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Burns JW, Quartana PJ, Gilliam W, Matsuura J, Nappi C, Wolfe B. Suppression of anger and subsequent pain intensity and behavior among chronic low back pain patients: the role of symptom-specific physiological reactivity. J Behav Med 2012; 35:103-14. [PMID: 21597981 PMCID: PMC4170675 DOI: 10.1007/s10865-011-9347-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2010] [Accepted: 04/11/2011] [Indexed: 11/26/2022]
Abstract
Suppression of anger may be linked to heightened pain report and pain behavior during a subsequent painful event among chronic low back patients, but it is not clear whether these effects are partly accounted for by increased physiological reactivity during suppression. Chronic low back pain patients (N = 58) were assigned to Suppression or No Suppression conditions for a "cooperative" computer maze task during which a confederate harassed them. During baseline and maze task, patients' lower paraspinal and trapezius muscle tension, blood pressure and heart rate were recorded. After the maze task, patients underwent a structured pain behavior task (behaviors were videotaped and coded). Results showed that: (a) Suppression condition patients revealed greater lower paraspinal muscle tension and systolic blood pressure (SBP) increases during maze task than No Suppression patients (previously published results showed that Suppression condition patients exhibited more pain behaviors than No Suppression patients); (b) residualized lower paraspinal and SBP change scores were related significantly to pain behaviors; (c) both lower paraspinal and SBP reactivity significantly mediated the relationship between Condition and frequency of pain behaviors. Results suggest that suppression-induced lower paraspinal muscle tension and SBP increases may link the actual suppression of anger during provocation to signs of clinically relevant pain among chronic low back pain patients.
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Affiliation(s)
- John W Burns
- Department of Behavioral Science, Rush University Medical Center, 1653 W. Congress Parkway, Chicago, IL, 60612, USA.
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52
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Nilsen KB, Sand T, Westgaard RH, Stovner LJ, White LR, Bang Leistad R, Helde G, Rø M. Autonomic activation and pain in response to low-grade mental stress in fibromyalgia and shoulder/neck pain patients. Eur J Pain 2012; 11:743-55. [PMID: 17224287 DOI: 10.1016/j.ejpain.2006.11.004] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2006] [Revised: 11/03/2006] [Accepted: 11/20/2006] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Psychosocial stress is a risk factor for musculoskeletal pain, but how stress affects musculoskeletal pain is poorly understood. We wanted to examine the relationship between low-grade autonomic activation and stress-related pain in patients with fibromyalgia and localised chronic shoulder/neck pain. METHODS Twenty-three female patients with fibromyalgia, 29 female patients with chronic shoulder-neck pain, and 35 healthy women performed a stressful task lasting 60min. With a blinded study design, we recorded continuous blood pressure, heart rate, finger skin blood flow and respiration frequency before (10min), during (60min) and after (30min) the stressful task. The physiological responses were compared with subjective reports of pain. RESULTS The increase in diastolic blood pressure and heart rate in response to the stressful task were smaller in fibromyalgia patients compared with the healthy controls. Furthermore, fibromyalgia patients had reduced finger skin blood flow at the end of the stressful task compared to healthy controls. We also found an inverse relationship between the heart rate response and development and recovery of the stress-related pain in fibromyalgia patients. CONCLUSION We found abnormal cardiovascular responses to a 60min long stressful task in fibromyalgia patients. Furthermore, we found a negative association between the heart rate response and the pain which developed during the stressful task in the fibromyalgia group, possibly a result of reduced stress-induced analgesia for fibromyalgia patients.
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Affiliation(s)
- Kristian Bernhard Nilsen
- Norwegian University of Science and Technology, Department of Neurosciences, N-7489, Trondheim, Norway.
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53
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Haas K, Lu Q, Evans S, Tsao JC, Zeltzer LK. Relationship between resting blood pressure and laboratory-induced pain among healthy children. GENDER MEDICINE 2011; 8:388-98. [PMID: 22035675 PMCID: PMC3319441 DOI: 10.1016/j.genm.2011.07.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2010] [Revised: 07/11/2011] [Accepted: 07/13/2011] [Indexed: 11/26/2022]
Abstract
BACKGROUND Adult studies have demonstrated that increased resting blood pressure (BP) levels correlate with decreased pain sensitivity. However, few studies have examined the relationship between BP and experimental pain sensitivity among children. OBJECTIVES This study investigated the association between resting BP levels and experimental pain tolerance, intensity, and unpleasantness in healthy children. We also explored whether these BP-pain relationships were age and gender dependent. METHODS Participants underwent separate 4-trial blocks of cutaneous pressure and thermal pain stimuli, and 1 trial of a cold pain stimulus in counterbalanced order. RESULTS A total of 235 healthy children (49.6% female; mean age 12.7 [2.9] years; age range 8-18 years) participated. The study revealed specific gender-based BP-pain relationships. Girls with higher resting systolic BP levels were found to have lower thermal intensity ratings than girls with lower resting systolic BP levels; this relationship was stronger among adolescent girls than among younger girls. Among young girls (8-11 years), those with higher resting diastolic BP (DBP) levels were found to have lower cold intensity and unpleasantness as well as lower thermal intensity ratings than did young girls with lower resting DBP levels; these DBP-pain response relationships were not seen among adolescent girls. CONCLUSIONS Age, rather than resting BP, was predictive of laboratory pain ratings in boys. The findings suggest that the relationship between BP and experimental pain is age and gender dependent. These aspects of cardiovascular relationships to pain in males and females need further attention to understand their clinical importance.
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Affiliation(s)
- Kelly Haas
- University of California, Irvine School of Medicine, Irvine, California
- UCLA Pediatric Residency Program, University of California-Los Angeles, Los Angeles, California
| | - Qian Lu
- Department of Psychology, University of Houston, Houston, Texas
| | - Subhadra Evans
- Department of Psychology, University of Houston, Houston, Texas
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Evers AWM, Zautra A, Thieme K. Stress and resilience in rheumatic diseases: a review and glimpse into the future. Nat Rev Rheumatol 2011; 7:409-15. [PMID: 21691322 DOI: 10.1038/nrrheum.2011.80] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Stress resilience factors, and interventions to ease stress and enhance resilience, are gaining increasing attention for the treatment of rheumatic conditions. This Review presents a digest of empirical work on the factors that determine the risk of adapting poorly to a rheumatic condition, and on the resilience factors that counteract such risks. We consider the types of stress-management and resilience treatments that are most effective in promoting the physical and psychological functioning of patients at risk of long-term adjustment problems. Prospective research shows that cognitive-behavioral and social risk and resilience factors predict the long-term physical and psychological functioning of patients with rheumatic conditions. Furthermore, validated screening instruments are becoming increasingly useful in clinical practice to identify and select patients at risk. Stress-management and resilience interventions offer promising ways to improve the long-term functioning of patients. These treatment methods might be especially useful when they are tailored to the specific risk and resilience factors of patients, and when they incorporate innovative approaches to the delivery of services, including internet applications such as eHealth, to increase efficiency and availability of treatments, and to optimize patient empowerment in rheumatic conditions.
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Affiliation(s)
- Andrea W M Evers
- Department of Medical Psychology (840), Radboud University Nijmegen Medical Center, PO Box 9101, 6500 HB, Nijmegen, the Netherlands.
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55
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Bereiter DA, Okamoto K. Neurobiology of estrogen status in deep craniofacial pain. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2011; 97:251-84. [PMID: 21708314 DOI: 10.1016/b978-0-12-385198-7.00010-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Pain in the temporomandibular joint (TMJ) region often occurs with no overt signs of injury or inflammation. Although the etiology of TMJ-related pain may involve multiple factors, one likely risk factor is female gender or estrogen status. Evidence is reviewed from human and animal studies, supporting the proposition that estrogen status acts peripherally or centrally to influence TMJ nociceptive processing. A new model termed the "TMJ pain matrix" is proposed as critical for the initial integration of TMJ-related sensory signals in the lower brainstem that is both modified by estrogen status, and closely linked to endogenous pain and autonomic control pathways.
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Affiliation(s)
- David A Bereiter
- Department of Diagnostic and Biological Sciences, University of Minnesota School of Dentistry, Minneapolis, MN 55455, USA
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Mechlin B, Heymen S, Edwards CL, Girdler SS. Ethnic differences in cardiovascular-somatosensory interactions and in the central processing of noxious stimuli. Psychophysiology 2010; 48:762-73. [PMID: 21039586 DOI: 10.1111/j.1469-8986.2010.01140.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Ethnic differences in central sensitization of pain processing and stress-relevant endogenous pain regulatory mechanisms were examined. Forty-four African Americans (AAs; 50% women) and 44 non-Hispanic Whites (nHWs; 50% women) matched for socioeconomic status, were tested for pain responses to the temporal summation of heat pulses and ischemic and cold pain. Resting and stress blood pressure (BP) and norepinephrine (NE) were assessed. AAs had heightened pain responses to all 3 pain tasks relative to nHWs. In nHWs, higher BP and NE were related to reduced pain. In AAs, there was no relationship between BP and pain, but higher NE was related to increased pain. This study provides evidence for ethnic differences in centrally mediated pain and extends prior research demonstrating ethnic differences in endogenous pain regulatory mechanisms. These results have implications for understanding biobehavioral factors contributing to ethnic disparities in clinical pain.
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Affiliation(s)
- Beth Mechlin
- Department of Psychology, Washington and Lee University, Lexington, Virginia 24450, USA.
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57
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Abstract
Despite ongoing efforts, neither effective treatments nor mechanistic understanding of the pathogenesis of human neuropathic pain exists. Genetic association studies may point to the novel molecules that mediate neuropathic pain, facilitating its understanding and management. Several studies used a candidate gene approach to elucidate genetic contribution to neuropathic pain phenotypes; however, the data is limited and inconsistent. Possible reasons include: sample heterogeneity, underpowered study design, population admixture, poor phenotyping, genotyping errors, and statistical analytical mistakes. This article summarizes and discusses current strategies to optimize population-based association studies of human neuropathic pain focusing on principles of measuring neuropathic pain phenotypes and genotyping techniques. We also consider advantages and challenges of study designs and statistical analyses.
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Pinho D, Morato M, Couto MR, Marques-Lopes J, Tavares I, Albino-Teixeira A. Does chronic pain alter the normal interaction between cardiovascular and pain regulatory systems? Pain modulation in the hypertensive-monoarthritic rat. THE JOURNAL OF PAIN 2010; 12:194-204. [PMID: 20736136 DOI: 10.1016/j.jpain.2010.06.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2010] [Revised: 04/23/2010] [Accepted: 06/24/2010] [Indexed: 01/27/2023]
Abstract
UNLABELLED Hypertension-associated hypoalgesia is widely recognized in acute pain conditions. In chronic pain states, however, the relationship between blood pressure and pain sensitivity is still ill-defined, with different authors reporting negative, positive, or even no relationship at all. This work addresses this issue, using complete Freund's adjuvant (CFA)-induced monoarthritis in different models of hypertension: Spontaneous (spontaneously hypertensive rats, SHR), induced by infusion of angiotensin II (ANG) or 1,3-dipropyl-8-sulfophenylxanthine (DPSPX, an adenosine receptors' antagonist), and renal artery ligation (RAL). Nociceptive responses associated with monoarthritis were evaluated by different behavioral tests (von Frey, ankle-bend and CatWalk) and by quantification of Fos expression at the dorsal horn upon noxious stimulation. In all hypertension models, higher von Frey thresholds and lower Fos expression were detected in hypertensive rats with chronic inflammatory pain, as compared to normotensive monoarthritic rats. In SHR and DPSPX, but not ANG or RAL models, hypertensive animals displayed lower inflammation than normotensives. Ankle-bend and CatWalk results indicated lower pain sensitivity in hypertensive rats only in SHR and DPSPX models. The present study shows the importance of using multiple models of hypertension, and evaluating pain responses by various methods, to better understand the complexity of the interactions between pain and cardiovascular regulatory systems. PERSPECTIVE This study used different models of hypertension to investigate whether chronic pain alters the normal integration of cardiovascular and pain regulatory systems. A complete understanding of the mechanisms underlying the complex interactions between these systems may disclose future therapeutic approaches to treat hypertension/chronic pain comorbidity states.
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Affiliation(s)
- Dora Pinho
- Instituto de Farmacologia e Terapêutica, Faculdade de Medicina, Universidade do Porto, Portugal
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59
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Umeda M, Newcomb LW, Ellingson LD, Koltyn KF. Examination of the dose-response relationship between pain perception and blood pressure elevations induced by isometric exercise in men and women. Biol Psychol 2010; 85:90-6. [PMID: 20594949 DOI: 10.1016/j.biopsycho.2010.05.008] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2009] [Revised: 05/25/2010] [Accepted: 05/26/2010] [Indexed: 10/19/2022]
Abstract
The purpose of this study was to examine exercise-induced hypoalgesia (EIH) in men and women, and whether different magnitudes of BP elevations induced by isometric exercise systematically influenced pain perception. Twenty-five men and 25 women performed isometric exercise at 25% MVC for 1-min, 3-min, and 5-min while BP and pain perception were assessed. Results indicated that BP was significantly elevated (p<0.05) by isometric exercise in a dose-response manner. Pain thresholds were found to be elevated while pain ratings were lower (p<0.05) immediately following isometric exercise but not in a dose-response manner. It was concluded that isometric exercise produced EIH in men and women, and there was not a dose-response relationship between BP and EIH.
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Affiliation(s)
- Masataka Umeda
- Department of Physical Medicine and Rehabilitation, University of Colorado-Denver, Aurora, CO, USA
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60
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Central processing of noxious somatic stimuli in patients with irritable bowel syndrome compared with healthy controls. Clin J Pain 2010; 26:104-9. [PMID: 20090435 DOI: 10.1097/ajp.0b013e3181bff800] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare a central analgesic mechanism known as diffuse noxious inhibitory controls (DNIC) using somatic test stimuli and somatic conditioning stimuli, (CS) in irritable bowel syndrome (IBS) patients and healthy controls. METHODS Participants were 48 premenopausal females (27 with IBS), mean age of 29 years. The phasic heat test stimulus (peak temperature, 50 degrees C) was applied to the left palm. The DNIC effect, which measured reductions in average pain ratings (APR) during counter irritation (submersion of the participant's right hand in painful 12 degrees C circulating water) compared with baseline, was compared between groups. In addition, a second, counterbalanced, CS protocol (right hand submerged in nonpainful 32 degrees C circulating water) was performed. Differences in APR between the 2 counterirritation protocols were compared between groups to control for nonspecific effects known to influence DNIC. Psychologic measures and cardiovascular reactivity were also assessed. RESULTS IBS patients demonstrated smaller DNIC than controls (P=0.011, repeated measures analysis of variance), and greater state-anxiety, depression, catastrophizing, and anger-out expression (P<0.05). Group differences in DNIC were enhanced after controlling for nonspecific effects occurring during the nonpainful CS, and for psychologic measures (P=0.001, repeated measures analysis of covariance). There were no group differences in age, cardiovascular reactivity, APR, or pain ratings for the 12 degrees C CS. DISCUSSION These data demonstrate deficient DNIC in IBS. This is the first study to adequately control for alternative explanations of pain reduction during counterirritation. Only by controlling for nonspecific effects can evidence of deficient DNIC be attributed to dysregulation in endogenous analgesic mechanisms.
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61
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Bruehl S, Dengler-Crish CM, Smith CA, Walker LS. Hypoalgesia related to elevated resting blood pressure is absent in adolescents and young adults with a history of functional abdominal pain. Pain 2010; 149:57-63. [PMID: 20122805 DOI: 10.1016/j.pain.2010.01.009] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2009] [Revised: 11/23/2009] [Accepted: 01/12/2010] [Indexed: 01/26/2023]
Abstract
Elevated resting blood pressure (BP) is hypoalgesic in healthy individuals, but this effect is absent in adults with chronic somatic pain. This study tested whether BP-related hypoalgesia is similarly altered in individuals with a history of chronic visceral pain in childhood. Resting BP was assessed in 94 adolescents and young adults with a known history of childhood functional abdominal pain (FAP) and 55 comparable healthy controls. Responses to an acute heat pain stimulus were then evaluated following exposure to two laboratory stressors. A significant participant type x systolic BP (SBP) interaction (p<.005) revealed that elevated resting SBP was associated with significantly higher heat pain threshold (p<.001) in healthy controls, but was unrelated to pain threshold in the FAP group. A similar pattern was observed for heat pain tolerance, with elevated SBP linked to significantly higher pain tolerance (p<.05) in healthy controls, but unrelated to tolerance in the FAP group. Dysfunction in BP-related hypoalgesia associated with FAP was evident regardless of whether childhood FAP had resolved or still persisted at the time of laboratory testing. Subgroup analyses indicated that BP-related hypoalgesia (in healthy controls) and FAP-linked absence of this hypoalgesia was observed only among females. Result suggest that childhood visceral chronic pain may be associated with relatively long-lasting dysfunction in overlapping systems modulating pain and BP that persists even after FAP resolves. Potential implications for later hypertension risk are discussed.
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Affiliation(s)
- Stephen Bruehl
- Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, TN, USA Department of Pediatrics, Vanderbilt University School of Medicine, The Monroe Carell Jr. Children's Hospital, Vanderbilt, Nashville, TN, USA Department of Psychology and Human Development, Vanderbilt University, Nashville, TN, USA
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62
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Bruehl S, Burns JW, Chung OY, Magid E, Chont M, Gilliam W, Matsuura J, Somar K, Goodlad JK, Stone K, Cairl H. Hypoalgesia associated with elevated resting blood pressure: evidence for endogenous opioid involvement. J Behav Med 2009; 33:168-76. [PMID: 20039197 DOI: 10.1007/s10865-009-9241-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2009] [Accepted: 12/09/2009] [Indexed: 01/07/2023]
Abstract
This study used a placebo-controlled, between-subjects opioid blockade design to evaluate endogenous opioid involvement in the hypoalgesia associated with elevated resting blood pressure (BP) in 163 healthy individuals. Participants were randomly assigned to Drug condition (placebo, naltrexone) and Task Order (computerized maze task with harassment followed by an ischemic pain task or vice versa). Resting BP was assessed, followed by drug administration, and then the pain and maze tasks. A significant Drug x Systolic BP (SBP) interaction was observed on McGill Pain Questionnaire-Affective pain ratings (P < .01), indicating that BP-related hypoalgesia observed under placebo was absent under opioid blockade. A significant Gender x Drug x SBP x Task Order interaction was observed for VAS pain intensity (P < .02). Examination of simple effects comprising this interaction suggested that BP-related hypoalgesia occurred only in male participants who experienced the pain task in the absence of emotional arousal, and indicated that this hypoalgesia occurred under placebo but not under opioid-blockade. Results suggest that under some circumstance, BP-related hypoalgesia may have an endogenous opioid-mediated component in healthy individuals, particularly men.
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Affiliation(s)
- Stephen Bruehl
- Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, TN, USA.
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63
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Vargas-Alarcón G, Fragoso JM, Cruz-Robles D, Vargas A, Martinez A, Lao-Villadóniga JI, García-Fructuoso F, Vallejo M, Martínez-Lavín M. Association of adrenergic receptor gene polymorphisms with different fibromyalgia syndrome domains. ACTA ACUST UNITED AC 2009; 60:2169-73. [DOI: 10.1002/art.24655] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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64
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McLean SA, Kirsch NL, Tan-Schriner CU, Sen A, Frederiksen S, Harris RE, Maixner W, Maio RF. Health status, not head injury, predicts concussion symptoms after minor injury. Am J Emerg Med 2009; 27:182-90. [PMID: 19371526 DOI: 10.1016/j.ajem.2008.01.054] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2008] [Accepted: 01/28/2008] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE Postconcussion (PC) syndrome etiology remains poorly understood. We sought to examine predictors of persistent PC symptoms after minor injury. METHODS Health status, symptom, and injury information were obtained on a sample of patients presenting to the emergency department after minor injury. Postconcussion and cognitive symptoms were assessed at 1, 3, and 12 months. RESULTS Among 507 patients enrolled, 339 had head injury. Repeated-measures logistic regression modeling of PC and cognitive symptom presence across time indicated that baseline mental health status and physical health status were most predictive of persistent symptoms. In contrast, head injury presence did not predict persistent PC syndrome. DISCUSSION Baseline mental health status and physical health status were associated with persistent PC syndrome after minor injury, but head injury status was not. Further studies of PC syndrome pathogenesis are needed.
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Affiliation(s)
- Samuel A McLean
- Department of Emergency Medicine and the TRYUMPH Research Program, University of North Carolina, Chapel Hill, NC 27599-7455, USA.
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65
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Fecho K, Miller NR, Merritt SA, Klauber-DeMore N, Hultman CS, Blau WS. Acute and Persistent Postoperative Pain after Breast Surgery. PAIN MEDICINE 2009; 10:708-15. [DOI: 10.1111/j.1526-4637.2009.00611.x] [Citation(s) in RCA: 117] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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66
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France CR, Taddio A, Shah VS, Pagé GM, Katz J. Maternal family history of hypertension attenuates neonatal pain response. Pain 2009; 142:189-193. [DOI: 10.1016/j.pain.2008.12.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2008] [Revised: 12/03/2008] [Accepted: 12/03/2008] [Indexed: 11/16/2022]
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67
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Frew AK, Drummond PD. Opposite effects of opioid blockade on the blood pressure–pain relationship in depressed and non-depressed participants. Pain 2009; 142:68-74. [DOI: 10.1016/j.pain.2008.11.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2008] [Revised: 11/14/2008] [Accepted: 11/24/2008] [Indexed: 02/04/2023]
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68
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Dannecker EA, George SZ. A comparison of laboratory measures of escape and avoidance behavior. THE JOURNAL OF PAIN 2008; 10:53-9. [PMID: 18774344 DOI: 10.1016/j.jpain.2008.07.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2007] [Revised: 06/24/2008] [Accepted: 07/08/2008] [Indexed: 10/21/2022]
Abstract
UNLABELLED Escape and avoidance of the onset of pain and exacerbations of pain can be difficult to distinguish in certain circumstances. This investigation compared measures of participants' (N = 61, 50.8% women) escape and avoidance behavior during an ischemic pain task. Instructions for the ischemic task were manipulated so that one group stopped the task whenever they wanted (eg, before the onset of pain) and another group endured the ischemic pain to tolerance. Delay time before beginning the task and willingness to complete the task were not related to self-reported escape/avoidance (r = -.21, P = .10; r = -.14, P = .30). Also, they were not predicted by fear, anxiety, or catastrophizing. Task duration with the unrestricted stop rule was not related to self-reported escape/avoidance (r = -.13, P = .50) and was not predicted by fear, anxiety, or catastrophizing. However, task duration with the tolerance stop rule was associated with self-reported escape/avoidance (r = -.40, P = .02) and was predicted by catastrophizing (t(29) = -2.92, P < .01). Thus, evidence for the validity of task duration with a tolerance stop rule as a measure of escape from pain or avoidance of pain exacerbation was found. PERSPECTIVE Measures of avoidance of pain onset were not supported. However, task duration was a valid measure of escape from pain or avoidance of pain exacerbation with tolerance stop rules. Other measures of escape/avoidance behavior and participants' perceptions of stable or increasing pain level throughout a pain task should be examined.
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Affiliation(s)
- Erin A Dannecker
- Department of Physical Therapy, University of Missouri, Columbia, Missouri 65211-4250, USA.
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69
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Chung OY, Bruehl S. The Impact of Blood Pressure and Baroreflex Sensitivity on Wind-Up. Anesth Analg 2008; 107:1018-25. [DOI: 10.1213/ane.0b013e31817f8dfe] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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70
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Chung OY, Bruehl S, Diedrich L, Diedrich A, Chont M, Robertson D. Baroreflex sensitivity associated hypoalgesia in healthy states is altered by chronic pain. Pain 2008; 138:87-97. [DOI: 10.1016/j.pain.2007.11.011] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2007] [Revised: 10/08/2007] [Accepted: 11/19/2007] [Indexed: 12/18/2022]
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71
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Experimental Pain Sensitivity in Women With Temporomandibular Disorders and Pain-free Controls: The Relationship to Orofacial Muscular Contraction and Cardiovascular Responses. Clin J Pain 2008; 24:343-52. [DOI: 10.1097/ajp.0b013e318162eaf4] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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72
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The relationship between resting blood pressure and acute pain sensitivity: effects of chronic pain and alpha-2 adrenergic blockade. J Behav Med 2007; 31:71-80. [DOI: 10.1007/s10865-007-9133-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2007] [Accepted: 09/20/2007] [Indexed: 10/22/2022]
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Diatchenko L, Anderson AD, Slade GD, Fillingim RB, Shabalina SA, Higgins TJ, Sama S, Belfer I, Goldman D, Max MB, Weir BS, Maixner W. Three major haplotypes of the beta2 adrenergic receptor define psychological profile, blood pressure, and the risk for development of a common musculoskeletal pain disorder. Am J Med Genet B Neuropsychiatr Genet 2006; 141B:449-62. [PMID: 16741943 PMCID: PMC2570772 DOI: 10.1002/ajmg.b.30324] [Citation(s) in RCA: 138] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Adrenergic receptor beta(2) (ADRB2) is a primary target for epinephrine. It plays a critical role in mediating physiological and psychological responses to environmental stressors. Thus, functional genetic variants of ADRB2 will be associated with a complex array of psychological and physiological phenotypes. These genetic variants should also interact with environmental factors such as physical or emotional stress to produce a phenotype vulnerable to pathological states. In this study, we determined whether common genetic variants of ADRB2 contribute to the development of a common chronic pain condition that is associated with increased levels of psychological distress and low blood pressure, factors which are strongly influenced by the adrenergic system. We genotyped 202 female subjects and examined the relationships between three major ADRB2 haplotypes and psychological factors, resting blood pressure, and the risk of developing a chronic musculoskeletal pain condition-Temporomandibular Joint Disorder (TMD). We propose that the first haplotype codes for lower levels of ADRB2 expression, the second haplotype codes for higher ADRB2 expression, and the third haplotype codes for higher receptor expression and rapid agonist-induced internalization. Individuals who carried one haplotype coding for high and one coding for low ADRB2 expression displayed the highest positive psychological traits, had higher levels of resting arterial pressure, and were about 10 times less likely to develop TMD. Thus, our data suggest that either positive or negative imbalances in ADRB2 function increase the vulnerability to chronic pain conditions such as TMD through different etiological pathways that imply the need for tailored treatment options.
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Affiliation(s)
- Luda Diatchenko
- University of North Carolina, Center for Neurosensory Disorders, North Carolina, USA.
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74
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Green AL, Wang S, Owen SLF, Xie K, Bittar RG, Stein JF, Paterson DJ, Aziz TZ. Stimulating the human midbrain to reveal the link between pain and blood pressure. Pain 2006; 124:349-359. [PMID: 16781077 DOI: 10.1016/j.pain.2006.05.005] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2005] [Revised: 04/20/2006] [Accepted: 05/02/2006] [Indexed: 10/24/2022]
Abstract
The periaqueductal grey area (PAG) in the midbrain is an important area for both cardiovascular control and modulation of pain. However, the precise relationship between pain and blood pressure is unknown. We prospectively studied 16 patients undergoing deep brain stimulation of the rostral PAG for chronic pain. Pre-operatively, post-operatively, and at 1 year, pain scores were assessed using both visual analogue scores and the McGill Pain Questionnaire. Patients were tested post-operatively to determine whether electrical stimulation of the PAG would modulate blood pressure. We found that the degree of analgesia induced by deep brain stimulation of the rostral PAG in man is related to the magnitude of reduction in arterial blood pressure. We found that this relationship is linear and is related to reduced activity of the sympathetic nervous system. Thus stimulation of the PAG may partly control pain by reducing sympathetic activity as predicted by William James over a century ago.
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Affiliation(s)
- Alexander L Green
- Department of Neurosurgery, Radcliffe Infirmary, Woodstock Road, Oxford, OX2 6HE, United Kingdom University Laboratory of Physiology, University of Oxford, Parks Road, Oxford, OX1 3PT, United Kingdom
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75
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Bruehl S, Burns JW, McCubbin JA. Altered cardiovascular/pain regulatory relationships in chronic pain. Int J Behav Med 2006; 5:63-75. [PMID: 16250716 DOI: 10.1207/s15327558ijbm0501_5] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
In healthy individuals, there is an inverse relationship between resting blood pressure (BP) and pain sensitivity. This study examined possible dysregulation of this adaptive relation in chronic pain patients, and tested whether the extent of this dysregulation is a function of pain duration. Continuous resting BP's were assessed for 5 min after a 5-min rest period in 121 chronic benign pain patients. Unlike the inverse relationship observed previously in normals, mean resting diastolic. BPs during the assessment period were correlated positively with ratings of pain severity. A Pain Duration x Systolic BP interaction emerged (p < .05) such that the magnitude of the BP-pain relation was greatest in patients with the longest duration of pain, r(38) = .50, p < .001. A hypothesized progressive alteration in endogenous pain regulatory systems in chronic pain patients was supported. A possible role of endogenous opioid dysfunction in accounting for these alterations is discussed.
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Affiliation(s)
- S Bruehl
- Center for Pain Studies, Rehabilitation Institute of Chicago, Chicago, IL 60611, USA
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76
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Mechlin MB, Maixner W, Light KC, Fisher JM, Girdler SS. African Americans show alterations in endogenous pain regulatory mechanisms and reduced pain tolerance to experimental pain procedures. Psychosom Med 2005; 67:948-56. [PMID: 16314600 DOI: 10.1097/01.psy.0000188466.14546.68] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To examine ethnic differences in pain sensitivity and relationship of pain tolerance to blood pressure and neuroendocrine factors. METHODS Fifty-one African Americans (24 men, 27 women) and 55 people from other ethnic groups (primarily Caucasian; 26 men, 29 women) were tested twice for pain sensitivity to tourniquet ischemia, thermal heat, and cold pressor tests, once following mental stress and once following rest control. Resting and stress-induced blood pressure (BP), plasma norepinephrine (NE), and cortisol were assessed. RESULTS In response to all three pain tests, African Americans had lower pain tolerance relative to Caucasian/Others after both rest and stress. Only the non-African American group showed the expected inverse relationship between BP and pain sensitivity. African Americans had lower cortisol concentrations at rest and stress and showed blunted NE and systolic BP responses to stress. Only in Caucasians/Others was the relationship seen between higher stress-induced BP, cortisol, and NE levels and greater pain tolerance. CONCLUSIONS The results suggest that there are alterations in endogenous pain regulatory mechanisms involving BP, cortisol, and NE in African Americans. Such dysregulation may contribute to the greater rate of clinical pain symptoms they experience. It is hypothesized that greater chronic stress in African Americans may be a contributing factor to the alterations in pain regulation.
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Affiliation(s)
- M Beth Mechlin
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-7175, USA
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77
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Foster DC, Dworkin RH, Wood RW. Effects of intradermal foot and forearm capsaicin injections in normal and vulvodynia-afflicted women. Pain 2005; 117:128-36. [PMID: 16087295 DOI: 10.1016/j.pain.2005.05.025] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2004] [Revised: 03/28/2005] [Accepted: 05/27/2005] [Indexed: 11/25/2022]
Abstract
Cutaneous response to capsaicin has been used to assess central sensitization in pain research. This study compared the response to intradermal capsaicin in the forearm and foot of vulvar vestibulitis (vestibulodynia)-afflicted cases and controls. We hypothesized that cases will experience greater spontaneous pain, larger cutaneous areas of punctate hyperalgesia and dynamic allodynia, and greater vascular flow than controls. We also hypothesized enhanced post-injection pain in the foot compared to the forearm based on dermatome proximity of the foot and vulva. Methods. Ten vulvar vestibulitis syndrome (VVS) cases and 10 age and ethnically matched controls underwent two randomized, cross-over trials with intra-dermal injections of capsaicin or a saline placebo in the forearm and foot. Outcome measures included spontaneous pain level, surface area of punctate hyperalgesia, surface area of dynamic allodynia, cutaneous blood flow, regional skin temperature and vital signs. Results. VVS cases experienced greater spontaneous pain, punctate hyperalgesia and dynamic allodynia than pain-free controls. Within the VVS group, post-capsaicin spontaneous pain, punctate hyperalgesia and dynamic allodynia were similar in the forearm and foot. Post-capsaicin blood flow did not differ between cases and controls by anatomic site. Measures of depression and anxiety correlated with spontaneous pain intensity but did not correlate with measures of hyperalgesia, allodynia, or blood flow. VVS cases had higher resting pulse rates and lower resting systolic blood pressures than in controls. Conclusion. VVS patients show enhancement of post-capsaicin pain response extending far beyond the anatomic location of the primary complaint.
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Affiliation(s)
- David C Foster
- Department of Obstetrics and Gynecology and Department of Anaesthesia, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.
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78
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Bruehl S, Chung OY, Jirjis JN, Biridepalli S. Prevalence of Clinical Hypertension in Patients With Chronic Pain Compared to Nonpain General Medical Patients. Clin J Pain 2005; 21:147-53. [PMID: 15722808 DOI: 10.1097/00002508-200503000-00006] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVES In healthy individuals, elevated blood pressure is associated with diminished acute pain sensitivity. These cardiovascular/pain regulatory system interactions appear altered in patients with chronic pain; elevated blood pressure is associated with increased acute and chronic pain responsiveness. If these alterations reflect failure of overlapping systems modulating pain and blood pressure, it was expected that prevalence of clinical hypertension would be increased in the chronic pain population. METHODS A retrospective review was conducted on randomly selected records of 300 patients with chronic pain (Pain) evaluated at a tertiary care pain center and 300 nonpain internal medicine (Medicine) patients seen at the same institution. RESULTS Results revealed that 39% of the Pain group was diagnosed with clinical hypertension, compared with 21% of the Medicine group (P < 0.001). Analyses by sex revealed similar group differences in males (P < 0.05) and females (P < 0.001), although the difference in females was double in magnitude compared with males. In contrast to more frequent male hypertension in the general population and the Medicine sample, females were more often diagnosed with hypertension (41.2%) than males (35.6%) in the Pain group. Similar group differences were obtained for antihypertensive use (P < 0.001). Stepwise logistic regression in the Pain group revealed that chronic pain intensity was a significant predictor of hypertensive status independent of the effects of age, race/ethnicity, and parental hypertension (P < 0.05). DISCUSSION These results suggest that chronic pain may be associated with increased risk of hypertension. Factors that may underlie this association are discussed.
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Affiliation(s)
- Stephen Bruehl
- Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, TN, USA.
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79
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Slater H, Arendt-Nielsen L, Wright A, Graven-Nielsen T. Sensory and motor effects of experimental muscle pain in patients with lateral epicondylalgia and controls with delayed onset muscle soreness. Pain 2005; 114:118-30. [PMID: 15733637 DOI: 10.1016/j.pain.2004.12.003] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2004] [Revised: 11/22/2004] [Accepted: 12/02/2004] [Indexed: 11/29/2022]
Abstract
This study compares the effect of experimental muscle pain on deep tissue sensitivity and force attenuation in the wrist extensors of patients with lateral epicondylalgia (n=20), and healthy controls (n=20) with experimentally induced sensori-motor characteristics simulating lateral epicondylalgia. Delayed onset muscle soreness (DOMS) in wrist extensors of healthy controls was induced by eccentric exercise in one arm 24h prior to injection (Day 0). Saline-induced pain intensity (visual analogue scale, VAS), distribution, and quality were assessed quantitatively in both arms for both groups. Pressure pain thresholds (PPT) were assessed at three different sites in the wrist extensors. Maximal grip force and wrist extension force were recorded. In response to saline-induced pain in the extensor carpi radialis brevis, regardless of arm, the patient group demonstrated a significantly quicker pain onset (P<0.01), mapped larger pain areas and more referred pain areas, compared to healthy controls (P<0.03). Pain persisted significantly longer in the sore arm of the patient group, compared with all other arms (P<0.02). Patients demonstrated significant bilateral hyperalgesia at extensor carpi radialis brevis during and post saline-induced pain compared to pre-injection and healthy controls (P<0.04). The sore arm in patients and the DOMS arms in healthy subjects showed significantly reduced maximal force (P<0.0001), at all Day 1 times compared with the control arms. In patients, the bilateral increase in deep tissue sensitivity and enlarged referred pain areas during saline-induced pain might suggest involvement of central sensitisation.
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Affiliation(s)
- Helen Slater
- Laboratory for Experimental Pain Research, Center for Sensory-Motor Interaction, Aalborg University, Fredrik Bajers Vej 7D, 9220 Aalborg E, Denmark
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80
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Sherman JJ, LeResche L, Huggins KH, Mancl LA, Sage JC, Dworkin SF. The relationship of somatization and depression to experimental pain response in women with temporomandibular disorders. Psychosom Med 2004; 66:852-60. [PMID: 15564349 DOI: 10.1097/01.psy.0000140006.48316.80] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Patients with temporomandibular pain disorders (TMD) have greater experimental pain perception when compared with pain-free controls. Common psychological features of TMD include somatization and depression. The impact of depression on experimental pain perception has received considerable attention. However, the role of somatization on experimental pain in a chronic pain population has not been explored. METHODS Fifty-six women with TMD and 59 pain-free controls underwent three experimental pain procedures, including palpation at fixed amounts of pressure, pressure pain thresholds, and an ischemic pain task. Levels of depression and somatization were assessed using the Research Diagnostic Criteria for TMD. Multiple regression analyses were performed to determine the extent to which depression and somatization were associated with experimental pain response. RESULTS After controlling for characteristic pain intensity and depression, somatization explained a significant proportion of variance in numbers of masticatory sites rated as painful (R2 change = 6.7%, p = .046) with the full model explaining 16.4% of the variance (p = .024). This did not meet an adjusted level of statistical significance (p = .008). After controlling for characteristic pain, only depression added significantly to the model predicting ischemic pain threshold and tolerance. The full models including characteristic pain and depression explained 49% and 20% of the variance in ischemic pain threshold and tolerance, respectively. CONCLUSIONS These findings suggest that depression and somatization are associated with different measures of experimental pain. Somatization may be related to more attentional and perceptual measures of clinically relevant pain while depression may be related to more behavioral measures of pain.
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Affiliation(s)
- Jeffrey J Sherman
- Department of Oral Medicine, University of Washington, Seattle, WA 98195-6370, USA.
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81
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Bruehl S, Chung OY. Interactions between the cardiovascular and pain regulatory systems: an updated review of mechanisms and possible alterations in chronic pain. Neurosci Biobehav Rev 2004; 28:395-414. [PMID: 15341037 DOI: 10.1016/j.neubiorev.2004.06.004] [Citation(s) in RCA: 263] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2004] [Revised: 06/16/2004] [Accepted: 06/16/2004] [Indexed: 01/14/2023]
Abstract
Endogenous pain regulatory system dysfunction appears to play a role in the maintenance of chronic pain. An important component of the pain regulatory process is the functional interaction between the cardiovascular and pain regulatory systems, which results in an association between elevated resting blood pressure (BP) and diminished acute pain sensitivity. This BP/pain sensitivity relationship is proposed to reflect a homeostatic feedback loop helping restore arousal levels in the presence of painful stimuli. Evidence is emerging that this normally adaptive BP/pain sensitivity relationship is significantly altered in chronic pain conditions, affecting responsiveness to both acute and chronic pain stimuli. Several mechanisms that may underlie this adaptive relationship in healthy individuals are overviewed, including endogenous opioid, noradrenergic, and baroreceptor-related mechanisms. Theoretical models are presented regarding how chronic pain-related alterations in the mechanisms above and increased pain facilatory system activity (central sensitization) may contribute to altered BP/pain sensitivity interactions in chronic pain. Clinical implications are discussed.
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Affiliation(s)
- Stephen Bruehl
- Department of Anesthesiology, School of Medicine, Vanderbilt University, 1211 Twenty-First Avenue South, Nashville, TN 37212, USA.
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82
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Granot M, Friedman M, Yarnitsky D, Tamir A, Zimmer EZ. Primary and secondary vulvar vestibulitis syndrome: systemic pain perception and psychophysical characteristics. Am J Obstet Gynecol 2004; 191:138-42. [PMID: 15295354 DOI: 10.1016/j.ajog.2003.09.060] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Women with primary and secondary vulvar vestibulitis syndrome (VVS) report similar vulvar pain symptoms; however, it is not clear whether these subsets have similar pain and psychophysical characteristics. This study evaluated systemic pain perception, cardiovascular measures, and anxiety level in women with primary and secondary VVS. STUDY DESIGN Eighty-nine women were enrolled in the study: 44 had primary vulvar vestibulitis, 45 had secondary vulvar vestibulitis. Their anxiety level was first assessed. Then, heat pain stimuli were applied to the forearm, and pain threshold and pain scores for suprathreshold phasic (44 degrees C-48 degrees C) and tonic (46 degrees C) stimuli were assessed by visual analog scale. Finally, blood pressure was recorded using a volume clamp method before, during, and after a tonic stimulus of 1 minute at 46 degrees C. RESULTS Women with primary vulvar vestibulitis had higher visual analog scale scores for pain perception at 46 degrees C to 48 degrees C, a higher level of trait anxiety 43.3 +/- 1.5 versus 37.8 +/- 1.5 (P=.010), an increased incidence of dysmenorrhea (chi(2) 8.9, P=.003), and lower resting blood pressure: systolic (108.6 +/- 2.1 vs 118.9 +/- 2.0 mm Hg) (P>.001) and diastolic (59.3 +/- 1.6 vs 64.2 +/- 1.5 mm Hg) (P=.038). Logistic regression revealed that dysmenorrhea and lower systolic blood pressure are associated with primary VVS. CONCLUSION Women with primary and secondary VVS differ in their systemic pain perception and psychophysical characteristics. The impact of these findings on treatment modalities should be further evaluated.
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Affiliation(s)
- Michal Granot
- The Faculty of Health and Welfare Studies, University of Haifa, Israel.
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83
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Abstract
OBJECTIVE Increased blood pressure is associated with decreased reports of aversiveness for both physical pain and psychosocial stressors. Based on these findings, higher blood pressure could be associated with altered emotional responses to a broader range of stimuli. There are at least 3 ways this could happen: a) less dire response to negative stimuli with no change in response to positive stimuli; b) more positive responses to both negative and positive stimuli; or c) dampened emotional responses to both positive and negative stimuli. METHODS Sixty-five normotensive volunteers had their resting blood pressure measured, then rated their emotional responses to a series of positive and negative photographs. RESULTS Resting systolic blood pressure was significantly and negatively correlated with subjective emotional ratings of both positive (r = -.26) and negative (r = -.35) photographs. CONCLUSION Results were consistent with emotion dampening for elevated resting blood pressure and may reflect homeostatic integration of neurocirculatory control and affect regulation.
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Affiliation(s)
- Cynthia L S Pury
- Department of Psychology, Clemson University, 418 Brackett Hall, Clemson, SC 29634-1355, USA.
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84
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Affiliation(s)
- Thomas G Pickering
- The Behavioral, Cardiovascular Health, and Hypertension Program, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA
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85
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Stewart JC, France CR, Sheffield D. Hypertension awareness and pain reports: data from the NHANES III. Ann Behav Med 2003; 26:8-14. [PMID: 12867349 DOI: 10.1207/s15324796abm2601_02] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND For this study we investigated the relationship between hypertension, pain reports, and hypertension awareness in a large and diverse sample of men and women. METHOD Data collected during the Third National Health and Nutrition Examination Survey (NHANES III) were examined for reports of pain at four body sites (chest, back, legs, and gallbladder) in 9,427 adults. Respondents were classified into four groups based on their self-reports of a previous diagnosis of hypertension (yes, no) and their current blood pressure levels (hypertensive, normotensive). RESULTS Logistic regression analyses indicated that hypertensives who were unaware of their condition were significantly less likely to report chest pain than normotensives without a previous hypertension diagnosis; however, these groups did not differ in pain reports at other body sites. In contrast, both hypertensives and normotensives with a previous hypertension diagnosis were significantly more likely to report pain at several body sites as compared to normotensives without a previous hypertension diagnosis. It was also found that when hypertension awareness was held constant, resting systolic blood pressure was negatively associated with the likelihood of reporting chest and gallbladder pain. CONCLUSIONS These findings suggest that existing laboratory evidence of hypertension-related hypoalgesia may not translate to decreased daily pain symptoms, although there is intriguing evidence of dampened cardiac pain in hypertensives who are unaware of their condition.
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86
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Affiliation(s)
- Eleni Sarlani
- Department of Oral and Craniofacial Biological Sciences, University of Maryland Dental School, and University of Maryland Research Center for Neuroendocrine Influences on Pain, Room # 5-A-14, University of Maryland, 666 West Baltimore Street, Baltimore, MD 21201, USA
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87
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Roy EA, Hollins M, Maixner W. Reduction of TMD pain by high-frequency vibration: a spatial and temporal analysis. Pain 2003; 101:267-274. [PMID: 12583869 DOI: 10.1016/s0304-3959(02)00332-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Under some conditions, vibration delivered to the skin can reduce pain (vibratory analgesia). Previous studies of this phenomenon in a clinical context have been somewhat variable in terms of stimulus control, and have not examined the way in which the spatial distribution of pain is affected. In the present study, we used rigorously controlled conditions to examine vibratory analgesia in participants (N=17) with painful temporomandibular disorders (TMD). Results of 20- and 100-Hz vibration were compared with data from a no-vibration control condition. The results document for the first time that vibratory analgesia occurs in TMD chronic pain conditions. We measured its time course using continuous visual analog scale (VAS) recording, and its spatial aspects by asking subjects to indicate painful regions on standardized drawings. VAS ratings and drawings both showed that pain is reduced by 100-Hz, but not by 20-Hz, vibration. The effectiveness of the high-frequency vibration cannot be attributed to a mechanism involving Pacinian corpuscles, since these receptors are lacking in the skin of the orofacial region. Spatial analyses revealed that ipsilateral and contralateral effects of vibration were statistically equivalent, suggesting that vibratory analgesia relies at least in part on central nervous system processes rather than local mechanisms.
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Affiliation(s)
- Elizabeth A Roy
- Department of Psychology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA Dental Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
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88
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Costello NL, Bragdon EE, Light KC, Sigurdsson A, Bunting S, Grewen K, Maixner W. Temporomandibular disorder and optimism: relationships to ischemic pain sensitivity and interleukin-6. Pain 2002; 100:99-110. [PMID: 12435463 DOI: 10.1016/s0304-3959(02)00263-4] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The current study examined patients with temporomandibular disorders (TMD) (n=20) and pain-free controls (n=28) under stress and relaxation conditions. Interleukin-6 (IL-6), norepinephrine and epinephrine (NE and E) were measured both before and during each of two conditions: a non-stressful relaxation period and a speech stressor. Ischemic pain sensitivity was also assessed after each of these conditions. Optimism (Life Orientation Test (LOT)), which has been associated with better outcomes in relationship to health and disease, was also evaluated in relationship to ischemic pain tolerance and unpleasantness ratings as well as to IL-6 levels under the two conditions. Regression analysis determined the unique contribution of each predictor and the interaction between Optimism and Group (TMD versus controls) after controlling for gender and blood pressure. During stress, IL-6 levels appeared to parallel NE with only controls displaying significant increases. After controlling for depressed mood, TMD patients as a whole showed a significantly blunted response in IL-6 levels produced during stress as compared to controls (beta=0.31*). Although TMD subjects as a whole did not show the expected greater pain sensitivity to the ischemic task, those displaying a less optimistic style did exhibit lower pain tolerance times (beta=-0.61*) and higher pain unpleasantness ratings (beta=0.48*), compared with low optimism controls and high optimism TMD patients. Less optimistic TMD patients also had higher NE and IL-6 levels during stress than other TMD patients, while optimism was unrelated to responses in controls (*P<0.05).
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Affiliation(s)
- Nancy L Costello
- Dental Research Center, School of Dentistry, Medical Research Building A, University of North Carolina, CB #7175, Chapel Hill, NC 27599-7455, USA
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89
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Bruehl S, Chung OY, Ward P, Johnson B, McCubbin JA. The relationship between resting blood pressure and acute pain sensitivity in healthy normotensives and chronic back pain sufferers: the effects of opioid blockade. Pain 2002; 100:191-201. [PMID: 12435472 DOI: 10.1016/s0304-3959(02)00295-6] [Citation(s) in RCA: 116] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Resting blood pressure is inversely correlated with acute pain sensitivity in healthy normotensives. This study tested: (1) whether endogenous opioid activity is necessary for this adaptive relationship to occur, (2) whether this relationship is altered in chronic low back pain (LBP), and (3) whether endogenous opioid dysfunction underlies any such alterations. Fifty-one pain-free normotensives and 44 normotensive chronic LBP sufferers received opioid blockade (8 mg naloxone i.v.) or placebo blockade (saline) in randomized, counterbalanced order in separate sessions. During each session, subjects participated in a 1-min finger pressure (FP) pain task followed by an ischemic (ISC) forearm pain task. Among pain-free normotensives, elevated resting systolic (SBP) and diastolic (DBP) blood pressure were associated with significantly higher ISC pain thresholds (P values <0.05). Elevated SBP was also associated with significantly lower FP pain ratings (P<0.05). Opioid blockade had no significant effect on the BP-pain relationships detected (P values >0.10). In combined groups analyses, a significant subject typexSBP interaction (P<0.005) was found on ISC pain threshold: elevated SBP was associated with higher pain threshold in pain-free controls, but with lower pain threshold in LBP subjects. Although subject typexBP interactions on FP and ISC pain ratings were not significant, inclusion of LBP subjects in these analyses resulted in the overall relationship between BP and pain sensitivity becoming positive (P values <0.05). Opioid blockade exerted no significant main or interaction effects in these combined groups analyses (p values >0.10). Higher DBP was associated with greater clinical pain intensity among the LBP subjects (P<0.001). Overall, these results suggest: (1) endogenous opioids do not mediate the inverse relationship between resting blood pressure and acute pain sensitivity in pain-free normotensives; (2) the BP-pain sensitivity relationship is altered in chronic pain, suggesting dysfunction in pain regulatory systems, and (3) these alterations are not related to opioid dysfunction.
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Affiliation(s)
- Stephen Bruehl
- Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, TN 37212, USA.
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90
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Abstract
Irritable bowel syndrome (IBS) is a common gastrointestinal disorder characterized by chronic abdominal pain and visceral hypersensitivity. In this study, resting blood pressure and heart rate were recorded in 20 IBS patients and 23 controls. We assessed pain intensity and unpleasantness to visceral and cutaneous stimuli using rectal distension and immersion of the foot in hot water. Mean resting heart rate was higher in IBS patients compared to controls. IBS patients rated pain intensity and unpleasantness to visceral and cutaneous stimuli significantly higher than controls. In IBS patients, blood pressure was significantly inversely associated with visceral pain and only weakly and positively associated with cutaneous pain; there were no relationships in controls. Sex and anxiety did not explain these relationships. In conclusion, we found evidence suggestive of central autonomic dysregulation in IBS patients.
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Affiliation(s)
- Vishal Gupta
- Department of Medicine, University of Florida, Gainesville, 32608-1197, USA
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91
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Bragdon EE, Light KC, Costello NL, Sigurdsson A, Bunting S, Bhalang K, Maixner W. Group differences in pain modulation: pain-free women compared to pain-free men and to women with TMD. Pain 2002; 96:227-237. [PMID: 11972994 DOI: 10.1016/s0304-3959(01)00451-1] [Citation(s) in RCA: 159] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Previously reported differences in sensitivity to experimental pain stimuli between the sexes, as well as between temporomandibular disorder (TMD) patients and healthy control subjects, may be attributable in part to group differences in two pain modulatory mechanisms: the baroreceptor reflex arc and the endogenous opioid system. Twenty-two pain-free (PF) men, 20 PF women and 20 women with TMD underwent two testing sessions in which heat pain and ischemic arm pain threshold and tolerance were measured during both sessions, but followed relaxation during one session and laboratory stress tasks during the other. Blood pressure (BP) and plasma -endorphin (E) concentration were measured during a baseline rest and during the stress or relaxation periods. PF men's threshold and tolerance for heat pain, but not for ischemic pain, exceeded that of PF women's during both sessions. PF women and TMD women did not differ in sensitivity to either pain modality; however, significantly lower ischemic pain threshold (IPTh) was linked to oral contraceptive use in PF women but not TMD patients. In the men alone, higher baseline systolic BP (SBP) was correlated with higher heat pain threshold on both days and heat pain tolerance on the stress day. Conversely, in TMD women, higher baseline SBP was correlated with lower ischemic pain tolerance (IPTol) on both days; BP and pain sensitivity were not related in PF women. In men, but not in PF or TMD women, stress systolic and diastolic BP were positively correlated with heat pain threshold and tolerance and higher diastolic reactivity to stress were correlated with higher heat pain and IPTh and tolerance. On the stress day, higher baseline E level was strongly associated with higher IPTol in PF women but marginally associated with lower IPTol in TMD women. Thus, it appears that a BP-related analgesic mechanism (probably baroreceptor-mediated) predominates in PF men, while an endogenous opioid mechanism predominates in PF women. Stress enhances the expression of these central mechanisms. Female TMDs appear unable to effectively engage normal pain-inhibitory systems; opioid receptor desensitization and/or downregulation are probably implicated, because TMDs' production of E appears normal.
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Affiliation(s)
- Edith E Bragdon
- Dental Research Center, School of Dentistry, University of North Carolina, Chapel Hill, NC 27599-7455, USA Department of Psychiatry, School of Medicine, Medical Research Building A/CB# 7175, University of North Carolina, Chapel Hill, NC 27599-7175, USA
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92
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Sherman JJ, Turk DC. Nonpharmacologic approaches to the management of myofascial temporomandibular disorders. Curr Pain Headache Rep 2001; 5:421-31. [PMID: 11560807 DOI: 10.1007/s11916-001-0053-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The temporomandibular disorders (TMDs) are a heterogeneous group of painful musculoskeletal conditions that include masticatory muscle pain. TMD is a common condition but its etiology is, as yet, poorly understood. Although TMD can be quite disabling, most patients presenting with symptoms improve regardless of treatment type. This article focuses on nonpharmacologic treatments for TMD; recent articles on etiology, assessment, and treatment for this muscle pain condition are reviewed. Psychological approaches include biofeedback, minimal therapist contact interventions, relaxation, and cognitive-behavioral therapy. We suggest that treatments based on the biopsychosocial model of illness should be used concurrently with treatments focusing only on the biomedical aspects of TMD. Psychological treatments need not be viewed as a treatment of last resort, but rather should be delivered concurrent with biomedical treatments. We present data from recent clinical trials showing that treatment-matching approaches tailoring psychological and educational treatments to psychosocial profiles, delivered concurrent with usual dental care, results in greater and more sustained improvement than usual dental care alone. As such, treatment for TMD should be viewed in much the same way as treatment for most other chronic pain conditions, that is, from a multidisciplinary perspective.
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Affiliation(s)
- J J Sherman
- Department of Anesthesiology, University of Washington, Box 356370, Seattle, WA 98195-6370, USA.
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93
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Rollman GB, Gillespie JM. The role of psychosocial factors in temporomandibular disorders. CURRENT REVIEW OF PAIN 2001; 4:71-81. [PMID: 10998718 DOI: 10.1007/s11916-000-0012-8] [Citation(s) in RCA: 105] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The temporomandibular disorders (TMDs) comprise a constellation of symptoms affecting the joints and muscles involved in jaw movement. Patients complain of orofacial pain, limited jaw opening, and clicking or popping sounds. Although pain is generally the defining characteristic of TMD, patients often report marked degrees of stress and interference in daily life. This article reviews recent studies on epidemiology, sex differences, pediatric TMD, classification systems, comparisons to other chronic pain disorders of uncertain etiology, psychological assessment, depression, central modulation and hypervigilance, sleep disturbances, stress, and the management of TMD by conservative physical interventions and cognitive behavioral therapy. Both the assessment and the management of TMD requires a multidisciplinary perspective with strong emphasis on psychosocial variables.
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Affiliation(s)
- G B Rollman
- Department of Psychology, University of Western Ontario, London, ON N6A 5C2, Canada.
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94
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al'Absi M, Petersen KL, Wittmers LE. Blood pressure but not parental history for hypertension predicts pain perception in women. Pain 2000; 88:61-68. [PMID: 11098100 DOI: 10.1016/s0304-3959(00)00306-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Previous work has suggested an attenuated sensitivity to painful stimulation in hypertensive men. We recently reported that, compared with persons with negative parental history, men, but not women, with a positive history for hypertension showed attenuated pain perception. This study specifically addressed factors that predict pain perception in women, including blood pressure, parental history and mood states. Fifty-four normotensive women with positive (PH+; n = 20) or negative parental history (PH-; n = 34) for hypertension and high or low casual systolic blood pressure (BP) performed the cold pressor (CP) test. Participants rated their pain every 15 s during a 90-s hand CP (0-4 degrees C) and a 90-s post-CP rest period. Detailed mood ratings were obtained immediately before the CP test. Data were evaluated using multivariate repeated measure analyses of variance and regression analyses. PH+ and PH- women did not differ in age, height, weight, education, resting BP, or heart rate. PH+ and PH- women did not differ in pain ratings during or after the CP, or pain ratings using the McGill Pain Questionnaire (MPQ), and they did not differ in their cardiovascular responses to the CP, confirming our earlier study in a separate sample. Women with high casual systolic BP reported significantly less pain, especially after the CP (P < 0.01). MPQ total scores confirmed this finding with high BP women reporting less pain than low BP women (P < 0.05). Regression analyses confirmed these effects. Controlling for potential confounding variables did not alter these relationships. These findings suggest that in women, phenotype systolic BP may be a better predictor of hypoalgesia than parental history of hypertension.
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Affiliation(s)
- Mustafa al'Absi
- Department of Behavioral Sciences, School of Medicine, University of Minnesota, Duluth, MN 55812-2487, USA Department of Family Medicine, School of Medicine, University of Minnesota, Duluth, MN 55812-2487, USA Department of Physiology, School of Medicine, University of Minnesota, Duluth, MN 55812-2487, USA
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95
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Abstract
Chronic diffuse pain and hyperalgesia are two cardinal features of pain in fibromyalgia syndrome (FMS). Advancement in understanding the pathophysiology and treatment efficacy often depends on pain that is defined and measured. Pain is a subjective phenomenon that we can measure only by indirect methods. In this article, we provide methodological guidelines for pain assessment and review recent developments in understanding pain mechanisms and evaluating treatments in FMS. Finally, we demonstrate the heterogeneity of the FMS population and suggest the need for matching treatments to patient characteristics in order to improve clinical outcomes.
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Affiliation(s)
- D C Turk
- Department of Anesthesiology, Box 356540, University of Washington, Seattle, WA 98195, USA
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96
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Bruehl S, McCubbin JA, Harden RN. Theoretical review: altered pain regulatory systems in chronic pain. Neurosci Biobehav Rev 1999; 23:877-90. [PMID: 10541062 DOI: 10.1016/s0149-7634(99)00039-1] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This review synthesizes the existing literature regarding the relationship between resting blood pressure and pain sensitivity, and the literature indicating possible endogenous opioid dysfunction in chronic pain. Adaptive interactions between the cardiovascular and pain regulatory systems occur in healthy individuals, with greater blood pressure associated with decreased acute pain sensitivity. Endogenous opioids appear necessary for full expression of this relationship. There is ample evidence indicating diminished endogenous opioid CSF/plasma levels in chronic pain patients, yet little is known about the functional effects of these opioid changes. A theoretical model is proposed based upon the literature reviewed suggesting progressive dysfunction in endogenous opioid systems with increasing chronic pain duration. This dysfunction is hypothesized to result in dysregulation of normally adaptive relationships between the cardiovascular and pain regulatory systems, resulting in increased chronic pain intensity and increased acute pain sensitivity among chronic pain patients. Preliminary data are consistent with the hypothesis of progressive opioid changes resulting in dysfunctional alterations in the adaptive blood pressure-pain relationship. Clinical implications of this theory are discussed.
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Affiliation(s)
- S Bruehl
- Northwestern University Medical School and Center for Pain Studies, Rehabilitation Institute of Chicago, IL 60611, USA
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97
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Okifuji A, Turk DC, Marcus DA. Comparison of generalized and localized hyperalgesia in patients with recurrent headache and fibromyalgia. Psychosom Med 1999; 61:771-80. [PMID: 10593628 DOI: 10.1097/00006842-199911000-00009] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Research suggests that dysregulated pain modulation may play an important role in recurrent headaches and fibromyalgia syndrome (FMS). The primary objective of this study was to investigate algesic responses in localized cervical and pericranial regions (ie, headache-specific areas) and distal locations (ie, trochanter and gluteal) in patients with primary headaches (tension-type and migraine). The headache patients' algesic responses were compared with those of a sample of patients with musculoskeletal pain who report generalized hyperalgesia, or FMS. METHODS Seventy patients with mixed headache diagnoses and 66 patients with FMS underwent a standardized examination of generalized hyperalgesia based on American College of Rheumatology criteria. RESULTS Twenty-eight of the 70 headache patients reported the presence of widespread TP pain, suggesting generalized hyperalgesia. Headache diagnosis was unrelated to the presence or absence of generalized hyperalgesia. The subset of headache patients with generalized hyperalgesia did not differ from the FMS patients in pain sensitivity in the cervical and pericranial areas. Regression analyses revealed that pressure pain sensitivity was significantly related to self-reported pain only in the headache patients with generalized hyperalgesia. CONCLUSIONS These results suggest that extensive dysregulation in pain modulation is important for a substantial minority of recurrent headache patients, who seem to be quite similar to FMS patients. Differential treatment planning targeting generalized hyperalgesia may be useful in treating headache patients exhibiting generalized hyperalgesia more effectively.
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Affiliation(s)
- A Okifuji
- Department of Anesthesiology, University of Washington, Seattle 98195, USA.
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98
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Lautenbacher S. Die Psychobiologie der Schmerzhemmung. ZEITSCHRIFT FUR KLINISCHE PSYCHOLOGIE UND PSYCHOTHERAPIE 1999. [DOI: 10.1026//0084-5345.28.4.235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Zusammenfassung. Schmerzhemmung basiert auf einer Vielzahl von Mechanismen, die unter einer psychobiologischen Perspektive am besten verstanden werden können. Zu diesen Mechanismen zählt auch die Art der Schmerzhemmung, die dem Phänomen “Schmerz unterdrückt Schmerz” zugrunde liegt. Der verantwortliche supraspinale neuronale Mechanismus, auch “diffuse noxious inhibitory controls” (DNIC) genannt, wird durch starke und andauernde Schmerzen schnell aktiviert und führt zu einer anatomisch generalisierten (heterotopen) Reduktion der Schmerzsensibilität außerhalb des primären Schmerzareals. Bei einigen chronischen Schmerzsyndromen scheint dieser Mechanismus, der eine Schmerzausbreitung verhindern hilft, defekt zu sein. Eine langsamer wirkende Variante der Schmerzhemmung wird durch psychischen und physischen Streß ausgelöst. Der verzögerte Beginn und das minutenlange Anhalten der “Streßanalgesie” lassen einen hormonellen Wirkungsmechanismus vermuten, und tatsächlich werden zeitparallel zur Streßanalgesie “Streßhormone” (ACTH, β-Endorphin, Kortisol) freigesetzt. Die direkte Gabe dieser Hormone verursacht jedoch keine Analgesie. Bestimmte Formen der Streßanalgesie sind offenbar opioiderg, weil sie durch Gabe von Opiatantagonisten aufgehoben werden können. Die beschriebene schnelle und langsame sowie weitere Varianten der Schmerzhemmung erlauben eine flexible Regulation der Schmerzsensibilität, die bei jedem Systemeingriff, also auch bei einem therapeutischen, beeinträchtigt werden kann.
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99
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Goldstein BH. Temporomandibular disorders: a review of current understanding. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 1999; 88:379-85. [PMID: 10519741 DOI: 10.1016/s1079-2104(99)70048-x] [Citation(s) in RCA: 72] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The purpose of this article is to conduct a narrative review of current evidence regarding the understanding, evaluation, management, and treatment of temporomandibular disorders to provide a broad perspective and updated introduction to an important and controversial subject with rapidly changing developments and limited well-designed research. DATA SOURCES Studies were identified through a search of MEDLINE for 3 topics (temporomandibular disorder, temporomandibular joint, and chronic pain) over a 10-year period (January 1988 to August 1998) and of bibliographies of identified studies and review articles. STUDY SELECTION More than 5000 articles were produced. In-depth review of all of this literature was beyond the scope of the present article, which is intended to provide an overview. The amount and diversity of the literature and the limitations of covering such a broad topic being recognized, the papers selected were those that reviewed limited topics or studied focused areas. This report is not a systematic (qualitative) or meta-analysis (quantitative) review. An acknowledged limitation of this narrative review method lies in the potential for bias in selection. The referenced works do not include all papers reviewed; only pertinent literature and reviews with comprehensive references were selectively included. CONCLUSIONS Advances in basic and clinical science have resulted in important changes in the understanding and management of temporomandibular disorders. Many treatments are not supported by research, and the role of dentistry is changing to a more diagnostic and management-based model from the hands-on treatment procedures of the past. The present science-based understand-ing of a biopsychosocial disorder is important in properly and responsibly dealing with patients with temporomandibular disorders.
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Affiliation(s)
- B H Goldstein
- The University of British Columbia, Department of Oral Biological & Medical Sciences, Faculty of Dentistry, Vancouver, Canada
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100
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Abstract
Just as our caveman forebears were frail in the face of predatory animals, we are frail in today's society of childhood neglect or abuse, bumper-to-bumper traffic, frustration at work, and multiple daily hassles. The same neuroendocrine systems and pain regulatory mechanisms that protected early man during acute stress are still encoded in our genome, but may be maladaptive in psychologically and physiologically vulnerable people faced with chronic stress. Many patients with fibromyalgia become vulnerable because of the long-lasting psychological and neurophysiological effects of negative experiences in childhood. Ill-equipped with positive cognitive, emotional, and behavioral skills as adults, they display maladaptive coping strategies, low self-efficacy, and negative mood when confronted with the inevitable stressors of life. Psychological distress ensues, which reduces thresholds for pain perception and tolerance (already relatively low in women) even further. Converging lines of psychological and neurobiological evidence strongly suggest that chronic stress-related blunting of the HPA, sympathetic, and other axes of the stress response together with associated alterations in pain regulatory mechanisms may finally explain the pain and fatigue of fibromyalgia. Vulnerable people who can be classified by the ACR criteria as having fibromyalgia do not have a discrete disease. They are simply the most ill in a continuum of distress, chronic pain, and painful tender points in the general population.
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Affiliation(s)
- J B Winfield
- Division of Rheumatology and Immunology, University of North Carolina, Chapel Hill, USA.
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