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Results for “Pain Perception”

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PubMed2006

Pain relief by single low-level laser irradiation in orthodontic patients undergoing fixed appliance therapy.

INTRODUCTION: The objective of this study was to analyze the effect of single low-level laser therapy (LLLT) irradiation on pain perception in patients having fixed appliance treatment. METHODS: Seventy-six patients (46 women, 30 men; mean age, 23.1 years) enrolled in this single-blind study were assigned to 2 groups. The patients in group 1 (G1; 38 patients, 13 men, 25 women; mean age, 25.1 years) received a single course of LLLT (Mini Laser 2075, Helbo Photodynamic Systems GmbH & Co KG, Linz, Austria; wavelength 670 nm, power output 75 mW) for 30 seconds per banded tooth. The patients in group 2 (G2; 38 patients, 17 men, 21 women; mean age, 21.0 years) received placebo laser therapy without active laser irradiation. Pain perception was evaluated at 6, 30, and 54 hours after LLLT by self-rating with a standardized questionnaire. RESULTS: Major differences in pain perception were found between the 2 groups. The number of patients reporting pain at 6 hours was significantly lower in G1 (n = 14) than in G2 (n = 29) (P <.05), and the differences persisted at 30 hours (G1, n = 22; G2, n = 33) (P <.05). At 54 hours, no significant differences were seen between the number of patients reporting pain (G1, n = 20; G2, n = 25), although the women had a different prevalence between G1 (n = 11) and G2 (n = 15) (P = .079). At 6, 30, and 54 hours, more than 90% of the subjects in both groups described the pain as "tearing." CONCLUSIONS: LLLT immediately after multibanding reduced the prevalence of pain perception at 6 and 30 hours. LLLT might have positive effects in orthodontic patients not only immediately after multibanding, but also for preventing pain during treatment.

Adolescent↗

PubMed1989

Chronic low back pain and the reaction to repeated acute pain stimulation.

Previous research has shown an interaction between chronic and acute pain behavior. Chronic low back pain (CLBP) patients seem to have a higher pain perception threshold and a lower pain tolerance than pain-free controls. The major focus is, however, on another aspect of pain behavior: habituation of the pain response after repeated stimulation. Habituation of the pain perception threshold was found for control subjects but not for CLBP patients. Inability to habituate to pain may be regarded as a risk factor in the development of CLBP.

Acute Disease↗

PubMed1998

Anandamide modulates sleep and memory in rats.

In this study we have assessed the effect of the intracerebroventricular administration of anandamide (ANA) as well as its precursor metabolite arachidonic acid (AA), on the sleep-wakefulness cycle, memory formation, locomotor activity and pain perception. Our results have indicated that ANA strikingly increases slow-wave sleep (SWS)2 and rapid-eye movement (REM) sleep at the expense of wakefulness (W); while deteriorating memory consolidation. ANA also increases locomotor activity but does not modify pain perception threshold. In contrast, AA increases W and reduces SWS2, while deteriorating memory consolidation and increasing locomotor activity. AA has no effect on pain perception. These results suggest that the brain cannabinoid system participates in the modulation of the vigilance states and mnemonic processes. Additionally, they suggest that the effect on pain perception may be a peripheral rather than a central effect.

Analysis of Variance↗

PubMed1990

The perception of painful and nonpainful stimuli during voluntary motor activity in man.

Previous studies have shown that voluntary movement diminishes the transmission of cutaneous afferent input through the dorsal column-medial lemniscal system, and also raises the threshold for detecting nonpainful, cutaneous stimuli (electrical shocks). Although there is some evidence that pain elicited by electrical stimulation is diminished during movement, no studies have tested the effect of movement on the perception of pain produced by natural stimulation. For this reason, we tested the effects of voluntary motor activity on the perception of noxious thermal stimuli in human volunteers. We first developed a motor paradigm in which the thermal stimulation could be applied to the immobile limb (isometric elbow flexion-extension). Both isometric and isotonic muscle contractions about the elbow increased the threshold for detecting weak cutaneous stimuli (electrical shocks) applied to the forearm, and to a lesser extent the detection of stimuli applied to the dorsum of the hand. Afterwards, noxious and innocuous heat stimuli were applied to the forearm during isometric contractions and at rest. Magnitude estimates for the intensity of the pain, as well as latency measures of the onset of pain, were recorded. We found no evidence that isometric motor activity diminished either the threshold for pain or the subjective intensity of the noxious and innocuous thermal stimuli. Thus, motor activity decreases the ability to detect weak low-threshold cutaneous inputs, but has no effect on the perception of warmth and heat pain.

Arousal↗

PubMed2003

Psychophysics of phasic and tonic heat pain stimuli by quantitative sensory testing in healthy subjects.

UNLABELLED: The increased use of quantitative sensory testing in the study of pain raises the need to characterize various aspects of psychophysical response to noxious stimulation in healthy subjects. The present study aims to address several issues regarding the use of heat pain stimuli: (a) Are pain scores for short-term repeated phasic stimuli consistent? (b) Does an exposure to tonic heat pain stimulus cause sensitization and change the scores for subsequent phasic stimuli? and (c) Are pain scores for phasic and tonic heat pain correlated? To address these questions, a series of four phasic heat pain stimuli of 47 degrees C were given to the forearms of 70 healthy volunteers, over the course of an hour. Pain scores by Visual Analog Scale (VAS) were obtained for each stimulus. In 50 subjects, a tonic heat pain of 70s duration at 47.5 degrees C was given between the first and second phasic stimuli. Pain scores were obtained at four points along this tonic stimulus. Repeated measures ANOVA and a sensitive post hoc analysis indicated that, while the pain perception was reduced on the second, nearly immediate trial, subsequent VAS scores of pain perception were not different from the first (#1: 35.2+/-19.2; #2: 31.4+/-20.2, #3: 33.0+/-21.6; and #4: 33.2+/-20.1, respectively), with strong correlation among the phasic tests. The average tonic pain score was 53.7+/-23.1. Administration of tonic pain stimuli did not result in different VAS scores of subsequent phasic pain stimuli, compared to those subjects who did not receive tonic pain stimuli. Tonic and phasic pain were positively correlated (e.g., r=0.45,p<0.001 for the first phasic stimuli). However, no relation was found between the level of perceived pain, either for phasic or for tonic stimuli, and presence or absence of temporal summation during the tonic pain. IN CONCLUSION: (i) phasic pain scores assessments at 30' and 60' after baseline is consistent; (ii) tonic heat pain, despite relatively high VAS scores, does not cause a change in the scoring of subsequent phasic stimuli; and (iii) phasic and tonic pain scores correlate with each other. Thus, the normal pattern of pain perception is stable and not altered by single tonic pain stimulation.

Adult↗

PubMed1998

Effects of naloxone on hemodynamic and sympathetic nerve responses to pain in normotensive vs. borderline hypertensive men.

Pain sensitivity decreases with increasing resting blood pressure. This blood pressure-pain interaction may be mediated by endogenous opioids which have been shown to affect both blood pressure and nociception. To test this hypothesis, we measured mean arterial blood pressure (MAP), central venous pressure (CVP), heart rate (HR), muscle sympathetic nerve activity (MSNA), serum catecholamines, and individual pain rating scales during 2 min periods of noxious mechanostimulation (skin fold pinching) in nine young (26 +/- 2 year), male normotensive (NT) subjects and in 12 age and weight matched males with borderline hypertension (BHT). Measurements were performed before and after the i.v. administration of naloxone (0.15 mg/kg) and placebo in a randomized double-blind cross-over trial. In the pre-naloxone trials, pain led to similar changes in MAP, CVP, MSNA and plasma catecholamines in the two groups except for a higher increase in HR in the BHT group as compared to the NT group (3 +/- 1 vs. 1 +/- 1 bpm; P < 0.005). Opioid blockade with naloxone increased MSNA responses to pain in the NT group (from 5 +/- 1 to 9 +/- 1 bursts/min, and, from 100 +/- 23 to 204 +/- 36 units/min, respectively; P < 0.05) but did not significantly affect the MSNA response to pain in the BHT group. Pain induced responses of MAP, CVP, and catecholamines were not altered by naloxone in either group. Overall, there was a highly significant inverse correlation between pain perception and resting blood pressure which was not significantly affected by naloxone. The BHT subjects exhibited a lower pain perception compared to the NT subjects (P < 0.005). Naloxone increased pain rating in the NT group (from 194 +/- 9 to 218 +/- 13; P < 0.005) but not in the borderline hypertensive group (160 +/- 8 vs. 168 +/- 10; P = 0.36). Except for a decreased HR response in the BHT group, placebo had no effect on the responses to pain. Our data do not indicate a major role of the endogenous opioid system for the blood pressure-pain interaction in man. Endogenous opioids affect pain perception and sympathetic nerve activity responses to pain in normotensive men but their activity seems to be attenuated in borderline hypertensive subjects. Therefore, the lower pain sensitivity in human essential hypertension is probably mediated by non-opioid mechanisms.

Adult↗

PubMed1999

Review article: gender-related differences in functional gastrointestinal disorders.

Many functional gastrointestinal disorders and other chronic visceral pain disorders such as interstitial cystitis and chronic pelvic pain are more common in women than in men. In irritable bowel syndrome (IBS) there is a 2:1 female to male ratio in prevalence of symptoms in community samples. Female irritable bowel syndrome patients are more likely to be constipated, complain of abdominal distension and of certain extracolonic symptoms. While animal studies have clearly demonstrated gender-related differences in pain perception and antinociceptive mechanisms, unequivocal evidence for gender-related differences in human pain perception or modulation has only been provided recently. Gender-related differences may be related to constant differences in the physiology of pain perception, such as structural or functional differences in the visceral afferent pathways involved in pain transmission or modulation, and/or they may be related to fluctuations in female sex hormones. Preliminary evidence suggests that female irritable bowel syndrome patients show specific perceptual alterations in regards to rectosigmoid balloon distension and that they show differences in regional brain activation measured by positron emission tomography. This preliminary evidence suggests that gender-related differences in symptoms and in the perceptual responses to visceral stimuli exist in IBS patients and can be detected using specific stimulation paradigms and neuroimaging techniques.

Animals↗

PubMed2000

Effects of hypnosis on diffuse noxious inhibitory controls.

The neurophysiological mechanisms of hypnotic analgesia are still under debate. It is known that pain occurring in one part of the body (counterstimulation) decreases pain in the rest of the body by activating the diffuse noxious inhibitory controls (DNICs). The aim of this study was to explore the effects of hypnosis on both pain perception and heterotopic nociceptive stimulation. The A forms of both the Harward Group Scale of Hypnotic Susceptibility and the Stanford Hypnotic Susceptibility Scale were administered to 50 healthy students. Twenty subjects were selected and assigned to two groups: group A, consisting of 10 subjects with high hypnotic susceptibility; and group B, consisting of 10 subjects with low hypnotic susceptibility. The subjects were then randomly assigned first to either a control session or a session of hypnotic analgesia. The nociceptive flexion reflex (RIII) was recorded from the biceps femoris muscle in response to stimulation of the sural nerve. The subjective pain threshold, the RIII reflex threshold, and the mean area with suprathreshold stimulation were determined. Heterotopic nociceptive stimulation was investigated by the cold-pressor test (CPT). During and immediately after the CPT, the subjective pain threshold, pain tolerance, and mean RIII area were determined again. The same examinations were repeated during hypnosis. Hypnosis significantly reduced the subjective pain perception and the nociceptive flexion reflex. It also increased pain tolerance and reduced pain perception and the nociceptive reflex during the CPT. These effects were found only in highly susceptible subjects. However, the DNIC's activity was less evident during hypnosis than during the CPT effects without hypnosis. Both hypnosis and DNICs were able to modify the perception of pain. It seems likely that DNICs and hypnosis use the same descending inhibitory pathways for the control of pain. The susceptibility of the subject is a critical factor in hypnotically induced analgesia.

Adult↗

PubMed2003

Postoperative pain, complications, and satisfaction rates in patients who undergo surgical sperm retrieval.

OBJECTIVE: To determine patients' experiences with surgical sperm retrieval and its common complications. DESIGN: A questionnaire based survey using visual analogue scales (VAS) and closed questions to analyze complication, pain, and satisfaction rates. SETTING: Tertiary care university hospital. PATIENT(S): One hundred consecutive males undergoing surgical sperm retrieval by percutaneous epididymal sperm aspiration (PESA) or testicular sperm extraction (TESE). INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): We surveyed for pain perception complication rates and satisfaction scores. RESULT(S): Of the 85 patients who replied, 21 underwent retrieval for nonobstructive causes, 37 following failed reversal of vasectomy, and 27 for other obstructive causes. Retrieval was successful in 100% of obstructive causes and in 61% for nonobstructive azoospermia. Epididymal retrieval was successful in 23 patients, 30 patients underwent TESE after failed PESA, and 23 had TESE only. There were significant increases in pain perception scores and reported complications with TESE over PESA (31 vs. 16; and 21 out of 63 vs. 2 out of 22, respectively), but no difference in satisfaction rate. The cause of azoospermia did not affect pain perception or satisfaction in TESE. Complication rates were increased in larger testes (3 out of 22 vs. 24 out of 63). Unsuccessful sperm retrieval did not significantly affect patients' pain perception or satisfaction. Surgical sperm retrieval was rated as significantly less painful than both vasectomy and reversal (21% vs. 42% vs. 57%, respectively) and was associated with significantly fewer days absent from work (3.0 vs. 8.5). CONCLUSION(S): Surgical sperm retrieval by PESA or TESE is a safe procedure with only minor complications that is tolerated well by patients.

Adult↗

PubMed2002

Comparison of topical anesthesia of 20% benzocaine and 60% lidocaine gel.

OBJECTIVE: The purpose of this study was to determine the efficacies of 2 topical anesthetics commonly used in dentistry. STUDY DESIGN: The alveolar mucosa of the upper incisor apices of 20 healthy male volunteers was applied for 20 minutes with either 20% benzocaine gel or nothing as a control. The second part of experiment was done with 60% lidocaine gel and vehicle as control. Three methods of stimulation were given, and the pain rating score and visual analog scale were measured after each stimulation. RESULTS: Twenty percent benzocaine did not significantly alter pain perception as measured by the pain rating score and visual analog scale with these 3 methods of stimulation. In contrast, 60% lidocaine significantly reduced pain perception according to these measurements. We conclude that 60% lidocaine gel is effective for topical anesthesia before infiltration anesthesia.

Adult↗

PubMed2002

Hypertension-related hypoalgesia, autonomic function and spontaneous baroreflex sensitivity.

OBJECTIVE: The mechanisms involved in the relationship between pain perception and hypertension are poorly understood. This study has sought to investigate whether the spontaneous baroreflex sensitivity and the autonomic nervous system balance are related to hypertension-associated hypoalgesia. METHODS: In the morning, 73 untreated male subjects (45 hypertensives, 28 normotensives) were submitted to a simultaneous recording of electrocardiographic and blood pressure signals in resting condition. The tracings were analysed off-line to evaluate the spectral components of the low frequency (LF) and high frequency (HF) powers (autoregressive algorithm; LF/HF ratio used in subsequent analysis as an index of sympathovagal balance), and the alphaLF (alphaLF), an index of baroreflex sensitivity. After the rest period, the subjects underwent dental pain perception evaluation (pulpar tester: test current increasing from 0 to 0.03 mA, expressed in relative Units) to determine the dental pain threshold and tolerance. Afterwards, a 24-h ambulatory blood pressure monitoring was performed. RESULTS: A significant relationship was observed between alphaLF and pain threshold (r = -0.34; p = 0.003). When a multivariate analysis was computed to control for age, 24-h systolic pressure and LF/HF ratio, alphaLF was a predictive independent factor associated with pain threshold (model p = 0.019; r = -0.31; p = 0.025). Moreover, the 24-h systolic pressure was independently associated with pain threshold (model p = 0.019; r = 0.30, p = 0.031). The relationship between alphaLF and relative tolerance was not statistically significant. When the association between the LF/HF ratio and pain sensitivity was assessed as a secondary endpoint, no significant relationship was observed. Since no significant interaction was found, the effect of alphaLF and LF/HF ratio on pain perception was assumed to be similar in normotensive and hypertensive subjects. CONCLUSIONS: The relationship found between unstimulated baroreflex sensitivity and pain threshold suggests a modulation of pain perception by baroreflex pathways in hypertension-associated hypoalgesia. In a baseline condition, the autonomic nervous system balance does not seem to influence pain sensitivity.

Adult↗

PubMed2001

Sex differences in chest pain in patients with documented coronary artery disease and exercise-induced ischemia: Results from the PIMI study.

BACKGROUND: Sex differences in the pathophysiologic course of coronary artery disease (CAD) are widely recognized, yet accurate diagnosis of coronary artery disease in women remains challenging. METHODS: To determine sex differences in the clinical manifestation of CAD, we studied chest pain reported during daily activities, exercise, and mental stress in 170 men and 26 women. All patients had documented CAD (>50% narrowing in at least 1 major coronary artery or prior myocardial infarction) and all had 1-mm ST-segment depression on treadmill exercise. We collected psychologic test results, serum samples (potassium, epinephrine, norepinephrine, cortisol, b-endorphin, and glucose), and cardiac function, sensory threshold, and autonomic function data at specified times before, during, or after exercise and mental stress tests to assess measures of depression, anxiety, and neurohormonal and thermal pain perception. RESULTS: Women reported chest pain more often than men during daily activities (P =.04) and during laboratory mental stressors (P =.01) but not during exercise. Men had lower scores than women on measures of depression, trait anxiety, harm avoidance, and reward dependence (P <.05 for all). Women had significantly lower plasma b-endorphin levels at rest (4.2 +/- 3.9 vs 5.0 +/- 2.5 pmol/L for men, P =.005) and at maximal mental stress (6.4 +/- 5.1 vs 7.4 +/- 3.5 pmol/L for men, P <.01). A higher proportion of women than men had marked pain sensitivity to graded heat stimuli applied to skin (hot pain threshold <41 degrees C, 33% vs 10%, P =.001). CONCLUSIONS: Our results reflect sex differences in the affective and discriminative aspects of pain perception and may help explain sex-related differences in clinical presentations.

Activities of Daily Living↗

PubMed1999

The validity of reported musculoskeletal problems. A study of questionnaire answers in relation to diagnosed disorders and perception of pain.

The objectives of the present study were to evaluate the validity of answers given in a questionnaire on musculoskeletal pain and conditions by means of a clinical assessment, and to get some understanding of the subject's perception of reported pain. This was performed by using measures of sensitivity and specificity comparing data from the questionnaire with the clinical diagnoses of conditions in the neck, shoulders and thoracic spine. Subjective perception of pain was obtained by the use of visual analogue scale (VAS) and pain drawings. For the combination of neck and shoulders, both sensitivity (95%) and specificity (88%) were high for current pain. The results of the study confirm the validity of the subjective reports of the respondents. A 'pain assessment instrument' including a questionnaire, VAS and pain drawings may be useful to reveal conditions in the neck and shoulders and thoracic spine, common sites of work related musculoskeletal disorders.

Adult↗

PubMedDate not supplied

Disparities between black and white patients with cancer pain: the effect of perception of control over pain.

CONTEXT: Pain continues to be a problem in ambulatory patients with cancer. Disparities in minority patients with pain have been previously identified. OBJECTIVE: To examine the effect of perception of control over pain on disparities in pain, symptom distress, and functional status in white and black patients with cancer. DESIGN: Cross-sectional, descriptive. SETTING: Outpatient clinic in a large urban cancer center. PATIENTS: A total of 281 patients who reported having pain within the last month and were receiving treatment in the cancer center. OUTCOME MEASURES: Pain intensity, pain-related distress, functional status, perception of control over pain. RESULTS: Black patients had significantly higher pain intensity, more pain-related distress, and reported more pain-related interference with function than white patients. Disparities in pain-related distress and functional status were significantly reduced and only disparities in pain intensity remained when perception of control over pain was held constant. CONCLUSIONS: Perception of control over pain is an important factor in understanding responses to pain. Increasing a patient's perception of control over pain may decrease disparities and increase functional status.

Adult↗

PubMed1996

[Exteroceptive suppression of activity of the temporal muscle in analysis of pain mechanisms].

Stimulating afferent fibers of the trigeminal nerve usually causes two successive suppressions (ES1 and ES2) of the voluntary muscle activity of chewing muscles. The first phase of decreased voluntary activity is called the early exteroceptive suppression period (ES1); the second phase is called the late exteroceptive suppression period (ES2). Between these two suppression periods is a phase of increased muscle activity, the so-called facilitation period (FP). Usually, in healthy subjects this normal pattern of exteroceptive suppression can be elicited regularly. The reflex answer may occur at low non-painful stimulus intensities; however, typically it appears to be most pronounced with high-intensity stimuli. Because of the obvious relationship between stimulus intensity, pain perception and reflex answer, the reflex is regarded as an antinociceptive reaction. Chronic pain syndromes like chronic tension-type headache and migraine without aura cause changes within the normal ES recording pattern. Furthermore, some substances used in pain therapy such as serotoninagonists or antagonists, acetylsalicylic acid or naloxon may also alter the general appearance of the ES. In this review different parameters that influence the ES reflex answer are summarized. Above, the diagnostic value of the changes of the ES for pathophysiological procedures regarding pain perception and pain processing in certain pain diseases is discussed.

English Abstract↗

PubMed1999

A comparative fMRI study of cortical representations for thermal painful, vibrotactile, and motor performance tasks.

Cortical activity due to a thermal painful stimulus applied to the right hand was studied in the middle third of the contralateral brain and compared to activations for vibrotactile and motor tasks using the same body part, in nine normal subjects. Cortical activity was demonstrated utilizing multislice echo-planar functional magnetic resonance imaging (fMRI) and a surface coil. The cortical activity was analyzed based upon individual subject activity maps and on group-averaged activity maps. The results show significant differences in activations across the three tasks and the cortical areas studied. The study indicates that fMRI enables examination of cortical networks subserving pain perception at an anatomical detail not available with other brain imaging techniques and shows that this cortical network underlying pain perception shares components with the networks underlying touch perception and motor execution. However, the thermal pain perception network also has components that are unique to this perception. The uniquely activated areas were in the secondary somatosensory region, insula, and posterior cingulate cortex. The posterior cingulate cortex activity was in a region that, in the monkey, receives nociceptive inputs from posterior thalamic medial and lateral nuclei that in turn are targets for spinothalamic terminations. Discrete subdivisions of the primary somatosensory and motor cortical areas were also activated in the thermal pain task, showing region-dependent differences in the extent of overlap with the other two tasks. Within the primary motor cortex, a hand region was preferentially active in the task in which the stimulus was painful heat. In the primary somatosensory cortex most activity in the painful heat task was localized to area 1, where the motor and vibratory task activities were also coincident. The study also indicates that the functional connectivity across multiple cortical regions reorganizes dynamically with each task.

Adult↗

PubMedDate not supplied

Antinociceptive effect of lidocaine in rats.

Lidocaine, a local anesthetic drug, exerts its effect by blocking sodium channels in peripheral sensory neurons. It is commonly used in clinical practice as a local anesthetic drug. This study was undertaken in order to determine the effect of lidocaine on sodium channels in neurons of the central nervous system and its modulatory effect on the pain perception in rats. Therefore, the effect of direct lidocaine administration icv on pain perception in rats exposed to noxious thermal stimuli was determined. A significant long-lasting antinociceptive effect of lidocaine injected at the doses ranging between 0.065-1.3 micromol (17.5-351 microg, respectively) was documented. It was concluded that intracerebral administration of sodium channel blockers might be a useful method in the study of pain perception in the brain.

Analgesics↗

PubMed2002

Adult patients' perceptions of pain management at triage: a small exploratory study.

Research studies reveal that pain management in Accident and Emergency (A&E) is often sub-optimal. The administration of simple oral analgesics at triage in a large teaching hospital provided the rationale to explore pain management in A&E from the patient's perspective in a small-scale exploratory study using a broadly qualitative approach. Structured interviews using open-ended questions and lasting no longer than 20 minutes explored patients' experiences and opinions of pain assessment, and pain management at triage. A sample of convenience produced a group of 65 patients from which 18 patients; 9 males and 9 females participated. Analysis of the data revealed that 16 patients presented in pain. Triage nurses trained to administer analgesics were available for 7 patients; 2 patients received analgesia. Six patients did not receive a pain assessment and in 3 cases the triage nurse was trained to administer analgesia. Sixteen patients considered pain management at triage to be important. The study reinforces the subjective and complex nature of pain, raises pragmatic questions regarding triage, the need for sustained education and training with any advance in nursing practice and further research regarding patients' perceptions of pain management in A&E.

Adult↗