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Relationship between dental pain perception and 24 hour ambulatory blood pressure: a study on 181 subjects.

OBJECTIVE: To investigate dental pain perception in a large group of essential hypertensive subjects. METHODS: A total of 130 hypertensive patients together with 51 normotensive subjects were submitted to tooth-electrical stimulation to determine the dental pain threshold (occurrence of pulp sensation) and tolerance (time when the subject asked for the test to be stopped). Blood pressure was measured at rest, before pain perception evaluation, and during a 24 h period by ambulatory monitoring. RESULTS: The normotensive and hypertensive subjects differed with regard to pain threshold (P = 0.002) and tolerance (P = 0.01). Pain perception variables were significantly correlated with both resting blood pressure and 24 h, diurnal and nocturnal arterial pressures, the correlation between pain threshold and 24 h systolic blood pressure being the most significant (r = 0.31, P < 0.0001). By contrast, parameters indicating 24 h blood pressure variability (percentage of nocturnal blood pressure reduction and 24 h blood pressure variation coefficients) were not associated with pain perception. Moreover, among the hypertensives only, a significant relationship was observed between pain sensitivity and both baseline and 24 h pressures. No association was found when pain perception and blood pressure were correlated in the normotensive group. CONCLUSIONS: The correlation between both baseline and 24 h blood pressure and pain perception has been confirmed in a large group study of normotensive and hypertensive subjects. Moreover, even among the hypertensive range of blood pressure, the higher the blood pressure is, the lower the sensitivity to pain is. These findings strengthen the hypothesis of a role of the degree of blood pressure elevation in modulating pain sensitivity.

Adult↗

Relationship between increased blood pressure and hypoalgesia: additional evidence for the existence of an abnormality of pain perception in arterial hypertension in humans.

An association between hypertension and decreased pain perception (hypoalgesia) has been shown in experimental hypertension and confirmed in humans by electrical tooth pulp stimulation. The aim of this study was to confirm, using two other techniques, whether hypertension is associated with hypoalgesia in humans. In 77 untreated essential hypertensive outpatients, 37 normotensive outpatients and 27 normotensive volunteers subjective cutaneous sensitivity was assessed by an electrical stimulator. Thirty-three measurements were repeated after one month. In addition, in eight normotensive volunteers and eight hypertensives the thresholds of the polysynaptic components R2 and R3 of the blink reflex to electrical stimulation of the supraorbitalis nerve were evaluated. Tooth pulp stimulation was done in 85 of the subjects who measured cutaneous sensitivity and in all of the blink reflex study. Cutaneous perceptive, pain and tolerance thresholds were significantly higher in the hypertensives compared with both normotensive groups, with no significant difference between these two. The results were identical when age and sex-matched subgroups were compared and a high reproducibility was found for all three parameters. Similar findings were obtained for the tooth pulp thresholds and highly statistically significant correlations were found between cutaneous and tooth pulp sensitivity and between these indices and blood pressure. The thresholds of R2 and R3 were also significantly higher in the hypertensives and a significant correlation was found between R3 threshold and diastolic pressure. These results confirm that hypertension is associated to hypoalgesia in humans.

Adult↗

Gender differences in pain perception: a signal detection theory approach.

BACKGROUND: Overseas studies suggest women report more pain and are more vulnerable to chronic pain conditions compared with men, however, it is unclear whether this difference in pain perception is due to sensory or non-sensory factors such as anxiety. Since gender differences in pain perception may have important implications for pain management, it is crucial that the relationship between pain, gender and anxiety in this culture be clarified. METHODS: The Signal Detection Theory Approach was used to determine gender differences in sensory discrimination [P(A)] and response bias (B). One hundred and twenty six Hong Kong Chinese adults responded to thirty pairs of thermal stimuli (36 degrees C-48 degrees C) and their responses to these stimuli were analyzed by computer software. The adapted Chinese version of the State-Trait Anxiety Inventory (STAI-Y) was used to assess state and trait anxiety of participants. RESULTS: Compared with men, women showed enhanced sensory discriminability (P = 0.004) and were less stoical in their response to pain (P = 0.03). Although there was no significant gender difference in state and trait anxiety, sensory discrimination was positively correlated with state anxiety (r = 0.19) and response bias was negatively correlated with trait anxiety (r = -0.18). The content validity index for the STAI-Y was 0.9 and the co-efficient alpha for reliability for state and trait anxiety was 0.88 and 0.92, respectively. CONCLUSIONS: Enhanced sensory discriminability in women may explain why women report more pain and seek healthcare more frequently compared with men. Men showed more stoical response to pain possibly because of gender-role expectations. The Signal Detection Theory approach was instrumental in assessing the sensory and non-sensory dimensions of pain perception. Awareness of the effects of gender and anxiety in pain perception will enable clinicians to be more efficient pain managers.

Adult↗

Thermal pain perception after aerobic exercise.

OBJECTIVE: To examine thermal pain perception before, 5 minutes after, and 30 minutes after 30 minutes of treadmill exercise at 75% of maximal oxygen uptake (V o 2 max). DESIGN: Repeated-measures. SETTING: Sports science laboratory. PARTICIPANTS: Convenience sample of 14 healthy male and female volunteers (mean age +/- standard deviation, 32+/-3y). INTERVENTIONS: Sensory thresholds, pain thresholds, and pain ratings to hot and cold stimuli were measured before and after 30 minutes of treadmill exercise at 75% of V o 2 max. The hot and cold stimuli were delivered by using a thermode placed on the thenar eminence of the nondominant hand. Thermal sensory and pain thresholds were determined during continuous ramps in temperature of the thermode. MAIN OUTCOME MEASURES: Pain ratings were measured on a visual analog scale at 10-second intervals over 2 minutes of thermal pain stimulation. RESULTS: There were no significant changes in thermal sensitivity, pain thresholds, or pain ratings for either heat or cold after 30 minutes of exercise at 75% of V o 2 max. CONCLUSIONS: Pain perception to thermal stimuli was unaltered after 30 minutes of exercise at 75% of V o 2 max, an intensity and duration of exercise previously shown to alter pain perception to electric and mechanical stimuli.

Adult↗

Defibrillation efficacy and pain perception of two biphasic waveforms for internal cardioversion of atrial fibrillation.

UNLABELLED: Efficacy and Pain Perception of Two Biphasic Waveforms. INTRODUCTION: We evaluated the influence of the peak voltage of waveforms used for internal cardioversion of atrial fibrillation on defibrillation efficacy and pain perception. A low peak voltage biphasic waveform generated by a 500-microF capacitor with 40% tilt was compared to a standard biphasic waveform generated by a 60-microF capacitor with 80% tilt. METHODS AND RESULTS: In 19 patients with paroxysmal atrial fibrillation (79% male, age 55 +/- 11 years, 21% with heart disease), the atrial defibrillation threshold (ADFT) was determined during deep sedation with midazolam for both waveforms in a randomized fashion using a step-up protocol. Internal cardioversion with a single lead (shock vector: coronary sinus to right atrium) was successful in 18 (95%) of 19 patients. ADFT energy and peak voltage were significantly lower for the low-voltage waveform (2.1 +/- 2.4 J vs 3.5 +/- 3.9 J, P < 0.01; 100 +/- 53 V vs 290 +/- 149 V, P < 0.01). Sedation then was reversed with flumazenil after ADFT testing. Two shocks at the ADFT (or a 3-J shock if ADFT >3 J) were administered to the patient using each waveform in random order. Pain perception was assessed using both a visual scale and a numerical score. ADFTs were above the pain threshold in 17 (94%) of 18 patients, even though the ADFT with the 500-microF waveform was <100 V in 63% of the patients. Pain perception was comparable for both waveforms (numerical score: 6.5 +/- 2.4 vs 6.3 +/- 2.6; visual scale: 5.4 +/- 2.6 vs 5.2 +/- 3.1; P = NS, 500-microF vs 60-microF). The second shock was perceived as more painful in 88% of the patients, independent of the waveform used. CONCLUSION: Despite a 66% lower peak voltage and a 40% lower energy, the 40% tilt, 500-microF capacitor biphasic waveform did not change the pain perceived by the patient during delivery of internal cardioversion shocks. Pain perception for internal cardioversion probably is not influenced by peak voltage alone and increases with the number of applied shocks.

Atrial Fibrillation↗

Twenty-four-hour noninvasive blood pressure monitoring and pain perception.

Although a hypertension-related hypalgesia has been described, the relation between pain perception and the 24-hour blood pressure trend is still unknown. The ambulatory blood pressure monitoring parameters and dental pain sensitivity were correlated in 67 male subjects. The pulpar test (graded increase of test current of 0 to 0.03 mA) was performed on three healthy teeth, and mean dental pain threshold (occurrence of pulp sensation) and pain tolerance (time when the subjects asked for the test to be stopped) were evaluated. Three groups of subjects with normal (n = 34), intermediate (n = 13), and high (n = 20) blood pressure values were identified according to ambulatory monitoring results. Pain threshold differed among the three groups (P < .02), being higher in the group with highest blood pressure. The groups of hypertensive subjects showed higher pain tolerance than the normotensive group (P < .02). Pain threshold was correlated with 24-hour, diurnal, and nocturnal blood pressure values. Pain tolerance was also related to 24-hour blood pressure and to diurnal and nocturnal diastolic and mean arterial pressure values. Systolic and diastolic blood pressure loads were significantly associated with pain threshold, and diastolic load was also associated with tolerance. The blood pressure variability (SD) did not relate to pain perception. The 24-hour arterial pressure was more closely associated with pain perception than the blood pressure values obtained before the pulpar test. A close correlation between pain perception and 24-hour ambulatory blood pressure was demonstrated.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Assessment of heat pain perception in relation to vibration exposure.

The effect of vibration on thin unmyelinated sensory fibers was studied by perception threshold measurement of heat pain. The investigation was a cross-sectional study of 98 vibration-exposed and 53 non-vibration-exposed workers. Pain perception was determined by using the "Marstock" method. The perception threshold of contact heat induced pain was assessed by the method of limits. Quantified personal energy-equivalent vibration exposure was assessed for all subjects on a group basis. The cumulated lifetime equivalent frequency-weighted vibration exposure was estimated based on measurements according to ISO 5349. The mean heat perception threshold was 46.2 degrees C (SD 2.6 degrees C) for the right hand and 46.0 degrees C (SD 2.7 degrees C) for the left. The results showed no mean difference (left = 0.1 degree C, right = 0.6 degree C) in heat pain perception between vibration-exposed and non-exposed subjects. There was a high correlation between the right and left hand measurements (r = 0.81). The risk (rate ratio) for impairment was 1.02 (95% CI 0.81-1.30) for the right hand and 1.00 (95% CI 0.79-1.26) for the left. The results of the study did not indicate any impairment as assessed by an increased perception threshold for heat pain. The lack of an increased heat pain threshold among the vibration-exposed workers in our study cannot exclude a possible lesional somatosensory influence from the exposure, as the lesional effect may also be a lowering of the threshold. The multiple and unrelated percepts of thermal sensations imply that it is not legitimate to draw conclusions about the total status of the small calibre afferents when testing only the heat pain perception.

Adult↗

Sex-related psychological predictors of baseline pain perception and analgesic responses to pentazocine.

Sex differences in pain perception and analgesic responses have garnered increasing attention in recent years. We examined the association of psychological factors to baseline pain perception and pentazocine analgesia among 49 healthy women and 39 men. Subjects completed psychological questionnaires measuring positive and negative affect as well as catastrophizing. Subsequently, responses to experimental pain were assessed before and after double-blind administration of intravenous pentazocine (0.5mg/kg). In correlational analyses, positive affect predicted lower pain sensitivity among men but not women. Negative affect predicted lower baseline pain tolerances among both sexes but predicted poorer analgesia only among men. Catastrophizing was associated with greater pain sensitivity and less analgesia more consistently in men than women. Regression models revealed that positive affect predicted lower overall pain sensitivity and catastrophizing predicted poorer overall analgesic responses among men, while no significant predictors of overall pain or analgesia emerged for women. Moreover, positive affect and catastrophizing were negatively and positively correlated, respectively, with side effects from the medication, but only among men. These findings indicate sex-dependent associations of psychological factors with baseline pain perception, analgesic responses, and medication side effects.

Adult↗

Counter-stimulatory effects on pain perception and processing are significantly altered by attention: an fMRI study.

Counter-stimulation reduces pain perception; however, the role of attention during this process is rarely discussed despite attention itself being a well known modulator of pain perception. This study investigated the effect of attentional modulation on pain perception during counter-stimulation using fMRI. Subjects received a noxious thermal stimulus together with an innocuous vibratory counter-stimulus. Subjects directed their attention towards either pain, vibration, or a neutral visual stimulus. During painful and counter-stimulation all subjects reported a reduction in pain perception when attending to counter-stimulation compared with attending to pain. Imaging data supported this behavioural finding showing reduced activity in pain processing areas (anterior cingulate, insula, thalamus). These results suggest attention plays an important part in the pain relief experienced from counter-stimulation.

Adult↗

A method for studying cutaneous pain perception and analgesia in horses.

Pain perception and its alteration by analgesic drugs is difficult to measure in the horse. The latency to onset of flexion of a limb in response to a noxious thermal stimulus has been used as a nociceptive end point for analgesic studies in many species. While this method has been employed in the horse, it may be confounded by the spontaneous locomotor activity observed after administration of narcotic analgesics. Consequently, an alternative method of assaying narcotic analgesia that did not involve the equine locomotor apparatus was developed. This report describes the use of the heat-evoked skin-twitch reflex as a reproducible measure of pain threshold and its alteration by the narcotic analgesic fentanyl. This method is compared with the heat-evoked hoof-withdrawal reflex, and the apparatus necessary to elicit both reflexes in the horse is described. Fentanyl, administered at intravenous doses of 0.010, 0.005, and 0.0025 mg/kg, produced a dose-related prolongation of the skin-twitch reflex but failed to alter the latency to hoof withdrawal following noxious thermal stimulation. The skin-twitch reflex is therefore a more sensitive assay of narcotic analgesia in the horse than is the hoof-withdrawal reflex.

Analgesia↗

Effects of age on pain perception: thermonociception.

The effect of age on pain sensitivity is unclear. Some studies suggest a loss of pain perception with age, whereas other studies indicate either no change or an increase in pain sensitivity with age. The present study assessed perceived intensities of six levels of painful contact thermal stimuli (43 degrees C, 45 degrees C, 47 degrees C, 48 degrees C, 49 degrees C, and 51 degrees C). Magnitude estimation procedures were used, and participants were instructed to provide separate ratings for the perceived sensory intensity and the perceived unpleasantness (affective intensity) of the thermal stimuli during separate sessions. Middle-age adults showed the lowest sensory sensitivity and greatest affective pain ratings. Although results indicate a significant but small tendency for older adults to underrate low and overrate higher intensity contact heat compared with younger adults, similarities in pain perception were stronger than differences among the age groups.

Adult↗

Psychological aspects of pain perception.

Interest in the assessment and management of pain increased dramatically after 1965, when the gate control theory was introduced. This increase is concurrent with enormous advances in our understanding of the plasticity and complexity of pain processing. New information about internal pain-inhibitory systems and the factors that trigger them has revolutionized traditional approaches to pain control. This article describes some of the new information on the factors that influence human pain perception, specifically the environmental and psychological factors that modify how pain is experienced. Pain is a complex, multidimensional perception that varies in quality, strength, duration, location, and unpleasantness. The strength and unpleasantness of pain is neither simply nor directly related to the nature and extent of tissue damage. Even newborn infants may experience different pains from the same stimulus, because of the differences in the situations in which it is administered. Pain experiences can range from an inability to perceive pain, regardless of the strength of stimulation, to the actual perception of pain in a limb that has been amputated. The perception of, expression of, and reaction to pain are influenced by genetic, developmental, familial, psychological, social and cultural variables. Psychological factors, such as the situational and emotional factors that exist when we experience pain, can profoundly alter the strength of these perceptions. Attention, understanding, control, expectations, and the aversive significance can affect pain perceptions. Consequently, the understanding of pain requires not only understanding of the nociceptive system, but recognition and control of the many environmental and psychological factors that modify human pain perceptions.

Acute Disease↗

Personality correlates of pain perception and tolerance.

Explored personality correlates of pain perception and tolerance in a nonmedical sample and setting. In a counter-balanced design, 70 Ss were administered several personality questionnaires and a cold-pressor test for pain perception and tolerance. In Experiment 1, 39 Ss were given the Adjective Check List and Rosenberg's Self-esteem Scale, while in Experiment 2, 31 different Ss received the Beck Depression Inventory. Results showed no significant correlations with personality measures and cold-pressor scores, but a significant relationship between pain tolerance and cognitive focus; those who focused on the experimental situation had much shorter tolerance times than those who used cognitive distraction. It is suggested that while chronic pain in a medical patient population may be related to personality characteristics, tolerance of pain in a non-patient population is related to situational variables, such as cognitive focus and distraction.

Adolescent↗

Influence of static magnetic fields on pain perception and sympathetic nerve activity in humans.

Static and pulsed magnetic fields have been reported to have a variety of physiological effects. However, the effect of static magnetic fields on pain perception and sympathetic function is equivocal. To address this question, we measured pain perception during reproducible noxious stimuli during acute exposure to static magnets. Pain perception, muscle sympathetic nerve activity, mean arterial pressure, heart rate, and forearm blood velocity were measured during rest, isometric handgrip, postexercise muscle ischemia, and cold pressor test during magnet and placebo exposure in 15 subjects (25 +/- 1 yr; 8 men and 7 women) following 1 h of exposure. During magnet exposure, subjects were placed on a mattress with 95 evenly spaced 0.06-T magnets imbedded in it. During placebo exposure, subjects were placed on an identical mattress without magnets. The order of the two exposure conditions was randomized. At rest, no significant differences were noted in muscle sympathetic nerve activity (8 +/- 1 and 7 +/- 1 bursts/min for magnet and placebo, respectively), mean arterial pressure (91 +/- 3 and 93 +/- 3 mmHg), heart rate (63 +/- 2 and 62 +/- 2 beats/min), and forearm blood velocity (3.0 +/- 0.3 and 2.6 +/- 0.3 cm/s). Magnets did not alter pain perception during the three stimuli. During all interventions, no significant differences between exposure conditions were found in muscle sympathetic nerve activity and hemodynamic measurements. These results indicate that acute exposure to static magnetic fields does not alter pain perception, sympathetic function, and hemodynamics at rest or during noxious stimuli.

Adult↗

Pain perception, obstructive imagery and phase-ordered gamma oscillations.

The neural mechanisms underlying pain perception and anti-nociceptive effects of mental imagery are not well understood. Using a measure of phase-ordered beta and gamma EEG oscillations in response to painful electric stimulation, we recently found that somatosensory event-related phase-ordered gamma oscillations (38-42 Hz), elicited by the onset of painful stimuli over Cz scalp site, were linearly related to pain perception. In the present study, 38 subjects were engaged in a painful stimulus detection task using an oddball paradigm. This task was performed under a condition in which subjects were required simply to count the number of target stimuli (pain condition) and under another condition in which subjects were required to produce an obstructive mental imagery of painful stimulus perception (obstructive imagery). Only EEG responses to standard stimuli were analyzed in this study. Correlation analysis of sweeps for each individual revealed brief intervals of phase ordering of EEG patterns in the beta and gamma bands. The frequencies of interest were the beta1 (26-30 Hz), beta2 (30-34 Hz), gamma1 (34-38 Hz), gamma2 (38-42 Hz) and gamma3 (42-46 Hz) bands. Obstructive imagery treatment, compared to pain condition, significantly reduced pain perception. This reduction was paralleled by significant decreases of evoked phase-ordered gamma2 and gamma3 patterns over Cz scalp site. Phase-ordered oscillations at Cz scalp site, for both gamma2 and gamma3 bands, significantly predicted pain ratings during pain condition. Phase-ordered oscillation scores, obtained for these gamma bands over parietal and frontal scalp sites, resulted the best predictor of pain ratings during obstructive imagery. This study provides evidence for the role of gamma oscillations in the subjective experience of pain. Further, it has provided support for the view that pain reduction during obstructive mental imagery is the product of an inhibitory process involving frontal and parietal cortical regions.

Adult↗

Dissociable modulating effect of repetitive transcranial magnetic stimulation on sensory and pain perception.

The effects of high frequency repetitive transcranial magnetic stimulation on sensory perception and the pain tolerance thresholds were investigated applying both motor cortex stimulation and medial frontal cortex stimulation in normal study participants. Both the sensory perception and pain tolerance thresholds were significantly increased in the motor cortex stimulation, whereas the pain tolerance thresholds, but not the sensory perception was significantly decreased in the medial frontal cortex stimulation. These results suggest the dissociable modulating effects of sensory and pain perception by the high frequency repetitive transcranial magnetic stimulation on the medial pain regulating system, but not the lateral pain regulating system.

Adult↗

[Pain perception and psychological status of patients suffering from spinal osteochondrosis with pain syndrome].

132 patients suffering from spinal osteochondrosis with pain syndrome were examined for pain perception and psychological status. Pain intensity in such patients showed association with hypochondriac and anxiodepressive disorders combination with rigidity and development of fixations. Deterioration of life quality correlated with severity of pain syndrome and such features as unsatisfaction, tension, anxiety, rigidity, fixation of attention on personal feelings, pessimistic outlook, low stress resistance. Psychological characteristics and quality of life depended on gender and location of vertebrogenic pain syndrome.

Adult↗

Surgical decompression in dogs with thoracolumbar intervertebral disc disease and loss of deep pain perception: A retrospective study of 46 cases.

The case details and outcome after surgical decompression of 46 dogs with thoracolumbar intervertebral disc disease with loss of deep pain perception prior to surgery were reviewed. Nineteen dogs (41.3%) recovered with a median follow-up period of 12.5 months. Recovery was defined as an ambulatory paraparesis, or better, with urinary and fecal continence. There was a better outcome in dogs with loss of deep pain for less than 24 hours prior to surgery (19/41; 46.3% recovered) than in dogs without deep pain perception for more than 24 hours (0/5; 0% recovered). Dogs with deep pain perception present at two weeks postoperatively had significantly higher success rate (8/12; 66.7% recovered) than dogs without deep pain perception at this time period (1/10; 10.0% recovered). The return of deep pain perception by two weeks postoperatively can be a useful positive prognostic indicator.

Animals↗