Intensive meditation for refractory pain and symptoms.

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Goyal, Madhav; Haythornthwaite, Jennifer; Levine, David; Becker, Diane; Vaidya, Dhananjay; Hill-Briggs, Felicia; Ford, Daniel

2010-06-01

The objective of this study was to assess patient interest in intensive meditation training for chronic symptoms. This was a cross-sectional anonymous survey among six chronic disease clinics in Baltimore including Chronic Kidney Disease, Crohn's Disease, Headache, Renal Transplant Recipients, General Rheumatology, and lupus clinic. Subjects were 1119 consecutive patients registering for their appointments at these clinics. Outcome measures were 6-month pain, global symptomatology, four-item perceived stress scale, use of complementary and alternative medicine (CAM) therapies, and attitudes toward use of meditation for managing symptoms. We then gave a scripted description of an intensive, 10-day meditation training retreat. Patient interest in attending such a retreat was assessed. Seventy-seven percent (77%) of patients approached completed the survey. Fifty-three percent (53%) of patients reported moderate to severe pain over the past 6 months. Eighty percent (80%) reported use of some CAM therapy in the past. Thirty-five percent (35%) thought that learning meditation would improve their health, and 49% thought it would reduce stress. Overall, 39% reported interest in attending the intensive 10-day meditation retreat. Among those reporting moderate to severe pain or stress, the percentages were higher (48% and 59%). In a univariate analysis, higher education, nonworking/disabled status, female gender, higher stress, higher pain, higher symptomatology, and any CAM use were all associated with a greater odds of being moderately to very interested in an intensive 10-day meditation retreat. A multivariate model that included prior use of CAM therapies as predictors of interest in the program fit the data significantly better than a model not including CAM therapies (p = 0.0013). Over 50% of patients followed in chronic disease clinics complain of moderate to severe pain. Patients with persistent pain or stress are more likely to be interested in intensive meditation.

Uncertainty about the intensity of impending pain increases ensuing pain responses in congenital blindness

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Holten-Rossing, S.; Slimani, H.; Ptito, M.

2018-01-01

about the intensity of a pending painful stimulus affects pain differently in congenitally blind and sighted control subjects. We measured pain and anxiety in a group of 11 congenitally blind and 11 age- and sex-matched normal sighted control participants. Painful stimuli were delivered under two...... psychological conditions, whereby participants were either certain or uncertain about the intensity of a pending noxious stimuli. Although both blind and sighted participants had increased anxiety ratings in the uncertain condition, pain ratings increased only in the congenitally blind participants. Our data...

The influence of pain-related expectations on intensity perception of non-painful somatosensory stimuli.

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Zaman, Jonas; Wiech, Katja; Claes, Nathalie; Van Oudenhove, Lukas; Van Diest, Ilse; Vlaeyen, Johan W S

2018-04-03

The extent to which pain-related expectations, known to affect pain perception, also affect perception of non-painful sensations remains unclear, as well as the potential role of unpredictability in this context. In a proprioceptive fear conditioning paradigm, various arm extension movements were associated with predictable and unpredictable electrocutaneous pain or its absence. During a subsequent test phase non-painful electrocutaneous stimuli with a high or low intensity were presented during movement execution. We used hierarchical drift diffusion modeling to examine the influence of expecting pain on the perceptual decision-making process underlying intensity perception of non-painful sensations. In the first experiment (n=36), the pain stimulus was never presented during the test phase after conditioning. In the second experiment (n=39), partial reinforcement was adopted to prevent extinction of pain expectations. In both experiments, movements that were associated with (un)predictable pain led to higher pain-expectancy, self-reported fear, unpleasantness and arousal, as compared to movements that were never paired with pain (effect sizes ηp ranging from .119 - .557; all p-values threat of the pain US remained present - we found that the expectation of pain affected decision-making. Compared to the no pain condition, an a priori decision-making bias towards the high intensity decision threshold was found with the strongest bias during unpredictable pain (effect sizes ηp ranging from .469 - .504; all p-values affects inferential processes for subsequent painful but also for non-painful bodily stimuli, with unpredictability moderating these effects, and only when the threat of pain remains present due to partial reinforcement.

Effect of expectation on pain assessment of lower- and higher-intensity stimuli.

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Ružić, Valentina; Ivanec, Dragutin; Modić Stanke, Koraljka

2017-01-01

Pain modulation via expectation is a well-documented phenomenon. So far it has been shown that expectations about effectiveness of a certain treatment enhance the effectiveness of different analgesics and of drug-free pain treatments. Also, studies demonstrate that people assess same-intensity stimuli differently, depending on the experimentally induced expectations regarding the characteristics of the stimuli. Prolonged effect of expectation on pain perception and possible symmetry in conditions of lower- and higher-intensity stimuli is yet to be studied. Aim of this study is to determine the effect of expectation on the perception of pain experimentally induced by the series of higher- and lower-intensity stimuli. 192 healthy participants were assigned to four experimental groups differing by expectations regarding the intensity of painful stimuli series. Expectations of two groups were congruent with actual stimuli; one group expected and received lower-intensity stimuli and the other expected and received higher-intensity stimuli. Expectations of the remaining two groups were not congruent with actual stimuli; one group expected higher-intensity stimuli, but actually received lower-intensity stimuli while the other group expected lower-intensity stimuli, but in fact received higher-intensity ones. Each group received a series of 24 varied-intensity electrical stimuli rated by the participants on a 30° intensity scale. Expectation manipulation had statistically significant effect on pain intensity assessment. When expecting lower-intensity stimuli, the participants underestimated pain intensity and when expecting higher-intensity stimuli, they overestimated pain intensity. The effect size of expectations upon pain intensity assessment was equal for both lower- and higher-intensity stimuli. The obtained results imply that expectation manipulation can achieve the desired effect of decreasing or increasing both slight and more severe pain for a longer period of

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

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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.

Ecological momentary assessment of the relationship between headache pain intensity and pain interference in women with migraine and obesity.

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Thomas, J Graham; Pavlovic, Jelena; Lipton, Richard B; Roth, Julie; Rathier, Lucille; O'Leary, Kevin C; Buse, Dawn C; Evans, E Whitney; Bond, Dale S

2016-11-01

Background While pain intensity during migraine headache attacks is known to be a determinant of interference with daily activities, no study has evaluated: (a) the pain intensity-interference association in real-time on a per-headache basis, (b) multiple interference domains, and (c) factors that modify the association. Methods Participants were 116 women with overweight/obesity and migraine seeking behavioral treatment to lose weight and decrease headaches in the Women's Health and Migraine trial. Ecological momentary assessment, via smartphone-based 28-day headache diary, and linear mixed-effects models were used to study associations between pain intensity and total- and domain-specific interference scores using the Brief Pain Inventory. Multiple factors (e.g. pain catastrophizing (PC) and headache management self-efficacy (HMSE)) were evaluated either as independent predictors or moderators of the pain intensity-interference relationship. Results Pain intensity predicted degree of pain interference across all domains either as a main effect (coeff = 0.61-0.78, p < 0.001) or interaction with PC, allodynia, and HMSE ( p < 0.05). Older age and greater allodynia consistently predicted higher interference, regardless of pain intensity (coeff = 0.04-0.19, p < 0.05). Conclusions Pain intensity is a consistent predictor of pain interference on migraine headache days. Allodynia, PC, and HMSE moderated the pain intensity-interference relationship, and may be promising targets for interventions to reduce pain interference.

Nurses' knowledge and barriers regarding pain management in intensive care units.

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Wang, Hsiang-Ling; Tsai, Yun-Fang

2010-11-01

To explore nurses' knowledge and barriers regarding pain management in intensive care units. Pain is a common and treatable condition among intensive care patients. Quality care of these patients depends on the pain knowledge and pain management skills of critical care nurses. However, no single study has explored these nurses' knowledge of and perceived barriers to pain management in Taiwan. A cross-sectional study. Intensive care unit nurses (n = 370) were recruited from 16 hospitals chosen by stratified sampling across Taipei County in Taiwan. Data were collected on nurses' knowledge of pain management using the Nurses' Knowledge and Attitudes Survey-Taiwanese version, on perceived barriers to pain management using a researcher-developed scale and on background information. The overall average correct response rate for the knowledge scale was 53.4%, indicating poor knowledge of pain management. The top barrier to managing pain identified by these nurses was 'giving proper pain prescription needs doctor's approval; can't depend on me'. Knowledge of pain management was significantly and negatively related to perceived barriers to pain management. In addition, scores for knowledge and perceived barriers differed significantly by specific intensive care unit. Knowledge also differed significantly by nurses' education level, clinical competence level (nursing ladder) and hospital accreditation category. Our results indicate an urgent need to strengthen pain education by including case analysis for intensive care nurses in Taiwan. Pain education should target knowledge deficits and barriers to changing pain management approaches for Taiwanese nurses in intensive care units. © 2010 Blackwell Publishing Ltd.

[Association between the intensity of childbirth pain and the intensity of postpartum blues].

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Boudou, M; Teissèdre, F; Walburg, V; Chabrol, H

2007-10-01

The aim of this study was to highlight a link between childbirth pain and mood disorders in the immediate postpartum. We met 43 women at three days postpartum in a maternity unit in Toulouse (France) between January and April 2004. The mean age of the mothers was 30 years (S.D., 4.8 years; range, 18-39 years). Mothers were excluded if they did not speak French, if they had past psychiatric history, and if their baby was premature, ill, or stillborn. Pain was measured using a French version of the McGill pain questionnaire (Melzack, 1975) [Br J Psychiatry 171 (1997) 550-555]. This questionnaire called questionnaire douleur Saint-Antoine (QDSA) is composed of 58 words and 16 classes (Boureau et at., 1984) [Thérapie 39 (1984) 119-129]. Classes 1-9 provide data on the sensory qualities of pain while Classes 10-16 reflect affective characteristics. Blues symptoms was assessed with the French version of the maternity blues questionnaire of Kennerley and Gath (1989) [Br J Psychiatry 145 (1984) 620-625]. For each 28 items women have to decide how much change there is from their usual self, by ticking one choice out of five, from "much less than usual" to "much more than usual". We used the French version of the EPDS (Cox et al., 1987) [Br J Psychiatry 150 (1987) 782-786]. This scale was used to assess the intensity of depressive mood. The results revealed a significant positive correlation between the pain scores and the "maternity blues" questionnaire scores, and between pain scores and EPDS score at three days postpartum. This study shows a stronger association between intensity of postpartum blues and affective aspect of childbirth pain (r=0.48; pdepressive mood was found to be associated with affective (r=0.32; pchildbirth pain (r=0.28; pdepressive mood, we entered the same predictors. This model accounted for 20% of the variance of blues intensity (F3,39=3.26, p=0.03). Age was the only significant predictor (beta=-0.31, p=0.04). These results confirm our hypothesis

Pain management intervention targeting nursing staff and general practitioners: Pain intensity, consequences and clinical relevance for nursing home residents.

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Dräger, Dagmar; Budnick, Andrea; Kuhnert, Ronny; Kalinowski, Sonja; Könner, Franziska; Kreutz, Reinhold

2017-10-01

Although chronic pain is common in older adults, its treatment is frequently inappropriate. This problem is particularly prevalent in nursing home residents. We therefore developed an intervention to optimize pain management and evaluated its effects on pain intensity and pain interference with function in nursing home residents in Germany. In a cluster-randomized controlled intervention, 195 residents of 12 Berlin nursing homes who were affected by pain were surveyed at three points of measurement. A modified German version of the Brief Pain Inventory was used to assess pain sites, pain intensity and pain interference with function in various domains of life. The intervention consisted of separate training measures for nursing staff and treating physicians. The primary objective of reducing the mean pain intensity by 2 points was not achieved, partly because the mean pain intensity at baseline was relatively low. However, marginal reductions in pain were observed in the longitudinal assessment at 6-month follow up. The intervention and control groups differed significantly in the intensity sum score and in the domain of walking. Furthermore, the proportion of respondents with pain scores >0 on three pain intensity items decreased significantly. Given the multifocal nature of the pain experienced by nursing home residents, improving the pain situation of this vulnerable group is a major challenge. To achieve meaningful effects not only in pain intensity, but especially in pain interference with function, training measures for nursing staff and physicians need to be intensified, and long-term implementation appears necessary. Geriatr Gerontol Int 2017; 17: 1534-1543. © 2016 Japan Geriatrics Society.

Pain, pain intensity and pain disability in high school students are differently associated with physical activity, screening hours and sleep.

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Silva, Anabela G; Sa-Couto, Pedro; Queirós, Alexandra; Neto, Maritza; Rocha, Nelson P

2017-05-16

Studies exploring the association between physical activity, screen time and sleep and pain usually focus on a limited number of painful body sites. Nevertheless, pain at different body sites is likely to be of different nature. Therefore, this study aims to explore and compare the association between time spent in self-reported physical activity, in screen based activities and sleeping and i) pain presence in the last 7-days for 9 different body sites; ii) pain intensity at 9 different body sites and iii) global disability. Nine hundred sixty nine students completed a questionnaire on pain, time spent in moderate and vigorous physical activity, screen based time watching TV/DVD, playing, using mobile phones and computers and sleeping hours. Univariate and multivariate associations between pain presence, pain intensity and disability and physical activity, screen based time and sleeping hours were investigated. Pain presence: sleeping remained in the multivariable model for the neck, mid back, wrists, knees and ankles/feet (OR 1.17 to 2.11); moderate physical activity remained in the multivariate model for the neck, shoulders, wrists, hips and ankles/feet (OR 1.06 to 1.08); vigorous physical activity remained in the multivariate model for mid back, knees and ankles/feet (OR 1.05 to 1.09) and screen time remained in the multivariate model for the low back (OR = 2.34. Pain intensity: screen time and moderate physical activity remained in the multivariable model for pain intensity at the neck, mid back, low back, shoulder, knees and ankles/feet (Rp 2 0.02 to 0.04) and at the wrists (Rp 2  = 0.04), respectively. Disability showed no association with sleeping, screen time or physical activity. This study suggests both similarities and differences in the patterns of association between time spent in physical activity, sleeping and in screen based activities and pain presence at 8 different body sites. In addition, they also suggest that the factors associated

Kinesiophobia is associated with pain intensity but not pain sensitivity before and after exercise

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Vægter, Henrik Bjarke; Madsen, Anders Bjarke; Handberg, Gitte

2018-01-01

OBJECTIVE: To compare clinical pain intensity, exercise performance, pain sensitivity and the effect of aerobic and isometric exercise on local and remote pressure pain thresholds (PPTs) in patients with chronic musculoskeletal pain with high and low levels of kinesiophobia. DESIGN: An experiment...

The Relationship between Fear of Movement and Pain Intensity with Physical Disability in Chronic Lew-Back Pain Patients

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Taher Afshar-Nezhad

2010-07-01

Full Text Available Objective: There is growing evidence for the idea that fear of movement may be as disabling as pain intensity in chronic low back pain patients (CLBP. The purpose of the present paper is to investigate the relation between fear of movement and pain intensity with physical disability in chronic low back pain patients and the role of pain duration, gender and age differences in these relations. Materials & Methods: In this analytical and cross-sectional study, 194 patients with chronic low back pain for more than three months, referred to seven rehabilitation clinics in Rasht city during four months, were selected consecutively. Data were collected by Numerical Rating Scale, Roland–Morris Disability Questionnaire, Tampa Scale for Kinesiophobia and Demographic questionnaire and analyzed by Pearson Correlation Coefficient and Multi Regression. Results: Significant correlations were found between physical disability with fear of movement, pain intensity and age (P<0.001 and also pain duration (P=0.036. These relations were not different between males and females. In first Regression model, fear of movement and pain intensity, were the strongest predictors of physical disability. No differences were found between these factors. Then, prediction model was prepared adding age, sex and pain duration. Multiple regression analyses revealed that the fear of movement and pain intensity were superior in predicting disability. Among demographic variables, only the Beta Coefficient for age was significant in predicting disability (P=0.002. Conclusion: Fear of movement, pain intensity and age are important factors influencing physical disability in individuals suffering a chronic low back pain. Thus, for minimizing physical disability, alone with reducing pain intensity, patients showing fear of movement can be offered interventions that focus on reduction of the fear.

Widespread pain - do pain intensity and care-seeking influence sickness absence? - A population-based cohort study

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Mose, Søren; Christiansen, David Høyrup; Jensen, Jens Christian

2016-01-01

BACKGROUND: Both musculoskeletal pain-intensity in relation to a specific location (e.g. lower back or shoulder) and pain in multiple body regions have been shown to be associated with impaired function and sickness absence, but the impact of pain intensity on the association between widespread...... between number of musculoskeletal pain sites and sickness absence, and to analyze the impact on absenteeism from care-seeking in general practice due to musculoskeletal disorders.METHODS: 3745 Danish adults registered with eight General Practitioners (GPs) in one primary medical center reported location...... pain and sickness absence has not been studied. Additionally it is unknown whether care-seeking in general practice due to musculoskeletal disorders has a positive or negative impact on future absenteeism. The purpose of this study was to examine the influence of pain intensity on the association...

Determinants of procedural pain intensity in the intensive care unit. The Europain® study

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Puntillo, Kathleen A; Max, Adeline; Timsit, Jean-Francois

2014-01-01

in 192 ICUs in 28 countries. MEASUREMENTS AND MAIN RESULTS: Pain intensity on a 0-10 numeric rating scale increased significantly from baseline pain during all procedures (P tube removal, wound drain removal, and arterial line insertion were the three most painful procedures, with median...

Assay sensitivity of pain intensity versus pain relief in acute pain clinical trials: ACTTION systematic review and meta-analysis.

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Singla, Neil; Hunsinger, Matthew; Chang, Phoebe D; McDermott, Michael P; Chowdhry, Amit K; Desjardins, Paul J; Turk, Dennis C; Dworkin, Robert H

2015-08-01

The magnitude of the effect size of an analgesic intervention can be influenced by several factors, including research design. A key design component is the choice of the primary endpoint. The purpose of this meta-analysis was to compare the assay sensitivity of 2 efficacy paradigms: pain intensity (calculated using summed pain intensity difference [SPID]) and pain relief (calculated using total pain relief [TOTPAR]). A systematic review of the literature was performed to identify acute pain studies that calculated both SPIDs and TOTPARs within the same study. Studies were included in this review if they were randomized, double-blind, placebo-controlled investigations involving medications for postsurgical acute pain and if enough data were provided to calculate TOTPAR and SPID standardized effect sizes. Based on a meta-analysis of 45 studies, the mean standardized effect size for TOTPAR (1.13) was .11 higher than that for SPID (1.02; P = .01). Mixed-effects meta-regression analyses found no significant associations between the TOTPAR - SPID difference in standardized effect size and trial design characteristics. Results from this review suggest that for acute pain studies, utilizing TOTPAR to assess pain relief may be more sensitive to treatment effects than utilizing SPID to assess pain intensity. The results of this meta-analysis suggest that TOTPAR may be more sensitive to treatment effects than SPIDs are in analgesic trials examining acute pain. We found that standardized effect sizes were higher for TOTPAR compared to SPIDs. Copyright © 2015 American Pain Society. Published by Elsevier Inc. All rights reserved.

Effects of exercise intensity on food intake and appetite in women.

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Pomerleau, Marjorie; Imbeault, Pascal; Parker, Torrey; Doucet, Eric

2004-11-01

Increasing exercise intensity has been shown to reduce energy intake in men. The main objective of this study was to investigate the effects of exercise intensity on energy intake in women. Thirteen moderately active (peak oxygen uptake: 44.0 +/- 4.7 mL . kg(-1) . min(-1)) women [body mass index (in kg/m(2)): 22.2 +/- 2.4; age: 22.2 +/- 2.0 y] were subjected to 3 experimental conditions: control with no exercise and 2 equicaloric (350 kcal) low- (LIE) and high- (HIE) intensity exercise sessions at 40% and 70% of peak oxygen uptake, respectively. After each session, the participants ate ad libitum from buffet-type meals at lunch and dinner and ate snacks during the afternoon and evening. Visual analogue scales were used to rate appetite. More energy was ingested at lunchtime after the HIE session than after the control session (878 +/- 309 and 751 +/- 230 kcal, respectively; P = 0.02). Relative energy intake (postexercise energy intake corrected for the energy cost of exercise above the resting level) at lunch was lower after the LIE session than after the control session (530 +/- 233 and 751 +/- 230 kcal, respectively; P kcal, respectively; P daily energy intake tended to increase during the HIE session relative to that during the control session. No treatment effect was found for appetite scores throughout the experiment. The results suggest that HIE increases energy intake in women.

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

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

2016-05-01

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

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

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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.

Enhanced presurgical pain temporal summation response predicts post-thoracotomy pain intensity during the acute postoperative phase.

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Weissman-Fogel, Irit; Granovsky, Yelena; Crispel, Yonathan; Ben-Nun, Alon; Best, Lael Anson; Yarnitsky, David; Granot, Michal

2009-06-01

Recent evidence points to an association between experimental pain measures obtained preoperatively and acute postoperative pain (POP). We hypothesized that pain temporal summation (TS) might be an additional predictor for POP insofar as it represents the neuroplastic changes that occur in the central nervous system following surgery. Therefore, a wide range of psychophysical tests (TS to heat and mechanical repetitive stimuli, pain threshold, and suprathreshold pain estimation) and personality tests (pain catastrophizing and anxiety levels) were administered prior to thoracotomy in 84 patients. POP ratings were evaluated on the 2nd and 5th days after surgery at rest (spontaneous pain) and in response to activity (provoked pain). Linear regression models revealed that among all assessed variables, enhanced TS and higher pain scores for mechanical stimulation were significantly associated with greater provoked POP intensity (overall r2 = 0.225, P = .008). Patients who did not demonstrate TS to both modalities reported lower scores of provoked POP as compared with patients who demonstrated TS in response to at least 1 modality (F = 4.59 P = .013). Despite the moderate association between pain catastrophizing and rest POP, none of the variables predicted the spontaneous POP intensity. These findings suggest that individual susceptibility toward a greater summation response may characterize patients who are potentially vulnerable to augmented POP. This study proposed the role of pain temporal summation assessed preoperatively as a significant psychophysical predictor for acute postoperative pain intensity. The individual profile of enhanced pain summation is associated with the greater likelihood of higher postoperative pain scores.

Postoperative Pain after Endodontic Retreatment Using Rotary or Reciprocating Instruments: A Randomized Clinical Trial.

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Comparin, Daniel; Moreira, Edson Jorge Lima; Souza, Erick M; De-Deus, Gustavo; Arias, Ana; Silva, Emmanuel João Nogueira Leal

2017-07-01

The aim of this randomized clinical trial was to evaluate the influence of rotary or reciprocating retreatment techniques on the incidence, intensity, duration of postoperative pain, and medication intake. After power analysis calculations, 65 patients who needed endodontic retreatment were randomly assigned to 1 of 2 groups according to the instrumentation system used: Mtwo (VDW, Munich, Germany) or Reciproc (VDW). Retreatments were performed in a single visit by an endodontic specialist. Participants were asked to rate the incidence and intensity of the postoperative pain on a verbal rating scale 24, 48, and 72 hours after treatment. Patients were also asked to record the number of prescribed analgesic medication tablets (ibuprofen 400 mg) taken. A logistic regression analysis was used to assess both the incidence and duration of pain. Differences in the intensity of pain were analyzed using the ordinal (linear) chi-square test, and the Mann-Whitney U test was used to assess differences in the intake of analgesic medication between groups. No statistically significant difference was found among the 2 groups in relation to postoperative pain or analgesic medication intake at the 3 time points assessed (P > .05). Multivariate analysis showed a significantly higher incidence of pain after 24 hours when preoperative pain was present and a significantly longer duration of pain for men than women independently of the retreatment technique used. The reciprocating system and the continuous rotary system were found to be equivalent regarding the incidence, intensity, duration of postoperative pain, and intake of analgesic medication. Copyright © 2017 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Facial Expression Overrides Lumbopelvic Kinematics for Clinical Judgements about Low Back Pain Intensity

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A. Courbalay

2016-01-01

Full Text Available Background. Through real-time behavioral observation systems, pain behaviors are commonly used by clinicians to estimate pain intensity in patients with low back pain. However, little is known about how clinicians rely on pain-related behaviors to make their judgment. According to the Information Integration Theory (IIT framework, this study aimed at investigating how clinicians value and integrate information from lumbopelvic kinematics (LK, a protective pain behavior, and facial expression intensity (FEI, a communicative pain behavior, to estimate pain in patients with chronic low back pain (cLBP. Methods. Twenty-one experienced clinicians and twenty-one novice clinicians were asked to estimate back pain intensity from a virtual character performing a trunk flexion-extension task. Results. Results revealed that both populations relied on facial expression and that only half of the participants in each group integrated FEI and LK to estimate cLBP intensity. Among participants who integrated the two pain behaviors, averaging rule predominated among others. Results showed that experienced clinicians relied equally on FEI and LK to estimate pain, whereas novice clinicians mostly relied on FEI. Discussion. The use of additive rule of integration does not appear to be systematic when assessing others’ pain. When assessing pain intensity, communicative and protective pain behaviors may have different relevance.

Grading the intensity of nondental orofacial pain: identification of cutoff points for mild, moderate, and severe pain

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Brailo V

2015-02-01

Full Text Available Vlaho Brailo,1 Joanna M Zakrzewska2 1Department of Oral Medicine, School of Dental Medicine, University of Zagreb, Zagreb, Croatia; 2Facial Pain Unit, Division of Diagnostic, Surgical and Medical Sciences, Eastman Dental Hospital, UCLH NHS Foundation Trust/University College London, London, UK Background: When assessing pain in clinical practice, clinicians often label pain as mild, moderate, and severe. However, these categories are not distinctly defined, and are often used arbitrarily. Instruments for pain assessment use more sophisticated scales, such as a 0–10 numerical rating scale, and apart from pain intensity assess pain-related interference and disability. The aim of the study was to identify cutoff points for mild, moderate, and severe nondental orofacial pain using a numerical rating scale, a pain-related interference scale, and a disability measurement. Materials and methods: A total of 245 patients referred to the Facial Pain Unit in London were included in the study. Intensity and pain-related interference were assessed by the Brief Pain Inventory. Pain-related disability was assessed by the Chronic Graded Pain Scale. Average pain intensity (0–10 was classified into nine schemes with varying cutoff points of mild, moderate, and severe pain. The scheme with the most significant intergroup difference, expressed by multivariate analysis of variance, provided the cutoffs between mild, moderate, and severe pain. Results: The combination that showed the greatest intergroup differences for all patients was scheme 47 (mild 1–4, moderate 5–7, severe 8–10. The same combination provided the greatest intergroup differences in subgroups of patients with temporomandibular disorder and chronic idiopathic facial pain, respectively. Among the trigeminal neuralgia patients alone, the combination with the highest intergroup differences was scheme 48 (mild 1–4, moderate 5–8, severe 9–10. Conclusion: The cutoff points established in

The primipara respons based on individual personality type to the intensity of delivery pain

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Gita N Sari

2016-01-01

Full Text Available Delivery period is one of periods that can cause stress to the mother and the fetus. This period is the natural common phenomenon that for some women subjectively can be considered as pain process that can cause simultaneous anxiety and pain. Psychology research has shown that pain is not only connected to physical respond, the culture that teaches and nurtures us also play important role in coping the pain. These two factors shape different personality for each individual. The objective of this study is to find out the primipara respons based on individual personality type to the intensity of delivery pain. The method of this study was analytical method with survey cross sectional approach. The data was collected prospectively from interview and questionnaire in the same time to find out the correlation between individual personality type and the intensity of delivery pain based on inclusive and exclusive period February 1st 2009 to April 30th 2009. The result with chi-square test and spearman rank test showed significant correlation between individual personality type and the intensity of delivery pain (X2= 8,571 ; p = 0,014. There is the negative correlation between extrovert individual personality and intensity of delivery pain (rs= -0,730; p <0,001, and there is the positive correlation between introvert individual personality type and intensity of delivery pain (rs = 0,726; p <0,001. Based on mann whitney, showed significant difference between extrovert personality type and introverts personality type to intensity of delivery pain (Z M-W: 3,050, p: 0,002. Based on chi-square test showed significant correlation between knowledge based on individual personality type to the intensity of delivery pain (X2= 4,418; p = 0,036 The conclusion of these study are the more extrovert individual personality type the less intense the delivery pain would be, the more introvert individual personality type then the more intense delivery pain would be. The

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

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

2015-01-01

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

On the relationship between pain intensity and postural sway in patients with non-specific neck pain

DEFF Research Database (Denmark)

Ruhe, Alexander; Fejer, René; Walker, Bruce

2013-01-01

Increased center of pressure excursions are well documented in patients with non-specific neck pain. While a linear relationship between pain intensity and postural sway has been described in low back pain patients, no such investigation has been conducted in adults with non-specific neck pain....

Effect of salt intensity in soup on ad libitum intake and on subsequent food choice.

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Bolhuis, Dieuwerke P; Lakemond, Catriona M M; de Wijk, Rene A; Luning, Pieternel A; de Graaf, Cees

2012-02-01

The effect of salt intensity on ad libitum intake of tomato soup was investigated when soup was served as a first course and as a second course. Also the effect of salt intensity in soup on subsequent sweet vs. savory choice of sandwich fillings was investigated. Forty-three healthy subjects consumed ad libitum a low-salt (LS), ideal-salt (IS) and high-salt (HS) tomato soup in both meal settings. The salt concentrations were selected on an individual basis, in a way that IS was most pleasant and LS and HS were similar in pleasantness. The ad libitum intake of IS soup was higher than that of LS and HS soup, and the ad libitum intake of LS soup was higher than that of HS soup. The meal setting, soup as a first or as a second course, did not affect ad libitum intake. Salt intensity in soup did not predict sweet vs. savory choice of fillings in grams or energy, although most sodium from fillings was consumed after intake of HS soup. In conclusion, a higher salt intensity lead to lower ad libitum intake of soup similar in palatability (LS vs. HS). In addition, salt intensity in soup does not predict sweet vs. savory food choice. Copyright © 2011 Elsevier Ltd. All rights reserved.

Life satisfaction in patients with chronic pain – relation to pain intensity, disability, and psychological factors

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Stålnacke BM

2011-11-01

Full Text Available Britt-Marie StålnackeDepartment of Community Medicine and Rehabilitation, Umeå University, Umeå, SwedenAims: To investigate pain intensity, posttraumatic stress, depression, anxiety, disability, and life satisfaction in patients with injury-related chronic pain and to analyze differences in these variables regarding gender.Methods: Questionnaires addressing pain intensity (visual analogue scale [VAS], anxiety and depression (hospital anxiety and depression [HAD] scale, posttraumatic stress (impact of event scale, disability (disability rating index, and life satisfaction [LiSat-11] were answered by 160 patients at assessment at the Pain Rehabilitation Clinic at the Umeå University Hospital (Umeå, Sweden.Results: High level of pain intensity was scored on the VAS (mean value 64.5 ± 21.1 mm together with high levels of anxiety, depression, and posttraumatic stress. Activity limitations in everyday life and decreased life satisfaction were reported, especially on the items physical health and psychological health. A multivariate logistic regression model showed a statistically significant association between low scores on the overall life satisfaction on LiSat-11 and high scores on HAD-depression (odds ratio = 1.141, confidence interval 1.014–1.285. Few gender differences were found.Conclusion: These findings highlight the value of a broad screening in patients with injury-related chronic pain with respect to the relationship of life satisfaction with pain intensity, anxiety, depression, posttraumatic stress, and disability. In addition, these findings support the biopsychosocial approach to assess and treat these patients optimally.Keywords: whiplash injuries, depression, quality of life

Chronic Temporomandibular Disorders: disability, pain intensity and fear of movement.

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Gil-Martínez, Alfonso; Grande-Alonso, Mónica; López-de-Uralde-Villanueva, Ibai; López-López, Almudena; Fernández-Carnero, Josué; La Touche, Roy

2016-12-01

The objective was to compare and correlate disability, pain intensity, the impact of headache on daily life and the fear of movement between subgroups of patients with chronic temporomandibular disorder (TMD). A cross-sectional study was conducted in patients diagnosed with chronic painful TMD. Patients were divided into: 1) joint pain (JP); 2) muscle pain (MP); and 3) mixed pain. The following measures were included: Craniomandibular pain and disability (Craniofacial pain and disability inventory), neck disability (Neck Dsiability Index), pain intensity (Visual Analogue Scale), impact of headache (Headache Impact Test 6) and kinesiophobia (Tampa Scale of Kinesiophobia-11). A total of 154 patients were recruited. The mixed pain group showed significant differences compared with the JP group or MP group in neck disability (p craniomandibular pain and disability (p Neck disability was a significant covariate (37 % of variance) of craniomandibular pain and disability for the MP group (β = 0.62; p neck disability (β = 0.40; p craniomandibular pain and disability. Mixed chronic pain patients show greater craniomandibular and neck disability than patients diagnosed with chronic JP or MP. Neck disability predicted the variance of craniofacial pain and disability for patients with MP. Neck disability and kinesiophobia predicted the variance of craniofacial pain and disability for those with chronic mixed pain.

Fixed or adapted conditioning intensity for repeated conditioned pain modulation.

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Hoegh, M; Petersen, K K; Graven-Nielsen, T

2017-12-29

Aims Conditioned pain modulation (CPM) is used to assess descending pain modulation through a test stimulation (TS) and a conditioning stimulation (CS). Due to potential carry-over effects, sequential CPM paradigms might alter the intensity of the CS, which potentially can alter the CPM-effect. This study aimed to investigate the difference between a fixed and adaptive CS intensity on CPM-effect. Methods On the dominant leg of 20 healthy subjects the cuff pressure detection threshold (PDT) was recorded as TS and the pain tolerance threshold (PTT) was assessed on the non-dominant leg for estimating the CS. The difference in PDT before and during CS defined the CPM-effect. The CPM-effect was assessed four times using a CS with intensities of 70% of baseline PTT (fixed) or 70% of PTT measured throughout the session (adaptive). Pain intensity of the conditioning stimulus was assessed on a numeric rating scale (NRS). Data were analyzed with repeated-measures ANOVA. Results No difference was found comparing the four PDTs assessed before CSs for the fixed and the adaptive paradigms. The CS pressure intensity for the adaptive paradigm was increasing during the four repeated assessments (P CPM-effect was higher using the fixed condition compared with the adaptive condition (P CPM paradigms using a fixed conditioning stimulus produced an increased CPM-effect compared with adaptive and increasing conditioning intensities.

The Use of Analgesic and Other Pain-Relief Drugs to Manage Chronic Low Back Pain: Results from a National Survey.

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Gouveia, Nélia; Rodrigues, Ana; Ramiro, Sofia; Eusébio, Mónica; Machado, Pedro M; Canhão, Helena; Branco, Jaime C

2017-03-01

To analyze and characterize the intake profile of pain-relief drugs in a population-based study of adults with chronic low back pain (CLBP). EpiReumaPt was a cross-sectional Portuguese population-based study (10,661 subjects). Self-reported active CLBP was considered to be low back pain on the day of enrollment and for ≥ 90 days. Prevalence and profile of analgesic intake was characterized among those self-reporting active CLBP, taking into account the intensity of pain and the World Health Organization (WHO) analgesic ladder. We further investigated whether the presence of active CLBP was a factor independently associated with the intake of analgesics (adjusted for potential confounders). Among 1,487 subjects with active CLBP, only 18.7% were using analgesic/pain-relief drugs. Estimated prevalence was anxiolytics, 14.1%; nonsteroidal anti-inflammatory drugs (NSAIDs), 12.3%; antidepressants, 10.1%; analgesic, antipyretics, 6.6%; anticonvulsants, 3.4%; central muscle relaxants, 2.6%; and analgesic opioids, 1.6%. Most subjects with severe pain were in the first step of the WHO analgesic ladder: NSAIDs plus anxiolytics (4.6%), NSAIDs plus antidepressants (3.2%), or NSAIDs plus muscle relaxants (2.5%). The presence of active CLBP was significantly associated with the intake of all therapeutic groups: antidepressants (odds ratio [OR] = 12.56; P pain-relief drug intake in patients with active CLBP was very low, even for those with severe pain. The WHO analgesic ladder was carefully followed, with an extremely conservative use of analgesic opioids even for those with severe pain. © 2016 World Institute of Pain.

Factors Associated with Vitamin D Testing, Deficiency, Intake, and Supplementation in Patients with Chronic Pain.

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

2017-11-02

Vitamin D deficiency is a public health issue, with reports of six- to twenty-five-fold rise in vitamin D testing. Vitamin D deficiency has been linked to many chronic diseases such as diabetes mellitus, cardiovascular disease, depression, and chronic pain. Identifying factors associated with risk of deficiency in individuals with chronic pain will help minimize time and cost. This study aims to examine the factors associated with vitamin D testing, intake, and physician-advised supplementation in individuals with chronic pain. Using a cross-sectional design, data were collected from 465 individuals with chronic pain. These data were analyzed using penalized logistic regression with the LASSO technique. Fifty-seven percent reported being tested for vitamin D, about 40% reported being diagnosed with vitamin D deficiency, and of those who had been tested, 60% reported taking vitamin D supplementation. The findings suggest older age (OR 3.12, CI [1.02, 9.50]) and higher mean pain intensity score (OR 2.02, CI [1.13, 3.59]) increased an individual's chance of being vitamin D deficient. Unemployment or on leave due to pain (OR 1.79, [CI 1.03, 3.11]), part-time employment (OR 1.86, CI [1.02, 3.39]), and being a resident of Australia (OR 2.32, CI [1.13, 4.72]) increased chances of being tested for vitamin D. Being diagnosed with vitamin D deficiency (OR 6.67, CI [2.75, 16.19]), unemployed or on leave due to pain (OR 3.71, CI [1.25, 11.00]), and in part-time employment (OR 2.69, CI [0.86, 8.38]) were associated with physician-advised vitamin D supplementation. Our results may have practical implications, as identifying pretest risk factors may assist in identifying who is at risk of vitamin D deficiency, whom to test, and when to treat.

The effect of local heat on term neonates pain intensity during heel-blood sampling

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R. GHobadi Mohebi

2017-04-01

Full Text Available Aims: Newborns are more sensitive to pain than adults and are more susceptible to the long-term complications of pain. So, it is necessary to use procedures for reducing pain in newborns. The aim of this study was to determine the effect of local heat on the pain intensity of heel-blood sampling in the term newborns. Material & Methods: In this randomized controlled clinical trial study, in 2012, 63 healthy 3 to 5-day newborns who were referred to Shahid Delkhah Health Center in Ferdows were selected by random sampling method and randomly divided into 3 groups (21 people in each group: test (heat, placebo (sound and control. The pain intensity of newborns before, during and after heel-blood sampling was evaluated. The data collection tools were demographic questionnaire and Neonatal Infant Pain Scale (NIPS. Data were analyzed by SPSS 14.5 software and chi-square test, one-way ANOVA, Tukey's post hoc test, and ANOVA with repeated observations. Finding: The mean pain intensity in the three groups was not significantly different before intervention (p=0.86, but the mean pain intensity was lower in the test group than in the other two groups (p=0.006. After heel-blood sampling, the mean pain intensity was the least in the test group and was the most in the control group (p<0.001. Conclusion: Local heat during and after heel blood sampling decreases pain intensity in the term newborns.

Intensity of musculoskeletal pain and (in) ability to work in nursing.

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Magnago, Tânia Solange Bosi de Souza; de Lima, Ana Cláudia Soares; Prochnow, Andrea; Ceron, Marinez Diniz da Silva; Tavares, Juliana Petri; Urbanetto, Janete de Souza

2012-01-01

the aim was to evaluate the association between the intensity of musculoskeletal pain and reduction in work ability among nursing workers. a cross-sectional study, involving 592 nursing staff in a public university hospital in Rio Grande do Sul, Brazil. The Brazilian version of the Finnish questionnaire for calculating Work Ability Index was used, whose score varies from 7 to 49 points. The score was dichotomized as reduced work ability (7 to 36 points) and good/excellent ability (37 to 49 points). The intensity of musculoskeletal pain over the previous week was evaluated, using a numerical pain scale. 43.3% of the participants had reduced work ability and 48.8% reported strong to unbearable pain. Even after adjusting for potentially confounding factors (function and length of service in the function), the workers who mentioned strong to unbearable pain were four times more likely to be classified in the group with reduced work ability. A positive association was determined between intensity of musculoskeletal pain and reduction in work ability. It is necessary to adopt intervention measures in the organizational structure, so as to promote/restore work ability.

Effect of a physiotherapy rehabilitation program on knee osteoarthritis in patients with different pain intensities.

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Abdel-Aziem, Amr Almaz; Soliman, Elsadat Saad; Mosaad, Dalia Mohammed; Draz, Amira Hussin

2018-02-01

[Purpose] To examine the effect of physiotherapy rehabilitation program on moderate knee osteoarthritis in patients with different pain intensities. [Subjects and Methods] Sixty subjects (37 men and 23 women) with moderate knee osteoarthritis participated in the current study. Randomization software was used to select the participating subjects' numbers from the clinic records. They were classified into three groups according to pain intensity: mild, moderate, and severe pain groups. All groups underwent a standard set of pulsed electromagnetic field, ultrasound, stretching exercises, and strengthening exercises. Pain intensity, knee range of motion, knee function, and isometric quadriceps strength were evaluated using the visual analogue scale, universal goniometer, Western Ontario and McMaster Universities osteoarthritis index, and Jamar hydraulic dynamometer, respectively. The evaluation was performed before and after a 4-week rehabilitation program. [Results] All groups showed significant differences in pain intensity, knee range of motion, isometric quadriceps strength, and knee function. The score change in moderate pain group was significantly greater than those in mild and severe pain groups. [Conclusion] Pain intensity is one of the prominent factors that are responsible for the improvement of knee osteoarthritis. Consequently, pain intensity should be considered during rehabilitation of knee osteoarthritis.

Comparison of pain intensity, emotional status and disability level in patients with chronic neck and low back pain.

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Altuğ, Filiz; Kavlak, Erdoğan; Kurtca, Mine Pekesen; Ünal, Ayşe; Cavlak, Uğur

2015-01-01

This study was planned to compare of pain, emotional status and disability level in patients with chronic neck pain and low back pain. In this study, fifty patients with chronic low back pain (Group I) and fifty patients with chronic neck pain (Group II) at least 6 months were evaluated. A Visual Analog Scale was used to describe pain intensity. To determine emotional status of the subjects, the Beck Depression Scale was used The Oswestry Disability Index and the Neck Disability Index were used to evaluate disability level. The mean age of the patients with low back pain and neck pain were 39.70 ± 9.71 years, 45.44 ± 10.39 years, respectively. It was not found a significant difference between in low back pain (Group I) and neck pain (Group II) in results of pain intensity (p= 0.286) and pain duration (p= 0.382). It was found a significant difference between group I and group II in results of emotional status (p= 0.000) and disability level (p= 0.000). The emotional status and disability level scores were found highest in patient's with low back pain. Chronic low back pain is affect in patients than chronic neck pain as a emotional status and disability level.

Sleep quality and covariates as predictors of pain intensity among the general population in rural China.

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Liu, Xiao-Kun; Xiao, Shui-Yuan; Zhou, Liang; Hu, Mi; Zhou, Wei; Liu, Hui-Ming

2018-01-01

The aims of this study were to investigate the distribution of sleep quality and its relationship with the prevalence of pain among rural Chinese people and to explore the association between sleep quality and pain intensity among the general population in real-life settings. This cross-sectional survey included a total of 2052 adults from rural areas in Liuyang, Hunan Province, recruited through random multistage sampling. The distributions of sleep quality and pain prevalence among the participants over a 4-week period were described. Because of multicollinearity among variables, the influence of self-rated sleep quality and psychosocial covariates on pain intensity was explored using a ridge regression model. The data showed that participants reporting all categories of sleep quality experienced some degree of pain. Sleep quality, along with physical and mental health, was a negative predictor of pain intensity among the general population. Symptoms of depression positively predicted pain intensity. Poor sleep quality increased pain intensity among the participants. Both previous research and the present data suggest that improving sleep quality may significantly decrease pain intensity in the general population. The relationship between sleep and pain may be bidirectional. This finding also suggests that treatment for sleep disorders and insomnia should be addressed in future efforts to alleviate pain intensity.

Sodium bicarbonate intake improves high-intensity intermittent exercise performance in trained young men

DEFF Research Database (Denmark)

Krustrup, Peter; Ermidis, Georgios; Mohr, Magni

2015-01-01

Background Sodium bicarbonate intake has been shown to improve exercise tolerance, but the effects on high-intensity intermittent exercise are less clear. Thus, the aim of the present study was to determine the effect of sodium bicarbonate intake on Yo-Yo intermittent recovery level 2 test......) prior intake of sodium bicarbonate (0.4 g · kg−1 body weight). Heart rate and rating of perceived exertion (RPE) were measured during the test and venous blood samples were taken frequently. Results Yo-Yo IR2 performance was 14 % higher (P = 0.04) in SBC than in CON (735 ± 61 vs 646 ± 46 m, respectively......-intensity intermittent exercise performance is improved by prior intake of sodium bicarbonate in trained young men, with concomitant elevations in blood alkalosis and peak blood lactate levels, as well as lowered rating of perceived exertion....

Immediate effects of Graston Technique on hamstring muscle extensibility and pain intensity in patients with nonspecific low back pain.

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Moon, Jong Hoon; Jung, Jin-Hwa; Won, Young Sik; Cho, Hwi-Young

2017-02-01

[Purpose] The purpose of this study was to analyze the effect of Graston Technique on hamstring extensibility and pain intensity in patients with nonspecific low back pain. [Subjects and Methods] Twenty-four patients with nonspecific low back pain (27-46 years of age) enrolled in the study. All participants were randomly assigned to one of two groups: Graston technique group (n=12) and a static stretching group (n=12). The Graston Technique was used on the hamstring muscles of the experimental group, while the static stretching group performed static stretching. Hamstring extensibility was recorded using the sit and reach test, and a visual analog scale was used to measure pain intensity. [Results] Both groups showed a significant improvement after intervention. In comparison to the static stretching group, the Graston technique group had significantly more improvement in hamstring extensibility. [Conclusion] The Graston Technique is a simple and effective intervention in nonspecific low back pain patients to improve hamstring extensibility and lower pain intensity, and it would be beneficial in clinical practice.

Effect of salt intensity on ad libitum intake of tomato soup similar in palatability and on salt preference after consumption.

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Bolhuis, Dieuwerke P; Lakemond, Catriona M M; de Wijk, Rene A; Luning, Pieternel A; de Graaf, Cees

2010-11-01

Sensory properties of food play an important role in satiation. Studies on the effect of taste intensity on satiation show conflicting results. This may be due to the notion that in these studies taste intensity and palatability were confounded. The objective of this study was to investigate the effect of salt intensity of tomato soup on ad libitum intake (satiation), while controlling for palatability on an individual basis. Forty-eight subjects consumed both a low-salt (LS) and high-salt (HS) soup ad libitum from a self-refilling bowl. The results showed no difference between LS and HS soup in ad libitum intake, eating rate, changes in appetite ratings, and changes in hedonic ratings after intake. After intake of HS soup, LS soup was perceived as more bland than before intake of HS soup. After intake of LS soup, HS soup was perceived as more salt intense than before intake of LS soup. In conclusion, this study found no effect of salt intensity on satiation of tomato soups that were similar in palatability. During consumption, subjects adapted quickly to the exposed salt intensity as contrasting salt intensities were rated further from the ideal salt intensity and therefore perceived as less pleasant after consumption.

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

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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

Evaluation of pain intensity measurement during the removal of wound dressing material using 'the PainVision™ system' for quantitative analysis of perception and pain sensation in healthy subjects.

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Matsumura, Hajime; Imai, Ryutaro; Gondo, Masahide; Watanabe, Katsueki

2012-08-01

Reducing pain caused by the removal of adhesive wound dressing materials is very important in clinical practice and is also one of the factors to consider when choosing dressing materials. A visual analogue scale is the most popular method for assessing pain, but it is subjective and is difficult to evaluate quantitatively or statistically. Recently, a new method for the quantitative measurement of pain intensity using a painless electrical stimulation system, PainVision™, has been developed. In this study, we evaluated pain intensity during the removal of wound dressing materials in healthy volunteers by comparing pain during the removal of wound dressing materials, which use acrylic pressure-sensitive adhesive and pain during the removal of materials, which use soft silicone adhesive, as evaluated using the PainVision™ system. Pain intensity was significantly lower with the dressing materials, which use soft silicone adhesive when measured with the PainVision™ system. The PainVision™ system promises to be useful for the quantitative assessment of pain caused by the removal of adhesive wound dressing materials. Further studies are needed to determine whether the PainVision™ system is also effective in measuring pain caused by the removal of wound dressing materials in actual wounds. © 2012 The Authors. © 2012 Blackwell Publishing Ltd and Medicalhelplines.com Inc.

Handling Ibuprofen increases pain tolerance and decreases perceived pain intensity in a cold pressor test.

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Abraham M Rutchick

Full Text Available Pain contributes to health care costs, missed work and school, and lower quality of life. Extant research on psychological interventions for pain has focused primarily on developing skills that individuals can apply to manage their pain. Rather than examining internal factors that influence pain tolerance (e.g., pain management skills, the current work examines factors external to an individual that can increase pain tolerance. Specifically, the current study examined the nonconscious influence of exposure to meaningful objects on the perception of pain. Participants (N = 54 completed a cold pressor test, examined either ibuprofen or a control object, then completed another cold pressor test. In the second test, participants who previously examined ibuprofen reported experiencing less intense pain and tolerated immersion longer (relative to baseline than those who examined the control object. Theoretical and applied implications of these findings are discussed.

Qualitative Evaluation of Pediatric Pain Behavior, Quality, and Intensity Item Candidates and the PROMIS Pain Domain Framework in Children With Chronic Pain.

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Jacobson, C Jeffrey; Kashikar-Zuck, Susmita; Farrell, Jennifer; Barnett, Kimberly; Goldschneider, Ken; Dampier, Carlton; Cunningham, Natoshia; Crosby, Lori; DeWitt, Esi Morgan

2015-12-01

As initial steps in a broader effort to develop and test pediatric pain behavior and pain quality item banks for the Patient-Reported Outcomes Measurement Information System (PROMIS), we used qualitative interview and item review methods to 1) evaluate the overall conceptual scope and content validity of the PROMIS pain domain framework among children with chronic/recurrent pain conditions, and 2) develop item candidates for further psychometric testing. To elicit the experiential and conceptual scope of pain outcomes across a variety of pediatric recurrent/chronic pain conditions, we conducted 32 semi-structured individual and 2 focus-group interviews with children and adolescents (8-17 years), and 32 individual and 2 focus-group interviews with parents of children with pain. Interviews with pain experts (10) explored the operational limits of pain measurement in children. For item bank development, we identified existing items from measures in the literature, grouped them by concept, removed redundancies, and modified the remaining items to match PROMIS formatting. New items were written as needed and cognitive debriefing was completed with the children and their parents, resulting in 98 pain behavior (47 self, 51 proxy), 54 quality, and 4 intensity items for further testing. Qualitative content analyses suggest that reportable pain outcomes that matter to children with pain are captured within and consistent with the pain domain framework in PROMIS. PROMIS pediatric pain behavior, quality, and intensity items were developed based on a theoretical framework of pain that was evaluated by multiple stakeholders in the measurement of pediatric pain, including researchers, clinicians, and children with pain and their parents, and the appropriateness of the framework was verified. Copyright © 2015 American Pain Society. Published by Elsevier Inc. All rights reserved.

Doxazosin oral intake therapy to relieve stent - related urinary symptoms and pain: a prospective, randomized, controlled study

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Long Zhang

Full Text Available ABSTRACT Objective: To assess the impact of Doxazosin Oral Intake Therapy on urinary symptoms and pain in patients with indwelling ureteral stents Patients and Methods: A total of 239 patients with ureteral stone-related hydronephrosis who underwent a double-J stent insertion after ureteroscopic lithotripsy were enrolled. Patients were randomized to receive doxazosin cotrolled release 4 mg once daily for 4 weeks or matching placebo. Patients completed the brief-form Chinese version Ureteric Stent Symptom Questionnaire (USSQ and quality of life (QoL score 2 weeks and 4 weeks after stent placement and 4 weeks after stent withdrawal. The analgesic use was also recorded during the stenting period. Results: Patients in Doxazosin Oral Intake Therapy group, in the first 2 weeks and second 2 weeks with the stent in situ, expressed significant lower daytime frequency (p=0.028 and p=0.038, nocturia (p=0.021 and p=0.008 and urgency (p=0.012 and p=0.014, respectively. Similarly, flank pain score, QoL score and analgesic use were also significant less in the stenting period. There was no significant difference in scores of urinary symptoms, pain and QoL during the post-stent period between two cohorts. Conclusions: Doxazosin Oral Intake Therapy reduced stent-related urinary symptoms, pain and the negative impact on QoL.

Disentangling the Sleep-Pain Relationship in Pediatric Chronic Pain: The Mediating Role of Internalizing Mental Health Symptoms

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Maria Pavlova

2017-01-01

Full Text Available Background. Pediatric chronic pain often emerges in adolescence and cooccurs with internalizing mental health issues and sleep impairments. Emerging evidence suggests that sleep problems may precede the onset of chronic pain as well as anxiety and depression. Studies conducted in pediatric populations with pain-related chronic illnesses suggest that internalizing mental health symptoms may mediate the sleep-pain relationship; however, this has not been examined in youth with primary pain disorders. Objective. To examine whether anxiety and depressive symptoms mediated relationships between sleep quality and pain outcomes among youth with chronic pain. Methods. Participants included 147 youth (66.7% female aged 8–18 years who were referred to a tertiary-level chronic pain program. At intake, the youth completed psychometrically sound measures of sleep quality, pain intensity, pain interference, and anxiety and depressive symptoms. Results. As hypothesized, poor sleep quality was associated with increased pain intensity and pain interference, and anxiety and depressive symptoms mediated these sleep-pain relationships. Discussion. For youth with chronic pain, poor sleep quality may worsen pain through alterations in mood and anxiety; however, prospective research using objective measures is needed. Future research should examine whether targeting sleep and internalizing mental health symptoms in treatments improve pain outcomes in these youth.

Just world beliefs moderate the relationship of pain intensity and disability with psychological distress in chronic pain support group members.

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McParland, Joanna L; Knussen, Christina

2010-01-01

The impact of pain beliefs on coping and adjustment is well established. However, less is known about how beliefs unrelated to pain might impact upon this experience. In particular, just world beliefs could impact upon and be influenced by chronic pain, given that pain is not experienced in a vacuum but instead is experienced in a social context where justice issues are potentially salient. The focus of this study was the ability of personal and general just world beliefs to moderate the relationships psychological distress held with pain intensity and disability in chronic pain. The sample (N=95) was recruited from members of arthritis and fibromyalgia support groups to investigate these social beliefs in a controlled community pain context. A cross-sectional, questionnaire design was adopted. The personal just world belief was endorsed significantly more than the general just world belief, and endorsement of the personal just world belief was negatively correlated with pain intensity, disability and psychological distress, while the general just world belief was unrelated to these variables. When interaction terms relating to personal and general just world beliefs were entered simultaneously into regression analyses, the personal just world belief did not predict psychological distress. However, pain intensity positively predicted psychological distress at low but not high levels of the general just world belief, while disability predicted psychological distress at low and high levels of this belief. This suggests that a strong general just world belief has implications for psychological well-being in chronic pain, and as such this belief may occupy a potential coping function in this context.

Is there a relationship between pain intensity and postural sway in patients with non-specific low back pain?

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Ruhe, Alexander; Fejer, René; Walker, Bruce

2011-07-15

Increased center of pressure excursions are well documented in patients suffering from non-specific low back pain, whereby the altered postural sway includes both higher mean sway velocities and larger sway area. No investigation has been conducted to evaluate a relationship between pain intensity and postural sway in adults (aged 50 or less) with non-specific low back pain. Seventy-seven patients with non-specific low back pain and a matching number of healthy controls were enrolled. Center of pressure parameters were measured by three static bipedal standing tasks of 90 sec duration with eyes closed in narrow stance on a firm surface. The perceived pain intensity was assessed by a numeric rating scale (NRS-11), an equal number of patients (n = 11) was enrolled per pain score. Generally, our results confirmed increased postural instability in pain sufferers compared to healthy controls. In addition, regression analysis revealed a significant and linear increase in postural sway with higher pain ratings for all included COP parameters. Statistically significant changes in mean sway velocity in antero-posterior and medio-lateral direction and sway area were reached with an incremental change in NRS scores of two to three points. COP mean velocity and sway area are closely related to self-reported pain scores. This relationship may be of clinical use as an objective monitoring tool for patients under treatment or rehabilitation.

Assessment of postoperative pain intensity by using photoplethysmography.

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Ling, Peng; Siyuan, Yu; Wei, Wei; Quan, Gong; Bo, Gao

2014-12-01

Timely assessment of acute postoperative pain is very important for pain management. No objective and reliable method to assess postoperative pain intensity exists till now. The aim of the study was to investigate the feasibility of photoplethysmography (PPG) signals in postoperative pain assessment. Thirty patients scheduled for elective abdominal surgery under general anesthesia were examined. Finger PPG signals and visual analogue scale (VAS) score were acquired before and 5, 10, 20, and 30 min after sufentanil administration when the patients were awake and transferred to the post-anesthesia care unit (PACU). During each pain rating, the patient's blood pressure, heart rate, and pulse oxygen saturation were recorded. The amplitude of alternating current (AC) and direct current (DC) extracted from finger PPG signals were analyzed, and the ratio of AC and DC (AC/DC) was calculated. Receiver operating characteristic (ROC) curves were built to assess the performance of AC and AC/DC to detect patients with VAS >4 in the PACU. After administration of sufentanil, VAS scores decreased significantly (p pain levels, but no obvious differences in blood pressures and heart rate. The area under the ROC curves were 0.754 for AC and 0.795 for AC/DC, respectively. The finger PPG signal can be used in acute postoperative pain assessment. Both AC/DC and AC had significant correlations with the pain rating levels, while blood pressure and heart rate were unreliable in pain assessment.

Evaluating acute pain intensity relief: challenges when using an 11-point numerical rating scale.

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Chauny, Jean-Marc; Paquet, Jean; Lavigne, Gilles; Marquis, Martin; Daoust, Raoul

2016-02-01

Percentage of pain intensity difference (PercentPID) is a recognized way of evaluating pain relief with an 11-point numerical rating scale (NRS) but is not without flaws. A new metric, the slope of relative pain intensity difference (SlopePID), which consists in dividing PercentPID by the time between 2 pain measurements, is proposed. This study aims to validate SlopePID with 3 measures of subjective pain relief: a 5-category relief scale (not, a little, moderate, very, complete), a 2-category relief question ("I'm relieved," "I'm not relieved"), and a single-item question, "Wanting other medication to treat pain?" (Yes/No). This prospective cohort study included 361 patients in the emergency department who had an initial acute pain NRS > 3 and a pain intensity assessment within 90 minutes after analgesic administration. Mean age was 50.2 years (SD = 19.3) and 59% were women. Area under the curves of receiver operating characteristic curves analyses revealed similar discriminative power for PercentPID (0.83; 95% confidence interval [CI], 0.79-0.88) and SlopePID (0.82; 95% CI, 0.77-0.86). Considering the "very" category from the 5-category relief scale as a substantial relief, the average cutoff for substantial relief was a decrease of 64% (95% CI, 59-69) for PercentPID and of 49% per hour (95% CI, 44-54) for SlopePID. However, when a cutoff criterion of 50% was used as a measure of pain relief for an individual patient, PercentPID underestimated pain-relieved patients by 12.1% (P pain intensity at baseline was an odd number compared with an even number (32.9% vs 45.0%, respectively). SlopePID should be used instead of PercentPID as a metric to evaluate acute pain relief on a 0 to 10 NRS.

Differentiating between heat pain intensities: the combined effect of multiple autonomic parameters.

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Treister, Roi; Kliger, Mark; Zuckerman, Galit; Goor Aryeh, Itay; Eisenberg, Elon

2012-09-01

Although it is well known that pain induces changes in autonomic parameters, the extent to which these changes correlate with the experience of pain is under debate. The aim of the present study was to compare a combination of multiple autonomic parameters and each parameter alone in their ability to differentiate among 4 categories of pain intensity. Tonic heat stimuli (1minute) were individually adjusted to induce no pain, low, medium, and high pain in 45 healthy volunteers. Electrocardiogram, photoplethysmogram, and galvanic skin response were recorded, and the following parameters were calculated: heart rate; heart rate variability-high frequency (0.15 to 0.4Hz) spectral power; skin conductance level; number of skin conduction fluctuations; and photoplethysmographic pulse wave amplitude. A combination of parameters was created by fitting an ordinal cumulative logit model to the data and using linear coefficients of the model. Friedman test with post-hoc Wilcoxon test were used to compare between pain intensity categories for every parameter alone and for their linear combination. All of the parameters successfully differentiated between no pain and all other pain categories. However, none of the parameters differentiated between all 3 pain categories (i.e., low and medium; medium and high; low and high). In contrast, the linear combination of parameters significantly differentiated not only between pain and no pain, but also between all pain categories (Ppain assessment. Copyright © 2012 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

Association of pain intensity with quality of life and functional disability in university students with lumbago

International Nuclear Information System (INIS)

Fatima, A.; Tanveer, F.; Ahmed, A.; Gillani, S.A.

2017-01-01

To determine an association of pain intensity with quality of life and functional disability in university students with lumbago. Methodology: In this cross sectional study 213 students participated. Standard questionnaire Numeric pain rating scale, Utian quality of life scale Oswestry Low Back Pain Disability Questionnaire were used for the data collection. Results: Mean age of students was 21.0 +- 1.970 years (range 18-24). Out of 213 students, 143 had lower quality of life. There was an association between pain intensity and quality of life (p=0.006). Out of 213 students, 120 had minimal disability with lower quality of life. There was strong association (p=0.015) between quality of life and functional disability. Conclusion: There was a strong association between pain intensity and quality of life, pain intensity and functional disability, quality of life and functional disability in university students with low back ache. (author)

Conditioned pain modulation is affected by occlusion cuff conditioning stimulus intensity, but not duration.

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Smith, A; Pedler, A

2018-01-01

Various conditioned pain modulation (CPM) methodologies have been used to investigate diffuse noxious inhibitory control pain mechanisms in healthy and clinical populations. Occlusion cuff parameters have been poorly studied. We aimed to investigate whether occlusion cuff intensity and/or duration influenced CPM magnitudes. We also investigated the role of physical activity levels on CPM magnitude. Two studies were performed to investigate the role of intensity and duration of occlusion cuff conditioning stimulus on test stimulus (tibialis anterior pressure pain thresholds). In Study 1, conditioning stimulus intensity of 2/10 or 5/10 (duration CPM magnitude. In Study 1, 27 healthy volunteers (mean ± SD: 24.9 years (±4.5); eight female) demonstrated that an occlusion cuff applied to the upper arm eliciting 5/10 local pain resulted in a significant (mean ± SD: 17% ± 46%) increase in CPM magnitude, when compared to 2/10 intensity (-3% ± 38%, p = 0.026), whereas in Study 2, 25 healthy volunteers (22.5 years (±2.7); 13 female) demonstrated that 3 min of 2/10 CS intensity did not result in a significant change in CPM (p = 0.21). There was no significant relationship between physical activity levels and CPM in either study (p > 0.22). This study demonstrated that an occlusion cuff of 5/10 conditioning stimulus intensity, when compared to 2/10, significantly increased CPM magnitude. Maintaining 2/10 conditioning stimulus for 3 min did not increase CPM magnitude. Dysfunctional conditioned pain modulation (CPM) has been associated with poor health outcomes. Various factors can influence CPM outcomes. The role of occlusion cuff conditioning stimulus intensity and duration has not been previously investigated. Intensity (5/10), but not duration of lower intensity (2/10) conditioning stimulus, affects CPM magnitude. © 2017 European Pain Federation - EFIC®.

Is there a relationship between pain intensity and postural sway in patients with non-specific low back pain?

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Fejer René

2011-07-01

Full Text Available Abstract Background Increased center of pressure excursions are well documented in patients suffering from non-specific low back pain, whereby the altered postural sway includes both higher mean sway velocities and larger sway area. No investigation has been conducted to evaluate a relationship between pain intensity and postural sway in adults (aged 50 or less with non-specific low back pain. Methods Seventy-seven patients with non-specific low back pain and a matching number of healthy controls were enrolled. Center of pressure parameters were measured by three static bipedal standing tasks of 90 sec duration with eyes closed in narrow stance on a firm surface. The perceived pain intensity was assessed by a numeric rating scale (NRS-11, an equal number of patients (n = 11 was enrolled per pain score. Results Generally, our results confirmed increased postural instability in pain sufferers compared to healthy controls. In addition, regression analysis revealed a significant and linear increase in postural sway with higher pain ratings for all included COP parameters. Statistically significant changes in mean sway velocity in antero-posterior and medio-lateral direction and sway area were reached with an incremental change in NRS scores of two to three points. Conclusions COP mean velocity and sway area are closely related to self-reported pain scores. This relationship may be of clinical use as an objective monitoring tool for patients under treatment or rehabilitation.

Effect of a single session of ear acupuncture on pain intensity and postural control in individuals with chronic low back pain: a randomized controlled trial

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Andrea Ushinohama

2016-01-01

Full Text Available ABSTRACT Background Ear Acupuncture (EA is a form of acupuncture in which needles are applied to the external ear and has been used in multiple painful conditions. Low back pain (LBP is highly prevalent in active individuals and causes high economic burden to health systems worldwide. LBP affects the person’s ability to keep balance, especially in challenging conditions. Objective The aim of the study was to examine the effects of a single session of EA on pain intensity and body sway during postural tasks. Method Eighty adults with LBP and pain intensity equal to or greater than 4 (0-10 scale were randomly allocated (1:1 to EA group (EAG or placebo group (PG. Initially, the level of pain intensity was assessed. Next, participants stood still on a force plate either with feet in parallel or in semi-tandem and with eyes open or closed. Then, the EAG was treated with EA for 20 min and the PG was treated with detuned ultrasound. After the treatment, pain intensity was assessed again and the postural test was repeated. Pain intensity was the primary outcome and center of pressure sway area and speed were the secondary outcomes measured. Results Results revealed that pain intensity decreased in both groups after treatment, but decreased more in the EAG. For postural control, no effect of treatment and no interaction between treatment and postural condition on body sway were found. Conclusion Those findings indicate that EA is better than placebo to reduce pain, but neither treatment has any effect on postural control.

The consequences of shoulder pain intensity on quality of life and community participation in paraplegic wheelchair users

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Nulle A.

2012-10-01

Full Text Available Background/Objective: Shoulder overuse due weight-bearing loads – wheelchair propulsion and transfers – are supposed to cause shoulder pain in active wheelchair users. Consequently, shoulder pain has been found to have a high prevalence in the spinal cord-injured population. Severity of pain levels in individuals with spinal cord injury has been shown to impact quality of life. Aim of this study was to describe the consequences of shoulder pain intensity on quality of life, physical activity, and community activities in spinal cord-injured paraplegic wheelchair users. Materials and Methods: It was a qualitative, analytical one moment study where was involved persons after spinal cord injury below Th1 with lower paraplegia, who used manually operated wheelchairs for mobility at least 50% of the time. Main outcomes measure: SF-36textregistered Health Survey, Physical Activity Scale for Individuals With Physical Disabilities, Community Activities Checklist, Wheelchair User’s Shoulder Pain Index, Functional Independence Measure, Goniometry for shoulder joint. Results and analysis: 40 participants (9 female, 31 male after spinal cord injury (SCI, mean age – 30,8 years, one to twenty years after spinal cord injury. 20 participants had pain in shoulder, 20 participants without pain in shoulder. The intensity of shoulder pain was not related to duration of SCI or the duration of shoulder pain. Shoulder pain intensity scores were inversely related to quality of life. There was a moderate, inverse relationship between shoulder pain intensity and physical activity. There was no relationship, however, between shoulder pain intensity and community activities. The level of community activity was positively related to quality of life. Conclusions: Persons with spinal cord injury who reported lower subjective quality of life and physical activity scores experienced significantly higher levels of shoulder pain. Shoulder pain intensity did not relate to

Does adherence to treatment mediate the relationship between patients' treatment outcome expectancies and the outcomes of pain intensity and recovery from acute low back pain?

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Haanstra, Tsjitske M; Kamper, Steven J; Williams, Christopher M; Spriensma, Alette S; Lin, Chung-Wei Christine; Maher, Christopher G; de Vet, Henrica C W; Ostelo, Raymond W J G

2015-08-01

It is believed that patients' expectancies about the effectiveness of treatment influence their treatment outcomes, but the working mechanism is rarely studied in patients with low back pain. Theoretical models suggest that adherence to treatment may be an important pathway. The aim of this study was to assess the mediating role of adherence to treatment in the relationship between expectancies and the outcomes of recovery and pain intensity in patients with acute low back pain. This study used data from a randomized placebo-controlled trial of paracetamol for acute low back pain. Expectancies were measured with the Credibility Expectancy Questionnaire. Adherence was measured with a medication diary. Pain intensity was recorded daily in a diary on a 0 to 10 pain scale, and recovery was defined as the first of 7 consecutive days scoring 0 or 1 on a 6-point pain scale. Cox regression (dependent variable: recovery) and linear mixed-model analyses (dependent variable: daily pain intensity scores) were performed. The "difference in coefficients" approach was used to establish mediation. A total of 1573 participants were included in current analyses. There was a small but highly significant relationship between expectancies and outcomes; 3.3% of the relationship between expectancies and recovery and 14.2% of the relationship between expectancies and pain intensity were mediated by adherence to treatment. This study does not convincingly support the theory that adherence is a key pathway in the relationship between treatment outcome expectancies and recovery and pain intensity in this acute low back pain population.

Bodily pain intensity in nursing home residents with pressure ulcers: analysis of national minimum data set 3.0.

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Ahn, Hyochol; Stechmiller, Joyce; Fillingim, Roger; Lyon, Debra; Garvan, Cynthia

2015-06-01

Clinical reports suggest that superficial pressure ulcers produce pain, but that pain decreases as the wound advances in stage. This study of the relationship between pressure ulcer stage and bodily pain intensity in nursing home residents was a secondary analysis of the national Minimum Data Set 3.0 assessment data in long-term care facilities, collected from nursing home residents at least 65 years of age. Data were examined from residents with pressure ulcers who completed a bodily pain intensity interview between January and March 2012 (N = 41,680) as part of the MDS comprehensive assessment. After adjusting for other variables (e.g., cognition, functional impairment, presence of comorbidities, use of scheduled pain medication, and sociodemographic variables), bodily pain intensity for those with more severe pressure ulcers in comparison to those with Stage I ulcers was higher by 11% (Stage II), 14% (Stage III), 24% (Stage IV), and 22% (suspected deep tissue injury). Because multivariate analysis showed that greater bodily pain intensity was associated with an advanced stage of pressure ulcer, health care providers should assess bodily pain intensity and order appropriate pain management for nursing home residents with pressure ulcers, particularly for those with advanced pressure ulcers who are vulnerable to greater bodily pain intensity. © 2015 Wiley Periodicals, Inc.

High frequency migraine is associated with lower acute pain sensitivity and abnormal insula activity related to migraine pain intensity, attack frequency, and pain catastrophizing

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Vani A Mathur

2016-09-01

Full Text Available Migraine is a pain disorder associated with abnormal brain structure and function, yet the effect of migraine on acute pain processing remains unclear. It also remains unclear whether altered pain-related brain responses and related structural changes are associated with clinical migraine characteristics. Using fMRI and three levels of thermal stimuli (non-painful, mildly painful, and moderately painful, we compared whole-brain activity between 14 migraine patients and 14 matched controls. Although, there were no significant differences in pain thresholds and pre-scan pain ratings to mildly painful thermal stimuli, patients had aberrant suprathreshold nociceptive processing. Compared to controls, patients had reduced activity in pain modulatory regions including left dorsolateral prefrontal, posterior parietal, and middle temporal cortices and, at a lower-threshold, greater activation in the right mid-insula to moderate pain versus mild pain. We also found that pain-related activity in the insula was associated with clinical variables in patients, including associations between: bilateral anterior insula and pain catastrophizing (PCS; bilateral anterior insula and contralateral posterior insula and migraine pain intensity; and bilateral posterior insula and migraine frequency at a lower-threshold. PCS and migraine pain intensity were also negatively associated with activity in midline regions including posterior cingulate and medial prefrontal cortices. Diffusion tensor imaging revealed a negative correlation between fractional anisotropy (a measure of white matter integrity; FA and migraine duration in the right mid-insula and a positive correlation between left mid-insula FA and PCS. In sum, while patients showed lower sensitivity to acute noxious stimuli, the neuroimaging findings suggest enhanced nociceptive processing and significantly disrupted modulatory networks, particularly involving the insula cortex, associated with indices of

Efficacy of hijamat bila shurt (dry cupping) on intensity of pain in dysmenorrhoea-a preliminary study.

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Sultana, Arshiya; Ur Rahman, Khaleeq; Farzana, Muzn; Lone, Azad

2010-10-01

Waje rehm (Dysmenorrhoea) means painful menstruation. Since ancient times, hijamat bila shurt (Dry cupping) is a method of treatment of for this disease. Therefore, objective of this preliminary study was to evaluate the efficacy of hijamat bila shurt on intensity of pain in waje rehm by using Visual Analogue Scale for pain. It was conducted from May 2009 to July 2010 on 25 patients in National Institute of Unani Medicine, Bangalore. Patients suffering from primary and secondary dysmenorrhoea with regular cycles, age group 12-37years were selected. For dry cupping, two glass cup of medium size were applied below the umbilicus for 15 minutes on day land/or day 2 of the menstrual phase for one cycle and pain intensity was assessed by Visual Analogue Scale score for pain before and after the treatment. The Mean and Standard Error Mean for pain intensity before and after the treatment was 6.48 (0.32) and 2.12 (0.32) respectively with P<0.001, considered significant. Thus, hijamat bila shurt was effective in reducing pain intensity in dysmenorrhoea.

The Effects of Music on Pain: A Meta-Analysis.

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Lee, Jin Hyung

2016-01-01

Numerous meta-analyses have been conducted on the topic of music and pain, with the latest comprehensive study published in 2006. Since that time, more than 70 randomized controlled trials (RCTs) have been published, necessitating a new and comprehensive review. The aim of this meta-analysis was to examine published RCT studies investigating the effect of music on pain. The present study included RCTs published between 1995 and 2014. Studies were obtained by searching 12 databases and hand-searching related journals and reference lists. Main outcomes were pain intensity, emotional distress from pain, vital signs, and amount of analgesic intake. Study quality was evaluated according to the Cochrane Collaboration guidelines. Analysis of the 97 included studies revealed that music interventions had statistically significant effects in decreasing pain on 0-10 pain scales (MD = -1.13), other pain scales (SMD = -0.39), emotional distress from pain (MD = -10.83), anesthetic use (SMD = -0.56), opioid intake (SMD = -0.24), non-opioid intake (SMD = -0.54), heart rate (MD = -4.25), systolic blood pressure (MD = -3.34), diastolic blood pressure (MD = -1.18), and respiration rate (MD = -1.46). Subgroup and moderator analyses yielded additional clinically informative outcomes. Considering all the possible benefits, music interventions may provide an effective complementary approach for the relief of acute, procedural, and cancer/chronic pain in the medical setting. © the American Music Therapy Association 2016. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Assessment of subjective intensity of pain during ultrasonic supragingival calculus removal: A comparative study

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Sachin Malagi

2014-01-01

Full Text Available Background: The background of the following study is to measure the subjective intensity of pain using the verbal rating scale (VRS during supragingival scaling in relation to mandibular anteriors, with an ultrasonic scaler, with 2 different inserts (Slimline and Focus spray- split mouth study. Materials and Methods: A total of 30 subjects with a combination of 17 males and 13 females with the chronic generalized gingivitis with a minimum calculus score of 1 (CSSI - Ennever J 1961 who reported to Department of Periodontics, Yenepoya Dental College, Mangalore were chosen for the study. Ultrasonic magnetostrictive scaler unit CAVITRON BOBCAT PRO ® - (DENTSPLY with maximum power setting at 130A and 25kHZ frequency with 2 different inserts i.e., Slim line insert and Focus spray (DENTSPLY were used for supragingival scaling in the study. A VRS was used to assess the subjective intensity of pain. Results: There was no statistically significant difference in pain perception when the scores were compared using Wilcoxon signed rank test. VRS rating scores with slimline inserts showed a pain intensity of 2 in 43.3%, 1 in 53.3% and 0 in 3.3%, whereas the focus spray insert showed a pain intensity of 1 in 23.3% and 0 in 76.7%. Statistical analysis showed a P = 0.251 and a z - 1.147 a . Conclusions: The use of both Slim line insert and Focus spray inserts when used at same settings of the scaling unit, showed no statistical significant difference in the intensity of pain perceived and it showed no correlation between patient acceptance and their pain perception.

Estimated intake of intense sweeteners from non-alcoholic beverages in Denmark

DEFF Research Database (Denmark)

Leth, Torben; Fabricius, N.; Fagt, Sisse

2007-01-01

In 1999, 116 samples of non-alcoholic beverages were analysed for the intense sweeteners cyclamate, acesulfame-K, aspartame and saccharin. High contents of cyclamate close to the maximum permitted level in 1999 of 400 mgl(-1) were found in many soft drinks. The estimated intake of the sweeteners...

Pain intensity and cervical range of motion in women with myofascial pain treated with acupuncture and electroacupuncture: a double-blinded, randomized clinical trial

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Aranha, Maria F. M.; Müller, Cristina E. E.; Gavião, Maria B. D.

2015-01-01

BACKGROUND: Acupuncture stimulates points on the body, influencing the perception of myofascial pain or altering physiologic functions. OBJECTIVE: The aim was to evaluate the effect of electroacupuncture (EAC) and acupuncture (AC) for myofascial pain of the upper trapezius and cervical range of motion, using SHAM acupuncture as control. METHOD: Sixty women presenting at least one trigger point at the upper trapezius and local or referred pain for more than six months were randomized into EAC, AC, and SHAM groups. Eight sessions were scheduled and a follow-up was conducted after 28 days. The Visual Analog Scale assessed the intensity of local and general pain. A fleximeter assessed cervical movements. Data were analyzed using paired t or Wilcoxon's tests, ANOVA or Friedman or Kruskal-Wallis tests and Pearson's correlation (α=0.05). RESULTS: There was reduction in general pain in the EAC and AC groups after eight sessions (P<0.001). A significant decrease in pain intensity occurred for the right trapezius in all groups and for the left trapezius in the EAC and AC groups. Intergroup comparisons showed improvement in general pain in the EAC and AC groups and in local pain intensity in the EAC group (P<0.05), which showed an increase in left rotation (P=0.049). The AC group showed increases in inclination (P=0.005) sustained until follow-up and rotation to the right (P=0.032). CONCLUSION : EAC and AC were effective in reducing the pain intensity compared with SHAM. EAC was better than AC for local pain relief. These treatments can assist in increasing cervical range of motion, albeit subtly. PMID:25714602

Relationships among head posture, pain intensity, disability and deep cervical flexor muscle performance in subjects with postural neck pain

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Arun V. Subbarayalu, PhD

2017-12-01

Full Text Available Objectives: Information Technology (IT professionals working with computers gradually develop forward head posture and, as a result, these professionals are susceptible to several neck disorders. This study intended to reveal the relationships between pain intensity, disability, head posture and deep cervical flexor (DCF muscle performance in patients with postural neck pain. Methods: A cross-sectional study was conducted on 84 IT professionals who were diagnosed with postural neck pain. The participants were recruited with a random sampling approach. A Visual Analogue Scale (VAS, the Northwick Park Neck Pain Questionnaire (NPQ, the Modified Head Posture Spinal Curvature Instrument (MHPSCI, and the Stabilizer Pressure Biofeedback Unit were used to measure neck pain intensity, neck disability, head posture, and DCF muscle performance, respectively. Results: The Pearson correlation coefficient revealed a significantly strong positive relationship between the VAS and the NPQ (r = 0.734. The cranio-vertebral (CV angle was found to have a significantly negative correlation with the VAS (r = −0.536 and a weak negative correlation with the NPQ (r = −0.389. Conclusion: This study concluded that a smaller CV angle corresponded to greater neck pain intensity and disability. Furthermore, there is no significant relationship between CV angle and DCF muscle performance, indicating that head posture re-education through postural correction exercises would not completely correct the motor control deficits in DCF muscles. In addition, a suitable exercise regimen that exclusively targets the deep cervical flexor muscle to improve its endurance is warranted. Keywords: Craniovertebral angle, Disability deep cervical flexors muscle performance, Head posture, Postural neck pain

The relative meaning of absolute numbers: the case of pain intensity scores as decision support systems for pain management of patients with dementia.

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Lichtner, Valentina; Dowding, Dawn; Closs, S José

2015-12-24

Assessment and management of pain in patients with dementia is known to be challenging, due to patients' cognitive and/or communication difficulties. In the UK, pain in hospital is managed through regular assessments, with the use of pain intensity scores as triggers for action. The aim of this study was to understand current pain assessment practices, in order to later inform the development of a decision support tool designed to improve the management of pain for people with dementia in hospital. An exploratory study was conducted in four hospitals in the UK (11 wards), with observations of patients with dementia (n = 31), interviews of staff (n = 52) and patients' family members (n = 4) and documentary analysis. A thematic analysis was carried out, structured along dimensions of decision making. This paper focuses on the emergent themes related to the use of assessment tools and pain intensity scores. A variety of tools were used to record pain intensity, usually with numerical scales. None of the tools in actual use had been specifically designed for patients with cognitive impairment. With patients with more severe dementia, the patient's body language and other cues were studied to infer pain intensity and then a score entered on behalf of the patient. Information regarding the temporality of pain and changes in pain experience (rather than a score at a single point in time) seemed to be most useful to the assessment of pain. Given the inherent uncertainty of the meaning of pain scores for patients with dementia, numerical scales were used with caution. Numerical scores triggered action but their meaning was relative - to the patient, to the clinician, to the time of recording and to the purpose of documenting. There are implications for use of data and computerized decision support systems design. Decision support interventions should include personalized alerting cut-off scores for individual patients, display pain scores over time and integrate

[Fear and preoperative anxiety behaviour and pain intensity perceived after knee arthroscopy].

Science.gov (United States)

Anguita-Palacios, M Carmen; Talayero-San-Miguel, Marta; Herrero-Cereceda, Salomé; Martín-Cadenas, Mar; Pardo-Cuevas, Pilar; Gil-Martínez, Alfonso

2016-01-01

The aim of this study was to investigate the short-term (24hours) association between postoperative pain and preoperative psychological variables (anxiety, pain catastrophizing and kinesiophobia) in a sample of knee arthroscopy ambulatory surgery. Observational cross-sectional study, conducted with 40 adult subjects who underwent knee arthroscopy in the surgical area of Cantoblanco Hospital (Hospital Universitario La Paz) in Madrid. The fear-avoidance beliefs and anxiety were assessed using validated questionnaires of pain catastrophizing, kinesiophobia and anxiety. Pre and post-surgical pain and perceived disability were evaluated by the Verbal Numeric Scale. Mean age of the sample (22 men and 18 women) was 52.85±14.21 without significant differences between gender. No statistically significant data for the association between variables of kinesiofobia, anxiety and pain catastrophizing and the intensity of perceived pain by the postoperative knee arthroscopy patient were found. Length of surgery in our study has a correlation with the immediate post-surgical pain (r=0.468; P=.002) and there is a relationship between age and pain intensity at 24hours (r=-0.329; P=.038), and between age and perceived disability (r=-0.314; P=.049). An association between catastrophizing and kinesiophobia scales (r=0.337; P=.033) is obtained likewise. In conclusion, preoperative fear-avoidance beliefs like pain anxiety or pain catastrophizing and kinesiophobia were not associated with acute postoperative pain in our study. Analyses of secondary pain related outcomes, however, indicated that reduced time of surgery may contribute to enhance clinical postoperative pain. If confirmed and replicated in larger samples, this may potentially enable clinicians to improve postoperative pain management in future patients. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

[Suppression of visceral pain by action of the low intensity polarized light on acupuncture antinociceptive points].

Science.gov (United States)

Lymans'kyĭ, Iu P; Tamarova, Z A; Huliar, S O

2003-01-01

In experiments on mice, statistically authentic weakening of visceral pain has been shown after an action of low intensity polarized light from a device Bioptron on antinociceptive acupuncture points (AP). Pain was caused by an intraperitoneal injection of 2% acetic acid (0.1 ml/10 g). The intensity of pain was judged on duration and frequency of painful behavioral reactions (writhing, licking of abdomen), as well as on duration of sleep, eating and motor activity. In animals which immediately after injections of acetic acid were exposed to polarized light of low intensity for 10 min, applied on any of antinociceptive APs (E-36, E-43, VC-8, RP-6), the duration of painful behavioral reaction was determined to be reduced, while that of non-painful one increased. The comparison of the total duration of the writhing at control and experimental mice showed that an activation of AP E-43 induced the greatest analgesic effect (76.5%), from AP VC-8 it was 76.3%, from RP-6--46.8%, and from E-36--41.4%. We have concluded that the effect of polarized light of low intensity on APs was a convenient non-pharmacological method of treating visceral pain.

Analgesic effect of clobazam in chronic low-back pain but not in experimentally induced pain.

Science.gov (United States)

Schliessbach, J; Vuilleumier, P H; Siegenthaler, A; Bütikofer, L; Limacher, A; Juni, P; Zeilhofer, H U; Arendt-Nielsen, L; Curatolo, M

2017-09-01

Chronic pain is frequently associated with hypersensitivity of the nervous system, and drugs that increase central inhibition are therefore a potentially effective treatment. Benzodiazepines are potent modulators of GABAergic neurotransmission and are known to exert antihyperalgesic effects in rodents, but translation into patients are lacking. This study investigates the effect of the benzodiazepine clobazam in chronic low-back pain in humans. The aim of this study is to explore the effect of GABA modulation on chronic low-back pain and on quantitative sensory tests. In this double-blind cross-over study, 49 patients with chronic low-back pain received a single oral dose of clobazam 20 mg or active placebo tolterodine 1 mg. Pain intensity on the 0-10 numeric rating scale and quantitative sensory tests were assessed during 2 h after drug intake. Pain intensity in the supine position was significantly reduced by clobazam compared to active placebo (60 min: 2.9 vs. 3.5, p = 0.008; 90 min: 2.7 vs. 3.3, p = 0.024; 120 min: 2.4 vs. 3.1, p = 0.005). Pain intensity in the sitting position was not significantly different between groups. No effects on quantitative sensory tests were observed. This study suggests that clobazam has an analgesic effect in patients with chronic low-back pain. Muscle relaxation or sedation may have contributed to the effect. Development of substances devoid of these side effects would offer the potential to further investigate the antihyperalgesic action of GABAergic compounds. Modulation of GABAergic pain-inhibitory pathways may be a potential future therapeutic target. © 2017 European Pain Federation - EFIC®.

Effect of Radiofrequency Denervation on Pain Intensity Among Patients With Chronic Low Back Pain: The Mint Randomized Clinical Trials.

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Juch, Johan N S; Maas, Esther T; Ostelo, Raymond W J G; Groeneweg, J George; Kallewaard, Jan-Willem; Koes, Bart W; Verhagen, Arianne P; van Dongen, Johanna M; Huygen, Frank J P M; van Tulder, Maurits W

2017-07-04

Radiofrequency denervation is a commonly used treatment for chronic low back pain, but high-quality evidence for its effectiveness is lacking. To evaluate the effectiveness of radiofrequency denervation added to a standardized exercise program for patients with chronic low back pain. Three pragmatic multicenter, nonblinded randomized clinical trials on the effectiveness of minimal interventional treatments for participants with chronic low back pain (Mint study) were conducted in 16 multidisciplinary pain clinics in the Netherlands. Eligible participants were included between January 1, 2013, and October 24, 2014, and had chronic low back pain, a positive diagnostic block at the facet joints (facet joint trial, 251 participants), sacroiliac joints (sacroiliac joint trial, 228 participants), or a combination of facet joints, sacroiliac joints, or intervertebral disks (combination trial, 202 participants) and were unresponsive to conservative care. All participants received a 3-month standardized exercise program and psychological support if needed. Participants in the intervention group received radiofrequency denervation as well. This is usually a 1-time procedure, but the maximum number of treatments in the trial was 3. The primary outcome was pain intensity (numeric rating scale, 0-10; whereby 0 indicated no pain and 10 indicated worst pain imaginable) measured 3 months after the intervention. The prespecified minimal clinically important difference was defined as 2 points or more. Final follow-up was at 12 months, ending October 2015. Among 681 participants who were randomized (mean age, 52.2 years; 421 women [61.8%], mean baseline pain intensity, 7.1), 599 (88%) completed the 3-month follow-up, and 521 (77%) completed the 12-month follow-up. The mean difference in pain intensity between the radiofrequency denervation and control groups at 3 months was -0.18 (95% CI, -0.76 to 0.40) in the facet joint trial; -0.71 (95% CI, -1.35 to -0.06) in the sacroiliac joint

Prospective study on prevalence, intensity, type, and therapy of acute pain in a second-level urban emergency department

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Mura P

2017-12-01

Full Text Available Paolo Mura,1 Elisabetta Serra,1 Franco Marinangeli,2 Sebastiano Patti,3 Mario Musu,1 Ilenia Piras,3 Maria Valeria Massidda,1 Giorgio Pia,3 Maurizio Evangelista,4 Gabriele Finco1 1Department of Medical Sciences “M. Aresu”, University of Cagliari, Cagliari, Italy; 2Department of Anesthesiology, Intensive Care and Pain Medicine, University of L’Aquila, L’Aquila, Italy; 3Department of Emergency Medicine, Santissima Trinità Hospital, Cagliari, Italy; 4Department of Anesthesiology and Pain Medicine, Cattolica University, Rome, Italy Aim: Pain represents the most frequent cause for patient admission to emergency departments (EDs. Oligoanalgesia is a common problem in this field. The aims of this study were to assess prevalence and intensity of pain in patients who visited a second-level urban ED and to evaluate the efficacy of pharmacological treatment administered subsequent to variations in pain intensity. Methods: A 4-week prospective observational study was carried out on 2,838 patients who visited a second-level urban ED. Pain intensity was evaluated using the Numeric Rating Scale at the moment of triage. The efficacy of prescribed analgesic therapy was evaluated at 30 and 60 minutes, and at discharge. Data concerning pain intensity were classified as absent, slight, mild, or severe. Pain was evaluated in relation to the prescribed therapy. Results: Pain prevalence was 70.7%. Traumatic events were the primary cause in most cases (40.44%, followed by pain linked to urologic problems (13.52%, abdominal pain (13.39%, and nontraumatic musculoskeletal pain (7.10%. Only 32.46% of patients were given pharmacological therapy. Of these, 76% reported severe pain, 19% moderate, and 5% slight, and 66% received nonsteroidal anti-inflammatory drugs or paracetamol, 4% opioids, and 30% other therapies. A difference of at least 2 points on the Numerical Rating Scale was observed in 84% of patients on reevaluation following initial analgesic therapy

Ensemble encoding of nociceptive stimulus intensity in the rat medial and lateral pain systems

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Woodward Donald J

2011-08-01

Full Text Available Abstract Background The ability to encode noxious stimulus intensity is essential for the neural processing of pain perception. It is well accepted that the intensity information is transmitted within both sensory and affective pathways. However, it remains unclear what the encoding patterns are in the thalamocortical brain regions, and whether the dual pain systems share similar responsibility in intensity coding. Results Multichannel single-unit recordings were used to investigate the activity of individual neurons and neuronal ensembles in the rat brain following the application of noxious laser stimuli of increasing intensity to the hindpaw. Four brain regions were monitored, including two within the lateral sensory pain pathway, namely, the ventral posterior lateral thalamic nuclei and the primary somatosensory cortex, and two in the medial pathway, namely, the medial dorsal thalamic nuclei and the anterior cingulate cortex. Neuron number, firing rate, and ensemble spike count codings were examined in this study. Our results showed that the noxious laser stimulation evoked double-peak responses in all recorded brain regions. Significant correlations were found between the laser intensity and the number of responsive neurons, the firing rates, as well as the mass spike counts (MSCs. MSC coding was generally more efficient than the other two methods. Moreover, the coding capacities of neurons in the two pathways were comparable. Conclusion This study demonstrated the collective contribution of medial and lateral pathway neurons to the noxious intensity coding. Additionally, we provide evidence that ensemble spike count may be the most reliable method for coding pain intensity in the brain.

Reduced dietary intake of simple sugars alters perceived sweet taste intensity but not perceived pleasantness.

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Wise, Paul M; Nattress, Laura; Flammer, Linda J; Beauchamp, Gary K

2016-01-01

Individuals who adhere to reduced-sodium diets come to prefer less salt over time, but it is unclear whether sweet taste perception is modulated by reduced sugar intake. The objective was to determine how a substantial reduction in dietary intake of simple sugars affects sweetness intensity and pleasantness of sweet foods and beverages. Healthy men and women aged 21-54 y participated for 5 mo. After the baseline month, 2 subject groups were matched for demographic characteristics, body mass index, and intake of simple sugars. One group (n = 16; 13 of whom completed key experimental manipulations) was randomly assigned to receive a low-sugar diet during the subsequent 3 mo, with instructions to replace 40% of calories from simple sugars with fats, proteins, and complex carbohydrates. The other (control) group (n = 17; 16 of whom completed the study) did not change their sugar intake. During the final month, both groups chose any diet they wished. Each month subjects rated the sweetness intensity and pleasantness of vanilla puddings and raspberry beverages that varied in sucrose concentration. ANOVA showed no systematic differences between groups in rated sweetness during the baseline or first diet month. During the second diet month, the low-sugar group rated low-sucrose pudding samples as more intense than did the control group (significant group-by-concentration interaction, P = 0.002). During the third diet month, the low-sugar subjects rated both low and high concentrations in puddings as ∼40% sweeter than did the control group (significant effect of group, P = 0.01). A weaker effect on rated sweetness was obtained for the beverages. Rated pleasantness was not affected for either of the stimuli. This experiment provides empirical evidence that changes in consumption of simple sugars influence perceived sweet taste intensity. More work is needed to determine whether sugar intake ultimately shifts preferences for sweet foods and beverages. This trial was

Persistent postoperative pain after cardiac surgery: a systematic review with meta-analysis regarding incidence and pain intensity.

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Guimarães-Pereira, Luís; Reis, Pedro; Abelha, Fernando; Azevedo, Luís Filipe; Castro-Lopes, José Manuel

2017-10-01

Persistent postoperative pain (PPP) has been described as a complication of cardiac surgery (CS). We aimed to study PPP after CS (PPPCS) by conducting a systematic review of the literature regarding its incidence, intensity, location, and the presence of neuropathic pain, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The review comprised 3 phases: a methodological assessment of 6 different databases identifying potential articles and screening for inclusion criteria by 2 independent reviewers; data extraction; and study quality assessment. Meta-analysis was used to estimate the pooled incidence rates using a random effects model. We have identified 442 potentially relevant studies through database searching. A total of 23 studies (involving 11,057 patients) met our inclusion criteria. Persistent postoperative pain affects 37% patients in the first 6 months after CS, and it remains present more than 2 years after CS in 17%. The reported incidence of PPP during the first 6 months after CS increased in recent years. Globally, approximately half of the patients with PPPCS reported moderate to severe pain. Chest is the main location of PPPCS followed by the leg; neuropathic pain is present in the majority of the patients. This is the first systematic review and meta-analysis to provide estimates regarding incidence and intensity of PPPCS, which elucidates its relevance. There is an urgent need for adequate treatment and follow-up in patients with PPPCS.

Heart rate variability parameters do not correlate with pain intensity in healthy volunteers

NARCIS (Netherlands)

Meeuse, Jan J; Löwik, Marco S P; Löwik, Sabine A M; Aarden, Eline; van Roon, Arie M; Gans, Reinold O B; van Wijhe, Marten; Lefrandt, Joop D; Reyners, Anna K L

OBJECTIVE: When patients cannot indicate pain, physiological parameters may be useful. We tested whether heart rate variability (HRV) parameters, as reflection of sympathetic and vagal tone, can be used to quantify pain intensity. DESIGN: Prospective study. SUBJECTS AND SETTING: A standardized heat

Effect of salt intensity in soup on ad libitum intake and on subsequent food choice

NARCIS (Netherlands)

Bolhuis, D.P.; Lakemond, C.M.M.; Wijk, de R.A.; Luning, P.A.; Graaf, de C.

2012-01-01

The effect of salt intensity on ad libitum intake of tomato soup was investigated when soup was served as a first course and as a second course. Also the effect of salt intensity in soup on subsequent sweet vs. savory choice of sandwich fillings was investigated. Forty-three healthy subjects

Appetite, food intake and gut hormone responses to intense aerobic exercise of different duration.

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Holliday, Adrian; Blannin, Andrew

2017-12-01

The purpose of the study is to investigate the effect of acute bouts of high-intensity aerobic exercise of differing durations on subjective appetite, food intake and appetite-associated hormones in endurance-trained males. Twelve endurance-trained males (age = 21 ± 2 years; BMI = 21.0 ± 1.6 kg/m 2 ; VO 2max  = 61.6 ± 6.0 mL/kg/min) completed four trials, within a maximum 28 day period, in a counterbalanced order: resting (REST); 15 min exercise bout (15-min); 30 min exercise bout (30-min) and 45 min exercise bout (45-min). All exercise was completed on a cycle ergometer at an intensity of ~76% VO 2max Sixty minutes post exercise, participants consumed an ad libitum meal. Measures of subjective appetite and blood samples were obtained throughout the morning, with plasma analyzed for acylated ghrelin, total polypeptide tyrosine-tyrosine (PYY) and total glucagon-like peptide 1 (GLP-1) concentrations. The following results were obtained: Neither subjective appetite nor absolute food intake differed between trials. Relative energy intake (intake - expenditure) was significantly greater after REST (2641 ± 1616 kJ) compared with both 30-min (1039 ± 1520 kJ) and 45-min (260 ± 1731 kJ), and significantly greater after 15-min (2699 ± 1239 kJ) compared with 45-min (condition main effect, P  exercise in 30-min and 45-min, respectively (condition × time interaction, P  exercise trials (condition × time interaction, P  = 0.011); the greatest, most enduring suppression, was observed in 45-min. PYY concentration was unchanged with exercise. In conclusion, high-intensity aerobic cycling lasting up to 45 min did not suppress subjective appetite or affect absolute food intake, but did reduce relative energy intake, in well-trained endurance athletes. Findings question the role of appetite hormones in regulating subjective appetite in the acute post-exercise period. © 2017 Society for Endocrinology.

Effects of exercise intensity on hypertension prevalence in Korean men with high sodium intake

OpenAIRE

Kim, Min Hee; Lee, Hae-Jeung

2015-01-01

[Purpose] The purpose of present study was to investigate the effects of exercise intensity on hypertension prevalence in Korean men with high sodium intake. [Subjects and Methods] This study was based on the data collected from 2007 to 2013 in the Korean National Health and Nutritional Examination Survey. A total of 8853 male adults were included in the analysis. The odds ratios for hypertension according to exercise groups were assessed by using logistic regression of each sodium intake gro...

Immediate effects of Graston Technique on hamstring muscle extensibility and pain intensity in patients with nonspecific low back pain

OpenAIRE

Moon, Jong Hoon; Jung, Jin-Hwa; Won, Young Sik; Cho, Hwi-Young

2017-01-01

[Purpose] The purpose of this study was to analyze the effect of Graston Technique on hamstring extensibility and pain intensity in patients with nonspecific low back pain. [Subjects and Methods] Twenty-four patients with nonspecific low back pain (27?46 years of age) enrolled in the study. All participants were randomly assigned to one of two groups: Graston technique group (n=12) and a static stretching group (n=12). The Graston Technique was used on the hamstring muscles of the experimenta...

Intensive group training protocol versus guideline physiotherapy for patients with chronic low back pain: a randomised controlled trial.

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van der Roer, Nicole; van Tulder, Maurits; Barendse, Johanna; Knol, Dirk; van Mechelen, Willem; de Vet, Henrica

2008-09-01

Intensive group training using principles of graded activity has been proven to be effective in occupational care for workers with chronic low back pain. Objective of the study was to compare the effects of an intensive group training protocol aimed at returning to normal daily activities and guideline physiotherapy for primary care patients with non-specific chronic low back pain. The study was designed as pragmatic randomised controlled trial with a setup of 105 primary care physiotherapists in 49 practices and 114 patients with non-specific low back pain of more than 12 weeks duration participated in the study. In the intensive group training protocol exercise therapy, back school and operant-conditioning behavioural principles are combined. Patients were treated during 10 individual sessions along 20 group sessions. Usual care consisted of physiotherapy according to the Dutch guidelines for Low Back Pain. Main outcome measures were functional disability (Roland Morris disability questionnaire), pain intensity, perceived recovery and sick leave because of low back pain assessed at baseline and after 6, 13, 26 and 52 weeks. Both an intention-to-treat analysis and a per-protocol analysis were performed. Multilevel analysis did not show significant differences between both treatment groups on any outcome measures during the complete follow-up period, with one exception. After 26 weeks the protocol group showed more reduction in pain intensity than the guideline group, but this difference was absent after 52 weeks. We finally conclude that an intensive group training protocol was not more effective than usual physiotherapy for chronic low back pain.

Subanesthetic ketamine for pain management in hospitalized children, adolescents, and young adults: a single-center cohort study

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Sheehy, Kathy A; Lippold, Caroline; Rice, Amy L; Nobrega, Raissa; Finkel, Julia C; Quezado, Zenaide MN

2017-01-01

Background Subanesthetic doses of ketamine, an N-methyl-d-aspartate receptor antagonist used as an adjuvant to opioid for the treatment of pain in adults with acute and chronic pain, have been shown, in some instances, to improve pain intensity and to decrease opioid intake. However, less is known about the role of ketamine in pain management in children, adolescents, and young adults. Purpose We examined the effects of subanesthetic ketamine on pain intensity and opioid intake in children, adolescents, and young adults with acute and chronic pain syndromes treated in an inpatient setting. Methods This is a longitudinal cohort study of patients treated with subanesthetic ketamine infusions in regular patient care units in a tertiary pediatric hospital. Primary outcomes included changes in pain scores and morphine-equivalent intake. Results The study cohort included 230 different patients who during 360 separate hospital admissions received subanesthetic ketamine infusions for pain management. Overall, ketamine infusions were associated with significant reductions in mean pain scores from baseline (mean pain scores 6.64 [95% CI: 6.38–6.90]) to those recorded on the day after discontinuation of ketamine (mean pain scores 4.38 [95% CI: 4.06–4.69]), pketamine on pain scores varied according to clinical diagnosis (p=0.011), infusion duration (p=0.004), and pain location (p=0.004). Interestingly, greater reductions in pain scores were observed in patients with cancer pain and patients with pain associated with pancreatitis and Crohn’s disease. There were no records of psychotomimetic side effects requiring therapy. Conclusion These data suggest that administration of subanesthetic ketamine for pain management is feasible and safe in regular inpatient care units and may benefit children, adolescents, and young adults with acute and chronic pain. This study is informative and can be helpful in determining sample and effect sizes when planning clinical trials to

Minocycline Does Not Decrease Intensity of Neuropathic Pain Intensity, But Does Improve Its Affective Dimension.

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Sumitani, Masahiko; Ueda, Hiroshi; Hozumi, Jun; Inoue, Reo; Kogure, Takamichi; Yamada, Yoshitsugu; Kogure, Takamichi

2016-01-01

Recent understanding of the neuron-glia communication shed light on an important role of microglia to develop neuropathic pain The analgesic effect of minocycline on neuropathic pain is promising but it remains unclear in clinical settings. This study included 20 patients with neuropathic pain of varied etiologies. We administered 100 mg/day of minocycline for 1 week and then 200 mg/day for 3 weeks, as an open-label adjunct to conventional analgesics. An 11-point numerical rating scale. (NRS) and the short-form McGill Pain Questionnaire (SF-MPQ) were used to evaluate pain severity. The data were collected at baseline and after 4 weeks of therapy and analyzed using the Wilcoxon signed-rank test. All except two of the patients tolerated the full dose of minocycline. There was no significant improvement in the scoring of NRS (5.6 ± 1.2 at baseline vs. 5.3 ± 1.9 at 4 weeks; P =.60). The total score of the SF-MPQ decreased significantly (17.2 ± 7.4 vs. 13.9 ± 9.6; P =.02), particularly in the affective subscale (4.4 ± 2.7 vs. 3.3 ± 3.6; P =.007) but not so in the sensory subscale (12.8 ± 5.2 vs. 10.6 ± 6.2; P =.06). We conclude that minocycline failed to decrease pain intensity but succeeded in reducing the affective dimension associated with neuropathic pain.

Frequency, character, intensity and impact of neuropathic pain in a cohort of spinal cord injury patients

International Nuclear Information System (INIS)

Ullah, H.; Akhtar, N.; Matee, S.; Butt, A.W.

2015-01-01

The purpose of this study was to determine frequency, character, approximate location and intensity of neuropathic pain in spinal cord injury and its impact on the quality of life. Study Design: A cross-sectional survey Place and Duration of Study: Armed Forces Institute of Rehabilitation Medicine (AFIRM), Rawalpindi from Feb 2009 to Feb 2010. Material and Methods: Through non-probability convenience sampling 87 patients of both genders diagnosed with spinal cord injury based on American Spinal Injury Association criteria and admitted within a year of injury were included. Those in spinal shock, having poor cognition, inability to communicate, concurrent brain injury and history of chronic pain before injury were excluded. The history, localization and characteristics of the pain and interference with life activities were recorded. Neuropathic pain of patients was evaluated with Leeds Assessment of Neuropathic Symptoms and Signs Pain Scale. Visual analogue scale was used to measure the severity of pain. Results: Out of 87 patients (mean age 36.9 years) seventy four were male and 13 were female. Seventy patients (80%) were AIS-A, 6 (7%) were AIS-B and 11 (13%) were AIS-C. Neuropathic pain was present in 57.5% (n=50). Most of the patients localized their pain below the neurological level of injury (78%) and rated pain intensity as moderate pain (54%). Majority (48%) described the pain as burning followed by electric shock like (42%), stabbing (8%) and pricking (2%). 48% patients reported that their quality of life was affected due to pain. 52% required two analgesics of different groups to relieve pain followed by 40% requiring three analgesics and 8% requiring one analgesic. Conclusion: Neuropathic pain is prevalent in people with spinal cord injury and adversely affects life quality. Neuropathic pain is primarily described as a burning sensation of moderate intensity mostly referred to below the neurological level of injury. (author)

Predicting the Trajectories of Perceived Pain Intensity in Southern Community-Dwelling Older Adults: The Role of Religiousness.

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Sun, Fei; Park, Nan Sook; Wardian, Jana; Lee, Beom S; Roff, Lucinda L; Klemmack, David L; Parker, Michael W; Koenig, Harold G; Sawyer, Patricia L; Allman, Richard M

2013-11-01

This study focuses on the identification of multiple latent trajectories of pain intensity, and it examines how religiousness is related to different classes of pain trajectory. Participants were 720 community-dwelling older adults who were interviewed at four time points over a 3-year period. Overall, intensity of pain decreased over 3 years. Analysis using latent growth mixture modeling (GMM) identified three classes of pain: (1) increasing ( n = 47); (2) consistently unchanging ( n = 292); and (3) decreasing ( n = 381). Higher levels of intrinsic religiousness (IR) at baseline were associated with higher levels of pain at baseline, although it attenuated the slope of pain trajectories in the increasing pain group. Higher service attendance at baseline was associated with a higher probability of being in the decreasing pain group. The increasing pain group and the consistently unchanging group reported more negative physical and mental health outcomes than the decreasing pain group.

Is there a relationship between pain intensity and postural sway in patients with non-specific low back pain?

DEFF Research Database (Denmark)

Ruhe, A.; Fejer, R.; Walker, B.

2011-01-01

compared to healthy controls. In addition, regression analysis revealed a significant and linear increase in postural sway with higher pain ratings for all included COP parameters. Statistically significant changes in mean sway velocity in antero-posterior and medio-lateral direction and sway area were......Background: Increased center of pressure excursions are well documented in patients suffering from non-specific low back pain, whereby the altered postural sway includes both higher mean sway velocities and larger sway area. No investigation has been conducted to evaluate a relationship between...... pain intensity and postural sway in adults (aged 50 or less) with non-specific low back pain. Methods: Seventy-seven patients with non-specific low back pain and a matching number of healthy controls were enrolled. Center of pressure parameters were measured by three static bipedal standing tasks of 90...

Comparison between Epidural Block vs. High Intensity Laser Therapy for Controlling Chronic Low Back Pain

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Badiozaman Radpay

2016-01-01

Full Text Available Background: Chronic low back pain is among a wide spread musculoskeletal conditions that is related to disability with high economy cost. There are several treatment modalities for controlling chronic low back pain (CLBP, among them high intensity laser therapy (HILT and epidural blocks (EB use more commonly. This study aimed to evaluate the benefits and hazards of each of these two methods.Materials and Methods: We designed a randomized controlled double blind study during 24 months.101 patients divided in 2 groups (52 in EB and 49 in HILT group. Pain intensity was assessed by using faces pain scales (FPS and LINKERT questionaries' before procedure and during one, four, 12, and 24 weeks after beginning the procedures.Results: There were no differences between two groups in FPS lumber tenderness, straight leg rising test (SLRT, paresthesia, deep tendon reflex (DTR, and imaging changes. Motor problems seem was less in HILT group comparing EB.Conclusion: This study showed both EB and HILT approaches can control the pain intensity and motor activities in CLBP patients. Future studies will clarify the precise importance of each these methods.

Procedural Pain in Palliative Care: Is It Breakthrough Pain? A Multicenter National Prospective Study to Assess Prevalence, Intensity, and Treatment of Procedure-related Pain in Patients With Advanced Disease.

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Magnani, Caterina; Giannarelli, Diana; Casale, Giuseppe

2017-08-01

To assess the prevalence of breakthrough pain (BTP) provoked by 6 common procedures in patients with advanced disease. A prospective, cross-sectional, multicenter, national study was performed in 23 palliative care units in Italy. Patients were recruited if they were undergoing one of the following procedures as part of normal care: turning, personal hygiene care, transfer from bed to chair, bladder catheterization, pressure ulcer care, and subcutaneous drug administration. The Numerical Rating Scale was used to measure pain intensity before, during, and after the procedure. One thousand seventy-nine eligible patients were enrolled: 49.7% were male and their mean age was 78.0±11.2 years. Of all patients, 20.9% had experienced a BTP episode within the 24 hours before recruitment. The overall prevalence of procedure-induced BTP was 11.8%, and the mean intensity score (Numeric Rating Scale) was 4.72±1.81. Notably, patients experienced a significant increase in pain intensity during all procedures (Ppatients (12.7%) received analgesics before undergoing any of the procedures, and almost none (1.7%) received analgesics during the procedures to alleviate acute pain. Our findings highlight that simple daily care procedures can lead to BTP among patients with advanced disease. Because such procedures are performed very often during palliative care, more individualized attention to procedural pain control is necessary. Additional research on procedural pain in patients with advanced disease should be encouraged to provide further evidence-based guidance on the use of the available medication for predictable pain flares.

Caffeine intake improves intense intermittent exercise performance and reduces muscle interstitial potassium accumulation

DEFF Research Database (Denmark)

Mohr, Magni; Nielsen, Jens Jung; Bangsbo, Jens

2011-01-01

The effect of oral caffeine ingestion on intense intermittent exercise performance and muscle interstitial ion concentrations was examined. The study consists of two studies (S1 and S2). In S1 twelve subjects completed the Yo-Yo intermittent recovery level 2 (Yo-Yo IR2) test with prior caffeine (6...... mg/kg b.w.; CAF) or placebo (PLA) intake. In S2 six subjects performed one low intense (20 W) and three intense (50 W) 3-min (separated by 5 min) one-legged knee-extension exercise bouts with (CAF) and without (CON) prior caffeine supplementation for determination of muscle interstitial K(+) and Na...

Dietary thiamin and riboflavin intake and blood thiamin and riboflavin concentrations in college swimmers undergoing intensive training.

Science.gov (United States)

Sato, Akiko; Shimoyama, Yoshimitsu; Ishikawa, Tomoji; Murayama, Nobuko

2011-06-01

The purpose of this study was to examine the effect of high-intensity physical activity during training on the biochemical status of thiamin and riboflavin in athletes. Thiamin and riboflavin concentrations in whole blood of a group of 19 athletes (6 men and 13 women) were measured during a low-intensity preparatory period and compared with measurements taken during a high-intensity training period. Additional variables measured included anthropometric characteristics, estimated energy expenditure during swim training, distance covered, resting energy expenditure obtained by indirect calorimetry, estimated energy requirement per day, and dietary intake of energy, thiamin, and riboflavin estimated from 3-day food records. For both male and female subjects, no major changes were observed in anthropometric characteristics or dietary intake, but energy expenditure during swim training per day significantly increased in the intensive-training period (496 ± 0 kcal in the preparation period compared with 995 ± 96 kcal in the intensive-training period for male subjects [p riboflavin was unchanged. These results suggest that intense training affects thiamin concentration, but not riboflavin concentration, in the whole blood of college swimmers.

Provoked Vestibulodynia: Does Pain Intensity Correlate With Sexual Dysfunction and Dissatisfaction?

Science.gov (United States)

Aerts, Leen; Bergeron, Sophie; Pukall, Caroline F; Khalifé, Samir

2016-06-01

Provoked vestibulodynia (PVD) is suspected to be the most frequent cause of vulvodynia in premenopausal women. Previous research has been inconclusive as to whether higher vulvovaginal pain ratings are associated with lower sexual function and satisfaction in women with PVD. Whether pain intensity correlates with sexual impairment is an important question given its implications for treatment recommendations. To examine the associations among self-reported and objective pain measurements, sexual function, and sexual satisfaction in a large combined clinical and community sample of premenopausal women diagnosed with PVD. Ninety-eight women with PVD underwent a cotton-swab test, a vestibular friction pain measurement, and a vestibular pressure-pain threshold measurement. In addition to sociodemographics, participants completed measurements of pain, sexual function, and sexual satisfaction. Self-report measurements were the pain numerical rating scale (0-10), the McGill-Melzack Pain Questionnaire, the Female Sexual Function Index, and the Global Measure of Sexual Satisfaction. Objective measurements were pain during a cotton-swab test, pain during a vestibular friction procedure, and the vestibular pressure-pain threshold measurement. Age and relationship duration were significantly correlated with the Female Sexual Function Index total score (r = -0.31, P sexual function and satisfaction in women with PVD. The findings show that in women with PVD, self-report and objective pain ratings are not associated with sexual function and satisfaction. The results support the biopsychosocial nature of PVD and underscore the importance of a patient-focused multidisciplinary treatment approach for PVD. Copyright © 2016 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.

THE IMPACT OF LAVENDER AROMATHERAPY ON PAIN INTENSITY AND BETA-ENDORPHIN LEVELS IN POST-CAESAREAN MOTHERS

Directory of Open Access Journals (Sweden)

Yohana Putri Apryanti

2017-10-01

Full Text Available Background: Caesarean section is one of the most common interventions to overcome labor complications. However, pain cannot be avoided after the surgery. Lavender aromatherapy is considered as one of non-pharmacological therapy to reduce pain and increase beta-endorphin levels. Objective: To examine the effect of lavender aromatherapy on the intensity of pain and beta-endorphin levels in post-caesarean mothers. Methods: This was a quasy-experimental study with pretest and posttest with control group at Sembiring Delitua General Hospital on December 2016 to February 2017. There were 40 samples selected using purposive sampling, with 20 samples assigned in the experiment and control group. Numerical Rating Scale (NRS was used to measure pain and ELIZA methods to measure beta-endorphin levels. Independent t-test and paired t-test were used for data analysis Results: Results of this study showed that there was a significant difference in the mean value of pain intensity levels (p=0.000 and beta-endorphin levels (p=0.023 between experiment and control group. Conclusion: There was a significant effect of lavender aromatherapy on the decrease of pain intensity and the increase of beta-endorphin hormone in post-caesarean mothers. It is expected that lavender aromatherapy can be used as an alternative treatment to reduce pain and increase beta-endorphin levels in post-caesarean mothers.

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

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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.

Threshold of musculoskeletal pain intensity for increased risk of long-term sickness absence among female healthcare workers in eldercare.

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Lars L Andersen

Full Text Available PURPOSE: Musculoskeletal disorders increase the risk for absenteeism and work disability. However, the threshold when musculoskeletal pain intensity significantly increases the risk of sickness absence among different occupations is unknown. This study estimates the risk for long-term sickness absence (LTSA from different pain intensities in the low back, neck/shoulder and knees among female healthcare workers in eldercare. METHODS: Prospective cohort study among 8,732 Danish female healthcare workers responding to a questionnaire in 2004-2005, and subsequently followed for one year in a national register of social transfer payments (DREAM. Using Cox regression hazard ratio (HR analysis we modeled risk estimates of pain intensities on a scale from 0-9 (reference 0, where 0 is no pain and 9 is worst imaginable pain in the low back, neck/shoulders and knees during the last three months for onset of LTSA (receiving sickness absence compensation for at least eight consecutive weeks during one-year follow-up. RESULTS: During follow-up, the 12-month prevalence of LTSA was 6.3%. With adjustment for age, BMI, smoking and leisure physical activity, the thresholds of pain intensities significantly increasing risk of LTSA for the low back (HR 1.44 [95%CI 1.07-1.93], neck/shoulders (HR 1.47 [95%CI 1.10-1.96] and knees (HR 1.43 [95%CI 1.06-1.93] were 5, 4 and 3 (scale 0-9, respectively, referencing pain intensity of 0. CONCLUSION: The threshold of pain intensity significantly increasing the risk for LTSA among female healthcare workers varies across body regions, with knee pain having the lowest threshold. This knowledge may be used in the prevention of LTSA among health care workers.

Prevalence and intensity of chronic pain and self-perceived health among elderly people: a population-based study

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Lilian Varanda Pereira

2014-08-01

Full Text Available OBJECTIVE: to identify the prevalence and intensity of chronic pain among elderly people of the community and to analyze associations with the self-perceived health status.METHOD: cross-sectional study with a populational sample (n=934, conducted through household interviews in the city of Goiânia, Brazil. The intensity of chronic pain (existing for 6 months or more was measured using a numerical scale (0-10 and the self-perceived health through a verbal scale (very good, good, fair, poor, very poor. For the statistical analysis, the absolute frequency and percentage, CI (95%, Chi-square test, Odds ratio, and regression analysis were used. Significance of 5%.RESULTS: The prevalence of chronic pain was 52.8% [CI (95%:49.4-56.1]; most frequently located in the lower limbs (34.5% and lumbar region (29.5%; with high or the worst possible intensity for 54.6% of the elderly people. The occurrence of chronic pain was associated with (p<0.0001 a worse self-perception of health (OR=4.2:2.5-7.0, a greater number of chronic diseases (OR=1.8:1.2-2.7, joint disease (OR=3.5:2.4-5.1 and the female gender (OR=2.3:1.7-3.0. A lower intensity of chronic pain was associated with a better self-perception of health (p<0.0001.CONCLUSION: the majority of the elderly people of the community reported chronic pain, of a severe intensity, and located in areas related to movement activities, thus influencing the morbidity and mortality of this population.

Comparison of the effects of knee and hip and single knee muscles strengthening/ stretching exercises on pain intensity and function in athletes with patellofemoral pain syndrome

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Vahid Mazloum

2016-08-01

Full Text Available Background: Patellofemoral pain syndrome (PFPS is a common musculoskeletal condition among athletes. The evidence emphasizes on the importance of hip musculature strengthening exercises for such patients. Objective: To investigate the effects of strengthening-stretching knee muscles exercises and hip posterolateral musculature exercises in athletes with PFPS. Methods: In this clinical trial, 28 athletes with age average of 22.7±2.4 years with PFPS were allocated into conventional knee muscles exercises (CKME (n=14 and posterolateral hip muscles exercises (PHME (n=14. The subjects of both groups performed the supervised exercise protocols in 12 sessions. The Visual Analogue Scale and 6-minute walking tests were administrated respectively to evaluate pain intensity and function. The data were analyzed using Shapiro-wilk test, Independent-sample t test, and Repeated Measure ANOVA test. Findings: Demographic, pain intensity, and physical function data were similar between groups at baseline. Both groups significantly improved in pain intensity and function following a 4-week exercise program. Additionally, the athletes in PHME group had higher level of decreased pain intensity and improved function in follow-up assessment than the subjects in CKME group. Conclusion: Using hip posterolateral musculature exercises in addition to the knee conventional exercises is more effective for athletes with PFPS.

Intensive dynamic training for females with chronic neck/shoulder pain. A randomized controlled trial

DEFF Research Database (Denmark)

Randløv, A; Østergaard, Mikkel; Manniche, C

1998-01-01

and activities of daily living (ADL) were used, and strength and endurance measurements of the cervical and shoulder muscles were carried out at baseline and completion of the study. Follow-up measurements were carried out by postal questionnaire at 6 and 12 months after inclusion, and included pain, ADL......OBJECTIVES: To compare the clinical effectiveness of an intensive three-month training programme with a less intensive programme on females suffering from chronic neck/shoulder pain. STUDY DESIGN: A prospective observer-blinded clinical trial including 12-month pretreatment follow-up. SETTING......: Patients were referred to the Departments of Rheumatology and Physical Medicine at Hvidovre Hospital by their general practitioners. Training was undertaken at a satellite clinic for physiotherapy of Hvidovre Hospital. SUBJECTS: Female patients aged 18-65 years suffering from chronic neck/shoulder pain...

CUTANEUS STIMULATION: SLOW-STROKE BACK MASSAGE REDUCES THE INTENSITY OF OSTEOARTRITIS PAIN OF ELDERLY

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Mira Triharini

2017-04-01

Full Text Available Introduction: Osteoarthritis disease is the result of both mechanical and biological process which lead come to unstable degradation and synthesis of condrozyte cartilage and extracellular matrix. The risk factor of this instability is aging process. The aging process stimulates osteophytes formation and degradation of cartilage, and emerged pain as primary clinical symptom. One of the non pharmacological ways to cope this pain is by applying cutaneus stimulation through slow-stroke back massage method. The objective of this study was to analyze the effect of applying cutaneus stimulation with slow-stroke back massage method to osteoarthritis’s pain intensity. Method: Pre experimental design with one group pre test-post test approach was used in this study. The subject of this study were elderly above 50 years old living in Panti Werdha Hargo Dedali Surabaya, 15 participants were involved using purpose sampling technique. This study started on January 29th until February 6th, 2010. Data were collected by interview and observation and analyzed by WIlcoxcon Signed Rank Test α = 0.05, p value <α. Result: The Result showed that the message intervention was significantly affect the elder’s level of osteoarthritis pain in Panti Werdha Hargo Dedali Surabaya (p = 0.003. Discussion: It can be concluded that gives stimulation cutaneus: slow-stroke back massage reduce osteoathritis pain intensity. Slow-stroke back massage increase level of endorphin, so that pain reduction and individual pain perception will decrease.

Correlates of Complementary and Alternative Use in a Pediatric Tertiary Pain Center

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Vinson, Rachel; Yeh, Gloria; Davis, Roger B.; Logan, Deirdre

2014-01-01

Objective To examine correlates of Complementary and Alternative Medicine (CAM) use in a pediatric population with chronic pain. To determine if CAM use is positively correlated with adaptive coping skills. Methods We examined patient data from children ages 7–18 (n=1175) with chronic pain who completed the intake assessment at the time of initial evaluation at Boston Children’s multidisciplinary Pain Treatment Service between 2003–2011. The intake assessment included validated measures of anxiety, depression, pain coping skills and functional disability. Parents were also asked whether their child had tried CAM modalities in the past. We used a multivariable logistic regression model to determine correlates of CAM use and a multivariable linear regression model to determine the relationship between bio-behavioral CAM (relaxation training, hypnosis, and biofeedback) and accommodative coping. Results In our multivariable model, we found that female gender (OR 1.47, CI 1.07–2.01), parental education (OR 1.11 per year, CI 1.06–1.16), greater pain intensity (OR 1.06 per point on an 11-point numerical analog scale, CI 1.01–1.11), and more functional disability (OR 1.19 per 10 point increment on the Functional Disability Inventory, CI 1.06–1.34) were independently associated with CAM use. Bio-behavioral CAM was found to have a statistically significant correlation with accommodative coping skills (β 0.2 p-value .003). Conclusion In a pediatric chronic pain center, CAM users tended to have higher pain intensity, and greater functional disability. Exposure to bio-behavioral CAM techniques was associated with adaptive coping skills. PMID:25169161

High Intensity Physical Exercise and Pain in the Neck and Upper Limb among Slaughterhouse Workers: Cross-Sectional Study

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Emil Sundstrup

2014-01-01

Full Text Available Slaughterhouse work involves a high degree of repetitive and forceful upper limb movements and thus implies an elevated risk of work-related musculoskeletal disorders. High intensity strength training effectively rehabilitates musculoskeletal disorders among sedentary employees, but less is known about the effect among workers with repetitive and forceful work demands. Before performing randomized controlled trials it may be beneficial to assess the cross-sectional connection between exercise and musculoskeletal pain. We investigated the association between high intensity physical exercise and pain among 595 slaughterhouse workers in Denmark, Europe. Using logistic regression analyses, odds ratios for pain and work disability as a function of physical exercise, gender, age, BMI, smoking, and job position were estimated. The prevalence of pain in the neck, shoulder, elbow, and hand/wrist was 48%, 60%, 40%, and 52%, respectively. The odds for experiencing neck pain were significantly lower among slaughterhouse workers performing physical exercise (OR = 0.70, CI: 0.49–0.997, whereas the odds for pain in the shoulders, elbow, or hand/wrist were not associated with exercise. The present study can be used as general reference of pain in the neck and upper extremity among slaughterhouse workers. Future studies should investigate the effect of high intensity physical exercise on neck and upper limb pain in slaughterhouse workers.

Correlates of complementary and alternative medicine use in a pediatric tertiary pain center.

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Vinson, Rachel; Yeh, Gloria; Davis, Roger B; Logan, Deirdre

2014-01-01

To examine correlates of complementary and alternative medicine (CAM) use in a pediatric population with chronic pain, and to determine whether CAM use is positively correlated with adaptive coping skills. We examined patient data from 1175 children aged 7 to 18 years with chronic pain who completed the intake assessment at the time of initial evaluation at Boston Children's multidisciplinary Pain Treatment Service between 2003 and 2011. The intake assessment included validated measures of anxiety, depression, pain coping skills, and functional disability. Parents were also asked whether their child had tried CAM modalities in the past. We used a multivariable logistic regression model to determine correlates of CAM use and a multivariable linear regression model to determine the relationship between biobehavioral CAM (relaxation training, hypnosis, and biofeedback) and accommodative coping. In our multivariable model, we found that female gender (odds ratio [OR] 1.48, 95% confidence interval [95% CI] 1.07-2.02), level of parental education (OR 1.11 per year, 95% CI 1.06-1.16), greater pain intensity (OR 1.06 per point on an 11-point numerical analog scale, 95% CI 1.01-1.11), and more functional disability (OR 1.19 per 10-point increment on the Functional Disability Inventory, 95% CI 1.06-1.34) were independently associated with CAM use. Biobehavioral CAM was found to have a statistically significant correlation with accommodative coping skills (β = 0.2, P = .004). In a pediatric chronic pain center, CAM users tended to have higher pain intensity and greater functional disability. Exposure to biobehavioral CAM techniques was associated with adaptive coping skills. Copyright © 2014 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

Impact of PCA Strategies on Pain Intensity and Functional Assessment Measures in Adults with Sickle Cell Disease during Hospitalized Vaso-Occlusive Episodes

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Dampier, Carlton D.; Wager, Carrie G.; Harrison, Ryan; Hsu, Lewis L.; Minniti, Caterina P.; Smith, Wally R.

2012-01-01

Clinical trials of sickle cell disease (SCD) pain treatment usually observe only small decrements in pain intensity during the course of hospitalization. Sub-optimal analgesic management and inadequate pain assessment methods are possible explanations for these findings. In a search for better methods for assessing inpatient SCD pain in adults, we examined several pain intensity and interference measures in both arms of a randomized controlled trial comparing two different opioid PCA therapie...

Pilot Randomized Trial Comparing Intersession Scheduling of Biofeedback Results to Individuals with Chronic Pain: Influence on Psychologic Function and Pain Intensity.

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Weeks, Douglas L; Whitney, Anthony A; Tindall, Angelique G; Carter, Gregory T

2015-10-01

The objective of this study was to compare the effectiveness of two biofeedback schedules on long-term improvement in physical and psychologic reactivity to chronic nonmalignant pain. This study is a prospective, randomized pilot trial. Twenty adults with chronic pain engaged in heart rate variability (HRV) biofeedback training for nine sessions with HRV presented visually. Two groups, formed by random assignment, were compared: The faded feedback group received concurrent visual HRV biofeedback in session 1, with the amount of biofeedback systematically reduced for ensuing sessions so that, by session 9, the participants were controlling HRV without external feedback. The full feedback group received visual HRV biofeedback continuously across all sessions. Outcome measures assessed at baseline, immediately after the program, and 3 mos after the program included pain intensity, fear-avoidance beliefs, and self-report physical functioning. Use of biofeedback skills was also assessed 3 mos after the program. Nominal variables were analyzed with χ. Continuous measures were analyzed with repeated-measures analyses of variance. The faded feedback schedule resulted in greater use of biofeedback skills at 3 mos and improved pain intensity and fear-avoidance beliefs after the program and at 3 mos. Physical functioning did not differ between groups. Systematically reducing the frequency of external visual feedback during HRV biofeedback training was associated with reduced reactivity to chronic pain. Results of this pilot study should be confirmed with a larger randomized study.

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

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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

Spouse criticism and hostility during marital interaction: effects on pain intensity and behaviors among individuals with chronic low back pain.

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Burns, John W; Post, Kristina M; Smith, David A; Porter, Laura S; Buvanendran, Asokumar; Fras, Anne Marie; Keefe, Francis J

2017-10-30

Individuals with chronic pain may experience negative responses from spouse, family, and friends. Responses such as overt criticism and hostility may be associated with worsening pain and function for chronic pain sufferers. We used a laboratory procedure to evaluate whether variability in spouse criticism/hostility exhibited toward chronic low back pain (CLBP) patients during a conflictual discussion predicted variability in patient pain and function during a subsequent pain-induction task. Chronic low back pain patients (n = 71) and their spouses (n = 71) participated in a 10-minute discussion followed by the patient undergoing a 10-minute structured pain behavior task (SPBT). Spouse criticism/hostility perceived by patients and patient Beck Depression Inventory-II (BDI) scores correlated significantly and positively with pain intensity during the SPBT, whereas perceived spouse hostility, patient BDI scores, and spouse trait hostility correlated significantly and positively with observed pain behaviors during the SPBT. Spouse criticism/hostility coded by raters from video recordings interacted significantly with patient BDI scores, such that observed spouse criticism/hostility was related significantly and positively with pain behaviors only for patients with high BDI scores. Patient sex interacted significantly with observed spouse criticism/hostility, such that observed spouse criticism/hostility was related significantly and positively with pain behaviors only for female patients. Results support the hypothesis that spouse criticism and hostility-actually expressed or perceived-may worsen CLBP patient symptoms. Further, women patients and patients high in depressive symptoms appeared most vulnerable to spouse criticism/hostility. Thus, negative marital communication patterns may be appropriate targets for intervention, especially among these 2 at risk groups.

Deep brain stimulation for phantom limb pain.

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Bittar, Richard G; Otero, Sofia; Carter, Helen; Aziz, Tipu Z

2005-05-01

Phantom limb pain is an often severe and debilitating phenomenon that has been reported in up to 85% of amputees. Its pathophysiology is poorly understood. Peripheral and spinal mechanisms are thought to play a role in pain modulation in affected individuals; however central mechanisms are also likely to be of importance. The neuromatrix theory postulates a genetically determined representation of body image, which is modified by sensory input to create a neurosignature. Persistence of the neurosignature may be responsible for painless phantom limb sensations, whereas phantom limb pain may be due to abnormal reorganisation within the neuromatrix. This study assessed the clinical outcome of deep brain stimulation of the periventricular grey matter and somatosensory thalamus for the relief of chronic neuropathic pain associated with phantom limb in three patients. These patients were assessed preoperatively and at 3 month intervals postoperatively. Self-rated visual analogue scale pain scores assessed pain intensity, and the McGill Pain Questionnaire assessed the quality of the pain. Quality of life was assessed using the EUROQOL EQ-5D scale. Periventricular gray stimulation alone was optimal in two patients, whilst a combination of periventricular gray and thalamic stimulation produced the greatest degree of relief in one patient. At follow-up (mean 13.3 months) the intensity of pain was reduced by 62% (range 55-70%). In all three patients, the burning component of the pain was completely alleviated. Opiate intake was reduced in the two patients requiring morphine sulphate pre-operatively. Quality of life measures indicated a statistically significant improvement. This data supports the role for deep brain stimulation in patients with phantom limb pain. The medical literature relating to the epidemiology, pathogenesis, and treatment of this clinical entity is reviewed in detail.

Determinant factors of pain intensity in overweight and obese adults with knee osteoarthritis.

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Carlota Leão Cunha

2016-10-01

Full Text Available Osteoarthritis is one of the most disabling diseases, the main symptom being pain, which is associated with a low level of physical activity. The incidence and progression of knee osteoarthritis are directly related with risk factors such as obesity, age and mechanical factors. OBJECTIVE: The aim of this study was to identify which variables (physical activity, anthropometry and body composition of the lower limb best predict pain intensity in obese individuals with knee osteoarthritis. METHODS: The sample consisted of 44 individuals of both genders (mean age 56.6 ± 6.6 yrs. Anthropometric measures of body mass, stature, mid-thigh, patellar and calf circumferences, and foot breadth were obtained. The body composition of the most painful lower limb was obtained by dual-energy X-ray absorptiometry in different regions: mid-thigh; patella; calf and foot. For each of these regions, fat mass percentage, the amount of fat and fat-free mass, bone mass and bone mineral density were evaluated. Physical activity was assessed by the International Physical Activity Questionnaire (short version and pain intensity with the numeric rating scale. Data analysis was done using the multifactorial logistic regression (backward conditional method. RESULTS: The multifactorial analysis showed that gender (Odds Ratio of 7.448 for a 95% Confidence Interval of [1.032 – 53.747] and foot breadth (Odds Ratio of 3.730 for a 95% Confidence Interval of [1.006 – 13.827] are important factors to explain the risk of pain. CONCLUSIONS: These results seem to indicate that the assessment of foot morphology must be considered in knee osteoarthritis studies, since foot breadth is a predictor of knee pain. Further research is required to investigate the influence of foot morphology as well as of the use of insoles, splints or adapting shoes, on obese individuals with knee osteoarthritis.

Effect of Spike Lavender Lakhlakhe on Pain Intensity Due to Phlebotomy Procedure in Premature Infants Hospitalized in Neonatal Intensive Care Unit: A Randomized Clinical Trial

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Noushin Beheshtipoor

2017-06-01

Full Text Available Background: A Premature infants undergo multiple painful procedures during treatment; thus, it must be tried to limit complications caused by diagnostic and treatment procedures using simple and practical methods. This study was performed to evaluate the effect of spike lavender lakhlakhe on pain intensity due to phlebotomy in hospitalized premature infants.Methods: This single-arm, randomized clinical trial was performed on 30 infants chosen through convenience sampling method. Each newborn was considered as its own control. For the test group, one drop of pure (100% spike lavender lakhlakhe was taken by a standard dropper and diluted with 4 ml of warm distilled water by the research assistant. This mixture was stirred at 2-3 cm distance of the newborns’ nose from 60 minutes before until 2 minutes after phlebotomy, such that it could be smelled by the newborns. In both groups, heart rate and blood oxygen saturation were measured by a standard portable device, and the corresponding data was recorded in data collection sheets. Moreover, the infants’ facial expression changes were recorded by a camera and the intensity of pain was measured by Premature Infant Pain Profile before and after the procedure. Finally, the data was analyzed by paired comparison analysis test in SPSS, version 17.Results: Comparison of mean pain intensity caused by phlebotomy in the control and test groups showed a significant difference (7.667±0.311 vs. 4.882±0.311; P

Subanesthetic ketamine for pain management in hospitalized children, adolescents, and young adults: a single-center cohort study

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Sheehy KA

2017-04-01

Full Text Available Kathy A Sheehy,1,* Caroline Lippold,1,* Amy L Rice,1 Raissa Nobrega,1 Julia C Finkel,1 Zenaide MN Quezado1,2 1Division of Anesthesiology, Pain, and Perioperative Medicine, The Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s Research Institute, Children’s National Health System, George Washington University School of Medicine and Health Sciences, 2Center for Neuroscience Research, Children’s Research Institute, Children’s National Health System, Washington, DC, USA *These authors contributed equally to this work Background: Subanesthetic doses of ketamine, an N-methyl-D-aspartate receptor antagonist used as an adjuvant to opioid for the treatment of pain in adults with acute and chronic pain, have been shown, in some instances, to improve pain intensity and to decrease opioid intake. However, less is known about the role of ketamine in pain management in children, adolescents, and young adults. Purpose: We examined the effects of subanesthetic ketamine on pain intensity and opioid intake in children, adolescents, and young adults with acute and chronic pain syndromes treated in an inpatient setting. Methods: This is a longitudinal cohort study of patients treated with subanesthetic ketamine infusions in regular patient care units in a tertiary pediatric hospital. Primary outcomes included changes in pain scores and morphine-equivalent intake. Results: The study cohort included 230 different patients who during 360 separate hospital admissions received subanesthetic ketamine infusions for pain management. Overall, ketamine infusions were associated with significant reductions in mean pain scores from baseline (mean pain scores 6.64 [95% CI: 6.38–6.90] to those recorded on the day after discontinuation of ketamine (mean pain scores 4.38 [95% CI: 4.06–4.69], p<0.001. Importantly, the effect of ketamine on pain scores varied according to clinical diagnosis (p=0.011, infusion duration (p=0.004, and pain location (p=0

Self-reported pain and disability outcomes from an endogenous model of muscular back pain

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George Steven Z

2011-02-01

Full Text Available Abstract Background Our purpose was to develop an induced musculoskeletal pain model of acute low back pain and examine the relationship among pain, disability and fear in this model. Methods Delayed onset muscle soreness was induced in 52 healthy volunteers (23 women, 17 men; average age 22.4 years; average BMI 24.3 using fatiguing trunk extension exercise. Measures of pain intensity, unpleasantness, and location, and disability, were tracked for one week after exercise. Results Pain intensity ranged from 0 to 68 with 57.5% of participants reporting peak pain at 24 hours and 32.5% reporting this at 48 hours. The majority of participants reported pain in the low back with 33% also reporting pain in the legs. The ratio of unpleasantness to intensity indicated that the sensation was considered more unpleasant than intense. Statistical differences were noted in levels of reported disability between participants with and without leg pain. Pain intensity at 24 hours was correlated with pain unpleasantness, pain area and disability. Also, fear of pain was associated with pain intensity and unpleasantness. Disability was predicted by sex, presence of leg pain, and pain intensity; however, the largest amount of variance was explained by pain intensity (27% of a total 40%. The second model, predicting pain intensity only included fear of pain and explained less than 10% of the variance in pain intensity. Conclusions Our results demonstrate a significant association between pain and disability in this model in young adults. However, the model is most applicable to patients with lower levels of pain and disability. Future work should include older adults to improve the external validity of this model.

Evaluation of the effect of patient-selected music on sleep quality and pain intensity in burn patients

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Mohaddes Ardabili Fatemeh

2016-08-01

Full Text Available Background and Objective: Sleep disturbances and pain are some of the most common problems among burn patients, which have adverse effects on recovery process and patient comfort. Given the use of music as a non-pharmacological approach to alleviate pain and provide comfort, this study aimed to evaluate the effect of patient-selected music on sleep quality and pain intensity in burn patients. Materials and Method: This clinical trial was conducted on burn patients hospitalized in one of the hospitals of Tehran, Iran in 2015. In total, 50 patients were selected using randomized convenience sampling and divided into two intervention (n=25 and control (n=25 groups. Intervention was carried out for the intervention group through playing instrumental music, selected by the patients, in three consecutive 45-minute sessions before sleep. Severity of pain in the participants was evaluated for three nights (before and five minutes after the intervention using visual analog scale (VAS. In addition, sleep quality of the samples was assessed three days before the intervention using Pittsburgh sleep quality index (PSQI and during the post-intervention days through interviews. The mentioned scales were applied for the control group as well. Data analysis was performed in SPSS version 18 using Chi-square, as well as paired and independent t-tests. Results: In this study, a significant improvement was observed in sleep quality (P<0.001  and pain intensity (P=0.012 in the participants of intervention group after listening to music. Moreover, a significant difference was observed between the study groups after the intervention in terms of mean sleep quality score (P<0.001 and pain intensity (P=0.046. Conclusion: According to the results of this study, application of patient-selected music therapy could be associated with a significant improve in sleep quality and decrease in pain intensity in burn patients. Therefore, it is recommended that this intervention

Effects of transcutaneous electrical nerve stimulation on pain intensity during application of carboxytherapy in patients with cellulite: A randomized placebo-controlled trial.

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Sadala, Adria Y; Machado, Aline F P; Liebano, Richard E

2018-01-16

Carboxytherapy may generate local pain that is considered the main limiting factor in clinical practice. Transcutaneous electric nerve stimulation (TENS) is widely used in the control of acute pain; however, the effect of TENS on pain relief during carboxytherapy has not been studied to date. To assess the effect of TENS on pain intensity during carboxytherapy in patients with cellulite in the gluteal region. This randomized clinical trial was conducted with 84 patients, 18-44 years of age, who had moderate cellulite in the gluteal region, according to Cellulite Severity Scale, but never received carboxytherapy. Patients were randomized into 3 groups: active TENS, placebo TENS, and control group. For the intervention, skin depressions with cellulite were outlined, and the gluteal area to be treated was defined. The subcutaneous injection of CO 2 was performed using 0.30 × 13 mm-needles at a 45° angle, with a controlled flow rate of 100 mL/min maintained for 1 minute at each puncture site. The parameters for TENS were as follows: frequency of 100 Hz and pulse duration of 200 μs; TENS intensity was adjusted until the patient reported strong paresthesia. The visual numeric pain rating scale was used to assess pain intensity after each puncture. The active TENS group reported lower pain intensity compared to the placebo TENS (P TENS) was effective in reducing pain intensity during carboxytherapy in patients with cellulite in the gluteal region. © 2018 Wiley Periodicals, Inc.

Subanesthetic ketamine infusions for the treatment of children and adolescents with chronic pain: a longitudinal study.

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Sheehy, Kathy A; Muller, Elena A; Lippold, Caroline; Nouraie, Mehdi; Finkel, Julia C; Quezado, Zenaide M N

2015-12-01

Chronic pain is common in children and adolescents and is often associated with severe functional disability and mood disorders. The pharmacological treatment of chronic pain in children and adolescents can be challenging, ineffective, and is mostly based on expert opinions and consensus. Ketamine, an N-methyl-D-aspartate receptor antagonist, has been used as an adjuvant for treatment of adult chronic pain and has been shown, in some instances, to improve pain and decrease opioid-requirement. We examined the effects of subanesthetic ketamine infusions on pain intensity and opioid use in children and adolescents with chronic pain syndromes treated in an outpatient setting. Longitudinal cohort study of consecutive pediatric patients treated with subanesthetic ketamine infusions in a tertiary outpatient center. Outcome measurements included self-reported pain scores (numeric rating scale) and morphine-equivalent intake. Over a 15-month period, 63 children and adolescents (median age 15, interquartile range 12-17 years) with chronic pain received 277 ketamine infusions. Intravenous administration of subanesthetic doses of ketamine to children and adolescents on an outpatient basis was safe and not associated with psychotropic effects or hemodynamic perturbations. Overall, ketamine significantly reduced pain intensity (p pain reduction in patients with complex regional pain syndrome (CRPS) than in patients with other chronic pain syndromes (p = 0.029). Ketamine-associated reductions in pain scores were the largest in postural orthostatic tachycardia syndrome (POTS) and trauma patients and the smallest in patients with chronic headache (p = 0.007). In 37% of infusions, patients had a greater than 20 % reduction in pain score. Conversely, ketamine infusions did not change overall morphine-equivalent intake (p = 0.3). These data suggest that subanesthetic ketamine infusion is feasible in an outpatient setting and may benefit children and adolescents with chronic pain

Pregnant women's expectations about pain intensity during childbirth and their attitudes towards pain management: Findings from an Icelandic national study.

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Karlsdottir, Sigfridur Inga; Sveinsdottir, Herdis; Olafsdottir, Olof Asta; Kristjansdottir, Hildur

2015-12-01

Pregnant women expect childbirth to be painful. However, little is known about their expectations of the intensity of pain in childbirth (EIPC) and their attitudes to pain management. The design was a cross-sectional survey, with self-reported questionnaires used to collect data from low-risk pregnant women (N = 1111) early in pregnancy at 26 of the largest primary health care centres in Iceland. This consecutive national sample was stratified by residency. The mean score for the EIPC was 5.58 (SD = 1.38) measured on a 7 point scale. The strongest predictors of a high EIPC score were: negative attitude to the impending childbirth (OR = 2.39), low manifestation of a sense of security (OR = 1.80), and a positive attitude to pain management with medication (OR = 1.63). Women living outside the capital area were less likely to have a high EIPC (OR = 0.68). Most women (77%) had a positive attitude towards pain management without medication and 35% had a positive attitude to pain management with medication. The study detected multiple predictors of women's EIPC and attitude to pain management. Early and throughout pregnancy, midwives and health care professionals need to address these predictors in order to assist women to prepare themselves for the pain of labour. Copyright © 2015 Elsevier B.V. All rights reserved.

Impact of PCA Strategies on Pain Intensity and Functional Assessment Measures in Adults with Sickle Cell Disease during Hospitalized Vaso-Occlusive Episodes

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Dampier, Carlton D.; Wager, Carrie G.; Harrison, Ryan; Hsu, Lewis L.; Minniti, Caterina P.; Smith, Wally R.

2012-01-01

Clinical trials of sickle cell disease (SCD) pain treatment usually observe only small decrements in pain intensity during the course of hospitalization. Sub-optimal analgesic management and inadequate pain assessment methods are possible explanations for these findings. In a search for better methods for assessing inpatient SCD pain in adults, we examined several pain intensity and interference measures in both arms of a randomized controlled trial comparing two different opioid PCA therapies. Based upon longitudinal analysis of pain episodes, we found that scores from daily average Visual Analogue Scales (VAS) and several other measures, especially the Brief Pain Inventory (BPI), were sensitive to change in daily improvements in pain intensity associated with resolution of vaso-occlusive pain. In this preliminary trial, the low demand, high basal infusion (LDHI) strategy demonstrated faster, larger improvements in various measures of pain than the high demand, low basal infusion (HDLI) strategy for opioid PCA dosing, however, verification in larger studies is required. The measures and statistical approaches used in this analysis may facilitate design, reduce sample size, and improve analyses of treatment response in future SCD clinical trials of vaso-occlusive episodes. PMID:22886853

Effects of red ginger capsule supplementin reducing PGF2α concentrations and pain intensity in primary dysmenorrhea

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Simarmata, M.; Halim, B.; Ardinata, D.

2018-03-01

Primary dysmenorrhea is a gynecological disorder which most commonly occurs like a pain in the initial menstruation. One ofthe attempts to handle dysmenorrhea is by using anon-pharmacological method such as herbal therapy which uses red ginger. The research was at Akbid and Akper Harapan Mama, Deli Serdang Regency, with pre-experimental design and one group pretest-posttest. The samples were 32 female students as the respondents, taken by using non-probability or consecutive sampling technique. PGF2a content measurement by ELISA, theintensity of pain by Visual Analogue Scale and analyzed by using Wilcoxon test. PGF2α content before giving red ginger capsule supplement median was 156.50 pg/ml (min-max: 57-1037 pg/ml), after giving it was 101 (min-max: 22-785), pain intensity before giving it in the mean score of 2 was 15 respondents (47%), after giving it in the mean score of 0 was 14 respondents (44%). The result of statistic test on PGF2α content before and after giving it was p-value = 0.001, and pain intensity before and after giving it was p < 0.001 which indicated that there was asignificant decrease in PGF2α and pain intensity after giving it. Red ginger capsule supplement could decrease PGF2α content during primary dysmenorrhea.

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

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

2017-02-01

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

Effectiveness of app-based relaxation for patients with chronic low back pain (Relaxback) and chronic neck pain (Relaxneck): study protocol for two randomized pragmatic trials.

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Blödt, Susanne; Pach, Daniel; Roll, Stephanie; Witt, Claudia M

2014-12-15

Chronic low back pain (LBP) and neck pain (NP) are highly prevalent conditions resulting in high economic costs. Treatment guidelines recommend relaxation techniques, such as progressive muscle relaxation, as adjuvant therapies. Self-care interventions could have the potential to reduce costs in the health care system, but their effectiveness, especially in a usual care setting, is unclear. The aim of these two pragmatic randomized studies is to evaluate whether an additional app-delivered relaxation is more effective in the reduction of chronic LBP or NP than usual care alone. Each pragmatic randomized two-armed study aims to include a total of 220 patients aged 18 to 65 years with chronic (>12 weeks) LBP or NP and an average pain intensity of ≥ 4 on a numeric rating scale (NRS) in the 7 days before recruitment. The participants will be randomized into an intervention and a usual care group. The intervention group will be instructed to practice one of these 3 relaxation techniques on at least 5 days/week for 15 minutes/day over a period of 6 months starting on the day of randomization: autogenic training, mindfulness meditation, or guided imagery. Instructions and exercises will be provided using a smartphone app, baseline information will be collected using paper and pencil. Follow-up information (daily, weekly, and after 3 and 6 months) will be collected using electronic diaries and questionnaires included in the app. The primary outcome measure will be the mean LBP or NP intensity during the first 3 months of intervention based on daily pain intensity measurements on a NRS (0 = no pain, 10 = worst possible pain). The secondary outcome parameters will include the mean pain intensity during the first 6 months after randomization based on daily measurements, the mean pain intensity measured weekly as the average pain intensity of the previous 7 days over 3 and 6 months, pain acceptance, 'LBP- and NP-related' stress, sick leave days, pain medication

The correlation of pain intensity and quality of life in chronic LBP patients in Adam Malik general hospital

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Nasution, I. K.; Lubis, N. D. A.; Amelia, S.; Hocin, K.

2018-03-01

Low back pain (LBP) is a world health problems and a major cause of disability. The study is to determine the correlation between pain intensity and quality of life (QoL) in patients with chronic LBP. This study was a descriptive, analytical research with the cross sectional design. Twenty-nine chronic LBP outpatients that have visited the Neurology Clinic of Adam Malik General Hospital Medan. Patients from July to November 2015 were selected by consecutive sampling. A questionnaire and interview are asking the information about subjects’ characteristics, diagnosis, medical history, pain intensity and quality of life-based on WHO QoL criteria were used to collect the data. Using Spearman correlation test, we found correlation among VAS and physical function (pphysical problems (phealth (p=0.040, r=-0.330). On the other hand, there was no correlation between VAS and mental health (p=0.110, r=-0.235). We concluded that pain intensity in outpatients with chronic LBP in the Neurology Clinic at Adam Malik General Hospital Medan correlates with the patients’ quality of life.

High intensity physical exercise and pain in the neck and upper limb among slaughterhouse workers

DEFF Research Database (Denmark)

Sundstrup, Emil; Jakobsen, Markus D.; Andersen, Kenneth Jay

2014-01-01

and pain among 595 slaughterhouse workers in Denmark, Europe. Using logistic regression analyses, odds ratios for pain and work disability as a function of physical exercise, gender, age, BMI, smoking, and job position were estimated. The prevalence of pain in the neck, shoulder, elbow, and hand...... about the effect among workers with repetitive and forceful work demands. Before performing randomized controlled trials it may be beneficial to assess the cross-sectional connection between exercise and musculoskeletal pain. We investigated the association between high intensity physical exercise....../wrist was 48%, 60%, 40%, and 52%, respectively. The odds for experiencing neck pain were significantly lower among slaughterhouse workers performing physical exercise (OR = 0.70, CI: 0.49-0.997), whereas the odds for pain in the shoulders, elbow, or hand/wrist were not associated with exercise. The present...

Multidimensional features of pain in patients with chronic neck pain

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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.

Effect of smoking status and nicotine dependence on pain intensity and outcome of treatment in Indian patients with temporomandibular disorders: A longitudinal cohort study.

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Katyayan, Preeti Agarwal; Katyayan, Manish Khan

2017-01-01

Evidence regarding the association of smoking with various forms of chronic musculoskeletal pain is vast, but that with temporomandibular disorders (TMD) is scarce. The aims of this study are to evaluate the effect of smoking status (SS) and nicotine dependence (ND) on TMD pain intensity and treatment outcome in an Indian population with TMD. Nine hundred and sixty-two patients with TMD were selected for this longitudinal cohort study. Lifetime SS was evaluated and patients were classified as current smokers (YS), former smokers (FS), or nonsmokers (NS). The Fagerstrom test was used to evaluate the ND of YS. Pain intensity was evaluated using visual analog scale scores. Six months posttreatment, the pain intensity was again recorded. The effect of treatment was evaluated using a global transition outcome measure and categorized as treatment success or failure. A minimum 30% reduction in pain was used as a criterion for categorizing patients as those who had gotten "better." Data obtained from the study were compared using Chi-square tests, paired samples t -tests, and one-way ANOVA tests. The criterion for statistical significance for all analyses was set at P = 0.05. Among groups of SS, YS showed the maximum pain intensity at baseline and posttreatment. The outcome of treatment was most successful in NS and least in FS. The number of patients who had gotten "better" after treatment was significantly highest in NS. There was no significant difference between groups of ND with respect to pain intensity, treatment outcome, or "better" patients. Among Indian patients with TMD, smokers reported significantly greater pain intensity and poorer response to treatment than NS. Pain intensity or treatment outcome was independent of ND.

Interplay among pain intensity, sleep disturbance and emotion in patients with non-specific low back pain

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Shilabant Sen Sribastav

2017-05-01

Full Text Available Background Low back pain (LBP is the most common problem worldwide. There are several negative consequences of LBP, such as sleep disorders, work leave, disability, depression, anxiety, and poor quality of life. In this study, we designed to evaluate the prevalence of sleep disturbance in patients with non-specific LBP(NSLBP, and cross-correlation among sleep disorder, anxiety, depression and pain intensity in patients with NSLBP. Aim In this study, we designed to evaluate the prevalence of sleep disturbance in patients with NSLBP, and cross-correlation among sleep disorder, anxiety, depression and pain intensity in patients with NSLBP. Methods A cross-sectional self-assessment questionnaire survey was carried out in an outpatient clinic. Anonymous assessments were used to characterize the presence of NSLBP, PSQI, VAS, SF-36 form, ODI, BAI and BDI. Cross-correlation among the severity of NSLBP and sleep disturbance, anxiety, depression and life quality were evaluated. Results Patients with NSLBP have a higher incidence of sleep disorder, anxiety and depression, and higher ODI scores than healthy people without LPB (P < 0.01. NSLBP patients with sleep disorders have more severe anxiety, depression, an increased VAS score and poor daily living (P < 0.05. NSLBP patients with anxiety have declined sleep quality, poor daily living, decreased work and social skills, and increased LBP severity (P < 0.05. NSLBP patients with depression have declined sleep quality, poor daily living, decreased work and social skills (P < 0.05. Significant associations were found between the severity of NSLBP and sleep disorders, anxiety and ODI scores. Conclusion Psychological and social factors play an important role in the development of NSLBP. NSLBP leads to sleep disorders, which decrease the sleep quality and increase the unpleasant emotions and memories in return; these can exacerbate the severity of LBP, with the cycle repeating to form a vicious circle.

Validation and Evaluation of Two Observational Pain Assessment Tools in a Trauma and Neurosurgical Intensive Care Unit

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Jane Topolovec-Vranic

2013-01-01

Full Text Available BACKGROUND: Studies have demonstrated that patients in the intensive care unit experience high levels of pain. While many of these patients are nonverbal at some point during their stay, there are few valid tools available to assess pain in this group.

Lower inhibitory control interacts with greater pain catastrophizing to predict greater pain intensity in women with migraine and overweight/obesity.

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Galioto, Rachel; O'Leary, Kevin C; Thomas, J Graham; Demos, Kathryn; Lipton, Richard B; Gunstad, John; Pavlović, Jelena M; Roth, Julie; Rathier, Lucille; Bond, Dale S

2017-12-01

Pain catastrophizing (PC) is associated with more severe and disabling migraine attacks. However, factors that moderate this relationship are unknown. Failure of inhibitory control (IC), or the ability to suppress automatic or inappropriate responses, may be one such factor given previous research showing a relationship between higher PC and lower IC in non-migraine samples, and research showing reduced IC in migraine. Therefore, we examined whether lower IC interacts with increased PC to predict greater migraine severity as measured by pain intensity, attack frequency, and duration. Women (n = 105) aged 18-50 years old (M = 38.0 ± 1.2) with overweight/obesity and migraine who were seeking behavioral treatment for weight loss and migraine reduction completed a 28-day smartphone-based headache diary assessing migraine headache severity. Participants then completed a modified computerized Stroop task as a measure of IC and self-report measures of PC (Pain Catastrophizing Scale [PCS]), anxiety, and depression. Linear regression was used to examine independent and joint associations of PC and IC with indices of migraine severity after controlling for age, body mass index (BMI) depression, and anxiety. Participants on average had BMI of 35.1 ± 6.5 kg/m 2 and reported 5.3 ± 2.6 migraine attacks (8.3 ± 4.4 migraine days) over 28 days that produced moderate pain intensity (5.9 ± 1.4 out of 10) with duration of 20.0 ± 14.2 h. After adjusting for covariates, higher PCS total (β = .241, SE = .14, p = .03) and magnification subscale (β = .311, SE = .51, p migraine attacks. Future studies are needed to determine whether interventions to improve IC could lead to less painful migraine attacks via improvements in PC.

Effect the exercise program on neuropathic pain intensity in patients with paraplegia Spinal Cord Injury

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Sedghi Goyaghaj N

2015-11-01

Full Text Available Background and Objective: Patients with spinal cord injury suffer from continuous and persistent neuropathic pain that has a destructive impact on their quality of life. Exercise therapy is one of the non-pharmacological interventions that is recommended to control chronic pain, This study aimed to determine the effect of exercise program on neuropathic pain intensity in patients with paraplegia Spinal Cord Injury. Materials and Method: This study is a clinical trial.that population was the all of the patients with spinal cord injury, who referred to one of the educational hospitals in Tehran in 2014, 40 patient were selected based on purposive sampling and were randomly allocated into two groups of experimental and control. Exercise program for paraplegia spinal cord injury was implemented in experimental group during twelve 45-60minutes sessions, twice a week. Data collection was done before and one week after the intervention through using personal information form and, The International Spinal Cord Injury Pain Basic Data Set. Data were analyzed with statistical software SPSS19 and Fisher's exact test, Independent samples T-test Paired T-test and Chi square. Results: The mean score of neuropathic pain intensity before the intervention was 8.05 ± 1.51 in intervention group and 7.57 ± 1.21 in the control group. These amounts after the intervention were 5.55 ± 1.61 and 7.37 ± 1.05 respectively (p < 0.001. Conclusion: Results showed that the regular exercise program can reduce neuropathic pain severity in patients with spinal cord injuries and it can be recommended as a non-pharmacological method of pain control in these patients.

Intensive group training protocol versus guideline physiotherapy for patients with chronic low back pain: a randomised controlled trial

OpenAIRE

van der Roer, Nicole; van Tulder, Maurits; Barendse, Johanna; Knol, Dirk; van Mechelen, Willem; de Vet, Henrica

2008-01-01

Intensive group training using principles of graded activity has been proven to be effective in occupational care for workers with chronic low back pain. Objective of the study was to compare the effects of an intensive group training protocol aimed at returning to normal daily activities and guideline physiotherapy for primary care patients with non-specific chronic low back pain. The study was designed as pragmatic randomised controlled trial with a setup of 105 primary care physiotherapist...

Predictors of pain intensity and persistence in a prospective Italian cohort of patients with herpes zoster: relevance of smoking, trauma and antiviral therapy

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Granchelli Carla

2010-10-01

Full Text Available Abstract Background Herpes zoster (HZ is a common disease, characterized by rash-associated localized pain. Its main complication, post-herpetic neuralgia (PHN, is difficult to treat and may last for months to years in the wake of rash resolution. Uncertainties remain as to the knowledge of predictors of HZ-related pain, including the role of antiviral therapy in preventing PHN in ordinary clinical practice. This prospective cohort study was aimed at investigating pain intensity at HZ presentation and its correlates, as well as the incidence of PHN and its predictors. Methods Patients diagnosed with HZ were consecutively enrolled by a network of Italian General Practitioners and Hospital Units in the health district of Pescara, Italy, over two years. Uncertain cases were referred for microbiological investigation. Data were collected through electronic case report form (e-CRFs at enrolment and at 1, 3, 6 and 12 months after enrolment. Pain intensity was coded on a five-degree semi-quantitative scale at each time point. PHN was defined as pain of any intensity during follow-up and quantified using an area-under-the-curve (AUC method. Results Four hundred and forty-one patients composed the final sample. Mean age was 58.1 years (SD = 20.4 years; 43.5% of patients were males; 7.9% did not receive prescription of antivirals. Intense/very intense pain at presentation was reported by 25.2% of patients and was significantly associated with female gender, older age, cigarette smoking, trauma and/or surgery at HZ site (logistic regression. PHN was diagnosed in 51.2% of patients at one month and in 30.0% of patients at three months. PHN was significantly associated with pain intensity at presentation, age, smoking, trauma and missed antiviral prescription (generalized estimating equations model. The same factors were also independent predictors of the overall pain burden as described by the AUC method (linear regression. Conclusions Smoking, traumas and

Comparison of the Effect of Dry Cupping Therapy and Acupressure at BL23 Point on Intensity of Postpartum Perineal Pain Based on the Short Form of McGill Pain Questionnaire.

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Akbarzade, Marzieh; Ghaemmaghami, Mehrnoush; Yazdanpanahi, Zahra; Zare, Najaf; Mohagheghzadeh, Abdolali; Azizi, Amir

2016-01-01

Perineal pain is a major morbidity in the first few days after delivery. This study aimed to investigate the effect of dry cupping therapy and acupressure at BL23 point on the intensity of postpartum perineal pain based on the short-form of McGill pain questionnaire (SMPQ). The present clinical trial was conducted on 150 subjects in 3 groups of 50 cases. After at least 4-8 hr of delivery, cupping therapy was performed for 15-20 min up to 3 times a week (once a day) and acupressure was performed for 15-20 min based on clockwise model. The short-form of McGill pain questionnaire was completed both before and after the intervention. The SPSS statistical software was used to analyze the data using repeated measures ANOVA. Besides, pcupping therapy group, mean of the perineal pain intensity reduced from 37.5±6.8 before the intervention to 11.1±6.1, 6.9±4.7, and 3.8±3.6 immediately, 24 hr, and 2 weeks after the intervention, respectively. The results of study showed that the differences between the intervention and control groups were statistically significant (pcupping therapy and acupressure reduced perineal pain. Therefore, they may be considered as effective treatments for reducing pain intensity of allowing delivery.

Effectiveness of attentional bias modification and cognitive behavioral therapy on the reduction of pain intensity in patients with chronic pain

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Fateme Babai

2016-08-01

Full Text Available The aim of the study was to determine the effectiveness of Attentional Bias Modification (ABM and Cognitive Behavioral Therapy (CBT on the reduction of pain intensityin patients with chronic pain. This study was a quasiexperimental pretest-posttest design with control group. All patients who referred to physiotherapy clinics for pain during 2015 were participated in the study. They completed the Brief Pain Inventory-short form (BPI-SF for assessing severity of pain. Attentional bias was evaluated using computerized Dot-Probe task. The patients with chronic pain were screened by diagnostic criteria of DSM-V; neurologic diagnosis, and interview. 36 people were selected and randomly divided to three groups computer-based ABM, CBT, and control (12 cases in each group. Group A was trained in 8 sessions-each 15 minutes with the modified computerized Dot-Probe task for attentional bias modification. Group B was trained in 11 sessions-each 45 minutes with CBT program of Turk and Ferry for the chronic pain treatment. And Placebo program was administered for group C in which they completed 8 classic DotProbe sessions. In the end, for the posttest (T2 the participants were tested to identify the changes in biased attention to the emotional stimuli using classing Dot-Probe tasks, and BPI questionnaire to evaluate the changes of severity of pain. Data were analyzed using one-way variance analysis(ANOVA. On the BPI-SF, CBT more reduced the pain intensitythan computer-based ABM.In addition ABM treatment is more effective in reduction of attentional bias.Both of treatments are effective but CBT is more effective than ABM in reduction of pain intensity.

Relationship between non-genital tender point tenderness and intra-vaginal muscle pain intensity: Ratings in women with provoked vestibulodynia and implications for treatment

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PHILLIPS, Nancy; BROWN, Candace; BACHMANN, Gloria; WAN, Jim; WOOD, Ronald; ULRICH, Dagny; BACHOUR, Candi; FOSTER, David

2016-01-01

Background Vulvodynia is a chronic vulvar pain disorder and fibromyalgia is a chronic widespread musculoskeletal pain disorder; both of unknown etiology. Association of these conditions is well documented. Intra-vaginal algometer measurement of tenderness to pressure applied to the pelvic floor muscles helps to define vulvodynia associated with musculoskeletal factors. Women with both vulvodynia and fibromyalgia might have increased pelvic muscle pain compared to women with vulvodynia alone, defining the possible link of these two conditions. Objective 1) correlate pain intensity during the non-genital tender point tenderness examination to pain intensity with the vaginal algometer in women with provoked vestibulodynia, 2) determine whether subjects with provoked vestibulodynia and fibromyalgia had higher pain intensity scores with the vaginal algometer than those without fibromyalgia. Study Design Ninety-two subjects referred for vulvar pain were confirmed to have provoked vestibulodynia using the cotton swab test. A diagnosis of fibromyalgia was made if pain was present (Numerical rating scale> 1) in at least 11 sites of the 18-point non-genital tender point tenderness exam. Vaginal pain sensitivity was measured using an intra-vaginal pressure algometer, where 0.1, 0.3, and 0.5 kg/cm2 forces were applied digitally in random assignment by force and location to the right and left iliococcygeus muscle regions and the posterior vaginal wall. Both tender point tenderness and algometer pain intensity were reported on a 0 (no pain) to 10 (worse pain) numeric rating scale. Correlations were computed between the composite pain intensity (total of rating scale from each pressure threshold at specified site) of non-genital and those of iliococcygeus regions and the posterior vaginal wall. Independent t-tests were used to determine differences in iliococcygeus regions and the posterior vaginal algometer pain ratings and presence or absence of fibromyalgia. The significance

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

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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.

Effect of foot reflexology on pain intensity and duration of labor on primiparous

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Soheila Moghimi Hanjani

2012-12-01

Full Text Available Introduction: The integration of reflexology as one of the non-pharmacological pain relief methods in to midwifery care has become more common in recent years. The aim of this study was to determine the effect of reflexology on pain intensity and the duration of labor in primiparous.Materials and Methods: This clinical trial study was carried out on 80 primiparous women with low risk pregnancy that referring to Karaj hospitals (Iran then randomized in two groups, intervention group which received reflexology for 40 minutes and control group. Severity of labor pain was shown by visual analogue scale (McGill questionnaire, before, half, one and two hours after intervention. Moreover, the duration of labor was determined for both groups.Results: Severity of labor pain before and immediately after intervention foot reflexology did not vary between case and control groups (p>0.05. But half, one and two hours after it, severity of labor pain in the intervention group was lower than the control group (P<0.001. Duration of labor in the intervention group significantly was lower than the control group (P<0.001.Conclusion: Reflexology can lead to decrease in labor pain as well as duration of labor. Therefore, we can use this non-invasive technique to decrease the labor pain and encourage mothers to normal vaginal delivery that is one of the aims of midwifery

Relationships between the intensity and duration of Peltier heat stimulation and pain magnitude.

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Vierck, Charles J; Mauderli, Andre P; Riley, Joseph L

2013-03-01

Ramp-and-hold heat stimulation with a Peltier thermode is a standard procedure for quantitative sensory testing of human pain sensitivity. Because myelinated and unmyelinated nociceptive afferents respond preferentially to changing and steady temperatures, respectively, ramp-and-hold heat stimulation could assess processing of input from A-delta nociceptors early and C nociceptors late during prolonged thermal stimulation. In order to evaluate the progression from dynamic change to a steady temperature during prolonged Peltier stimulation, recordings of temperatures at the probe-skin interface were obtained. First, recordings of temperature during contact-and-hold stimulation (solenoid powered delivery of a preheated thermode to the skin) provided an evaluation of heat dissipation from the beginning of stimulation, uncontaminated by ramping. The heat-sink effect lasted up to 8 s and accounted in part for a slow increase in pain intensity for stimulus durations of 1-16 s and stimulus intensities of 43-59 °C. Recordings during longer periods of stimulation showed that feedback-controlled Peltier stimulation generated oscillations in temperature that were tracked for up to 75 s by subjects' continuous ratings of pain. During 120-s trials, sensitization of pain was observed over 45 s after the oscillations subsided. Thus, long-duration stimulation can be utilized to evaluate sensitization, presumably of C nociception, when not disrupted by oscillations in thermode temperature (e.g., those inherent to feedback control of Peltier stimulation). In contrast, sensitization was not observed during 130.5 s of stimulation with alternately increasing and decreasing temperatures that repeatedly activated A-delta nociceptors.

Pain-related guilt in low back pain.

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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.

A Single-Arm Feasibility Trial of Problem-Solving Skills Training for Parents of Children with Idiopathic Chronic Pain Conditions Receiving Intensive Pain Rehabilitation.

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Law, Emily F; Fales, Jessica L; Beals-Erickson, Sarah E; Failo, Alessandro; Logan, Deirdre; Randall, Edin; Weiss, Karen; Durkin, Lindsay; Palermo, Tonya M

2017-05-01

To adapt problem-solving skills training (PSST) for parents of children receiving intensive pain rehabilitation and evaluate treatment feasibility, acceptability, and satisfaction. Using a prospective single-arm case series design, we evaluated the feasibility of delivering PSST to 26 parents (84.6% female) from one of three pediatric pain rehabilitation programs. Parents completed four to six sessions of PSST delivered during a 2-4-week period. A mixed-methods approach was used to assess treatment acceptability and satisfaction. We also assessed changes in parent mental health and behavior outcomes from pretreatment to immediate posttreatment and 3-month follow-up. Parents demonstrated excellent treatment adherence and rated the intervention as highly acceptable and satisfactory. Preliminary analyses indicated improvements in domains of mental health, parenting behaviors, health status, and problem-solving skills. Findings demonstrate the potential role of psychological interventions directed at reducing parent distress in the context of intensive pediatric pain rehabilitation. © The Author 2016. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Long-term use of minimal footwear on pain, self-reported function, analgesic intake, and joint loading in elderly women with knee osteoarthritis: A randomized controlled trial.

Science.gov (United States)

Trombini-Souza, Francis; Matias, Alessandra B; Yokota, Mariane; Butugan, Marco K; Goldenstein-Schainberg, Claudia; Fuller, Ricardo; Sacco, Isabel C N

2015-12-01

Efforts have been made to retard the progressive debilitating pain and joint dysfunction in patients with knee osteoarthritis. We aimed to evaluate the therapeutic effect of a low-cost minimalist footwear on pain, function, clinical and gait-biomechanical aspects of elderly women with knee osteoarthritis. Throughout a randomized, parallel and controlled clinical trial, fifty-six patients with medial knee osteoarthritis were randomly allocated to an intervention (n=28) or control group (n=28), and assessed at baseline and after three and six months. The intervention involved wearing Moleca(®) footwear for at least 6h/day, 7 days/week, over 6 months. The pain subscale of the Western Ontario and McMaster Universities Osteoarthritis Index was the primary outcome. The secondary outcomes were the other subscales, Lequesne score, distance walked in 6 min, knee oedema and effusion, knee adduction moment and paracetamol intake. Intention-to-treat analysis was performed using two-way casewise ANOVA (coefficient. Intervention group showed improvement in pain (effect size: 1.41, p<.001), function (effect size: 1.22, p=.001), stiffness (effect size: 0.76, p=.001), Lequesne score (effect size: 1.07, p<.001), and reduction by 21.8% in the knee adduction moment impulse (p=.017) during gait wearing Moleca(®). The analgesic intake was lower in the intervention group. The long-term use of Moleca(®) footwear relieves pain, improves self-reported function, reduces the knee loading while wearing Moleca(®), refrains the increase of analgesic intake in elderly women with knee osteoarthritis and can be considered as a conservative mechanical treatment option. ClinicalTrials.gov (NCT01342458). Copyright © 2015 Elsevier Ltd. All rights reserved.

Associations between psychosocial factors and pain intensity, physical functioning, and psychological functioning in patients with chronic pain: a cross-cultural comparison.

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Ferreira-Valente, Maria A; Pais-Ribeiro, José L; Jensen, Mark P

2014-08-01

Current models of chronic pain recognize that psychosocial factors influence pain and the effects of pain on daily life. The role of such factors has been widely studied on English-speaking individuals with chronic pain. It is possible that the associations between such factors and adjustment may be influenced by culture. This study sought to evaluate the importance of coping responses, self-efficacy beliefs, and social support to adjust to chronic pain in a sample of Portuguese patients, and discuss the findings with respect to their similarities and differences from findings of studies on English-speaking individuals. Measures of pain intensity and interference, physical and psychological functioning, coping responses, self-efficacy, and satisfaction with social support were administered to a sample of 324 Portuguese patients with chronic musculoskeletal pain. Univariate and multivariate analyses were computed. Findings were interpreted with respect to those from similar studies using English-speaking individuals. Coping responses and perceived social support were significantly associated with pain interference and both physical and psychological functioning; self-efficacy beliefs were significantly associated with all criterion variables. All coping responses, except for task persistence, were positively associated with pain interference and negatively associated with physical and psychological functioning, with the strongest associations found for catastrophizing, praying/hoping, guarding, resting, asking for assistance, and relaxation. The findings provide support for the importance of the psychosocial factors studied in terms of adjustment to chronic pain in Portuguese patients, and also suggest the possibility of some differences in the role of these factors due to culture.

Pain intensity in patients with juvenile idiopathic arthritis with respect to the level of their activity and disease acceptance

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Grażyna Cepuch

2014-11-01

Full Text Available Objectives: Being diagnosed with a chronic disease, such as juvenile idiopathic arthritis (JIA, may adversely affect the activity of a young person. Additionally, the pain associated with the disease may cause difficulty accepting it. The aim was to assess the intensity of pain as well as the degree of activity and acceptance of the disease in young people aged 14–18 years with JIA. Material and methods : The study group consisted of youth of both genders suffering from JIA aged 14–18 years during remission of the disease. The study included 50 people and used the following: numerical rating scale (NRS 0–10, Cantril ladder, activity scale of own authorship (grouped items of the questionnaire form subscales of: tiredness, physical activity, social and intellectual activity and Acceptance of Illness Scale (AIS. Statistical analysis included the following tests: Mann-Whitney U test, Wilcoxon’s, χ2 test, Fisher’s, and Spearman rank correlation. The statistical significance level was set as p value below 0.05. Results : The majority of the respondents observed currently do not feel pain or feel pain of low intensity. The young people are physically, psychologically and socially active. The majority of patients accept their illness. The patients who suffer from pain on the NRS scale within 4–7 points do not adapt to living with the disease as do patients without pain or experiencing pain of low intensity. There was a strong correlation between acceptance of the disease at the time of the study determined by the Cantril ladder and AIS. Conclusions : 1. The pain suffered by patients with juvenile idiopathic arthritis (JIA has undoubtedly a negative impact on their activity and acceptance of the disease. 2. It seems to be crucial to recognize pain as a significant determinant of acceptance of the disease.

The Implementation of Pain Management and Assessment in Neonatal Intensive Care Units of Teaching Hospitals Affiliated to Tehran University of Medical Sciences

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O Rahimi

2017-06-01

Full Text Available BACKGROUND AND OBJECTIVE: Neonatal pain causes changes in the structure and function of brain in addition to acute physiologic symptoms and is followed by delayed development of infants. This study aims to determine the implementation of pain management and assessment in neonatal intensive care units. METHODS: This cross-sectional study was conducted among 138 nurses working in neonatal intensive care units through census. The data were collected using researcher – made questionnaire including two parts: pain management and assessment and demographic information. The minimum and maximum scores were 0 and 552, respectively, shown in the form of percentage. FINDINGS: At a response rate of 80.23%, the mean age of participants was 31.76±5.41 years and the mean experience of nurses working in a neonatal intensive care unit was 4.36 ± 3.58 years. The cases of implementation of pain management and assessment were as follows: care management for pain reduction (72.8%, allow parents to relieve pain (68.5%, swaddling (66.7%, pain assessment while implementing therapeutic and caring measures (62.9%, the use of sucrose solution (61.6%, teaching parents about observing pain symptoms in the infant’s face (58.7%, recording infant’s pain behaviors and the method for relieving the pain (52.4%, pain assessment at least every 4 hours (52.2% and the use of valid tools for pain assessment (36.8%. CONCLUSION: According to the results of this study, pain management and assessment was implemented in more than half of the cases.

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

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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

Pain sensitivity mediates the relationship between stress and headache intensity in chronic tension-type headache.

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Cathcart, Stuart; Bhullar, Navjot; Immink, Maarten; Della Vedova, Chris; Hayball, John

2012-01-01

A central model for chronic tension-type headache (CTH) posits that stress contributes to headache, in part, by aggravating existing hyperalgesia in CTH sufferers. The prediction from this model that pain sensitivity mediates the relationship between stress and headache activity has not yet been examined. To determine whether pain sensitivity mediates the relationship between stress and prospective headache activity in CTH sufferers. Self-reported stress, pain sensitivity and prospective headache activity were measured in 53 CTH sufferers recruited from the general population. Pain sensitivity was modelled as a mediator between stress and headache activity, and tested using a nonparametric bootstrap analysis. Pain sensitivity significantly mediated the relationship between stress and headache intensity. The results of the present study support the central model for CTH, which posits that stress contributes to headache, in part, by aggravating existing hyperalgesia in CTH sufferers. Implications for the mechanisms and treatment of CTH are discussed.

Influence of Mild Traumatic Brain Injury (TBI) and Posttraumatic Stress Disorder (PTSD) on Pain Intensity Levels in OEF/OIF/OND Veterans.

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Stojanovic, Milan P; Fonda, Jennifer; Fortier, Catherine Brawn; Higgins, Diana M; Rudolph, James L; Milberg, William P; McGlinchey, Regina E

2016-11-01

Mild traumatic brain injury (mTBI) and posttraumatic stress disorder (PTSD) are common among US veterans of Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND). We postulated that these injuries may modulate pain processing in these individuals and affect their subjective pain levels. Cross-sectional. 310 deployed service members of OEF/OIF/OND without a lifetime history of moderate or severe TBI were included in this study. All participants completed a comprehensive evaluation for Blast Exposure, mTBI, PTSD, and Pain Levels. The Boston Assessment of TBI-Lifetime Version (BAT-L) was used to assess blast exposure and potential brain injury during military service. The Clinician-Administered PTSD Scale (CAPS) characterized presence and severity of PTSD. The Visual Analog Scale (VAS) was used to assess pain intensity over the previous month before the interview, with higher scores indicative of worse pain. Statistical analysis was performed by ANOVA and results were adjusted for co-morbidities, clinical characteristics and demographic data. In comparison to control participants (veterans without mTBI or current PTSD), veterans with both current PTSD and mTBI reported the highest pain intensity levels, followed by veterans with PTSD only (P Pain levels in veterans with mTBI only were comparable to control participants. Comorbid PTSD and mTBI is associated with increased self-reported pain intensity. mTBI alone was not associated with increased pain. Published by Oxford University Press on behalf of the American Academy of Pain Medicine 2016. This work is written by US Government employees and is in the public domain in the US.

Exploring the relationship between analgesic event rate and pain intensity in kidney stone surgery: A Repeated Time to Event Pilot Study

DEFF Research Database (Denmark)

Juul, Rasmus Vestergaard; Pedersen, Katja Venborg; Christrup, Lona Louring

III-60 Rasmus Juul Exploring the relationship between analgesic event rate and pain intensity in kidney stone surgery: A Repeated Time to Event Pilot Study RV Juul(1), KV Pedersen(2, 4), LL Christrup(1), AE Olesen(1, 3), AM Drewes(3), PJS Osther(4), TM Lund(1) 1) Department of Drug Design...... a relationship with pain intensity has not yet been established. The aim of this pilot study was to discuss how best to investigate the relationship between RTTE hazard of analgesic events and pain intensity in postoperative pain. Methods: Data was available from 44 patients undergoing kidney stone surgery......). Gompertz and exponential distribution models were evaluated. Post-hoc linear mixed effect modelling was performed between estimated RTTE hazard and observed NRS using the lme4 package in R (3). Results: A Gompertz distribution model adequately described data, with a baseline event rate of 0.64h-1 (RSE 25...

Dysregulation of the autonomic nervous system and its association with the presence and intensity of chronic widespread pain

NARCIS (Netherlands)

Barakat, A.; Vogelzangs, N.; Licht, C.M.M.; Geenen, R.; Macfarlane, G.J.; de Geus, E.J.C.; Smit, J.H.; Penninx, B.W.J.H.; Dekker, J.

2012-01-01

Objective To test the hypotheses that dysregulation of the autonomic nervous system (ANS) is associated with the presence of chronic widespread pain (CWP), and that dysregulation of the ANS is associated with higher pain intensity in CWP. Methods Cross-sectional data were obtained from 1,574

Dysregulation of the Autonomic Nervous System and Its Association With the Presence and Intensity of Chronic Widespread Pain

NARCIS (Netherlands)

Barakat, Ansam; Vogelzangs, Nicole; Licht, Carmilla M. M.; Geenen, Rinie; Macfarlane, Gary J.; de Geus, Eco J. C.; Smit, Johannes H.; Penninx, Brenda W. J. H.; Dekker, Joost

Objective. To test the hypotheses that dysregulation of the autonomic nervous system (ANS) is associated with the presence of chronic widespread pain (CWP), and that dysregulation of the ANS is associated with higher pain intensity in CWP. Methods. Cross-sectional data were obtained from 1,574

Relationship between nongenital tender point tenderness and intravaginal muscle pain intensity: ratings in women with provoked vestibulodynia and implications for treatment.

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Phillips, Nancy; Brown, Candace; Bachmann, Gloria; Wan, Jim; Wood, Ronald; Ulrich, Dagny; Bachour, Candi; Foster, David

2016-12-01

Vulvodynia is a chronic vulvar pain disorder and fibromyalgia is a chronic widespread musculoskeletal pain disorder, both of unknown etiology. Association of these conditions is well documented. Intravaginal algometer measurement of tenderness to pressure applied to the pelvic floor muscles helps define vulvodynia associated with musculoskeletal factors. Women with both vulvodynia and fibromyalgia might have increased pelvic muscle pain compared to women with vulvodynia alone, defining the possible link of these 2 conditions. We sought to: (1) correlate pain intensity during the nongenital tender point tenderness examination to pain intensity with the vaginal algometer in women with provoked vestibulodynia, and (2) determine whether subjects with provoked vestibulodynia and fibromyalgia had higher pain intensity scores with the vaginal algometer than those without fibromyalgia. In all, 92 subjects referred for vulvar pain were confirmed to have provoked vestibulodynia using the cotton swab test. A diagnosis of fibromyalgia was made if pain was present (numeric rating scale >1) in at least 11 sites of the 18-point nongenital tender point tenderness exam. Vaginal pain sensitivity was measured using an intravaginal pressure algometer, where 0.1, 0.3, and 0.5 kg/cm 2 forces were applied digitally in random assignment by force and location to the right and left iliococcygeus muscle regions and the posterior vaginal wall. Both tender point tenderness and algometer pain intensity were reported on a 0 (no pain) to 10 (worse pain) numeric rating scale. Correlations were computed between the composite pain intensity (total of rating scale from each pressure threshold at specified site) of nongenital and those of iliococcygeus regions and the posterior vaginal wall. Independent t tests were used to determine differences in iliococcygeus regions and the posterior vaginal algometer pain ratings and presence or absence of fibromyalgia. The significance level was at P pain

Using insulin pen needles up to five times does not affect needle tip shape nor increase pain intensity.

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Puder, Jardena J; Atar, Michael; Muller, Beat; Pavan, Marco; Keller, Ulrich

2005-02-01

Reusing insulin pen needles could help to reduce the increasing economic burden of diabetes. We tested the hypothesis that reusing insulin pen needles leads to needle tip deformity and increased pain. Three blinded reviewers assessed 123 electron microscope pictures analyzing needle tip deformity of insulin pen needles used up to four times by diabetic subjects and up to five times by blinded non-diabetic volunteers. The estimated frequency of needle use was correlated to the actual number of needle use. Pain intensity and unpleasantness of each injection were measured by a visual analogue scale and their differences analyzed by Kruskal-Wallis analysis of variance. Unused needles could be differentiated visually from used needles. However, there was no correlation between the actual and guessed number of times a needle was used (r = 0.07, P = 0.2). Evaluating all 270 injections, neither pain intensity nor unpleasantness increased with repeated injections of the same needles in people with diabetes (P = 0.1 and 0.96) and in the volunteers (P = 0.63 and 0.92). Using pen needles four to five times does not lead to progressive needle tip deformity and does not increase pain intensity or unpleasantness, but could increase convenience and lead to substantial financial savings in Europe of around EUR 100 million/year.

Evaluation of the effects of patient-selected music therapy on the sleep quality and pain intensity of burn patients

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Fatemeh Muhaddith Ardabili

2016-02-01

Full Text Available Background: Sleep disturbances and pain are some of the most common problems among burn patients, which have adverse effects on recovery process and patient comfort. Given the use of music as a non-pharmacological approach to alleviate pain and provide comfort, this study aimed to evaluate the effect of patient-selected music on sleep quality and pain intensity in burn patients. Methods: This clinical trial was conducted on burn patients hospitalized in one of the hospitals of Tehran, Iran in 2015. In total, 50 patients were selected using randomized convenience sampling and divided into two intervention (n=25 and control (n=25 groups. Intervention was carried out for the intervention group through playing instrumental music, selected by the patients, in three consecutive 45-minute sessions before sleep. Severity of pain in the participants was evaluated for three nights (before and five minutes after the intervention using visual analog scale (VAS. In addition, sleep quality of the samples was assessed three days before the intervention using Pittsburgh sleep quality index (PSQI and during the post-intervention days through interviews. The mentioned scales were applied for the control group as well. Data analysis was performed in SPSS version 18 using Chi-square, as well as paired and independent t-tests. Results: In this study, a significant improvement was observed in sleep quality (P<0.001 and pain intensity (P=0.012 in the participants of intervention group after listening to music. Moreover, a significant difference was observed between the study groups after the intervention in terms of mean sleep quality score (P<0.001 and pain intensity (P=0.046. Conclusion: According to the results of this study, application of patient-selected music therapy could be associated with a significant improve in sleep quality and decrease in pain intensity in burn patients. Therefore, it is recommended that this intervention approach be applied by

The influence of demographic and psychosocial factors on the intensity of pain among chronic patients receiving home-based nursing care

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T Antony

2016-01-01

Full Text Available Aim: To determine the influence of the demographic and the psychosocial factors on the intensity of pain manifestation among the chronic ill patients. Materials and Methods: A descriptive, cross-sectional study was carried out among 328 chronic patients under home-based nursing care in Southern State of Kerala, India, from July to August 2015. Each patient was interviewed during a scheduled home visit by a trained health professional. The translated version of the assessment tool questionnaire "Medical Outcome Study-Short Form Health Survey" was used for the data collection. Results: Sixty-four (19.5% out of 328 patients reported pain as one of the primary symptoms of their disease. The percentage of the patients who were suffering from pain increases with the improvements in both the educational level and the monthly income (P = 0.002 and 0.019, respectively. The social interaction with the relatives and other community members was significantly related to pain manifestation (P = 0.013. A higher degree of social interaction was associated with lower pain intensity (P = 0.019. Conclusion: The results of this study showed that certain demographic and psychosocial factors carry a significant level of influence on the pain manifestation and its intensity among the chronic patients. Hence, improvements in education, economic status, and psychosocial support should be considered for the management of the chronic patients.

Improvement in clinical outcomes after dry needling versus myofascial release on pain pressure thresholds, quality of life, fatigue, pain intensity, quality of sleep, anxiety, and depression in patients with fibromyalgia syndrome.

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Castro Sánchez, Adelaida M; García López, Hector; Fernández Sánchez, Manuel; Pérez Mármol, José Manuel; Aguilar-Ferrándiz, María Encarnación; Luque Suárez, Alejandro; Matarán Peñarrocha, Guillermo Adolfo

2018-04-23

To compare the effectiveness of dry needling versus myofascial release on myofascial trigger points pain in cervical muscles, quality of life, impact of symptoms pain, quality of sleep, anxiety, depression, and fatigue in patients with fibromyalgia syndrome. A single-blind randomized controlled trial was conducted. Sixty-four subjects with fibromyalgia were randomly assigned to a dry needling group or a myofascial release group. Pain pressure thresholds of myofascial trigger points were evaluated in the cervical muscles. In addition, quality of life, impact of fibromyalgia symptoms, quality of sleep, intensity of pain, anxiety and depression symptoms, impact of fatigue at baseline and post treatment after four weeks of intervention were evaluated. Significant improvement was found in most pain pressure thresholds of the myofascial trigger points in cervical muscles in the dry needling group compared to myofascial release (p quality of life of physical function (F = 12.74, p = 0.001), physical role (F = 11.24, p = 0.001), body pain (F =30.26, p quality of sleep (F = 11.96, p = 0.001), state anxiety (F = 7.40, p = 0.009), and trait anxiety (F = -14.63, p quality of life of physical role, body pain, vitality and social function, as well as the total impact of FMS symptoms, quality of sleep, state and trait anxiety, hospital anxiety-depression, general pain intensity and fatigue. Implications for rehabilitation Dry needling therapy reduces myofascial trigger point pain in the short term in patients with fibromyalgia syndrome. This therapeutic approach improves anxiety, depression, fatigue symptoms, quality of life, and sleep after treatment. Dry needling and myofascial release therapies decrease intensity of pain, and the impact of fibromyalgia symptoms in this population. These intervention approaches should be considered in an independent manner as complementary therapies within a multidisciplinary setting.

Pain flare following external beam radiotherapy and meaningful change in pain scores in the treatment of bone metastases

International Nuclear Information System (INIS)

Chow, Edward; Ling, Alison; Davis, Lori; Panzarella, Tony; Danjoux, Cyril

2005-01-01

Background and purpose: To examine the incidence of pain flare following external beam radiotherapy and to determine what constitutes a meaningful change in pain scores in the treatment of bone metastases. Patients and methods: Patients with bone metastases treated with external beam radiotherapy were asked to score their pain on a scale of 0-10 before the treatment (baseline), daily during the treatment and for 10 days after completion of external beam radiation. Pain flare was defined as a two-point increase from baseline pain in the pain scale of 0-10 with no decrease in analgesic intake or a 25% increase in analgesic intake employing daily oral morphine equivalent with no decrease in pain score. To distinguish pain flare from progression of pain, we required the pain score and analgesic intake to return back to baseline levels after the increase/flare. They were also asked to indicate if their pain changed during that time compared to pre-treatment level. The change in pain score was compared with patient perception. Results: Eighty-eight patients were evaluated in this study. There were 49 male and 39 female patients with the median age of 70 years. Twelve of 88 patients (14%) had pain flare on day 1. The overall incidence of pain flare during the study period ranged from 2 to 16%. A total of 797 pain scorings were obtained. Patients perceived an improvement in pain when their self-reported pain score decreased by at least two points. Conclusions: Our study confirms the occurrence of pain flare following the external beam radiotherapy in the treatment of bone metastases. Further studies are required to predict who are at risk for flare. Appropriate measures can be taken to alleviate the pain flare. The finding in the meaningful change in pain scores supports the investigator-defined partial response used in some clinical trials

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...

The Effect of Dry Needling Compared With Ischemic Pressure on Pain Intensity on Active Trigger Point in Upper Trapezius Muscle

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Maryam Ziaeifar

2013-07-01

Full Text Available Objective: Myofascial trigger point is one of the most common causes of musculoskeletal pain and disorders. Myofascial trigger point in upper trapezius has been reported as a frequent symptom in patients with neck and thoracic pain. The purpose of this study was to investigate the effect of dry needling compared with ischemic pressure on active trigger point in upper trapezius muscle. Materials & Methods: 32 women with active myofascial trigger point in upper trapezius muscle participated in this randomized clinical trial (RCT study. The subjects were randomly assigned into two groups: dry needling (N=15 and ischemic pressure (N=17. The visual analogue scale (VAS was used to assess the pain intensity before and after treatment in both groups. Paired t-test was used to determine any significant difference in pain intensity after treatment sessions compared with pre-treatment score in control and experimental group. Analysis of Covariance (ANCOVA was calculated to determine the significance of differences between the control and experimental groups in post-test scores, with pre-treatment scores used as covariates in the analysis. Results: Statistical analysis (paired t-test revealed significant decrease in pain intensity after treatment sessions in control and experimental group (P=0.00 compared with pre-treatment score. In the ANCOVA, controlling for pre-test scores, no significant difference was found between the two groups (P=0.8. Conclusion: It seems that that both dry needling and ischemic pressure are effective in improvement in the pain intensity in subjects with myofascial trigger points. However, dry needling can be used by clinicians and therapist in physiotherapy clinics.

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.

High Intensity Laser Therapy (HILT) versus TENS and NSAIDs in low back pain: clinical study

Science.gov (United States)

Zati, Allesandro; Fortuna, Damiano; Valent, A.; Filippi, M. V.; Bilotta, Teresa W.

2004-09-01

Low back pain, caused by lumbar disc herniation, is prevalently treated with a conservative approach. In this study we valued the efficacy of High Intensity Laser Therapy (HILT), compared with accepted therapies such as TENS and NSAIDs. Laser therapy obtained similar results in the short term, but better clinical effect over time than TENS and NSAIDs. In conclusion high intensity laser therapy appears to be a interesting new treatment, worthy of further research.

Intensive short-term vasodilation effect in the pain area of sciatica patients--case study.

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Skorupska, Elżbieta; Rychlik, Michał; Pawelec, Wiktoria; Bednarek, Agata; Samborski, Włodzimierz

2014-09-09

Varied and complicated etiology of low back pain radiating distally to the extremities is still causing disagreement and controversy around the issue of its diagnosis and treatment. Most clinicians believe that the source of that pain is generally radicular. While some of them postulate the clinical significance of the sacroiliac joint syndrome, others demonstrate that almost one in five people with back pain experience symptoms indicative of the neuropathic pain component. To date, neuropathic involvement has not been completely understood, and different mechanisms are thought to play an important role. It has been established that muscle pain (myofascial pain) e.g. active trigger points from the gluteus minimus, can mimic pain similar to sciatica, especially in the chronic stage. This paper describes patients presenting with radicular sciatica (case one and two) and sciatica-like symptoms (case three). For the first time, intensive short-term vasodilation in the pain area following needle infiltration of the gluteus minimus trigger point was recorded. Three Caucasian, European women suffering from radicular sciatica (case one and two) and sciatica-like symptoms (case three) at the age of 57, 49 and 47 respectively underwent infrared camera observation during needle infiltration of the gluteus minimus trigger point. The patients were diagnosed by a neurologist; they underwent magnetic resonance imaging, electromyography, neurography and blood test analysis. Apart from that, the patients were diagnosed by a clinician specializing in myofascial pain diagnosis. In the examined cases, trigger points-related short-term vasodilation was recorded. Confirmation of these findings in a controlled, blinded study would indicate the existence of a link between the pain of sciatica patients (radicular or sciatica-like pain) and the activity of the autonomic nervous system. Further studies on a bigger group of patients are still needed.

Autonomic responses to heat pain: Heart rate, skin conductance, and their relation to verbal ratings and stimulus intensity.

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Loggia, Marco L; Juneau, Mylène; Bushnell, M Catherine

2011-03-01

In human pain experiments, as well as in clinical settings, subjects are often asked to assess pain using scales (eg, numeric rating scales). Although most subjects have little difficulty in using these tools, some lack the necessary basic cognitive or motor skills (eg, paralyzed patients). Thus, the identification of appropriate nonverbal measures of pain has significant clinical relevance. In this study, we assessed heart rate (HR), skin conductance (SC), and verbal ratings in 39 healthy male subjects during the application of twelve 6-s heat stimuli of different intensities on the subjects' left forearm. Both HR and SC increased with more intense painful stimulation. However, HR but not SC, significantly correlated with pain ratings at the group level, suggesting that HR may be a better predictor of between-subject differences in pain than is SC. Conversely, changes in SC better predicted variations in ratings within a given individual, suggesting that it is more sensitive to relative changes in perception. The differences in findings derived from between- and within-subject analyses may result from greater within-subject variability in HR. We conclude that at least for male subjects, HR provides a better predictor of pain perception than SC, but that data should be averaged over several stimulus presentations to achieve consistent results. Nevertheless, variability among studies, and the indication that gender of both the subject and experimenter could influence autonomic results, lead us to advise caution in using autonomic or any other surrogate measures to infer pain in individuals who cannot adequately report their perception. Skin conductance is more sensitive to detect within-subject perceptual changes, but heart rate appears to better predict pain ratings at the group level. Copyright © 2010 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

Does neonatal pain management in intensive care units differ between night and day? An observational study.

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Guedj, Romain; Danan, Claude; Daoud, Patrick; Zupan, Véronique; Renolleau, Sylvain; Zana, Elodie; Aizenfisz, Sophie; Lapillonne, Alexandre; de Saint Blanquat, Laure; Granier, Michèle; Durand, Philippe; Castela, Florence; Coursol, Anne; Hubert, Philippe; Cimerman, Patricia; Anand, K J S; Khoshnood, Babak; Carbajal, Ricardo

2014-02-20

To determine whether analgesic use for painful procedures performed in neonates in the neonatal intensive care unit (NICU) differs during nights and days and during each of the 6 h period of the day. Conducted as part of the prospective observational Epidemiology of Painful Procedures in Neonates study which was designed to collect in real time and around-the-clock bedside data on all painful or stressful procedures. 13 NICUs and paediatric intensive care units in the Paris Region, France. All 430 neonates admitted to the participating units during a 6-week period between September 2005 and January 2006. During the first 14 days of admission, data were collected on all painful procedures and analgesic therapy. The five most frequent procedures representing 38 012 of all 42 413 (90%) painful procedures were analysed. Observational study. We compared the use of specific analgesic for procedures performed during each of the 6 h period of a day: morning (7:00 to 12:59), afternoon, early night and late night and during daytime (morning+afternoon) and night-time (early night+late night). 7724 of 38 012 (20.3%) painful procedures were carried out with a specific analgesic treatment. For morning, afternoon, early night and late night, respectively, the use of analgesic was 25.8%, 18.9%, 18.3% and 18%. The relative reduction of analgesia was 18.3%, pnight-time and 28.8%, pday. Parental presence, nurses on 8 h shifts and written protocols for analgesia were associated with a decrease in this difference. The substantial differences in the use of analgesics around-the-clock may be questioned on quality of care grounds.

Intensive group training protocol versus guideline physiotherapy for patients with chronic low back pain: a randomised controlled trial

NARCIS (Netherlands)

van der Roer, N.; van Tulder, M.W.; Barendse, J.; Knol, D.L.; van Mechelen, W.; de Vet, H.C.W.

2008-01-01

Intensive group training using principles of graded activity has been proven to be effective in occupational care for workers with chronic low back pain. Objective of the study was to compare the effects of an intensive group training protocol aimed at returning to normal daily activities and

Development and validation of an observation tool for the assessment of nursing pain management practices in intensive care unit in a standardized clinical simulation setting.

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Gosselin, Emilie; Bourgault, Patricia; Lavoie, Stephan; Coleman, Robin-Marie; Méziat-Burdin, Anne

2014-12-01

Pain management in the intensive care unit is often inadequate. There is no tool available to assess nursing pain management practices. The aim of this study was to develop and validate a measuring tool to assess nursing pain management in the intensive care unit during standardized clinical simulation. A literature review was performed to identify relevant components demonstrating optimal pain management in adult intensive care units and to integrate them in an observation tool. This tool was submitted to an expert panel and pretested. It was then used to assess pain management practice during 26 discrete standardized clinical simulation sessions with intensive care nurses. The Nursing Observation Tool for Pain Management (NOTPaM) contains 28 statements grouped into 8 categories, which are grouped into 4 dimensions: subjective assessment, objective assessment, interventions, and reassessment. The tool's internal consistency was calculated at a Cronbach's alpha of 0.436 for the whole tool; the alpha varies from 0.328 to 0.518 for each dimension. To evaluate the inter-rater reliability, intra-class correlation coefficient was used, which was calculated at 0.751 (p nurses' pain management in a standardized clinical simulation. The NOTPaM is the first tool created for this purpose. Copyright © 2014 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

Effects of functional taping compared with sham taping and minimal intervention on pain intensity and static postural control for patients with non-specific chronic low back pain: a randomised clinical trial protocol.

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Jassi, F J; Del Antônio, T; Moraes, R; George, S Z; Chaves, T C

2017-06-01

To investigate the immediate and 1-month effects of functional taping to lumbar spine for pain intensity and postural control in patients with chronic non-specific low back pain. Randomised clinical trial. One hundred and twenty participants aged 18 to 50 years. Participants will be allocated at random to receive one of three interventions: functional star-shape taping for 7 days, sham functional taping for 7 days or minimal intervention, one session. The primary outcomes will be pain intensity and postural control. Four measurements of static posturography will be conducted: pre-intervention, immediately after application of the tape, 7 days post-intervention (after removal of the tape) and 1-month follow-up. The secondary outcomes will be low-back-pain-related disability, global perceived effect of treatment and fear avoidance beliefs. Primary and secondary outcomes will be assessed on three occasions: pre-intervention, 7 days post-intervention and at 1-month follow-up. All statistical analyses will be conducted following intention-to-treat principles, and the treatment effects will be calculated using linear mixed models. The results of this study will determine the effects of functional taping on pain intensity and postural control compared with sham taping and minimal intervention. NCT02546466. Copyright © 2016 Chartered Society of Physiotherapy. All rights reserved.

A pain in the bud? Implications of cross-modal sensitivity for pain experience.

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Perkins, Monica; de Bruyne, Marien; Giummarra, Melita J

2016-11-01

There is growing evidence that enhanced sensitivity to painful clinical procedures and chronic pain are related to greater sensitivity to other sensory inputs, such as bitter taste. We examined cross-modal sensitivities in two studies. Study 1 assessed associations between bitter taste sensitivity, pain tolerance, and fear of pain in 48 healthy young adults. Participants were classified as non-tasters, tasters and super-tasters using a bitter taste test (6-n-propythiouracil; PROP). The latter group had significantly higher fear of pain (Fear of Pain Questionnaire) than tasters (p=.036, effect size r = .48). There was only a trend for an association between bitter taste intensity ratings and intensity of pain at the point of pain tolerance in a cold pressor test (p=.04). In Study 2, 40 healthy young adults completed the Adolescent/Adult Sensory Profile before rating intensity and unpleasantness of innocuous (33 °C), moderate (41 °C), and high intensity (44 °C) thermal pain stimulations. The sensory-sensitivity subscale was positively correlated with both intensity and unpleasantness ratings. Canonical correlation showed that only sensitivity to audition and touch (not taste/smell) were associated with intensity of moderate and high (not innocuous) thermal stimuli. Together these findings suggest that there are cross-modal associations predominantly between sensitivity to exteroceptive inputs (i.e., taste, touch, sound) and the affective dimensions of pain, including noxious heat and intolerable cold pain, in healthy adults. These cross-modal sensitivities may arise due to greater psychological aversion to salient sensations, or from shared neural circuitry for processing disparate sensory modalities.

COMPARISON OF EFFECTS OF ABDOMINAL STRETCHING EXERCISE AND COLD COMPRESS THERAPY ON MENSTRUAL PAIN INTENSITY IN TEENAGE GIRLS

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Desta Ayu Cahya Rosyida

2017-07-01

Full Text Available Background: Pain during menstruation is not uncommon, especially in young women, which has an impact on their life activities. Objective: To examine the effect of abdominal stretching exercise and cold compress therapy on decreasing intensity of menstrual pain in teenage girls at SMK Bakti Indonesia Medika. Design: A Quasy Experimental Study with two group comparison pretest-postest design. There were 46 respondents selected in this study by consecutive sampling that consisted of 23 samples in the abdominal stretching exercise group and 23 samples in the cold compress group. The menstrual pain was measured using VAS (visual analog scale. Data were analyzed using Mann-Whitney, Chi-Square, and Wilcoxon test. Results: Findings showed that the mean of menstrual pain before intervention in the abdominal stretching exercise was 7.04 and in the cold compress therapy was 6.74 with p-value 0.211 (<0.05, which indicated that there was no mean difference of pain between both groups. However, after intervention, the menstrual pain was reduced from 7.04 to 1.91 (5.09 difference in the abdominal stretching exercise group; and from 6.74 to 5.52 (1.22 difference in the cold compress group with p-value 0.000 (<0.05, which indicated that there was statistically significant difference of menstrual pain before and after intervention, both abdominal stretching exercise and cold compress therapy. Conclusion: There were statistically significant effects of abdominal stretching exercise and cold compress therapy on menstrual pain in teenage girls. The abdominal stretching exercise is more effective than cold compress therapy in reducing menstrual pain intensity. Thus, it is suggested that abdominal stretching exercise can be an alternative choice of management of dysmenorrhea in teenage girls, and can be a part of subject in the education as non-pharmacological medicine.

Magnetic Resonance-Guided High-Intensity-Focused Ultrasound for Palliation of Painful Skeletal Metastases: A Pilot Study.

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Chan, Michael; Dennis, Kristopher; Huang, Yuexi; Mougenot, Charles; Chow, Edward; DeAngelis, Carlo; Coccagna, Jennifer; Sahgal, Arjun; Hynynen, Kullervo; Czarnota, Gregory; Chu, William

2017-10-01

Bone is one of the most common sites of metastases, with bone metastases-related pain representing a significant source of morbidity among patients with cancer. Magnetic resonance-guided focused ultrasound is a noninvasive, outpatient modality with the potential for treating painful bone metastases. The aim of this study is to report our initial experience with magnetic resonance-guided focused ultrasound in the treatment of bone metastases and our preliminary analysis of urinary cytokine levels after therapy. This was a single-center pilot study of 10 patients with metastatic cancer to investigate the feasibility of magnetic resonance-guided focused ultrasound for primary pain control in device-accessible skeletal metastases. Treatments were performed on a clinical magnetic resonance-guided focused ultrasound system using a volumetric ablation technique. Primary efficacy was assessed using Brief Pain Inventory scores and morphine equivalent daily dose intake at 3 time points: before, day 14, and day 30 after the magnetic resonance-guided focused ultrasound treatment. Urine cytokines were measured 3 days before treatment and 2 days after the treatment. Of the 10 patients, 8 were followed up 14 days and 6 were followed up 30 days after the treatment. At day 14, 3 patients (37.5%) exhibited partial pain response and 4 patients (50%) exhibited an indeterminate response, and at day 30 after the treatment, 5 patients (83%) exhibited partial pain response. No treatment-related adverse events were recorded. Of the urine cytokines measured, only Transforming growth factor alpha (TGFα) demonstrated an overall decrease, with a trend toward statistical significance ( P = .078). Our study corroborates magnetic resonance-guided focused ultrasound as a feasible and safe modality as a primary, palliative treatment for painful bone metastases and contributes to the limited body of literature using magnetic resonance-guided focused ultrasound for this clinical indication.

Increased water intake to reduce headache: learning from a critical appraisal.

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Price, Amy; Burls, Amanda

2015-12-01

Water intake is a cost effective, non-invasive and low-risk intervention to reduce or prevent headache pain. Chronic mild dehydration may trigger headache. Increased water intake could help. A small trial shows modest benefit; however, a larger methodologically sound randomized controlled trial is needed to confirm efficacy. Spigt, M., Weerkamp, N., Troost, J., van Schayck, C. P., & Knottnerus, J. A. (2012). 'A randomized trial on the effects of regular water intake in patients with recurrent headaches.' Family practice, 29(4), 370-5. Doi: 10.1093/fampra/cmr112 CLINICAL SCENARIO: Patients from primary care registered as 'headache', 'tension headache' and/or 'migraine' for more than one year who suffer at least two episodes of moderately intense headache or more than four mildly intense episodes of headache per month with a daily fluid intake of less than 2.5 litres per day. Patient/Problem = Headache > 1 year with 2 moderately intense or 4 mildly intense episodes per month Intervention = 1.5 litres water per day + stress control and sleep hygiene Comparison/Control = stress control and sleep hygiene Outcome = Reduce or eliminate headache Methodology = Therapy RCT Table 1: Final Search Terms TRIP Data Base: hits = 517 used filter Extended Primary research 4 found 1 paper applicable 'Water intake '[MeSH Terms] AND 'Headache '[All Fields]' Best match to PICO, (2012) RCT SELECTION CRITERION AND OVERALL RESULTS: 102 headache patients in16 primary care clinics were randomized into control (n = 50) and intervention groups (n = 52) Inclusion criteria = two > episodes of moderately intense headache or five > mildly intense headaches per month and total fluid intake > 2.5 litres per day, Follow-up @ 3 months. 79% intervention and 66% of controls completed RCT. Drinking more water resulted in a statistically significant improvement of 4.5 (confidence interval: 1.3-7.8) points on Migraine-Specific Quality of Life (MSQOL

Alexithymic trait, painful heat stimulation and everyday pain experience

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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.

Is there an association between fear avoidance beliefs, and pain and disability in patients with orofacial pain?

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Edmond, S L; Enriquez, C S; Millner, M H; Nasri-Heir, C; Heir, G M

2017-06-01

Numerous psychosocial factors have been shown to contribute to the development and perpetuation of orofacial pain. One well-recognized model for explaining the link between psychosocial factors and chronic pain is the fear avoidance model. To date, this proposed link has not been studied in subjects with orofacial pain. During the initial evaluation of subjects with orofacial pain, we collected data on fear avoidance beliefs using the Fear Avoidance Beliefs Questionnaire, and disability and pain. At between 6 and 8 weeks follow-up, we re-collected these data, as well as data addressing subjects' perceived change in their condition. Data were analyzed using correlation coefficients and linear regression. Fear avoidance beliefs at intake were inversely correlated with intake disability, There were no significant associations between fear avoidance beliefs at initial evaluation or in changes in fear avoidance beliefs during the 6-8 weeks follow-up period; and changes in disability, pain or perceived change in condition at 6-8 weeks follow-up. Of note, fear avoidance beliefs increased over the follow-up period, despite improvements in all outcome measures. There was insufficient evidence to suggest that high levels of fear avoidance beliefs at initial evaluation are associated with higher levels of disability or pain at intake, or with change in disability, pain or perceived change in condition at 6-8 weeks follow-up. Similarly, there was insufficient evidence to suggest that changes in fear avoidance beliefs during treatment are associated with any of these outcome measures. © 2017 John Wiley & Sons Ltd.

Is there really a relationship between serum vitamin D (25OHD) levels and the musculoskeletal pain associated with statin intake? A systematic review.

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Pereda, Claudia Alejandra; Nishishinya, Maria Betina

Musculoskeletal pain associated to statin use, is the most common adverse event, leading to cessation of treatment. Several studies proposed Vitamin D deficiency to increase the risk of pain associated to statin intake. To evaluate whether vitamin D status is linked to musculoskeletal pain associated to statin use. We performed a systematic review based on electronic searches through MEDLINE, Cochrane Central and EMBASE to identify studies that 1) included patients on statin therapy 2) with vitamin D serum levels assessment, 3) in relation to musculoskeletal pain. The electronic search identified 127 potentially eligible studies, of which three were included and analysed in the present study. The heterogeneity of studies did not allow metanalysis. A systematic review and two cohort studies not included in the previous systematic review, revealed a statistically significant association of vitamin D deficit in patients with musculoskeletal pain on statin therapy. The displayed evidence suggests a significant association between 25OHD serum levels<30ng/ml and the presence of musculoskeletal pain in patients on statin therapy. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.

Sodium bicarbonate intake improves high-intensity intermittent exercise performance in trained young men.

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Krustrup, Peter; Ermidis, Georgios; Mohr, Magni

2015-01-01

Sodium bicarbonate intake has been shown to improve exercise tolerance, but the effects on high-intensity intermittent exercise are less clear. Thus, the aim of the present study was to determine the effect of sodium bicarbonate intake on Yo-Yo intermittent recovery test level 2 performance in trained young men. Thirteen men aged 23 ± 1 year (height: 180 ± 2 cm, weight: 78 ± 3 kg; VO2max: 61.3 ± 3.3 mlO2 · kg(-1) · min(-1); means ± SEM) performed the Yo-Yo intermittent recovery test level 2 (Yo-Yo IR2) on two separate occasions in randomized order with (SBC) and without (CON) prior intake of sodium bicarbonate (0.4 g · kg(-1) body weight). Heart rate and rating of perceived exertion (RPE) were measured during the test and venous blood samples were taken frequently. Yo-Yo IR2 performance was 14 % higher (P = 0.04) in SBC than in CON (735 ± 61 vs 646 ± 46 m, respectively). Blood pH and bicarbonate were similar between trials at baseline, but higher (P = 0.003) immediately prior to the Yo-Yo IR2 test in SBC than in CON (7.44 ± 0.01 vs 7.32 ± 0.01 and 33.7 ± 3.2 vs 27.3 ± 0.6 mmol · l(-1), respectively). Blood lactate was 0.9 ± 0.1 and 0.8 ± 0.1 mmol · l(-1) at baseline and increased to 11.3 ± 1.4 and 9.4 ± 0.8 mmol · l(-1) at exhaustion in SBC and CON, respectively, being higher (P = 0.03) in SBC. Additionally, peak blood lactate was higher (P = 0.02) in SBC than in CON (11.7 ± 1.2 vs 10.2 ± 0.7 mmol · l(-1)). Blood glucose, plasma K(+) and Na(+) were not different between trials. Peak heart rate reached at exhaustion was 197 ± 3 and 195 ± 3 bpm in SBC and CON, respectively, with no difference between conditions. RPE was 7% lower (P = 0.003) in SBC than in CON after 440 m, but similar at exhaustion (19.3 ± 0.2 and 19.5 ± 0.2). In conclusion, high-intensity intermittent exercise performance is improved by prior

Deficient conditioned pain modulation after spinal cord injury correlates with clinical spontaneous pain measures.

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Albu, Sergiu; Gómez-Soriano, Julio; Avila-Martin, Gerardo; Taylor, Julian

2015-02-01

The contribution of endogenous pain modulation dysfunction to clinical and sensory measures of neuropathic pain (NP) has not been fully explored. Habituation, temporal summation, and heterotopic noxious conditioning stimulus-induced modulation of tonic heat pain intensity were examined in healthy noninjured subjects (n = 10), and above the level of spinal cord injury (SCI) in individuals without (SCI-noNP, n = 10) and with NP (SCI-NP, n = 10). Thermoalgesic thresholds, Cz/AFz contact heat evoked potentials (CHEPs), and phasic or tonic (30 seconds) heat pain intensity were assessed within the C6 dermatome. Although habituation to tonic heat pain intensity (0-10) was reported by the noninjured (10 s: 3.5 ± 0.3 vs 30 s: 2.2 ± 0.5 numerical rating scale; P = 0.003), loss of habituation was identified in both the SCI-noNP (3.8 ± 0.3 vs 3.6 ± 0.5) and SCI-NP group (4.2 ± 0.4 vs 4.9 ± 0.8). Significant temporal summation of tonic heat pain intensity was not observed in the 3 groups. Inhibition of tonic heat pain intensity induced by heterotopic noxious conditioning stimulus was identified in the noninjured (-29.7% ± 9.7%) and SCI-noNP groups (-19.6% ± 7.0%), but not in subjects with SCI-NP (+1.1% ± 8.0%; P pain modulation response correlated positively with Cz/AFz CHEP amplitude (ρ = 0.8; P = 0.015) and evoked heat pain intensity (ρ = 0.8; P = 0.007) in the SCI-NP group. Stepwise regression analysis revealed that the mean conditioned pain modulation (R = 0.72) correlated with pain severity and pressing spontaneous pain in the SCI-NP group. Comprehensive assessment of sensory dysfunction above the level of injury with tonic thermal test and conditioning stimuli revealed less-efficient endogenous pain modulation in subjects with SCI-NP.

Spinal pain in adolescents

DEFF Research Database (Denmark)

Aartun, Ellen; Hartvigsen, Jan; Wedderkopp, Niels

2014-01-01

BACKGROUND: The severity and course of spinal pain is poorly understood in adolescents. The study aimed to determine the prevalence and two-year incidence, as well as the course, frequency, and intensity of pain in the neck, mid back, and low back (spinal pain). METHODS: This study was a school......-based prospective cohort study. All 5th and 6th grade students (11-13 years) at 14 schools in the Region of Southern Denmark were invited to participate (N = 1,348). Data were collected in 2010 and again two years later, using an e-survey completed during school time. RESULTS: The lifetime prevalence of spinal pain...... reported their pain as relatively infrequent and of low intensity, whereas the participants with frequent pain also experienced pain of higher intensity. The two-year incidence of spinal pain varied between 40% and 60% across the physical locations. Progression of pain from one to more locations and from...

Specific proteins of the trapezius muscle correlate with pain intensity and sensitivity – an explorative multivariate proteomic study of the trapezius muscle in women with chronic widespread pain

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Olausson P

2016-06-01

Full Text Available Patrik Olausson, Bijar Ghafouri, Nazdar Ghafouri, Björn Gerdle Pain and Rehabilitation Centre, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden Abstract: Chronic widespread pain (CWP including fibromyalgia syndrome (FMS has a high prevalence and is associated with prominent negative consequences. CWP/FMS exhibits morphological and functional alterations in the central nervous system. The importance of peripheral factors for maintaining the central alterations are under debate. In this study, the proteins from biopsies of the trapezius muscle from 18 female CWP/FMS patients and 19 healthy female controls were analyzed. Pain intensity and pressure pain thresholds (PPT over the trapezius muscles were registered. Twelve proteins representing five different groups of proteins were important regressors of pain intensity in CWP/FMS (R2=0.99; P<0.001. In the regression of PPT in CWP/FMS, it was found that 16 proteins representing six groups of proteins were significant regressors (R2=0.95, P<0.05. Many of the important proteins were stress and inflammation proteins, enzymes involved in metabolic pathways, and proteins associated with muscle damage, myopathies, and muscle recovery. The altered expression of these proteins may reflect both direct and indirect nociceptive/inflammatory processes as well as secondary changes. The relative importance of the identified proteins and central alterations in CWP need to be investigated in future research. Data from this and the previous study concerning the same cohorts give support to the suggestion that peripheral factors are of importance for maintaining pain aspects in CWP/FMS. Keywords: chronic widespread pain, proteomics, biomarkers, multivariate data analysis, pain threshold, numeric rating scale

Evaluation of spinal cord stimulation on the symptoms of anxiety and depression and pain intensity in patients with failed back surgery syndrome.

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Robb, L P; Cooney, J M; McCrory, C R

2017-08-01

Spinal cord stimulation (SCS) is now established as the primary treatment for failed back surgery syndrome (FBSS). Commonly, patients with chronic pain and FBSS often report symptoms of anxiety and depression resulting from this condition. These factors can modulate and amplify the pain experience, therefore, further challenging treatment success. This study examined the efficacy of SCS on alleviating the symptoms of anxiety and depression associated with chronic pain as well as pain intensity in a group of patients with FBSS. A convenience sample (n = 26) was selected for participation. Questionnaires [Hospital Anxiety and Depression Scale (HADS) and Brief Pain Inventory Short Form (BPI-SF)] were completed and examined pre and post spinal cord implant. Analysis of the data 1 year following SCS indicates that there was a statistical significant improvement in the symptoms of depression and anxiety reported as well as pain intensity in all participants (p anxiety and depression scores on the HADS were significantly lower compared to baseline (p anxiety and depression with an associated reduction in opioid consumption.

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.

Transversus abdominis plane block reduces postoperative pain intensity and analgesic consumption in elective cesarean delivery under general anesthesia.

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Eslamian, Laleh; Jalili, Zorvan; Jamal, Ashraf; Marsoosi, Vajiheh; Movafegh, Ali

2012-06-01

It is reported that following abdominal surgery, transversus abdominis plane (TAP) block can reduce postoperative pain. The primary outcome of this study was the evaluation of the efficacy of TAP block on pain intensity following cesarean delivery with Pfannenstiel incision. Fifty pregnant women were randomized blindly to receive either a TAP block with 15 ml 0.25% bupivacaine in both sides (group T, n = 25) or no blockade (group C, n = 25) at the end of the surgery, which was performed with a Pfannenstiel incision under general anesthesia. The pain intensity in the patients was assessed by a blinded investigator at the time of discharge from recovery and at 6, 12, and 24 h postoperatively, with a visual analogue scale (VAS) for pain. The women in the TAP block group had significantly lower VAS pain scores at rest and during coughing and consumed significantly less tramadol than the women in group C [50 mg (0-150) vs. 250 mg (0-400), P = 0.001]. There was a significantly longer time to the first request for analgesic in the TAP block group [210 min (0-300) vs. 30 min (10-180) in group C, P = 0.0001]. Two-sided TAP block with 0.25% bupivacaine in parturients who undergo cesarean section with a Pfannenstiel incision under general anesthesia can decrease postoperative pain and analgesic consumption. The time to the first analgesic rescue was longer in the parturients who received the TAP block.

Endogenous Opioid Inhibition of Chronic Low Back Pain Influences Degree of Back Pain Relief Following Morphine Administration

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Bruehl, Stephen; Burns, John W.; Gupta, Rajnish; Buvanendran, Asokumar; Chont, Melissa; Schuster, Erik; France, Christopher R.

2014-01-01

Background and Objectives Factors underlying differential responsiveness to opioid analgesic medications used in chronic pain management are poorly understood. We tested whether individual differences in endogenous opioid inhibition of chronic low back pain were associated with magnitude of acute reductions in back pain ratings following morphine administration. Methods In randomized, counterbalanced order over three sessions, 50 chronic low back pain patients received intravenous naloxone (8mg), morphine (0.08 mg/kg), or placebo. Back pain intensity was rated pre-drug and again after peak drug activity was achieved using the McGill Pain Questionnaire-Short Form (Sensory and Affective subscales, VAS intensity measure). Opioid blockade effect measures to index degree of endogenous opioid inhibition of back pain intensity were derived as the difference between pre-to post-drug changes in pain intensity across placebo and naloxone conditions, with similar morphine responsiveness measures derived across placebo and morphine conditions. Results Morphine significantly reduced back pain compared to placebo (MPQ-Sensory, VAS; P effects of opioid blockade on back pain intensity. However, individual differences in opioid blockade effects were significantly associated with degree of acute morphine-related reductions in back pain on all measures, even after controlling for effects of age, sex, and chronic pain duration (P morphine. Conclusions Morphine appears to provide better acute relief of chronic back pain in individuals with lower natural opioidergic inhibition of chronic pain intensity. Possible implications for personalized medicine are discussed. PMID:24553304

The effects of total knee replacement and non-surgical treatment on pain sensitization and clinical pain

DEFF Research Database (Denmark)

Skou, S. T.; Roos, E. M.; Simonsen, O.

2016-01-01

(PPTs) at the knee (localized sensitization) and the lower leg (spreading sensitization), (2) peak pain intensity during the previous 24 h, (3) pain intensity after 30 min of walking, (4) pain location and pattern, (5) spreading of pain on a region-divided body chart and (6) the usage of pain medication...

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...

Food intake assessment and quality of life in women with fibromyalgia

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Emmanuelle Dias Batista

2016-04-01

Full Text Available ABSTRACT Objective: To compare the food intake of women with and without fibromyalgia and verify if the food intake of patients with fibromyalgia interferes with the pain and quality of life. Methods: Study participants were women with fibromyalgia (FM seen in Fibromyalgia Outpatient Clinic, Hospital das Clínicas/UFPR and a control group (CT with healthy women. Data collection was conducted from March to October 2012. For the assessment of food intake we used the Food Registration and analyzed items were: total calories, carbohydrates, proteins, lipids, vitamins (A, C, B12, D and E and minerals (folate, selenium, zinc, iron, calcium and magnesium. The software used was Avanutri Online®. To evaluate the quality of life, the Fibromyalgia Impact Questionnaire (FIQ and pain threshold were used. Results: 43 patients with FM and 44 healthy women were evaluated. CT group showed a mean consumption of nutrients greater than FM group except for iron. However, only caloric intake, carbohydrates, proteins and lipids in grams and percentage of lipids, vitamin A, E, B12, folate, selenium and calcium were statistically significant. In FM group there was a negative correlation between vitamin E and FIQ and a positive correlation between percentage of protein and pain threshold. Conclusion: Women with FM showed a lower qualitatively and quantitatively intake in comparison with CT group. Only vitamin E correlated with quality of life and percentage of protein in the diet with sensation of pain.

Lumbopelvic Core Stabilization Exercise and Pain Modulation Among Individuals with Chronic Nonspecific Low Back Pain.

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Paungmali, Aatit; Joseph, Leonard H; Sitilertpisan, Patraporn; Pirunsan, Ubon; Uthaikhup, Sureeporn

2017-11-01

Lumbopelvic stabilization training (LPST) may provide therapeutic benefits on pain modulation in chronic nonspecific low back pain conditions. This study aimed to examine the effects of LPST on pain threshold and pain intensity in comparison with the passive automated cycling intervention and control intervention among patients with chronic nonspecific low back pain. A within-subject, repeated-measures, crossover randomized controlled design was conducted among 25 participants (7 males and 18 females) with chronic nonspecific low back pain. All the participants received 3 different types of experimental interventions, which included LPST, the passive automated cycling intervention, and the control intervention randomly, with 48 hours between the sessions. The pressure pain threshold (PPT), hot-cold pain threshold, and pain intensity were estimated before and after the interventions. Repeated-measures analysis of variance showed that LPST provided therapeutic effects as it improved the PPT beyond the placebo and control interventions (P pain intensity under the LPST condition was significantly better than that under the passive automated cycling intervention and controlled intervention (P pain threshold under the LPST condition also showed a significant trend of improvement beyond the control (P pain threshold were evident. Lumbopelvic stabilization training may provide therapeutic effects by inducing pain modulation through an improvement in the pain threshold and reduction in pain intensity. LPST may be considered as part of the management programs for treatment of chronic low back pain. © 2017 World Institute of Pain.

Pain following foraminal enlargement in mandibular molars with necrosis and apical periodontitis: A randomized controlled trial.

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Saini, H R; Sangwan, P; Sangwan, A

2016-12-01

This randomized controlled trial was conducted to evaluate the effect of foraminal enlargement during chemomechanical root canal preparation on postoperative pain. Seventy mandibular first molars with asymptomatic pulp necrosis and chronic apical periodontitis were randomized into two groups - foraminal enlargement (FE) and conventional nonforaminal enlargement (NFE). Canals were prepared according to the respective protocols, and the teeth were restored temporarily. Postoperatively, the patients were prescribed ibuprofen 400 mg, to be taken if required. Pain experience and analgesic intake were recorded for 7 days following chemomechanical preparation. The data were analysed using Mann-Whitney U-test and chi-square tests. Pain experience was higher with foraminal enlargement than when using a conventional technique. A significant difference was observed in postoperative pain during the first 4 days and the sixth day (P  0.05). Enlargement of the apical foramen during root canal treatment increased the incidence and intensity of postoperative pain. © 2015 International Endodontic Journal. Published by John Wiley & Sons Ltd.

An Intensive Locomotor Training Paradigm Improves Neuropathic Pain following Spinal Cord Compression Injury in Rats.

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Dugan, Elizabeth A; Sagen, Jacqueline

2015-05-01

Spinal cord injury (SCI) is often associated with both locomotor deficits and sensory dysfunction, including debilitating neuropathic pain. Unfortunately, current conventional pharmacological, physiological, or psychological treatments provide only marginal relief for more than two-thirds of patients, highlighting the need for improved treatment options. Locomotor training is often prescribed as an adjunct therapy for peripheral neuropathic pain but is rarely used to treat central neuropathic pain. The goal of this study was to evaluate the potential anti-nociceptive benefits of intensive locomotor training (ILT) on neuropathic pain consequent to traumatic SCI. Using a rodent SCI model for central neuropathic pain, ILT was initiated either 5 d after injury prior to development of neuropathic pain symptoms (the "prevention" group) or delayed until pain symptoms fully developed (∼3 weeks post-injury, the "reversal" group). The training protocol consisted of 5 d/week of a ramping protocol that started with 11 m/min for 5 min and increased in speed (+1 m/min/week) and time (1-4 minutes/week) to a maximum of two 20-min sessions/d at 15 m/min by the fourth week of training. ILT prevented and reversed the development of heat hyperalgesia and cold allodynia, as well as reversed developed tactile allodynia, suggesting analgesic benefits not seen with moderate levels of locomotor training. Further, the analgesic benefits of ILT persisted for several weeks once training had been stopped. The unique ability of an ILT protocol to produce robust and sustained anti-nociceptive effects, as assessed by three distinct outcome measures for below-level SCI neuropathic pain, suggests that this adjunct therapeutic approach has great promise in a comprehensive treatment strategy for SCI pain.

Benefits of implementing pain-related disability and psychological assessment in dental practice for patients with temporomandibular pain and other oral health conditions.

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Visscher, Corine M; Baad-Hansen, Lene; Durham, Justin; Goulet, Jean-Paul; Michelotti, Ambra; Roldán Barraza, Carolina; Häggman-Henrikson, Birgitta; Ekberg, EwaCarin; Raphael, Karen G

2018-04-10

Evidence in the field of dentistry has demonstrated the importance of pain-related disability and psychological assessment in the development of chronic symptoms. The Diagnostic Criteria for Temporomandibular Disorders offer a brief assessment for the diagnostic process in patients with orofacial pain (Axis II). The authors describe relevant outcomes that may guide general oral health care practitioners toward tailored treatment decisions and improved treatment outcomes and provide recommendations for the primary care setting. The authors conducted a review of the literature to provide an overview of knowledge about Axis II assessment relevant for the general oral health care practitioner. The authors propose 3 domains of the Axis II assessment to be used in general oral health care: pain location (pain drawing), pain intensity and related disability (Graded Chronic Pain Scale [GCPS]), and psychological distress (Patient Health Questionnaire-4 [PHQ-4]). In the case of localized pain, low GCPS scores (0-II), and low PHQ-4 scores (0-5), patients preferably receive treatment in primary care. In the case of widespread pain, high GCPS scores (III-IV), and high PHQ-4 scores (6-12), the authors recommend referral to a multidisciplinary team, especially for patients with temporomandibular disorder (TMD) pain. The authors recommend psychological assessment at first intake of a new adult patient or for patients with persistent TMD pain. The authors recommend the pain-related disability screening tools for all TMD pain symptoms and for dental pain symptoms that persist beyond the normal healing period. A brief psychological and pain-related disability assessment for patients in primary care may help the general oral health care practitioner make tailored treatment decisions. Copyright © 2018 American Dental Association. Published by Elsevier Inc. All rights reserved.

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

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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.

Endpoints in pediatric pain studies

NARCIS (Netherlands)

M. van Dijk (Monique); I. Ceelie (Ilse); D. Tibboel (Dick)

2011-01-01

textabstractAssessing pain intensity in (preverbal) children is more difficult than in adults. Tools to measure pain are being used as primary endpoints [e.g., pain intensity, time to first (rescue) analgesia, total analgesic consumption, adverse effects, and long-term effects] in studies on the

Prediction of pain in orthodontic patients based on preoperative pain assessment

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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

Correlation Between Protein Intake and Nitrogen Balance of Surgical Patients in Anesthesiology and Intensive Care Installation, Sanglah General Hospital, Denpasar, Bali, Indonesia

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Made Wiryana

2016-06-01

Full Text Available Background: A cell injury from surgical stress in a trauma or a non-trauma case will induce a hyper metabolic response in which the protein degradation increases, the somatic protein synthesis decreases and the amino acid catabolism increases. Thus, the pyper metabolic response contributes to nitrogen loss in urine. This response, without an adequate nutrition, will lead an iatrogenic malnutrition and deterioration. A balance nitrogen formula through urinary urea nitrogen is one of many nutrition evaluation methods. This method aids in evaluating the daily nutrition status and it can be the baseline data for daily intake. Objective: To find a correlation between the protein intake and the nitrogen balance of the surgical patients in anesthesiology and intensive care installation, Sanglah General Hospital, Denpasar, Bali. Methods: Fifty-one surgical patients with trauma and non-trauma cases were observed for their protein intake for 2-3 days continuously. Moreover, they were evaluated for their nitrogen balance based on the urinary urea nitrogen per 24 hours for 2-3 days. For statistical analysis, we utilized Shapiro-Francia, Shapiro-Wilk, Spearman Frank correlation, two-sample t test, and multivariate regression analysis in Strata SE 12.1. Results: The correlation between the protein intake and the nitrogen balance on the first day was ra=0.50 (p<0.05, on the second day ra=0.70 (p<0,05, and on the third day ra=0.740 (p<0,05. Conclusions: There is a correlation between the protein intake and the nitrogen balance of surgical patients in Anesthesiology and Intensive Care Installation Sanglah General Hospital Denpasar. 

Effects of prehospital nitroglycerin on hemodynamics and chest pain intensity.

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Engelberg, S; Singer, A J; Moldashel, J; Sciammarella, J; Thode, H C; Henry, M

2000-01-01

To assess the effects of prehospital nitroglycerin (NTG) on vital signs and chest pain intensity. A retrospective review of advanced life support (ALS) run sheets was performed in a suburban volunteer emergency medical services (EMS) system receiving 8,000 annual ALS calls. All consecutive patients who were administered NTG by EMS were included. Standardized forms were used to collect data on patient demographics, history, and physical exam. Patients assessed their chest pain (CP) before and after NTG on a verbal numeric scale of 0-10 from least to most severe. The presence of syncope, dysrhythmias, or profound hypotension [loss of peripheral pulses, a systolic blood pressure (SBP) of 100 mm Hg in BP] was noted. Results. One thousand six hundred sixty-two patients received NTG over 18 months, their mean age was 66 years, and 48% were female. Indications for NTG included CP (83%), dyspnea (45%), and congestive heart failure (20%). After NTG administration, the CP score decreased from 6.9 to 4.4 (mean difference = 2.6; 95% CI = 2.4 to 2.8). The CP completely resolved in 10% of the patients. Mean decreases in SBPs and diastolic BPs were 11.8 mm Hg (95% CI = 10.7 to 13.0) and 4.0 mm Hg (95% CI = 2.9 to 5.1). The mean pulse rate increased by 2.7 beats/min (95% CI = 0.6 to 4.9). There were 12 patients with adverse events [0.7% (95% CI = 0.4% to 1.3%)], including profound bradycardia and hypotension (1), transient drop in SBP of 100 mm Hg responding to fluids (6), post-NTG SBP <90 mm Hg (4), and syncope (1). There were no deaths in the prehospital setting. Use of prehospital NTG appears safe. While NTG reduces CP, most patients have residual pain.

The effects of music therapy on pain in patients with neuropathic pain.

Science.gov (United States)

Korhan, Esra Akın; Uyar, Meltem; Eyigör, Can; Hakverdioğlu Yönt, Gülendam; Çelik, Serkan; Khorshıd, Leyla

2014-03-01

The aim of this study was to investigate the effect of relaxing music on pain intensity in patients with neuropathic pain. A quasi-experimental study, repeated measures design was used. Thirty patients, aged 18-70 years, with neuropathic pain and hospitalized in an Algology clinic were identified as a convenience sample. Participants received 60 minutes of music therapy. Classical Turkish music was played to patients using a media player (MP3) and headphones. Participants had pain scores taken immediately before the intervention and at the 30th and 60th minutes of the intervention. Data were collected over a 6-month period in 2012. The patients' mean pain intensity scores were reduced by music, and that decrease was progressive over the 30th and 60th minutes of the intervention, indicating a cumulative dose effect. The results of this study implied that the inclusion of music therapy in the routine care of patients with neuropathic pain could provide nurses with an effective practice for reducing patients' pain intensity. Copyright © 2014 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

Music for pain relief.

Science.gov (United States)

Cepeda, M S; Carr, D B; Lau, J; Alvarez, H

2006-04-19

The efficacy of music for the treatment of pain has not been established. To evaluate the effect of music on acute, chronic or cancer pain intensity, pain relief, and analgesic requirements. We searched The Cochrane Library, MEDLINE, EMBASE, PsycINFO, LILACS and the references in retrieved manuscripts. There was no language restriction. We included randomized controlled trials that evaluated the effect of music on any type of pain in children or adults. We excluded trials that reported results of concurrent non-pharmacological therapies. Data was extracted by two independent review authors. We calculated the mean difference in pain intensity levels, percentage of patients with at least 50% pain relief, and opioid requirements. We converted opioid consumption to morphine equivalents. To explore heterogeneity, studies that evaluated adults, children, acute, chronic, malignant, labor, procedural, or experimental pain were evaluated separately, as well as those studies in which patients chose the type of music. Fifty-one studies involving 1867 subjects exposed to music and 1796 controls met inclusion criteria. In the 31 studies evaluating mean pain intensity there was a considerable variation in the effect of music, indicating statistical heterogeneity ( I(2) = 85.3%). After grouping the studies according to the pain model, this heterogeneity remained, with the exception of the studies that evaluated acute postoperative pain. In this last group, patients exposed to music had pain intensity that was 0.5 units lower on a zero to ten scale than unexposed subjects (95% CI: -0.9 to -0.2). Studies that permitted patients to select the music did not reveal a benefit from music; the decline in pain intensity was 0.2 units, 95% CI (-0.7 to 0.2). Four studies reported the proportion of subjects with at least 50% pain relief; subjects exposed to music had a 70% higher likelihood of having pain relief than unexposed subjects (95% CI: 1.21 to 2.37). NNT = 5 (95% CI: 4 to 13). Three

A Randomized Double-Blind Controlled Trial Comparing Davanloo Intensive Short-Term Dynamic Psychotherapy as Internet-Delivered Vs Treatment as Usual for Medically Unexplained Pain: A 6-Month Pilot Study.

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Chavooshi, Behzad; Mohammadkhani, Parvaneh; Dolatshahi, Behrouz

2016-01-01

Research has shown that Intensive Short-Term Dynamic Psychotherapy (ISTDP) can effectively decrease pain intensity and improve quality of life in patients with medically unexplained pain. Understanding that not all patients with medically unexplained pain have access to in-person ISTDP, this study aims to investigate the efficacy of an Internet-delivered ISTDP for individuals with medically unexplained pain using Skype in comparison with treatment as usual. In this randomized controlled trial, 100 patients were randomly allocated into Internet-delivered ISTDP (n = 50) and treatment-as- usual (n = 50) groups. Treatment intervention consisted of 16 weekly, hour-long therapy sessions. The primary outcome was perceived pain assessed using the Numeric Pain Rating Scale. The secondary outcome included Depression Anxiety Stress Scale-21, Emotion Regulation Questionnaire, Mindful Attention Awareness Scale, and Quality-of-Life Inventory. Blind assessments were conducted at the baseline, posttreatment, and at a 6-month follow-up. In the intention-to-treat analysis, pain symptoms in the intervention group were significantly reduced (p Skype can significantly improve pain intensity and clinical symptoms of medically unexplained pain. Copyright © 2016 The Academy of Psychosomatic Medicine. Published by Elsevier Inc. All rights reserved.

Omega-3 index and prognosis in acute coronary chest pain patients with a low dietary intake of omega-3.

Science.gov (United States)

de la Fuente, Ricardo León; Naesgaard, Patrycja Anna; Nilsen, Stein Tore; Woie, Leik; Aarsland, Torbjørn; Gundersen, Thomas; Nilsen, Dennis W T

2013-04-01

The omega-3 index (eicosapentaenoic acid + docosahexaenoic acid) content in red blood cell membranes has been suggested as a novel risk marker for cardiac death. Objective. To assess the ability of the omega-3 index to predict all-cause mortality, cardiac death and sudden cardiac death following hospitalization with an acute coronary syndrome (ACS), and to include arachidonic acid (AA) in risk assessment. The omega-3 index was measured in 572 consecutive patients (median 63 years and 59% males) admitted with chest pain and suspected ACS in an inland Northern Argentinean city with a dietary habit that was essentially based on red meat and a low intake of fish. Clinical endpoints were collected during a 5-year follow-up period, median 3.6 years, range 1 day to 5.5 years. Stepwise Cox regression analysis was employed to compare the rate of new events in the quartiles of the omega-3 index measured at inclusion. Multivariable analysis was performed. No statistical significant differences in baseline characteristics were noted between quartiles of the omega-3 index. The median of the adjusted omega-3 index was 3.6%. During the follow-up period, 100 (17.5%) patients died. Event rates were similar in all quartiles of the omega-3 index, with no statistical significant differences. AA added no prognostic information. In a population with a low intake of fish and fish oils, the adjusted omega-3 index did not predict fatal events following hospitalization in patients with acute chest pain and suspected ACS.

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

The influence of pain-related expectations on intensity perception of non-painful somatosensory stimuli

NARCIS (Netherlands)

Zaman, Jonas; Wiech, Katja; Claes, Nathalie; Van Oudenhove, Lukas; Van Diest, Ilse; Vlaeyen, Johan W. S.

2018-01-01

OBJECTIVE: The extent to which pain-related expectations, known to affect pain perception, also affect perception of non-painful sensations remains unclear, as well as the potential role of unpredictability in this context. METHODS: In a proprioceptive fear conditioning paradigm, various arm

[Performance enhancement by carbohydrate intake during sport: effects of carbohydrates during and after high-intensity exercise].

Science.gov (United States)

Beelen, Milou; Cermak, Naomi M; van Loon, Luc J C

2015-01-01

Endogenous carbohydrate availability does not provide sufficient energy for prolonged moderate to high-intensity exercise. Carbohydrate ingestion during high-intensity exercise can therefore enhance performance.- For exercise lasting 1 to 2.5 hours, athletes are advised to ingest 30-60 g of carbohydrates per hour.- Well-trained endurance athletes competing for longer than 2.5 hours at high intensity can metabolise up to 90 g of carbohydrates per hour, provided that a mixture of glucose and fructose is ingested.- Athletes participating in intermittent or team sports are advised to follow the same strategies but the timing of carbohydrate intake depends on the type of sport.- If top performance is required again within 24 hours after strenuous exercise, the advice is to supplement endogenous carbohydrate supplies quickly within the first few hours post-exercise by ingesting large amounts of carbohydrate (1.2 g/kg/h) or a lower amount of carbohydrate (0.8 g/kg/h) with a small amount of protein (0.2-0.4 g/kg/h).

A Controlled and Retrospective Study of 144 Chronic Low Back Pain Patients to Evaluate the Effectiveness of an Intensive Functional Restoration Program in France

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Isabelle Caby

2016-04-01

Full Text Available Study Design: A controlled and retrospective study of 144 chronic low back pain patients to evaluate the effectiveness of an intensive functional restoration program in France. Objective: Evaluating the efficiency of an intensive, dynamic and multidisciplinary functional restoration program in patients with chronic low back pain (LBP, during 6 and 12 months follow up. Summary of background data: Chronic low back pain disease has a multifactor nature, involving physical, psychological professional and social factors. A functional restoration program (FRP has been included in a multidisciplinary training program which provides an efficient therapeutic solution. However, the effectiveness of an FRP has not been yet established. Methods: 144 subjects (71 males, 73 females with chronic low back pain were included in a functional restoration program. The FRP includes physiotherapy and occupational therapy interventions together with psychological counselling. Patients participated as in- or outpatients 6 h per day, 5 days a week over 5 weeks. Pain intensity, trunk flexibility, trunk strength, lifting ability, quality of life and return to work were recorded before, immediately after, and at 6 months and 12 months after the treatment period. Results: All outcome measures were significantly higher just after the FRP (144 patients and at 6 and 12 months (from available data in 31 subjects compared to pre-treatment values. This FRP for chronic low back pain maintained its benefits whatever the patient’s activities. Conclusions: The effects reflected on all outcome measures, both on short and long term follow-up. The multidisciplinary FRP for chronic low back pain patients durably stopped the de-conditioning syndrome and involved new life-style habits for the patient, daily pain management and a return to work.

Pain intensity among institutionalized elderly: a comparison between numerical scales and verbal descriptors

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Lílian Varanda Pereira

2015-10-01

Full Text Available AbstractOBJECTIVECorrelating two unidimensional scales for measurement of self-reported pain intensity for elderly and identifying a preference for one of the scales.METHODA study conducted with 101 elderly people living in Nursing Home who reported any pain and reached ( 13 the scores on the Mini-Mental State Examination. A Numeric Rating Scale - (NRS of 11 points and a Verbal Descriptor Scale (VDS of five points were compared in three evaluations: overall, at rest and during movement.RESULTSWomen were more representative (61.4% and the average age was 77.0±9.1 years. NRS was completed by 94.8% of the elderly while VDS by 100%. The association between the mean scores of NRS with the categories of VDS was significant, indicating convergent validity and a similar metric between the scales.CONCLUSIONPain measurements among institutionalized elderly can be made by NRS and VDS; however, the preferred scale for the elderly was the VDS, regardless of gender.

Systematic Review of Self-Report Measures of Pain Intensity in 3- and 4-Year-Old Children: Bridging a Period of Rapid Cognitive Development.

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von Baeyer, Carl L; Jaaniste, Tiina; Vo, Henry L T; Brunsdon, Georgie; Lao, Hsuan-Chih; Champion, G David

2017-09-01

Claims are made for the validity of some self-report pain scales for 3- and 4-year-old children, but little is known about their ability to use such tools. This systematic review identified self-report pain intensity measures used with 3- and/or 4- year-old participants (3-4yo) and considered their reliability and validity within this age span. The search protocol identified research articles that included 3-4yo, reported use of any pain scale, and included self-reported pain intensity ratings. A total of 1,590 articles were screened and 617 articles met inclusion criteria. Of the included studies, 98% aggregated self-report data for 3-4yo with data for older children, leading to overestimates of the reliability and validity of self-report in the younger age group. In the 14 studies that provided nonaggregated data for 3-4yo, there was no evidence for 3-year-old and weak evidence for 4-year-old children being able to use published self-report pain intensity tools in a valid or reliable way. Preschool-age children have been reported to do better with fewer than the 6 response options offered on published faces scales. Simplified tools are being developed for young children; however, more research is needed before these are adopted. Some self-report pain scales have been promoted for use with 3- and 4-year-old children, but this is on the basis of studies that aggregated data for younger and older children, resulting in overestimates of reliability and validity for the preschool-age children. Scales with fewer response options show promise, at least for 4-year-old children. Copyright © 2017 American Pain Society. Published by Elsevier Inc. All rights reserved.

Does moderate-to-high intensity Nordic walking improve functional capacity and pain in fibromyalgia? A prospective randomized controlled trial

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Mannerkorpi, Kaisa; Nordeman, Lena; Cider, ?sa; Jonsson, Gunilla

2010-01-01

Introduction The objective of this study was to investigate the effects of moderate-to-high intensity Nordic walking (NW) on functional capacity and pain in fibromyalgia (FM). Methods A total of 67 women with FM were recruited to the study and randomized either to moderate-to-high intensity Nordic Walking (n = 34, age 48 ? 7.8 years) or to a control group engaging in supervised low-intensity walking (LIW, n = 33, age 50 ? 7.6 years). Primary outcomes were the six-minute walk test (6MWT) and t...

Assessment of pressure-pain thresholds and central sensitization of pain in lateral epicondylalgia

DEFF Research Database (Denmark)

Jespersen, Anders; Amris, Kirstine; Graven-Nielsen, Thomas

2013-01-01

pressure stimulation at intensity relative to the individual pain threshold, the pain intensity was continuously recorded using an electronic visual analogue scale (VAS), and from this the degree of temporal summation was estimated. For LE, a Doppler ultrasound examination of the elbow was made to identify...

Mechanical factors relate to pain in knee osteoarthritis.

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Maly, Monica R; Costigan, Patrick A; Olney, Sandra J

2008-07-01

Pain experienced by people with knee osteoarthritis is related to psychosocial factors and damage to articular tissues and/or the pain pathway itself. Mechanical factors have been speculated to trigger this pain experience; yet mechanics have not been identified as a source of pain in this population. The purpose of this study was to identify whether mechanics could explain variance in pain intensity in people with knee osteoarthritis. Data from 53 participants with physician-diagnosed knee osteoarthritis (mean age=68.5 years; standard deviation=8.6 years) were analyzed. Pain intensity was reported on the Western Ontario and McMaster Universities Osteoarthritis Index. Mechanical measures included weight-bearing varus-valgus alignment, body mass index and isokinetic quadriceps torque. Gait analysis captured the range of adduction-abduction angle, range of flexion-extension angle and external knee adduction moment during level walking. Pain intensity was significantly related to the dynamic range of flexion-extension during gait and body mass index. A total of 29% of the variance in pain intensity was explained by mechanical variables. The range of flexion-extension explained 18% of variance in pain intensity. Body mass index added 11% to the model. The knee adduction moment was unrelated to pain intensity. The findings support that mechanical factors are related to knee osteoarthritis pain. Because limitations in flexion-extension range of motion and body size are modifiable factors, future research could examine whether interventions targeting these mechanics would facilitate pain management.

Case Study of High-Dose Ketamine for Treatment of Complex Regional Pain Syndrome in the Pediatric Intensive Care Unit.

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Pasek, Tracy Ann; Crowley, Kelli; Campese, Catherine; Lauer, Rachel; Yang, Charles

2017-06-01

Complex regional pain syndrome (CRPS) is a life-altering and debilitating chronic pain condition. The authors are presenting a case study of a female who received high-dose ketamine for the management of her CRPS. The innovative treatment lies not only within the pharmacologic management of her pain, but also in the fact that she was the first patient to be admitted to our pediatric intensive care unit solely for pain control. The primary component of the pharmacotherapy treatment strategy plan was escalating-dose ketamine infusion via patient-controlled-analgesia approved by the pharmacy and therapeutics committee guided therapy for this patient. The expertise of advanced practice nurses blended exquisitely to ensure patient and family-centered care and the coordination of care across the illness trajectory. The patient experienced positive outcomes. Copyright © 2017 Elsevier Inc. All rights reserved.

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

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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.

High-intensity stepwise conditioning programme for improved exercise responses and agility performance of a badminton player with knee pain.

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Chen, Bob; Mok, Damon; Lee, Winson C C; Lam, Wing Kai

2015-02-01

To examine the effect of a high-intensity stepwise conditioning programme combined with multiple recovery measures on physical fitness, agility, and knee pain symptoms of an injured player. A single case study. University-based conditioning training laboratory. One 26-year-old male world-class badminton player (height, 190.0 cm; weight, 79.3 kg; left dominant hand; playing experience, 16 years; former world champion) with patellar tendinosis and calcification of his left knee. The player received seven conditioning sessions over three weeks. During the programme, there was a gradual increase in training duration and load across sessions while cold therapy, manual stretches and massage were administered after each session to minimise inflammation. The training outcome was evaluated with three different testing methods: standard step test, badminton-specific agility test, and tension-pain rating. The conditioning programme reduced knee pain symptoms and improved actual performance and cardiopulmonary fitness during the agility task. The player was able to return to sport and compete within a month. A high-intensity stepwise conditioning programme improved the physical fitness while sufficient recovery measures minimised any possible undesirable effects and promoted faster return to elite level competition. Copyright © 2014 Elsevier Ltd. All rights reserved.

Quality of life in major depressive disorder: the role of pain and pain catastrophizing cognition.

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Chung, Ka-Fai; Tso, Kwok-Chu; Yeung, Wing-Fai; Li, Wei-Hui

2012-05-01

Pain symptoms are frequent complaints in patients with major depressive disorder (MDD). Although it is known that pain intensity and pain-related cognition predict quality of life (QOL) in patients with chronic pain, limited studies have examined their roles in MDD. The study aimed to determine whether pain and pain catastrophizing were independent predictors of QOL in MDD after accounting for the impact of anxiety and depression. This is a prospective, naturalistic follow-up study. Ninety-one Chinese patients were enrolled during an acute episode of MDD, 82 of them were reassessed 3 months later using the same assessment on pain, anxiety, depression, and QOL. Pain intensity was evaluated using a verbal rating scale and a visual analog scale. Quality of life was assessed using the 36-item Short Form Health Survey. Pain-related cognition was assessed at baseline with the Pain Catastrophizing Scale. There was significant improvement in pain, anxiety, depression, and QOL from baseline to 3-month follow-up. Hierarchical regression analyses showed that pain intensity was significantly associated with QOL at baseline and 3 months. Pain complaint was more important than anxiety and depressive symptoms in predicting changes in both physical and psychosocial domains of QOL. After controlling for the severity of pain, anxiety, and depression, Pain Catastrophizing Scale score was independently associated with QOL in MDD. The study supports the specific role of pain and pain-related cognition in predicting QOL in depressed patients. Further studies targeting pain-related cognition for improving the outcome of MDD are necessary. Copyright © 2012 Elsevier Inc. All rights reserved.

Effect of Eight Weeks High Intensity Interval Training and Medium Intensity Interval Training and Aloe vera Intake on Serum Vaspin and Insulin Resistance in Diabetic Male Rats

Directory of Open Access Journals (Sweden)

Darya Asgari Hazaveh

2018-02-01

Full Text Available Abstract Background: The use of herbal supplements and exercise training for the treatment of diabetic has increased.The purpose of this study was to investigate the effect of eight weeks high intensity interval training and moderate intensity interval training and Aloe vera intake on serum vaspin and insulin resistance in diabetic male rats. Materials and Methods: During this experimental study, 32 diabetic rats with STZ Wistar were randomly divided into four groups including the control, high intensity interval training +supplement, moderate intensity interval training + supplement and supplement. Training program was planned for 8 weeks and 3 sessions per week. Each session consisted of 6 to 12 periods of 2-minute activity with the intensity of 90% and 60% with one minute rest (speed: 10m/min. In the supplement groups, 300milligrams Aloe vera solution per kilogram of body weight Gavage was given 5 sessions per week for 8 weeks. The data were analyzed using one-way analysis of variance (ANOVA. Results: The results showed that high and moderate intensity interval training with supplement has no significant effect on the of serum vaspin (p=0.112. High intensity interval training with supplement had significant effects on insulin in diabetic male rats (0.000. Conclusion: .Based on the findings of this study, it seems that supplementation of Aloe vera with high intensity interval training can have better effects on serum insulin in diabetic rats.

Alexithymia and Fear of Pain Independently Predict Heat Pain Intensity Ratings among Undergraduate University Students

OpenAIRE

Katz, Joel; Martin, Andrea L; Pagé, M Gabrielle; Calleri, Vincent

2009-01-01

BACKGROUND: Alexithymia is a disturbance in awareness and cognitive processing of affect that is associated with over-reporting of physical symptoms, including pain. The relationship between alexithymia and other psychological constructs that are often associated with pain has yet to be evaluated.OBJECTIVES: The present study examined the importance of alexithymia in the pain experience in relation to other integral psychological components of Turk’s diathesis-stress model of chronic pain and...

Economic evaluation of an intensive group training protocol compared with usual care physiotherapy in patients with chronic low back pain.

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van der Roer, Nicole; van Tulder, Maurits; van Mechelen, Willem; de Vet, Henrica

2008-02-15

Economic evaluation from a societal perspective conducted alongside a randomized controlled trial with a follow-up of 52 weeks. To evaluate the cost effectiveness and cost utility of an intensive group training protocol compared with usual care physiotherapy in patients with nonspecific chronic low back pain. The intensive group training protocol combines exercise therapy, back school, and behavioral principles. Two studies found a significant reduction in absenteeism for a graded activity program in occupational health care. This program has not yet been evaluated in a primary care physiotherapy setting. Participating physical therapists in primary care recruited 114 patients with chronic nonspecific low back pain. Eligible patients were randomized to either the protocol group or the guideline group. Outcome measures included functional status (Roland Morris Disability Questionnaire), pain intensity (11-point numerical rating scale), general perceived effect and quality of life (EuroQol-5D). Cost data were measured with cost diaries and included direct and indirect costs related to low back pain. After 52 weeks, the direct health care costs were significantly higher for patients in the protocol group, largely due to the costs of the intervention. The mean difference in total costs amounted to [Euro sign] 233 (95% confidence interval: [Euro sign] -2.185; [Euro sign] 2.764). The cost-effectiveness planes indicated no significant differences in cost effectiveness between the 2 groups. The results of this economic evaluation showed no difference in total costs between the protocol group and the guideline group. The differences in effects were small and not statistically significant. At present, national implementation of the protocol is not recommended.

Thresholds and perception of cold pain, heat pain, and the thermal grill illusion in patients with major depressive disorder.

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Boettger, Michael Karl; Grossmann, David; Bär, Karl-Jürgen

2013-04-01

The thermal grill illusion (TGI) in which interlacing cold and warm bars create the illusion of a painful sensation has been suggested as an experimental model for central pain states and pain processing. The aim of this study was to use this technique to gain further insights into the altered pain perception in major depressive disorder (MDD). In 18 unmedicated patients with MDD, cold and heat pain thresholds (CPT/HPT) as well as the perception of the TGI were examined and compared with 18 matched controls. CPT and HPT were significantly increased in patients (7.9°C and 47.5°C) compared with controls (15.9°C and 45.2°C, respectively; p painful by controls, the patients did not indicate painful sensations, thereby indicating a shift of the stimulus-response curve of TGI pain perception toward higher stimulus intensities, that is, greater temperature differentials between cold and warm bars (11.5°C for controls, 16.7°C for patients). The patients rated the pain intensity perceived at the respective pain thresholds (CPT and HPT) in tendency higher than did the controls, whereas they perceived the TGI less painful despite increased stimulus intensities. Unpleasantness ratings were similar between groups. CPT, HPT and temperature differentials for the perception of the TGI, were increased in patients with MDD as compared with controls. Pain intensity, however, was rated differently for CPT and HPT, where patients indicated higher ratings in tendency, and for the TGI stimulation, where pain was perceived less intense.

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

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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.

Effects of gabapentin on experimental somatic pain and temporal summation

DEFF Research Database (Denmark)

Arendt-Nielsen, Lars; Frøkjaer, Jens Brøndum; Staahl, Camilla

2007-01-01

at 2 Hz); (2) stimulus-response function relating pain intensity scores (visual analog scale, VAS) to increasing current intensities for electrical skin and muscle stimuli (single and repeated, determined at baseline); and (3) the pain intensity (VAS) and pain areas after intramuscular injection......, was to examine the effect of a single dose of 1200 mg gabapentin on multi-modal experimental cutaneous and muscle pain models. METHODS: The following pain models were applied: (1) pain thresholds to single and repeated cutaneous and intramuscular electrical stimulation (temporal summation to 5 stimuli delivered...... reduced the area under the pain intensity curve to hypertonic saline injections in the muscle (P = .02); and (3) significantly reduced the area of pain evoked by hypertonic saline (P = .03). CONCLUSIONS: Gabapentin reduces temporal summation of skin stimuli at pain threshold intensities; this may have...

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

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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.

Low intensity laser therapy and functional orthopedics contribution in pain and temporo mandibular dysfunction treatment

International Nuclear Information System (INIS)

Lollato, Renata Fronzaglia

2003-01-01

Temporo Mandibular Dysfunction (TMD) is a term used to describe disorders which involve temporomandibular joint (TMJ), masticatory muscles, and associated structures, isolatedly or not, whose most frequent symptoms pain. Its etiology involve controversies, and among risk factors is Class 11 malocclusion. A lot of techniques are used for TMD treatment, and the most recent are Low Intensity Laser Therapy (LILT) and Functional Orthopedics (FO). The aim of this study was to evaluate pain and buccal mobility in subjects with Class II malocclusion and TMD symptoms, treated with LILT and FO associated or not. Eighteen subjects were selected and divided in three groups. Group 1 was treated with LILT, λ = 780 nm, 70 mW, 15 J/cm 2 per point, in six sessions during two weeks. The application was in three points around the TMJ and in masticatory muscles: masseter, temporalis, sternomastoid and trapezius, on both sides when there was pain. Palpation was made before and five minutes after application and subjects answered a questionnaire with a score for pain evaluation. Group 2 received functional orthopedics aparatology Planas Indirect Composed Plates, and was evaluated once a week during two weeks, after palpation and following the same score as group 1. Group 3 received both therapies at the same time, and the first application coincided with the aparatology installation. The evaluation followed the parameters of group 1. The results were statically analyzed , and in general form did not show significant differences. There was remission of pain symptoms in ali of the groups, and group 3 showed more rapidly results. This fact leaded us to a conclusion that the association of the LILT with FO was the best treatment for the pain symptoms remission in TMD. (author)

Influence of dietary isoflavone intake on gastrointestinal symptoms in ulcerative colitis individuals in remission.

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Głąbska, Dominika; Guzek, Dominika; Grudzińska, Dominika; Lech, Gustaw

2017-08-07

To analyse the association between isoflavone intake and ulcerative colitis motility symptoms in individuals in remission. Cross-sectional study was conducted in a group of ulcerative colitis remission individuals, in sub-groups characterised by various intestinal motility and functioning characteristics (abdominal pain, flatulence, constipations, tenesmus). Total of 56 individuals with ulcerative colitis in remission (19 males and 37 females) were recruited for the study. Assessment of diet was based on self-reported data from each patient's dietary records taken over a period of three typical, random days (2 weekdays and 1 d of the weekend). The daily isoflavone intake (daidzein, genistein, glycitein and total isoflavones) and daily isoflavone intake per 1000 kcal of diet were assessed. No correlations between isoflavone intake levels and number of bowel movements per day were observed both in the case of intake and intake per 1000 kcal of diet. In the group of individuals declaring lack of abdominal pain, the higher intakes of daidzein ( P = 0.0075), daidzein per 1000 kcal of diet ( P = 0.0358) and total isoflavone ( P = 0.0358) were stated, than in the group of individuals declaring abdominal pain. In the group of individuals declaring lack of constipations, the lower intakes of glycitein ( P = 0.0213) and glycitein per 1000 kcal of diet ( P = 0.0213) were stated, than in the group of individuals declaring presence of constipations. No differences were observed in isoflavone intake between groups of ulcerative colitis individuals declaring lack of flatulence and declaring presence of flatulence, as well as between groups declaring lack of tenesmus and declaring presence of tenesmus. The moderate dietary isoflavone intake may be beneficial for individuals with ulcerative colitis in remission, however, before including it into recommendations, further prospective studies are needed.

The effect of inhalation aromatherapy with damask rose (Rosa damascena) essence on the pain intensity after dressing in patients with burns: A clinical randomized trial.

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Bikmoradi, Ali; Harorani, Mehdi; Roshanaei, Ghodratollah; Moradkhani, Shirin; Falahinia, Golam Hossein

2016-01-01

Pain is one of the common problems encountered by patients with burns, which increases after each dressing. This study aimed to investigate the effect of inhalation aromatherapy with damask rose essence on the pain of patients with burns that is caused after dressing. A randomized clinical trial was conducted on 50 patients with second- and third-degree burn wounds. The baseline pain of the patients was assessed 30 min before they entered into the dressing room on the first and second days of intervention. The patients in the experimental group inhaled five drops of damask rose essence 40% in distilled water, while those in the control group inhaled five drops of distilled water as placebo. The pain intensity was assessed using Visual Analogue Scale at 15 and 30 min after the patients exited from the dressing room. Data were analyzed by SPSS (version 18) using descriptive and inferential statistics. There was significant difference between the mean of pain intensity before and after intervention at 15 and 30 min after dressing (P rose could be effective for relieving the pain caused after dressing in patients with burns. Therefore, it could be suggested as a complementary therapy in burn patients for pain relief.

TENS (transcutaneous electrical nerve stimulation) for labour pain.

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Francis, Richard

2012-05-01

Because TENS is applied inconsistently and not always in line with optimal TENS application theory, this may explain why TENS for labour pain appears to be effective in some individuals and not in others. This article reviews TENS theory, advises upon optimal TENS application for labour pain and discusses some of the limitations of TENS research on labour pain. TENS application for labour pain may include TENS applied to either side of the lower spine, set to 200 mus pulse duration and 100 pulses per second. As pain increases, TENS intensity should be increased and as pain decreases, TENS intensity should be reduced to maintain a strong but pain free intensity of stimulation. This application may particularly reduce back pain during labour.

The effectiveness of music on pain among preterm infants in the neonatal intensive care unit: a systematic review.

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Pölkki, Tarja; Korhonen, Anne

The objective of this review is to synthesize the best available evidence related to the effectiveness of music as pain relieving method among preterm infants during painful procedures in the neonatal intensive care unit.Review questions are: Among preterm infants in the neonatal intensive care unit, is music effective in reducing BACKGROUND: Preterm infants (i.e. babies born at or before 37 gestational weeks) compose a patient group of the most vulnerable to pain. Infants treated in a neonatal intensive care unit (NICU) are exposed to a variety of painful procedures (e.g. heel prick, iv cannula insertion, endotracheal suctioning) and to environmental stress (e.g. noise, light). Simons et al., for example, described an average 14 +/- 4 painful procedures during the first 2 weeks of life within a period of 24 hours among 151 neonates. Many studies have shown that repeated and sustained pain can have direct and long-term consequences on the neurological and behavior-oriented development of the neonates during the rapid development phase of the central nervous system. Pain can cause detectable physiological, behavioral and hormonal changes and contribute to the altered development of the pain system during later childhood and adolescence. Instead, live music such as singing is excellent type of music when it is steady, constant, quiet, soothing and directed to the infants. Graven emphasizes that recorded sound should not replace human voice exposure in the NICU; therefore, health care providers should provide ample opportunity for the infant to hear parent's voices live, such as singing or humming, in interactions between the parent and the infant at the bedside.The AmericanAcademy of Pediatrics Committee on Environmental Health has recommended safe levels of sound, and these recommendations have been updated by an expert team of practitioners. Recommendations specify that continuous sound should not exceed an hourly equivalent sound level of 50 A-weighted decibels (d

Effectiveness of Splanchnic Nerve Neurolysis for Targeting Location of Cancer Pain: Using the Pain Drawing as an Outcome Variable.

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Novy, Diane M; Engle, Mitchell P; Lai, Emily A; Cook, Christina; Martin, Emily C; Trahan, Lisa; Yu, Jun; Koyyalagunta, Dhanalakshmi

2016-07-01

The effectiveness of splanchnic nerve neurolysis (SNN) for cancer-related abdominal pain has been investigated using numeric pain intensity rating as an outcome variable. The outcome variable in this study used the grid method for obtaining a targeted pain drawing score on 60 patients with pain from pancreatic or gastro-intestinal primary cancers or metastatic disease to the abdominal region. Results demonstrate excellent inter-rater agreement (intra-class correlation [ICC] coefficient at pre-SNN = 0.97 and ICC at within one month post-SNN = 0.98) for the grid method of scoring the pain drawing and demonstrate psychometric generalizability among patients with cancer-related pain. Using the Wilcoxon signed rank test and associated effect sizes, results show significant improvement in dispersion of pain following SNN. Effect sizes for the difference in pre-SNN to 2 post-SNN time points were higher for the pain drawing than for pain intensity rating. Specifically, the effect size difference from pre- to within one month post-SNN was r = 0.42 for pain drawing versus r = 0.23 for pain intensity rating. Based on a smaller subset of patients who were seen within 1 - 6 months following SNN, the effect size difference from pre-SNN was r = 0.46 for pain drawing versus r = 0.00 for pain intensity rating. Collectively, these data support the use of the pain drawing as a reliable outcome measure among patients with cancer pain for procedures such as SNN that target specific location and dispersion of pain.

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

Passion for leisure activity contributes to pain experiences during rehabilitation.

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Courbalay, Anne; Deroche, Thomas; Brewer, Britton

2017-03-01

The primary aim of this study was to determine whether the levels of obsessive passion (OP) and harmonious passion for a suspended leisure activity contribute to pain catastrophizing and pain intensity in patients undergoing the rehabilitation process. The secondary aim was to examine whether the levels of passion associated with a maintained leisure activity offset the contribution of having a leisure activity suspended to pain intensity and catastrophizing. Ninety-one outpatients from functional rehabilitation units (Mage=37, SD=13.44 years) completed measures of pain catastrophizing, pain intensity, and passion about valued leisure activities (one they were prevented from practicing and one they remained able to practice). Correlation analysis showed that the level of OP for a suspended valued leisure activity was positively associated with pain catastrophizing and pain intensity. Results showed that pain catastrophizing mediated the relationship between this level of passion and pain intensity. The levels of harmonious passion and OP for a maintained valued leisure activity did not offset the contribution of OP for a suspended leisure activity to pain-related outcomes. When prevented from practicing a valued leisure activity, only OP contributes to the prediction of pain catastrophizing and pain intensity. The contribution of pain catastrophizing provides a potential explanation for why the level of OP for a suspended leisure activity is related to pain intensity ratings. The benefits of maintaining a valued leisure activity during rehabilitation do not seem sufficient to counterbalance the maladaptive effects of being prevented from the practice of a previous/another valued leisure activity.

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

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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.

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

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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.

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

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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.

Pain relief is associated with decreasing postural sway in patients with non-specific low back pain.

Science.gov (United States)

Ruhe, Alexander; Fejer, René; Walker, Bruce

2012-03-21

Increased postural sway is well documented in patients suffering from non-specific low back pain, whereby a linear relationship between higher pain intensities and increasing postural sway has been described. No investigation has been conducted to evaluate whether this relationship is maintained if pain levels change in adults with non-specific low back pain. Thirty-eight patients with non-specific low back pain and a matching number of healthy controls were enrolled. Postural sway was measured by three identical static bipedal standing tasks of 90 sec duration with eyes closed in narrow stance on a firm surface. The perceived pain intensity was assessed by a numeric rating scale (NRS-11). The patients received three manual interventions (e.g. manipulation, mobilization or soft tissue techniques) at 3-4 day intervals, postural sway measures were obtained at each occasion. A clinically relevant decrease of four NRS scores in associated with manual interventions correlated with a significant decrease in postural sway. In contrast, if no clinically relevant change in intensity occurred (≤ 1 level), postural sway remained similar compared to baseline. The postural sway measures obtained at follow-up sessions 2 and 3 associated with specific NRS level showed no significant differences compared to reference values for the same pain score. Alterations in self-reported pain intensities are closely related to changes in postural sway. The previously reported linear relationship between the two variables is maintained as pain levels change. Pain interference appears responsible for the altered sway in pain sufferers. This underlines the clinical use of sway measures as an objective monitoring tool during treatment or rehabilitation.

Association between preoperative magnetic resonance imaging, pain intensity and quantitative sensory testing in patients awaiting lumbar diskectomy.

LENUS (Irish Health Repository)

Hegarty, Dominic

2011-02-01

Magnetic resonance imaging (MRI) offers important information regarding the morphology, location and size of a herniated disc, which influences the decision to offer lumbar diskectomy (LD). This study aims to examine the association between clinical neurophysiologic indices including pain intensity and quantitative sensory testing (QST), and the degree of lumbar nerve root compromise depicted on magnetic resonance (MR) in patients awaiting LD.

Relationship between onset of pain relief and patient satisfaction with fentanyl pectin nasal spray for breakthrough pain in cancer.

Science.gov (United States)

Torres, Luis M; Revnic, Julia; Knight, Alastair D; Perelman, Michael

2014-10-01

Satisfaction with pain relief in patients with breakthrough pain in cancer (BTPc) has typically been assessed by overall efficacy without consideration of the rapidity of that response. To determine the relationship between speed of onset of pain relief and patient satisfaction for treated BTPc episodes overall and for individual treatments. Pooled data from two randomized, double-blinded crossover studies. Patients having 1-4 BTPc episodes per day on ≥60 mg/day oral morphine or equivalent. Episodes treated with fentanyl pectin nasal spray (FPNS; 100-800 μg), immediate-release morphine sulfate (IRMS), or placebo. Pain intensity was measured on an 11-point scale (5-60 minutes posttreatment); satisfaction was measured on a 4-point scale (30 and 60 minutes). The primary analysis assessed the overall relationship of time to onset of pain relief (pain intensity difference [PID]≥1) or time to clinically meaningfully reduction in pain (PID≥2) versus patient satisfaction and overall pain intensity (summed pain intensity difference at 30 [SPID30] and 60 minutes [SPID60]) assessed by analysis of variance (ANOVA). A secondary analysis assessed whether satisfaction was different between treatments using a within-patient comparison. Eight hundred thirty-one FPNS-treated, 368 IRMS-treated, and 200 placebo-treated episodes were analyzed. Overall, within the pool there was a statistically significant relationship between time to onset of pain relief (PID≥1 and PID≥2) and patient satisfaction (both speed of relief and overall) at 30 and 60 minutes (ppain intensity reduction. When treatment groups were compared using within-patient data, FPNS provided earlier onset of pain relief than IRMS or placebo (ppain relief resulted in greater patient satisfaction and overall relief of pain; between-treatment comparisons showed that FPNS provided earlier pain relief and greater satisfaction than IRMS or placebo.

Complex Regional Pain Syndrome

Science.gov (United States)

Complex regional pain syndrome (CRPS) is a chronic pain condition. It causes intense pain, usually in the arms, hands, legs, or feet. It may happen ... move the affected body part The cause of CRPS is unknown. There is no specific diagnostic test. ...

Effects and Mechanisms of Low-Intensity Pulsed Ultrasound for Chronic Prostatitis and Chronic Pelvic Pain Syndrome

Directory of Open Access Journals (Sweden)

Guiting Lin

2016-07-01

Full Text Available Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS is one of the most common urologic diseases, and no curative treatments have been identified. Low-intensity pulsed ultrasound (LIPUS has been successfully used in promoting tissue healing, inhibiting inflammation and pain, differentiating stem cells, and stimulating nerve regeneration/muscle regeneration, as well as enhancing angiogenesis. Very recently, LIPUS has been proven an effective approach for CP/CPPS. This review summarizes the possible mechanisms responsible for the therapeutic effect of LIPUS for CP/CPPS. To search publications relevant to the topics of this review, the search engine for life sciences of Entrez was used. We reviewed the available evidence from 1954 through 2015 concerning LIPUS for CP/CPPS. According to the literature, both transrectal and transperineal approaches of LIPUS are effective for CP/CPPS.

Effects of Combined Selective Aerobic Moderate Intensity Exercises and Soya Intake on Serum Lipids and Obesity in Obese Postmenopausal Women

Directory of Open Access Journals (Sweden)

A Zarneshan

2012-02-01

Full Text Available Background & Aim: Today, the percentage of deaths due to heart diseases has increased and along with the exercise training role in reducing obesity and cardiovascular disease, soy is a useful source of food in reducing blood lipid and obesity. The present study investigated the effect of combined selective short aerobic moderate intensity exercise and soya intake on serum lipids and obesity in obese postmenopausal women. Methods: In the present quasi-experimental study conducted in 2006 on women of Urmia, Iran, 56 obese postmenopausal women were selected and randomly divided into four groups of 14 subjects as follow: exercise-soya, exercise, soya, and control group. Pre- and post protocol blood samples were collected and the level of TG (Triglyceride, tCho (Total Cholesterol, LDL-C (Low density lipoprotein, HDL-C (high density lipoprotein were measured. Exercise training within the range of 60-70% maximum heart rate (MHR was performed for 60 minutes, 3 sessions per week. The subjects of soya group and exercise-soya group had a 100 gram soya nut intake daily for 10 weeks. After The training course, blood samples were taken from the subjects. The collected data was analyzed using Two-way ANOVA and paired t-test. Results: Having soya along with exercise had significant impact on reduction of TG, tCho, LDL-C means (p<0.05. Body mass index and waist to hip ratio decreased significantly in exercise-soya group after 10 weeks (p<0.05. Conclusion: Based on the findings of this study, aerobic moderate intensity exercise along with soya intake, decrease obesity and serum lipids in obese postmenopausal women.

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.

Monitoring of skin conductance to assess postoperative pain intensity.

Science.gov (United States)

Ledowski, T; Bromilow, J; Paech, M J; Storm, H; Hacking, R; Schug, S A

2006-12-01

Pain is known to alter the electrogalvanic properties of the skin. The aim of this pilot study was to investigate the influence of postoperative pain on skin conductance (SC) readings. After obtaining ethical approval and written informed consent, 25 postoperative patients were asked to quantify their level of pain on a numeric rating scale (NRS, 0-10) at different time points in the recovery room. As a parameter of SC, the number of fluctuations within the mean SC per second (NFSC) was recorded. Simultaneously, the NRS was obtained from patients by a different observer who was blinded to the NFSC values. Data from 110 readings of 25 patients (14 female, 11 male; 21-67 yr) were included. NFSC showed a significant correlation with the NRS (r=0.625; P3 on the NRS was predicted with sensitivity of 89% and specificity of 74%. The severity of postoperative pain significantly influences SC. Using cut-off values, NFSC may prove a useful tool for pain assessment in the postoperative period.

Alcohol and smoking behavior in chronic pain patients: the role of opioids

DEFF Research Database (Denmark)

Ekholm, Ola; Grønbaek, Morten; Peuckmann, Vera

2008-01-01

The primary aim of this epidemiological study was to investigate associations between chronic non-cancer pain with or without opioid treatment and the alcohol and smoking behavior. The secondary aims were to investigate self-reported quality of life, sleeping problems, oral health and the use...... chronic/long-lasting pain lasting 6 months or more?' The question concerning alcohol intake assessed the frequency of alcohol intake and binge drinking. Smoking behavior assessed the daily number of cigarettes. Individuals reporting chronic pain were stratified into two groups (opioid users and non...... individuals. We found, that individuals suffering from chronic pain were less likely to drink alcohol. In opioid users alcohol consumption was further reduced. Cigarette smoking was significantly increased in individuals suffering from chronic pain and in opioid users smoking was further increased. Poor oral...

Optimism Moderates the Influence of Pain Catastrophizing on Shoulder Pain Outcome: A Longitudinal Analysis.

Science.gov (United States)

Coronado, Rogelio A; Simon, Corey B; Lentz, Trevor A; Gay, Charles W; Mackie, Lauren N; George, Steven Z

2017-01-01

Study Design Secondary analysis of prospectively collected data. Background An abundance of evidence has highlighted the influence of pain catastrophizing and fear avoidance on clinical outcomes. Less is known about the interaction of positive psychological resources with these pain-associated distress factors. Objective To assess whether optimism moderates the influence of pain catastrophizing and fear avoidance on 3-month clinical outcomes in patients with shoulder pain. Methods Data from 63 individuals with shoulder pain (mean ± SD age, 38.8 ± 14.9 years; 30 female) were examined. Demographic, psychological, and clinical characteristics were obtained at baseline. Validated measures were used to assess optimism (Life Orientation Test-Revised), pain catastrophizing (Pain Catastrophizing Scale), fear avoidance (Fear-Avoidance Beliefs Questionnaire physical activity subscale), shoulder pain intensity (Brief Pain Inventory), and shoulder function (Pennsylvania Shoulder Score function subscale). Shoulder pain and function were reassessed at 3 months. Regression models assessed the influence of (1) pain catastrophizing and optimism and (2) fear avoidance and optimism. The final multivariable models controlled for factors of age, sex, education, and baseline scores, and included 3-month pain intensity and function as separate dependent variables. Results Shoulder pain (mean difference, -1.6; 95% confidence interval [CI]: -2.1, -1.2) and function (mean difference, 2.4; 95% CI: 0.3, 4.4) improved over 3 months. In multivariable analyses, there was an interaction between pain catastrophizing and optimism (β = 0.19; 95% CI: 0.02, 0.35) for predicting 3-month shoulder function (F = 16.8, R 2 = 0.69, Poptimism lessened the influence of pain catastrophizing on function. There was no evidence of significant moderation of fear-avoidance beliefs for 3-month shoulder pain (P = .090) or function (P = .092). Conclusion Optimism decreased the negative influence of pain

The effect of inhalation aromatherapy with damask rose (Rosa damascena) essence on the pain intensity after dressing in patients with burns: A clinical randomized trial

Science.gov (United States)

Bikmoradi, Ali; Harorani, Mehdi; Roshanaei, Ghodratollah; Moradkhani, Shirin; Falahinia, Golam Hossein

2016-01-01

Background: Pain is one of the common problems encountered by patients with burns, which increases after each dressing. This study aimed to investigate the effect of inhalation aromatherapy with damask rose essence on the pain of patients with burns that is caused after dressing. Materials and Methods: A randomized clinical trial was conducted on 50 patients with second- and third-degree burn wounds. The baseline pain of the patients was assessed 30 min before they entered into the dressing room on the first and second days of intervention. The patients in the experimental group inhaled five drops of damask rose essence 40% in distilled water, while those in the control group inhaled five drops of distilled water as placebo. The pain intensity was assessed using Visual Analogue Scale at 15 and 30 min after the patients exited from the dressing room. Data were analyzed by SPSS (version 18) using descriptive and inferential statistics. Results: There was significant difference between the mean of pain intensity before and after intervention at 15 and 30 min after dressing (P aromatherapy in the experimental group (P aromatherapy with damask rose could be effective for relieving the pain caused after dressing in patients with burns. Therefore, it could be suggested as a complementary therapy in burn patients for pain relief. PMID:27186201

Catecholamine-o-methyltransferase polymorphisms are associated with postoperative pain intensity.

LENUS (Irish Health Repository)

Lee, Peter J

2011-02-01

single nucleotide polymorphisms (SNPs) in the genes for catecholamine-O-methyltransferase (COMT), μ-opioid receptor and GTP cyclohydrolase (GCH1) have been linked to acute and chronic pain states. COMT polymorphisms are associated with experimental pain sensitivity and a chronic pain state. No such association has been identified perioperatively. We carried out a prospective observational clinical trial to examine associations between these parameters and the development of postoperative pain in patients undergoing third molar (M3) extraction.

Multidisciplinary pain management programs.

OpenAIRE

Kaiser, Ulrike; Arnold, Bernhard; Pfingsten, Michael; Nagel, Bernd; Lutz, Johannes; Sabatowski, Rainer

2013-01-01

Ulrike Kaiser,1 Bernhard Arnold,2 Michael Pfingsten,3 Bernd Nagel,4 Johannes Lutz,5 Rainer Sabatowski1,61Comprehensive Pain Center, University Hospital “Carl Gustav Carus”, Dresden, 2Department of Pain Management, Klinikum Dachau, Dachau, 3Pain Clinic, University Medicine, University of Göttingen, 4Day Care Unit, DRK Pain Center, Mainz, 5Interdisciplinary Pain Center, Zentralklinik Bad Berka, Bad Berka, 6Department of Anesthesiology and Intensive Care, University ...

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)

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.

Pain locations in the postoperative period after cardiac surgery: Chronology of pain and response to treatment.

Science.gov (United States)

Roca, J; Valero, R; Gomar, C

Postoperative pain after cardiac surgery (CS) can be generated at several foci besides the sternotomy. Prospective descriptive longitudinal study on the chronological evolution of pain in 11 sites after CS including consecutive patients submitted to elective CS through sternotomy. The primary endpoints were to establish the main origins of pain, and to describe its chronological evolution during the first postoperative week. Secondary endpoints were to describe pain characteristics in the sternotomy area and to correlate pain intensity with other variables. Numerical Pain Rating Scale from 0 to 10 at rest and at movement on postoperative days 1, 2, 4 and 6. Numerical Pain Rating Scale>3 was considered moderate pain. Statistical analysis consisted in Mann-Whitney U-test, a Chi-squared, a Fisher exact text and Pearson's correlations. Forty-seven patients were enrolled. In 4 of 11 locations pain was reported as Numerical Pain Rating Scale>3 (sternotomy, oropharynx, saphenectomy and musculoskeletal pain in the back and shoulders). Maximum intensity of pain on postoperative days 1 and 2 was reported in the sternotomy area, while on postoperative days 4 and 6 it was reported at the saphenectomy. Pain at rest and at movement differed considerably in the sternotomy, saphenectomy and oropharynx. Pain at back and shoulders and at central venous catheter entry were not influenced by movement. Pain in the sternotomy was mainly described as oppressive. Patients with arthrosis and younger patients presented higher intensity of pain (P=.004; P=.049, respectively). Four locations were identified as the main sources of pain after CS: sternotomy, oropharynx, saphenectomy, and back and shoulders. Pain in different focuses presented differences in chronologic evolution and was differently influenced by movement. Copyright © 2017 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

A prospective analysis of pain experience, beliefs and attitudes, and pain management of a cohort of Danish surgical patients

DEFF Research Database (Denmark)

Lorentzen, Vibeke; Hermansen, I.L.; Botti, M

2012-01-01

Abstract: ABSTRACT Background: Adequacy of pain management is a process indicator of health care quality with consequences for patient outcomes and satisfaction. The reported incidence of moderate to severe postoperative pain worldwide is between 20 to 80%. Objectives: The purpose was to assess...... the quality of pain management in a cohort of Danish postoperative patients by examining their pain experience, beliefs about pain and pain treatment, and relationships between pain intensity, its effect on function, and pharmacological pain management. Methods: The American Pain Society's Patient Outcome...... Questionnaire was used in a consecutive cohort of Danish patients who had undergone gastrointestinal, gynaecological, orthopaedic or urological surgery in the previous 48 hours. Results: Findings indicated uncontrolled pain in 45.5% of patients, who experienced moderate to severe intensity average pain...

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

Knowledge and Attitudes of Nurses Regarding Pain in the Intensive ...

African Journals Online (AJOL)

The purpose of this study is to assess nurses knowledge and attitudes toward ... Introduction. In critical care settings, moderate to severe pain has been identified as a common cause of patient stress (Kabes, ... the importance of cultural aspect of pain management. Therefore .... On-the-job training on pain ..... Gender and.

Adult tonsillectomy: postoperative pain depends on indications

Directory of Open Access Journals (Sweden)

Olaf Zagólski

Full Text Available ABSTRACT INTRODUCTION: Intense pain is one of the most important postoperative complaints after tonsillectomy. It is often described by patients as comparable to the pain that accompanies an acute tonsillitis. Although recurrent tonsillitis is the most frequent indication for surgery, many tonsillectomies are performed due to other indications and these patients may be unfamiliar with such pain. OBJECTIVE: To verify whether individuals with recurrent tonsillitis experience different post-tonsillectomy pain intensity than those with other indications for surgery, with no history of episodes of acute tonsillitis. METHODS: A total of 61 tonsillectomies were performed under general anesthesia, using a potassium titanyl phosphate (KTP laser (to eliminate the potential influence on the study results of forceful dissection of fibrotic tonsils in patients with history of recurrent tonsillitis and multiple ligations of blood vessels within the tonsillar beds. The patients received 37.5 mg Tramadoli hydrochloridum + 325 mg Paracetamol tablets for 10 days. Postoperative variables included the duration of hospital stay, postoperative hemorrhage and readmission rate. The patients reported pain intensity on consecutive days, pain duration, weight loss on postoperative day 10, character, intensity and duration of swallowing difficulties, and the need for additional doses of painkillers. Healing was also assessed. Capsular nerve fibers were histologically examined in the resected tonsils by immunostainings for general and sensory markers. RESULTS: Indications for the surgery were: recurrent acute tonsillitis (34 patients, no history of recurrent tonsillitis: focus tonsil (20 and intense malodour (7. Pain intensity on postoperative days 3-4 and incidence of readmissions due to dehydration were significantly higher in the group with no history of recurrent tonsillitis. No significant differences in relative densities of protein gene product (PGP 9.5- and

Expectations contribute to reduced pain levels during prayer in highly religious participants.

Science.gov (United States)

Jegindø, Else-Marie Elmholdt; Vase, Lene; Skewes, Joshua Charles; Terkelsen, Astrid Juhl; Hansen, John; Geertz, Armin W; Roepstorff, Andreas; Jensen, Troels Staehelin

2013-08-01

Although the use of prayer as a religious coping strategy is widespread and often claimed to have positive effects on physical disorders including pain, it has never been tested in a controlled experimental setting whether prayer has a pain relieving effect. Religious beliefs and practices are complex phenomena and the use of prayer may be mediated by general psychological factors known to be related to the pain experience, such as expectations, desire for pain relief, and anxiety. Twenty religious and twenty non-religious healthy volunteers were exposed to painful electrical stimulation during internal prayer to God, a secular contrast condition, and a pain-only control condition. Subjects rated expected pain intensity levels, desire for pain relief, and anxiety before each trial and pain intensity and pain unpleasantness immediately after on mechanical visual analogue scales. Autonomic and cardiovascular measures provided continuous non-invasive objective means for assessing the potential analgesic effects of prayer. Prayer reduced pain intensity by 34 % and pain unpleasantness by 38 % for religious participants, but not for non-religious participants. For religious participants, expectancy and desire predicted 56-64 % of the variance in pain intensity scores, but for non-religious participants, only expectancy was significantly predictive of pain intensity (65-73 %). Conversely, prayer-induced reduction in pain intensity and pain unpleasantness were not followed by autonomic and cardiovascular changes.

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.

[The assessment of the impact of rehabilitation on the pain intensity level in patients with herniated nucleus pulposus of the intervertebral disc].

Science.gov (United States)

Koszela, Kamil; Krukowska, Sylwia; Woldańska-Okońska, Marta

2017-06-23

Back disorders are very common phenomena in modern society. One of the methods of spinal pain treatment is performing surgery. Unfortunately, this method is not one hundred percent effective. Some patients show no improvement after surgery, the pain persists and even increases. In these cases, it is reasonable to use the term Failed Back Surgery Syndrome (FBSS), i.e. back pain syndrome after unsuccessful spine surgery. The aim of the study is to assess the impact of rehabilitation on the pain intensity level in patients with FBSS. The study was conducted in a group of 38 patients aged from 32 to 87 (mean age 61 years), including 20 women and 18 men. All patients were operated for spinal pain syndrome. Afterwards, they underwent rehabilitation because of persisting pain after the surgery. For the pain assessment was used The Visual- Analogue Scale and The Laitinen Modified Questionnaire Indicators of Pain. The results were statistically analyzed. The study showed the high efficacy of specialized rehabilitation in patients with FBSS. The rehabilitation in patients with FBSS has a significant analgesic effect. Rehabilitation should be a gold standard in patients with FBSS.

Experimental knee pain reduces muscle strength

DEFF Research Database (Denmark)

Henriksen, Marius; Mortensen, Sara Rosager; Aaboe, Jens

2011-01-01

Pain is the principal symptom in knee pathologies and reduced muscle strength is a common observation among knee patients. However, the relationship between knee joint pain and muscle strength remains to be clarified. This study aimed at investigating the changes in knee muscle strength following...... experimental knee pain in healthy volunteers, and if these changes were associated with the pain intensities. In a crossover study, 18 healthy subjects were tested on 2 different days. Using an isokinetic dynamometer, maximal muscle strength in knee extension and flexion was measured at angular velocities 0....... Knee pain reduced the muscle strength by 5 to 15% compared to the control conditions (P knee extension and flexion at all angular velocities. The reduction in muscle strength was positively correlated to the pain intensity. Experimental knee pain significantly reduced knee extension...

[Model to predict staffing for anesthesiology and post-anesthesia intensive care units and pain clinics].

Science.gov (United States)

Canet, J; Moral, V; Villalonga, A; Pelegrí, D; Gomar, C; Montero, A

2001-01-01

Human resources account for a large part of the budgets of anesthesia and post-anesthesia intensive care units and pain clinics (A-PICU-PC). Adequate staffing is a key factor in providing for both effective care and professional staff development. Changes in professional responsibilities have rendered obsolete the concept of one anesthesiologist per operating room. Duties must be analyzed objectively to facilitate understanding between hospital administrators and A-PICU-PC chiefs of service when assigning human resources. The Catalan Society of Anesthesiology, Post-anesthesia Intensive Care and Pain Therapy has developed a model for estimating requirements for A-PICU-PC staffing based on three factors: 1) Definition of staff positions that must be filled and criteria for assigning human resources; 2) Estimation of non-care-related time required by the department for training, teaching, research and internal management, and 3) Estimation of staff required to cover absences from work for vacations, personal leave or illness. The model revealed that the ratio of number of staff positions to number of persons employed by an A-PICU-PC is approximately 1.3. Differences in the nature of services managed by an A-PICU-PC or the type of hospital might change the ratio slightly. The model can be applied universally, independently of differences that might exist among departments. Widespread application would allow adoption of a common language to be used by health care managers and A-PICU-PC departments when discussing a basis for consensus about our specialty.

Fibromyalgia patients' quality of life and pain intensity variation Variação da intensidade da dor e da qualidade de vida de pacientes com fibromialgia

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José Eduardo Martinez

2008-12-01

Full Text Available INTRODUCTION: One of the most reported issues on the Fibromyalgia syndrome is the pain intensity variation and its impact on patients' life quality. OBJECTIVES: 1 to establish the correlation among pain, anxiety and depression intensity perception; 2 to determine whether there is a correlation between pain intensity variation and the impact of fibromyalgia on patients' quality of life. MATERIAL AND METHODS: A study was carried out with 21 patients, who received a diary to register their perceptions on pain, anxiety and depression intensity. The patients have made this procedure three times a day, for a fifteen-day period. The impact on life quality was measured by the the Fibromyalgia Impact Questionaire (FIQ. RESULTS: It was observed a significant variation on pain intensity during the day periods. There was not a significant variation for anxiety and depression through the day periods. It was not observed any significant correlation between pain and depression or pain and anxiety intensity perception at any time of the day, during the study period. When considering the whole study period, it was observed that there was a correlation between pain and anxiety and pain and depression in the morning. CONCLUSION: It is concluded that there is a significant pain variation through the day periods and there is a correlation between pain and anxiety and pain and depression in the morning. There is a significant correlation of life quality with pain in the morning, anxiety in the afternoon and evening; and depression in all periods of the day.INTRODUÇÃO: Uma das questões mais relatadas é a variação da intensidade da dor no decorrer do dia e seu impacto na qualidade de vida. OBJETIVOS: Estabelecer a correlação entre a percepção da intensidade da dor, da ansiedade e da depressão e determinar a correlação entre a variação da intensidade da dor e o impacto na qualidade de vida. MATERIAL E MÉTODOS: Estudou-se 21 pacientes com fibromialgia. As

Is Sweet Taste Perception Associated with Sweet Food Liking and Intake?

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Jayasinghe, Shakeela N; Kruger, Rozanne; Walsh, Daniel C I; Cao, Guojiao; Rivers, Stacey; Richter, Marilize; Breier, Bernhard H

2017-07-14

A range of psychophysical taste measurements are used to characterize an individual's sweet taste perception and to assess links between taste perception and dietary intake. The aims of this study were to investigate the relationship between four different psychophysical measurements of sweet taste perception, and to explore which measures of sweet taste perception relate to sweet food intake. Forty-four women aged 20-40 years were recruited for the study. Four measures of sweet taste perception (detection and recognition thresholds, and sweet taste intensity and hedonic liking of suprathreshold concentrations) were assessed using glucose as the tastant. Dietary measurements included a four-day weighed food record, a sweet food-food frequency questionnaire and a sweet beverage liking questionnaire. Glucose detection and recognition thresholds showed no correlation with suprathreshold taste measurements or any dietary intake measurement. Importantly, sweet taste intensity correlated negatively with total energy and carbohydrate (starch, total sugar, fructose, glucose) intakes, frequency of sweet food intake and sweet beverage liking. Furthermore, sweet hedonic liking correlated positively with total energy and carbohydrate (total sugar, fructose, glucose) intakes. The present study shows a clear link between sweet taste intensity and hedonic liking with sweet food liking, and total energy, carbohydrate and sugar intake.

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

NARCIS (Netherlands)

Hanssen, D.J.; Naarding, P.; Collard, R.M.; Comijs, H.C.; Oude Voshaar, R.C.

2014-01-01

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)

Back Pain and Modic

DEFF Research Database (Denmark)

Manniche, Claus; Jordan, Alan; Mikkelsen, Connie

Long awaited breakthrough Approximately 25 years ago a few researchers managed to publish an article in the renowned medical journal, The Lancet. The article demonstrated that intensive exercise was most useful for patients with chronic back pain. Many of our colleagues found this difficult...... to accept, nonetheless, intensive exercise has for chronic back pain has spread across the world and has become – in different forms – the most commonly prescribed treatment for back pain patients. Since that time, there has not been much research based progress in back science, however, we have taken...... a significant step forward with the advent of the new back pain diagnosis, ”Modic changes”. During the coming years, thousands of back pain patients will now be given a precise diagnosis as well as a useful treatment in cases where we previously we unable to provide either a diagnosis or a useful treatment...

Cost-effectiveness of an intensive group training protocol compared to physiotherapy guideline care for sub-acute and chronic low back pain: design of a randomised controlled trial with an economic evaluation. [ISRCTN45641649

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Franken Willemien K

2004-11-01

Full Text Available Abstract Background Low back pain is a common disorder in western industrialised countries and the type of treatments for low back pain vary considerably. Methods In a randomised controlled trial the cost-effectiveness and cost-utility of an intensive group training protocol versus physiotherapy guideline care for sub-acute and chronic low back pain patients is evaluated. Patients with back pain for longer than 6 weeks who are referred to physiotherapy care by their general practitioner or medical specialist are included in the study. The intensive group training protocol combines exercise therapy with principles of behavioural therapy ("graded activity" and back school. This training protocol is compared to physiotherapy care according to the recently published Low Back Pain Guidelines of the Royal Dutch College for Physiotherapy. Primary outcome measures are general improvement, pain intensity, functional status, work absenteeism and quality of life. The direct and indirect costs will be assessed using cost diaries. Patients will complete questionnaires at baseline and 6, 13, 26 and 52 weeks after randomisation. Discussion No trials are yet available that have evaluated the effect of an intensive group training protocol including behavioural principles and back school in a primary physiotherapy care setting and no data on cost-effectiveness and cost-utility are available.

Procedure-specific postoperative pain treatment

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Gerbershagen, H.J.

2015-01-01

The aims of this thesis are: To give an overview of one of the serious consequences of acute pain – the transition to chronic pain; To measure and rank pain intensity in a large number of surgical groups in order to define the surgical groups where pain treatment is insufficient and those where

Neuromuscular adaptations predict functional disability independently of clinical pain and psychological factors in patients with chronic non-specific low back pain.

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Dubois, Jean-Daniel; Abboud, Jacques; St-Pierre, Charles; Piché, Mathieu; Descarreaux, Martin

2014-08-01

Patients with chronic low back pain exhibit characteristics such as clinical pain, psychological symptoms and neuromuscular adaptations. The purpose of this study was to determine the independent contribution of clinical pain, psychological factors and neuromuscular adaptations to disability in patients with chronic low back pain. Clinical pain intensity, pain catastrophizing, fear-avoidance beliefs, anxiety, neuromuscular adaptations to chronic pain and neuromuscular responses to experimental pain were assessed in 52 patients with chronic low back pain. Lumbar muscle electromyographic activity was assessed during a flexion-extension task (flexion relaxation phenomenon) to assess both chronic neuromuscular adaptations and neuromuscular responses to experimental pain during the task. Multiple regressions showed that independent predictors of disability included neuromuscular adaptations to chronic pain (β=0.25, p=0.006, sr(2)=0.06), neuromuscular responses to experimental pain (β=-0.24, p=0.011, sr(2)=0.05), clinical pain intensity (β=0.28, p=0.002, sr(2)=0.08) and psychological factors (β=0.58, ppain intensity and psychological factors, and contribute to inter-individual differences in patients' disability. This suggests that disability, in chronic low back pain patients, is determined by a combination of factors, including clinical pain, psychological factors and neuromuscular adaptations. Copyright © 2014 Elsevier Ltd. All rights reserved.

What are the factors that influence the attainment of satisfactory energy intake in pediatric intensive care unit patients receiving enteral or parenteral nutrition?

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de Menezes, Fernanda Souza; Leite, Heitor Pons; Nogueira, Paulo Cesar Koch

2013-01-01

Children admitted to the intensive care unit (ICU) are at risk of inadequate energy intake. Although studies have identified factors contributing to an inadequate energy supply in critically ill children, they did not take into consideration the length of time during which patients received their estimated energy requirements after having achieved a satisfactory energy intake. This study aimed to identify factors associated with the non-attainment of estimated energy requirements and consider the time this energy intake is maintained. This was a prospective study involving 207 children hospitalized in the ICU who were receiving enteral and/or parenteral nutrition. The outcome variable studied was whether 90% of the estimated basal metabolic rate was maintained for at least half of the ICU stay (satisfactory energy intake). The exposure variables for outcome were gender, age, diagnosis, use of vasopressors, malnutrition, route of nutritional support, and Pediatric Index of Mortality and Pediatric Logistic Organ Dysfunction scores. Satisfactory energy intake was attained by 20.8% of the patients, within a mean time of 5.07 ± 2.48 d. In a multivariable analysis, a diagnosis of heart disease (odds ratio 3.62, 95% confidence interval 1.03-12.68, P = 0.045) increased the risk of insufficient energy intake, whereas malnutrition (odds ratio 0.43, 95% confidence interval 0.20-0.92, P = 0.030) and the use of parenteral nutrition (odds ratio 0.34, 95% confidence interval 0.15-0.77, P = 0.001) were protective factors against this outcome. A satisfactory energy intake was reached by a small proportion of patients during their ICU stay. Heart disease was an independent risk factor for the non-attainment of satisfactory energy intake, whereas malnutrition and the use of parenteral nutrition were protective factors against this outcome. Copyright © 2013 Elsevier Inc. All rights reserved.

Validation of the Persian Version of the Brief Pain Inventory (BPI-P) in Chronic Pain Patients.

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Majedi, Hossein; Dehghani, S Sharareh; Soleyman-Jahi, Saeed; Emami Meibodi, S Ali; Mireskandari, S Mohammad; Hajiaghababaei, Marzieh; Tafakhori, Abbas; Mendoza, Tito R; Cleeland, Charles S

2017-07-01

Chronic pain needs to be evaluated with a standard instrument. The Brief Pain Inventory (BPI) is a pain assessment tool that has been validated in many languages. The aim of the present study was to develop the Persian version of the Brief Pain Inventory (BPI-P) and also to evaluate the psychometric properties of the BPI-P in the Iranian population. The BPI-P was translated from the original version of BPI using standard procedure. The Persian version of the BPI and 12-item Short-Form Health Survey (SF-12) were completed by 201 patients with chronic pain who were referred to a tertiary pain care clinic from 2013 to 2015. The performance status of the patients was evaluated by physicians using Eastern Cooperative Oncology Group performance test. Factor analysis of the BPI-P identified two scales: pain intensity and pain interference with life. These two factors explained 68.4% of the variance. Coefficient alpha values for BPI-P items ranging from 0.87 to 0.91 showed good internal consistency of the factors. The high intraclass correlation coefficients for the items of the questionnaire confirmed the test-retest reliability for the BPI-P. Patients with higher scores in Eastern Cooperative Oncology Group performance test reported higher levels of pain intensity and pain interference with life. Pain intensity in BPI-P correlated with physical functioning, bodily pain, mental health, and vitality of the SF-12 questionnaire, whereas pain interference was associated with general health, bodily pain, mental health, vitality, and social functioning. The present study demonstrated that the Persian version of the BPI could be a valid and reliable instrument for pain assessment in Persian-speaking patients. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Importance of Pain Acceptance in Relation to Headache Disability and Pain Interference in Women with Migraine and Overweight/Obesity

Science.gov (United States)

Lillis, Jason; Thomas, J. Graham; Seng, Elizabeth K.; Lipton, Richard B.; Pavlovic, Jelena; Rathier, Lucille; Roth, Julie; O’Leary, Kevin C.; Bond, Dale S.

2018-01-01

BACKGROUND Pain acceptance involves willingness to experience pain and engaging in valued activities while pain is present. Though pain acceptance could limit both headache-related disability and pain interference in individuals with migraine, few studies have addressed this issue. The current study evaluated whether higher levels of total pain acceptance and it’s 2 subcomponents, pain willingness and activity engagement, were associated with lower levels of headache-related impairment in women who had both migraine and overweight/obesity. METHODS In this cross-sectional study, participants seeking weight loss and headache relief in the Women’s Health and Migraine (WHAM) trial completed baseline measures of pain acceptance (Chronic Pain Acceptance Questionnaire [CPAQ]), headache-related disability (Headache Impact Test-6 [HIT-6]), and pain interference (Brief Pain Inventory [BPI]). Migraine headache frequency and pain intensity were assessed daily via smartphone diary. Using CPAQ total and subcomponent (pain willingness and activity engagement) scores, headache frequency, pain intensity, and BMI as predictors in linear regression, headache-related disability and pain interference were modeled as outcomes. RESULTS On average, participants (n=126; age=38.5±8.2 years; BMI=35.3±6.6 kg/m2) reported 8.4±4.7 migraine days/month and pain intensity of 6.0±1.5 on a 0–10 scale on headache days. After correcting for multiple comparisons (adjusted α=.008), pain willingness was independently associated with both lower headache related disability (pheadache related disability (p=.128; β= −.138) and pain interference (p=.042; β= −.154). CPAQ Total Score was not associated with headache related disability (p=.439; β=.066) and pain interference (p=.305; β=.074). Pain intensity was significantly associated with outcomes in all analyses (p’s headache-related disability and general pain interference in treatment-seeking women with migraine and overweight

Contextual influences on pain communication in couples with and without a partner with chronic pain.

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Gagnon, Michelle M; Hadjistavropoulos, Thomas; MacNab, Ying C

2017-10-01

This is an experimental study of pain communication in couples. Despite evidence that chronic pain in one partner impacts both members of the dyad, dyadic influences on pain communication have not been sufficiently examined and are typically studied based on retrospective reports. Our goal was to directly study contextual influences (ie, presence of chronic pain, gender, relationship quality, and pain catastrophizing) on self-reported and nonverbal (ie, facial expressions) pain responses. Couples with (n = 66) and without (n = 65) an individual with chronic pain (ICP) completed relationship and pain catastrophizing questionnaires. Subsequently, one partner underwent a pain task (pain target, PT), while the other partner observed (pain observer, PO). In couples with an ICP, the ICP was assigned to be the PT. Pain intensity and PO perceived pain intensity ratings were recorded at multiple intervals. Facial expressions were video recorded throughout the pain task. Pain-related facial expression was quantified using the Facial Action Coding System. The most consistent predictor of either partner's pain-related facial expression was the pain-related facial expression of the other partner. Pain targets provided higher pain ratings than POs and female PTs reported and showed more pain, regardless of chronic pain status. Gender and the interaction between gender and relationship satisfaction were predictors of pain-related facial expression among PTs, but not POs. None of the examined variables predicted self-reported pain. Results suggest that contextual variables influence pain communication in couples, with distinct influences for PTs and POs. Moreover, self-report and nonverbal responses are not displayed in a parallel manner.

The Effect of Positive Affect on the Memory of Pain.

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Bąbel, Przemysław

2017-06-01

The aim of the study was to assess the accuracy of the memory of experimentally induced pain and the affect that accompanies experimentally induced pain. Sixty-two healthy female volunteers participated in the study. In the first phase of the study, the participants received three pain stimuli and rated pain intensity, pain unpleasantness, state anxiety, and their positive and negative affect. About a month later, in the second phase of the study, the participants were asked to rate the pain intensity, pain unpleasantness, state anxiety, and the emotions they had felt during the first phase of the study. Both recalled pain intensity and recalled pain unpleasantness were found to be underestimated. Although the positive affect that accompanied pain was remembered accurately, recalled negative affect was overestimated and recalled state anxiety was underestimated. Experienced pain, recalled state anxiety, and recalled positive affect accounted for 44% of the total variance in predicting recalled pain intensity and 61% of the total variance in predicting recalled pain unpleasantness. Together with recent research findings on the memory of other types of pain, the present study supports the idea that pain is accompanied by positive as well as negative emotions, and that positive affect influences the memory of pain. Copyright © 2017 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

Pain acceptance and opiate use disorders in addiction treatment patients with comorbid pain.

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Lin, Lewei Allison; Bohnert, Amy S B; Price, Amanda M; Jannausch, Mary; Bonar, Erin E; Ilgen, Mark A

2015-12-01

Studies from pain treatment settings indicate that poor acceptance of pain may be an important and modifiable risk factor for higher severity of opioid use. However, the degree to which pain acceptance relates to opioid use severity in the addiction treatment population is unknown. In this study of addiction treatment patients with co-morbid pain, we examined correlates of severity of opiate (heroin and prescription opioid) use, with a particular focus on the role of pain acceptance. Patients in residential addiction treatment with comorbid pain (N=501) were stratified into low, moderate and high severity of opiate use. Demographic and clinical characteristics were compared across opiate severity categories. 72% (N=360) of the participants had symptoms that were consistent with an opiate use disorder. Younger age, Caucasian race, female gender, cocaine use and lower pain acceptance were associated with higher severity of opiate use, whereas pain intensity was not. Controlling for demographic and other risk factors, such as substance use and pain intensity, higher pain acceptance was associated with lower odds of severe prescription opioid (AOR 0.50, 95% CI 0.38-0.68 for a one SD increase in pain acceptance) and heroin use (AOR 0.57, 95% CI 0.44-0.75 for a one SD increase in pain acceptance). Problematic opiate use is common in addictions treatment patients with chronic pain. Lower pain acceptance is related to greater opiate use severity, and may be an important modifiable target for interventions to successfully treat both pain and opiate use disorders. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Doubling Your Payoff: Winning Pain Relief Engages Endogenous Pain Inhibition

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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.

[Device for quantitative analysis of perception and pain sensation].

Science.gov (United States)

Arita, Hideko; Kato, Jitsu; Ogawa, Setsuro; Hanaoka, Kazuo

2014-07-01

The article describes an analysing device that measures the perception and intensity of pain quantitatively. While it is not necessarily true that psychological aspect is totally irrelevant to pain measurement, this device is remarkable in that it is capable of measuring the intensity of pain felt by the patient more objectively by using electric stimuli. The feature of this device is that it uses a non-pain heteresthesia for measuring the intensity of pain. The device is compact, light-weight, and portable. Unlike VAS that requires only a scale, the device requires a person to carry out the measurement. Nevertheless, as the National Health Insurance (NHI) coverage has been approved, introduction of the device may be facilitated in terms of budget for the purchase and labor. The device is useful to better understand not only the intensity of pain but also the pathological conditions, resulting in more appropriate treatment, by (1) comparing degree of pain or VAS values taken by a multicenter study with those of a patient; (2) using both degree of pain and VAS; and (3) multiple measurements of degree of pain and VAS in one case.

Maternal Anxiety and Children’s Laboratory Pain: The Mediating Role of Solicitousness

Directory of Open Access Journals (Sweden)

Subhadra Evans

2016-06-01

Full Text Available There has been limited empirical examination of how parent variables such as anxiety and solicitousness collectively impact child pain response. We sought to examine the relationships among maternal anxiety, solicitous parenting, and children’s laboratory anxiety and pain intensity in children with chronic pain. Participants included 80 children and adolescents (ages 8–18 with chronic pain and their mothers. Children completed questionnaires and lab pain tasks measuring their parents’ solicitous parenting, pressure, cold and heat pain anticipatory anxiety and pain intensity. Using bootstrapping analysis, maternal anxiety predicted child anticipatory anxiety and pain intensity in girls with chronic pain, which was mediated by the child’s report of parental solicitousness. For boys with chronic pain, maternal anxiety predicted boys’ anticipatory anxiety and pain intensity, with no support for mediation. This study adds to the growing literature demonstrating the impact of maternal anxiety on children’s pain. The study highlights the importance of considering parents in treatment designed to reduce children’s pain.

Multidisciplinary pain management programs

Directory of Open Access Journals (Sweden)

Kaiser U

2013-05-01

Full Text Available Ulrike Kaiser,1 Bernhard Arnold,2 Michael Pfingsten,3 Bernd Nagel,4 Johannes Lutz,5 Rainer Sabatowski1,61Comprehensive Pain Center, University Hospital “Carl Gustav Carus”, Dresden, 2Department of Pain Management, Klinikum Dachau, Dachau, 3Pain Clinic, University Medicine, University of Göttingen, 4Day Care Unit, DRK Pain Center, Mainz, 5Interdisciplinary Pain Center, Zentralklinik Bad Berka, Bad Berka, 6Department of Anesthesiology and Intensive Care, University Hospital “Carl Gustav Carus”, Dresden, Germany

Dietary intakes in people with irritable bowel syndrome

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Corfe Bernard M

2011-02-01

Full Text Available Abstract Background Irritable Bowel Syndrome (IBS is a functional bowel disorder characterised by episodes of abdominal pain associated with altered bowel habits. Many IBS sufferers believe that diet may play a role in triggering these episodes and may avoid certain foods. However relatively few studies have undertaken a dietary assessment in IBS sufferers to examine the wider impact of the condition upon diet. Methods 104 individuals with IBS were recruited and asked to complete a validated food frequency questionnaire (FFQ. The data were analysed against Dietary Reference Values for food energy and nutrients for the United Kingdom and observed intakes for the general population and for differences between IBS subtypes and the UK population. Results The data show that the dietary intakes of this population of IBS sufferers met the UK Dietary Reference Values. The average energy intake of the population exceeded the Estimated Average Requirements of the UK population and the balance of macronutrients was favourable. Intakes of selected micronutrients significantly exceeded the reference nutrient intakes. There were no differences between IBS subtypes. Conclusions The IBS subpopulation appear to have an adequate and balanced macronutrient intake with no evidence of inadequate micronutrient intake.

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

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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.

[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

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...

Psychophysics, flare, and neurosecretory function in human pain models: capsaicin versus electrically evoked pain.

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Geber, Christian; Fondel, Ricarda; Krämer, Heidrun H; Rolke, Roman; Treede, Rolfe-Detlef; Sommer, Claudia; Birklein, Frank

2007-06-01

Intradermal capsaicin injection (CAP) and electrical current stimulation (ES) are analyzed in respect to patterns and test-retest reliability of pain as well as sensory and neurosecretory changes. In 10 healthy subjects, 2x CAP (50 microg) and 2x ES (5 to 30 mA) were applied to the volar forearm. The time period between 2 identical stimulations was about 4 months. Pain ratings, areas of mechanical hyperalgesia, and allodynia were assessed. The intensity of sensory changes was quantified by using quantitative sensory testing. Neurogenic flare was assessed by using laser Doppler imaging. Calcitonin gene-related peptide (CGRP) release was quantified by dermal microdialysis in combination with an enzyme immunoassay. Time course and peak pain ratings were different between CAP and ES. Test-retest correlation was high (r > or = 0.73). Both models induced primary heat hyperalgesia and primary plus secondary pin-prick hyperalgesia. Allodynia occurred in about half of the subjects. Maximum flare sizes did not differ between CAP and ES, but flare intensities were higher for ES. Test-retest correlation was higher for flare sizes than for flare intensity. A significant CGRP release could only be measured after CAP. The different time courses of pain stimulation (CAP: rapidly decaying pain versus ES: pain plateau) led to different peripheral neurosecretory effects but induced similar central plasticity and hyperalgesia. The present study gives a detailed overview of psychophysical and neurosecretory characteristics induced by noxious stimulation with capsaicin and electrical current. We describe differences, similarities, and reproducibility of these human pain models. These data might help to interpret past and future results of human pain studies using experimental pain.

Pain relief is associated with decreasing postural sway in patients with non-specific low back pain

DEFF Research Database (Denmark)

Ruhe, A.; Fejer, René; Walker, B.

2012-01-01

is maintained if pain levels change in adults with non-specific low back pain. Methods: Thirty-eight patients with non-specific low back pain and a matching number of healthy controls were enrolled. Postural sway was measured by three identical static bipedal standing tasks of 90 sec duration with eyes closed......Background: Increased postural sway is well documented in patients suffering from non-specific low back pain, whereby a linear relationship between higher pain intensities and increasing postural sway has been described. No investigation has been conducted to evaluate whether this relationship...... in narrow stance on a firm surface. The perceived pain intensity was assessed by a numeric rating scale (NRS 11). The patients received three manual interventions (e. g. manipulation, mobilization or soft tissue techniques) at 3-4 day intervals, postural sway measures were obtained at each occasion. Results...

Music therapy in relief of pain in oncology patients

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Mariana Franco

2009-03-01

Full Text Available Objective: To evaluate the perception of oncology patients with chronic pain as to the effects of music in alleviating pain, to identify if there are changes in the vital signs of these patients before and after the musicotherapy session, and to identify whether the intensity of pain is diminished after the music session as per an analogic scale of pain. Methods: This level II, descriptive-exploratory and cross-sectional study used a quantitative and qualitative approach. The sample consisted of ten oncology patients with chronic pain. Rresults: There was a reduction in vital signs and in intensity of pain in ten patients of the sample; after the music sessions, the patients reported a sensation of relief of pain, relaxation, and a belief in the power of music as a supplementary therapy. Cconclusions: Music showed an influence in reducing vital signs and pain intensity, and the patients perceived a reduction of pain and anxiety, and began to believe in music as a form of therapy.

Investigating the affective component of pain: no startle modulation by tonic heat pain in startle responsive individuals.

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Horn, Claudia; Schaller, Jörg; Lautenbacher, Stefan

2012-06-01

Experimental tonic pain has been assumed to equal clinical pain by triggering sizeable affective responses. A psycho-physiological indicator of defensive affective-motivational responses is the startle reflex. However, earlier studies have not provided unequivocal evidence for a potentiation of the startle reflex during tonic contact heat pain. The demonstration of modulating effects of pain on the startle reflex might require very intense tonic stimulation and investigation of subjects, who are particularly sensitive to startle potentiation by threatening cues. We investigated a sample of healthy subjects (N=20), who had shown pronounced startle amplitude potentiation in response to attack pictures. Noxious stimulation was provided by hand immersion into a hot water bath, which is a tonic pain model known for intense and summated stimulation. Modulation of the startle reflex was attempted by use of two stimulation intensities (42 °C, 46 °C) and one control condition (no stimulation). Even in these favorable conditions, we did not observe startle potentiation under painful stimulation in comparison to non-painful conditions although subjects reported to be experiencing moderate to high pain. Our findings indicate that tonic heat pain does not trigger defensive affective-motivational responses as measured by the startle reflex when it is applied in a predictable and thus non-threatening fashion. Future research should investigate the effects of manipulations of threat on startle responses to painful stimulation. Copyright © 2012 Elsevier B.V. All rights reserved.

Headache attributed to temporomandibular disorders and masticatory myofascial pain.

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Hara, Kazuhiko; Shinozaki, Takahiro; Okada-Ogawa, Akiko; Matsukawa, Yumiko; Dezawa, Ko; Nakaya, Yuka; Chen, Jui-Yen; Noma, Noboru; Oka, Shunichi; Iwata, Koichi; Imamura, Yoshiki

2016-01-01

We investigated the temporal association between temporomandibular disorders (TMD)-related symptoms and headache during TMD treatment for patients who fulfilled the diagnostic criteria for headache attributed to TMD (HATMD) specified in the Diagnostic criteria for TMD (DC/TMD) and International classification of headache disorders (ICHD)-3 beta. The study enrolled 34 patients with HATMD induced by masticatory myofascial pain but not by temporomandibular arthralgia. Facial pain intensity, the pressure pain threshold of pericranial muscles, and maximum unassisted opening of the jaw were assessed at an initial examination and before and after physical therapy. The intensity and frequency of headache episodes and tooth contact ratio were also recorded before and after the intervention. Headache intensity and frequency significantly decreased, and these reductions were temporally related to improvements in facial pain intensity, maximum unassisted opening, and pressure pain threshold during TMD treatment. Linear regression analysis showed significant correlations between facial pain intensity and headache intensity and between tooth contact ratio and pressure pain threshold. Among patients who fulfilled the DC/TMD and ICHD-3 beta diagnostic criteria for HATMD, headache improved during TMD treatment, and the improvement was temporally related to amelioration of TMD symptoms. These findings suggest that sensitization in the central and peripheral nervous systems is responsible for HATMD. (J Oral Sci 58, 195-204, 2016).

The Level of Anxiety and Pain Perception of Endodontic Patients

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Ivana Perković

2014-01-01

Full Text Available Objectives: to compare the level of anxiety reported by patients and assessed by dentists. Also, the expected and actual pain during the treatment perceived by the patient and dentist were assessed. Methods: sixty six endodontic patients filled in two questionnaires, prior to and after the treatment, so did their therapists. The first set of questions for patients was regarding demographics, the frequency of dental visits, the level of anxiety and expectations about the level of pain. Before the treatment, dentists estimated the level of patients’ anxiety and the expected intensity of pain. After the treatment, the patients evaluated the level of experienced pain and dentists’ empathy during the treatment, while dentists reassessed the intensity of patients’ pain.The data were statistically analysed by t-test for paired samples and by Spearmans’s Rho correlation coefficient at level of significance set at 0.05. Results: Patients’ expectation of pain intensity was higher than the actual pain during the treatment (t-test=3.540, p=0.001. There was no difference in the level of pain which dentists expected and their perception of pain during the procedure. There was a statistically significant correlation between the patients’ level of anxiety and recognition of it by dentists (Spearman Rho=0.460, p<0.001. A higher level of anxiety increased the expected intensity of pain (Spearman Rho=0.401, p=0.001. Actual intensity of pain was not significantly associated with dental anxiety (Spearman Rho=0.080, p=0.524. Conclusion: Since the level of dental anxiety was associated with the increased intensity of expected pain, a vicious cycle of pain and anxiety may be terminated by giving positive information to the patient before and during endodontic procedures.

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

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

2016-03-01

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

Difficulties in controlling mobilization pain using a standardized patient-controlled analgesia protocol in burns.

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Nilsson, Andreas; Kalman, Sigga; Sonesson, Lena Karin; Arvidsson, Anders; Sjöberg, Folke

2011-01-01

The aim of this study was to evaluate pain relief for patients with burns during rest and mobilization with morphine according to a standard protocol for patient-controlled analgesia (PCA). Eighteen patients with a mean (SD) burned TBSA% of 26 (20) were studied for 10 days. Using a numeric rating scale (NRS, 0 = no pain and 10 = unbearable pain), patients were asked to estimate their acceptable and worst experienced pain by specifying a number on a scale and at what point they would like additional analgesics. Patients were allowed free access to morphine with a PCA pump device. Bolus doses were set according to age, (100 - age)/24 = bolus dose (mg), and 6 minutes lockout time. Degrees of pain, morphine requirements, doses delivered and demanded, oral intake of food, and antiemetics given were used as endpoints. Acceptable pain (mean [SD]) was estimated to be 3.8 (1.3) on the NRS, and additional treatment was considered necessary at scores of 4.3 (1.6) or more. NRS at rest was 2.7 (2.2) and during mobilization 4.7 (2.6). Required mean morphine per day was 81 (15) mg, and the number of doses requested increased during the first 6 days after the burn. The authors found no correlation between dose of morphine required and any other variables. Background pain can be controlled adequately with a standard PCA protocol. During mobilization, the pain experienced was too intense, despite having the already high doses of morphine increased. The present protocol must be refined further to provide analgesia adequate to cover mobilization as well.

Can preoperative electrical nociceptive stimulation predict acute pain after groin herniotomy?

DEFF Research Database (Denmark)

Aasvang, Eske Kvanner; Hansen, J.B.; Kehlet, H.

2008-01-01

Preoperative identification of patients at risk for high-intensity postoperative pain may be used to predict patients at risk for development of a persistent pain state and allocate patients to more intensive specific pain therapy. Preoperative pain threshold to electrocutaneus stimulation has...... repair. The correlation between the pain data for electrical stimulation was compared with the postoperative pain during the first week in 165 patients, whereof 3 were excluded. Preoperative electrical pain detection threshold and electrical pain tolerance threshold did not correlate to postoperative...... pain (rho = -0.13, P = .09, and rho = -1.2, P = .4, respectively. PERSPECTIVE: Although preoperative electrical nociceptive stimulation may predict patients at risk of high-intensity acute pain after other surgical procedures, this was not the case in groin hernia repair patients receiving concomitant...

Integrative medicine for chronic pain

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Saha, Felix J.; Brüning, Alexander; Barcelona, Cyrus; Büssing, Arndt; Langhorst, Jost; Dobos, Gustav; Lauche, Romy; Cramer, Holger

2016-01-01

Abstract Introduction: Integrative medicine inpatient treatment has been shown to improve physical and mental health in patients with internal medicine conditions. The aim of this study was to investigate the effectiveness of a 2-week integrative medicine inpatient treatment in patients with chronic pain syndromes and the association of treatment success with patient-related process variables. Methods: Inpatients with chronic pain syndromes participating in a 2-week integrative medicine inpatient program were included. Patients’ pain intensity, pain disability, pain perception, quality of life, depression, and perceived stress were measured on admission, discharge, and 6 months after discharge. Likewise process variables including ability and will to change, emotional/rational disease acceptance, mindfulness, life and health satisfaction, and easiness of life were assessed. Results: A total of 310 inpatients (91% female, mean age 50.7 ± 12.4 year, 26.5% low back pain, and 22.9% fibromyalgia) were included. Using mixed linear models, significant improvements in pain intensity, pain disability, pain perception, quality of life, depression, and perceived stress were found (all P medicine inpatient treatment can benefit patients with chronic pain conditions. Functional improvements are associated with improved ability to change and implementation, disease acceptance, and satisfaction. PMID:27399133

The Experience of Intense Pain: Nursing Management and Interventions.

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Kiser-Larson, Norma

Personal stories of illness give depth to otherwise clinical descriptions of diagnoses. This article offers an autobiographical narrative of complications after total knee replacement surgery. Diagnosis and nursing management of acute compartment syndrome, nociceptive and neuropathic origins of pain, pharmacologic and nursing interventions for pain, the use of prayer in illness, and compassionate caring from a Christian perspective are discussed.

Pain among older Hispanics in the United States: is acculturation associated with pain?

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Jimenez, Nathalia; Dansie, Elizabeth; Buchwald, Dedra; Goldberg, Jack

2013-08-01

Previous studies suggest that acculturation may influence the experience of pain. We conducted a cross-sectional study to estimate the association between acculturation and the prevalence, intensity, and functional limitations of pain in older Hispanic adults in the United States. Participants were English- (HE) and Spanish-speaking (HS) Hispanic and non-Hispanic White (NHW) individuals aged 50 years and older who were interviewed for the Health and Retirement Study during 1998-2008. We measured: 1) acculturation as defined by language used in interviews, and 2) the presence, intensity, and functional limitations of pain. We applied logistic regression using generalized estimating equations, with NHW as the reference category. Among 18,593 participants (16,733 NHW, 824 HE, and 1,036 HS), HS had the highest prevalence (odds ratio [OR] = 1.3; 95% confidence interval [CI  = 1.1-1.4) and intensity (OR = 1.6; 95% CI = 1.4-1.9) of pain, but these differences were not significant after adjusting for age, sex, years of education, immigration status (U.S.- vs non-U.S-born), and health status (number of health conditions). Even after adjustment, HS reported the lowest levels of functional limitation (OR = 0.7; 95% CI 0.6-0.9). Pain prevalence and intensity were not related to acculturation after adjusting for sociodemographic factors, while functional limitation was significantly lower among HS even after adjusting for known risk factors. Future studies should explore the reasons for this difference. Wiley Periodicals, Inc.

Importance of Pain Acceptance in Relation to Headache Disability and Pain Interference in Women With Migraine and Overweight/Obesity.

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Lillis, Jason; Graham Thomas, J; Seng, Elizabeth K; Lipton, Richard B; Pavlović, Jelena M; Rathier, Lucille; Roth, Julie; O'Leary, Kevin C; Bond, Dale S

2017-05-01

Pain acceptance involves willingness to experience pain and engaging in valued activities while pain is present. Though pain acceptance could limit both headache-related disability and pain interference in individuals with migraine, few studies have addressed this issue. This study evaluated whether higher levels of total pain acceptance and its two subcomponents, pain willingness and activity engagement, were associated with lower levels of headache-related impairment in women who had both migraine and overweight/obesity. In this cross-sectional study, participants seeking weight loss and headache relief in the Women's Health and Migraine trial completed baseline measures of pain acceptance (Chronic Pain Acceptance Questionnaire [CPAQ]), headache-related disability (Headache Impact Test-6), and pain interference (Brief Pain Inventory). Migraine headache frequency and pain intensity were assessed daily via smartphone diary. Using CPAQ total and subcomponent (pain willingness and activity engagement) scores, headache frequency, pain intensity, and body mass index (BMI) as predictors in linear regression, headache-related disability, and pain interference were modeled as outcomes. On average, participants (n = 126; age = 38.5 ± 8.2 years; BMI = 35.3 ± 6.6 kg/m 2 ) reported 8.4 ± 4.7 migraine days/month and pain intensity of 6.0 ± 1.5 on a 0-10 scale on headache days. After correcting for multiple comparisons (adjusted α = .008), pain willingness was independently associated with both lower headache-related disability (P treatment-seeking women with migraine and overweight/obesity. Future studies are needed to clarify direction of causality and test whether strategies designed to help women increase pain willingness, or relinquish ineffective efforts to control pain, can improve functional outcomes in women who have migraine and overweight/obesity. © 2017 American Headache Society.

The Effectiveness of Mindfulness-Based Stress Reduction on Perceived Pain Intensity and Quality of Life in Patients With Chronic Headache.

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Bakhshani, Nour Mohammad; Amirani, Ahmadreza; Amirifard, Hamed; Shahrakipoor, Mahnaz

2015-08-06

The aim of this study was to determine the effectiveness of Mindfulness-Based Stress reduction (MBSR) on perceived pain intensity and quality of life in patients with chronic headache. Thus, forty patients based on the diagnosis of a neurologist and diagnostic criteria of the International Headache Society (IHS) for migraine and chronic tension-type headache were selected and randomly assigned to the intervention group and control group, respectively. The participants completed the Pain and quality of life (SF-36) questionnaire. The intervention group enrolled in an eight-week MBSR program that incorporated meditation and daily home practice, per week, session of 90-minutes. Results of covariance analysis with the elimination of the pre-test showed significantly improvement of pain and quality of life in the intervention group compared with the control group. The findings from this study revealed that MBSR can be used non-pharmacological intervention for improvement the quality of life and development of strategies to cope with pain in patients with chronic headache. And can be used in combination with other therapies such as pharmacotherapy.

Effects of a Tailored Positive Psychology Intervention on Well-Being and Pain in Individuals With Chronic Pain and a Physical Disability: A Feasibility Trial.

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Müller, Rachel; Gertz, Kevin J; Molton, Ivan R; Terrill, Alexandra L; Bombardier, Charles H; Ehde, Dawn M; Jensen, Mark P

2016-01-01

To determine the feasibility, acceptability, and efficacy of a computer-based positive psychology intervention in individuals with a physical disability and chronic pain. Individuals with spinal cord injury, multiple sclerosis, neuromuscular disease, or postpolio syndrome and chronic pain were randomly assigned to a positive psychology or a control condition. Participants in the intervention group were instructed to practice 4 personalized positive psychology exercises. Participants in the control group were instructed to write about life details for 8 weeks. Participants completed online well-being and pain-related questionnaires at baseline, posttreatment, and at the 2.5-month follow-up, and rated treatment satisfaction at posttreatment. Ninety-six participants were randomized and 68 (70%) completed follow-up assessments. Participants in the positive psychology intervention group reported significant pretreatment to posttreatment improvements in pain intensity, pain control, pain catastrophizing, pain interference, life satisfaction, positive affect, and depression. Improvements in life satisfaction, depression, pain intensity, pain interference, and pain control were maintained to the 2.5-month follow-up. Participants in the control group reported significant pretreatment to posttreatment improvements in life satisfaction, and pretreatment to follow-up improvements in pain intensity and pain control. Significant between-group differences, favoring the treatment group, emerged for pretreatment to posttreatment improvements in pain intensity and pain control. Participants were similarly satisfied with both treatments. The results support the feasibility, acceptability, and potential efficacy of a computer-based positive psychology intervention for improving well-being and pain-related outcomes in individuals with physical disabilities and chronic pain, and indicate that a full trial of the intervention is warranted.

Ciguatoxins activate specific cold pain pathways to elicit burning pain from cooling

OpenAIRE

Vetter, Irina; Touska, Filip; Hess, Andreas; Hinsbey, Rachel; Sattler, Simon; Lampert, Angelika; Sergejeva, Marina; Sharov, Anastasia; Collins, Lindon S; Eberhardt, Mirjam; Engel, Matthias; Cabot, Peter J; Wood, John N; Vlachová, Viktorie; Reeh, Peter W

2012-01-01

Ciguatoxins derived from fish lead to cold allodynia in humans, the perception of intense burning pain in response to mild cooling. A novel mouse model of ciguatoxin-induced cold allodynia reveals that ciguatoxin activates the TRPA1 thermosensitive ion channel to mediate pain perception.

Relationship between adaptation and cardiovascular response to tonic cold and heat pain Adaptability to tonic pain and cardiovascular responses.

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Devoize, L; Chalaye, P; Lafrenaye, S; Marchand, S; Dallel, R

2016-05-01

The mechanisms of adaptation to tonic pain are not elucidated. We hypothesized that the adaptability to tonic pain is related to the cardiovascular system. Twenty-six subjects received over two sessions in a random order: tonic cold (7 ± 0.2 °C) and heat pain (47.5 ± 0.5 °C) on the hand for 5 min. Pain intensity, blood pressure (BP), and heart rate (HR) were continuously monitored. Pain experience during the heat (HIT) and cold (CIT) immersion tests exhibited different average time courses, being approximated with a linear and cubic function, respectively. In each test, two groups of participants could be identified based on the time course of their tonic thermal pain: one-third of participants were pain adaptive and two-thirds non adaptive. The adaptive group exhibited higher initial pain, lower last pain, and shorter latency to peak pain than the non-adaptive one. Interestingly, some participants were adaptive to both pain stimuli, most were not. HIT as well as CIT produced a stable elevation of BP. However, BP was higher during CIT than HIT (p = 0.034). HR was also increased during CIT and HIT, but the two tests differed with respect to the time course of responses. Finally, the intensity and time course of pain rating to both HIT and CIT correlated with neither BP nor HR responses. These results suggest that individual sensitivity and adaptability to tonic thermal pain is related to the intensity of initial pain rating and the latency to peak pain but not to cardiovascular responses. © 2015 European Pain Federation - EFIC®

Effects of ethnicity and gender role expectations of pain on experimental pain: a cross-cultural study.

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Alabas, O A; Tashani, O A; Johnson, M I

2013-05-01

Gender role expectations of pain (GREP) have been shown to mediate sex differences in experimental pain. Few studies have investigated the role of ethnicity in shaping GREP. The aim of this study was to examine interactions between ethnicity and GREP on experimentally induced pressure and ischaemic pain in Libyan and white British students in their respective countries. Libyan (n = 124) and white British (n = 51) students completed a GREP questionnaire and their response to experimental pain was measured. Blunt pressure pain threshold (PPT) was measured over the 1st interosseous muscle using algometry. Pain intensity and pain unpleasantness (100 mm visual analogue scale) were measured at 1-min intervals during a submaximal effort tourniquet test on the forearm. Multivariate analysis of variance detected significant effects for Sex and Ethnicity on pain measurements. Men had higher PPTs than women (p 0.05). Libyan participants had higher pain intensity (p < 0.01) and pain unpleasantness (p < 0.05) ratings compared with white British participants. There were effects for Sex and Ethnicity for all GREP dimensions. Libyan participants exhibited stronger stereotypical views in GREP than white British participants (p < 0.001). GREP was the mediator of sex but not ethnic differences in pain report, suggesting that gender stereotypical attitudes to pain account for differences in pain expression between men and women. © 2012 European Federation of International Association for the Study of Pain Chapters.

Self-reported pain intensity with the numeric reporting scale in adult dengue.

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Joshua G X Wong

Full Text Available BACKGROUND: Pain is a prominent feature of acute dengue as well as a clinical criterion in World Health Organization guidelines in diagnosing dengue. We conducted a prospective cohort study to compare levels of pain during acute dengue between different ethnicities and dengue severity. METHODS: Demographic, clinical and laboratory data were collected. Data on self-reported pain was collected using the 11-point Numerical Rating Scale. Generalized structural equation models were built to predict progression to severe disease. RESULTS: A total of 499 laboratory confirmed dengue patients were recruited in the Prospective Adult Dengue Study at Tan Tock Seng Hospital, Singapore. We found no statistically significant differences between pain score with age, gender, ethnicity or the presence of co-morbidity. Pain score was not predictive of dengue severity but highly correlated to patients' day of illness. Prevalence of abdominal pain in our cohort was 19%. There was no difference in abdominal pain score between grades of dengue severity. CONCLUSION: Dengue is a painful disease. Patients suffer more pain at the earlier phase of illness. However, pain score cannot be used to predict a patient's progression to severe disease.

Pre-operative pain and sensory function in groin hernia

DEFF Research Database (Denmark)

Aasvang, Eske K; Hansen, Jeanette B; Kehlet, Henrik

2009-01-01

(rho=-0.413, p=0.049), indicating a paradoxical association between level of mechanical pain threshold and magnitude of spontaneous pain. No other sensory modality was significantly correlated to pain intensity. New/increased pain during repetitive pinprick stimulation (wind-up) was seen in 3 patients...... mechanism. AIMS: To investigate the correlation between pre-operative pain intensity and sensory functions in the groin hernia area. METHODS: Patients with unilateral groin hernia were examined preoperatively by quantitative sensory testing (thermal, mechanical, and pressure [detection and pain thresholds...... pain is not related to findings of hyperalgesia or other changes in sensory function that may support pain-induced pre-operative neuroplasticity as a pathogenic mechanism for the development of persistent postherniotomy pain....

Prospective Observational Evaluation of Sedation and Pain Management Guideline Adherence Across New Jersey Intensive Care Units.

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Brophy, Alison; Cardinale, Maria; Andrews, Liza B; Kaplan, Justin B; Adams, Christopher; Opsha, Yekaterina; Brandt, Kimberly A; Dixit, Deepali; Nerenberg, Steven F; Saleh, Julie A

2018-01-01

The practice guidelines for the management of pain, agitation, and delirium (PAD) from the Society of Critical Care Medicine shifted from primarily focusing on the treatment of anxiety in 2002 to the treatment of pain in 2013. This prospective, observational, multicenter study aimed to assess the degree of practice adherence to the PAD guidelines for ventilated patients in New Jersey intensive care units (ICUs). Pharmacist investigators at 8 centers designated 4 days at least 10 days apart to evaluate all patients on mechanical ventilation. The primary outcomes included adherence to 4 guideline recommendations: treatment of pain before sedation, use of nonnarcotic analgesic medications, use of nonbenzodiazepine sedative medications, and use of goal-directed sedation. Of 138 patients evaluated, 50% had a primary medical diagnosis (as opposed to surgical, cardiac, or neurological diagnosis), and the median Sequential Organ Failure Assessment (SOFA) score was 7. Pain was treated prior to administration of sedatives in 55.4% of subjects, with fentanyl being the primary analgesic used. In addition, 19% received no analgesia, and 11.5% received nonopioid analgesia. Sedative agents were administered to 87 subjects (48 nonbenzodiazepine and 39 benzodiazepine). Of those receiving benzodiazepines, 22 received intermittent bolus regimens and 16 received continuous infusions, of which 5 were for another indication besides sedation. Validated scales measuring the degree of sedation were completed at least once in 56 (81.6%) patients receiving sedatives. Current sedation practices suggest that integration of evidence-based PAD guidelines across New Jersey adult ICUs is inconsistent despite pharmacist involvement.

Personalized pain medicine: the clinical value of psychophysical assessment of pain modulation profile.