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Paula TMHD, Castro MS, Medeiros LF, Paludo RH, Couto FF, Costa TRD, Fortes JP, Salbego MDO, Behnck GS, Moura TAMD, Tarouco ML, Caumo W, Souza AD. Association of low-dose naltrexone and transcranial direct current stimulation in fibromyalgia: a randomized, double-blinded, parallel clinical trial. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ELSEVIER) 2022:S0104-0014(22)00104-X. [PMID: 35988815 PMCID: PMC10362456 DOI: 10.1016/j.bjane.2022.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 08/08/2022] [Accepted: 08/09/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Fibromyalgia is a complex, generalized, and diffuse chronic musculoskeletal pain. Pharmacological approaches are widely used to relieve pain and increase quality of life. Low-Dose Naltrexone (LDN) was shown to increase the nociceptive threshold in patients with fibromyalgia. Transcranial Direct Current Stimulation (tDCS) is effective for pain management. OBJECTIVE The purpose of this study was to evaluate the analgesic and neuromodulatory effects of a combination of LDN and tDCS in patients with fibromyalgia. METHODS This was a randomized, double-blinded, parallel, placebo/sham-controlled trial (NCT04502251; RBR-7HK8N) in which 86 women with fibromyalgia were included, and written informed consent was obtained from them. The patients were allocated into four groups: LDN + tDCS (n = 21), LDN + tDCS Sham (n = 22), placebo + tDCS (n = 22), and placebo+tDCS Sham (n = 21). The LDN or placebo (p.o.) intervention lasted 26 days; in the last five sessions, tDCS was applied (sham or active, 20 min, 2 mA). The following categories were assessed: sociodemographic, Visual Analog Pain Scale (VAS), Pain Catastrophizing Scale (PCS), State-Trait Anxiety Inventory (STAI), Fibromyalgia Impact Questionnaire (FIQ), Beck Depression Inventory (BDI-II), Profile of Chronic Pain Scale (PCP:S), Pain Pressure Threshold (PPT), and Conditioned Pain Modulation (CPM). Blood samples were collected to analyze BDNF serum levels. RESULTS At baseline, no significant difference was found regarding all measurements. VAS pain was significantly reduced in the LDN + tDCS (p = 0.010), LDN + tDCS Sham (p = 0.001), and placebo+tDCS Sham (p = 0.009) groups. In the PCP:S, the LDN+tDCS group showed reduced pain frequency and intensity (p = 0.001), effect of pain on activities (p = 0.014) and emotions (p = 0.008). Depressive symptoms reduced after all active interventions (p > 0.001). CONCLUSION Combined LDN+tDCS has possible benefits in reducing pain frequency and intensity; however, a placebo effect was observed in pain using VAS, and further studies should be performed to analyze the possible association.
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Affiliation(s)
| | - Mariane Schäffer Castro
- Universidade La Salle, Programa de Pós-Graduação em Saúde e Desenvolvimento Humano, Canoas, RS, Brazil; Universidade La Salle, Canoas, RS, Brazil
| | - Liciane Fernandes Medeiros
- Universidade La Salle, Programa de Pós-Graduação em Saúde e Desenvolvimento Humano, Canoas, RS, Brazil; Universidade Federal do Rio Grande do Sul, Programa de Pós-Graduação em Ciências Biológicas: Farmacologia e Terapêutica, Porto Alegre, RS, Brazil
| | - Rodrigo Hernandes Paludo
- Universidade La Salle, Programa de Pós-Graduação em Saúde e Desenvolvimento Humano, Canoas, RS, Brazil; Universidade La Salle, Canoas, RS, Brazil
| | - Fabricia Fritz Couto
- Universidade La Salle, Programa de Pós-Graduação em Saúde e Desenvolvimento Humano, Canoas, RS, Brazil; Universidade La Salle, Canoas, RS, Brazil
| | - Tainá Ramires da Costa
- Universidade La Salle, Programa de Pós-Graduação em Saúde e Desenvolvimento Humano, Canoas, RS, Brazil; Universidade La Salle, Canoas, RS, Brazil
| | - Juliana Pereira Fortes
- Universidade La Salle, Programa de Pós-Graduação em Saúde e Desenvolvimento Humano, Canoas, RS, Brazil; Universidade La Salle, Canoas, RS, Brazil
| | - Maiara de Oliveira Salbego
- Universidade La Salle, Programa de Pós-Graduação em Saúde e Desenvolvimento Humano, Canoas, RS, Brazil; Universidade La Salle, Canoas, RS, Brazil
| | - Gabriel Schardosim Behnck
- Universidade La Salle, Programa de Pós-Graduação em Saúde e Desenvolvimento Humano, Canoas, RS, Brazil; Universidade La Salle, Canoas, RS, Brazil
| | - Thielly Amaral Mesquita de Moura
- Universidade La Salle, Programa de Pós-Graduação em Saúde e Desenvolvimento Humano, Canoas, RS, Brazil; Universidade La Salle, Canoas, RS, Brazil
| | - Mariana Lenz Tarouco
- Universidade La Salle, Programa de Pós-Graduação em Saúde e Desenvolvimento Humano, Canoas, RS, Brazil; Universidade La Salle, Canoas, RS, Brazil
| | - Wolnei Caumo
- Universidade Federal do Rio Grande do Sul, Programa de Pós-Graduação em Ciências Biológicas: Farmacologia e Terapêutica, Porto Alegre, RS, Brazil
| | - Andressa de Souza
- Universidade La Salle, Programa de Pós-Graduação em Saúde e Desenvolvimento Humano, Canoas, RS, Brazil; Universidade Federal do Rio Grande do Sul, Programa de Pós-Graduação em Ciências Biológicas: Farmacologia e Terapêutica, Porto Alegre, RS, Brazil; Universidade Federal do Rio Grande do Sul, Programa de Pós-Graduação em Ciências Médicas: Medicina, Porto Alegre, RS, Brazil.
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Du Q, Ma X, Wang S, Zhou S, Luo C, Tian K, Fei W, Liu X. A digital intervention using virtual reality helmets to reduce dental anxiety of children under local anesthesia and primary teeth extraction: A randomized clinical trial. Brain Behav 2022; 12:e2600. [PMID: 35485000 PMCID: PMC9226823 DOI: 10.1002/brb3.2600] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 05/24/2021] [Accepted: 03/26/2022] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION Behavior management of children during dental treatment is an important but challenging issue. As a new technique, VR has been applied in pediatric dental anxiety. But there is no final conclusion whether VR reduces children's dental anxiety. METHODS The aim of the study is to assess the effectiveness of a digital intervention using virtual reality (VR) helmets on dental anxiety, pain perception, and behavior triggered for children, as well as occurrence of simulator sickness in local anesthesia and primary teeth extraction. A total of 128 children, who needed primary teeth extraction under local anesthesia, were randomly allocated into two groups: use VR helmets and traditional behavior guidance procedures (control). Modified Child Fear Survey Schedule Dental Subscale (CFSS-DS), Wong-Baker FACES Pain Scale, Houpt Scale, and Simulator sickness questionnaire (SSQ) were used to assess children's dental anxiety, pain perception, and behavior triggered and occurrence of simulator sickness. RESULTS CFSS-DS score in the VR group was significantly decreased after dental treatment (34.58±6.90 before operation and 32.32±15.58 after operation, p = .02). The score of Wong Baker Scale in the VR group (3.47±0.76) was significantly lower than that in the control group (5.56±1.13, p = .015). There was no significant difference in the Houpt Behavior Scale score and the SSQ score between the VR group and the control group (p = .35, p = .305). CONCLUSION The use of VR helmets in primary teeth extraction can significantly reduce dental anxiety and pain perception in children without occurrence of simulator sickness.
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Affiliation(s)
- Qin Du
- Department of Stomatology, Sichuan Academy of Medical Science & Sichuan People's Hospital, Sichuan, China.,School of Medicine, University of Electronic Science and Technology, Sichuan, China
| | - Xinru Ma
- Department of Stomatology, Sichuan Academy of Medical Science & Sichuan People's Hospital, Sichuan, China.,School of Stomatology, Zunyi Medical University, Guizhou, China
| | - Shasha Wang
- Department of Stomatology, Sichuan Academy of Medical Science & Sichuan People's Hospital, Sichuan, China.,Department of Stomatology, North Sichuan Medical College, Sichuan, China
| | - Shiyu Zhou
- Department of Stomatology, Sichuan Academy of Medical Science & Sichuan People's Hospital, Sichuan, China.,Department of Stomatology, North Sichuan Medical College, Sichuan, China
| | - Chunmei Luo
- Department of Stomatology, Sichuan Academy of Medical Science & Sichuan People's Hospital, Sichuan, China.,School of Stomatology, Zunyi Medical University, Guizhou, China
| | - Kun Tian
- Department of Stomatology, Sichuan Academy of Medical Science & Sichuan People's Hospital, Sichuan, China.,School of Medicine, University of Electronic Science and Technology, Sichuan, China
| | - Wei Fei
- Department of Stomatology, Sichuan Academy of Medical Science & Sichuan People's Hospital, Sichuan, China.,School of Medicine, University of Electronic Science and Technology, Sichuan, China
| | - Xianghong Liu
- Department of Stomatology, Eastern Hospital, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Sichuan, China
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Álvarez-Rodríguez J, Leirós-Rodríguez R, Morera-Balaguer J, Marqués-Sánchez P, Rodríguez-Nogueira Ó. The Influence of the Locus of Control Construct on the Efficacy of Physiotherapy Treatments in Patients with Chronic Pain: A Systematic Review. J Pers Med 2022; 12:232. [PMID: 35207720 PMCID: PMC8880621 DOI: 10.3390/jpm12020232] [Citation(s) in RCA: 2] [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: 01/18/2022] [Revised: 01/31/2022] [Accepted: 02/04/2022] [Indexed: 01/27/2023] Open
Abstract
The biopsychosocial paradigm contemplates the patient's personality traits in physiotherapy treatments for chronic pain. Among these traits, the locus of control has a direct relationship with the person's coping strategies in the face of their health problems. The objective of this systematic review was to assess the influence of locus of control on the efficacy of physiotherapy treatments in patients with chronic pain. A systematic review of the publications of the last ten years in Pubmed, Scopus, Science Direct and Web of Science databases was conducting with the terms physical therapy modalities, chronic pain, internal-external control, self-management, physical therapy and physiotherapy. The inclusion criteria were participants with chronic pain lasting at least three months who have received at least one session of physical therapy; the studies should have collected the patient's locus of control as a prognostic factor at the beginning of physiotherapy treatment; the variables studied should include the pain intensity or clinical variables related to pain. A total of 13 articles were found, of which three were experimental studies and ten were observational studies. The included samples had chronic knee pain, nonspecific back pain, low back pain or neck pain; were people over 65 years of age or patients who had undergone hand surgery. In patients with chronic pain for more than three months, the locus of control construct participates as a predictor of the results of physiotherapy treatment. The presence of an internal locus of control favors better results. The personality traits of the subjects represent an important factor to take into account when planning physiotherapy treatments.
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Affiliation(s)
- Julia Álvarez-Rodríguez
- Physical Therapy Section, Nursing and Physical Therapy Department, University of León, 24401 Ponferrada, Spain;
| | - Raquel Leirós-Rodríguez
- SALBIS Research Group, Physical Therapy Section, Nursing and Physical Therapy Department, University of León, 24401 Ponferrada, Spain; (P.M.-S.); (Ó.R.-N.)
| | - Jaume Morera-Balaguer
- Department of Physiotherapy, Health Science Faculty, CEU-Cardenal Herrera University, CEU Universities, 03204 Elche, Spain;
| | - Pilar Marqués-Sánchez
- SALBIS Research Group, Physical Therapy Section, Nursing and Physical Therapy Department, University of León, 24401 Ponferrada, Spain; (P.M.-S.); (Ó.R.-N.)
| | - Óscar Rodríguez-Nogueira
- SALBIS Research Group, Physical Therapy Section, Nursing and Physical Therapy Department, University of León, 24401 Ponferrada, Spain; (P.M.-S.); (Ó.R.-N.)
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Njogu A, Qin S, Chen Y, Hu L, Luo Y. The effects of transcutaneous electrical nerve stimulation during the first stage of labor: a randomized controlled trial. BMC Pregnancy Childbirth 2021; 21:164. [PMID: 33627077 PMCID: PMC7905652 DOI: 10.1186/s12884-021-03625-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 02/08/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Labor pain during childbirth can have devastating effects on the progress of labor, mother, and fetus. Consequently, the management of labor pain is crucial for the well-being of the mother and fetus. Transcutaneous electrical nerve stimulation (TENS) is a non -pharmacological analgesic technique. It uses a low-voltage electrical current to activate descending inhibitory systems in the central nervous system to relieve pain. This study aimed to determine the effects of TENS therapy in the first stage of labor. METHODS In this single-blind randomized controlled trial, we screened low-risk pregnant women who anticipated spontaneous vaginal delivery. Women were assigned (1:1) to either the experimental group (received TENS therapy in the first stage of labor) or the control group (received routine obstetric care). The women, midwives, and researchers working in the gynecology and obstetric department were aware of the treatment group, but statisticians analysis the data were blinded. The primary outcome was labor pain intensity, assessed by visual analog scale (VAS) immediately after the randomization, at 30, 60, and 120 min after TENS therapy, and 2-24 h post-delivery. We used SPSS 21.0 software in data analysis. An independent sample t-test compared the mean VAS scores and labor duration between groups. A Chi-square test was employed to compare categorical variables between the groups. A significant level of ≤0.05 was statistically significant. RESULTS A total of 326 pregnant women were eligible: experimental group (n = 161) and control group (n = 165). The experimental group had statistically significantly lower mean VAS scores at a different time (30, 60, and 120 min post-intervention and 2-24 h post-delivery) than the control group (p < 0.001). The experimental group demonstrated a statistically significant shorter duration of the active labor phase than the control group (p < 0.001). CONCLUSION This study indicates that TENS can be used as a non-pharmacological therapy to reduce pain and shorten the active labor phase. TRIAL REGISTRATION ISRCTN registry, ISRCTN23857995 . Registered on 11/12/2020, 'retrospectively registered.
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Affiliation(s)
- Anne Njogu
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Si Qin
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Yujie Chen
- Department of Nursing, Hunan Provincial People's Hospital, the First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Lizhen Hu
- Department of Nursing, Hunan Provincial People's Hospital, the First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Yang Luo
- Xiangya School of Nursing, Central South University, Changsha, China.
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Yang FP, Chao AS, Lin SH, Chao A, Wang TH, Chang YL, Chang HS, Wang JJ. Functional human brain connectivity during labor and its alteration under epidural analgesia. Brain Imaging Behav 2020; 14:2647-2658. [PMID: 31900889 DOI: 10.1007/s11682-019-00216-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study used functional magnetic resonance imaging to explore the neural networks of pain during labor and its relief. It was hypothesized that epidural analgesia would affect the neural activities and the underlying network connectivity. Analysis using dynamic causal modelling and functional connectivity was performed to investigate the spatial activity and network connection of labor pain with and without epidural analgesia. This Institutional Review Board approved study acquired Magnetic Resonance Imaging from 15 healthy women of spontaneous normal delivery (with/without epidural analgesia = 7/8, aged 29.6 ± 2.3 and 29.3 ± 4.8 years old respectively) using a 1.5 Tesla scanner. Numerical rating score of pain was evaluated by a research nurse in the beginning of the first stage of labor and approximately 30 min after imaging examination. Six regions of interested from the activated clusters and literature were selected for dynamic causal modelling, which included primary and secondary somatosensory cortex, middle frontal gyrus, anterior cingulate cortex, insula and lentiform. Functional connectivity was calculated from selected sensory and affective regions. All analyses were performed by using software of statistical parametric mapping version 8 and CONN functional connectivity toolbox. The result showed that the experience of labor pain can lead to activations within a distributed brain network. The pain relief from epidural analgesia can be accompanied with altered functional connectivity, which was most evident in the cingulo-frontal system. The present study, therefore, provides an overview of a pain-related neural network that occur during labor and upon epidural analgesia.
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Affiliation(s)
- Fan-Pei Yang
- Department of Foreign Languages and Literature, National Tsing Hua University, Hsinchu, Taiwan
| | - An-Shine Chao
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan City, Taiwan
| | - Sung-Han Lin
- Department of Medical Imaging and Radiological Sciences, Chang Gung University, 259 WenHua 1st Road, TaoYuan county, Taiwan
| | - Anne Chao
- Department of Anesthesia, National Taiwan University Hospital, Taipei, Taiwan
| | - Tzu-Hao Wang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan City, Taiwan
| | - Yao-Lung Chang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan City, Taiwan
| | - Hong-Shiu Chang
- Department of Neurology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan City, Taiwan
| | - Jiun-Jie Wang
- Department of Medical Imaging and Radiological Sciences, Chang Gung University, 259 WenHua 1st Road, TaoYuan county, Taiwan.
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Keelung, Taiwan.
- Healthy Aging Research Center, Chang Gung University, Taoyuan City, Taiwan.
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Abstract
OBJECTIVES To describe assessment and interdisciplinary management of pain in the cancer survivor over the continuum of cancer care. DATA SOURCES Review of the literature and treatment standards. CONCLUSION Pain remains a primary concern throughout the cancer trajectory across all age groups and diagnoses, emphasizing the need to integrate pain assessment and management across the continuum of cancer survivorship and across care settings. Types of pain, pain patterns, assessment of cancer pain in cancer survivors, current strategies and challenges for management, and effective communication and documentation of the process are described. Communication between and among health care clinicians in a way that effectively articulates the individual patient experience, including documentation in the electronic medical record, requires consistent workflows and terminology. The opioid crisis increases the urgency in effective strategies for interdisciplinary pain assessment and management. IMPLICATIONS FOR NURSING PRACTICE Oncology clinicians must be able to adequately assess pain, track pain over time, understand and implement a cadre of strategies to manage pain, and effectively pursue any suspicious pain patterns that may indicate recurrence or progression of cancer or other underlying etiologies. The oncology nurse is at the core of patient-clinician communication, critical to effectively describing pain as experienced by the individual patient and continues to play a key role in maintaining consistency of message that is necessary to manage pain over the continuum of cancer survivorship.
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Affiliation(s)
- Sandra Kurtin
- Director Advanced practice and Clinical Integration, The University of Arizona Cancer Center, The University of Arizona, Tucson, AZ.
| | - Abby Fuoto
- Head and Neck and Supportive Care, The University of Arizona Cancer Center, Tucson, AZ
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Akadri AA, Odelola OI. Labour pain perception: experiences of Nigerian mothers. Pan Afr Med J 2019; 30:288. [PMID: 30637072 PMCID: PMC6320448 DOI: 10.11604/pamj.2018.30.288.16672] [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: 07/27/2018] [Accepted: 08/07/2018] [Indexed: 11/11/2022] Open
Abstract
Introduction Labour pain perception is influenced by a variety of factors; hence women experience and cope with labour pain differently. This study was designed to assess labour pain perception among parturient. Methods A cross-sectional study involving 132 pregnant women who had vaginal delivery at two tertiary hospitals in south west Nigeria. A structured questionnaire was administered to women within 24 hours of delivery to record details of labour and delivery. Labour pain perception was assessed using the Visual Analogue Score (VAS). Data analysis were done using IBM-SPSS Statistics for Windows version 21.0 (IBM Corp., Armonk, NY, USA). Results The mean age of the parturients was 30.6±4.8 years. The mean pain perception of the parturients as assessed by VAS was 7.0 with range of 1.2-10.0. Sixty-six (50%) parturients rated labour pain to be severe (VAS > 7.1). Majority of the respondents 114(86.4%) desired some form of pain relief. The Body Mass Index (BMI) of respondents and birth weight of their babies had statistically significant association with pain perception (p = 0.010; p = 0.038 respectively). Factors associated with increased odds of having severe pain perception include unbooked status, secondary level education, BMI < 30, and gestational age ≥ 37 weeks. Conclusion Women in south west Nigeria perceived labour pain as severe and many desired pain relief during labour. Occupation, BMI, gestational age and baby's birth weight were significant mediating variables in women's experience of labour pain. Modern methods of labour analgesia should be offered to parturients who express desire for it. This will lead to improvements women's childbirth experience.
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Affiliation(s)
- Adebayo Adekunle Akadri
- Department of Obstetrics and Gynaecology, Babcock University, Ilishan-Remo, Ogun State, Nigeria
| | - Oluwaseyi Isaiah Odelola
- Department of Obstetrics and Gynaecology, Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State, Nigeria
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Lier EJ, Harder J, Oosterman JM, de Vries M, van Goor H. Modulation of tactile perception by Virtual Reality distraction: The role of individual and VR-related factors. PLoS One 2018; 13:e0208405. [PMID: 30507958 PMCID: PMC6277112 DOI: 10.1371/journal.pone.0208405] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 11/17/2018] [Indexed: 11/18/2022] Open
Abstract
Background Virtual reality (VR) has shown to be an effective distraction method in health care. However, questions remain regarding individual and VR-related factors that may modulate the effect of VR. Purpose To explore the effect of VR distraction on tactile perception thresholds in healthy volunteers, in relation to personal characteristics and interactivity of VR applications. Methods A randomized three way cross-over study was conducted to investigate the effects of active and passive VR applications in 50 healthy participants. Main outcome measures were monofilament detection thresholds (MDT) and electrical detection thresholds (EDT). Personal characteristics (e.g. age, gender, susceptibility for immersion) and immersion in the VR conditions were analyzed for their effect on VR induced threshold differences. Results The use of VR caused a significant increase in both MDT and EDT compared to the control condition (MDT: F (2, 76) = 20.174, p < 0.001; EDT F (2, 76) = 6.907, p = 0.002). Furthermore, a significant difference in favour of active VR compared to passive VR was found in MDT (p = 0.012), but not in EDT. No significant gender effect was found. There was a significant positive correlation between age and active VR distraction (r = 0.333, p = 0.018). Immersion in the VR world was positively correlated with the effect of VR, whereas visualization and daydreaming were negatively correlated with VR effects. Conclusion VR increased tactile perception thresholds, with active VR having the largest effect. Results indicate that the efficacy of VR may increase with increasing age. Gender did not affect VR susceptibility.
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Affiliation(s)
- E. J. Lier
- Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
- * E-mail:
| | - J. Harder
- Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - J. M. Oosterman
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands
| | - M. de Vries
- Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - H. van Goor
- Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
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Borsook D, Youssef AM, Barakat N, Sieberg CB, Elman I. Subliminal (latent) processing of pain and its evolution to conscious awareness. Neurosci Biobehav Rev 2018; 88:1-15. [PMID: 29476771 DOI: 10.1016/j.neubiorev.2018.02.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 02/07/2018] [Accepted: 02/19/2018] [Indexed: 12/18/2022]
Abstract
By unconscious or covert processing of pain we refer to nascent interactions that affect the eventual deliverance of pain awareness. Thus, internal processes (viz., repeated nociceptive events, inflammatory kindling, reorganization of brain networks, genetic) or external processes (viz., environment, socioeconomic levels, modulation of epigenetic status) contribute to enhancing or inhibiting the presentation of pain awareness. Here we put forward the notion that for many patients, ongoing sub-conscious changes in brain function are significant players in the eventual manifestation of chronic pain. In this review, we provide clinical examples of nascent or what we term pre-pain processes and the neurobiological mechanisms of how these changes may contribute to pain, but also potential opportunities to define the process for early therapeutic interventions.
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Affiliation(s)
- David Borsook
- Center for Pain and the Brain, 9 Hope Avenue, Mailbox 26, Waltham, MA, 06524-9936, United States.
| | - Andrew M Youssef
- Center for Pain and the Brain, 9 Hope Avenue, Mailbox 26, Waltham, MA, 06524-9936, United States
| | - Nadia Barakat
- Center for Pain and the Brain, 9 Hope Avenue, Mailbox 26, Waltham, MA, 06524-9936, United States
| | - Christine B Sieberg
- Center for Pain and the Brain, 9 Hope Avenue, Mailbox 26, Waltham, MA, 06524-9936, United States
| | - Igor Elman
- Dayton Veterans Affairs Medical Center 4100 West Third Street Dayton, OH, 45428, United States
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Pham PC, Khaing K, Sievers TM, Pham PM, Miller JM, Pham SV, Pham PA, Pham PT. 2017 update on pain management in patients with chronic kidney disease. Clin Kidney J 2017; 10:688-697. [PMID: 28979781 PMCID: PMC5622905 DOI: 10.1093/ckj/sfx080] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 06/19/2017] [Indexed: 12/14/2022] Open
Abstract
The prevalence of pain has been reported to be >60-70% among patients with advanced and end-stage kidney disease. Although the underlying etiologies of pain may vary, pain per se has been linked to lower quality of life and depression. The latter is of great concern given its known association with reduced survival among patients with end-stage kidney disease. We herein discuss and update the management of pain in patients with chronic kidney disease with and without requirement for renal replacement therapy with the focus on optimizing pain control while minimizing therapy-induced complications.
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Affiliation(s)
- Phuong Chi Pham
- Division of Nephrology and Hypertension, Olive View-UCLA Medical Center, Sylmar, CA, USA
| | - Kathy Khaing
- Division of Nephrology and Hypertension, Olive View-UCLA Medical Center, Sylmar, CA, USA
| | - Theodore M. Sievers
- Division of Nephrology, Kidney Transplantation, Ronald Reagan Medical Center at UCLA, Los Angeles, CA, USA
| | - Phuong Mai Pham
- Department of Medicine, Veterans Administrations Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Jeffrey M. Miller
- Division of Hematology and Oncology, Olive View-UCLA Medical Center, Sylmar, CA, USA
| | - Son V. Pham
- Division of Cardiovascular Diseases, Audie L Murphy Memorial Veterans Hospital, San Antonio, TX, USA
| | - Phuong Anh Pham
- Division of Cardiovascular Diseases, Veterans Administration Nebraska–Western Iowa Healthcare System, Omaha, NE, USA
| | - Phuong Thu Pham
- Division of Nephrology, Kidney Transplantation, Ronald Reagan Medical Center at UCLA, Los Angeles, CA, USA
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Sundaramurthi T, Gallagher N, Sterling B. Cancer-Related Acute Pain: A Systematic Review of Evidence-Based Interventions for Putting Evidence Into Practice. Clin J Oncol Nurs 2017; 21:13-30. [DOI: 10.1188/17.cjon.s3.13-30] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Norepinephrine and dopamine transmission in 2 limbic regions differentially respond to acute noxious stimulation. Pain 2015; 156:318-327. [PMID: 25599453 DOI: 10.1097/01.j.pain.0000460312.79195.ed] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Central dopamine and norepinephrine regulate behavioral and physiological responses during rewarding and aversive stimuli. Here, we investigated and compared norepinephrine and dopamine transmission in 2 limbic structures, the ventral bed nucleus of the stria terminalis and the nucleus accumbens shell of anesthetized rats, respectively, in response to acute tail pinch, a noxious stimulus. Norepinephrine release in the ventral bed nucleus of the stria terminalis responded monophasically, increasing at the time of the tail pinch and remaining elevated for a period after its cessation. In contrast, dopamine transmission in the nucleus accumbens shell displayed a heterogeneous and time-locked response to tail pinch. For most trials, there was a suppression of extracellular dopamine concentration throughout the duration of the stimuli. At the termination of the stimuli, however, extracellular dopamine either recovered back to or spiked above the initial baseline concentration. These signaling patterns were more clearly observed after administration of selective catecholamine autoreceptor and transporter inhibitors. The results suggest that the opposing responses of these catecholamines can provide integration of noxious inputs to influence behavioral outputs appropriate for survival such as escape or fighting.
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Giummarra MJ, Fitzgibbon BM, Tsao JW, Gibson SJ, Rich AN, Georgiou-Karistianis N, Chou M, Bradshaw JL, Alphonso AL, Tung ML, Drastal CA, Hanling S, Pasquina PF, Enticott PG. Symptoms of PTSD Associated With Painful and Nonpainful Vicarious Reactivity Following Amputation. J Trauma Stress 2015; 28:330-8. [PMID: 26243674 DOI: 10.1002/jts.22030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Although the experience of vicarious sensations when observing another in pain have been described postamputation, the underlying mechanisms are unknown. We investigated whether vicarious sensations are related to posttraumatic stress disorder (PTSD) symptoms and chronic pain. In Study 1, 236 amputees completed questionnaires about phantom limb phenomena and vicarious sensations to both innocuous and painful sensory experiences of others. There was a 10.2% incidence of vicarious sensations, which was significantly more prevalent in amputees reporting PTSD-like experiences, particularly increased arousal and reexperiencing the event that led to amputation (φ = .16). In Study 2, 63 amputees completed the Empathy for Pain Scale and PTSD Checklist-Civilian Version. Cluster analyses revealed 3 groups: 1 group did not experience vicarious pain or PTSD symptoms, and 2 groups were vicarious pain responders, but only 1 had increased PTSD symptoms. Only the latter group showed increased chronic pain severity compared with the nonresponder group (p = .025) with a moderate effect size (r = .35). The findings from both studies implicated an overlap, but also divergence, between PTSD symptoms and vicarious pain reactivity postamputation. Maladaptive mechanisms implicated in severe chronic pain and physical reactivity posttrauma may increase the incidence of vicarious reactivity to the pain of others.
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Affiliation(s)
- Melita J Giummarra
- School of Psychological Sciences, Monash University, Clayton, Victoria, Australia.,Caulfield Pain Management and Research Centre, Caulfield Hospital, Caulfield, Victoria, Australia
| | - Bernadette M Fitzgibbon
- Monash Alfred Psychiatry Research Centre, Central Clinical School, Monash University and the Alfred Hospital, Melbourne, Victoria, Australia
| | - Jack W Tsao
- Departments of Neurology and Physical Medicine & Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Stephen J Gibson
- Caulfield Pain Management and Research Centre, Caulfield Hospital, Caulfield, Victoria, Australia.,National Ageing Research Institute, Parkville, Victoria, Australia
| | - Anina N Rich
- Department of Cognitive Science and ARC Centre of Excellence in Cognition and its Disorders, Macquarie University, Sydney, New South Wales, Australia
| | | | - Michael Chou
- Amputee Unit, Caulfield Hospital, Caulfield, Victoria, Australia.,Rehabilitation Services, Caulfield Hospital, Caulfield, Victoria, Australia
| | - John L Bradshaw
- Caulfield Pain Management and Research Centre, Caulfield Hospital, Caulfield, Victoria, Australia
| | - Aimee L Alphonso
- Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Monica L Tung
- Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Carol A Drastal
- Pain Medicine Center, Naval Medical Center, San Diego, California, USA
| | - Steven Hanling
- Pain Medicine Center, Naval Medical Center, San Diego, California, USA
| | - Paul F Pasquina
- Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Peter G Enticott
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Burwood, Victoria, Australia
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Mainau E, Cuevas A, Ruiz-de-la-Torre JL, Abbeloos E, Manteca X. Effect of meloxicam administration after calving on milk production, acute phase proteins, and behavior in dairy cows. J Vet Behav 2014. [DOI: 10.1016/j.jveb.2014.07.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abstract
This research is an investigation of whether consciousness-one's ongoing experience-influences one's behavior and, if so, how. Analysis of the components, structure, properties, and temporal sequences of consciousness has established that, (1) contrary to one's intuitive understanding, consciousness does not have an active, executive role in determining behavior; (2) consciousness does have a biological function; and (3) consciousness is solely information in various forms. Consciousness is associated with a flexible response mechanism (FRM) for decision-making, planning, and generally responding in nonautomatic ways. The FRM generates responses by manipulating information and, to function effectively, its data input must be restricted to task-relevant information. The properties of consciousness correspond to the various input requirements of the FRM; and when important information is missing from consciousness, functions of the FRM are adversely affected; both of which indicate that consciousness is the input data to the FRM. Qualitative and quantitative information (shape, size, location, etc.) are incorporated into the input data by a qualia array of colors, sounds, and so on, which makes the input conscious. This view of the biological function of consciousness provides an explanation why we have experiences; why we have emotional and other feelings, and why their loss is associated with poor decision-making; why blindsight patients do not spontaneously initiate responses to events in their blind field; why counter-habitual actions are only possible when the intended action is in mind; and the reason for inattentional blindness.
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Affiliation(s)
- Brian Earl
- Independent Researcher, Formerly Affiliated with the School of Psychological Sciences, Monash University Melbourne, Australia
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Tomé-Pires C, Miró J. Electrodermal responses and memory recall in migraineurs and headache-free controls. Eur J Pain 2014; 18:1298-306. [DOI: 10.1002/j.1532-2149.2014.490.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2014] [Indexed: 11/06/2022]
Affiliation(s)
- C. Tomé-Pires
- Unit for the Study and Treatment of Pain - ALGOS, Research Center for Behavior Assessment (CRAMC); Department of Psychology and Institut d'Investigació Sanitària Pere Virgili; Universitat Rovira i Virgili; Catalonia Spain
| | - J. Miró
- Unit for the Study and Treatment of Pain - ALGOS, Research Center for Behavior Assessment (CRAMC); Department of Psychology and Institut d'Investigació Sanitària Pere Virgili; Universitat Rovira i Virgili; Catalonia Spain
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18
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Passik SD. Tamper-resistant opioid formulations in the treatment of acute pain. Adv Ther 2014; 31:264-75. [PMID: 24526323 DOI: 10.1007/s12325-014-0099-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Pain-including acute or persistent acute pain-is a common condition that is increasingly being treated with opioids in the United States. The acute pain treatment setting may represent a key target for addressing the growing epidemic of prescription drug abuse occurring hand in hand with the rise in opioid prescribing. Balancing the needs of pain treatment with abuse prevention can be challenging for clinicians. METHODS This article identified efforts to balance opioid abuse risks with opioid availability through the extensive experience of the author in this field. In addition, PubMed literature searches using terms such as "prescription opioid abuse", "abuse-deterrent opioids", and "tamper-resistant opioids"; and inspection of the bibliographies of relevant articles were used to identify relevant sources. RESULTS These multifaceted efforts have included: improving assessment of patient risk for drug misuse, abuse, or diversion; funding of and encouraging referral to addiction treatment programs; access to and widespread use of prescription monitoring programs (PMPs); public knowledge of prescription opioid abuse; proper storage of opioid medications; and development of new formulations designed to resist tampering and deter abuse. This review discusses the problem of prescription opioid abuse and strategies to minimize risk within the context of acute pain treatment, and explores the potential role of tamper-resistant opioid formulations and other abuse deterrence strategies in the area of acute or persistent acute pain management. CONCLUSION In order to stem the tide of prescription opioid abuse and preserve the availability of opioids as a much needed analgesic option, a multifaceted approach that includes tamper-resistant opioid formulations-for chronic or acute pain-along with strategies such as improved patient risk assessment, funding for and referral to addiction treatment programs, greater use of PMPs, and raised awareness of prescription opioid abuse is needed.
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Affiliation(s)
- Steven D Passik
- Millennium Laboratories, Inc. and Millennium Research Institute, San Diego, CA, USA,
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Enea V, Dafinoiu I, Opriş D, David D. Effects of hypnotic analgesia and virtual reality on the reduction of experimental pain among high and low hypnotizables. Int J Clin Exp Hypn 2014; 62:360-77. [PMID: 24837064 DOI: 10.1080/00207144.2014.901087] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
This research compared a no-treatment control condition and 3 experimentally induced pain treatment conditions: (a) virtual reality distraction (VRD), (b) hypnotic analgesia (HA), and (c) HA + VRD in relieving finger-pressure pain. After receiving baseline pain stimulus, each participant received hypnosis or no hypnosis, followed by VRD or no VRD during another pain stimulus. The data analysis indicated that, overall, all 3 treatments were more effective compared to the control group, irrespective of whether it involved hypnotic analgesia, virtual reality distraction, or both (hypnosis and virtual reality). Nevertheless, the participants responded differently to the pain treatment, depending on the hypnotizability level. High hypnotizables reported hypnotic analgesia, but low hypnotizables did not show hypnotic analgesia. VR distraction reduced pain regardless of hypnotizability.
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Affiliation(s)
- Violeta Enea
- a "Alexandru Ioan Cuza" University of Iaşi , Romania
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20
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Casty FE, Wieman MS. Drug Development in the 21st Century: The Synergy of Public, Private, and International Collaboration. Ther Innov Regul Sci 2013; 47:375-383. [DOI: 10.1177/2168479013480787] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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21
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Kökönyei G, Urbán R, Reinhardt M, Józan A, Demetrovics Z. The Difficulties in Emotion Regulation Scale: Factor Structure in Chronic Pain Patients. J Clin Psychol 2013; 70:589-600. [DOI: 10.1002/jclp.22036] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | | | - Melinda Reinhardt
- Eötvös Loránd University
- Károli Gáspár University of the Reformed Church
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22
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Caumo W, Ruehlman LS, Karoly P, Sehn F, Vidor LP, Dall-Ágnol L, Chassot M, Torres ILS. Cross-Cultural Adaptation and Validation of the Profile of Chronic Pain: Screen for a Brazilian Population. PAIN MEDICINE 2013; 14:52-61. [DOI: 10.1111/j.1526-4637.2012.01528.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Sehn F, Chachamovich E, Vidor LP, Dall-Agnol L, Custódio de Souza IC, Torres ILS, Fregni F, Caumo W. Cross-Cultural Adaptation and Validation of the Brazilian Portuguese Version of the Pain Catastrophizing Scale. PAIN MEDICINE 2012; 13:1425-35. [DOI: 10.1111/j.1526-4637.2012.01492.x] [Citation(s) in RCA: 115] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Azize PM, Humphreys A, Cattani A. The impact of language on the expression and assessment of pain in children. Intensive Crit Care Nurs 2011; 27:235-43. [PMID: 21862332 DOI: 10.1016/j.iccn.2011.07.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2011] [Accepted: 07/13/2011] [Indexed: 11/19/2022]
Abstract
This paper focuses on the importance of language in the expression of pain. Variation in definitions of pain is presented, together with a review of the evidence examining the impact language may have on the way pain is expressed linguistically. The implications for conducting research with children who speak different languages are explored. Strategies such as using non-linguistic methods of communication, additional time required for conducting interviews and the inclusion of research team members from the same ethnic or linguistic background are presented.
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Affiliation(s)
- Pary M Azize
- School of Nursing and Midwifery, University of Plymouth, Drake Circus campus, Plymouth, PL4 8AA, United Kingdom.
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26
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Chapman CR. Interview: Reflections on pain research and management: past, present and future. Pain Manag 2011; 1:213-6. [DOI: 10.2217/pmt.11.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
C Richard Chapman is Professor and Director of the Pain Research Center in the department of Anesthesiology at the University of Utah, Salt Lake City (UT, USA). A psychologist and psychophysiologist, he has worked in the pain research field since 1970. He spent 29 years at the University of Washington before coming to the University of Utah. His interests span acute pain, chronic pain, cancer pain and pain measurement.
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Affiliation(s)
- C Richard Chapman
- Pain Research Center, Department of Anesthesiology, 615 Arapeen Drive, Suite 200, Salt Lake City, UT, USA
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28
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Bob P. Pain, dissociation and subliminal self-representations. Conscious Cogn 2008; 17:355-69. [DOI: 10.1016/j.concog.2007.12.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2006] [Revised: 11/19/2007] [Accepted: 12/03/2007] [Indexed: 10/22/2022]
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31
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Hoffman HG, Seibel EJ, Richards TL, Furness TA, Patterson DR, Sharar SR. Virtual Reality Helmet Display Quality Influences the Magnitude of Virtual Reality Analgesia. THE JOURNAL OF PAIN 2006; 7:843-50. [PMID: 17074626 DOI: 10.1016/j.jpain.2006.04.006] [Citation(s) in RCA: 136] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2005] [Revised: 04/03/2006] [Accepted: 04/04/2006] [Indexed: 11/20/2022]
Abstract
UNLABELLED Immersive Virtual Reality (VR) distraction can be used in addition to traditional opioids to reduce procedural pain. The current study explored whether a High-Tech-VR helmet (ie, a 60-degree field-of-view head-mounted display) reduces pain more effectively than a Low-Tech-VR helmet (a 35-degree field-of-view head-mounted display). Using a double-blind between-groups design, 77 healthy volunteers (no patients) aged 18-23 were randomly assigned to 1 of 3 groups. Each subject received a brief baseline thermal pain stimulus, and the same stimulus again minutes later while in SnowWorld using a Low-Tech-VR helmet (Group 1), using a High-Tech-VR helmet (Group 2), or receiving no distraction (Group 3, control group). Each participant provided subjective 0-10 ratings of cognitive, sensory, and affective components of pain, and amount of fun during the pain stimulus. Compared to the Low-Tech-VR helmet group, subjects in the High-Tech-VR helmet group reported 34% more reduction in worst pain (P < .05), 46% more reduction in pain unpleasantness (P = .001), 29% more reduction in "time spent thinking about pain" (P < .05), and 32% more fun during the pain stimulus in VR (P < .05). Only 29% of participants in the Low-Tech helmet group, as opposed to 65% of participants in the High-Tech-VR helmet group, showed a clinically significant reduction in pain intensity during virtual reality. These results highlight the importance of using an appropriately designed VR helmet to achieve effective VR analgesia (see ). PERSPECTIVE Pain during medical procedures (eg, burn wound care) is often excessive. Adjunctive virtual reality distraction can substantially reduce procedural pain. The results of the present study show that a higher quality VR helmet was more effective at reducing pain than a lower quality VR helmet.
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Affiliation(s)
- Hunter G Hoffman
- Human Interface Technology Laboratory, University of Washington, Seattle, Washington, USA.
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32
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Karoly P, Ruehlman LS, Aiken LS, Todd M, Newton C. Evaluating chronic pain impact among patients in primary care: further validation of a brief assessment instrument. PAIN MEDICINE 2006; 7:289-98. [PMID: 16898938 DOI: 10.1111/j.1526-4637.2006.00182.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the psychometric properties of the Profile of Chronic Pain: Screen (PCP:S) in primary care. The PCP:S is a brief assessment device designed to gauge pain severity, interference, and emotional burden. DESIGN Questionnaire survey with short-term reliability and validity follow-up. METHODS Two hundred and forty-four outpatients (52% female) with chronic pain recruited from five primary care settings completed the 15-item PCP:S at an initial testing session. Approximately 1 week later, two subgroups participated in a retest reliability and validity follow-up. The battery of follow-up questionnaires included a measure of social desirability response bias and several instruments designed to provide convergent validity for the PCP:S. RESULTS Retest reliability, internal consistency, factor structure, and social desirability bias were all found to be acceptable. Likewise, preliminary evidence suggests that, by virtue of its correlation with established measures of pain adjustment, the PCP:S is a valid pain assessment device. CONCLUSIONS Although the PCP:S was initially developed and validated using a national community sample of adults with chronic pain who provided data via telephone interviews, the present findings support its use as a brief and psychometrically sound paper-and-pencil measure for the assessment of three key components of chronic pain in primary care.
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Affiliation(s)
- Paul Karoly
- Arizona State University and Consultants in Behavioral Research, Tempe, Arizona 85287-1104, USA.
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Abstract
Any ED system for the management of pain in the ED should consider the following: assessment of pain including mandatory use of some assessment tool, a guideline for treatment of pain, communication with other members of the health care team, assessment tools, program monitoring, and a continuous quality assurance program. The treatment guideline should consider acute versus chronic pain, potential medication tolerance, concurrent anxiety and psychiatric issues, special populations, and disease-specific conditions.
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Affiliation(s)
- Christopher F Richards
- Center for Policy and Research in Emergency Medicine, Oregon Health and Science University, 3181 S.W. Sam Jackson Park Road, Portland, OR 97239-2984, USA.
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Bullington J, Sjöström-Flanagan C, Nordemar K, Nordemar R. From pain through chaos towards new meaning: Two case studies. ARTS IN PSYCHOTHERAPY 2005. [DOI: 10.1016/j.aip.2005.04.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Ruehlman LS, Karoly P, Newton C, Aiken LS. The development and preliminary validation of a brief measure of chronic pain impact for use in the general population. Pain 2005; 113:82-90. [PMID: 15621367 DOI: 10.1016/j.pain.2004.09.037] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2004] [Revised: 09/14/2004] [Accepted: 09/28/2004] [Indexed: 10/26/2022]
Abstract
From a biopsychosocial perspective, assessing chronic pain's psychological impact should involve at minimum the measurement of pain severity, functional interference, and pain-related emotional burden. This article details the development of a brief instrument, the 15-item Profile of Chronic Pain: Screen (PCP:S), designed to address these three key elements in a national (US) sample of over 2400 individuals recruited via random digit dialing. Retest reliability, internal consistency, and preliminary validity were excellent. The scales also demonstrated minimal social desirability response bias. A series of confirmatory factor analyses on several distinct samples revealed a stable, 3-factor solution reflecting pain severity, interference, and emotional burden. Finally, national norms were developed by gender and three age groups. In view of its strong psychometric properties, the PCP:S has the potential to serve as a brief, cost-effective assessment tool for identifying individuals whose chronic pain merits more detailed psychosocial evaluation.
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Affiliation(s)
- Linda S Ruehlman
- Department of Psychology, Arizona State University, Box 871104, Tempe, AZ 85287, USA
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Neuman Y. What does pain signify? A hypothesis concerning pain, the immune system and unconscious pain experience under general anesthesia. Med Hypotheses 2004; 63:1051-3. [PMID: 15504574 DOI: 10.1016/j.mehy.2004.02.056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2004] [Accepted: 02/25/2004] [Indexed: 10/26/2022]
Abstract
In this paper, I present a case-study that initiates a discussion about the meaning of pain. The case-study concerns a person who was under deep sedation during colonoscopy. The person did not experience pain from a first-person perspective, although pain was evident to the medical team from a second-person perspective. The divergence of pain perspectives raises an interesting quandary. If the body communicates pain while pain consciousness is blocked by the sedation procedure, our conclusion should be that the intersubjective aspect of pain precedes the "subjective," first-person experience of pain. This conclusion is not consistent with the common representational conception of pain that places the intrasubjective point of view prior to the intersubjective point of view. The solution I offer to this quandary is the quasi-paradoxical idea that pain can be experienced unconsciously through the immune system. Following this suggestion, I hypothesize that post-traumatic stress disorders following general anesthesia may result from this unconscious pain experience. If this idea is scientifically grounded, then physicians should: (1) consider ways of blocking the unconscious pain experience produced by the immune system without interfering with the immune response, and (2) study pain as a complex cognitive and unconscious system by drawing an analogy with the immune system, which follows similar logic.
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Affiliation(s)
- Yair Neuman
- Ben-Gurion University of the Negev, Beer-Sheva, Israel.
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Hoffman HG, Sharar SR, Coda B, Everett JJ, Ciol M, Richards T, Patterson DR. Manipulating presence influences the magnitude of virtual reality analgesia. Pain 2004; 111:162-8. [PMID: 15327820 DOI: 10.1016/j.pain.2004.06.013] [Citation(s) in RCA: 119] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2004] [Revised: 06/06/2004] [Accepted: 06/07/2004] [Indexed: 11/18/2022]
Abstract
Excessive pain during medical procedures performed in unanesthetized patients is frequently reported, but can be reduced with virtual reality (VR) distraction. Increasing the person's illusion of going into the virtual world may increase how effectively VR distracts pain. Healthy volunteers aged 18-20 years participated in a double-blind between-groups design. Each subject received a brief baseline thermal pain stimulus, and the same stimulus again minutes later with either a Low Tech or a High Tech VR distraction. Each subject provided subjective 0-10 ratings of cognitive, sensory and affective components of pain, and rated their illusion of going inside the virtual world. Subjects in the High Tech VR group reported a stronger illusion of going into the virtual world (VR presence) than subjects in the Low Tech VR group, (4.2 vs. 2.5, respectively, P = 0.009) and more pain reduction (reduction of worst pain is 3.1 for High Tech VR vs. 0.7 for Low Tech VR, P < 0.001). Across groups, the amount of pain reduction was positively and significantly correlated with VR presence levels reported by subjects ( r = 0.48 for 'worst pain', P < 0.005).
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Affiliation(s)
- Hunter G Hoffman
- Human Interface Technology Laboratory, 215 Fluke Hall, Box 352142, University of Washington, Seattle, WA 98195, USA.
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Chandroo K, Duncan I, Moccia R. Can fish suffer?: perspectives on sentience, pain, fear and stress. Appl Anim Behav Sci 2004. [DOI: 10.1016/j.applanim.2004.02.004] [Citation(s) in RCA: 237] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Cepeda MS, Lau J, Carr DB. Defining the therapeutic role of local anesthetic sympathetic blockade in complex regional pain syndrome: a narrative and systematic review. Clin J Pain 2002; 18:216-33. [PMID: 12131063 DOI: 10.1097/00002508-200207000-00002] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE There is growing controversy on the value of blocking the sympathetic nervous system for the treatment of complex regional pain syndromes (CRPS). The authors sought to evaluate the efficacy of sympathetic blockade with local anesthetic in these syndromes. In addition, they performed a comprehensive review of the pathophysiology and other treatments for CRPS. DESIGN Systematic review of the literature was performed. MEDLINE was searched from 1966 through 1999. The authors identified only three randomized controlled trials (RCTs) that evaluated sympathetic blockade with local anesthetic, but because of differences in study design they were unable to pool the study data. The authors therefore included nonrandomized studies and case series. INTERVENTIONS Studies were included if local anesthetic sympathetic blockade was used in at least 10 patients. Studies were excluded if continuous infusion techniques, somatic nerve blocks, or combined sympatholytic therapies were evaluated. OUTCOME MEASURES Pain relief was classified as full, partial, or absent. The lack of a comparison group in the studies allowed only the calculation of distribution of the response categories, and the sum of the pooled rates does not equal 100%. RESULTS Twenty-nine studies were included that evaluated 1,144 patients. Nineteen studies were retrospective, 5 prospective case series, 3 RCTs, and 2 nonrandomized controlled studies. The quality of the publications was generally poor. Twenty-nine percent of patients had full response, 41% had partial response, and 32% had absent response. It was not possible to estimate the duration of pain relief. CONCLUSIONS This review raises questions as to the efficacy of local anesthetic sympathetic blockade as treatment of CRPS. Its efficacy is based mainly on case series. Less than one third of patients obtained full pain relief. The absence of control groups in case series leads to an overestimation of the treatment response that can explain the findings.
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Affiliation(s)
- M Soledad Cepeda
- Department of Anesthesia, San Ignacio Hospital, and Javeriana University School of Medicine, Bogota, Colombia
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Hadjistavropoulos T, Craig KD. A theoretical framework for understanding self-report and observational measures of pain: a communications model. Behav Res Ther 2002; 40:551-70. [PMID: 12038648 DOI: 10.1016/s0005-7967(01)00072-9] [Citation(s) in RCA: 233] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Self-report and observational measures of pain are examined from the perspective of a model of human communication. This model examines the experience of pain as affected by intrapersonal and contextual factors, the process whereby it is encoded into expressive behaviour, and the process of decoding by observers prior to their engaging in action. Self-report measures primarily capture expressive pain behaviour that is under the control of higher mental processes, whereas observational measures capture behaviour that is less subject to voluntary control and more automatic. Automatic expressive behaviours are subject to less purposeful distortion than are behaviours dependent upon higher mental processes. Consequently, observational measures can be used and have clinical utility as indices of pain when self-report is not available, for example, in infants, young children, people with intellectual disabilities or brain damage, and seniors with dementia. These measures are also useful when the credibility of self-report is questioned and even when credible self-report is available. However, automatic behaviours may be more difficult for observers to decode. The model outlined herein takes into account the role of various human developmental stages in pain experience and expression and in understanding the utility of self-report and observational measures. We conclude that both observational and self-report measures are essential in the assessment of pain because of the unique information that each type contributes.
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