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Powell-Roach KL, Yao Y, Rutherford JN, Schlaeger JM, Patil CL, Suarez ML, Shuey D, Angulo V, Carrasco J, Ezenwa MO, Fillingim RB, Wang ZJ, Molokie RE, Wilkie DJ. Thermal and mechanical quantitative sensory testing values among healthy African American adults. J Pain Res 2019; 12:2511-2527. [PMID: 31496792 PMCID: PMC6693422 DOI: 10.2147/jpr.s211855] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 07/09/2019] [Indexed: 12/26/2022] Open
Abstract
PURPOSE Only a few studies have reported quantitative sensory testing (QST) reference values for healthy African Americans, and those studies are limited in sample size and age of participants. The study purpose was to characterize QST values in healthy, pain-free African American adults and older adults whose prior pain experiences and psychological status were also measured. We examined the QST values for differences by sex, age, and body test site. PATIENTS AND METHODS A cross-sectional sample of 124 pain-free African American adults (age 18-69 years, 49% female) completed demographic and self-reported pain, fatigue and psychosocial measures. QST was performed to obtain thermal and mechanical responses and associated pain intensity levels. RESULTS We found thermal detection values at the anterior forearm were (29.2 °C±1.6) for cool detection (CD) and (34.5 °C±1.2) for warm detection (WD). At that site the sample had cold pain threshold (CPTh) (26.3 °C±5.0), heat pain threshold (HPTh) (37.8 °C±3.6), and mechanical pain thresholds (MPTH) (16.7±22.2 grams of force, gF). There was a significant between sex difference for WD, with women being more sensitive (q=0.027). Lower body sites were less sensitive than upper body sites across all thermal modalities (q<0.003), but not for the mechanical modality. CONCLUSION The QST values from this protocol at the anterior forearm indicate that the healthy African American adults had average thermal pain thresholds close to the temperature of adaptation and average MPTh under 20 gF. Differences in responses to thermal and mechanical stimuli for upper verses lower body were consistent with prior research.
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Affiliation(s)
- Keesha L Powell-Roach
- Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, Gainesville, FL, USA
| | - Yingwei Yao
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, FL, USA
| | - Julienne N Rutherford
- Department of Women, Children and Family Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Judith M Schlaeger
- Department of Women, Children and Family Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Crystal L Patil
- Department of Women, Children and Family Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Marie L Suarez
- Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - David Shuey
- Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Veronica Angulo
- Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Jesus Carrasco
- Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Miriam O Ezenwa
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, FL, USA
| | - Roger B Fillingim
- Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, Gainesville, FL, USA
| | - Zaijie J Wang
- Department of Biopharmaceutical Sciences, College of Pharmacy, Cancer Center, University of Illinois at Chicago, Chicago, IL, USA
| | - Robert E Molokie
- Department of Biopharmaceutical Sciences, College of Pharmacy, Cancer Center, University of Illinois at Chicago, Chicago, IL, USA
- Division of Hematology/Oncology, University of Illinois at Chicago College of Medicine, Chicago, IL, USA
- Department of Hematology/Oncology, Jessie Brown Veteran’s Administration Medical Center, Chicago, IL, USA
| | - Diana J Wilkie
- Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, Gainesville, FL, USA
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, FL, USA
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Ng TS. Racial differences in experimental pain sensitivity and conditioned pain modulation: a study of Chinese and Indians. J Pain Res 2019; 12:2193-2200. [PMID: 31410053 PMCID: PMC6643485 DOI: 10.2147/jpr.s197803] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 05/29/2019] [Indexed: 11/23/2022] Open
Abstract
Background: Substantial literature has demonstrated racial differences in pain perception and endogenous pain modulation is proposed to be a mechanism for the racial differences. Although Indians in Singapore reported higher pain severity than Chinese, the only study on racial difference in experimental pain response in Singapore did not find any difference between the two racial groups. Purpose: The aim of this study was to investigate pain sensitivity and conditioned pain modulation in Chinese and Indians in Singapore. Patients and methods: Sixty age-and sex-matched (30 Chinese 50% female, 30 Indian, 50% female) healthy adults participated in this study. Pressure pain threshold, thermal pain threshold and cold pain tolerance were measured. Conditioned pain modulation, general self-efficacy and depression were also tested, in an attempt to assess endogenous pain inhibition and psychological presentation between the two groups. Results: No difference in pain thresholds was found between the two groups. Indians demonstrated less cold pain tolerance and less efficacious conditioned pain modulation than Chinese. Conditioned pain modulation was a mediator between race and cold pain tolerance. Conclusion: These findings of racial disparities in pain tolerance and endogenous pain inhibition could possibly contribute to the higher pain severity in Indians.
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Affiliation(s)
- Tze Siong Ng
- Department of Rehabilitation, Physiotherapy Section, National University Hospital, Singapore, Singapore
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Effects of manipulating the interstimulus interval on heat-evoked temporal summation of second pain across the age span. Pain 2019; 160:95-101. [PMID: 30169423 DOI: 10.1097/j.pain.0000000000001382] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study examined the effects of interstimulus interval (ISI) on heat-evoked temporal summation of second pain (TSSP) and tested whether greatest maintenance of TSSP would occur at longer ISIs in older adults. Several lines of evidence support that TSSP is associated with central sensitization and is centrally mediated. The participants were 198 community-dwelling adults divided into 3 age cohorts (18-39, 40-59, and 60-78 years of age). Six TSSP trials used a train of 10 contacts with a preheated probe that made repetitive contact with the volar forearm. Participants completed 2 trials at each ISI of 2.5, 3.5, and 4.5 seconds. The intraclass correlations for each pair of trials support the reliability of the current methodology. Temporal summation of second pain scores declined in a time-dependent manner across ISI. In addition, greater maintenance of TSSP at longer ISIs was observed in middle-aged and older age groups compared with the younger cohort. Significant associations were found between TSSP and measures of recent pain. Greater summation at longer ISIs in older adults would suggest slower decay of excitability in spinal neurons and infer increased risk for central sensitization with advancing age.
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Bock JM, Hughes WE, Casey DP. Age-Associated Differences in Central Artery Responsiveness to Sympathoexcitatory Stimuli. Am J Hypertens 2019; 32:564-569. [PMID: 30854541 DOI: 10.1093/ajh/hpz035] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 03/01/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Age-associated arterial stiffening may be the result of greater tonic sympathetic nerve activity. However, age-associated changes in central artery responsiveness to sympathoexcitatory stimuli are understudied. Therefore, we examined changes in central artery stiffness and wave reflection in response to sympathoexcitatory stimuli in young and older adults. METHODS Fourteen young (25 ± 4 years) and 15 older (68 ± 4 years) subjects completed 3 minutes of the cold pressor test (CPT) and lower-body negative pressure (LBNP) separated by 15 minutes. Carotid-femoral pulse wave velocity (cfPWV), central augmentation pressure (cAP), and augmentation index (AIx) were measured in duplicate during rest and the final minute of each perturbation. RESULTS Young subjects had lower baseline cfPWV, cAP, and AIx than older subjects (P < 0.05 for all). During the CPT mean arterial pressure (MAP), cfPWV, cAP, and AIx increased in both groups (P < 0.05 for all); however, changes (Δ) in MAP (18 ± 7 vs. 9 ± 5 mm Hg), cfPWV (1.3 ± 0.7 vs. 0.6 ± 0.9 m/s), cAP (4 ± 2 vs. 6 ± 3 mm Hg), and AIx (18 ± 9% vs. 7 ± 4%) were greater in young vs. older subjects, respectively (P < 0.05 for all). With MAP as a covariate, cfPWV, cAP, and AIx responses to the CPT were no longer significantly different between groups. During LBNP, changes in MAP (-1 ± 3 vs. -3 ± 5 mm Hg), cfPWV (0.5 ± 0.3 vs. 0.5 ± 0.7 m/s), cAP (-2 ± 2 vs. -2 ± 3 mm Hg), and AIx (-7 ± 7% vs. -3 ± 6%) were similar between young and older groups, respectively (P > 0.05 for all). CONCLUSIONS Collectively, our data suggest the sympathetic nervous system may directly modulate central hemodynamics and that age-associated differences in central artery responsiveness to sympathoexcitatory stimuli are largely attributable to differential blood pressure responses.
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Affiliation(s)
- Joshua M Bock
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, The University of Iowa, Iowa City, Iowa, USA
| | - William E Hughes
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, The University of Iowa, Iowa City, Iowa, USA
| | - Darren P Casey
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, The University of Iowa, Iowa City, Iowa, USA
- François M. Abboud Cardiovascular Research Center, Carver College of Medicine, The University of Iowa, Iowa City, Iowa, USA
- Fraternal Order of Eagles Diabetes Research, Carver College of Medicine, The University of Iowa, Iowa City, Iowa, USA
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Patanwala AE, Norwood C, Steiner H, Morrison D, Li M, Walsh K, Martinez M, Baker SE, Snyder EM, Karnes JH. Psychological and Genetic Predictors of Pain Tolerance. Clin Transl Sci 2018; 12:189-195. [PMID: 30468309 PMCID: PMC6440569 DOI: 10.1111/cts.12605] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 11/09/2018] [Indexed: 12/18/2022] Open
Abstract
Previous studies have shown associations between genetic polymorphisms and pain tolerance, but psychological evaluations are seldom measured. The objective of this study was to determine the independent effects of demographic, psychological, and genetic predictors of cold noxious pain tolerance. Healthy subjects (n = 89) completed the Pain Catastrophizing Scale (PCS) and Fear of Pain Questionnaire (FPQ‐III), underwent genotyping for candidate single nucleotide polymorphisms (SNPs), and completed a cold‐pressor test in a 1–2°C water bath for a maximum of 3 minutes. The primary outcome measure was pain tolerance, defined as the maximum duration of time subjects left their nondominant hand in the cold‐water bath. Cox proportional hazards regression indicated that female sex, Asian race, and increasing PCS and FPQ‐III scores were associated with lower pain tolerance. No candidate SNP was significantly associated with pain tolerance. Future genetic studies should include demographic and psychological variables as confounders in experimental pain models.
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Affiliation(s)
- Asad E Patanwala
- Sydney School of Pharmacy, University of Sydney, Sydney, Australia
| | - Charles Norwood
- Department of Pharmacy Practice and Science, University of Arizona College of Pharmacy, Tucson, Arizona, USA
| | - Heidi Steiner
- Department of Pharmacy Practice and Science, University of Arizona College of Pharmacy, Tucson, Arizona, USA
| | - Daniel Morrison
- Department of Pharmacy Practice and Science, University of Arizona College of Pharmacy, Tucson, Arizona, USA
| | - May Li
- Department of Pharmacy Practice and Science, University of Arizona College of Pharmacy, Tucson, Arizona, USA
| | - Keith Walsh
- Department of Pharmacy Practice and Science, University of Arizona College of Pharmacy, Tucson, Arizona, USA
| | - Marina Martinez
- Department of Pharmacy Practice and Science, University of Arizona College of Pharmacy, Tucson, Arizona, USA.,Department of Neurology, University of Arizona College of Medicine, Tucson, Arizona, USA
| | - Sarah E Baker
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Eric M Snyder
- Department of Kinesiology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Jason H Karnes
- Department of Pharmacy Practice and Science, University of Arizona College of Pharmacy, Tucson, Arizona, USA
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Comparisons of Conditioned Pain Modulation and Physical Activity Between Hispanic and Non-Hispanic White Adults. J Racial Ethn Health Disparities 2018; 6:472-480. [PMID: 30478510 DOI: 10.1007/s40615-018-00544-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 11/01/2018] [Accepted: 11/09/2018] [Indexed: 12/26/2022]
Abstract
It is well-documented that adults of racial/ethnic minorities experience pain more frequently and suffer from more severe pain compared to non-Hispanic White (NHW) adults. These observations are consistent with laboratory findings that adults of racial/ethnic minorities show increased sensitivity to laboratory pain stimuli compared to NHW adults. Research generally shows that central pain inhibitory processing, as quantified using conditioned pain modulation (CPM), serves as a risk factor of clinical pain. Currently, racial/ethnic differences in CPM are poorly understood, and research suggests that physical activity (PA) may help understand potential racial/ethnic differences in CPM. However, very little is known regarding CPM in Hispanic compared to NHW adults. Therefore, the present study compared CPM and PA between Hispanic and NHW adults. Twenty-one young, healthy Hispanic and 21 NHW adults completed validated questionnaires to assess PA, pain catastrophizing, and dispositional optimism. The participants then completed the CPM test to quantify changes in pain ratings to electrical stimuli delivered to the ankle during concurrent application of pressure pain applied to the finger compared to baseline. Results indicated that Hispanic and NHW adults exhibited comparable CPM responses and PA levels, along with similar levels of pain catastrophizing and dispositional optimism (p > 0.05). These results suggest that young, healthy Hispanic and NHW adults may possess a similar risk of clinical pain when they are comparable in PA, pain catastrophizing, and dispositional optimism. More research is needed to explore the role of PA in racial/ethnic disparities in clinical pain and central pain inhibitory processing.
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57
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Moana-Filho EJ, Herrero Babiloni A. Endogenous pain modulation in chronic temporomandibular disorders: Derivation of pain modulation profiles and assessment of its relationship with clinical characteristics. J Oral Rehabil 2018; 46:219-232. [DOI: 10.1111/joor.12745] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 09/26/2018] [Accepted: 10/31/2018] [Indexed: 01/14/2023]
Affiliation(s)
- Estephan J. Moana-Filho
- Division of TMD & Orofacial Pain, School of Dentistry; University of Minnesota; Minneapolis Minnesota
| | - Alberto Herrero Babiloni
- Division of TMD & Orofacial Pain, School of Dentistry; University of Minnesota; Minneapolis Minnesota
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58
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Lv K, Song W, Tang R, Pan Z, Zhang Y, Xu Y, Lv B, Fan Y, Xu M. Neurotransmitter alterations in the anterior cingulate cortex in Crohn's disease patients with abdominal pain: A preliminary MR spectroscopy study. NEUROIMAGE-CLINICAL 2018; 20:793-799. [PMID: 30268988 PMCID: PMC6169252 DOI: 10.1016/j.nicl.2018.09.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 08/14/2018] [Accepted: 09/13/2018] [Indexed: 02/07/2023]
Abstract
Purpose Crohn's disease (CD) has been known to cause both abdominal pain alongside functional and structural alterations in the central nervous system (CNS) in affected patients. This study seeks to determine the alternations of metabolites in the bilateral anterior cingulate cortex (ACC) of CD patients with abdominal pain by using proton magnetic resonance spectroscopy (1H-MRS) to further explore the neural mechanism. Methods Sixteen CD patients with abdominal pain and 13 CD patients without abdominal pain, were recruited alongside 20 healthy controls (HCs) for this study. Clinical evaluations, including the 0–10 Visual Analogue Scale (VAS) of pain, Hospital Anxiety and Depression Scale (HADS) and Crohn's Disease Activity Index (CDAI), were evaluated prior to MR scanning. This study selected the bilateral ACC as the region of interest (ROI). The metabolites of the bilateral ACC were quantitatively analyzed by LCModel and Gannet. A independent sample t-test and one-way analysis of variance (ANOVA) were performed for statistical analysis. Spearman correlation analyses were performed to examine the relationship between the metabolite levels and clinical evaluations. Results The results indicated that CD patients with abdominal pain exhibited significantly higher levels of Glutamate (Glu)/(creatine + phosphocreatine, total creatine, tCr) over CD patients without abdominal pain, and HCs (p = 0.003, 0.009, respectively) in the bilateral ACC. The level of (Glutamate + Glutamine, Glx)/tCr of pain CD group was higher than non-pain CD group (p = 0.022). Moreover, within the pain CD group, Glu/tCr and Glx/tCr levels correlated strongly with the VAS scores of pain (ρ = 0.86, 0.59 respectively, p < 0.05). Meanwhile, the results indicates that CD patients with abdominal pain have significantly lower levels of γ-aminobutyric acid plus (GABA+)/tCr (p = 0.002) than HCs. To some extent, CDAI demonstrated a trend of negative correlation with GABA+/tCr levels (p = 0.088, ρ = −0.60). Conclusion The neural mechanism of CD patients with abdominal pain in pain processing is tightly associated with neurochemical metabolites. An imbalance in Glu and GABA may play a key role in abdominal pain processing for patients with CD. This mechanism of pain may associate with the intestinal microbiota on the brain-gut axis. The brain metabolite in CD patients with abdominal pain was firstly investigated. The study was conducted in vivo by using 1H-MRS. Glu and GABA levels altered in ACC of CD patients with abdominal pain. CD patients with abdominal pain in pain processing implicated neurotransmitters.
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Affiliation(s)
- Kun Lv
- The First Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, China; Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Wenwen Song
- Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Rui Tang
- The First Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, China; Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Zhiyong Pan
- Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Yong Zhang
- MR research, GE Healthcare, Shanghai, China
| | - Yi Xu
- Department of Gastroenterology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Bin Lv
- Department of Gastroenterology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Yihong Fan
- Department of Gastroenterology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China.
| | - Maosheng Xu
- Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China.
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McPhee M, Graven-Nielsen T. Alterations in Temporal Summation of Pain and Conditioned Pain Modulation Across an Episode of Experimental Exercise-Induced Low Back Pain. THE JOURNAL OF PAIN 2018; 20:264-276. [PMID: 30236748 DOI: 10.1016/j.jpain.2018.08.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 07/20/2018] [Accepted: 08/23/2018] [Indexed: 12/31/2022]
Abstract
Persistent pain conditions, including low back pain (LBP), are often accompanied by alterations in pronociceptive and antinociceptive mechanisms, as quantified by temporal summation of pain (TSP) and conditioned pain modulation (CPM). It remains unclear whether altered pain sensitivity, CPM, and/or TSP are a consequence of pain presence or determine the degree of pain development. Pressure pain sensitivity, TSP, and CPM were assessed across an episode of exercise-induced LBP maintained for several days. Thirty healthy individuals participated in 3 experimental sessions: before (day 0), 2 days after fatiguing back muscle exercise with exercise-induced LBP present (day 2), and after pain resolution (day 7). Both handheld and cuff pressure-pain thresholds, along with TSP (10-cuff pain stimuli at .5 Hz) and CPM (cuff pain detection threshold prior versus during painful pressure conditioning) were assessed, alongside questionnaires pertaining to pain, disability, mood, sleep, menstruation, physical activity, and catastrophizing. The exercise-induced LBP model produced mild pain and disability, and reductions in pressure pain thresholds over both the lumbar and distant testing sites (p < .007). No pain-related changes were observed for TSP (p > .44) or CPM (p > .17). The baseline TSP was associated with the peak pain intensity of the exercise-induced LBP (p < .003). Perspective: Pressure-pain sensitivity was impacted by the presence of exercise-induced LBP, whereas TSP seemed to be more stable and was instead associated with the intensity of pain developed. No significant pain-related changes or associations were observed for CPM, suggesting this measure may have less usefulness in mild musculoskeletal pain conditions.
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Affiliation(s)
- Megan McPhee
- Center for Neuroplasticity and Pain (CNAP), SMI, Aalborg University, Aalborg, Denmark
| | - Thomas Graven-Nielsen
- Center for Neuroplasticity and Pain (CNAP), SMI, Aalborg University, Aalborg, Denmark.
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Meints SM, Wang V, Edwards RR. Sex and Race Differences in Pain Sensitization among Patients with Chronic Low Back Pain. THE JOURNAL OF PAIN 2018; 19:1461-1470. [PMID: 30025944 DOI: 10.1016/j.jpain.2018.07.001] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 06/21/2018] [Accepted: 07/03/2018] [Indexed: 12/21/2022]
Abstract
Growing evidence suggests that chronic low back pain (CLBP) is associated with pain sensitization, and that there are sex and race disparities in CLBP. Given the sex and race differences in pain sensitization, this has been hypothesized as a mechanism contributing to the sex and race disparities in CLBP. This study examined sex and race differences in pain sensitization among patients with CLBP, as well as the role of catastrophizing as a potential mediator of those differences. The study found that compared with men, women required less pressure to produce deep muscle pain and rated mechanical punctate pain as more painful. Compared with non-Hispanic white patients, black patients demonstrated greater pain sensitivity for measures of deep muscle hyperalgesia and mechanical punctate pain. Furthermore, catastrophizing partially mediated the race differences in deep muscle pain such that black participants endorsed greater pain catastrophizing, which partially accounted for their increased sensitivity to, and temporal summation of, deep muscle pain. Taken together, these results support the need to further examine the role of catastrophizing and pain sensitization in the context of sex and race disparities in the experience of CLBP. PERSPECTIVE: This study identifies sex and race differences in pain sensitization among patients with CLBP. Further, it recognizes the role of catastrophizing as a contributor to such race differences. More research is needed to further dissect these complex relationships.
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Affiliation(s)
- Samantha M Meints
- Department of Anesthesiology, Pain Management Center, Brigham and Women's Hospital, Harvard Medical School, Chestnut Hill, Massachusetts..
| | - Victor Wang
- Department of Anesthesiology, Pain Management Center, Brigham and Women's Hospital, Harvard Medical School, Chestnut Hill, Massachusetts
| | - Robert R Edwards
- Department of Anesthesiology, Pain Management Center, Brigham and Women's Hospital, Harvard Medical School, Chestnut Hill, Massachusetts
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Tawonsawatruk T, Sriwatananukulkit O, Himakhun W, Hemstapat W. Comparison of pain behaviour and osteoarthritis progression between anterior cruciate ligament transection and osteochondral injury in rat models. Bone Joint Res 2018; 7:244-251. [PMID: 29922442 PMCID: PMC5987699 DOI: 10.1302/2046-3758.73.bjr-2017-0121.r2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Objectives In this study, we compared the pain behaviour and osteoarthritis (OA) progression between anterior cruciate ligament transection (ACLT) and osteochondral injury in surgically-induced OA rat models. Methods OA was induced in the knee joints of male Wistar rats using transection of the ACL or induction of osteochondral injury. Changes in the percentage of high limb weight distribution (%HLWD) on the operated hind limb were used to determine the pain behaviour in these models. The development of OA was assessed and compared using a histological evaluation based on the Osteoarthritis Research Society International (OARSI) cartilage OA histopathology score. Results Both models showed an increase in joint pain as indicated by a significant (p < 0.05) decrease in the values of %HLWD at one week post-surgery. In the osteochondral injury model, the %HLWD returned to normal within three weeks, while in the ACLT model, a significant decrease in the %HLWD was persistent over an eight-week period. In addition, OA progression was more advanced in the ACLT model than in the osteochondral injury model. Furthermore, the ACLT model exhibited a higher mean OA score than that of the osteochondral injury model at 12 weeks. Conclusion The development of pain patterns in the ACLT and osteochondral injury models is different in that the OA progression was significant in the ACLT model. Although both can be used as models for a post-traumatic injury of the knee, the selection of appropriate models for OA in preclinical studies should be specified and relevant to the clinical scenario. Cite this article: T. Tawonsawatruk, O. Sriwatananukulkit, W. Himakhun, W. Hemstapat. Comparison of pain behaviour and osteoarthritis progression between anterior cruciate ligament transection and osteochondral injury in rat models. Bone Joint Res 2018;7:244–251. DOI: 10.1302/2046-3758.73.BJR-2017-0121.R2.
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Affiliation(s)
- T Tawonsawatruk
- Department of Orthopedics, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - O Sriwatananukulkit
- Department of Pharmacology, Faculty of Science, Mahidol University, Bangkok 10400, Thailand
| | - W Himakhun
- Department of Pathology and Forensic Medicine, Faculty of Medicine, Thammasat University, Pathumthani 12120, Thailand
| | - W Hemstapat
- Department of Pharmacology, Faculty of Science, Mahidol University, Bangkok 10400, Thailand
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Depressive Symptoms and Sleep Efficiency Sequentially Mediate Racial Differences in Temporal Summation of Mechanical Pain. Ann Behav Med 2018; 51:673-682. [PMID: 28337602 DOI: 10.1007/s12160-017-9889-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Racial differences in endogenous pain facilitatory processes have been previously reported. Evidence suggests that psychological and behavioral factors, including depressive symptoms and sleep, can alter endogenous pain facilitatory processes. Whether depressive symptoms and sleep might help explain racial differences in endogenous pain facilitatory processes has yet to be determined. PURPOSE This observational, microlongitudinal study examined whether depressive symptoms and sleep were sequential mediators of racial differences in endogenous pain facilitatory processes. METHODS A total of 50 (26 African American and 24 non-Hispanic white) community-dwelling adults without chronic pain (mean 49.04 years; range 21-77) completed the Center for Epidemiological Studies Depression Scale prior to seven consecutive nights of sleep monitoring with actigraphy in the home environment. Participants subsequently returned to the laboratory for assessment of endogenous pain facilitation using a mechanical temporal summation protocol. RESULTS Findings revealed greater depressive symptoms, poorer sleep efficiency, and greater temporal summation of mechanical pain in African Americans compared to non-Hispanic whites. In a sequential mediation model, greater depressive symptoms predicted poorer sleep efficiency (t = -2.55, p = .014), and poorer sleep efficiency predicted enhanced temporal summation of mechanical pain (t = -4.11, p < .001), particularly for African Americans. CONCLUSIONS This study underscores the importance of examining the contribution of psychological and behavioral factors when addressing racial differences in pain processing. Additionally, it lends support for the deleterious impact of depressive symptoms on sleep efficiency, suggesting that both sequentially mediate racial differences in endogenous pain facilitation.
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McLoughlin M, Imran A, Hannigan A, Harmon D. Does Age Impact on Expectations and Concerns of Patients Attending a Chronic Pain Clinic? Pain Pract 2017; 18:23-28. [DOI: 10.1111/papr.12576] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Revised: 12/31/2016] [Accepted: 02/07/2017] [Indexed: 11/30/2022]
Affiliation(s)
| | - Ather Imran
- Department of Anaesthesia and Pain Medicine; Limerick University Hospital; Dooradoyle Limerick Ireland
| | - Ailish Hannigan
- Graduate Entry Medical School; University of Limerick; Limerick Ireland
| | - Dominic Harmon
- Department of Anaesthesia and Pain Medicine; Limerick University Hospital; Dooradoyle Limerick Ireland
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Bagwath Persad LA, Kamerman PR, Wadley AL. Predictors of Cold and Pressure Pain Tolerance in Healthy South African Adults. PAIN MEDICINE (MALDEN, MASS.) 2017; 18:2126-2137. [PMID: 28082523 DOI: 10.1093/pm/pnw291] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Studies on relationships between sex, ethnicity, and pain have largely emanated from the United States and Europe. We compared cold (CPT) and pressure pain tolerance (PPT) in male and female South Africans of African and European ancestry and assessed whether psychosocial factors (including pain beliefs) predicted differences in pain tolerance. METHODS We recruited 106 (62 female) students of African ancestry and 106 (55 female) of European ancestry and subjected them to a cold-pressor test and pressure algometry. Socioeconomic status (SES), pain catastrophizing, depression, anxiety, and pain beliefs were assessed as predictors of pain tolerance. RESULTS CPT was lower in students of African compared with European ancestry (for both sexes), and PPT was lower in female than male students (for both ethnicities). Females were very accepting of men expressing pain and males less so. Males of African ancestry were least accepting but still tolerant. Multivariate analysis identified African ancestry, and particularly being a female of African ancestry, as strong predictors of lower CPT. Anxiety was a weak predict or of CPT. Sex was the only strong predictor of PPT on multivariate analysis (PPT females < males), and catastrophizing was a weak predictor. Female sex and African ancestry were strong predictors of acceptance of expression of pain in males. SES was a weak predictor of the Appropriate Pain Behavior Questionnaire-Malescore. CONCLUSIONS Despite different cultural and social backgrounds from US and European cohorts, we saw similar patterns of sex and ethnic differences in CPT and PPT in an African cohort. Traditional psychosocial predictors of pain sensitivity predicted variation in the outcome variables but were not strong predictors.
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Affiliation(s)
- Leeana Aarthi Bagwath Persad
- Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Peter Rowland Kamerman
- Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Antonia Louise Wadley
- Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Physical Activity May Be Associated with Conditioned Pain Modulation in Women but Not Men among Healthy Individuals. Pain Res Manag 2017; 2017:9059140. [PMID: 29081683 PMCID: PMC5634578 DOI: 10.1155/2017/9059140] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 07/27/2017] [Accepted: 08/20/2017] [Indexed: 12/30/2022]
Abstract
Background Conditioned pain modulation (CPM), a phenomenon also known as diffuse noxious inhibitory control, is thought to be affected by various factors, including sex and level of physical activity. However, the involvement of these factors in CPM remains unclear. Methods Eighty-six healthy young subjects (M/F, 43/43) participated in this study. Participants were assessed on the basis of their mechanical pressure pain threshold (PPT), CPM response, body mass index (BMI), basal metabolic rate (BMR), and duration of moderate-to-vigorous physical activity (MVPA) over a week, using a motion counter. Response to CPM was evaluated as PPT during painful cold stimulation relative to baseline PPT. Results Men showed significantly higher baseline PPT than women; however, this difference was no longer significant after controlling for confounders. Stepwise multiple linear regression analyses revealed BMR to be a significant contributor towards baseline PPT in the entire study population. In contrast, although there were no significant contributors to CPM response among men and in the overall study group, MVPA was positively associated with CPM response among women (β = 0.397). Conclusions These results suggest that, among healthy young individuals, CPM response may be associated with moderate-to-vigorous physical activity in women but not in men.
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Sun J, Duan G, Li N, Guo S, Zhang Y, Ying Y, Zhang M, Wang Q, Liu JY, Zhang X. SCN11A variants may influence postoperative pain sensitivity after gynecological surgery in Chinese Han female patients. Medicine (Baltimore) 2017; 96:e8149. [PMID: 28953656 PMCID: PMC5626299 DOI: 10.1097/md.0000000000008149] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Nav1.9, encoded by sodium voltage-gated channel alpha subunit 11 (SCN11A), is one of the main sodium channels involved in pain transmission. Dysfunction of Nav1.9 alters pain sensitivity, resulting in insensitivity to pain or familial episodic pain. Our purpose was to explore the effects of SCN11A single-nucleotide polymorphisms (SNPs) on postoperative pain sensitivity in Chinese Han female patients after gynecological surgery.Here, we combined the methods of tag SNPs and candidate SNPs. The associations between eleven SCN11A SNPs and basic pain sensitivity in female healthy volunteers were analyzed using the Plink software. The SNPs associated with basic pain sensitivity were termed positive SCN11A SNPs. The effect of these positive SNPs on postoperative pain sensitivity was explored in patients undergoing elective gynecological laparoscopic surgery and receiving postoperative patient-controlled analgesia (PCA). We assessed pain intensity using the numeric pain rating scale (NRS) and recorded PCA consumption.Our results suggested that 5 SNPs (rs33985936, rs13080116, rs11720988, rs11709492, and rs11720013) in 11 tag and candidate SNPs were associated with basic pain sensitivity (P < .05). No evident association was found between the 5 positive SNPs and NRS (P > .05). However, among these positive SNPs, the minor alleles of rs33985936 and rs13080116 were significantly associated with increased PCA consumption (P < .01).To our knowledge, this is the first study to report that SCN11A SNPs affect postoperative pain sensitivity in Chinese Han women after gynecological surgery. The SNP rs33985936 and rs13080116 may serve as novel predictors for postoperative pain.
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Affiliation(s)
- Jiaoli Sun
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
| | - Guangyou Duan
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
- Department of Anesthesiology, Xinqiao Hospital, Third Military Medical University, Chongqing
| | - Ningbo Li
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
| | - Shanna Guo
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
| | - Yuhao Zhang
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
- Department of Anesthesiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai
| | - Ying Ying
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
| | - Mi Zhang
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
| | - Qingli Wang
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
- Department of Anesthesiology, Wuhan General Hospital of Guangzhou Military
| | - Jing Yu Liu
- Key Laboratory of Molecular Biophysics of the Ministry of Education, College of Life Science and Technology and Center for Human Genome Research, Huazhong University of Science and Technology, Wuhan, China
| | - Xianwei Zhang
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
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Ono K, Viet CT, Ye Y, Dang D, Hitomi S, Toyono T, Inenaga K, Dolan JC, Schmidt BL. Cutaneous pigmentation modulates skin sensitivity via tyrosinase-dependent dopaminergic signalling. Sci Rep 2017; 7:9181. [PMID: 28835637 PMCID: PMC5569050 DOI: 10.1038/s41598-017-09682-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 07/27/2017] [Indexed: 12/19/2022] Open
Abstract
We propose a new mechanism of sensory modulation through cutaneous dopaminergic signalling. We hypothesize that dopaminergic signalling contributes to differential cutaneous sensitivity in darker versus lighter pigmented humans and mouse strains. We show that thermal and mechanical cutaneous sensitivity is pigmentation dependent. Meta-analyses in humans and mice, along with our own mouse behavioural studies, reveal higher thermal sensitivity in pigmented skin relative to less-pigmented or albino skin. We show that dopamine from melanocytes activates the D1-like dopamine receptor on primary sensory neurons. Dopaminergic activation increases expression of the heat-sensitive TRPV1 ion channel and reduces expression of the mechanically-sensitive Piezo2 channel; thermal threshold is lower and mechanical threshold is higher in pigmented skin.
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Affiliation(s)
- Kentaro Ono
- Bluestone Centre for Clinical Research, New York University College of Dentistry, New York, NY, 10010, USA
| | - Chi T Viet
- Bluestone Centre for Clinical Research, New York University College of Dentistry, New York, NY, 10010, USA.,Department of Oral Maxillofacial Surgery, New York University College of Dentistry, New York, NY, 10010, USA
| | - Yi Ye
- Bluestone Centre for Clinical Research, New York University College of Dentistry, New York, NY, 10010, USA
| | - Dongmin Dang
- Bluestone Centre for Clinical Research, New York University College of Dentistry, New York, NY, 10010, USA
| | - Suzuro Hitomi
- Division of Physiology, Kyushu Dental University, Kitakyushu, Fukuoka, 803-8580, Japan
| | - Takashi Toyono
- Division of Oral Anatomy, Kyushu Dental University, Kitakyushu, Fukuoka, 803-8580, Japan
| | - Kiyotoshi Inenaga
- Division of Physiology, Kyushu Dental University, Kitakyushu, Fukuoka, 803-8580, Japan
| | - John C Dolan
- Bluestone Centre for Clinical Research, New York University College of Dentistry, New York, NY, 10010, USA.,Department of Oral Maxillofacial Surgery, New York University College of Dentistry, New York, NY, 10010, USA
| | - Brian L Schmidt
- Bluestone Centre for Clinical Research, New York University College of Dentistry, New York, NY, 10010, USA. .,Department of Oral Maxillofacial Surgery, New York University College of Dentistry, New York, NY, 10010, USA.
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Methodological Considerations for the Temporal Summation of Second Pain. THE JOURNAL OF PAIN 2017; 18:1488-1495. [PMID: 28801070 DOI: 10.1016/j.jpain.2017.07.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 07/11/2017] [Accepted: 07/30/2017] [Indexed: 12/15/2022]
Abstract
Temporal summation of second pain (TSSP) is a psychophysical indication of a central pain encoding mechanism, potentially enhanced in pathological pain conditions. Low-frequency repetitive stimulation of unmyelinated (C) nociceptors results in a progressive increase of pain intensity when thermal stimulation intensity remains constant. However, when using different methods of nociceptive delivery to the skin, regularity as well as rate of pain enhancement with repetition varies between experiments. Specifically, repetitive ramping up and down from a neutral to a painful temperature has produced weak and inconsistent pain summation. In contrast, repetitive contact of the skin with a preheated probe has generated substantial pain summation. In the present study, TSSP by the intermittent contact with a preheated thermode and constant contact, ramp and hold methods were compared during 10 iterations of stimulation of glabrous skin of the hand or hairy forearm skin, with an onset to onset interval of 3.3 seconds and stimulus interval of .8 seconds. Significantly greater TSSP was observed for intermittent contact stimulation at both sites (P < .001). Differential activation of myelinated and unmyelinated nociceptors by ramping and tapping may account for different rates of temporal summation of heat pain. PERSPECTIVE This article presents direct evidence suggesting the constant contact, ramp and hold stimulus may underestimate the level of TSSP. This evidence suggests the re-evaluation of stimulation techniques used for temporal summation tests, especially within clinical models.
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Kasielska-Trojan A, Stabryła P, Antoszewski B. Digit ratio (2D:4D) and postoperative pain perception. Early Hum Dev 2017; 110:25-30. [PMID: 28499134 DOI: 10.1016/j.earlhumdev.2017.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 05/01/2017] [Accepted: 05/02/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUNDS It has not been established whether sex differences in pain perception are influenced by prenatal sex hormones. Digit ratio as an indicator of prenatal hormone exposure can be used as a simple measure of the influence of prenatal hormones on pain sensitivity or perception in adulthood. OBJECTIVE The aim of this study was to determine a correlation between the 2D:4D ratio and pain perception in the postoperative period after rhinoplasty. METHOD A prospective cohort study of 100 patients (50 women of the mean age of 30.74±8.09years and 50 men of the mean age of 30.98±10.86years) who underwent posttraumatic rhinoplasty due to the nose trauma in Plastic, Reconstructive and Aesthetic Surgery Clinic. The following measurements were taken the day before a surgery: body height, waist and hip circumference, II and IV digits' lengths and body weight. All subjects filled in a questionnaire including 0-10-point VAS scales to assess postoperative pain 1h after an operation (AO), 6h AO, 12h AO, 24h AO and 48h AO. RESULTS Women with low 2D:4D reported significantly more pain 1h after an operation than women with high 2D:4D. Similar correlation was observed for low 2D:4D in women 48h AO. In men, low 2D:4D was associated with lower postoperative pain 12h AO (p=0.029). CONCLUSION In conclusion, we showed that low 2D:4D in women was associated with high postoperative pain, and low right 2D:4D in men was associated with low postoperative pain. This may suggest that intrauterine estrogen exposure makes women more resistant to pain.
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Affiliation(s)
- Anna Kasielska-Trojan
- Plastic, Reconstructive and Aesthetic Surgery Clinic, University Hospital No 1 in Lodz, Lodz, Poland; Plastic, Reconstructive and Aesthetic Surgery Clinic, Institute of Surgery, Medical University of Lodz, Lodz, Poland.
| | - Piotr Stabryła
- Plastic, Reconstructive and Aesthetic Surgery Clinic, University Hospital No 1 in Lodz, Lodz, Poland
| | - Bogusław Antoszewski
- Plastic, Reconstructive and Aesthetic Surgery Clinic, University Hospital No 1 in Lodz, Lodz, Poland; Plastic, Reconstructive and Aesthetic Surgery Clinic, Institute of Surgery, Medical University of Lodz, Lodz, Poland
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Speed TJ, Richards JM, Finan PH, Smith MT. Sex moderates the effects of positive and negative affect on clinical pain in patients with knee osteoarthritis. Scand J Pain 2017; 16:66-73. [PMID: 28850415 PMCID: PMC5576503 DOI: 10.1016/j.sjpain.2017.03.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 02/22/2017] [Accepted: 03/27/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIMS Sex differences in clinical pain severity and response to experimental pain are commonly reported, with women generally showing greater vulnerability. Affect, including state (a single rating) and stable (average daily ratings over two weeks) positive affect and negative affect has also been found to impact pain sensitivity and severity, and research suggests that affect may modulate pain differentially as a function of sex. The current study aimed to examine sex as a moderator of the relationships between affect and pain-related outcomes among participants with knee osteoarthritis (KOA). METHODS One hundred and seventy-nine participants (59 men) with KOA completed electronic diaries assessing clinical pain, positive affect, and negative affect. A subset of participants (n=120) underwent quantitative sensory testing, from which a single index of central sensitization to pain was derived. We used multiple regression models to test for the interactive effects of sex and affect (positive versus negative and stable versus state) on pain-related outcomes. We used mixed effects models to test for the moderating effects of sex on the relationships between state affect and pain over time. RESULTS Sex differences in affect and pain were identified, with men reporting significantly higher stable positive affect and lower central sensitization to pain indexed by quantitative sensory testing, as well as marginally lower KOA-specific clinical pain compared to women. Moreover, there was an interaction between stable positive affect and sex on KOA-specific clinical pain and average daily non-specific pain ratings. Post hoc analyses revealed that men showed trends towards an inverse relationship between stable positive affect and pain outcomes, while women showed no relationship between positive affect and pain. There was also a significant interaction between sex and stable negative affect and sex on KOA-specific pain such that men showed a significantly stronger positive relationship between stable negative affect and KOA-specific pain than women. Sex did not interact with state affect on pain outcomes. CONCLUSIONS Findings suggest that men may be particularly sensitive to the effects of stable positive affect and negative affect on clinical pain. Future work with larger samples is needed in order to identify potential mechanisms driving the sex-specific effects of affect on pain. IMPLICATIONS The current study provides novel data that suggesting that the association of positive affect, negative affect, and pain are different in men versus women with KOA. Further understanding of the difference in affective expression between men and women may lead to the development of novel therapeutic interventions and help to identify additional modifiable factors in the prevention and management of pain.
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Affiliation(s)
- Traci J Speed
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, United States.
| | - Jessica M Richards
- The Sandra and Malcolm Berman Brain & Spine Institute, Department of Neurology, United States
| | - Patrick H Finan
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, United States
| | - Michael T Smith
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, United States
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Wong AYL, Karppinen J, Samartzis D. Low back pain in older adults: risk factors, management options and future directions. SCOLIOSIS AND SPINAL DISORDERS 2017; 12:14. [PMID: 28435906 PMCID: PMC5395891 DOI: 10.1186/s13013-017-0121-3] [Citation(s) in RCA: 216] [Impact Index Per Article: 30.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 04/04/2017] [Indexed: 12/12/2022]
Abstract
Low back pain (LBP) is one of the major disabling health conditions among older adults aged 60 years or older. While most causes of LBP among older adults are non-specific and self-limiting, seniors are prone to develop certain LBP pathologies and/or chronic LBP given their age-related physical and psychosocial changes. Unfortunately, no review has previously summarized/discussed various factors that may affect the effective LBP management among older adults. Accordingly, the objectives of the current narrative review were to comprehensively summarize common causes and risk factors (modifiable and non-modifiable) of developing severe/chronic LBP in older adults, to highlight specific issues in assessing and treating seniors with LBP, and to discuss future research directions. Existing evidence suggests that prevalence rates of severe and chronic LBP increase with older age. As compared to working-age adults, older adults are more likely to develop certain LBP pathologies (e.g., osteoporotic vertebral fractures, tumors, spinal infection, and lumbar spinal stenosis). Importantly, various age-related physical, psychological, and mental changes (e.g., spinal degeneration, comorbidities, physical inactivity, age-related changes in central pain processing, and dementia), as well as multiple risk factors (e.g., genetic, gender, and ethnicity), may affect the prognosis and management of LBP in older adults. Collectively, by understanding the impacts of various factors on the assessment and treatment of older adults with LBP, both clinicians and researchers can work toward the direction of more cost-effective and personalized LBP management for older people.
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Affiliation(s)
- Arnold YL Wong
- Department of Rehabilitation Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, SAR China
| | - Jaro Karppinen
- Medical Research Center Oulu, Department of Physical and Rehabilitation Medicine, University of Oulu and Oulu University Hospital, Oulu, Finland
- Finnish Institute of Occupational Health, Oulu, Finland
| | - Dino Samartzis
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong, SAR China
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Abstract
The development of patient profiles to subgroup individuals on a variety of variables has gained attention as a potential means to better inform clinical decision making. Patterns of pain sensitivity response specific to quantitative sensory testing (QST) modality have been demonstrated in healthy subjects. It has not been determined whether these patterns persist in a knee osteoarthritis population. In a sample of 218 participants, 19 QST measures along with pain, psychological factors, self-reported function, and quality of life were assessed before total knee arthroplasty. Component analysis was used to identify commonalities across the 19 QST assessments to produce standardized pain sensitivity factors. Cluster analysis then grouped individuals who exhibited similar patterns of standardized pain sensitivity component scores. The QST resulted in 4 pain sensitivity components: heat, punctate, temporal summation, and pressure. Cluster analysis resulted in 5 pain sensitivity profiles: a "low pressure pain" group, an "average pain" group, and 3 "high pain" sensitivity groups who were sensitive to different modalities (punctate, heat, and temporal summation). Pain and function differed between pain sensitivity profiles, along with sex distribution; however, no differences in osteoarthritis grade, medication use, or psychological traits were found. Residualizing QST data by age and sex resulted in similar components and pain sensitivity profiles. Furthermore, these profiles are surprisingly similar to those reported in healthy populations, which suggests that individual differences in pain sensitivity are a robust finding even in an older population with significant disease.
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Robinson-Lane SG, Booker SQ. Culturally Responsive Pain Management for Black Older Adults. J Gerontol Nurs 2017; 43:1-8. [PMID: 28253407 PMCID: PMC5581727 DOI: 10.3928/00989134-20170224-03] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 01/16/2017] [Indexed: 12/30/2022]
Abstract
HOW TO OBTAIN CONTACT HOURS BY READING THIS ARTICLE INSTRUCTIONS XX contact hours will be awarded by Villanova University College of Nursing upon successful completion of this activity. A contact hour is a unit of measurement that denotes 60 minutes of an organized learning activity. This is a learner-based activity. Villanova University College of Nursing does not require submission of your answers to the quiz. A contact hour certificate will be awarded once you register, pay the registration fee, and complete the evaluation form online at http://goo.gl/gMfXaf. To obtain contact hours you must: 1. Read the article, "XXXX XXXX XXXXXX XXXXXXX XXXX XXXX XXX XXX XXXX XX" found on pages XX-XX, carefully noting any tables and other illustrative materials that are included to enhance your knowledge and understanding of the content. Be sure to keep track of the amount of time (number of minutes) you spend reading the article and completing the quiz. 2. Read and answer each question on the quiz. After completing all of the questions, compare your answers to those provided within this issue. If you have incorrect answers, return to the article for further study. 3. Go to the Villanova website listed above to register for contact hour credit. You will be asked to provide your name; contact information; and a VISA, MasterCard, or Discover card number for payment of the $20.00 fee. Once you complete the online evaluation, a certificate will be automatically generated. This activity is valid for continuing education credit until MONTH XX, 20XX. CONTACT HOURS This activity is co-provided by Villanova University College of Nursing and SLACK Incorporated. Villanova University College of Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. ACTIVITY OBJECTIVES 1. XXX 2. XXX DISCLOSURE STATEMENT Neither the planners nor the author have any conflicts of interest to disclose. The management of pain for Black older adults has received inadequate attention by health care professionals despite evidence of greater pain intensity, depressive symptoms, and functional disability compared with White American older adults. Pain management for this population may be significantly improved with more careful attention to the provision of culturally responsive care. As professionals concerned with the optimization of health and reduction of suffering throughout the lifespan, nurses have an ethical, moral, and professional responsibility to provide culturally responsive care to the populations they serve-particularly when clear disparities in health exist. By considering how culture affects important health beliefs, values, preferences, and customs, and integrating this understanding into practice, quality of life is likely to be improved. [Journal of Gerontological Nursing, xx(x), xx-xx.].
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Affiliation(s)
- Sheria G. Robinson-Lane
- Assistant Professor, University of Michigan School of Nursing, Department of Systems, Populations and Leadership, Ann Arbor, MI
| | - Staja Q. Booker
- Doctoral Candidate, University of Iowa College of Nursing, Iowa City, IA
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Skovbjerg S, Jørgensen T, Arendt-Nielsen L, Ebstrup JF, Carstensen T, Graven-Nielsen T. Conditioned Pain Modulation and Pressure Pain Sensitivity in the Adult Danish General Population: The DanFunD Study. THE JOURNAL OF PAIN 2017; 18:274-284. [DOI: 10.1016/j.jpain.2016.10.022] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 10/19/2016] [Accepted: 10/31/2016] [Indexed: 10/20/2022]
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Abstract
Sensory decline is viewed as an inevitable consequence of the ageing process. However, reports of declines have not been a consistent finding across the sensory systems. Reports from psychophysical studies indicate that the most common declines with ageing are in vision and audition and, to a lesser degree, olfaction and gustation. Findings for the somatosensory system (mechanoreception, warming and cooling thermoreception and pain) are less conclusive. Factors that contribute to individual differences in sensory ratings beyond chronological ageing include stimulus factors including stimulus type and body location, response measures and instructions, systemic disease that may affect the peripheral or central nervous system and environmental factors that may affect the skin integrity.
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Affiliation(s)
- M W Heft
- Department of Oral & Maxillofacial Surgery and Claude D. Pepper Center on Oral Health in Aging, University of Florida, Gainesville, FL, USA
| | - M E Robinson
- Department of Clinical & Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
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Factors Predicting Catheter-Related Bladder Discomfort in Surgical Patients. J Perianesth Nurs 2016; 32:400-408. [PMID: 28938975 DOI: 10.1016/j.jopan.2016.03.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Revised: 02/22/2016] [Accepted: 03/04/2016] [Indexed: 11/23/2022]
Abstract
PURPOSE The study was conducted to identify the factors predicting catheter-related bladder discomfort (CRBD) in the postanesthesia care unit, to assess the level of CRBD and urinary catheter-related pain for the first 24 hours postoperatively, and to compare UCRP with the postoperative pain in the surgical site. BACKGROUND About 20% of hospitalized patients receive an indwelling urinary catheter, and more than half of these patients complain of CRBD or urinary catheter-related pain. DESIGN This prospective descriptive study conducted in an 800-bed university hospital involved 160 patients who had undergone elective surgery from February 5, 2012 to June 5, 2012. METHODS Demographic data including gender, age, American Society of Anesthesiologists class, weight, and height were collected on the preoperative visit. Factors predicting CRBD were identified by multiple logistic regression analysis. Comparison of the UCRP and postoperative pain was analyzed using the Mann-Whitney U test. FINDINGS Multiple logistic regression analysis showed that the factors predicting CRBD ≥2 30 minutes after arrival to the postanesthesia care unit were age <50 years (odds ratio [OR], 4.79; P = .005), male gender (OR, 7.07; P = .015), obstetric and gynecological surgery (OR, 11.07; P = .045), and UCRP (OR, 132.3; P < .015). Postoperative pain (P < .001) was significantly greater than UCRP. CONCLUSIONS Age <50 years, male gender, open abdominal surgery, and UCRP ≥4 predict CRBD. CLINICAL RELEVANCE Perioperative care providers should screen surgical patients for risk factors of CRBD during the first postoperative 12 hours.
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Are multidisciplinary interventions multicultural? A topical review of the pain literature as it relates to culturally diverse patient groups. Pain 2016; 157:321-328. [PMID: 26588691 DOI: 10.1097/j.pain.0000000000000412] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Torensma B, Thomassen I, van Velzen M, In 't Veld BA. Pain Experience and Perception in the Obese Subject Systematic Review (Revised Version). Obes Surg 2016; 26:631-9. [PMID: 26661107 DOI: 10.1007/s11695-015-2008-9] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Pain is an integral part of life and has an important protective function. Pain perception has been shown to differ between subjects and changes with gender, race, and culture. In addition, it has been suggested that obesity influences pain perception and that obesity can be a risk factor for increased pain thresholds. The aim of this systematic review was to examine pain thresholds in obese subjects compared to non-obese subjects. The electronic databases of the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, and EMBASE were searched using combinations of terms for obese, pain measurement, visual analog scale, quantitative sensory testing, and pain perception. Studies without comparison as well as cross-sectional studies, case series, and case reports were excluded. The search was conducted without restrictions on language or date of publication. From a total of 1818 identified studies, seven studies fulfilled the inclusion criteria, whereby only one study tested the pain threshold difference between obese and non-obese and also before and after body weight loss surgery. Two studies showed a lower pain threshold and four studies a higher pain threshold in obese subjects compared to non-obese subjects. Two studies showed no difference in pain threshold before and after substantial body weight loss due to surgery. Weight loss after surgery was not identified as a factor for higher pain thresholds in obese subjects. In view of the heterogeneity of the studies, the variability of the subjects and differences in methodological quality, a meta-analysis could not be performed. From the available literature, there is a tendency towards higher pain thresholds in obese subjects. Neither substantial weight loss, nor gender, were factors explaining difference in threshold. Future randomized, controlled trials should explore demographic variables that could influence pain perception or pain thresholds in obese individuals, and multimodal pain testing is necessary for better understanding of the apparent differences in pain thresholds in obese individuals.
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Affiliation(s)
- Bart Torensma
- Department of Anesthesiology, Leiden University Medical Center P5-Q, 2300 RC, Leiden, The Netherlands. .,Department of Anesthesiology, Haaglanden Medical Center, The Hague, The Netherlands.
| | - Irene Thomassen
- Department of Surgery, Spaarne Gasthuis, Harlem, The Netherlands.
| | - Monique van Velzen
- Department of Anesthesiology, Leiden University Medical Center P5-Q, 2300 RC, Leiden, The Netherlands.
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79
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Racial and ethnic differences in experimental pain sensitivity: systematic review and meta-analysis. Pain 2016; 158:194-211. [DOI: 10.1097/j.pain.0000000000000731] [Citation(s) in RCA: 117] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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80
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Duan G, Han C, Wang Q, Guo S, Zhang Y, Ying Y, Huang P, Zhang L, Macala L, Shah P, Zhang M, Li N, Dib-Hajj SD, Waxman SG, Zhang X. A SCN10A SNP biases human pain sensitivity. Mol Pain 2016; 12:12/0/1744806916666083. [PMID: 27590072 PMCID: PMC5011395 DOI: 10.1177/1744806916666083] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 07/19/2016] [Indexed: 12/19/2022] Open
Abstract
Background: Nav1.8 sodium channels, encoded by SCN10A, are preferentially expressed in nociceptive neurons and play an important role in human pain. Although rare gain-of-function variants in SCN10A have been identified in individuals with painful peripheral neuropathies, whether more common variants in SCN10A can have an effect at the channel level and at the dorsal root ganglion, neuronal level leading to a pain disorder or an altered normal pain threshold has not been determined. Results: Candidate single nucleotide polymorphism association approach together with experimental pain testing in human subjects was used to explore possible common SCN10A missense variants that might affect human pain sensitivity. We demonstrated an association between rs6795970 (G > A; p.Ala1073Val) and higher thresholds for mechanical pain in a discovery cohort (496 subjects) and confirmed it in a larger replication cohort (1005 female subjects). Functional assessments showed that although the minor allele shifts channel activation by −4.3 mV, a proexcitatory attribute, it accelerates inactivation, an antiexcitatory attribute, with the net effect being reduced repetitive firing of dorsal root ganglion neurons, consistent with lower mechanical pain sensitivity. Conclusions: At the association and mechanistic levels, the SCN10A single nucleotide polymorphism rs6795970 biases human pain sensitivity.
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Affiliation(s)
- Guangyou Duan
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China Department of Anesthesiology, Xinqiao Hospital, Third Military Medical University, Chongqing, P.R. China
| | - Chongyang Han
- Department of Neurology and Center for Neuroscience and Regeneration Research, Yale University School of Medicine, New Haven, CT, USA Rehabilitation Research Center, Veterans' Affairs Connecticut Healthcare System, West Haven, CT, USA
| | - Qingli Wang
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China Department of Anesthesiology, Wuhan General Hospital of Guangzhou Military, Wuhan, P.R. China
| | - Shanna Guo
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
| | - Yuhao Zhang
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
| | - Ying Ying
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
| | - Penghao Huang
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
| | - Li Zhang
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
| | - Lawrence Macala
- Department of Neurology and Center for Neuroscience and Regeneration Research, Yale University School of Medicine, New Haven, CT, USA Rehabilitation Research Center, Veterans' Affairs Connecticut Healthcare System, West Haven, CT, USA
| | - Palak Shah
- Department of Neurology and Center for Neuroscience and Regeneration Research, Yale University School of Medicine, New Haven, CT, USA Rehabilitation Research Center, Veterans' Affairs Connecticut Healthcare System, West Haven, CT, USA
| | - Mi Zhang
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
| | - Ningbo Li
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
| | - Sulayman D Dib-Hajj
- Department of Neurology and Center for Neuroscience and Regeneration Research, Yale University School of Medicine, New Haven, CT, USA Rehabilitation Research Center, Veterans' Affairs Connecticut Healthcare System, West Haven, CT, USA
| | - Stephen G Waxman
- Department of Neurology and Center for Neuroscience and Regeneration Research, Yale University School of Medicine, New Haven, CT, USA Rehabilitation Research Center, Veterans' Affairs Connecticut Healthcare System, West Haven, CT, USA
| | - Xianwei Zhang
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
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81
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Bartley EJ, King CD, Sibille KT, Cruz-Almeida Y, Riley JL, Glover TL, Goodin BR, Sotolongo AS, Herbert MS, Bulls HW, Staud R, Fessler BJ, Redden DT, Bradley LA, Fillingim RB. Enhanced Pain Sensitivity Among Individuals With Symptomatic Knee Osteoarthritis: Potential Sex Differences in Central Sensitization. Arthritis Care Res (Hoboken) 2016; 68:472-80. [PMID: 26434740 DOI: 10.1002/acr.22712] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 07/15/2015] [Accepted: 08/18/2015] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Symptomatic knee osteoarthritis (OA) is a condition commonly associated with increased pain, disability, and functional limitations. Given the poor correspondence between radiographic evidence and clinical pain, central sensitization has been implicated as a potential mechanism underlying pain facilitation in knee OA. Sex may be a moderator of centrally mediated changes in knee OA pain; however, few studies have systematically assessed this. Therefore, the aim of this study was to examine differences in peripheral and central sensitization in men and women with symptomatic knee OA, as well as to determine whether these differences vary across age (middle age versus older age). METHODS Participants (n = 288) between the ages of 45 and 85 years completed a battery of quantitative sensory pain procedures assessing sensitivity to contact heat, cold pressor, mechanical pressure, and punctate stimuli. Differences in temporal summation (TS) were examined, as well as measures of clinical pain and functional performance. RESULTS When compared to men, women exhibited greater sensitivity to multiple pain modalities (i.e., lower heat, cold, pressure thresholds/tolerances, greater TS of pain); however, there were no sex differences in clinical pain, with the exception of greater widespread pain observed in women. Although there were select age-related differences in pain sensitivity, sex differences in pain varied minimally across the age cohort. CONCLUSION Overall, these findings provide evidence for greater overall sensitivity to experimental pain in women with symptomatic knee OA compared to men, suggesting that enhanced central sensitivity may be an important contributor to pain in this group.
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82
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Comparative Associations of Working Memory and Pain Catastrophizing With Chronic Low Back Pain Intensity. Phys Ther 2016; 96:1049-56. [PMID: 26700272 PMCID: PMC4935786 DOI: 10.2522/ptj.20150335] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 12/13/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND Because of its high global burden, determining biopsychosocial influences of chronic low back pain (CLBP) is a research priority. Psychological factors such as pain catastrophizing are well established. However, cognitive factors such as working memory warrant further investigation to be clinically useful. OBJECTIVE The purpose of this study was to determine how working memory and pain catastrophizing are associated with CLBP measures of daily pain intensity and movement-evoked pain intensity. DESIGN This study was a cross-sectional analysis of individuals with ≥3 months of CLBP (n=60) compared with pain-free controls (n=30). METHOD Participants completed measures of working memory, pain catastrophizing, and daily pain intensity. Movement-evoked pain intensity was assessed using the Back Performance Scale. Outcome measures were compared between individuals with CLBP and those who were pain-free using nonparametric testing. Associations were determined using multivariate regression analyses. RESULTS Participants with CLBP (mean age=47.7 years, 68% female) had lower working memory performance (P=.008) and higher pain catastrophizing (P<.001) compared with pain-free controls (mean age=47.6 years, 63% female). For individuals with CLBP, only working memory remained associated with daily pain intensity (R(2)=.07, standardized beta=-.308, P=.041) and movement-evoked pain intensity (R(2)=.14, standardized beta=-.502, P=.001) after accounting for age, sex, education, and interactions between pain catastrophizing and working memory. LIMITATIONS The cross-sectional design prevented prospective analysis. Findings also are not indicative of overall working memory (eg, spatial) or cognitive performance. CONCLUSION Working memory demonstrated the strongest association with daily pain and movement-evoked pain intensity compared with (and after accounting for) established CLBP factors. Future research will elucidate the prognostic value of working memory on prevention and recovery of CLBP.
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83
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Booker SQ, Herr KA, Tripp-Reimer T. Culturally Conscientious Pain Measurement in Older African Americans. West J Nurs Res 2016; 38:1354-73. [PMID: 27174228 DOI: 10.1177/0193945916648952] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Despite considerable pain disparities across the care continuum, pain is an understudied health problem in older ethnic minority groups, such as African Americans. Quality pain measurement is a core task in pain management and a mechanism by which pain disparities may be reduced. Pain measurement includes the methods (e.g., assessment approaches, tools) and metrics that researchers and clinicians use to understand the characteristics of pain. However, there are significant issues and gaps that negatively affect pain measurement in older African Americans. Of concern is insufficient representation in pain research, which impedes the testing and refinement of many standardized self-report, behavioral and surrogate report, physiological, and composite measures of pain. The purposes for this article are to discuss the status of pain measurement and factors that affect our knowledge on pain measurement in older African Americans, and to provide guidance for culturally conscientious pain measurement using the available literature.
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84
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Dobscha SK, Lovejoy TI, Morasco BJ, Kovas AE, Peters DM, Hart K, Williams JL, McFarland BH. Predictors of Improvements in Pain Intensity in a National Cohort of Older Veterans With Chronic Pain. THE JOURNAL OF PAIN 2016; 17:824-35. [PMID: 27058162 DOI: 10.1016/j.jpain.2016.03.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Revised: 03/21/2016] [Accepted: 03/24/2016] [Indexed: 12/25/2022]
Abstract
UNLABELLED Little is known about the factors associated with pain-related outcomes in older adults. In this observational study, we sought to identify patient factors associated with improvements in pain intensity in a national cohort of older veterans with chronic pain. We included 12,924 veterans receiving treatment from the Veterans Health Administration with persistently elevated numeric rating scale scores in 2010 who had not been prescribed opioids in the previous 12 months. We examined: 1) percentage decrease over 12 months in average pain intensity scores relative to average baseline pain intensity score; and 2) time to sustained improvement in average pain intensity scores, defined as a 30% reduction in 3-month scores compared with baseline. Average relative improvement in pain intensity scores from baseline ranged from 25% to 29%; almost two-thirds met criteria for sustained improvement during the 12-month follow-up period. In models, higher baseline pain intensity and older age were associated with greater likelihood of improvement in pain intensity, whereas Veterans Affairs service-connected disability, mental health, and certain pain-related diagnoses were associated with lower likelihood of improvement. Opioid prescription initiation during follow-up was associated with lower likelihood of sustained improvement. The findings call for further characterization of heterogeneity in pain outcomes in older adults as well as further analysis of the relationship between prescription opioids and treatment outcomes. PERSPECTIVE This study identified factors associated with improvements in pain intensity in a national cohort of older veterans with chronic pain. We found that older veterans frequently show improvements in pain intensity over time, and that opioid prescriptions, mental health, and certain pain diagnoses are associated with lower likelihood of improvement.
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Affiliation(s)
- Steven K Dobscha
- Center to Improve Veteran Involvement in Care, Veterans Affairs Portland Health Care System, Portland, Oregon; Department of Psychiatry, Oregon Health and Science University, Portland, Oregon.
| | - Travis I Lovejoy
- Center to Improve Veteran Involvement in Care, Veterans Affairs Portland Health Care System, Portland, Oregon; Department of Psychiatry, Oregon Health and Science University, Portland, Oregon
| | - Benjamin J Morasco
- Center to Improve Veteran Involvement in Care, Veterans Affairs Portland Health Care System, Portland, Oregon; Department of Psychiatry, Oregon Health and Science University, Portland, Oregon
| | - Anne E Kovas
- Center to Improve Veteran Involvement in Care, Veterans Affairs Portland Health Care System, Portland, Oregon
| | - Dawn M Peters
- Department of Public Health and Preventive Medicine, Oregon Health and Science University, Portland, Oregon
| | - Kyle Hart
- Center to Improve Veteran Involvement in Care, Veterans Affairs Portland Health Care System, Portland, Oregon
| | - J Lucas Williams
- Center to Improve Veteran Involvement in Care, Veterans Affairs Portland Health Care System, Portland, Oregon
| | - Bentson H McFarland
- Department of Psychiatry, Oregon Health and Science University, Portland, Oregon; Department of Public Health and Preventive Medicine, Oregon Health and Science University, Portland, Oregon
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85
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Kapoor S, White J, Thorn BE, Block P. Patients Presenting to the Emergency Department with Acute Pain: The Significant Role of Pain Catastrophizing and State Anxiety. PAIN MEDICINE 2015; 17:1069-78. [PMID: 26814269 DOI: 10.1093/pm/pnv034] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 09/19/2015] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Pain is one of the most common reasons for emergency department (ED) visits. Given the significant association of psychological variables and pain experience, it is critical to examine the relation of such factors with ED pain reports. This study sought to analyze the association of reported pain intensity in ED with pain catastrophizing and state anxiety. METHODS One hundred participants presenting with a primary complaint of acute pain in an urban ED completed the study. The measures included a demographic survey with questions pertaining to pain intensity, type and duration of present pain, the Pain Catastrophizing Scale (PCS), and the State-Trait Anxiety Inventory-State Subscale (STAI-S). RESULTS Pain intensity was significantly and positively associated with pain catastrophizing and state anxiety. Follow-up PROCESS mediation analysis revealed a significant indirect effect of pain catastrophizing on the relationship between state anxiety and pain intensity. CONCLUSIONS The results suggest that it is important to assess the psychological distress due to anxiety and pain catastrophizing of patients presenting to EDs with acute pain. Setting-appropriate brief behavioral interventions in conjunction with pharmacological interventions could improve outcomes.
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Affiliation(s)
- Shweta Kapoor
- *Department of Psychology, the University of Alabama, Tuscaloosa, Alabama;
| | - Jessica White
- Alabama College of Osteopathic Medicine, Dothan, Alabama, USA
| | - Beverly E Thorn
- *Department of Psychology, the University of Alabama, Tuscaloosa, Alabama;
| | - Phoebe Block
- *Department of Psychology, the University of Alabama, Tuscaloosa, Alabama
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86
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Wranker LS, Rennemark M, Berglund J. Pain among older adults from a gender perspective: findings from the Swedish National Study on Aging and Care (SNAC-Blekinge). Scand J Public Health 2015; 44:258-63. [PMID: 26647094 DOI: 10.1177/1403494815618842] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND AIMS Pain is common in the elderly population and its prevalence varies according to the studied disease, clinical setting, sex and age. This study examines pain in an aging population from a gender perspective. METHODS The Swedish National study on Aging and Care (SNAC) is conducted at four research centres. Participants were recruited from the baseline sample (n=1402) at one of the research centres, SNAC-Blekinge. Individuals aged 60 years and older were included and non-participation was documented. Research personnel conducted the medical examination on two occasions. RESULTS The prevalence of pain was 769/1402 (54.8%), distributed as 496/817 (64.5%) women and 273/585 (35.5%) men,p<0.01. Women reported more pain located in the vertebral column,p<0.01. The most common pain location was the legs and feet. About 84% reported pain intensity as 4 or higher on the visual analogue scale (VAS). Pain intensity declines with age among men,p<0.01. The most frequent treatment was painkillers. A total of 128/263 (48.7%) of the men received no pain treatment compared with 177/478 (37.0%) of the women,p<0.01. In a multivariate logistic regression model, women yielded the highest OR [OR 1.94 (C.I. 1.51-2.49)] for pain. CONCLUSIONS Pain is common among older adults and there are significant differences between the sexes. Almost 55% of participants reported pain, predominantly women. In the majority of cases the intensity was rated as moderate or severe (VAS >4) and women rated higher than men p<002. Almost half of the men (48.7%) did not receive any treatment compared to 37% of the women, p<001.
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Affiliation(s)
- Lena Sandin Wranker
- Department of Health, Blekinge Institute of Technology, Karlskrona, Sweden Department of Health Sciences, Division of Geriatric Medicine, Lund University, Sweden
| | | | - Johan Berglund
- Department of Health, Blekinge Institute of Technology, Karlskrona, Sweden
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87
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Bulls HW, Goodin BR, McNew M, Gossett EW, Bradley LA. Minority Aging and Endogenous Pain Facilitatory Processes. PAIN MEDICINE 2015; 17:1037-48. [PMID: 26814250 DOI: 10.1093/pm/pnv014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 09/05/2015] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The aim of the current study was to examine the relationships among age, ethnicity, and endogenous pain facilitation using temporal summation (TS) responses to mechanical and heat stimuli. DESIGN The present study assessed hyperalgesia and pain facilitation to thermal and mechanical stimuli at the knee and distal sites in 98 pain-free men and women. Participants were drawn from two ethnic groups [African-American (AA) and non-Hispanic white (NHW)] and two age groups (19-35 and 45-85). RESULTS Significant main effects of ethnicity were demonstrated for both mechanical and heat modalities (all P's ≤ 0.05), suggesting that AA participants, relative to NHW counterparts, demonstrated enhanced hyperalgesia. Age differences (older > younger) in hyperalgesia were found in mechanical pain ratings only. Results indicated that mechanical pain ratings significantly increased from first to maximal pain as a function of both age group and ethnicity (all P's ≤ 0.05), and a significant ethnicity by age interaction for TS of mechanical pain was found at the forearm (P < 0.05) and trended toward significance at the knee (P = 0.071). Post-hoc tests suggested that results were primarily driven by the older AA participants, who demonstrated the greatest mechanical TS. Additionally, evidence of differences in heat TS due to both ethnicity alone (all P's ≤ 0.05) and minority aging was also found. CONCLUSIONS This study provides evidence suggesting that older AAs demonstrate enhanced pain facilitatory processes, which is important because this group may be at increased risk for development of chronic pain. These results underscore the necessity of testing pain modulatory mechanisms when addressing questions related to pain perception and minority aging.
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Affiliation(s)
| | - Burel R Goodin
- *Department of Psychology Division of Pain Medicine, Department of Anesthesiology
| | | | | | - Laurence A Bradley
- *Department of Psychology Division of Clinical Immunology and Rheumatology, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Simon CB, Riley JL, Fillingim RB, Bishop MD, George SZ. Age Group Comparisons of TENS Response Among Individuals With Chronic Axial Low Back Pain. THE JOURNAL OF PAIN 2015; 16:1268-1279. [PMID: 26342650 PMCID: PMC4666741 DOI: 10.1016/j.jpain.2015.08.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 08/05/2015] [Accepted: 08/19/2015] [Indexed: 12/19/2022]
Abstract
UNLABELLED Chronic low back pain (CLBP) is a highly prevalent and disabling musculoskeletal pain condition among older adults. Transcutaneous electrical nerve stimulation (TENS) is commonly used to treat CLBP, however response to TENS in older adults compared with younger adults is untested. In a dose-response study stratified by age, 60 participants with axial CLBP (20 young, 20 middle-aged, 20 older) received four 20-minute sessions of high-frequency high-intensity TENS over a 2- to 3-week period in a laboratory-controlled setting. Experimental measures of pain sensitivity (mechanical pressure pain detection threshold) and central pain excitability (phasic heat temporal summation and heat aftersensations) were assessed before and after TENS. Episodic or immediate axial CLBP relief was assessed after TENS via measures of resting pain, movement-evoked-pain, and self-reported disability. Cumulative or prolonged axial CLBP relief was assessed by comparing daily pain reports across sessions. Independent of age, individuals experienced episodic increase in the pressure pain detection threshold and reduction in aftersensation after TENS application. Similarly, all groups, on average, experienced episodic axial CLBP relief via improved resting pain, movement-evoked pain, and disability report. Under this design, no cumulative effect was observed as daily pain did not improve for any age group across the 4 sessions. However, older adults received higher TENS amplitude across all sessions to achieve TENS responses similar to those in younger adults. These findings suggest that older adults experience similar episodic axial CLBP relief to that of younger individuals after high-frequency, high-intensity TENS when higher dose parameters are used. PERSPECTIVE This study examined age group differences in experimental and axial CLBP response to TENS, delivered under the current recommended parameters of strong, but tolerable amplitude. Older adults had comparable TENS response although at higher TENS amplitude than younger adults, which may have important mechanistic and clinical implications.
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Affiliation(s)
- Corey B Simon
- Department of Physical Therapy, College of Public Health and Health Professions, University of Florida, Gainesville, Florida; Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, Florida.
| | - Joseph L Riley
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, Florida
| | - Roger B Fillingim
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, Florida
| | - Mark D Bishop
- Department of Physical Therapy, College of Public Health and Health Professions, University of Florida, Gainesville, Florida; Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, Florida
| | - Steven Z George
- Department of Physical Therapy, College of Public Health and Health Professions, University of Florida, Gainesville, Florida; Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, Florida
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89
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Li WQ, Gao X, Tworoger SS, Qureshi AA, Han J. Natural hair color and questionnaire-reported pain among women in the United States. Pigment Cell Melanoma Res 2015; 29:239-42. [PMID: 26603013 DOI: 10.1111/pcmr.12445] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Wen-Qing Li
- Department of Dermatology, Warren Alpert Medical School, Brown University, Providence, RI, USA.,Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA
| | - Xiang Gao
- Department of Nutritional Sciences, College of Health and Human Development, The Pennsylvania State University, University Park, PA, USA.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Shelley S Tworoger
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.,Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
| | - Abrar A Qureshi
- Department of Dermatology, Warren Alpert Medical School, Brown University, Providence, RI, USA.,Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Jiali Han
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.,Department of Epidemiology, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, IN, USA.,Melvin and Bren Simon Cancer Center, Indiana University, Indianapolis, IN, USA
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90
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Characteristics of Patients with Lower Extremity Trauma with Improved and Not Improved Pain During Hospitalization: A Pilot Study. Pain Manag Nurs 2015; 17:3-13. [PMID: 26545732 DOI: 10.1016/j.pmn.2015.06.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 06/13/2015] [Accepted: 06/15/2015] [Indexed: 02/02/2023]
Abstract
Up to 62% of patients report chronic pain at the injury site 6-12 months after blunt trauma, with pain from lower extremity fractures exceeding that from other sites. High pain intensity at time of injury is a risk factor for chronic pain, but it is not clear what patient characteristics influence the pain intensity level during the immediate hospitalization following injury. The purpose of this pilot study was to determine the feasibility of collecting pain scores from medical records to calculate pain trajectories and to determine whether it is possible to examine patient characteristics by classifying them into those whose pain improved and those whose pain did not improve. This descriptive study retrospectively reviewed medical records of 18 randomly chosen patients admitted to an academic trauma center. Patient characteristics and pain scores were collected form electronic and handwritten medical records. The pain trajectories calculated from routinely collected pain scores during the inpatient stay showed that for 44% of patients the pain improved during the hospitalization, for 39% the pain remained the same, and for 17% the pain worsened. The variables age, smoking, weight, abbreviated injury scores, length of hospital stay, mean pain score, and opioid equianalgesic dose differed based on pain trajectory. While patient characteristics differed based on pain trajectory, any significant effects seen from individual tests should be considered tentative, given the number of analyses conducted on this data set. However, feasibility and significance of conducting a larger study has been established.
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Anton SD, Woods AJ, Ashizawa T, Barb D, Buford TW, Carter CS, Clark DJ, Cohen RA, Corbett DB, Cruz-Almeida Y, Dotson V, Ebner N, Efron PA, Fillingim RB, Foster TC, Gundermann DM, Joseph AM, Karabetian C, Leeuwenburgh C, Manini TM, Marsiske M, Mankowski RT, Mutchie HL, Perri MG, Ranka S, Rashidi P, Sandesara B, Scarpace PJ, Sibille KT, Solberg LM, Someya S, Uphold C, Wohlgemuth S, Wu SS, Pahor M. Successful aging: Advancing the science of physical independence in older adults. Ageing Res Rev 2015; 24:304-27. [PMID: 26462882 DOI: 10.1016/j.arr.2015.09.005] [Citation(s) in RCA: 163] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 09/08/2015] [Accepted: 09/30/2015] [Indexed: 02/08/2023]
Abstract
The concept of 'successful aging' has long intrigued the scientific community. Despite this long-standing interest, a consensus definition has proven to be a difficult task, due to the inherent challenge involved in defining such a complex, multi-dimensional phenomenon. The lack of a clear set of defining characteristics for the construct of successful aging has made comparison of findings across studies difficult and has limited advances in aging research. A consensus on markers of successful aging is furthest developed is the domain of physical functioning. For example, walking speed appears to be an excellent surrogate marker of overall health and predicts the maintenance of physical independence, a cornerstone of successful aging. The purpose of the present article is to provide an overview and discussion of specific health conditions, behavioral factors, and biological mechanisms that mark declining mobility and physical function and promising interventions to counter these effects. With life expectancy continuing to increase in the United States and developed countries throughout the world, there is an increasing public health focus on the maintenance of physical independence among all older adults.
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92
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Cruz-Almeida Y, Aguirre M, Sorenson HL, Tighe P, Wallet SM, Riley JL. Age differences in cytokine expression under conditions of health using experimental pain models. Exp Gerontol 2015; 72:150-6. [PMID: 26456458 DOI: 10.1016/j.exger.2015.09.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 09/23/2015] [Accepted: 09/25/2015] [Indexed: 11/20/2022]
Abstract
Older adults are at an increased risk to develop frequent and prolonged pain. Emerging evidence proposes a link between immune changes and pain, which is consistent with the inflammation theory of aging and the increased incidence of age-related diseases. This study tested the hypothesis that older adults show greater immune responses to experimental pain compared to younger individuals. Study subjects (8 younger and 9 older healthy adults) underwent 3 experimental sessions using well-validated human experimental pain models: the cold pressor task (CPT), focal heat pain (FHP), and a non-painful thermal control. Blood was collected through an indwelling catheter at baseline and 3, 15, 30, 45, 60, and 90 min post-stimuli administration. Pro-inflammatory cytokines (TNF-α IL-6 and IL-8) peaked at the same time points for both groups, with greater elevations among older subjects for TNF-α and IL-8 in both pain models and elevations in IL-6 only for CPT. Anti-inflammatory cytokines (IL-4, IL-5, and IL-10) generally peaked later for the older subjects, with increased elevations for FHP but not the CPT. These data are consistent with the assertion that age-related immune system dysregulation may account for the increased prevalence of pain in older adults.
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Affiliation(s)
- Yenisel Cruz-Almeida
- Pain Research & Intervention Center of Excellence (PRICE), United States; Institute of Aging, College of Medicine, United States; Department of Community Dentistry and Behavioral Science, College of Dentistry, United States
| | - Maria Aguirre
- Pain Research & Intervention Center of Excellence (PRICE), United States; Department of Community Dentistry and Behavioral Science, College of Dentistry, United States
| | | | - Patrick Tighe
- Pain Research & Intervention Center of Excellence (PRICE), United States; Department of Anesthesiology, College of Medicine, United States
| | | | - Joseph L Riley
- Pain Research & Intervention Center of Excellence (PRICE), United States; Department of Community Dentistry and Behavioral Science, College of Dentistry, United States
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93
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Inter-individual differences in pain processing investigated by functional magnetic resonance imaging of the brainstem and spinal cord. Neuroscience 2015; 307:231-41. [DOI: 10.1016/j.neuroscience.2015.08.059] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 08/23/2015] [Accepted: 08/24/2015] [Indexed: 01/01/2023]
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94
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Duan G, Guo S, Zhang Y, Ying Y, Huang P, Wang Q, Zhang L, Zhang X. The Effect of SCN9A Variation on Basal Pain Sensitivity in the General Population: An Experimental Study in Young Women. THE JOURNAL OF PAIN 2015; 16:971-80. [DOI: 10.1016/j.jpain.2015.06.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 06/09/2015] [Accepted: 06/24/2015] [Indexed: 10/23/2022]
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95
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Daoust R, Paquet J, Piette É, Sanogo K, Bailey B, Chauny JM. Impact of Age on Pain Perception for Typical Painful Diagnoses in the Emergency Department. J Emerg Med 2015; 50:14-20. [PMID: 26416133 DOI: 10.1016/j.jemermed.2015.06.074] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Revised: 06/16/2015] [Accepted: 06/25/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Age-related differences in pain perception have been demonstrated in experimental settings but have been investigated scarcely and without valid scale in the clinical framework. OBJECTIVES To examine the effect of age on pain perception for recognized painful diagnoses encountered in the emergency department (ED). METHODS A post-hoc analysis of real-time archived data was performed in a tertiary urban and a secondary regional ED. We included all consecutive adult patients (≥18 years) with the following diagnosis at discharge: renal colic, pancreatitis, appendicitis, headache/migraine, dislocation and extremities fractures, and a pain evaluation of ≥1 (0-10, verbal numerical scale) at triage. The primary outcome was to compare for each of these diagnoses the level of pain intensity between four age groups (18-44; 45-64; 65-74; 75+ years). RESULTS A total of 15,670 patients (48% women) were triaged with a mean pain intensity of 7.7 (SD=2.0). Women exhibited greater pain scores than men for pancreatitis, headache/migraine, and extremity fracture. Renal colic, pancreatitis, appendicitis, and headache/migraine showed a linear decrease in pain scores with age whereas dislocation and extremity fractures did not present age differences. Mean differences in pain intensity scores between young adults (18-44 years) and patients aged ≥75 years were 0.79 (95% confidence interval [95% CI] 0.5-1.1) for renal colic, 1.1 (95% CI 0.7-1.4) for pancreatitis, 0.70 (95% CI 0.2-1.2) for appendicitis, and 0.86 (95% CI 0.6-1.1) for headache/migraine. CONCLUSION Older patients perceive similar pain for dislocation and extremity fractures and less for visceral and headache/migraine pain; however, these age differences may not be clinically important.
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Affiliation(s)
- Raoul Daoust
- Department of Emergency Medicine, Research Centre, Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada; Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Jean Paquet
- Department of Emergency Medicine, Research Centre, Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada; Centre for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada
| | - Éric Piette
- Department of Emergency Medicine, Research Centre, Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada; Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Karine Sanogo
- Department of Emergency Medicine, Hôpital régional de St-Jérôme, St-Jérôme, Québec, Canada
| | - Benoit Bailey
- Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada; Division of Emergency Medicine, Department of Pediatrics, Centre hospitalier universitaire Sainte-Justine, Montréal, Québec, Canada
| | - Jean-Marc Chauny
- Department of Emergency Medicine, Research Centre, Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada; Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
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96
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Glover TL, Horgas AL, Fillingim RB, Goodin BR. Vitamin D status and pain sensitization in knee osteoarthritis: a critical review of the literature. Pain Manag 2015; 5:447-53. [PMID: 26399462 DOI: 10.2217/pmt.15.43] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Diagnostic imaging of disease severity has been found thus far to be a relatively modest predictor of knee osteoarthritis (OA) pain and disability, suggesting that other factors likely contribute to clinical symptoms in this condition. Recent evidence suggests that sensitization of the peripheral and central pathways that process nociceptive information (i.e., pain sensitization) is an important contributor to knee OA clinical symptoms. Furthermore, low levels of vitamin D have been found to be associated with the presence of pain sensitization, as well as the overall experience of clinical pain severity in knee OA. African-Americans with knee OA may be at increased risk for poor clinical outcomes given evidence of lower vitamin D levels as well as greater pain sensitization compared with non-Hispanic whites. Whether vitamin D supplementation is effective for alleviating knee OA clinical symptoms is an important topic to be addressed in future research with racially diverse samples that include sufficient numbers of African-Americans.
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Affiliation(s)
- Toni L Glover
- University of Florida, College of Nursing, Biobehavioral Nursing Science, Gainesville, FL 32610, USA.,University of Florida, Pain Research & Intervention Center of Excellence (PRICE), Gainesville, FL 32610, USA
| | - Ann L Horgas
- University of Florida, College of Nursing, Biobehavioral Nursing Science, Gainesville, FL 32610, USA
| | - Roger B Fillingim
- University of Florida, Pain Research & Intervention Center of Excellence (PRICE), Gainesville, FL 32610, USA.,University of Florida, College of Dentistry, Department of Community Dentistry & Behavioral Science, Gainesville, FL 32610, USA
| | - Burel R Goodin
- University of Alabama at Birmingham, Departments of Psychology & Anesthesiology & Perioperative Medicine, Birmingham, AL 35294, USA
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97
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Simon CB, Riley JL, Coronado RA, Valencia C, Wright TW, Moser MW, Farmer KW, George SZ. Older Age as a Prognostic Factor of Attenuated Pain Recovery After Shoulder Arthroscopy. PM R 2015; 8:297-304. [PMID: 26376336 DOI: 10.1016/j.pmrj.2015.09.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 09/01/2015] [Accepted: 09/03/2015] [Indexed: 01/08/2023]
Abstract
BACKGROUND Shoulder pain and surgery are common among older adults. However, the extent to which older age affects recovery after shoulder surgery is not well understood. OBJECTIVE To assess influence of older age on postoperative recovery factors 3 and 6 months after shoulder arthroscopy. DESIGN Prospective cohort study. SETTING University-affiliated outpatient orthopedic surgical center. PATIENTS A convenience sample of 139 persons between 20 and 79 years of age who experienced shoulder pain, had musculoskeletal dysfunction based on imaging and physician assessment, and were scheduled for an arthroscopic shoulder procedure. MAIN OUTCOME MEASURES Postoperative outcomes were compared among younger, middle-aged, and older adults before surgery and at 3 and 6 months after surgery using analysis of variance modeling. Movement-evoked pain and an experimental laboratory correlate of pain processing were assessed at each time point. The influence of older age on 3- and 6-month pain outcomes were determined via multivariate regression analyses after accounting for preoperative, intraoperative, and postoperative prognostic factors. RESULTS Older adults had higher movement-evoked pain intensity (F2,108 = 5.18, P = .007) and experimental pain response (F2,111 = 7.24, P = .001) at 3 months compared with young and middle-aged adults. After controlling for key prognostic factors, older age remained a positive predictor of 3-month movement-evoked pain (R(2) = 0.05; standardized [St.] β = 0.263, P = .031) and experimental pain response (R(2) = 0.07; St. β = 0.295, P = .014). Further, older age remained a positive predictor of movement-evoked pain at 6 months (R(2) = 0.04; St. β = 0.231, P = .004), despite no age group differences in outcome. Older age was found to be the strongest predictor of 3- and 6-month movement-evoked pain. CONCLUSION Older adults may experience more pain related to movement, as well as endogenous pain excitation, in the first few months after shoulder arthroscopy. Future age-related research should consider use of movement-evoked pain intensity and experimental pain response as pain outcomes, as well as the utility of such measures in clinical care.
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Affiliation(s)
- Corey B Simon
- Department of Physical Therapy, College of Public Health and Health Professions, University of Florida, 2004 Mowry Rd, PO Box 100242, Gainesville, FL 32610; Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, FL(∗).
| | - Joseph L Riley
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, FL(†)
| | - Rogelio A Coronado
- Department of Orthopaedic Surgery and Rehabilitation, Vanderbilt University, Nashville, TN(‡)
| | - Carolina Valencia
- Department of Applied Medicine and Rehabilitation, Indiana State University, Terre Haute, IN(¶)
| | - Thomas W Wright
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL(§)
| | - Michael W Moser
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL(∗∗)
| | - Kevin W Farmer
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL(††)
| | - Steven Z George
- Department of Physical Therapy, College of Public Health and Health Professions, University of Florida, 2004 Mowry Rd, PO Box 100242, Gainesville, FL 32610; Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, FL(‡‡)
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98
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Morris MC, Walker L, Bruehl S, Hellman N, Sherman AL, Rao U. Race Effects on Conditioned Pain Modulation in Youth. THE JOURNAL OF PAIN 2015; 16:873-80. [PMID: 26086899 PMCID: PMC4556599 DOI: 10.1016/j.jpain.2015.06.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 05/05/2015] [Accepted: 06/09/2015] [Indexed: 11/15/2022]
Abstract
Race and ethnicity shape the experience of pain in adults. African Americans typically exhibit greater pain intensity and evoked pain responsiveness than non-Hispanic whites. However, it remains unclear whether there are racial differences in conditioned pain modulation (CPM) and if these are present in youth. CPM refers to a reduction in perceived pain intensity for a test stimulus during application of a conditioning stimulus and may be especially relevant in determining risk for chronic pain. The present study assessed CPM to evoked thermal pain in 78 healthy youth (ages 10-17 years), 51% of whom were African American and 49% of whom were non-Hispanic white. African American youth reported lower mean conditioning pain ratings than non-Hispanic white youth, controlling for mean preconditioning pain ratings, which is consistent with stronger CPM. Multilevel models demonstrated stronger CPM effects in African American than non-Hispanic white youth, as evident in more rapid within-person decreases in pain ratings during the conditioning phase. These findings suggest that diminished CPM likely does not account for the enhanced responsiveness to evoked thermal pain observed in African American youth. These results may have implications for understanding racial differences in chronic pain experienced in adulthood. Perspective: This study evaluated conditioned pain modulation to evoked thermal pain in African American and non-Hispanic white youth. Findings could have implications for the development of personalized chronic pain treatment strategies that are informed by race and ethnicity.
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Affiliation(s)
- Matthew C Morris
- Department of Family and Community Medicine, Meharry Medical College, Nashville, Tennessee; Center for Molecular and Behavioral Neuroscience, Meharry Medical College, Nashville, Tennessee; Department of Psychology, Vanderbilt University, Nashville, Tennessee
| | - Lynn Walker
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee; Vanderbilt Kennedy Center, Nashville, Tennessee
| | - Stephen Bruehl
- Vanderbilt Kennedy Center, Nashville, Tennessee; Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Natalie Hellman
- Department of Family and Community Medicine, Meharry Medical College, Nashville, Tennessee
| | - Amanda L Sherman
- Department of Psychology and Human Development, Vanderbilt University, Nashville, Tennessee
| | - Uma Rao
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee; Vanderbilt Kennedy Center, Nashville, Tennessee; Children's Mental Health Services Research Center, University of Tennessee, Knoxville, Tennessee.
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99
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Hermans L, Van Oosterwijck J, Goubert D, Goudman L, Crombez G, Calders P, Meeus M. Inventory of Personal Factors Influencing Conditioned Pain Modulation in Healthy People: A Systematic Literature Review. Pain Pract 2015; 16:758-69. [DOI: 10.1111/papr.12305] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 02/09/2015] [Indexed: 01/19/2023]
Affiliation(s)
- Linda Hermans
- Department of Rehabilitation Sciences and Physiotherapy; Faculty of Medicine and Health Sciences; Ghent University; Ghent Belgium
- Pain in Motion Research Group; Belgium
| | - Jessica Van Oosterwijck
- Department of Rehabilitation Sciences and Physiotherapy; Faculty of Medicine and Health Sciences; Ghent University; Ghent Belgium
- Pain in Motion Research Group; Belgium
| | - Dorien Goubert
- Department of Rehabilitation Sciences and Physiotherapy; Faculty of Medicine and Health Sciences; Ghent University; Ghent Belgium
- Pain in Motion Research Group; Belgium
| | - Lisa Goudman
- Department of Rehabilitation Sciences and Physiotherapy; Faculty of Medicine and Health Sciences; Ghent University; Ghent Belgium
| | - Geert Crombez
- Department of Experimental Clinical and Health Psychology; Ghent University; Ghent Belgium
| | - Patrick Calders
- Department of Rehabilitation Sciences and Physiotherapy; Faculty of Medicine and Health Sciences; Ghent University; Ghent Belgium
| | - Mira Meeus
- Department of Rehabilitation Sciences and Physiotherapy; Faculty of Medicine and Health Sciences; Ghent University; Ghent Belgium
- Pain in Motion Research Group; Belgium
- Department of Rehabilitation Sciences and Physiotherapy; Faculty of Medicine and Health Sciences; University of Antwerp; Antwerp Belgium
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100
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Morris MC, Walker L, Bruehl S, Hellman N, Sherman AL, Rao U. Race effects on temporal summation to heat pain in youth. Pain 2015; 156:917-922. [PMID: 25734994 PMCID: PMC4402253 DOI: 10.1097/j.pain.0000000000000129] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Racial differences in pain responsiveness have been demonstrated in adults. However, it is unclear whether racial differences are also present in youth and whether they extend to experimental pain indices assessing temporal summation of second pain (TSSP). Temporal summation of second pain provides an index of pain sensitivity and may be especially relevant in determining risk for chronic pain. This study assessed pain tolerance and TSSP to evoked thermal pain in 78 healthy youth (age range, 10-17), 51% of whom were African American and 49% were non-Hispanic white. Multilevel models revealed within-individual increases in pain ratings during the temporal summation task in non-Hispanic white youth that were consistent with TSSP. Pain ratings did not change significantly during the temporal summation task in African-American youth. Baseline evoked pain ratings were significantly higher in African-American compared with non-Hispanic white youth. These findings suggest that enhanced responsiveness to evoked thermal pain in African Americans is present in adolescence but is unlikely to be related to elevated TSSP. These results may have implications for understanding racial differences in chronic pain experience in adulthood.
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Affiliation(s)
- Matthew C. Morris
- Department of Family and Community Medicine, Meharry Medical College
- Center for Molecular and Behavioral Neuroscience, Meharry Medical College
| | - Lynn Walker
- Department of Pediatrics, Vanderbilt University School of Medicine
- Vanderbilt Kennedy Center
| | - Stephen Bruehl
- Vanderbilt Kennedy Center
- Department of Anesthesiology, Vanderbilt University School of Medicine
| | - Natalie Hellman
- Department of Family and Community Medicine, Meharry Medical College
| | - Amanda L. Sherman
- Department of Psychology and Human Development, Vanderbilt University
| | - Uma Rao
- Department of Pediatrics, Vanderbilt University School of Medicine
- Vanderbilt Kennedy Center
- Children’s Mental Health Services Research Center, University of Tennessee
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