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PubMed1978

"It hurts red:" a preliminary study of children's perception of pain.

Children's perception of pain was investigated in an exploratory study. Some synaesthetic aspects were examined such as the color of pain, texture, shape, pattern and continuous vs intermittent quality. A projective test was developed using cartoons to illustrate two situations in which children commonly experience pain, a self-administered hammer blow and a doctor-administered needle. Interviews were tape-recorded with 58 children in hospital outpatient clinics and school situations in Kindergarten and Grades 1 through 3 in Licking County, Ohio. Significantly more children perceived the pain of a needle as jagged rather than smooth, and the pain of a hammer blow as a continuous rather than on-and-off pain. A finding of interest is the consistently greater differentiation in synaesthetic perception by the younger group on four of the five variables. Synaesthetic perception may be more characteristic of children in Piager's preoperational stage (aged 4-6); more cognitively oriented perception may be exhibited by 7- to 9-yr.-old children who approximate the stage of concrete operations.

Age Factors↗
PubMed1986

Cultural perceptions of pain and pain coping among patients and dentists.

A combination of qualitative and quantitative methods were developed to describe pain and pain coping perceptions of 25 Chinese, 25 Anglo-Americans and 35 Scandinavians (54 patients and 21 dentists). Results revealed universal dimensions of pain such as time, intensity, location, quality, cause and curability. More culture-specific dimensions included the Chinese concept suantong, a multivariate concept of bone, muscle, joint, tooth and gingival pain. "Real" and "imagined" pains were mostly described by Western subjects, especially dentists; "imagined pain" being the conversion of fear or anxiety into perceived pain. These data indicate that the methods were sensitive to culture as a variable and indicate that ethnicity may play a stronger role in the perceptions of pain description than does professional socialization, but that professional socialization processes may have more influence on the perception of pain coping modes for this sample population.

Adaptation, Psychological↗
PubMed1999

Cerebral Activity in the Perception of Visceral Pain.

Specific patterns of cerebral activity have recently been identified in relation to acute and chronic visceral pain experiences in humans. Activity may occur in a brain region as a consequence of receiving and processing neurally encoded information perceived to be arising from the viscera. (This includes, but is not necessarily limited to, information actually arising from the viscera.) Observed cerebral activity may also represent the mobilization and output of instructions emanating from the cerebrum, which helps create and respond to visceral events. Functional neuroanatomy underlying the transmission of both kinds of neuronally encoded information is outlined. Recent research and ideas on cerebral activity associated with visceral pain perceived to be arising from within the abdomen, chest, or pelvis are considered. Finally, the relationships of pain perception and cerebral activity to depression, autonomic function, and sex are discussed.

Journal Article↗
PubMed1999

Chronic pain-associated behaviors in the nursing home: resident versus caregiver perceptions.

Pain assessment in nursing home residents poses challenges since many of these individuals are too cognitively impaired to respond to traditional self-report instruments. Assessment of pain behavior in this population offers a logical alternative. The purpose of this study was to compare perceptions of behaviors identified as being pain-related in 42 nursing home residents with chronic pain, as reported by residents themselves, their nursing home caregivers and their family caregivers. Our specific research agenda was to identify the most salient behaviors that signal pain in nursing home residents; to determine the test-retest agreement of residents' self-perceived pain behaviors; to learn of the confidence that caregivers feel regarding assessment of residents' pain behavior; and to examine the agreement between caregivers and residents about pain behaviors in particular residents. We also wanted to compare residents' and caregivers' ratings of the residents' pain intensity. Finally, we explored the beliefs of nursing home staff about the influence of dementia on pain and pain assessment. Twenty-two of 26 pain-related behaviors identified by residents showed fair to perfect test-retest agreement (kappas 0.40-1). For the vast majority of pain-related behavior items, kappas for resident-caregiver agreement were <0.30. Agreement with regard to pain intensity was similarly poor (r = -0.19-0.34). Confidence in pain rating was high for both nurse (on average, 7.2 on a scale of 0-10) and family (on average, 6.7) caregivers. Seventy-one percent of nurses felt that pain assessment is more difficult in demented individuals, but that cognitive function does not influence pain prevalence. While nursing home residents with chronic pain and their caregivers have different perceptions regarding which behaviors are pain-related, additional studies are required to determine the underpinnings of these differing perceptions and to determine the extent to which formal pain behavior observation protocols will be useful for evaluating nursing home residents with chronic pain.

Adult↗
PubMed2005

Affective modulation of brain potentials to painful and nonpainful stimuli.

In accordance with the emotional priming hypothesis, emotions seem to modulate pain perception and pain tolerance thresholds. To further evaluate this association, event-related brain potentials (ERPs) elicited by painful and nonpainful electrical stimuli during processing of positive, neutral, and negative valenced pictures were recorded from 30 healthy volunteers. Valence of pictures affected pain ratings and the N150 elicited by painful stimuli, with lowest amplitudes for positive pictures and highest amplitudes for negative pictures. The P260 elicited by painful and nonpainful stimuli was modulated by arousal with reduced amplitudes with arousing (positive or negative) compared to neutral pictures. N150 amplitudes varying with picture valence seem to reflect an affective modulation of pain perception whereas P260 amplitudes varying with picture arousal rather reflect non-pain-specific attentional processes.

Adolescent↗
PubMed2005

Attenuation of sensory and affective responses to heat pain: evidence for contralateral mechanisms.

Attenuation of responses to repeated sensory events has been thoroughly studied in many modalities; however, attenuation of pain perception has not yet benefitted from such extensive investigation. Described here are two psychophysical studies that examined the effects of repeated exposure to thermal stimuli, assessing potential attenuation of the perception of pain and its possible spatial specificity. Twenty-two subjects were presented thermal stimuli to the volar surface of the right and left forearms. Twelve subjects in study 1 received the same stimuli and conditions on each of five daily experimental sessions, whereas 10 subjects in study 2 received thermal stimuli, which were restricted to one side for four daily sessions and then applied to the other side on the fifth session. Ratings of warmth intensity, pain intensity, and pain unpleasantness were recorded while the subjects performed a thermal sensory discrimination task. Results of study 1 demonstrate that repeated stimulation with noxious heat can lead to long-term attenuation of pain perception; results of study 2 extend these findings of attenuation to both pain intensity and unpleasantness and show that this effect is highly specific to the exposed body side for both aspects of the pain experience. We suggest that the functional plasticity underlying this attenuation effect lies in brain areas with a strong contralateral pattern of pain-related activation.

Adaptation, Physiological↗
PubMed2005

Control over brain activation and pain learned by using real-time functional MRI.

If an individual can learn to directly control activation of localized regions within the brain, this approach might provide control over the neurophysiological mechanisms that mediate behavior and cognition and could potentially provide a different route for treating disease. Control over the endogenous pain modulatory system is a particularly important target because it could enable a unique mechanism for clinical control over pain. Here, we found that by using real-time functional MRI (rtfMRI) to guide training, subjects were able to learn to control activation in the rostral anterior cingulate cortex (rACC), a region putatively involved in pain perception and regulation. When subjects deliberately induced increases or decreases in rACC fMRI activation, there was a corresponding change in the perception of pain caused by an applied noxious thermal stimulus. Control experiments demonstrated that this effect was not observed after similar training conducted without rtfMRI information, or using rtfMRI information derived from a different brain region, or sham rtfMRI information derived previously from a different subject. Chronic pain patients were also trained to control activation in rACC and reported decreases in the ongoing level of chronic pain after training. These findings show that individuals can gain voluntary control over activation in a specific brain region given appropriate training, that voluntary control over activation in rACC leads to control over pain perception, and that these effects were powerful enough to impact severe, chronic clinical pain.

Adolescent↗
PubMed1987

Private body consciousness, anxiety and the perception of pain.

Two studies are described which present data consistent with Barsky and Klerman's hypothesis that people who report pain in the absence of an identifiable organic etiology may be attending to and amplifying normal bodily sensations. The results of these studies demonstrated that young college students with a predisposition toward focusing attention on somatic symptoms (high private body consciousness) and scoring high on State Anxiety reported more areas of aches and pains and rated these sensations as more noxious. Additionally, the most frequent areas of pain identified corresponded to the areas commonly seen in a chronic pain population. An attempt to manipulate self-focused attention with a mirror manipulation in Study 2 failed to produce reliable results.

Adult↗
PubMedDate not supplied

Cerebral slow waves related to the perception of pain in man.

Significant amplitude and temporal augmentation occurred in later time segments of human somatosensory evoked responses (60-700 ms) when percutaneous electrical pulse stimulation, delivered to finger, toe, or lip, indicated subjectively both crossing of a perceptual pain threshold and somatotopic movement associated with a noxious, qualitative change. Sequential pseudorandomizing of stimulus intensity (noxious and nonnoxious) or modality (contingent acoustic clicks) suggested that the waveform changes represented, at least in part, stimulus-specific information due to differential activation of peripheral fiber systems, rather than stimulus-nonspecific processing of event significances. The late waves were localizable, on scalp, to parietal and vertex regions, with insignificant contralateralization for finger stimuli. Their augmentation was related to subjective reports rather than to physical stimulus parameters, confirming previous data on potentially noxious mechanical stimulation of digits and palm, and another laboratory's noxious stimulation of tooth pulp. Subsequent data from a third laboratory, resulting from noxious laser stimulation of forearm, have replicated this late, slow-wave activity.

Adolescent↗
PubMed1990

Perceptions of pain relief after surgery.

OBJECTIVE: To assess patients' satisfaction with postoperative pain relief. DESIGN: A descriptive and questionnaire study of patients' experience. SETTING: Two surgical and two gynaecological wards. PATIENTS: 50 Patients admitted to hospital for cholecystectomy and 51 admitted for hysterectomy. MAIN OUTCOME MEASURES: Visual analogue scales with no divisions were completed by the patients immediately after each dose of postoperative analgesia was administered throughout their stay in hospital. A questionnaire completed on the fifth postoperative day recorded patients' recollections of their experience. Opinions were also sought from medical and nursing staff. RESULTS: During the first 24 hours after surgery recorded pain levels were 60% of the maximum and were not influenced by age, sex, or the type of operation performed. The median interval between the return of pain and a further injection of analgesic was 2 hours (interquartile range 1 to 3.5 hours). Expectations of pain relief were low, and for 70% of the patients the pain was at least as bad as they had expected. Only half of the medical and nursing staff questioned thought that postoperative analgesia should relieve pain completely; drugs were prescribed and administered with too little attention to the patient's response and too much concern about adverse effects and opioid dependence. CONCLUSIONS: The results suggest that the standard of postoperative pain relief is poor because of inadequate education of patients in what to expect (and demand), and of medical and nursing staff in how to prescribe and administer analgesia with reference to individual drug response.

Analgesics↗