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PubMed2006

Differences in pain perception in women using concentric and monopolar needles.

OBJECTIVE: To examine pain perception using concentric needle electrodes and monopolar needle electrodes in an all-female study group without underlying hand or arm pain complaints, using study subjects as their own controls. DESIGN: Prospective randomized study. Two muscles--the biceps and abductor pollicis brevis (APB)--were examined using both a concentric needle electrode and a monopolar needle electrode. SETTING: University community. PARTICIPANTS: Eighty healthy female employees at the University of Utah and Primary Children's Hospital were enrolled. All completed the study. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Pain scores. Posttest verbal analog pain scale (0-10) measures were obtained after each muscle was studied. A subset of subjects (n=51) was asked to identify needle preference after completion of the study. RESULTS: There was no significant difference in mean pain scores between the concentric needle electrode and the monopolar needle electrode (3.06 and 3.10, respectively; P=.803). The APB muscle was significantly more painful than the biceps muscle with both needle types (mean pain scores, 3.92 and 2.24, respectively; P<.001). In the subset of subjects asked to identify needle preference after completion of the study, 21 chose a concentric needle electrode and 30 a monopolar needle electrode. This difference was not statistically significant. However, verbal analog pain scores were lower with the needle preferred by each subject (P<.20). CONCLUSIONS: There is no significant difference in mean pain scores reported between a concentric needle electrode and a monopolar needle electrode. Subjects were clear on the needle they preferred, and the pain scores reported for the less painful needle were lower than those for the other needle.

Adult↗
PubMed2005

Psychosocial aspects associated with pain perception in individuals undergoing coronary surgery.

OBJECTIVE: To identify the psychological factors that influence post-surgery pain perception in patients undergoing coronary artery bypass graft surgery (CABG). METHODS: This was an exploratory correlational study of 91 patients (71 men and 20 women) who underwent CABG (aortocoronary anastomosis) by sternotomy. Mean age was 63.8 + 9.6 years (between 39 and 84). The following instruments were used: visual analogical scales at 24, 48 and 96 hours of post-surgery; demographic characteristics survey; pain expectations scale; perceived support scale; self-efficacy scale, Mental Inventory (5 items); health perception scale; and satisfaction with treatment, doctors and nurses (American Pain Society questionnaire) at 96 hours after surgery. RESULTS: Patients who had presented high expectations of pain, perceived more support, presented high levels of self-efficacy to deal with pain or were male, felt less pain. Furthermore, patients who presented better mental health, perceived their general health as being good, or expressed greater satisfaction with treatment, felt less pain. Pain was not influenced by age, level of education or satisfaction with doctors and nurses. CONCLUSION: After the first 48 hours following surgery, the pain experience is influenced by psychosocial factors, in particular by expectation of pain and of self-efficacy, perceived support, perception of general and mental health, and satisfaction with pain treatment. The results confirm the need to bring together different kinds of knowledge for a broad, multidisciplinary approach to postoperative CABG pain treatment, focusing, along with other aspects, on management of patients' expectations.

Adult↗
PubMed1999

Extracardiac contributions to chest pain perception in patients 6 months after acute myocardial infarction.

OBJECTIVES: The amount of perceived anginal pain in patients after infarction deserves the attention of the physician. This study sought to identify the modulating influence of extracardiac factors on persistent angina pectoris after myocardial infarction. METHODS AND RESULTS: A total of 552 male survivors of acute myocardial infarction (age 29 to 65 years, median 54 years) were followed for a period of 6 months; the affective state was assessed immediately after the acute event. The prognostic importance of postinfarction depression on chest pain perception was evaluated 6 months after the cardiac event in 376 patients. After the 6-month follow-up period, 199 (53%) of the patients with myocardial infarction had angina pectoris. Somatic risk factors and electrocardiographic data at initial testing did not contribute to the risk of having chest pain. However, patients with high levels of depression at initial testing had an almost 3-fold risk of having angina pectoris 6 months after the index event. Older age, lower social class status, and preinfarction angina were also significantly related to angina pectoris at the end of the study. Patients who were pain free before the index infarction reported significantly more symptoms of chest pain at the study end point (P </=.02), when they had moderate to high degrees of postinfarction depression. In the logistic regression model, depression, then followed by preinfarction angina pectoris and low social class index, contributed significantly to the prediction of follow-up angina pectoris. CONCLUSIONS: The results of this study add evidence to the hypothesis that the perception of chest pain may be triggered not only by the nociceptive stimulation of the ischemic heart but also by extracardiac sources. Depressive mood state, when concomitant with cardiac disease, is shown to intensify perceived chest pain.

Adult↗
PubMed1978

Pain perception in man after long term spinal cord stimulation.

Thresholds of non-painful and painful perception for electrical stimuli are not altered significantly during dorsal column stimulation either in the area of induced paresthesia or outside it. After long term stimulation of the dorsal column the thresholds for stimuli are significantly higher within the area of induced paresthesia but not outside it. Median nerve evoked somatosensory cortical potentials are not altered by conditioning or simultaneous DC stimulation. During DCS in three of eight patients only the vibration evoked cortical potentials were attenuated in the early three components of the potential.

Adult↗
PubMed1989

Effects of diffuse noxious inhibitory controls (DNICs) on the sensory-discriminative dimension of pain perception.

We have recently demonstrated that humans report heat stimuli as less painful when presented concurrently with a second noxious stimulus applied to another part of the body. Previous neurophysiological studies have shown that similar heterotopically applied noxious stimuli selectively and completely inhibit the activity of wide-dynamic-range (WDR) neurons in the dorsal horn - a phenomenon termed diffuse noxious inhibitory controls (DNICs). Taken together, these 2 lines of evidence suggest that activation of WDR cells may be necessary for normal perception of pain. Recent studies in the behaving monkey have additionally shown that WDR neurons respond to small changes in noxious heat stimuli better than do high threshold neurons, thus indicating a more specific role for WDR neurons in sensory-discriminative aspects of pain perception. If DNICs do indeed selectively and completely inhibit the activity of WDR neurons, then a heterotopically applied noxious stimulus should selectively interfere with a subject's ability to discriminate noxious stimuli. This hypothesis was tested using a noxious heat discrimination task and a cold water (5 degrees C) diffuse noxious stimulus. We found that the ability to detect small changes (0.4-0.8 degrees C) in painful heat stimuli applied to the face decreases when the person's hand is submerged in painfully cold water (P = 0.005) and that this effect persists, to a lesser extent, after the hand is removed from water. Control tasks, using visual stimuli, demonstrated that the modulation of nociceptive discrimination was not a generalized effect on sensory perception; other control measures indicated that the results could not be attributed to distraction, fatigue or changes in response bias.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2000

A clinical comparison of pain perception to the Wand and a traditional syringe.

OBJECTIVES: This study compared the pain response of a group of 40 volunteers to the Wand with the response to syringe injections. STUDY DESIGN: Of 240 total injections given, 120 were with the Wand system, and 120 were with the traditional aspirating syringe. Three injections were evaluated: injections to the middle superior alveolar (MSA) of the maxillary right first premolar and the maxillary left first premolar; palatal injections of the maxillary right first premolar and the maxillary left first premolar; and inferior alveolar nerve injection (IAN) of both the right and the left sides. Each volunteer received 6 injections, 3 on one side with the Wand and 3 on the opposite side with the syringe (control). All injections were given by the primary investigator without the use of a topical anesthetic. Pain perception levels were recorded with a 4-point visual analog scale: no pain, mild pain, moderate pain, and severe pain. The results were evaluated statistically by using an unpaired t test. RESULTS: The results showed injections with the syringe were statistically more painful than injections with the Wand in 4 of 18 evaluations: MSA of the maxillary left first premolar, female volunteers responses to MSA of the maxillary left first premolar, IAN left side injections, and male responses to IAN left injections (P =.01, P =.05, P =.05 and P =.05, respectively). CONCLUSIONS: The Wand generally seemed to provide less painful injections; however, the mean ratings of pain were mostly mild pain for both injections. Therefore, the clinical significance of the results should be interpreted with caution. The operator technique and tactile skill in syringe injections and site of injection (right or left) could be important factors that were not evaluated in this study.

Adult↗
PubMedDate not supplied

Similarities in age differences in heat pain perception and thermal sensitivity.

Age differences in the thresholds for heat pain, warmth and cold were studied in 64 healthy persons from 17 to 63 years of age (32 women, 32 men). The stimuli were applied to the thenar and the dorsum pedis with a contact thermode. The thresholds increased significantly with age in all modalities on the foot, but not on the hand. Furthermore, the quotients of the individual foot and hand thresholds revealed a significant relative increase in all thresholds on the foot. The length of the afferent pathways seems to influence the degree of age-related changes both in heat pain perception and in thermal sensitivity, resulting in a distal-proximal pattern of age-dependent decline.

Adolescent↗
PubMed2005

Heterosynaptic long-term depression of craniofacial nociception: divergent effects on pain perception and blink reflex in man.

Noxious low-frequency stimulation (LFS) of presynaptic nerve fibers induces long-term depression (LTD) of synaptic transmission. In vitro studies suggest a sole homosynaptic effect. Consequently, the present study addressed the hypothesis that LTD of craniofacial nociception in man is mediated by a homosynaptic mechanism. Nociceptive supraorbital afferents were excited by electric pulses via a concentric electrode in ten healthy volunteers. The electrically evoked bilateral blink reflex (BR) was recorded from both orbicularis oculi muscles by surface electrodes. The BR was evoked in blocks of ten electric stimuli each (0.1 Hz) with an interblock interval of 8 min. Conditioning noxious LFS (1 Hz, 20 min) was applied via concentric electrode either to the same site as BR test stimuli (ipsilateral) or to the corresponding contralateral forehead area (contralateral). LFS and test stimulus intensities corresponded to about threefold the pain threshold. After three baseline stimulus blocks, either conditioning ipsilateral or contralateral LFS were applied or stimulation was interrupted for 20 min as a control task. Afterwards, test stimulation blocks were continued for 40 min. Each volunteer participated in all three sessions on different days. Noxious LFS induced LTD of the BR independently from the side of conditioning stimulation. Pain perception decreased after ipsilateral LFS but not after contralateral LFS. The bilateral effect of noxious LFS on the BR provides evidence for heterosynaptic LTD based on bilateral projections of supraorbital nerve afferents onto spinal trigeminal nuclei. The divergent effect on pain perception may be due to a preferential contralateral projection of nociceptive afferents onto reflex interneurons but not onto trigeminothalamic projection neurons.

Adult↗
PubMed2001

Influence of intense light stimulation on trigeminal and cervical pain perception thresholds.

Thirty-three migraineurs and 23 healthy controls were submitted to pressure algometry before and after light-induced discomfort was elicited by progressive light stimulation in a monoblind fashion. Pressure algometries were performed on the emergence of the supraorbital, infraorbital, mental and greater occipital nerves, and over the temporal muscles, always throughout the same sequence and from right to left. Measurements were carried out before and immediately after light stimulation and after 10 min of the second algometry. The final result for each site measured at each time-point was the mean of the three measurements. Light stimulation was carried out progressively until light-induced discomfort was reported, to a maximum of 20,000 lux. A heat-blocking glass protected patients' eyes. Migraineurs presented significant and persistent drops in pain perception thresholds after light stimulation, at all sites tested (P = 0.002 to < 0.0001). These drops were not seen in controls, in whom, conversely, a less significant increase was seen on right infraorbital and left temporal muscle sites. Our results indicate that in migraineurs, light may have a relevant role in trigeminal and cervical pain perception thresholds.

Adult↗
PubMed1991

Modulation of heat pain perception by high frequency transcutaneous electrical nerve stimulation (TENS).

Although many studies have indicated that high frequency nonpainful transcutaneous electrical nerve stimulation (TENS) reduces clinical pain, controlled studies of the modulation of experimental pain by TENS have produced conflicting results. This study evaluated the effect of high frequency nonpainful TENS on heat pain perception using a model that we have previously shown to be sensitive to other nonpharmacological analgesic treatments. We found that TENS significantly reduced subjects' ratings of painful and near painful heat stimuli (43-51 degrees C) (p = 0.01) and increased the pain threshold from 46.7 to 47.9 degrees C (p = 0.002). Placebo stimulation had no effect on the subjects' ratings or on their pain thresholds. Furthermore, TENS did not alter subjects' ratings of visual stimuli, indicating that the analgesic effect was not due to a nonspecific distraction. These data suggest that TENS alters the perception of experimentally produced natural pain stimuli. The TENS related modulation also appears to be comparable to that produced by other nonpharmacological analgesic manipulations such as counterirritation and changes in attention.

Adult↗
PubMed1998

The influence of film-induced mood on pain perception.

It has been shown that a person's mood can influence pain tolerance. Films have been used as a means of inducing a desired mood. The effect on pain perception of film type and film length to induce mood was investigated. Previous research with brief humorous films had not indicated any unique advantage of humor over distraction approaches. Other recent research had indicated that after exposure to film stimulation there is a need to wait approximately 40 min before physiological changes can be obtained. Thus, the present study varied both film type and length and introduced a 30-min waiting period following the mood induction via film prior to exposure to cold-pressor pain. Two hundred subjects in nine different groups participated in the study. Three types of films were used: (1) humorous, (2) holocaust, (3) neutral. Three lengths of each type were also used: 15 min, 30 min, and 45 min. In addition, a tenth no-film group served as a control for the effects of a film. Each subject was given a baseline trial of cold-pressor pain, a trial immediately following the film and a trial 30 min later. Results indicated an advantage in increased pain tolerance for the humorous film and an increased pain tolerance for the longer film regardless of type only after the 30-min waiting period. Results were discussed from a pain theoretical perspective with emphasis placed on returning to psychological manipulations of the sensory aspects of pain and not just the cognitive/emotional/motivational dimensions.

Adolescent↗
PubMed1999

Pain perception: is there a role for primary somatosensory cortex?

Anatomical, physiological, and lesion data implicate multiple cortical regions in the complex experience of pain. These regions include primary and secondary somatosensory cortices, anterior cingulate cortex, insular cortex, and regions of the frontal cortex. Nevertheless, the role of different cortical areas in pain processing is controversial, particularly that of primary somatosensory cortex (S1). Human brain-imaging studies do not consistently reveal pain-related activation of S1, and older studies of cortical lesions and cortical stimulation in humans did not uncover a clear role of S1 in the pain experience. Whereas studies from a number of laboratories show that S1 is activated during the presentation of noxious stimuli as well as in association with some pathological pain states, others do not report such activation. Several factors may contribute to the different results among studies. First, we have evidence demonstrating that S1 activation is highly modulated by cognitive factors that alter pain perception, including attention and previous experience. Second, the precise somatotopic organization of S1 may lead to small focal activations, which are degraded by sulcal anatomical variability when averaging data across subjects. Third, the probable mixed excitatory and inhibitory effects of nociceptive input to S1 could be disparately represented in different experimental paradigms. Finally, statistical considerations are important in interpreting negative findings in S1. We conclude that, when these factors are taken into account, the bulk of the evidence now strongly supports a prominent and highly modulated role for S1 cortex in the sensory aspects of pain, including localization and discrimination of pain intensity.

Brain Mapping↗
PubMed2003

Randomized study comparing radiofrequency ablation with cryoablation for the treatment of atrial flutter with emphasis on pain perception.

BACKGROUND: Radiofrequency ablation (RF) of atrial flutter (AFL) has a high procedural efficacy, a low recurrence rate, and reports of procedure-related pain. The aim of the present study was to compare RF with cryoablation (cryo) for the treatment of AFL, with emphasis on pain perception during application of energy. METHODS AND RESULTS: Fourteen patients (55+/-11 years, 11 males) with AFL were randomized to receive ablation of the cavotricuspid isthmus (CTI) by either RF or cryo. Cryothermia was delivered with the CryoCor Cryoablation System (10F, 6-mm tip), and radiofrequency energy was delivered with the use of an 8-mm-tip catheter. Pain was evaluated according to a visual analogue scale (VAS; 0 to 100). All patients in the cryo group were successfully ablated with a mean of 18 applications (9 sites), and RF was successful in 6 of 7 patients (not significant) with 13 applications (not significant). The mean temperature was -82 degrees C and 55 degrees C for cryo and RF, respectively. One patient in the cryo group perceived pain, versus all 7 patients in the RF group (P<0.05). The proportion of painful applications averaged 75.3% in the RF group and 2.0% in the cryo group (P<0.05), whereas the corresponding VAS for pain was 38.3+/-25.3 and 0.32+/-0.86, respectively (P<0.05). At 6-month follow-up, there were no recurrences of atrial flutter. CONCLUSION: Cryo, as compared with RF, produces significantly less pain during application. Although in the present study there was no significant difference in efficacy, larger studies will be needed to definitively compare efficacy.

Adult↗
PubMed1976

Detection and decision factors in pain perception in young and elderly men.

The effect of age on ability to discriminate between levels of electrical stimulation of tooth pulp and willingness to report shocks as painful was evaluated using the Sensory Decision Theory. While threshold did not increase with age for tooth pulp stimulation as is often observed for thermal pain thresholds, a significant age deficit in ability to discriminate between suprathreshold shocks was observed. Significant changes with age in willingness to report the electrical shocks as painful were also observed. These results indicate that changes with age in pain perception are complex, involving not only possible discrimination deficits but also changes in bias for and against labeling noxious events as painful. These findings stress the need for within individual comparisons of laboratory techniques for evoking acute pain experiences where variables such as age are under consideration.

Adult↗
PubMed1999

Medical hypnosis and orthopedic hand surgery: pain perception, postoperative recovery, and therapeutic comfort.

Orthopedic hand-surgery patients experience severe pain postoperatively, yet they must engage in painful exercises and wound care shortly after surgery; poor patient involvement may result in loss of function and disfigurement. This study tested a hypnosis intervention designed to reduce pain perception, enhance postsurgical recovery, and facilitate rehabilitation. Using a quasi-experimental research design, 60 hand-surgery patients received either usual treatment or usual treatment plus hypnosis. After controlling for gender, race, and pretreatment scores, the hypnosis group showed significant decreases in measures of perceived pain intensity (PPI), perceived pain affect (PPA), and state anxiety. In addition, physician's ratings of progress were significantly higher for experimental subjects than for controls, and the experimental group had significantly fewer medical complications. These results suggest that a brief hypnosis intervention may reduce orthopedic hand-surgery patients' postsurgical PPI, PPA, and anxiety; decrease comorbidity; and enhance postsurgical recovery and rehabilitation. However, true experimental research designs with other types of controls must be employed to determine more fully the contribution of hypnosis to improved outcome.

Adult↗
PubMed2005

Cigarette smoking, stress-induced analgesia and pain perception in men and women.

This study examined gender differences in smoking-related analgesia and stress-induced analgesia (SIA), as a function of pain modality. Forty men (20 smokers, 20 nonsmokers) and 37 women (17 smokers) were tested twice for pain sensitivity to tourniquet ischemia, thermal heat, and cold pressor tests; once following mental stress and once following rest control, counterbalancing order. Cardiovascular and neuroendocrine responses to mental stress were also examined. While expected gender differences in pain sensitivity were observed, women smokers had greater threshold and tolerance times to ischemic pain than women nonsmokers (P<0.05) when pain testing followed rest. Male smokers had greater threshold and tolerance to cold pressor pain than male nonsmokers (P<0.05) after both rest and stress. Only women showed evidence for SIA, since women nonsmokers demonstrated greater ischemic pain threshold and tolerance following mental stress versus rest (P<0.05), and all women reported lower thermal heat pain unpleasantness after stress versus rest (P=0.05). Only nonsmokers showed expected inverse relationships between sympathetic and hypothalamic-pituitary-adrenal (HPA) axis reactivity measures and sensitivity to pain. Smokers showed evidence for blunted HPA-axis function at rest and stress. These results indicate that analgesia related to both being a smoker and stress is influenced by gender and pain modality. The reduced pain perception in smokers and absence of relationships between endogenous pain regulatory mechanisms and pain sensitivity may reflect a maladaptive response to chronic smoking.

Adrenocorticotropic Hormone↗
PubMed2005

The effect of propofol on thermal pain perception.

We studied the effect of propofol, a widely used sedative-hypnotic drug, on pain perception. Eighteen subjects received propofol in two sedative concentrations that were balanced and randomized in order. Painful (45 degrees C, 47 degrees C, and 49 degrees C) stimulation temperatures were presented in random order, and nonpainful 31 degrees C stimuli were presented on alternate trials. We used a target-controlled infusion and chose effect site concentrations of 0.5 mug/mL for mild sedation and 1.0 mug/mL for moderate sedation. Using a visual analog scale, subjects rated both pain intensity and unpleasantness higher when sedated with propofol. The average pain intensity was 28/100 for placebo, 35/100 for mild, and 40/100 for moderate sedation. Pain unpleasantness was 23/100 for placebo, 29/100 for mild, and 33/100 for moderate sedation. This effect was unexpected and may be explained by a difference of subjective pain experience by a patient and the perceived level of analgesia by a health care provider in sedated patients. This finding calls further attention to the need for adequate analgesia in patients sedated with propofol.

Adult↗