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PubMed2004

Effects of smoking, distraction, and gender on pain perception.

Whereas research on the antinociceptive effects of cigarette smoking has produced inconsistent findings, certain aspects of attentional processing repeatedly have been found to have an impact on pain perception. In an effort to delineate the relation between smoking and pain, the present study tested the attentional mediation model of smoking in pain perception. The authors hypothesized that by narrowing attentional focus, smoking in the presence of a distractor would facilitate distraction from painful stimuli, producing the most pronounced antinociceptive effect, compared with smoking or distraction alone. On the basis of previous findings of gender differences in pain, the authors hypothesized that the effects would vary by gender. The authors used the cold pressor test to assess pain threshold and tolerance in 76 smokers. A 2 (smoking/not smoking) x 2 (distraction/no distraction) x 2 (male/female) between-subjects analysis of variance (ANOVA) yielded Distraction x Gender interactions for pain threshold and pain tolerance. Pain sensitivity was lower in the distraction condition for men only. Whereas the results did not support the attentional mediation model of smoking in pain perception, they highlight the importance of distraction and gender differences in experimental pain.

Adolescent↗

PubMedDate not supplied

Pain perception and its relation to functional status post total knee arthroplasty: a pilot study.

PURPOSE: This pilot study examined the influence of pain perception on functional status. DESIGN: A descriptive longitudinal correlational exploratory design was used. SAMPLE: The sample comprised 23 participants ranging in age from 47 to 85 years. RESULTS: Data were collected for pain perception components, anxiety, and functional status. Negative correlations were noted between pain and functional status on days 42 and 84. Common descriptors used over the first 3 days were sharp, aching, tender, and tiring. CONCLUSIONS: Pain intensity is only one component of pain perception. Management of the sensory and affective components needs further research.

Activities of Daily Living↗

PubMed2004

Loss of pain perception in diabetes is dependent on a receptor of the immunoglobulin superfamily.

Molecular events that result in loss of pain perception are poorly understood in diabetic neuropathy. Our results show that the receptor for advanced glycation end products (RAGE), a receptor associated with sustained NF-kappaB activation in the diabetic microenvironment, has a central role in sensory neuronal dysfunction. In sural nerve biopsies, ligands of RAGE, the receptor itself, activated NF-kappaBp65, and IL-6 colocalized in the microvasculature of patients with diabetic neuropathy. Activation of NF-kappaB and NF-kappaB-dependent gene expression was upregulated in peripheral nerves of diabetic mice, induced by advanced glycation end products, and prevented by RAGE blockade. NF-kappaB activation was blunted in RAGE-null (RAGE(-/-)) mice compared with robust enhancement in strain-matched controls, even 6 months after diabetes induction. Loss of pain perception, indicative of long-standing diabetic neuropathy, was reversed in WT mice treated with soluble RAGE. Most importantly, loss of pain perception was largely prevented in RAGE(-/-) mice, although they were not protected from diabetes-induced loss of PGP9.5-positive plantar nerve fibers. These data demonstrate, for the first time to our knowledge, that the RAGE-NF-kappaB axis operates in diabetic neuropathy, by mediating functional sensory deficits, and that its inhibition may provide new therapeutic approaches.

Animals↗

PubMed1999

A meta-analytic review of pain perception across the menstrual cycle.

The purpose of this article is to review the sixteen published studies that examine associations between the perception of experimentally induced pain across menstrual cycle phases of healthy females. We also performed a meta-analysis to quantitatively analyze the data and attempt to draw conclusions. The results suggest that there are relatively consistent patterns in the sensitivity to painful stimulation. These patterns are similar across stimulus modality with the exception of electrical stimulation. The magnitude of the effect was approximately 0.40 across all stimulation. For pressure stimulation, cold pressor pain, thermal heat stimulation, and ischemic muscle pain, a clear pattern emerges with the follicular phase demonstrating higher thresholds than later phases. When the effect size was pooled across studies (excluding electrical) comparisons involving the follicular phase were small to moderate (periovulatory phase, d(thr) = 0.34; luteal phase, d(thr) = 0.37; premenstrual phase, d(thr) = 0.48). The pattern of effects was similar for tolerance measures. Electrical stimulation was different than the other stimulus modalities, showing the highest thresholds for the luteal phase. When the effect size was pooled across studies for electrical stimulation, effect sizes were small to moderate (menstrual (d(thr) = -0.37), follicular d(thr) = -0.30) periovulatory d(thr) = -0.61), and premenstrual d(thr) = 0.35) phases. This paper raises several important questions, which are yet to be answered. How much and in what way does this menstrual cycle effect bias studies of female subjects participating in clinical trials? Furthermore, how should studies of clinical pain samples control for menstrual related differences in pain ratings and do they exist in clinical pain syndromes? What this paper does suggest is that the menstrual cycle effect on human pain perception is too large to ignore.

Adult↗

PubMed2007

Intracervical block and pain perception during the performance of a hysterosalpingogram: a randomized controlled trial.

OBJECTIVE: To estimate whether an intracervical block of 1% lidocaine decreased pain perception compared with placebo during the performance of a hysterosalpingogram. METHODS: A randomized controlled trial was conducted with 120 patients assessing pain perception during a hysterosalpingogram. Patients were randomly assigned to one of three groups. Patients received either a 1% lidocaine intracervical block, an intracervical saline injection, or no injection. Visual analog (VAS) and qualitative scales were used to assess study participants' pain at six different time points during the hysterosalpingogram. RESULTS: Subjects receiving the lidocaine block had significantly less pain (P<.001) by VAS during tenaculum placement (approximately 61% less, 1.303 cm) and with tenaculum traction (approximately 40% less, 2.804 cm) compared with both the intracervical saline injection group and the no injection group (tenaculum placement, 3.384 cm and 3.354 cm, and tenaculum traction, 4.705cm and 4.961 cm, respectively). There was no improvement seen with pain perception during instillation of the contrast in the lidocaine group compared with the saline or no injection group (P<.073). Subjects who received the saline injection had statistically more pain (P<.001) by VAS (2.647 cm) immediately after the injection compared with the lidocaine (approximately 79% greater, 1.476 cm) and no injection groups (115% greater, 1.232 cm). CONCLUSION: Lidocaine intracervical block provides better pain relief than placebo during tenaculum placement and tenaculum traction during a hysterosalpingogram. This study suggests that patients should be offered an intracervical block before placement of the cervical tenaculum to decrease pain during the performance of a hysterosalpingogram. CLINICAL TRIAL REGISTRATION: (www.ClinicalTrials.gov), NCT00372658 LEVEL OF EVIDENCE: I.

Adult↗

PubMed1976

[Interaction between the systems involved in fast pain perception and in slow, persistent pain (author's transl)].

A single pinprick triggers both a pang, the "1st pain" and after a pause of 0.5 s, a spreading burning feeling, the "2nd pain". The 2nd pain is delayed because it is conducted by unmyelinated C-fibers at a rate of less than 1 m/s, 20 times slower than conduction of the 1st pain. In the spino-thalamic tract the myelinated fibers of the 1st pain conduct much faster than those of the 2nd pain, and terminate in the parvocellular ventroposterior (VP) thalamic nucleus, which projects to area 3b in the postcentral gyrus. The slow C-fibers of the 2nd pain terminate in cortex-independent thalamic nuclei like limitans, which project to the outer segment of the pallidum. This subcortical pain pathway is disinhibited after destruction of the cortical pathway of the 1st pain, so that the patients suffer from spontaneous agonizing pain feeling (thalamic pain). Unbearable pain in cases of thalamic softening, in anaesthesia dolorosa and in phantom pain can be relieved by stereotactic coagulation of the thalamic nuclei involved in the 2nd pain. Normally they are inhibited by the cortical pathway of the 1st pain.

Analgesia↗

PubMed1987

Endorphins are related to pain perception in coronary artery disease.

Plasma beta-endorphin levels were measured by radioimmunoassay before and after exercise in 25 patients with coronary artery disease. Eighteen patients were men and 7 were women; age range was 36 to 75 years (mean 60). All patients had angina pectoris, a positive treadmill test response or positive exercise radionuclide findings. The mean preexercise plasma endorphin level was 4.9 +/- 3.0 pmol/liter (range 0.7 to 13.5). The mean postexercise plasma endorphin level of 6.6 +/- 4.6 mol/liter (range 0 to 19.5) was significantly higher (p less than 0.05). A significant positive correlation was seen between postexercise endorphin levels and time to onset of angina (r = 0.4, p = 0.03). There were negative correlations between postexercise endorphin levels and occurrence (r = -0.4, p = 0.04) and duration of angina (r = -0.4, p = 0.05). No association was found for maximal heart rate-blood pressure product, workload, time to ST-segment depression or stress ejection fraction. A positive correlation was found between rest left ventricular ejection fraction and postexercise endorphin levels (r = 0.5, p = 0.02). In conclusion, in patients with exercise-induced myocardial ischemia, plasma beta-endorphin levels are increased after exercise; postexercise endorphin levels are related to timing and occurrence (presence or absence) of angina; and endorphins may alter the perception of pain caused by myocardial ischemia.

Adult↗

PubMed1981

Changes in pain perception after treatment for chronic pain.

Pain threshold, sensitivity, response bias and ability to discriminate were measured before and after treatment for 15 improved and 15 unimproved chronic pain patients diagnosed as having myofascial pain dysfunction (MPD) syndrome, There were no differences between the groups before treatment. After treatment, the improved group showed an increase in pain threshold, sensitivity and ability to discriminate between different levels of painful stimulation and a decrease in response bias to report pain. The unimproved group showed no changes.

Chronic Disease↗

PubMed2004

Effect of midazolam on anxiety level and pain perception in cataract surgery with topical anesthesia.

PURPOSE: To study the effect of sedation on patients' anxiety level and perception of pain during cataract surgery under topical anesthesia. SETTING: Royal Eye Infirmary, Plymouth, England. METHODS: This prospective controlled double-blind clinical trial comprised 100 consecutive patients having routine phacoemulsification with posterior chamber intraocular lens implantation under topical anesthesia by a single experienced surgeon. Patients were randomized to receive intravenous midazolam (0.015 mg/kg body weight) 15 minutes before surgery or no sedation. The main evaluation criteria were the anxiety based on the 6-item, short form of the State-Trait Anxiety Inventory, the pain score using a visual analog scale, and overall patient satisfaction. RESULTS: All operations were uneventful, and no side effects were noted from the use of midazolam. Anxiety scores were significantly higher on arrival at the hospital than just before the commencement and after the conclusion of the surgery in both groups (P<.05). Patients were less anxious after administration of midazolam, but this did not achieve statistical significance. The mean pain score was 0.29 (range 0 to 4) in the sedation group and 0.38 (range 0 to 4) in the control group; the difference between groups was not statistically significant. The patients were equally satisfied in both groups, with mean scores of 3.84 (range 0 to 4) and 3.88 (range 2 to 4), respectively. CONCLUSIONS: Patients who had cataract surgery under topical anesthesia were highly satisfied with their operative experience and reported minimal pain during surgery. Anxiety levels diminished after arrival at the hospital, possibly because of reassurance by experienced staff. Intravenous midazolam did not seem to significantly reduce pain or anxiety.

Aged↗

PubMed1992

Effect of variation in the burst and carrier frequency modes of neuromuscular electrical stimulation on pain perception of healthy subjects.

The purpose of this study was to explore the effect of various combinations of burst and carrier frequencies of neuromuscular electrical stimulation (NMES) on subjects' perception of pain intensity associated with induction of high intensity muscle contractions. Twenty-seven healthy volunteers completed the study. After the initial test session, all subjects were treated in three additional sessions with nine combinations of burst frequencies (50, 70, and 90 bursts per second [bps]) and carrier frequencies (2,500, 5,000, and 10,000 Hz) at an NMES amplitude that produced torque equivalent to 50% of maximal voluntary contraction of their quadriceps femoris muscle. Subjects rated each frequency combination for perceived pain intensity with a visual analog scale. The combinations of burst frequencies (50, 70, and 90 bps) and carrier frequencies (2,500 and 5,000 Hz) do not differ from each other in perceived pain intensity but do differ significantly in perceived pain from the combinations of burst frequencies at the carrier frequency of 10,000 Hz. Thus, the clinician may have to try different stimulus combinations on patients at different current training levels to obtain the least individually perceived pain.

Adult↗

PubMed2001

The effect of an intrauterine application of two percent lignocaine gel on pain perception during Vabra endometrial sampling: a randomised double-blind, placebo-controlled trial.

OBJECTIVE: To determine whether two percent lignocaine gel can reduce the perception of pain during Vabra endometrial aspiration. DESIGN: Randomised, double-blind placebo-controlled trial. SETTING: Women's Health Directorate, Warrington Hospital NHS Trust. POPULATION: Women were referred to the endometrial sampling clinic for the investigation of pre and postmenopausal vaginal bleeding. METHODS: Randomisation to either pre-sampling intrauterine two percent lignocaine gel or an inert gel. Patients, recruiters and assessors were blinded to the gel used. MAIN OUTCOME MEASURES: The difference between the study groups in the proportion of women who, after Vabra sampling, recorded a pain score of > or = 6 out of 10 on a visual analogue scale. RESULTS: Three hundred and eight women were randomised, 284 (92%) completed a pain scale before and immediately after the procedure. After the procedure, 84 women (30%) recorded a pain score of > or = 6, 38 (26%) received anaesthetic and 46 (33%) an inert gel. The difference in the proportion of women recording a pain score of 6 or above between the two study groups was not significant (relative risk (RR) for the anaesthetic gel = 0.79 95% CI, 0.55, 1.14). CONCLUSIONS: Intrauterine application of 2% lignocaine gel did not significantly reduce the frequency with which women experienced unacceptable levels of pain or anxiety during endometrial aspiration compared with placebo.

Administration, Topical↗

PubMed2000

Pain perception with pH buffered peribulbar anaesthesia: a pilot study.

AIMS: To determine the relation between pH of anaesthetic solutions and patient perception of pain with peribulbar injection of local anaesthesia. METHODS: This prospective randomised controlled double blind pilot study involved 60 consecutive patients who received a peribulbar block with either a standard acidic local anaesthetic of 5 ml 2% lignocaine and 5 ml of 0.5% bupivacaine (solution A), or an alkalinised solution composed of the same anaesthetic agents but with a pH of 7.44 (solution B). Before surgery patients were asked to grade the pain of both the preoperative dilating drops and the peribulbar injection using a visual analogue scale. RESULTS: The mean pain scores were similar in the two treatment groups-slightly higher (4.97) in group B who received the buffered solution, compared with group A (4.84) who received the plain solution. The small difference (-0.13, 95% confidence limits -1.6 and +1.3) was not significant. There was, however, a highly significant association between pain threshold ("drop pain") and injection pain levels (p<0.0001). CONCLUSION: This study showed no difference in the reduction in the pain experienced by patients undergoing peribulbar anaesthesia with pH buffered local anaesthetic. The study suggests the importance of "pain threshold" as a confounder and also showed the considerable pain felt by some patients on instillation of the preoperative dilating drops.

Analysis of Variance↗

PubMed2002

The unique and transient impact of acute exercise on pain perception in older, overweight, or obese adults with knee osteoarthritis.

This study examined the unique contribution of acute exercise to perceptions of pain in 32 older, overweight, or obese adults with knee osteoarthritis (OA), statistically controlling for the effect of diurnal variation, supplemental medication intake, and stress. Using an ecological momentary assessment method, 964 pain appraisals were recorded and coded into experience samplings that occurred either on a nonexercise day or before or following scheduled activity on an exercise day. Univariate and multivariate multilevel modeling analyses controlling for supplemental medication intake and stress revealed a quadratic trend in diurnal pain variations with the peak occurring mid-afternoon. Although pain was significantly elevated following exercise in comparison with the predicted diurnal pattern, pain reports later in the day following exercise were significantly lower than immediately following exercise. We conclude that the pain associated with acute exercise by older, overweight, or obese adults who have knee OA is transient. Findings are discussed in terms of the implications of exercise therapy for patients with knee OA.

Aged↗

PubMed2004

Central mechanisms of pain perception.

Mechanisms of human nociception can be studied by the use of CO2 laser stimulation, which selectively activates nociceptive receptors, and by the use of various noninvasive techniques. In addition to the contralateral thalamus, at least several cortical areas including the contralateral SI, bilateral SII, anterior cingulated cortex, and insular cortices are involved in the pain sensation/perception. Pain perception (Fig. 8) is unique because these cortical structures seem to be activated in parallel at nearly the same latency after the stimulus presentation. SI seems to play a role in basic pain processing while SII and insula are involved in higher functions of pain perception. Emotional aspects of pain perception are mediated by anterior cingulate cortex and posterior insula/parietal operculum.

Brain Mapping↗

PubMed1985

Low-back pain. Perception and tolerance.

The relationship between pain modifying factors, pain duration, and the role of anxiety in low-back pain experience were studied. Three groups of patients with low-back pain were examined using the Tourniquet Pain Test, McGill Pain Questionnaire, Rating Scale of Pain Intensity, State-Trait Anxiety Inventory, and Psychological Discomfort Questionnaire. Significant differences in all measured features emerged between acute and chronic pain groups. Groups of acute and subchronic pain and groups of subchronic and chronic pain differed only in several parameters, suggesting an intermittent phase in acute pain transition into chronicity. While pain prolonged, pain experience gradually but irregularly changed, exaggerating pain perception. The changes concerned mainly emotional factors and were related to the chronicity itself. Anxiety also played a significant role.

Adult↗

PubMed1994

Central effects of baroreceptor activation in humans: attenuation of skeletal reflexes and pain perception.

Activating the arterial baroreceptors blunts pain sensation and produces other forms of central nervous system inhibition in animals. These effects may be important to blood pressure regulation but have not been rigorously verified in humans. We describe (i) a noninvasive behaviorally unbiased method for baroreceptor stimulation and (ii) the application of this method to measurement of baroreceptor-mediated attenuation of pain perception and of the Achilles tendon reflex. The findings are relevant to basic mechanisms of blood pressure stabilization and cardiovascular reactivity and may also have implications for noncompliance with antihypertensive medications and for the pathophysiology of essential hypertension.

Achilles Tendon↗

PubMed2005

Electrophysiological studies on human pain perception.

OBJECTIVE: We reviewed the recent progress in electrophysiological studies using electroencephalography (EEG), magnetoencephalography (MEG) and repetitive transcranial magnetic stimulation (rTMS) on human pain perception. METHODS: For recording activities following A delta fiber stimulation relating to first pain, several kinds of lasers such as CO2, Tm:YAG and argon lasers are now widely used. The activity is frequently termed laser evoked potential (LEP), and we reviewed previous basic and clinical reports on LEP. We also introduced our new method, epidermal stimulation (ES), which is useful for recording brain activities by the signals ascending through A delta fibers. For recording activities following C fiber stimulation relating to second pain, several methods have been used but weak CO2 laser stimuli applied to tiny areas of the skin were recently used. RESULTS: EEG and MEG findings following C fiber stimulation were similar to those following A delta fiber stimulation except for a longer latency. Finally, we reviewed the effect of rTMS on acute pain perception. rTMS alleviated acute pain induced by intracutaneous injection of capsaicin, which activated C fibers, but it enhanced acute pain induced by laser stimulation, which activated A delta fibers. CONCLUSIONS: One promising approach in the near future is to analyze the change of a frequency band. This method will probably be used for evaluation of continuous tonic pain such as cancer pain, which evoked response studies cannot evaluate.

Brain↗

PubMed2000

Autonomic responses and pain perception in Alzheimer's disease.

We analysed the effects of electrical noxious stimulation on the autonomic nervous system of Alzheimer's disease (AD) patients who were assessed by means of the Mini Mental State Examination test (MMSE). To do this, we used electrical stimuli at two different intensities: just above pain threshold and twice pain threshold. We recorded heart rate and systolic blood pressure by using conventional electrocardiography and finger photo-plethysmography. When a pain stimulus just above threshold was delivered, AD patients were found to have blunted autonomic responses compared to controls of the same age. Similarly, prestimulus expectation produced a less pronounced increase of the responses in AD patients compared to the controls. However, when the painful stimulus was increased to twice the pain threshold, the systolic blood pressure increase of AD patients did not differ from the controls, whereas heart rate increase was still slightly diminished. By contrast, pain perception was similar in the two groups when the stimulus was at pain threshold, whereas it was blunted in AD patients when the stimulus was twice the pain threshold. These findings show that in AD mild noxious stimulation produces blunted autonomic responses and normal pain perception, whereas strong noxious stimulation produces quasi-normal autonomic responses and blunted pain perception. These results indicate that AD patients have an increased threshold for both autonomic activation and pain tolerance.

Aged↗