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Critical roles for bradykinin and prostanoids in acute inflammatory reactions: a search using experimental animal models.

Searches for chemical mediators of inflammation underlying classical signs of inflammation i.e. heat, redness, swelling, and pain have been performed and various experimental models for evaluation of new agents to manage these inflammatory signs have been developed extensively during the last century. Now, at the beginning of the 21st-century, after great progress in gene technology, the necessity of in vivo animal study is being reconsidered. Therefore, this review introduces and describes findings obtained by the use of various experimental animal models. We have compared the inflammatory characteristics among species using reported animal models such as dye exudation in the skin, paw edema, pleurisy, and writhing reaction; then we have precisely examined mediators involved in these inflammatory reactions. In the process of plasma exudation and pain perception in the earlier phases of acute inflammation, involvement of the kallikrein-kinin system and prostanoids was demonstrated. Precisely, bradykinin, and PGI(2) among the prostanoids, are major mediators for exudation and pain perception of the initial acute phase of inflammation; both mediators collaborate to enhance these effects. PGE(2), perhaps produced by cyclooxygenase-2, was involved in induction of plasma exudation and pain perception in a later phase than the timing of involvement of PGI(2). Precise roles of various prostanoids will hopefully be clarified by the research projects in progress.

Acute Disease↗

Patients' perceptions of pain management and use of coping strategies.

As a result of the Joint Commission on Accreditation of Healthcare Organizations accreditation standards for 2001, pain management for hospitalized patients has become a top priority of healthcare facilities. In addition to using the traditional pharmacological approach to pain management, many patients also use complementary or alternative medicine (CAM) treatments. However, CAM treatments may not be discussed or offered to patients by healthcare providers who lack awareness about these alternatives. The purpose of this study was to assess patients' perceptions of pain, their beliefs about the use of pharmacological and CAM pain management techniques, and their satisfaction with pain management. Researchers verbally administered a survey to patients by using a combination of open-ended questions and a 0-10 rating scale, and they recorded their responses. This study was conducted in a not-for-profit teaching hospital in the southeast United States. Convenience sampling was used to select the 137 patients who completed the surveys. No treatment intervention was provided. Pharmacological treatment was the primary method expected and used by the majority of patients for pain management. Chi-squared statistics were used to analyze nonparametric data. An analysis of variance was used to analyze parametric data. The frequency with which nonpharmacological CAM options were used ranged from 6 to 34 percent. The most commonly used CAM method was distraction, such as watching television or reading.

Adaptation, Psychological↗

Effects of 3 analgesic regimens on the perception of pain after removal of femoral artery sheaths.

BACKGROUND: Effective pain management after removal of femoral artery sheaths after percutaneous transluminal coronary angioplasty is highly individualized and requires frequent, accurate assessment and administration of analgesics as needed. OBJECTIVE: To determine which of 3 analgesic regimens is most effective in decreasing patients' perception of pain with the fewest side effects after removal of a femoral artery sheath. SAMPLE: 130 adult who had undergone percutaneous transluminal coronary angioplasty and were in an 8-bed cardiac short-stay unit in a 1400-bed acute care hospital. METHOD: Patients were randomized to receive either intravenous morphine, intravenous fentanyl, subcutaneous lidocaine around the sheath site, or an intravenous placebo before sheath removal. Rescue analgesia (intravenous fentanyl) was made available to all groups. Patients used a visual analog scale to assess pain within 10 minutes before, 1 minute after, and 20 minutes after sheath removal. Pain levels, frequency of side effects, and use of rescue analgesia were compared among groups. RESULTS: Age, sex, number of stents, and frequency of hematomas did not differ significantly among groups. Pain ratings, use of rescue analgesia, and side effects (nausea, vomiting, or vasovagal symptoms) were not significantly different among treatment groups. Ratings of pain were slightly higher immediately after sheath removal in all groups. CONCLUSION: For most patients, removal of femoral artery sheaths and manual compression for hemostasis are relatively pain-free. Pain scores among patients given analgesia with subcutaneous lidocaine, intravenous morphine, or intravenous fentanyl were not significantly different from pain scores among control patients.

Adult↗

Effect of neurotensin on colorectal motor and sensory function in humans.

PURPOSE: Animal studies have shown that neurotensin stimulates colonic motility, but little is known on the effect on rectocolonic function in humans. This study was designed to investigate the effect of neurotensin on rectal and colonic motor and sensory function and colonic reflexes in humans. METHODS: Motor and sensory function of the descending colon and rectum were studied in eight healthy volunteers (5 females; age range, 20-58 years) by using a dual, computerized, rectocolonic, barostat assembly. Measurements were performed during placebo and neurotensin infusion (5 pmol/kg per minute), respectively. Compliance and reflex mechanisms were assessed in both rectum and descending colon. Symptom perception (urge and pain) was scored using Visual Analog Scales (0-10 cm). RESULTS: Neurotensin significantly (P < 0.05) increased rectal compliance (from 9 +/- 1.1 to 10.1 +/- 1.1 ml/mmHg) and colonic compliance (from 7.9 +/- 0.4 to 9 +/- 0.7 ml/mmHg) during stepwise distensions. Intensity of urge and pain perception during rectal distension was increased by neurotensin (P < 0.05). Sensations during colonic distensions were not altered by neurotensin. For colonic reflexes, during rectal distension the colonic bag volume increased significantly (P < 0.05), whereas during colonic distension rectal bag volume decreased significantly (P < 0.05). Neurotensin delayed the occurrence of these reflexes: they were present at significantly higher pressures compared to placebo (P < 0.05). CONCLUSIONS: We demonstrated the presence of both a rectocolonic inhibitory and a colorectal stimulatory reflex in healthy volunteers. Neurotensin increases compliance and modulates rectal but not colonic sensitivity. Colorectal and rectocolonic reflexes are impaired during infusion of neurotensin.

Adult↗

Elevated pain thresholds correlate with dissociation and aversive arousal in patients with borderline personality disorder.

In addition to reduced pain perception, patients with borderline personality disorder (BPD) show higher pain thresholds under subjective stress conditions as compared with non-stress conditions. However, the correlation between symptoms of stress and pain thresholds has not been investigated so far. Using a new and convenient methodology, electric stimulation, we expected higher pain and detection thresholds in patients with BPD than in to healthy controls as well as a positive correlation between pain thresholds and symptoms of stress (aversive arousal and dissociation) in BPD patients. Twelve female patients with BPD and twelve healthy controls were included in the study. Electric stimulation was applied on the right index finger, and detection and pain thresholds were assessed by gradually intensifying the stimuli. We found significantly elevated pain thresholds in patients with BPD as compared with healthy controls, but no difference between patients and controls in detection thresholds. In patients, a significant positive correlation was revealed between pain thresholds and dissociation as well as between pain thresholds and aversive arousal. Besides demonstrating a close correlation between pain thresholds and symptoms of stress in patients with BPD, this study replicated earlier findings of reduced pain perception in patients with BPD. Measuring electric pain thresholds is a valid and reasonable method for larger studies.

Adult↗

Comparison of a controlled injection pressure system with a conventional technique.

OBJECTIVE: The purpose of this study was to compare a device that controls flow rate during injection through use of a foot pedal with a conventional atraumatic syringe injection technique. We determined the change from preinjection to postinjection anxiety, the pain perception, procedure tolerance, and anxiety about future injections. STUDY DESIGN: Dental injection anxiety questionnaires were completed by 80 endodontic patients immediately before and after administration of local anesthetic with the 2 experimental methods. Patients also completed visual analog scales to rate their pain perception during injection, their rating of the overall experience, and their anticipated anxiety about a future dental injection. RESULTS: Patients experienced significantly lower overall postinjection anxiety and pain of injection and had significantly more positive overall experience ratings with the conventional technique than with the controlled-rate procedure. CONCLUSIONS: A conventional atraumatic syringe injection technique was superior to a controlled injection pressure system in pain perception and procedure tolerance and in reducing postinjection dental anxiety.

Adolescent↗

Analgesic and placebo effects of thalamic stimulation.

Numerous clinical studies have reported successful relief of chronic pain with sensory thalamic stimulation. However, even with the extensive use of sensory thalamic stimulation as a clinical tool in the relief of chronic pain, the results are still inconsistent. This discrepancy could probably be explained by the fact that the majority of these studies are case reports or retrospective analyses, which have often used imprecise pain measurements that do not allow a rigorous statistical evaluation of pain relief. None of these studies measured the effect of stimulation on clinical pain for longer than a few hours per day, which is an important aspect considering that clinical pain can vary over time. Moreover, placebo controls are seldom included. In the current study, we measured patients' pain perception at home over a 2-week period, both during days of normal stimulation of the sensory thalamus and during days without stimulation. Patients also came to the laboratory to assess the effects of thalamic and placebo stimulation on clinical pain, experimental heat pain, innocuous air puff and visual stimulation. A potential relation between the perceived paresthesia and analgesic efficacy during thalamic and placebo stimulation was also explored. We found that thalamic stimulation significantly affected clinical and experimental pain perception, but that an important placebo component also exists. On the other hand, neither thalamic nor placebo stimulation affected air puff and visual ratings, suggesting that the effect applies specifically to pain and hence is not caused by a general change in attention. The level of paresthesia elicited during the placebo manipulation was also directly correlated with the degree of placebo pain relief. These results suggest that thalamic stimulation produces a small but significant reduction in pain perception, but that a significant placebo effect also exists.

Adult↗

Naloxone does not alter the perception of pain induced by electrical and thermal stimulation of the skin in healthy humans.

It has been hypothesized that, in the absence of acute or chronic pain, a tonically active system exists involving opioid peptides, which ensures a certain level of pain insensitivity. Although various studies have failed to support this concept, it has been reported that in conditions of both experimentally induced and clinical pain, high doses of the opioid antagonist naloxone induced a state of hyperalgesia and thus seemed to set off this hypothetical system. Lower doses were, however, without effect or even acted as analgesics. This study investigated the effect of 5 and 20 mg naloxone i.v., compared to placebo, on the perception of pain in healthy humans. Pain was induced by two methods, using electrical and thermal stimulation of the skin, which have previously been shown to be sensitive to the effects of opioid as well as of non-steroidal anti-inflammatory analgesics. Each of 12 males and 12 females participated in 3 experimental sessions, in which the treatments were administered double-blind according to a Latin square design. Threshold and tolerance to electrically induced pain and threshold to thermally induced pain were measured at 30 min intervals for 90 min before and 90 min after drug administration. Electrical stimuli were square wave constant current impulses of linearly increasing intensity; thermal stimuli were of constant intensity and variable duration. Threshold and tolerance to electrically induced pain were not altered by either dose of naloxone, whereas the threshold to thermally induced pain was significantly higher after both 5 and 20 mg naloxone than after placebo, the effects of the two naloxone doses not differing from each other.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

The experience of pain and perceptions of quality of life: validation of a conceptual model.

Pain is a common symptom of terminally ill cancer patients and a major challenge for hospice care. This paper presents a conceptual model of the relationship between pain and quality of life that was derived from the authors' previous research. The model should prove useful to hospice clinicians and researchers in evaluating the impact of palliative care on the quality of life.

Evaluation Studies as Topic↗

Prospective randomized clinical trial on suction elastic band ligator versus forceps ligator in the treatment of haemorrhoids.

OBJECTIVE: This prospective randomized clinical trial was undertaken to compare the use of a single-operator vacuum suction ligator and the traditional forceps ligator in terms of pain perception following the procedure, intra-procedure bleeding and other complications. METHODS: One hundred consecutive patients with second- and third-degree haemorrhoids presenting between July 2002 and September 2003 were randomized into suction and forceps groups for rubber band ligations. They were equally distributed in both groups, with a mean age of 48.7 years (range, 15-83 years). The immediate, 24-hour, 7-day and 14-day pain scores after the procedure were evaluated using a visual analogue scale. Intra-procedure bleeding and other complications at follow-up were evaluated. RESULTS: Pain perception was worse in the forceps group immediately after ligation, with a mean score of 6.08 compared with 3.08 in the suction group (p < 0.001). Pain score remained high among the forceps patients at 24 hours post-banding, with a mean score of 4.00 compared with 1.92 in the suction group (p < 0.001). There was no significant difference in terms of immediate and 24-hour pain perceptions whether two or three haemorrhoids were banded per session (p = 0.904 and p = 0.058). The amount of analgesia consumed after banding correlated well with the severity of pain reported, being higher among the forceps group with a mean of 4.48 tablets (p = 0.003). Intra-procedure bleeding occurred in 25 patients in the forceps group compared with five in the suction group (p < 0.001). There were no severe complications such as perianal sepsis, urinary retention, sphincter dysfunction or bleeding during the trial. CONCLUSION: Suction band ligation is superior to forceps ligation for the treatment of second- and third-degree haemorrhoids in terms of pain tolerance, amount of analgesia consumed and intra-procedure bleeding.

Adolescent↗

A new ultrasonic device in maintenance therapy: perception of pain and clinical efficacy.

BACKGROUND: A recently introduced piezo-driven ultrasonic device (Vector) generates longitudinal oscillations. As a result, the instrument tip moves parallel to the tooth surface. By avoiding vertical oscillations, maintenance treatment with the Vector device should be less painful than treatment with conventional systems. We investigated whether patients perceive treatment with the Vector device as less painful than with a conventional ultrasonic device, and whether the clinical efficacy of the Vector device is comparable with that of the conventional ultrasonic device in maintenance patients. MATERIAL AND METHODS: Thirty-eight maintenance patients with moderate to advanced periodontal disease took part in this prospective, randomized controlled clinical study. Each patients had to have at least two teeth with probing depths of >4 mm. They were treated either with Dentsply (n=22) at a reduced power setting or with the Vector device (n=16). The observation period was 6 months. Probing pocket depth, attachment level, and bleeding upon probing were assessed at six sites on each treated tooth by a blinded investigator Patient were asked to report perceived pain during instrumentation with a visual analog scale immediately after treatment, in the evening of the treatment day, and in the evenings 1 and 2 days after treatment. RESULTS: Bleeding on probing, probing depth, and attachment level improved in both instrumentation groups from baseline to month 6; however, there was no difference between the two instrumentation modalities. The patients perceived treatment with neither instrument as unpleasant, and their perception of pain intensity both during instrumentation and on the following days did not differ. CONCLUSION: In maintenance therapy, clinical efficacy of the vector device is comparable with that of conventional ultrasonic device. It makes no difference whether the ultrasonic device at a reduced power setting or the Vector device is used, since patients perceive both instruments as causing very little pain.

Adult↗

Low hot pain threshold predicts shorter time to exercise-induced angina: results from the psychophysiological investigations of myocardial ischemia (PIMI) study.

OBJECTIVES: The purpose of this study was to test whether cutaneous thermal pain thresholds are related to anginal pain perception. BACKGROUND: Few ischemic episodes are associated with angina; symptoms have been related to pain perception thresholds. METHODS: A total of 196 patients with documented coronary artery disease underwent bicycle exercise testing and thermal pain testing. The Marstock test of cutaneous sensory perception was administered at baseline after 30 min of rest on two days and after exercise and mental stress. Resting hot pain thresholds (HPTs) were averaged for the two baseline visits and divided into two groups: 1) average HPT <41 degrees C, and 2) average HPT > or =41 degrees C, to be clearly indicative of abnormal hypersensitivity to noxious heat. RESULTS: Patients with HPT <41 degrees C had significantly shorter time to angina onset on exercise testing than patients with HPT > or =41 degrees C (p < 0.04, log-rank test). Heart rates, systolic blood pressure and rate-pressure product at peak exercise were not different for the two groups. Resting plasma beta-endorphin levels were significantly higher in the HPT <41 degrees C group (5.9+/-3.7 pmol/liter vs. 4.7+/-2.8 pmol/liter, p = 0.02). Using a Cox proportional hazards model, patients with HPT <41 degrees C had an increased risk of angina (p = 0.03, rate ratio = 2.0). These differences persisted after adjustment for age, gender, depression, anxiety and history of diabetes or hypertension (p < 0.01). CONCLUSIONS: Occurrence of angina and timing of angina onset on an exercise test are related to overall hot pain sensory perception. The mechanism of this relationship requires further study.

Adult↗

The effect of situation-evoked anxiety and gender on pain report using the cold pressor test.

The aims of the present study were to investigate the influence of anxiety on pain perception and to test whether gender differences in pain perception are anxiety dependent. Sixty male and female university students exposed to situation-evoked anxiety or a control procedure were measured for their pain threshold, tolerance, and perceived intensity during a cold pressor test. Both subjective and autonomic responses indicated that anxiety was successfully induced in participants exposed to the anxiety condition. Increased situational anxiety had no significant effect on pain threshold or pain tolerance. Significant increases in pain intensity were found for the anxiety group. Levels of anxiety, however, did not correlate with this increased intensity, raising doubt as to the role of anxiety in producing this effect. No gender differences were found for pain tolerance or pain intensity. Gender differences were found for pain threshold in the anxiety group with, contrary to past findings, females showing significantly higher pain thresholds than males. The results are discussed in the light of related studies.

Adult↗

Microvascular angina in patients with syndrome X.

Syndrome X (SX) is usually diagnosed in the presence of angina and normal coronary arteriograms. It is an heterogeneous syndrome which encompasses different pathogenic mechanisms. Whether myocardial ischaemia is responsible for the condition remains controversial. The term "microvascular angina" has been used to define the syndrome of chest pain and normal coronary arteries with heightened sensitivity of the coronary microcirculation to vasoconstrictor stimuli. It has been suggested that the abnormal vasodilator response of the coronary circulation in patients with SX is due to impaired endothelial function. Plasma levels of endothelin in patients with chest pain and normal coronary arteries were found to be significantly raised compared to normal controls. Endothelial dysfunction in SX is likely to be multifactorial and many cardiac risk factors, such as hypertension, hypercholesterolemia, oestrogen deficiency and smoking, can contribute to its development. As the majority of SX patients are women and most are post-menopausal, oestrogen deficiency has been proposed as a pathogenic factor. A large proportion of patients satisfying the stated criteria for SX have one or more coronary risk factors. Additional factors, such as abnormal pain perception, may contribute to the evolution of chest pain in patients with normal coronaries and endothelial dysfunction. Combined alteration of pain perception and microvascular dysfunction are likely to explain a proportion of all cases of SX. The treatment of this syndrome represents a major challenge for the cardiologist. Beta-blockers and calcium channel blockers are effective in controlling chest pain in SX patients. A very important therapeutic intervention in microvascular angina is the control of risk factors that can lead to endothelial dysfunction. Different approaches, including spinal cord stimulation and psychological treatment, have been proposed especially for those patients in whom a cardiac origin of pain is unlikely.

Antidepressive Agents, Tricyclic↗

Prognostic value of magnetic resonance imaging in dogs with paraplegia caused by thoracolumbar intervertebral disk extrusion: 77 cases (2000-2003).

OBJECTIVE: To determine whether magnetic resonance imaging findings in dogs with paraplegia caused by thoracolumbar intervertebral disk extrusion were predictive of clinical outcome. DESIGN: Retrospective case series. ANIMALS: 77 dogs. PROCEDURE: Medical records and magnetic resonance images were reviewed; clinical outcome was classified as successful (regained ability to walk with no more than mild neurologic deficits) or unsuccessful (severe neurologic deficits persisted). The prognostic value of magnetic resonance imaging was compared with prognostic value of deep pain perception, duration of clinical signs, and rate of onset of clinical signs. RESULT: 33 (43%) dogs had areas of hyperintensity of the spinal cord greater than or equal to the length of the L2 vertebral body on T2-weighted magnetic resonance images. All 44 dogs without areas of hyperintensity on T2-weighted images had a successful outcome, but only 18 of the 33 (55%) dogs with an area of hyperintensity did. Only 5 of 16 dogs with an area of hyperintensity that had also lost deep pain perception had a successful outcome. The odds ratio for an unsuccessful outcome for a dog with an area of hyperintensity (29.87) was higher than the odds ratio for a dog that had lost deep pain perception (5.24). Duration and rate of onset of clinical signs were not associated with clinical outcome. CONCLUSIONS AND CLINICAL RELEVANCE: Findings suggest that results of magnetic resonance imaging can be used to predict clinical outcome in dogs with paraplegia caused by intervertebral disk extrusion.

Animals↗

Increased taste intensity perception exhibited by patients with chronic back pain.

There is overlap between brain regions involved in taste and pain perception, and cortical injuries may lead to increases as well as decreases in sensitivity to taste. Recently it was shown that chronic back pain (CBP) is associated with a specific pattern of brain atrophy. Since CBP is characterized by increased sensitivity to pain, we reasoned that the sense of taste might also be enhanced in CBP. Detection and recognition thresholds were established for a sour taste and ratings of both suprathreshold taste intensity and pleasantness-unpleasantness perception were collected for sweet, sour, salty and bitter stimuli in 11 CBP patients and 11 matched control subjects. As a control, ratings were also collected for visual assessment of degree of grayness. There was no difference between CBP and control subjects for visual grayness rating. On the other hand, CBP patients in comparison to control subjects rated gustatory stimuli as significantly more intense but no more or less pleasant and showed a trend towards a lower detection threshold (i.e. increased sensitivity). The selectivity of the taste disturbance suggests interaction between pain and taste at specific brain sites and provides further evidence that CBP involves specific brain abnormalities.

Adult↗

[The impact of Alzheimer's disease on the pain processing].

It is well known that patients with Alzheimer's disease report less pain in comparison to their age group. However, little is yet known about the underlying mechanisms causing the decreased pain report. In order to learn more about these mechanisms, experimental studies are indispensable, since only in experimental settings, noxious input and pain experience can be assessed independently. We therefore report on experimental data on pain perception in Alzheimer's disease in this review. The experimental data suggest that the threshold for pain tolerance is markedly increased and the autonomic pain reaction is, at least in part, considerably diminished. On the other hand, pain threshold and pain event-related brain potentials remain largely unchanged. As possible explanations we discuss age-related changes in pain perception and neuroanatomical changes in Alzheimer's disease. Particularly the atrophy of limbic structures may have a modifying impact on the pain experience. We also discuss what influence communicational deficits have on pain report.

Aged↗

The effects of high-volt pulsed current electrical stimulation on delayed-onset muscle soreness.

OBJECTIVE: We investigated three 30-minute high-volt pulsed current electrical stimulation (HVPC) treatments of 125 pps to reduce pain, restore range of motion (ROM), and recover strength loss associated with delayed-onset muscle soreness (DOMS). DESIGN AND SETTING: Randomized, masked comparison of three 30-minute treatment and sham HVPC regimens over a 48-hour period. SUBJECTS: Twenty-eight college students. MEASUREMENTS: Subjects performed concentric and eccentric knee extensions with the right leg to induce muscle soreness. Assessments were made before and after the exercise bout and each treatment at 24, 48, and 72 hours postexercise. RESULTS: Three separate 2 x 3 x 2 ANOVAs were used to determine significant differences (p < .05) between days, treatments, and pre-post treatment effects and significant interaction among these variables. Scheffe post hoc tests showed no significant reduction in pain perception or improvement in loss of function at 24, 48, and 72 hours postexercise. Mean pain perception assessments (0 = no pain, 10 = severe pain) for the HVPC group were 2.9, 4.5, and 3.5 and for the sham group 3.8, 4.8, and 3.5). Mean ROM losses for the HVPC group were 9.0 degrees , 22.3 degrees , and 26.2 degrees , and for the sham group were 9.5 degrees , 23.1 degrees , and 23.0 degrees . Mean strength losses (1RM) for the HVPC group were 25.9, 25.7, and 20.8 lbs and for the sham group were 22.3, 22.3, and 13.8 lbs. CONCLUSIONS: HVPC as we studied it was ineffective in providing lasting pain reduction and at reducing ROM and strength losses associated with DOMS.

Journal Article↗