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PubMed1995

Nurse and patient perceptions of pain.

Patient pain is a problem frequently encountered by nurses, who are often directly responsible for its management. Accurate pain assessment is vital for appropriate management. The nurse's role in pain control should evolve to one of empowering patients to determine the management of their own pain where possible.

Attitude of Health Personnel↗
PubMedDate not supplied

Strategies to reduce children's perception of pain.

Pain is one of the most complex of all human stressors. This paper reviews the literature specific to children's pain and outlines the factors that influence how they perceive pain. The author also describes how children's pain is observed and how their needs are met in his own unit, and the importance of involving children in the management of their pain.

Child↗
PubMed1995

[Do neonates and small infants feel pain?].

Infants and even premature neonates, although immature, possess the basic pathways and nociceptors necessary for pain perception. Their responses to painful stimuli are complex, and indicate the presence of central modulating mechanisms. By definition, pain is a subjective experience, but children under the age of three years are unable to communicate their experience. Observer rating systems for pain assessment must take into account the variation in pain expression among infants. In many settings, measurement of different physiological variables are used as indices of pain experience and the effect of intervention. Although the beneficial effect of intervention is well established, it may also have an impact on the possible long-term effects in early childhood. Thorough pain assessment is a prerequisite for successful intervention, and may be improved by introduction of "pain services".

Analgesics↗
PubMed1997

[Does anesthesia always involve analgesia?].

The primary aim of anesthesia is the prevention of pain perception (analgesia), intraoperative awareness (hypnosis), and postoperative recall (amnesia) (anesthetic trade). Analgesia would be a component of the anesthetic state. Pain is the conscious perception of a noxious stimulus and analgesia is the abolished perception of pain in an otherwise conscious patient. During general anesthesia pain can not be experienced, since the patient is unconscious. However, there is no certainty that during anesthesia a blockade of the nociceptive system is reliably provided in all circumstances. The impact of insufficient blockade of nociceptive pathways during anesthesia on mental status and implicit memory are largely unknown. Therefore, the anesthetic trade should consist of hypnosis, amnesia and antinociception.

Analgesia↗
PubMed1998

Trigeminal neuropathic pain: pathophysiological mechanisms examined by quantitative assessment of abnormal pain and sensory perception.

OBJECTIVE: This study was undertaken to examine the pathophysiological characteristics of trigeminal neuropathic pain. METHODS: The study included 23 consecutive patients with trigeminal neuropathic pain (15 patients with pain after nerve injury and 8 patients with pain of spontaneous origin). For each patient, quantitative examination of sensory and pain perception was performed in the painful facial skin area, and results were compared with the findings for the contralateral nonpainful facial skin area. RESULTS: In the painful facial skin area of patients with neuropathic pain after nerve injury, we demonstrated increased temperature and tactile thresholds, as well as abnormal temporal summation of pain (i.e., repetitive nonpainful skin stimulation produced an abnormal progressive increase of pain intensity, with abnormal radiation of pain and aftersensation). In the painful skin area of patients with pain of spontaneous origin, temperature and tactile thresholds were not increased, but heat pain and cold pain thresholds were significantly reduced, indicating heat and cold hyperalgesia. The characteristics of temporal summation of pain were not significantly altered in the painful facial skin area in this group of patients. CONCLUSION: This clinical study provides evidence that the pathophysiological mechanisms of trigeminal neuropathic pain after nerve injury involve impaired function of both small unmyelinated fibers and large myelinated fibers. An explanation for the finding of abnormal temporal summation of pain may involve hyperexcitability of central wide-dynamic range neurons. The results suggest that other mechanisms are involved in trigeminal neuropathic pain of spontaneous origin. Reduced heat and cold pain thresholds indicate heat and cold hyperalgesia, which possibly may be explained by sensitization of peripheral C nociceptors.

Adult↗
PubMed2005

Characteristics of rectal perception are altered in irritable bowel syndrome.

A hallmark symptom of irritable bowel syndrome (IBS) is a lower pain threshold during rectal distension, but the mechanism underlying this disorder remains unclear. Examining the relationship between physiological and perceptual responses to rectal distension can provide insight into the underlying peripheral or central dysfunction in IBS. Therefore, we carried out a study of the rectal sensations of urge to defecate, pain and unpleasantness in relation to the varying states of the rectum. Ten IBS patients and 13 healthy controls underwent six sets of isobaric rectal distensions. The first set was ascending stepwise distensions terminating upon report of moderate pain where verbal ratings of urge, pain, and unpleasantness were acquired. The remaining sets were phasic or tonic distensions at a single pressure eliciting either moderate urge or moderate pain intensity where subjects gave continuous ratings of urge or pain percepts. The McGill Pain Questionnaire (MPQ) was used to assess different qualities of the pain experience during single pressure distensions. Abnormalities in IBS patients included: (1) higher incidence of distensions where unpleasantness is greater than pain intensity, (2) significantly longer persistence of ratings after stimulus termination during phasic distensions eliciting either moderate urge or moderate pain, (3) significantly smaller ratings fluctuations during tonic distensions, and (4) significantly higher MPQ scores for painful tonic distensions. Our study demonstrates that IBS patients have abnormal temporal and intensity properties of rectal sensation. These can be accounted for by either altered peripheral neuromuscular processing and/or processing of ascending rectal input in the central nervous system.

Humans↗
PubMed2001

Perceptions of labour pain by mothers and their attending midwives.

AIMS: The aim of the current study was to examine the perception of pain by labouring women and their attendant midwife, from the onset of labour to delivery. RATIONALE: Accurate measurement and appropriate management of pain is a significant problem for attendant medical and nursing personnel. Both the experience and perception of pain are regarded as subjective and are therefore difficult to measure objectively. Indeed, much of the literature reports that pain is often under- or over-estimated by nursing staff who as a consequence consistently fail to administer adequate analgesia. Few studies have specifically examined the ability of midwives to assess the pain of labouring women. DESIGN: The short form McGill Pain Questionnaire (SF-MPQ), routinely used to assess pain in obstetric environments, was used to determine pain perception. Thirteen labouring women and nine midwives completed the SF-MPQ every 15 minutes beginning at the time of admittance to the delivery suite. Peak pain ratings for the preceding 15 minutes were obtained without reference to prior ratings or each other's scores. Further, midwives in the maternity unit of The Queen Elizabeth Hospital (TQEH), Adelaide, South Australia completed a survey investigating the cues they use to assess pain during labour. RESULTS: On each measure of pain on the SF-MPQ, the midwives scores correlated with the mothers' scores across the entire pain range. Further analysis showed that mothers' and midwives' pain scores were similar at mild-moderate pain levels, but midwives significantly underestimated pain intensity at levels that mothers described as severe. The survey responses indicated that midwives rely on both verbal and nonverbal cues to assess pain levels. CONCLUSIONS: The cues used by midwives to differentiate pain intensities and qualities are similar to those used in other clinical settings, but may have limited discriminatory value as pain levels become severe.

Adult↗
PubMed2002

The influence of experimental pain intensity in the local and referred pain area on somatosensory perception in the area of referred pain.

The aim of this study was to investigate the influence of experimental pain intensity in the local and referred pain area on somatosensory perception thresholds in the area of referred pain. Pain was induced by intramuscular electrical stimulation of the left infraspinatus muscle in 12 healthy individuals. The stimulation corresponded to the local pain threshold ("mild local pain"), the referred pain threshold ("mild referred pain"), and a pain intensity corresponding to 2 on a 10-point category scale in the referred pain area ("moderate referred pain"). Quantitative sensory testing was performed to assess perception thresholds in the referred pain area and the homologous contralateral area before and during stimulation. Perception thresholds to light touch (LTTs), pressure pain (PPTs), and to innocuous as well as noxious warmth and cold were assessed. During stimulation the LTTs increased in the referred pain area compared to baseline, uninfluenced by pain intensity. Perception thresholds to innocuous cold and warmth increased bilaterally during the stimulation, without relation to pain intensity. Heat pain thresholds were not affected. Compared to baseline, PPTs increased bilaterally during stimulation corresponding to "mild local pain" and "mild referred pain", respectively, and a further increase was seen during "moderate referred pain". The decreased sensitivity to innocuous cold, warmth, and pressure pain was bilateral, indicating activation of endogenous net inhibitory mechanisms interacting bilaterally. We found no influence of pain intensity on somatosensory thresholds restricted to the referred pain area and light touch was the only affected modality in the referred pain area only.

Adult↗
PubMed2005

Sensitization and habituation of AMH and C-fiber related percepts of repetitive radiant heat stimulation.

OBJECTIVE: Pain perception involves neuronal plasticity at peripheral and central stages, resulting in sensitization or habituation, depending on intensity and temporal features of stimulation. Concurrent assessment of perceptual change over different time spans is therefore important for understanding the dynamics of pain processing. METHODS: A new psychophysical procedure was established to assess sensitization and habituation during repetitive radiant heat stimulation. Short-term perceptual change (<1 min) during trials with 10 stimuli applied at 3 frequencies (0.2-0.6-1.8 Hz) and 3 intensities was assessed for AMH-II or C-fiber related percepts. Perceptual changes were monitored for medium-term (1-15 min) and for long-term (15-90 min) time spans. RESULTS: Short-term sensitization occurred only at frequencies above 0.3 Hz and was affected by both stimulus frequency and intensity, but the AMH-fiber related sensitization depended on intensity only above 0.6 Hz. Multiple stimulation of the same skin area during medium-term time spans resulted in habituation. No long-term perceptual changes occurred. CONCLUSIONS: The procedure permits concurrent assessment of short-term sensitization and medium-term habituation, assumed to be related to spinal windup and cutaneous nociceptive fiber fatigue, respectively. SIGNIFICANCE: The method is suitable for quantitative sensory testing of dynamic pain processing over different time spans, relevant in clinical testing of pain and in drug assessment.

Adult↗
PubMed2004

Influences of gender role and anxiety on sex differences in temporal summation of pain.

UNLABELLED: Previous research has consistently shown moderate to large differences between pain reports of men and women undergoing experimental pain testing. These differences have been shown for a variety of types of stimulation. However, only recently have sex differences been demonstrated for temporal summation of second pain. This study examined sex differences in response to temporal summation of second pain elicited by thermal stimulation of the skin. The relative influences of state anxiety and gender role expectations on temporal summation were investigated. Asymptomatic undergraduates (37 women and 30 men) underwent thermal testing of the thenar surface of the hand in a temporal summation protocol. Our results replicated those of Fillingim et al indicating that women showed increased temporal summation compared to men. We extended those findings to demonstrate that temporal summation is influenced by anxiety and gender role stereotypes about pain responding. When anxiety and gender role stereotypes are taken into account, sex is no longer a significant predictor of temporal summation. These findings highlight the contribution of social learning factors in the differences between sexes' pain perception. PERSPECTIVE: Results of this study demonstrate that psychosocial variables influence pain mechanisms. Temporal summation was related to gender role expectations of pain and anxiety. These variables explain a significant portion of the differences between men and women's pain processing, and may be related to differences in clinical presentation.

Adolescent↗
PubMed2005

Inter- and intraindividual variabilities in pharmacokinetics of fentanyl after repeated 72-hour transdermal applications in cancer pain patients.

Perception of pain by the patient is frequently one of the early signs preceding a diagnosis of cancer and, later, a sinister sign of disease progression. Among opioid drugs, transdermal fentanyl has been evaluated in the treatment of moderate to severe cancer pain. The objective of this study was to investigate the intra- and interindividual variabilities in pharmacokinetics after fentanyl drug delivery by the transdermal fentanyl patch delivery system in patients with cancer pain. As a first step, a liquid chromatography-mass spectrometry method was developed for the determination of the analgesic fentanyl in human plasma. This method was validated over the concentration range 0.15-100 ng/mL. The study group consisted of 29 inpatients (18 men and 11 women; age range 29-80 years). The initial transdermal fentanyl delivery rate was chosen depending on the patient's analgesic requirements. For 20 patients, the initial TTS fentanyl delivery rate was 25 or 50 microg/h. For 6 patients, the initial delivery rate was 75-150 microg/h. Two patients received up to 300 microg/h fentanyl delivery rate, and 3 patients received up to 350 microg/h fentanyl delivery rate. Fifteen of the 29 patients received rescue doses of subcutaneous or oral morphine, and 26 patients received paracetamol with codeine (30 mg per os). Blood samples were collected at the following intervals: 2-5, 22-26, or 45-47 hours following fentanyl patch application. The severity of pain experienced by the patient was assessed thrice daily using a visual analogue scale. The study period was 46 days. Large patient-to-patient variations in pharmacokinetic parameters occurred, although intraindividual variability was limited. A mean bioavailability of 78% was estimated; the total clearance averaged 41 L/h. From 25 to 100 mug/h fentanyl delivery rate, the pharmacokinetics was linear. At the 2 highest doses, an increase of total clearance was observed (>60 L/h). For the whole group, transdermal fentanyl treatment provided good to excellent pain relief in the majority of patients.

Acetaminophen↗
PubMed2002

Central neural mechanisms that interrelate sensory and affective dimensions of pain.

The perception of pain is highly complex, and requires neural integration from a variety of routes. Spinal pathways to the amygdala, hypothalamus, reticular formation, medial thalamic nuclei, and limbic cortical structures transmit information involved arousal, bodily regulation, and emotional responses. Other, albeit indirect, pathways can carry signals to these same structures, for example, from spinal pathways to somatosensory thalamic and cortical areas, and from these to cortical limbic structures. Indirect cortico-limbic pathways integrate nociception with information about the status of the body and indirect routes must culminate in the prioritization of emotions and responses to pain.

Animals↗