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PubMed2005

Clinical comparison of pain perception rates between computerized local anesthesia and conventional syringe in pediatric patients.

The purpose of this study was to evaluate pain perception rates in pediatric patients by comparing computerized injection device and traditional injection procedure. In a clinical trial, by using a crossover design, sixty-four patients were randomly assigned to receive, in consecutive sessions, dental anesthetic techniques with either traditional or computerized device. Visual Analogue Scale qualification and heart rate monitoring as physiologic indicator of pain response were used for the evaluation. Results showed that traditional syringe injections were more painful than computerized injection device (p < 0.001). Results suggested that computerized injection device reduces pain perception compared to the traditional syringe during the dental anesthetic management.

Anesthesia, Local↗
PubMed2000

Neurophysiology and functional neuroanatomy of pain perception.

The traditional view that the cerebral cortex is not involved in pain processing has been abandoned during the past decades based on anatomic and physiologic investigations in animals, and lesion, functional neuroimaging, and neurophysiologic studies in humans. These studies have revealed an extensive central network associated with nociception that consistently includes the thalamus, the primary (SI) and secondary (SII) somatosensory cortices, the insula, and the anterior cingulate cortex (ACC). Anatomic and electrophysiologic data show that these cortical regions receive direct nociceptive thalamic input. From the results of human studies there is growing evidence that these different cortical structures contribute to different dimensions of pain experience. The SI cortex appears to be mainly involved in sensory-discriminative aspects of pain. The SII cortex seems to have an important role in recognition, learning, and memory of painful events. The insula has been proposed to be involved in autonomic reactions to noxious stimuli and in affective aspects of pain-related learning and memory. The ACC is closely related to pain unpleasantness and may subserve the integration of general affect, cognition, and response selection. The authors review the evidence on which the proposed relationship between cortical areas, pain-related neural activations, and components of pain perception is based.

Animals↗
PubMed1976

Effect of acupuncture on the pain perception thresholds of human teeth.

The effect of acumpuncture on the pain perception threshold of maxillary incisors and canines as determined by a Bofors Pulp Tester was studied in 33 dental students 19-30 years of age. Test teeth were cleaned with pumice and 10% alcohol, air-dried, and insulated at the approximal surfaces with strips of rubber dam. Based on a comparison of bipolar and monopolar stimulation the latter method was chosen, with the cathode placed on the incisal third of the facial surface, the indifferent electrode in the subject's hand. In separate groups of subjects thresholds were assessed four times at intervals of 15 min without acupuncture (1), with acupuncture performed manually (2) and electrically (3), and during electrical stimulation with surface electrodes over acupuncture points (4). On separate days acupuncture and surface stimulation was applied unilaterally at the points S2 (cheek), Li4 (hand), or S44 (foot). Compared with control threshold (8.44 muA) acupuncture was accompanied by a small increase, most pronounced after 45 min (1.51 muA, P less than 0.0005). However, the hypalgesia observed was insufficient to justify acupuncture as a means of pain control in conservative dentistry.

Acupuncture Therapy↗
PubMed2003

Pain perception in recovered bulimia nervosa patients.

OBJECTIVE: Decreased pain sensitivity is found in individuals who are ill with bulimia nervosa (BN). The purpose of this study is to determine whether altered pain perception persists after recovery from bulimia nervosa (RBN). METHODS: Eleven women who were recovered from BN for more than 1 year were compared with 15 healthy volunteer women. The participants received two pain evaluations--thermal pain stimulation (TPS), which evaluates threshold and tolerance to heat, and the submaximal effort tourniquet test (SETT), which assesses threshold and tolerance to ischemic pain induced by inflation of a blood pressure cuff. RESULTS: Compared with the controls, the RBN women showed elevated pain threshold as measured with the SETT and a tendency to elevated pain threshold on the TPS. DISCUSSION: Decreased pain sensitivity persists after recovery from BN and may reflect altered modulatory function in this illness.

Adult↗
PubMed1985

Comprehensive assessment of chronic low back pain patients and controls: physical abilities, level of activity, psychological adjustment and pain perception.

A comprehensive functional evaluation designed for patients with chronic low back pain (CLBP) is described. The evaluation includes measures from 4 domains of the CLBP syndrome; physical abilities, level of activity, psychological adjustment and pain perception. New measures for standardized assessment of physical abilities and employment of body mechanics are introduced. Evaluation data from 68 CLBP subjects and 35 age-matched, pain-free, controls is presented. Results indicate important deficits in physical abilities and psychological adjustment for the CLBP group compared to the controls. Factor analysis of the evaluation measures yielded a general conditioning factor and a general psychological adjustment factor but complicated factor structures for report of pain and time in activities. Further analysis demonstrated a strong relationship between objective disability and psychological and psychosocial adjustment but little relationship between level of pain and other disability measures.

Activities of Daily Living↗
PubMed1996

Effects of noxious cooling of the skin on pain perception in man.

By means of somatosensory evoked brain potentials following painful CO2 laser stimulation (pain SEPs) and a pain visual analogue scale (VAS), we investigated changes in pain perception caused by noxious cooling of the skin in normal subjects. Pain SEPs were recorded from scalp electrodes following laser stimulation applied to the leg under various conditions as follows: (1) control (without any interference); (2) 46 degrees C foot (dipping the foot ipsilateral to the stimulated leg in hot water at 46 degrees C); (3) 0 degrees C foot (dipping the foot ipsilateral to the stimulated leg in ice water at 0 degrees C); and (4) 0 degrees C hand (dipping the hand contralateral to the stimulated leg in ice water at 0 degrees C). Marked decreases in amplitude of pain SEPs and VAS were observed under all conditions as compared with the control (P < 0.001); the degree of pain relief was significantly correlated with changes in pain SEPs. These changes were greatest in the '0 degrees C hand' condition, followed in decreasing order by '0 degrees C foot' and '46 degrees C foot', and there was a significant difference between '0 degrees C hand' and the '46 degrees C foot' condition. We considered that the decrease in pain is due to the diffuse noxious inhibitory control (DNIC). The reason why the degree of pain relief in '0 degrees C foot' condition was less than that in '0 degrees C hand' condition is unclear, but some particular spatial summation of two kinds of nociceptive impulses mediated by the same pathway might take place.

Adult↗
PubMed1979

[Psychophysiology of fire walking. II. Pain perception in pyrovasy (fire walking)].

Our paper is concerned with considerations of pain physiology in pyrovasy and with neuropharmacological effects of the Opiate antagonist Naloxone. These considerations explain the relationship of analgesia and hypersthesia with stress induced behavior and states of consciousness. Apart from psychophysiological aspects we can distinguish from a biochemical and neurophysiological point of view two mechanisms of pain perception in pyrovates: 1. Certain mechanical stimuli brought about by the individual running technique of the pyrovate cause convergence of noxis and non-noxic afferent impulses as well as central inhibition of the effect of noxic stimuli. 2. The long stressful period of preparations induces a temporary surplus of Endorphins elevating the pain threshold.

Adult↗
PubMed2004

The tridimensional personality theory and pain: harm avoidance and reward dependence traits correlate with pain perception in healthy volunteers.

The aim of the present study was to examine the possible role of personality traits in determining the variability of pain perception among individuals. More specifically, it was intended to test whether or not the three personality dimensions suggested by Cloninger in 1987 - mainly harm avoidance (HA), but also reward dependence (RD), and novelty seeking (NS), can predict interpersonal differences in responsiveness to experimental pain. Seventy healthy volunteers participated in the study. Their personality traits were evaluated through Cloninger's tridimensional personality questionnaire (TPQ). Pain threshold (latency to pain onset), pain magnitude (VAS), and pain tolerance (time to withdrawal) were measured by using the cold pressor test. Bonferroni-adjusted correlations were found between HA and the pain parameters as follows: a negative correlation between HA and threshold (rho=-0.297, P(adj)=0.039); no significant correlation between HA and tolerance (rho=-0.219, P(adj)=0.207); and a trend for a positive correlation between HA and VAS (rho=0.266, P(adj)=0.081). Possible correlations between pain perception and the various possible combinations of high and low scoring for each of the three traits were also investigated. Correlations were found only for the combinations of high/low HA and high/low RD. The low HA/low RD combination demonstrated the lowest responsiveness to pain (VAS 65.2+/-21.4; tolerance 107.6+/-71.8 s), whereas the high HA/low RD combination was correlated with the highest responsiveness (VAS 83.3+/-10.8; tolerance 30.8+/-28.4 s). The results indicate that HA personality trait correlates best with pain responsiveness. As such, a high HA are likely to predict a heightened pain response. RD may modify this pattern. The possible relevant behavioral and neuro-chemical mechanisms are discussed.

Adult↗
PubMed1990

Aging and pain perception in ischemic heart disease.

Age is a recognized risk factor for coronary artery disease, but the relationship between age and silent ischemia is not well understood. We analyzed the data from 35 rest/stress radionuclide ventriculography examinations in patients with documented ischemic coronary artery disease who had experienced 1 mm ST segment depression accompanied by angina during exercise testing. An index of ischemic cardiac pain perception (PPI) was calculated by subtracting the time of onset of 1 mm ST segment depression from the time of onset of angina. The mean value of PPI was -97 +/- 311 seconds. PPI was significantly correlated with age (r = 0.37, p = 0.03). This suggests that as age increases, perception of pain during myocardial ischemic episodes becomes muted. This relationship remained significant when we controlled for the presence of medication and severity of disease (change in ejection fraction from rest to peak exercise). These findings suggest that age is an independent risk factor for a decreased perception of ischemic cardiac pain, and thus for silent myocardial ischemia.

Adult↗
PubMed1988

Ultralate cerebral potentials as correlates of delayed pain perception: observation in a case of neurosyphilis.

Evoked cerebral potentials were investigated in a patient with neurosyphilis, who showed the symptoms of delayed pain perception in the lower limbs: a pinprick to the legs was perceived with a latency of more than one second. After stimulation with CO2 laser radiant heat pulses, evoked cerebral potentials of upper limbs were observed in a latency range comparable to those of healthy subjects, with a negative peak at 250 ms and a positive peak at 370 ms. In contrast, after application of laser stimuli to body sites with delayed pain perception, latency of the evoked potentials drastically increased with a vertex negativity at 1300 ms and a positivity at 1420 ms. Evoked potential measurements with conventional electrical stimuli did not show any difference between affected and unaffected body sites, that is, stimulation of the affected body sites did not produce pathological potentials.

Afferent Pathways↗
PubMed1999

Differentiating cortical areas related to pain perception from stimulus identification: temporal analysis of fMRI activity.

In a recent functional magnetic resonance imaging study (fMRI), we reported the cortical areas activated in a thermal painful task and compared the extent of overlap between this cortical network and those activated during a vibrotactile task and a motor task. In the present study we examine the temporal properties of the cortical activations for all three tasks and use linear systems identification techniques to functionally differentiate the cortical regions identified in the painful thermal task. Cortical activity was examined in the contralateral middle third of the brain of 10 right-handed subjects, using echo-planar imaging and a surface coil. In another eight subjects the temporal properties of the thermal task were examined psychophysically. The fMRI impulse response function was estimated from the cortical activations in the vibrotactile and motor tasks and shown to correspond to earlier reports. Given the fMRI impulse response function and the time courses for the thermal stimulus and the associated pain ratings, predictor functions were generated. The correlation between these predictor functions and cortical activations in the painful thermal task indicated a gradual transition of information processing anteroposteriorly in the parietal cortex. Within this region, activity in the anterior areas more closely reflected thermal stimulus parameters, whereas activity more posteriorly was better related to the temporal properties of pain perception. Insular cortex at the level of the anterior commissure was the region best related to the thermal stimulus, and Brodmann's area 5/7 was the region best related to the pain perception. The functional implications of these observations are discussed.

Adolescent↗
PubMed1998

Is rectal pain sensitivity a biological marker for irritable bowel syndrome: psychological influences on pain perception.

BACKGROUND & AIMS: Rectal pain sensitivity has been called a biological marker for irritable bowel syndrome, but this conclusion may be premature. This article is a critical review of the evidence for psychological influences on perception. METHODS: The world literature accessible through Index Medicus from 1973 to 1997 was systematically reviewed. RESULTS: Evidence favoring a biological basis for pain sensitivity is that two thirds of patients report pain at abnormally low thresholds of rectal distention despite normal somatic pain thresholds. Pain thresholds are not correlated with anxiety or depression. Evidence favoring psychological influences on perception is that patients with the irritable bowel syndrome rate even sham distentions as more painful, and when perception tests that minimize psychological influences are used, they have normal sensory thresholds. Also, stress alters sensory thresholds. Sensitization by repeated distention has been cited as evidence of a biological basis for hyperalgesia, but it is not unique to patients with irritable bowel. Brain imaging shows that different regions are activated by painful distention in patients with irritable bowel syndrome, but this is consistent with psychological influences on perception. CONCLUSIONS: Psychological factors influence pain thresholds in patients with the irritable bowel syndrome. Two cognitive traits, selective attention to gastrointestinal sensations and disease attribution, may account for increased pain sensitivity.

Biomarkers↗
PubMed1978

Psychometric correlates of pain perception.

There is disagreement in the literature as to whether responsivity to painful stimuli possesses psychometric correlates. A series of methodological and statistical factors are specified in this paper which could account for the equivocality of the literature. A series of experiments were performed in which (a) various methodological and statistical issues were first resolved and (b) psychometric correlates of pain perception were then identified by means of a stepwise multiple regression procedure. The criterion variable consisted of the psychophysical judgment of pain during a 2-min. exposure to a 3,000 gm. force on the periosteum of the left fore-finger's second digit. The predictor variables consisted of selected psychological states and traits measured by the State-Trait Anxiety Inventory, Somatic Perception Questionnaire, Depression Adjective Checklist, Profile of Mood States, Eysenck Personality Inventory, and the Embedded Figures Test. The test-retest reliability of the pain test ranged from .64 to .84 across trials separated by a 3-wk. period. In the first experiment significant multiple regressions ranging between .57 and .72 were observed and psychological traits (field dependence, extraversion and trait anxiety) accounted for the variance in these analyses. In the next experiment significant multiple Rs ranging from .62 to .68 were observed. This served as cross-validation for the first experiment. The major difference was that psychological states (depression and vigor) as well as traits entered the multiple regression equations for certain of the analyses. It was concluded that selected psychological states and traits are significantly correlated with the perception of pain.

Adult↗
PubMed1993

Analysis of gender effects on pain perception and symptom presentation in temporomandibular pain.

Based on clinical populations, chronic orofacial pain of temporomandibular disorders (TMD) occurs more frequently (range: 2:1 to 9:1) in women than men. The reasons for this difference are not clear. The present study evaluated symptom presentation, sensitivity to pain, personality, and illness behavior in 2 samples of patients suffering with orofacial pain. Also, pain responses were studied in pain-free volunteers, controlling for experimenter-gender effects. The results showed few gender differences based on ratings of chronic or experimental pain, pain-related illness behavior, and personality. The higher ratio of women versus men seeking TMD care is consistent with greater health awareness or interest in symptoms by women than by men.

Adolescent↗
PubMed2000

[Extracorporeal shock-wave lithotripsy: anxiety and pain perception].

UNLABELLED: Three factors in extracorporeal shock-wave lithotripsy (ESWL) result in pain: shock wave pressure, size of focal area and pressure distribution at entry in the skin. Our Lithotripsy Unit has performed 21,000 outpatient treatments (Dornier HM-4 Lithotripter) with no sedation or anaesthetics. Pain requiring treatment discontinuation resulted in 10% instances. Anxiety-associated pain increases the perceived intensity of pain and influences the emotional response to pain. OBJECTIVE: To determine whether the variability in the response to the pain stimulus caused by ESWL is related to the patient's status/trait of anxiety. METHOD: Sample 20 patients; inclusion criteria: pyelic lithiasis > 2 cm, no previous SWEL and no obesity. One SWEL session (2500 pulses, 22 Kv). Anxiety was first evaluated using the status/trait of anxiety index (STAI) questionnaire; after treatment, pain was evaluated on a Numerical Analogic Scale. RESULTS: Pain scores ranged from 2 to 8, mean score 4.1 (S.D. = 1.67); mean score for trait of anxiety 21.8 (S.D. = 8.52), and status of anxiety 29 (S.D. = 5.89). A significant correlation was found between pain-anxiety trait (R = .51; p = .02), which was higher when compared to pain-anxiety status (R = .67; p = .001). CONCLUSIONS: SWEL is a painful therapy (95% of sample had mild-to-moderate pain); pain perception is increased by status of anxiety (45% of pain variance) more than by the trait of anxiety (26.3%); therefore, usage of sedation-analgesia in patients with high anxiety status would improve the lithotripter efficacy ratio.

Adult↗