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Results for “Pain Perception”

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At least 523 records · Page 29Linked to original sources

PubMed2002

Central neural contribution to the perception of chest pain in cardiac syndrome X.

OBJECTIVE: To investigate the central neural contribution to chest pain perception in cardiac syndrome X (angina-like pain, ECG changes during stress, angiographically normal coronary arteriogram). SUBJECTS: Eight syndrome X patients and eight healthy volunteers. METHODS: Dobutamine stress using echocardiography to assess myocardial function, and positron emission tomography to measure changes in regional cerebral blood flow, as an index of neuronal activity. RESULTS: During similar doses of dobutamine, syndrome X patients and controls showed comparable regional cerebral blood flow changes in the hypothalamus, thalami, right orbito-frontal cortex, and anterior temporal poles, associated with the sensation of a fast or powerful heart beat. In patients, but not controls, the stress also generated severe chest pain associated with increased activity in the right anterior insula/frontal operculum junction. There were ischaemia-like ECG changes in the syndrome X patients, but no left ventricular dysfunction on echocardiography. Activation of the right insula during chest pain clearly distinguished the syndrome X patients from a group of patients with known coronary disease. CONCLUSIONS: Chest pain and ECG changes were not accompanied by demonstrable myocardial dysfunction in syndrome X patients, but altered central neural handling of afferent signals may contribute to the abnormal pain perception in these patients.

Aged↗

PubMedDate not supplied

Psychological factors associated with perception of experimental pain in vulvar vestibulitis syndrome.

This study assessed the association between pain perception and psychological variables in women with vulvar vestibulitis syndrome (VVS) by comparing 28 VVS women with 50 healthy women. We assessed non genital systemic pain perception with quantitative sensory testing by administering experimental pain stimuli to the forearm. The VVS women demonstrated a lower pain threshold and a higher magnitude estimation of pain, combined with a higher trait anxiety, increased somatization, and a lower body image. Among the VVS women, nonvaginal pain catastrophizing was significantly related to reported pain during coitus. A cluster analysis revealed four subtypes of VVS women, as characterized by levels of pain and personality variables. I suggest implications for the assessment and treatment of women suffering from painful coitus.

Adult↗

PubMed1999

Analysis of the perception of and reactivity to pain and heat in patients with wallenberg syndrome and severe spinothalamic tract dysfunction.

BACKGROUND: The aim of the study was to assess the consequences of severe spinothalamic tract lesions resulting from lateral medullary infarct and to show that a specific pain perception can be elicited by strong thermal stimulation. CASE DESCRIPTIONS: Both patients examined presented with severe thermoalgic dissociation of the limbs contralateral to the lesion, with normal discriminative somatosensory perception and motor strength. They reported pain perception when touching very warm (>50 degrees C to 60 degrees C) objects and a brisk, occasionally uncontrolled withdrawal reaction of the arm and hand under the same conditions, without any perception of the heat nature of the stimulus. Warm stimulation, <45 degrees C, elicited no thermal perception or discrimination. Pain perception could be elicited in both patients by increasing the temperature, with a reproducible threshold of 47 degrees C to 49 degrees C. Pain always occurred after a prolonged delay of 8 to 10 seconds in response to threshold heat, and was described as deep and osseous, and clearly different from that perceived on the nonaffected side. The delay was much shorter when the temperature was increased by 4 degrees C to 5 degrees C. Cold stimulation elicited similar pain perception in one patient. Analysis of subjective perception of laser stimulation showed a much higher pain threshold on the affected hand. There were no laser-evoked potentials on this side, which suggested major spinothalamic injury. Assessment of the RIII noxious reflex revealed persistent response withdrawal reactions, with an increased threshold on the affected side, and partial consciousness of the noxious nature of the stimulus. CONCLUSIONS: To our knowledge, this is the first description of the appearance of pain perception of high temperatures in patients with severe spinothalamic injury who are suffering from a complete loss of temperature perception. This implies that noxious thermal stimulation can still be perceived via extra spinothalamic pathways (which are slow and multisynaptic), such as the spinoreticulothalamic tract. Patients with Wallenberg syndrome should be informed and made aware of their residual perception of and reactions to noxious stimulation.

Central Nervous System Diseases↗

PubMed2002

Motion sickness and migraine: optokinetic stimulation increases scalp tenderness, pain sensitivity in the fingers and photophobia.

The aim of this study was to determine whether scalp tenderness and photophobia, two well-recognized symptoms of migraine, develop during the motion sickness induced by optokinetic stimulation. To investigate whether motion sickness has a general influence on pain perception, pain was also assessed in the fingertips. After optokinetic stimulation, nausea increased more and headache persisted longer in 21 migraine sufferers than in 15 non-headache controls. Scalp tenderness increased during optokinetic stimulation in nauseated subjects, and pain in the fingertips increased more and photophobia persisted longer in migraine sufferers than controls. These findings suggest that the disturbance responsible for nausea also sensitizes trigeminal nociceptive neurones or releases inhibitory controls on their discharge. A low nausea threshold and a propensity for sensitization to develop rapidly in nociceptive pathways may increase susceptibility to migraine.

Adult↗

PubMed2006

[Genetics, pain and analgesia].

Genomic variations influencing nociceptive sensitivity and susceptibility to pain conditions, as well as responses to pharmacotherapy of pain are currently under investigation. Candidate genes involved in pain perception, pain processing and pain management such as (opioid) receptors, transporters and other targets of pharmacotherapy are discussed. Drug metabolizing enzymes represent a further major target of ongoing research in order to identify associations between an individual's genetic profile and drug response (pharmacogenetics). Polymorphisms of the cytochrome P 450 enzymes influence analgesic efficacy of codeine, tramadol and tricyclic antidepressants (CYP2D6). Blood levels of some non-steroidal anti-inflammatory drugs (NSAIDs) are dependent on CYP2C9 activity, whereas opioid receptor polymorphisms are discussed with respect to differences in opioid-mediated analgesia and side-effects. Pharmacogenetics is seen as a potential diagnostic tool for improving patient therapy and care and will contribute to a more individualized drug treatment in the future.

Analgesia↗

PubMed2005

Genetics and variability in opioid response.

The human genome project has revealed data on genomic variation which may influence the pharmacological responses. In pain therapy, the genetic background influencing the efficacy of opioid therapy is of special interest. Screening for variations in expression of drug metabolizing enzymes has been suggested as a potential tool for improving patient therapy. CYP2D6 genetic variability is supposed to be a major factor of adverse drug reaction, possibly influencing hospital stay and total costs. Further candidate genes involved in pain perception, pain processing and pain management like opioid receptors, transporters and other targets of pharmacotherapy are under investigation. Aspects of genetic differences influencing efficacy, side effects and adverse outcome of pharmacotherapy will be of importance for future pain management.

Analgesics, Opioid↗

PubMed2024

Associations between (pharmaco-)genetic markers and postoperative pain after inguinal hernia repair - a prospective study protocol.

BACKGROUND: Postoperative pain is a common complication following surgery, with severity and duration varying between patients. Chronic postoperative pain after inguinal hernia surgery has an incidence rate of approximately 10%. Risk factors for acute and chronic pain following hernia surgery include age, sex, psychosocial factors, and demographic background. Additionally, genetic polymorphisms in enzymes involved in pain mechanisms, as well as the metabolism of analgesics might influence pain perception, pain development, and response to pain medications. Key enzymes include the catechol-o-methyltransferase (COMT), the µ-opioid receptor 1 (OPRM1), and the cytochrome P450 2D6 (CYP2D6). CYP2D6 plays a crucial role in metabolizing analgesics such as tramadol, codeine, and oxycodone. It is also suspected to be involved in the synthesis of catecholamines and endogenous morphines suggesting a potential role in pathophysiology of pain. We hypothesize that the CYP2D6 activity influences the development of postoperative pain after hernia surgery. METHODS: This study is a prospective, observational, multicenter association study investigating adult patients scheduled for inguinal hernia surgery using a robotic-assisted (rTAPP) approach. Patients are enrolled during the preoperative surgical consultation. A buccal swab is collected for genetic testing at this time. Pain at the site of the hernia is assessed using the validated EuraHSQoL score preoperatively and at 2, 4, and 6 weeks postoperatively. Additionally, information on co-medication and details of the surgery will be collected. The planned number of participants is 350 patients. The primary objective is to analyze the association between different genotype-predicted CYP2D6 phenotypes and patient-reported pain intensity 6 weeks after surgery. Secondary objectives include the association between further genetic variants, such as the COMT rs4680 and OPRM1 rs1799971 genotype, and pain severity. Additionally, the potential of pharmacogenetic panel testing to optimize analgesic therapy in hernia surgery patients will be explored. DISCUSSION: The findings of this study are expected to provide valuable insights into identifying patients at higher risk for postoperative pain before surgery. This knowledge could pave the way for tailored interventions during and after surgery for these specific patients. TRIAL REGISTRATION: Deutsches Register Klinischer Studien https://www.drks.de/DRKS00034796 Registered on August 07, 2024.

Genetic Association Studies↗

PubMed1994

Effects of cognitive-behavioral strategies on pain in cancer patients.

The purpose of this pilot study was to examine the effects of a combination of cognitive and behavioral nursing interventions on pain perception, pain control, and mood in metastatic breast cancer patients who were experiencing physical pain. A pretest-posttest experimental research design was utilized in this pilot study. Twenty-four patients with metastatic breast cancer who were experiencing physical pain were randomly assigned to a control group, to a treatment group who received relaxation and visualization training, or to a treatment group who received relaxation, visualization, and cognitive coping skills training. Measures of the subjects' pain intensity, pain distress, pain control, ability to decrease pain, and mood were taken pre- and posttreatment. Significant differences were found between the treatment groups and the control group in ability to decrease pain. There were no significant differences found in pain intensity or distress or mood. The results indicate that these cognitive-behavioral interventions could be useful clinical nursing interventions for selected cancer patients experiencing physical pain.

Adaptation, Psychological↗

PubMed1997

Pain during early abortion.

OBJECTIVE: To determine which factors predict pain perception in women undergoing first-trimester abortion under local anesthesia. STUDY DESIGN: Women undergoing first-trimester abortion with local anesthesia were asked about their perception of pain during the procedure and at the time of discharge from the recovery room. They were also asked to compare the amount of pain experienced to their expected amount of pain. Additional data were abstracted from the patient record. RESULTS: During the study period, 1,055 women had abortions and had records suitable for analysis. Factors that were not found to be related to pain were the operating physician, maximal amount of cervical dilatation, size of the suction cannula, prior abortion and prior pelvic examination. Gestational age did not show a consistent relationship to pain, although there was a suggestion that pain perception increases at the highest gestational ages. Longer procedures and procedures following the use of osmotic dilators tended to have higher pain scores. Prior abdominal delivery did not have a significant relationship to pain score, but prior vaginal delivery correlated with decreased pain by any method of analysis. The difference in pain perception between women with and those without prior vaginal birth was most striking at the earliest gestational ages. CONCLUSION: Prior vaginal delivery was the most consistent predictor of decreased pain perception during first-trimester abortion. Future studies on discomfort during abortion should include gestational age, patient age and the route of prior deliveries.

Abortion, Induced↗

PubMed1994

Exercise-induced analgesia and the role of reactivity in pain sensitivity.

The present study was designed to evaluate whether pain perception and pain tolerance are altered by submaximal aerobic exercise. Sixty male volunteers were randomly assigned to one of two control or experimental groups in the first of two sessions. In session 1, baseline measures of pain tolerance and pain perception were obtained for half of the subjects in each of the experimental and control groups, respectively. In addition, all subjects completed the Reactivity Scale, followed by estimation of their maximum aerobic power (VO2 max) using the Canadian Home Fitness Test. In session 2, the subjects in the two experimental groups exercised for 12 min by climbing a double step to pre-recorded musical cadences, working on average at 63% VO2 max, whereas the subjects in the two control groups spent approximately 12 min completing two short unrelated questionnaires. Measures of pain tolerance and pain perception were obtained from all subjects after exercising or completing questionnaires. Pain tolerance was assessed by the amount of time (up to 10 min) that subjects could voluntarily endure a 2300 g pressure to the index finger of their dominant hand. Pain perception was defined by participants' intensity ratings on an 11-point scale, made at 30 and 60 s. The results showed that reactivity and exercise were significant predictors of pain tolerance, together accounting for approximately 22% of the variance. The finding that submaximal workloads produce analgesia supports the potential usefulness of exercise in therapeutic intervention.

Adolescent↗

PubMed2005

Self-pain enmeshment and the perception of pain.

Explore the source record for details and available documents.

Humans↗

PubMed1998

Pain coping strategies predict perceived control over pain.

Perceptions of control over pain and specific pain coping strategies are associated with a number of positive outcomes in patients with chronic pain conditions. Transactional models of stress have emphasized coping as a process that is both determined by, and influences appraisals of control. While perceptions of control and coping efforts are associated with better adjustment, little is known about the specific coping strategies that contribute to perceptions that pain is controllable. One hundred and ninety-five (65% female) individuals with chronic pain conditions admitted to an inpatient unit completed the Multidimensional Pain Inventory, the Survey of Pain Attitudes and the Coping Strategies Questionnaire. Stepwise multiple regression analyses were used to predict perceived pain control from measures of pain severity and coping. After controlling for pain severity and education, coping self-statements and reinterpreting pain sensations predicted greater perceptions of control over pain, whereas ignoring pain sensations predicted lower perceptions of control over pain. The coping strategies did not interact with pain severity in predicting perceptions of control. Coping flexibility, or the number of pain coping strategies reported at a high frequency, also predicted perceptions of control over pain and did not interact with pain severity. The present findings suggest that, regardless of pain severity, the use of specific cognitive pain coping strategies may increase perceptions of control over pain. Since the existing coping literature largely identifies maladaptive pain coping strategies, it is especially critical to establish which pain coping strategies are adaptive. Specific cognitive strategies, particularly coping self statements, are important components for cognitive-behavioral interventions for chronic pain management. Future research will need to determine whether other adaptive cognitive strategies such as reinterpreting pain sensations can be increased with cognitive interventions, since this strategy is infrequently used.

Adaptation, Psychological↗

PubMed1995

Differences in pain knowledge and perception of the pain experience between outpatients with cancer and their family caregivers.

PURPOSE/OBJECTIVES: To determine if knowledge about pain and the perception of the pain experience differ when comparing outpatients experiencing cancer-related pain with their family caregivers. DESIGN: Quantitative, descriptive. SETTING: Sixteen oncology outpatient settings that are part of the Oncology Nursing Research Network. SAMPLE: Eighty-six outpatients with cancer-related pain and their family caregivers. METHODS: Patients and their family caregivers were recruited in the outpatient setting and asked to complete a demographic questionnaire and the Pain Experience Scale. The patients also were asked to complete the Karnofsky Performance Scale. MAIN RESEARCH VARIABLES: Patients' and their family caregivers' knowledge about pain and their perception of the pain experience. FINDINGS: No significant differences in knowledge scores were found between the patients and their family caregivers. A significant difference in the perception of the pain experience was found, with the family caregivers viewing the experience more negatively than the patients did. Family caregivers reported that (a) patients had significantly higher levels of pain compared to patient reports, (b) patients experienced significantly greater distress from their pain than the patients reported for themselves, and (c) family caregivers experienced significantly greater distress from the patients' pain than the patients reported for their caregiver. CONCLUSIONS: Outpatients with cancer and their family caregivers possess limited knowledge about pain and pain management and perceive the pain experience differently. IMPLICATIONS FOR NURSING PRACTICE: Outpatients and their family caregivers need to be better educated about how to manage cancer-related pain. In addition, to reduce patient and caregiver distress, oncology nurses need to facilitate communication between patients and family caregivers about the pain experience.

Caregivers↗

PubMed2003

Arthroscopic knee surgery does not modify hyperalgesic responses to heat injury.

BACKGROUND: Experimental studies suggest that surgical injury may up- or down-regulate nociceptive function. Therefore, the aim of this clinical study was to evaluate the effect of elective arthroscopically assisted knee surgery on nociceptive responses to a heat injury. METHODS: Seventeen patients scheduled to undergo repair of the anterior cruciate ligament and 16 healthy controls were studied. The first burn injury was induced 6 days before surgery, and the second burn was induced 1 day after surgery with a contact thermode (12.5 cm2, 47 degrees C for 7 min) placed on the medial aspect of the calf contralateral to the surgical side. Ibuprofen and acetaminophen were given for 2 days before the first burn injury and again from the time of surgery. In the controls, the two burn injuries were separated by 7 days. Sensory variables included cumulated pain score during induction of the burn (visual analog scale), secondary hyperalgesia area, and mechanical and thermal pain perception and pain thresholds assessed before and 1 h after the burn injury. RESULTS: The heat injuries induced significant increases in pain perception (P < 0.001) and decreases in pain thresholds (P < 0.02). Baseline heat pain thresholds were higher during the second burn injury in patients (P < 0.001) and controls (P < 0.01). However, there were no significant differences in pain to heat injury (P > 0.8), secondary hyperalgesia areas (P > 0.1), mechanical and thermal pain perception (P > 0.1), or mechanical and thermal pain thresholds (P > 0.08) in the burn area before surgery compared to after surgery. CONCLUSION: Arthroscopic knee surgery did not modify nociceptive responses to a contralaterally applied experimental burn injury.

Adult↗

PubMed2003

Older people in persistent pain: nursing and paramedical staff perceptions and pain management.

BACKGROUND: Persistent pain is a common problem for older people. Knowledge about how nursing and paramedical staff perceive these people and what they do to relieve the pain seems scarce. AIM: To explore nursing and paramedical staff perceptions of older people in persistent pain and their day-to-day management of pain. METHODS: Interviews in Swedish with 52 nursing auxiliaries, Registered Nurses, physiotherapists and occupational therapists were collected from February to May 2000. The analysis was based on their stories (n = 150) about older people in persistent pain who received help in their own homes or in special accommodation. A typology of staff perceptions of pain in older people was developed. Activities to manage pain were examined using content analysis. RESULTS: Respondents perceived the pain as real, exaggerated, trivial, care-related, endured, concealed, self-caused or inarticulate. Older people perceived as exaggerating the pain, those with care-related and self-caused pain evoked frustration in the staff, while those perceived as enduring their pain evoked satisfaction. Various strategies to manage pain were used: no activity, medication, mediating contacts, distracting activities, physical therapies, mobility, work in a gentle way, rest or relieving pressure on body part, and communication concerning pain. The activities differed between the types, as well as between staff with different professional backgrounds. CONCLUSION: Care and treatment provided by staff should be based on older people's needs rather than on staff attitudes and preferences. The typology revealed that staff perceived older people in pain as a heterogeneous group and that their perceptions affected the pain-relieving activities that were offered. It seems urgent to address how to handle pain in older people who never complain and those who complain a great deal, as well as how to handle pain in people with impaired communicative ability. Reflective discussions on feelings related to different individuals are needed.

Aged↗

PubMed2004

Cancer-related pain in palliative care: patients' perceptions of pain management.

BACKGROUND: Pain is still a significant problem for many patients with cancer, despite numerous, clear and concise guidelines for the treatment of cancer-related pain. The impact of pain cognition on patients' experiences of cancer-related pain remains relatively unexplored. AIM: The aim of this study was to describe how patients with cancer-related pain in palliative care perceive the management of their pain. METHOD: Thirty patients were strategically selected for interviews with open-ended questions, designed to explore the pain and pain management related to their cancer. The interviews were analysed using a phenomenographic approach. FINDINGS: Patients described 10 different perceptions of pain and pain management summarized in the three categories: communication, planning and trust. In terms of communication, patients expressed a need for an open and honest dialogue with health care professionals about all problems concerning pain. Patients expressed an urgent need for planning of their pain treatment including all caring activities around them. When they felt trust in the health care organization as a whole, and in nurses and physicians in particular, they described improved ability and willingness to participate in pain management. While the findings are limited to patients in palliative care, questions are raised about others with cancer-related pain without access to a palliative care team. CONCLUSION: The opportunity for patients to discuss pain and its treatment seems to have occurred late in the course of disease, mostly not until coming in contact with a palliative care team. They expressed a wish to be pain-free, or attain as much pain relief as possible, with as few side effects as possible.

Adult↗

PubMed1990

Effects of chronic back pain on the perception of experimental heat pain.

19 patients between 23 and 65 yr. of age whose chronic back pain was caused by lumbosacral disk disease and 19 healthy volunteers matched for age and sex were studied. Pain thresholds under phasic and tonic heat stimulation and thermal thresholds for warmth and cold were measured on the right hand. The patients rated any current back pain on a visual analog scale. There was a significant negative correlation between current back pain and the threshold for tonic pain, but there was no correlation between current back pain and either the threshold for phasic pain or temperature sensitivity. Hence, current back pain and experimental tonic pain seem to have an additive effect on pain perception because perceptual qualities are similar. Reduced somatosensory perception of chronic back pain patients could be demonstrated for temperature sensitivity and to a lesser degree for phasic pain, but as a consequence of the "opposing" effect of current back pain, not for tonic pain perception.

Arousal↗

PubMed1991

Toward an understanding of the rationale for the use of dietary supplementation for chronic pain management: the serotonin model.

The use of dietary metabolic precursors to neurotransmitter in the management of chronic pain patients has received critical attention for several years. As pain evolves from acute to chronic, different neuronal pathways are used and diverse areas of the brain become involved in pain perception and modulation. The serotonergic system serves as a useful model for understanding the effect of metabolic precursors. Oral L-tryptophan administration decreases the perception of pain, appearing to act synergistically with the enkephalins and endorphins. Drugs that either increase the serotonin level or block reuptake are associated with decreased pain perception, increased pain threshold, and improved sleep. From a therapeutic standpoint, dietary modification would appear to be attractive, due to its low economic basis, decreased risk of addiction and dependence, as well as simplicity. However, potential risk from toxicity is only recently being recognized, along with difficulty in reliability of analgesic effect from one patient to another. Currently, L-tryptophan is unavailable for therapeutic use in the United States and is not recommended implicitly or explicitly by the author because of its potential health risk.

Chronic Disease↗