

Jinyi, Li; Yungui, Wang

2015-06-01

Pain and anxiety engender major psychic problems during all phases of treatment for burn patients. Analgesic alone does not allay these problems satisfactorily in these patients. Music therapy, as an important complementary and alternative therapy, has been widely used in multiple medical fields. However, its positive effect on alleviation of pain and anxiety in burn patients is undefined. The objective of this review is to summarize the feasibility, application fields, methods, and the effectiveness of music therapy in allaying pain and anxiety of burn patients during the whole course of treatment.

Priming psychic and conjuring abilities of a magic demonstration influences event interpretation and random number generation biases

Science.gov (United States)

Mohr, Christine; Koutrakis, Nikolaos; Kuhn, Gustav

2015-01-01

Magical ideation and belief in the paranormal is considered to represent a trait-like character; people either believe in it or not. Yet, anecdotes indicate that exposure to an anomalous event can turn skeptics into believers. This transformation is likely to be accompanied by altered cognitive functioning such as impaired judgments of event likelihood. Here, we investigated whether the exposure to an anomalous event changes individuals’ explicit traditional (religious) and non-traditional (e.g., paranormal) beliefs as well as cognitive biases that have previously been associated with non-traditional beliefs, e.g., repetition avoidance when producing random numbers in a mental dice task. In a classroom, 91 students saw a magic demonstration after their psychology lecture. Before the demonstration, half of the students were told that the performance was done respectively by a conjuror (magician group) or a psychic (psychic group). The instruction influenced participants’ explanations of the anomalous event. Participants in the magician, as compared to the psychic group, were more likely to explain the event through conjuring abilities while the reverse was true for psychic abilities. Moreover, these explanations correlated positively with their prior traditional and non-traditional beliefs. Finally, we observed that the psychic group showed more repetition avoidance than the magician group, and this effect remained the same regardless of whether assessed before or after the magic demonstration. We conclude that pre-existing beliefs and contextual suggestions both influence people’s interpretations of anomalous events and associated cognitive biases. Beliefs and associated cognitive biases are likely flexible well into adulthood and change with actual life events. PMID:25653626

Priming psychic and conjuring abilities of a magic demonstration influences event interpretation and random number generation biases

Directory of Open Access Journals (Sweden)

Christine eMohr

2015-01-01

Full Text Available Magical ideation and belief in the paranormal is considered to represent a trait-like character; people either believe in it or not. Yet, anecdotes indicate that exposure to an anomalous event can turn sceptics into believers. This transformation is likely to be accompanied by altered cognitive functioning such as impaired judgements of event likelihood. Here, we investigated whether the exposure to an anomalous event changes individuals’ explicit traditional (religious and non-traditional (e.g. paranormal beliefs as well as cognitive biases that have previously been associated with non-traditional beliefs, e.g. repetition avoidance when producing random numbers in a mental dice task. In a classroom, 91 students saw a magic demonstration after their psychology lecture. Before the demonstration, half of the students were told that the performance was done respectively by a conjuror (magician group or a psychic (psychic group. The instruction influenced participants’ explanations of the anomalous event. Participants in the magician, as compared to the psychic group, were more likely to explain the event through conjuring abilities while the reverse was true for psychic abilities. Moreover, these explanations correlated positively with their prior traditional and non-traditional beliefs. Finally, we observed that the psychic group showed more repetition avoidance than the magician group, and this effect remained the same regardless of whether assessed before or after the magic demonstration. We conclude that pre-existing beliefs and contextual suggestions both influence people’s interpretations of anomalous events and associated cognitive biases. Beliefs and associated cognitive biases are likely flexible well into adulthood and change with actual life events.

The physical and psychical sphere in the context of development of student young people on the stage of teaching in the institute of higher

Directory of Open Access Journals (Sweden)

Sobko S.G.

2010-05-01

Full Text Available Influence of employments is shown a physical culture and sport on psychical activity of students of the non-special faculties of institutes of higher education. The questions of system resulting bases of integral development of student young people are examined: physical and psychical his spheres. It is certain that psychical activity is depending on to physically-health-improvement. The higher estimations of results of psychical activity are got on five scales of the modified form of questionnaire of FPI for the students of groups of sporting perfection.

Psychic centrality: reflections on two psychohistoriographic cultural therapy workshops in Montreal.

Science.gov (United States)

Hickling, Frederick W; Guzder, Jaswant; Robertson-Hickling, Hilary; Snow, Stephen; Kirmayer, Laurence J

2010-02-01

The use of psychohistoriographic cultural therapy (PCT) developed in Jamaica is described in the context of two workshops in Montreal. PCT is a form of group intervention that seeks to elicit and clarify the "psychic centrality" of a group. Psychic centrality refers to a sense of psychological containment or organization of diverse individual points of view through creating a historical map of collective experience. In PCT, this collective map is constructed and techniques borrowed from creative arts therapies are used to develop a performance. This performance provides additional containment and fosters a group process that can contain collective conflicts. The performance can also be used to engage an audience, working to contain conflict while representing diverse perspectives within the group. Factors that may contribute to the effectiveness of PCT and those that may derail the process are identified through the systematic comparison of the two workshops. PCT was demonstrated to cross successfully from a Third to a First World culture, and established potential as a method to facilitate group conflict resolution and for the promotion of pluralistic civil societies.

Psychic blindness or visual agnosia: early descriptions of a nervous disorder.

Science.gov (United States)

Baumann, Christian

2011-01-01

This article briefly reports on three early contributions to the understanding of visual agnosia as a syndrome sui generis. The authors of the respective papers worked in different fields such as physiology, ophthalmology, and neurology, and, although they were not in direct contact with each other, their results converged upon a consistent view of a nervous disorder that they called psychic blindness.

[Long-term effects of traumatic experiences on somatic and psychic complaints of German World War Two refugees].

Science.gov (United States)

Fischer, C J; Struwe, J; Lemke, M R

2006-01-01

The effects of expulsion from German territories following World War Two have not been studied systematically, and little is known about long-term effects of this potentially traumatic experience. Via mail, 600 refugees from former German territories due to World War Two were asked to complete questionnaires about biographic data, somatic and psychic health (SCL-90-R questionnaire), and specific aspects related to traumatic experiences (post-traumatic stress disorder questionnaire). Of those contacted, 25% participated in the investigation. Of them, 9.8% fulfilled diagnostic criteria of post-traumatic stress disorder according to DSM IV. Only 1.8% of an age-matched control group met these criteria. Analysis of the SCL-90-R questionnaire showed higher scores for former refugees in somatic and psychic complaints than the control group. We show that expulsion following war may lead to symptoms of post-traumatic stress disorder and somatic and psychic complaints after more than 50 years. Our investigation supports the necessity of adequate care for subjects expelled from their home countries and the psychologically traumatised.

Psychic disorders caused by the Chernobyl accident

International Nuclear Information System (INIS)

Kondrashenko, V.T.; Sorokina, T.T.; Donskoj, D.I.; Kopytov, A.V.; Igumnov, S.A.; Avin, A.I.; Golovach, A.A.; Bosina, L.G.

1997-01-01

The results of the investigations being fulfilled in accordance with three programs for different groups of people are received. People living in the radionuclide contaminated areas from the both Gomel and Mogilev Regions (n=304), liquidators (n=114), children, having been born from the mothers living on the radionuclide contaminated territories (n=154), when they were pregnant, were involved in the study. The number of persons of male and female sex were accordingly 63% and 47%. 50 children and 50 adults from the both Minsk and Vitebsk Regions (clean zones) were in the control group. The study has shown that neuro psychic disorders occurred in the majority of the examined persons and it was caused mainly by an organic impairment of brain

Enrico Morselli's Psychology and "Spiritism": psychiatry, psychology and psychical research in Italy in the decades around 1900.

Science.gov (United States)

Brancaccio, Maria Teresa

2014-12-01

This paper traces Enrico Morselli's intellectual trajectory from the 1870s to the early 1900s. His interest in phenomena of physical mediumship is considered against the backdrop of the theoretical developments in Italian psychiatry and psychology. A leading positivist psychiatrist and a prolific academic, Morselli was actively involved in the making of Italian experimental psychology. Initially sceptical of psychical research and opposed to its association with the 'new psychology', Morselli subsequently conducted a study of the physical phenomena produced by the medium Eusapia Palladino. He concluded that her phenomena were genuine and represented them as the effects of an unknown bio-psychic force present in all human beings. By contextualizing Morselli's study of physical mediumship within contemporary theoretical and disciplinary discourse, this study elaborates shifts in the interpretations of 'supernormal' phenomena put forward by leading Italian psychiatrists and physiologists. It demonstrates that Morselli's interest in psychical research stems from his efforts to comprehend the determinants of complex psychological phenomena at a time when the dynamic theory of matter in physics, and the emergence of neo-vitalist theories influenced the theoretical debates in psychiatry, psychology and physiology. Copyright © 2014 Elsevier Ltd. All rights reserved.

Influence of living environment and subjective economic hardship on new-onset of low back pain for survivors of the Great East Japan Earthquake.

Science.gov (United States)

Yabe, Yutaka; Hagiwara, Yoshihiro; Sekiguchi, Takuya; Sugawara, Yumi; Sato, Mari; Kanazawa, Kenji; Koide, Masashi; Itaya, Nobuyuki; Tsuchiya, Masahiro; Tsuji, Ichiro; Itoi, Eiji

2017-01-01

The Great East Japan Earthquake and subsequent tsunami devastated the northeastern part of Japan. Low back pain is thought to increase after a natural disaster and is related to various factors. The aim of this study was to examine the influencing factors of "Living environment" and "Subjective economic hardship" on new-onset of low back pain in the chronic phase for the survivors of the earthquake evaluated by a self-report questionnaire. A panel study was conducted with the Great East Japan Earthquake survivors at 2 and 3 years after the disaster. New-onset of low back pain was defined as low back pain absent at the 1st period (2 years after the earthquake) and present at the 2nd period (3 years after the earthquake). Living environment was divided into 4 categories (1. Living in the same house as before the earthquake, 2. Living in a prefabricated house, 3. Living in a new house, 4. Others: Living in an apartment, house of relatives or acquaintance). Subjective economic hardship was obtained using the following self-report question: "How do you feel about the current economic situation of your household?" The response alternatives were "Normal", "A little bit hard", "Hard", and "Very hard". A univariate and multivariate logistic regression models were used. 1357 survivors consented to join this study. There was no significant association between new-onset of low back pain and living environment. There was significant association between new-onset of low back pain and "A little hard" (OR = 1.6, 95% CI = 1.07-2.40), "Hard" (OR = 2.2, 95% CI = 1.56-3.74), and "Very hard" (OR = 3.19, 95% CI = 1.84-5.53) in subjective economic hardship. Subjective economic hardship was significantly associated with new-onset of low back pain in the chronic phase for survivors of the Great East Japan Earthquake. Copyright © 2016. Published by Elsevier B.V.

Violence against children/adolescents in psychic suffering and nursing care: reflections of social phenomenology.

Science.gov (United States)

Freitas, Rodrigo Jácob Moreira de; Moura, Natana Abreu de; Monteiro, Ana Ruth Macêdo

2016-03-01

Objective To reflect on violence against children and adolescents in psychic suffering, and nursing care based on social phenomenology. Method Theoretical study based on the conceptions of Alfred Schütz. Results The subject in psychic suffering shows conflicts in family relationships, and is often immersed in a biographical situation that removes their autonomy, contributing violence itself. Violence is a social phenomenon expressed through power relations in the everyday world and, through group relationships, resulting in suffering for the victims. Conclusions Studies performed by Schütz enable a new look for the nursing care/health professionals who deal with this problem by allowing them to know the biographical situation, and have full stock of knowledge about their patients, their motivations and the meanings these patients attribute to their experiences. This enables the overcoming of the biomedical model and leads to valuing interpersonal relations from the perspective of a culture of peace.

[Harry Potter--the trauma as a drive for psychic development].

Science.gov (United States)

Subkowski, Peter

2004-12-01

The Harry Potter books are centered around the psychic development of a traumatised young boy starting from his internalised early experience of being loved by his mother to the sudden loss of both of his parents at the anal stage and the later cumulative traumatisation by being negleced and mistreated by his relatives up to the present times. By identifying with his father and other father replacements Harry Potter finally acquires self-assurance and wins new friends. Harry goes through different stages of initiation into the adult world with all its conflicts and rivalries but also friendships. He stands up to his fears and symptoms resulting from his early childhood traumata and thereby helps to encourage readers of all ages to handle their own conflicts. On the oedipal level Harry Potter finally has to deidealize his father and Dumbledore, but also their opponent the dark Lord Voldemort, who thereby becomes more human, understandable and in the long run probably defeatable. The reader can identify himself with Harry and/ or a wide range of other characters. He can recognize his own experiences in life and conflicts in the story and argue internally with the demonstrated conflict solving patterns on different levels. It is the skillfully displayed and logically constructed story of the psychic development of a child that is traumatised at an early age and the possibilities the reader has to identify selectively with the different characters that constitutes the attractiveness of the Harry Potter novels.

The dynamic interplay of mourning and forgiveness in the early development of the self and psychic structure.

Science.gov (United States)

Rankin, Eric D

2014-04-01

Mourning has received considerable attention in the psychoanalytic literature. Beginning with Freud's 1917 investigation, the central role of mourning in psychical development via identification has been articulated and subsequently elaborated upon by various authors (e.g., Klein, 1940; Schafer, 2005). Forgiveness, on the other hand, has until recently received considerably less attention, perhaps because of the strong religious and moral connotations often associated with it (Lansky, 2009a). Contemporary writers exploring the psychoanalytic implications of mourning and forgiveness, however, have suggested the importance of both in normal psychical development. The purpose of this paper is to propose an integrated model of mourning and forgiveness and explore its potential role in nascent infant development.

[Borderline structure and painful skin hemorrhages: a case of Gardner-Diamond syndrome].

Science.gov (United States)

Plassmann, R

1985-01-01

The Gardner-Diamond Syndrome is an infrequently diagnosed impressive psychosomatosis. The patients (exclusively female) suffering from this disorder are described as "angry young women". They are considered hysterical, masochistic, depressive, hostile and timid. Physically the syndrome is characterized by atypical, painful, apparently spontaneous skin bleeding in young women and these patients look like they have been beaten, injured or are seriously ill. Besides hematoma, renal hemorrhage, uterine hemorrhage, headaches or unconsciousness as well as numerous symptoms of conversion in the narrower sense of the word have been observed, e.g. loss speech, gait deviation, or feelings of discomfort. To this day the pathophysiological peculiarity that enables the patients to transform subconscious psychic events into the specific temporary alteration in the permeability of the capillary walls being a constitutional variant characteristic of females suffering from Gardner-Diamond Syndrome and activated by psychic stimuli. In the case history presented, the problem is the psychic working out of narcissistic injuries in the context of a borderline structure. These injuries turn into physical symptoms analogous to the process of conversion. Since, in this case, there is no question of a defense against oedipal fantasies one would prefer to speak of a "narcissistic conversion". Quite peculiar is the universally described resemblance of the patients to one another. The syndrome, together with the character and psychodynamic features, is repeated in almost a stereotypical manner. An explanation for this phenomenon cannot be expected even from the discovery of a pathophysiological detail in the blood vessels. Rather, we are confronted with one of those extremely rare syndromes where, in a limited field, physical and psychic events are completely blended. The physical events such as affects and defense mechanisms for which they can be substituted at random and without mutual

'What to do with anger?': Psychic osmosis, Sylvia Plath and Virginia Woolf

Directory of Open Access Journals (Sweden)

Mušović Azra A.

2013-01-01

Full Text Available According to Virginia Woolf, we think back through our mothers if we are women. It is useless to go to the great men writers for help, however much we may go to them for pleasure. Plath took Woolf as a model very early in her career. She undoubtedly considered Woolf the greatest woman writer of the century. But beyond that appeal, she identified her own life pattern with the one she saw in Woolf. This paper considers Plath's creative acts within the context of her relationship with biological mother, described as a sometimes wonderful, sometimes unwelcome sort of 'psychic osmosis', and within the context of other creative acts by women. The question of what to do with anger becomes Plath's key personal and creative question for studying the ways she lays claim to her matrilineal inheritance. This method assumes that literary influence retraces the outlines of the initial parent-child bond. And the most prominent writer who showed her what it meant to be a powerful female creator, the writer whose creative acts incorporated her life and whose death doubled her words - that literary mother was Virginia Woolf. Plath opened herself to what she believed to be a power associated with Woolf, a power intended to transform the influence of the biological mother. As a result, the texts of the two writers interact across time.

Nonlocality and exceptional experiences: a study of genius, religious epiphany, and the psychic.

Science.gov (United States)

Schwartz, Stephan A

2010-01-01

Two hundred years of reductive materialism has failed to explain the extraordinary experiences we know as moments of genius, religious epiphany, and psychic insight. This paper proposes that these three experiences are in essence the same experience, differentiated only by intention and context. It reaches this conclusion based on well-conducted experimental research across the continuum of science--work that proposes a new interdependent model of consciousness that takes into consideration a nonlocal linkage or entanglement, as an aspect of consciousness not limited by space and time. The paper surveys some of the most important relevant research from quantum biology, physics, psychology, medicine, anthropology, and parapsychology. It proposes that more attention should be paid to the autobiographies, correspondence, and journals of men and women to whom history unequivocally accords the designation of genius, saint, or psychic, offering examples from these sources. And it presents comparisons between ethnohistorical material and spiritual traditions, suggesting they arrive at a similar worldview. Finally, it proposes that meditation research, some examples of which are cited, be seen in the context of psychophysical self-regulation, and that it offers one powerful avenue for producing these exceptional experiences. 2010 Elsevier Inc. All rights reserved.

Funciones psíquicas de las marcas corporales. // Psychic functions of body marking.

Directory of Open Access Journals (Sweden)

Margarita María Valencia Valencia.

2010-06-01

Full Text Available This article shows the results of a research titled Funciones psíquicas de las marcas corporales (Psychic Functions of Body Marking that analyses the tattoo, scarification and piercing boom in teenagers and young people. Its aim is to elucidate the body statute in our days. From the acknowledgment of the changes in status of human body throughout history and in different cultures, we investigate the special psychic functions of those practices and their symbolic implications, by using some psychoanalytical theories about body image and adolescence. // Este artículo presenta los resultados de la investigación Funciones psíquicas de las marcas corporales, que interroga el significado del auge de tatuajes, escarificaciones y piercings en adolescentes y jóvenes, con el fin de esclarecer el estatuto del cuerpo en la contemporaneidad. A partir de un reconocimiento de los cambios de estatus que el cuerpo ha tenido a través de la historia y las culturas, se indaga, con ayuda de las teorizaciones psicoanalíticas sobre lo corporal y la adolescencia, acerca de las funciones psíquicas particulares de dichas prácticas y su alcance simbolizador.

Physiology or psychic powers? William Carpenter and the debate over spiritualism in Victorian Britain.

Science.gov (United States)

Delorme, Shannon

2014-12-01

This paper analyses the attitude of the British Physiologist William Benjamin Carpenter (1813-1885) to spiritualist claims and other alleged psychical phenomena in the second half of the Nineteenth Century. It argues that existing portraits of Carpenter as a critic of psychical studies need to be refined so as to include his curiosity about certain 'unexplained phenomena', as well as broadened so as to take into account his overarching epistemological approach in a context of theological and social fluidity within nineteenth-century British Unitarianism. Carpenter's hostility towards spiritualism has been well documented, but his interest in the possibility of thought-transference or his secret fascination with the medium Henry Slade have not been mentioned until now. This paper therefore highlights Carpenter's ambivalences and focuses on his conciliatory attitude towards a number of heterodoxies while suggesting that his Unitarian faith offers the keys to understanding his unflinching rationalism, his belief in the enduring power of mind, and his effort to resolve dualisms. Copyright © 2014 Elsevier Ltd. All rights reserved.

From catalepsy to psychical research: The itinerary of Timothée Puel (1812-1890).

Science.gov (United States)

Evrard, Renaud; Pratte, Erika Annabelle

2017-02-01

The physician and botanist Timothée Puel (1812-1890) lived through a pivotal period of psychology (1848-1878), between the academic prohibition of the study of animal magnetism to its disjointed recovery in hypnotism and psychical research. One of his cases of "catalepsy complicated with somnambulism" triggered a lively debate on "extraordinary neuroses" within the young Société médico-psychologique [Medico-psychological Society]. In 1874, Puel founded the Revue de psychologie expérimentale [Journal of Experimental Psychology], the first of its kind in French, which he intended as the vehicle of international interest in psychical research, the scholarly and institutionalized study of "psychism" that prepared the way for the recognition of academic psychology. Puel circulated between these different currents by taking advantage of the polysemy of concepts like "sleep," "experimental psychology," and "psychism." This article discusses his role in the context of emerging French psychology in the mid- to late 19th century. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Predictability of psychic outcome for exercise training and exercise training including relaxation therapy after myocardial infarction

NARCIS (Netherlands)

H.J. Duivenvoorden (Hugo); J. van Dixhoorn (J.)

1991-01-01

markdownabstractAbstract Predictability of the psychic outcome for two cardiac rehabilitation programmes was investigated in 119 myocardial infarction patients. They were randomly assigned to either a five-week daily exercise training or to an identical training in combination with six sessions

Psicología y Salud Psíquica Psychology and Psychic Health

Directory of Open Access Journals (Sweden)

Juan Diego Lopera Echavarría

2011-06-01

Full Text Available Es frecuente utilizar la expresión salud mental en lugar de salud psíquica. Partiendo de una definición del objeto de la psicología como cultura encarnada, en este escrito argumentaremos por qué es preferible utilizar la expresión salud psíquica. Consideramos que psyché es un concepto mucho más amplio que mente, y que abarca las diferentes facetas de la realidad humana. Basándonos en las elaboraciones de Canguilhem sobre lo normal y lo patológico, proponemos un concepto de salud que contempla el despliegue del ser humano, en tanto continuación de las pautas que la vida misma establece en su proceso de evolución.It is common to use the term "mental health" rather than "psychic health". Starting with a definition of the object of psychology as culture incarnate, in this paper we will argue why it is preferable to use the term psychic health. We believe that "psyche" is a much broader concept than mind, covering the different facets of human reality. Based on the working of Canguilhem on the normal and the pathological, we propose a concept of health that includes the deployment of human beings, like a continuation of the patterns that life itself states in its evolution process.

[Correlation between adolescents psychical disorders and their difficulties of psychosocial adaptation].

Science.gov (United States)

Markeviciūte, Aurelija; Kalkyte, Rūta; Adomaitiene, Virginija; Gudiene, Devika; Velaviciene, Dalia

2007-01-01

To study the correlation between adolescents' psychical disorders and their difficulties of psychosocial adaptation. There were 63 adolescent participants in our study (47 girls and 16 boys) who were hospitalized in Department of Children and Adolescent Psychiatry, Kaunas University of Medicine Hospital (Lithuania) during the period from September to December, 2005. Twenty-seven adolescents (19 girls and 8 boys) had suicidal and self-harming behavior. Psychical disorders were diagnosed according to ICD-10 diagnostic criterions. We used Strengths and Difficulties Questionnaire SDQ-lit adapted for Lithuania. While comparing the mean scores in both sexes of adolescents with diagnoses of depressive, behavioral and adaptation disturbances, we found a statistically significant difference only in emotionally disturbance scale results (p=0.016). Analyzing groups of girls and boys separately, girls showed to be worse psychosocially adapted and had more emotional problems. Girls who tried to commit suicide had more emotional (p=0.006) and psychosocial problems (padaptation (p=0.031) difficulties. Parents noted that those who committed a suicide and had behavior disturbances had more expressed emotional (p=0.007) and general adaptation (p=0.053) problems. 1. Adolescent girls who were diagnosed depressive illnesses had more emotional and general adaptation problems than girls who were diagnosed behavior or adaptation disorders. 2. Adolescent girls who tried to commit suicide had more expressed behavior problems and difficulties of emotional, general adaptation. 3. Most expressed difficulties of emotional and general adaptation were typical to girls who were diagnosed with depression and who tried to commit a suicide.

Psychic pathology of anthropogenic accidents at risk enterprises

International Nuclear Information System (INIS)

Pukhovskij, N.N.

1993-01-01

The literary data on the clinic and pathogenesis distinctions of traumatic and posttraumatic stress following the accidents are analyzed. The inner contradictory character of the Chernobyl NPP operators reaction to psychodraumatic situation is revealed. A number of concepts liable to discussion is given: inner contradiction of the reactions to traumatic stress on account of accidents at risk cuterprises puts forward the way for psychology evolution in process, besides, posttraumatic stress may be considered as one of the stages of such evolution; the misuse of spirits by the persons with traumatic stress appeared on account of accidents at risk enterprises puts forward the way for the subsequent evolution towards psychic degeneration; the prevailing effect of the reality denial among the personnel of the risk enterprises may form a muthcreative attitude to technical sphere and play a certain role in the emergence of anthropogenic accidents at these enterprises. 22 refs

THE SUBJECTIVAL CONTENT OF IMAGES “SUCCESSFUL MAN” AND “SUCCESSFUL WOMAN” AS A FACTOR OF PSYCHIC ADJUSTMENT OF WOMEN IN INVOLUNTARY UNEMPLOYMENT SITUATION

Directory of Open Access Journals (Sweden)

Ольга Геннадьевна Лопухова

2013-09-01

Full Text Available Purpose of the study is investigation of correlation between a content of gender appearance of image “successful person” and parameters of psychic and social adjustment of women belonging to different generations.Methodology.  Subjective image “successful person” means a stable and possibly gender differentiated element of “Ideal Me” images system. It includes cognitive component (conscious and verbalization representations of typical description of successful person, and affective component (positive or negative positions in regards to image “successful person”. We have compared results of survey and valuation of 265 women belonging to different generations and staying in different social situations: involuntary unemployment situation, employment and getting professional education. Subjective and projective methods were used in survey of cognitive and affective components of “successful person” image. Valuation of psychic adjustment based on parameters of internal conflict in comparison with manifestations of anxiety, frustration, aggression, rigidity, neurotic. Data analysis used parametric and nonparametric methods, including ANOVA/MANOVA.Results. It has been discovered that level of psychic adjustment of women depends much more on proper integration of subjective “successful person” image content with individual features of self-conception than on objective “social status” (being in involuntary unemployment situation.Practical implications are psychology consulting and correction of social or psychic unadjustment.DOI: http://dx.doi.org/10.12731/2218-7405-2013-6-41

Alteraciones psíquicas en niños con retinosis pigmentaria Psychical disorders in retinitis pigmentosa-affected children

Directory of Open Access Journals (Sweden)

Irene Quiñones Varela

1999-12-01

Full Text Available Se realizó un estudio observacional, transversal y descriptivo en niños diagnosticados con retinosis pigmentaria y atendidos en el Centro Provincial de Retinosis Pigmentaria de Camagüey, con el fin de determinar la frecuencia de alteraciones psíquicas en pacientes con retinosis pigmentaria, identificar los principales tipos de estas alteraciones y mostrar los principales síntomas que nos permiten diagnosticar cada una de las entidades. Se le aplicó una encuesta a cada paciente donde se recogieron síntomas psíquicos y se diagnosticaron entidades psicopatológicas. Se comprobó que la frecuencia de alteraciones psíquicas en los niños es de 77,77 % y que las principales entidades fueron: síntomas especiales, trastornos neuróticos y trastornos del aprendizaje.An observational, crosswise and descriptive study of children diagnosed with retinitis pigmentosa and cared for at the Provincial Center of Retinitis Pigmentosa in Camagüey was under taken to determine the frequency of psychic disorders in patients with this diseases, identify the main types of such disorders and show the principal symptoms that allow the diagnosis of each of these entities. A survey was made to each patient where psychical symptoms were collected and psychopathological entities were diagnosed. It was shown that the frequency of psychic disorders in children was 77,77 % and that the main problems were special symptoms, neurotic disorders and learning disorders.

Trauma, dream, and psychic change in psychoanalyses: a dialog between psychoanalysis and the neurosciences

OpenAIRE

Fischmann, Tamara; Russ, Michael O.; Leuzinger-Bohleber, Marianne

2013-01-01

To many psychoanalysts dreams are a central source of knowledge of the unconscious-the specific research object of psychoanalysis. The dialog with the neurosciences, devoted to the testing of hypotheses on human behavior and neurophysiology with objective methods, has added to psychoanalytic conceptualizations on emotion, memory, sleep and dreams, conflict and trauma. To psychoanalysts as well as neuroscientists, the neurological basis of psychic functioning, particularly concerning trauma, i...

Materialismo histórico e definição de psíquico Historical materialism and definition of psychic

Directory of Open Access Journals (Sweden)

Fernando G. Castro

2009-08-01

Full Text Available No Brasil, autores de referência no campo da Saúde Mental e trabalho vêm trabalhando no sentido de demarcar o objeto da Psicologia com base no materialismo histórico, em função de uma série de insuficiências teóricas detectadas na ciência psicológica. Este artigo analisa as fontes teóricas da definição de psíquico utilizada por Codo e colaboradores baseados no materialismo histórico em seus estudos sobre o sofrimento psíquico e trabalho, identifica suas deficiências teóricas e mostra as razões pelas quais os autores não conseguiram superar a noção de psíquico psicanalítica como se propuseram. Indica, por fim, uma hipótese teórica baseada na definição de práxis, para um avanço na compreensão das relações entre sofrimento psíquico e trabalho que não se reporte a posições metafísicas como fizeram os autores analisados.In Brazil, authors of reference in the field of Mental Health and Labour have been working to demarcate the object of Psychology based on historical materialism, according to a series of theoretical shortcomings detected in psychological science. This paper examines the theoretical functions of the definition of psychic used by Codo and collaborators, based on historical materialism in their studies about psychic suffering and work, and mean to identify its theoretical shortcomings, and show the reasons why the authors failed to overcome the notion of psychic psychotherapy as proposed. Finally, indicates a theoretical hypothesis based on the definition of praxis for a breakthrough in the understanding of the relationship between psychic suffering and work that does not carry the metaphysical positions as did the authors analyzed.

Great Apes

Science.gov (United States)

Sleeman, Jonathan M.; Cerveny, Shannon

2014-01-01

Anesthesia of great apes is often necessary to conduct diagnostic analysis, provide therapeutics, facilitate surgical procedures, and enable transport and translocation for conservation purposes. Due to the stress of remote delivery injection of anesthetic agents, recent studies have focused on oral delivery and/or transmucosal absorption of preanesthetic and anesthetic agents. Maintenance of the airway and provision of oxygen is an important aspect of anesthesia in great ape species. The provision of analgesia is an important aspect of the anesthesia protocol for any procedure involving painful stimuli. Opioids and nonsteroidal anti-inflammatory drugs (NSAIDs) are often administered alone, or in combination to provide multi-modal analgesia. There is increasing conservation management of in situ great ape populations, which has resulted in the development of field anesthesia techniques for free-living great apes for the purposes of translocation, reintroduction into the wild, and clinical interventions.

A first assessment of the psychic and social effects of the Chernobyl accident

International Nuclear Information System (INIS)

Heriard Dubreuil, G.

1994-01-01

A synthesis has been made of a series of surveys carried out in Ukraine in 1992 and 1993 on the psychic and social consequences of the Chernobyl accident, within the framework of the ''Evaluation programme of the consequences of the Chernobyl nuclear accident'' of the Commission of the European communities. The main results demonstrate the strength of the post-accident dynamics of the accident, more than 7 years later. Some 3 millions people were directly affected in their everyday life by the post-accident management which resulted in many perverse effects on the social and psychic levels. Economically, each year, financing of the post-accident management system requires nearly 1/6 of the Ukraine budget. Politically speaking, Chernobyl is still a major stake for the various actors of the institutional transition process underway since the disappearance of the soviet system. The article shows the systemic complexity of the local situation and the many explanatory factors (physical, sanitary, political, cultural, historical) at the origin of the post-accident dynamics. A systemic modelling of the interactions between these factors is presented. It makes it possible to better define the contributions of both accident and post-accident stages to the process that has led to the present situation. It shows out the close connections between the different accident stages and the need, from the very beginning of an accident, to take into account the mid-and long-term consequences arising from the accident management. (author). 11 refs., 3 figs

[From social distress to psychic pain].

Science.gov (United States)

Lery, J F; Bardaune, I; Edy, T; Guglielmi, S; Maisondieu, J

1991-01-01

Regarding 75 subjects of both sex sent to psychiatric and alcological consultations by social departments to which they required some help, the authors ask the question about limits between social alienation and mental alienation for people in precarity and poverty position. They inquire into role part and position of the psychiatrist beside them.

Standardisation vs. adaption : a conjoint experiment on the influence of psychic, cultural and geographical distance on international marketing mix decisions

NARCIS (Netherlands)

Kraus, Sascha; Meier, Fabian; Eggers, Felix; Bouncken, Ricarda B.; Schuessler, Felix

2016-01-01

This paper delivers new insights into how psychic, cultural and geographical distance influence international marketing mix decisions on the basis of a choice-based conjoint analysis with 96 managers from Switzerland and Liechtenstein. In this experiment, the managers had to decide whether the four

[Testing the significance of psychic factors in the etiology of alopecia areata. II. Examination of personality by means of Eysenck's Personality Inventory (MPI) adapted by Choynowski].

Science.gov (United States)

Wygledowska-Kania, M; Bogdanowski, T

1995-01-01

We evaluated the role of psychic factors in the etiopathogenesis of alopecia areata on the basis of Eysenck's Personality Inventory adapted by Choynowski. 55 patients were tested (28 women and 27 men). The control group consisted of 50 volunteers. The analysis of the results showed that the neurotic type of personality was predominant in the group of patients (43.64%). Neurotic personality found in such a high percentage of the patients with alopecia areata may be an additional element in the group of psychic factors that possibly have some influence on the development of the disease.

Influence of living environments and working status on low back pain for survivors of the Great East Japan Earthquake.

Science.gov (United States)

Hagiwara, Yoshihiro; Yabe, Yutaka; Sugawara, Yumi; Sato, Mari; Watanabe, Takashi; Kanazawa, Kenji; Sonofuchi, Kazuaki; Koide, Masashi; Sekiguchi, Takuya; Tsuchiya, Masahiro; Tsuji, Ichiro; Itoi, Eiji

2016-03-01

The Great East Japan Earthquake and devastating Tsunami caused irreparable damage on the northeastern coast of Japan. This study aimed to examine the influencing factors of "Living environment" and "Working status" on low back pain for the survivors of the earthquake evaluated by a self-report questionnaire. Between 2011 and 2013, survivors replied to the self-report questionnaire, and 986 people consented to join this study. The living environment was divided into 3 categories (1. Living in the same house as before the earthquake, 2. Living in a safe shelter or temporary small house, 3. Living in a house of relatives or apartment house) and working status was divided into 5 categories (1. Unemployed before the earthquake, 2. Unemployed after the earthquake, 3. Decrease in income, 4. Different occupation after the earthquake, 5. The same occupation as before the earthquake). Age, gender, living areas, past history of arthritis, arthropathy, osteoporosis, sleep disturbance, psychological distress, and economic status were considered as confounding factors. Generalized estimating regression models with logit link function were used because outcome variables are repeatedly measured and binomial. We evaluated the correlation between the presence/severity of low back pain over time and housing status/working status at 1 year after the earthquake. There were no significant differences between age, gender, living areas, working status, or living environment before or after the earthquake. There was no significant difference in the risk of having low back pain in living environment or gender. There was significant difference in the risk of having low back pain in those with "Decrease in income" (OR = 1.93, 95% CI = 1.23-3.03) and "The same occupation as before the earthquake" (OR = 1.67, 95% CI = 1.1-2.52). Though living environment has little effect, "Decrease in income" and "The same occupation as before the earthquake" have strong influences on low back pain

American Society for Pain Management Nursing position statement: pain management at the end of life.

Science.gov (United States)

Reynolds, Janice; Drew, Debra; Dunwoody, Colleen

2013-09-01

Pain at the end of life continues to be of great concern as it may be unrecognized or untreated. While nurses have an ethical obligation to reduce suffering at the end of life, barriers remain regarding appropriate and adequate pain management at the end of life. This position statement from the American Society for Pain Management Nursing contains recommendations for nurses, prescribers, and institutions that would improve pain management for this vulnerable population. Copyright © 2013 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

[Extensive interactions between eating and weight disorder, major depression, pain, and sarcoidosis - case 5/2012].

Science.gov (United States)

Schäflein, Eva; Wettach, Irmtraud; Smolka, Robert; Kuprion, Jürgen; Zipfel, Stephan; Teufel, Martin

2012-06-01

We report on a 41-year-old female patient suffering from obesity, binge eating more than twice a week with loss of control, eating rapidly and feeling guilty after eating, dyspnoea and chronic pain in the whole body, especially in her arms, legs and in both ankles. Furthermore, subdued mood, loss of interest and pleasure, fatigue and impaired concentration could be recognized. In the past, weight increase had been observed when corticosteroids were given against exacerbations of sarcoidosis. In the case of our patient, the beginning of sarcoidosis and increase of weight and pain correlated with augmentation of depression and psychosocial stress. Dysfunctional behavioral features and multiple interactions between diseases could be observed. We diagnosed obesity, binge eating disorder, major depression, chronic pain disease with somatic and psychical components and sarcoidosis. The patient was treated in a multimodal therapy program including psychotherapy, pharmacotherapy and psychopharmacotherapy, nutritionist advice and therapeutic exercise. A weight loss of 7.9 kg (5.9 %), well-balanced diet, reduction of binge eating and of pain intensity, mood stabilization as well as perception and expression of emotions and coping strategies in chronic diseases were achieved. Interdisciplinary treatment of patients suffering from psychosomatic, somatic and mental diseases is crucial for a good outcome. © Georg Thieme Verlag KG Stuttgart · New York.

Pain. Part 2a: Trigeminal Anatomy Related to Pain.

Science.gov (United States)

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.

[From Descartes to fMRI. Pain theories and pain concepts].

Science.gov (United States)

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.

O sofrimento psíquico na perspectiva da psicopatologia fundamental Psychic suffering from the fundamental psychopathology perspective

Directory of Open Access Journals (Sweden)

Paulo Ceccarelli

2005-12-01

Full Text Available Partindo da palavra PSICOPATOLOGIA, o autor mostra, de forma resumida, como cada contexto histórico tentou "decompor" o sofrimento psíquico em seus elementos de base para classificá-lo, estudá-lo e tratá-lo. Após uma breve apresentação da psicopatologia na contemporaneidade, o autor introduz os pressupostos da Psicopatologia Fundamental e suas contribuições na compreensão do sofrimento psíquico. Ainda que não seja objetivo do texto participar do debate atual sobre as diretrizes curriculares que norteiam a formação do psicólogo, o autor toma o estudo do conhecimento (logos da alma (psyché - a psicologia - como exemplo de um dos campos de aplicação da Psicopatologia Fundamental.From the word PSYCHOPATHOLOGY the author briefly shows how each historical context had its own way to decompose psychic suffering in order to classify, study and search for its cure. After a short discussion about psychopathology in contemporaneity the author introduces the theoretical bases of Fundamental Psychopathology and its contributions to understanding psychic suffering. Although this text does not claim to participate in the debate about psychology students training, the author exemplifies through the study of the soul (psyche knowledge (logos one of the applications of Fundamental Psychopathology.

Psychical research in the history and philosophy of science. An introduction and review.

Science.gov (United States)

Sommer, Andreas

2014-12-01

As a prelude to articles published in this special issue, I sketch changing historiographical conventions regarding the 'occult' in recent history of science and medicine scholarship. Next, a review of standard claims regarding psychical research and parapsychology in philosophical discussions of the demarcation problem reveals that these have tended to disregard basic primary sources and instead rely heavily on problematic popular accounts, simplistic notions of scientific practice, and outdated teleological historiographies of progress. I conclude by suggesting that rigorous and sensitively contextualized case studies of past elite heterodox scientists may be potentially useful to enrich historical and philosophical scholarship by highlighting epistemologies that have fallen through the crude meshes of triumphalist and postmodernist historiographical generalizations alike. Copyright © 2014 Elsevier Ltd. All rights reserved.

A new theoretical approach to the functional meaning of sleep and dreaming in humans based on the maintenance of 'predictive psychic homeostasis'.

Science.gov (United States)

Agnati, Luigi F; Barlow, Peter W; Baluška, František; Tonin, Paolo; Guescini, Michele; Leo, Giuseppina; Fuxe, Kjell

2011-11-01

Different theories have been put forward during the last decade to explain the functional meaning of sleep and dreaming in humans. In the present paper, a new theory is presented which, while taking advantage of these earlier theories, introduces the following new and original aspects:   • Circadian rhythms relevant to various organs of the body affect the reciprocal interactions which operate to maintain constancy of the internal milieu and thereby also affect the sleep/wakefulness cycle. Particular attention is given to the constancy of natraemia and osmolarity and to the permissive role that the evolution of renal function has had for the evolution of the central nervous system and its integrative actions. • The resetting of neuro-endocrine controls at the onset of wakefulness leads to the acquisition of new information and its integration within previously stored memories. This point is dealt with in relation to Moore-Ede's proposal for the existence of a 'predictive homeostasis'. • The concept of 'psychic homeostasis' is introduced and is considered as one of the most important states since it is aimed at the well-being, or eudemonia, of the human psyche. Sleep and dreaming in humans are discussed as important functions for the maintenance of a newly proposed composite state: that of 'predictive psychic homeostasis'. On the basis of these assumptions, and in accordance with the available neurobiological data, the present paper puts forward the novel hypothesis that sleep and dreaming play important functions in humans by compensating for psychic allostatic overloads. Hence, both consolatory dreams and disturbing nightmares can be part of the vis medicatrix naturae, the natural healing power, in this case, the state of eudemonia.

Chronic neck pain and anxiety-depression: prevalence and associated risk factors.

Science.gov (United States)

Elbinoune, Imane; Amine, Bouchra; Shyen, Siham; Gueddari, Sanae; Abouqal, Redouane; Hajjaj-Hassouni, Najia

2016-01-01

Chronic pain in rheumatology often has a psychic impact, which may aggravate the daily life of patients. Chronic neck pain, as an example, is a frequent reason for consultation. The aim of this study is to assess the prevalence of anxiety and depression in patients with neck pain, and identify risk factors associated with their occurrence. It was a cross-sectional study that concerned 80 patients with neck pain lasting for more than 3 months, seen in rheumatology consultations. All patients with symptomatic neck pain or psychological history or receiving psychotropic medication were excluded from the study. For each patient, we determined the sociodemographic characteristics and clinical ones. The anxious and depressed mood was assessed by the Hospital Anxiety and Depression Scale (HAD). Of the 80 patients, 67 (83.8%) were women. Average age of our population was 51.8± 11.8 years. Median duration of symptoms was 24 months [12, 48]. Mean VAS pain was 63.9% ± 12.5, mean VAS functional discomfort was 60.9% ± 14.2 and mean VAS disability was 59.8% ± 14.7. 32 patients (40%) were illiterate and 18 (22.5%) had university level. Anxiety was found in 54 (68.4%) and 44 (55.7%) patients were depressed. In univariate analysis, VAS disability was statistically linked to anxiety (OR:1.05; 95%CI: 1.01-1.08; p = 0.02). The cervicobrachial neuralgia (CBN) was significantly associated with depression (OR: 3.33; 95%CI: 1.20-9.23; p = 0.02). Primary education level had a statistically significant relationship with anxiety (OR: 6.00; 95%CI: 1.03-34.84; p = 0.04) and depression (OR: 5.00; 95%CI: 1.09-22.82; p = 0.03). In multivariate analysis, VAS disability and CBN were independently associated with anxiety and depression respectively. This study underlines the fact that anxiety and depression are prevalent in chronic neck pain (CNP) patients. Furthermore, disability and CBN which are linked to CNP can predict which patient is at higher risk of psychological distress.

A Cluster Analysis Typology of Suicide in the United States Air Force

Science.gov (United States)

2011-08-01

Egoistic Lacks social integration and purpose Menninger (1938) Wish to Die Unbearable psychic pain, blame, and guilt Henderson & Williams (1974...Egotic Psychic conflict, isolation, and narrowed attention O’Connor et al. (1999) Cluster 1 Lives alone, moderate depression, low on substance...Shneidman (1966) Psyde-initiators Controls death to avoid ineffective view of self, older, unemployed , terminal illness Henderson & Williams

Enhanced Gamma Oscillatory Activity in Rats with Chronic Inflammatory Pain

OpenAIRE

Wang, Jing; Wang, Jing; Xing, Guo-Gang; Li, Xiaoli; Wan, You

2016-01-01

It has been reported that oscillatory gamma activity participates in brief acute pain and tonic ongoing pain. It is of great interest to determine whether the gamma activity is involved in chronic pain since chronic pain is a more severe pathological condition characterized by pain persistency. To investigate the oscillatory gamma activity in chronic pain, in the present study, we recorded spontaneous electrocorticogram (ECoG) signals during chronic pain development in rats with chronic infla...

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

Science.gov (United States)

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.

Sexual function and associated factors in Iranian patients with chronic low back pain.

Science.gov (United States)

Nikoobakht, M; Fraidouni, N; Yaghoubidoust, M; Burri, A; Pakpour, A H

2014-04-01

Case-control study. (i) To describe the prevalence of sexual dysfunction in chronic low back pain (CLBP) patients, (ii) to compare the range of sexual function outcomes between patients with CLBP and healthy controls and (iii) to investigate which factors are associated with sexual function within the cohort of individuals with CLBP. Low back pain (LBP) clinic of Qazvin University of Medical Sciences, Qazvin, Iran. A total of 702 patients with CLBP and 888 healthy controls participated in the study. The Female Sexual Function Index (FSFI), International Index of Erectile Function (IIEF) and Premature Ejaculation Diagnostic Tool (PEDT) were used to evaluate sexual function. In addition, quality of life, anxiety, functional status and pain intensity were assessed in patients. Univariate and multiple linear regression analyses were performed for the identification of factors associated with sexual function. The prevalence of sexual problems in female patients with CLBP was 71.1% (n=177) while the corresponding figure for healthy women was 36.8% (n=161). Erectile dysfunction was present in 59.5% of male patients and in 24.5% of healthy males. Higher sexual function in both male and female patients with CLBP were being younger, lower duration of back pain, lower BMI, higher education level, being unemployed, physically active shorter sick leave, lower level of pain intensity, lower disability, higher family income, lower levels of depressive and anxiety symptoms, and higher psychical functioning and mental functioning. CLBP patients report considerably higher prevalences of sexual problems compared with healthy controls. Sex therapy and sexual management should be added to routine care and treatment of patients with CLBP.

Fatores de risco psíquico ao desenvolvimento infantil: implicações para a fonoaudiologia Psychical risk factors to the child development: implications on speech-language and hearing therapy

Directory of Open Access Journals (Sweden)

Luciele Dias Oliveira

2012-04-01

Full Text Available TEMA: fatores de risco psíquico ao desenvolvimento infantil e as implicações para a fonoaudiologia. OBJETIVOS: estudar, por meio de uma revisão teórica os riscos psíquicos ao desenvolvimento infantil, com ênfase nos riscos para aquisição da linguagem, e discutir as implicações para a atuação fonoaudiológica em idade precoce. CONCLUSÃO: a partir da literatura revisada, constatou-se que crianças que convivem com riscos biológicos e, sobretudo psíquicos, nos primeiros anos de vida, são mais propensas a desenvolver problemas que podem afetar o seu desenvolvimento. Assim, considera-se a necessidade daatuação fonoaudiológica estar vinculada a uma constante observação dos fatores de risco psíquico ao desenvolvimento infantil e aquisição da linguagem, podendo participar da detecção e estimulação precoces em uma perspectiva promocional.BACKGROUND: psychical risk factors to child development and implications on speech-language and hearing therapy. PURPOSE: to study, through a theoretical review, the psychical risks to the child development, emphasizing the risks for language acquisition, and discuss the implications on the speech-language and hearing therapy performance for precocious age. CONCLUSION: through reviewed literature, we evidenced that children who live with biological and especially psychic risks, during their first years, are more inclined to develop problems that may come to affect their development. So, we consider the need for speech-language and hearing therapy to be linked to a constant observation of the psychical risk factors to the child development and language acquisition, being this professional able to take part in the precocious detection and stimulation under a promotional perspective.

Psychical and social effects related to post-accident situations: some training of Chernobyl accident

International Nuclear Information System (INIS)

Lochand, J.

1995-01-01

Some preliminary considerations on the psychic and societal dimensions related to post-accident situations connected to large scale and heavy land contamination are presented. This is done with the objective of exploring the role that these dimensions could play in the elaboration of new radiological protection principles and concepts in order to restore confidence among affected populations after a nuclear accident. It is important to facilitate the return to normal or, at least, acceptable living conditions, as soon as reasonably achievable, and to prevent the possible emergence of a post-accident crisis. A scheme is proposed for understanding the dynamics of the various phases after an accident, taking into account the collective response to the consequences as well as, the response to the countermeasures. (Author)

Illusion as a Basic Psychic Principle: Winnicott, Freud, Oedipus, and Trump.

Science.gov (United States)

Seligman, Stephen

2018-04-01

Illusion can be viewed as a creative engagement with the world, and as a central psychic motivation and capacity, rather than as a form of self-deception. Winnicott and other Middle Group writers have understood integrative, imaginative illusion as an essential part of healthy living and psychosocial development. As such, it emerges and presents itself in a variety of ways, in transaction with the realities that support or degrade it. In its absence, varied difficulties in living ensue. To elaborate and illustrate this conceptualization, Freud's notion that the oedipus complex is resolved is reconsidered as a creative misreading of Sophocles' Oedipus trilogy, one based on the plausible illusion of a civilizing psychosocial development that would serve as a protective bastion against his experience of the political chaos and violence of the first decades of twentieth-century European history. Finally, the place of illusion and disillusionment among those most disillusioned by the recent election of Donald Trump in the United States is considered in relation to the recent right-wing populist turn.

What Psychoanalysis, Culture And Society Mean To Me

Science.gov (United States)

Layton, Lynne

2007-01-01

The paper reviews some ways that the social and psychic have been understood in psychoanalysis and argues that a model for understanding the relation between the psychic and the social must account both for the ways that we internalize oppressive norms as well as the ways we resist them. The author proposes that we build our identities in relation to other identities circulating in our culture and that cultural hierarchies of sexism, racism, classism push us to split off part of what it means to be human, thereby creating painful individual and relational repetition compulsions. These “normative unconscious processes” replicate the unjust social norms that cause psychic pain in the first place. The paper concludes with thoughts about contemporary US culture, in which the government has abdicated responsibility toward its most vulnerable citizens and has thus rendered vulnerability and dependence shameful states. PMID:22058628

Cutaneous and mucosal pain syndromes

Directory of Open Access Journals (Sweden)

Siddappa K

2002-01-01

Full Text Available The cutaneous and mucosal pain syndromes are characterized by pain, burning sensation, numbness or paraesthesia of a particular part of the skin or mucosal surface without any visible signs. They are usually sensory disorders, sometimes with a great deal of psychologic overlay. In this article various conditions have been listed and are described. The possible causative mechanisms are discussed when they are applicable and the outline of their management is described.

[The pain experience according to a phenomenological view on palliative care].

Science.gov (United States)

Fromage, B; Hatti, M

2015-12-01

its behavioural expression. This could be due to the refocusing of attention and transformation of emotional experience through a figurative and discursive activity. The ETA seems to reduce somatic pain by allowing verbalization. The emotional repression of some patients who inhibited the expression of their pain would explain the increase of painful sensation. The psychological approach associated with the theme of the tree offers an opportunity to expound upon the experience of pain in an analogical mode, situating the current painful personal experience in a specific biography. Furthermore, part of the suffering highlighted in protocols was the break that makes the announcement of illness. It generated a sense of rupture between the time before and after, sometimes until a real crisis of identity, which can take on one of the facets of depression. ETA encourages the rebuilding of a psychic continuity between before and after the disease. Copyright © 2014 L’Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.

[Ethic charter of the German Society for the Study of Pain (DGSS)].

Science.gov (United States)

Reiter-Theil, S; Graf-Baumann, T; Kutzer, K; Müller-Busch, H C; Stutzki, R; Traue, H C; Willweber-Strumpf, A; Zimmermann, M; Zenz, M

2008-04-01

The German Society for the Study of Pain has formed an interdisciplinary committee to answer urgent ethical questions on the diagnosis and treatment of pain and to give an ethical orientation on the care of pain and palliative patients. The treatment of pain is a fundamental objective of medicine. Competent and adequate relief of pain in all stages of life is a basic characteristic of a humane medicine oriented to the quality and meaning of life for people. However, there are substantial deficits in all areas, especially in the knowledge of physicians and patients, in training and further education, diagnosis and therapy. Freedom from pain is a substantial element of quality of life. A central duty of all physicians is an adequate diagnosis and treatment of acute pain and thereby the prophylaxis of chronic pain. If pain persists over a longer period of time, it loses the warning function and becomes taken for granted. Alterations, disabilities and limitations of the physical, psychic and social levels are the consequences. For these patients an interdisciplinary approach is necessary by which various medical disciplines, psychologists and physiotherapists are involved and all collaborate on the diagnosis and therapy of pain. All patients have the right to sufficient and individually tailored treatment of pain. Special attention must be paid to vulnerable patient groups, such as newborns, children and adolescents, as well as aged and mentally retarded patients. For cancer patients pain relief of their tumor pain is totally in the forefront. Indications of "unbearable pain" must not lead to resignation or even be seen as an argument for legalization of "death on request". The nursing of terminally ill patients necessitates a special measure not only of clinical, but also ethical competence, communication and multiprofessional collaboration. The modern options for palliative care are real alternatives to demands for legalization of "death on request". Physician

Risk Perception of Nonspecific Low Back Pain among Nurses: A Qualitative Approach

Directory of Open Access Journals (Sweden)

Sedigheh Abedini

2014-12-01

Full Text Available Background:Low back pain (LBP is a common medical problem among nurses. A better understanding of nurses’ experiences about LBP may help to develop preventative approaches. The study aimed to explore risk perceptions of nonspecific LBP among nurses in Bandar Abbas City, southern Iran. Methods: This qualitative study conducted as directed content analysis in 2013. Private semi-structured interviews were conducted with a convenience sample of 30 nurses with minimum of 1-year working experience in hospital. The interview questions were based on perceived severity and vulnerability structures of Protection Motivation Theory. All interviews were transcribed and analyzed using thematic analysis. Results: Perceived Severity had the following sub-themes: developing disorders in one’s own life and profession, psychical and mental consequences, conflicts and problems in family life, and financial problems. Two sub-themes (problems and limitations in hospital’s working system, nature of nursing profession were identified in relation to perceived vulnerability. Conclusion: Nurses reflected their concerns about the impact of LBP on their job security and their considerations about how their back pain might be interpreted by their employers and co-workers. Importance of transparent medical diagnostic procedure and clinical evidence to justify degree of LBP and its burden on the nurses’ performance was also addressed.

Hostility and Anger in Chronic Pain

Directory of Open Access Journals (Sweden)

Sara Oliveira

2013-11-01

Full Text Available Introduction: The affective component of pain incorporates various emotions, primarily negative in quality. A great emphasis has been traditionally given to the role of depression and anxiety in chronic pain. More recently, the focus has been directed towards hostility and anger, as fundamental components of the emotional experience of chronic pain. Objective: The aim of this article is to present a literature’s review about the association between chronic pain, anger and hostility. Discussion: Patients with several chronic disorders are characterized by high levels of trait anger and hostility. On the other hand, the manner in which angry feelings are typically handled (anger management style, especially the marked tendency to suppress or express angry feelings, is a particularly important determinant of the chronic pain severity. Conclusion: Hostility and anger are involved in the development, maintenance and treatment of chronic pain. Further research is needed to clarify its relationship with chronic pain and to evaluate the effects of anger management on treatment outcomes.

Hostility and Anger in Chronic Pain

Directory of Open Access Journals (Sweden)

Lúcia Ribeiro

2012-06-01

Full Text Available Introduction: The affective component of pain incorporates various emotions, primarily negative in quality. A great emphasis has been traditionally given to the role of depression and anxiety in chronic pain. More recently, the focus has been directed towards hostility and anger, as fundamental components of the emotional experience of chronic pain. Objective: The aim of this article is to present a literature’s review about the association between chronic pain, anger and hostility. Discussion: Patients with several chronic disorders are characterized by high levels of trait anger and hostility. On the other hand, the manner in which angry feelings are typically handled (anger management style, especially the marked tendency to suppress or express angry feelings, is a particularly important determinant of the chronic pain severity. Conclusion: Hostility and anger are involved in the development, maintenance and treatment of chronic pain. Further research is needed to clarify its relationship with chronic pain and to evaluate the effects of anger management on treatment outcomes.

Acute pain control and accelerated postoperative surgical recovery

DEFF Research Database (Denmark)

Kehlet, H

1999-01-01

Postoperative pain relief continues to demand our awareness, and surgeons should be fully aware of the potential physiologic benefits of effective dynamic pain relief regimens and the great potential to improve postoperative outcome if such analgesia is used for rehabilitation. To achieve advanta...... to recent knowledge within surgical pathophysiology. Such efforts must be expected to lead to improved quality of care for patients, with less pain and reduced morbidity leading to cost efficiency....

Multidimensional Diagnostic Criteria for Chronic Pain: Introduction to the ACTTION-American Pain Society Pain Taxonomy (AAPT).

Science.gov (United States)

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

Pain Recognition using Spatiotemporal Oriented Energy of Facial Muscles

DEFF Research Database (Denmark)

Irani, Ramin; Nasrollahi, Kamal; Moeslund, Thomas B.

2015-01-01

Pain is a critical sign in many medical situations and its automatic detection and recognition using computer vision techniques is of great importance. Utilizes this fact that pain is a spatiotemporal process, the proposed system in this paper employs steerable and separable filters to measures e...

The Src family kinase inhibitor dasatinib delays pain-related behaviour and conserves bone in a rat model of cancer-induced bone pain

DEFF Research Database (Denmark)

Appel, Camilla Kristine; Gallego-Pedersen, Simone; Andersen, Line

2017-01-01

Pain is a severe and debilitating complication of metastatic bone cancer. Current analgesics do not provide sufficient pain relief for all patients, creating a great need for new treatment options. The Src kinase, a non-receptor protein tyrosine kinase, is implicated in processes involved in cancer......-induced bone pain, including cancer growth, osteoclastic bone degradation and nociceptive signalling. Here we investigate the role of dasatinib, an oral Src kinase family and Bcr-Abl tyrosine kinase inhibitor, in an animal model of cancer-induced bone pain. Daily administration of dasatinib (15 mg/kg, p...

Right upper quadrant pain

International Nuclear Information System (INIS)

Ralls, P.W.; Colletti, P.M.; Boswell, W.D. Jr.; Halls, J.M.

1984-01-01

Historically, assessment of acute right upper quadrant abdominal pain has been a considerable clinical challenge. While clinical findings and laboratory data frequently narrow the differential diagnosis, symptom overlap generally precludes definitive diagnosis among the various diseases causing acute right upper quadrant pain. Fortunately, the advent of newer diagnostic imaging modalities has greatly improved the rapidity and reliability of diagnosis in these patients. An additional challenge to the physician, with increased awareness of the importance of cost effectiveness in medicine, is to select appropriate diagnostic schema that rapidly establish accurate diagnoses in the most economical fashion possible. The dual goals of this discussion are to assess not only the accuracy of techniques used to evaluate patients with acute right upper quadrant pain, but also to seek out cost-effective, coordinated imaging techniques to achieve this goal

[Pharmacological aspects of pain research in Germany].

Science.gov (United States)

Niederberger, E; Kuner, R; Geißlinger, G

2015-10-01

In spite of several approved analgesics, the therapy of pain still constitutes a challenge due to the fact that the drugs do not exert sufficient efficacy or are associated with severe side effects. Therefore, the development of new and improved painkillers is still of great importance. A number of highly qualified scientists in Germany are investigating signal transduction pathways in pain, effectivity of new drugs and the so far incompletely investigated mechanisms of well-known analgesics in preclinical and clinical studies. The highlights of pharmacological pain research in Germany are summarized in this article.

A Journey full of Pain through the General Population

NARCIS (Netherlands)

M. de Kruijf (Marjolein)

2016-01-01

markdownabstractChronic musculoskeletal pain is a common disabling condition with a great impact on daily functioning. In the Netherlands, 19% of all individuals aged 21 years and older experience chronic pain and in elderly this is more than half. This means that more than 2 million Dutch people

Chronic Neuropathic Pain in Spinal Cord Injury: The Patient's Perspective

Directory of Open Access Journals (Sweden)

Penelope Henwood

2004-01-01

Full Text Available BACKGROUND: Chronic neuropathic pain (CNP in spinal cord injury (SCI is recognized as severely compromising, in both adjustment after injury and quality of life. Studies indicate that chronic pain in SCI is associated with great emotional distress over and above that of the injury itself. Currently, little is known about the SCI patient's perception of the impact of living with chronic neuropathic pain.

Occupational hazards in hospitals: accidents, radiation, exposure to noxious chemicals, drug addiction and psychic problems, and assault

Energy Technology Data Exchange (ETDEWEB)

Gestal, J.J.

1987-08-01

Except for infectious diseases all the main occupational hazards affecting health workers are reviewed: accidents (explosions, fires, electrical accidents, and other sources of injury); radiation (stochastic and non-stochastic effects, protective measures, and personnel most at risk); exposure to noxious chemicals, whose effects may be either local (allergic eczema) or generalised (cancer, mutations), particular attention being paid to the hazards presented by formol, ethylene oxide, cytostatics, and anaesthetic gases; drug addiction (which is more common among health workers than the general population) and psychic problems associated with promotion, shift work, and emotional stress; and assault (various types of assault suffered by health workers, its causes, and the characterisation of the most aggressive patients).

Occupational hazards in hospitals: accidents, radiation, exposure to noxious chemicals, drug addiction and psychic problems, and assault

International Nuclear Information System (INIS)

Gestal, J.J.

1987-01-01

Except for infectious diseases all the main occupational hazards affecting health workers are reviewed: accidents (explosions, fires, electrical accidents, and other sources of injury); radiation (stochastic and non-stochastic effects, protective measures, and personnel most at risk); exposure to noxious chemicals, whose effects may be either local (allergic eczema) or generalised (cancer, mutations), particular attention being paid to the hazards presented by formol, ethylene oxide, cytostatics, and anaesthetic gases; drug addiction (which is more common among health workers than the general population) and psychic problems associated with promotion, shift work, and emotional stress; and assault (various types of assault suffered by health workers, its causes, and the characterisation of the most aggressive patients). (author)

Los trastornos severos del desarrollo y el proceso de constitución psíquica Severe developmental disorders and the process of psychic constitution

Directory of Open Access Journals (Sweden)

Juan José Calzetta

2011-12-01

Full Text Available Este proyecto tiene, como uno de sus objetivos, estudiar las peculiaridades en la estructuración del aparato psíquico a partir del proceso de adquisición de escritura, bajo condiciones particulares, en niños y jóvenes que carecen de lenguaje oral o poseen un lenguaje oral muy limitado, ecolálico o bizarro, inadecuado para la comunicación, y no utilizan señas ni escritura manuscrita espontánea. Se presenta, a modo de ejemplo, una síntesis de los avances en la escritura y modificaciones de las manifestaciones de estructuración psíquica producto de la misma, en un adolescente de 16 años que carecía prácticamente de lenguaje oral al comenzar el tratamiento siete años atrás. Se discute la validez de los modelos teóricos utilizados en relación con los casos abordados así como el aporte que se puede realizar al conocimiento del proceso general de constitución, los principios reguladores y la forma de funcionamiento inicial del aparato psíquico dado que en estos casos las condiciones de producción del mismo divergen considerablemente de las habituales.One of the objectives of this research is to explore the peculiarities in the structuring of the psychic apparatus, by means of the process of writing acquisition under specific conditions, in children and young people lacking or presenting a very limited oral language, echolalic or bizarre, inappropriate for communication, and do not use either signs or spontaneous handwriting. We show as an example, a summary of the progress in writing and its subsequent modification of the manifestations of psychic structuring, in an adolescent of sixteen years old lacking the oral language at the beginning of the treatment seven years ago. We discuss the validity of the theoretical models used as well as the possible contribution to understand the overall process of constitution, the regulatory principles, and the initial functioning of the psychic apparatus.

Dynamic Changes in Nociception and Pain Perception After Spinal Cord Stimulation in Chronic Neuropathic Pain Patients.

Science.gov (United States)

Biurrun Manresa, José A; Sörensen, Jan; Andersen, Ole K; Arendt-Nielsen, Lars; Gerdle, Björn

2015-12-01

Patients with an implanted spinal cord stimulation (SCS) system for pain management present an opportunity to study dynamic changes in the pain system in a situation where patients are not stimulated (ie, experiencing severe pain) compared with a situation in which patients have just been stimulated (ie, pain free or greatly reduced pain). The aims of this study were (1) to determine if there are differences in nociceptive withdrawal reflex thresholds (NWR-T) and electrical pain thresholds (EP-T) before and after SCS; and (2) to establish if these differences are related to psychological factors associated with chronic pain. Seventeen volunteers with chronic neuropathic pain participated in the experiment. Electrical stimuli were applied to assess the NWR-T and the EP-T. In addition, psychological factors (ie, pain characteristics, depression, anxiety, and disability indexes) were also recorded. The NWR-T and EP-T were assessed with the SCS system off (at least 8 h before the experiment), and then reassessed 1 hour after the SCS system was turned on. Ongoing pain intensity ratings decreased (P=0.018), whereas the NWR-T increased (P=0.028) after the SCS was turned on, whereas no significant difference was found for EP-T (P=0.324). Psychological factors were significant predictors for EP-T but not for NWR-T. The results of this study suggest that pain relief after SCS is partially mediated by a decrease in the excitability of dorsal horn neurons in the spinal cord.

Men's experiences of sexuality after cancer: a material discursive intra-psychic approach.

Science.gov (United States)

Gilbert, Emilee; Ussher, Jane M; Perz, Janette; Wong, W K Tim; Hobbs, Kim; Mason, Catherine

2013-01-01

Men can experience significant changes to their sexuality following the onset of cancer. However, research on men's sexuality post-cancer has focused almost exclusively on those with prostate and testicular cancer, despite evidence that the diagnosis and treatment for most cancers can impact on men's sexuality. This Australian qualitative study explores the experiences of changes to sexuality for 21 men across a range of cancer types and stages, sexual orientations and relationship contexts. Semi-structured interviews were analysed with theoretical thematic analysis guided by a material discursive intra-psychic approach, recognising the materiality of sexual changes, men's intrapsychic experience of such changes within a relational context and the influence of the discursive construction of masculine sexuality. Material changes included erectile difficulty, decreased desire, and difficulty with orgasm. The use of medical aids to minimise the impact of erectile difficulties was shaped by discursive constructions of 'normal' masculine sexuality. The majority of men reported accepting the changes to their sexuality post-cancer and normalised them as part of the natural ageing process. Men's relationship status and context played a key role managing the changes to their sexuality. We conclude by discussing the implications for clinical practice.

Correlates and consequences of the disclosure of pain-related distress to one’s spouse

OpenAIRE

Cano, Annmarie; Leong, Laura E. M.; Williams, Amy M.; May, Dana K. K.; Lutz, Jillian R.

2012-01-01

The communication of pain has received a great deal of attention in the pain literature; however, one form of pain communication—emotional disclosure of pain-related distress (e.g., sadness, worry, anger about pain)—has not been studied extensively. The current study examined the extent to which this form of pain communication occurred during an observed conversation with one’s spouse and also investigated the correlates and consequences of disclosure. Individuals with chronic pain (ICPs) and...

Post operative pain control in inguinal hernia repair: comparison of ...

African Journals Online (AJOL)

Background: Post-operative pain control is a key factor in surgery. It greatly increases patient satisfaction, and influences the hospital stay period. Local wound infiltration has often been used to control postoperative pain following hernia surgery, with the use of the conventional local anesthetics like Lidocaine or ...

Pain, quality of life and activity in aged evacuees living in temporary housing after the Great East Japan earthquake of 11 March 2011: a cross-sectional study in Minamisoma City, Fukushima prefecture.

Science.gov (United States)

Yabuki, Shoji; Ouchi, Kazuo; Kikuchi, Shin-ichi; Konno, Shin-ichi

2015-09-10

The aim of this study was to clarify pain, quality of life and activity in the aged evacuees living in temporary housing after the Great East Japan Earthquake on 11 March 2011. The study was a cross-sectional study performed in Minamisoma City, Fukushima Prefecture 1 year and 6 months after the disaster. Inclusion criteria were the ability to walk independently and consent to answer questionnaires. Seventy-one evacuees who met the inclusion criteria were included in this study. There were 16 men and 55 women with a mean age of 75.9 years. Sixty evacuees were surveyed when they gathered at the assembly hall in the temporary housing (Assembled group) and 11 evacuees were surveyed through individual visits to their residences (Individual group). Evacuees in the Individual group agreed to participate in this study, but refused to visit the assembly hall to engage in exercise and recreation. Pain, quality of life (QOL) and level of activity were assessed with the Numeric Rating Scale (NRS), the MOS Short-Form 36 item Health Survey (SF-36) and a pedometer, respectively. Student's t-test, Mann-Whitney U test, and Fisher's exact test were used for statistical analysis. Forty-four (62.0 %) residents had chronic pain with a mean NRS of 2.74. Twenty-one (29.6 %) of these residents had relatively severe pain rated 5 or above on the NRS. QOL was significantly lower for the subscales of "physical functioning," "role physical", "general health", "social functioning", "role emotional" and "mental health", when compared with the national standard values. Values were also visibly lower for "physical component summary" in the summary score. On comparing the Assembled group and the Individual group, "physical function", "role physical", "social functioning" and "physical component summary" were found to be significantly lower in the Individual group. The mean daily number of steps was 1,892 in the Individual group and 4,579 in the Assembled group. The Individual group thus

The application of conditioning paradigms in the measurement of pain.

Science.gov (United States)

Li, Jun-Xu

2013-09-15

Pain is a private experience that involves both sensory and emotional components. Animal studies of pain can only be inferred by their responses, and therefore the measurement of reflexive responses dominates the pain literature for nearly a century. It has been argued that although reflexive responses are important to unveil the sensory nature of pain in organisms, pain affect is equally important but largely ignored in pain studies primarily due to the lack of validated animal models. One strategy to begin to understand pain affect is to use conditioning principles to indirectly reveal the affective condition of pain. This review critically analyzed several procedures that are thought to measure affective learning of pain. The procedures regarding the current knowledge, the applications, and their advantages and disadvantages in pain research are discussed. It is proposed that these procedures should be combined with traditional reflex-based pain measurements in future studies of pain, which could greatly benefit both the understanding of neural underpinnings of pain and preclinical assessment of novel analgesics. © 2013 Elsevier B.V. All rights reserved.

Pain management in patients with Parkinson's disease: challenges and solutions.

Science.gov (United States)

Skogar, Orjan; Lokk, Johan

2016-01-01

This review focuses on the diagnosis and management of Parkinson-related pain which is one of the more frequently reported nonmotor symptoms in Parkinson's disease (PD), which is the second most common neurodegenerative disease after Alzheimer's disease. Pain is ranked high by patients as a troublesome symptom in all stages of the disease. In early-stage PD, pain is rated as the most bothersome symptom. Knowledge of the correct diagnosis of pain origin and possible methods of treatments for pain relief in PD is of great importance. The symptoms have a great negative impact on health-related quality of life. Separating PD-related pain from pain of other origins is an important challenge and can be characterized as "many syndromes under the same umbrella". Among the different forms of PD-related pain, musculoskeletal pain is the most common form, accounting for 40%-90% of reported pain in PD patients. Augmentation by pathophysiological pathways other than those secondary to rigidity, tremor, or any of the other motor manifestations of the disease seems most probable. In PD, the basal ganglia process somatosensory information differently, and increased subjective pain sensitivity with lower electrical and heat-pain thresholds has been reported in PD patients. The mechanism is assumed to be diminished activity of the descending inhibitory control system of the basal ganglia. PD pain, like many of the nonmotor symptoms, remains underdiagnosed and, thus, poorly managed. A systematic collection of patient descriptions of type, quality, and duration of pain is, therefore, of utmost importance. Recent studies have validated new and more specific and dedicated pain scales for PD-related symptoms. Symptomatic treatments based on clinical pain classification include not only pharmacological but also nonpharmacological methods and, to some degree, invasive approaches. In the clinic, pharmacological and nonpharmacological interventions can be effective to varying degrees - as

DO PATIENTS WITH CHRONIC LOW BACK PAIN EXPERIENCE PAIN REDUCTION AND FUNCTIONAL IMPROVEMENT AFTER TREATMENT AT A MULTIDISCIPLINARY OUTPATIENT CLINIC?

Directory of Open Access Journals (Sweden)

Norbye Anja

2017-04-01

Full Text Available Background: Low back pain is the most common affliction of the musculoskeletal system. Patients with chronic low back pain cost the society great expenses in treatments and other social benefits; however, the effects of interventions are discussed. The purpose of this study was to determine whether patients with chronic low back pain experience pain reduction and functional improvement after treatment at a multidisciplinary outpatient clinic. Methods: A prospective study design was used, including 446 patients who participated in follow-up questionnaires with data collection at 6 and 12 months after treatment. The primary outcome was alterations in pain and function. Result: By 12 months after treatment, 71.3 % of the included patients had completed the follow-up questionnaires. Based on these questionnaires, we identified statistically significant changes from baseline at all end points, with clinically significant changes in approximately half of the participants (p = 0.000. Conclusion: Treatment of chronic low back pain at a multidisciplinary outpatient clinic resulted in clinically significant pain reduction and functional improvement within 12 months for approximately half of affected patients.

Neonatal Pain in Very Preterm Infants: Long-Term Effects on Brain, Neurodevelopment and Pain Reactivity

Directory of Open Access Journals (Sweden)

Ruth Eckstein Grunau

2013-10-01

Full Text Available Effects of early life psychosocial adversity have received a great deal of attention, such as maternal separation in experimental animal models and abuse/neglect in young humans. More recently, long-term effects of the physical stress of repetitive procedural pain have begun to be addressed in infants hospitalized in neonatal intensive care. Preterm infants are more sensitive to pain and stress, which cannot be distinguished in neonates. The focus of this review is clinical studies of long-term effects of repeated procedural pain-related stress in the neonatal intensive care unit (NICU in relation to brain development, neurodevelopment, programming of stress systems, and later pain sensitivity in infants born very preterm (24–32 weeks’ gestational age. Neonatal pain exposure has been quantified as the number of invasive and/or skin-breaking procedures during hospitalization in the NICU. Emerging studies provide convincing clinical evidence for an adverse impact of neonatal pain/stress in infants at a time of physiological immaturity, rapidly developing brain microstructure and networks, as well as programming of the hypothalamic-pituitary-adrenal axis. Currently it appears that early pain/stress may influence the developing brain and thereby neurodevelopment and stress-sensitive behaviors, particularly in the most immature neonates. However, there is no evidence for greater prevalence of pain syndromes compared to children and adults born healthy at full term. In addressing associations between pain/stress and outcomes, careful consideration of confounding clinical factors related to prematurity is essential. The need for pain management for humanitarian care is widely advocated. Non-pharmacological interventions to help parents reduce their infant’s stress may be brain-protective.

Ethnocultural and Sex Characteristics of Patients Attending a Tertiary Care Pain Clinic in Toronto, Ontario

Directory of Open Access Journals (Sweden)

Angela Mailis-Gagnon

2007-01-01

Full Text Available BACKGROUND: Ethnocultural factors and sex may greatly affect pain perception and expression. Emerging literature is also documenting racial and ethnic differences in pain access and care.

Old and in pain: Enduring and situational effects of cultural aging stereotypes on older people's pain experiences.

Science.gov (United States)

Bernardes, S F; Marques, S; Matos, M

2015-08-01

This study aimed to investigate the interplay between enduring and situational aging stereotype (AS) effects in older adults' self-reports of clinical and experimentally induced pain. We expected that, as compared with the situational activation of positive AS or a neutral condition, the activation of negative AS would lead to more severe self-reports of clinical pain (H1, hypothesis 1), higher cold pressor task (CPT) pain threshold (H2) and lower CPT pain tolerance (H3), especially among older adults who more strongly endorsed AS. This was a prospective study across two moments in time. At time 1 (T1), 52 older adults (Mage  = 74.7; 51.9% women) filled out measures of cultural AS endorsement, clinical pain severity and interference. Three months afterwards (T2), some of these participants collaborated in an experimental study on the effects of AS activation on reported clinical pain (n = 40) and experimentally induced (using CPT) pain threshold and tolerance (n = 35). Our results supported H2, i.e., as compared with the activation of positive AS or a neutral condition, when negative AS were activated older adults showed higher CPT pain thresholds, but this effect was more salient among those who more strongly endorsed AS at T1. This study stresses the influence of cultural AS in older adults' pain experiences showing that the situational activation of negative AS greatly increases experimentally induced pain thresholds of elders who more strongly endorse those stereotypes. It also highlights the relevance of interventions at the level of the physical and/or social environments surrounding elders in pain. © 2014 European Pain Federation - EFIC®

Hyperbaric oxygen therapy in management of severe dry socket pain

International Nuclear Information System (INIS)

Abdellateef, Abdelamajeed; Elrefai, Jamil; AlJadid, Omar; Alabbadi, Amjad

2009-01-01

To assess the role and efficacy of hyperbaric oxygen therapy (HBOT) in the treatment of pain resulting from dry socket. From January 2006 to May 2007, 25 patients who had been diagnosed by the oral surgeon in the Dental Department of Princess Haya Hospital, Aqaba, Jordan with dry socket with severe intolerable pain, untreated with the classical treatments, were treated with HBOT. Fifteen patients (60%) were treated in a single HBOT session after which an almost complete resolution of pain took place, 7 patients (28%) were treated in 2 sessions and 3 patients (12%) needed 3 HBOT sessions to cure the pain. This preliminary study to assess the role of HBOT in the treatment of dry socket pain showed a great reduction of pain intensity of dry socket following administration of HBOT. (author)

Population health concerns during the United States' Great Recession.

Science.gov (United States)

Althouse, Benjamin M; Allem, Jon-Patrick; Childers, Matthew A; Dredze, Mark; Ayers, John W

2014-02-01

Associations between economic conditions and health are usually derived from cost-intensive surveys that are intermittently collected with nonspecific measures (i.e., self-rated health). This study identified how precise health concerns changed during the U.S. Great Recession analyzing Google search queries to identify the concern by the query content and their prevalence by the query volume. Excess health concerns were estimated during the Great Recession (December 2008 through 2011) by comparing the cumulative difference between observed and expected (based on linear projections from pre-existing trends) query volume for hundreds of individual terms. As performed in 2013, the 100 queries with the greatest excess were ranked and then clustered into themes based on query content. The specific queries with the greatest relative excess were stomach ulcer symptoms and headache symptoms, respectively, 228% (95% CI=35, 363) and 193% (95% CI=60, 275) greater than expected. Queries typically involved symptomology (i.e., gas symptoms) and diagnostics (i.e., heart monitor) naturally coalescing into themes. Among top themes, headache queries were 41% (95% CI=3, 148); hernia 37% (95% CI=16, 142); chest pain 35% (95% CI=6, 313); and arrhythmia 32% (95% CI=3, 149) greater than expected. Pain was common with back, gastric, joint, and tooth foci, with the latter 19% (95% CI=4, 46) higher. Among just the top 100, there were roughly 205 million excess health concern queries during the Great Recession. Google queries indicate that the Great Recession coincided with substantial increases in health concerns, hinting at how population health specifically changed during that time. © 2013 Published by American Journal of Preventive Medicine on behalf of American Journal of Preventive Medicine.

Diagnosis and Surgical Management of Male Pelvic, Inguinal, and Testicular Pain.

Science.gov (United States)

Belanger, Gabriel V; VerLee, Graham T

2016-06-01

Pain occurs in the male genitourinary organs as for any organ system in response to traumatic, infectious, or irritative stimuli. A knowledge and understanding of chronic genitourinary pain can be of great utility to practicing nonurologists. This article provides insight into the medical and surgical management of subacute and chronic pelvic, inguinal, and scrotal pain. The pathophysiology, diagnosis, and medical and surgical treatment options of each are discussed. Copyright © 2016 Elsevier Inc. All rights reserved.

Bibliographic update work. Dental pulp sensory function. Pain.

OpenAIRE

Gomez, Natanael

2011-01-01

Dental pulp is a soft connective tissue type that thanks to its components can fulfill a number of vital functions to the tooth. Within these, the sensory function is of great interest since there is a close relationship between histomolecular tissue changes and clinical manifestations of odontogenic pain. To think about the painful history that the patient reports, knowing the tissue level events, helps to arrive to a correct diagnosis, treatment plan and prognosis. The aim of thi...

Orofacial pain

Directory of Open Access Journals (Sweden)

Marjolijn Oomens

2016-06-01

Full Text Available In the primary care sector, diagnosis and initial management of orofacial pain are often performed by familydoctors and dentists. Knowledge of the different types of orofacial pain and headache disorders is therefor of great importance. The International Classification of Headache Disorders (ICHD-3 provides an overview of the different types of orofacial pain and will be discussed in this lecture. The main focus will be on trigeminal neuralgia and cluster headache and the current research in this field. Trigeminal Neuralgia (TN is defined as a disorder characterized by recurrent, unilateral, brief, electricshock-like pains, abrupt in onset and termination, limited to the distribution of one or more divisions of thetrigeminal nerve and triggered by innocuous stimuli. Unfortunately, most TN is idiopathic, and the aetiology isnot clear. The guidelines on pharmaceutical TN management published by the American Academy of Neurology (AAN and the European Federation of Neurological Societies (EFNS recommend carbamazepine (CBZ; 200–1200 mg/day or oxcarbazepine (OXC; 600–1800 mg/day as first-line therapy. Both are antiepileptics with well known interactions with other drugs and safety problems. An overview of the currently available literature on the pharmaceutical management of TN patients is discussed. Cluster headache (CH is one of the most painful primary headache disorders. It is characterized by daily or almost daily attacks of unilateral excruciating periorbital pain associated with ipsilateral cranial autonomic symptoms, typically lasting between 15 and 180 minutes if untreated. Cluster headache is caused by the relaesement of neurotransmitters and vasodilators from the sphenopalatine ganglion (SPH. The SPG is a large extracranial parasympathetic ganglion located in the pterygopalatine fossa (PPF. The current treatments for CH attacks are injectable sumatriptan and oxygen inhalation. Both treatments have well known side effects and

The Impact of Chronic Low Back Pain on Daily Occupations: A Qualitative Study in Iranian Context

Directory of Open Access Journals (Sweden)

Fariba Dehkordi

2016-03-01

Discussion: Chronic low back pain greatly influences the daily occupations of individuals. Mind struggle with back pain, which implies preoccupation with back pain, in addition to the fear of movement are significant findings of the present study. Occupational therapists can play an important role in re-engagement of people with chronic low back pain in their daily occupations.

The Disparagement of Pain: Social Influences on Medical Thinking

Directory of Open Access Journals (Sweden)

Harold Merskey

2000-01-01

Full Text Available Patients with pain often feel that their suffering is taken lightly, dismissed or denied. Before the introduction of anesthesia, pain was regarded as an awful affliction. This view diminished somewhat once anesthesia became available, although it still holds true for some forms of pain, eg, pain associated with terminal cancer. Pain was then treated as less troublesome when it became a reason for disability compensation to be paid. Examples are given of the disparagement of complaints by individuals reporting pain in the past 150 years. Factors that encourage doctors to underestimate patients' pain include the requirement for doctors to control the issue of narcotics; circumstances in which patients may benefit from compensation by claiming that their pain is great; and the development of attitudes that understate the importance of the relief of pain and overstate the importance of activity, exercise and not complaining. Current attitudes in this respect are associated with the insurance industry, but it has been shown that, even patients who do not have a compensable injury or have pain that is not disabling fail to receive the treatment for pain that is appropriate, eg, postoperatively. The present paper reviews and discusses these problems and suggests that disparagement of pain and disability in the medicolegal field also leads to the rejection of pain in other contexts.

Mechanism of Chronic Pain in Rodent Brain Imaging

Science.gov (United States)

Chang, Pei-Ching

Chronic pain is a significant health problem that greatly impacts the quality of life of individuals and imparts high costs to society. Despite intense research effort in understanding of the mechanism of pain, chronic pain remains a clinical problem that has few effective therapies. The advent of human brain imaging research in recent years has changed the way that chronic pain is viewed. To further extend the use of human brain imaging techniques for better therapies, the adoption of imaging technique onto the animal pain models is essential, in which underlying brain mechanisms can be systematically studied using various combination of imaging and invasive techniques. The general goal of this thesis is to addresses how brain develops and maintains chronic pain in an animal model using fMRI. We demonstrate that nucleus accumbens, the central component of mesolimbic circuitry, is essential in development of chronic pain. To advance our imaging technique, we develop an innovative methodology to carry out fMRI in awake, conscious rat. Using this cutting-edge technique, we show that allodynia is assoicated with shift brain response toward neural circuits associated nucleus accumbens and prefrontal cortex that regulate affective and cognitive component of pain. Taken together, this thesis provides a deeper understanding of how brain mediates pain. It builds on the existing body of knowledge through maximizing the depth of insight into brain imaging of chronic pain.

Stress induces pain transition by potentiation of AMPA receptor phosphorylation.

Science.gov (United States)

Li, Changsheng; Yang, Ya; Liu, Sufang; Fang, Huaqiang; Zhang, Yong; Furmanski, Orion; Skinner, John; Xing, Ying; Johns, Roger A; Huganir, Richard L; Tao, Feng

2014-10-08

Chronic postsurgical pain is a serious issue in clinical practice. After surgery, patients experience ongoing pain or become sensitive to incident, normally nonpainful stimulation. The intensity and duration of postsurgical pain vary. However, it is unclear how the transition from acute to chronic pain occurs. Here we showed that social defeat stress enhanced plantar incision-induced AMPA receptor GluA1 phosphorylation at the Ser831 site in the spinal cord and greatly prolonged plantar incision-induced pain. Interestingly, targeted mutation of the GluA1 phosphorylation site Ser831 significantly inhibited stress-induced prolongation of incisional pain. In addition, stress hormones enhanced GluA1 phosphorylation and AMPA receptor-mediated electrical activity in the spinal cord. Subthreshold stimulation induced spinal long-term potentiation in GluA1 phosphomimetic mutant mice, but not in wild-type mice. Therefore, spinal AMPA receptor phosphorylation contributes to the mechanisms underlying stress-induced pain transition. Copyright © 2014 the authors 0270-6474/14/3413737-10$15.00/0.

Work-related stress according to the demand-control model and minor psychic disorders in nursing workers

Directory of Open Access Journals (Sweden)

Janete de Souza Urbanetto

2013-10-01

Full Text Available This was a cross-sectional study that aimed to assess the association between work-related stress according to the Demand-Control Model, and the occurrence of Minor Psychic Disorder (MPD in nursing workers. The participants were 335 professionals, out of which 245 were nursing technicians, aged predominantly between 20 and 40 years. Data were collected using the Job Stress Scale and the Self-Reporting Questionnaire-20. The analysis was performed using descriptive and analytical statistics. The prevalence of suspected MPD was 20.6%. Workers classified in the quadrants active job and high strain of the Demand-Control Model presented higher potential for developing MPD compared with those classified in the quadrant low strain. In conclusion, stress affects the mental health of workers and the aspects related to high psychological demands and high control still require further insight in order to understand their influence on the disease processes of nursing workers.

Prevalence of pain and relative diagnostic performance of screening tools for neuropathic pain in cancer patients: A cross-sectional study.

Science.gov (United States)

Pérez, C; Sánchez-Martínez, N; Ballesteros, A; Blanco, T; Collazo, A; González, F; Villoria, J

2015-07-01

Neuropathic pain can be overlooked in cancer patients. The advent of screening tools can help in recognizing it. However, little is known about their relative diagnostic performance and factors that affect it. This study evaluated the prevalence of neuropathic pain using several diagnostic strategies in cancer patients undergoing chemotherapy. Patients attending the Oncology Unit of the investigators' site to continue their chemotherapy schedule were systematically screened for this cross-sectional study. Before starting chemotherapy drugs, pain specialists made a clinical diagnosis of neuropathic pain (either disease related, treatment related or comorbid) and medical oncologists administered three validated screening tools. Their relative diagnostic performance and the impact of some pain features on it were analysed using multivariate statistical methods. From a total of 358 patients, 194 (54.2%) suffered from pain and 73 (20.4%) had a clinical diagnosis of pure neuropathic or mixed pain. Among the screening tools, the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) was more specific (93.4%), although less sensitive (68.1%) than the Douleur Neuropathique in 4 Questions (DN4) (sensitivity: 87.5%, specificity: 88.4%). Interestingly, the specificities of these two instruments did not differ in patients with mild pain, while the DN4 remained to be more sensitive than the LANSS regardless of pain severity. Neuropathic pain is common in cancer patients undergoing chemotherapy. The DN4 might be of great help for the early detection of patients at risk because of incipient chemotherapy-related neuropathies and the LANSS to rule out neuropathic pain in patients with complex pain conditions. © 2014 The Authors. European Journal of Pain published by John Wiley & Sons Ltd on behalf of European Pain Federation - EFIC®.

El problema del acto a partir de la metapsicología freudiana: mediación psíquica y derivación motora. // The problem of act from the freudian metapsychology perspective: psychic mediation and motor derivation.

Directory of Open Access Journals (Sweden)

Frank Herr Rico Barbosa.

2009-12-01

Full Text Available This article was written as a result of a master research project (Rico, 2009, and it tackles the problem of the act from a wide metapsychological revision of Freud’s work. The author first analyses the bipartite model of psychic functioning found in “The Interpretation of dreams” (Freud, 1900. The text gathers together several arguments to justify a third dimension of psychic mediation operated by the motor derivation and, despite its indirect associative process exclusion, it is difficult to understand it from the elementary logic in which we find the direct psychic mediation. // En este artículo, que está inspirado en una investigación de maestría (Rico, 2009, se aborda el problema del acto a partir de una amplia revisión metapsicológica por la obra freudiana. Se inicia analizando el modelo bipartito de funcionamiento psíquico que se halla en “La interpretación de los sueños” (Freud, 1900. En el devenir del texto se reúnen argumentos para justificar una tercera modalidad de mediación psíquica que opera la derivación motora y que, aunque excluye el proceso asociativo indirecto, es difícil concebirla a partir de la lógica elemental en que se presenta la mediación psíquica directa.

Pain management in patients with Parkinson's disease: challenges and solutions

Directory of Open Access Journals (Sweden)

Skogar O

2016-09-01

Full Text Available Orjan Skogar,1,2 Johan Lokk2 1Academy for Health and Care (FUTURUM, Region Jönköping County, Jönköping, 2Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Stockholm, Sweden Abstract: This review focuses on the diagnosis and management of Parkinson-related pain which is one of the more frequently reported nonmotor symptoms in Parkinson’s disease (PD, which is the second most common neurodegenerative disease after Alzheimer’s disease. Pain is ranked high by patients as a troublesome symptom in all stages of the disease. In early-stage PD, pain is rated as the most bothersome symptom. Knowledge of the correct diagnosis of pain origin and possible methods of treatments for pain relief in PD is of great importance. The symptoms have a great negative impact on health-related quality of life. Separating PD-related pain from pain of other origins is an important challenge and can be characterized as “many syndromes under the same umbrella”. Among the different forms of PD-related pain, musculoskeletal pain is the most common form, accounting for 40%–90% of reported pain in PD patients. Augmentation by pathophysiological pathways other than those secondary to rigidity, tremor, or any of the other motor manifestations of the disease seems most probable. In PD, the basal ganglia process somatosensory information differently, and increased subjective pain sensitivity with lower electrical and heat-pain thresholds has been reported in PD patients. The mechanism is assumed to be diminished activity of the descending inhibitory control system of the basal ganglia. PD pain, like many of the nonmotor symptoms, remains underdiagnosed and, thus, poorly managed. A systematic collection of patient descriptions of type, quality, and duration of pain is, therefore, of utmost importance. Recent studies have validated new and more specific and dedicated pain scales for PD-related symptoms. Symptomatic treatments based

Contextual modulation of pain sensitivity utilising virtual environments.

Science.gov (United States)

Smith, Ashley; Carlow, Klancy; Biddulph, Tara; Murray, Brooke; Paton, Melissa; Harvie, Daniel S

2017-05-01

Investigating psychological mechanisms that modulate pain, such as those that might be accessed by manipulation of context, is of great interest to researchers seeking to better understand and treat pain. The aim of this study was to better understand the interaction between pain sensitivity, and contexts with inherent emotional and social salience - by exploiting modern immersive virtual reality (VR) technology. A within-subjects, randomised, double-blinded, repeated measures (RM) design was used. In total, 25 healthy participants were exposed to neutral, pleasant, threatening, socially positive and socially negative contexts, using an Oculus Rift DK2. Pressure pain thresholds (PPTs) were recorded in each context, as well as prior to and following the procedure. We also investigated whether trait anxiety and pain catastrophisation interacted with the relationship between the different contexts and pain. Pressure pain sensitivity was not modulated by context ( p  = 0.48). Anxiety and pain catastrophisation were not significantly associated with PPTs, nor did they interact with the relationship between context and PPTs. Contrary to our hypothesis, socially and emotionally salient contexts did not influence pain thresholds. In light of other research, we suggest that pain outcomes might only be tenable to manipulation by contextual cues if they specifically manipulate the meaning of the pain-eliciting stimulus, rather than manipulate psychological state generally - as per the current study. Future research might exploit immersive VR technology to better explore the link between noxious stimuli and contexts that directly alter its threat value.

In Search of a Definition of Bullying : Revisiting Psychic Damage Need for Your Configuration

Directory of Open Access Journals (Sweden)

Renato de Almeida Oliveira Muçouçah

2016-06-01

Full Text Available This research aims study the mobbing phenomenon and seek to place it beyond the borders of persecution or psychological damage, as can be observed on very recent court decisions. After a brief historical introduction about the fundamentals required to recognize an employment relationship as valid, and also trying to understand relationships where there is not formal characterization, the directive power of the employer and the form of its manifestation can be constituted in facilitating elements to practice of mobbing. The next act seeks to propose a broad definition of mobbing, not just based on psychic damage, in order to cover various forms of violence in employment relationships, with the desire to give them ways to legal protection to suppress or prevent such practices. The directive power of the employer eventually can become the productive force and the pressure in the culture of companies, which may constitute the mobbing, although whether or not damages of any kind. It is necessary, therefore, a reinterpretation of the concept of mobbing, which defends them with more promptness relations considered “normal” in the workplace, but which, in fact, are violent acts of disrespect about fundamental rights of the worker.

'Report of the Committee on Mediumistic Phenomena', by William James (1886): With an introduction by.

Science.gov (United States)

Alvarado, Carlos S

2016-03-01

Mediumship was a topic of great interest to some nineteenth-century students of mental phenomena. Together with the phenomena of hypnosis and other manifestations, mediumship was seen by many as a dissociative phenomenon. The purpose of this Classic Text is to present an excerpt of an article about the topic that William James (1842-1910) published in 1886 in the Proceedings of the American Society for Psychical Research about American medium Leonora E. Piper (1857-1950). The article, an indication of late nineteenth-century interactions between dissociation studies and psychical research, was the first report of research with Mrs Piper, a widely investigated medium of great importance for the development of mediumship studies. In addition to studying the case as a dissociative experience, James explored the possibility that Piper's mentation contained verifiable information suggestive of 'supernormal' knowledge. Consequently, James provides an example of a topic neglected in historical studies, the ideas of those who combined conventional dissociation studies with psychical research. © The Author(s) 2016.

Cervical biomechanics and neck pain of "head-spinning" breakdancers.

Science.gov (United States)

Kauther, M D; Piotrowski, M; Hussmann, B; Lendemans, S; Wedemeyer, C; Jaeger, M

2014-05-01

The cervical spine of breakdancers is at great risk due to reversed body loading during headspin manoeuvers. This study focused on the cervical biomechanics of breakdancers and a correlation with neck pain. A standardized interview and biomechanical testing of the cervical spine of 25 participants with "headspin" ability ages 16-34 years and an age-matched cohort of 25 participants without any cervical spine problems was conducted. Neck pain history, Neck Disability Index (NDI), cervical range of motion (CROM) and cervical torque were recorded. The "headspin" group reported significantly better subjective fitness, more cervical complaints, higher pain intensity, a longer history of neck pain and a worse NDI compared to the "normal" collective. The "headspin" group showed a 2-2.5 times higher rate of neck pain than the normal population, with increased cervical flexion (pcervical torque in all planes (ppain intensity and history of neck pain. Sports medicine practitioners should be aware of headspin maneuver accidents that pose the risk of fractures, dislocations and spinal cord injuries of breakdancers. © Georg Thieme Verlag KG Stuttgart · New York.

The sanctuary of empathy and the invitation of engagement: psychic retreat, Kafka's "A Hunger Artist," and the psychoanalytic process.

Science.gov (United States)

Karbelnig, Alan Michael

2014-12-01

As part of a broader scholarly and political effort to unify clinical psychoanalysis, the author argues that psychoanalysts' presence, engagement, and framing constitute the three overarching features of their work. Additionally, patients' propensity to turn inward, alternatively known as psychic retreat or narcissistic withdrawal, provides a similarly unifying way to view psychoanalytic patients. Narrowing the investigation to a phenomenological one, the author tapers the exploration further by studying the psychoanalytic process as it unfolds in real time. After addressing the problems of diffusion in professional identity and psychoanalytic theory that have plagued psychoanalysis from the start, the author presents three case examples into which he integrates Kafka's short story "A Hunger Artist." These vehicles are utilized to demonstrate how such nomenclature provides the basis for a more cohesive understanding of how psychoanalysts work.

Entre os sonhos e a interpretação: aparelho psíquico/aparelho simbólico Between dreams and interpretation: psychic apparatus/symbolic apparatus

Directory of Open Access Journals (Sweden)

João A. Frayze-Pereira

1999-01-01

Full Text Available Este texto interroga a idéia de "aparelho psíquico" nos limites da primeira tópica freudiana. Considerando que, no capítulo VII da Interpretação dos Sonhos, Freud define a realidade psicológica como uma forma especial de existência e o sonho como uma forma especial de pensamento, interroga-se que relação há entre essas formas, a forma de existir e a forma de pensar. Há equivalência entre elas? Ou há uma relação de fundamentação de uma pela outra? Tais perguntas levam o autor a analisar a questão da interpretação para chegar, com Freud, a uma compreensão do "aparelho psíquico" como "aparelho simbólico", aberto à intersubjetividade e às formações culturais como a literatura e as artes.This paper presents and discusses the idea of the "psychic apparatus" within the limits of Freudian First Topography. Considering that in chapter VII of Interpretation of Dreams, Freud defines the psychological reality as a special form of existence and the dream as a special form of thought, the relation between these forms is questioned. Then the author analyzes the question of interpretation to reach, along with Freud, a comprehension of the "psychic apparatus" as a symbolic apparatus opened to intersubjectivity and to cultural formations, such as literature and art.

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

Science.gov (United States)

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.

[Stumbling-blocks: initiating a psychosomatic pain clinic].

Science.gov (United States)

Heger, S; Lieberz, K

2000-12-01

Despite psychosocial factors playing an important role in the course of chronic pain disorder, there is a noticeable imbalance between demand and availability of psychosomatic care for these patients. This led us to establish a psychosomatic pain clinic within the framework of our outpatient clinic at the Department of Psychosomatic Medicine and Psychotherapy at the Central Institute of Mental Health, Mannheim, Germany. A recent study aimed at the evaluation of sociodemographic variables, state of chronification, symptom load and psychiatric comorbidity. Additionally we wanted to determine whether existing conditions at our hospital can be considered suitable for those patients. During the clinic's first year we assessed 40 consecutive patients based on a psychosomatic interview as well as a set of psychometric questionnaires (BDI, STAI, SCL-90-R). To detect differences between pain patients and psychotherapy inpatients, we compared the two groups in terms of sociodemographic variables and symptom load. Most pain patients were in advanced states of chronification, showing extensive psychiatric comorbidity, particularly anxiety and depressive syndromes. Drug addiction was found more infrequently. Use of the before mentioned questionnaires prevented us from underestimating existing anxiety syndromes. Pain patients differed substantially from psychotherapy inpatients in terms of age, education, family status and symptom load. Our examination routine effectively demonstrated the special needs of chronic pain patients. As there is significant demand for psychosomatic intervention in those patients, earlier referral appears highly desirable. As pain patients differ also greatly from the remaining hospital population, specialized therapeutic concepts must be developed.

Ketamine for pain management in France, an observational survey.

Science.gov (United States)

Martinez, Valeria; Derivaux, Benoit; Beloeil, Helene

2015-12-01

Before updating the French guidelines on postoperative pain treatment in 2015, the Pain Committee of the French Society of Anaesthesiology and Intensive Care (SFAR) conducted a survey on the medical use of ketamine in France. An online questionnaire was nationally distributed to members of SFAR, the French Pain Society (SFETD) and the French Society of Emergency Medicine (SFMU). The questionnaire included questions on demographic data, the type of patients for whom ketamine was prescribed, the doses used, the side effects and safety measures associated with the administration of ketamine. A total of 1388 questionnaires were analysed. Ninety-two percent of the responders declared that they used ketamine. Ketamine was widely used as anti-hyperalgesic medication but the modalities of administration and the doses varied greatly and were not in accordance with the guidelines. Despite the lack of evidence and guidelines, ketamine has also been used to treat acute and chronic pain. Doses, duration and localization of the patients during administration have varied greatly. Psychedelic effects and hallucinations are the most feared side effects. In terms of monitoring during ketamine infusion, 15% of physicians declared that no monitoring was necessary while 59%, 55%, 59% and 77% monitored heart rate, SpO2, blood pressure and level of consciousness, respectively. Anaesthesiologists have integrated the benefit of ketamine in preventing hyperalgesia but there is no consensus on doses and duration. For other indications (acute and chronic pain treatment), toxicity and the absence of significant benefit call for guidelines from scientific societies. Copyright © 2015 Société française d’anesthésie et de réanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.

Trauma, dream and psychic change in psychoanalyses: a dialogue between psychoanalysis and the neurosciences

Directory of Open Access Journals (Sweden)

Tamara eFischmann

2013-12-01

Full Text Available To many psychoanalysts dreams are a central source of knowledge of the unconscious – the specific research object of psychoanalysis. The dialogue with the neurosciences, devoted to the testing of hypotheses on human behaviour and neurophysiology with objective methods, has added to psychoanalytic conceptualizations on emotion, memory, sleep and dreams, conflict and trauma. To psychoanalysts as well as neuroscientists, the neurological basis of psychic functioning, particularly concerning trauma, is of special interest. In this article, an attempt is made to bridge the gap between psychoanalytic findings and neuroscientific findings on trauma. We then attempt to merge both approaches in one experimental study devoted to the investigation of the neurophysiological changes (fMRI associated with psychoanalytic treatment in chronically depressed patients. We also report on an attempt to quantify psychoanalysis-induced transformation in the manifest content of dreams. To do so, we used two independent methods. First, dreams reported during the cure of chronic depressed analysands were assessed by the treating psychoanalyst. Second, dreams reported in an experimental context were analysed by an independent evaluator using a standardized method to quantify changes in dream content (Moser method. Single cases are presented. Preliminary results suggest that psychoanalysis-induced transformation can be assessed in an objective way.

Trauma, dream, and psychic change in psychoanalyses: a dialog between psychoanalysis and the neurosciences

Science.gov (United States)

Fischmann, Tamara; Russ, Michael O.; Leuzinger-Bohleber, Marianne

2013-01-01

To many psychoanalysts dreams are a central source of knowledge of the unconscious—the specific research object of psychoanalysis. The dialog with the neurosciences, devoted to the testing of hypotheses on human behavior and neurophysiology with objective methods, has added to psychoanalytic conceptualizations on emotion, memory, sleep and dreams, conflict and trauma. To psychoanalysts as well as neuroscientists, the neurological basis of psychic functioning, particularly concerning trauma, is of special interest. In this article, an attempt is made to bridge the gap between psychoanalytic findings and neuroscientific findings on trauma. We then attempt to merge both approaches in one experimental study devoted to the investigation of the neurophysiological changes (fMRI) associated with psychoanalytic treatment in chronically depressed patients. We also report on an attempt to quantify psychoanalysis-induced transformation in the manifest content of dreams. To do so, we used two independent methods. First, dreams reported during the cure of chronic depressed analysands were assessed by the treating psychoanalyst. Second, dreams reported in an experimental context were analyzed by an independent evaluator using a standardized method to quantify changes in dream content (Moser method). Single cases are presented. Preliminary results suggest that psychoanalysis-induced transformation can be assessed in an objective way. PMID:24381554

Trauma, dream, and psychic change in psychoanalyses: a dialog between psychoanalysis and the neurosciences.

Science.gov (United States)

Fischmann, Tamara; Russ, Michael O; Leuzinger-Bohleber, Marianne

2013-01-01

To many psychoanalysts dreams are a central source of knowledge of the unconscious-the specific research object of psychoanalysis. The dialog with the neurosciences, devoted to the testing of hypotheses on human behavior and neurophysiology with objective methods, has added to psychoanalytic conceptualizations on emotion, memory, sleep and dreams, conflict and trauma. To psychoanalysts as well as neuroscientists, the neurological basis of psychic functioning, particularly concerning trauma, is of special interest. In this article, an attempt is made to bridge the gap between psychoanalytic findings and neuroscientific findings on trauma. We then attempt to merge both approaches in one experimental study devoted to the investigation of the neurophysiological changes (fMRI) associated with psychoanalytic treatment in chronically depressed patients. We also report on an attempt to quantify psychoanalysis-induced transformation in the manifest content of dreams. To do so, we used two independent methods. First, dreams reported during the cure of chronic depressed analysands were assessed by the treating psychoanalyst. Second, dreams reported in an experimental context were analyzed by an independent evaluator using a standardized method to quantify changes in dream content (Moser method). Single cases are presented. Preliminary results suggest that psychoanalysis-induced transformation can be assessed in an objective way.

THE PHYSICAL AND/OR PSYCHIC INABILITY DISMISALL OF THE EMPLOYEE IN ROMANIAN LABOUR LAW

Directory of Open Access Journals (Sweden)

Olimpia-Monica Matiaș

2013-11-01

Full Text Available On the historical and legal side, the physical and/or psychic inability of the employee to provide the corresponding post in which he was employed as a basis for the contract of employment that equated professional discordance (article 130 paragraph 1 letter e of the Labor Code of 1973, adopted by law No. 10 of 25 November 1972. Dismissal for medical reasons is one of the cases of termination of the individual contract of work from the employer, which excludes the employee's contributory negligence. The employee is unable to fulfill his/her service obligations due to the reduction of some of his/her biological, intellectual capacity. The physical condition and/or mental inability of an employee in the performance of the duties corresponding to a post service is not general, but specific workplace at the time. Owing to the nature of the objective medical lies, we appreciate the useful proposal de lege ferenda, that where the employer opts for the dismissal of the employee pursuant to art. 61(c the Labor Code, due to the fact that at the same time there is no vacancy in the unit, to opt for the cessation of the individual employment contract.

Neuropathic pain in people with cancer (part 2): pharmacological and non-pharmacological management.

Science.gov (United States)

Taverner, Tarnia

2015-08-01

The aim of this paper is to provide an overview of the management of neuropathic pain associated with cancer and to provide helpful clinical advice for nurses working with patients who may have neuropathic pain. While cancer pain is a mixed-mechanism pain, this article will focus only on neuropathic pain management. The impact of neuropathic pain on patients' quality of life is great and while many patients recover from their cancer, a significant number continue to suffer from a neuropathic pain syndrome. Management of neuropathic pain is significantly different from management of nociceptive pain with respect to pharmacological and non-pharmacological strategies. Neuropathic pain is complex, and as such requires complex management using pharmacological as well as non-pharmacological approaches. Specific drugs for neuropathic pain may be effective for some patients, but not all; therefore, ongoing and comprehensive assessment and management are required. Furthermore, these patients may require trials of several drugs before they find one that works for them. It is important for nurses to understand neuropathic pain, its manifestation, impact on quality of life and management when nursing patients with neuropathic pain associated with cancer.

[Bladder pain syndrome--an urological-gynecological problem].

Science.gov (United States)

Zabkowski, Tomasz; Bortnowski, Leszek; Zieliński, Henryk

2011-03-01

Bladder Pain Syndrome remains a great challenge for urologists, both in diagnostics and treatment. Etiopathogenesis of the disease is unknown. It is reported that the reason for Bladder Pain Syndrome is the urothelium dysfunction resulting in the destruction of the protective glycosaminoglycan layer/barrier protecting the urothelium from bacteria adhesion and penetration of toxic substances/by bacteria. It is considered to be a syndrome of dysuria and diuresis. Urine analysis usually is normal. It is diagnosed after exclusion of other causes leading to painful symptoms. It is estimated that 90% of the cases of the disease concern women. Treatment with glycocorticosteroids, antihistaminic drugs and antiallergic drugs was not successful. The attempts to find the right method of treatment led to the introduction of hyaluronic acid, which alleviated Bladder Pain Syndrome and its symptoms. Hyaluronic acid reacting with glycosaminoglycans on the bladder decreases penetrability of irritant substances. The patients were treated with 4-8 weekly instillations--40 mg of hyaluronic acid in 50 ml NaCl solution for 1-2 months. After the last instillation, therapy is repeated for the next 6-8 months with one instillation monthly. This method is for patients a chance for getting rid of painful symptoms from the bladder

What do monoamines do in pain modulation?

Science.gov (United States)

Bannister, Kirsty; Dickenson, Anthony H

2016-06-01

Here, we give a topical overview of the ways in which brain processing can alter spinal pain transmission through descending control pathways, and how these change in pain states. We link preclinical findings on the transmitter systems involved and discuss how the monoamines, noradrenaline, 5-hydroxytryptamine (5-HT), and dopamine, can interact through inhibitory and excitatory pathways. Descending pathways control sensory events and the actions of the neurotransmitters noradrenaline and 5-HT in the dorsal horn of the spinal cord are chiefly implicated in nociception or antinociception according to the receptor that is activated. Abnormalities in descending controls effect central pain processing. Following nerve injury a noradrenaline-mediated control of spinal excitability is lost, whereas its restoration reduces neuropathic hypersensitivity. The story with 5-HT remains more complex because of the myriad of receptors that it can act upon; however the most recent findings support that facilitations may dominate over inhibitions. The monoaminergic system can be manipulated to great effect in the clinic resulting in improved treatment outcomes and is the basis for the actions of the antidepressant drugs in pain. Looking to the future, prediction of treatment responses will possible by monitoring a form of inhibitory descending control for optimized pain relief.

The American Home Front. Revolutionary War, Civil War, World War 1, World War 2

Science.gov (United States)

1983-01-01

Union officer become Supreme Court Justice, spoke of the Civil War’s psychic effect on those who had fought. Determined to act greatly, Holmes and his...than psychic and hardiy limited to those who, like himself, had served in the Union armies. Institutions as well as individuals had emerged from the war...to match unemployed workers with vacant jobs. 39 If by the close of 1918, the government reacted to possible strikes with threatened removal of a

Facilitated pronociceptive pain mechanisms in radiating back pain compared with localized back pain

DEFF Research Database (Denmark)

Vaegter, Henrik Bjarke; Palsson, Thorvaldur Skuli; Graven-Nielsen, Thomas

2017-01-01

Facilitated pain mechanisms and impaired pain inhibition are often found in chronic pain patients. This study compared clinical pain profiles, pain sensitivity, as well as pro-nociceptive and anti-nociceptive mechanisms in patients with localized low back pain (n=18), localized neck pain (n=17......), low back and radiating leg pain (n=18), or neck and radiating arm pain (n=17). It was hypothesized that patients with radiating pain had facilitated pain mechanisms and impaired pain inhibition compared with localized pain patients. Cuff algometry was performed on the non-painful lower leg to assess...... threshold (HPT) at the non-painful hand were also assessed. Clinical pain intensity, psychological distress, and disability were assessed with questionnaires. TSP was increased in patients with radiating back pain compared with localized back pain (Ppain or localized low...

Opioid Therapy for Chronic Nonmalignant Pain

Directory of Open Access Journals (Sweden)

Russell K Portenoy

1996-01-01

Full Text Available Long term administration of an opioid drug for chronic nonmalignant pain continues to be controversial, but is no longer uniformly rejected by pain specialists. This is true despite concerns that the regulatory agencies that oversee physician prescribing of opioid drugs continue to stigmatize the practice. The changing clinical perspective has been driven, in part, by widespread acknowledgement of the remarkably favourable outcomes achieved during opioid treatment of cancer pain. These outcomes contrast starkly with popular teaching about chronic opioid therapy and affirm the potential for prolonged efficacy, tolerable side effects, enhanced function associated with improved comfort and minimal risk of aberrant drug-related behaviours consistent with addiction. A large anecdotal experience in populations with nonmalignant pain suggests that these patients are more heterogeneous and that opioid therapy will greatly benefit some and will contribute to negative outcomes for others. The few controlled clinical trials that have been performed support the safety and efficacy of opioid therapy, but have been too limited to ensure generalization to the clinical setting. A critical review of the medical literature pertaining to chronic pain, opioid pharmacology and addiction medicine can clarify misconceptions about opioid therapy and provide a foundation for patient selection and drug administration. The available data support the view that opioids are no panacea for chronic pain, but should be considered in carefully selected patients using clinically derived guidelines that stress a structured approach and ongoing monitoring of efficacy, adverse effects, functional outcomes and the occurrence of aberrant drug-related behaviours.

The Role of Cartilage Stress in Patellofemoral Pain

Science.gov (United States)

Besier, Thor F.; Pal, Saikat; Draper, Christine E.; Fredericson, Michael; Gold, Garry E.; Delp, Scott L.; Beaupré, Gary S.

2015-01-01

Purpose Elevated cartilage stress has been identified as a potential mechanism for retropatellar pain; however, there are limited data in the literature to support this mechanism. Females are more likely to develop patellofemoral pain than males, yet the causes of this dimorphism are unclear. We used experimental data and computational modeling to determine whether patients with patellofemoral pain had elevated cartilage stress compared to pain-free controls and test the hypothesis that females exhibit greater cartilage stress than males. Methods We created finite element models of 24 patients with patellofemoral pain (11 males; 13 females) and 16 pain-free controls (8 males; 8 females) to estimate peak patellar cartilage stress (strain energy density) during a stair climb activity. Simulations took into account cartilage morphology from MRI, joint posture from weight-bearing MRI, and muscle forces from an EMG-driven model. Results We found no difference in peak patellar strain energy density between patellofemoral pain (1.9 ± 1.23 J/m3) and control subjects (1.66 ± 0.75 J/m3, p=0.52). Females exhibited greater cartilage stress compared to males (2.2 vs 1.3 J/m3, respectively, p=0.0075), with large quadriceps muscle forces (3.7BW females vs 3.3BW males) and 23% smaller joint contact area (females: 467 ± 59 mm2 vs males: 608 ± 95mm2). Conclusion Patellofemoral pain patients did not display significantly greater patellar cartilage stress compared to pain-free controls; however, there was a great deal of subject variation. Females exhibited greater peak cartilage stress compared to males, which might explain the greater prevalence of patellofemoral pain in females compared to males but other mechanical and biological factors are clearly involved in this complex pathway to pain. PMID:25899103

Imaging of non-cardiac, non-traumatic causes of acute chest pain

Energy Technology Data Exchange (ETDEWEB)

Kienzl, Daniela, E-mail: daniela.kienzl@meduniwien.ac.at [Department of Radiology, Medical University of Vienna (Austria); Prosch, Helmut; Töpker, Michael; Herold, Christian [Department of Radiology, Medical University of Vienna (Austria)

2012-12-15

Non-traumatic chest pain is a common symptom in patients who present in the emergency department. From a clinical point of view, it is important to differentiate cardiac chest pain from non-cardiac chest pain (NCCP). Among the plethora of potential causes of NCCP, life-threatening diseases, such as aortic dissection, pulmonary embolism, tension pneumothorax, and esophageal rupture, must be differentiated from non-life threatening causes. The majority of NCCP, however, is reported to be benign in nature. The presentation of pain plays an important role in narrowing the differential diagnosis and initiating further diagnostic management and treatment. As the benign causes tend to recur, and may lead to patient anxiety and great costs, a meticulous evaluation of the patient is necessary to diagnose the underlying disorder or disease.

An essay on dreaming, psychical working out and working through.

Science.gov (United States)

da Rocha Barros, Elias M

2002-10-01

In this paper the author attempts to expand the idea put forward by Freud who considered dreams as a special form of unconscious thinking. It is the author's contention that the psychical working-out function performed by dreams is a form of unconscious thinking, which transforms affects into memories and mental structures. He also attempts to clarify the way in which meaning is built and transformed in mental life. In that respect the unconscious internal world is seen as a form of unconscious thinking, a private theatre where meaning is generated and transformed. He focuses on what happens to feelings in dreams in connection with the meanings as a result of and an expression of the several stages of working through. The dream world is described as the setting where the mind gives expressive pictorial representation to the emotions involved in a conflict: a first step towards thinkability. The dreamwork also constitutes a process through which meaning is apprehended, built on and transformed at an expressive non-discursive level, based on representation through figurative/pictorial images. The author draws on Meltzer's formulation to conjecture that the working-through function of dreams, mainly in response to interpretations, is performed by a process of progression in formal qualities of the representations made available by dreaming in the form he has called affective pictograms. It is through progression in formal qualities of the representation that the thinking capabilities of the affective life develop and become part of the process of what is called metaphorically the metabolisation of emotional life. This process takes place through migration of meaning across various levels of mental process. In this perspective the analyst's interpretations of dreams effect what linguists call transmutation of the symbolic basis, a process that is necessary to help the mind to improve its capacity to think. Something expressed on the evocative plane and condensed into a

Calcineurin-inhibitor pain syndrome.

Science.gov (United States)

Prommer, Eric

2012-07-01

There has been increased recognition of calcineurin, a phosphoprotein serine/threonine phosphatase enzyme, in the regulation of many physiologic systems. Calcineurin mediates activation of lymphocytes, which play a role in immune response. Widely distributed in the central nervous system, calcinuerin also plays an important role in sensory neural function, via its role in the regulation of newly discovered 2-pore potassium channels, which greatly influence neuronal resting membrane potentials. Calcinuerin inhibition is the mechanism of action of immunomodulatory drugs such as cyclosporine and tacrolimus, which are widely used in transplantation medicine to prevent rejection. While important for immunosuppression, the use of calcineurin inhibitors has been associated with the development of a new pain syndrome called the calcineurin pain syndrome, which appears to be an untoward complication of the interruption of the physiologic function of calcineurin. This is a narrative review focusing on the epidemiology, pathophysiology, characterization of a newly recognized pain syndrome associated with the use of calcineurin inhibitors. The use of immunosuppressants however is associated with several well-known toxicities to which the calcineurin pain syndrome can be added. The development of this syndrome most likely involves altered nociceptive processing due to the effect of calcineurin inhibition on neuronal firing, as well as effects of calcineurin on vascular tone. The most striking aspect of the treatment of this syndrome is the response to calcium channel blockers, which suggest that the effects of calcineurin inhibition on vascular tone play an important role in the development of the calcineurin pain syndrome. The calcineurin syndrome is a newly recognized complication associated with the use of calcineurin inhibitors. There is no standard therapy at this time but anecdotal reports suggest the effectiveness of calcium channel blockers.

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

Science.gov (United States)

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.

Pain-relevant anxiety affects desire for pain relief, but not pain perception

Directory of Open Access Journals (Sweden)

Adriana Banozic

2017-01-01

Full Text Available Background: Pain context plays a significant role in the perception of pain. Despite recent interest in vicarious learning and anxiety in pain modulation, there have been no attempts to explore pain modulation by specific environmental cues. Aims: Therefore, the present study evaluated pain responses in the condition that was attributed as either anxiety relevant (AR or anxiety irrelevant. Materials and Methods: Participants were exposed to both conditions through social observational learning. Pain perception was assessed by means of a visual analog scale ranging from 0 = no pain to 10 = maximum imaginable pain. State anxiety, empathy, expectancy, and desire for pain relief were also measured at both neutral and emotionally inducing conditions. Results: No effect of relevancy of anxiety for the pain context on any of the pain-related constructs was found. However, participants in the AR condition reported an increased desire for pain relief. Maximizing similarities between observed and experienced pain context did not enhance observational learning effects in the emotionally inducing condition regardless of its relevance, but significant changes were found in comparison to the affectively neutral group. Conclusions: These results could have potentially significant clinical implications suggesting that even though observing painful procedures does not increase pain it could affect medication usage.

Efficient conditioned pain modulation despite pain persistence in painful diabetic neuropathy

Directory of Open Access Journals (Sweden)

Yelena Granovsky

2017-06-01

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.

Leiomyosarcoma of the great saphenous vein

Directory of Open Access Journals (Sweden)

Alexandre Campos Moraes Amato

2015-06-01

Full Text Available A 56-year-old male patient presented with a complaint of two painful, hard, palpable nodules in the right lower limb. A Doppler ultrasound scan revealed the presence of nodules, likely to be neoplastic. Computed angiography showed two solid hypervascular nodules in the right great saphenous vein, fed by branches of the posterior tibial artery. Embolization of the nodules using surgical cyanoacrylate was performed, followed by an excisional biopsy. Anatomical pathology and immunohistochemical analysis identified the nodule as a high-grade leiomyosarcoma, characterized by ten mitotic figures per ten high-power fields, necrosis and cell pleomorphism. Immunohistochemical analysis results were positive for caldesmon and desmin labeling. A second surgical procedure was performed to enlarge the free margins.

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

Science.gov (United States)

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 pain modulation in CLP was significantly higher than that in CWP and FMS (P 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 pain inhibition seem to be more indicated the higher the pain extent.

Back pain - a feeling of being mistrusted and lack of recognition: A qualitative study

DEFF Research Database (Denmark)

Damsgaard, Janne Brammer; Norlyk, Annelise; Jørgensen, Lene Bastrup

2016-01-01

of interpretation. Findings Before the spinal fusion surgery, back pain had a great negative influence on the patients’ everyday lives. Insinuations of being a hypochondriac and having to hide their pain to avoid becoming a burden caused insecurity. Several patients experienced pain relieving effect when talking...... about their experiences. However, they felt that the healthcare professionals were pressed for time and mainly interested in their physiological problems. Patients were left with a feeling of being mistrusted, powerlessness, insecurity and loss of identity. Conclusion Lifeworld-experiences are not given...

Overload pain but root differentiation discomfort in the lumbar spine

Directory of Open Access Journals (Sweden)

Joanna Siminska

2017-06-01

Full Text Available Lumbar pain syndromes of the spine can also be referred to as the pain of the cross. These ailments have now become epidemics of our time. In literature, these pain are referred to as localized ailments that are located in the lumbar, lumbosacral, and cross-iliac areas. Cross pains are a very general term because there are a multitude of factors that cause lumbar disc herniation. This problem poses great diagnostic difficulties. [4]. The nature of these ailments is often difficult to pinpoint by the patient, but it can be the pain that describes patients from blunt, piercing, biting, baking, to those that are termed cold feeling. Keep in mind that the location of the lumbar pain symptoms varies. Patients report pain that is located throughout the lumbar-sacral area or only on one side of the spine, or occurs only in the area of the hip joints. These complaints often radiate along the lower limb. They are often the result of a lack of proper spine prevention: they contribute to this poor body posture, improper sleep positioning, as well as lack of coping skills, as well as a bad diet. In daily life, it is important to remember to do your daily activities in the correct position as well as to use prevention to avoid pain in the lumbar area.

How is trunk muscle activity during forward bending in standing in chronic non-specific low back pain patients presenting with psychosocial characteristics such as fear avoidance beliefs, pain catastrophizing or kinesiophobia? A systematic review of the literature

DEFF Research Database (Denmark)

Sørensen, Brian Østergaard

2016-01-01

Low back pain (LBP) is the most common single reason for addressing the health care system due to musculoskeletal pain. More than 80% will experience LBP at some point in life; 6 - 10% of those experiencing LBP will develop persistent and chronic pain with great variance in level of disability an...... the importance of not treating all patients with LBP in the same way but trying to provide stratified care has been highlighted resulting in better outcomes....

Compression Stockings after Endovenous Laser Ablation of the Great Saphenous Vein : A Prospective Randomized Controlled Trial

NARCIS (Netherlands)

Bakker, N. A.; Schieven, L. W.; Bruins, R. M. G.; van den Berg, M.; Hissink, R. J.

2013-01-01

Objectives: To determine if the duration of wearing compression stockings after endovenous laser ablation (EVLA) of the great saphenous vein (GSV) has influence on pain and quality of life. Methods: This was a prospective randomized controlled trial. Between December 2006 and February 2008, 109

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

Directory of Open Access Journals (Sweden)

Meryl J. Alappattu, DPT, PhD

2015-03-01

Conclusions: Differences in local pain ratings suggest that women with pelvic pain perceive stimuli in this region as more painful than pain-free women although the magnitude of stimuli does not differ. Alappattu MJ, George SZ, Robinson ME, Fillingim RB, Moawad N, LeBrun EW, and Bishop MD. Painful intercourse is significantly associated with evoked pain perception and cognitive aspects of pain in women with pelvic pain. Sex Med 2015;3:14–23.

Moral reasoning about great apes in research

Science.gov (United States)

Okamoto, Carol Midori

2006-04-01

This study explored how individuals (biomedical scientists, Great Ape Project activists, lay adults, undergraduate biology and environmental studies students, and Grade 12 and 9 biology students) morally judge and reason about using great apes in biomedical and language research. How these groups perceived great apes' mental capacities (e.g., pain, logical thinking) and how these perceptions related to their judgments were investigated through two scenarios. In addition, the kinds of informational statements (e.g., biology, economics) that may affect individuals' scenario judgments were investigated. A negative correlation was found between mental attributions and scenario judgments while no clear pattern occurred for the informational statements. For the biomedical scenario, all groups significantly differed in mean judgment ratings except for the biomedical scientists, GAP activists and Grade 9 students. For the language scenario, all groups differed except for the GAP activists, and undergraduate environmental studies and Grade 9 students. An in-depth qualitative analysis showed that although the biomedical scientists, GAP activists and Grade 9 students had similar judgments, they produced different mean percentages of justifications under four moral frameworks (virtue, utilitarianism, deontology, and welfare). The GAP activists used more virtue reasoning while the biomedical scientists and Grade 9 students used more utilitarian and welfare reasoning, respectively. The results are discussed in terms of developing environmental/humane education curricula.

Transdermal opioid patches for pain treatment in ancient Greece

DEFF Research Database (Denmark)

Harrison, Adrian Paul; Hansen, Steen Honore'; Bartels, Else M.

2012-01-01

that OVDO can be useful for treating extreme pain and swellings, forming one of the best eye salves. Olympic Victor's Dark Ointment, an opium-based treatment, forms a "patch" when applied externally as an ointment, because it quickly dries to cover a localized region but still retains its elastic properties......Pain treatment in ancient Greece, and through the middle ages in Europe, was to a great extent based on the expertise of the Greek physician Galen (c. 129-200 A.D.). Galen makes particular reference to "Olympic Victor's Dark Ointment" (OVDO), which is listed with a number of collyria. Galen states...... abilities in terms of drug delivery, which could be transferred to modern medicine. Indeed, this may lead to a better choice of morphine use and controlled management in individual patient cases, taking both pain relief and anti-inflammatory aspects into account....

Psychoneuroimmunological disorders and temporomandibular joint pain: A review

Directory of Open Access Journals (Sweden)

Ranjani Shetty

2014-01-01

Full Text Available Psychoneuroimmunology characterizes a disease entity that combines psychological components, central nervous system regulation, and immunology, to explain the etiological complexity of a disease. Temporomandibular disorders (TMDs include a heterogeneous group of painful conditions that involve the temporomandibular joint (TMJ, muscles of mastication, and the adjacent anatomic structures. This review focuses on the psychoneuroimmunological diseases and disorders that mimic the symptoms of TMDs. The differentiation of these disorders is of great significance to the oral physician - differentiating and diagnosing the cause of TMJ pain and treating it effectively to benefit the patient.The literature for this review was taken from Medline/PubMed, other indexed journals, standard text books, and online material.

Management of pain on hallux valgus with percutaneous intra-articular Pulse-Dose Radiofrequency.

Science.gov (United States)

Masala, Salvatore; Fiori, Roberto; Calabria, Eros; Raguso, Mario; de Vivo, Dominique; Cuzzolino, Alessandro; Simonetti, Giovanni

2017-01-01

The purpose of our study was to investigate the role of intra-articular pulse-dose radiofrequency in management of painful hallux valgus refractory to conservative therapies. Between November 2010 and April 2012, 51 patients (15 male, 36 female) with a median age of 71.4 years were included in our clinical trial. Under fluoroscopic guidance we introduced a 22 gauge 10 cm length cannula by a percutaneous access in the first metatarsophalangeal joint and its tip was placed intra-articularly. After removing the spindle, a radiofrequency needle with a 5 mm active tip was introduced. The following parameters were used: 1200 pulses at high voltage (45 V) with 20 msec duration followed by 480 msec silent phases. A great reduction in pain intensity was documented at 1 week, 1 month and 3 months after procedures. Pain intensity increased between 5 and 8 months after treatments, so we performed a second procedure in all patients between 7 months and 9 months since the first treatment. Also in this case we obtained a great reduction of pain intensity in the first 3 months after the procedure. Pain intensity returned at preprocedural values after 9 months after second procedure. No complications were observed. Our experience shows pulse-dose radiofrequency is a safe, repeatable and effective technique for managing patients with symptomatic hallux valgus in the short and medium term. Pulse-dose radiofrequency may improve pain control and quality of life in patients with hallux valgus refractory to conservative therapies. © 2014 Asia Pacific League of Associations for Rheumatology and Wiley Publishing Asia Pty Ltd.

Colorectal surgery patients' pain status, activities, satisfaction, and beliefs about pain and pain management.

Science.gov (United States)

Brown, Carolyn; Constance, Kristel; Bédard, Denise; Purden, Margaret

2013-12-01

This study describes surgical colorectal cancer patients' pain levels, recovery activities, beliefs and expectations about pain, and satisfaction with pain management. A convenience sample of 50 adult inpatients who underwent colorectal surgery for cancer participated. Patients were administered the modified American Pain Society Patient Outcome Questionnaire on postoperative day 2 and asked to report on their status in the preceding 24 hours. Patients reported low current (mean 1.70) and average (mean 2.96) pain scores but had higher scores and greater variation for worst pain (mean 5.48). Worst pain occurred mainly while turning in bed or mobilizing, and 25% of patients experienced their worst pain at rest. Overall, patients expected to have pain after surgery and were very satisfied with pain management. Patients with worst pain scores >7 reported interference with recovery activities, mainly general activity (mean 5.67) and walking ability (mean 5.15). These patients were likely to believe that "people can get addicted to pain medication easily" (mean 3.39 out of 5) and that "pain medication should be saved for cases where pain gets worse" (mean 3.20 out of 5). These beliefs could deter patients from seeking pain relief and may need to be identified and addressed along with expectations about pain in the preoperative nursing assessment. Copyright © 2013 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

Dancing in pain: pain appraisal and coping in dancers.

Science.gov (United States)

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.

The cultural production of Bioterapia: psychic healing and the natural medicine movement in Slovakia.

Science.gov (United States)

Rubens, D; Gyurkovics, D; Hornacek, K

1995-11-01

Despite powerful opposition, natural medicine (NM) has achieved a toe-hold in the state-run biomedical system in the Slovak Republic. The physician-leader of the NM movement hopes to leverage his ministerial post as NM 'supreme expert' and his interlocking NM clinical and research facilities to achieve a complex, unified health care system under control of medical doctors. This health care model simultaneously reinforces biomedical hegemony and decenters classical medicine by substituting a bioenergetical paradigm. NM includes, among other diagnostic and healing modalities, acupuncture, herbal therapies, bee therapy, reflexology, iridology. However, its paradigmatic form is bioterapia, the focus of this paper. Bioterapia is a form of psychic healing or therapeutic touch. According to its practitioners, it is based on bioenergetic and information-processing principles. Conceptually, bioterapia unifies psyche, soma and energy dimensions of the human body and situates the human organism in an extended transpersonal social, physical and cosmological environment. Bioterapia is a scientized and medicalized reconstruction of a folk healing tradition whose appropriation simultaneously secularized and re-sacralized this tradition by re-locating its practice from lay healers to medical doctors, from the religious domain to the venerated scientific domain, from deviant science to normal science. The reconfiguration into bioterapia as part of the creation of an academic secular parapsychology in the former Soviet Bloc in the late 1960s, illustrates the use of the privileged discourse of science for a cultural production that seems to have both supported and subverted the regime.

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

Science.gov (United States)

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.

Spontaneous pain attacks: neuralgic pain

NARCIS (Netherlands)

de Bont, L.G.

2006-01-01

Paroxysmal orofacial pains can cause diagnostic problems, especially when different clinical pictures occur simultaneously. Pain due to pulpitis, for example, may show the same characteristics as pain due to trigeminal neuralgia would. Moreover, the trigger point of trigeminal neuralgia can either

Sensitization of the Nociceptive System in Complex Regional Pain Syndrome

Science.gov (United States)

Diedrichs, Carolina; Baron, Ralf; Gierthmühlen, Janne

2016-01-01

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

Sensitization of the Nociceptive System in Complex Regional Pain Syndrome.

Directory of Open Access Journals (Sweden)

Maren Reimer

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

Pain-related worry in patients with chronic orofacial pain.

Science.gov (United States)

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.

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

Science.gov (United States)

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 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.

Maintenance of Pain in Children With Functional Abdominal Pain.

Science.gov (United States)

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.

Central sensitization: implications for the diagnosis and treatment of pain.

Science.gov (United States)

Woolf, Clifford J

2011-03-01

Nociceptor inputs can trigger a prolonged but reversible increase in the excitability and synaptic efficacy of neurons in central nociceptive pathways, the phenomenon of central sensitization. Central sensitization manifests as pain hypersensitivity, particularly dynamic tactile allodynia, secondary punctate or pressure hyperalgesia, aftersensations, and enhanced temporal summation. It can be readily and rapidly elicited in human volunteers by diverse experimental noxious conditioning stimuli to skin, muscles or viscera, and in addition to producing pain hypersensitivity, results in secondary changes in brain activity that can be detected by electrophysiological or imaging techniques. Studies in clinical cohorts reveal changes in pain sensitivity that have been interpreted as revealing an important contribution of central sensitization to the pain phenotype in patients with fibromyalgia, osteoarthritis, musculoskeletal disorders with generalized pain hypersensitivity, headache, temporomandibular joint disorders, dental pain, neuropathic pain, visceral pain hypersensitivity disorders and post-surgical pain. The comorbidity of those pain hypersensitivity syndromes that present in the absence of inflammation or a neural lesion, their similar pattern of clinical presentation and response to centrally acting analgesics, may reflect a commonality of central sensitization to their pathophysiology. An important question that still needs to be determined is whether there are individuals with a higher inherited propensity for developing central sensitization than others, and if so, whether this conveys an increased risk in both developing conditions with pain hypersensitivity, and their chronification. Diagnostic criteria to establish the presence of central sensitization in patients will greatly assist the phenotyping of patients for choosing treatments that produce analgesia by normalizing hyperexcitable central neural activity. We have certainly come a long way since the

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

Science.gov (United States)

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 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.

Predicting postoperative pain by preoperative pressure pain assessment.

Science.gov (United States)

Hsu, Yung-Wei; Somma, Jacques; Hung, Yu-Chun; Tsai, Pei-Shan; Yang, Chen-Hsien; Chen, Chien-Chuan

2005-09-01

The goal of this study was to evaluate whether preoperative pressure pain sensitivity testing is predictive of postoperative surgical pain. Female subjects undergoing lower abdominal gynecologic surgery were studied. A pressure algometer was used preoperatively to determine the pressure pain threshold and tolerance. A visual analog scale (VAS) was used to assess postoperative pain. A State-Trait Anxiety Inventory was used to assess patients' anxiety. Subjects received intravenous patient-controlled analgesia for postoperative pain control. The preoperative pain threshold and tolerance were compared with the postoperative VAS pain score and morphine consumption. Forty women were enrolled. Their preoperative pressure pain threshold and tolerance were 141 +/- 65 kPa and 223 +/- 62 kPa, respectively. The VAS pain score in the postanesthesia care unit and at 24 h postoperatively were 81 +/- 24 and 31 +/- 10, respectively. Highly anxious patients had higher VAS pain scores in the postanesthesia care unit (P pain tolerance was significantly correlated with the VAS at 24 h postoperatively (P pain tolerance after fentanyl administration (mean, 272 +/- 68 kPa) correlated significantly with morphine consumption in the first 24 h postoperatively (P pain tolerance is significantly correlated with the level of postoperative pain. Pain tolerance assessment after fentanyl was administered and fentanyl sensitivity predicted the dose of analgesics used in the first 24 h after surgery. The algometer is thus a simple, useful tool for predicting postoperative pain and analgesic consumption.

Pain and the ethics of pain management.

Science.gov (United States)

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.

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

Science.gov (United States)

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.

Characterizing individual painDETECT symptoms by average pain severity

Directory of Open Access Journals (Sweden)

Sadosky A

2016-07-01

Full Text Available Alesia Sadosky,1 Vijaya Koduru,2 E Jay Bienen,3 Joseph C Cappelleri4 1Pfizer Inc, New York, NY, 2Eliassen Group, New London, CT, 3Outcomes Research Consultant, New York, NY, 4Pfizer Inc, Groton, CT, USA Background: painDETECT is a screening measure for neuropathic pain. The nine-item version consists of seven sensory items (burning, tingling/prickling, light touching, sudden pain attacks/electric shock-type pain, cold/heat, numbness, and slight pressure, a pain course pattern item, and a pain radiation item. The seven-item version consists only of the sensory items. Total scores of both versions discriminate average pain-severity levels (mild, moderate, and severe, but their ability to discriminate individual item severity has not been evaluated.Methods: Data were from a cross-sectional, observational study of six neuropathic pain conditions (N=624. Average pain severity was evaluated using the Brief Pain Inventory-Short Form, with severity levels defined using established cut points for distinguishing mild, moderate, and severe pain. The Wilcoxon rank sum test was followed by ridit analysis to represent the probability that a randomly selected subject from one average pain-severity level had a more favorable outcome on the specific painDETECT item relative to a randomly selected subject from a comparator severity level.Results: A probability >50% for a better outcome (less severe pain was significantly observed for each pain symptom item. The lowest probability was 56.3% (on numbness for mild vs moderate pain and highest probability was 76.4% (on cold/heat for mild vs severe pain. The pain radiation item was significant (P<0.05 and consistent with pain symptoms, as well as with total scores for both painDETECT versions; only the pain course item did not differ.Conclusion: painDETECT differentiates severity such that the ability to discriminate average pain also distinguishes individual pain item severity in an interpretable manner. Pain

The peripheral and central mechanisms of transition of acute to chronic pain and the possible role of cyclooxygenase-2 inhibition in the prevention of pain syndrome chronization

Directory of Open Access Journals (Sweden)

O. S. Davydov

2016-01-01

Full Text Available Chronic pain syndromes as a cause of suffering, short-term or persistent disability, and social losses greatly worsen quality of life. The mechanisms leading to the occurrence and maintenance of chronic pain are traditionally of interest for in-depth study since each of them is potentially a target for pharmacotherapy. Peripheral and central sensitizations, as well as disinhibition make different contributions to the development of chronic pain. The fact that cyclooxygenase-2 (COX-2 inhibitors may affect at both the peripheral and central, spinal levels, by modulating such a phenomenon as central sensitization, has been recently discussed. There are theoretical prerequisites for a discussion of this action of COX-2 inhibitors; however, clinical findings supporting this hypothesis have been scarce so far. In this connection, of interest is the clinical trial published in 2016, which may suggest to a high degree of accuracy that some analgesic effect of the selective COX-2 inhibitor etoricoxib is realized through the central mechanisms of pain modulation. 

Female sexual compulsivity: a new syndrome.

Science.gov (United States)

Turner, Martha

2008-12-01

present in the families-of-origin, helps patients put their problems in context. Treatment can be successful if patients develop a capacity to bond, can tolerate the psychic pain of disclosure, are willing to be accountable, are resilient, and can forgive themselves and others. The rewards for this endeavor are great. The successful interruption and healing of patterns of abuse, shame, and distortions of intimacy and sexuality is a great contribution to society.

Changes of spontaneous oscillatory activity to tonic heat pain.

Science.gov (United States)

Peng, Weiwei; Hu, Li; Zhang, Zhiguo; Hu, Yong

2014-01-01

Transient painful stimuli could induce suppression of alpha oscillatory activities and enhancement of gamma oscillatory activities that also could be greatly modulated by attention. Here, we attempted to characterize changes in cortical activities during tonic heat pain perception and investigated the influence of directed/distracted attention on these responses. We collected 5-minute long continuous Electroencephalography (EEG) data from 38 healthy volunteers during four conditions presented in a counterbalanced order: (A) resting condition; (B) innoxious-distracted condition; (C) noxious-distracted condition; (D) noxious-attended condition. The effects of tonic heat pain stimulation and selective attention on oscillatory activities were investigated by comparing the EEG power spectra among the four experimental conditions and assessing the relationship between spectral power difference and subjective pain intensity. The change of oscillatory activities in condition D was characterized by stable and persistent decrease of alpha oscillation power over contralateral-central electrodes and widespread increase of gamma oscillation power, which were even significantly correlated with subjective pain intensity. Since EEG responses in the alpha and gamma frequency band were affected by attention in different manners, they are likely related to different aspects of the multidimensional sensory experience of pain. The observed contralateral-central alpha suppression (conditions D vs. B and D vs. C) may reflect primarily a top-down cognitive process such as attention, while the widespread gamma enhancement (conditions D vs. A) may partly reflect tonic pain processing, representing the summary effects of bottom-up stimulus-related and top-down subject-driven cognitive processes.

Changes of spontaneous oscillatory activity to tonic heat pain.

Directory of Open Access Journals (Sweden)

Weiwei Peng

Full Text Available Transient painful stimuli could induce suppression of alpha oscillatory activities and enhancement of gamma oscillatory activities that also could be greatly modulated by attention. Here, we attempted to characterize changes in cortical activities during tonic heat pain perception and investigated the influence of directed/distracted attention on these responses. We collected 5-minute long continuous Electroencephalography (EEG data from 38 healthy volunteers during four conditions presented in a counterbalanced order: (A resting condition; (B innoxious-distracted condition; (C noxious-distracted condition; (D noxious-attended condition. The effects of tonic heat pain stimulation and selective attention on oscillatory activities were investigated by comparing the EEG power spectra among the four experimental conditions and assessing the relationship between spectral power difference and subjective pain intensity. The change of oscillatory activities in condition D was characterized by stable and persistent decrease of alpha oscillation power over contralateral-central electrodes and widespread increase of gamma oscillation power, which were even significantly correlated with subjective pain intensity. Since EEG responses in the alpha and gamma frequency band were affected by attention in different manners, they are likely related to different aspects of the multidimensional sensory experience of pain. The observed contralateral-central alpha suppression (conditions D vs. B and D vs. C may reflect primarily a top-down cognitive process such as attention, while the widespread gamma enhancement (conditions D vs. A may partly reflect tonic pain processing, representing the summary effects of bottom-up stimulus-related and top-down subject-driven cognitive processes.

A magnetoencephalography study of multi-modal processing of pain anticipation in primary sensory cortices.

Science.gov (United States)

Gopalakrishnan, R; Burgess, R C; Plow, E B; Floden, D P; Machado, A G

2015-09-24

Pain anticipation plays a critical role in pain chronification and results in disability due to pain avoidance. It is important to understand how different sensory modalities (auditory, visual or tactile) may influence pain anticipation as different strategies could be applied to mitigate anticipatory phenomena and chronification. In this study, using a countdown paradigm, we evaluated with magnetoencephalography the neural networks associated with pain anticipation elicited by different sensory modalities in normal volunteers. When encountered with well-established cues that signaled pain, visual and somatosensory cortices engaged the pain neuromatrix areas early during the countdown process, whereas the auditory cortex displayed delayed processing. In addition, during pain anticipation, the visual cortex displayed independent processing capabilities after learning the contextual meaning of cues from associative and limbic areas. Interestingly, cross-modal activation was also evident and strong when visual and tactile cues signaled upcoming pain. Dorsolateral prefrontal cortex and mid-cingulate cortex showed significant activity during pain anticipation regardless of modality. Our results show pain anticipation is processed with great time efficiency by a highly specialized and hierarchical network. The highest degree of higher-order processing is modulated by context (pain) rather than content (modality) and rests within the associative limbic regions, corroborating their intrinsic role in chronification. Copyright © 2015 IBRO. Published by Elsevier Ltd. All rights reserved.

Detection of cold pain, cold allodynia and cold hyperalgesia in freely behaving rats

Directory of Open Access Journals (Sweden)

Woolf Clifford J

2005-12-01

Full Text Available Abstract Background Pain is elicited by cold, and a major feature of many neuropathic pain states is that normally innocuous cool stimuli begin to produce pain (cold allodynia. To expand our understanding of cold induced pain states we have studied cold pain behaviors over a range of temperatures in several animal models of chronic pain. Results We demonstrate that a Peltier-cooled cold plate with ± 1°C sensitivity enables quantitative measurement of a detection withdrawal response to cold stimuli in unrestrained rats. In naïve rats the threshold for eliciting cold pain behavior is 5°C. The withdrawal threshold for cold allodynia is 15°C in both the spared nerve injury and spinal nerve ligation models of neuropathic pain. Cold hyperalgesia is present in the spared nerve injury model animals, manifesting as a reduced latency of withdrawal response threshold at temperatures that elicit cold pain in naïve rats. We also show that following the peripheral inflammation produced by intraplantar injection of complete Freund's adjuvant, a hypersensitivity to cold occurs. Conclusion The peltier-cooled provides an effective means of assaying cold sensitivity in unrestrained rats. Behavioral testing of cold allodynia, hyperalgesia and pain will greatly facilitate the study of the neurobiological mechanisms involved in cold/cool sensations and enable measurement of the efficacy of pharmacological treatments to reduce these symptoms.

The relationship between chest pain during thallium-201 scintigraphy with dipyridamole and myocardial ischemia

International Nuclear Information System (INIS)

Takeishi, Yasuchika; Tono-oka, Ichiro; Meguro, Mitsuhiko; Hoshi, Hikaru; Masakane, Ikuto; Ikeda, Kozue; Tsuiki, Kai; Yasui, Shoji

1991-01-01

Dipyridamole thallium-201 scintigraphy (DP-Tl) and coronary angiography were studied on 74 patients with suspected coronary artery disease. We compared the clinical features, hemodynamic responses, angiographic results and scintigraphic findings of patients who had chest pain during DP-Tl testing ('chest pain' group) with those of patients who did not have chest pain ('no pain' group). Thirty eight (51%) of the 74 patients developed chest pain. Heart rate and rate pressure product during DP infusion of 'chest pain' group were greater than those of the 'no pain' group (p<0.05). Ischemic ST depression was more frequently observed among 'chest pain' patients (p<0.01). There were no differences in angiographic severity of coronary artery disease between 'chest pain' and 'no pain' group. Also, we could find no differences in extent and severity scores of perfusion defects and washout abnormalities between the two groups. However, when patients with myocardial infarction were excluded, the 'chest pain' group had significantly greater extent and severity scores of washout abnormalities than the 'no pain' group (extent score: 38±8 vs 18±5, p<0.05, severity score: 55±15 vs 18±7, p<0.01). Our study indicated that in patients without myocardial infarction, patients with 'chest pain' had more severe ischemia than 'no pain' patients. But in patients with myocardial infarction, myocardial ischemia not accompanied by chest pain might be as severe as that with chest pain. The presence or absence of myocardial infarction might have great influence on results regarding the relation of chest pain to myocardial ischemia. (author)

Psychometric Properties of “Community Assessment of Psychic Experiences”: Review and Meta-analyses

Science.gov (United States)

Mark, Winifred; Toulopoulou, Timothea

2016-01-01

The Community Assessment of Psychic Experiences (CAPE) has been used extensively as a measurement for psychosis proneness in clinical and research settings. However, no prior review and meta-analysis have comprehensively examined psychometric properties (reliability and validity) of CAPE scores across different studies. To study CAPE’s internal reliability—ie, how well scale items correlate with one another—111 studies were reviewed. Of these, 18 reported unique internal reliability coefficients using data at hand, which were aggregated in a meta-analysis. Furthermore, to confirm the number and nature of factors tapped by CAPE, 17 factor analytic studies were reviewed and subjected to meta-analysis in cases of discrepancy. Results suggested that CAPE scores were psychometrically reliable—ie, scores obtained could be attributed to true score variance. Our review of factor analytic studies supported a 3-factor model for CAPE consisting of “Positive”, “Negative”, and “Depressive” subscales; and a tripartite structure for the Negative dimension consisting of “Social withdrawal”, “Affective flattening”, and “Avolition” subdimensions. Meta-analysis of factor analytic studies of the Positive dimension revealed a tridimensional structure consisting of “Bizarre experiences”, “Delusional ideations”, and “Perceptual anomalies”. Information on reliability and validity of CAPE scores is important for ensuring accurate measurement of the psychosis proneness phenotype, which in turn facilitates early detection and intervention for psychotic disorders. Apart from enhancing the understanding of psychometric properties of CAPE scores, our review revealed questionable reporting practices possibly reflecting insufficient understanding regarding the significance of psychometric properties. We recommend increased focus on psychometrics in psychology programmes and clinical journals. PMID:26150674

[Hypnosis to fight against pain and anxiety in palliative care].

Science.gov (United States)

Quintini, Didier; Vitale, Claire; Gaide, Michelle; Surdej, Frédérique; Salas, Sébastien

2017-12-01

In our society, hypnosis sometimes has a negative, distorted image. For several years now it has become more widespread in the healthcare field and its use has increased in caring for symptoms such as pain and anxiety. It can be of great help in palliative situations. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Silencing of FKBP51 alleviates the mechanical pain threshold, inhibits DRG inflammatory factors and pain mediators through the NF-kappaB signaling pathway.

Science.gov (United States)

Yu, Hong-Mei; Wang, Qi; Sun, Wen-Bo

2017-09-05

Neuropathic pain is chronic pain caused by lesions or diseases of the somatosensory system, currently available analgesics provide only temporal relief. The precise role of FK506 binding protein 51 (FKBP51) in neuropathic pain induced by chronic constriction injury (CCI) is not clear. The purpose of the present study was to investigate the effects and possible mechanisms of FKBP51 in neuropathic pain in the rat model of CCI. Our results showed that FKBP51 was obviously upregulated in a time-dependent manner in the dorsal root ganglion (DRG) of CCI rats. Additionally, silencing of FKBP51 remarkably attenuated mechanical allodynia and thermal hyperalgesia as reflected by paw withdrawal threshold (PWT) and paw withdrawal latency (PWL) in CCI rats. Moreover, knockdown of FKBP51 reduced the production of pro-inflammatory cytokines (TNF-α, IL-1β and IL-6), nerve growth factor (NGF) and brain-derived neurotrophic factor (BDNF) expression in the DRG of CCI rats. Furthermore, we revealed that inhibition of FKBP51 greatly suppressed the activation of the NF-kappaB (NF-κB) signaling in the DRG of CCI rats. Interestingly, similar to the FKBP51 siRNA (si-FKBP51), ammonium pyrrolidinedithiocarbamate (PDTC, an inhibitor of NF-κB) also alleviated neuropathic pain and neuro-inflammation, indicating that knockdown of FKBP51 alleviated neuropathic pain development of CCI rats by inhibiting the activation of NF-κB signaling pathway. Taken together, our findings indicate that FKBP51 may serve as a novel therapeutic target for neuropathic pain. Copyright © 2017. Published by Elsevier B.V.

Correlates and consequences of the disclosure of pain-related distress to one's spouse.

Science.gov (United States)

Cano, Annmarie; Leong, Laura E M; Williams, Amy M; May, Dana K K; Lutz, Jillian R

2012-12-01

The communication of pain has received a great deal of attention in the pain literature; however, one form of pain communication--emotional disclosure of pain-related distress (e.g., sadness, worry, anger about pain)--has not been studied extensively. This study examined the extent to which this form of pain communication occurred during an observed conversation with one's spouse and also investigated the correlates and consequences of disclosure. Individuals with chronic pain (ICP) and their spouses (N=95 couples) completed several questionnaires regarding pain, psychological distress, and relationship distress as well as video recorded interactions about the impact of pain on their lives. Approximately two-thirds of ICPs (n=65) disclosed their pain-related distress to their spouses. ICPs who reported greater pain severity, ruminative catastrophizing and affective distress about pain, and depressive and anxiety symptoms were more likely to disclose their distress to their spouses. Spouses of ICPs who disclosed only once or twice were significantly less likely to invalidate their partners whereas spouses of ICPs who disclosed at a higher rate were significantly more likely to validate their partners. Furthermore, spouses were more likely to engage in invalidation after attempting more neutral or validating responses, suggesting an erosion of support when ICPs engaged in high rates of disclosure. Correlates of spousal invalidation included both spouses' helplessness catastrophizing, ICPs' affective distress about pain, and spouses' anxiety, suggesting that both partners' distress are implicated in maladaptive disclosure-response patterns. Findings are discussed in light of pain communication and empathy models of pain. Copyright © 2012 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

Behavioral cues to expand a pain model of the cognitively impaired elderly in long-term care

Directory of Open Access Journals (Sweden)

Burfield AH

2012-07-01

residents. Patients most at risk are those with mild to severe cognitive decline, or those unable to report pain verbally. Nursing homes are under great scrutiny to maintain standards of care and provide uniform high-quality care outcomes. Existing data from federally required resident surveys can serve as a valuable tool to identify indicators of pain and trends in care. Great responsibility lies in ensuring pain is included and monitored as a quality measure in long-term care, especially for residents unable to communicate their pain verbally.Keywords: cognitive impairment, minimum data set, pain behaviors, structural equation modeling, theoretical model

Back pain and the resolution of diagnostic uncertainty in illness narratives.

Science.gov (United States)

Lillrank, Annika

2003-09-01

In this paper I consider 30 Finnish women's written narratives about the process of getting back pain diagnosed. From the beginning of the early discomfort of back pain, the women were sure of its bodily and subjective reality. They struggled repeatedly to be taken seriously, and only after years of medical disparagement did they encounter medical professionals who were able solve the riddle and give it a name, a diagnosis. Since back pain is a baffling problem and challenges the central biomedical epistemology-objective knowledge and measurable findings separate from subjective experience-it allowed the doctors to show a disrespectful attitude toward back pain sufferers. The moral essence of the women's common story was the stigmatizing experience when doctors did not take subjective pain seriously. Instead, doctors' neglectful attitudes became part of the prolonged problem. During the long-lasting uncertainty, women tried multiple coping strategies to ease their lives and developed mental attitudes to endure the pain. Since the protagonists did not give up the lived certainty of back pain they were gradually able to challenge medical uncertainty and to demand a thorough medical examination, and/or through random circumstance they encountered doctors who were willing to take their symptoms seriously. This triggered turning points that immediately or very soon resulted in solving the riddle of the puzzling pain. To be finally diagnosed was a great relief. However, to be taken seriously as a person was considered to be the greatest relief.

Reduction of painful area as new possible therapeutic target in post-herpetic neuropathic pain treated with 5% lidocaine medicated plaster: a case series

Directory of Open Access Journals (Sweden)

Casale R

2014-06-01

��drug interactions. Such patients benefit greatly from topical treatment of PHN. Our observations confirm the effectiveness of lidocaine plasters in the treatment of PHN, indicating that 5% lidocaine medicated plaster could reduce the size of the painful area. This last observation has to be confirmed and the mechanisms clarified in appropriate larger randomized controlled trials.Keywords: localized neuropathic pain, topical treatment, chronic pain, drug–drug interactions, patient's outcome

Evolution of the Great Tehuelche Paleolake in the Torres del Paine National Park of Chilean Patagonia during the Last Glacial Maximum and Holocene Evolución del Gran Paleolago Tehuelche en el Parque Nacional Torres del Paine de la Patagonia chilena durante el Último Máximo Glacial y Holoceno

Directory of Open Access Journals (Sweden)

Marcelo A Solari

2012-01-01

Full Text Available A number of glacial moraines are distributed from the eastern margin of the Torres del Paine drainage basin to near the present margin of the Patagonian Ice Fields, together with a set of regionally continuous lacustrine terraces related to glacial fluctuations. The geomorphology, supported by lake sediment evidence, indicates the existence of a single proglacial paleolake in this area, here referred to as the Great Tehuelche Paleolake. This concept helps to clarify the chronology of glacial events and leads to a better understanding of the evolution of the hydrologic system in the Torres del Paine area. Glacial advances previously referred to as A, B and C occurred during the Last Glacial Maximum and fed the Great Tehuelche Paleolake with meltwater, allowing it to reach its maximum extension. The discovery of thrombolites at Laguna Amarga suggests that the drainage of the paleolake towards the Última Esperanza Fjord took place at 7,113 Cal. yr BP, after the melting of an ice barrier that existed during the earlier glacial advance. This gave rise to the development of a complex fluvio-lacustrine hydrologic system that persists to the present day.Un grupo de morrenas glaciales están distribuidas desde el margen este de la cuenca de drenaje de Torres del Paine hacia el margen actual de los Campos de Hielo Patagónicos. Las morrenas se observan en conjunto con un grupo de terrazas lacustres regionales, las cuales están vinculadas a las fluctuaciones glaciales. La geomorfología y evidencias de sedimentos lacustres indican la existencia de un único lago proglacial, referido en este estudio como Gran Paleolago Tehuelche. Este concepto ayuda a clarificar la cronología de los eventos glaciales y permite una mejor comprensión de la evolución del sistema hidrológico del sector de Torres del Paine. Los eventos glaciales, previamente referidos como Avance A, B y C, ocurrieron durante el Último Máximo Glacial y alimentaron con aguas de fusión al

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

Science.gov (United States)

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.

Addiction and Pain Medicine

Directory of Open Access Journals (Sweden)

Douglas Gourlay

2005-01-01

Full Text Available The adequate cotreatment of chronic pain and addiction disorders is a complex and challenging problem for health care professionals. There is great potential for cannabinoids in the treatment of pain; however, the increasing prevalence of recreational cannabis use has led to a considerable increase in the number of people seeking treatment for cannabis use disorders. Evidence that cannabis abuse liability is higher than previously thought suggests that individuals with a history of substance abuse may be at an increased risk after taking cannabinoids, even for medicinal purposes. Smoked cannabis is significantly more reinforcing than other cannabinoid administration methods. In addition, it is clear that the smoked route of cannabis delivery is associated with a number of adverse health consequences. Thus, there is a need for pharmaceutical-grade products of known purity and concentration using delivery systems optimized for safety. Another factor that needs to be considered when assessing the practicality of prescribing medicinal cannabinoids is the difficulty in differentiating illicit from prescribed cannabinoids in urine drug testing. Overall, a thorough assessment of the risk/benefit profile of cannabinoids as they relate to a patient’s substance abuse history is suggested.

Pain adaptability in individuals with chronic musculoskeletal pain is not associated with conditioned pain modulation

DEFF Research Database (Denmark)

Wan, Dawn Wong Lit; Arendt-Nielsen, Lars; Wang, Kelun

2018-01-01

(MSK). CPTs at 2°C and 7°C were used to assess the status of pain adaptability in participants with either chronic non-specific 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 demographics, pain thresholds from thermal and pressure stimuli, or potency of local inhibition or CPM. PA reached their maximum pain faster than PNA (t41=-2.76, p... days whereas PNA did not (F (6,246) = 3.01, p = 0.01). The dichotomy of pain adaptability exists in MSK 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 which...

Pain Control After Surgery: Pain Medicines

Science.gov (United States)

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

Correlates and consequences of the disclosure of pain-related distress to one’s spouse

Science.gov (United States)

Cano, Annmarie; Leong, Laura E. M.; Williams, Amy M.; May, Dana K. K.; Lutz, Jillian R.

2012-01-01

The communication of pain has received a great deal of attention in the pain literature; however, one form of pain communication—emotional disclosure of pain-related distress (e.g., sadness, worry, anger about pain)—has not been studied extensively. The current study examined the extent to which this form of pain communication occurred during an observed conversation with one’s spouse and also investigated the correlates and consequences of disclosure. Individuals with chronic pain (ICPs) and their spouses (N = 95 couples) completed several questionnaires regarding pain, psychological distress, and relationship distress as well as video recorded interactions about the impact of pain on their lives. Approximately two-thirds of ICPs (n = 65) disclosed their pain-related distress to their spouses. ICPs who reported greater pain severity, ruminative catastrophizing and affective distress about pain, and depressive and anxiety symptoms were more likely to disclose their distress to their spouses. Spouses of ICPs who disclosed only once or twice were significantly less likely to invalidate their partners whereas spouses of ICPs who disclosed at a higher rate were significantly more likely to validate their partners. Furthermore, spouses were more likely to engage in invalidation after attempting more neutral or validating responses, suggesting an erosion of support when ICPs engaged in high rates of disclosure. Correlates of spousal invalidation included both spouses’ helplessness catastrophizing, ICPs’ affective distress about pain, and spouses’ anxiety, suggesting that both partners’ distress are implicated in maladaptive disclosure-response patterns. Findings are discussed in light of pain communication and empathy models of pain. PMID:23059054

Electronic diary assessment of pain-related fear, attention to pain, and pain intensity in chronic low back pain patients.

NARCIS (Netherlands)

Roelofs, J.; Peters, M.L.; Patijn, J.; Schouten, E.G.; Vlaeyen, J.W.

2004-01-01

The present study investigated the relationships between pain-related fear, attention to pain, and pain intensity in daily life in patients with chronic low back pain. An experience sampling methodology was used in which electronic diary data were collected by means of palmtop computers from 40

Altered Pain Sensitivity in Elderly Women with Chronic Neck Pain

Science.gov (United States)

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 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

Doubling Your Payoff: Winning Pain Relief Engages Endogenous Pain Inhibition

Science.gov (United States)

Becker, Susanne; Gandhi, Wiebke; Kwan, Saskia; Ahmed, Alysha-Karima; Schweinhardt, Petra

2015-01-01

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.

Pain Sensitivity and Pain Catastrophizing are Associated with Persistent Pain and Disability after Lumbar Spine Surgery

Science.gov (United States)

Coronado, Rogelio A.; George, Steven Z.; Devin, Clinton J.; Wegener, Stephen T.; Archer, Kristin R.

2015-01-01

Objective To examine whether pain sensitivity and pain catastrophizing are associated with persistent pain and disability after lumbar spine surgery. Design Prospective observational cohort study. Setting Academic medical center. Participants Patients (N = 68, mean ± SD age = 57.9 ± 13.1 years, N female = 40 (58.8%)) undergoing spine surgery for a degenerative condition from March 1, 2012 to April 30, 2013 were assessed 6 weeks, 3 months, and 6 months after surgery. Interventions Not applicable. Main Outcome Measure(s) The main outcome measures were persistent back pain intensity, pain interference, and disability. Patients with persistent back pain intensity, pain interference, or disability were identified as those patients reporting Brief Pain Inventory scores ≥ 4 and Oswestry Disability Index scores ≥ 21 at all postoperative time points. Results From 6 weeks to 6 months after surgery, approximately 12.9%, 24.2%, and 46.8% of patients reported persistent back pain intensity, pain interference, or disability, respectively. Increased pain sensitivity at 6 weeks was associated with having persistent back pain intensity (OR = 2.0, 95% CI = 1.0; 4.1) after surgery. Increased pain catastrophizing at 6 weeks was associated with having persistent back pain intensity (OR = 1.1, 95% CI = 1.0; 1.2), pain interference (OR = 1.1, 95% CI = 1.0; 1.2), and disability (OR = 1.3, 95% CI = 1.1; 1.4). An interaction effect was not found between pain sensitivity and pain catastrophizing on persistent outcomes (p > 0.05). Conclusion(s) Findings suggest the importance of early postoperative screening for pain sensitivity and pain catastrophizing in order to identify patients at-risk for poor postoperative pain intensity, interference, and/or disability outcomes. Future research should consider the benefit of targeted therapeutic strategies for patients with these postoperative prognostic factors. PMID:26101845

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

Science.gov (United States)

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.

The Great Recession was not so Great

NARCIS (Netherlands)

van Ours, J.C.

2015-01-01

The Great Recession is characterized by a GDP-decline that was unprecedented in the past decades. This paper discusses the implications of the Great Recession analyzing labor market data from 20 OECD countries. Comparing the Great Recession with the 1980s recession it is concluded that there is a

Pain as social glue: shared pain increases cooperation.

Science.gov (United States)

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.

Pain-related guilt in low back pain.

Science.gov (United States)

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.

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

Science.gov (United States)

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 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.

Assessment of pain experience in adults and children after bracket bonding and initial archwire insertion

Directory of Open Access Journals (Sweden)

Marcio José da Silva Campos

2013-10-01

Full Text Available INTRODUCTION: Ninety five percent of orthodontic patients routinely report pain, due to alterations in the periodontal ligament and surrounding soft tissues, with intensity and prevalence varying according to age. OBJECTIVE: This study aimed to assess toothache and buccal mucosal pain in adults and children during two initial phases of the orthodontic treatment. METHODS: The intensity of toothache and buccal mucosal pain reported by 20 patients, 10 children (11-13 years and 10 adults (18-37 years was recorded with the aid of a Visual Analog Scale (VAS, during 14 days - 7 days with bonded brackets only and 7 days with the initial archwire inserted. RESULTS: There was no significant difference in pain intensity among adults and children. After bracket bonding, 50% of the children and 70% of the adults reported pain. 70% of both groups reported pain after initial archwire insertion. While adults reported constant, low intensity, buccal mucosal pain, the children showed great variation of pain intensity, but with a trend towards decreasing pain during the assessment period. After initial archwire insertion the peaks of toothache intensity and prevalence occurred 24 hours in children and 48 hours in adults. CONCLUSIONS: In general, children reported pain less frequently than adults did, though with greater intensity.

Headache attributed to masticatory myofascial pain: impact on facial pain and pressure pain threshold.

Science.gov (United States)

Costa, Y M; Porporatti, A L; Stuginski-Barbosa, J; Bonjardim, L R; Speciali, J G; Conti, P C R

2016-03-01

There is no clear evidence on how a headache attributed to temporomandibular disorder (TMD) can hinder the improvement of facial pain and masticatory muscle pain. The aim of this study was to measure the impact of a TMD-attributed headache on masticatory myofascial (MMF) pain management. The sample was comprised of adults with MMF pain measured according to the revised research diagnostic criteria for temporomandibular disorders (RDC/TMD) and additionally diagnosed with (Group 1, n = 17) or without (Group 2, n = 20) a TMD-attributed headache. Both groups received instructions on how to implement behavioural changes and use a stabilisation appliance for 5 months. The reported facial pain intensity (visual analogue scale--VAS) and pressure pain threshold (PPT--kgf cm(-2)) of the anterior temporalis, masseter and right forearm were measured at three assessment time points. Two-way anova was applied to the data, considering a 5% significance level. All groups had a reduction in their reported facial pain intensity (P 0·100). A TMD-attributed headache in patients with MMF pain does not negatively impact pain management, but does change the pattern for muscle pain improvement. © 2015 John Wiley & Sons Ltd.

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

Science.gov (United States)

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

Effects of Chronic Musculoskeletal Pain on Fertility Potential in Lean and Overweight Male Patients

Directory of Open Access Journals (Sweden)

Fereshteh Dardmeh

2017-01-01

Full Text Available Both chronic pain and obesity are known to affect reproductive hormone profiles in male patients. However, the effect of these conditions, alone or in combination, on male fertility potential has received less attention. 20 chronic musculoskeletal pain patients and 20 healthy controls were divided into lean and overweight subgroups according to their BMI. Current level of chronic pain (visual analogue scale and pressure pain thresholds (PPTs in 16 predefined sites, classically described and tested as painful points on the lower body, were measured. Levels of reproductive hormone and lipid profiles were assessed by ELISA. Sperm concentration and motility parameters were analyzed using a computer-aided sperm analysis system. Sperm concentration, progressive motility, and percentage of hyperactivated sperm were generally lower in the chronic pain patients in both lean and overweight groups. The overweight control and the lean chronic pain groups demonstrated a significantly lower percentage of progressively motile sperm compared with the lean control group, suggesting that musculoskeletal chronic pain may have a negative influence on sperm quality in lean patients. However, due to the potential great negative influence of obesity on the sperm parameters, it is difficult to propose if musculoskeletal chronic pain also influenced sperm quality in overweight patients. Further research in chronic pain patients is required to test this hypothesis.

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

Science.gov (United States)

Markschies, C

2007-08-01

Pain and Christianity appear to belong together: Christ's pain stands at the centre of God's healing; his pain leads to the salvation of mankind. We can learn from Jesus' example how to bear suffering and pain. In early Christian times, the belief that Jesus Christ suffered pain on the cross was usually not accepted. In line with the "apathy axiom", freedom from emotion was something to strive for at that time. Only after the acceptance of Christianity as the state religion of the Roman Empire in 380 AD did the pain of Christ again stand in the centre of the Christian doctrine of salvation. The memory of the fact that Jesus himself had to undergo the worst pain can still help people to overcome their pain and comfort them.

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

NARCIS (Netherlands)

Mazaheri, M.; Heidari, E.; Mostmand, J.; Negahban, H.; van Dieen, J.H.

2014-01-01

STUDY DESIGN. A cross-sectional, observational study. OBJECTIVE. To determine whether pain and fear of pain have competing effects on postural sway in patients with low back pain (LBP). SUMMARY OF BACKGROUND DATA. Competing effects of pain and pain-related fear on postural control can be proposed as

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

Science.gov (United States)

Beach, Paul Anthony

, somatosensation, and interoception (p<0.05, FWE corrected). These findings provide further evidence and an improved understanding of the neural basis for heightened pain sensitivity in patients with AD. They also emphasize the necessity to improve pain assessment and treatment strategies for a vulnerable patient population set to expand greatly in the coming decades.

Indifference to pain syndrome in a twelve-year-old boy (case report

Directory of Open Access Journals (Sweden)

Baghdadi T

2007-08-01

Full Text Available Background: People vary greatly in their response to painful stimuli, from those with a low pain threshold to those with indifference to pain. However, insensitivity to pain is a rare disorder, characterized by the lack of usual subjective and objective responses to noxious stimuli. Patients who have congenital indifference to pain sustain painless injuries beginning in infancy, but have sensory responses that are otherwise normal on examination. Perception of passive movement, joint position, and vibration is normal in these patients, as are tactile thresholds and light touch perception. Case report: A twelve-year-old boy was admitted to the hospital for a painless deformity, degeneration in both knees and a neglected femoral neck fracture that was inappropriately painless. Further examination revealed normal sensory responses, perception of passive movement, joint position, vibration tactile thresholds and light touch perception. Spinal cord and brain MRI were normal as was the electromyography and nerve conduction velocity (EMG/NCV examination. There was no positive family history for this disorder. Conclusion: The deficits present in the different pain insensitivity syndromes provide insight into the complex anatomical and physiological nature of pain perception. Reports on pain asymbolia, in which pain is perceived but does not cause suffering, and related cortical conditions illustrate that there can be losses that independently involve either the sensory-discriminative component or the affective-motivational component of pain perception, thus highlighting their different anatomical localization. The paucity of experience with this entity and the resultant diagnostic problems, the severity of the associated disabling arthropathy and underscore the importance of this case report of indifference to pain.

Menopause affects pain depending on pain type and characteristics.

Science.gov (United States)

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.

Pain perception and modulation in acute and chronic pain states

NARCIS (Netherlands)

Oudejans, L.C.J.

2016-01-01

This thesis describes the evaluation of pain perception in acute and chronic pain patients and the strength of the endogenous pain modulation system in chronic pain patients. Additionally, pain phenotypes are determined in patients with chronic pain. The ability of patients with acute pain after

The periodontal pain paradox: Difficulty on pain assesment in dental patients (The periodontal pain paradox hypothesis

Directory of Open Access Journals (Sweden)

Haryono Utomo

2006-12-01

Full Text Available In daily dental practice, the majority of patients’ main complaints are related to pain. Most patients assume that all pains inside the oral cavity originated from the tooth. One particular case is thermal sensitivity; sometimes patients were being able to point the site of pain, although there is neither visible caries nor secondary caries in dental radiograph. In this case, gingival recession and dentin hypersensitivity are first to be treated to eliminate the pain. If these treatments failed, pain may misdiagnose as pulpal inflammation and lead to unnecessary root canal treatment. Study in pain during periodontal instrumentation of plaque-related periodontitis revealed that the majority of patients feel pain and discomfort during probing and scaling. It seems obvious because an inflammation, either acute or chronic is related to a lowered pain threshold. However, in contrast, in this case report, patient suffered from chronic gingivitis and thermal sensitivity experienced a relative pain-free sensation during probing and scaling. Lowered pain threshold which accompanied by a blunted pain perception upon periodontal instrumentation is proposed to be termed as the periodontal pain paradox. The objective of this study is to reveal the possibility of certain factors in periodontal inflammation which may involved in the periodontal pain paradox hypothesis. Patient with thermal hypersensitivity who was conducted probing and scaling, after the relative pain-free instrumentation, thermal hypersensitivity rapidly disappeared. Based on the successful periodontal treatment, it is concluded that chronic gingivitis may modulate periodontal pain perception which termed as periodontal pain paradox

Characteristics of effective interventions supporting quality pain management in Australian emergency departments: an exploratory study.

Science.gov (United States)

Shaban, Ramon Z; Holzhauser, Kerri; Gillespie, Kerri; Huckson, Sue; Bennetts, Scott

2012-02-01

It is well established that pain is the most common presenting complaint in Emergency Departments. Despite great improvements in available pain management strategies, patients are left waiting for longer than 60min for pain relief on arrival to the emergency department. The aim of this study was to describe interventions that lead to successful implementation of the National Health and Medical Research Council approved guidelines Acute Pain Management: Scientific Evidence (2nd Edition) that include specific recommendations for best practice pain management. A two-phased, mixed-method, exploratory study of all 52 Australian hospital emergency departments participating in the National Emergency Care Pain Management Initiative incorporating interview and document analysis was undertaken. Interventions used by clinicians to improve pain management included nurse initiated analgesia, intranasal fentanyl for paediatric patients and lignocaine, and facio illiaca block. Education formed a major part of the intervention and the development of a working group of key stakeholders was critical in the successful implementation of change. Staff perceptions of patients' pain level and attitudes toward pain assessment and pain management were identified as barriers. This study highlighted how an effective framework to plan and implement practice change and tailored interventions, including education and training systems and products using the best available evidence, best equipped clinicians to manage pain in the ED. Copyright © 2011 College of Emergency Nursing Australasia Ltd. All rights reserved.

Can Fear, Pain, and Muscle Tension Discriminate Vaginismus from Dyspareunia/Provoked Vestibulodynia? Implications for the New DSM-5 Diagnosis of Genito-Pelvic Pain/Penetration Disorder.

Science.gov (United States)

Lahaie, Marie-Andrée; Amsel, Rhonda; Khalifé, Samir; Boyer, Stephanie; Faaborg-Andersen, Marie; Binik, Yitzchak M

2015-08-01

Fear has been suggested as the crucial diagnostic variable that may distinguish vaginismus from dyspareunia. Unfortunately, this has not been systematically investigated. The primary purpose of this study, therefore, was to investigate whether fear as evaluated by subjective, behavioral, and psychophysiological measures could differentiate women with vaginismus from those with dyspareunia/provoked vestibulodynia (PVD) and controls. A second aim was to re-examine whether genital pain and pelvic floor muscle tension differed between vaginismus and dyspareunia/PVD sufferers. Fifty women with vaginismus, 50 women with dyspareunia/PVD, and 43 controls participated in an experimental session comprising a structured interview, pain sensitivity testing, a filmed gynecological examination, and several self-report measures. Results demonstrated that fear and vaginal muscle tension were significantly greater in the vaginismus group as compared to the dyspareunia/PVD and no-pain control groups. Moreover, behavioral measures of fear and vaginal muscle tension were found to discriminate the vaginismus group from the dyspareunia/PVD and no-pain control groups. Genital pain did not differ significantly between the vaginismus and dyspareunia/PVD groups; however, genital pain was found to discriminate both clinical groups from controls. Despite significant statistical differences on fear and vaginal muscle tension variables between women suffering from vaginismus and dyspareunia/PVD, a large overlap was observed between these conditions. These findings may explain the great difficulty health professionals experience in attempting to reliably differentiate vaginismus from dyspareunia/PVD. The implications of these data for the new DSM-5 diagnosis of Genito-Pelvic Pain/Penetration Disorder are discussed.

Stimulation of the peripheral nervous system for pain control.

Science.gov (United States)

Long, D M

1983-01-01

Transcutaneous stimulation is a proven effective way to relieve pain. Its optimal use requires an accurate patient diagnosis. Treatment of pain as a symptom only is likely to fail. There must be a careful psychosocial evaluation, for the majority of patients who come to the doctor complaining of pain have major psychological, social, or behavioral factors that are most important in the genesis of the complaint. Drug abuse must be corrected. Related symptoms, such as anxiety and depression, must be treated. Then, a thorough trail of transcutaneous stimulation is mandatory. A desultory use will undoubtedly lead to failure. This trial must begin with patient education by experienced personnel. Then the electrodes must be properly applied, and there must be a regular follow-up of stimulation to be certain the patient is utilizing it correctly. The patient must be supported through an adequate trial which should extend over 2-4 weeks before purchase of the device is contemplated. Furthermore, all related nursing and physician personnel must be educated in the proper use of the technique. The uninformed professional who denigrates the therapy is a very effective deterrent to appropriate use. In this situation, transcutaneous electrical stimulation will be of great value in the treatment of acute musculoskeletal injury and acute postoperative pain. It will be effective in the treatment of peripheral nerve injury pain, chronic musculoskeletal abnormalities, chronic pain in the patient who has undergone multiple operations upon the low back and neck, visceral pain, some of the reflex sympathetic dystrophies, and postherpetic neuralgia. Stimulation will not help a complaint which is psychosomatic in origin. It will not influence drug addiction. It is not likely to be useful in any situation where secondary gain is important. The metabolic neuropathies, pain of spinal cord injury, and pain from cerebrovascular accident will not respond frequently enough to warrant more than

Pain Scores Are Not Predictive of Pain Medication Utilization

Directory of Open Access Journals (Sweden)

Suzanne Galloway

2011-01-01

Full Text Available Objective. To compare Visual Analogue Scale (VAS scores with overall postoperative pain medication requirements including cumulative dose and patterns of medication utilization and to determine whether VAS scores predict pain medication utilization. Methods. VAS scores and pain medication data were collected from participants in a randomized trial of the utility of phenazopyridine for improved pain control following gynecologic surgery. Results. The mean age of the 219 participants was 54 (range19 to 94. We did not detect any association between VAS and pain medication utilization for patient-controlled anesthesia (PCA or RN administered (intravenous or oral medications. We also did not detect any association between the number of VAS scores recorded and mean pain scores. Conclusion. Postoperative VAS scores do not predict pain medication use in catheterized women inpatients following gynecologic surgery. Increased pain severity, as reflected by higher VAS scores, is not associated with an increase in pain assessment. Our findings suggest that VAS scores are of limited utility for optimal pain control. Alternative or complimentary methods may improve pain management.

Characterizing neuropathic pain profiles: enriching interpretation of painDETECT

Directory of Open Access Journals (Sweden)

Cappelleri JC

2016-07-01

Full Text Available Joseph C Cappelleri,1 Vijaya Koduru,2 E Jay Bienen,3 Alesia Sadosky4 1Pfizer Inc, Groton, CT, USA; 2Eliassen Group, New London, CT, USA; 3Outcomes Research Consultant, New York, NY, USA; 4Pfizer Inc, New York, NY, USA Purpose: To psychometrically evaluate painDETECT, a patient-reported screening questionnaire for neuropathic pain (NeP, for discriminating among sensory pain symptoms (burning, tingling/prickling, light touching, sudden pain attacks/electric shock-type pain, cold/heat, numbness, and slight pressure. Methods: The seven-item version of painDETECT provides an overall score that targets only sensory symptoms, while the nine-item version adds responses on two items to the overall score, covering pain course pattern and pain radiation. Both versions have relevance in terms of characterizing broad NeP. The nine- and seven-item versions of painDETECT were administered to subjects with confirmed NeP across six conditions identified during office visits to US community-based physicians. Responses on the sensory symptom items were dichotomized into “at least moderate” (ie, moderate, strongly, very strongly relative to the combined other responses (never, hardly noticed, slightly. Logistic regression of dichotomized variables on the total painDETECT score provided probabilities of experiencing each symptom across the range of painDETECT scores. Results: Both painDETECT versions discriminated among the symptoms with similar probabilities across the score ranges. Using these data, the probability of moderately experiencing each pain sensory item was estimated for a particular score, providing a pain profile. Additionally, the likelihood of experiencing each sensation was determined for a discrete increase in score, ie, the odds of at least a moderate sensation of burning (versus less than a moderate sensation was 1.29 for a 1-point increase, 3.52 for a 5-point increase, and 12.42 for every 10-point increase in the nine-item painDETECT score

Dysfunctional pain modulation in somatoform pain disorder patients.

Science.gov (United States)

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.

Spinal pain

International Nuclear Information System (INIS)

Izzo, R.; Popolizio, T.; D’Aprile, P.; Muto, M.

2015-01-01

Highlights: • Purpose of this review is to address the current concepts on the pathophysiology of discogenic, radicular, facet and dysfunctional spinal pain, focusing on the role of the imaging in the diagnostic setting, to potentially address a correct approach also to minimally invasive interventional techniques. • Special attention will be given to the discogenic pain, actually considered as the most frequent cause of chronic low back pain. • The correct distinction between referred pain and radicular pain contributes to give a more correct approach to spinal pain. • The pathogenesis of chronic pain renders this pain a true pathology requiring a specific management. - Abstract: The spinal pain, and expecially the low back pain (LBP), represents the second cause for a medical consultation in primary care setting and a leading cause of disability worldwide [1]. LBP is more often idiopathic. It has as most frequent cause the internal disc disruption (IDD) and is referred to as discogenic pain. IDD refers to annular fissures, disc collapse and mechanical failure, with no significant modification of external disc shape, with or without endplates changes. IDD is described as a separate clinical entity in respect to disc herniation, segmental instability and degenerative disc desease (DDD). The radicular pain has as most frequent causes a disc herniation and a canal stenosis. Both discogenic and radicular pain also have either a mechanical and an inflammatory genesis. For to be richly innervated, facet joints can be a direct source of pain, while for their degenerative changes cause compression of nerve roots in lateral recesses and in the neural foramina. Degenerative instability is a common and often misdiagnosed cause of axial and radicular pain, being also a frequent indication for surgery. Acute pain tends to extinguish along with its cause, but the setting of complex processes of peripheral and central sensitization may influence its evolution in chronic

Spinal pain

Energy Technology Data Exchange (ETDEWEB)

Izzo, R., E-mail: roberto1766@interfree.it [Neuroradiology Department, A. Cardarelli Hospital, Naples (Italy); Popolizio, T., E-mail: t.popolizio1@gmail.com [Radiology Department, Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo (Fg) (Italy); D’Aprile, P., E-mail: paoladaprile@yahoo.it [Neuroradiology Department, San Paolo Hospital, Bari (Italy); Muto, M., E-mail: mutomar@tiscali.it [Neuroradiology Department, A. Cardarelli Hospital, Napoli (Italy)

2015-05-15

Highlights: • Purpose of this review is to address the current concepts on the pathophysiology of discogenic, radicular, facet and dysfunctional spinal pain, focusing on the role of the imaging in the diagnostic setting, to potentially address a correct approach also to minimally invasive interventional techniques. • Special attention will be given to the discogenic pain, actually considered as the most frequent cause of chronic low back pain. • The correct distinction between referred pain and radicular pain contributes to give a more correct approach to spinal pain. • The pathogenesis of chronic pain renders this pain a true pathology requiring a specific management. - Abstract: The spinal pain, and expecially the low back pain (LBP), represents the second cause for a medical consultation in primary care setting and a leading cause of disability worldwide [1]. LBP is more often idiopathic. It has as most frequent cause the internal disc disruption (IDD) and is referred to as discogenic pain. IDD refers to annular fissures, disc collapse and mechanical failure, with no significant modification of external disc shape, with or without endplates changes. IDD is described as a separate clinical entity in respect to disc herniation, segmental instability and degenerative disc desease (DDD). The radicular pain has as most frequent causes a disc herniation and a canal stenosis. Both discogenic and radicular pain also have either a mechanical and an inflammatory genesis. For to be richly innervated, facet joints can be a direct source of pain, while for their degenerative changes cause compression of nerve roots in lateral recesses and in the neural foramina. Degenerative instability is a common and often misdiagnosed cause of axial and radicular pain, being also a frequent indication for surgery. Acute pain tends to extinguish along with its cause, but the setting of complex processes of peripheral and central sensitization may influence its evolution in chronic

Reward and motivation in pain and pain relief

Science.gov (United States)

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

Pain and pain tolerance in professional ballet dancers.

Science.gov (United States)

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

Pain genes.

Directory of Open Access Journals (Sweden)

Tom Foulkes

2008-07-01

Full Text Available Pain, which afflicts up to 20% of the population at any time, provides both a massive therapeutic challenge and a route to understanding mechanisms in the nervous system. Specialised sensory neurons (nociceptors signal the existence of tissue damage to the central nervous system (CNS, where pain is represented in a complex matrix involving many CNS structures. Genetic approaches to investigating pain pathways using model organisms have identified the molecular nature of the transducers, regulatory mechanisms involved in changing neuronal activity, as well as the critical role of immune system cells in driving pain pathways. In man, mapping of human pain mutants as well as twin studies and association studies of altered pain behaviour have identified important regulators of the pain system. In turn, new drug targets for chronic pain treatment have been validated in transgenic mouse studies. Thus, genetic studies of pain pathways have complemented the traditional neuroscience approaches of electrophysiology and pharmacology to give us fresh insights into the molecular basis of pain perception.

Shoulder pain: the role of diagnostic injections.

Science.gov (United States)

Larson, H M; O'Connor, F G; Nirschl, R P

1996-04-01

Many different shoulder disorders cause similar symptoms and pain patterns. An accurate diagnosis can generally be made by obtaining a detailed history, performing a comprehensive, directed physical examination and obtaining selected radiographs. Occasionally, shoulder injections can be of great assistance in establishing a clear diagnosis and providing relief of symptoms. Subacromial space injection, acromioclavicular joint injection, intra-articular injection and injection of the biceps tendon are helpful in identifying such disorders as subacromial bursitis, acromioclavicular arthritis, injury to the glenohumeral joint and bicipital tendinitis.

Cancer pain management: Basic information for the young pain physicians

Directory of Open Access Journals (Sweden)

SPS Rana

2011-01-01

Full Text Available Cancer pain is multifactorial and complex. The impact of cancer pain is devastating, with increased morbidity and poor quality of life, if not treated adequately. Cancer pain management is a challenging task both due to disease process as well as a consequence of treatment-related side-effects. Optimization of analgesia with oral opioids, adjuvant analgesics, and advanced pain management techniques is the key to success for cancer pain. Early access of oral opioid and interventional pain management techniques can overcome the barriers of cancer pain, with improved quality of life. With timely and proper anticancer therapy, opioids, nerve blocks, and other non-invasive techniques like psychosocial care, satisfactory pain relief can be achieved in most of the patients. Although the WHO Analgesic Ladder is effective for more than 80% cancer pain, addition of appropriate adjuvant drugs along with early intervention is needed for improved Quality of Life. Effective cancer pain treatment requires a holistic approach with timely assessment, measurement of pain, pathophysiology involved in causing particular type of pain, and understanding of drugs to relieve pain with timely inclusion of intervention. Careful evaluation of psychosocial and mental components with good communication is necessary. Barriers to cancer pain management should be overcome with an interdisciplinary approach aiming to provide adequate analgesia with minimal side-effects. Management of cancer pain should comprise not only a physical component but also psychosocial and mental components and social need of the patient. With risk-benefit analysis, interventional techniques should be included in an early stage of pain treatment. This article summarizes the need for early and effective pain management strategies, awareness regarding pain control, and barriers of cancer pain.

Multidimensional features of pain in patients with chronic neck pain

Directory of Open Access Journals (Sweden)

Fabianna Resende de Jesus-Moraleida

Full Text Available Abstract Introduction: Chronic neck pain is associated with significant health costs and loss of productivity at work. Objective: to assess pain and disability in individuals with chronic neck pain. Methods: 31 volunteers with chronic neck pain, mean age 29, 65 years, were assessed using the McGill Pain Questionnaire in Brazilian version (Br-MPQ and Neck Disability Index (NDI. The Br-MPQ analysis was performed based on the numerical values associated with the words selected to describe the experience of pain (Pain Rating Index - PRI, and present pain intensity (PPI. NDI was used to evaluate the influence of neck pain in performance of everyday tasks. Finally, we investigated the association between PPI and NDI. Results: PRI revealed that the most significant dimension was the sensory pain (70%, and the number of chosen words was 10 (2,62 out of 20 words. Mean PPI value was 1,23 (0,76 in five points; 40% of participants described pain intensity as moderate. NDI score was 9,77 (3,34, indicating mild disability. There was a positive association between disability and pain intensity (r = 0,36; p =0,046. Pain intensity and duration of pain were not associated. Conclusions: Findings of this study identified important information related to neck pain experienced by patients when suffering from chronic neck pain, moreover, the association between disability and pain intensity reinforces the importance of complementary investigation of these aspects to optimize function in them.

Postoperative pain

DEFF Research Database (Denmark)

Kehlet, H; Dahl, J B

1993-01-01

also modify various aspects of the surgical stress response, and nociceptive blockade by regional anesthetic techniques has been demonstrated to improve various parameters of postoperative outcome. It is therefore stressed that effective control of postoperative pain, combined with a high degree......Treatment of postoperative pain has not received sufficient attention by the surgical profession. Recent developments concerned with acute pain physiology and improved techniques for postoperative pain relief should result in more satisfactory treatment of postoperative pain. Such pain relief may...

Alexithymic trait, painful heat stimulation and everyday pain experience

Directory of Open Access Journals (Sweden)

Olga ePollatos

2015-10-01

Full Text Available Background: Alexithymia was found to be associated with a variety of somatic complaints including somatoform pain symptoms. This study addressed the question of whether the different facets of alexithymia are related to responses in heat pain stimulation and its interrelations with levels of everyday pain as assessed by self report. Methods: In the study, sensitivity to heat pain was assessed in fifty healthy female participants. Alexithymia facets were assessed by the Toronto Alexithymia Scale. Pain threshold and tolerance were determined using a testing the limits procedure. Participants furthermore rated subjective intensities and unpleasantness of tonic heat stimuli (45.5 C to 47.5 C on visual analogue scales and on a questionnaire. Possible confounding with temperature sensitivity and mood was controlled. Everyday pain was assessed by self-report addressing everyday pain frequency, intensity and impairment experienced over the last two months. Results: Main results were that the facets of alexithymia were differentially associated with pain perception. The affective scale difficulties in describing feelings was associated with hyposensitivity to pain as indicated by higher pain tolerance scores. Furthermore, everyday pain frequency was related to increased alexithymia values on the affective scale difficulties in identifying feelings, whereas higher values on the cognitive alexithymia scale externally oriented thinking were related to lower pain impairment and intensity. Conclusions: We conclude that the different facets of alexithymia are related to alternations in pain processing. Further research on clinical samples is necessary to elucidate whether different aspects of alexithymia act as vulnerability factor for the development of pain symptoms.

Chinese FDI and psychic distance perceptions on regulations in the German renewable energy sector

International Nuclear Information System (INIS)

Vaccarini, Katiuscia; Lattemann, Christoph; Spigarelli, Francesca; Tavoletti, Ernesto

2017-01-01

Countries vary in dimensions such as culture, language, business practices, policy-making, regulations, etc. Research shows that distances between countries concerning these dimensions affect foreign direct investment (FDI) flows. The higher the distances, the higher the difficulties for businesses, as managers’ decision-making is based on their perception of those distances. This paper analyzes the perception of distances between China and Germany by surveying Chinese managers who invested in Germany in the renewable energy (RE) sector, using Child et al.’s (2009) measure of psychic distance (PD) as a guide. The RE sector is young and highly dynamic, and the dimensions of PD are constantly changing. Mismatches in the perception of PD ex ante and ex post the decision to engage in FDI may lead to possible FDI failure. We use a five-company multiple case study to analyze if Chinese managers perceive distances in various dimensions, particularly regulation-based, and if there is a mismatch of perceptions between the pre-market and post-market entry period to investigate if managers’ perceptions change over time. Our findings lead to recommendations for practitioners and international business scholars, and policy making in the RE sector, by showing that operationalizing the PD construct should be complemented by dynamic analysis. - Highlights: • Chinese managers investing in Germany cope with distances on various dimensions • Decision-making is based on managers’ perception of those distances • This is particularly true for the RE sector and the relative regulation-based dimensions • “Prior experience” is a moderating variable and impacts managers’ perceptions. • Literature gap: perceptions vary over time and learning effects are detected.

Correlation of digital health use and chronic pain coping strategies.

Science.gov (United States)

Ranney, Megan L; Duarte, Cassandra; Baird, Janette; Patry, Emily J; Green, Traci C

2016-01-01

Digital health is an increasingly popular tool for patient engagement, having shown great success in arenas such as medication adherence, management of chronic conditions, and patient safety. Given the growth of chronic pain diagnoses, it is imperative to find new technologies to improve care for this particular population. Little research has catalogued the use of digital health in the chronic pain patient population. This manuscript's objective was to describe current patterns of digital health usage among chronic pain patients and how digital health use correlates with health care utilization and health outcomes. A cross-sectional survey was administered to patients with a self-identified chronic pain diagnosis participating in 'Patients Like Me' ® (PLM), an organization that directly collects data from patients experiencing chronic health conditions, with emphasis on patient-centered outcomes and experiences interacting with the health care system. Validated measures of healthcare utilization, chronic pain management, and digital health use were adapted for the survey. Digital health was defined as the use of online sites, social media, and mobile phone applications before, during, or after healthcare utilization. Descriptive statistics, chi square tests, logistic regression, and linear regression were used as appropriate for analysis. Among 565 respondents (mean age 51.3, 87.2% female, 45.7% publicly insured), most participants (89.5%) reported some digital health use. Females and users below the age of 50 were more likely to use multiple forms of digital health. Healthcare utilization, education level, and race/ethnicity did not correlate with digital health use. Patients using more types of digital health reported significantly higher levels of pain coping skills in the realms of social support, relaxation, and exercise. Digital health use is common among a wide range of patients with chronic pain diagnoses. The use of multiple forms of digital health is

Chronic Pain

Science.gov (United States)

... pain. Psychotherapy, relaxation and medication therapies, biofeedback, and behavior modification may also be employed to treat chronic pain. × ... pain. Psychotherapy, relaxation and medication therapies, biofeedback, and behavior modification may also be employed to treat chronic pain. ...

Effect of pain chronification and chronic pain on an endogenous pain modulation circuit in rats.

Science.gov (United States)

Miranda, J; Lamana, S M S; Dias, E V; Athie, M; Parada, C A; Tambeli, C H

2015-02-12

We tested the hypothesis that chronic pain development (pain chronification) and ongoing chronic pain (chronic pain) reduce the activity and induce plastic changes in an endogenous analgesia circuit, the ascending nociceptive control. An important mechanism mediating this form of endogenous analgesia, referred to as capsaicin-induced analgesia, is its dependence on nucleus accumbens μ-opioid receptor mechanisms. Therefore, we also investigated whether pain chronification and chronic pain alter the requirement for nucleus accumbens μ-opioid receptor mechanisms in capsaicin-induced analgesia. We used an animal model of pain chronification in which daily subcutaneous prostaglandin E2 (PGE2) injections into the rat's hind paw for 14 days, referred to as the induction period of persistent hyperalgesia, induce a long-lasting state of nociceptor sensitization referred to as the maintenance period of persistent hyperalgesia, that lasts for at least 30 days following the cessation of the PGE2 treatment. The nociceptor hypersensitivity was measured by the shortening of the time interval for the animal to respond to a mechanical stimulation of the hind paw. We found a significant reduction in the duration of capsaicin-induced analgesia during the induction and maintenance period of persistent mechanical hyperalgesia. Intra-accumbens injection of the μ-opioid receptor selective antagonist Cys(2),Tyr(3),Orn(5),Pen(7)amide (CTOP) 10 min before the subcutaneous injection of capsaicin into the rat's fore paw blocked capsaicin-induced analgesia. Taken together, these findings indicate that pain chronification and chronic pain reduce the duration of capsaicin-induced analgesia, without affecting its dependence on nucleus accumbens μ-opioid receptor mechanisms. The attenuation of endogenous analgesia during pain chronification and chronic pain suggests that endogenous pain circuits play an important role in the development and maintenance of chronic pain. Copyright © 2014 IBRO

Sexual pain.

Science.gov (United States)

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.

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

Science.gov (United States)

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.

[Acute scrotal pain in childhood: legal pitfalls].

Science.gov (United States)

Bader, Pia; Hugemann, Christoph; Frohneberg, Detlef

2017-12-01

Acute scrotal pain in childhood is an emergency.Sudden scrotal pain may be caused by a variety of diseases. Therefore, it is important to carefully consider the specific medical history and possible differential diagnoses in each case for fast and decisive action (e. g. in case of testicular torsion). As minors lack the capacity for consent, it is absolutely necessary to obtain consent from their legal guardian. However, obtaining consent in the available time frame can cause organisational challenges in an acute emergency, which may lead to situations in the daily routine where a therapeutic decision needs to be taken (including surgery) without legal security based on consent by the guardian. In some cases, the child's consent also needs to be taken into account, depending on its age and development.For the physician and surgeon in charge, the legal evaluation of the case at hand and therewith the obtainment of legal security are of great significance. © Georg Thieme Verlag KG Stuttgart · New York.

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

Science.gov (United States)

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.

Pain-related psychological correlates of pediatric acute post-surgical pain

Directory of Open Access Journals (Sweden)

Pagé MG

2012-11-01

Full Text Available M Gabrielle Pagé,1 Jennifer Stinson,2,3 Fiona Campbell,2,4 Lisa Isaac,2,4 Joel Katz1,4,51Department of Psychology, Faculty of Health, York University, 2Department of Anesthesia and Pain Medicine, Hospital for Sick Children, 3Lawrence S Bloomberg Faculty of Nursing, University of Toronto, 4Department of Anesthesia, Faculty of Medicine, University of Toronto, 5Department of Psychology, Hospital for Sick Children, Toronto, ON, CanadaBackground: Post-surgical pain is prevalent in children, yet is significantly understudied. The goals of this study were to examine gender differences in pain outcomes and pain-related psychological constructs postoperatively and to identify pain-related psychological correlates of acute post-surgical pain (APSP and predictors of functional disability 2 weeks after hospital discharge.Methods: Eighty-three children aged 8–18 (mean 13.8 ± 2.4 years who underwent major orthopedic or general surgery completed pain and pain-related psychological measures 48–72 hours and 2 weeks after surgery.Results: Girls reported higher levels of acute postoperative anxiety and pain unpleasantness compared with boys. In addition, pain anxiety was significantly associated with APSP intensity and functional disability 2 weeks after discharge, whereas pain catastrophizing was associated with APSP unpleasantness.Conclusion: These results highlight the important role played by pain-related psychological factors in the experience of pediatric APSP by children and adolescents.Keywords: acute post-surgical pain, children, adolescents, pain anxiety, pain catastrophizing

Prognostic factors for duration of sick leave in patients sick listed with acute low back pain: a systematic review of the literature

NARCIS (Netherlands)

Steenstra, I. A.; Verbeek, J. H.; Heymans, M. W.; Bongers, P. M.

2005-01-01

Background: The percentages of patients with acute low back pain ( LBP) that go on to a chronic state varies between studies from 2% to 34%. In some of these cases low back pain leads to great costs. Aims: To evaluate the evidence for prognostic factors for return to work among workers sick listed

Prognostic factors for duration of sick leave in patients sick listed with acute low back pain: a systematic review of the literature

NARCIS (Netherlands)

Steenstra, I.A.; Verbeek, J.H.A.M.; Heymans, M.W.; Bongers, P.M.

2005-01-01

BACKGROUND: The percentages of patients with acute low back pain (LBP) that go on to a chronic state varies between studies from 2% to 34%. In some of these cases low back pain leads to great costs. AIMS: To evaluate the evidence for prognostic factors for return to work among workers sick listed

Prognostic factors for duration of sick leave in patients sick listed with acute low back pain: A systematic review of the literature

NARCIS (Netherlands)

Steenstra, I.A.; Verbeek, J.H.; Heymans, M.W.; Bongers, P.M.

2005-01-01

Background: The percentages of patients with acute low back pain (LBP) that go on to a chronic state varies between studies from 2% to 34%. In some of these cases low back pain leads to great costs. Aims: To evaluate the evidence for prognostic factors for return to work among workers sick listed

The Fear of Movement/Pain in Musculoskeletal Pain-A Review

Directory of Open Access Journals (Sweden)

Behnam Akhbari

2012-07-01

Full Text Available Objective: To investigate and review psychological influences of pain such as kinesiophobia and pain-related fear on patients with musculoskeletal pain and on rehabilitation outcomes. Materials & Methods: Fear is a universal and powerful emotion and, as a result, it can have a profound impact on human behavior. the fear-motivated behavior has the potential to adversely impact rehabilitation outcomes for patients with musculoskeletal pain. cross-sectional studies consistently documented a positive association between elevated pain-related fear and increased pain intensity and disability. in addition, several longitudinal studies indicated that elevated pain-related fear is a precursor to poor clinical outcomes. existence of catastrophizing in patients effect on the fear of movement/ (reinjury. this fear contributes to avoidance behaviors and subsequent disuse, depression, and disability. it has been established that kinesiophobia plays a negative role in the outcome of the rehabilitation of acute and chronic low back pain, chronic fatigue syndrome and fibromyalgia syndrome. Results: The recent studies suggest that physical therapists should consider the role of pain-related fear and avoidance behaviors in patients' function and they should assess these cognitive and behavioral factors. or (physical therapists should assess pain-related fear when rehabilitating certain individuals with musculoskeletal pain. currently, there is a lot of evidence for the assessment of pain-related fear in patients with musculoskeletal pain. self-report questionnaires are readily available for assessment and investigation of pain-related fear and several studies have found support for their validity and reliability. recent research indicated that besides fear-avoidance responses, endurance-related responses lead to chronic pain via physical overload. the existence of mental kinesiophobia has been established in patients with chronic stress complaints, and this

Attitude and Intention Regarding Pain Management among Chinese Nursing Students: A Cross-Sectional Questionnaire Survey.

Science.gov (United States)

Fang, Liang-Yu; Xu, Yin-Chuan; Lin, Dan-Ni; Jin, Jing-Feng; Yan, Min

2017-08-01

Optimal pain management is a priority in effective nursing care. Lack of sufficient pain knowledge associated with inadequate pain management has been proved. However, the intention, defined as the predictor of behavior, regarding pain management remains unknown. Therefore, the study was to determine the attitude and intention regarding pain management among Chinese nursing students and investigate the underlying determinants and their interactions in terms of intention toward pain management. The Pain Management Survey Questionnaire, comprising the key determinants of the theory of planned behavior-that is, direct attitude, belief-based intention, subjective norm, direct control, and indirect control-was used to collect data from 512 nursing students who undertook clinical rotation in an affiliated hospital of a medical college in China. Data were analyzed using descriptive statistics, independent sample t test, Pearson correlation analysis, or structural equation modeling analysis. Chinese nursing students reported negative attitudes and behavioral intentions toward pain management. Direct control, subjective norm, belief-based attitude, and indirect control independently predicted nursing students' intention to treat patients with pain. Direct control was the strongest predictor. Structural equation modeling analysis further revealed 39.84% of the variance associated with intention that could be explained by determinants of the theory of planned behavior. Additionally, educational school level and previous pain management training had great effects on pain management intention. Overall, this study identified intention as an important factor in effective pain treatment. Chinese nursing students have negative attitudes and insufficient intention to pain management. Therefore, hospitals and universities in China should manage these factors to improve nursing students' practice regarding pain management. Copyright © 2017 American Society for Pain Management Nursing

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

Science.gov (United States)

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

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

Science.gov (United States)

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.

Endovenous laser ablation of the great saphenous vein using a bare fibre versus a tulip fibre: a randomised clinical trial.

Science.gov (United States)

Vuylsteke, M E; Thomis, S; Mahieu, P; Mordon, S; Fourneau, I

2012-12-01

This clinical trial aimed to evaluate the clinical results of the use of a tulip fibre versus the use of a bare fibre for endovenous laser ablation. In a multicentre prospective randomised trial 174 patients were randomised for the treatment of great saphenous vein reflux. A duplex scan was scheduled 1 month, 6 months and 1 year postoperatively. Ecchymosis was measured on the 5th postoperative day. In addition, pain, analgesics requirement, postoperative quality of life (CIVIQ 2) and patient satisfaction rate were noted. Patients treated with a tulip fibre had significantly less postoperative ecchymosis (0.04 vs. 0.21; p tulip fibre for EVLA of the great saphenous vein results, when compared with the use of a bare fibre, in equal occlusion rates at 1 year but causes less postoperative ecchymosis and pain and in a better postoperative quality of life. Copyright © 2012 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

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

Science.gov (United States)

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 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.

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

Science.gov (United States)

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.

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

Science.gov (United States)

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.

Results of comparative evaluations concerning the psychic process of perceiving and assessing risk-objects by the general public

International Nuclear Information System (INIS)

Peters, H.P.; Renn, O.

1983-01-01

The perception of risk has become a mayor research field, after scientists and politicians recognized that scientific risk studies like the Rasmussen-Report on nuclear energy had no large impact on the public acceptance. With our surveys we aimed to combine two methodological approaches (object perception and attitude theory) and to develop a technique in which the psychic process of perceiving and assessing risk-objects by the general public was followed up and analyzed. Psychological experiments in the field of isolating relevant factors of qualitative risk properties as well as demographic surveys for the measurement of the belief structure were carried out. Our results indicate that in objection to the common conception by natural scientists people in general have a good estimative ability to judge the expected value of different risks. But beyond this estimation of fatalities people also use other criteria (like personal control) to order different objects in respect to their riskiness. The perceived risk is but one factor influencing attitude. A simplified model of the acceptance-building process is carried out showing that acceptance-building is not a purely individual process. Individuals are linked together by their social environment so that every individual decision is influenced by the decision of other people

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

Science.gov (United States)

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.

Suprathreshold Heat Pain Response Predicts Activity-Related Pain, but Not Rest-Related Pain, in an Exercise-Induced Injury Model

Science.gov (United States)

Coronado, Rogelio A.; Simon, Corey B.; Valencia, Carolina; Parr, Jeffrey J.; Borsa, Paul A.; George, Steven Z.

2014-01-01

Exercise-induced injury models are advantageous for studying pain since the onset of pain is controlled and both pre-injury and post-injury factors can be utilized as explanatory variables or predictors. In these studies, rest-related pain is often considered the primary dependent variable or outcome, as opposed to a measure of activity-related pain. Additionally, few studies include pain sensitivity measures as predictors. In this study, we examined the influence of pre-injury and post-injury factors, including pain sensitivity, for induced rest and activity-related pain following exercise induced muscle injury. The overall goal of this investigation was to determine if there were convergent or divergent predictors of rest and activity-related pain. One hundred forty-three participants provided demographic, psychological, and pain sensitivity information and underwent a standard fatigue trial of resistance exercise to induce injury of the dominant shoulder. Pain at rest and during active and resisted shoulder motion were measured at 48- and 96-hours post-injury. Separate hierarchical models were generated for assessing the influence of pre-injury and post-injury factors on 48- and 96-hour rest-related and activity-related pain. Overall, we did not find a universal predictor of pain across all models. However, pre-injury and post-injury suprathreshold heat pain response (SHPR), a pain sensitivity measure, was a consistent predictor of activity-related pain, even after controlling for known psychological factors. These results suggest there is differential prediction of pain. A measure of pain sensitivity such as SHPR appears more influential for activity-related pain, but not rest-related pain, and may reflect different underlying processes involved during pain appraisal. PMID:25265560

What (if anything) is shared in pain empathy?

DEFF Research Database (Denmark)

Michael, John Andrew; Fardo, Francesca

2014-01-01

There is currently a great deal of debate in philosophy and cognitive neuroscience about how best to conceptualize empathy, with much of the controversy centering on the issue of how to articulate the common intuition that empathy involves the sharing of emotional experiences. In a recent paper...... in Philosophy of Science, De Vignemont and Jacob (2012) defend the view that empathy involves interpersonal similarity between an empathizer and a target person with respect to their internal affective states. To support this, they home in on a specific type of empathy, namely empathy for pain, and propose...... a theory of the neural substrate of pain empathy. We point out several flaws in their interpretation of the data, and argue that currently available data does not differentiate between De Vignemont and Jacob’s model of empathy and alternative models. Finally, we offer some suggestions about how this might...

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

OpenAIRE

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

2016-01-01

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 acti...

PAIN INTENSITY AND PAIN INTERFERENCE AMONG TRAUMA PATIENTS: A LITERATURE REVIEW

Directory of Open Access Journals (Sweden)

Deya Prastika

2016-12-01

Full Text Available Background: The incidence of trauma has been high and has gained attention worldwide. The energy involved in trauma results in specific tissue damage. Such tissue damage generally leads to pain. The high pain intensity possibly is consequence of trauma due to transfer energy to the body from external force and absorbed in wide area. This pain affected patients’ physical and psychological function, in which well known as pain interference. Objective: The aim of this review is to describe the pain intensity and pain interference among trauma patients. Method: A systematic search of electronic databases (CINHAL, ProQuest, Science Direct, and Google scholar was conducted for quantitative and qualitative studies measuring pain intensity and pain interference. The search limited to hospitalized trauma patients in adult age. Results: The search revealed 678 studies. A total of 10 descriptive studies examined pain intensity and pain interference and met inclusion criteria. The pain intensity and pain interference was assessed using Brief Pain Inventory (BPI. Pain intensity of hospitalized trauma patients were moderate to severe. These including 6 studies in orthopedic trauma, one study in musculoskeletal, two in studies in combinational between orthopedic and musculoskeletal, and two studies in burn injury. Moreover, the patients also reported pain was relentless & unbearable. In accordance, data showed that pain interference was moderate to severe from six studies. These studies result in vary of functional interference. However, those studies examined pain interference on sleep, enjoyment of life, mood, relationship with other, walking, general activity, and walking. Conclusion: The evidence from 10 studies included in this review indicates that hospitalized trauma patients perceived moderate to severe pain intensity and pain interference. Further research is needed to better evaluate the pain of hospitalized trauma patients.

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

Science.gov (United States)

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.

Suprascapular block in the therapy of chronic pain in the shoulder and the shoulder joint: Suprascapular block

Directory of Open Access Journals (Sweden)

Palibrk Ivan

2016-01-01

Full Text Available Introduction: Chronic pain in the shoulder and the shoulder joint is a very common pathology in modern human population. The etiology of chronic pain is often unknown, although the trauma, degenerative diseases, inflammation, tumors and neurological disease appear as common etiologic factors. Patients with this pain had a significantly reduced quality of life.1,2 Method: During the two years, twelve patients diagnosed painful shoulder syndrome. Eleven of the twelve patients involved in the study had started physical therapy. Under the physical treatment pain intensity decreased, but not completely. Hand had reduced mobility. We applied a suprascapular block. We used 1 ml (7 mg betamethasone. Results: Suprascapular block was applied to the eleven patients in physical therapy. After three days of application, the pain was significantly reduced, by 50% in seven patients. Mobility of the hand was greatly improved. In three of the remaining four patients the block was repeated after one month. The pain was significantly smaller after that. Physical therapy is done all the time. Conclusion: The treatment of chronic pain in the shoulder and the shoulder joint is multidisciplinary. In some cases, the use of corticosteroids suprascapular block is very useful.

Biobehavioral pain profile in individuals with chronic spine pain.

Science.gov (United States)

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.

Entre a Arte e a Psicanálise: a melancolia em Edvard Munch.

Directory of Open Access Journals (Sweden)

Mariana Rodrigues Festucci Ferreira

2015-07-01

Full Text Available This text proposes a dialogue between the fields of Art and Psychoanalysis and their relationship with the pathos from the “pain of existence” in Edvard Munch. It is known that the “pain of existence” is present in all psychic structures, but it is sung at full power by the melancholic individual. In Edvard Munch, “the pain of existence”, more than being outlined in his work, is the fermenting component of his own life, his leitmotiv, as demonstrated in this paper that represents a summary of a research developed in the context of the specialization “Psychoanalysis and Language” at the Pontifical Catholic University of São Paulo (PUC-SP.

Measuring pain self-efficacy and health related quality of life among hemodialysis patients in Greece: a cross-sectional study

Directory of Open Access Journals (Sweden)

Paraskevi Theofilou

2013-09-01

Full Text Available Patients suffering from end-stage kidney disease often complain about pain. It is also known that the presence of chronic pain greatly impacts upon patients’ quality of life (QOL and can play a crucial role in the co-morbidity of mental health symptoms such as depression and anxiety. The main aim of this study protocol is the investigation of pain self-efficacy, QOL as well as their relation in patients undergoing hemodialysis treatment. The final sample size will be around 70-80 patients. Each subject’s QOL and pain self-efficacy will be measured using the following instruments: i the Missoula-ITAS Quality of Life Index-15 and ii the Pain Self-Efficacy Questionnaire. QOL is expected to be related to pain self-efficacy scores. This probable association will be indicated performing regression as well as correlation analysis after controlling for gender, age, education and marital status.

Mitigating the risk of opioid abuse through a balanced undergraduate pain medicine curriculum

Directory of Open Access Journals (Sweden)

Morley-Forster PK

2013-12-01

Full Text Available Patricia K Morley-Forster,1,2 Joseph V Pergolizzi,3–5 Robert Taylor Jr,5 Robert A Axford-Gatley,6 Edward M Sellers71Department of Anesthesia and Perioperative Medicine, University of Western Ontario, London, ON, Canada; 2Outpatient Pain Clinic, St Joseph’s Hospital, London, ON, Canada; 3Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; 4Department of Pharmacology, Temple University School of Medicine, Philadelphia, PA, USA; 5NEMA Research Inc, Naples, FL, USA; 6Clinical Content and Editorial Services, Complete Healthcare Communications, Inc, Chadds Ford, PA, USA; 7DL Global Partners Inc, Toronto, ON, CanadaAbstract: Chronic pain is highly prevalent in the United States and Canada, occurring in an estimated 30% of the adult population. Despite its high prevalence, US and Canadian medical schools provide very little training in pain management, including training in the safe and effective use of potent analgesics, most notably opioids. In 2005, the International Association for the Study of Pain published recommendations for a core undergraduate pain management curriculum, and several universities have implemented pilot programs based on this curriculum. However, when outcomes have been formally assessed, these initiatives have resulted in only modest improvements in physician knowledge about chronic pain and its treatment. This article discusses strategies to improve undergraduate pain management curricula and proposes areas in which those efforts can be augmented. Emphasis is placed on opioids, which have great potency as analgesics but also substantial risks in terms of adverse events and the risk of abuse and addiction. The authors conclude that the most important element of an undergraduate pain curriculum is clinical experience under mentors who are capable of reinforcing didactic learning by modeling best practices.Keywords: chronic pain, curricular content, medical education, opioids, pain

Pain: metaphor, body, and culture in Anglo-American societies between the eighteenth and twentieth centuries.

Science.gov (United States)

Bourke, Joanna

2014-10-02

This article explores the relationship between metaphorical languages, body, and culture, and suggests that such an analysis can reveal a great deal about the meaning and experience of pain in Anglo-American societies between the eighteenth and twentieth centuries. It uses concepts within embodied cognition to speculate on how historians can write a history of sensation. Bodies are actively engaged in the linguistic processes and social interactions that constitute painful sensations. Language is engaged in a dialogue with physiological bodies and social environments. And culture collaborates in the creation of physiological bodies and metaphorical systems.

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

Science.gov (United States)

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.

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

Science.gov (United States)

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 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 axioscapular and trunk muscle activity in addition to widespread decrease in pressure pain sensitivity. © 2016 European Pain Federation - EFIC®.

Cancer Pain Physiology

DEFF Research Database (Denmark)

Falk, Sarah; Bannister, Kirsty; Dickenson, Anthony

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...

Pain during mammography: Possible risk factors and ways to alleviate pain

International Nuclear Information System (INIS)

Davey, Belinda

2007-01-01

This article reviews the literature surrounding the issue of pain experienced during mammography. This is an important topic since many women may refuse screening mammograms due to the possibility of a painful examination. It is a difficult area to research since the experience of pain is by nature subjective and the manner by which data have been collected has varied with many different pain assessment instruments being utilised. Accordingly there is wide variation in the degree of pain felt from only slight pain to some women finding it acutely painful. To discover why some women find it so painful certain risk factors that have been associated with painful mammography are explored. There are many of these risk factors but this article concentrates on three main areas: biological, psychological and staff-related. Once the reasons why some women experience such acute pain, ways to ease this may be found. Methods to alleviate painful mammography are suggested and discussed. The article concludes that there is a wide variance in the data collection techniques which could account for the wide variance in the reported pain. More research is required using a validated pain measurement to establish the extent of pain and to establish the effect of this on future compliance

Conditioned pain modulation and situational pain catastrophizing as preoperative predictors of pain following chest wall surgery: a prospective observational cohort study.

Directory of Open Access Journals (Sweden)

Kasper Grosen

Full Text Available 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.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.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.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 phase. These findings may have

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

Science.gov (United States)

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

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

Science.gov (United States)

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

Implicit associations between pain and self-schema in patients with chronic pain.

Science.gov (United States)

Van Ryckeghem, Dimitri M L; De Houwer, Jan; Van Bockstaele, Bram; Van Damme, Stefaan; De Schryver, Maarten; Crombez, Geert

2013-12-01

Chronic pain often interferes with daily functioning, and may become a threat to an individual's sense of self. Despite the development of a recent theoretical account focussing upon the relationship between the presence of chronic pain and a person's self, research investigating this idea is limited. In the present study we aimed to (1) compare the strength of association between self- and pain schema in patients with chronic pain and healthy control subjects and (2) research whether the strength of association between self- and pain-schema is related to particular pain-related outcomes and individual differences of patients with chronic pain. Seventy-three patients with chronic pain (M(age) = 49.95; SD = 9.76) and 53 healthy volunteers (M(age) = 48.53; SD = 10.37) performed an Implicit Association Test (IAT) to assess the strength of association between pain- and self-schema. Patients with chronic pain also filled out self-report measures of pain severity, pain suffering, disability, depression, anxiety, acceptance, and helplessness. Results indicated that the pain- and self-schema were more strongly associated in patients with chronic pain than in healthy control subjects. Second, results indicated that, in patients with chronic pain, a stronger association between self- and pain-schema, as measured with the IAT, is related to a heightened level of pain severity, pain suffering, anxiety, and helplessness. Current findings give first support for the use of an IAT to investigate the strength of association between self- and pain-schema in patients with chronic pain and suggest that pain therapies may incorporate techniques that intervene on the level of self-pain enmeshment. Copyright © 2013 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

Prediction of pain in orthodontic patients based on preoperative pain assessment

Science.gov (United States)

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 (P0.05). 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

Comparison of complementary and alternative medicine with conventional mind-body therapies for chronic back pain: protocol for the Mind-body Approaches to Pain (MAP) randomized controlled trial.

Science.gov (United States)

Cherkin, Daniel C; Sherman, Karen J; Balderson, Benjamin H; Turner, Judith A; Cook, Andrea J; Stoelb, Brenda; Herman, Patricia M; Deyo, Richard A; Hawkes, Rene J

2014-06-07

The self-reported health and functional status of persons with back pain in the United States have declined in recent years, despite greatly increased medical expenditures due to this problem. Although patient psychosocial factors such as pain-related beliefs, thoughts and coping behaviors have been demonstrated to affect how well patients respond to treatments for back pain, few patients receive treatments that address these factors. Cognitive-behavioral therapy (CBT), which addresses psychosocial factors, has been found to be effective for back pain, but access to qualified therapists is limited. Another treatment option with potential for addressing psychosocial issues, mindfulness-based stress reduction (MBSR), is increasingly available. MBSR has been found to be helpful for various mental and physical conditions, but it has not been well-studied for application with chronic back pain patients. In this trial, we will seek to determine whether MBSR is an effective and cost-effective treatment option for persons with chronic back pain, compare its effectiveness and cost-effectiveness compared with CBT and explore the psychosocial variables that may mediate the effects of MBSR and CBT on patient outcomes. In this trial, we will randomize 397 adults with nonspecific chronic back pain to CBT, MBSR or usual care arms (99 per group). Both interventions will consist of eight weekly 2-hour group sessions supplemented by home practice. The MBSR protocol also includes an optional 6-hour retreat. Interviewers masked to treatment assignments will assess outcomes 5, 10, 26 and 52 weeks postrandomization. The primary outcomes will be pain-related functional limitations (based on the Roland Disability Questionnaire) and symptom bothersomeness (rated on a 0 to 10 numerical rating scale) at 26 weeks. If MBSR is found to be an effective and cost-effective treatment option for patients with chronic back pain, it will become a valuable addition to the limited treatment options

The relationship between ethnicity and the pain experience of cancer patients: A systematic review

Directory of Open Access Journals (Sweden)

Wingfai Kwok

2014-01-01

Full Text Available Background: Cancer pain is a complex multidimensional construct. Physicians use a patient-centered approach for its effective management, placing a great emphasis on patient self-reported ratings of pain. In the literature, studies have shown that a patient′s ethnicity may influence the experience of pain as there are variations in pain outcomes among different ethnic groups. At present, little is known regarding the effect of ethnicity on the pain experience of cancer patients; currently, there are no systematic reviews examining this relationship. Materials and Methods: A systematic search of the literature in October 2013 using the keywords in Group 1 together with Group 2 and Group 3 was conducted in five online databases (1 Medline (1946-2013, (2 Embase (1980-2012, (3 The Cochrane Library, (4 Pubmed, and (5 Psycinfo (1806-2013. The search returned 684 studies. Following screening by inclusion and exclusion criteria, the full text was retrieved for quality assessment. In total, 11 studies were identified for this review. The keywords used for the search were as follows: Group 1-Cancer; Group 2- Pain, Pain measurement, Analgesic, Analgesia; Group 3- Ethnicity, Ethnic Groups, Minority Groups, Migrant, Culture, Cultural background, Ethnic Background. Results: Two main themes were identified from the included quantitative and qualitative studies, and ethnic differences were found in: (1 The management of cancer pain and (2 The pain experience. Six studies showed that ethnic groups face barriers to pain treatment and one study did not. Three studies showed ethnic differences in symptom severity and one study showed no difference. Interestingly, two qualitative studies highlighted cultural differences in the perception of cancer pain as Asian patients tended to normalize pain compared to Western patients who engage in active health-seeking behavior. Conclusion: There is an evidence to suggest that the cancer pain experience is different between

Translational pain research: evaluating analgesic effect in experimental visceral pain models

DEFF Research Database (Denmark)

Olesen, Anne Estrup; Andresen, Trine; Christrup, Lona Louring

2009-01-01

Deep visceral pain is frequent and presents major challenges in pain management, since its pathophysiology is still poorly understood. One way to optimize treatment of visceral pain is to improve knowledge of the mechanisms behind the pain and the mode of action of analgesic substances. This can ...... studies and clinical condition in patients suffering from visceral pain, and thus constitute the missing link in translational pain research.......Deep visceral pain is frequent and presents major challenges in pain management, since its pathophysiology is still poorly understood. One way to optimize treatment of visceral pain is to improve knowledge of the mechanisms behind the pain and the mode of action of analgesic substances. This can...... facilitate minimizing the gap between knowledge gained in animal and human clinical studies. Combining experimental pain studies and pharmacokinetic studies can improve understanding of the pharmacokinetic-pharmacodynamic relationship of analgesics and, thus, provide valuable insight into optimal clinical...

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

Science.gov (United States)

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.

Differences in Pain Processing Between Patients with Chronic Low Back Pain, Recurrent Low Back Pain, and Fibromyalgia.

Science.gov (United States)

Goubert, Dorien; Danneels, Lieven; Graven-Nielsen, Thomas; Descheemaeker, Filip; Meeus, Mira

2017-05-01

The impairment in musculoskeletal structures in patients with low back pain (LBP) is often disproportionate to their complaint. Therefore, the need arises for exploration of alternative mechanisms contributing to the origin and maintenance of non-specific LBP. The recent focus has been on central nervous system phenomena in LBP and the pathophysiological mechanisms underlying the various symptoms and characteristics of chronic pain. Knowledge concerning changes in pain processing in LBP remains ambiguous, partly due to the diversity in the LBP population. The purpose of this study is to compare quantitative sensory assessment in different groups of LBP patients with regard to chronicity. Recurrent low back pain (RLBP), mild chronic low back pain (CLBP), and severe CLBP are compared on the one hand with healthy controls (HC), and on the other hand with fibromyalgia (FM) patients, in which abnormal pain processing has previously been reported. Cross-sectional study. Department of Rehabilitation Sciences, Ghent University, Belgium. Twenty-three RLBP, 15 mild CLBP, 16 severe CLBP, 26 FM, and 21 HC participated in this study. Quantitative sensory testing was conducted by manual pressure algometry and computer-controlled cuff algometry. A manual algometer was used to evaluate hyperalgesia as well as temporal summation of pain and a cuff algometer was used to evaluate deep tissue hyperalgesia, the efficacy of the conditioned pain modulation and spatial summation of pain. Pressure pain thresholds by manual algometry were significantly lower in FM compared to HC, RLBP, and severe CLBP. Temporal summation of pain was significantly higher in FM compared to HC and RLBP. Pain tolerance thresholds assessed by cuff algometry were significantly lower in FM compared to HC and RLBP and also in severe CLBP compared to RLBP. No significant differences between groups were found for spatial summation or conditioned pain modulation. No psychosocial issues were taken into account for this

The differences of brain cortical activation between superficial pain and deep pain

International Nuclear Information System (INIS)

Ikemoto, Tatsunori; Ushida, Takahiro; Taniguchi, Shinichirou; Tani, Toshikazu; Morio, Kazuo; Sasaki, Toshikazu; Tanaka, Shigeki

2006-01-01

Using functional magnetic resonance imaging (FMRI) technology, we investigated the difference of pain related brain cortical activation derived from noxious stimulation to the skin and muscular tissue. Ten healthy volunteers who have no history of brain vascular disease were enrolled in this study. A cutaneous pain was provoked by isotonic (0.9%) saline injection into intra-dermal space on right lower leg through 24G plastic catheter, and a muscle pain was provoked by hypertonic (3%) saline injection into right tibialis anterior muscle. We used event-related FMRI to measure brain activity during each injection. Visual analogue scale (VAS) was used to quantify pain intensity and unpleasantness, and pain quality was assessed with several verbal descriptions. Pain unpleasantness rating was higher in the muscle pain compared to the cutaneous pain, despite the same pain intensity rating. The cutaneous pain had more acute pain onset than the muscle pain. Pain duration after stimulation was short in the cutaneous pain, but long in the muscle pain. The extent of the painful region tended to be larger with the muscle pain, but there was no statistical significance. Evoked FMRI response from the cutaneous pain showed distinct brain activation in the inferior and superior parietal cortex (BA: Brodmann area 5/7/40), primary and secondary somatosensory cortex (S1 and S2), insula, supplementary motor area (SMA, BA6), posterior cingulate cortex and cerebellum. On the other hand, FMRI response from muscle pain showed distinct brain activation mainly in the contralateral insula. These results suggest that the parietal lobe including the S1 is the essential area for cognition of sharp and well-localized pain conditions such as cutaneous pain, and may not be essential for cognition of diffuse pain derived from muscular tissue. (author)

Characterizing the Pain Narratives of Parents of Youth with Chronic Pain

Science.gov (United States)

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

Nursing leadership in a chronic pain management group approach.

Science.gov (United States)

Dysvik, Elin; Furnes, Bodil

2012-03-01

To explore and debate nursing leadership and challenges on organizational and group levels when conducting rehabilitation groups for people suffering from chronic pain. Group approaches based on cognitive behavioural therapy are generally described as effective. Leadership in group approaches offered to people suffering from chronic pain is a great challenge for nurses on an organizational as well as a group level. One overall leader and nine group leaders conducting 13 groups constituted the sample. Qualitative content analysis was used by identifying categories, subthemes and themes. The results from the content analysis revealed one main theme ('Complexity in nursing leadership') and three subthemes ('Challenges in leadership on organizational level', 'Challenges in leadership on teamwork level' and 'Challenges in leadership on group level'. The results show how important it is to have firm overall leadership and trained group leaders with a common purpose, interdependent roles and complementary skills, who are thus well prepared to prevent or deal with challenging group processes. The leaders of both levels, which are highly interrelated, should have a current theoretical understanding of pain theory, group leadership skills and a cognitive behavioural approach. © 2012 Blackwell Publishing Ltd.

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

Science.gov (United States)

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.

Behaviours and beliefs about pain and treatment among Chinese immigrants and New Zealand Europeans.

Science.gov (United States)

Ho, Ping Carolyn; Johnson, Malcolm H

2013-03-01

To investigate how pain is construed and managed across Western and Chinese cultures. Adults from the general public completed an anonymous survey developed for this study. Participants responded to recruitment posters and handouts that were distributed to Auckland community centres, libraries and relevant social organisations. 165 participants were recruited with slightly more Chinese respondents (57.0%). 128 participants (77.5%) reported having experienced persistent pain which did not recover within expected periods in the last 5 years, and occurred more among Chinese (60.2%) than New Zealand Europeans (39.8%). Pain behaviours and coping strategies were found to be significantly different between Europeans and Chinese. However, differences in perceptions regarding pain and treatment were not substantial. Interestingly, for both cultures some participants reported behaving differently than expected according to their perceptions. Acculturation levels, however, did not show any great impact on Chinese immigrants. The high incidence of persistent pain reported in the study compared to random population surveys suggest individuals who had pain experiences were more likely to respond to the study. It is evident that culture plays an important role in determining various aspects of pain experience and response, although further investigation using randomised samples instead of self-selected survey populations is required to clarify the picture. The effect of acculturation levels particularly should be further investigated.

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

Science.gov (United States)

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.

Chronic abdominal wall pain misdiagnosed as functional abdominal pain.

Science.gov (United States)

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.

Pain and Nociception

DEFF Research Database (Denmark)

Falk, Sarah; Dickenson, Anthony H

2014-01-01

Cancer pain, especially pain caused by metastasis to bone, is a severe type of pain, and unless the cause and consequences can be resolved, the pain will become chronic. As detection and survival among patients with cancer have improved, pain has become an increasing challenge, because traditiona...

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

Science.gov (United States)

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.

Bone pain

DEFF Research Database (Denmark)

Frost, Charlotte Ørsted; Hansen, Rikke Rie; Heegaard, Anne-Marie

2016-01-01

Skeletal conditions are common causes of chronic pain and there is an unmet medical need for improved treatment options. Bone pain is currently managed with disease modifying agents and/or analgesics depending on the condition. Disease modifying agents affect the underlying pathophysiology...... of the disease and reduce as a secondary effect bone pain. Antiresorptive and anabolic agents, such as bisphosphonates and intermittent parathyroid hormone (1-34), respectively, have proven effective as pain relieving agents. Cathepsin K inhibitors and anti-sclerostin antibodies hold, due to their disease...... modifying effects, promise of a pain relieving effect. NSAIDs and opioids are widely employed in the treatment of bone pain. However, recent preclinical findings demonstrating a unique neuronal innervation of bone tissue and sprouting of sensory nerve fibers open for new treatment possibilities....

A survey of Canadian cancer patients' perspectives on the characteristics and treatment of breakthrough pain.

Science.gov (United States)

Bedard, Gillian; Hawley, Philippa; Zhang, Liying; Slaven, Marissa; Gagnon, Pierre; Bisland, Stuart; Bennett, Margaret; Tardif, Francois; Chow, Edward

2013-09-01

Breakthrough pain is defined as a transient exacerbation of pain that occurs spontaneously or in response to a trigger despite stable and controlled background pain. The purpose of this study was to explore Canadian patients' awareness of and experience with breakthrough pain in cancer (BTPc). Four Canadian cancer centers participated in a non-interventional survey recruiting cancer patients who experienced breakthrough pain. These patients were asked about their pain, its impact on functioning, current management and interest in new treatments of BTPc. Ninety-four Canadian cancer patients participated in this study, with 96% stating that cancer pain impacted their daily living with over half unable to go to work or shopping. Fifty percent of patients said that an episode of BTPc lasted greater than 60 minutes, with the pain score being on average 7.8/10, impacting normal work (7.2/10) and general activity (7.1/10). Only 35% of patients were very satisfied with the speed of relief of their medications. Those who did not take their breakthrough pain medication for every episode stated that was because the pain was not always severe (37%), or they were afraid of becoming tolerant (23%) or addicted (12%). Patients stated that the most important features of a new treatment for BTPc were the ability to relieve pain completely (47%), and quickly (43%). Patients expressed willingness to try transmucosal products (80%) or nasal products (59%). Breakthrough cancer pain in Canadian cancer patients greatly impacts their daily lives. There is room for improvement in the management of BTPc, and the majority of patients would be willing to try new treatments.

Pain patterns and descriptions in patients with radicular pain: Does the pain necessarily follow a specific dermatome?

Directory of Open Access Journals (Sweden)

Hurwitz Eric L

2009-09-01

Full Text Available Abstract Background It is commonly stated that nerve root pain should be expected to follow a specific dermatome and that this information is useful to make the diagnosis of radiculopathy. There is little evidence in the literature that confirms or denies this statement. The purpose of this study is to describe and discuss the diagnostic utility of the distribution of pain in patients with cervical and lumbar radicular pain. Methods Pain drawings and descriptions were assessed in consecutive patients diagnosed with cervical or lumbar nerve root pain. These findings were compared with accepted dermatome maps to determine whether they tended to follow along the involved nerve root's dermatome. Results Two hundred twenty-six nerve roots in 169 patients were assessed. Overall, pain related to cervical nerve roots was non-dermatomal in over two-thirds (69.7% of cases. In the lumbar spine, the pain was non-dermatomal in just under two-thirds (64.1% of cases. The majority of nerve root levels involved non-dermatomal pain patterns except C4 (60.0% dermatomal and S1 (64.9% dermatomal. The sensitivity (SE and specificity (SP for dermatomal pattern of pain are low for all nerve root levels with the exception of the C4 level (Se 0.60, Sp 0.72 and S1 level (Se 0.65, Sp 0.80, although in the case of the C4 level, the number of subjects was small (n = 5. Conclusion In most cases nerve root pain should not be expected to follow along a specific dermatome, and a dermatomal distribution of pain is not a useful historical factor in the diagnosis of radicular pain. The possible exception to this is the S1 nerve root, in which the pain does commonly follow the S1 dermatome.

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

Science.gov (United States)

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.

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

Science.gov (United States)

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

Case of thyroid cancer with bone metastasis greatly ameliorated by radiotherapy

Energy Technology Data Exchange (ETDEWEB)

Tanaka, Reiko; Hara, Hisato; Hukumitsu, Masayuki; Kamisasa, Isao; Tanaka, Kiyoshi; Miyanaga, Yutaka; Ben, Morikatsu; Asahara, Akira; Hayakawa, Kinya

1988-01-01

A 53-year-old woman complaining of a cervical mass and intractable lumbago was admitted to the hospital. Eight years ago she had a tumor in her left thyroid lobe enucleated and it proved to be a microfollicular adenoma. This time she underwent total thyroidectomy under the diagnosis of thyroid cancer with vertebral metastasis and this was followed by /sup 131/I therapy but severe lumbago remained unchanged. Irradiation to the lumbar vertebra was added and this greatly relieved her from pain. Pathological examination revealed poorly differentiated thyroid carcinoma. We suppose that the unusually excellent radiosensitivity of this bone metastasis was attributable to its histopathological nature.

Chronic pelvic pain syndrome: role of a thorough clinical assessment.

Science.gov (United States)

Quaghebeur, Jörgen; Wyndaele, Jean-Jacques

2015-04-01

Chronic pelvic pain syndrome (CPPS) presents with a variety of symptoms affecting multiple systems. There is no universal treatment that can be given to all patients with CPPS. The results of treatment depend greatly on an accurate diagnosis. A thorough clinical assessment, including a "four-step plan", should include paying special attention to the musculoskeletal system. This assessment is not difficult to perform and provides valuable information on possible muscular problems and neuropathy.

Future Directions for Pain Management: Lessons from the Institute of Medicine Pain Report and the National Pain Strategy.

Science.gov (United States)

Mackey, Sean

2016-02-01

According to the Institute of Medicine Relieving Pain in America Report and the soon to be released National Pain Strategy, pain affects over 100 million Americans and costs our country in over $500 billion per year. We have a greater appreciation for the complex nature of pain and that it can develop into a disease in itself. As such, we need more efforts on prevention of chronic pain and for interdisciplinary approaches. For precision pain medicine to be successful, we need to link learning health systems with pain biomarkers (eg, genomics, proteomics, patient reported outcomes, brain markers) and its treatment. Copyright © 2016 Elsevier Inc. All rights reserved.

Review: Psychogenic Aspect of Pain & Coceptualization of Psychogenic Pain in Children

Directory of Open Access Journals (Sweden)

Ali Reza Jazayeri

2004-06-01

Full Text Available Pain is the sensory and emotional experience of discomfort whiehis usually associated with actual or threatened physical damsge or irritation . Virtvally all people experience pain at all ages. Children also experience pain from the moment of birth through childhood years. Underestaning pain in children is very important , because of treatment implication and its influence in child physical and psychological development . Experienced researchers have found that pain is a concequence of emotional disorder which is observed in some patients . in many cases we have seen that a patient says to his / her clinician that she has no pain because there is no evidence of somatic disease. Dicomfont involved in psychogenic pain seems to resort primerly from psychological process. Many of physicion are familiar with unpleasant and avoidant concequences of these distortions . In these cases , it s better for us to agree with patients , experience of pain and not to prob somatic risk factors and their mechanism all the time. The researches hove recognized that psychological factors cam cause pain which is named psychogenic pain. It means that the cause of pain has psychological roots , versus organic pain which is related to discomfort is caused by tissue damage . In this study , theorical , psychological , psychoanalytical and psycho social approaches and personality characteristics description related to pain and the relations among these approaches in this area have been studied . Also, the perception of pain among children with different gender have been probed

Understanding cultural influences on back pain and back pain research.

Science.gov (United States)

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.

Evaluation of pain management interventions for neonatal circumcision pain.

Science.gov (United States)

Joyce, B A; Keck, J F; Gerkensmeyer, J

2001-01-01

The purpose of the study was to determine the efficacy of music and eutectic mixture of local anesthetics (EMLA) on pain responses of neonates undergoing circumcision. A randomized, double-blind experimental design was used with 23 neonates. Pain response was measured using an observational pain intensity rating scale and the physiologic parameters of heart rate, respiratory rate, oxygen saturation levels, salivary cortisol levels, and length of cry. Each infant's state was examined for a potential contribution to the pain response. Infant state, salivary cortisol levels, and respiratory rates were not significant. Pain ratings had considerable variability for all treatment conditions, but both single treatment groups had less pain by the end of the procedure. The heart rate was significantly lower for the EMLA group and remained stable for the music group. Oxygen saturation differences were statistically significant for the music group (P =.02) and approached significance for the EMLA group. Preliminary support was provided for the efficacy of EMLA and music to contribute to the pain relief of neonates undergoing circumcision. Further study is warranted. Neonates deserve interventions that will provide them with a less painful start in life.

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

DEFF Research Database (Denmark)

Vaegter, Henrik B.; Graven-Nielsen, Thomas

2016-01-01

between subgroups. Cuff algometry was performed on lower legs in 400 chronic pain patients to assess pressure pain threshold (cPPT), pressure pain tolerance (cPTT), temporal summation of pain (TSP: increase in pain scores to ten repeated stimulations), and conditioned pain modulation (CPM: increase in c......PPT during cuff pain conditioning on the contralateral leg). Heat detection (HDT) and heat pain thresholds (HPT) at clinical painful and non-painful body areas were assessed. Based on TSP and CPM four 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. Group 4 (n=122) had normal CPM and normal TSP. Group 1 showed more pain regions compared with the other three groups (PCPM and facilitated TSP plays an important role in widespread pain. Group 1...

Vicarious pain experiences while observing another in pain: an experimental approach

Directory of Open Access Journals (Sweden)

Sophie eVandenbroucke

2013-06-01

Full Text Available Objective: This study aimed at developing an experimental paradigm to assess vicarious pain experiences. We further explored the putative moderating role of observer’s characteristics such as hypervigilance for pain and dispositional empathy. Methods: Two experiments are reported using a similar procedure. Undergraduate students were selected based upon whether they reported vicarious pain in daily life, and categorized into a pain responder group or a comparison group. Participants were presented a series of videos showing hands being pricked whilst receiving occasionally pricking (electrocutaneous stimuli themselves. In congruent trials, pricking and visual stimuli were applied to the same spatial location. In incongruent trials, pricking and visual stimuli were in the opposite spatial location. Participants were required to report on which location they felt a pricking sensation. Of primary interest was the effect of viewing another in pain upon vicarious pain errors, i.e., the number of trials in which an illusionary sensation was reported. Furthermore, we explored the effect of individual differences in hypervigilance to pain, dispositional empathy and the rubber hand illusion (RHI upon vicarious pain errors. Results: Results of both experiments indicated that the number of vicarious pain errors was overall low. In line with expectations, the number of vicarious pain errors was higher in the pain responder group than in the comparison group. Self-reported hypervigilance for pain lowered the probability of reporting vicarious pain errors in the pain responder group, but dispositional empathy and the RHI did not. Conclusion: Our paradigm allows measuring vicarious pain experiences in students. However, the prevalence of vicarious experiences of pain is low, and only a small percentage of participants display the phenomenon. It remains however unknown which variables affect its occurrence.

Low back pain - acute

Science.gov (United States)

Backache; Low back pain; Lumbar pain; Pain - back; Acute back pain; Back pain - new; Back pain - short-term; Back strain - new ... lower back supports most of your body's weight. Low back pain is the number two reason that Americans see ...

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

Science.gov (United States)

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

The study of correlation between forward head posture and neck pain in Iranian office workers.

Science.gov (United States)

Nejati, Parisa; Lotfian, Sara; Moezy, Azar; Nejati, Mina

2015-01-01

Factors such as prolonged sitting at work or improper posture of head during work may have a great role in neck pain occurrence among office employees, particularly among those who work with computers. Although some studies claim a significant difference in head posture between patients and pain-free participants, in literature the forward head posture (FHP) has not always been associated with neck pain. Since head, cervical and thoracic postures and their relation with neck pain has not been studied in Iranian office employees, the purpose of this study was to investigate the relationship between some work-related and individual factors, such as poor posture, with neck pain in the office employees. It was a cross-sectional correlation study carried out to explore the relationship between neck pain and sagittal postures of cervical and thoracic spine among office employees in forward looking position and also in a working position. Forty-six subjects without neck pain and 55 with neck pain were examined using a photographic method. Thoracic and cervical postures were measured using the high thoracic (HT) and craniovertebral (CV) angles, respectively. High thoracic and CV angles were positively correlated with the presence of neck pain only in working position (p 0.05). Our findings have revealed that office employees had a defective posture while working and that the improper posture was more severe in the office employees who suffered from the neck pain. This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.

Learning from the Law. A review of 21 years of litigation for pain during caesarean section.

Science.gov (United States)

McCombe, K; Bogod, D G

2018-02-01

The large majority of caesarean sections in the UK are now carried out under neuraxial anaesthesia. Although this technique is widely accepted as being the safest option in most circumstances, the use of regional anaesthesia increases the risk of patients experiencing intra-operative discomfort or pain. Pain during operative obstetric delivery is the commonest successful negligence claim relating to regional anaesthesia against obstetric anaesthetists in the UK. In the following article, using a database of over 360 cases spanning 21 years, we break down and examine the recurrent components of medicolegal claims concerning pain during caesarean section and consider how anaesthetists might avoid litigation. © 2017 The Association of Anaesthetists of Great Britain and Ireland.

Managing painful chronic wounds: the Wound Pain Management Model

DEFF Research Database (Denmark)

Price, Patricia; Fogh, Karsten; Glynn, Chris

2007-01-01

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...... 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...... 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. Udgivelsesdato: 2007-Apr...

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

Science.gov (United States)

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

Paediatric pain management

African Journals Online (AJOL)

patients is musculoskeletal pain, headache or abdominal pain.2. The pain ... Children older than four years of age can usually talk about their pain; at the age of six to eight years they can use the ... Pain presentation in children normally falls into one of the ... expression, body posture and movement.10 This scale is often.

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

Science.gov (United States)

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

Pain begets pain: When marathon runners are not in pain anymore, they underestimate their memory of marathon pain: A mediation analysis

NARCIS (Netherlands)

Babel, P.; Bajcar, E.A.; Smieja, M.; Adamczyk, W.; Swider, K.J.; Kicman, P.; Lisinska, N.

2018-01-01

Background: A previous study has shown that memory of pain induced by running a marathon might be underestimated. However, little is known about the factors that might influence such a memory distortion during pain recall. The aim of the study was to investigate the memory of pain induced by running

The impact of experiential avoidance on the relations between illness representations, pain catastrophising and pain interference in chronic pain.

Science.gov (United States)

Karademas, Evangelos C; Karekla, Maria; Flouri, Magdalini; Vasiliou, Vasilis S; Kasinopoulos, Orestis; Papacostas, Savvas S

2017-12-01

The aim of this study was to examine the effects of experiential avoidance (EA) on the indirect relationship of chronic pain patients' illness representations to pain interference, through pain catastrophising Design and main outcome measure: The sample consisted of 162 patients diagnosed with an arthritis-related or a musculoskeletal disorder. The effects of EA on the pathway between illness representations, pain catastrophising and pain interference were examined with PROCESS, a computational tool for SPSS Results: After controlling for patient and illness-related variables and pain severity, the 'illness representations-pain catastrophising-pain interference' pathway was interrupted at the higher levels of EA. The reason was that, at the high levels of EA, either the relation of illness representations to pain catastrophising or the relation of pain catastrophising to pain interference was not statistically significant. The findings indicate that EA is not a generalised negative response to highly aversive conditions, at least as far as the factors examined in this study are concerned. EA may rather reflect a coping reaction, the impact of which depends on its specific interactions with the other aspects of the self-regulation mechanism. At least in chronic pain, EA should become the focus of potential intervention only when its interaction with the illness-related self-regulation mechanism results in negative outcomes.

Noite e dia e alguns monocromos psíquicos Night and day - and some psychical monochromes

Directory of Open Access Journals (Sweden)

Edson Luiz André de Sousa

2006-06-01

Full Text Available O artigo apresenta uma leitura do conto de Jack London "A sombra e o brilho" mostrando o funcionamento do princípio da mímesis no processo de identificação. Propõe-se a expressão monocromos psíquicos para esses espaços mentais de indiferenciação entre o eu e o Outro. Adota-se a tese de Caillois, que afirma que o eu é permeável ao espaço. Nessa perspectiva, o tema do duplo, amplamente desenvolvido por Freud, é fundamental. Partindo-se de notas sobre o trabalho do fotógrafo cego Bavcar, procura-se mostrar alguns traços da estrutura do olhar. O artigo finaliza mostrando as conexões possíveis dessas reflexões para a prática psicanalítica.The paper presents a reading of Jack London's tale "The Shadow and the brightness", showing how the principle of mimesis works in the process of the identification. We propose to call psychical monochromes the spaces of mental indifference between the self and the other. We follow the thesis of Roger Caillois: "the self is permeable in the space". In this perspective, the subject of the double, developped by Freud is essential. We try to show the dialectic of the structure of the look based in some notes about the work of the blind photographer Bavcar. The article finish with showing the possibles connections of all these points with the clinical work.

Can We "Predict" Long-Term Outcome for Ambulatory Transcutaneous Electrical Nerve Stimulation in Patients with Chronic Pain?

NARCIS (Netherlands)

Koke, A.J.; Smeets, R.J.E.M.; Perez, R.S.G.M.; Kessels, A.; Winkens, B.; van Kleef, M.; Patijn, J.

2015-01-01

Background: Evidence for effectiveness of transcutaneous electrical nerve stimulation (TENS) is still inconclusive. As heterogeneity of chronic pain patients might be an important factor for this lack of efficacy, identifying factors for a successful long-term outcome is of great importance.

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

Science.gov (United States)

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.

Pain Information Brochure

Science.gov (United States)

... Library Health Care Systems Research Collaboratory Pain Registries IOM Report: Relieving Pain in America HHS Pathways to ... Library Health Care Systems Research Collaboratory Pain Registries IOM Report: Relieving Pain in America HHS Pathways to ...

NIH Pain Consortium

Science.gov (United States)

... Library Health Care Systems Research Collaboratory Pain Registries IOM Report: Relieving Pain in America HHS Pathways to ... Library Health Care Systems Research Collaboratory Pain Registries IOM Report: Relieving Pain in America HHS Pathways to ...

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

Science.gov (United States)

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.

Pain, emotion, headache.

Science.gov (United States)

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.

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

Science.gov (United States)

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.

Evaluation of pain incidence and pain management in a South ...

African Journals Online (AJOL)

Design. A prospective observational study, using the Numerical Rating Scale for pain (NRS pain), Numerical Rating Scale for anxiety (NRS anxiety), the Alder Hey Triage Pain Score (AHTPS), the COMFORT behaviour scale and the Touch Visual Pain Scale (TVPS). All patients were assessed at admission; those who were ...

[Actual care and funding situation with regard to mother-child units for psychic disorders associated with pregnancy in Germany].

Science.gov (United States)

Jordan, Wolfgang; Bielau, Hendrik; Cohrs, Stefan; Hauth, Iris; Hornstein, Christiane; Marx, Alexandra; Reck, Corinna; von Einsiedel, Regina

2012-07-01

CONCERN: The current care and financial situation of mother-child units for psychic disorders associated with pregnancies in Germany should be documented in preparation for the development of the new reimbursement system for psychiatry and psychosomatics. In accordance with the last survey of 2005, a brief questionnaire was developed and a nationwide poll was conducted. The survey revealed severe (10 fold) service deficits for severely and gravely mentally ill mothers, who require an inpatient treatment with specific professional competence. Compared with the last poll, these service deficits have increased. This is due to continued insufficient funding and unresolved financing in the new reimbursement system. With the establishment of an additional code for mother-child treatment the precondition for ensuring the funding of this important care form in the new reimbursement system was created. It is to be hoped that the decision-makers of health policy will finally face up to their social responsibility and ensure adequate funding of the additional diagnostic and therapeutic expenditure of mother-child treatment. The health care providers have an obligation to implement a transparent record of services of the additional expenditure and to augment the national evaluation approaches to inpatient mother-child treatments. © Georg Thieme Verlag KG Stuttgart · New York.

Happiness, Pain Intensity, Pain Interference, and Distress in Individuals with Physical Disabilities.

Science.gov (United States)

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 Happiness showed a significant direct effect on pain intensity (β = -0.20, P 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.

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

Science.gov (United States)

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.

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

Science.gov (United States)

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.

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

Science.gov (United States)

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.

Glia and pain: is chronic pain a gliopathy?

Science.gov (United States)

Ji, Ru-Rong; Berta, Temugin; Nedergaard, Maiken

2013-12-01

Activation of glial cells and neuro-glial interactions are emerging as key mechanisms underlying chronic pain. Accumulating evidence has implicated 3 types of glial cells in the development and maintenance of chronic pain: microglia and astrocytes of the central nervous system (CNS), and satellite glial cells of the dorsal root and trigeminal ganglia. Painful syndromes are associated with different glial activation states: (1) glial reaction (ie, upregulation of glial markers such as IBA1 and glial fibrillary acidic protein (GFAP) and/or morphological changes, including hypertrophy, proliferation, and modifications of glial networks); (2) phosphorylation of mitogen-activated protein kinase signaling pathways; (3) upregulation of adenosine triphosphate and chemokine receptors and hemichannels and downregulation of glutamate transporters; and (4) synthesis and release of glial mediators (eg, cytokines, chemokines, growth factors, and proteases) to the extracellular space. Although widely detected in chronic pain resulting from nerve trauma, inflammation, cancer, and chemotherapy in rodents, and more recently, human immunodeficiency virus-associated neuropathy in human beings, glial reaction (activation state 1) is not thought to mediate pain sensitivity directly. Instead, activation states 2 to 4 have been demonstrated to enhance pain sensitivity via a number of synergistic neuro-glial interactions. Glial mediators have been shown to powerfully modulate excitatory and inhibitory synaptic transmission at presynaptic, postsynaptic, and extrasynaptic sites. Glial activation also occurs in acute pain conditions, and acute opioid treatment activates peripheral glia to mask opioid analgesia. Thus, chronic pain could be a result of "gliopathy," that is, dysregulation of glial functions in the central and peripheral nervous system. In this review, we provide an update on recent advances and discuss remaining questions. Copyright © 2013 International Association for the

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

OpenAIRE

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

2011-01-01

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 experi...

Pain after earthquake

Directory of Open Access Journals (Sweden)

Angeletti Chiara

2012-06-01

Full Text Available Abstract Introduction On 6 April 2009, at 03:32 local time, an Mw 6.3 earthquake hit the Abruzzi region of central Italy causing widespread damage in the City of L Aquila and its nearby villages. The earthquake caused 308 casualties and over 1,500 injuries, displaced more than 25,000 people and induced significant damage to more than 10,000 buildings in the L'Aquila region. Objectives This observational retrospective study evaluated the prevalence and drug treatment of pain in the five weeks following the L'Aquila earthquake (April 6, 2009. Methods 958 triage documents were analysed for patients pain severity, pain type, and treatment efficacy. Results A third of pain patients reported pain with a prevalence of 34.6%. More than half of pain patients reported severe pain (58.8%. Analgesic agents were limited to available drugs: anti-inflammatory agents, paracetamol, and weak opioids. Reduction in verbal numerical pain scores within the first 24 hours after treatment was achieved with the medications at hand. Pain prevalence and characterization exhibited a biphasic pattern with acute pain syndromes owing to trauma occurring in the first 15 days after the earthquake; traumatic pain then decreased and re-surged at around week five, owing to rebuilding efforts. In the second through fourth week, reports of pain occurred mainly owing to relapses of chronic conditions. Conclusions This study indicates that pain is prevalent during natural disasters, may exhibit a discernible pattern over the weeks following the event, and current drug treatments in this region may be adequate for emergency situations.

[Dante's Inferno and the McGill Pain Questionnaire].

Science.gov (United States)

Tonelli, N; Marcolongo, R

2007-01-01

To study the images which depict the damned's sufferings in Dante's Inferno, in their expression of the several meanings of "pain", the semantics of "pain" in the poem has been analyzed, eventually trying to determine whether the organization of punishments of Inferno may somehow mirror a disability scale. A detailed analysis of the text was carried out, which proved a valuable tool for interpreting the organization of punishments as a possible disability scale. The semantics of pain in the Divine Comedy was studied through all the forms of the pain descriptors (included the archaic terminological forms) from the Italian version of the McGill Pain Questionnaire (MGPQ) by Maiani and Sanavio. In Dante's Inferno a classification of pain is provided, based on the experience of sufferings; Dante's images seem not only instrumental to investigating the sensorial but also the affective and intellectual spheres by introducing a number of characters and describing the impact of punishment onto their souls. Our research highlighted that 46 out of 78 terms from the MGPQ are present in Inferno, though with different forms; the Groups the MGPQ is divided into are also represented with the exception of Group XII, the most frequently detected being Groups XIII-which studies the fear-related sensations in the emotional sphere - XIV, XIX and XX. The great attention emerges that Dante devoted to describing simple sensorial experiences as well as the way punishments affected the soul. As a whole, the terms pertaining to the sensorial sphere are the most frequently encountered. The lack of motion which increases circle after circle in Hell, well matches the progressing physical and psychological impairment caused by some invalidating diseases. Noticeably, Dante created such a complex system centuries before the studies were released on the impact of pain and its quantitative and mostly qualitative definition. In conclusion, this interpretation suggests that the writing on the door to

The ACTTION-American Pain Society Pain Taxonomy (AAPT): an evidence-based and multidimensional approach to classifying chronic pain conditions.

Science.gov (United States)

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

Analyzing musculoskeletal neck pain, measured as present pain and periods of pain, with three different regression models: a cohort study

Directory of Open Access Journals (Sweden)

Hagberg Mats

2009-06-01

Full Text Available Abstract 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

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

Directory of Open Access Journals (Sweden)

Rebeccah Slater

2008-06-01

Full Text Available 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.

Early visceral pain predicts chronic pain after laparoscopic cholecystectomy

DEFF Research Database (Denmark)

Blichfeldt-Eckhardt, Morten Rune; Ording, Helle; Andersen, Claus

2014-01-01

Chronic pain after laparoscopic cholecystectomy is related to postoperative pain during the first postoperative week, but it is unknown which components of the early pain response is important. In this prospective study, 100 consecutive patients were examined preoperatively, 1week postoperatively...

Pain cognition versus pain intensity in patients with endometriosis: toward personalized treatment.

Science.gov (United States)

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.

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

Science.gov (United States)

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

Epidemiology of chronic pain in the office of a pain specialist neurologist

Directory of Open Access Journals (Sweden)

Karen dos Santos Ferreira

2015-07-01

Full Text Available Objective 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. Method 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. Results 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. Conclusion This data can guide new medical residency programs on Neurology, area of concentration pain, to plan activities and studies.

Reconsidering the International Association for the Study of Pain definition of pain.

Science.gov (United States)

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.

Appraised leadership styles, psychosocial work factors, and musculoskeletal pain among public employees.

Science.gov (United States)

Fjell, Ylva; Osterberg, Mia; Alexanderson, Kristina; Karlqvist, Lena; Bildt, Carina

2007-10-01

The main aim of this study was to explore the associations between appraised leadership styles, psychosocial work factors and musculoskeletal pain among subordinates in four different public service sectors from an epidemiological perspective. A cross-sectional questionnaire study was conducted; data from 2,403 public sector employees in subordinate positions (86% women) were analysed. The appraised leadership styles were measured through items from a modified version of the CPE questionnaire (C change, P production/structure, E employee/relation). The structure validity of the CPE-model was examined by principal component analysis (PCA). Univariate and multivariate analyses of associations between levels of musculoskeletal pain and appraised leadership styles and with psychosocial work factors were conducted. Odds ratios (ORs) with confidence intervals (CIs) of 95% were used as a measure of associations. There were small variations in the appraisals of the immediate manager among the subordinates. However, the associations between musculoskeletal pain and leadership styles varied according to sector. Poor appraisals (low scores) on "change" and "employee relation" dimensions were associated with high levels of musculoskeletal pain in two sectors: home and health care services. In the domestic catering services, poor appraisals of managers in the "production/structure" dimension had the strongest association with high levels of pain. In general, poor appraisals of the "change" dimension was most strongly associated with high levels of musculoskeletal pain. "High work demands" had the strongest association with high levels of pain, particularly among the men. Poor appraisals of managers and their leadership styles were associated with high levels of musculoskeletal pain among both female and male subordinates in different public service sectors. There is therefore a great need of further studies of the mechanisms behind the relationships between the leadership

Children's pain perspectives.

Science.gov (United States)

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

Patellofemoral Pain.

Science.gov (United States)

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.

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

Science.gov (United States)

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

Children in pain: recurrent back pain, abdominal pain, and headache in children and adolescents in a four-year-period.

Science.gov (United States)

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.

Comparative Responsiveness of the PROMIS Pain Interference Short Forms, Brief Pain Inventory, PEG, and SF-36 Bodily Pain Subscale.

Science.gov (United States)

Kean, Jacob; Monahan, Patrick O; Kroenke, Kurt; Wu, Jingwei; Yu, Zhangsheng; Stump, Tim E; Krebs, Erin E

2016-04-01

To compare the sensitivity to change and the responsiveness to intervention of the PROMIS Pain Interference short forms, Brief Pain Inventory (BPI), 3-item PEG scale, and SF-36 Bodily Pain subscale in a sample of patients with persistent musculoskeletal pain of moderate severity. Standardized response means, standardized effect sizes, and receiver operating curve analyses were used to assess change between baseline and 3-month assessments in 250 participants who participated in a randomized clinical effectiveness trial of collaborative telecare management for moderate to severe and persistent musculoskeletal pain. The BPI, PEG, and SF-36 Bodily Pain measures were more sensitive to patient-reported global change than the PROMIS Pain Interference short forms, especially for the clinically improved group, for which the change detected by the PROMIS short forms was not statistically significant. The BPI was more responsive to the clinical intervention than the SF-36 Bodily Pain and PROMIS Pain Interference measures. Post hoc analyses exploring these findings did not suggest that differences in content or rating scale structure (number of response options or anchoring language) adequately explained the observed differences in the detection of change. In this clinical trial, the BPI and PEG measures were better able to detect change than the SF-36 Bodily Pain and PROMIS Pain Interference measures.

Neck pain and disability due to neck pain: what is the relation?

DEFF Research Database (Denmark)

Fejer, René; Hartvigsen, Jan

2008-01-01

Pain and disability are interrelated, but the relationship between pain and disability is not straightforward. The objective of this study was to investigate the relationship between neck pain (NP) intensity, NP duration, and disability based on the population-based 'Funen Neck and Chest Pain......' study. Pain intensity was measured using 11-box numerical rating scales, pain duration was measured using the Standardized Nordic Questionnaire, and disability was measured by the Copenhagen Neck Functional Disability Scale. Spearman rank correlation coefficients and logistic regression analyses were...... used to measure correlations and strength of associations between pain intensity, pain duration, and disability given domain specific characteristics (socioeconomic, health and physical, comorbidity, and variables related to consequences of NP). Neck pain was very common, but mainly mild and did...

Relationship of musculoskeletal pain and well-being at work - Does pain matter?

Science.gov (United States)

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

CRPS Knee: How frequently encountered in differential diagnosis of Knee pain?

Science.gov (United States)

Aggarwal, Aakanksha; Agarwal, Anil

2018-04-13

We have read with great interest the paper by Catelijne M. van Bussel [1] recently published in Pain Practice. I wish to congratulate the authors for their valuable contributions. In the said article, 12 patients who had complex regional pain syndrome confined to the knee have been included. Though reports have been published involving primarily the knee after total knee arthroplasty [2,3] the incidence of CRPS knee following trauma or otherwise is not well appreciated. We would have appreciated if presence or absence of any inciting event for the development CRPS knee in these 12 patients could be mentioned, which could be helpful in a better diagnosis and management of the patients with CRPS knee. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Optimism, pain coping strategies and pain intensity among women with rheumatoid arthritis

Directory of Open Access Journals (Sweden)

Zuzanna Kwissa-Gajewska

2014-07-01

Full Text Available Objectives: According to the biopsychosocial model of pain, it is a multidimensional phenomenon, which comprises physiological (sensation-related factors, psychological (affective and social (socio-economic status, social support factors. Researchers have mainly focused on phenomena increasing the pain sensation; very few studies have examined psychological factors preventing pain. The aim of the research is to assess chronic pain intensity as determined by level of optimism, and to identify pain coping strategies in women with rheumatoid arthritis (RA. Material and methods : A survey was carried out among 54 women during a 7-day period of hospitalisation. The following questionnaires were used: LOT-R (optimism; Scheier, Carver and Bridges, the Coping Strategies Questionnaire (CSQ; Rosenstiel and Keefe and the 10-point visual-analogue pain scale (VAS. Results: The research findings indicate the significance of optimism in the experience of chronic pain, and in the pain coping strategies. Optimists felt a significantly lower level of pain than pessimists. Patients with positive outcome expectancies (optimists experienced less pain thanks to replacing catastrophizing (negative concentration on pain with an increased activity level. Regardless of personality traits, active coping strategies (e.g. ignoring pain sensations, coping self-statements – appraising pain as a challenge, a belief in one’s ability to manage pain resulted in a decrease in pain, whilst catastrophizing contributed to its intensification. The most common coping strategies included praying and hoping. Employment was an important demographic variable: the unemployed experienced less pain than those who worked. Conclusions : The research results indicate that optimism and pain coping strategies should be taken into account in clinical practice. Particular attention should be given to those who have negative outcome expectations, which in turn determine strong chronic pain

Phantom Pain

Science.gov (United States)

... Because this is yet another version of tangled sensory wires, the result can be pain. A number of other factors are believed to contribute to phantom pain, including damaged nerve endings, scar tissue at the site of the amputation and the physical memory of pre-amputation pain in the affected area. ...

Neuropathic pain

Directory of Open Access Journals (Sweden)

Giuseppe Re

2009-02-01

Full Text Available Neuropathic pain is the expression of a dysfunction or primary lesion of a nerve in the peripheral or central nervous system, or both, rather than the biological signal transmitted by the nerve following peripheral nociceptor activation. It represents about 20% of all painful syndromes, with an estimated prevalence of 1.5%, however is actual incidence is hard to pinpoint due to the difficulties encountered in distinguishing it from chronic pain, of which it represents a significant percentage, on account of the not infrequent concurrence of conditions. It is crucial to recognise the variety of symptoms with which it can present: these can be negative and positive and, in turn, motor, sensitive and autonomic. In public health terms, it is important to emphasise that the diagnosis of neuropathic pain does not in most cases require sophisticated procedures and does not therefore weigh on health expenditure. In clinical practice, a validated scale (the LANSS is mentioned is useful for identifying patients presenting neuropathic pain symptoms. Therapy is based on three categories of medication: tricyclic antidepressants, anti-epileptics and opioids at high doses: neuropathic pain has a bad reputation for often resisting common therapeutic approaches and responding less well that nociceptor pain to monotherapy. Therapeutic strategies are all the more adequate the more they are based on symptoms and therefore on the pain generation mechanisms, although the recommendations are dictated more by expert opinions that double-blind randomised trials.

The psychological results of the consequence of the ChNPP accident

International Nuclear Information System (INIS)

Salamatov, V.A.; Volodina, I.A.

1992-01-01

The ChNPP accident grought about the following stress reactions among the exposed population registered: psychosomatic reactions (headaches, gastro-intestinal tract disorders pains in the heart etc.), psychoemotional reactions (panic, sleep disturbance, restlessness etc.), behaviour reaction (aggressiveness, apathy) the whole structure of the human psychic is stated to have been affected by the Chernobyl' accident. The changes in the emotion-and-will sphere appear most distinctly. 2 tab

Workplace Ergonomic and Psychosocial Factors in Occupational Back Disorders, Healthcare Utilization, and Lost Time: Cross-Sectional and Prospective Studies

Science.gov (United States)

1999-03-31

tolerance). work history (short time in job. unemployed prior to current job), psycho-behavioral resources (worker traits. psychological readiness~ pain...when employees are new to their jobs. Additionally~ if an employee has been unemployed for a period of time prior to hislher current job. there appears...CLASSIFIED PSYCHIC FACTORS ASSOCIATED WI DISEASES CLASSIFIED MULTIPLE~:fCl.EROSIS. · GENEf~AlI:iED CONVULSIVE EPILEPSY. WIO MENTION Of IN CLASSICAL

Microsurgical DREZotomy in the treatment of chronic pain due to spinal cord and cauda equina injuries: 2 cases report and related literature review

Directory of Open Access Journals (Sweden)

LIU Qing-jun

2013-10-01

Full Text Available Objective The dorsal root entry zone (DREZ is a hyperactive focus in neuropathic pain (NP syndromes, and DREZotomy has been used in selective cases of NP. This study aims to investigate the therapeutic effect of microsurgical DREZotomy in chronic pain due to spinal cord and cauda equina injuries. Methods Two patients suffered with chronic pain due to spinal cord and cauda equina injuries were treated with microsurgical DREZotomy, and postoperative therapeutic effect and complications were observed. Results One patient had great pain, and the pain was alleviated 2 weeks after surgery, while carbamazepine (300 mg/d was administered continously. Another patient was completely free of pain 2 weeks after surgery, and no recurrence occurred during 3-year follow up. No severe complications were found in the 2 patients. Conclusion Microsurgical DREZotomy is an effective approach in treating chronic pain due to spinal cord and cauda equina injuries.

Pain without nociceptors?

DEFF Research Database (Denmark)

Minett, Michael S; Falk, Sarah; Santana-Varela, Sonia

2014-01-01

Nav1.7, a peripheral neuron voltage-gated sodium channel, is essential for pain and olfaction in mice and humans. We examined the role of Nav1.7 as well as Nav1.3, Nav1.8, and Nav1.9 in different mouse models of chronic pain. Constriction-injury-dependent neuropathic pain is abolished when Nav1.......7 is deleted in sensory neurons, unlike nerve-transection-related pain, which requires the deletion of Nav1.7 in sensory and sympathetic neurons for pain relief. Sympathetic sprouting that develops in parallel with nerve-transection pain depends on the presence of Nav1.7 in sympathetic neurons. Mechanical...... and cold allodynia required distinct sets of neurons and different repertoires of sodium channels depending on the nerve injury model. Surprisingly, pain induced by the chemotherapeutic agent oxaliplatin and cancer-induced bone pain do not require the presence of Nav1.7 sodium channels or Nav1.8-positive...

Inviting pain? Pain, dualism and embodiment in narratives of self-injury.

Science.gov (United States)

Chandler, Amy

2013-06-01

The role of pain in the practice of self-injury is not straightforward. Existing accounts suggest that self-injury does not cause 'physical' pain, however self-injury is also said to alleviate 'emotional' pain by inflicting 'physical' pain. This article explores these tensions using sociological theories regarding the socio-cultural and subjective nature of pain. Analysis derives from in-depth, life-story interviews carried out in the UK with people who had self-injured. Findings contribute to on-going debates within social science regarding the nature of pain. Participants' narratives about pain and self-injury both drew on and challenged dualistic models of embodiment. I suggest that self-injury offers a unique case on which to extend existing theoretical work, which has tended to focus on pain as an unwanted and uninvited entity. In contrast, accounts of self-injury can feature pain as a central aspect of the practice, voluntarily invited into lived experience. © 2013 The Author. Sociology of Health & Illness © 2013 Foundation for the Sociology of Health & Illness/John Wiley & Sons Ltd.

Physical, lifestyle, psychological, and social determinants of pain intensity, pain disability, and the number of pain locations in depressed older adults.

Science.gov (United States)

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, Presearch 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.

A Broad Consideration of Risk Factors in Pediatric Chronic Pain: Where to Go from Here?

Science.gov (United States)

McKillop, Hannah N; Banez, Gerard A

2016-11-30

Pediatric chronic pain is a significant problem associated with substantial functional impairment. A variety of risk factors have been found to be associated with chronic pain in youth. The greatest amount of evidence appears to support that temperament, anxiety, depression, subjective experience of stress, passive coping strategies, sleep problems, other somatic-related problems, and parent and/or family factors are important variables. However, a great deal of this research focuses on a single risk factor or on multiple risk factors in isolation. Much of the literature utilizes older diagnostic criteria and would benefit from replication, larger sample sizes, and comparison across pain disorders. Problems also exist with disagreement across definitions, resulting in inconsistency or unclear use of terms. Furthermore, recent consideration has suggested that outcome measures should include functional disability in addition to pain. A second generation of research is needed to shed light on the complex interactions that likely play a role in the transition from acute to chronic pain. Building on recent calls for changes in research in this area, we propose the next steps for this research, which involve consideration of both biopsychosocial and developmental contexts.

Sudden amnesia resulting in pain relief: the relationship between memory and pain.

Science.gov (United States)

Choi, Daniel S; Choi, Deborah Y; Whittington, Robert A; Nedeljković, Srdjan S

2007-11-01

Nociceptive pain and its emotional component can result in the development of a "chronic pain memory". This report describes two patients who had long histories of chronic pain and opioid dependence. Both patients experienced sudden memory loss that was followed by significant pain reduction and an eradication of their need for opioid management. Neural centers involved in sensory pain, its affective component, opioid dependence, and memory overlap in the brain and share common pathways. The anterior cingulate cortex, the insular cortex, and the amygdala are examples of regions implicated in both pain and memory. One of the patients in the report experienced multiple seizure episodes, which may have contributed to memory loss and pain relief. The role of electroconvulsive therapy as it relates to amnesia and pain is reviewed. Questions are raised regarding whether therapies that address the memory component of pain may have a role in the treatment of long-term chronic pain patients.

Ketamine for pain

Science.gov (United States)

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

The role of pain behaviour and family caregiver responses in the link between pain catastrophising and pain intensity : A moderated mediation model

NARCIS (Netherlands)

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

2017-01-01

Objectives: This study investigated the mediating role of pain behaviours in the association between pain catastrophising and pain intensity and explored the moderating role of family caregivers’ responses to pain in the link between pain behaviours and pain intensity. Methods: The sample consisted

The role of pain behaviour and family caregiver responses in the link between pain catastrophising and pain intensity : A moderated mediation model

NARCIS (Netherlands)

Mohammadi, Somayyeh; Dehghani, Mohsen; Sanderman, Robbert; Hagedoorn, Mariet

2017-01-01

Objectives: This study investigated the mediating role of pain behaviours in the association between pain catastrophising and pain intensity and explored the moderating role of family caregivers' responses to pain in the link between pain behaviours and pain intensity. Methods: The sample consisted

Parental Perceptions about Pain and Pain Management Practices in ...

African Journals Online (AJOL)

Background: Pain management in neonates remains sub-optimal in sub-Saharan countries like Kenya due to lack of resources to procure pharmacological analgesics. There, however, exist low-cost, mother-driven pain management strategies such as breastfeeding and kangaroo care that can be used for pain relief in ...

Conditioned pain modulation: a predictor for development and treatment of neuropathic pain.

Science.gov (United States)

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.

Do psychological states associate with pain and disability in chronic neck pain patients?

Science.gov (United States)

Dimitriadis, Zacharias; Kapreli, Eleni; Strimpakos, Nikolaos; Oldham, Jacqueline

2015-01-01

Chronic neck pain is one of the most usual neuromusculoskeletal pain conditions which can lead patients to chronic disability. Similarly to other pain conditions, the changed psychological status of these patients is believed to be associated with their pain condition and disability. However, the association between the psychological status of patients with idiopathic neck pain and their pain intensity and disability is minimally explored. This study was aimed at investigating the association between psychological states (anxiety, depression, kinesiophobia, catastrophizing) of patients with chronic idiopathic neck pain and self-reported pain and disability. Forty five patients with idiopathic chronic neck pain (more than 6 months, at least once a week) participated. Their psychological states were assessed by using the Hospital Anxiety and Depression scale, Pain Catastrophizing scale and Tampa Scale for Kinesiophobia. Self-reported disability was recorded with the Neck Disability Index. Pain intensity was recorded by using a visual analog scale. Neck pain intensity was significantly correlated with anxiety (pneck pain is associated with their self-reported disability, whereas anxiety is also associated with their pain intensity. Anxiety and catastrophizing may be important predicting markers of patients' self-reported disability.

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

Directory of Open Access Journals (Sweden)

Terrighena EL

2017-07-01

Full Text Available Esslin L Terrighena,1,2 Ge Lu,1 Wai Ping Yuen,1 Tatia M C Lee,1–4 Kati Keuper1,2,5 1Department of Psychology, Laboratory of Neuropsychology, The University of Hong Kong, Hong Kong; 2Laboratory of Social Cognitive Affective Neuroscience, The University of Hong Kong, Hong Kong; 3The State Key Laboratory of Brain and Cognitive Sciences, Hong Kong; 4Institute of Clinical Neuropsychology, The University of Hong Kong, Hong Kong; 5Institute for Biomagnetism and Biosignalanalysis, University of Münster, Münster, Germany Abstract: 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

Corporatization of pain medicine: implications for widening pain care disparities.

Science.gov (United States)

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.

Conditioned pain modulation predicts duloxetine efficacy in painful diabetic neuropathy.

Science.gov (United States)

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.

Physical activity, pain responses to heat stimuli, and conditioned pain modulation in postmenopausal women.

Science.gov (United States)

Adrian, Amanda L; O'Connor, Patrick J; Ward-Ritacco, Christie L; Evans, Ellen M

2015-08-01

Postmenopausal women (PMW) are at high risk for disabling pain and physical inactivity. This study sought to enhance the understanding of relationships between physical activity (PA) and pain among PMW using heat pain sensitivity test and conditioned pain modulation test. We hypothesized that, compared with active women, (i) inactive women would report higher pain intensity and pain unpleasantness ratings; (ii) inactive women in disabling pain would report higher pain intensity and pain unpleasantness at high, but not low, stimulus intensities; and (iii) inactive women would have less modulation. Sixty-eight PMW rated the pain intensity and pain unpleasantness of hot stimuli presented to the thenar eminence of the hand. A subset of 31 women rated the pain intensity of a test stimulus (noxious heat) and a conditioning stimulus (cold water) as part of the conditioned pain modulation task. PA was assessed objectively with accelerometry. Mixed-model analysis of variance (2 × 4 × 2; PA × Temperature × Pain Status) showed that inactive women in disabling pain rated pain unpleasantness higher than active women in disabling pain (F3,192 = 3.526, ∂η = 0.052, P = 0.016). Significantly lower pain unpleasantness ratings were found at the highest stimulus intensity (49°C) only for active women in disabling pain compared with inactive women in disabling pain (t11 = 2.523, P = 0.028). The other hypotheses were not supported. PA is associated with a reduced sensitivity to the unpleasantness of painful high-intensity heat stimuli among women in disabling pain.

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

Directory of Open Access Journals (Sweden)

Bulls HW

2015-06-01

Full Text Available Hailey W Bulls,1 Emily L Freeman,1 Austen JB Anderson,2 Meredith T Robbins,3 Timothy J Ness,3 Burel R Goodin1,3 1Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA; 2Department of Biology, Samford University, Birmingham, AL, USA; 3Department of Anesthesiology, University of Alabama at Birmingham, Birmingham, AL, USA Abstract: It has been suggested that increased pain sensitivity and disruption of endogenous pain inhibitory processes may account, at least in part, for the greater prevalence and severity of chronic pain in women compared to men. However, previous studies addressing this topic have produced mixed findings. This study examined sex differences in pain sensitivity and inhibition using quantitative sensory testing (QST, while also considering the influence of other important factors such as depressive symptoms and sleep quality. Healthy men (n=24 and women (n=24 each completed a QST battery. This battery included an ischemic pain task (IPT that used a submaximal effort tourniquet procedure as well as a conditioned pain modulation (CPM procedure for the assessment of endogenous pain inhibition. Prior to QST, participants completed the Center for Epidemiologic Studies Depression Scale and the Pittsburgh Sleep Quality Index. Analyses revealed significant sex differences for the ischemic pain task and the conditioned pain modulation procedure, such that women tolerated the ischemic pain for a shorter amount of time and demonstrated less pain inhibition compared with men. This remained true even when accounting for sex differences in depressive symptoms and sleep quality. The results of this study suggest that women may be more pain sensitive and possess less-efficient endogenous pain inhibitory capacity compared with men. Whether interventions that decrease pain sensitivity and enhance pain inhibition in women ultimately improve their clinical pain outcomes is an area of research that deserves additional

Iraq: Usa and Great Britain hold up an agreement on limited sales of Iraq petroleum

International Nuclear Information System (INIS)

Anon.

1996-01-01

The negotiations United Nations/Iraq have been stopped because of objections coming from Usa and Great Britain. Three points were developed: The distribution of medicine and foods in three Kurdish countries, these countries are actually under the United nations control, Iraq wants to participate at the distribution but Usa and Great Britain think that it could be a way of pressure from Iraq on Kurdish countries and in this mind they refuse. The second point is about the sequestered banking account on which must be deposited the receipts of Iraqi petroleum sales which must be put under United Nation control in order to avoid, according to Washington and London, that Iraq uses it to get round the sanctions. The third point is that Usa and Great Britain consider that the resolution number 986 has only for object to relieve the pains of Iraqi people and its application must not be interpreted as a lightening of international sanctions against Iraq. The results of the suspension are a surge of petroleum prices on international market and a fall of Iraqi Dinar. (N.C.)

Needs and requests--patients and physicians voices about improving the management of spinal cord injury neuropathic pain.

Science.gov (United States)

Norrbrink, Cecilia; Löfgren, Monika

2016-01-01

The present purpose was to explore patients' and involved physicians' needs and requests for improving their management of neuropathic pain following spinal cord injury (SCI). Sixteen patients with SCI and neuropathic pain, and nine physicians, were interviewed in focus-groups or individual interviews. An emergent design was used and the interviews and analyses were carried out in parallel, making it possible to use and deepen new emerging knowledge. The interviews were transcribed verbatim and processed according to content analysis. A final model with four themes described the results. Three themes covered the current situation: limitations in structure, lack of knowledge and competence, and frustrations. A fourth theme, needs and requests, described suggestions by patients and physicians for future improvements. Suggestions included increased participation, increased patient involvement in the pain rehabilitation process, support in the process of learning to live with pain, implementation of multi-modal pain rehabilitation, and the use of complementary treatments for neuropathic pain. Neuropathic pain following SCI needs to be assessed and treated using a structured, inter-disciplinary, multi-modal rehabilitation approach involving patients in planning and decision-making. For improving SCI neuropathic pain management, there is a great need for individually-tailored management, planned in a dialogue on equal terms between health care and the patient. Patients desire continuity and regularity and the possibility of receiving complementary treatments for SCI neuropathic pain. Access to structured pain rehabilitation is needed. Support and tools need to be provided in the learning-to-live with pain process.

Role of microglia in neuropathic pain, postoperative pain, and morphine tolerance

Science.gov (United States)

Wen, Yeong-Ray; Tan, Ping-Heng; Cheng, Jen-Kun; Liu, Yen-Chin; Ji, Ru-Rong

2011-01-01

Management of chronic pain such as nerve injury-induced neuropathic pain associated with diabetic neuropathy, viral infection, and cancer is a real clinical challenge. Major surgeries such as breast and thoracic surgery, leg amputation, and coronary artery bypass surgery also lead to chronic pain in 10–50% of individuals after acute postoperative pain, in part due to surgery-induced nerve injury. Current treatments mainly focus on blocking neurotransmission in the pain pathway and have only resulted in limited success. Ironically, chronic opioid exposure may lead to paradoxical pain. Development of effective therapeutic strategies requires a better understanding of cellular mechanisms underlying the pathogenesis of neuropathic pain. An important progress in pain research points to important role of microglial cells in the development of chronic pain. Spinal cord microglia are strongly activated after nerve injury, surgical incision, and chronic opioid exposure. Increasing evidence suggests that under all these conditions the activated microglia not only exhibit increased expression of microglial markers CD11b and Iba1 but also display elevated phosphorylation of p38 MAP kinase. Inhibition of spinal cord p38 has been shown to attenuate neuropathic pain and postoperative pain, as well as morphine-induced antinociceptive tolerance. Activation of p38 in spinal microglia results in increased synthesis and release of the neurotrophin BDNF and the proinflammatory cytokines IL-1β, IL-6, and TNF-α. These microglia-released mediators can powerfully modulate spinal cord synaptic transmission, leading to increased excitability of dorsal horn neurons, i.e. central sensitization, in part via suppressing inhibitory synaptic transmission. We review the studies that support the pronociceptive role of microglia in conditions of neuropathic pain, post-surgical pain, and opioid tolerance. Some of these studies have been accomplished by four Taiwanese anesthesiologists who are also

How Is Pain Managed?

Science.gov (United States)

... Detection- Goggins Lab Sol Goldman Center Discussion Board Pain Management Pain is a very common symptom in patients ... of pain. Pain Assessment The first step in pain management is a thorough assessment. Your healthcare provider will ...

Cerebral interactions of pain and reward and their relevance for chronic pain.

Science.gov (United States)

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.

The epidemiology of neck pain: what we have learned from our population-based studies

Science.gov (United States)

Côté, Pierre; Cassidy, J. David; Carroll, Linda

2003-01-01

Background: There are few population-based studies on the epidemiology of neck pain in the general population. Purpose: To synthesize the findings of two large population-based studies of the epidemiology of neck pain and whiplash-associated disorders from the province of Saskatchewan, Canada. Study Design and Methods: We conducted two population-based cohort studies of neck pain and its related disability in Saskatchewan, Canada. First, the Saskatchewan Health and Back Pain Survey was designed to determine the prevalence and factors associated with neck pain in randomly selected adults. Second, we conducted a cohort study of the incidence and prognosis of whiplash and studied whether a change in the insurance system from tort to no-fault was related to a reduction in the number of whiplash claims and faster recovery. Results: In 1995, the six-month prevalence of neck pain was 54.2% and 4.6% of adults experienced disabling neck pain in the previous six-months. Neck pain was associated with education, comorbidities, smoking, self-reported general health and a history of neck injury in a motor vehicle collision. The incidence of treated and/or compensated whiplash injury was estimated at 834/100,000 adults in 1994, and dropped by 28% to 598/100,000 adults in 1995, after tort reform. Compared to tort, the median time-to-recovery was more than 230 days faster under no-fault. The strongest predictors of recovery were age, gender, education, injury severity, lawyer involvement and type of initial care provider. Conclusion: Neck pain is a public health problem. The incidence and prognosis of whiplash injuries are greatly influenced by compensation for pain and suffering, legal factors, injury severity and sociodemographic characteristics. Overall, neck pain is a multifaceted disabling problem that deserves more attention. When treating patients with neck pain, clinicians need to recognize that it is more than a physical problem and that its prognosis is influenced by