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Biomedical subjects

Roger B Fillingim

Publications and source records attributed to Roger B Fillingim.

54 records · Page 3Linked to original sources
PubMed2003

Individual differences in diffuse noxious inhibitory controls (DNIC): association with clinical variables.

Laboratory pain research has been criticized as being irrelevant to the clinical experience of pain. Previous findings have been inconsistent with some studies suggesting that experimental pain responses may be related to the reported presence or severity of chronic pain, while others report no such associations. However, few of these studies assess a variety of laboratory pain responses, and none has assessed relationships between clinical pain and diffuse noxious inhibitory controls (DNIC) in healthy subjects. We administered questionnaire measures of pain, quality of life, and psychological variables to a sample of healthy adults participating in a laboratory study of age differences in pain responses. DNIC was not related to other laboratory pain responses, psychological variables, or physiological variables measured in the present study. Regression models predicting health-related quality of life (e.g. pain, physical functioning) revealed that age, sex, and DNIC responses explained between 10 and 25% of the variance in these dependent measures. Of the laboratory pain variables, only DNIC was the sole consistent predictor of clinical pain and physical health, with greater DNIC responses related to less pain, better physical functioning, and better self-rated health. In addition, age differences in DNIC appeared to partially mediate age differences in physical functioning. These findings highlight the potential clinical relevance of experimental pain procedures and suggest that DNIC may be the laboratory pain response most closely associated with clinical pain and health-related variables.

Adult↗
PubMed2003

Age-related differences in endogenous pain modulation: a comparison of diffuse noxious inhibitory controls in healthy older and younger adults.

Despite decades of research, hundreds of studies, and a number of recent reviews, the effects of aging on the experience of pain remain poorly understood. Many prior investigators have reported increases in persistent pain conditions and diminished tolerance for certain types of laboratory-induced pain among the elderly. While explanations for these effects often propose senescent decrements in endogenous analgesic systems as a possible contributory mechanism, almost no direct empirical evidence for this hypothesis has yet emerged in human studies. The present investigation was designed to evaluate the existence and nature of these putative age-related differences in endogenous pain inhibition. Groups of healthy younger (n=45, mean age=21.6 years, range=18-25) and older (n=48, mean age=63.1 years, range=55-67) adults participated in a controlled, two-session laboratory assessment of diffuse noxious inhibitory controls (DNIC), a measure of endogenous pain inhibition. In this study, we examined age differences in the effects of concurrent cold pain on ratings of heterotopically presented repetitive noxious thermal stimuli. Interestingly, older adults demonstrated facilitation rather than inhibition of thermal pain during concurrent noxious cold stimulation while younger adults demonstrated some expected DNIC effects (i.e. a reduction in thermal pain ratings during heterotopic stimulation with noxious cold). Collectively, the findings of the present study suggest age-associated decrements in at least one form of endogenous analgesic response. If replicated, such findings of reduced pain-modulatory capacity in the elderly may partially explain age-related differences in the prevalence, severity, and impact of chronic pain.

Adult↗
PubMed2003

The unequal burden of pain: confronting racial and ethnic disparities in pain.

CONTEXT: Pain has significant socioeconomic, health, and quality-of-life implications. Racial- and ethnic-based differences in the pain care experience have been described. Racial and ethnic minorities tend to be undertreated for pain when compared with non-Hispanic Whites. OBJECTIVES: To provide health care providers, researchers, health care policy analysts, government officials, patients, and the general public with pertinent evidence regarding differences in pain perception, assessment, and treatment for racial and ethnic minorities. Evidence is provided for racial- and ethnic-based differences in pain care across different types of pain (i.e., experimental pain, acute postoperative pain, cancer pain, chronic non-malignant pain) and settings (i.e., emergency department). Pertinent literature on patient, health care provider, and health care system factors that contribute to racial and ethnic disparities in pain treatment are provided. EVIDENCE: A selective literature review was performed by experts in pain. The experts developed abstracts with relevant citations on racial and ethnic disparities within their specific areas of expertise. Scientific evidence was given precedence over anecdotal experience. The abstracts were compiled for this manuscript. The draft manuscript was made available to the experts for comment and review prior to submission for publication. CONCLUSIONS: Consistent with the Institute of Medicine's report on health care disparities, racial and ethnic disparities in pain perception, assessment, and treatment were found in all settings (i.e., postoperative, emergency room) and across all types of pain (i.e., acute, cancer, chronic nonmalignant, and experimental). The literature suggests that the sources of pain disparities among racial and ethnic minorities are complex, involving patient (e.g., patient/health care provider communication, attitudes), health care provider (e.g., decision making), and health care system (e.g., access to pain medication) factors. There is a need for improved training for health care providers and educational interventions for patients. A comprehensive pain research agenda is necessary to address pain disparities among racial and ethnic minorities.

Attitude of Health Personnel↗
PubMed2002

Sex differences in perceptual and cardiovascular responses to pain: the influence of a perceived ability manipulation.

Sex differences in responses to experimental pain have been widely reported, with women typically showing lower pain threshold and tolerance than men. One possible explanation for these differences is that traditional gender roles may lead to sex differences in perceived ability to tolerate pain. To address this possibility, the present study evaluated the influence of a sex-related perceived ability manipulation on pain tolerance and cardiovascular responses to ischemic pain assessed via the submaximal effort tourniquet procedure. A sample of 68 young adults (35 women, 33 men) were randomly assigned to 1 of 2 perceived ability conditions, which depicted either women (FEM condition) or men (MASC condition) as more able to tolerate the painful task. The results indicated that men had higher pain tolerance than women. Although there was no overall effect of the experimental condition, only men in the FEM condition had higher tolerance than women. Also, men had greater blood pressure reactivity than women, and further analysis showed that women in the MASC condition had the lowest systolic blood pressure reactivity. Cardiovascular reactivity and motivation to tolerate the pain were positively correlated with pain tolerance only among men in the FEM condition. These findings indicate that the perceived ability manipulation produced only modest effects on pain tolerance and cardiovascular reactivity, but the relationship of cardiovascular and subjective responses to pain tolerance differed across conditions. These findings suggest that perceived ability may contribute to perceptual and cardiovascular responses to pain in a complex fashion, and further research to explicate these relationships is needed.

Journal Article↗
PubMed2002

The influence of athletic status and gender on experimental pain responses.

To examine the role of athletic status and gender on experimental pain responses, 24 athletes (12 male, 12 female) and 24 nonathletes (12 male, 12 female) participated in 3 experimental pain tasks. After a series of psychologic inventories and demographic questionnaires, pressure pain thresholds (4 sites: pectoralis, trapezius, biceps, quadriceps), ischemic pain threshold and tolerance (lower arm), and cold pressor pain threshold and tolerance (lower arm) were assessed. No significant overall effects of athletic status or gender were identified for measures of pressure pain threshold. No group differences emerged for ischemic pain threshold. Athletes demonstrated significantly higher tolerance for ischemic pain, and cold pressor pain threshold and tolerance were higher among athletes than nonathletes. Overall analyses indicated higher pain thresholds and tolerance for cold pain among men than among women. A final interview found that many participants who approached the upper limits of these pain tasks reported using a competitive coping strategy.

Journal Article↗
PubMed2001

Race, ethnicity and pain.

The current paper provides a brief overview of research on the effects of race and ethnicity on pain. More specifically, the article reviews the utility of the concepts of race and ethnicity for pain research, suggests operational definitions of race and ethnicity, reviews the literature on the effects of race and ethnicity on laboratory and clinical pain, and provides suggestions for future research.

Black or African American↗
PubMed1999

The relationship of sex and clinical pain to experimental pain responses.

Considerable research indicates increased experience of clinical pain among females relative to males, and females also demonstrate enhanced responses to experimentally-induced pain. However, previous research has not investigated the relationship between clinical and experimental pain responses in healthy females and males. This experiment examined recent clinical pain as well as thermal pain thresholds and tolerances in 209 (117 female, 92 male) healthy young adults. All subjects completed questionnaires concerning pain-related symptoms over the previous month and subsequently underwent thermal pain assessment. Females reported a larger number of pain sites and greater health care utilization over the month preceding the experimental session, and females also exhibited greater sensitivity to thermal stimuli. In addition, females above the median on the number of pain episodes demonstrated greater thermal pain sensitivity compared to females below the median, but thermal pain responses did not differ as a function of clinical pain among males. The differences remained significant after correcting for psychological variables including hypervigilance and sex role expectancies. These results indicate that experimental pain responses may be more clinically relevant for females than males. Potential explanations and implications for this pattern of results are discussed.

Adult↗
PubMed1998

Sex differences in temporal summation but not sensory-discriminative processing of thermal pain.

Gender differences in experimental pain sensitivity have been widely investigated, and the results generally indicate that females exhibit greater sensitivity to noxious stimuli than males. However, results using thermal pain procedures have been inconsistent, with some studies reporting greater responses among females and other studies reporting no gender differences. The present study investigated gender differences in thermal pain perception using several different psychophysical procedures. Twenty-seven females and 22 males underwent thermal testing, including: determination of thermal pain threshold and tolerance, a thermal discrimination procedure, real-time magnitude estimates of heat pulses, and temporal summation of thermal pain. The results indicated lower thermal pain threshold and tolerance and greater temporal summation of thermal pain among females, but no gender differences in thermal discrimination or real-time magnitude estimates of discrete heat pulses. These findings suggest that gender differences in thermal pain perception may be more robust for sustained, temporally dynamic thermal stimuli with a strong C-fiber component.

Adult↗
PubMed1998

Generalized vibrotactile allodynia in a patient with temporomandibular disorder.

This report presents the findings from a psychophysical study of vibrotactile responses in a patient diagnosed with temporomandibular disorder (TMD). This patient unexpectedly reported pain due to innocuous vibrotactile stimulation, and this allodynia appeared to have a component of temporal summation. The pain response occurred not only in the region of the clinical pain (the face), but also on the volar forearm, where the patient reported no clinical pain. Administration of the N-methyl-D-aspartate (NMDA) receptor antagonist dextromethorphan (DM), but not vehicle, attenuated the vibration-induced pain at both sites.

Adult↗
PubMedDate not supplied

Spousal responses are differentially associated with clinical variables in women and men with chronic pain.

OBJECTIVES: Spousal responses have been related to clinical variables in patients with chronic pain. For example, solicitous responses from spouses have been associated with greater levels of pain and disability among patients with chronic pain. However, few investigators have determined whether spousal solicitousness produces different effects in women versus men with chronic pain. The present study examined pain reports, medication use, psychosocial factors, functional measures, and pain tolerance in patients with chronic pain. METHODS: Subjects included 114 female and 213 male chronic pain patients, who described their spouses as either high or low in solicitousness on the Multidimensional Pain Inventory. Measures of pain severity, affective distress, physical function, medication use, and pain tolerance were examined in women and men with high versus low scores on spousal solicitousness. RESULTS: Among males only, high spousal solicitousness was associated with greater numerical ratings of pain and greater self-reported disability compared with patients with low solicitous spouses. Among females only, the high spousal solicitousness patients showed lower pain tolerance, greater pain-related interference, poorer performance on functional tasks (eg, timed walking, lifting, and carrying tasks), and greater use of opioid medications. In both women and men, spousal solicitousness was associated with higher scores on the MPI pain severity scale. DISCUSSION: These results extend previous findings demonstrating a relationship between spousal responses and patients' adjustment to pain; however, the pattern of these effects appears to be moderated by the sex of the patient. Implications for assessment and treatment of chronic pain are discussed.

Adult↗
PubMedDate not supplied

Is self-reported childhood abuse history associated with pain perception among healthy young women and men?

OBJECTIVE: A self-reported history of childhood physical and/or sexual abuse is frequently reported among chronic pain populations and has been associated with poorer adjustment to pain. In addition, self-reported abuse history has been related to increased pain complaints in population-based studies. One possible explanation for the association between abuse and clinical pain is that abuse victims may display enhanced sensitivity to painful stimuli, which increases the risk of developing clinical pain. However, the limited evidence addressing this issue has been mixed. The purpose of this study was to examine the association between self-reported history of childhood sexual or physical abuse and experimental pain responses in a nonclinical sample of generally healthy young adults. DESIGN: Participants were 110 (56 female, 54 male) college students who completed a series of questionnaires assessing abuse history, recent pain, health care utilization, perceived health, and psychologic variables. Also, measures of thermal and ischemic pain threshold and tolerance were obtained in all participants. In addition, a procedure assessing temporal summation of heat pain was conducted in which intensity and unpleasantness ratings of repetitive thermal stimuli were obtained. Systolic and diastolic blood pressure and heart rate were assessed at resting and during the ischemic pain task. RESULTS: Participants with a positive childhood abuse history were oversampled, yielding 21 out of 56 (37.5%) women with a positive history of abuse and 13 out of 54 (24.1%) PHA men. No abuse group differences emerged for thermal or ischemic pain thresholds or tolerances (P values>0.05). However, compared to women with no childhood abuse history, women with a positive history of abuse provided significantly lower average pain unpleasantness and peak pain unpleasantness ratings and lower unpleasantness ratings of the first trial during the temporal summation procedure, whereas no abuse group differences emerged for men. Also, compared to participants with no childhood abuse history, participants of both genders with a positive history of abuse demonstrated smaller increases (ie, less temporal summation) in pain unpleasantness ratings across trials of thermal stimulation, and participants with a positive history of abuse showed greater decreases in pain intensity and unpleasantness after reaching their peak pain level (ie, greater wind-down) compared to participants with no childhood abuse history. In addition, participants with a positive history of abuse reported more sites of recent pain, poorer perceived health, greater somatization, and more negative affect. No group differences in resting cardiovascular measures or cardiovascular reactivity were observed. CONCLUSION: These findings indicate that a self-reported history of childhood abuse is associated with decreased sensitivity to experimentally induced pain, especially among women. However, abuse history was associated with increased pain complaints, poorer self-reported health, and greater negative affect. These data highlight the complexity of the relationship between abuse history and pain and illustrate the need for further investigation of potential pain-related correlates of abuse.

Adult↗
PubMedDate not supplied

Sex differences and incentive effects on perceptual and cardiovascular responses to cold pressor pain.

OBJECTIVE: Sex differences in pain perception have been widely reported, with women typically displaying greater pain sensitivity than men, but the mechanisms underlying these differences remain unclear. One possible explanation suggests that men are more motivated to tolerate and suppress expressions of pain because of the masculine sex role, whereas the feminine sex role encourages pain expression and produces lower motivation to tolerate pain among women. METHODS: To examine the influence of motivation on perceptual and cardiovascular responses to pain among women and men, different levels of monetary incentive (high vs. low incentive) were provided to a group of 81 healthy young adults undergoing the cold pressor pain procedure. It was anticipated that men would have greater endogenous motivation and would therefore be less affected by the external incentive. RESULTS: Men had higher pain thresholds and tolerances and lower pain ratings than women, but the incentive condition produced no significant effect on pain responses. Resting blood pressure was positively correlated with pain tolerance among the low incentive group, whereas blood pressure reactivity to the cold pressor predicted pain tolerance in the high incentive group. CONCLUSIONS: Thus, monetary incentive did not influence pain responses, but the relationship between cardiovascular measures and pain responses was influenced by the incentive manipulation. Potential explanations for the observed results are presented, and the implications for applying the biopsychosocial model to pain research are discussed.

Adult↗
PubMedDate not supplied

Sensory and affective pain discrimination after inhalation of essential oils.

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

Aromatherapy↗
PubMedDate not supplied

Multidimensional success criteria and expectations for treatment of chronic pain: the patient perspective.

OBJECTIVE: The study's primary objective is to define treatment success from the patient perspective across four domains (pain, fatigue, emotional distress, interference with daily activities) using the Patient Centered Outcomes Questionnaire (PCOQ). Secondary objectives include examination of patient expectations for treatment across domains and derivation of patient subgroups based on PCOQ responses. DESIGN: Cross-sectional. Setting. University of Florida or affiliated pain clinics. Patients. Participants were 110 patients seeking treatment for chronic pain who completed the PCOQ before their routine medical appointment. RESULTS: Patients reported moderate usual levels of pain (mean = 6.1), fatigue (mean = 5.9), distress (mean = 5.5), and interference (mean = 6.4). Patients considered a mean reduction in pain of 3.4 points (56%) to represent treatment success. Mean reductions in fatigue, distress, and interference of 3.35 points (57%), 3.64 points (65%), and 4.3 points (68%), respectively, also signified treatment success. Analyses revealed patients expected their level of interference following treatment (mean = 2.6) to be higher than their success criterion for interference (mean = 2.0). Cluster analysis of PCOQ responses revealed a three-cluster solution. Differences were obtained among clusters on demographic and pain-related variables. CONCLUSIONS: Patients might require larger reductions in pain than has previously been reported in the literature as "meaningful" for them to consider treatment successful. Patients did not expect treatment to meet their criterion for success in the interference domain, suggesting patients' success criteria and treatment expectations might differ for some domains. The finding of patient subgroups has implications for treatment matching.

Activities of Daily Living↗
PubMedDate not supplied

Ethnic differences and responses to pain in healthy young adults.

Ethnic disparities in pain have recently gained increasing attention; however, relatively few studies have examined ethnic differences in pain prevalence, and even fewer have addressed whether ethnic groups differ in their pain-reducing behaviors. Thus, this study investigated ethnic differences in pain prevalence and impact among healthy young African Americans, Hispanics, and non-Hispanic whites.(1) Also, ethnic differences in pain-reducing behaviors were explored. Undergraduate students (N = 1,037) from three ethnic groups completed a telephone survey of recent pain experiences. Groups did not differ in overall pain frequency or severity; however, more African Americans reported chest and stomach region pain, whereas more Hispanics reported pain in the legs/feet. Significant group differences regarding pain-reducing behaviors emerged. More whites utilized self-care behaviors, compared to Hispanics and African Americans. Conversely, greater numbers of African Americans and Hispanics than whites reported having prayed to relieve pain. The predictors of the total number of pain-reducing behaviors used differed across ethnic groups. For whites, pain intensity and interference were the strongest predictors of pain-reducing behaviors. For African Americans, total pain sites, as well as interference and frustration, were significantly associated with pain-reducing behaviors, while among Hispanics, worry and frustration were the strongest predictors for total pain-reducing behaviors. These results suggest potentially important ethnic differences in patterns and predictors of pain-reducing actions, and their emergence in a healthy sample suggest that ethnic differences in pain-related responses predate the development of chronic pain. These findings may have important implications for understanding ethnic differences in responses to clinical pain and for tailoring treatment approaches to eliminate disparities.

Adaptation, Psychological↗