51
|
Petrov ME, Goodin BR, Cruz-Almeida Y, King C, Glover TL, Bulls HW, Herbert M, Sibille KT, Bartley EJ, Fessler BJ, Sotolongo A, Staud R, Redden D, Fillingim RB, Bradley LA. Disrupted sleep is associated with altered pain processing by sex and ethnicity in knee osteoarthritis. THE JOURNAL OF PAIN 2015; 16:478-90. [PMID: 25725172 DOI: 10.1016/j.jpain.2015.02.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 01/21/2015] [Accepted: 02/08/2015] [Indexed: 10/23/2022]
Abstract
UNLABELLED Studies indicate that improving sleep decreases reported pain in patients with knee osteoarthritis, but it is unclear if this association extends to experimentally induced pain responses. A community-based sample of 88 African American and 52 non-Hispanic white adults (45-76 years) with knee osteoarthritis completed the Insomnia Severity Index and the arousal subscale of the Sleep Hygiene and Practices Scale. Participants underwent quantitative sensory testing, including measures of pain sensitivity and facilitation at the knee, and pain inhibition. Outcomes were analyzed with multiple Tobit hierarchical regression models, with adjustment for relevant covariates. Ethnicity and sex by sleep interactions were also entered into the models. After covariate adjustment, main associations were not observed. However, sex interacted with insomnia severity to predict greater temporal summation of heat and punctate pressure pain among women and lower heat temporal summation among men. Men and women who engaged in frequent arousal-associated sleep behaviors demonstrated higher and lower heat temporal summation, respectively. Non-Hispanic whites with greater insomnia severity displayed lower pressure pain thresholds and pain inhibition. Our findings are the first to demonstrate that disrupted sleep is associated with altered pain processing differentially by sex and ethnicity/race among people with knee osteoarthritis. PERSPECTIVE This article presents the association between insomnia severity, maladaptive sleep behaviors, and experimentally induced pain responses among people with knee osteoarthritis. Disrupted sleep was associated with altered pain processing by sex and ethnicity/race. Offering sleep interventions may help ameliorate pain, but treatment may need to be tailored by sex and ethnicity/race.
Collapse
Affiliation(s)
- Megan E Petrov
- College of Nursing & Health Innovation, Arizona State University, Phoenix, Arizona.
| | - Burel R Goodin
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Yenisel Cruz-Almeida
- Department of Aging & Geriatric Research, University of Florida, Gainesville, Florida
| | - Chris King
- Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, Florida
| | - Toni L Glover
- College of Nursing, University of Florida, Gainesville, Florida
| | - Hailey W Bulls
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Matthew Herbert
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Kimberly T Sibille
- Department of Aging & Geriatric Research, University of Florida, Gainesville, Florida; Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, Florida
| | - Emily J Bartley
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, Florida
| | - Barri J Fessler
- Division of Clinical Immunology & Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Adriana Sotolongo
- Division of Clinical Immunology & Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Roland Staud
- Division of Rheumatology and Clinical Immunology, College of Medicine, University of Florida, Gainesville, Florida
| | - David Redden
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Roger B Fillingim
- Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, Florida; Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, Florida
| | - Laurence A Bradley
- Division of Clinical Immunology & Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama
| |
Collapse
|
52
|
Effect of Types and Anatomic Arrangement of Painful Stimuli on Conditioned Pain Modulation. THE JOURNAL OF PAIN 2015; 16:176-85. [DOI: 10.1016/j.jpain.2014.11.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 10/22/2014] [Accepted: 11/10/2014] [Indexed: 11/20/2022]
|
53
|
Umeda M, Williams JP, Marino CA, Hilliard SC. Muscle pain and blood pressure responses during isometric handgrip exercise in healthy African American and non-Hispanic White adults. Physiol Behav 2014; 138:242-6. [PMID: 25455868 DOI: 10.1016/j.physbeh.2014.09.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 09/29/2014] [Indexed: 11/16/2022]
Abstract
It has been shown that African Americans (AAs) are more sensitive to experimental pain stimuli compared to non-Hispanic Whites (NHWs). A single bout of exercise results in naturally-occurring muscle pain and elevation in blood pressure (BP); however, it is currently unclear whether AAs and NHWs differ in muscle pain and BP responses during exercise. Therefore, we examined the differences in muscle pain and blood pressure (BP) during isometric handgrip exercise in African Americans (AAs) and non-Hispanic Whites (NHWs). Fourteen AAs and 14 NHWs completed isometric exercise consisting of squeezing a hand dynamometer at 25% of maximal strength for 3 min. During exercise, muscle pain ratings (MPRs) were assessed every 30s, whereas systolic and diastolic BP (SBP and DBP) were recorded every minute. During exercise, AAs generally reported greater MPR than NHWs (p<0.001), and MPR increased more rapidly during exercise in AAs than NHWs (p<0.05). In contrast, SBP and DBP continued to increase similarly during exercise in both AAs and NHWs (p>0.05). The results suggest that AAs generally experienced a greater intensity of muscle pain than NHWs during isometric handgrip exercise, but both groups exhibited similar elevations in BP during exercise.
Collapse
Affiliation(s)
- Masataka Umeda
- Department of Health, Exercise, and Sport Sciences, Texas Tech University, Lubbock, TX, USA.
| | - Jon P Williams
- Department of Health, Exercise, and Sport Sciences, Texas Tech University, Lubbock, TX, USA
| | - Courtney A Marino
- Department of Health, Exercise, and Sport Sciences, Texas Tech University, Lubbock, TX, USA
| | - Shelby C Hilliard
- Department of Health, Exercise, and Sport Sciences, Texas Tech University, Lubbock, TX, USA
| |
Collapse
|
54
|
Analysis of meaningful conditioned pain modulation effect in a pain-free adult population. THE JOURNAL OF PAIN 2014; 15:1190-1198. [PMID: 25241218 DOI: 10.1016/j.jpain.2014.09.001] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 08/20/2014] [Accepted: 09/01/2014] [Indexed: 11/24/2022]
Abstract
UNLABELLED Conditioned pain modulation (CPM) encompasses the effects of inhibitory and facilitatory pain modulatory systems and is inefficient in some chronic pain states. A proportion of healthy subjects also exhibit little or no CPM, perhaps suggesting that inherent factors such as gender or genetics may be influential. However, there is no consensus on how best to determine a meaningful CPM effect. This study aimed to determine the proportion of pain-free subjects exhibiting a meaningful CPM effect. Analyses of associations between 5HTTLPR (serotonin transporter-linked polymorphic region) polymorphisms on the serotonin transporter gene (SLC6A4), gender, and CPM effect were also carried out. A total of 125 healthy subjects (47 male; 78 female) underwent pressure pain threshold testing before, during, and after a cold pressor conditioning stimulus. A buccal cell sample was collected for analysis of 5HTTLPR genotype. Meaningful CPM effect was determined as an increase in pressure pain threshold values from baseline greater than the inherent error of measurement, calculated as 5.3%. During the conditioning stimulus, 116 subjects (92.8%) exhibited a CPM effect whereas 9 did not. CPM effect did not differ significantly between genders or between 5HTTLPR genotypes. This provides a clear basis on which to determine the proportion of patients with a chronic pain disorder that exhibit a meaningful CPM effect. PERSPECTIVE This study proposes a method for calculating meaningful CPM effect and reports the proportion and magnitude of effect elicited in a large sample. Associations between CPM, gender, and genotype were also analyzed. Clarification of normal CPM response may help to elucidate the mechanisms driving CPM inefficiency in chronic pain.
Collapse
|
55
|
Cruz-Almeida Y, Sibille KT, Goodin BR, Petrov ME, Bartley EJ, Riley JL, King CD, Glover TL, Sotolongo A, Herbert MS, Schmidt JK, Fessler BJ, Staud R, Redden D, Bradley LA, Fillingim RB. Racial and ethnic differences in older adults with knee osteoarthritis. Arthritis Rheumatol 2014; 66:1800-10. [PMID: 24729357 DOI: 10.1002/art.38620] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 03/04/2014] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Knee osteoarthritis (OA) contributes significantly to disability in older individuals, and racial/ethnic minorities are disproportionately affected. The present study aimed to characterize differences in clinical and experimental pain, including pain inhibition, among older African American (AA) and non-Hispanic white (NHW) subjects with knee OA. METHODS AA and NHW subjects with knee OA (n = 267) completed clinical and functional pain assessments, including quantitative sensory testing (QST). We hypothesized that, when compared to NHW subjects, AA subjects would display 1) lower pain tolerance and higher ratings of heat-, mechanical-, and cold-induced pain, 2) greater temporal summation of pain, 3) reduced pain inhibition, and 4) greater clinical pain and poorer function. In addition, we hypothesized that the findings from QST would significantly predict the severity of clinical pain within each race/ethnicity. RESULTS AA subjects with knee OA displayed increased pain sensitivity, greater temporal summation, and reduced pain inhibition when compared to NHW subjects with knee OA. Moreover, AA subjects reported greater clinical pain and poorer function. Racial/ethnic differences in clinical pain became nonsignificant when the analyses were controlled for education and annual income, whereas differences in QST findings remained highly significant. Although the extent of pain inhibition predicted the severity of clinical pain in both groups, different QST measures were additionally predictive of clinical pain within each group. CONCLUSION The results of this study establish that there are racial/ethnic differences in experimental and clinical pain and function in older individuals with knee OA. Our findings indicating that different QST measures were associated with clinical pain within the 2 racial/ethnic groups, whereas reduced pain inhibition was important in all participants, warrant further study in order to elucidate the common and group-specific pathophysiologic mechanisms contributing to clinical pain in OA.
Collapse
|
56
|
Temporal summation of pain as a prospective predictor of clinical pain severity in adults aged 45 years and older with knee osteoarthritis: ethnic differences. Psychosom Med 2014; 76:302-10. [PMID: 24804882 PMCID: PMC4066647 DOI: 10.1097/psy.0000000000000058] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Enhanced pain facilitation is reportedly an important contributor to the clinical pain experiences of individuals with knee osteoarthritis (OA). Ethnic differences in the prevalence and severity of knee OA in addition to associated pain are also well documented. Temporal summation (TS) of pain is a widely applicable quantitative sensory testing method that invokes neural mechanisms related to pain facilitatory processes. This study tested whether TS of pain, an index of pain facilitation, differentially predicts the clinical pain experiences of African Americans and non-Hispanic whites with symptomatic knee OA. METHODS A total of 225 study participants underwent assessment of TS of mechanical and heat pain stimuli applied to their most symptomatic knee and their ipsilateral hand (mechanical) or forearm (heat). Using telephone-based surveys, participants subsequently reported their average and worst clinical pain severity across four consecutive weeks after the assessment of TS. RESULTS In predicting future clinical pain, ethnicity interacted with TS of mechanical pain (but not heat pain), such that TS of mechanical pain at the knee significantly predicted greater clinical ratings of average (b = 0.02, p = .016) and worst (b = 0.02, p = .044) clinical pain for non-Hispanic whites but not African Americans (p values > .30). CONCLUSIONS These results reveal the importance of considering ethnicity when examining pain facilitation and the clinical pain of individuals with symptomatic knee OA. The results of this study are discussed in terms of ethnic differences in the predictors of clinical pain experiences among African Americans and non-Hispanic whites with knee OA.
Collapse
|
57
|
Goodin BR, Pham QT, Glover TL, Sotolongo A, King CD, Sibille KT, Herbert MS, Cruz-Almeida Y, Sanden SH, Staud R, Redden DT, Bradley LA, Fillingim RB. Perceived racial discrimination, but not mistrust of medical researchers, predicts the heat pain tolerance of African Americans with symptomatic knee osteoarthritis. Health Psychol 2014; 32:1117-26. [PMID: 24219416 DOI: 10.1037/a0031592] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Studies have shown that perceived racial discrimination is a significant predictor of clinical pain severity among African Americans. It remains unknown whether perceived racial discrimination also alters the nociceptive processing of painful stimuli, which, in turn, could influence clinical pain severity. This study examined associations between perceived racial discrimination and responses to noxious thermal stimuli among African Americans and non-Hispanic Whites. Mistrust of medical researchers was also assessed given its potential to affect responses to the noxious stimuli. METHOD One-hundred and 30 (52% African American, 48% non-Hispanic White) community-dwelling older adults with symptomatic knee osteoarthritis completed two study sessions. In session one, individuals provided demographic, socioeconomic, physical and mental health information. They completed questionnaires related to perceived lifetime frequency of racial discrimination and mistrust of medical researchers. In session two, individuals underwent a series of controlled thermal stimulation procedures to assess heat pain sensitivity, particularly heat pain tolerance. RESULTS African Americans were more sensitive to heat pain and reported greater perceived racial discrimination as well as greater mistrust of medical researchers compared with non-Hispanic Whites. Greater perceived racial discrimination significantly predicted lower heat pain tolerance for African Americans but not non-Hispanic Whites. Mistrust of medical researchers did not significantly predict heat pain tolerance for either racial group. CONCLUSION These results lend support to the idea that perceived racial discrimination may influence the clinical pain severity of African Americans via the nociceptive processing of painful stimuli.
Collapse
|
58
|
Jarrett ME, Shulman RJ, Cain KC, Deechakawan W, Smith LT, Richebé P, Eugenio M, Heitkemper MM. Conditioned pain modulation in women with irritable bowel syndrome. Biol Res Nurs 2014; 16:368-77. [PMID: 24463504 DOI: 10.1177/1099800413520486] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Evidence suggests that patients with irritable bowel syndrome (IBS) are more vigilant to pain-associated stimuli. The aims of this study were to compare women with IBS (n = 20) to healthy control (HC, n = 20) women on pain sensitivity, conditioned pain modulation (CPM) efficiency, and salivary cortisol levels before and after the CPM test and to examine the relationship of CPM efficiency with gastrointestinal pain, somatic pain, psychological distress symptoms, and salivary cortisol levels in each group. Women, aged 20-42 years, gave consent, completed questionnaires, and kept a symptom diary for 2 weeks. CPM efficiency was tested with a heat test stimulus and cold water condition stimulus in a laboratory between 8 and 10 a.m. on a follicular phase day. Salivary cortisol samples were collected just before and after the experimental testing. Compared to the HC group, women with IBS reported more days with gastrointestinal and somatic pain/discomfort, psychological distress, fatigue, and feeling stressed. During the CPM baseline testing, women with IBS reported greater pain sensitivity compared to the HC group. There was no significant group difference in salivary cortisol levels nor in CPM efficiency, though a post-hoc analysis showed a higher prevalence of impaired CPM efficiency among IBS subjects with more severe lower-GI symptoms. In the IBS group, reduced CPM efficiency was associated with daily abdominal pain/discomfort and psychological distress. Overall, women with IBS exhibited an increased sensitivity to thermal stimuli. Impaired CPM was present in a subset of women with IBS.
Collapse
Affiliation(s)
- Monica E Jarrett
- Department of Biobehavioral Nursing and Health Systems, University of Washington, Seattle, WA, USA
| | - Robert J Shulman
- Department of Pediatrics, Children's Nutrition Research Center, Houston, TX, USA Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Kevin C Cain
- Department of Biostatistics and Office of Nursing Research, University of Washington, Seattle, WA, USA
| | - Wimon Deechakawan
- Department of Biobehavioral Nursing and Health Systems, University of Washington, Seattle, WA, USA
| | - Lynne T Smith
- Department of Biobehavioral Nursing and Health Systems, University of Washington, Seattle, WA, USA
| | - Philippe Richebé
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
| | | | - Margaret M Heitkemper
- Department of Biobehavioral Nursing and Health Systems, University of Washington, Seattle, WA, USA
| |
Collapse
|
59
|
Palit S, Kerr KL, Kuhn BL, DelVentura JL, Terry EL, Bartley EJ, Shadlow JO, Rhudy JL. Examining emotional modulation of pain and spinal nociception in Native Americans: A preliminary investigation. Int J Psychophysiol 2013; 90:272-81. [DOI: 10.1016/j.ijpsycho.2013.08.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 08/20/2013] [Accepted: 08/22/2013] [Indexed: 10/26/2022]
|
60
|
King CD, Sibille KT, Goodin BR, Cruz-Almeida Y, Glover TL, Bartley E, Riley JL, Herbert MS, Sotolongo A, Schmidt J, Fessler BJ, Redden DT, Staud R, Bradley LA, Fillingim RB. Experimental pain sensitivity differs as a function of clinical pain severity in symptomatic knee osteoarthritis. Osteoarthritis Cartilage 2013; 21:1243-52. [PMID: 23973137 PMCID: PMC3831366 DOI: 10.1016/j.joca.2013.05.015] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Revised: 05/14/2013] [Accepted: 05/20/2013] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Pain in knee osteoarthritis (OA) has historically been attributed to peripheral pathophysiology; however, the poor correspondence between objective measures of disease severity and clinical symptoms suggests that non-local factors, such as altered central processing of painful stimuli, also contribute to clinical pain in knee OA. Consistent with this notion, recent evidence demonstrates that patients with knee OA exhibit increased sensitivity to painful stimuli at body sites unaffected by clinical pain. DESIGN In order to further investigate the contribution of altered pain processing to knee OA pain, the current study tested the hypothesis that symptomatic knee OA is associated with enhanced sensitivity to experimental pain stimuli at the knee and at remote body sites unaffected by clinical pain. We further anticipated that pain sensitivity would differ as a function of the OA symptom severity. Older adults with and without symptomatic knee OA completed a series of experimental pain assessments. A median split of the Western Ontario and McMaster Universities Index of Osteoarthritis (WOMAC) was used to stratify participants into low vs high OA symptom severity. RESULTS Compared to controls and the low symptom group, individuals in the high symptom group were more sensitive to suprathreshold heat stimuli, blunt pressure, punctuate mechanical, and cold stimuli. Individuals in the low symptomatic OA group subgroup exhibited experimental pain responses similar to the pain-free group on most measures. No group differences in endogenous pain inhibition emerged. CONCLUSIONS These findings suggest that altered central processing of pain is particularly characteristic of individuals with moderate to severe symptomatic knee OA.
Collapse
Affiliation(s)
- Christopher D. King
- University of Florida Pain Research and Intervention Center of Excellence (PRICE), FL 32610, USA
| | - Kimberly T. Sibille
- University of Florida Pain Research and Intervention Center of Excellence (PRICE), FL 32610, USA
| | - Burel R. Goodin
- University of Alabama-Birmingham, Department of Psychology, Birmingham, AL 35294, USA
| | - Yenisel Cruz-Almeida
- University of Florida Pain Research and Intervention Center of Excellence (PRICE), FL 32610, USA
| | - Toni L. Glover
- University of Florida Pain Research and Intervention Center of Excellence (PRICE), FL 32610, USA
- University of Florida College of Nursing, Gainesville, FL 32610, USA
| | - Emily Bartley
- University of Florida Pain Research and Intervention Center of Excellence (PRICE), FL 32610, USA
| | - Joseph L. Riley
- University of Florida Pain Research and Intervention Center of Excellence (PRICE), FL 32610, USA
| | - Matthew S. Herbert
- University of Alabama at Birmingham, Division of Clinical Immunology and Rheumatology, Birmingham, AL 35294, USA
| | - Adriana Sotolongo
- University of Alabama at Birmingham, Division of Clinical Immunology and Rheumatology, Birmingham, AL 35294, USA
| | - Jessica Schmidt
- University of Alabama at Birmingham, Division of Clinical Immunology and Rheumatology, Birmingham, AL 35294, USA
| | - Barri J. Fessler
- University of Alabama at Birmingham, Division of Clinical Immunology and Rheumatology, Birmingham, AL 35294, USA
| | - David T. Redden
- University of Alabama at Birmingham, School of Public Health, Department of Biostatistics, Birmingham AL 35294, USA
| | - Roland Staud
- University of Florida, College of Medicine, Gainesville, FL 32610, USA
| | - Laurence A. Bradley
- University of Alabama at Birmingham, Division of Clinical Immunology and Rheumatology, Birmingham, AL 35294, USA
| | - Roger B. Fillingim
- University of Florida Pain Research and Intervention Center of Excellence (PRICE), FL 32610, USA
| |
Collapse
|
61
|
Cardiovascular influences on conditioned pain modulation. Pain 2013; 154:1377-82. [DOI: 10.1016/j.pain.2013.04.027] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Revised: 04/09/2013] [Accepted: 04/11/2013] [Indexed: 01/07/2023]
|
62
|
Kong JT, Schnyer RN, Johnson KA, Mackey S. Understanding central mechanisms of acupuncture analgesia using dynamic quantitative sensory testing: a review. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2013; 2013:187182. [PMID: 23762107 PMCID: PMC3666367 DOI: 10.1155/2013/187182] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/24/2012] [Revised: 03/17/2013] [Accepted: 03/29/2013] [Indexed: 01/14/2023]
Abstract
We discuss the emerging translational tools for the study of acupuncture analgesia with a focus on psychophysical methods. The gap between animal mechanistic studies and human clinical trials of acupuncture analgesia calls for effective translational tools that bridge neurophysiological data with meaningful clinical outcomes. Temporal summation (TS) and conditioned pain modulation (CPM) are two promising tools yet to be widely utilized. These psychophysical measures capture the state of the ascending facilitation and the descending inhibition of nociceptive transmission, respectively. We review the basic concepts and current methodologies underlying these measures in clinical pain research, and illustrate their application to research on acupuncture analgesia. Finally, we highlight the strengths and limitations of these research methods and make recommendations on future directions. The appropriate addition of TS and CPM to our current research armamentarium will facilitate our efforts to elucidate the central analgesic mechanisms of acupuncture in clinical populations.
Collapse
Affiliation(s)
- Jiang-Ti Kong
- Stanford Systems Neuroscience & Pain Laboratory, Department of Anesthesiology, Division of Pain Medicine, School of Medicine, Stanford University, 1070 Arastradero Road, Suite 200, Palo Alto, CA 94304, USA
| | - Rosa N. Schnyer
- School of Nursing, The University of Texas at Austin, Austin, TX 78701, USA
| | - Kevin A. Johnson
- Stanford Systems Neuroscience & Pain Laboratory, Department of Anesthesiology, Division of Pain Medicine, School of Medicine, Stanford University, 1070 Arastradero Road, Suite 200, Palo Alto, CA 94304, USA
| | - Sean Mackey
- Stanford Systems Neuroscience & Pain Laboratory, Department of Anesthesiology, Division of Pain Medicine, School of Medicine, Stanford University, 1070 Arastradero Road, Suite 200, Palo Alto, CA 94304, USA
| |
Collapse
|
63
|
Conditioned pain modulation in children and adolescents: effects of sex and age. THE JOURNAL OF PAIN 2013; 14:558-67. [PMID: 23541066 DOI: 10.1016/j.jpain.2013.01.010] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Revised: 01/10/2013] [Accepted: 01/11/2013] [Indexed: 11/21/2022]
Abstract
UNLABELLED Conditioned pain modulation (CPM) refers to the diminution of perceived pain intensity for a test stimulus following application of a conditioning stimulus to a remote area of the body, and is thought to reflect the descending inhibition of nociceptive signals. Studying CPM in children may inform interventions to enhance central pain inhibition within a developmental framework. We assessed CPM in 133 healthy children (mean age = 13 years; 52.6% girls) and tested the effects of sex and age. Participants were exposed to 4 trials of a pressure test stimulus before, during, and after the application of a cold water conditioning stimulus. CPM was documented by a reduction in pressure pain ratings during cold water administration. Older children (12-17 years) exhibited greater CPM than younger children (8-11 years). No sex differences in CPM were found. Lower heart rate variability at baseline and after pain induction was associated with less CPM, controlling for child age. The findings of greater CPM in the older age cohort suggest a developmental improvement in central pain inhibitory mechanisms. The results highlight the need to examine developmental and contributory factors in central pain inhibitory mechanisms in children to guide effective, age appropriate pain interventions. PERSPECTIVE In this healthy sample, younger children exhibited less CPM than did older adolescents, suggesting a developmental improvement in CPM. Cardiac vagal tone was associated with CPM across age. The current findings may inform the development of targeted, developmentally appropriate pain interventions for children.
Collapse
|
64
|
Alabas OA, Tashani OA, Johnson MI. Gender role expectations of pain mediate sex differences in cold pain responses in healthy Libyans. Eur J Pain 2012; 16:300-11. [PMID: 22323382 DOI: 10.1016/j.ejpain.2011.05.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Previous studies found a relationship between response to experimentally-induced pain and scores for the gender role expectations of pain (GREP) questionnaire. Findings were similar in individuals from America, Portugal and Israel suggesting that gender role expectations may be universal. The aim of this study was to translate and validate Arabic GREP using Factor Analysis and to investigate if sex differences to cold-pressor pain in healthy Libyan men and women are mediated through stereotypical social constructs of gender role expectations and/or pain-related anxiety. One hundred fourteen university students (58 women) underwent two cycles of cold pressor pain test to measure pain threshold, tolerance, intensity, and unpleasantness. Participants also completed the Arabic GREP questionnaire and the Pain Anxiety Symptom Scale-Short form (PASS-20). It was found that Libyan men had higher pain thresholds and tolerances than women (mean difference, 95% CI: threshold = 4.69 (s), -0.72 to 10.1, p = 0.005; tolerance = 13.46 (s), 0.5-26.4, p = 0.018). There were significant differences between sexes in 6 out of 12 GREP items (p < 0.004 after Bonferonni adjustment). The results of mediational analysis showed that GREP factors were the mediators of the effects of sex on pain threshold (z = -2.452, p = 0.014 for Self Sensitivity); (z = -2.563, p = 0.01, for Self Endurance) and on pain tolerance (z = -2.538, p = 0.01 for Self Endurance). In conclusion, sex differences in response to pain were mediated by gender role expectations of pain but not pain-related anxiety.
Collapse
Affiliation(s)
- O A Alabas
- Faculty of Health and Social Sciences, Leeds Metropolitan University, UK.
| | | | | |
Collapse
|
65
|
Mao J. Current challenges in translational pain research. Trends Pharmacol Sci 2012; 33:568-73. [PMID: 22959652 PMCID: PMC3482290 DOI: 10.1016/j.tips.2012.08.001] [Citation(s) in RCA: 90] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2012] [Revised: 08/08/2012] [Accepted: 08/13/2012] [Indexed: 12/31/2022]
Abstract
The current gap between basic science research and the development of new analgesics presents a serious challenge for the future of pain medicine. This challenge is particularly difficult in the search for better treatment for comorbid chronic pain conditions because: (i) animal 'pain' models do not simulate multidimensional clinical pain conditions; (ii) animal behavioral testing does not assess subjective pain experience; (iii) preclinical data provide little assurance regarding the direction of new analgesic development; and (iv) clinical trials routinely use over-sanitized study populations and fail to capture the multidisciplinary consequences of comorbid chronic pain. Therefore, a paradigm shift in translational pain research is necessary to transform the current strategy from focusing on molecular switches of nociception to studying pain as a system-based integral response that includes psychosocial comorbidities. Several key issues of translational pain research are discussed in this review.
Collapse
Affiliation(s)
- Jianren Mao
- MGH Center for Translational Pain Research, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
| |
Collapse
|
66
|
Bartley EJ, Rhudy JL. Endogenous inhibition of the nociceptive flexion reflex (NFR) and pain ratings during the menstrual cycle in healthy women. Ann Behav Med 2012; 43:343-51. [PMID: 22289982 DOI: 10.1007/s12160-012-9345-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
BACKGROUND The menstrual cycle influences pain, with symptoms often increasing during the premenstrual (late-luteal) phase. Deficiencies in endogenous inhibition of afferent nociception at the spinal level might contribute to menstrual phase-related changes in pain. PURPOSE This study assessed whether conditioned pain modulation (CPM) of spinal nociception differs between mid-follicular and late-luteal phases. METHODS CPM was evoked by a blood pressure cuff affixed to the right forearm and inflated to induce ischemia in 41 healthy women during both menstrual phases. Suprathreshold electric stimuli were delivered to the left sural nerve to evoke pain and the nociceptive flexion reflex (NFR) before, during, and after forearm ischemia. RESULTS Forearm ischemia produced CPM of electrocutaneous pain and NFR, but inhibition did not differ across mid-follicular and late-luteal phases. CONCLUSIONS Mechanisms contributing to changes in experimental pain across mid-follicular and late-luteal phases in healthy women are not due to deficits in CPM of spinal nociception.
Collapse
Affiliation(s)
- Emily J Bartley
- Department of Psychology, The University of Tulsa, OK 74104, USA
| | | |
Collapse
|
67
|
Ladouceur A, Tessier J, Provencher B, Rainville P, Piché M. Top-down attentional modulation of analgesia induced by heterotopic noxious counterstimulation. Pain 2012; 153:1755-1762. [DOI: 10.1016/j.pain.2012.05.019] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Revised: 05/09/2012] [Accepted: 05/15/2012] [Indexed: 01/20/2023]
|
68
|
Nilsen KB, Christiansen SE, Holmen LB, Sand T. The effect of a mental stressor on conditioned pain modulation in healthy subjects. Scand J Pain 2012; 3:142-148. [DOI: 10.1016/j.sjpain.2012.04.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2011] [Accepted: 04/30/2012] [Indexed: 10/28/2022]
Abstract
Abstract
Background and purpose
In animal studies, enhanced sensitivity to painful stimuli succeeding chronic stress has been reported, while acute stress is reported to induce analgesia. Human studies on the effect of mental stress on pain are more equivocal. A disturbed stress-response resulting in an increased sensitivity to painful stimuli has also been discussed as a potential mechanism for e.g., the fibromyalgia syndrome. Endogenous analgesia may be studied in humans by measuring the analgesic effect of heterotopic noxious conditioning stimulation. In neurophysiological animal studies this phenomenon was originally denoted “diffuse noxious inhibitory controls” (DNIC), but for human studies it has been suggested to use the term conditioned pain modulation (CPM).
The clinical relevance of aberrances in CPM is not clear. Inhibitory CPM is reported as being reduced in several medically unexplained syndromes with musculoskeletal pain aggravated by mental stress. However, whether the reported reduced CPM effects are causally related to clinical pain is unknown.
In the present study the effect of a mental stressor on CPM is studied.
Methods
With tourniquet-induced pain as the conditioning stimulus we estimated the CPM effect in twenty healthy subjects. Heat pain threshold (HPT), supra-threshold heat pain level (SHPL) and pressure pain threshold (PPT) were used as test stimuli. Measurements were performed at baseline, after a stressful task and after a non-stressful task presented in a blinded cross-over design. We used repeated-measures ANOVAs in the analysis with simple contrasts for post hoc analysis.
Results
With a ANOVA repeated measures model we found a significant task effect (F = 18.5, p ≤ 0.001), indicating that CPM was successfully induced. In our ANOVA model, we found a significant effect of stress in the contrast analysis (F = 5.2, p = 0.037), indicating that CPM was affected by the stressful task. The effects on PPT could not be analyzed due to a significant carry-over effect (for PPT only).
Conclusions
In the present blinded crossover study, we found a significant small to medium inhibitory effect of mental stress upon the CPM of thermal pain.
Implications
Our results suggest that previously reported reduced inhibitory CPM in several medically unexplained syndromes with musculoskeletal pain aggravated by mental stress possibly can be related to confounding or clinically relevant stress level differences. However, the result might be modality-specific. Further studies in patients are obviously needed, and the impact of mental stress on CPM should be investigated also with other stressors.
Collapse
Affiliation(s)
- Kristian B. Nilsen
- Norwegian University of Science and Technology , Department of Neuroscience , Trondheim , Norway
- National Institute of Occupational Health , Dept. of Work-related Musculoskeletal Disorders , Oslo , Norway
- Oslo University Hospital – Ullevål , Department of Neurology, Section for Clinical Neurophysiology , Oslo , Norway
| | - Sunniva E. Christiansen
- Norwegian University of Science and Technology , Department of Neuroscience , Trondheim , Norway
| | - Line B. Holmen
- Norwegian University of Science and Technology , Department of Neuroscience , Trondheim , Norway
| | - Trond Sand
- Norwegian University of Science and Technology , Department of Neuroscience , Trondheim , Norway
- St. Olavs Hospital , Department of Neurology and Clinical Neurophysiology , Trondheim , Norway
| |
Collapse
|
69
|
Olesen AE, Andresen T, Staahl C, Drewes AM. Human experimental pain models for assessing the therapeutic efficacy of analgesic drugs. Pharmacol Rev 2012; 64:722-79. [PMID: 22722894 DOI: 10.1124/pr.111.005447] [Citation(s) in RCA: 161] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Pain models in animals have shown low predictivity for analgesic efficacy in humans, and clinical studies are often very confounded, blurring the evaluation. Human experimental pain models may therefore help to evaluate mechanisms and effect of analgesics and bridge findings from basic studies to the clinic. The present review outlines the concept and limitations of human experimental pain models and addresses analgesic efficacy in healthy volunteers and patients. Experimental models to evoke pain and hyperalgesia are available for most tissues. In healthy volunteers, the effect of acetaminophen is difficult to detect unless neurophysiological methods are used, whereas the effect of nonsteroidal anti-inflammatory drugs could be detected in most models. Anticonvulsants and antidepressants are sensitive in several models, particularly in models inducing hyperalgesia. For opioids, tonic pain with high intensity is attenuated more than short-lasting pain and nonpainful sensations. Fewer studies were performed in patients. In general, the sensitivity to analgesics is better in patients than in healthy volunteers, but the lower number of studies may bias the results. Experimental models have variable reliability, and validity shall be interpreted with caution. Models including deep, tonic pain and hyperalgesia are better to predict the effects of analgesics. Assessment with neurophysiologic methods and imaging is valuable as a supplement to psychophysical methods and can increase sensitivity. The models need to be designed with careful consideration of pharmacological mechanisms and pharmacokinetics of analgesics. Knowledge obtained from this review can help design experimental pain studies for new compounds entering phase I and II clinical trials.
Collapse
Affiliation(s)
- Anne Estrup Olesen
- Mech-Sense, Department of Gastroenterology & Hepatology, Aalborg Hospital, Mølleparkvej 4, 9000 Aalborg, Denmark.
| | | | | | | |
Collapse
|
70
|
Hastie BA, Riley JL, Kaplan L, Herrera DG, Campbell CM, Virtusio K, Mogil JS, Wallace MR, Fillingim RB. Ethnicity interacts with the OPRM1 gene in experimental pain sensitivity. Pain 2012; 153:1610-1619. [PMID: 22717102 DOI: 10.1016/j.pain.2012.03.022] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2011] [Revised: 02/28/2012] [Accepted: 03/21/2012] [Indexed: 01/13/2023]
Abstract
Robust interindividual variation in pain sensitivity has been observed, and recent evidence suggests that some of the variability may be genetically mediated. Our previous data revealed significantly higher pressure pain thresholds among individuals possessing the minor G allele of the A118G SNP of the mu-opioid receptor gene (OPRM1) compared with those with 2 consensus alleles. Moreover, ethnic differences in pain sensitivity have been widely reported. Yet, little is known about the potential interactive associations of ethnicity and genotype with pain perception. This study aimed to identify ethnic differences in OPRM1 allelic associations with experimental pain responses. A total of 247 healthy young adults from three ethnic groups (81 African Americans; 79 non-white Hispanics; and 87 non-Hispanic whites) underwent multiple experimental pain modalities (thermal, pressure, ischemic, cold pressor). Few African Americans (7.4%) expressed the rare allele of OPRM1 compared to non-Hispanic whites and Hispanics (28.7% vs. 27.8%, respectively). Across the entire sample, OPRM1 genotype did not significantly affect pain sensitivity. However, analysis in each ethnic group separately revealed significant genotype effects for most pain modalities among non-Hispanic-whites (P<.05) but not Hispanics or African Americans. The G allele was associated with decreased pain sensitivity among whites only; a trend in the opposite direction emerged in Hispanics. The reasons for this dichotomy are unclear; they may involve ethnic differences in haplotypic structure, or A118G may be a tag-SNP linked to other functional polymorphisms. These findings demonstrate an ethnicity-dependent association of OPRM1 genotype with pain sensitivity. Additional research is warranted to uncover the mechanisms influencing these relationships.
Collapse
Affiliation(s)
- Barbara A Hastie
- Department of Community Dentistry and Behavioral Science, University of Florida College of Dentistry, Gainesville, FL, USA Genoptix Medical Laboratory, Carlsbad, CA, USA Centers for Disease Control and Prevention, Atlanta, GA, USA Department of Psychiatry and Behavioral Science, Johns Hopkins University, Baltimore, MD, USA Department of Psychology and Alan Edwards Centre for Research on Pain, McGill University, Montreal, Quebec, Canada Department of Molecular Genetics and Microbiology, University of Florida College of Medicine, Gainesville, FL, USA Malcom Randall V.A. Medical Center, Gainesville, FL, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
71
|
Reliability of the conditioned pain modulation paradigm to assess endogenous inhibitory pain pathways. Pain Res Manag 2012; 17:98-102. [PMID: 22518372 DOI: 10.1155/2012/610561] [Citation(s) in RCA: 138] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Conditioned pain modulation paradigms are often used to assess the diffuse noxious inhibitory control (DNIC) system. DNICs provide one of the main supraspinal pain inhibitory pathways and are impaired in several chronic pain populations. Only one previous study has examined the psychometric properties of the conditioned pain modulation technique and this study did not evaluate intersession reliability. OBJECTIVES To evaluate and compare the intra- and intersession reliability of two conditioned pain modulation paradigms using different conditioning stimuli, and to determine the time course of conditioned pain inhibition following stimulus removal. METHODS An electronic pressure transducer was used to determine the pressure-pain threshold at the knee during painful conditioning of the opposite hand using the ischemic arm test and the cold pressor test. Assessments were completed twice on one day and repeated once approximately three days later. RESULTS The two conditioning stimuli resulted in a similar increase in the pressure-pain threshold at the knee, reflecting presumed activation of the DNIC system. Intrasession intraclass correlation coefficients for the cold pressor (0.85) and ischemic arm tests (0.75) were excellent. The intersession intraclass correlation coefficient for the cold pressor test was good (0.66) but was poor for the ischemic arm test (-0.4). Inhibition of the pressure-pain threshold remained significant at 10 min following conditioning, but returned to baseline by 15 min. CONCLUSIONS Within-session reliability of DNIC assessment using conditioned pain modulation paradigms was excellent, but the applicability of assessing pain modulation over multiple sessions was influenced by the conditioning stimulus. The cold pressor test was the superior technique.
Collapse
|
72
|
Abstract
Considerable evidence demonstrates substantial ethnic disparities in the prevalence, treatment, progression and outcomes of pain-related conditions. Elucidating the mechanisms underlying these group differences is of crucial importance in reducing and eliminating disparities in the pain experience. Over recent years, accumulating evidence has identified a variety of processes, from neurophysiological factors to structural elements of the healthcare system, that may contribute to shaping individual differences in pain. For example, the experience of pain differentially activates stress-related physiological responses across various ethnic groups, members of different ethnic groups appear to use differing coping strategies in managing pain complaints, providers' treatment decisions vary as a function of patient ethnicity and pharmacies in predominantly minority neighborhoods are far less likely to stock potent analgesics. These diverse factors, and others may all play a role in facilitating elevated levels of pain-related suffering among individuals from ethnic minority backgrounds. Here, we present a brief, nonexhaustive review of the recent literature and potential physiological and sociocultural mechanisms underlying these ethnic group disparities in pain outcomes.
Collapse
Affiliation(s)
- Claudia M Campbell
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, G Building, Suite 100, Baltimore, MD 21224, USA
| | | |
Collapse
|
73
|
McCann B, Miaskowski C, Koetters T, Baggott C, West C, Levine JD, Elboim C, Abrams G, Hamolsky D, Dunn L, Rugo H, Dodd M, Paul SM, Neuhaus J, Cooper B, Schmidt B, Langford D, Cataldo J, Aouizerat BE. Associations between pro- and anti-inflammatory cytokine genes and breast pain in women prior to breast cancer surgery. THE JOURNAL OF PAIN 2012; 13:425-37. [PMID: 22515947 PMCID: PMC3348353 DOI: 10.1016/j.jpain.2011.02.358] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2011] [Revised: 01/27/2012] [Accepted: 02/04/2012] [Indexed: 02/07/2023]
Abstract
UNLABELLED The purposes of this study were to determine the occurrence rate for preoperative breast pain; describe the characteristics of this pain; evaluate for differences in demographic and clinical characteristics; and evaluate for variations in pro- and anti-inflammatory cytokine genes between women who did and did not report pain. Patients (n = 398) were recruited prior to surgery and completed self-report questionnaires on a number of pain characteristics. Genotyping was done using a custom genotyping array. Women (28.2%) who reported breast pain were significantly younger (P < .001); more likely to be nonwhite (P = .032); reported significantly lower Karnofsky Performance Status scores (P = .008); were less likely to be postmenopausal (P = .012); and had undergone significantly more biopsies (P = .006). Carriers of the minor allele for a single nucleotide polymorphism in interleukin (IL)1-receptor 1 (IL1R1) (rs2110726) were less likely to report breast pain prior to surgery (P = .007). Carriers of the minor allele for a single nucleotide polymorphism in IL13 (rs1295686) were more likely to report breast pain prior to surgery (P = .019). Findings suggest that breast pain occurs in over a quarter of women who are about to undergo breast cancer surgery. Based on phenotypic and genotypic characteristics found, inflammatory mechanisms contribute to preoperative breast pain. PERSPECTIVE In women with breast cancer, preoperative pain may be associated with increases in inflammatory responses associated with an increased number of biopsies. In addition, differences in cytokine genes may contribute to this preoperative breast pain.
Collapse
Affiliation(s)
- Birha McCann
- School of Nursing, University of California, San Francisco, CA
| | | | | | | | - Claudia West
- School of Nursing, University of California, San Francisco, CA
| | - Jon D. Levine
- School of Medicine, University of California, San Francisco, CA
| | | | - Gary Abrams
- School of Medicine, University of California, San Francisco, CA
| | | | - Laura Dunn
- School of Medicine, University of California, San Francisco, CA
| | - Hope Rugo
- School of Medicine, University of California, San Francisco, CA
| | - Marylin Dodd
- School of Nursing, University of California, San Francisco, CA
| | - Steven M. Paul
- School of Nursing, University of California, San Francisco, CA
| | - John Neuhaus
- School of Medicine, University of California, San Francisco, CA
| | - Bruce Cooper
- School of Nursing, University of California, San Francisco, CA
| | - Brian Schmidt
- School of Dentistry, New York University, New York, NY
| | - Dale Langford
- School of Nursing, University of California, San Francisco, CA
| | - Janine Cataldo
- School of Nursing, University of California, San Francisco, CA
| | - Bradley E. Aouizerat
- School of Nursing, University of California, San Francisco, CA
- the Institute for Human Genetics, University of California, San Francisco, CA
| |
Collapse
|
74
|
Testing the relation between dispositional optimism and conditioned pain modulation: does ethnicity matter? J Behav Med 2012; 36:165-74. [PMID: 22367226 DOI: 10.1007/s10865-012-9411-7] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2011] [Accepted: 02/15/2012] [Indexed: 10/28/2022]
Abstract
Greater dispositional optimism has been related to less severe pain; however, whether optimism is associated with endogenous pain modulation has not yet been examined. The beneficial effects of dispositional optimism often vary according to cultural dynamics. Thus, assessing optimism-pain relationships across different ethnic groups is warranted. This study sought to examine the association between optimism and conditioned pain modulation (CPM), and test whether this association differs according to ethnicity. Optimism and CPM were assessed in a sample of healthy, ethnically diverse young adults. CPM was determined by comparing pressure pain thresholds obtained before and during exposure to a cold pressor task. All participants completed a validated measure of dispositional optimism. Greater reported optimism was significantly associated with enhanced CPM, and the strength of this association did not vary according to individuals' ethnic background. These findings suggest that an optimistic disposition may potentiate endogenous pain inhibition.
Collapse
|
75
|
Tomecka MJ, Bortsov AV, Miller NR, Solano N, Narron J, McNaull PP, Ricketts KJ, Lupa CM, McLean SA. Substantial postoperative pain is common among children undergoing laparoscopic appendectomy. Paediatr Anaesth 2012; 22:130-5. [PMID: 21958060 DOI: 10.1111/j.1460-9592.2011.03711.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Laparoscopic appendectomy is one of the most common surgical procedures performed in children. However, to our knowledge, the postoperative pain experience of children undergoing laparoscopic appendectomy has never been described. In this study, we assessed the postoperative pain experience of children undergoing laparoscopic appendectomy. METHODS A retrospective chart review of children aged 9-17 years undergoing laparoscopic appendectomy at a large academic medical center from 2004 to 2010 was performed. Demographic and clinical characteristics and self-reported pain scores (0-10 numeric rating scale) during hospitalization were abstracted from the medical record. Pain scores ≥4 were classified as moderate or severe. If ≥60% of pain ratings were moderate or severe during a specified time period (e.g., particular postoperative day), then the child was defined as experiencing substantial pain during that time. Pain outcomes were summarized using descriptive statistics. Secondary analyses assessed the predictors of substantial postoperative pain. RESULTS Hundred and eighty-six children underwent laparoscopic appendectomy during the study period. One in three children experienced substantial postoperative pain on the day of surgery, and one in five children continued to have substantial pain the next day. Commonly available clinical and demographic characteristics were poor predictors of substantial postoperative pain. CONCLUSION These preliminary data suggest that substantial postoperative pain is common in children undergoing laparoscopic appendectomy. More studies of postoperative pain outcomes among children undergoing laparoscopic appendectomy and other common pediatric surgical procedures are needed.
Collapse
Affiliation(s)
- Maggie J Tomecka
- Department of Anesthesiology, University of North Carolina, Chapel Hill, NC 27599-7455, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
76
|
Does acupuncture needling induce analgesic effects comparable to diffuse noxious inhibitory controls? EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2011; 2012:785613. [PMID: 21760827 PMCID: PMC3132481 DOI: 10.1155/2012/785613] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2011] [Accepted: 05/10/2011] [Indexed: 12/03/2022]
Abstract
Diffuse noxious inhibitory control (DNIC) is described as one possible mechanism of acupuncture analgesia. This study investigated the analgesic effect of acupuncture without stimulation compared to nonpenetrating sham acupuncture (NPSA) and cold-pressor-induced DNIC. Forty-five subjects received each of the three interventions in a randomized order. The analgesic effect was measured using pressure algometry at the second toe before and after each of the interventions. Pressure pain detection threshold (PPDT) rose from 299 kPa (SD 112 kPa) to 364 kPa (SD 144), 353 kPa (SD 135), and 467 kPa (SD 168) after acupuncture, NPSA, and DNIC test, respectively. There was no statistically significant difference between acupuncture and NPSA at any time, but a significantly higher increase of PPDT in the DNIC test compared to acupuncture and NPSA. PPDT decreased after the DNIC test, whereas it remained stable after acupuncture and NPSA. Acupuncture needling at low pain stimulus intensity showed a small analgesic effect which did not significantly differ from placebo response and was significantly less than a DNIC-like effect of a painful noninvasive stimulus.
Collapse
|
77
|
Defrin R, Eli I, Pud D. Interactions Among Sex, Ethnicity, Religion, and Gender Role Expectations of Pain. ACTA ACUST UNITED AC 2011; 8:172-83. [DOI: 10.1016/j.genm.2011.04.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2011] [Revised: 03/23/2011] [Accepted: 04/04/2011] [Indexed: 11/25/2022]
|
78
|
Mao J, Gold MS, Backonja MM. Combination drug therapy for chronic pain: a call for more clinical studies. THE JOURNAL OF PAIN 2011; 12:157-66. [PMID: 20851058 PMCID: PMC3006488 DOI: 10.1016/j.jpain.2010.07.006] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2010] [Revised: 06/28/2010] [Accepted: 07/10/2010] [Indexed: 01/06/2023]
Abstract
UNLABELLED Chronic pain is a debilitating clinical condition associated with a variety of disease entities including diabetic neuropathy, postherpetic neuralgia, low back pathology, fibromyalgia, and neurological disorders. For many general practitioners and specialists, managing chronic pain has become a daunting challenge. As a modality of multidisciplinary chronic pain management, medications are often prescribed in combinations, an approach referred to as combination drug therapy (CDT). However, many medications for pain therapy, including antidepressants and opioid analgesics, have significant side effects that can compound when used in combination and impact the effectiveness of CDT. To date, clinical practice of CDT for chronic pain has been based largely on clinical experiences. In this article, we will focus on (1) the scientific basis and rationales for CDT, (2) current clinical data on CDT, and (3) the need for more clinical studies to establish a framework for the use of CDT. PERSPECTIVE More preclinical, clinical, and translational studies are needed to improve the efficacy of combination drug therapy that is an integral part of a comprehensive approach to the management of chronic pain.
Collapse
Affiliation(s)
- Jianren Mao
- MGHCenter for Translational Pain Research, Department of Anesthesia, Harvard Medical School, Boston, MA 02114, USA.
| | | | | |
Collapse
|
79
|
Mechlin B, Heymen S, Edwards CL, Girdler SS. Ethnic differences in cardiovascular-somatosensory interactions and in the central processing of noxious stimuli. Psychophysiology 2010; 48:762-73. [PMID: 21039586 DOI: 10.1111/j.1469-8986.2010.01140.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Ethnic differences in central sensitization of pain processing and stress-relevant endogenous pain regulatory mechanisms were examined. Forty-four African Americans (AAs; 50% women) and 44 non-Hispanic Whites (nHWs; 50% women) matched for socioeconomic status, were tested for pain responses to the temporal summation of heat pulses and ischemic and cold pain. Resting and stress blood pressure (BP) and norepinephrine (NE) were assessed. AAs had heightened pain responses to all 3 pain tasks relative to nHWs. In nHWs, higher BP and NE were related to reduced pain. In AAs, there was no relationship between BP and pain, but higher NE was related to increased pain. This study provides evidence for ethnic differences in centrally mediated pain and extends prior research demonstrating ethnic differences in endogenous pain regulatory mechanisms. These results have implications for understanding biobehavioral factors contributing to ethnic disparities in clinical pain.
Collapse
Affiliation(s)
- Beth Mechlin
- Department of Psychology, Washington and Lee University, Lexington, Virginia 24450, USA.
| | | | | | | |
Collapse
|
80
|
Popescu A, LeResche L, Truelove EL, Drangsholt MT. Gender differences in pain modulation by diffuse noxious inhibitory controls: A systematic review. Pain 2010; 150:309-318. [DOI: 10.1016/j.pain.2010.05.013] [Citation(s) in RCA: 147] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2010] [Revised: 05/12/2010] [Accepted: 05/14/2010] [Indexed: 01/25/2023]
|
81
|
van Wijk G, Veldhuijzen DS. Perspective on Diffuse Noxious Inhibitory Controls as a Model of Endogenous Pain Modulation in Clinical Pain Syndromes. THE JOURNAL OF PAIN 2010; 11:408-19. [DOI: 10.1016/j.jpain.2009.10.009] [Citation(s) in RCA: 204] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2009] [Revised: 09/28/2009] [Accepted: 10/26/2009] [Indexed: 11/16/2022]
|
82
|
Racial and ethnic disparities in pain: causes and consequences of unequal care. THE JOURNAL OF PAIN 2010; 10:1187-204. [PMID: 19944378 DOI: 10.1016/j.jpain.2009.10.002] [Citation(s) in RCA: 542] [Impact Index Per Article: 38.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
UNLABELLED The purpose of our review is to evaluate critically the recent literature on racial and ethnic disparities in pain and to determine how far we have come toward reducing and eliminating disparities in pain. We examined peer-reviewed research articles published between 1990 and early 2009 that focused on racial and ethnic disparities in pain in the United States. The databases used were PubMed, Medline, Scopus, CINAHL, and PsycInfo. The probable causes of minority group disparities in pain are discussed, along with suggested strategies for eliminating pain-related disparities. This review reveals the persistence of racial and ethnic disparities in acute, chronic, cancer, and palliative pain care across the lifespan and treatment settings, with minorities receiving lesser quality pain care than non-Hispanic whites. Although health and health care disparities attract local, state, and federal attention, disparities in pain care continue to be missing from publicized public health agendas and health care reform plans. Ensuring optimal pain care for all is critically important from a public health and policy perspective. A robust research program on disparities in pain is needed, and the results must be successfully translated into practices and policies specifically designed to reduce and eliminate disparities in care. PERSPECTIVE This review evaluates the recent literature on racial and ethnic disparities in pain and pain treatment. Racial and ethnic disparities in acute pain, chronic cancer pain, and palliative pain care continue to persist. Rigorous research is needed to develop interventions, practices, and policies for eliminating disparities in pain.
Collapse
|
83
|
Bruehl S, Dengler-Crish CM, Smith CA, Walker LS. Hypoalgesia related to elevated resting blood pressure is absent in adolescents and young adults with a history of functional abdominal pain. Pain 2010; 149:57-63. [PMID: 20122805 DOI: 10.1016/j.pain.2010.01.009] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2009] [Revised: 11/23/2009] [Accepted: 01/12/2010] [Indexed: 01/26/2023]
Abstract
Elevated resting blood pressure (BP) is hypoalgesic in healthy individuals, but this effect is absent in adults with chronic somatic pain. This study tested whether BP-related hypoalgesia is similarly altered in individuals with a history of chronic visceral pain in childhood. Resting BP was assessed in 94 adolescents and young adults with a known history of childhood functional abdominal pain (FAP) and 55 comparable healthy controls. Responses to an acute heat pain stimulus were then evaluated following exposure to two laboratory stressors. A significant participant type x systolic BP (SBP) interaction (p<.005) revealed that elevated resting SBP was associated with significantly higher heat pain threshold (p<.001) in healthy controls, but was unrelated to pain threshold in the FAP group. A similar pattern was observed for heat pain tolerance, with elevated SBP linked to significantly higher pain tolerance (p<.05) in healthy controls, but unrelated to tolerance in the FAP group. Dysfunction in BP-related hypoalgesia associated with FAP was evident regardless of whether childhood FAP had resolved or still persisted at the time of laboratory testing. Subgroup analyses indicated that BP-related hypoalgesia (in healthy controls) and FAP-linked absence of this hypoalgesia was observed only among females. Result suggest that childhood visceral chronic pain may be associated with relatively long-lasting dysfunction in overlapping systems modulating pain and BP that persists even after FAP resolves. Potential implications for later hypertension risk are discussed.
Collapse
Affiliation(s)
- Stephen Bruehl
- Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, TN, USA Department of Pediatrics, Vanderbilt University School of Medicine, The Monroe Carell Jr. Children's Hospital, Vanderbilt, Nashville, TN, USA Department of Psychology and Human Development, Vanderbilt University, Nashville, TN, USA
| | | | | | | |
Collapse
|
84
|
Affiliation(s)
- Mark Hollins
- Department of Psychology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599;
| |
Collapse
|
85
|
Kindler LL, Bennett RM, Jones KD. Central sensitivity syndromes: mounting pathophysiologic evidence to link fibromyalgia with other common chronic pain disorders. Pain Manag Nurs 2009; 12:15-24. [PMID: 21349445 DOI: 10.1016/j.pmn.2009.10.003] [Citation(s) in RCA: 105] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2009] [Revised: 10/22/2009] [Accepted: 10/22/2009] [Indexed: 10/20/2022]
Abstract
The aim of this study was to review emerging data from the fields of nursing, rheumatology, dentistry, gastroenterology, gynecology, neurology, and orthopedics that support or dispute pathophysiologic similarities in pain syndromes studied by each specialty. A literature search was performed through PubMed and Ovid using the terms fibromyalgia, temporomandibular joint disorder, irritable bowel syndrome, irritable bladder/interstitial cystitis, headache, chronic low back pain, chronic neck pain, functional syndromes, and somatization. Each term was linked with pathophysiology and/or central sensitization. This paper presents a review of relevant articles with a specific goal of identifying pathophysiologic findings related to nociceptive processing. The extant literature presents considerable overlap in the pathophysiology of these diagnoses. Given the psychosomatic lens through which many of these disorders are viewed, demonstration of evidence-based links supporting shared pathophysiology between these disorders could provide direction to clinicians and researchers working to treat these diagnoses. "Central sensitivity syndromes" denotes an emerging nomenclature that could be embraced by researchers investigating each of these disorders. Moreover, a shared paradigm would be useful in promoting cross-fertilization between researchers. Scientists and clinicians could most effectively forward the understanding and treatment of fibromyalgia and other common chronic pain disorders through an appreciation of their shared pathophysiology.
Collapse
Affiliation(s)
- Lindsay L Kindler
- Center for Comprehensive Pain Research, University of Florida, Gainesville, Florida, USA.
| | | | | |
Collapse
|
86
|
Keen HI, Bingham CO, Bradley LA, Conaghan PG, Heald AE, Kaeley GS, Maksymowych WP, Moskowitz RW, Schumacher HR, Woodworth TE, Mease PJ. Assessing single joints in arthritis clinical trials. J Rheumatol 2009; 36:2092-6. [PMID: 19738219 DOI: 10.3899/jrheum.090364] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The need to develop validated outcome measures to assess response to therapies in single joints has been recognized. In 2004, a task force was established to assess established and novel outcome measures in accordance with the OMERACT filter (truth, discrimination, and feasibility) for single joint assessment. This report describes the proceedings of the single joint assessment special interest group (SIG) at OMERACT 9, including an updated literature review of imaging of the knee joints, with a focus on the extent to which these modalities fulfill the OMERACT filter. A series of studies are reported that examine patient reported, clinical examination, and imaging outcomes in therapeutic studies in knee arthritis. A summary of discussions from the meeting are presented that raise many of the ongoing challenges in establishing appropriate domains to evaluate a range of conditions and potential therapeutic interventions. Because of emerging drug candidates and modalities targeting individual joints, the ongoing work of this SIG is providing the evidence base that can be used to establish a core domain set to incorporate as outcomes in future studies.
Collapse
Affiliation(s)
- Helen I Keen
- School of Medicine and Pharmacology, University of Western Australia, Perth, Australia.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
87
|
Mao J. Translational pain research: achievements and challenges. THE JOURNAL OF PAIN 2009; 10:1001-11. [PMID: 19628433 DOI: 10.1016/j.jpain.2009.06.002] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2009] [Revised: 05/29/2009] [Accepted: 05/29/2009] [Indexed: 10/20/2022]
Abstract
UNLABELLED The achievements in both preclinical and clinical pain research over the past 4 decades have led to significant progress in clinical pain management. However, pain research still faces enormous challenges and there remain many obstacles in the treatment of clinical pain, particularly chronic pain. Translational pain research needs to involve a number of important areas including: 1) bridging the gap between pain research and clinical pain management; 2) developing objective pain-assessment tools; 3) analyzing current theories of pain mechanisms and their relevance to clinical pain; 4) exploring new tools for both preclinical and clinical pain research; and 5) coordinating research efforts among basic scientists, clinical investigators, and pain-medicine practitioners. These issues are discussed in this article in light of the achievements and challenges of translational pain research. PERSPECTIVE The subjective nature of clinical pain calls for innovative research approaches. As translational pain research emerges as an important field in pain medicine, it will play a unique role in improving clinical pain management through coordinated bidirectional research approaches between bedside and bench.
Collapse
Affiliation(s)
- Jianren Mao
- MGH Center for Translational Pain Research, Department of Anesthesia and Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA.
| |
Collapse
|
88
|
Pud D, Granovsky Y, Yarnitsky D. The methodology of experimentally induced diffuse noxious inhibitory control (DNIC)-like effect in humans. Pain 2009; 144:16-9. [DOI: 10.1016/j.pain.2009.02.015] [Citation(s) in RCA: 311] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2009] [Revised: 02/15/2009] [Accepted: 02/19/2009] [Indexed: 01/28/2023]
|