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Results for “Pain Perception”

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PubMed1993

Alterations in pain threshold and psychomotor response associated with subanaesthetic concentrations of inhalation anaesthetics in humans.

We studied the effects of six inhalation anaesthetics at subanaesthetic concentrations of 0.2 MAC on pain threshold and psychomotor function in six healthy volunteers. When compared with 100% oxygen inhalation, nitrous oxide and methyoxyflurane significantly increased pain threshold as measured by a radiant heat algometer, and prolonged the response time to auditory stimuli. In contrast, halothane, enflurane, isoflurane and sevoflurane produced prolongation of the response time to auditory stimuli but did not influence pain perception. The pain threshold with nitrous oxide remained significantly increased 30 min after its discontinuation, while the response time returned to the preinhalation value. We conclude that nitrous oxide and methoxyflurane possess both analgesic and hypnotic actions but halothane, enflurane, isoflurane and sevoflurane do not have an analgesic action at subanaesthetic concentrations, and the analgesic action of nitrous oxide persists after its elimination.

Adult↗

PubMed2004

Prediction of postoperative pain by preoperative nociceptive responses to heat stimulation.

BACKGROUND: Despite major advances in the understanding of the neurobiologic mechanisms of pain, the wide variation in acute pain experience has not been well explained. Therefore, the authors investigated the potential of a preoperatively induced heat injury to predict subsequent postoperative pain ratings in patients undergoing knee surgery. METHODS: Twenty patients were studied. The burn injury was induced 6 days before surgery with a contact thermode (12.5 cm2, 47 degrees C for 7 min). The sensory testing, before and 1 h after the injury, included pain score during induction of the burn, secondary hyperalgesia area, thermal and mechanical pain perception, and pain thresholds. Postoperative analgesia consisted of ibuprofen and acetaminophen. Pain ratings (visual analog scale) at rest and during limb movement were followed for 10 days after surgery. RESULTS: The burn injury was associated with development of significant hyperalgesia. There was a significant correlation between preoperative pain ratings during the burn injury and early (0-2 days, area under the curve) and late (3-10 days, area under the curve) postoperative dynamic pain ratings during limb movement. CONCLUSION: The results of this study suggest that the pain response to a preoperative heat injury may be useful in research in predicting the intensity of postoperative pain. These findings may have important implications to identify patients at risk for development of chronic pain and to stratify individuals for investigations of new analgesics.

Adult↗

PubMed2002

Adverse effects of pain on the nervous systems of newborns and young children: a review of the literature.

There are immediate and long-lasting harmful consequences to the nervous system when infants experience severe or repetitive pain. These effects are especially significant in preterm infants, who are vulnerable to neurological damage during this critical time of neurodevelopment. Painful experiences may cause structural and physiological changes within the nervous system. Repeated painful procedures may result in decreased pain thresholds and hypersensitivity to pain. Immediate harmful effects of pain include physiologic instability and increased incidence of serious complications such as intraventricular hemorrhage. Painful stressors may lead to sleep disturbances, feeding problems, and inability to self-regulate. Long-term effects of pain may include altered pain perception, chronic pain syndromes, and somatic complaints. Repetitive pain in the preterm infant may be associated with attention deficit disorders, learning disorders, and behavioral problems in later childhood. Nursing involvement with pain management is crucial to achieve positive health outcomes for high-risk infants and older children and adults who have experienced repetitive or severe pain as infants.

Humans↗

PubMed1981

Chest pain--prophet of doom or nagging neurosis.

A six month survey of 588 patients presenting with chest pain to our emergency room revealed some 85 different diagnoses. The most common ages were the sixties and there were more men than women. Myocardial infarction and reflux esophagitis were more common in men, esophageal spasm equally prevalent in both sexes and psychiatric disorders more common in women. Site, radiation, duration and description were helpful in presumptive diagnosis with a few surprises. The problem was common (3.7% of 15.716 visits to the Emergency Room) and frequently perplexing. Wrong diagnoses abound! An overview of the problem is presented including neural mechanisms in pain perception. Chest pain due to intrathoracic structures, the chest wall, nerve roots and extrathoracic structures are considered.

Aged↗

PubMed2006

Patient-reported outcomes for open versus laparoscopic living donor nephrectomy.

BACKGROUND: Rates of living kidney donation have increased dramatically in recent years, in large part because of improved surgical techniques such as laparoscopic nephrectomy. OBJECTIVE: To compare patient-reported outcomes of laparoscopic nephrectomy versus open donor nephrectomy in 84 adult live kidney donors. OUTCOME MEASURES: Outcomes included perceptions of pain and surgical scarring, number of surgical/medical complications, hospital length of stay, physical health problems related to donation, return to work, financial impact, health-related quality of life, and satisfaction with the donation experience. RESULTS AND CONCLUSION: The 2 groups did not differ significantly in pain perceptions, number of surgical/medical complications, physical health problems, financial impact, health-related quality of life, or overall satisfaction. However, laparoscopic nephrectomy donors had significantly fewer hospital days and faster return to work time than open donor nephrectomy donors. The majority of donors report excellent health-related quality of life and no complications in the months following surgery. In addition, it appears that laparoscopic nephrectomy, in comparison to open donor nephrectomy, may reduce barriers to living kidney donation by reducing hospital length of stay and time away from work. Being able to return to work much sooner after surgery may significantly reduce the indirect costs (ie, lost wages) associated with living donation.

Adult↗

PubMed2006

Effect of controlled masticatory exercise on pain and muscle performance in myofascial pain patients: A pilot study.

The aim of this study was to test the hypothesis that strengthening masticatory muscles using a controlled chewing exercise protocol improves muscle function, as evaluated quantitatively by electromyogram, and reduces pain at rest and during function. The study included 20 patients diagnosed with myofascial pain according to the Research Diagnostic Criteria for Temporomandibular Disorders with low masseter volume increase during maximal clench. The exercise group (ten patients) was subjected to a controlled gum chewing exercise protocol for eight weeks: the control group (ten patients) received only support and encouragement. Patients were examined at the beginning and at the end of the experiment which included an electromyogram (EMG) to assess muscle performance, masticatory muscle tenderness to palpation, mouth opening range, subjective anamnestic indices to evaluate pain perception and pain relief, and chewing tests. The EMG showed that the masticatory muscle exercise did produce objective physiologic results. In the exercise group, a significant increase was found in the electric muscle activity of the masseters during maximal voluntary clench (p=0.007). The exercise group showed significant reduction in pain during rest, pain during the chewing test, and a disability score. At the end of the study, a difference between the two groups was shown in the Pain Relief Scale: significantly greater pain relief was found in the exercise group as compared to the control group (p=0.019). For all other clinical parameters, there was no difference between the two groups or interaction between time and treatment. The results of this study seem to be equivocal. Additional experiments on larger population groups with extended chewing protocols are necessary before a more substantial conclusion can be reached.

Adult↗

PubMedDate not supplied

Pain and the placebo in rehabilitation using TENS and laser.

The placebo effect of many health-related treatment is generally acknowledged. This paper discusses the role of the placebo in relation to pain perception and pain control. The theoretical basis of the placebo response is examined, followed by a discussion of the factors influencing the placebo response. Finally, the magnitude of the placebo response is explored specifically in relation to outcome measures and the efficacy of transcutaneous electrical nerve stimulation (TENS) and laser for pain relief.

Adaptation, Psychological↗

PubMedDate not supplied

Pain threshold in humans. A study with the pressure algometer.

Pain perception threshold (PPT) in the head was assessed with a pressure algometer in 40 control individuals (24 females and 16 males). Threshold was assessed at 11 symmetrical points on each side. The average threshold for each side was calculated, and differences between two sides were evaluated with an asymmetry index. Subjects were studied in relation to age and sex, and any difference in the symmetrical perception of pain on the head was registered. The deltoid muscle was chosen as a reference point, since it is rarely a site of trigger points. The reproducibility of the method was satisfactory. A significantly positive correlation was found between PPT value of the head and the deltoid muscle. There was no tendency to rise or fall in PPT during the same "session", which consisted of 3 separate complete measurements. The mean of mean values showed that there was little asymmetry as for the thresholds pertaining to the head in the total material. Age and sex apparently played little role as for the outcome of the test. The assessment of PPT in the head might be a useful tool in the study of lateralization of pain in unilateral headache syndromes.

Adult↗

PubMed1990

Contemporary pain management.

Pain management is a dynamic clinical area. Basic research is generating new drugs and new technologies for their delivery. Clinical research has demonstrated the important roles of psychological and environmental factors in the complaint of pain. Surgical strategies are improving. The recognition that the human brain plays a major role in pain perception and pain behaviours has led to the development of multidisciplinary teams that can bring a diversity of diagnostic and therapeutic skills to clinical medicine. The specialty of pain management is gaining momentum throughout the world. Australian health care delivery needs to respond to these developments to permit the citizens of this country to receive state-of-the-art care. Not only will this be more humane, but it will permit a reduction in the enormous financial costs of the poor management of both acute and chronic pain.

Acute Disease↗

PubMedDate not supplied

Influence of sex and anxiety on pain threshold and tolerance.

The influence of sex and anxiety on experimental pain perception was studied in a homogeneous population of 50 volunteer and healthy dental students. Three threshold (minimum perceptible threshold, pain threshold and pain tolerance threshold) were determined by delivering electrical stimulations, at regular intervals, on the left hand finger pads. At the same time, the students were asked to complete the Cattell's anxiety test, so allowing their degree of anxiety to be quantified. Statistical analysis of the results showed a lower pain tolerance threshold in females than in males and a significant correlation between the anxiety score and the pain tolerance threshold. The fact that females are more anxious than males could explain these results.

Adult↗

PubMed1981

[Pain and pain therapy - neurophysiologic view].

Usually, pain is caused by the excitation of nociceptors or of nociceptive afferent fibers. The responsiveness of the nociceptors can be modulated by endogenously released algesic substances or local hormones. Lesioned and regenerating nerve fibers show enhanced excitability and spontaneous activity. Motor and sympathetic reflexes sometimes have an excitatory action on nociceptors, a positive feedback which often is essential in chronic pain states such as the sympathetic reflex dystrophies. Proper diagnosis of these influences on nociceptor excitation is crucial if therapeutic interference is to be rendered possible at the peripheral site of encoding of pain stimuli. No pain center exists in the central nervous system. The cognitive, affective, motor and vegetative dimensions of pain perception and pain behaviour are based on a complex interaction of several brain systems. An important feature of brain function in relation to pain is the fact that nervous information related to pain can be modulated in the central nervous system. Various inhibitory modulations have recently been described which may be used for pain therapy. Inhibition of spinal neurons, and analgesia, can be produced by stimulation of brain stem structures. Pharmacologically, pain inhibitory systems may involve serotonin and endogenous opioids as transmitter or modulator substances. For pain therapy, pain inhibitory systems may be activated e.g. by morphine and ther analgesic drugs, focal brain stimulation, various means of somatosensory afferent stimulation and by psychological influences such as stress.

Afferent Pathways↗

PubMedDate not supplied

Occlusal therapy in the management of chronic orofacial pain.

Review of the literature indicates that most routine orofacial dysfunctions are characterized by deep pain. Various disorders of the masticatory systems, particularly musculoskeletal conditions, are thought to be triggered by occlusal disharmonies. The pain component develops following a pattern of bruxism, muscle hyperactivity, fatigue and spasm. Treatment for most disorders has been to modify the occlusion, although the rational for doing so appears questionable.CRITICAL ISSUES IN THE FIELD OF OCCLUSION RELATED TO OROFACIAL PAIN ARE REVIEWED: occlusal disharmonies, coincidence of retruded-intercuspal contact positions, non-working side interferences, maximum intercuspation of teeth, occlusal adjustment, and occlusal appliances.The studies reviewed fail to support the clinical objective of obtaining equal contact at retruded and intercuspal positions and that the lateral pterygoid muscles stabilize the temporomandibular joint. The relationship between non-working side interferences and pain dysfunction is also not readily supported by controlled studies. Occlusal adjustment appears to be unsatisfactory as a modality for management of pain: not all patients improved following treatment, some relapse occurs even with the most stable contacts, and other treatments such as intra-articular injections of corticosteroids reduced symptoms more readily. Occlusal splints seem to reduce most clinical signs and symptoms on both a short-term and long-term basis. Placement of mandibular orthopedic repositioning appliances results in reduction of pain in some patients, but usually this treatment is followed by extensive rehabilitation.Six major areas are suggested for clinical studies that attempt to relate occlusion to management of orofacial pain. These include: establishment of an ideal jaw position, sequencing of symptoms in the pain history, relationship of pain to other symptoms, development of physiological methods to assess how occlusal modification affects pain perception and pain tolerance, and determination of which treatment modalities produce the most effective relief of pain.

Chronic Disease↗

PubMed1993

[Pain, pain assessment and analgesia in newborn infants].

Although during the past few years more knowledge on pain and analgesia in the neonate has been acquired, adequate treatment is not always given. To achieve better understanding and treatment of pain in newborn infants, a review of pain perception and pain assessment is given as well as guidelines regarding its prevention and treatment. A proper assessment and an adequate relief of pain contributes to the quality of care for the newborn infant.

Analgesia↗

PubMed1998

Children's cognitive level and perception of pain.

Doctors and nurses tend not to approach children according to their developmental level. Children develop an understanding of illness and of the cause and effect of pain that reflects Piaget's stages of cognitive development. Until nurses begin routinely to consider a child's developmental level when assessing pain, children will continue to suffer unnecessary pain and anxiety.

Child↗

PubMed1989

Opioid involvement in the perception of pain due to endurance exercise in trained man.

The purpose of this study was to evaluate the role of endogenous opiates in modulating physical performance during dynamic exercise in conscious man. The plasma concentration of beta-endorphin (BEP) and of adrenocorticotropic hormone (ACTH) along with muscle pain (McGuill Pain Questionnaire) were assessed in 17 trained, male runners before and after running the longest possible distance within 12 min (i.e., the Cooper test). Each runner participated twice in the test (double-blind cross-over design), with a 1-week interval--with or without an injection of the opiate antagonist naloxone (0.8 mg i.v.). The average (SEM) distance reached was 3,198 (45) m in the naloxone test and 3,240 (38) m in the placebo test. The BEP increased significantly during the tests by a factor of 4.1 on naloxone and by 2.8 on placebo (from the normal resting averages of 1.7 and 2.1 pmol/l, respectively). The ACTH also increased significantly by a factor of 2.0 on naloxone and 2.5 on placebo (from the normal resting averages of 19.3 and 16.8 pmol/l, respectively). There were no significant differences between the naloxone and the placebo test with respect to the increments of BEP or ACTH by exercise. However, the perception of muscle pain was enhanced with naloxone. The increased perception of pain did not decrease the athletes ability to perform in terms of the distance run. We conclude that endogenous opiates are involved in the perception of pain associated with exhaustive exercise and may subserve psychological rather than physiological functions during exercise.

Adrenocorticotropic Hormone↗

PubMed2006

Immediate effects of spinal manipulation on thermal pain sensitivity: an experimental study.

BACKGROUND: The underlying causes of spinal manipulation hypoalgesia are largely unknown. The beneficial clinical effects were originally theorized to be due to biomechanical changes, but recent research has suggested spinal manipulation may have a direct neurophysiological effect on pain perception through dorsal horn inhibition. This study added to this literature by investigating whether spinal manipulation hypoalgesia was: a) local to anatomical areas innervated by the lumbar spine; b) correlated with psychological variables; c) greater than hypoalgesia from physical activity; and d) different for A-delta and C-fiber mediated pain perception. METHODS: Asymptomatic subjects (n = 60) completed baseline psychological questionnaires and underwent thermal quantitative sensory testing for A-delta and C-fiber mediated pain perception. Subjects were then randomized to ride a stationary bicycle, perform lumbar extension exercise, or receive spinal manipulation. Quantitative sensory testing was repeated 5 minutes after the intervention period. Data were analyzed with repeated measures ANOVA and post-hoc testing was performed with Bonferroni correction, as appropriate. RESULTS: Subjects in the three intervention groups did not differ on baseline characteristics. Hypoalgesia from spinal manipulation was observed in lumbar innervated areas, but not control (cervical innervated) areas. Hypoalgesic response was not strongly correlated with psychological variables. Spinal manipulation hypoalgesia for A-delta fiber mediated pain perception did not differ from stationary bicycle and lumbar extension (p > 0.05). Spinal manipulation hypoalgesia for C-fiber mediated pain perception was greater than stationary bicycle riding (p = 0.040), but not for lumbar extension (p = 0.105). CONCLUSION: Local dorsal horn mediated inhibition of C-fiber input is a potential hypoalgesic mechanism of spinal manipulation for asymptomatic subjects, but further study is required to replicate this finding in subjects with low back pain.

Adult↗

PubMed1982

Repression-sensitization, stress, and perception of pain in others.

To assess the influence of individuals' defensive style on perception of pain in others, 60 undergraduate women rated the amount of pain expressed in slides of people displaying high or low pain. Subjects were categorized as high or low on Byrne's Repression-Sensitization Scale, and their level of stress was varied by presentation of an anxiety-provoking film (stress condition) or a neutral film (control condition) prior to the rating task. A significant interaction between Repression-Sensitization and slide category (high versus low pain) indicated that sensitizers assigned higher ratings of pain than repressers to slides that were relatively low in rated expressiveness of pain. Individual differences in readiness to recognize potentially threatening stimuli seem most evident when the stimuli are relatively ambiguous. The manipulation of stress produced no significant effects on ratings of pain.

Female↗

PubMed1996

Perception of pain as a result of orthodontic treatment with fixed appliances.

The aims of this study were to investigate the intensity, location and duration of patients' discomfort following insertion of orthodontic appliances, and to examine for interactions between patient age, gender, appliance type and the perception of pain. After insertion of orthodontic appliances, 170 patients received eight questionnaires, one they completed and returned after 4 h, then one daily for 7 days. The respondents' ages ranged from 8-53 years (median age 13 years 7 months); 45 per cent were male and 55 per cent female. Of the patients, 65 per cent reported pain after 4 h and 95 per cent after 24 h. After 7 days, 25 per cent of the patients still reported discomfort. Patients' pain intensity scores were significantly higher for the anterior than for the posterior teeth. On day 1, 16 per cent took analgesics and 18 per cent reported being awakened the first night. Comparing a 2 x 4 appliance, a full appliance in one arch and in both arches, no statistical differences were found for reported pain frequency, general intensity of pain, pain at the teeth, discomfort when biting and chewing and analgesic consumption. The perception of general pain intensity, analgesic consumption, pain when eating and the influence of discomfort on daily life were all significantly greater in girls than in boys. Patients younger than 13 years reported pain significantly less frequently than the older patients. The highest frequency of pain was found in the group of 13-16 year olds. The pain intensity did not differ among the age groups.

Adolescent↗