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PubMedDate not supplied

Evaluation of demographic, behavioral, and procedural factors on pain perception by patients undergoing colonoscopy and moderate sedation.

This prospective study collected demographic, behavioral, and procedural factors data on the pain perception of 100 patients as they were undergoing colonoscopy and moderate sedation. Patients were asked to rate pain on a 4-point categorical scale (no, slight, moderate, or severe pain) before the colonoscopy, every 5 minutes during, and after the colonoscopy. Before discharge, patients recorded overall pain control satisfaction on a 100-mm visual analog scale (0=not satisfied and 100=satisfied). The average patient age was 54.3 years, and 56% were male. A total of 59 subjects reported an averaged "no pain" or "slight pain" rating, and 41 reported moderate or severe pain. The median visual analog scale score was 92.5, demonstrating a high level of overall pain-control satisfaction. Patient reports of pain during the colonoscopy procedure may not be recalled by the moderately sedated patient, as evidenced from the high level of satisfaction of overall pain control demonstrated by the visual analog scale finding. Compared with women and non-Whites, a larger proportion (P<.05) of men and Whites reported "no" or "slight pain"; moreover, a larger proportion (P<.05) of patients experiencing no preprocedure anxiety reported "no" or "slight pain" compared with those experiencing anxiety before their procedure. Compared with other sedation groups, a larger proportion (P<.05) of patients receiving Versed + Fentanyl reported "no" or "slight pain" during their procedures. Other factors that were analyzed, including age, body mass index, history of alcohol consumption, smoking, narcotic use, length of procedure, and medical or nursing intervention, did not appear to influence the level of pain perceived by patients observed in this study.

Adult↗
PubMed2004

A comparison of anticipatory and postprocedure pain perception in patients who undergo urodynamic procedures.

OBJECTIVE: The purpose of this study was to compare anticipatory and postprocedure pain perception in female patients who undergo multichannel urodynamic evaluation in an office setting. STUDY DESIGN: One hundred consecutive patients completed a visual analogue pain scale before and after urodynamic testing. RESULTS: The mean postprocedure pain score of 2.32 cm was significantly lower than the anticipatory pain rating of 4.35 cm (P<.05). The lower postprocedure pain score was not influenced by previous hysterectomy, body mass index, menopausal status, estrogen replacement therapy, or analgesic or psychiatric medication usage. Patients who had undergone previous anti-incontinence surgery reported significantly higher levels of pain during the procedure (mean visual analogue pain scale score, 3.10 cm vs 2.06 cm; P=.027). CONCLUSION: Patients who undergo urodynamic testing anticipate higher degrees of discomfort than they perceive during the procedure. Previous anti-incontinence surgery appears to lower the pain threshold.

Anxiety↗
PubMedDate not supplied

Psychopathology and aggressive behaviour in cancer pain perception.

In order to investigate the relationships between psychopathology and aggressive behaviour on the one hand and cancer pain perception on the other, 11 patients who suffered from neoplasm were investigated by means of Symptomatology Check List (SCL-90) by Derogatis, Inventory for assessing different kinds of hostility (QTA) by Buss-Durkee, Scala di Autovalutazione per la Depressione (SAD) by Cassano & Castrogiovanni and Mc-Gill Pain Questionnaire (MPQ.) by Melzack. The results show that when psychopathologic symptoms are present, they lead the patient to feel pain as unbearable, thus arousing violently homicidal thoughts. Features of aggressivity once experienced, lead to an almost personified and extremely active image of pain.

Aggression↗
PubMed2001

Effect of age on acute pain perception of a standardized stimulus in the emergency department.

STUDY OBJECTIVE: The study was undertaken to determine whether pain perception is different in elderly patients than in younger patients. METHODS: A cross-sectional, observational study was conducted at 2 urban academic emergency departments. Adult patients (> or =18 years of age) who required an 18-gauge intravenous catheter as part of their ED care were eligible. Patients were excluded for the following conditions: more than one attempt at intravenous catheter placement, altered mental status, visual impairment, intoxication, distracting pain, or abnormal upper extremities. Patients were asked to indicate on a 10-cm visual analog scale (VAS) the amount of pain they had at baseline immediately before intravenous catheter placement. They were then asked to indicate on a separate VAS the amount of pain caused by intravenous catheter placement. Patients aged 65 years and older were defined a priori as elderly. RESULTS: Of 100 patients enrolled in the study, 32 (32%) were elderly. Elderly patients reported significantly less pain than nonelderly patients (Delta = -15 mm, 95% confidence interval -26 to -4 mm). Pain of intravenous catheter placement was not associated with sex, baseline pain, site of intravenous catheter insertion, or level of training of the individual placing the intravenous catheter. CONCLUSION: Elderly patients experienced less acute pain than their younger counterparts in response to a standardized stimulus in a clinical setting. This difference is both statistically and clinically significant. This may have clinical implications for the assessment and treatment of acute pain in the elderly.

Acute Disease↗
PubMed1986

Effects of L-5HTP with and without carbidopa on plasma beta-endorphin and pain perception: possible implications in migraine prophylaxis.

L-Tryptophan (L-TP) has been used in migraine and other pain conditions. The mechanism underlying the analgesic effect is still partly undefined. In this study the effects of subchronic administration of L-5-hydroxytryptophan (L-5HTP) (with and without carbidopa) on plasma beta-endorphin (beta-EP) levels and subjective pain threshold and tolerance were investigated in seven healthy volunteers. To measure also an objective indicator of pain, the nociceptive flexion reflex threshold was studied. L-5HTP treatment with and without carbidopa administration increased beta-EP levels significantly (p less than 0.05). L-5HTP plus carbidopa induced an increase in beta-EP significantly (p less than 0.05) greater than that induced by L-5HTP alone. Neither the subjective pain threshold and tolerance nor the RIII threshold was modified by either treatment. Our data seem to point to the existence of a complex linkage between plasma opioid levels and pain perception.

Adult↗
PubMed1986

Effects of L-5HTP with and without carbidopa on plasma beta-endorphin and pain perception. Possible implications in migraine prophylaxis.

L-Tryptophan (L-TP) has been used in migraine and other pain conditions. The mechanism underlying the analgesic effect is still partly undefined. In this study the effects of subchronic administration of L-5-hydroxy-tryptophan (L-5HTP) (with and without carbidopa) on plasma beta-endorphin (beta-EP) levels and subjective pain threshold and tolerance were investigated in seven healthy volunteers. To measure also an objective indicator for pain, the nociceptive flexion reflex threshold was studied. L-5HTP treatment with and without carbidopa administration increased beta-EP levels significantly (p less than 0.05). L-5HTP plus carbidopa induced an increase in beta-EP significantly (p less than 0.05) higher than that after L-5HTP alone. Neither subjective pain threshold and tolerance nor RIII threshold was modified by either treatment. Our data seem to point to the existence of a complex linkage between plasma opioid levels and pain perception.

5-Hydroxytryptophan↗
PubMed2003

Pain perception, brain and consciousness.

The brain-mind debate presents two principal streams of thought: materialist (brain and mind are different aspects of the same extremely complex "thing") and dualist (brain and mind are two independent things). Originating as a signal of damage transmitted to the thalamus, a warning message becomes perceived pain when the thalamus sends it to, and it is integrated by, the cerebral and cingulated cortices. In addition to various endogenous and exogenous physical factors that may affect (or even inhibit) the perception of pain, pain perception may be modulated, that is, enhanced or inhibited, by cognitive and emotive factors whose origins and existence are principal elements in the brain-mind debate. Studying the perception and modulation of pain provides an excellent heuristic model for studying the brain-mind debate and, in turn, an understanding of the brain-mind debate may offer new possibilities in pain therapy.

Brain↗
PubMedDate not supplied

Effects of opioid prescription medication dependence and detoxification on pain perceptions and self-reports.

The purpose of this work is to document whether prescription opioid medications used for pain enhanced or worsened pain syndromes from medical conditions in patients who received a diagnosis of prescription opioid dependence as determined by a diagnosis by Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV criteria. Further, whether detoxification improved or worsened pain perceptions and self-reports in patients who chronically administered prescription opioid medications. Our study consisted of a retrospective sample of patients taken from the Addiction Treatment Unit at St Lawrence Hospital in Lansing, MI. Patients were selected from those who voluntarily sought detoxification from opioid medications in an inpatient setting. Selection criteria for the study consisted of a DSM-IV diagnosis of opioid prescription medication dependence, willingness to undergo medical detoxification, cooperation with self-report scales, and abstinence from opioid medications. Study patients were randomly selected from discharges in patient census for the years 2001 to 2003. The significant findings were that self-reported pain scores improved during the detoxification from admission to discharge, from a mean of 5.5 at admission to mean of 3.4 at discharge (0 is no pain and 10 is the most pain). The detoxification period extended to an average of 5 days. Whereas oxycodone CR (OxyContin) produced higher levels of self-reported pain at admission than at discharge, and these patients experienced significant levels of pain reduction with decremental opioid doses as with other opioid medications. Patients with a DSM-IV diagnosis of prescription opioid dependence reported (self) less pain with detoxification and abstinence from the opioid medications.

Adult↗
PubMed1993

Right-left asymmetry in tonic pain perception and its modification by simultaneous contralateral noxious stimulation.

Administration of the cold pressor test (I test) in normal healthy subjects revealed lateralization of pain perception with the right hand showing higher threshold and tolerance, as well as lower pain scores on Graphic Rating Scale, PPI and MPQ. To find out whether this lateralization persists, the cold pressor test was given while the contralateral hand was simultaneously exposed to non-noxious stimulus (II test) or noxious stimulus (III test). Reversal of laterality to the left hand was observed in the III test in 40% of the subjects for pain threshold. The mechanism of diffuse noxious controls and attentional focus to the noxious stimulus that is more intense, are suggested for the observed changes in laterality when two concurrent noxious stimuli are present.

Adolescent↗
PubMedDate not supplied

Plasma beta-endorphin-like immunoreactivity, self reported pain perception and anxiety levels in women during pregnancy and labor.

Plasma Beta-endorphin (B-END) immunoreactivity was measured in 19 men, 16 women at midcycle, and ten pregnant women at various points in their pregnancies. There is a significant difference between the levels measured in males and females (t = 3.74, df = 31, p = .0007). Pregnant women demonstrated a steady increase in plasma Beta-End-like immunoreactivity between second and third trimester and through labor. The levels dropped rapidly postpartum. The material being measured is predominantly B-end-sized. Psychological studies indicate that these changes are not strongly correlated with pain perception or self-reported anxiety levels.

Adult↗
PubMed2001

Effect of isometric exercise on pain perception and blood pressure in men and women.

PURPOSE: To examine the influence of isometric handgrip exercise (ISO EX) on pain perception and blood pressure in men and women. METHODS: Fifteen men and 16 women completed max and submax ISO EX consisting of squeezing a hand dynamometer with the right hand as hard as possible for the max session, and squeezing between 40% and 50% of max for 2 min for the submax session. Pain thresholds (PT), pain ratings (PR), blood pressure (SBP and DBP), and heart rate (HR) were assessed while a noxious pressure stimulus was applied to the right forefinger for 2 min before and after ISO EX. Data were analyzed with a 2 (gender) x 2 (trials) ANOVA. RESULTS: Results indicated a significant trials effect and a significant gender by trials interaction (P < 0.05) for PT for the max and submax sessions. Women had lower PT before ISO EX in comparison with the men. In addition, PT for the women increased significantly after ISO EX but did not change for the men. There were significant gender and trials effects (P < 0.05) for SBP for the submax session. Women had lower SBP before ISO EX, and SBP increased after ISO EX. DBP was also found to be lower (P < 0.05) in women before max and submax ISO EX, with DBP increasing after submax ISO EX in men and women. PR were found to be lower after max ISO EX in men and women, whereas PR were found to be lower in women after submax ISO EX. CONCLUSION: It is concluded that: 1) men and women differed in PT, SBP, and DBP before ISO EX; and 2) analgesia after ISO EX is observed more consistently in women.

Adult↗
PubMed2006

[Voltage-dependent calcium channels at the heart of pain perception].

Voltage-dependent calcium channels represent a major pathway of calcium entry into neurons, where they participate actively to cell excitability and to the molecular processes of synaptic transmission. For that reason, they have been the direct or indirect pharmacological targets of analgesics and this long before their implication in the physiology of nociception had been demonstrated. These last years, the still more refined molecular characterization of these channels and their associated regulatory subunits and the demonstration of their implication in nociceptive processes indicates that these structures are prime pharmacological targets for the management of pain. Herein, we detail the recent breakthroughs on calcium channel structure, function and pharmacology, review the implication of calcium channels in the transmission of nociception, and evaluate their importance as targets for the treatment of pain perception. The search for specific inhibitors of voltage-dependent calcium channels appears as a prelude to the development of new promising analgesic molecules.

Afferent Pathways↗
PubMed1990

Evidence of a role for NMDA receptors in pain perception.

Both chiral forms of ketamine caused analgesia when administered in subanesthetic doses to human volunteers suffering acute, experimentally induced ischemic pain. S-Ketamine was 4 times more potent than R-ketamine as an analgesic agent in this model system. The relative order of analgesic potency of the two enantiomers was compared to their relative affinity for phencyclidine (PCP) binding sites (associated with the NMDA receptor-operated ion channel) and for sigma binding sites (which are not associated with the NMDA receptor complex). The relative analgesic potency of the enantiomers correlated positively with their relative affinity for PCP sites and negatively with their relative affinity for sigma sites. The results strongly indicate that PCP sites, but not sigma sites, are functional receptors mediating the analgesic effect of ketamine. This is consistent with the hypothesis that NMDA receptors are essential for pain perception in humans. Disturbances of other sensory modalities, in particular somatosensory perception, vision and hearing, were the main side-effects observed. These effects were qualitatively similar for both enantiomers and were closely associated with their analgesic action. The NMDA type of excitatory amino acid receptor thus appears to be widely involved in the processing of sensory afferent signals in the human brain.

Humans↗
PubMed2006

The effects of the steroid androstadienone and pleasant odorants on the mood and pain perception of men and women.

BACKGROUND AND PURPOSE: We previously found that for both men and women odors influence mood, which in turn influences pain unpleasantness perception. Others showed that the steroid androstadienone modulates mood differently in men and women, improving mood in women and worsening it or leaving it unchanged in men. Based on its dissociable effect on mood, we hypothesized that women exposed to androstadienone would report lower pain unpleasantness than when exposed to the vehicle, while men would show no change or the reverse pattern. Because of the expected beneficial effect of pleasant odors on mood in both men and women, all subjects should report lower pain unpleasantness when exposed to the pleasant odor compared to the unscented air. METHODS: In one session subjects were exposed to: (1) androstadienone diluted in a vehicle while breathing unscented air and (2) androstadienone in vehicle while breathing a pleasant odorant. In another session they were exposed to: (1) vehicle and unscented air and (2) vehicle and a pleasant odorant. Phasic contact heat was used to induce pain. RESULTS AND CONCLUSIONS: Planned comparisons confirmed that, in the absence of pain, androstadienone improved mood only in women, while the pleasant odorants improved mood for all subjects. However, these positive mood changes did not persist with the introduction of pain. Consistent with the absence of positive mood changes, pain unpleasantness was not modulated. Unexpectedly, the presence of androstadienone increased perceived pain intensity especially in women, suggesting an effect of androstadienone on pain perception, independent of mood changes. Heightened attentional state may be responsible.

Adolescent↗
PubMed2006

Pain perception development and maturation.

Newborn infants are not small adults. The pharmacokinetics and dynamics of analgesic drugs are immature at birth. Volumes of distribution, drug clearances, side-effects and drug efficacy all differ in newborns as compared to adults. Interestingly, these parameters develop before birth and during the postnatal period, reaching adult values after a period of months or years. This means that clinicians should anticipate on pharmacokinetic/pharmacodynamic (PK/PD) changes in newborns with increasing post-conceptual age. The ability to perceive pain might also be immature at birth. Lower pain thresholds due to the absence of inhibitory descending spinothalamic fibers and a not yet fully developed cortical pain memory system are points of interest for our understanding of differences in pain perception in the newborn infant. Although this is a relatively unexplored area of research in humans, we will discuss the maturation and development of neonatal pain experience and perception in this paper.

Analgesics↗