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PubMed1994

Heat-induced pain diminishes vibrotactile perception: a touch gate.

The gate control theory of pain (Melzack and Wall, 1965) suggests that tactile stimuli can decrease the perception of pain. We have found the reverse effect: Heat at levels that induce pain can substantially suppress tactile sensitivity, independently of shifts in attention or arousal. Ten human observers were stimulated by a tonic, pain-producing heat stimulus and vibrotactile stimuli (1, 10, and 100 Hz) coincidentally presented to the right thenar eminence. Vibrotactile thresholds were assessed with the skin at a normative temperature of 31 degrees C and at higher temperatures producing pain. Increases in vibrotactile thresholds (mean change = 7.3 dB) occurred at skin temperatures just below and above those that induced pain. Furthermore, absolute-magnitude estimates of suprathreshold vibrotactile stimuli determined during the same experiments showed decreased sensitivity and psychophysical recruitment. The changes are not attributable to attentional or arousal shifts, since they were not associated with changes in auditory thresholds. Furthermore, the changes occurred just below the subjects' pain thresholds (where nociceptors are presumably activated). This over-twofold diminution of vibrotactile sensitivity suggests that heat stimuli capable of inducing pain can significantly diminish taction, perhaps through a "touch gate" in a manner similar to the gate control theory proposed for pain.

Adult↗
PubMed2006

Perception of labour pain among the Yoruba ethnic group in Nigeria.

In Nigeria, it is generally assumed that labour is well tolerated and pain relief is not usually considered an important part of intra-partum care. This prospective study was carried out to assess mothers' perception of labour pain and determine any factor that may influence it. During the period of study, 281 women who delivered at Wesley Guild Hospital Ilesa, Nigeria were interviewed within 2 h of delivery to assess the severity of labour pain and desire for analgesia. Perception of labour pain was assessed using a 3-point verbal rating. The majority (68.3%) of women described labour pain as severe with only 5.3% describing it as mild. More than 86% of the women would want the pain relieved. Perception of pain was not influenced by age, parity and educational level. Management of pain in labour should form an important part of intra-partum care as is the case in developed countries.

Adult↗
PubMed2005

Increased sensitivity to thermal pain and reduced subcutaneous lidocaine efficacy in redheads.

BACKGROUND: Anesthetic requirement in redheads is exaggerated, suggesting that redheads may be especially sensitive to pain. Therefore, the authors tested the hypotheses that women with natural red hair are more sensitive to pain and that redheads are resistant to topical and subcutaneous lidocaine. METHODS: The authors evaluated pain sensitivity in red-haired (n = 30) or dark-haired (n = 30) women by determining the electrical current perception threshold, pain perception, and maximum pain tolerance with a Neurometer CPT/C (Neurotron, Inc., Baltimore, MD). They evaluated the analogous warm and cold temperature thresholds with the TSA-II Neurosensory Analyzer (Medoc Ltd., Minneapolis, MN). Volunteers were tested with both devices at baseline and with the Neurometer after 1-h exposure to 4% liposomal lidocaine and after subcutaneous injection of 1% lidocaine. Data are presented as medians (interquartile ranges). RESULTS: Current perception, pain perception, and pain tolerance thresholds were similar in the red-haired and dark-haired women at 2,000, 250, and 5 Hz. In contrast, redheads were more sensitive to cold pain perception (22.6 [15.1-26.1] vs. 12.6 [0-20] degrees C; P = 0.004), cold pain tolerance (6.0 [0-9.7] vs. 0.0 [0.0-2.0] degrees C; P = 0.001), and heat pain (46.3 [45.7-47.5] vs. 47.7 [46.6-48.7] degrees C; P = 0.009). Subcutaneous lidocaine was significantly less effective in redheads (e.g., pain tolerance threshold at 2,000-Hz stimulation in redheads was 11.0 [8.5-16.5] vs. > 20.0 (14.5 to > 20) mA in others; P = 0.005). CONCLUSION: Red hair is the phenotype for mutations of the melanocortin-1 receptor. Results indicate that redheads are more sensitive to thermal pain and are resistant to the analgesic effects of subcutaneous lidocaine. Mutations of the melanocortin-1 receptor, or a consequence thereof, thus modulate pain sensitivity.

Adult↗
PubMedDate not supplied

Patient and caregiver perceptions of cancer pain control.

OBJECTIVES: This study measured the perceptions of cancer patients and caregivers in Utah concerning knowledge about and adequacy of pharmacologic cancer pain control. MATERIALS AND METHODS: A descriptive survey was sent to a stratified random sample of adult cancer patients obtained from the Utah Tumor Registry. Questionnaires asked cancer patients and caregivers about their knowledge of pain control and about perceptions of the adequacy of pharmacologic cancer pain management. RESULTS: The study had a 52% response rate (259 of 500) after two mailings. Eighty-five percent (219 of 259) of the respondents stated that they had no cancer pain. With the first mailing, a "no pain" response was not offered as an option. When the researchers realized that this might be a possible response, a second mailing was sent, which may be the reason for the high response rate. CONCLUSIONS: Cancer literature indicates that much cancer pain is not effectively controlled. The majority of the respondents of this study reported no pain. Because this result is different than that reported in the literature, it may indicate that education of healthcare providers, patients, and families can improve cancer pain management and control. It may also indicate an inability of the study to obtain data from those patients having cancer pain. This study should be repeated with a focused population of advanced stage cancer patients with types of cancer typically producing high levels of cancer pain.

Adult↗
PubMed1980

Enkephalin and fear-motivated behavior.

Leu[Enkephalin (400.0 micrograms/kg) and the enkephalin analog [DAla,DLeu]enkephalin (0.4, 4.0, and 40.0 micrograms/kg) were intraperitoneally administered to rats 5 min before they were trained on aversively motivated tasks. The peptides impaired acquisition of a one-way active avoidance response, facilitated acquisition of an inhibitory avoidance response, and had no effect on acquisition of a swim-escape response. The data indicate that the enkephalin effects are not mediated through actions on locomotor activity, pain perception or reactivity, or light sensitivity. Rather, we suggest that [Leu]enkephalin and its analog strengthen the tendency of rats to suppress behavior in the presence of cues previously associated with aversive stimulation. This effect may be due to an enkephalin-induced increase in fear or arousal. The enkephalin effect on behavior was obtained at low doses and was observed within a few minutes after administration. These findings are consistent with the interpretation that enkephalin effects may be initiated at a peripheral site.

Animals↗
PubMed1996

Analgesic effect of ceruletide in men is limited to specific pain qualities.

Cholecystokinin (CCK) and related peptides are supposed to be potent analgesic neuropeptides. Studies in rodents suggest a dose-dependent biphasic effect. The present study aimed to examine the pain modulating effect of different doses (0.5 microgram and 5 micrograms) of ceruletide (CRL), infused i.v. for 30 min. Pain thresholds were obtained for ischemic, mechanical, and thermal pain. In addition, pain tolerance was measured for mechanical pain. According to a placebo-controlled double-blind within-subject design 25 healthy men attended three experimental sessions each. Pain perception was measured as a baseline and twice after the infusion. The effect of both doses of CRL to enhance the pain threshold for thermal stimuli is in line with former studies. However, perception of heat stimuli above or below the threshold was not substantially affected by CRL treatment. Algesic properties of CRL are also indicated, because the tolerance for mechanical pain decreased after administration of the high dose of CRL. Perception of ischemic pain was not obviously influenced by any of the treatments. The role of CRL in human pain modulation seems to vary, depending on the type of experimental pain.

Adult↗
PubMed1990

Is analgesia required for transvaginal single-follicle aspiration in in vitro fertilization? A double-blind study.

High oocyte retrieval rates using transvaginal follicular aspiration for single follicles and improved laboratory techniques have engendered renewed interest in natural-cycle in vitro fertilization (IVF). To assess analgesia requirements during single-follicle aspiration, a double-blind study was set up in 30 patients comparing intraprocedure intravenous fentanyl with normal saline as a placebo. Analysis of pain perception using visual analogue scoring showed a similar pain tolerance in both groups for the procedures of vaginal ultrasound scanning, needle insertion, and follicular aspiration. A correlation between each patient's tolerance of common pain-producing experiences with that for the procedure was not well defined (r = 0.5). We conclude that one of the benefits of natural-cycle IVF using transvaginal single-follicle aspiration is that it can be performed without analgesia.

Analgesia↗
PubMed1992

Provocation testing in noncardiac chest pain.

The ability to reproduce chest pain and to identify the esophagus as the source of this pain are the major reasons why provocation testing has become standard in the evaluation of patients with noncardiac chest pain. Recent studies that challenge the validity of performing provocation tests have polarized experts into two camps: those who would abandon such testing because of its low sensitivity and low specificity, and those who would use testing judiciously because of moderate increases in diagnostic yield. Use of 24-hour pH and pressure testing has shown a high number of chest pain events associated with acid reflux in patients with positive cholinergic stimulation tests and esophageal dysmotility, as well as pain with esophageal dysmotility in patients with positive acid infusion tests. Mechanisms of esophageal chest pain are not known. All provocation agents can decrease coronary flow reserve (i.e., induce microvascular angina), thus raising the question of a cardiac source of pain even in patients with positive presumed esophageal provocation. Acid infusion, cholinergic stimulation, and balloon distention are discussed in light of 24-hour pH and pressure monitoring. Esophageal distention and the role of acid in inducing chest pain are emphasized. The role of stress, the use of defined stressors to induce chest pain, and altered pain perception as a final common pathway for chest pain are examined.

Chest Pain↗
PubMed2005

Intrathecally-administered histamine facilitates nociception through tachykinin NK1 and histamine H1 receptors: a study in histidine decarboxylase gene knockout mice.

Intrathecal injection of histamine elicited behavioral responses consisting of scratching, biting and licking in conscious mice. To study the participation of histamine in pain perception, histidine decarboxylase knockout mice were examined for pain threshold by means of three different kinds of noxious stimuli: thermal nociception (hot-plate, tail-flick, and paw-withdrawal), mechanical nociception (tail-pressure), and chemical nociception (formalin test and capsaicin test). Mutant mice lacking histidine decarboxylase showed significantly fewer nociceptive responses to the hot-plate, tail-flick, paw-withdrawal, tail-pressure, formalin and capsaicin tests. Sensitivity to noxious stimuli in the histidine decarboxylase knockout mice was significantly lower when compared to the wild-type mice. The intrathecally-administered histamine (400 pmol) significantly shortened the latency in the histidine decarboxylase knockout mice, but not in the wild-type mice in tail-flick tests. Pyrilamine, a histamine H(1) receptor antagonist, but not ranitidine, a histamine H(2) receptor antagonist, produced inhibition of the induced behavioral responses in the tail-flick test when co-administered with histamine. Sendide, a tachykinin NK(1) receptor antagonist, inhibited histamine-induced nociceptive behavior in the histidine decarboxylase knockout mice. In contrast, the treatment with D-(-)-2 amino-5-phosponovaleric acid (D-APV), an N-methyl-D-aspartate (NMDA) receptor antagonist, did not prevent the induction of the behavioral responses by histamine. These studies substantiate the evidence that nociceptive behavior induced by intrathecal injection of histamine is largely mediated through tachykinin NK(1) and histamine H(1) receptors in the spinal cord.

2-Amino-5-phosphonovalerate↗
PubMed2001

Effects of rapid eye movement (REM) sleep deprivation on pain sensitivity in the rat.

The relationship between pain and sleep seems to be reciprocal: if pain may interrupt or disturb sleep, poor sleep can also influence pain perception. However the influence of sleep disturbances on pain sensitivity remain poorly investigated. The aim of this study was to assess the effect of REM sleep deprivation on the reaction of rats subjected to different noxious stimuli. In each experiment 16 Wistar male rats were randomly assigned to two groups: controls (n=8), and REM sleep deprived rats (n=8). REM sleep deprivation was elicited using the 'inverted flower pot' technique. Four different experiments were performed to assess the sensitivity to mechanical (vocalization threshold in paw pressure), thermal (tail withdrawal latency in hot water immersion), electrical (envelope of 2nd peep in tail shock test) and chemical (analgesic behavior in formalin test) noxious stimuli. All experiments were performed over a 5-day period with baseline (day 1, day 2) in a dry environment and REM sleep deprivation (day 3, day 4 and day 5) in a wet environment. Under wet conditions, vocalization threshold in the paw pressure test (-20%, P=0.005), and tail withdrawal latency in the hot water immersion test (-21%, P=0.006) were significantly lower, and the envelope of 2nd peep in the tail electrical shock was significantly greater (+78%, P=0.009), in REM sleep deprived rats compared to controls. However, under wet conditions the mean duration of nociceptive behaviors in the formalin test did not differ between the two groups. In conclusion, REM sleep deprivation induces a significant increase in the behavioral responses to noxious mechanical, thermal and electrical stimuli in rats.

Animals↗
PubMed2003

Atropine reverses the antinociception of nonsteroidal anti-inflammatory drugs in the tail-flick test of mice.

The nonsteroidal anti-inflammatory drugs (NSAIDs) clonixin, diclofenac, piroxicam, ketoprofen, meloxicam, and paracetamol induced antinociception after intraperitoneal or intrathecal administration in mice submitted to an acute thermal algesiometric test without inflammation (tail-flick). Antinociception was evaluated by the increase in reaction time difference (Delta latency), between readings obtained before and after the administration of drugs. The antinociception induced by doses of NSAIDs producing between 20% and 30% of the maximum possible effect (MPE) 30 min after intraperitoneal and 15 min after intrathecal injections was compared with the antinociception obtained after pretreatment with 1 mg/kg atropine ip, 30 min before. Systemic atropine (1 mg/kg) significantly antagonized NSAID-induced antinociception in all cases, both after intraperitoneal and intrathecal administration. Cholinergic depletion by intracerebroventricular hemicholinium-3 (HC-3, 5 microg) 5 h before prevented the antinociceptive effect of all NSAIDs. These observations suggest that intrinsic muscarinic cholinergic facilitatory pathways represent an important modulating system in pain perception in this animal model of acute thermal pain. The results of the present work support the increasingly accepted notion that NSAIDs are effective analgesics even when inflammation is not present, acting by mechanisms that involve actions on spinal and supraspinal nociceptive transmission. It is suggested that, similar to morphine and clonidine, the active mechanism of NSAIDs may involve the release of acetylcholine (ACh) in the spinal cord.

Analgesics↗
PubMed2001

Analysis of the physician variable in pain management.

BACKGROUND: The role of physician variability in pain management is unknown. OBJECTIVE: To assess the role of physician variability in the management of pain and provide quantitative data regarding the status of pain management in Michigan. DESIGN: A multi-item mail survey was used to determine the physician's perceived knowledge of pain management modalities, goals, satisfaction, and confidence with pain treatment. Participants. The focus of this report was a group of 368 licensed Michigan physicians who provide clinical care. RESULTS: Overall, 30% of the study group reported no formal education in pain management, although younger physicians reported more education (correlation coefficient = -0.252, P <.001). The physicians reported greater confidence in their knowledge of meperidine than other Schedule II opioids (P <.001 ). In regards to the opinion that prescribing strong opioids would attract a medical review, the physician responses ranged from 1 (strongly disagree) to 5 (strongly agree). The median score for this scale was 4, accounting for 46% of the responses. The study group expressed less satisfaction with their treatment of chronic pain as well as lower goals for relief (mean: 3.8; 95% confidence interval: 3.7-3.9). CONCLUSIONS: Lower expectations for relief and less satisfaction in its management may contribute to the undertreatment of chronic pain. Perceptions of regulatory scrutiny may contribute to suboptimal pain management. These preliminary data highlight physician variability in pain decision making while providing insights into educational needs.

Journal Article↗
PubMed1998

Meteorological conditions and self-report of low back pain.

STUDY DESIGN: Six months of daily low back pain ratings for 94 individuals were tested for the influence of prevailing weather conditions during the spring, summer, and fall seasons. Intergroup differences were tested for study participants who reported weather sensitivity and for those who did not. OBJECTIVES: To investigate the relation between pain ratings and prevailing weather conditions in a population with chronic or recurrent low back pain. SUMMARY OF BACKGROUND DATA: Weather conditions have been reported to influence pain perception in some disease states, including low back pain. Investigations of this relation in chronic or recurrent low back pain have involved varied methodologies, and conflicting results have been reported. METHODS: The effects of eight weather variables reported to influence musculoskeletal pain were tested on daily pain ratings. A post hoc weather sensitivity questionnaire was used to disperse 73 individuals into groups based on perceived weather sensitivity, and group differences were tested. RESULTS: Significant effects on pain scores were found, most notably for temperature and vapor pressure. The magnitude of the effects were small compared with autocorrelation of an individual's own pain scores. Significant differences were found between the group of individuals who were insensitive to weather conditions and that of individuals with perceived sensitivity to cold temperatures. No significant intergroup differences were found for damp, rainy conditions or changes in barometric pressure. CONCLUSIONS: Weather conditions may influence subjective reporting of low back pain significantly. Although the effects are small in magnitude, they should be considered in clinical treatment of the patient with chronic, nonspecific low back pain. Pain scores may demonstrate greater interaction with certain weather conditions in individuals perceiving sensitivity to those conditions.

Adult↗
PubMed2006

Pain-related catastrophizing in healthy women is associated with greater temporal summation of and reduced habituation to thermal pain.

OBJECTIVE: Pain-related coping strategies, especially catastrophizing, play an influential role in shaping pain responses. However, although numerous studies have examined the impact of catastrophizing on chronic pain outcomes, relatively few have evaluated relationships between individual differences in pain-related catastrophizing and pain perception, with most of those studies examining only pain threshold or pain tolerance. We assessed, for the first time, catastrophizing's association with the magnitude of temporal summation of pain, a primary marker for central nervous system sensitizability. METHODS: Thirty-eight healthy young women underwent standardized experimental pain testing, followed by administration of a brief questionnaire that assessed catastrophizing cognitions during the pain-testing session. RESULTS: Higher levels of pain-related catastrophizing were related to higher suprathreshold pain ratings and greater temporal summation of thermal pain, suggesting that catastrophizing may play a facilitatory role in the processing of pain-related information, though the specific pathways underlying this facilitation are not clear. CONCLUSIONS: These preliminary findings highlight the importance of coping in shaping individuals' responses to noxious stimuli, and suggest that interventions that decrease pain catastrophizing may reduce the burden of acute and chronic pain.

Adaptation, Physiological↗
PubMed1993

The effect of incisional infiltration of bupivacaine upon pain and respiratory function following open cholecystectomy.

A controlled, prospective, double-blind trial of wound infiltration with bupivacaine in elective open cholecystectomy was performed to determine if this was an effective method of pain relief and reduced respiratory complications. Additionally, dextran was added to the bupivacaine in an attempt to prolong the effect. The solutions used were, bupivacaine alone 0.25% (n = 14), bupivacaine 0.25% with dextran 70 (n = 16) and saline (n = 16) as a control. To determine the effect of each solution, the subjects were assessed for pain perception and respiratory function before and after surgery. Pain was assessed using a visual analogue scale and narcotic usage, and respiratory function was assessed by spirometry, chest X-rays and arterial blood gases. The study did not demonstrate any objective improvement in either pain relief or respiratory function. This may reflect inadequate infiltration by the surgeons in the study or that infiltration should have been performed prior to incision.

Adult↗