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

Science.gov (United States)

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.

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.

Painful Memories: Reliability of Pain Intensity Recall at 3 Months in Senior Patients

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Raoul Daoust

2017-01-01

Full Text Available Background. Validity of pain recall is questioned in research. Objective. To evaluate the reliability of pain intensity recall for seniors in an emergency department (ED. Methods. This study was part of a prospective multicenter project for seniors (≥65 years old treated in an ED for minor traumatic injury. Pain intensity (0–10 numerical rating scale was evaluated at the initial ED visit, at one week (baseline, and 3 months. At three months, patients were asked to recall the pain intensity they had at baseline. Results. 482 patients were interviewed (mean age 76.6 years, SD ± 7.3 and 72.8% were female. Intraclass correlation coefficient between pain at baseline and its recall was 0.24 (95% CI: 0.14–0.33. Senior patients tended to overestimate their pain intensity by a mean of 1.2 (95% CI: 0.9–1.5 units. A stepwise multiple regression analysis showed that the variance of baseline pain recall at 3 months was explained by pain at ED visit (11%, pain at 3 months (7%, and pain at baseline (2%. Conclusion. The accuracy of pain intensity recall after three months is poor in seniors and seems to be influenced by the pain experienced at the time of injury.

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

Negative beliefs about low back pain are associated with persistent high intensity low back pain.

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Ng, Sin Ki; Cicuttini, Flavia M; Wang, Yuanyuan; Wluka, Anita E; Fitzgibbon, Bernadette; Urquhart, Donna M

2017-08-01

While previous cross-sectional studies have found that negative beliefs about low back pain are associated with pain intensity, the relationship between back beliefs and persistent low back pain is not well understood. This cohort study aimed to examine the role of back beliefs in persistent low back pain in community-based individuals. A hundred and ninety-two participants from a previous musculoskeletal health study were invited to take part in a two-year follow-up study. Beliefs about back pain were assessed by the Back Beliefs Questionnaire (BBQ) at baseline and low back pain intensity was measured by the Chronic Pain Grade Questionnaire at baseline and follow-up. Of the 150 respondents (78.1%), 16 (10.7%) reported persistent high intensity low back pain, 12 (8.0%) developed high intensity low back pain, in 16 (10.7%) their high intensity low back pain resolved and 106 (70.7%) experienced no high intensity low back pain. While participants were generally positive about low back pain (BBQ mean (SD) = 30.2 (6.4)), those with persistent high intensity pain reported greater negativity (BBQ mean (SD) = 22.6 (4.9)). Negative beliefs about back pain were associated with persistent high intensity low back pain after adjusting for confounders (M (SE) = 23.5 (1.6) vs. >30.1 (1.7), p back beliefs were associated with persistent high intensity low back pain over 2 years in community-based individuals. While further longitudinal studies are required, these findings suggest that targeting beliefs in programs designed to treat and prevent persistent high intensity low back pain may be important.

Sex differences in pain anchors revisited: further investigation of "most intense" and common pain events.

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Robinson, Michael E; George, Steven Z; Dannecker, Erin A; Jump, Rebecca L; Hirsh, Adam T; Gagnon, Christine M; Brown, Jennifer L

2004-08-01

Recent research suggests that the interpretation of maximal endpoints of pain scales vary between sexes. The purposes of this study were to investigate sex differences in (a) maximal endpoints of pain scales and (b) bias, discrimination, and the "better than average effect" for ratings of common pain events. Study participants described and rated the intensity of events that were the "most intense pain imaginable" for the typical woman, typical man, and one's self. Study participants also described and rated the intensity of the "most painful" events they had experienced. Study participants completed the situational pain questionnaire (SPQ), which measured the amount of pain that the typical woman, typical man, or one's self would be expected to experience during thirty common painful events. One hundred and fifteen undergraduate psychology students completed this study. Men and women differed in the categories of events selected for most intense pain imaginable for one's self. There were no significant sex differences for the intensity of most intense self-imagined pain or most painful event experienced. However, women were more likely to report the intensity of their worst self-imagined pain event as 100/100. In addition, only women demonstrated a significant correlation between the intensity of most painful self-experienced event and intensity of most intense self-imagined event. Analyses of the SPQ discrimination scores revealed no sex or version differences. Analyses of the SPQ bias scores showed that both sexes indicated that the typical woman would rate the intensity of common pain events higher than would the typical man. Women rated the intensity of common pain events for themselves lower than for the typical woman, but higher than the typical man, and men rated also rated themselves as lower than the typical women, but the same as the typical man. Thus, there was inconsistent support for the "better than average effect". Future research is needed to

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

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van Aken, Mieke A W; Oosterman, Joukje M; van Rijn, C M; Ferdek, Magdalena A; Ruigt, Gé S F; Peeters, B W M M; Braat, Didi D M; Nap, Annemiek W

2017-10-01

To explore how pain intensity and pain cognition are related to health-related quality of life (HRQoL) in women with endometriosis. Cross-sectional questionnaire-based survey. Multidisciplinary referral center. Women with laparoscopically and/or magnetic resonance imaging-proven endometriosis (n = 50) and healthy control women (n = 42). For HRQoL, two questionnaires: the generic Short Form Health Survey (SF-36) and the Endometriosis Health Profile 30 (EHP-30). For pain cognition, three questionnaires: the Pain Catastrophizing Scale (PCS), the Pain Vigilance and Awareness Questionnaire (PVAQ), and the Pain Anxiety Symptoms Scale (PASS). For pain intensity, the verbal Numeric Rating Scale (NRS). Association between pain intensity and pain cognition with HRQoL in women with endometriosis, and the differences in HRQoL and pain cognition between women with endometriosis and healthy controls. Health-related quality of life was statistically significantly impaired in women with endometriosis as compared with healthy control women. The variables of pain intensity and pain cognition were independent factors influencing the HRQoL of women with endometriosis. Patients with endometriosis had statistically significantly more negative pain cognition as compared with controls. They reported more pain anxiety and catastrophizing, and they were hypervigilant toward pain. Pain cognition is independently associated with the HRQoL in endometriosis patients. Clinicians should be aware of this phenomenon and may consider treating pain symptoms in a multidimensional, individualized way in which the psychological aspects are taken into account. In international guidelines on management of women with endometriosis more attention should be paid to the psychological aspects of care. Copyright © 2017 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Intensive interdisciplinary outpatient pain management program for chronic back pain: a pilot study

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Artner J

2012-07-01

Full Text Available Juraj Artner, Stephan Kurz, Balkan Cakir, Heiko Reichel, Friederike LattigDepartment of Orthopaedic Surgery, University of Ulm, RKU, GermanyBackground: Chronic back pain is relatively resistant to unimodal therapy regimes. The aim of this study was to introduce and evaluate the short-term outcome of a three-week intensive multidisciplinary outpatient program for patients with back pain and sciatica, measured according to decrease of functional impairment and pain.Methods: The program was designed for patients suffering from chronic back pain to provide intensive interdisciplinary therapy in an outpatient setting, consisting of interventional injection techniques, medication, exercise therapy, back education, ergotherapy, traction, massage therapy, medical training, transcutaneous electrical nerve stimulation, aquatraining, and relaxation.Results: Based on Oswestry Disability Index (ODI and Numeric Rating Scale (NRS scores, a significant improvement in pain intensity and functionality of 66.83% NRS and an ODI of 33.33% were achieved by our pain program within 3 weeks.Conclusion: This paper describes the organization and short-term outcome of an intensive multidisciplinary program for chronic back pain on an outpatient basis provided by our orthopedic department, with clinically significant results.Keywords: chronic back pain, intense, multidisciplinary, program, outpatient

Effects of listening to music on pain intensity and pain distress after surgery: an intervention.

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Vaajoki, Anne; Pietilä, Anna-Maija; Kankkunen, Päivi; Vehviläinen-Julkunen, Katri

2012-03-01

To evaluate the effects of music listening on pain intensity and pain distress on the first and second postoperative days in abdominal surgery patients and the long-term effects of music on the third postoperative day. Music has been found to relieve pain intensity in surgery patients. There are only a few studies on music intervention in abdominal surgery. Music intervention studies assessing multidimensional pain such as pain intensity and pain distress are also scarce. Prospective clinical study with two parallel groups. Patients undergoing elective abdominal surgery (n = 168) were divided into either a music group (n = 83) or a control group (n = 85). Patients assessed pain intensity and pain distress in bed rest, during deep breathing and in shifting position once in the evening of the operation day and on the first and second postoperative days in the morning, at noon and in the evening. On the third postoperative day, the patients assessed their pain intensity and pain distress only once. In the music group, the patients' pain intensity and pain distress in bed rest, during deep breathing and in shifting position were significantly lower on the second postoperative day compared with control group of patients. On the third postoperative day, when long-term effects of music on pain intensity and pain distress were assessed, there were no significant differences between music and control groups. This study demonstrates that the use of music alleviates pain intensity and pain distress in bed rest, during deep breathing and in shifting position after abdominal surgery on the second postoperative day. Music intervention is safe, inexpensive and easily used to improve the healing environment for abdominal surgery patients. Music intervention should be offered as an adjunct alternative to pharmacological pain relief after abdominal surgery in nursing practice. © 2011 Blackwell Publishing Ltd.

Analysis of the cranio-cervical curvatures in subjects with migraine with and without neck pain.

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Ferracini, Gabriela Natália; Chaves, Thais Cristina; Dach, Fabíola; Bevilaqua-Grossi, Débora; Fernández-de-Las-Peñas, César; Speciali, José Geraldo

2017-12-01

To investigate the differences in head and cervical spine alignment between subjects with migraine and healthy people. A cross-sectional, observational study. Fifty subjects with migraine and 50 matched healthy controls. The presence of neck pain and neck pain-related disability was assessed. Four angles (high cervical angle, low cervical angle, atlas plane angle and cervical lordosis Cobb angle) as well as four distances (anterior translation distance, C0 to C1 distance, C2 to C7 posterior translation and hyoid triangle) were calculated using digitalised radiographs and analysed using K-Pacs ® software. Subjects with migraine reported a longer history of neck pain symptoms, and higher pain intensity and neck-pain-related disability than controls (Ppain was included in the analysis, the differences did not change. Differences in anterior translation and hyoid triangle distances were considered clinically relevant for subjects with migraine suffering from neck pain. Subjects with migraine exhibited straightening of cervical lordosis curvature. The presence of neck pain did not influence head posture in subjects with and without migraine. Copyright © 2017 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

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

2017-01-01

[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...

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.

Effects of a three-month therapeutic exercise programme on flexibility in subjects with low back pain.

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Kuukkanen, T; Mälkiä, E

2000-01-01

Spinal and muscle flexibility have been studied intensively and used clinically as outcome measurements in the rehabilitation of subjects with low back pain. The results of previous studies are contradictory and there is a lack of longitudinal data on the effects of long term therapeutic exercise on flexibility. A controlled experimental study was conducted to determine the effects of progressive therapeutic exercise on spinal and muscle flexibility. Eighty-six chronic low back pain subjects fulfilled the inclusion criteria and were divided into three study groups: (1) intensive training group, (2) home exercise group and (3) control group. The intervention period lasted three months and measurements were performed at both the beginning of the study and immediately after intervention. Follow-up measurements were carried out six and 12 months after baseline. Spinal flexibility was measured with lumbar flexion, extension, spinal lateral flexion and rotation, and muscle flexibility was measured with measurements of erector spinae, hamstring and iliopsoas muscles. Also self-reported outcomes of the Oswestry Index and Borg Scale--Back Pain Intensity were used. Associations between change (pre- to post-treatment) were determined for the dependent variables. The results showed no correlation between flexibility, the Oswestry Index or back pain intensity. After the first three-month period lumbar flexion, extension and spinal rotation decreased among all subjects. Spinal rotation and erector spinae muscle flexibility improved significantly with intensive training. At the nine-month follow-up, erector spine flexibility was still greater than at baseline. Hamstring flexibility increased among the intensive training and home exercise groups from pre- to post-intervention. However, the degree of hamstring flexibility gained during training was subsequently lost following the period without programmed exercise in both training groups. Self-reported outcome variables showed

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.

Do intensity ratings and skin conductance responses reliably discriminate between different stimulus intensities in experimentally induced pain?

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Breimhorst, Markus; Sandrock, Stephan; Fechir, Marcel; Hausenblas, Nadine; Geber, Christian; Birklein, Frank

2011-01-01

The present study addresses the question whether pain-intensity ratings and skin conductance responses (SCRs) are able to detect different intensities of phasic painful stimuli and to determine the reliability of this discrimination. For this purpose, 42 healthy participants of both genders were assigned to either electrical, mechanical, or laser heat-pain stimulation (each n = 14). A whole range of single brief painful stimuli were delivered on the right volar forearm of the dominant hand in a randomized order. Pain-intensity ratings and SCRs were analyzed. Using generalizability theory, individual and gender differences were the main contributors to the variability of both intensity ratings and SCRs. Most importantly, we showed that pain-intensity ratings are a reliable measure for the discrimination of different pain stimulus intensities in the applied modalities. The reliability of SCR was adequate when mechanical and heat stimuli were tested but failed for the discrimination of electrical stimuli. Further studies are needed to reveal the reason for this lack of accuracy for SCRs when applying electrical pain stimuli. Our study could help researchers to better understand the relationship between pain and activation of the sympathetic nervous system. Pain researchers are furthermore encouraged to consider individual and gender differences when measuring pain intensity and the concomitant SCRs in experimental settings. Copyright © 2011 American Pain Society. Published by Elsevier Inc. All rights reserved.

A meta-analysis of fear-avoidance and pain intensity: The paradox of chronic pain.

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Kroska, Emily B

2016-10-01

The fear-avoidance model of chronic pain has established avoidance as a predictor of negative outcomes in chronic pain patients. Avoidance, or deliberate attempts to suppress or prevent unwanted experiences (e.g., pain), has been studied extensively, with multiple reviews implicating this behavior as a predictor of disability, physical disuse, and depression. Despite hundreds of studies examining the associations between different components of this model (i.e., catastrophizing, fear, avoidance, depression), the association between fear-avoidance and pain intensity has remained unclear. The present study seeks to clarify this association across samples. The present analyses synthesize the literature (articles from PsycInfo, PubMed, and ProQuest) to determine if fear-avoidance and pain intensity are consistently correlated across studies, samples, and measures. Eligible studies measured pain intensity and fear-avoidance cross-sectionally in chronic pain patients. The search resulted in 118 studies eligible for inclusion. A random-effects model was used to estimate the weighted mean effect size. Comprehensive Meta-Analysis software was used for all analyses. Moderation analyses elucidate the variables that affect the strength of this association. Meta-regression and meta-ANOVA analyses were conducted to examine moderating variables. Moderator variables include demographic characteristics, pain characteristics, study characteristics, and national cultural characteristics (using Hofstede's cultural dimensions). Publication bias was examined using the funnel plot and the p-curve. Results indicate a small-to-moderate positive association between fear-avoidance and pain intensity. The results were stable across characteristics of the sample, including mean age, gender distribution, marital status, and duration of pain. Moderation analyses indicate that the measures utilized and cultural differences affect the strength of this association. Weaker effect sizes were observed

A Model-Based Approach for Joint Analysis of Pain Intensity and Opioid Consumption in Postoperative Pain

DEFF Research Database (Denmark)

Juul, Rasmus V; Knøsgaard, Katrine R; Olesen, Anne E

2016-01-01

Joint analysis of pain intensity and opioid consumption is encouraged in trials of postoperative pain. However, previous approaches have not appropriately addressed the complexity of their interrelation in time. In this study, we applied a non-linear mixed effects model to simultaneously study pain...... intensity and opioid consumption in a 4-h postoperative period for 44 patients undergoing percutaneous kidney stone surgery. Analysis was based on 748 Numerical Rating Scale (NRS) scores of pain intensity and 51 observed morphine and oxycodone dosing events. A joint model was developed to describe...... the recurrent pattern of four key phases determining the development of pain intensity and opioid consumption in time; (A) Distribution of pain intensity scores which followed a truncated Poisson distribution with time-dependent mean score ranging from 0.93 to 2.45; (B) Probability of transition to threshold...

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.

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

NARCIS (Netherlands)

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

2017-01-01

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

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

NARCIS (Netherlands)

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

2017-01-01

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

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

NARCIS (Netherlands)

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

2004-01-01

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

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.

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.

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

Directory of Open Access Journals (Sweden)

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

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

Science.gov (United States)

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

Pain progression, intensity and outcomes following tonsillectomy.

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Warnock, F F; Lander, J

1998-03-01

The objective of this study was to assess outcomes of pediatric day surgery tonsillectomy. A total of 129 children, aged 5-16 years, and their parents were recruited from three urban hospitals which provided pediatric day surgery. Children reported pain on a visual analogue scale (VAS) in day surgery and then daily at home for 7 days. Parents reported outcomes of surgery, including fluid intake, nausea, vomiting and sleep disturbances. They also recorded analgesic administration. Three main results related to extent and duration of pain, quality of management of pain, and effect of pain on utilization of health services. Tonsillectomy caused considerable pain which lasted more than 7 days. Pain followed a trajectory of intense or moderately intense pain for the first 3 days followed by a gradual decline over the next 4 days. In general, post-tonsillectomy pain was poorly managed by health professionals and parents. An unexpected observation was that children who had a bupivacaine infiltration of the tonsil fossa during surgery had significantly more pain in the evening of surgery than children who did not have an infiltration. The increase in postoperative pain experienced by those who had the infiltration was attributed to quality of pain management. Children with persistent pain (those who did not follow the typical trajectory) were likely to be taken to a medical practitioner. One-third of the sample made unscheduled visits to practitioners with most occurring from Day 4 to Day 7 of the follow-up.

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.

Influence of headache frequency on clinical signs and symptoms of TMD in subjects with temple headache and TMD pain.

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Anderson, Gary C; John, Mike T; Ohrbach, Richard; Nixdorf, Donald R; Schiffman, Eric L; Truelove, Edmond S; List, Thomas

2011-04-01

The relationship of the frequency of temple headache to signs and symptoms of temporomandibular joint (TMJ) disorders (TMD) was investigated in a subset of a larger convenience sample of community TMD cases. The study sample included 86 painful TMD, nonheadache subjects; 309 painful TMD subjects with varied frequency of temple headaches; and 149 subjects without painful TMD or headache for descriptive comparison. Painful TMD included Research Diagnostic Criteria for Temporomandibular Disorders diagnoses of myofascial pain, TMJ arthralgia, and TMJ osteoarthritis. Mild to moderate-intensity temple headaches were classified by frequency using criteria based on the International Classification of Headache Disorder, 2nd edition, classification of tension-type headache. Outcomes included TMD signs and symptoms (pain duration, pain intensity, number of painful masticatory sites on palpation, mandibular range of motion), pressure pain thresholds, and temple headache resulting from masticatory provocation tests. Trend analyses across the painful TMD groups showed a substantial trend for aggravation of all of the TMD signs and symptoms associated with increased frequency of the temple headaches. In addition, increased headache frequency showed significant trends associated with reduced PPTs and reported temple headache with masticatory provocation tests. In conclusion, these findings suggest that these headaches may be TMD related, as well as suggesting a possible role for peripheral and central sensitization in TMD patients. Copyright © 2010 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

[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

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...

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.

Deep pain thresholds in the distal limbs of healthy human subjects.

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Rolke, R; Andrews Campbell, K; Magerl, W; Treede, R-D

2005-02-01

Pressure pain thresholds (PPTs) in distal limbs have been under-investigated despite their potential clinical importance. Therefore, we compared PPTs over nail bed, bony prominences, and muscle in distal parts of upper and lower limbs. We investigated 12 healthy subjects using three handheld devices: a spring-loaded, analogue pressure threshold meter (PTM) with two operating ranges, and an electronic Algometer. PPTs were determined with three series of ascending stimulus intensities with a ramp of about 50 kPa/s. PPTs were normally distributed in logarithmic space. PPTs over different tissues varied significantly (ANOVA, pAlgometer than with PTMs (ANOVA, ptesting over muscle. There was no significant right-left difference (ANOVA, p=0.33). In spite of considerable variability across subjects, reproducibility within subjects was high (correlation coefficients>0.90). For within-subject comparisons, threshold elevations beyond 33-43% would be abnormal (95% confidence intervals), whereas only deviations from the group mean by at least a factor of two would be abnormal with respect to absolute normative values. PPTs over distal muscles were comparable to published values on proximal limb and trunk muscles. These findings suggest that pressure pain testing over distal muscles may be a sensitive test for deep pain sensitivity and that the simple and less expensive devices are sufficient for testing this tissue type. Intra-individual site-to-site comparisons will be more sensitive than absolute normative values.

[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.

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

DEFF Research Database (Denmark)

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

Directory of Open Access Journals (Sweden)

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

DEFF Research Database (Denmark)

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

DEFF Research Database (Denmark)

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.

Science.gov (United States)

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.

Effect of painful and non-painful sensorimotor manipulations on subjective body midline

Directory of Open Access Journals (Sweden)

Jason eBouffard

2013-03-01

Full Text Available Patients with chronic pain often show disturbances in their body perception. Understanding the exact role played by pain is however complex, as confounding factors can contribute to the observed deficits in these clinical populations. To address this question, acute experimental pain was used to test the effect of lateralized pain on body perception in healthy subjects. Subjects were asked to indicate the position of their body midline (subjective body midline, SBM by stopping a moving luminescent dot projected on a screen placed in front of them, in a completely dark environment. The effect of other nonpainful sensorimotor manipulations was also tested to assess the potential unspecific attentional effects of stimulating one side of the body. SBM judgment was made in seventeen volunteers under control and three experimental conditions: 1 painful (heat stimulation; 2 nonpainful vibrotactile stimulation; and 3 muscle contraction. The effects of the stimulated side and the type of trial (control vs. experimental condition, were tested separately for each condition with a 2 x 2 repeated measures ANOVA. The analyses revealed a significant interaction in both pain (p = 0.05 and vibration conditions (p = 0.04. Post-hoc tests showed opposite effects of pain and vibration. Pain applied on the right arm deviated the SBM toward the right (stimulated side (p = 0.03 while vibration applied on the left arm deviated the SBM toward the right (not stimulated side (p = 0.01. These opposite patterns suggest that the shift in SBM is likely to be specifically linked to the stimulation modality. It is concluded that acute experimental pain can induce an SBM shift toward the stimulated side, which might be functionally beneficial to protect the painful area of the body. Interestingly, it appears to be easier to bias SBM toward the right side, regardless of the modality and of the stimulated side.

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.

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

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

Science.gov (United States)

Hanssen, Denise J C; Naarding, Paul; Collard, Rose M; Comijs, Hannie C; Oude Voshaar, Richard C

2014-10-01

Late-life depression and pain more often co-occur than can be explained by chance. Determinants of pain in late-life depression are unknown, even though knowledge on possible determinants of pain in depression is important for clinical practice. Therefore, the objectives of the present study were 1) to describe pain characteristics of depressed older adults and a nondepressed comparison group, and 2) to explore physical, lifestyle, psychological, and social determinants of acute and chronic pain intensity, disability, and multisite pain in depressed older adults. Data from the Netherlands Study of Depression in Older Persons cohort, consisting of 378 depressed persons, diagnosed according to Diagnostic and Statistical Manual of Mental Disorders, 4th edition criteria, and 132 nondepressed persons aged 60 years and older, were used in a cross-sectional design. Pain characteristics were measured by the Chronic Graded Pain Scale. Multiple linear regression analyses were performed to explore the contribution of physical, lifestyle, psychological, and social determinants to outcomes pain intensity, disability, and the number of pain locations. Depressed older adults more often reported chronic pain and experienced their pain as more intense and disabling compared to nondepressed older adults. Adjusted for demographic, physical, and lifestyle characteristics, multinomial logistic regression analyses showed increased odds ratios (OR) for depression in acute pain (OR 3.010; P=0.005) and chronic pain (OR 4.544, Presearch could focus on the temporal relationship between anxiety, late-life depression, and pain. Copyright © 2014 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

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.

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

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

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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....

Properties of tonic episodes of masseter muscle activity during waking hours and sleep in subjects with and without history of orofacial pain.

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Mude, Acing Habibie; Kawakami, Shigehisa; Kato, Seiya; Minagi, Shogo

2018-04-01

To provide a scientific data related to the tonic activity of masseter muscle in subjects with and without history of orofacial pain during their normal daily life. Thirty-three subjects were divided into two groups, a pain history group (PHG) and a non-pain history group (non-PHG), based on their responses to the Research Diagnostic Criteria for Temporomandibular Disorders questionnaire. After excluding four subjects with incomplete recordings, full-day masseter muscle surface EMGs of 29 subjects (10 men, 19 women; mean age 24.1 years) were analyzed. Tonic episode (TE) was defined as continuous EMG activity with a duration at least 2s with intensities above twice the baseline noise level. TEs were classified into 6 strength categories (40% of the maximum voluntary clenching (MVC)). The mean duration of activity observed in the non-PHG+2 SD was adopted as a cutoff for identifying sustained TE. During waking hours, the incidence of sustained TEs was significantly higher in the PHG than in the non-PHG (porofacial pain and the intensity range of 7.5-25% MVC would be an important range for future clenching studies. Copyright © 2017. Published by Elsevier Ltd.

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.

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.

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

Schedule-induced masseter EMG in facial pain subjects vs. no-pain controls.

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Gramling, S E; Grayson, R L; Sullivan, T N; Schwartz, S

1997-02-01

Empirical reports suggest that oral habits (e.g., teeth clenching) may be behavioral mediators linking stress to muscle hyperreactivity and the development of facial pain. Another report suggests that excessive behavioral adjuncts develop in conjunction with fixed-time stimulus presentation. The present study assessed the extent to which the oral habits exhibited by facial pain patients are schedule-induced. Subjects with Temporomandibular Disorder (TMD) symptomatology (n = 15) and pain-free controls (n = 15) participated in a 4-phase experiment (adaptation, baseline, task, recovery) designed to elicit schedule-induced behaviors. Self-report of oral habits and negative affect were recorded after each phase. Objective measures of oral habits were obtained via behavioral observation and masseter EMG recordings. Results revealed that negative arousal significantly increased during the fixed-time (FT) task and was also associated with increased oral habits among the TMD subjects. Moreover, 40% of the TMD subjects and none of the controls exhibited a pattern of EMG elevations in the early part of the inter-stimulus interval that met a strict criteria for scheduled-induced behavior per se. Taken together, these results suggest that the TMD subjects were engaging in schedule-induced oral habits. The adjunctive behavior literature seems to provide a plausible explanation as to how oral habits develop and are maintained in TMD patients, despite their painful consequences.

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.

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.

[Subject and pain: introduction to a philosophy of medicine].

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Pérez Marc, Gonzalo

2010-10-01

Pain cannot be explained. It may only be understood from the most unpleasant of positions: suffering it. Thus, in the attempt to account for its multiple occurrences, meanings and mechanisms, developing a philosophy of pain appears to be essential. The approach to these issues by traditional occidental medicine has not considered the particular language in their background, which contains a double subjectivity: the subjectivity it represents itself, and that which frames the relationship between the agents where this language circulates. Articulating traditional scientific medicine with social, anthropological, and artistic disciplines would allow for a satisfactory response to this double subjectiveness, resulting in a deep change in current pain therapies.

The Effects of Counterforce Brace Size on the Wrist Range of Motility, Pain, Grip & Wrist Extension Sterngth in Normal Subjects and Patients with Tennis Elbow

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Ali Asghar Jameh-Bozorgi

2006-04-01

Full Text Available Objective: Counter force brace is one of the most usefull treatments for lateral opicondylitis (Tennis elbow because it decreases grip pain and increases the power of grip, power of wrist extension and Wrist Range of Motility. The purpose of this quasi experimental (repeated measurementsstudy was to determine the effect of 3 counterforce brace sizes on the wrist R.O.M, grip and wrist extension strength and pain intensity in two groups of healthy subjects and patients with tennis elbow. Materials & Methods: 18 normal subjects & 18 patients with tennis elbow were selected simple conveniently and were tested with no brace and 3 size of counterforce (1,2 and 3 inches. The R.O.M , strength and pain intensity were measured by jamar goniometry and Nicholas MMT dynamometry & VAS, respectively. Results: 1 With all sizes there was a significant decrease of R.O.M on normal subjects but no significant difference in patients. 2 There was a significant decrease of grip strength with 1-inch brace in normal subjects but a significant increase of grip strength with 2 and 3-inch brace in patiens. 3 All sizes of brace caused significant decrease of extension strength in normal subjects but increase in patients. 4All size caused significant decrease of pain intensity that was more considerable in the case of 2 and 3 inch size. Conclusion: The results shows that the counterforce brace may be considered as an effective treatment for increasing strength and decreasing pain in patients with tennis elbow.

Modification of electrical pain threshold by voluntary breathing-controlled electrical stimulation (BreEStim in healthy subjects.

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Shengai Li

Full Text Available BACKGROUND: Pain has a distinct sensory and affective (i.e., unpleasantness component. BreEStim, during which electrical stimulation is delivered during voluntary breathing, has been shown to selectively reduce the affective component of post-amputation phantom pain. The objective was to examine whether BreEStim increases pain threshold such that subjects could have improved tolerance of sensation of painful stimuli. METHODS: Eleven pain-free healthy subjects (7 males, 4 females participated in the study. All subjects received BreEStim (100 stimuli and conventional electrical stimulation (EStim, 100 stimuli to two acupuncture points (Neiguan and Weiguan of the dominant hand in a random order. The two different treatments were provided at least three days apart. Painful, but tolerable electrical stimuli were delivered randomly during EStim, but were triggered by effortful inhalation during BreEStim. Measurements of tactile sensation threshold, electrical sensation and electrical pain thresholds, thermal (cold sensation, warm sensation, cold pain and heat pain thresholds were recorded from the thenar eminence of both hands. These measurements were taken pre-intervention and 10-min post-intervention. RESULTS: There was no difference in the pre-intervention baseline measurement of all thresholds between BreEStim and EStim. The electrical pain threshold significantly increased after BreEStim (27.5±6.7% for the dominant hand and 28.5±10.8% for the non-dominant hand, respectively. The electrical pain threshold significantly decreased after EStim (9.1±2.8% for the dominant hand and 10.2±4.6% for the non-dominant hand, respectively (F[1, 10] = 30.992, p = .00024. There was no statistically significant change in other thresholds after BreEStim and EStim. The intensity of electrical stimuli was progressively increased, but no difference was found between BreEStim and EStim. CONCLUSION: Voluntary breathing controlled electrical stimulation

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.

Low pain intensity after opioid withdrawal as a first step of a comprehensive pain rehabilitation program predicts long-term nonuse of opioids in chronic noncancer pain.

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Krumova, Elena K; Bennemann, Philipp; Kindler, Doris; Schwarzer, Andreas; Zenz, Michael; Maier, Christoph

2013-09-01

In specialized pain clinics there is an increasing number of patients with severe chronic noncancer pain (CNCP) despite long-term opioid medication. Few clinical studies show short-term pain relief after opioid withdrawal (OW). We have evaluated the relation between pain intensity after OW and long-term opioid nonuse. One hundred two consecutive patients with severe CNCP despite opioid medication (mean treatment duration, 43 mo) reported pain intensity (numerical rating scale, 0 to 10), Pain Disability Index, mood (CES-D), and quality of life (Short Form 36) before, shortly, and 12 to 24 months after inpatient OW. Total opioid withdrawal (n = 78) or significant dose reduction (DR; n = 24, mean reduction, 82%) was performed after individual decision. Opioid intake 12 to 24 months later, respectively dose increase ≥ 100% (DR group), was considered relapse. T tests, multivariable analysis of variance, logistic regression. After OW current pain intensity significantly decreased on an average by 41% (6.4 ± 2.4 vs. 3.8 ± 2.5), maximal and average pain by 18% and 24%, respectively. Twelve to 24 months later 42 patients (41%) relapsed (31 of the total opioid withdrawal group, 6 of the DR group, 5 lost). Patients without later relapse showed significantly lower pain scores than the later relapsed patients already shortly after OW (5.0 ± 2.2 vs. 5.9 ± 2.1) and 12 to 24 months later (5.5 ± 2.4 vs. 6.5 ± 2.0). There was a significant relation between relapse probability and pain intensity immediately after OW. In many patients with severe CNCP, despite opioid medication, sustainable pain relief can be achieved if OW is included in the rehabilitation program. Consequently, we recommend OW for opioid-resistant CNCP before any opioid escalation. Lower pain intensity shortly after OW may predict the long-term opioid nonuse probability.

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

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.

Forefoot deformity, pain, and mobility in rheumatoid and nonarthritic subjects.

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O'Connell, P G; Lohmann Siegel, K; Kepple, T M; Stanhope, S J; Gerber, L H

1998-09-01

To evaluate how painful metatarsal arthritis affects foot and ankle mechanics and mobility. We studied 16 symptomatic forefeet in 10 patients with rheumatoid arthritis (RA) and compared them with 14 asymptomatic forefeet in 7 nonarthritic subjects. RA limbs with significant disease at other locations were excluded. We measured pain and deformity of the foot using a visual analog scale and a modified articular index. A video based 3 dimensional gait analysis system and force platform were used to collect data on subjects walking barefoot at a self-selected pace according to an established protocol. Mobility level was quantified using the Sickness Impact Profile (SIP) ambulation subscale. We observed considerable pain and deformity of the forefeet of RA subjects. During gait, motion and force measures revealed that RA subjects significantly (p SIP scores revealed that these changes in gait resulted in moderate disability in RA subjects (p=0.05). Impairments of the forefoot due to RA include pain and deformity, which produce characteristic stance phase abnormalities in foot function, a slow walking speed, and moderate disability.

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.

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

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

VASTUS LATERALIS OBLIQUE ACTIVITY DURING GAIT OF SUBJECTS WITH PATELLOFEMORAL PAIN

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Gilmar Moraes Santos

Full Text Available ABSTRACT Introduction: So far, little is known about the behavior of electromyographic activity of vastus lateralis oblique muscle during treadmill gait in subjects with and without patellofemoral pain syndrome. Objective: The purpose of this study was to investigate the electromyographic activity of the patellar stabilizers muscles and the angle of the knee joint flexion in subjects with and without patellofemoral pain syndrome. Method: Fifteen subjects without (21 ± 3 years and 12 with patellofemoral pain syndrome (20 ± 2 years were evaluated. The electromyographic activity and flexion angle of the knee joint were obtained during gait on the treadmill with a 5 degree inclination. Results: The knee flexion angle was significantly lower in the subjects with patellofemoral pain syndrome when compared with the healthy controls. The electromyographic activity of vastus lateralis longus was significantly greater during gait on the treadmill with inclination in subjects with patellofemoral pain syndrome. The results also showed that the electromyographic activity of vastus lateralis oblique and vastus medialis oblique were similar in both groups, regardless of the condition (with/without inclination. Conclusion: We have shown that knee kinematics during gait differs among patients with and without patellofemoral pain syndrome and healthy controls and that a different motor strategy persists even when the pain is no longer present. In addition, the findings suggested that the vastus lateralis oblique has a minor role in patellar stability during gait.

Subjective pain perception during calculus detection with use of a periodontal endoscope.

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Poppe, Kjersta; Blue, Christine

2014-04-01

Periodontal endoscopes are relatively new to the dental field. The purpose of this study was to determine the amount of pain reported by subjects with periodontal disease after experiencing the use of a periodontal endoscope compared with the use of a periodontal probe during calculus detection. A total of 30 subjects with at least 4 sites of 5 to 8 mm pocket depths were treated with scaling and root planing therapy in a split-mouth design. The 2 quadrants were randomly assigned to either S/RP with tactile determination of calculus using an 11/12 explorer, or S/RP treatment with endoscopic detection of calculus. Each subject's pain experience was determined by via a Heft-Parker Visual Analogue Scale (VAS), which measured perceived pain level during periodontal probing and during subgingival visualization via endoscopy. Since subjects expressing some level of dental anxiety generally express increased levels of pain, a pre-treatment survey was also given to determine each subject's level of dental anxiety in order to eliminate dental anxiety as a confounding factor in determining the expressed level of pain. The level of perceived pain was significantly lower with the periodontal endoscope versus the probe (mean VAS 33.0 mm versus 60.2 mm, pdental anxiety did express increased pain levels, but these levels were not statistically significant. Subjects did not find the periodontal endoscope to elicit significant anxiety or pain during subgingival visualization.

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.

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.

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.

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.

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

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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)

Activity of masticatory muscles in subjects with different orofacial pain conditions.

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Bodéré, Céline; Téa, Say Hack; Giroux-Metges, Marie Agnes; Woda, Alain

2005-07-01

The existence of a pathophysiological link between tonic muscle activity and chronic muscle pain is still being debated. The purpose of this retrospective, controlled study was to evaluate the electromyographic (EMG) activity of masticatory muscles in subjects with different orofacial pain conditions. The temporal and masseter EMG activity at rest and the masseteric reflex were recorded in two groups of patients with either myofascial pain (n=33) or neuropathic pain (n=20), one group of non-pain patients with disc derangement disorders (n=27) and one control group of healthy, asymptomatic subjects (n=32). The EMG activities of both muscles at rest were significantly higher in the pain patient groups compared to the asymptomatic control group. There was no significant difference between the disc derangement disorder group and the control group. The masseteric reflex amplitude was reduced in all patient groups when compared with the control group. In pain patient groups, the increased EMG activity at rest and the reduction of the masseteric reflex amplitude were equally distributed in the pain and non-pain sides. In addition, subjects presenting with bilateral pain showed higher EMG activity at rest than those with unilateral pain. These results suggested that the modulation of muscle activity was not the direct consequence of a peripheral nociceptive mechanism and seemed to indicate that a central mechanism was at work. The contrast between the increased EMG activity at rest and the reduction of the masseteric reflex amplitude may reflect modulations of motoneurones that differed in tonic versus phasic conditions in chronic pain patients.

Sleep quality in subjects suffering from chronic pain.

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Keilani, Mohammad; Crevenna, Richard; Dorner, Thomas Ernst

2018-01-01

Sleeping problems are very common in patients with chronic pain. The aim of the study was to investigate the association between different dimensions of chronic pain and sleep quality in chronic pain patients. In this cross-sectional interview-based questionnaire study, patients from 3 different pain treatment centers in Vienna aged 18-65 years, with pain lasting 3 months or longer were asked to participate. The association between the short-form McGill pain questionnaire (SF-MPQ) and sleep quality (sleep onset latency, interrupted sleep due to pain, sleep duration and recovering effect of sleep) was assessed. In this study 121 patients (male 32, female 89, mean age 49 ± 9 years) could be analyzed. Of the patients 38.8% needed more than 30 min for falling asleep, 63.6% reported sleep fragmentation, 30.6% slept less than 5 h and 60.3% reported no recovering effect of sleep. The strongest associations between pain characteristics and sleep quality were found for pain intensity and affective pain aspects. Logistic regression analyses revealed that one point more in the total score of SF-MPQ increased the odds of needing more than 30 min for falling asleep, waking up more than 3 times due to pain, sleeping less than 5 h, and perceiving the sleep as non-recovering, by 6%. Adjusting for physical and psychological quality of life lowered the odds ratios and the association was no longer significant. The results underline the importance of paying attention to sleep quality in patients with chronic pain. The results also indicate that psychological factors might mediate the association between pain and sleep quality.

Do Subjects with Whiplash-Associated Disorders Respond Differently in the Short-Term to Manual Therapy and Exercise than Those with Mechanical Neck Pain?

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Castaldo, Matteo; Catena, Antonella; Chiarotto, Alessandro; Fernández-de-Las-Peñas, César; Arendt-Nielsen, Lars

2017-04-01

To compare the short-term effects of manual therapy and exercise on pain, related disability, range of motion, and pressure pain thresholds between subjects with mechanical neck pain and whiplash-associated disorders. Twenty-two subjects with mechanical neck pain and 28 with whiplash-associated disorders participated. Clinical and physical outcomes including neck pain intensity, neck-related disability, and pain area, as well as cervical range of motion and pressure pain thresholds over the upper trapezius and tibialis anterior muscles, were obtained at baseline and after the intervention by a blinded assessor. Each subject received six sessions of manual therapy and specific neck exercises. Mixed-model repeated measures analyses of covariance (ANCOVAs) were used for the analyses. Subjects with whiplash-associated disorders exhibited higher neck-related disability ( P  = 0.021), larger pain area ( P  = 0.003), and lower pressure pain thresholds in the tibialis anterior muscle ( P  = 0.009) than those with mechanical neck pain. The adjusted ANCOVA revealed no between-group differences for any outcome (all P  > 0.15). A significant main effect of time was demonstrated for clinical outcomes and cervical range of motion with both groups experiencing similar improvements (all P   0.222). The current clinical trial found that subjects with mechanical neck pain and whiplash-associated disorders exhibited similar clinical and neurophysiological responses after a multimodal physical therapy intervention, suggesting that although greater signs of central sensitization are present in subjects with whiplash-associated disorders, this does not alter the response in the short term to manual therapy and exercises. © 2016 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

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.

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.

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

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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

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.

Subjective assessment of kinesitherapy as an element of comprehensive rehabilitation process of subjects with lower spine pain

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Wioletta Łubkowska

2016-02-01

  Abstract Background. Spinal pain has triggered interest in many fields of medicine, such as orthopedics, neurology, rheumatology, and rehabilitation. Despite ongoing development of surgery techniques, a major role is played by fitness improvement treatments, which need to be promoted. The aim of the research was a subjective assessment of kinesitherapy as an element of comprehensive rehabilitation process of subjects with lower spine pain. Material/Methods. This paper has an empirical character. The research was conducted amongst a randomly selected group of 60 patients of Independent Public Health Care Unit in Choszczno, Poland (rehabilitation at an outpatients’ clinic, aged 20-51. All of them were subjected to a series of 10 kinesitherapy treatments. The research used diagnostic polling method and the following techniques: survey and implicit interview. Results. The research proved that after completion of 10 treatments, the subjects noticed a significant improvement of their health. Kinesitherapy helped return to an active professional life for those who were forced to resign or suspend their work. Subjects reported that 10 kinesitherapy treatments were enough to notice their effectiveness in lumbar spine pain reduction. Kinesitherapy treatments resulted in a reduced usage of painkillers. Conclusions. There is evidence of positive impact of physical exercise on treatment results and beneficial effects in patients with spinal pain. Proper education aimed at changing bad habits and advising how to care for spine may be a powerful way to fight for health.   Keywords: spine, pain syndromes, lumbar spine, kinesitherapy, curative exercises, improving fitness.

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.

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.

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.

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.

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.

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.

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®.

Assessment of patient satisfaction with pain management in small community inpatient and outpatient settings.

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Corizzo, C C; Baker, M C; Henkelmann, G C

2000-09-01

To describe patient outcomes (e.g., pain intensity and relief, satisfaction, expectations) and analgesic practices of healthcare providers for inpatients and outpatients in community hospital settings. Descriptive, correlational, and random sampling. Three community-based institutions in southeast Louisiana. 114 inpatients and outpatients with cancer-related or acute postoperative pain. Inpatients (n = 68) mostly were women and younger than 60 years of age. Outpatients (n = 46) mostly were men and older than 60 years of age. Both groups were predominantly well-educated and Caucasian. Subjects completed a modified version of the American Pain Society's Patient Satisfaction Survey. Researchers completed a chart audit tool reviewing analgesic prescriptive and administrative practices. Weak to moderately strong correlations existed for the relationships between the satisfaction variables and the pain intensity, pain relief, and expectation variables for all subjects. Satisfaction with current pain intensity was correlated most strongly with pain intensity and relief scores. Higher pain intensity and relief were related to lower satisfaction with current pain intensity. Regardless of setting or pain type, subjects experienced significant amounts of pain during a 24-hour period. Patient expectations for experiencing high levels of pain were realized, but expectations for significant pain relief were not. Institutional pain management programs that approach pain from a multidimensional perspective need to be developed. Continued education for healthcare professionals and patients is a vital part of this process.

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.

Insula-specific responses induced by dental pain. A proton magnetic resonance spectroscopy study

International Nuclear Information System (INIS)

Gutzeit, A.; Weymarn, C. von; Froehlich, J.M.; Binkert, C.A.; Meier, D.; Meier, M.L.; Bruegger, M.; Ettlin, D.A.; Graf, N.

2011-01-01

To evaluate whether induced dental pain leads to quantitative changes in brain metabolites within the left insular cortex after stimulation of the right maxillary canine and to examine whether these metabolic changes and the subjective pain intensity perception correlate. Ten male volunteers were included in the pain group and compared with a control group of 10 other healthy volunteers. The pain group received a total of 87-92 electrically induced pain stimuli over 15 min to the right maxillary canine tooth. Contemporaneously, they evaluated the subjective pain intensity of every stimulus using an analogue scale. Neurotransmitter changes within the left insular cortex were evaluated by MR spectroscopy. Significant metabolic changes in glutamine (+55.1%), glutamine/glutamate (+16.4%) and myo-inositol (-9.7%) were documented during pain stimulation. Furthermore, there was a significant negative correlation between the subjective pain intensity perception and the metabolic levels of Glx, Gln, glutamate and N-acetyl aspartate. The insular cortex is a metabolically active region in the processing of acute dental pain. Induced dental pain leads to quantitative changes in brain metabolites within the left insular cortex resulting in significant alterations in metabolites. Negative correlation between subjective pain intensity rating and specific metabolites could be observed. (orig.)

Insula-specific responses induced by dental pain. A proton magnetic resonance spectroscopy study

Energy Technology Data Exchange (ETDEWEB)

Gutzeit, A.; Weymarn, C. von; Froehlich, J.M.; Binkert, C.A. [Cantonal Hospital Winterthur, Department of Radiology, Winterthur (Switzerland); Meier, D. [University and ETH Zurich, Institute for Biomedical Engineering, Zurich (Switzerland); Meier, M.L.; Bruegger, M. [University of Zurich, Institute of Psychology, Division Neuropsychology, Zurich (Switzerland); Ettlin, D.A. [University of Zuerich, Center for Dental and Oral Medicine and Cranio-Maxillofacial Surgery, Clinic for Removable Prosthodontics, Masticatory Disorders and Special Care Dentistry, Zuerich (Switzerland); Graf, N. [University Hospital of Zurich, Clinical Trials Center, Center for Clinical Research, Zurich (Switzerland)

2011-04-15

To evaluate whether induced dental pain leads to quantitative changes in brain metabolites within the left insular cortex after stimulation of the right maxillary canine and to examine whether these metabolic changes and the subjective pain intensity perception correlate. Ten male volunteers were included in the pain group and compared with a control group of 10 other healthy volunteers. The pain group received a total of 87-92 electrically induced pain stimuli over 15 min to the right maxillary canine tooth. Contemporaneously, they evaluated the subjective pain intensity of every stimulus using an analogue scale. Neurotransmitter changes within the left insular cortex were evaluated by MR spectroscopy. Significant metabolic changes in glutamine (+55.1%), glutamine/glutamate (+16.4%) and myo-inositol (-9.7%) were documented during pain stimulation. Furthermore, there was a significant negative correlation between the subjective pain intensity perception and the metabolic levels of Glx, Gln, glutamate and N-acetyl aspartate. The insular cortex is a metabolically active region in the processing of acute dental pain. Induced dental pain leads to quantitative changes in brain metabolites within the left insular cortex resulting in significant alterations in metabolites. Negative correlation between subjective pain intensity rating and specific metabolites could be observed. (orig.)

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.

Socio-material assemblies, the subjectivity of pain and work identity

DEFF Research Database (Denmark)

Nickelsen, Niels Christian Mossfeldt

2015-01-01

Based on science and technology studies (STS) and actor-network theory (ANT) a roleplay from a production hall, is discussed in relation to the notions of subjectivity and work identity. The article argues that an instance of arthralgia (pain) may both be seen as an effect and a driver of human–machine......-material translations. This article is predominantly a methodological one that discusses the performance and effects of the subjectivity of pain and argues that pain may be seen as a pivotal actor in the construction not only of an ongoing controversy among production workers and engineers, but also of different work...... identities.. It is argued that pain should not simply be seen as illness, or as resistance against the dominant engineering practice and general increase of speed, but also as an important actor in mobilizing a machine operator network. The strength of the analytical approach is that it elucidates...

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

Experience with dental pain and fear of dental pain

NARCIS (Netherlands)

van Wijk, A.J.; Hoogstraten, J.

2005-01-01

Anxious people tend to overestimate the intensity of aversive events such as fear and pain. When an aversive event has been experienced personally, prediction is based on experience and is possibly less subject to bias due to anxiety. Therefore, it was hypothesized that subjects will overestimate

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.

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

Pilates versus general exercise effectiveness on pain and functionality in non-specific chronic low back pain subjects.

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Mostagi, Fernanda Queiroz Ribeiro Cerci; Dias, Josilainne Marcelino; Pereira, Ligia Maxwell; Obara, Karen; Mazuquin, Bruno Fles; Silva, Mariana Felipe; Silva, Monica Angelica Cardoso; de Campos, Renata Rosa; Barreto, Maria Simone Tavares; Nogueira, Jéssyca Fernandes; Lima, Tarcísio Brandão; Carregaro, Rodrigo Luiz; Cardoso, Jefferson Rosa

2015-10-01

Low back pain (LBP) is one of the most common causes of disability, and the Pilates method has been associated with improvements in symptoms. The purpose of this study was to assess the effectiveness of the Pilates method, when compared to general exercises, on pain and functionality after eight weeks (16 sessions, 2×/week) and a follow-up of three months, in subjects with non-specific chronic low back pain (NSCLBP). A randomised controlled trial composed of 22 subjects was proposed. Subjects were allocated into two groups: the Pilates group (PG) (n = 11) and the general exercise group (GEG) (n = 11). The PG protocol was based on the Pilates method and the GEG performed exercises to manage NSCLBP. There were no differences between the groups. When analysed over time, the GEG demonstrated improvements in functionality between baseline and the end of treatment (P = .02; Cohen'sd¯ = 0.34) and baseline and follow-up (P = .04; Cohen'sd¯ = 0.31). There were no differences between the Pilates and general exercises with regard to pain and functionality in NSCLBP subjects but general exercises were better than Pilates for increasing functionality and flexibility. Copyright © 2014 Elsevier Ltd. All rights reserved.

Differential effects of painful and non-painful stimulation on tactile processing in fibromyalgia syndrome and subjects with masochistic behaviour.

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Bettina Pollok

Full Text Available BACKGROUND: In healthy subjects repeated tactile stimulation in a conditioning test stimulation paradigm yields attenuation of primary (S1 and secondary (S2 somatosensory cortical activation, whereas a preceding painful stimulus results in facilitation. METHODOLOGY/PRINCIPAL FINDINGS: Since previous data suggest that cognitive processes might affect somatosensory processing in S1, the present study aims at investigating to what extent cortical reactivity is altered by the subjective estimation of pain. To this end, the effect of painful and tactile stimulation on processing of subsequently applied tactile stimuli was investigated in patients with fibromyalgia syndrome (FMS and in subjects with masochistic behaviour (MB by means of a 122-channel whole-head magnetoencephalography (MEG system. Ten patients fulfilling the criteria for the diagnosis of FMS, 10 subjects with MB and 20 control subjects matched with respect to age, gender and handedness participated in the present study. Tactile or brief painful cutaneous laser stimuli were applied as conditioning stimulus (CS followed by a tactile test stimulus (TS 500 ms later. While in FMS patients significant attenuation following conditioning tactile stimulation was evident, no facilitation following painful stimulation was found. By contrast, in subjects with MB no attenuation but significant facilitation occurred. Attenuation as well as facilitation applied to cortical responses occurring at about 70 ms but not to early S1 or S2 responses. Additionally, in FMS patients the amount of attenuation was inversely correlated with catastrophizing tendency. CONCLUSION: The present results imply altered cortical reactivity of the primary somatosensory cortex in FMS patients and MB possibly reflecting differences of individual pain experience.

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.

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

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

Portable Brain-Computer Interface for the Intensive Care Unit Patient Communication Using Subject-Dependent SSVEP Identification.

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Dehzangi, Omid; Farooq, Muhamed

2018-01-01

A major predicament for Intensive Care Unit (ICU) patients is inconsistent and ineffective communication means. Patients rated most communication sessions as difficult and unsuccessful. This, in turn, can cause distress, unrecognized pain, anxiety, and fear. As such, we designed a portable BCI system for ICU communications (BCI4ICU) optimized to operate effectively in an ICU environment. The system utilizes a wearable EEG cap coupled with an Android app designed on a mobile device that serves as visual stimuli and data processing module. Furthermore, to overcome the challenges that BCI systems face today in real-world scenarios, we propose a novel subject-specific Gaussian Mixture Model- (GMM-) based training and adaptation algorithm. First, we incorporate subject-specific information in the training phase of the SSVEP identification model using GMM-based training and adaptation. We evaluate subject-specific models against other subjects. Subsequently, from the GMM discriminative scores, we generate the transformed vectors, which are passed to our predictive model. Finally, the adapted mixture mean scores of the subject-specific GMMs are utilized to generate the high-dimensional supervectors. Our experimental results demonstrate that the proposed system achieved 98.7% average identification accuracy, which is promising in order to provide effective and consistent communication for patients in the intensive care.

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

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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.

The influence of working memory capacity on experimental heat pain.

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Nakae, Aya; Endo, Kaori; Adachi, Tomonori; Ikeda, Takashi; Hagihira, Satoshi; Mashimo, Takashi; Osaka, Mariko

2013-10-01

Pain processing and attention have a bidirectional interaction that depends upon one's relative ability to use limited-capacity resources. However, correlations between the size of limited-capacity resources and pain have not been evaluated. Working memory capacity, which is a cognitive resource, can be measured using the reading span task (RST). In this study, we hypothesized that an individual's potential working memory capacity and subjective pain intensity are related. To test this hypothesis, we evaluated 31 healthy participants' potential working memory capacity using the RST, and then applied continuous experimental heat stimulation using the listening span test (LST), which is a modified version of the RST. Subjective pain intensities were significantly lower during the challenging parts of the RST. The pain intensity under conditions where memorizing tasks were performed was compared with that under the control condition, and it showed a correlation with potential working memory capacity. These results indicate that working memory capacity reflects the ability to process information, including precise evaluations of changes in pain perception. In this work, we present data suggesting that changes in subjective pain intensity are related, depending upon individual potential working memory capacities. Individual working memory capacity may be a phenotype that reflects sensitivity to changes in pain perception. Copyright © 2013 American Pain Society. Published by Elsevier Inc. All rights reserved.

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.

Mode of action of cupping--local metabolism and pain thresholds in neck pain patients and healthy subjects.

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Emerich, M; Braeunig, M; Clement, H W; Lüdtke, R; Huber, R

2014-02-01

Cupping worldwide has been part of traditional medicine systems and is in the western world used as CAM therapy mainly for treating pain syndromes. The mode of action is up to now unclear. In order to investigate its mechanism we measured in parallel metabolic changes in the tissue under the cupping glass and pressure pain thresholds. In 12 volunteers (6 healthy subjects and 6 patients with chronic neck pain) a microdialysis system was implanted subcutaneously on both sides (left and right) above the trapezius muscle. After baseline measures cupping was performed at one randomly selected side (left or right), the other side served as control. Every 20 min during baseline measures and for 280 min after cupping, microdialysis probes for detection of lactate, pyruvate, glucose and glycerin were taken. In addition, pain thresholds were measured before and after cupping with algometry. Cupping resulted in a strong increase of lactate (beginning 160 min after cupping until the end of the measurements) and the lactate/pyruvate ratio, indicating an anaerobe metabolism in the surrounding tissue. Baseline pain thresholds were non-significantly lower in neck pain patients compared to healthy controls and slightly increased immediately after cupping (pcupping in healthy subjects and on the foot in neck pain patients). After 280 min no more significant changes of pain thresholds were detected. Cupping induces >280 min lasting anaerobe metabolism in the subcutaneous tissue and increases immediate pressure pain thresholds in some areas. Copyright © 2014 Elsevier Ltd. All rights reserved.

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

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

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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.

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.

Influence of chronic neck pain on cervical joint position error (JPE): Comparison between young and elderly subjects.

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Alahmari, Khalid A; Reddy, Ravi Shankar; Silvian, Paul; Ahmad, Irshad; Nagaraj, Venkat; Mahtab, Mohammad

2017-11-06

Evaluation of cervical joint position sense in subjects with chronic neck pain has gained importance in recent times. Different authors have established increased joint position error (JPE) in subjects with acute neck pain. However, there is a paucity of studies to establish the influence of chronic neck pain on cervical JPE. The objective of the study was to understand the influence of chronic neck pain on cervical JPE, and to examine the differences in cervical JPE between young and elderly subjects with chronic neck pain. Forty-two chronic neck pain patients (mean age 47.4) were compared for cervical JPE with 42 age-matched healthy subjects (mean age 47.8), using a digital inclinometer. The cervical JPE were measured in flexion, extension, and rotation in right and left movement directions. The comparison of JPE showed significantly larger errors in subjects with chronic neck pain when compared to healthy subjects (ppain revealed no significant differences (P> 0.05) in cervical JPE. Cervical joint position sense is impaired in subjects with chronic neck pain.

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.

Prevalence and Risk Factor of Neck Pain in Elderly Korean Community Residents

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Son, Kyeong Min; Cho, Nam H.; Lim, Seung Hun

2013-01-01

Neck pain is a common musculoskeletal condition, which causes substantial medical cost. In Korea, prevalence of neck pain in community based population, especially in elderly subjects, has scarcely been reported. We evaluated the prevalence, the severity and the risk factors of neck pain in elderly Korean community residents. Data for neck pain were collected for 1,655 subjects from a rural farming community. The point, 6-months and cumulative lifetime prevalence of neck pain was obtained in addition to the measurement of the severity of neck pain. The mean age of the study subjects was 61 yr and 57% were females. The lifetime prevalence of neck pain was 20.8% with women having a higher prevalence. The prevalence did not increase with age, and the majority of individuals had low-intensity/low-disability pain. Subjects with neck pain had a significantly worse SF-12 score in all domains except for mental health. The prevalence of neck pain was significantly associated with female gender, obesity and smoking. This is the first large-scale Korean study estimating the prevalence of neck pain in elderly population. Although the majority of individuals had low-intensity/low-disability pain, subjects with neck pain had a significantly worse SF-12 score indicating that neck pain has significant health impact. PMID:23678258

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

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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

Timing and Activation Intensity of Shoulder Muscles during Handball Penalty Throwing in Subjects with and without Shoulder Impingement

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Zahra Zonnor

2017-08-01

Full Text Available Introduction: Shoulder injuries are common among athletes in sports that involve overhead throwing of the ball such as handball. The objectives of this study were to evaluate the timing and activation intensity of shoulder muscles during handball penalty throwing in individuals with shoulder pain and in control subjects. Materials and Methods: Using BTS FREE EMG 300 system with bipolar surface electrodes, the timing (onset and intensity of the activation of the shoulder muscles were measured including upper trapezius, anterior, middle and posterior deltoid, latissimus dorsi, pectoralis major, supraspinatus and triceps during penalty throwing. Multivariate analysis of variance (ANOVA was used for between group comparisons with the significance level P< 0.05. Results: The activation intensity of upper trapezius and latissimus dorsi muscles in the healthy individuals were about 50.74% and 43.42% higher than in patients. Middle deltoid in healthy individuals was about 38.05% smaller than that in patients. In control group, supraspinatus muscle started earlier (23.5 ms than the shoulder motion initiation. Triceps muscle was activated about 18.5 ms later than shoulder motion initiation. In patients, supraspinatus muscle started sooner (11 ms and triceps brachialis muscle started later than the other muscles (22.16 ms. Conclusion: The coordination of shoulder muscles i.e. the onset and intensity of muscle activity is disturbed in the patient group during throwing. Hence, strength and stretching programs are recommended for athletes to reduce the risk of shoulder pain syndrome. The rehabilitation program can be focused on modifying the pattern of activity in upper trapezius, supraspinatus, latissimus dorsi and deltoid muscles in addition to pain control in the rehabilitation centers.

Short-term test-retest-reliability of conditioned pain modulation using the cold-heat-pain method in healthy subjects and its correlation to parameters of standardized quantitative sensory testing.

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Gehling, Julia; Mainka, Tina; Vollert, Jan; Pogatzki-Zahn, Esther M; Maier, Christoph; Enax-Krumova, Elena K

2016-08-05

Conditioned Pain Modulation (CPM) is often used to assess human descending pain inhibition. Nine different studies on the test-retest-reliability of different CPM paradigms have been published, but none of them has investigated the commonly used heat-cold-pain method. The results vary widely and therefore, reliability measures cannot be extrapolated from one CPM paradigm to another. Aim of the present study was to analyse the test-retest-reliability of the common heat-cold-pain method and its correlation to pain thresholds. We tested the short-term test-retest-reliability within 40 ± 19.9 h using a cold-water immersion (10 °C, left hand) as conditioning stimulus (CS) and heat pain (43-49 °C, pain intensity 60 ± 5 on the 101-point numeric rating scale, right forearm) as test stimulus (TS) in 25 healthy right-handed subjects (12females, 31.6 ± 14.1 years). The TS was applied 30s before (TSbefore), during (TSduring) and after (TSafter) the 60s CS. The difference between the pain ratings for TSbefore and TSduring represents the early CPM-effect, between TSbefore and TSafter the late CPM-effect. Quantitative sensory testing (QST, DFNS protocol) was performed on both sessions before the CPM assessment. paired t-tests, Intraclass correlation coefficient (ICC), standard error of measurement (SEM), smallest real difference (SRD), Pearson's correlation, Bland-Altman analysis, significance level p Pain ratings during CPM correlated significantly (ICC: 0.411…0.962) between both days, though ratings for TSafter were lower on day 2 (p pain thresholds. The short-term test-retest-reliability of the early CPM-effect using the heat-cold-pain method in healthy subjects achieved satisfying results in terms of the ICC. The SRD of the early CPM effect showed that an individual change of > 20 NRS can be attributed to a real change rather than chance. The late CPM-effect was weaker and not reliable.

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.

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.

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.

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.

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...

Cuff Pressure Pain Detection Is Associated with Both Sex and Physical Activity Level in Nonathletic Healthy Subjects.

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Lemming, Dag; Börsbo, Björn; Sjörs, Anna; Lind, Eva-Britt; Arendt-Nielsen, Lars; Graven-Nielsen, Thomas; Gerdle, Björn

2017-08-01

The aim of this study was to evaluate pressure pain sensitivity on leg and arm in 98 healthy persons (50 women) using cuff algometry. Furthermore, associations with sex and physical activity level were investigated. Normal physical activity level was defined as Godin Leisure-Time Exercise Questionnaire (GLTEQ) score ≤ 45 and high activity level as GLTEQ > 45. A pneumatic double-chamber cuff was placed around the arm or leg where a single chamber was inflated. The cuff inflation rate (1 kPa/s) was constant, and pain intensity was registered continuously on a 10 cm electronic visual analogue scale (VAS). The pain detection threshold (PDT) was defined as when the pressure was perceived as painful, and pain tolerance (PTT) was when the subject terminated the cuff inflation. For PTT, the corresponding VAS score was recorded (VAS-PTT). The protocol was repeated with two chambers inflated. Only single cuff results are given. For women compared with men, the PDT was lower when assessed in the arm ( P = 0.002), PTTs were lower in the arm and leg ( P active participants compared with less active had higher PDT ( P = 0.027) in the leg. Women showed facilitated spatial summation ( P physical activity level. © 2017 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

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.

BOLD responses in somatosensory cortices better reflect heat sensation than pain.

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Moulton, Eric A; Pendse, Gautam; Becerra, Lino R; Borsook, David

2012-04-25

The discovery of cortical networks that participate in pain processing has led to the common generalization that blood oxygen level-dependent (BOLD) responses in these areas indicate the processing of pain. Physical stimuli have fundamental properties that elicit sensations distinguishable from pain, such as heat. We hypothesized that pain intensity coding may reflect the intensity coding of heat sensation during the presentation of thermal stimuli during fMRI. Six 3T fMRI heat scans were collected for 16 healthy subjects, corresponding to perceptual levels of "low innocuous heat," "moderate innocuous heat," "high innocuous heat," "low painful heat," "moderate painful heat," and "high painful heat" delivered by a contact thermode to the face. Subjects rated pain and heat intensity separately after each scan. A general linear model analysis detected different patterns of brain activation for the different phases of the biphasic response to heat. During high painful heat, the early phase was associated with significant anterior insula and anterior cingulate cortex activation. Persistent responses were detected in the right dorsolateral prefrontal cortex and inferior parietal lobule. Only the late phase showed significant correlations with perceptual ratings. Significant heat intensity correlated activation was identified in contralateral primary and secondary somatosensory cortices, motor cortex, and superior temporal lobe. These areas were significantly more related to heat ratings than pain. These results indicate that heat intensity is encoded by the somatosensory cortices, and that pain evaluation may either arise from multimodal evaluative processes, or is a distributed process.

Double-Cone Coil TMS Stimulation of the Medial Cortex Inhibits Central Pain Habituation.

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Federico D'Agata

Full Text Available The aim of this study was to investigate whether Transcranial Magnetic Stimulation (TMS applied over the medial line of the scalp affects the subjective perception of continuous pain induced by means of electric stimulation. In addition, we wanted to identify the point of stimulation where this effect was maximum.Superficial electrical stimulation was used to induce continuous pain on the dominant hand. At the beginning of the experiment we reached a pain rating of 5 on an 11-point numeric rating scale (NRS; 0 = no pain and 10 = maximum tolerable pain for each subject by setting individually the current intensity. The TMS (five pulses at increasing intensities was applied on 5 equidistant points (one per session over the medial line of the scalp in 13 healthy volunteers using a double-cone coil to stimulate underlying parts of the brain cortex. In every experimental session the painful stimulation lasted 45 minutes, during which pain and distress intensities NRS were recorded continuously. We calculated the effect of adaptation and the immediate effect of the TMS stimulation for all locations. Additionally, an ALE (Activation Likelihood Estimation meta-analysis was performed to compare our results with the neuroimaging literature on subjective pain rating.TMS stimulation temporarily decreased the pain ratings, and pain adaptation was suppressed when applying the TMS over the FCz site on the scalp. No effect was found for distress ratings.The present data suggest that the medial cortex in proximity of the cingulated gyrus has a causal role in adaptation mechanisms and in processing ongoing pain and subjective sensation of pain intensity.

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.

Effect of subjective knee-joint pain on the laterality of knee extension strength and gait in elderly women.

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Sugiura, Hiroki; Demura, Shinichi

2012-01-01

This study aimed to examine the effect of subjective knee-joint pain on the laterality of knee extension strength and gait in elderly women. The subjects were 144 elderly women (62-94 years old; mean age 76.2±6.0 years; ±S.D.) who were divided into the following groups: 81 persons without knee-pain (no knee-pain group), 39 persons with the subjective pain in right or left knee (single knee-pain group), and 24 persons with the subjective pain in both knees (double knee-pain group). The subjects took a knee extension strength test and a 12 m maximum effort walk test. Knee extension strength, stance time, swing time, stride length, step length and swing speed were selected as parameters. A significant laterality was found in knee extension strength only in the one knee-pain group. The laterality of gait parameters was not found in all groups. In conclusion, elderly women who can perform daily living activity independently, even though having subjective pain in either knee or laterality in knee extension strength exertion show little laterality of gait during short distance walking. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Prevalence of sleep disturbance in chronic pain.

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Karaman, S; Karaman, T; Dogru, S; Onder, Y; Citil, R; Bulut, Y E; Tapar, H; Sahin, A; Arici, S; Kaya, Z; Suren, M

2014-01-01

Sleep is a vital function for human beings, which can be affected by several factors. Chronic pain is one of these factors where it is the most frequent cause for seeking medical care in combination with insomnia. The aim of this study is to examine the prevalence and relationship between sleep disturbance and chronic pain. After approval, a total of 85 Family Medicine Units from over 170 in Tokat were randomly selected using a 50% sampling. A sample of 2635 subjects, over the age of 19 years, who were registered with the selected Family Medicine Units, were assessed due to gender, age group, and the urban/rural population size of Tokat using the stratified sampling method. The sample size distribution was calculated as 1515 urban subjects, 1120 rural subjects; 1345 female subjects, 1290 male subjects; 1123 subjects between 20-39 years of age, 1103 subjects between the ages of 40-64, and 409 subjects over 64 years of age. After sampling, subjects were invited to participate in the study via an invitation letter, and agreeing individuals were taken to the Family Medicine Unit for face-to-face meetings. Written, informed consent was obtained, along with demographic data. The presence of chronic pain was recorded. According to the presence of chronic pain, all subjects were separated into two groups as Group Chronic Pain and Group Non-Chronic Pain. The visual analog scale for pain intensity, and Pittsburgh Sleep Quality Index for sleep quality, were performed with all subjects. A multiple linear regression model was used to assess the predictors of sleep quality. Analyses were conducted using the Statistical Package for Social Sciences program (SPSS Inc., Chicago, IL, USA), version 20.0. The statistical significance for all analyses was set at p 5. A moderate positive correlation was found between the global Pittsburgh Sleep Quality Index and Visual Analog Scale scores (r = 0.310, p < 0.01). A multiple linear regression analysis showed that age, gender, income, Visual

Effects of low strength pedaling exercise on stress sensitivity and pain threshold

OpenAIRE

坂野, 裕洋

2017-01-01

　This study conducted a comparative assessment of the effects of low intensity lower limb pedaling exercise on the stress sensitivity and pain threshold in healthy subjects and those with chronic stiff neck or lower back pain. The results showed a reduction in pain threshold depending on the applied mechanical stress in both healthy and chronic pain groups. The individuals with chronic pain felt pain more intensely compared to the healthy individuals, and showed a significant reduction in pai...

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.

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

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

2017-01-01

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

Individual Cognitive Social Capital and Its Relationship with Pain and Sick Leave Due to Pain in the Austrian Population

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Muckenhuber, Johanna; Pollak, Lorenz; Stein, Katharina Viktoria; Dorner, Thomas Ernst

2016-01-01

Background Individual cognitive social capital has repeatedly been shown to be linked to health disparities in many dimensions. The aim of the study was to investigate the association between social capital and pain-related measures. Methods 15,474 subjects older than 15 years were personally interviewed on subjective health, quality of life, health behaviour, and utilisation of healthcare in the Austrian Health Interview Survey. An indicator for cognitive social capital at the individual level consisting of nine questions targeted at different social resources was built and its association with pain-related items analysed. Results Odds ratios, adjusted for age, chronic diseases, and educational level for having suffered from severe pain in the last 12 months were 2.02 (95% CI 1.77–2.03) in the lowest tertile and 1.30 (95% CI 1.14–1.47) in the middle tertile of social capital for men. The corresponding odds ratios for women were 2.28 (95% CI 2.01–2.59) and 1.30 (95% CI 1.15–1.46). In both sexes, pain intensity increased significantly with decreasing level of social capital. The proportion of subjects that have been on sick leave in the last 12 months due to pain were 16.3%, 12.0%, and 7.7% (Psocial capital in men, and 16.5%, 12.3%, and 6.7%, respectively (Psocial capital at individual level is significantly associated not only with higher prevalence of pain and higher pain intensity, but also with a higher chance for sick leave due to pain in employed subjects. PMID:27322649

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

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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

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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.

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.

Quantifying and Characterizing Tonic Thermal Pain Across Subjects From EEG Data Using Random Forest Models.

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Vijayakumar, Vishal; Case, Michelle; Shirinpour, Sina; He, Bin

2017-12-01

Effective pain assessment and management strategies are needed to better manage pain. In addition to self-report, an objective pain assessment system can provide a more complete picture of the neurophysiological basis for pain. In this study, a robust and accurate machine learning approach is developed to quantify tonic thermal pain across healthy subjects into a maximum of ten distinct classes. A random forest model was trained to predict pain scores using time-frequency wavelet representations of independent components obtained from electroencephalography (EEG) data, and the relative importance of each frequency band to pain quantification is assessed. The mean classification accuracy for predicting pain on an independent test subject for a range of 1-10 is 89.45%, highest among existing state of the art quantification algorithms for EEG. The gamma band is the most important to both intersubject and intrasubject classification accuracy. The robustness and generalizability of the classifier are demonstrated. Our results demonstrate the potential of this tool to be used clinically to help us to improve chronic pain treatment and establish spectral biomarkers for future pain-related studies using EEG.

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.

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

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

2012-03-01

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

Motor control patterns during an active straight leg raise in pain-free subjects.

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Beales, Darren John; O'Sullivan, Peter Bruce; Briffa, N Kathryn

2009-01-01

Repeated measures. To investigate motor control (MC) patterns of normal subjects during the low level physical load of the active straight leg raise (ASLR). Aberrant MC patterns, as observed with the ASLR test, are considered to be a mechanism for ongoing pain and disability in subjects with chronic musculoskeletal pelvic girdle pain. These patterns may not only affect the provision of lumbopelvic stability, but also respiration and the control of continence. Greater understanding of MC patterns in pain-free subjects may improve the management of pelvic girdle pain. METHODS.: Fourteen pain-free nulliparous women were examined during the ASLR. Electromyography of the anterior abdominal wall, right chest wall and the anterior scaleni, intraabdominal pressure (IAP), intrathoracic pressure (ITP), respiratory rate, pelvic floor kinematics, and downward leg pressure of the nonlifted leg were compared between a left and right ASLR. There was greater activation of obliquus internus abdominis and obliquus externus abdominis on the side of the ASLR. The predominant pattern of activation for the chest wall was tonic activation during an ipsilateral ASLR, and phasic respiratory activation lifting the contralateral leg. Respiratory fluctuation of both IAP and ITP did not differ lifting either leg. The baseline shifts of these pressure variables in response to the physical demand of lifting the leg was also the same either side. There was no difference in respiratory rate, pelvic floor kinematics, or downward leg pressure. Pain-free subjects demonstrate a predominant pattern of greater ipsilateral tonic activation of the abdominal wall and chest wall on the side of the ASLR. This was achieved with minimal apparent disruption to IAP and ITP. The findings of this study demonstrate the plastic nature of the abdominal cylinder and the flexibility of the neuromuscular system in controlling load transference during an ASLR.

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

Science.gov (United States)

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

2018-03-26

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

Individual Cognitive Social Capital and Its Relationship with Pain and Sick Leave Due to Pain in the Austrian Population.

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Johanna Muckenhuber

Full Text Available Individual cognitive social capital has repeatedly been shown to be linked to health disparities in many dimensions. The aim of the study was to investigate the association between social capital and pain-related measures.15,474 subjects older than 15 years were personally interviewed on subjective health, quality of life, health behaviour, and utilisation of healthcare in the Austrian Health Interview Survey. An indicator for cognitive social capital at the individual level consisting of nine questions targeted at different social resources was built and its association with pain-related items analysed.Odds ratios, adjusted for age, chronic diseases, and educational level for having suffered from severe pain in the last 12 months were 2.02 (95% CI 1.77-2.03 in the lowest tertile and 1.30 (95% CI 1.14-1.47 in the middle tertile of social capital for men. The corresponding odds ratios for women were 2.28 (95% CI 2.01-2.59 and 1.30 (95% CI 1.15-1.46. In both sexes, pain intensity increased significantly with decreasing level of social capital. The proportion of subjects that have been on sick leave in the last 12 months due to pain were 16.3%, 12.0%, and 7.7% (P<0.001 from lowest to highest tertile of social capital in men, and 16.5%, 12.3%, and 6.7%, respectively (P<0.001 in women.Our findings indicate that low cognitive social capital at individual level is significantly associated not only with higher prevalence of pain and higher pain intensity, but also with a higher chance for sick leave due to pain in employed subjects.

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.

Learned helplessness and responses to nerve blocks in chronic low back pain patients.

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Chapman, S L; Brena, S F

1982-01-01

In a double-blind study, 67 chronic low back pain patients received 4 lumbar sympathetic nerve blocks, two given with bupivacaine and two given with saline. It was hypothesized that patients showing evidence of 'learned helplessness,' as measured by dependence on habit-forming medications for the pain, low activity levels, and elevated MMPI scores on Hypochondriasis, Depression and Hysteria would show the least reduction in subjective pain intensity following injections with both bupivacaine and saline. It also was hypothesized that placebo responses would be greatest in patients who had a high educational level, were divorced, and had no pending disability claims. Responses 30 min following nerve blocks failed to correlate with these variables. However, decreases in subjective pain intensity 24 h following both types of nerve blocks were greater in patients who showed low levels of pain behavior, who were divorced, and who had no pending disability claims. Decreased pain 24 h following saline injections was significantly related to low scores on the Lie, Defensiveness, Hypochondriasis, and Hysteria scales of the MMPI and to reduced subjective pain intensity following a 6 week comprehensive outpatient pain rehabilitation program. It was concluded that chronic pain patients who are fixed in their focus on pain, high in pain-related behaviors, and low in responsibilities are less likely to respond favorably to nerve blocks and that medical treatment for them needs to be paired with therapies designed to reduce their helplessness.

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

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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.

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.

Effect profile of paracetamol, Δ9-THC and promethazine using an evoked pain test battery in healthy subjects.

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van Amerongen, G; Siebenga, P; de Kam, M L; Hay, J L; Groeneveld, G J

2018-04-10

A battery of evoked pain tasks (PainCart) was developed to investigate the pharmacodynamic properties of novel analgesics in early-phase clinical research. As part of its clinical validation, compounds with different pharmacological mechanisms of actions are investigated. The aim was to investigate the analgesic effects of classic and nonclassic analgesics compared to a sedating negative control in a randomized placebo-controlled crossover study in 24 healthy volunteers using the PainCart. The PainCart consisted of pain tasks eliciting electrical, pressure, heat, cold and inflammatory pain. Subjective scales for cognitive functioning and psychotomimetic effects were included. Subjects were administered each of the following oral treatments: paracetamol (1000 mg), Δ9-THC (10 mg), promethazine (50 mg) or matching placebo. Pharmacodynamic measurements were performed at baseline and repeated up to 10 h postdose. Paracetamol did not show a significant reduction in pain sensation or subjective cognitive functioning compared to placebo. Promethazine induced a statistically significant reduction in PTT for cold pressor and pressure stimulation. Furthermore, reduced subjective alertness was observed. Δ9-THC showed a statistically significant decrease in PTT for electrical and pressure stimulation. Δ9-THC also demonstrated subjective effects, including changes in alertness and calmness, as well as feeling high and psychotomimetic effects. This study found a decreased pain tolerance due to Δ9-THC and promethazine, or lack thereof, using an evoked pain task battery. Pain thresholds following paracetamol administration remained unchanged, which may be due to insufficient statistical power. We showed that pain thresholds determined using this pain test battery are not driven by sedation. The multimodal battery of evoked pain tasks utilized in this study may play an important role in early-phase clinical drug development. This battery of pain tasks is not sensitive to the

Pain increases during sympathetic arousal in patients with complex regional pain syndrome.

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Drummond, P D; Finch, P M; Skipworth, S; Blockey, P

2001-10-09

To investigate the effect of sympathetic arousal on pain and vasomotor responses in healthy control subjects and patients with complex regional pain syndrome (CRPS), and to determine whether pain increases in patients with particular symptoms. In experiments 1 and 2, capsaicin was applied to the forearm of 24 healthy subjects to induce thermal hyperalgesia. Vascular responses were monitored and subjects rated thermal hyperalgesia before and after being startled (experiment 1), and before, during, and after mental arithmetic, breath holding, forehead cooling, the Valsalva maneuver, and a cold pressor test in experiment 2. In a third experiment, sensitivity to heat, cold, and mechanical stimulation was investigated in 61 patients with CRPS. Pain ratings and vascular and electrodermal responses were recorded after patients were startled and during forehead cooling. In experiment 1, thermal hyperalgesia decreased in healthy control subjects after they were startled, and digital blood vessels constricted symmetrically. In experiment 2, thermal hyperalgesia decreased during and after other forms of sympathetic arousal. However, in experiment 3, ratings of clinical pain increased during forehead cooling or after being startled in over 70% of patients with CRPS. Pain increased most consistently during forehead cooling in patients with cold allodynia or punctate allodynia. Digital blood vessels constricted more intensely on the symptomatic than the nonsymptomatic side in patients with CRPS during sympathetic arousal. Normal inhibitory influences on pain during sympathetic arousal are compromised in the majority of patients with CRPS. The augmented vasoconstrictor response in the symptomatic limb during sympathetic arousal is consistent with adrenergic supersensitivity. An adrenergic sensitivity in nociceptive afferents might contribute to pain and hyperalgesia during sympathetic arousal in certain patients with CRPS.

The effect of Kinesio Taping on postural control in subjects with non-specific chronic low back pain.

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Abbasi, Soheila; Rojhani-Shirazi, Zahra; Shokri, Esmaeil; García-Muro San José, Francisco

2018-04-01

The aim of this study was to investigate the possible alterations in postural control during upright standing in subjects with non-specific chronic low back pain and the effect of Kinesio taping on the postural control. Twenty subjects with non-specific chronic low back pain and twenty healthy subjects participated in this study. The center of pressure excursion was evaluated before the intervention for both groups, and immediately after intervention for the low back pain group. Independent sample t-test, Mann-Whitney test and repeated measure ANOVA were used for the statistical analysis of the data. There were significant differences in the center of pressure excursion between the low back pain group versus the healthy group. The results of the ANOVA demonstrated a statistically significant difference in the mean COP displacement and velocity before Kinesio Taping, immediately after, and 24 h after in the low back pain group. There are poor postural control mechanisms in subjects with non-specific chronic low back pain. Kinesio taping seems to change postural control immediately and have lasting effects until the day after. Copyright © 2017 Elsevier Ltd. All rights reserved.

Sex differences in the neural representation of pain unpleasantness.

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

2014-08-01

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

Subjective assessment of the effectiveness of physiotherapeutic methods in lumbosacral discogenic pain syndrome

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Michał Grzegorczyk

2018-03-01

Full Text Available Aging society, lack of habit shaping attitude to correct posture among children and youth and a lifestyle that often requires excessive effort make lumbosacral discogenic pain syndrome a social disease. It is essential that effective methods for the prevention and treatment of these changes go hand in hand with the frequently occurring pains of the lumbosacral spine. Aim of the study: Comparison of the subjective assessment of the patient's feelings related to the lumbosacral discogenic pain. Material and method: The research group included 60 people diagnosed with a lumbosacral discogenic pain. All patients were divided into three groups of 20 people. Each group was subjected to a different type of rehabilitation, depending on the method analyzed - PNF, manual therapy, and physical treatments. The questionnaire was used as the research tool, it was filled in by the respondents. Results: The patients, before and after the treatments, regardless of the type of rehabilitation to which they were subjected, declared that the most common pain is in the buttock, thigh and calf. Before the rehabilitation, the most frequent additional complaints of the examined patients were numbness and muscle weakness, after rehabilitation it was muscle weakness. After the rehabilitation, the number of painkillers taken by the respondents decreased. Only in the case of patients who underwent physiotherapeutic procedures, the number of people taking medication increased. Conclusions: The best results from the analyzed therapies were obtained after manual therapy. The second most effective was PNF therapy, while the weakest result was achieved by physiotherapeutic procedures.

A preliminary report on stem cell therapy for neuropathic pain in humans

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Vickers ER

2014-05-01

Full Text Available E Russell Vickers,1 Elisabeth Karsten,2 John Flood,3 Richard Lilischkis21Sydney Oral and Maxillofacial Surgery, NSW, Australia; 2Regeneus Ltd, Gordon, NSW, Australia; 3St Vincents Hospital, Sydney, NSW, AustraliaObjective: Mesenchymal stem cells (MSCs have been shown in animal models to attenuate chronic neuropathic pain. This preliminary study investigated if: i injections of autologous MSCs can reduce human neuropathic pain and ii evaluate the safety of the procedure.Methods: Ten subjects with symptoms of neuropathic trigeminal pain underwent liposuction. The lipoaspirate was digested with collagenase and washed with saline three times. Following centrifugation, the stromal vascular fraction was resuspended in saline, and then transferred to syringes for local injections into the pain fields. Outcome measures at 6 months assessed reduction in: i pain intensity measured by standard numerical rating scale from 0–10 and ii daily dosage requirements of antineuropathic pain medication.Results: Subjects were all female (mean age 55.3 years ± standard deviation [SD] 14.67; range 27–80 years with pain symptoms lasting from 4 months to 6 years and 5 months. Lipoaspirate collection ranged from 102–214 g with total cell numbers injected from 33 million to 162 million cells. Cell viability was 62%–91%. There were no systemic or local tissue side effects from the stem cell therapy (n=41 oral and facial injection sites. Clinical pain outcomes showed that at 6 months, 5/9 subjects had reduced both pain intensity scores and use of antineuropathic medication. The mean pain score pre-treatment was 7.5 (SD 1.58 and at 6 months had decreased to 4.3 (SD 3.28, P=0.018, Wilcoxon signed-rank test. Antineuropathic pain medication use showed 5/9 subjects reduced their need for medication (gabapentin, P=0.053, Student's t-test.Conclusion: This preliminary open-labeled study showed autologous administration of stem cells for neuropathic trigeminal pain

rTMS of the prefrontal cortex has analgesic effects on neuropathic pain in subjects with spinal cord injury.

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Nardone, R; Höller, Y; Langthaler, P B; Lochner, P; Golaszewski, S; Schwenker, K; Brigo, F; Trinka, E

2017-01-01

Repetitive transcranial magnetic stimulation study. The analgesic effects of repetitive transcranial magnetic stimulation (rTMS) in chronic pain have been the focus of several studies. In particular, rTMS of the premotor cortex/dorsolateral prefrontal cortex (PMC/DLPFC) changes pain perception in healthy subjects and has analgesic effects in acute postoperative pain, as well as in fibromyalgia patients. However, its effect on neuropathic pain in patients with traumatic spinal cord injury (SCI) has not been assessed. Merano (Italy) and Salzburg (Austria). In this study, we performed PMC/DLPFC rTMS in subjects with SCI and neuropathic pain. Twelve subjects with chronic cervical or thoracic SCI were randomized to receive 1250 pulses at 10 Hz rTMS (n=6) or sham rTMS (n=6) treatment for 10 sessions over 2 weeks. The visual analog scale, the sensory and affective pain rating indices of the McGill Pain Questionnaire (MPQ), the Hamilton Depression Rating Scale and the Hamilton Anxiety Rating Scale were used to assed pain and mood at baseline (T0), 1 day after the first week of treatment (T1), 1 day (T2), 1 week (T3) and 1 month (T4) after the last intervention. Subjects who received active rTMS had a statistically significant reduction in pain symptoms in comparison with their baseline pain, whereas sham rTMS participants had a non-significant change in daily pain from their baseline pain. The findings of this preliminary study in a small patient sample suggest that rTMS of the PMC/DLPFC may be effective in relieving neuropathic pain in SCI patients.

Effect of experimental chewing on masticatory muscle pain onset

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Paulo César Rodrigues Conti

2011-02-01

Full Text Available OBJECTIVES: To evaluate the effect of a chewing exercise on pain intensity and pressure-pain threshold in patients with myofascial pain. METHODS: Twenty-nine consecutive women diagnosed with myofascial pain (MFP according to the Research Diagnostic Criteria comprised the experimental group and 15 healthy age-matched female were used as controls. Subjects were asked to chew a gum stick for 9 min and to stay at rest for another 9 min afterwards. Pain intensity was rated on a visual analog scale (VAS every 3 min. At 0, 9 and 18 min, the pressure-pain threshold (PPT was measured bilaterally on the masseter and the anterior, medium, and posterior temporalis muscles. RESULTS: Patients with myofascial pain reported increase (76% and no change (24% on the pain intensity measured with the VAS. A reduction of the PPT at all muscular sites after the exercise and a non-significant recovery after rest were also observed. CONCLUSION: The following conclusions can be drawn: 1. there are at least two subtypes of patients with myofascial pain that respond differently to experimental chewing; 2. the chewing protocol had an adequate discriminative ability in distinguishing patients with myofascial pain from healthy controls.

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...

Characteristics of ocular pain complaints in patients with idiopathic dry eye symptoms

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Kalangara, Jerry P.; Galor, Anat; Levitt, Roy C.; Covington, Derek B.; McManus, Katherine T.; Sarantopoulos, Constantine D.; Felix, Elizabeth R.

2016-01-01

Objective The purpose of this study was to examine the severity and quality of ocular pain complaints in patients with dry eye symptoms. Methods Subjects with clinically-relevant dry eye symptoms (dryness, discomfort, tearing) of unknown origin seen in the Miami Veterans Affairs eye clinic were administered questionnaires for dry eye symptoms and ocular pain and underwent a standardized ocular examination. Qualities and severity ratings of ocular pain in subjects with idiopathic dry eye were compared to similar measures from published data in other chronic pain populations. Results The study sample consisted of 154 subjects, of which 91% were male and ranged in age from 27 to 89 (mean age = 61). Fifty-three percent of participants reported an average ocular pain of at least moderate intensity (numerical rating scale (NRS) ≥ 4), with specific characteristics (i.e., “burning” spontaneous pain) reported at frequencies comparable to prevalent chronic neuropathic pain syndromes as reported in the literature. Significant correlations were found between ocular pain metrics and dry eye symptom severity scores (r=0.57 to 0.66). Dry eye signs, however, did not generally correlate with ocular pain severity. Conclusions A significant proportion of subjects with idiopathic dry eye symptoms reported moderate or greater ocular pain intensity, with the majority endorsing descriptors commonly used by patients with non-ocular neuropathic pain conditions. Identifying sub-groups of dry eye patients based on the presence and characteristics of ocular pain complaints may improve dry eye sub classification and better individualize treatment strategies. PMID:26925537

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.

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.

EFFECTS OF POSTEROANTERIOR LUMBAR SPINE MOBILIZATIONS ON PAIN, ROM AND FUNCTIONAL DISABILITY IN FEMALE SUBJECTS WITH CHRONIC NONSPECIFIC LOW BACK PAIN

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C. Shanthi

2014-12-01

Full Text Available Background: Chronic nonspecific low back pain (CNSLBP i.e., low back pain of at least 12 weeks duration without a specific cause is a major cause of activity limitation, absenteeism , and high health care expenses. The prevalence of CNSLBP is estimated approximately 23% and activity limitation due to LBP have been found to be 11% to 12% of the population. Previous studies comparing the efficacy of postero-anterior mobilisation and prone-press ups were done and revealed statistically significant improvements in extension ranges but not clinical relevant improvements. This is possibly attributable to single session of interventions. So long term gains in pain reduction and lumbar extension cannot be assumed. Hence this study would be intending to prove the effect of postero-anterior mobilisation and prone press ups on chronic non-specific low back pain after 6 weeks and their clinical application. Method: 30 subjects who met the inclusion criteria were selected randomly from the department of physiotherapy, SVIMS and BIRRD, Tirupati. The study conducted for a period of 6 weeks.2 groups were formed with 15 in each group. PA lumbar glide and prone press up's was given to group I and only prone press up's was given to group II. Subjects were evaluated pre and post treatment for VAS, extension ROM of lumbar spine and functional disability. Result: Results showed that there exists a statistical significance between the groups in all the 3 parameters. Present randomized clinical trial provided evidence to support the use of postero-anterior mobilisation and prone press-ups in relieving pain, improving ROM and reducing disability in subjects with non-specific low back pain. In addition, results supported that postero-anterior mobilisation was more effective than prone press-ups.

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

Infusion pressure and pain during microneedle injection into skin of human subjects

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Gupta, Jyoti; Park, Sohyun; Bondy, Brian; Felner, Eric I.; Prausnitz, Mark R.

2011-01-01

Infusion into skin using hollow microneedles offers an attractive alternative to hypodermic needle injections. However, the fluid mechanics and pain associated with injection into skin using a microneedle have not been studied in detail before. Here, we report on the effect of microneedle insertion depth into skin, partial needle retraction, fluid infusion flow rate and the co-administration of hyaluronidase on infusion pressure during microneedle-based saline infusion, as well as on associated pain in human subjects. Infusion of up to a few hundred microliters of fluid required pressures of a few hundred mmHg, caused little to no pain, and showed weak dependence on infusion parameters. Infusion of larger volumes up to 1 mL required pressures up to a few thousand mmHg, but still usually caused little pain. In general, injection of larger volumes of fluid required larger pressures and application of larger pressures cause more pain, although other experimental parameters also played a significant role. Among the intradermal microneedle groups, microneedle length had little effect; microneedle retraction lowered infusion pressure but increased pain; lower flow rate reduced infusion pressure and kept pain low; and use of hyaluronidase also lowered infusion pressure and kept pain low. We conclude that microneedles offer a simple method to infuse fluid into the skin that can be carried out with little to no pain. PMID:21684001

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.

Masticatory muscle and temporomandibular joint pain in Croatian war veterans with posttraumatic stress disorder.

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Uhac, Ivone; Tariba, Petra; Kovac, Zoran; Simonić-Kocijan, Suncana; Lajnert, Vlatka; Mesić, Vesna Fugosić; Kuis, Davor; Braut, Vedrana

2011-12-01

The aim of this study was to investigate the prevalence and intensity of masticatory muscle and temporomandibular joint (TMJ) pain in Croatian war veterans with posttraumatic stress disorder (PTSD). The examined group consisted of 100 Croatian war veterans, in whom PTSD had previously been diagnosed. Patients were compared with 92 subjects who had not taken part in the war and in whom PTSD was excluded by psychiatric examination. The clinical examination consisted of palpation of the masticatory muscles, the prominent neck musculature, and TMJ. The examination technique used and the definition of items were previously tested for reliability and validity. 93% of the subjects with PTSD had masticatory muscle tenderness compared to 45.65% of the subjects in the control group (chi2 = 51.46, p < 0.0001). The most frequent painful location in the subjects with PTSD was the left lateral pterygoid site in 88%, and in subjects of the control group the right lateral pterygoid site in 28.26% of cases. The most painful location in the PTSD group was the left lateral pterygoid site in 72%, and in the control group the left posterior digastric in 4.35% of cases. 58% of the subjects with PTSD had TMJ tenderness compared to 3.26% of subjects in the control group (chi2 = 66.23, p < 0.0001). The most frequent painful location of TMJ in both groups was the left posterior capsule; in the PTSD group 38% and in subjects in the control group 2.17% of cases. The most painful location was the left posterior capsule in 28% of subjects with PTSD, while not one subject in the control group reported severe painful sensitivity. The very high frequency and intensity of pain in subjects with PTSD confirms the effect of stress on muscle and joint sensitivity, i.e. perception of 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

ASSESSMENT AND COMPARISION OF CERVICAL JOINT POSITION SENSE IN SUBJECTS WITH CHRONIC NECK PAIN vs NORMALS

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Oberoi Mugdha

2015-06-01

Full Text Available Background: The abundance of mechanoreceptors in the cervical spine and their central and reflex afferent connections to the vestibular, visual and postural control system suggests that the cervical proprioceptive information provides important somatosensory information influencing postural stability, head orientation and eye movement control. Disturbances to the afferent input from the cervical region is thought to underlie symptoms of dizziness, unsteadiness, visual disturbances and signs of altered postural stability, cervical proprioception and head and eye movement control in people with chronic neck pain. This study aimed to assess and compare cervical joint position sense in subjects with chronic neck pain vs normals. Methods: Total 60 subjects, divided into two groups chronic neck pain group (n=30 (12 males and 18 females with mean age of 40.7 years and control group (n=30 with age and gender matched normal individuals were assessed for baseline data and demographic variables. Head repositioning accuracy test was used to assess cervical joint position sense in degrees. Results: The difference in the head repositioning error values were found to be extremely significant (p<0.0001 for all the neck movements for subjects with chronic neck pain as compared to normals. Conclusion: Cervical joint position sense in subjects with chronic neck pain is found to be altered as compared to age and gender matched normals.

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.

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.

Kinesiophobia in relation to physical activity in chronic neck pain.

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Demirbüken, İlkşan; Özgül, Bahar; Kuru Çolak, Tuğba; Aydoğdu, Onur; Sarı, Zübeyir; Yurdalan, Saadet Ufuk

2016-01-01

Little research is available concerning physical activity and its determinants in people with chronic neck pain. To explore the relation between kinesiophobia and physical activity and gender effect on these relations in people with chronic neck pain. Ninety-nine subjects (34 men and 65 women) with chronic neck pain were participated in the study. Pain intensity was assessed with Visual Analog Scale and kinesiophobia degree was determined by using Tampa Scale of Kinesiophobia. Level of physical activity was assessed with short form of the International Physical Activity Questionnaire. There was no statistically correlation between neck pain intensity and kinesiophobia degree (p= 0.246, r= 0.123) and physical activity level (p= 0.432, r= -0.083). It was also found that kinesiophobia degree was not correlated to physical activity level (p= 0.148, r= -0.153). There was a negative correlation between kinesiophobia degree and physical activity level only for women, not for men (p= 0.011, r= -0.318). Our results showed that although people with chronic neck pain reported higher pain intensity and fear of movement, pain intensity and kinesiophobia degree did not associate to their physical activity levels. It can be speculated that high kinesiophobia degrees cause low physical activity levels for women, but not for men.

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®

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.

[Procedural pain perception of preterm newborn in neonatal intensive care unit: assessment and non-pharmacological approaches].

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Bernardini, V; De Liso, P; Santoro, F; Allemand, F; Allemand, A

2011-08-01

The aim of this study was to evaluate the reaction to the procedural pain of preterm newborn and to demonstrate the different effectiveness of the two analgesic and not pharmacological techniques of recent clinical acquisition, the use of glucose solution and the sensorial saturation, in order to identify an optimal strategy for the prevention and pain treatment. We take a sample of 28 preterm newborns of 30-35 weeks. The subjects are divided in two randomized groups following the kind of analgesia used during the hematic sample from heel: the first group (group A) included 14 subjects, who received glucose solution associated to no nutritive suction; the second group (group B) included 14 subjects who received the sensorial saturation. The symptoms associated with pain at the moment of venous sample are measured through premature infant pain profile (PIPP) scale. Results show that the score was lower in the group treated with sensorial saturation (media 6.52; Pneonatal age could develop.

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.

Relationship between sleep and pain in adolescents with juvenile primary fibromyalgia syndrome.

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Olsen, Margaret N; Sherry, David D; Boyne, Kathleen; McCue, Rebecca; Gallagher, Paul R; Brooks, Lee J

2013-04-01

To investigate sleep quality in adolescents with juvenile primary fibromyalgia syndrome (JPFS) and determine whether sleep abnormalities, including alpha-delta sleep (ADS), correlate with pain intensity. We hypothesized that successful treatment for pain with exercise therapy would reduce ADS and improve sleep quality. Single-center preintervention and postintervention (mean = 5.7 ± 1.0 weeks; range = 4.0-7.3 weeks) observational study. Ten female adolescents (mean age = 16.2 ± 0.65 SD yr) who met criteria for JPFS and completed treatment. Multidisciplinary pain treatment, including intensive exercise therapy. Pain and disability were measured by a pain visual analog scale (VAS) and the functional disability inventory. Subjective sleep measures included a sleep VAS, an energy VAS, and the School Sleep Habits Survey. Objective sleep measures included actigraphy, polysomnography (PSG), and the Multiple Sleep Latency Test. Baseline PSG was compared with that of healthy age- and sex-matched control patients. At baseline, patients had poorer sleep efficiency, more arousals/awakenings, and more ADS (70.3% of total slow wave sleep [SWS] versus 21.9% SWS, P = 0.002) than controls. ADS was unrelated to pain, disability, or subjective sleep difficulty. After treatment, pain decreased (P = 0.000) and subjective sleep quality improved (P = 0.008). Objective sleep quality, including the amount of ADS, did not change. Although perceived sleep quality improved in adolescents with JPFS after treatment, objective measures did not. Our findings do not suggest exercise therapy for pain improves sleep by reducing ADS, nor do they support causal relationships between ADS and chronic pain or subjective sleep quality.

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.

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

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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

Assessment of psychological pain management techniques: a comparative study between athletes and non-athletes

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Azevedo Daniel Câmara

2003-01-01

Full Text Available Athletes usually deal with injuries and pain. They seem to have similar pain threshold when compared to non-athletes, although they have higher pain tolerance and the exact cause for that is unknown. High levels for pain tolerance and control can improve performance and time for injury recovery. The literature shows that use of coping strategies can increase pain control; possible differences on coping with pain between athletes and non-athletes are poorly described. The purpose of this study was to evaluate frequency of coping strategies used by athletes and non-athletes of both genders and look for possible association between preferred coping style and pain intensity. The sample included 160 subjects with actual pain experience, 80 athletes (52 male, 28 female and 80 non-athletes (50 male and 30 female. All subjects were evaluated for pain intensity, frequency and duration and for coping strategies using a questionnaire (SBS-V. The results show that athletes and non-athletes, despite of gender, use with the same frequency coping strategies. The less common coping strategies for all groups were those poor-adaptative (p < 0.001; the most commonly strategy used was self-statement and regulation of body tension (p < 0.001. Female athletes use more frequently poor-adaptative strategies when pain intensity increases (p < 0.05.

Pen needle design influences ease of insertion, pain, and skin trauma in subjects with type 2 diabetes

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Præstmark, Kezia A; Jensen, Morten L; Berg Madsen, Nils

2016-01-01

subject and in random order. Penetration force (PF) through the skin, pain perception on 100 mm visual analog scale, and change in skin blood perfusion (SBP) were quantified after the insertions. RESULTS: Needle diameter was positively related to PF and SBP (ptrend relation...... of insertion, pain and skin trauma. RESEARCH DESIGN AND METHODS: 30 subjects with injection-treated type 2 diabetes and body mass index 25-35 kg/m(2) were included in the single-blinded study. Each subject received abdominal insertions with 18 different types of needles. All needles were tested twice per....... Lack of needle lubrication and small 'needle hooks' increased PF and SBP (pskin and in polyurethane rubber were linearly related, and pain outcome...

Psychiatric Characteristics of the Cardiac Outpatients with Chest Pain

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Lee, Jea-Geun; Choi, Joon Hyouk; Kim, Song-Yi; Kim, Ki-Seok; Joo, Seung-Jae

2016-01-01

Background and Objectives A cardiologist's evaluation of psychiatric symptoms in patients with chest pain is rare. This study aimed to determine the psychiatric characteristics of patients with and without coronary artery disease (CAD) and explore their relationship with the intensity of chest pain. Subjects and Methods Out of 139 consecutive patients referred to the cardiology outpatient department, 31 with atypical chest pain (heartburn, acid regurgitation, dyspnea, and palpitation) were ex...

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

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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...

Striatal μ-opioid receptor availability predicts cold pressor pain threshold in healthy human subjects

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Hagelberg, Nora; Aalto, Sargo; Tuominen, Lauri

2012-01-01

the potential associations between μ-opioid receptor BP(ND) and psychophysical measures. The results show that striatal μ-opioid receptor BP(ND) predicts cold pressor pain threshold, but not cold pressor pain tolerance or tactile sensitivity. This finding suggests that striatal μ-opioid receptor density......Previous PET studies in healthy humans have shown that brain μ-opioid receptor activation during experimental pain is associated with reductions in the sensory and affective ratings of the individual pain experience. The aim of this study was to find out whether brain μ-opioid receptor binding...... at the resting state, in absence of painful stimulation, can be a long-term predictor of experimental pain sensitivity. We measured μ-opioid receptor binding potential (BP(ND)) with μ-opioid receptor selective radiotracer [(11)C]carfentanil and positron emission tomography (PET) in 12 healthy male subjects...

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

Influence of Elastic Bandage and Neoprene Sleeve on Knee Position Sense and Pain in Subjects with Knee Osteoarthritis

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Basir Majdoleslami

2003-12-01

Full Text Available Objective: to investigate whether a neoprene sleeve and elastic bandage around the knee joint of subjects with knee osteoarthritis (OA would , in short term (a reduce pain (b improve knee joint position sense and comparison of their effect with each other if they have. Materials & Methods: In a semi-experimental study, 30 subjects (11 men, 19 women, age between 33-75 with unilateral knee OA. Subjects had to have at least 2cm from 10cm visual analogue scale (VAS of knee pain for study entry.All patients were randomly assigned to either an elastic bandage or a neoprene sleeve. One week later they were assigned to the opposite selection. Joint position sense was assessed in the sitting position using an electrogoniometer and pain by VAS where 0cm equals no pain and 10 cm equals worst pain. Knee pain and JPS were assessed for each selection one week apart. During each visit assessment were performed at baseline and after 20 min of bandage/neoprene sleeve application. Results: the mean of scores for knee variables JPS and VAS was taken and paired-t test and Wilcoxon signed rank test was employed to calculate the different between two trails. Neoprene sleeve had significant effect on knee JPS (P=0.037. But elastic bandage had no effect (P=0.631. Both of them had significantly reduced knee pain. (P=0.000 Conclusion: In subjects with both neoprene sleeve and elastic bandage reduced knee pain with more effect of neoprene sleeve. Only the neoprene sleeve had effect on knee JPS.

Effects of Reflexology on Pain in Patients With Fibromyalgia.

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Akin Korhan, Esra; Uyar, Meltem; Eyigör, Can; Yönt, Gülendam Hakverdioğlu; Khorshid, Leyla

The aim of this study was to investigate the effect of reflexology on pain intensity in patients with fibromyalgia, using an experimental repeated-measures design, and a convenience sample of 30 fibromyalgia inpatients. Thirty patients aged 18 to 70 years with fibromyalgia and hospitalized in the algology clinic were taken as a convenience sample. Patients received a total of 12 60-minute sessions of reflexology over a period of 6 consecutive weeks. Reflexology was carried out bilaterally on the hands and feet of patients at the reflex points relating to their pain at a suitable intensity and angle. Subjects had pain scores taken immediately before the intervention (0 minute), and at the 60th minute of the intervention. Data were collected over a 10-month period in 2012. The patients' mean pain intensity scores were reduced by reflexology, and this decrease improved progressively in the first and sixth weeks of the intervention, indicating a cumulative dose effect. The results of this study implied that the inclusion of reflexology in the routine care of patients with fibromyalgia could provide nurses with an effective practice for reducing pain intensity in these patients.

The influence of patient's motivation on reported pain during orthodontic treatment

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Marcio José da Silva Campos

2013-06-01

Full Text Available INTRODUCTION: Patients usually experience pain during orthodontic treatment. This fact can affect cooperation and the development of treatment. Reporting pain during treatment seems to be influenced by emotional aspects such as the patient's motivation. OBJECTIVE: To assess the relationship between patient's motivation and the intensity of reported pain during two stages of treatment. METHODS: Twenty males (11-37 years old answered a questionnaire divided into five categories regarding their motivation towards treatment. The subjects were studied for 14 days (7 days with bonded brackets and 7 days with the initial arch inserted and the intensity of pain was evaluated on a daily basis. All the issues, including the intensity of pain, were measured through the visual analog scale (VAS. RESULTS: The VAS-associated questionnaire proved to have good temporal reliability and reasonable internal consistency, being that the "perceived severity" domain had the greatest, although not significant (p = 0.196 correlation with pain intensity. Only the question asking the patients if they thought that their teeth were too uneven showed a positive correlation with pain intensity (p = 0.048. CONCLUSION: The results seem to indicate that the five categories related to treatment motivation cannot be used to predict discomfort during treatment. In addition, patients who think their teeth are too uneven may experience more severe pain due to greater force application after insertion of the initial arch.

Ligamentum flavum hypertrophy in asymptomatic and chronic low back pain subjects.

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Justin J Munns

Full Text Available To examine ligamentum flavum thickness using magnetic resonance (MR images to evaluate its association with low back pain symptoms, age, gender, lumbar level, and disc characteristics.Sixty-three individuals were part of this IRB-approved study: twenty-seven with chronic low back pain, and thirty-six as asymptomatic. All patients underwent MR imaging and computed tomography (CT of the lumbar spine. The MR images at the mid-disc level were captured and enlarged 800% using a bilinear interpolation size conversion algorithm that allowed for enhanced image quality. Ligamentum flavum thickness was assessed using bilateral medial and lateral measurements. Disc height at each level was measured by the least-distance measurement method in three-dimensional models created by CT images taken of the same subject. Analysis of variance and t-tests were carried out to evaluate the relationship between ligamentum flavum thickness and patient variables.Ligamentum flavum thickness was found to significantly increase with older age, lower lumbar level, and chronic low back pain (p < 0.03. No difference in ligamentum flavum thickness was observed between right and left sided measurements, or between male and female subjects. Disc height and both ligamentum flavum thickness measurements showed low to moderate correlations that reached significance (p < 0.01. Additionally, a moderate and significant correlation between disc degeneration grade and ligamentum flavum thickness does exist (p <0.001.By measuring ligamentum flavum thickness on MR images at two different sites and comparing degrees of disc degeneration, we found that ligamentum flavum thickness may be closely related to the pathogenesis of pain processes in the spine.

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

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Kwan, Saskia; Schweinhardt, Petra

2015-01-01

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

Changes of spontaneous oscillatory activity to tonic heat pain.

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

2014-01-01

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

Changes of spontaneous oscillatory activity to tonic heat pain.

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Weiwei Peng

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

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.

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 aerobic dance on pain, functional disability and quality of life on patients with chronic low back pain

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U.A.C. Okafor

2012-12-01

Full Text Available Low back pain (LBP is often an indication of pathologicalcondition of the intervertebral discs, vertebral bodies or supporting soft tissuesof the lower vertebral region. Chronic Low Back Pain (CLBP presents withenormous consequence on the general performance of the sufferer, exerting ahuge cost on the individual, the family and the society. Dance therapy is arelatively new approach in the management of low back pain. This study wastherefore designed to investigate the effect of dance therapy on pain, functionaldisability and quality of life in patients with chronic low back pain.Thirty subjects diagnosed with non-specific CLBP particpated in the study.They were randomly divided into 2 groups, A and B, each comprising 15 subjects.In addition to conventional physiotherapy programme given to both groups,subjects in Group A also received aerobic dance, which comprised a four stage protocol. The entire treatment routinewas administered in a group session three times weekly consecutively for six weeks. Data as obtained in the copies ofcompleted questionnaires (Roland Morris Diability questionnaires and Nottingham Health Profile questionnaires andother measurements were summarized using mean, standard deviation and frequency tables. Student T-test was used toanalyze the data at 95 % confidence interval.There was a statistically significant difference (p<0.05 between the pre- and post- intervention scores for painintensity, functional disability and quality of life within the groups. There was also a statistically significant difference(p<0.05 in the mean change (pre/post intervention scores between Group A and Group B for pain intensity,functional disability and quality of life. Also the opinions and testimonies given by participants formed part of theevidence-based data.Whereas both conventional physiotherapy and aerobic dance showed significant effects in the pre/post-interventionscores, the aerobic dance group reported more significant effect in all

Investigating the neural processing of spatial summation of pain: the role of A-delta nociceptors.

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Raz, Netta; Granovsky, Yelena; Defrin, Ruth

2015-02-01

The underlying mechanism of spatial summation (SS) of pain, an essential component in pain perception and detection, is unknown. Because of the possible differential innervations by A-delta nociceptors and pain sensitivity of hairy and glabrous skin, a comparison of the SS characteristics between the two skin types could contribute to the elucidation of its subserving system and processing. The effect of sex on SS of pain was also evaluated due to the scarcity of information on the subject. Twenty-nine healthy subjects (13 males, 16 females) received four series of heat stimuli of various intensities, in hairy and glabrous skin of the hand using large (27 mm diameter) and small (12 mm) stimulation areas, and the perceived pain intensity (PPI) was rated. A fast temperature increase rate (70°/s) was used in order to selectively activate A-delta nociceptors. The effect of skin type, stimulation intensity and sex on SS and PPI was calculated. Skin type significantly affected PPI and SS of pain; values of both variables were significantly greater in hairy compared with glabrous skin. SS of pain gradually increased concomitantly with stimulation intensity magnitude, to a point when it became saturated in both skin types. Females exhibited greater SS in glabrous skin. It would appear that AMH-II nociceptive fibers in particular subserve SS of pain. Furthermore, SS is increased under stronger stimulation intensities, probably as defense mechanism against tissue damage. Sex differences in dynamic sensory processes such as SS are revealed only under conditions where the phenomenon is subtle (as in glabrous skin).

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

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

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.

The Anti-Inflammatory Actions of Auricular Point Acupressure for Chronic Low Back Pain

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Wei-Chun Lin

2015-01-01

Full Text Available Background. Auricular point acupressure (APA is a promising treatment for pain management. Few studies have investigated the physiological mechanisms of APA analgesics. Method. In this pilot randomized clinical trial (RCT, a 4-week APA treatment was used to manage chronic low back pain (CLBP. Sixty-one participants were randomized into a real APA group (n=32 or a sham APA group (n=29. Blood samples, pain intensity, and physical function were collected at baseline and after 4 weeks of treatment. Results. Subjects in the real APA group reported a 56% reduction of pain intensity and a 26% improvement in physical function. Serum blood samples showed (1 a decrease in IL-1β, IL-2, IL-6, and calcitonin gene-related peptide [CGRP] and (2 an increase in IL-4. In contrast, subjects in the sham APA group (1 reported a 9% reduction in pain and a 2% improvement in physical function and (2 exhibited minimal changes of inflammatory cytokines and neuropeptides. Statistically significant differences in IL-4 and CGRP expression between the real and sham APA groups were verified. Conclusion. These findings suggest that APA treatment affects pain intensity through modulation of the immune system, as reflected by APA-induced changes in serum inflammatory cytokine and neuropeptide levels.

Pain volatility and prescription opioid addiction treatment outcomes in patients with chronic pain.

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Worley, Matthew J; Heinzerling, Keith G; Shoptaw, Steven; Ling, Walter

2015-12-01

The combination of prescription opioid dependence and chronic pain is increasingly prevalent and hazardous to public health. Variability in pain may explain poor prescription opioid addiction treatment outcomes in persons with chronic pain. This study examined pain trajectories and pain volatility in patients with chronic pain receiving treatment for prescription opioid addiction. We conducted secondary analyses of adults with chronic pain (n = 149) who received buprenorphine/naloxone (BUP/NLX) and counseling for 12 weeks in an outpatient, multisite clinical trial. Good treatment outcome was defined as urine-verified abstinence from opioids at treatment endpoint (Week 12) and during at least 2 of the previous 3 weeks. Pain severity significantly declined over time during treatment (b = -0.36, p opioid dependence. Patients with greater volatility in subjective pain during treatment have increased risk of returning to opioid use by the conclusion of an intensive treatment with BUP/NLX and counseling. Future research should examine underlying mechanisms of pain volatility and identify related therapeutic targets to optimize interventions for prescription opioid addiction and co-occurring chronic pain. (PsycINFO Database Record (c) 2015 APA, all rights reserved).

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.

Brain Mechanisms Supporting Modulation of Pain by Mindfulness Meditation

Science.gov (United States)

Zeidan, F.; Martucci, K.T.; Kraft, R.A.; Gordon, N.S.; McHaffie, J.G.; Coghill, R.C.

2011-01-01

The subjective experience of one’s environment is constructed by interactions among sensory, cognitive, and affective processes. For centuries, meditation has been thought to influence such processes by enabling a non-evaluative representation of sensory events. To better understand how meditation influences the sensory experience, we employed arterial spin labeling (ASL) functional magnetic resonance imaging to assess the neural mechanisms by which mindfulness meditation influences pain in healthy human participants. After four-days of mindfulness meditation training, meditating in the presence of noxious stimulation significantly reduced pain-unpleasantness by 57% and pain-intensity ratings by 40% when compared to rest. A two factor repeated measures analysis of variance was used to identify interactions between meditation and pain-related brain activation. Meditation reduced pain-related activation of the contra lateral primary somatosensory cortex. Multiple regression analysis was used to identify brain regions associated with individual differences in the magnitude of meditation-related pain reductions. Meditation-induced reductions in pain intensity ratings were associated with increased activity in the anterior cingulate cortex and anterior insula, areas involved in the cognitive regulation of nociceptive processing. Reductions in pain unpleasantness ratings were associated with orbitofrontal cortex activation, an area implicated in reframing the contextual evaluation of sensory events. Moreover, reductions in pain unpleasantness also were associated with thalamic deactivation, which may reflect a limbic gating mechanism involved in modifying interactions between afferent in put and executive-order brain areas. Taken together, these data indicate that meditation engages multiple brain mechanisms that alter the construction of the subjectively available pain experience from afferent information. PMID:21471390

Hippocampal morphology mediates biased memories of chronic pain

Science.gov (United States)

Berger, Sara E.; Vachon-Presseau, Étienne; Abdullah, Taha B.; Baria, Alex T.; Schnitzer, Thomas J.; Apkarian, A. Vania

2018-01-01

Experiences and memories are often mismatched. While multiple studies have investigated psychological underpinnings of recall error with respect to emotional events, the neurobiological mechanisms underlying the divergence between experiences and memories remain relatively unexplored in the domain of chronic pain. Here we examined the discrepancy between experienced chronic low back pain (CBP) intensity (twice daily ratings) and remembered pain intensity (n = 48 subjects) relative to psychometric properties, hippocampus morphology, memory capabilities, and personality traits related to reward. 77% of CBP patients exaggerated remembered pain, which depended on their strongest experienced pain and their most recent mood rating. This bias persisted over nearly 1 year and was related to reward memory bias and loss aversion. Shape displacement of a specific region in the left posterior hippocampus mediated personality effects on pain memory bias, predicted pain memory bias in a validation CBP group (n = 21), and accounted for 55% of the variance of pain memory bias. In two independent groups (n = 20/group), morphology of this region was stable over time and unperturbed by the development of chronic pain. These results imply that a localized hippocampal circuit, and personality traits associated with reward processing, largely determine exaggeration of daily pain experiences in chronic pain patients. PMID:29080714

Altered brain responses in subjects with irritable bowel syndrome during cued and uncued pain expectation.

Science.gov (United States)

Hong, J-Y; Naliboff, B; Labus, J S; Gupta, A; Kilpatrick, L A; Ashe-McNalley, C; Stains, J; Heendeniya, N; Smith, S R; Tillisch, K; Mayer, E A

2016-01-01

A majority of the subjects with irritable bowel syndrome (IBS) show increased behavioral and brain responses to expected and delivered aversive visceral stimuli during controlled rectal balloon distension, and during palpation of the sigmoid colon. We aimed to determine if altered brain responses to cued and uncued pain expectation are also seen in the context of a noxious somatic pain stimulus applied to the same dermatome as the sigmoid colon. A task-dependent functional magnetic resonance imaging technique was used to investigate the brain activity of 37 healthy controls (18 females) and 37 IBS subjects (21 females) during: (i) a cued expectation of an electric shock to the abdomen vs a cued safe condition; and (ii) an uncued cross-hair condition in which the threat is primarily based on context vs a cued safe condition. Regions within the salience, attention, default mode, and emotional arousal networks were more activated by the cued abdominal threat condition and the uncued condition than in the cued safe condition. During the uncued condition contrasted to the cued safe condition, IBS subjects (compared to healthy control subjects) showed greater brain activations in the affective (amygdala, anterior insula) and attentional (middle frontal gyrus) regions, and in the thalamus and precuneus. These disease-related differences were primarily seen in female subjects. The observed greater engagement of cognitive and emotional brain networks in IBS subjects during contextual threat may reflect the propensity of IBS subjects to overestimate the likelihood and severity of future abdominal pain. © 2015 John Wiley & Sons Ltd.

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

Science.gov (United States)

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.

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

Effects of music engagement on responses to painful stimulation.

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Bradshaw, David H; Chapman, C Richard; Jacobson, Robert C; Donaldson, Gary W

2012-06-01

We propose a theoretical framework for the behavioral modulation of pain based on constructivism, positing that task engagement, such as listening for errors in a musical passage, can establish a construction of reality that effectively replaces pain as a competing construction. Graded engagement produces graded reductions in pain as indicated by reduced psychophysiological arousal and subjective pain report. Fifty-three healthy volunteers having normal hearing participated in 4 music listening conditions consisting of passive listening (no task) or performing an error detection task varying in signal complexity and task difficulty. During all conditions, participants received normally painful fingertip shocks varying in intensity while stimulus-evoked potentials (SEP), pupil dilation responses (PDR), and retrospective pain reports were obtained. SEP and PDR increased with increasing stimulus intensity. Task performance decreased with increasing task difficulty. Mixed model analyses, adjusted for habituation/sensitization and repeated measures within person, revealed significant quadratic trends for SEP and pain report (Pchangemusic listening task. Engaging activities may prevent pain by creating competing constructions of reality that draw on the same processing resources as pain. Better understanding of these processes will advance the development of more effective pain modulation through improved manipulation of engagement strategies.

LUMBAR LORDOSIS IN ASYMPTOMATICS SUBJECTS AND PATIENTS WITH CHRONIC LOW BACK PAIN

OpenAIRE

S.J MOUSAVI; MOHAMMAD REZA NOURBAKHSH

2003-01-01

Introduction: The relationship between the degree of lumbar lordosis and chronic and purpose low back pain (LBP) has long been speculated, but there is discrepancy in findings of previous researchers. The purpose of this of this study was to drtermin differences between lumbar lordosis in asymptomatic and LBP subjects. Matherials: Lumbar lordosis of 420 patients with chronic LBP and 420 asymptomatic subjects was measured by two examiner. A flexible ruler was used to measure lumbar l...

Associations between psychological factors and the effect of home-based physical exercise in women with chronic neck and shoulder pain

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Linn Karlsson

2016-09-01

Full Text Available Background: Exercise is often used in the treatment of chronic neck and shoulder muscle pain. It is likely that psychological aspects have an impact on the results of exercise-based treatments. Objectives: (1 To examine the associations between psychological factors and the effect of a home-based physical exercise intervention. (2 To examine differences in psychological factors at baseline between (a subjects who continued in the trial and those who did not and (b subjects who completed the intervention and those who did not. Method: A total of 57 women with chronic neck and shoulder pain were included in a home-based exercise intervention trial. Pain intensity, disability, and psychological factors (anxiety and depression symptoms, catastrophizing, fear-avoidance beliefs, self-efficacy, and pain acceptance were measured at baseline, after 4–6 months, and after 1 year of exercise. Associations between the psychological factors and changes in pain intensity and disability were analysed, as well as differences in psychological factors at baseline between subjects who continued in and completed the intervention, and those who did not. Results: Associations between positive changes in pain intensity and disability were found for low fear-avoidance beliefs and low-pain self-efficacy at baseline. In addition, fear-avoidance beliefs at baseline were higher in the subjects who dropped out of the intervention than in those who continued. Pain acceptance at baseline was higher in the subjects who completed the intervention at the end of the trial. Conclusion: Particularly, fear-avoidance beliefs and pain self-efficacy should be taken into consideration when implementing home-based physical exercise as treatment for chronic neck pain. In addition, high pain acceptance might improve the adherence to prescribed exercise.

Increased objectively assessed vigorous-intensity exercise is associated with reduced stress, increased mental health and good objective and subjective sleep in young adults.

Science.gov (United States)

Gerber, Markus; Brand, Serge; Herrmann, Christian; Colledge, Flora; Holsboer-Trachsler, Edith; Pühse, Uwe

2014-08-01

The role of physical activity as a factor that protects against stress-related mental disorders is well documented. Nevertheless, there is still a dearth of research using objective measures of physical activity. The present study examines whether objectively assessed vigorous physical activity (VPA) is associated with mental health benefits beyond moderate physical activity (MPA). Particularly, this study examines whether young adults who accomplish the American College of Sports Medicine's (ACSM) vigorous-intensity exercise recommendations differ from peers below these standards with regard to their level of perceived stress, depressive symptoms, perceived pain, and subjective and objective sleep. A total of 42 undergraduate students (22 women, 20 men; M=21.24years, SD=2.20) volunteered to take part in the study. Stress, pain, depressive symptoms, and subjective sleep were assessed via questionnaire, objective sleep via sleep-EEG assessment, and VPA via actigraphy. Meeting VPA recommendations had mental health benefits beyond MPA. VPA was associated with less stress, pain, subjective sleep complaints and depressive symptoms. Moreover, vigorous exercisers had more favorable objective sleep pattern. Especially, they had increased total sleep time, more stage 4 and REM sleep, more slow wave sleep and a lower percentage of light sleep. Vigorous exercisers also reported fewer mental health problems if exposed to high stress. This study provides evidence that meeting the VPA standards of the ACSM is associated with improved mental health and more successful coping among young people, even compared to those who are meeting or exceeding the requirements for MPA. Copyright © 2014 Elsevier Inc. All rights reserved.

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.

Factors affecting experiences of intensive care patients in Turkey: patient outcomes in critical care setting.

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Demir, Yurdanur; Korhan, Esra Akin; Eser, Ismet; Khorshid, Leyla

2013-07-01

To determine the factors affecting a patient's intensive care experience. The descriptive study was conducted at an intensive care unit in the Aegean Region of Turkey, and comprised 158 patients who spent at least 48 hours at the unit between June and November 2009. A questionnaire form and the Intensive Care Experience Scale were used as data collection tools. SPSS 11.5 was used for statistical analysis of the data. Of the total, 86 (54.4%) patients related to the surgical unit, while 72 (45.5%) spent time at the intensive care unit. Most of the subjects (n=113; 71.5%) reported that they constantly experienced pain during hospitalisation. Patients receiving mechanical ventilation support and patients reporting no pain had significantly higher scores on the intensive care experience scale. Patients who reported pain remembered their experiences less than those having no pain. Interventions are needed to make the experiences of patients in intensive care more positive.

Kinesthetic illusions attenuate experimental muscle pain, as do muscle and cutaneous stimulation.

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Gay, André; Aimonetti, Jean-Marc; Roll, Jean-Pierre; Ribot-Ciscar, Edith

2015-07-30

In the present study, muscle pain was induced experimentally in healthy subjects by administrating hypertonic saline injections into the tibialis anterior (TA) muscle. We first aimed at comparing the analgesic effects of mechanical vibration applied to either cutaneous or muscle receptors of the TA or to both types simultaneously. Secondly, pain alleviation was compared in subjects in whom muscle tendon vibration evoked kinesthetic illusions of the ankle joint. Muscle tendon vibration, which primarily activated muscle receptors, reduced pain intensity by 30% (p<0.01). In addition, tangential skin vibration reduced pain intensity by 33% (p<0.01), primarily by activating cutaneous receptors. Concurrently stimulating both sensory channels induced stronger analgesic effects (-51%, p<0.01), as shown by the lower levels of electrodermal activity. The strongest analgesic effects of the vibration-induced muscle inputs occurred when illusory movements were perceived (-38%, p=0.01). The results suggest that both cutaneous and muscle sensory feedback reduce muscle pain, most likely via segmental and supraspinal processes. Further clinical trials are needed to investigate these new methods of muscle pain relief. Copyright © 2015 Elsevier B.V. All rights reserved.

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...

Differences in cortical coding of heat evoked pain beyond the perceived intensity: an fMRI and EEG study.

Science.gov (United States)

Haefeli, Jenny; Freund, Patrick; Kramer, John L K; Blum, Julia; Luechinger, Roger; Curt, Armin

2014-04-01

Imaging studies have identified a wide network of brain areas activated by nociceptive stimuli and revealed differences in somatotopic representation of highly distinct stimulation sites (foot vs. hand) in the primary (S1) and secondary (S2) somatosensory cortices. Somatotopic organization between adjacent dermatomes and differences in cortical coding of similarly perceived nociceptive stimulation are less well studied. Here, cortical processing following contact heat nociceptive stimulation of cervical (C4, C6, and C8) and trunk (T10) dermatomes were recorded in 20 healthy subjects using functional magnetic resonance imaging (fMRI) and electroencephalography (EEG). Stimulation of T10 compared with the C6 and C8 revealed significant higher response intensity in the left S1 (contralateral) and the right S2 (ipsilateral) even when the perceived pain was equal between stimulation sites. Accordingly, contact heat evoked potentials following stimulation of T10 showed significantly higher N2P2 amplitudes compared to C6 and C8. Adjacent dermatomes did not reveal a distinct somatotopical representation. Within the assessed cervical and trunk dermatomes, nociceptive cortical processing to heat differs significantly in magnitude even when controlling for pain perception. This study provides evidence that controlling for pain perception is not sufficient to compare directly the magnitude of cortical processing [blood oxygen level dependence (BOLD) response and amplitude of evoked potentials] between body sites. Copyright © 2013 Wiley Periodicals, Inc.

Assessment of pain sensitivity in patients with deep bite and sex- and age-matched controls

DEFF Research Database (Denmark)

Sonnesen, Ane Liselotte; Svensson, Peter

2011-01-01

AIMS: To compare pain sensitivity between deep bite patients and a sex- and age-matched control group with normal occlusion. METHODS: Pain sensitivity was assessed by injections of the excitatory amino acid glutamate into the masseter and brachioradialis muscles. Intensity of glutamate-evoked pai...... of gender-related differences in somatosensory sensitivity and for the first time indicate that subjects with deep bite may be more sensitive to glutamate-evoked pain and thermal stimuli.......AIMS: To compare pain sensitivity between deep bite patients and a sex- and age-matched control group with normal occlusion. METHODS: Pain sensitivity was assessed by injections of the excitatory amino acid glutamate into the masseter and brachioradialis muscles. Intensity of glutamate-evoked pain...

Population analyses of efficacy and safety of ABT-594 in subjects with diabetic peripheral neuropathic pain.

Science.gov (United States)

Dutta, Sandeep; Hosmane, Balakrishna S; Awni, Walid M

2012-06-01

ABT-594, a neuronal nicotinic acetylcholine receptor ligand, is 30- to 100-fold more potent than morphine in animal models of nociceptive and neuropathic pain. Efficacy and safety of ABT-594 in subjects with painful diabetic polyneuropathy was evaluated in a phase 2 study. The objective of this work was to use a nonlinear mixed effects model-based approach for characterizing the relationship between dose and response (efficacy and safety) of ABT-594. Subjects (N = 266) were randomized into four groups in a double-blind, placebo-controlled, 7-week study to receive twice daily regimens of placebo or 150, 225, and 300 μg of ABT-594. The primary efficacy variable, pain score (11-point Likert scale), was assessed on five occasions. The probability of change from baseline pain score of ≥1, ≥2, and ≥3 was modeled using cumulative logistic regression with dose and days of treatment as explanatory variables. The incidence of five most frequently occurring adverse events (AEs) was modeled using linear logistic regression. ABT-594 ED(50) values (improvement in 50% of subjects) for improvement in pain scores of ≥1, ≥2, and ≥3 were 50, 215, and 340 μg, respectively, for the average number of days (33) on treatment. The rank order of ED(50) values for AEs was nausea, vomiting, dizziness, headache, and abnormal dreams; nicotine users were less sensitive to AEs. Population pharmacodynamic models developed to characterize the improvement in pain score and incidence of adverse events indicate an approximately twofold separation between the ED(50) values for efficacy and AEs.

Assessment of psychological pain in major depressive episodes.

Science.gov (United States)

Mee, Steven; Bunney, Blynn G; Bunney, William E; Hetrick, William; Potkin, Steven G; Reist, Christopher

2011-11-01

Severe psychological or mental pain is defined as an experience of unbearable torment which can be associated with a psychiatric illness (e.g., major depressive disorder) or a tragic loss such as the death of a child. A brief self-rating scale (Mee-Bunney Psychological Pain Assessment Scale [MBPPAS]) was developed to assess the intensity of psychological pain. The scale was used to measure psychological pain in 73 major depressive episode (MDE) patients and 96 non-psychiatric controls. In addition to the MBPPAS, all subjects completed four additional instruments: Suicidal Behavior Questionnaire (SBQ), Beck Depression Inventory (BDI), Beck Hopelessness Scale (BHS), and the Brief Pain Inventory (BPI). Known-groups, content and convergent validity, and internal reliability of the scale were established. MDE and control subjects were ranked according to MBPPAS scores. A threshold was set at 32 representing 0.5 SD above the mean for MDEs. MDE subjects above the threshold of 32 had significantly higher SBQ scores than those below. A significant linear correlation between psychological pain and SBQ suicidality scores was observed. This is the first study to contrast psychological pain in controls and patients with MDE. Our results suggest that psychological pain is a useful and unique construct in patients with MDE that can be reliably assessed and may aid in the evaluation of suicidal risk. Published by Elsevier Ltd.

Influence of Catastrophizing and Personality Traits on Recalled Ratings of Acute Pain Experience in Healthy Young Adults.

Science.gov (United States)

Pallegama, Ranjith Wasantha; Ariyasinghe, Sajjiv; Perera, Eranthi Dinoka; Treede, Rolf-Detlef

2017-01-01

To investigate whether pain catastrophizing and personality traits bias recalled ratings of acute pain in an experimental tonic pain model. Fifty-six undergraduates (14 males) recruited from the University of Peradeniya (mean age 21.7 ± 0.8 SD years). Participants completed the Pain Catastrophizing Scale and the Eysenck Personality Questionnaire. They were subjected to two cold pressor tests (dominant and non-dominant hands) and pain threshold, maximum pain intensity, and pain tolerance were recorded. One-week later, the maximum pain intensities of both hands were recalled and percentage distortions in recalling were calculated. Based on a 180 s cutoff, two participants were considered pain-insensitive during the test and were excluded from the analysis. The maximum pain intensity was recalled with a moderate accuracy (Intraclass Correlation Coefficients = 0.68 for dominant and 0.59 for non-dominant hands). Hierarchical multiple regression analyses revealed that maximum pain intensity ( P  personality traits only neuroticism exhibited a weak positive association with the recalled ratings. © 2016 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Sleep quality in subjects suffering from chronic pain

OpenAIRE

Keilani, Mohammad; Crevenna, Richard; Dorner, Thomas Ernst

2017-01-01

Summary Background Sleeping problems are very common in patients with chronic pain. The aim of the study was to investigate the association between different dimensions of chronic pain and sleep quality in chronic pain patients. Methods In this cross-sectional interview-based questionnaire study, patients from 3 different pain treatment centers in Vienna aged 18–65 years, with pain lasting 3 months or longer were asked to participate. The association between the short-form McGill pain questio...

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.

Is TENS purely a placebo effect? A controlled study on chronic low back pain.

Science.gov (United States)

Marchand, S; Charest, J; Li, J; Chenard, J R; Lavignolle, B; Laurencelle, L

1993-07-01

Although high-frequency low-intensity transcutaneous electric nerve stimulation (TENS) has been extensively used to relieve low back pain, experimental studies of its effectiveness have yielded contradictory findings mainly due to methodological problems in pain evaluation and placebo control. In the present study, separate visual analog scales (VAS) were used to measure the sensory-discriminative and motivational-affective components of low back pain. Forty-two subjects were randomly assigned to 1 of 3 groups: TENS, placebo-TENS, and no treatment (control). In order to measure the short-term effect of TENS, VAS pain ratings were taken before and after each treatment session. Also, to measure long-term effects, patients rated their pain at home every 2 h throughout a 3-day period before and 1 week, 3 months and 6 months after the treatment sessions. In comparing the pain evaluations made immediately before and after each treatment session, TENS and placebo-TENS significantly reduced both the intensity and unpleasantness of chronic low back pain. TENS was significantly more efficient than placebo-TENS in reducing pain intensity but not pain unpleasantness. TENS also produced a significant additive effect over repetitive treatment sessions for pain intensity and relative pain unpleasantness. This additive effect was not found for placebo-TENS. When evaluated at home, pain intensity was significantly reduced more by TENS than placebo-TENS 1 week after the end of treatment, but not 3 months and 6 months later. At home evaluation of pain unpleasantness in the TENS group was never different from the placebo-TENS group.(ABSTRACT TRUNCATED AT 250 WORDS)

Ethnic Differences in Nonverbal Pain Behaviors Observed in Older Adults with Dementia.

Science.gov (United States)

Ford, Brianne; Snow, A Lynn; Herr, Keela; Tripp-Reimer, Toni

2015-10-01

Research supports using nonverbal pain behaviors to identify pain in persons with dementia. It is unknown whether variations exist among ethnic groups in the expression of nonverbal pain behaviors in this special population. The purpose of this descriptive study was to examine ethnic differences in the presentation and intensity of nonverbal pain behaviors among African American, Caucasian, and Hispanic older adults with dementia when screened for pain by certified nursing assistants. Six certified nursing assistants were trained to review and score 28 video recordings of subjects with dementia for nonverbal pain behaviors using the Non-Communicative Patient's Pain Assessment Instrument. Chi-square was used to examine differences among ethnic groups with regard to the display of nonverbal pain behaviors, and ANOVA was used to evaluate differences in the intensity of overall pain across ethnic groups. Of the 168 assessments, pain words (28%), pain noises (29.8%), and pain faces (28%) were observed most often as indicators of pain. Rubbing, bracing, and restlessness were rarely noted. Chi-square analysis revealed ethnic differences in the expression of pain words (χ(2) = 19.167, p ethnic groups with regards to overall pain intensity. These findings are the first to examine ethnic differences in nonverbal pain behaviors for older adults with dementia. However, future work should examine assessment tendencies of providers in a larger, more diverse sample. Copyright © 2015 American Society for Pain Management Nursing. All rights reserved.

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.

Interactive effects of music tempi and intensities on grip strength and subjective affect.

Science.gov (United States)

Karageorghis, C I; Cheek, P; Simpson, S D; Bigliassi, M

2018-03-01

Pretask music is widely used by athletes albeit there is scant empirical evidence to support its use. The present study extended a line of work into pretask music by examining the interactive effects of music tempo and intensity (volume) on the performance of a simple motor skill and subjective affect. A 2 × 2 within-subjects factorial design was employed with an additional no-music control, the scores from which were used as a covariate. A sample of 52 male athletes (M age  = 26.1 ± 4.8 years) was exposed to five conditions: fast/loud (126 bpm/80 dBA), fast/quiet (126 bpm/70 dBA), slow/loud (87 bpm/80 dBA), slow/quiet (87 bpm/70 dBA) music, and a no-music control. Dependent variables were grip strength, measured with a handgrip dynamometer, and subjective affect, assessed by use of the Affect Grid. The tempo and intensity components of music had interactive effects for grip strength but only main effects for subjective affect. Fast-tempo music played at a high intensity yielded the highest grip strength, while fast-tempo music played at a low-intensity resulted in much lower grip strength (M diff.  = -1.11 Force kg). For affective valence, there were main effects of tempo and intensity, with fast and loud music yielding the highest scores. For affective arousal, there was no difference between tempi although there was between intensities, with the high-intensity condition yielding higher scores. The present findings indicate the utility of fast/loud pretask music in enhancing affective valence and arousal in preparation for a simple or gross motor task. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

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

Science.gov (United States)

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.

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

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

2014-05-01

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

Reliability and minimal detectable change of a modified passive neck flexion test in patients with chronic nonspecific neck pain and asymptomatic subjects.

Science.gov (United States)

López-de-Uralde-Villanueva, Ibai; Acuyo-Osorio, Mario; Prieto-Aldana, María; La Touche, Roy

2017-04-01

The Passive Neck Flexion Test (PNFT) can diagnose meningitis and potential spinal disorders. Little evidence is available concerning the use of a modified version of the PNFT (mPNFT) in patients with chronic nonspecific neck pain (CNSNP). To assess the reliability of the mPNFT in subjects with and without CNSNP. The secondary objective was to assess the differences in the symptoms provoked by the mPNFT between these two populations. We used repeated measures concordance design for the main objective and cross-sectional design for the secondary objective. A total of 30 asymptomatic subjects and 34 patients with CNSNP were recruited. The following measures were recorded: the range of motion at the onset of symptoms (OS-mPNFT), the range of motion at the submaximal pain (SP-mPNFT), and evoked pain intensity on the mPNFT (VAS-mPNFT). Good to excellent reliability was observed for OS-mPNFT and SP-mPNFT in the asymptomatic group (intra-examiner reliability: 0.95-0.97; inter-examiner reliability: 0.86-0.90; intra-examiner test-retest reliability: 0.84-0.87). In the CNSNP group, a good to excellent reliability was obtained for the OS-mPNFT (intra-examiner reliability: 0.89-0.96; inter-examiner reliability: 0.83-0.86; intra-examiner test-retest reliability: 0.83-0.85) and the SP-PNFT (intra-examiner reliability: 0.94-0.98; inter-examiner reliability: 0.80-0.82; intra-examiner test-retest reliability: 0.88-0.91). The CNSNP group showed statistically significant differences in OS-mPNFT (t = 4.92; P reliable tool regardless of the examiner and the time factor. Patients with CNSNP have a decrease range of motion and more pain than asymptomatic subjects in the mPNFT. This exceeds the minimal detectable changes for OS-mPNFT and VAS-mPNFT. Copyright © 2017 Elsevier Ltd. All rights reserved.

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

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

Science.gov (United States)

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.

LUMBAR LORDOSIS IN ASYMPTOMATICS SUBJECTS AND PATIENTS WITH CHRONIC LOW BACK PAIN

Directory of Open Access Journals (Sweden)

S.J MOUSAVI

2003-12-01

Full Text Available Introduction: The relationship between the degree of lumbar lordosis and chronic and purpose low back pain (LBP has long been speculated, but there is discrepancy in findings of previous researchers. The purpose of this of this study was to drtermin differences between lumbar lordosis in asymptomatic and LBP subjects. Matherials: Lumbar lordosis of 420 patients with chronic LBP and 420 asymptomatic subjects was measured by two examiner. A flexible ruler was used to measure lumbar lodosis in all subjects. Results: The averagr degree of lumbar lordosis for all subjects was 37±13°. Females had greater lumbar lordosis (42 ±15° than males (32±100 and elderly subjects had lesser lumbar lordosis than younger and middle aged subjects. Conclussoion: The degree of lumbar lordosis was not differet between normal subjects and those with LBP. It seems that effects of lumbar lordosis on LBP and treatment programs need to be reevaluated.

Physical and psychosocial disability in elderly subjects in relation to pain in the hip and/or knee

NARCIS (Netherlands)

Hopman-Rock, M.; Odding, E.; Hofman, A.; Kraaimaat, F.W.; Bijlsma, J.W.J.

1996-01-01

Objective. To determine physical and psychosocial disability in subjects aged 55 to 74 years living in the community, in relation to pain in the hip and/or knee, and to explore the relationships between pain, physical and psychosocial disability, and selected background variables. Methods. A

ROLE OF PSYCHOLOGICAL PROBLEMS IN EFFICACY OF TRANSCUTANEOUS ELECTRICAL NERVE STIMU-LATION IN PATIENTS SUFFERING FROM CHRONIC PAIN

Directory of Open Access Journals (Sweden)

S. M. Mirzamani

2006-07-01

Full Text Available Patients afflicted with chronic pain have both physical and psychological problems. This research investigated the impact of the psychological factors in the treatment results of transcutaneous electrical nerve stimulation (TENS in the patients afflicted with chronic diseases. The subjects were 37 individuals (20 males and 17 females with the mean age of 46 who had referred to two centers of physiotherapy treatment to receive TENS treatment process. Subjects were suffering from chronic pain in upper part of their body, hands and legs. The subjects were tested and screened psychologically by PDQ4+, MPQ, MPI, and BDI questionnaires. On the basis of the personality disorder and the intensity of the depression, they were divided into two groups: 1 patients with psychological symptoms (n = 14; and 2 patients without psychological symptoms (n = 23. In order to study the rate of the pain intensity reduction in both groups, the MPQ questionnaire was used in three stages (before beginning, in the middle and at the end of the treatment. Also, the MPI questionnaire was used in order to review the inter-personal problems, the interference of the pain in life, daily performance and the rate of social support. Results showed that in each group, the pain intensity had significantly reduced as a result of the impact of TENS treatment and the psychological factors did not have meaningful impacts. Also there was statistically significant correlation between the rate of social support of the family members and the reduction of pain intensity.

Three-dimensional Cervical Movement Characteristics in Healthy Subjects and Subgroups of Chronic Neck Pain Patients Based on Their Pain Location.

Science.gov (United States)

Waeyaert, Patirck; Jansen, Daniel; Bastiaansen, Marco; Scafoglieri, Aldo; Buyl, Ronald; Schmitt, Maarten; Cattrysse, Erik

2016-08-01

A cross-sectional observational study of three-dimensional (3D) cervical kinematics in 41 chronic neck pain (CNPs) patients and 156 asymptomatic controls. The objective was to investigate 3D cervical kinematics by analyzing and comparing quantitative and qualitative parameters in healthy subjects and CNPs. Furthermore, subgroups were formed to explore the influence of pain-location on cervical kinematics. The possible correlation of kinematic parameters with the degree of functional disability was examined as well. In patients with chronic neck pain, a clear pathological cause is frequently not identifiable. Therefore, the need to assess neck pain with a broader view than structure or anatomical-based divergences is desirable. Movements of the cervical spine were registered using an electromagnetic tracking system. Quantitative and qualitative kinematics were analyzed for active axial rotation, lateral bending, and flexion-extension motion components. During lateral bending, the range of the main motion demonstrated significant higher values (P = 0.001) in the controls (mean: 68.67° ± 15.17°) than patients (mean: 59.28° ± 15.41°). Significant differences were demonstrated between subgroups for several kinematic parameters (P pain group, some parameters also distinguished subgroups from controls. On average, the symmetrical group showed significant less harmonic movement patterns, expressed by qualitative parameters, in comparison with the "asymmetrical" group and controls. Furthermore, the "asymmetrical" group showed significant lower scores on quantitative parameters than the "symmetrical" group and controls. The degree of functional disability correlated moderately with changes in qualitative parameters. In this study, chronic neck pain patients with a symmetrical pain pattern showed significant poorer quality of movement, while those with asymmetrical pain showed a significant reduction in quantitative measures. Subgrouping of neck patients

The Effect of a Novel form of Extended-Release Gabapentin on Pain and Sleep in Fibromyalgia Subjects: An Open-Label Pilot Study.

Science.gov (United States)

North, James M; Hong, Kyung-Soo J; Rauck, Richard L

2016-07-01

We assessed the efficacy and safety of extended-release gabapentin in a 15-week, open-label, single-arm, single-center study in patients with fibromyalgia (FM). Subjects with documented diagnosis of FM were allowed to participate in the study. We opened enrollment to those who have tried and failed gabapentinoids such as gabapentin or pregabalin due to side effects. Subjects with autoimmune conditions, and or taking opioids for management of their FM pain, were excluded from the study. Subjects were given an extended-release gabapentin starter pack and treated for total of 12 weeks. The primary study endpoint of pain relief was measured using Numeric Pain Rating System (NPRS) scores, and secondary study endpoints were measured with Fibromyalgia Impact Questionnaire (FIQ), Patient's Global Impression of Change (PGIC), and Medical Outcome Sleep questionnaires (MOS). A total of 34 subjects were enrolled and 29 subjects completed the starter pack (85%). Patients reported significant pain relief on NPRS by end of 4 weeks (P life by end of 4 weeks on FIQ (P quality. Improvements in primary and secondary measurements were reflected in PGIC, with significant improvement in patient's impression of FM by week 8. Small sample size, geographical bias, relatively short duration of treatment, and single-arm study without control group. Extended-release gabapentin relieved FM pain symptoms and improved quality-of-life for the FM subjects studied. Subjects reported improvements in both quantity and quality of sleep. © 2015 World Institute of Pain.

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.

Science.gov (United States)

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.

Muscle activation during selected strength exercises in women with chronic neck muscle pain

DEFF Research Database (Denmark)

Andersen, Lars L; Kjaer, Michael; Andersen, Christoffer H

2008-01-01

selected strengthening exercises in women undergoing rehabilitation for chronic neck muscle pain (defined as a clinical diagnosis of trapezius myalgia). SUBJECTS: The subjects were 12 female workers (age=30-60 years) with a clinical diagnosis of trapezius myalgia and a mean baseline pain intensity of 5......BACKGROUND AND PURPOSE: Muscle-specific strength training has previously been shown to be effective in the rehabilitation of chronic neck muscle pain in women. The aim of this study was to determine the level of activation of the neck and shoulder muscles using surface electromyography (EMG) during...... muscle pain. Several of the strength exercises had high activation of neck and shoulder muscles in women with chronic neck pain. These exercises can be used equally in the attempt to achieve a beneficial treatment effect on chronic neck muscle pain....

Sedation and memories of patients subjected to mechanical ventilation in an intensive care unit.

Science.gov (United States)

Costa, Jaquilene Barreto da; Marcon, Sonia Silva; Macedo, Claudia Rejane Lima de; Jorge, Amaury Cesar; Duarte, Péricles Almeida Delfino

2014-01-01

To investigate the relationship between sedation and the memories reported by patients subjected to mechanical ventilation following discharge from the intensive care unit. This prospective, observational, cohort study was conducted with individuals subjected to mechanical ventilation who remained in the intensive care unit for more than 24 hours. Clinical statistics and sedation records were extracted from the participants' clinical records; the data relative to the participants' memories were collected using a specific validated instrument. Assessment was performed three months after discharge from the intensive care unit. A total of 128 individuals were assessed, most of whom (84.4%) reported recollections from their stay in the intensive care unit as predominantly a combination of real and illusory events. The participants subjected to sedation (67.2%) at deep levels (Richmond Agitation-Sedation Scale [RASS] -4 and -5) for more than two days and those with psychomotor agitation (33.6%) exhibited greater susceptibility to occurrence of illusory memories (p>0.001). The probability of the occurrence of illusory memories was greater among the participants who were subjected to deep sedation. Sedation seems to be an additional factor that contributed to the occurrence of illusory memories in severely ill individuals subjected to mechanical ventilation.

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

Science.gov (United States)

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.

Effect of chronic nonmalignant pain on highway driving performance.

Science.gov (United States)

Veldhuijzen, D S; van Wijck, A J M; Wille, F; Verster, J C; Kenemans, J L; Kalkman, C J; Olivier, B; Volkerts, E R

2006-05-01

Most pain patients are treated in an outpatient setting and are engaged in daily activities including driving. Since several studies showed that cognitive functioning may be impaired in chronic nonmalignant pain, the question arises whether or not chronic nonmalignant pain affects driving performance. Therefore, the objective of the present study was to determine the effects of chronic nonmalignant pain on actual highway driving performance during normal traffic. Fourteen patients with chronic nonmalignant pain and 14 healthy controls, matched on age, educational level, and driving experience, participated in the study. Participants performed a standardized on-the-road driving test during normal traffic, on a primary highway. The primary parameter of the driving test is the Standard Deviation of Lateral Position (SDLP). In addition, driving-related skills (tracking, divided attention, and memory) were examined in the laboratory. Subjective assessments, such as pain intensity, and subjective driving quality, were rated on visual analogue scales. The results demonstrated that a subset of chronic nonmalignant pain patients had SDLPs that were higher than the matched healthy controls, indicating worse highway driving performance. Overall, there was a statistically significant difference in highway driving performance between the groups. Further, chronic nonmalignant pain patients rated their subjective driving quality to be normal, although their ratings were significantly lower than those of the healthy controls. No significant effects were found on the laboratory tests.

Temporal summation of heat pain in humans: Evidence supporting thalamocortical modulation.

Science.gov (United States)

Tran, Tuan D; Wang, Heng; Tandon, Animesh; Hernandez-Garcia, Luis; Casey, Kenneth L

2010-07-01

Noxious cutaneous contact heat stimuli (48 degrees C) are perceived as increasingly painful when the stimulus duration is extended from 5 to 10s, reflecting the temporal summation of central neuronal activity mediating heat pain. However, the sensation of increasing heat pain disappears, reaching a plateau as stimulus duration increases from 10 to 20s. We used functional magnetic resonance imaging (fMRI) in 10 healthy subjects to determine if active central mechanisms could contribute to this psychophysical plateau. During heat pain durations ranging from 5 to 20s, activation intensities in the bilateral orbitofrontal cortices and the activation volume in the left primary (S1) somatosensory cortex correlated only with perceived stimulus intensity and not with stimulus duration. Activation volumes increased with both stimulus duration and perceived intensity in the left lateral thalamus, posterior insula, inferior parietal cortex, and hippocampus. In contrast, during the psychophysical plateau, both the intensity and volume of thalamic and cortical activations in the right medial thalamus, right posterior insula, and left secondary (S2) somatosensory cortex continued to increase with stimulus duration but not with perceived stimulus intensity. Activation volumes in the left medial and right lateral thalamus, and the bilateral mid-anterior cingulate, left orbitofrontal, and right S2 cortices also increased only with stimulus duration. The increased activity of specific thalamic and cortical structures as stimulus duration, but not perceived intensity, increases is consistent with the recruitment of a thalamocortical mechanism that participates in the modulation of pain-related cortical responses and the temporal summation of heat pain. Published by Elsevier B.V.

Responses to tonic heat pain in the ongoing EEG under conditions of controlled attention.

Science.gov (United States)

Giehl, Janet; Meyer-Brandis, Gesa; Kunz, Miriam; Lautenbacher, Stefan

2014-03-01

To confirm the existence of an ongoing electroencephalogram (EEG) pattern that is truly suggestive of pain, tonic heat pain was induced by small heat pulses at 1 °C above the pain threshold and compared to slightly less intense tonic non-painful heat pulses at 1 °C below the pain threshold. Twenty healthy subjects rated the sensation intensity during thermal stimulation. Possible confounding effects of attention were thoroughly controlled for by testing in four conditions: (1) focus of attention directed ipsilateral or (2) contralateral to the side of the stimulation, (3) control without a side preference, and (4) no control of attention at all. EEG was recorded via eight leads according to the 10/20 convention. Absolute power was computed for the frequency bands delta (0.5-4 Hz), theta (4-8 Hz), alpha1 (8-11 Hz), alpha2 (11-14 Hz), beta1 (14-25 Hz), and beta2 (25-35 Hz). Ratings were clearly distinct between the heat and pain conditions and suggestive for heat and pain sensations. Manipulation of attention proved to be successful by producing effects on the ratings and on the EEG activity (with lower ratings and lower EEG activity (theta, beta1, 2) over central areas for side-focused attention). During pain stimulation, lower central alpha1 and alpha2 activity and higher right-parietal and right-occipital delta power were observed compared to heat stimulation. This EEG pattern was not influenced by the manipulation of attention. Since the two types of stimuli (pain, heat) were subjectively felt differently although stimulation intensities were nearby, we conclude that this EEG pattern is clearly suggestive of pain.

Numerical evaluation of stress intensity factor for vessel and pipe subjected to thermal shock

International Nuclear Information System (INIS)

Kim, Y.W.; Lee, H.Y.; Yoo, B.

1994-01-01

The thermal weight function method and the finite element method were employed in the numerical computation of the stress intensity factor for a cracked vessel and the cracked pipe subjected to thermal shock. A wall subjected to thermal shock was analyzed, and it has been shown that the effect of thermal shock on the stress intensity factor is dominant for the crack with small crack length to thickness ratio. Convection at the crack face had an influence on the stress intensity factor in the early stage of thermal shock. (Author)

Pen needle design influences ease of insertion, pain, and skin trauma in subjects with type 2 diabetes.

Science.gov (United States)

Præstmark, Kezia A; Jensen, Morten L; Madsen, Nils B; Kildegaard, Jonas; Stallknecht, Bente M

2016-01-01

Pen needles used for subcutaneous injections have gradually become shorter, thinner and more thin walled, and thereby less robust to patient reuse. Thus, different needle sizes, alternative tip designs and needles resembling reuse were tested to explore how needle design influences ease of insertion, pain and skin trauma. 30 subjects with injection-treated type 2 diabetes and body mass index 25-35 kg/m 2 were included in the single-blinded study. Each subject received abdominal insertions with 18 different types of needles. All needles were tested twice per subject and in random order. Penetration force (PF) through the skin, pain perception on 100 mm visual analog scale, and change in skin blood perfusion (SBP) were quantified after the insertions. Needle diameter was positively related to PF and SBP (ptrend relation. Lack of needle lubrication and small 'needle hooks' increased PF and SBP (pskin and in polyurethane rubber were linearly related, and pain outcome was dependent of SBP increase. The shape and design of a needle and the needle tip affect ease of insertion, pain and skin trauma. Relations are seen across different data acquisition methods and across species, enabling needle performance testing outside of clinical trials. NCT02531776; results.

EFFECT OF ECCENTRIC EXERCISE PROGRAMME ON PAIN AND GRIP STRENGTH FOR SUBJECTS WITH MEDIAL EPICONDYLITIS

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Mishra Prashant Akhilesh

2014-04-01

Full Text Available Background and Objective: Therapeutic eccentric exercise may provide both a structural and functional benefit during tendinopathy rehabilitation. The objective is to find the effect of eccentric exercises on improvement of pain and grip strength for subjects with Medial Epicondylitis. Method: Pre to post test experimental study design randomized thirty subjects with medial epicondylitis, 15 each into Group A and Group B. Group B subjects were treated with conventional therapy and Eccentric exercises. Group A subjects were treated with conventional therapy. Results: When means of post intervention were compared using Independent ‘t’ between groups there was no statistically significant difference in improvements obtained in VAS scores and grip strength. There was a statistically significant change in means of VAS score and Grip strength when means were analyzed by using Paired‘t’ test and Wilcoxon signed rank test within the groups with positive percentage of change. Conclusion: It is concluded that four weeks of Eccentric Exercise Programme combined with conventional therapy shown significant effect on improving pain and Grip strength, however the improvement obtained has no difference when compared with control conventional treatment for Subjects with Medial Epicondylitis.

Effectiveness of fixed-site high-frequency transcutaneous electrical nerve stimulation in chronic pain: a large-scale, observational study

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Kong, Xuan; Gozani, Shai N

2018-01-01

Objective The objective of this study was to assess the effectiveness of fixed-site high-frequency transcutaneous electrical nerve stimulation (FS-TENS) in a real-world chronic pain sample. Background There is a need for nonpharmacological treatment options for chronic pain. FS-TENS improved multisite chronic pain in a previous interventional study. Large observational studies are needed to further characterize its effectiveness. Methods This retrospective observational cohort study examined changes in chronic pain measures following 60 days of FS-TENS use. The study data were obtained from FS-TENS users who uploaded their device utilization and clinical data to an online database. The primary outcome measures were changes in pain intensity and pain interference with sleep, activity, and mood on an 11-point numerical rating scale. Dose–response associations were evaluated by stratifying subjects into low (≤30 days), intermediate (31–56 days), and high (≥57 days) utilization subgroups. FS-TENS effectiveness was quantified by baseline to follow-up group differences and a responder analysis (≥30% improvement in pain intensity or ≥2-point improvement in pain interference domains). Results Utilization and clinical data were collected from 11,900 people using FS-TENS for chronic pain, with 713 device users meeting the inclusion and exclusion criteria. Study subjects were generally older, overweight adults. Subjects reported multisite pain with a mean of 4.8 (standard deviation [SD] 2.5) pain sites. A total of 97.2% of subjects identified low back and/or lower extremity pain, and 72.9% of subjects reported upper body pain. All pain measures exhibited statistically significant group differences from baseline to 60-day follow-up. The largest changes were pain interference with activity (−0.99±2.69 points) and mood (−1.02±2.78 points). A total of 48.7% of subjects exhibited a clinically meaningful reduction in pain interference with activity or mood. This

Relevance of infiltration analgesia in pain relief after total knee arthroplasty

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Znojek-Tymborowska, Justyna; Kęska, Rafał; Paradowski, Przemysław T.; Witoński, Dariusz

2013-01-01

OBJECTIVE: The aim of the study was to assess the effect of different types of anesthesia on pain intensity in early postoperative period. PATIENTS AND METHODS: A total of 87 patients (77 women, 10 men) scheduled for total knee arthroplasty (TKA) were assigned to receive either subarachnoid anesthesia alone or in combination with local soft tissue anesthesia, local soft tissue anesthesia and femoral nerve block and pre-emptive infiltration together with local soft tissue anesthesia. We assessed the pain intensity, opioid consumption, knee joint mobility, and complications of surgery. RESULTS: Subjects with pre-emptive infiltration and local soft tissue anesthesia had lower pain intensity on the first postoperative day compared to those with soft tissue anesthesia and femoral nerve block (P=0.012, effect size 0.68). Subjects who received pre-emptive infiltration and local soft-tissue anesthesia had the greatest range of motion in the operated knee at discharge (mean 90 grades [SD 7], P=0.01 compared to those who received subarachnoid anesthesia alone, and P=0.001 compared to those with subarachnoid together with soft tissue anesthesia). CONCLUSION: Despite the differences in postoperative pain and knee mobility, the results obtained throughout the postoperative period do not enable us to favour neither local nor regional infiltration anesthesia in TKA. Level of Evidence II, Prospective Comparative Study. PMID:24453679

Increased intensity discrimination thresholds in tinnitus subjects with a normal audiogram

DEFF Research Database (Denmark)

Epp, Bastian; Hots, J.; Verhey, J. L.

2012-01-01

Recent auditory brain stem response measurements in tinnitus subjects with normal audiograms indicate the presence of hidden hearing loss that manifests as reduced neural output from the cochlea at high sound intensities, and results from mice suggest a link to deafferentation of auditory nerve...... fibers. As deafferentation would lead to deficits in hearing performance, the present study investigates whether tinnitus patients with normal hearing thresholds show impairment in intensity discrimination compared to an audiometrically matched control group. Intensity discrimination thresholds were...... significantly increased in the tinnitus frequency range, consistent with the hypothesis that auditory nerve fiber deafferentation is associated with tinnitus....

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

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

2015-11-01

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

Glucosamine-containing supplement improves locomotor functions in subjects with knee pain: a randomized, double-blind, placebo-controlled study.

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Kanzaki, Noriyuki; Ono, Yoshiko; Shibata, Hiroshi; Moritani, Toshio

2015-01-01

The aim of this study was to investigate the ability of a glucosamine-containing supplement to improve locomotor functions in subjects with knee pain. A randomized, double-blind, placebo-controlled, parallel-group comparative study was conducted for 16 weeks in 100 Japanese subjects (age, 51.8±0.8 years) with knee pain. Subjects were randomly assigned to one of the two supplements containing 1) 1,200 mg of glucosamine hydrochloride, 60 mg of chondroitin sulfate, 45 mg of type II collagen peptides, 90 mg of quercetin glycosides, 10 mg of imidazole peptides, and 5 μg of vitamin D per day (GCQID group, n=50) or 2) a placebo (placebo group, n=50). Japanese Knee Osteoarthritis Measure, visual analog scale score, normal walking speed, and knee-extensor strength were measured to evaluate the effects of the supplement on knee-joint functions and locomotor functions. In subjects eligible for efficacy assessment, there was no significant group × time interaction, and there were improvements in knee-joint functions and locomotor functions in both groups, but there was no significant difference between the groups. In subjects with mild-to-severe knee pain at baseline, knee-extensor strength at week 8 (104.6±5.0% body weight vs 92.3±5.5% body weight, P=0.030) and the change in normal walking speed at week 16 (0.11±0.03 m/s vs 0.05±0.02 m/s, P=0.038) were significantly greater in the GCQID group than in the placebo group. Further subgroup analysis based on Kellgren-Lawrence (K-L) grade showed that normal walking speed at week 16 (1.36±0.05 m/s vs 1.21±0.02 m/s, Pknee pain, GCQID supplementation was effective for relieving knee pain and improving locomotor functions.

Referred pain elicited by manual exploration of the lateral rectus muscle in chronic tension-type headache.

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Fernández-de-Las-Peñas, César; Cuadrado, Maria Luz; Gerwin, Robert D; Pareja, Juan A

2009-01-01

To analyze the presence of referred pain elicited by manual examination of the lateral rectus muscle in patients with chronic tension-type headache (CTTH). A case-control blinded study. It has been found previously that the manual examination of the superior oblique muscle can elicit referred pain to the head in some patients with migraine or tension-type headache. However, a referred pain from other extraocular muscles has not been investigated. Fifteen patients with CTTH and 15 healthy subjects without headache history were included. A blinded assessor performed a manual examination focused on the search for myofascial trigger points (TrPs) in the right and left lateral rectus muscles. TrP diagnosis was made when there was referred pain evoked by maintained pressure on the lateral corner of the orbit (anatomical projection of the lateral rectus muscle) for 20 seconds, and increased referred pain while the subject maintained a medial gaze on the corresponding side (active stretching of the muscle) for 15 seconds. On each side, a 10-point numerical pain rate scale was used to assess the intensity of referred pain at both stages of the examination. Ten patients with CTTH (66.6%) had referred pain that satisfied TrPs diagnostic criteria, while only one healthy control (0.07%) reported referred pain upon the examination of the lateral rectus muscles (P < 0.001). The elicited referred pain was perceived as a deep ache located at the supraorbital region or the homolateral forehead. Pain was evoked on both sides in all subjects with TrPs, with no difference in pain intensity between the right and the left. The average pain intensity was significantly greater in the patient group (P < 0.001). All CTTH patients with referred pain recognized it as the frontal pain that they usually experienced during their headache attacks, which was consistent with active TrPs. In some patients with CTTH, the manual examination of lateral rectus muscle TrPs elicits a referred pain that

EFFECTIVENESS OF MEDIAL TO LATERAL TAPING WITH EXERCISE PROGRAMME IN SUBJECTS WITH LATERAL EPICONDYLITIS

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Bhavana Dattaram Desai

2014-06-01

Full Text Available Background: Medial to lateral tapping and exercise programme has been found to be effective in Lateral epicondylitis. The purpose to find the combined effect of Medial to lateral tapping with exercise programme for subjects with lateral epicondylitis on pain intensity and functional ability. Method: An experimental study design, selected 40 subjects with Lateral epicondylitis randomized 20 subjects each into Study and Control group. Control group received only exercise programme while study group received combined medial to lateral tapping with exercise programme thrice a week for 4 weeks. Pain intensity was measured using Visual analogue scale and functional ability was measured using Patient Rated Tennis Elbow Evaluation questionnaire before and after 4 weeks of treatment. Results: When the post-intervention means were compared between Study and Control group after 4 weeks of treatment found statistically significant difference in the improvement in outcomes measures in means of VAS and PRTEE before and after intervention within the groups. Conclusion: It is concluded that the Medial to lateral tapping with exercise programme is more effective than the exercise programme in reduction of pain and improve functional abilities for subjects with Lateral epicondylitis.

Masticatory and cervical muscle tenderness and pain sensitivity in a remote area in subjects with a temporomandibular disorder and neck disability.

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Silveira, Anelise; Armijo-Olivo, Susan; Gadotti, Inae C; Magee, David

2014-01-01

To compare the masticatory and cervical muscle tenderness and pain sensitivity in the hand (remote region) between patients with temporomandibular disorders (TMD) and healthy controls. Twenty female subjects were diagnosed with chronic TMD, and 20 were considered healthy. Subjects completed the Neck Disability Index and Limitations of Daily Functions in a TMD questionnaire. Tenderness of the masticatory and cervical muscles and pain sensitivity in the hand were measured using an algometer. Three-way mixed analysis of variance (ANOVA) evaluated differences in muscle tenderness between groups. One-way ANOVA compared pain sensitivity in the hand between groups. Effect sizes were assessed using Cohen guidelines. Significantly increased masticatory and cervical muscle tenderness and pain sensitivity in the hand were found in subjects with TMD when compared with healthy subjects. Moderate to high effect sizes showed the clinical relevance of the findings. The results of this study have highlighted the importance of assessing TMD patients not only in the craniofacial region but also in the neck and other parts of the body. Future studies should focus on testing the effectiveness of treatments addressing the neck and the pain sensitivity in the hand in patients with TMD.

Cross friction algometry (CFA): Comparison of pressure pain thresholds between patients with chronic non-specific low back pain and healthy subjects.

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Farasyn, Andre; Lassat, Bert

2016-04-01

Palpation is widely used to assess muscular sensitivity in clinical settings but still remains a subjective evaluation. This cross-sectional study assessed a newly developed cross-friction algometry making palpation measurable. The objective was to investigate the reliability of pressure pain thresholds obtained using Cross-Friction Algometry (CFA-PPTs) measured at the level of Erector spinae and Gluteus maximus central muscle parts, and to compare the CFA-PPTs between patients with chronic nonspecific low back pain (nCLBP) and matching healthy subjects. Patients presenting nCLBP to GP's and send into a Pain Center and healthy subjects recruited via university ad valvas & flyers distribution. 30 patients with nCLBP were measured for cross-friction algometry. Other evaluations consisted of the Visual Analogue Scale (VAS) and the Oswestry Disability Index (ODI). The inter- and intra-reliability were tested and found to be sufficient. The mean CFA-PPT values of the Erector spinae at levels T8, T10, L1 & L3 and the Gluteus maximus of the nCLBP group were significantly lower (p ≤ 0.001) when compared to the CFA-PPT values of the healthy group. The greatest difference (-58%) was found at L1 Erector spinae level and at the superior part of the Gluteus maximus measuring point (-59%). Within the group of patients with nCLBP it was surprising to notice that there was no significant correlation between all the reference points measured using CFA-PPTs and the outcomes of the VAS and ODI scores. With the aid of CFA, the importance of local muscular disorder in the lumbar part of the Erector spinae and Gluteus maximus in patients with nCLBP is obviously demonstrated, but also reveals the very large inter-individual differences in muscular fibrosis sensitivity and/or pain behavior in daily life. This possibly re-opens the debate on which influences can be put forward as the most important: the central or the peripheral sensitization system. Copyright © 2015 Elsevier Ltd. All

Medication overuse reinstates conditioned pain modulation in women with migraine.

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Guy, Nathalie; Voisin, Daniel; Mulliez, Aurélien; Clavelou, Pierre; Dallel, Radhouane

2018-05-01

Background This study investigated the effects of medication overuse and withdrawal on modulation of pain processing in women with migraine. Temporal summation of laser-evoked thermal pain was used to measure the effects of conditioned pain modulation. Methods 36 female participants (12 healthy volunteers, 12 with episodic migraine and 12 with medication overuse headache) were included in a two session protocol. Medication overuse headache subjects were also tested three weeks after medication overuse headache withdrawal. Mechanical and laser-evoked thermal pain thresholds were measured on the back of the non-dominant hand where, later, temporal summation of laser-evoked thermal pain to repetitive thermal stimuli was elicited for 30 min, at an intensity producing moderate pain. Between the 10 th and 20 th minutes, the contralateral foot was immersed into a water bath at a not painful (30℃) or painfully cold (8℃; conditioned pain modulation) temperature. Results Episodic migraine, medication overuse headache and medication overuse headache withdrawal were associated with an increase in extracephalic temporal summation of laser-evoked thermal pain as compared to healthy volunteer subjects, while there was no alteration of laser-evoked thermal and mechanical extracephalic pain thresholds in these subjects. Conditioned pain modulation was highly efficient in temporal summation of laser-evoked thermal pain in healthy volunteer subjects, with a solid post-effect (reduction of pain). Conditioned pain modulation was still present, but reduced, in episodic migraine. By contrast, conditioned pain modulation was normal in medication overuse headache and strongly reduced in medication overuse headache withdrawal. Furthermore, in medication overuse headache withdrawal, the post-effect was no longer a decrease, but a facilitation of pain. Conclusions These data show that a decrease in conditioned pain modulation does not underlie medication overuse headache in women. On

Opposite patterns of change in perception of imagined and physically induced pain over the course of repeated thermal stimulations.

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Gács, B; Szolcsányi, T; Csathó, Á

2017-08-01

Individuals frequently show habituation to repeated noxious heat. However, given the defensive function of human pain processing, it is reasonable to assume that individuals anticipate that they would become increasingly sensitive to repeated thermal pain stimuli. No previous studies have, however, been addressed to this assumption. Therefore, in the current study, we investigated how healthy human individuals imagine the intensity of repeated thermal pain stimulations, and compared this with the intensity ratings given after physically induced thermal pain trials. Healthy participants (N = 20) gave pain intensity ratings in two conditions: imagined and real thermal pain. In the real pain condition, thermal pain stimuli of two intensities (minimal and moderate pain) were delivered in four consecutive trials. The duration of the peak temperature was 20 s, and stimulation was always delivered to the same location. In each trial, participants rated the pain intensity twice, 5 and 15 s after the onset of the peak temperature. In the imagined pain condition, participants were subjected to a reference pain stimulus and then asked to imagine and rate the same sequence of stimulations as in the induced pain condition. Ratings of imagined pain and physically induced pain followed opposite courses over repeated stimulations: Ratings of imagined pain indicated sensitization, whereas ratings for physically induced pain indicated habituation. The findings were similar for minimal and moderate pain intensities. The findings suggest that, rather than habituating to pain, healthy individuals imagine that they would become increasingly sensitive to repeated thermal pain stimuli. This study identified opposite patterns of change in perception of imagined pain (sensitization) and physically induced pain (habituation). The findings show that individuals anticipate that they would become increasingly sensitive to repeated pain stimuli, which might also have clinical implications. �

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...

EFFICACY OF POST ISOMETRIC RELAXATION VERSUS STATIC STRECHING IN SUBJECTS WITH CHRONIC NON SPECIFIC NECK PAIN